California
Chapter 1
News Update November 1997
California Supreme Court Supports Childhood Lead Poisoning Prevention Fees
In June 1997 the California Supreme Court overturned a lower court ruling and restored funding to the lead prevention program. This unanimous ruling reestablishes a dedicated funding source for childhood lead poisoning prevention activities throughout the State.
The funding for California’s State and local childhood lead programs has been in jeopardy for the last two years. In 1995, Sinclair Paint Company sued the Board of Equalization, claiming that the program’s fee collection was illegal, because the fees were not fees but illegal taxes. The Sacramento Superior Court and the Third District Court of Appeals agreed, and the funding for childhood lead program activities was reduced by over 1/3 last fiscal year. Now that fee support has been restored the hope is that the funding for the program can be increased to provide stronger support to the estimated 23,000 children in California with blood lead levels of 20 ug/dl or higher and in need of public health case management. Restored funding will allow the State program to complete it’s surveillance system of blood lead levels, better map the occurrence of lead poisoning statewide, and develop effective methods to transition to targeted blood lead screening over time. In the interim, and in response to the numerous requests by physicians, the State Childhood Lead Poisoning Prevention Branch is working to implement broader use of fingerstick blood sampling for blood lead testing.
New AAP Book
To help parents target their child’s symptoms, the AAP has released the Guide to Your Child’s Symptoms (Villard/$25.00). Edited by Donald Schiff, M.D. and Steven Shelov, M.D., M.S., this book is an easy-to-use guide to the 100 most common childhood symptoms. The guide allows parents to quickly identify a symptom, learn its possible cause, and determine how best to proceed, whether it’s taking action at home or calling the pediatrician. In addition, the second part of the book is an illustrated first-aid manual, which covers lifesaving techniques and how to treat less dire situations such as bites, stings, cuts and scrapes.
By Tom Long
I am a backpacker. I cannot tell you how many times I have come across a sign post in the wilderness or in the center of one of our national parks.You have seen them too ¾ 1500 miles to somewhere, 60 miles to someplace else. The arrows are askew and other than being cute the sign post is not much help. In the wilderness without a compass it could be a disaster. Not only do you need to know where you are going but you need to know how to get there.
This principle applies to your chapter too. We get calls ¾ to support this or that policy, to go to Sacramento, to assist a member, to speak up for infants and children in day care and in schools. We initiate public health campaigns such as our anti tobacco campaign. And we sponsor educational programs. Our scope of activities is quite broad and can really be as inclusive as we wish it to be. But what do we want? What do you want?
Chapter I is a large chapter and was nominated again for the Academy’s Large Chapter Award to be presented in New Orleans. It was an honor to be nominated and indeed a credit to our efforts. The award was given to the Washington chapter which has made significant legislative progress. Some large chapters are closely tied to their state medical societies with astonishing budgets and projects. We network with the CMA and form coalitions as necessary. Our budget is not excessive and is prudently managed to accomplish our goals. How closely should our programs mirror the National Academy? Our financial support is local although the National Academy has considerable resources that we utilize. We all know that all politics is local and our needs in California are unique if only because we lead the nation in the managed care evolution. Our activities are much more closely linked to the District. In conjunction with the other California chapters we have participated in immunization projects and we are credible advocates in Sacramento as evidenced by our lobbying success for the State Children’s Health Insurance Program. Opportunities abound most notably because the state now faces an incredible challenge to balance constituent needs with the available Medicaid funds. It may not be the windfall which it first seems. I am sure special interests will need to be confronted to ensure that the children’s needs are met.
All of these thoughts are but background for a very important Chapter activity to be held in January 1998. In 1990 the Chapter held an executive retreat. Good and caring pediatricians gave us a map to guide us over these last few years. The future is unforeseeable and predictions are only a best guess.
It was the consensus of the Board at our Memorial Day meeting to organize another planning retreat. We will do this in January 1998. This is timely since our District has just completed the study for the Managed Care Initiative. I believe that you will soon receive an informative brochure that will assist you in the education of our patients and purchasers of health care. We do need to promote the value added benefit of pediatricians as the choice for children’s health care. More importantly a strategic plan is but a blue print, a guide for the allocation of resources in the face of the many requests, recommendations and initiatives that come to our attention.
We need your input. I would encourage each and every one of you to speak to your member-at-large. How are the Chapter and the Academy meeting your needs? What children’s issues do you think need attention? Would you like the Chapter to assume a different function than it now serves? Are the programs for pediatricians and child advocacy satisfactory? Please share your thoughts and ideas. Write it, fax it, call and leave a message.
Changing times and crossroads are challenging. The task can be formidable. We again have the opportunity to exercise some imagination and creativity to be the architects of tomorrow’s Chapter I. I hope our medical students and resident pediatricians will look favorably on our efforts because the next blue print will be theirs to draw. What will be our legacy?
By Paul Jewett
The AAP Annual Chapter Forum this September revealed again the strength of our Chapter, District, and National Academy. Most resolutions presented dealt with ideas for addressing the essential issues facing our profession at this moment in history. These issues are, it seems to me, preserving and improving the quality of medical care delivered to children, increasing appropriate access to health care for all children, restoring and enhancing the sense of professionalism that we all have in being a physician who cares and advocates for children planning for the future of our profession as it prepares to enter the next century Chapters were asked to discuss projects that they had undertaken in the past year. We can be very proud of the breadth and significance of the efforts of our Chapter and District. Someone questioned whether medicine in California represents “the wave or the undertow.” Clearly, we understand the problems facing medicine as well or better than our colleagues in other areas of the country do, and we are positioned to show them the wave. All we must do is maintain our enthusiasm and energy level, and we can continue to help define the future of Pediatrics in both a professional and positive fashion. Our Academy is respected as few others are, and by belonging to it, and working within it, we can help assure that “managed care” doesn’t turn into mangled care, and that children have in us a powerful advocate for change on their behalf.
At the meeting of the National Committee on Hospital Care, I attended in September, debate on issues from the forum continued. The Committee has retired its Policy Statement on General Pediatric Inpatient Units, and is looking at defining the needs and requirements for the newer functional units developing in hospital care. As one example, I will be working with other committee members to prepare an article for the AAP News on “short stay units.” This includes units with both medical and surgical patients. I would appreciate learning from those of you who have these types of programs how they have been organized, staffed, and accepted by patients and staff. E-mail (hpjewett@aol.com), write, or call me with a brief description of the positives and any negative that you have experienced.
A second area of interest is the retention of hospital privileges ¾ how important is it? How can it be done? What help do you need? If you relinquish hospital privileges, how can you maintain proficiency in those skills necessary for pre-transfer stabilization of the seriously ill child? More questions than answers ¾ but a very important topic of debate for our profession, both in terms of our identity and in terms of appeal as experts in the primary and specialty care of children. Please share your thoughts so we can represent your ideas as the discussion continues.
Most children are eating below the minimum recommendations for food group intake, with many not meeting any of the recommendations, according to a study from the NIH and U.S. Department of Agriculture. According to the study, 16 percent of the 3,300 children aged 2 to 19 years did not meet any daily recommendations, and only 1 percent met all recommendations. In addition, fat and added sugars supplied more than 40 percent of the energy in children’s diets. (September Pediatrics)
Parents Need Help Giving Medicines
A study from Phoenix shows parents have trouble giving correct medication dosages. Ninety children with otitis and treated with liquid antibiotics were divided into 3 groups:
Same as item two except the syringe had a line drawn on it to indicate the correct dose. The percentages of children receiving the correct dose were, respectively, 37, 83, and 100 percent. (September Pediatrics)
Teens Not Being Tested For HIV
Despite concerns about getting HIV, many adolescents still are not being tested, according to a study from Boston University. Of 906 adolescents in Massachusetts aged 16 to 19 years, 567 (63%) had had sex within the past year, 127 (22%) had had HIV testing with 54 (10%) testing for personal reasons. However, more than half of the adolescents expressed a “great deal” or “some” worry about contracting HIV and more than half said it was at least a little likely they will get AIDS. Adolescents who discussed HIV testing with their doctor were more than twice as likely to be tested. More than 136 (30%) who had visited their doctor within the past year had discussed AIDS with their doctor, but this conversation was initiated by the physician in 85 percent of the cases.
Of 288,000 children aged 13 and younger in 1991 and 1992 in Colorado’s Medicaid program, amoxicillin accounted for almost half of the total antibiotic fills, but for only 9 to 10 percent of the expenditures. More expensive antibiotics used for 30 percent of the fills generated 76 to 77 percent of the expenditures. The more expensive antibiotics were not associated with better outcomes. (October Pediatrics)
Delayed School Entry May Cause Problems Later
A University of Rochester study of more than 9,000 children found that of the 26 percent of students who were old-for-grade, those students who repeated a year as well as those who delayed school entry were more likely to have behavioral problems than their younger classmates, especially once they reached adolescence. Behavior problems include feeling or complaining that no one loves him or her, crying excessively, cheating or lying, or losing one’s tempers. The researchers were surprised to learn their findings pertained only to white and not black children. (October Pediatrics)
Among 101 children hospitalized for air gun injuries, half required surgery, three died and 25 suffered permanent visual loss, with 15 permanently blinded, according to a study from the Universities of Washington and Cincinnati. There are no national regulations regarding air guns. The velocity required to penetrate the human eye is 130 feet per second, yet some air guns have velocities of up to 900 feet per second. (October Pediatrics)
From the Pediatrics electronic pages
Bathtub Seats Associated With Drowning
The bathtub seat, an aid commonly used by caregivers to bathe infants, has been associated with an increasing number of reported infant drowning deaths. In 91 percent of the incidents, there was a lapse in adult supervision that coincided with the drownings. Researchers conclude that bath seats are not safety items and cannot be relied on as a substitution for constant supervision of infants while they are in or around water. (October)
AAP Position on Air Bags
The National Highway Traffic Safety Administration is considering allowing on-off switches to deactivate automobile air bags instead of permitting car owners to disconnect them permanently. However, the AAP recommends that children be placed in the back seat whether or not there is an active air bag in the vehicle. The AAP does not believe that cut off switches should be installed on demand in a vehicle that can accommodate a child in the back seat. If NHTSA allows on-off switches, the AAP believes the system should require, or at least prompt, the driver to make an affirmative decision about the status of the air bag each time the car is started, for example, an interlock system where the car does not start until the decision has been made, or a buzzer that sounds and a light that flashes. This would prevent any mistakes a driver might make if he or she forgot the air bag status.
AAP Analysis of Tobacco Use Among Children
from The Public Relations Chair
An analysis of 1995 data of over 2,000 U.S. high school seniors from the “Monitoring the Future” project at the University of Michigan’s Institute for Social Research shows:
The majority of those surveyed understand the risks in smoking, disapprove of it and feel their friends would disapprove of their smoking. However, 88 percent report having at least a few friends who smoke; 59 percent report they definitely will not smoke in the future;
Not much of an effort is made keeping young people from smoking in schools. Specifically, less than half reported teachers and administrators fairly or very vigorously attempt to prevent smoking, while more than half said the consequences for smoking are either mild or that there are no consequences.
Most adults who smoke began to do so before the age of 19, at an average age of 12-1/2, and most were regular smokers by the age of 14. Approximately 19 percent of high school students report daily smoking of cigarettes; this rate has remained approximately the same over the past few years. Among smokers aged 12 to 17 years, 70 percent already regret their decision to smoke and 66 percent say they want to quit.
In just 20 years the percentage of children enrolled in childcare has soared from 30 percent (1970) to 70 percent (1993). By the year 2000, 75 percent of women with children under five years of age will be employed — and in need of childcare. With almost a million California children in out-of-home care, the California Childcare Health Program has received funding from the federal Maternal and Child Health Bureau, Department of Health and Human Services to spearhead the creation of an agenda for needed improvements or changes. The CCHP is coordinating efforts to respond to the national Blueprint for Action and establish a plan for California. For more information, contact Marsha Sherman, campaign coordinator (1212 Broadway, Suite 904, Oakland, CA 94612-1841, FAX (510) 839-0339), the Childcare Healthline 1-800-333-3212, or Alameda County Member-at-Large Bruce Gach, MD.
The CCHP Mission: “To assure the quality of California’s child care by promoting and facilitating the linkages between the health, safety and child care communities and the families they serve. The program’s focus is on the provision of support and knowledge about health and safety issues for child care providers.”
Facts About Childcare Providers in California
Wages for the lowest paid teaching assistants, the fastest growing segment of the child care work force, average $8,890 per year.
Wages for the highest paid teaching staff average $15,488 per year.
Only 27% of centers provided fully paid health insurance for their teaching staff, and of these 32% did not cover assistant teachers.
Between 1988 and 1992, 70% of the teaching staff interviewed in 1988 had left their jobs.
Of the 55,251 child care facilities licensed in 1995 by the State of California, Department of Social Services, 77% were Family Child Care Homes. Little is formally known about their working conditions.
Six out of 10 ¾ nearly 13 million — infants, toddlers and preschool children are enrolled in childcare nationwide. Nearly 88 percent of children whose mothers work full-time and 75 percent of children whose mothers work part-time are enrolled in childcare.
Healthy Childcare America Campaign Blueprint for Action
Goals
10 Steps that Communities Can Take to Promote Safe and Healthy Child Care
Looking for Work
Board Certified Pediatrician available for Locums. NALS and NPR certified, speaks Spanish, and will travel. Please contact Ann Troy, MD (415) 924-9141
I am a board-certified, UCSF-trained pediatrician looking for full or part-time work in private practice in the East Bay or Marin County. Please call Cynthia Hann at 510/450-0539.
Attention Chapter 1 Comittee Members
Are you feeling lonely? Do you feel that your committee has been neglecting you? It’s not their fault.... it’s our computer. Unfortunately, the Executive Office computer had a major melt-down recently and destroyed our committee roster information. Beverly Busher is trying to reconstruct the committee data and needs your help. If you are currently on a committee and have not been receiving information recently, please call the office and let Beverly know that you wish to be reinstated on that particular committee(s). She can be reached by phone at (415) 459-4775, fax at (415) 459-0617, or E-mail at aapbev@sbcglobal.net. Thanks for your help with this project.
AAP Chapter website is alive
We have had interruptions in service beyond our control. You can still find us at http://www.aapca1.org. The future growth of the site is unlimited if we decide that there are areas we need to pursue. I would appreciate your comments and suggestions to simonian@valleychildrens.org or 209-221-7192. Mark M. Simonian (Webmaster)
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This page create 12/30/97 Last Updated 08/10/04
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