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MNAAP Newsletter

Opening Vaccine Dialogue Across Cultures: Measles Outbreak in Minnesota

nusheen ameenudinBy Nusheen Ameenuddin, MD, FAAP

“Most of you already know Dr. Nusheen, because she sees your kids” is how I was introduced on my home turf at the first of a series of talks with Minnesota’s Somali community. It was during our state’s worst measles outbreak to date.

By the week before Memorial Day this year, Minnesota had already reached 69 measles cases, more than all U.S. cases in the previous year. Because the outbreak primarily affected unvaccinated Somali children, our state health department, American Academy of Pediatrics chapter and others partnered with leaders in the Somali community to train and dispatch teams of imams (religious leaders) and physicians to engage and inform the community about this threat.

I feel privileged to work with a vibrant patient population that includes many Somali-Americans. I met some families as new arrivals to this country, while others have become my second generation of patients. We are fortunate that Minnesota’s children’s health insurance coverage is at an all-time high of 97 percent, thanks to Medicaid and CHIP. But despite having some of the best health measures in the nation, we still struggle with the highest disparity in health outcomes between ethnic groups.

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Lessons Learned on Increasing MMR Vaccines During the Outbreak

By Anne Valaas-Turner, MD, FAAP

On August 25, 2017, the Minnesota Department of Health declared an end to the measles outbreak…. along with a collective, statewide sigh of relief. As part of this announcement, Commissioner of Health Dr. Ed Ehlinger thanked all of the health systems, hospitals, clinics, doctors, pediatric clinicians, clinic staff and local public health who worked so hard to contain the Spring epidemic. He also highlighted the Allina Health System, which according to MDH records, provided the most MMR vaccine during the outbreak.

Pediatric staff reflected on this news and identified several key beliefs and lessons that we learned.

Communications: We were immediately notified of the measles outbreak by the MDH vaccine preventable disease listserv. Lesson: It may be useful to include “helpful e-mail lists to join” as part of the onboarding process for new providers.
Team structure: As a pediatrician, I share work space with my assistant, two partners, and their assistants. It was easy to teach the team the new vaccine recommendation, since we all work together in the same space. I will begrudgingly admit that the daily huddle system I sometimes rail against allowed for communication up and down the leadership structure about our measles response. We also got regular updates about the number of MMR doses in clinic, which was helpful.

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Food Insecurity Screening and Referrals

NeilBratneyNeil Bratney, MD, FAAP

Nearly 1 in 10 Minnesotans are food insecure; that’s a half-a-million Minnesotans who don’t always know where their next meal is coming from. While poverty is a common contributing factor, transportation and geographic factors may also affect families without cars or without a grocery store nearby. Many families are just above the threshold for qualifying for assistance programs and still cannot afford the nutritious food important for their families.
Screening

Screening for food insecurity can be easy, but may require small changes to your office workflow. Screening should be completed at every well child exam, and whenever concerns exist. Screening can be accomplished using a standard, validated, two-question screening tool, known as the Hunger Vital Sign.

  • Within the past 12 months, we worried whether our food would run out before we got money to buy more.
  • Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.

A patient or caregiver can respond “Often true,” “Sometimes true,” “Never true,” or “Don’t know / Refused.” An “Often true” or “Sometimes true” response is considered a positive screen and should prompt advice and referral.

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Disaster Preparedness: Planning for the Unimaginable

PaulaKocken2By Paula Kocken, MD, FAAP

It seems that there are disasters happening every day and everywhere. Some occur very far away from us and others seem to be at our doorsteps. The AAP, recognizing the increase in disasters, has encouraged each state chapter to ask for pediatricians knowledgeable and interested in disaster preparedness to champion the efforts in their state to improve preparedness.  Dr. Kiragu asked if I could accept the challenge of improving the awareness of information and programs about disaster preparedness and move forward Minnesota’s pediatricians in their ability to respond to disasters.

I was very pleased to be asked to help Minnesota and the AAP in this complex and challenging topic. I have been working with disaster preparedness for over the past 15 years through many venues.  Beyond being a pediatric emergency medicine physician based at Children’s of Minnesota, I took additional training in the hospital response to disasters with the U.S. army.  As the medical director of Minnesota’s Emergency Medical Services for Children (EMSC), I have been working on “all hazards” readiness for pediatric disaster preparedness for EMS providers and emergency departments. I also participate with the MN Department of Health Advisory Committee for emergencies.

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No Hit Zone at the U of M Masonic Children’s Hospital

 

By Rebecca E. Foell, MSW, LICSW, and Nancy S. Harper, MD, FAAP

In 2016, The University of Minnesota Masonic Children’s Hospital launched the first No Hit Zone in the state of Minnesota. A No Hit Zone is an environment in which no adult shall hit a child, no adult shall hit another adult, no child shall hit an adult, and no child shall hit another child. The purpose of the No Hit Zone is to create a safe and healthy environment for patients, families, visitors, and staff as well as to provide support, education, and resources surrounding effective discipline.

Definition and Prevalence
The United Nations Convention on the Rights of the Child in 2006 defined corporal punishment or physical punishment to include hitting with a hand or object as well as shaking, throwing, scratching, biting, kicking, and burning of children with a call for countries to enact legislation prohibiting violence against children as a form of discipline.

To date, 52 countries have banned physical punishment of children starting with Sweden in 1979. The United States has not yet banned corporal punishment. In fact, 19 states in America still allow corporal punishment in schools, but there appears to be a general shift in the use of corporal punishment in the United States. According to one study, the percentage of mothers reporting that they would hit or spank their kindergarten-age child in response to a child’s misbehavior declined by 20 to 26 percentage points across all income levels between 1988 and 2011. Likewise, the percentage of mothers reporting that they spanked their child in the past week declined by 26 to 40 percentage points. These declines emerged at all income levels.

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