S A N M AT E O C O U N T Y May 2014 Volume 3 Issue 5
I NS I D E
S A N M AT E O C O U N T Y M E D I C A L A S S O C I AT I O N
Focusing treatment on bullies, not just victims
Physicians, parents, and youth providers: partners in sex education
Ergonomics in the modern age of computers and video games
Tools and resources for ensuring adolescentsâ€™ life-long good health
You have to pay for workers’ compensation insurance. But...
YOU DON’T HAVE TO
In California, rates for workers’ compensation insurance are soaring. In the second half of 2013, rates increased by an average of 8.7%.1 That’s after a 10% increase in the ﬁrst half of 2013.2 1
Source: Workers Compensation Insurance Rating Bureau of California, http://www.wcirb.com/sites/default/ﬁles/documents/132023_010114_ amended_ppr_ﬁling_complete.pdf
SMCMA members, call 800-842-3761 to see if you can save!
Are you paying too much for your workers’ compensation coverage? Finding out is easy. Just call 800-842-3761 to compare your current policy with workers’ compensation insurance available through the San Mateo County Medical Association. This members-only program is available through Mercer. As the world’s leading insurance broker, Mercer can provide the outstanding service and expertise you deserve. Call Mercer at 800-842-3761 today to get your free, no-obligation quote.
2 Source: Business Insurance, https://www.businessinsurance.com/ article/20130925/NEWS08/130929901
C[hY[h>[Wbj^8[d[Óji?dikhWdY[I[hl_Y[iBB997?di$B_Y$&=)/-&/ ,-'(,+%'*9efoh_]^j(&'*C[hY[hBB9$7bbh_]^jih[i[hl[Z$ ---Iekj^<_]k[heWIjh[[j"Bei7d][b[i"97/&&'-.&&#.*(#)-,' 9C79ekdjo$?dikhWdY[$i[hl_Y[6c[hY[h$Yecmmm$9ekdjo9C7C[cX[h?dikhWdY[$Yec
S A N M AT E O C O U N T Y
Physician Editorial Committee Russ Granich, MD, Chair Sharon Clark, MD Edward Morhauser, MD Gurpreet Padam, MD Sue U. Malone, Executive Director Shannon Goecke, Managing Editor
SMCMA Leadership Amita Saxena,, MD, President; Vincent Mason, MD, President-Elect; Michael Norris, MD; SecretaryTreasurer; Gregory C. Lukaszewicz, MD, Immediate Past President Alexander Ding, MD; Manjul Dixit, MD; Russ Granich, MD; Edward Koo, MD; C.J. Kunnappilly, MD; Susan Nguyen, MD; Michael O’Holleran, MD; Chris Threatt, MD; Kristen Willison, MD; David Goldschmid, MD, CMA Trustee; Scott A. Morrow, MD, Health Officer, County of San Mateo; Dirk Baumann, MD, AMA Alternate Delegate
Editorial/Advertising Inquiries San Mateo County Physician is published ten times per year by the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted. Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised. For more information, contact the managing editor at (650) 312-1663 or email@example.com. Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/SMCMedAssoc.
© 2014 San Mateo County Medical Association
May 2014 / Volume 3, Issue 5 Adolescent Health Columns President’s Message: Healthy kids, healthy world ..........................4 Niki Saxena, MD
Feature Articles Focusing treatment on bullies, not just victims ...............................7 Wesley Dunn, MD
Physicians, parents, and youth providers: Partners in sex education .................................................................9 Abigail Karlin-Resnick and Kathryn Davis
Ergonomics in the modern age of computers and video games ......................................................... 11 Chunbo Cai, MD, MPH
Tools and resources for ensuring adolescents’ life-long good health ..................................................................... 13 Nancy L. Brown, PhD, and Elizabeth W. Lee, MD
Of Interest SMCMA Nominating Committee Report Member Updates, Index of Advertisers ..........................................14
President’s Message by Niki Saxena, MD
Healthy kids, healthy world This month’s theme is adolescent health, a topic near and dear to my pediatrician-heart. The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Healthy children can become healthy adults, and healthy adults are key for a healthy society. And in a country as resource-rich
as ours, the real question should be how to make health accessible to all children. As I watch my patients grow from infancy to teenagers to young adults, I see their problems evolve and the stakes seem to get higher: eating disorders, bullying, social media use and abuse, self-medication with food or mind-altering substances, educational challenges, and questionable decision making are just a few. I see anxiety and rebellion mixed with sex and drugs, which makes for a potentially frightening obstacle course through adolescence. How do we help kids learn good decision making skills? Help them
manage educational challenges? Help them develop a healthy relationship with technology? Help them develop self-reliance, confidence and compassion? I’m not sure any one person can do all those things, but as a group we can make a difference. The proof is in the statistics released by the CDC, and there is good news mixed in with bad news. The prevalence of obesity in children is decreasing (good news) but there are still disparities amongst different socioeconomic and ethnic groups (bad news). There are significant declines in the rates of teenage pregnancy, teens seem to be less sexually active, but alcohol/drug abuse continues to be a significant public health concern. According to data updated in 2012, 72 percent of teens reported consuming more than a few sips of alcohol by the end
4 SAN MATEO COUNTY PHYSICIAN | MAY 2014
of high school, and 37 percent have done so by the end of 8th grade. The rates of teenagers drinking and driving have dropped by 54 percent in the past two decades, but 16 percent of all drivers younger than 20 involved in fatal crashes were distracted while driving. How can we help? By educating ourselves and our families on these issues and helping connect them with the right resources. In this issue we have articles about bullying, teen health and sexuality, reducing the risk of musculoskeletel pain in young technology users, and adolescent health resources within the PAMF system. We as a society can and should help all children reach their potential, for ultimately it is society as a whole that benefits from creating healthy, happy and emotionally mature human beings. ■
Know you what it is to be a child? It is to be something very different from the man of today. It is to have a spirit yet streaming from the waters of baptism; it is to believe in love, to believe in loveliness, to believe in belief; it is to be so little that the elves can reach to whisper in your ear; it is to turn pumpkins into coaches, and mice into horses, lowness into loftiness, and nothing into everything, for each child has its fairy godmother in its own soul. — Percy Shelley Any society, any nation, is judged on the basis of how it treats its weakest members; the last, the least, the littlest. — Cardinal Roger Mahony
SAN MATEO COUNTY MEDICAL ASSOCIATION
ANNUAL MEETING OF MEMBERS Thursday, June 19, 2014
Peninsula Golf & Country Club
6:30 P.M. Hosted Reception 7:30 P.M. Dinner & Program
701 Madera Drive San Mateo
Zubin Damania, MD
Founder/CEO of Turntable Health and ZDoggMD.com Keynote Speaker
Dirk Baumann, MD
Palo Alto Medical Foundation - PMC Recipient, SMCMA Distinguished Service Award $60 SMCMA Members & Guests / $90 All Others / Tables of 10: $600
Name and Address of Medical Practice:
Number of tickets/tables: _____ @ $_______ each (see prices above) = TOTAL DUE: $ ___________ Payment Method: Card Number:
Charge my Visa/Mastercard/Discover (circle card type) Expiration:
3-Digit Security Code:
Please fax your completed reservation form to (650) 312-1664, email to firstname.lastname@example.org or mail to SMCMA, 777 Mariners Island Boulevard, Suite 100, San Mateo, CA 94404. Questions? Call (650) 312-1663.
MAY 2014 | SAN MATEO COUNTY PHYSICIAN 5
PAIN MANAGEMENT & OPIOID PRESCRIBING: MANAGING THE RISKS Thursday, June 12, 2014 - 6:00 - 8:00 P.M. By reviewing the key risk issues related to pain management and the prescribing of opioids, this presentation, geared toward all physicians, will support your ability to: • • •
Adhere to federal and state law pertaining to the prescribing of controlled substances Recognize the signs of potential drug addiction and drug diversion Apply risk management best practices that support sound pain management principles to improve patient safety and increase defensibility in the event of a claim
BONUS: Meet with a DOJ representative and complete your CURES Database registration! This is an SMCMA member benefit separate from the CME program. If you are interested in taking advantage of this opportunity, you must contact the SMCMA in advance to schedule your DOJ appointment and complete your CURES pre-registration before your appointment—please see instructions at right).
LOCATION San Mateo County Medical Association 777 Mariners Island Blvd., #100 San Mateo
SCHEDULE 4:30 P.M. Meet with a DOJ Representative and Complete CURES Database Registration (by appointment only— please see instructions at right) 5:45 P.M.
Register for the CURES Database—INSTRUCTIONS You must complete these steps before your DOJ appointment! 1.
Pre-register online Go to https://pmp.doj.ca.gov/ and register as a “New User”— Practitioner
Print your registration confirmation Upon completion of your online registration, immediately print your registration confirmation page.
Reply to email confirmation within 72 hours After completing your online registration, you will receive an email requesting verification of your email address. You must complete the verification within 72 hours of receipt of the email.
Contact SMCMA for a DOJ appointment Call (650) 313-1663 to make an appointment with a DOJ representative on June 12, 2014, between 4:30 and 7:00 P.M.
Bring supporting materials to your DOJ appointment on June 12, 2014, to be validated:
TO REGISTER • • • •
Online: www.smcma.org Phone: (650) 312-1663 Fax: (650) 312-1664 Mail: SMCMA, 777 Mariners Island Blvd., #100, San Mateo, CA 94404
Check-in and Dinner CURES Database Explored Department of Justice Presentation 6:00 P.M. Pain Management & Opioid Prescribing: Managing the Risks NORCAL Mutual CME Presentation
COST SMCMA Members: FREE
I would like to make an appointment to complete my CURES registration with a DOJ representative at the SMCMA office on June 12, 2014. I am a non-member. Contact me about payment.
• • • •
Signed application form (#2 above) Copy of your medical/ pharmacy license Copy of your DEA certificate Copy of your governmentissued ID (driver’s license or passport)
CME Information & Disclosure: NORCAL Mutual Insurance Company is accredited by the ACCME to provide continuing medical education for physicians. NORCAL Mutual Insurance Company designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. The faculty member—Katie Theodorakis—has no relevant financial relationships to disclose. The planners from NORCAL Mutual Insurance Company— Kirsten Padgett (Regional Risk Management Manager) and Jo Townson (CME Manager)—have no relevant financial interests to disclose.
6 SAN MATEO COUNTY PHYSICIAN | MAY 2014
FOCUSING TREATMENT ON BULLIES, NOT JUST VIC TIMS
by Wesley Dunn, MD
Bullying is widespread in American schools today. Studies have shown that one in four students reports being a victim of bullying, whether it is verbal, physical, prejudicial or cyber bullying. These victims are more likely to suffer from mental health disorders such as social anxiety, depression and suicidal ideation. Research estimates that 70 percent of school shooting perpetrators were victims of bullying. Fortunately, there has been significant progress in the war against bullying. Given its traumatic, long-term consequences, bullying is no longer accepted as a “normal” part of growing up, and we have begun to put in place policies that attempt to reduce these harmful acts. California laws specify that students have a right to a safe learning environment, and school districts without appropriate safety measures in place can risk legal action. Many schools have adopted a no-tolerance policy and some participate in anti-bullying campaigns. Presently, much of the discussion regarding bullying focuses on the effect it has on its victims and the ways in which we can protect them. Equally important is an examination of why bullies behave the way that they do. Interestingly, bullies have worse mental health outcomes compared to their victims. They are at high risk for depression, suicidal ideation, ADHD, substance abuse and early sexual activity. Additionally, being a bully is predictive of future adult criminal activity such as spousal and child abuse. In my practice as a child and adolescent psychiatrist, I have seen increasing numbers of bullies. Consistent with the research, these bullies tend to suffer from mental health disorders at a more severe level compared to the counterparts they victimize. The bullies who I have treated frequently
misinterpret social cues and tend to live in a hypervigilant state. They exhibit paranoid tendencies that cause them to wrongly perceive threats that do not really exist. When my patient “Sam” was accidentally bumped by a peer, he did not see it as an accident. He saw it as a call to arms. Sam acted out physically and aggressively because he felt attacked and challenged. His inability to relate to others and his misunderstanding of others’ feelings and intentions led him to react violently, experience emotional dysregulation and dominate and humiliate others. Consistent with being socially blind to the thoughts and feelings of his peers, Sam is unaware of just how much he is disliked. We used to think that bullies act the way they do because of low self-esteem and their subsequent need to disparage others to boost their own egos. In fact, bullies have a highly distorted level of over-confidence. Because of this, any perceived insult is something that their ego cannot tolerate. Bullies lash out defensively to preserve the elevated image they have of themselves. Sam’s therapy was geared toward getting him to recognize his social miscues. He learned to slow his reaction time and control his impulsivity so that he could come to more accurate conclusions about his peers’ actions. He practiced
MAY 2014 | SAN MATEO COUNTY PHYSICIAN 7
putting himself in other peoples’ shoes so that he could see their perspectives. Sam worked on reality testing to gain insight into what was a distorted level of over-confidence. He slowly began to realize that much of his behavior was based on narcissism instead of reality with humility as the driving force. When therapy does not provide sufficient improvement, some individuals like Sam benefit from mood stabilizers, anti-anxiety medication and other forms of pharmacotherapy to reduce the stress response, impulsivity and hypervigilant state.
Sam’s behavior has improved significantly. Had he not been treated appropriately, research shows that he would have been at greater risk of having children who also become bullies. Now, he also has a lower risk for depression, criminal activity and abuse of his future spouse and children.
Because Sam has a better understanding of others’ thoughts and intentions, his interactions with them have become more positive. There is still much more to be done to stop bullying. Focusing our anti-bullying campaigns on prevention as well as the treatment of both victims AND bullies will take us much further in the war against bullying. ■
About the Author Wesley Dunn, M.D. is a child, adolescent and adult psychiatrist in private practice in Burlingame. His experience includes treatment of a wide range of psychiatric diagnoses, such as mood disorders, anxiety disorders, and ADHD/disruptive behavior.
Tracy Zweig Associates INC.
Physicians Nurse Practitioners Physician Assistants
SUCCESSFUL FERTILITY TREATMENT STARTS WITH GOOD TEAMWORK That’s why the renowned doctors at PAMF Fertility Physicians of Northern California work with your patient to ensure they get the latest treatments and emotional support they need. It’s another way we plus you.
Locum Tenens Permanent Placement
Ofﬁces in Fremont, Palo Alto and San Jose/Los Gatos.
V oi ce : 8 0 0 - 9 1 9 -9 1 4 1 or 8 0 5 -6 4 1 -9 1 4 1 FA X : 8 0 5 -6 4 1 -9 1 4 3 tzwe i g @ t r ac y z w ei g. c om www.t r ac y z w ei g. c om
8 SAN MATEO COUNTY PHYSICIAN | MAY 2014
(800) 597-2234 pamf.org/fertility
Fertility Physicians of Northern California
PHYSICIANS, PARENTS, AND YOUTH PROVIDERS: Partners in Sex Education “Do you get a lot of angry phone calls from parents?” It’s not a question most of us would think to ask a preschool teacher friend, or a volleyball coach acquaintance, or really any other person who works with youth on a regular basis. But, almost universally when our staff members tell a new person that we work in sex education, we are confronted with the same interested, well-intentioned line of inquiry: What do the parents say? Are they upset about your programs? Do they call to complain?
“No,” we say, slightly baffled. “Why do you ask?” by Kathryn Davis and Abigail Karlin-Resnick Our organization, Teen Talk Sexuality Education (or Teen Talk) has been providing comprehensive sexuality education services to teens in San Mateo County for more than 20 years. Our mission is to help young people feel confident and supported to make informed decisions about their own sexual health, a goal we strive to achieve through our inschool puberty and sexuality education programs for students ages 10-18, teacher and youth provider trainings, and parent education workshops. California Education Code (51930-51939) mandates that students receive HIV/AIDS prevention education at least twice during their academic careers: once in middle school and once in high school. Sex education is not required, but, if a school chooses to offer sex ed, the program must be medically accurate and age-appropriate. It must also be comprehensive, covering abstinence, effectiveness and safety of contraception, protection from sexually transmitted diseases, and sexual decision-making. CA Education Code also requires that sex ed programs respect and address the needs of English Language Learners, students with disabilities, and students of all sexual orientations. Teen Talk develops its own medically accurate, age-appropriate curricula based on CA Education Code and Health Education Content Standards as well as best practices in the field, and then contracts with schools to provide one to two weeks of programming during school hours, usually during students’ science classes. During the current school year, our trained educators deliver our curricula to almost 6,000 10-18 year-olds, each of whom is asked to complete a parent communication homework assignment as part of our program.
In short, we’re not just reaching 6,000 students every year— we’re reaching at least 6,000 parents, too. And far from the imagined influx of angry calls and emails, 89% of parents who complete the homework with their child say the program made them feel more comfortable continuing conversations with their child about sex, sexuality, and relationships in the future. So what’s going on here? Well, the (erroneous) assumption that parents pose major opposition to sexual health education programming is grounded in some deeply entrenched societal stereotypes about parental attitudes. The specter of the uncomfortable, out-of-touch, repressed parent of an adolescent has been lurking around since the dawn of rock ‘n’ roll, pitted against sexuality educators, youth activists, and reproductive health service providers in a presumed culture clash. But, like most binary divisions, the parent/sex educator opposition is a false dichotomy, and one the field of sexual health—educators, activists, and clinicians alike —would do well to combat. Parents are not our opponents, and the popular portrayal of them as such—on television, in the news media, and in our day-to-day interactions with well-intentioned friends and family—does a tremendous disservice to all involved. It’s terribly unfair to parents, who may differ in their attitudes, religious beliefs, and value systems, but who, by and large, share a fierce commitment to their children’s health and happiness. It’s unfair to youth providers (like Teen Talk) as well, as it places us on the defensive and discounts our own experiences as parents, guardians, and people of faith. And beyond issues of fairness or reputation, positioning parents as opponents in the fight to promote teen sexual health is patently poor health strategy. However much we MAY 2014 | SAN MATEO COUNTY PHYSICIAN 9
may hear about the influence of television, music, and video games on teens’ perceptions of sex and sexuality, teens themselves say that parents are the biggest influence on their sexual decisions (Albert, 2007). Furthermore, teens who have repeated conversations about sex, sexuality, and reproductive development with their parents are less likely to engage in sexual risk-taking behaviors, more likely to use contraception when they become sexually active, and more likely to talk with their parents when they have sexual issues in the future (Advocates for Youth, “Parent-Child Communication: Promoting Sexually Healthy Youth”). All of this means that, where educating youth is concerned, sex ed teachers and medical providers most often play a supporting role to parents, not the other way around. None of this is news to youth-serving physicians. Parents and guardians have a significant influence on their children’s medical care as well as their education. Sex educators and medical providers both grapple with similar gray-area questions: how do we provide information that is complete and medically accurate while maintaining the trust of the youth we serve and their parents—some of whom hold strong personal attitudes about the sexual behaviors we discuss? Our answer: it’s time for a return to values. The topic of personal values is often touched on in sex ed programming, but the idea of incorporating a full values discussion in the sex education classroom has been largely dismissed as too tense, too political, and too ripe for classroom discord. Some voices in the field have expressed concern that acknowledging differences in personal values might open up the door for medically inaccurate teachings or diminish the educator’s credibility as a source of sound information. These are valid concerns, particularly given the proliferation in the late 1990s and early 2000s of sexual health programs promoting abstinence as the only moral choice, at the cost of scientifically accurate information on contraception. Valuesfocused sex education shouldn’t advocate for any one set of values or system of personal beliefs. And, of course, it should never contradict or in any way supplant the medical facts— accurate information is an essential ingredient to sound sexual health decision-making. But, if we want to maximize the chances that our young people will make decisions that are right for their health and general well-being, we need to help them develop the confidence and skills to identify their personal values (whether these values are consistent with those of their family or not), communicate those values to others, and translate those values into their sexual and relationship choices. This might sound like a tall order, but many physicians, reproductive health counselors, educators, and other youth service providers are already accounting for personal values as a matter of practice. Making room for personal values can mean exploring with young people and their families what messages and expectations regarding sex and sexuality are being set at home. It can mean helping young people to identify trusted adults in their lives with whom they can 10 SAN MATEO COUNTY PHYSICIAN | MAY 2014
talk openly. It can mean providing parents with resources for initiating and maintaining conversations about sex and sexuality with their teens. And it can mean asking for parents’ trust and understanding of our professional responsibilities when their teens speak with us in confidence. Most importantly, the end result of this strategy—consistent messaging and partnership among parents, educators, and medical providers—greatly benefits the youth we serve. Even (or maybe especially) for teens whose beliefs and behaviors break from their familial value systems, open communication with parents can be incredibly important for teens’ mental health and happiness. As Margaret Moon, MD, MPH, assistant professor of pediatrics at Johns Hopkins School of Medicine notes, “While pediatricians have a duty to support and encourage the developing autonomy of a teenager, the fact remains that most teens live and thrive within a family structure. Pediatricians seeking to promote and protect the well-being of teenagers should strive to offer advice that will strengthen the bonds between teen and family while protecting health and the teen’s developing sexual identity.” (Amednews.com, 2011). In the effort to ensure that our teens are informed, healthy, and personally fulfilled, we face new challenges every day. Access to affordable and confidential medical care can be a problem for teens seeking reproductive health services. Media messaging that normalizes unhealthy relationships and sexual assault can be a problem. Drug and alcohol use can be a problem. Parents are not the problem. If we as educators and medical providers join together to engage with parents as partners in our vision of creating a community-wide commitment to teen sexual health, they may very well prove to be the solution. ■
About the Authors Abigail Karlin-Resnick is executive director of Teen Talk Sexuality Education in Redwood City. Her work is driven by a desire to give all children an opportunity to reach their potential
Kathryn Davis is communications manager at Teen Talk. She is particularly interested in the power of online communication tools to connect and inspire teenagers.
ERGONOMICS IN THE MODERN AGE OF COMPUTERS AND VIDEO GAMES
by Chumbo Cai, MD, MPH Information and communication technology (ICT) has become an important part of the lives of schoolchildren, who surf the Internet, chat, and play online games. In the meantime, the prevalence of neck-shoulder and low back pain has increased among adolescents. Studies among adolescents confirm a connection between musculoskeletal symptoms and the use of ICT, especially computers and handheld devices.1 Musculoskeletal pain has become a major symptomatic complaint among children and adolescents and is increasingly occurring at a younger age. Prins et al have reported a systematic review on the studies evaluating the evidence for the contribution of posture and psychosocial factors to the development of upper-quadrant musculoskeletal pain in children and adolescents. The review included ten studies, which measured upper-quadrant musculoskeletal pain as an outcome measure. Five studies evaluated sitting posture and found an association between the duration of static sitting and upper-quadrant musculoskeletal pain. Six studies measured psychosocial factors, of which depression, stress, and psychosomatic symptoms were the factors most commonly found to influence the development of upper quadrant musculoskeletal pain. The review concludes that the duration of sitting posture and psychosocial factors may influence the experience of musculoskeletal pain among children and adolescents.2 By the anatomic sites of the musculoskeletal pain, headache, neck-shoulder pain, and lower back pain are more common among computer users than among nonusers. The risk of developing musculoskeletal pain increases with an increase in the amount of time spent on the computer. The findings of several studies indicate that computer use induces pain and discomfort not only in the neck-shoulder and back regions but also in the hands, fingers, wrists, eyes, and head. Roth- Isigkeit et al investigated the prevalence and characteristics of pain (e.g., pain intensity) among 735 children and adolescents aged ten to eighteen years. Girls reported pain that was significantly more severe than did boys, and half of the sample reported pain lasting longer than three months. Hakala et al suggest that musculoskeletal symptoms causing moderate and severe pain as well as inconvenience to everyday life are common among adolescent computer users. Daily computer use of two hours or more increases the risk at most anatomic sites. The prevalence of moderate to severe pain was 20.7 percent for neckshoulders, 19.7 percent for head, and 13.8 percent for eyes. The prevalence of moderate to severe inconvenience to everyday
life was 28.3 percent due to head pain, 20.7 percent due to neck-shoulder pain, and 15.4 percent due to low back pain. Pain intensity was reported as follows: Girls reported more moderate to severe computer-associated pain than boys at all anatomic sites, except the low back, for which the prevalence was higher among the boys.1 Other epidemiological studies also have found high prevalence rates of back pain among schoolchildren. Community-based studies of back pain in childhood indicate that low back pain does have a relatively high prevalence during school years, varying from country to country: Finland, 20 percent; England, 26 percent; Canada, 33 percent; United States, 36 percent; and Switzerland, 51 percent. Murphy et al studied sitting postures of schoolchildren in the classroom using the Portable Ergonomic Observation Method (PEO). The study found significant associations between flexed postures and low back pain. Static postures and neck and upper back pain were also associated. The study has implications for schools, designers, and people in the fields of work related musculoskeletal disorders.3 All these research results call for more societal and medical attention on the implementation and reenforcement of the ergonomic applications in children and adolescents. Heyman et al have proposed educating about balanced posture, body function, and movement patterns, as well as their ergonomic implications, to minimize and even prevent these problems. Such an ergonomics awareness educational program has to start at childhood and should be an integral part of the curriculum in the schools.4 Cornell Human Factors and Ergonomics Research Group (CHFERG) has studied ergonomics in children extensively and proposed guidelines for neutral work posture for children and fitting of work/computer stations. The guidelines are detailed on its website.5 â– References appear on page 14.
About the Author Chunbo Cai, MD, MPH, is a physician in the department of physical medicine and rehabilitation at Kaiser Permanente San Francisco. This article was originally published in the June 2013 issue of San Francisco Medicine, the magazine of the San Francisco Medical Society.
MAY 2014 | SAN MATEO COUNTY PHYSICIAN 11
TA K E W E N A GET O N YO U R I S T. L T E K C BU ɑȨɨȐHɄɤɜȐҲҲ HȨȇȐǸȣɄɜǸȨɑǾǸȵȵɄɄȽ PǸȰȐǸɕǸȵɕǸȵȐɕɕɄȽ ɄɄȽǸɕǸȘǸɑȨ
(PEUDFHDFRPPXQLW\OLNHQRRWKHU:KHUHVRSKLVWLFDWHG HOHJDQWOX[XU\HPEUDFHVDQDGYHQWXURXVRXWORRNDQGHYHU\ GHWDLOLVDQWLFLSDWHGWRUHIOHFW\RXUSHUVRQDOVW\OHDQG]HVWIRU OLIH )LUVW&ODVV6HUYLFHV $PHQLWLHV_)LQH'LQLQJ_ 3RRO 6SD_6RFLDO$FWLYLWLHV_3UHPLHU5HVLGHQFHV 201 Chadbourne Avenue | Millbrae, CA 94030 RCFE# 415600154
(888) 862-6915 (650) 697-7700 www.themagnolia.com
THE PENINSULA’S PREMIER RETIREMENT COMMUNITY
12 SAN MATEO COUNTY PHYSICIAN | MAY 2014
TOOLS AND RESOURCES FOR ENSURING ADOLESCENTS’ LIFE-LONG GOOD HEALTH
By Nancy L. Brown, Ph.D., and Elizabeth W. Lee, M.D.
Adolescence is a critical developmental stage when health-risk behaviors are often initiated. This is due to increased independence from parents and the desire to engage in perceived “adult” behaviors, combined with social opportunities to engage in problem behaviors with peers (DuRant et al., 1999). Risk behaviors initiated in adolescence may be the cause of both immediate and chronic health problems if the behaviors continue into adulthood. In addition, economic consequences stemming from chronic, preventable health problems include rising health care costs, overburdened health systems and the life-long expense of chronic disease care. Risk behaviors learned in adolescence, such as smoking, alcohol/drug use, physical inactivity and high-risk sexual behaviors, are a cause for concern. Although the majority of teens are not participating in high-risk behavior, there are minorities that begin to smoke, drink alcohol and/or use marijuana (NIDA, 2014). Risky sexual behaviors put young people in the highest rate of sexually transmitted infections of any age group. Unhealthy eating habits and physical inactivity contribute to the rising rates of obesit —about 25 million children in the U.S. are at a greater risk of health issues such as high cholesterol, hypertension and diabetes (CDC, 2012). Barriers to Getting Health Information There are several barriers to making sure adolescents, parents, schools and clinicians have access to accurate health information: 1.
Adolescents tend to turn to the Internet to find health information, but experience difficulty in assessing the reliability and quality of information found online. They may also either find an overwhelming amount or not enough relevant sites (American College Health Association, 2008). Clinicians may need a tool to help them gather risk information and have conversations with teens about the many health behaviors relevant to discuss in wellness checks.
Schools and community-based organizations face time, financial, training and resource deficits for health education.
Parents may not be aware of the importance of initiating conversations about personal risk behaviors or know where to find reliable and accurate resources to share with their teens. In addition, some parents have an unrealistic perception that their children are not engaging in highrisk behaviors.
Resources for Improving Adolescent Health In response to these barriers, the Palo Alto Medical Foundation (PAMF), a Sutter Health affiliate, has developed a suite of free information and online health tools to help clinics, schools, families and individuals improve adolescent health. These include electronic wellness assessment and health tracking tools and medically accurate websites with interactive components for preteens, teens, and young adults. on PAMF’s website, pamf.org/healtheducation/. ■
About the Authors Nancy L. Brown, PhD, is a health educator who leads the Adolescent Interest Group for the Palo Alto Medical Foundation’s teen, preteen and young adult websites.
Elizabeth W. Lee, MD, is a board-certified family medicine physician at the Palo Alto Medical Foundation in Palo Alto. She completed her medical education at the University of California, Los Angeles School of Medicine.
MAY 2014 | SAN MATEO COUNTY PHYSICIAN 13
SMCMA Nominating Committee Report The 2014 SMCMA Nominating Committee has proposed the following candidates to officer, board, and delegation positions. Nominations may also be made by members of the Association. These nominations are to be in writing, signed by 10 active members, and delivered in person to the association headquarters or by registered mail no later than June 20, 2014. Officers President-Elect: Secretary-Treasurer: Immediate Past-President:
Michael Norris, MD Russ Granich, MD Amita Saxena, MD
The office of the President will be filled by Vincent R. Mason, MD. Board of Directors
Continued from page 11 1. Hakala PT, Saarni LA, Punamäki RL, Wallenius MA, Nygård CH, Rimpelä AH. Musculoskeletal symptoms and computer use among Finnish adolescents—pain intensity and inconvenience to everyday life: A cross-sectional study. BMC Musculoskelet Disord. 2012 Mar 22; 13:41. 2. Prins Y, Crous L, Louw QA. A systematic review of posture and psychosocial factors as contributors to upper quadrant musculoskeletal pain in children and adolescents. Physiother Theory Pract. 2008 Jul-Aug; 24(4):221-42. 3. Murphy S, Buckle P, Stubbs D. Classroom posture and selfreported back and neck pain in schoolchildren. Appl Ergon. 2004 Mar; 35(2):113-20. 4. Heyman E, Dekel H. Ergonomics for children: An educational program for elementary school. Work. 2009; 32(3):261-5. 5. http://ergo.human.cornell.edu/cuweguideline.htm.
Toby Frescholtz, MD Alex Lakowksy, MD
C.J. Kunnappilly, MD Chris Threatt, MD
Board members continuing terms: Alexander Ding, MD; Manjul S. Dixit, MD; Edward Y. Koo, MD; Susan Nguyen, MD; Michael O’Holleran, MD; Kristen Willison, MD.
NEW SMCMA MEMBER
Delegation Leslie Kim, MD Vincent R. Mason, MD Amita Saxena, MD
Elizabeth Nadiv, MD *PD/Daly City
Gregory Lukaszewicz, MD James Missett, MD William Tatomer, MD
Delegates continuing terms: Dirk Baumann, MD; John Hoff, MD; Steve Kmucha, MD; Michael Norris, MD. Alternate Delegates Gordon A. Brody, MD Alexander Ding, MD Julie O’Callahan, MD
* Board-certified by the American Board of Medical Specialties
Martin Bronk, MD Mark Levsky, MD
Alternative Delegates continuing terms: Alexander Ding, MD; Edward Lipton, MD. Nominating Committee Sonia Declerq, MD David Goldschmid, MD Mark Levsky, MD Susan Nguyen, MD Marie President, MD Amita Saxena, MD
Alexander Ding, MD Russ Granich, MD Gregory Lukaszewicz, MD Gurpreet Padam, MD Karen Relucio, MD Claire Serrato, MD
SAVE THE DATE!
SMCMA Family Picnic Sunday, August 24, 2014 Huddart Park, Woodside
14 SAN MATEO COUNTY PHYSICIAN | MAY 2014
In Memoriam Robert Dorin, MD
Ward Hart, MD
May 5, 2014
November 30, 2013
INDEX OF ADVERTISERS The Doctor’s Company................................... Inside Back Cover Fertility Physicians of Northern California ............................... 8 The Magnolia of Millbrae ..............................................................12 Mercer....................................................................Inside Front Cover NORCAL ............................................................. Outside Back Cover Tracy Zweig Associates ..................................................................... 8
Physicians have faced over 90,000 alleged HIPAA violations. Make sure you’re prepared. *
For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner. Call (800) 852-8872 today for a quote or a complimentary insurance assessment. Q
Employment Practices Liability
Directors and Officers/Management Liability
Health and Disability
Errors and Omissions Liability
Property and General Liability
Billing Errors and Omissions Liability
*Source: U.S. Department of Health and Human Services
CA License #0677182
777 Mariners Island Boulevard, Suite 100 San Mateo, California 94404
ADDRESS SERVICE REQUESTED
PROUD TO BE ENDORSED BY THE SAN MATEO COUNTY MEDICAL ASSOCIATION
NORCAL Mutual is owned and directed by its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our ďŹ rst priority. Visit norcalmutual.com, call 877-453-4486, or contact your broker.
A N O R C A L G R O U P C O M PA N Y