Guest Post: Making Lifelong Connections

Danielle Young tells us about her time at the 2nd annual Making Lifelong Connections meeting. Funded by the Maternal and Child Health Bureau, and sponsored by two MCH training programs across the U.S., Making Lifelong Connections is a one and a half day MCHInterdisciplinary Leadership retreat. 

Sunny Walt Disney World was the perfect setting for the second annual Making Lifelong Connections Meeting. The purpose of this two-day meeting was to build connections between MCHers from across the country. I learned a lot about the many training programs that the Maternal and Child Health Bureau training grants fund. I had no idea the breadth of interdisciplinary programs and the range of students they attract. For example, I met students in social work, physical therapy, nursing, behavioral health, and the list goes on. It was a pleasant surprise to meet four other maternal and child health trainees from the University of Minnesota that I had not met before. Two were former students of the School of Public Health and the remaining two were from different disciplines.

An important theme of the meeting was leadership development. Michael Fraser, the CEO of the Association of Maternal and Child Health Programs (AMCHP) gave the keynote presentation on being a leader rather than a manager. This presentation got me thinking about ways to mentor and benefit any future team members that I may be in charge in a managerial position. He stressed focusing on the vision of your organization or project and remaining committed to that vision rather than immediate tasks. This was a great takeaway message and guided the remainder of our time in Florida.

The best part of the meeting by far, was seeing fellow classmate, Annie Fedorowicz, present research from her field experience in Mobile, Alabama this past summer. Annie provided a concise, well-thought out, and professional presentation on her research. I greatly enjoyed listening to her presentation and I learned a lot about how pregnancy and contraception are viewed in the neighborhoods where she was working.

It was rewarding to see the successes of colleagues both near and far. A series of MCH trainees presented their work to the meeting attendees. Some projects were nearing their end while some were just beginning. This was an exciting part of the meeting as it was fun to see what other MCH trainees across the country are working on.

The meeting was designed as a way for MCH trainees to network with other trainees from around the country in order to learn from each other and collaborate on projects together in the future. This was especially helpful for me as I recently moved to Chicago, Il and I was happy to meet other MCH trainees and former trainees from the Chicagoland area. This was a pleasant surprise and I’m thankful to be able to start growing my network in Chicago.

Overall, the meeting was a great experience and I’m thankful to have had the opportunity to attend.

Danielle Young is a second year MPH student in the Maternal and Child Health program at the University of Minnesota.

Local Highlight: Reported Kids Concussions on the Rise

Concussions are a form of Mild Traumatic Brain Injury, and are on the rise in Minnesotan children. Symptoms can range from mild (e.g. headaches) to severe (e.g. mood changes, blurry vision, slowness in acting) and may not appear until days or weeks after an injury.

The Star Tribune reports that from 2000 to 2008, the number of children treated for concussions in Minnesota hospitals had increased by 75%. Although most of the injuries were in adolescent boys (ages 15-19), the number of concussions in younger children has sharply increased. Football, hockey, and soccer are the top 3 sports most treated for concussions. These research results come from Minnesota Department of Health Injury and Violence Department epidemiologist, Dr. Leslie Seymour.

An issue to consider with rate changes is whether the actual number of concussions has risen, or the number of children getting treatment has risen. A law (MN Chapter 90) enacted at the start of the school year aims to improve awareness among coaches, parents, and players. Information will reflect the National Centers for Disease Control and Prevention’s (CDC) guidelines and ‘Heads Up’ training.

Dr. Seymour recently received a federal grant to explore the effect of Minnesota’s and various states’ concussion laws. Other possible explanations may be an increase in organized sports involvement or more violent, stronger competition. What are your thoughts on this rise in concussions? Are there any other explanations? What about kids’ participation in extreme sports? Are there disparities between populations?

NCS Speakers’ Series Feeding Young Children: The Good, the Bad and the Picky

The National Children’s Study Speaker Series is sponsored by the Center for Leadership Education in Maternal and Child Public Health and the National Children’s Study – Ramsey County Location. On January 11, 2012, the series offered a talk on “Feeding Young Children: The Good, the Bad and the Picky” by Jamie Stang, PhD, MPH, RD, LN, from the UMN School of Public Health. She describes behaviors of young children that are common concerns of parents, discusses the role of parent feeding styles in early childhood obesity risk, as well as identifies behavioral strategies that parents can utilize to cope with challenging food behaviors. Dr. Stang also discusses the role of food allergies and intolerances in challenging food behaviors of young children.

The archived presentation is now available online: https://umconnect.umn.edu/p51351258/.

For more information on the National Children’s Study, visit their webpage at: http://www.nationalchildrensstudy.gov/Pages/default.aspx

Global Efforts in MCH- Female Genital Cutting

Female Genital Cutting (FGC) is a practice that completely or partially removes the external female genitalia. FGC has been reported in various cultures and countries across the world, but according to the U.S. Department of Health and Human Services (HHS), almost ½ of all incidents occur in Egypt or Ethiopia. In communities that practice FGC—some Islamic– many proponents believe that FGC is sanctioned by the Quran (also spelled Koran; Islamic religious text); in fact, no religion, including Islam, is associated with FGC (HHS Office on Women’s Health). Debates continue as many do not understand that formal religious endorsement of FGC has never occurred.

Tradition and superstitions, such as cleanliness and family honor, contribute to the continuation of the practice. For communities that practice the tradition, fears drive families to participate: if a girl is not cut, she will be viewed as an outsider to a community and runs the risk of being unwed. Intervention strategies target men to abandon FGC as a norm, focusing on patriarchal belief systems and the subordination of women.

Although some groups point to the issue of cultural competence, human rights groups and the World Health Organization (WHO) argue that the health risks of FGC outweigh this. Article 25 of the Universal Declaration of Human Rights (UDHR) (created by the United Nations General Assembly in 1948) states that every person has the right to health, well-being, and security. Although critics have argued that the UDHR is framed in a Western lens, the document guides issues that compromise the safety and health of humans, especially if inflicted by another being. According to the World Health Organization, health problems related to FGC include: bleeding; hemorrhaging; increased risk of Sexually Transmitted Infection (STI) and HIV infection; infection of the genitals and urethra; painful scarring and menstruation; trauma and emotional distress; infertility; and problems during labor/pregnancy (http://www.who.int/mediacentre/factsheets/fs241/en/).

Other strategies to decrease the incidence of FGC are seen in the below PBS documentary as well as in a New York Times focus. Grassroots social mobilization agents teach the community about the harms of female genital mutilation by moving this taboo topic out into public discourse. Their efforts are based on the belief that “before abandonment, comes communication and awareness.”

For more information on Female Genital Cutting, please visit the WHO’s website: http://www.who.int/mediacentre/factsheets/fs241/en/. The New York Times video report is available at: http://video.nytimes.com/video/2011/10/16/world/africa/100000001115488/the-fight-against-female-genital-cutting.html

Is there a Plan b for Plan B?

Plan B One-Step is a single-dose emergency contraceptive pill that contains higher levels of levonorgestrel, a hormone found in some birth control pills, and has been available in the U.S. since 2009. Its effectiveness is linked with timeliness of use: the drug should be taken within 72 hours of intercourse. The Food and Drug Administration (FDA), after reviewing the scientific evidence on its safety and effectiveness, recommended that it be available–without prescription–to females of any age.

On December 7, 2011, Secretary of Health and Human Services (HHS) Kathleen Sebelius overruled this FDA recommendation. While the Secretary of HHS has the authority to override the FDA, The New York Times reported that this issue was the first time a HHS secretary has publicly overruled the FDA. Secretary Sebelius’ action limits an attempt by the FDA to improve the accessibility of Plan B One-Step among young girls, but it does not affect the legality of the drug. Plan B One-Step remains available, without a prescription, to women who are 17-years old and older; and it is still approved for use, with a prescription, for females who are younger than 17.

Sebelius argued that there should be no change in the current law requiring females younger than 17 to obtain a prescription for Plan B One-Step because they require health-care provider guidance to use the pill properly and safely (to see Sebelius’ counterstatement to the FDA’s recommendation, click: http://www.hhs.gov/news/press/2011pres/12/20111207a.html). However, as FDA Commissioner Dr. Margaret Hamburg stated, “Based on the information submitted to the agency, [the FDA’s] CDER [the Center for Drug Evaluation and Research] determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider.” Further, young girls are able purchase a variety of over-the-counter medications and personal products that could be harmful in large doses, such as Tylenol, with no ill effects. President Barack Obama had the opportunity to overrule Sebelius’ decision, but instead agreed with her, noting that he felt uncomfortable, as a father, with the FDA’s decision.

What’s at play here?  What’s going on in this dance between science and good health policy? Did upcoming presidential race play a role here? Are there additional moral or ethical considerations about the proper age for emergency contraception? What’s going on?

How much should, or do,  data really matter in creating health policy? How we talk about – frame – this and other politically charged health issues matters. Consider the language used in various news sources covering the issue. The emotionally charged responses to this specific drug from both evidence-based and ethical-based sides merge to create a unique and complicated discussion. As we launch into an election year, how can we expand the conversation on the topic with our peers and colleagues to further consider the multiple dimensions influencing the availability and accessibility of Plan B for women of all ages across the U.S.?

December 13, 2011 Coverage Update:  14 U.S. Senators, including Minnesota’s Al Franken, have called for further explanation of Sebelius’ decision made on December 7, 2011. The letter–defending the importance of using science to create policy—asks Sebelius for “specific rationale and scientific data” behind limiting Plan B’s accessibility. To see the letter and co-signers, visit: http://murray.senate.gov/public/index.cfm/newsreleases?ContentRecord_id=77e3d54b-bb6b-4c7c-9f05-bfe8c8d3b304. Sebelius has not yet released a response.