Saturday, October 29, 2011

A Great Way for Students to Give Back: AFYA

I first heard about AFYA when I returned from Haiti after the earthquake in 2010.  Right in our backyard, in Yonkers and run by Danielle Butin, AFYA is an extraordinarily efficient and well organized not-for-profit that collects medical and other supplies from individual, commercial and medical sources and responds to the call for them from around the world.  When I first met her, what impressed me most about Danielle 
was not only her spirit and energy but the tremendous organization of her vast supplies.  I saw row upon row of packed and tidy shelves labelled "Pediatric cardiology" or "Gastroenterology" and an entire room of drugs and pharmaceuticals in properly labelled bins.  This doesn't happen by itself.  Volunteers are taught to do this and in short order accomplish a small miracle which allows AFYA to continue its work around the world.  Please look at their website and consider organizing a group of friends to contribute your community service hours to this wonderful cause:

Calling All School Age Volunteers!
On Saturday, November 12th, AFYA is sponsoring a 16-hour sortathon, where we will celebrate and honor our teenage and young adult volunteers. At the Sortathon, volunteers will sort, inventory and pack supplies for 2-hour segments and contribute enormously to global health. We have a full day of entertainment and amazing, moving speakers lined up.

Start a team or work independently - there will be gifts for all, and prizes as well! We're expecting lots of participation, so register early and make sure to choose your two-hour shift of preference.

Please visit and share our brand new Sortathon website:  www.Sortathon.afyafoundation.org
to register and find out the details about this event -- participants will
contribute to the improvement in health for thousands abroad. Registration will require a $25 tax deductible donation.

Please help us to get the word out -- send this sortathon link to everyone you
know!

Thank you!
MORE

Wednesday, October 26, 2011

Readin' Writin' Rithmetic and Relationships

I am pleased today that my professional organization, Society for Adolescent Health and Medicine, and its president-elect,John Santelli, have come down from what is frequently the organization's ivory tower in the clouds to comment on the sex education program that is going into effect in New York City schools.  Along with Arik Marcell,  a pediatrician from Johns Hopkins, their op ed piece is a smart and compassionate answer to the October 19 Op-Ed piece entitled "Does Sex-Ed Undermine Parental Rights?"

In that article the authors painted an unsavory picture of young middle schoolers exploring all sorts of "solitary and mutual sex acts" using flash or "risk" cards.  This is what they imagine the new NYC Department of Education's requirements will consist of and fear that parents will lose control as "the effect of such lessons is as much to promote a certain sexual ideology among the young as it is to protect their health."

But Santelli and Marcell help us to see this new educational mandate in a different way:

"...public health is built on the twin pillars of scientific understanding and human rights, not ideology.
Children and adolescents are developing human beings, with rights to protection, to health and to education — and sexuality is a normal and vital aspect of human development. Comprehensive sexuality education equips young people with information they need to protect themselves against sexually transmitted infections and unplanned pregnancy and to adopt healthier sexual behaviors."
No matter what the curricula turn out to contain, parents can still have a lock on the values and morality and the when (and maybe the how and with whom) of sexuality in their children.  In fact, multiple studies have shown that kids want to know how their parents feel about sex and what their values are.   But parents have not done a very good job of it. In another Op-Ed piece today, one of the teenage staff writers for Sex,Etc, one of my favorite publications (cheap, well written by teens, and sharing a diverse and biologically correct view of sexuality in teens) points out that in 2008 while 47% of girls (ages 14-18) "said they had never discussed sex with their parents, only 6% of parents said they had never discussed sex with their children."

It might even turn out that the introduction of the biology and science of human sexuality in our schools may present an invitation to parents to engage in important conversations with their kids.  Not unlike proof-reading an English paper or (attempting to) help with math problems, the course in human sexuality can open the dialogue that so many parents and kids all want to be having.

image credit from hispanicallyspeakingnews.com

Monday, October 17, 2011

What they are NOT saying about HPV....

While the political candidates hurl insults and untruths at each other about all manner of topics, there is something getting lost in the melee.   Ever since Gardisil vaccine (to protect against Human Papilloma Virus) was approved for girls, I have been telling sceptical parents that Governor Perry's early and messy endorsement of Gardisil  really bollixed it up for those of us on the front lines.  What do I mean?  In spite of a great track record of safety and efficacy, the HPV vaccine is still not accepted as widely as it should be.  This is partly  because Perry made it look like one more BigPharma boondoggle. But it's also due to the fear that we will have to discuss SEX when we talk about the shot.

But we must talk about sex.  Listen to this:

A new study in the Journal of Clinical Oncology --available here only in abstract (abbreviated) form-- brings the stunning news that HPV is contributing to a growing number of head and neck cancers (tonsils, throat and tongue).  It seems that there are two types of oropharyngeal cancers, those caused by tobacco use and those caused by HPV. Between 1984 and 2004 in a study of 6000 patients, HPV-positive cancers increased 225% while HPV-negative oropharynx cancers dropped 50%–most likely because of a reduction in smoking and tobacco use.

Abstinence from intercourse will certainly prevent transmission of HPV to the cervix but what no one is talking about in public is that abstinence and fears of pregnancy and HIV have fostered an explosion in oral sex and other non-intercourse (some call it "outercourse") activities.  Of course they look at me funny when I tell my patients that if they are engaging in oral sex (or giving "head") there should be a condom involved.  Almost no one actually does that.  And so, the HPV is being transmitted to both men and women in growing numbers.

One other problem is that there is as of yet no screening tool to detect early HPV infection or early cancerous cells in the head, neck and oral cavity.  For cervical cancer, the Pap smear has been the standard method of early detection and along with HPV vaccine is responsible for dropping incidence of cervical cancer.

"Should the observed declines in cervical cancer and the observed increases in HPV positive oropharyngeal cancers continue into the future," Chaturvedi, the principal investigator on this study, said, (then) "HPV positive oropharyngeal cancers will be the leading HPV associated cancers over the next decade–by around 2020." 

What we need is a rational conversation and some quick, good research to determine whether the vaccine actually does prevent these oropharyngeal cancers, as most believe it will. Then we need to continue to press our insurance companies to cover this vaccine for both women and men.

Finally, we need to talk about SEX before it's a conversation about CANCER.

image from halimdeichatmd.tumblr.com via google

Tuesday, October 11, 2011

My 200th Blog: What does Sponge Bob do to our minds?

I am celebrating my 200th blogpost with a fresh little article from the October 2011 issue of Pediatrics, "Fast Paced Television and Children's Executive Function." Not exactly about teens but read on.

Researchers at the University of Virginia did a neat little experiment on sixty 4-year-olds---admittedly a small sample but just wait to see the results. What they found is that only a few minutes of certain kinds of television can have a remarkable impact on the childrens' "executive function."

Executive function (EF) is quoted in the article as including "a collection of prefrontal skills underlying goal-directed behavior, including atention, working memory, inhibitory control, problem solving, self-regulation, and delay of gratification."

The kids were randomly assigned to a 9 minute epidose of "fast-paced television" (with scene changes every 11 seconds and almost constant motion on the screen); the same amount of time watching educational television(not specified but I think we mean Sesame Street); or 9 minutes of drawing with crayons and markers on paper. Before the test phase of the research the children were evaluated to show that each group was similar with respect to socio-economic facotrs, television habits and rough measures of attention span.  They were then given four tests of executive function (HTKS, backward digit recall, tower of Hanoi, and a test of delayed gratification--all age appropriate and really interesting if you care to take a look at the descriptions of the tests).  After the 9 minute TV or drawing test period the kids were re-evaluated and the following graph shows the change between pre- activity (fast-paced tv, educational tv, or drawing) and afterwards:




Essentially what we learn here is that fast paced television can affect these four year olds' minds in a way that slower paced entertainment doesn't. All of the fast-paced TV group scored worse on all of the EF tests that were included in this study.  It did not address how long this effect persists or what effect more than nine minutes of watching might have.

In an accompanying editorial in Pediatrics, Dr Dimitri Christakis compares the fast paced television to multi-tasking in older students and adults.   Multitasking is the ability to rapidly oscillate between two or more activities, similar perhaps to watching the hyperactive motion on the screen of some shows.  He raises the question of what the social and educational implications of this potential deficit in executive function might mean as we move forward. 

Is the anxiety and inability to focus (read "poor executive functioning") we see in our teens and young adults related to this fast-paced input?  Is it a result of the related multitasking that most of our kids do so "well?"
Stay tuned.



image from sandiego6.com via Google

Thursday, October 6, 2011

An Apple from the Teacher

In my morning haze, I was paging through this morning's New York Times, feeling sad about Steve Jobs when I scanned the lead OpEd piece entitled Where's the Jobs Bill?  I was thinking the editors had come out awfully quickly with an oped piece on the genius, only to realize it was another demoralizing plea for Republicans and Democrats to get along with each other.  If Steve Jobs were writing a "bill" I think it would be in a beautiful font and it would take the lessons from his own life which he so simply recounted in the now famous Stanford graduation speech in 2004.  Some of his words:

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma — which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.
Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.
I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.



If you know a junior or a senior (high school or college) or a gradutae or even a worried child in kindergarten who might feel overwhelmed and stressed by uncertainty or feeling powerless, share Jobs words with them.  Print them out and put them on a card against the salt and pepper shaker on the dinner table tonight.  Ponder the wisdom of this man's many gifts to all of us, including his personal philosophy. And try putting the iphones away just for the length of the conversation.

image from frumforum.com via Google

Wednesday, October 5, 2011

Autism newsletter


For the family, friend, therapist, teacher or ally of a child, teen, young adult or grown-up with autism spectrum disorder (ASD), Asperger's syndrome or high functioning autism (HFA) the Autism Spectrum News paper is a trove of wonderful information.  Almost all of us know someone in our midst who fits into these broadly defined categories.   Reading the newsletter is a brilliant way to slip inside the minds and hearts of these people.  That's saying something for a segment of our population that is often ignored and misunderstood or worse, bullied and abused. 

Just a look at some of the subjects that are covered in the Fall issue:

"Important facts about adult autism employment"

"Do parents and teachers 'get' children with AS/HFA?"

The impact of bullying on individuals with HFA and AS"

"Sensory Processing Difficulties-Dressing for Success"

Even the advertisements are interesting and enlightening:

CUNY's master of arts degree in disability studies
Research centers in New York City, including Mount Sinai's Seaver Autism Center for Research
WJCS family center for community support
and
Prince's sensory delights or "sensory engineered clothing and products" for those kids who scratch and itch and fidget because their neurology is different.