- April, 2013
- March, 2013
- February, 2013
- January, 2013
- December, 2012
- November, 2012
- October, 2012
- September, 2012
- August, 2012
- July, 2012
- June, 2012
- May, 2012
- April, 2012
- March, 2012
- February, 2012
- January, 2012
- December, 2011
- November, 2011
- October, 2011
- September, 2011
- August, 2011
- July, 2011
- June, 2011
- May, 2011
- April, 2011
- March, 2011
- February, 2011
- January, 2011
- December, 2010
- November, 2010
- October, 2010
- September, 2010
- August, 2010
- July, 2010
- June, 2010
- May, 2010
- April, 2010
- March, 2010
- February, 2010
- January, 2010
- December, 2009
- November, 2009
|Thursday, November 19, 2009
|Role of the Health Care Professional in Bullying Prevention
|by Pediatric Perspectives at 01:18 PM
Lisa Lowery, MD, Adolescent Medicine
Helen DeVos Children's Hospital
I know you ask your patients and their parents about seat belts and bike helmets, as well as Internet and TV time, but do you know if your patients are being bullied?
Studies find that about one in three children are bullied1 and that bullying has significant negative effects on children's physical and emotional health.2,3 This, I believe, puts bullying squarely in the medical realm, making it an important issue in your patients' overall health.
That's why the American Academy of Pediatrics (AAP) recently revised its policy statement on the Role of the Pediatrician in Youth Violence Prevention. The guidelines call for doctors to "employ their skills and influence in the implementation of youth violence prevention strategies" through clinical practice, advocacy, education, and research.
Although I understand that community physicians are already overwhelmed with the amount of information they need to collect and ask about during routine visits, this is something that doesn't have to be a burden. It can be as simple as asking the child if they have friends at school, feel safe at school, or if anyone is bullying or picking on them at school.
The thing NOT to do is ask "How's school?" because, as any parent knows, you will get the ubiquitous "fine" response.
If the responses to your questions raise alarms, you can offer some concrete strategies depending on the severity of the case. Ask, "How do you handle that situation?" "Who can you tell that you're being bullied?"
The AAP also recommends that you be familiar with the Connected Kids: Safe Strong Secure primary care violence prevention protocol, and provide readily accessible materials in your office for children and parents. The committee also recommends maintaining an accurate list of community-based counseling and treatment resources, ideally one you that can be accessed through the electronic health record system or linked to your practices internal or external Web site.
COMMENT: How does your office address bullying issues with your patients?
1Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, Scheidt P. Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. JAMA. 2001;285 (16):2094 -2100[Abstract/Free Full Text]
2 Wolke D, Woods S, Bloomfield L, et al. Bullying involvement in primary school and common health problems. Arch Dis Child. 2001;85:197-201. (Abstract/Free Full Text)
3 Bond L, Carlin JB, Thomas L, et al. Does bullying cause emotional problems? A prospective study of young teenagers. BMJ. 2001;323:480-484. (Abstract/Free Full Text)
|Wednesday, November 18, 2009
|H1N1 Hitting Kent County and Region Hard
|by Pediatric Perspectives at 03:37 PM
Karen Dahl, MD, Division Chief, Pediatric Infectious Disease
Helen DeVos Children's Hospital
It should come as no surprise that the H1N1 influenza has hit the region hard in the past two weeks. The Michigan Department of Public Health reported nearly 10,000 cases of influenza-like illness between October 25 and 31 in Kent County, about a 12% increase over the previous week. However, the rate of increase appears to be slowing in the county, with the number of cases statewide having fallen the last week of October.
Throughout the state, 801 individuals have been hospitalized with any influenza strain since September 1 and 28 deaths have been reported. In Kent County, about 72% of the 210 influenza cases reported since September 1 have occurred in children up to age 17, and more than half (116) of all cases were reported just in the week of October 23.
That week also saw the county's first flu-related death. Since then, the media has reported the death of 33-year-old adult male who developed encephalitis after his initial infection with H1N1. There have also been pediatric flu-related deaths. Nationally, the CDC reports 73 pediatric deaths due to HINI virus infection since August 30. In addition, Michigan recently reported its first pediatric death.
Although we're seeing more children hospitalized with influenza than is typical for this time of the year, our inpatient census isn't higher than normal.
One problem I'm seeing is children who were not treated with antivirals because the providers were misled by a negative rapid flu test. These are only about 50% sensitive, so a negative result should not impact the decision to treat a patient.
I am also seeing high-risk patients who were diagnosed with influenza but weren't provided with antiviral medicines, perhaps because their high-risk condition wasn't considered by the treating physician.
Children at high risk for complications of H1N1 infection who should be considered for antiviral therapy are:
- Those younger than 2 years old
- Those with certain chronic medical or immunosuppressive conditions including asthma and other chronic pulmonary disorders, diabetes and other metabolic disorders, cardiovascular, hepatic, hematological, neurologic, and neuromuscular disorders, and immunosuppression caused by primary immune deficiency, medications, chemotherapy, or HIV infection
Primary care, urgent care, and emergency departments are being hit particularly hard. It's important that you put into place the appropriate processes to enable you and your staff to cope with the pandemic while still making yourselves available to the rest of your patients. Some suggestions:
- Add a recording to your voice mail alerting callers to the availability of H1N1 vaccine so they don't tie up your receptionists with questions.
- Post a sign on your door and an area on your web site updating patients about vaccine availability and eligibility. The Kent County Health Department announced new vaccine clinics November 14 and 21 by reservation only.
- Send an email blast and/or postcard to parents of patients and post information on your web site providing key information about the flu and vaccines. Include:
- Symptoms of the flu
- Reassurance that parents do not need to bring their child in to see you unless the child is sicker than expected from influenza or has an underlying health condition described earlier
- Warnings about using aspirin to treat the flu. Instead, list approved over-the-counter medications such as acetaminophen and ibuprofen
- Warning signs of a more serious illness, including:
- Difficulty breathing or chest pain
- Purple or blue discoloration of the lips
- Vomiting and unable to keep liquids down
- Signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when crying
- Changes in responsiveness
- Train your staff to answer routine patient questions about H1N1. Make sure they take breaks so they can handle the angry and frightened parents they may be exposed to.
How is the flu impacting your office?
Post your comments below.