Archive for August, 2011

Continuation of Sex Education Funding of Young People in 2012

August 27, 2011

See Arlette Brown’s posting at


Improving Pre-School Eye Care in Children: Keeping Eye Care Health and Good Vision Habits a Priority

August 18, 2011

Babies are born with complete visual structures. However, at birth, they cannot see as well as older children or adults. Their eyes and visual system are not completely developed at birth and their vision continues to develop throughout their pre-school years.

–       Noting that the period from birth through school age is critical for visual development. Any abnormality in this period can lead to permanent visual impairments.

–       Recognizing that amblyopia (lazy eye) is the most common cause of visual impairment in children with a prevalence of about 2-2.6% in the U.S.1-2

–       Noting that most vision conditions in children during the pre-school years cannot be determined on gross physical examination and may remain undiagnosed till children can read standard visual acuity charts around the age of 5.3

–       Realizing that binocular visual impairment can lead to problems in motor and intellectual development.4-6

–       Noting that the majority of pediatricians perform limited eye and vision exams.7

–       Recognizing that the AAO, AAP, AAPOS, and the U.S. PHS emphasized on the need for eye screening in all children under age 3; those with amblyopia should be diagnosed and treated as early as possible.8-12


  • All children should undergo a regular complete eye exam at the ages of 6 months, 2 and 4 years.
  • Health care providers should be encouraged to educate parents on the importance of comprehensive eye exam.
  • Pediatricians should recommend all children receive a complete eye exam.
  • All schools districts in every state should require a complete eye and vision exam – just as they require up-to-date vaccinations – as a condition for completing a child’s registration therein.

AAO: American Academy of Ophthalmology, AAP: American Academy of Pediatrics, AAPOS: American Association for Pediatric ophthalmology and Strabismus, the U.S. PHS: public health services.


1. Friedman DS, Repka MX, Katz J, et al. Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months the Baltimore Pediatric Eye Disease Study. Ophthalmology. 2009 Nov;116 (11):2128-34.e1-2.

2. Multi-ethnic Pediatric Eye Disease Study Group. Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study. Ophthalmology. 2008 Jul;115(7):1229-1236.

3. Arnaud C, Baille MF, Grandjean H, et al. Visual impairment in children: prevalence, aetiology and care, 1976-85. Paediatr Perinat Epidemiol 1998;12:228-39.

4. Rosner J, Gruber J. Differences in the perceptual skills development of young myopes and hyperopes. Am J Optom Physiol Opt 1985;62:501-04.

5. Rosner J, Rosner J. Some observations of the relationship between visual perceptual skills development of young hyperopes and age of first lens correction. Clin Exper Optom 1986;69:166- 68.

6. Williams SM, Sanderson GF, Share DL, Silva PA. Refractive error, IQ, and reading ability: A longitudinal study from age seven to 11. Devel Med Child Neurol 1988;30:735-42.

7. Wasserman RC, Croft CA, Brotherton SE. Preschool vision screenings in pediatric practice: a study from the pediatric research in office settings (PROS) network. Pediatrics 1992;89:834-38.

8. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. Eye examination and vision screening in infants, children, and young adults. Pediatrics 1996; 98:153-7.

9. American Academy of Ophthalmology. Pediatric Eye Evaluations. Preferred Practice Pattern. San Francisco: American Academy of Ophthalmology, 1997.

10. The American Association for Pediatric Ophthalmology and Strabismus. Eye care for the children of America. J Pediatr Ophthalmol Strabismus 1991;28:64-7

11. American Optometric Association Consensus Panel on Pediatric Eye and Vision Examination. Optometric clinical practice guidelines: pediatric eye and vision examination. St. Louis: American Optometric Association, 1994.

12. U.S. Public Health Services Task Force. Guide to clinical preventive services, Second Edition. Washington, DC: U.S. Department of Health and Human Services, 1996.


  1. Building a Comprehensive Child Vision Care System. A Report of the National Commission on Vision on Health (2009). Available at:
  2. American Association for Pediatric Ophthalmology and Strabismus (AAPOS);
  3. American Academy of Ophthalmology (AAO).
  4. American Public Health Society (APHS)
  5. American Optometric Society (AOS).
  6. Vision First Foundation.
  7. Star pupils.
  8. World Health Organization; Prevention of Blindness and Visual Impairment.

DOMA Makes Healthcare Less Accessible

August 18, 2011

In 1996, the Defense of Marriage Act (DOMA) was signed into law that prohibits the United States government from recognizing marriage between individuals of the same-sex performed in territories, states and countries where it is legal.  It further specifies that individual states are not obligated to recognize same-sex marriages that were performed in territories, states and countries where it is legal.

DOMA is a discriminatory policy that has substantial negative impact on the access to health care, as well as on the physical and mental health, of those in loving, committed same-sex marriages. While the National Organization for Marriage advocates for opposite-sex marriage only, they dismiss the needs of same-sex couples that would automatically be provided by legal marriage.

It is well established that couples in opposite-sex marriages enjoy many benefits not afforded couples in same-sex marriages including tax benefits, insurance benefits, inheritance benefits, hospital visitation rights, next-of-kin precedence and permanent residency status.  Employers in states that do not recognize same-sex marriage are under no legal obligation to provide benefits for same-sex partners as they would opposite-sex spouses.  This leads to a substantial disparity among health care access for lesbian and gay couples.

No other single policy in the United States has as broad-reaching discrimination against lesbian and gay couples as DOMA.  DOMA should be repealed so that all married couples in the United States, irrespective of sexual orientation, are afforded spousal privileges under the law.

The UN Secretary General should make universal health coverage a global goal

August 18, 2011

WHR 2010

This May the WHO’s World Health Assembly passed a resolution (WHA64.9) specifically requesting the Director-General, “to convey to the United Nations Secretary-General the importance of universal health coverage (UHC) for discussion by a forthcoming session of the United Nations General Assembly.” This resolution reflects a growing commitment to target universal health coverage explicitly as a global development goal, and builds upon the work of the 2010 World Health Report on universal coverage.

As experts have noted, the vertical-horizontal approach debate pendulum has swung back to horizontal; for now, focusing on health systems and UHC is the right approach.  Given the current fiscally austere environment, it is also the right moment for UHC. UHC is the right approach at the right time. Huge new donor investments, like those required for the Global Fund or GAVI, are not necessarily needed to achieve UHC.  In fact, some emerging economies like Thailand, Mexico, Brazil and others are already reaching near universal coverage, while others like Ghana, Bangladesh, Rwanda, Vietnam and South Africa are commiting to reaching universal coverage.

This September, the Secretary-General (SG) should harness the lobbies and momentum of HIV/AIDS, Every Woman and Every Child, the Millennium Development Goals, and the nascent NCD movement, and transform them into an even more robust movement and strategic commitment to implementing universal health coverage. The SG has a unique opportunity to build on recent impressive successes in global health, and enshrine a path forward on UHC that every country can own.

Universal HIV Testing for Pregnant Women

August 17, 2011

Prenatal testing is very important for the health of newborn infants.  Routine prenatal testing includes multiple blood tests that are related to the health of the mother and infant.  Routine prenatal care includes testing for blood type and multiple tests for infection.  These tests for infection include Hepatitis B, Syphilis, Rubella, and various cultures to detect bacterial infections such as urinary infections and Group B streptococcus infections.  The current recommendations from the Centers of Disease Control and Prevention (CDC), American Academy of Pediatrics, and American Congress of Obstetricians and Gynecologists all recommend universal testing for Human Immunodeficiency Virus (HIV).  HIV is a progressive chronic illness that may lead to early death and transmission can be prevented by medication therapy provided to the mother during pregnancy and delivery.  Testing can be done with the other prenatal laboratory blood tests and does not require extra clinic appointments or procedures.   Even with the above recommendations and almost 100% prevention of transmission of HIV to the infant, universal testing for HIV in pregnant women is not still routine.    Some of this may be related to the stigma associated with HIV/AIDS.  There are still cases of perinatal transmission (infection from mother to infant) in the United States. (See figure below from CDC website)

AIDS cases due to the perinatal transmission of HIV infection,

by year of diagnosis, 2001–2005, United States

Our mission is to obtain universal prenatal testing of all pregnant women for HIV in the state of California.  We encourage all health care providers and hospitals to include HIV testing with routine antenatal testing.  We also want to encourage all pregnant women to ask their physicians to provide testing for HIV.

Other Important Links:

One Test Two Lives – CDC site with HIV information for pregnant women.

Act Against Aids – CDC site with general HIV information including testing locations.

California Department of Public – Find the health department in your area.


August 17, 2011

 Nigerians have now heaved a sigh of relief with the passage of the National healthcare bill. Several organizations including National council   of women organizations (NCWS), market Women Association, International federation of women lawyers, Health reform foundation of Nigeria (HERFON) among others stormed the National Assembly as shown in the photograph demanding for the immediate passage of the bill. Most of these people are acting out of ignorance and poverty of knowledge thinking the solution to their entire health care problems lies with the passage of the bill.

 This National health insurance scheme (NHIS) to me is an exercise in futility. It is like one of those elephant projects like the Ajaokuta Steel Mill that is usually embarked upon by our inept leaders only to be abandoned mid way when it had already gulped billions of Naira. The national health bill comes with a very attractive package but how can the country sustain its funding in this era of high economic recession. Expecting a workforce of 25% to cater for 75% of the population is unrealistic. Also mal-distribution of health facilities between urban and rural areas where 90% of disease burdens are in the rural areas which has only 10% of health facilities, increased maternal and child health care relative to spending. The signs of failure are already ominous. After almost 10 years of operation, it has only covered less than 5% of 150 million people despite the huge amount of money that has been sunk there. Hence, the NHIS is not the “messiah” we are waiting for that will take care of our health care needs. It is a complete socialist ideology that will not survive in a capitalist and highly corrupt country like Nigeria. It faces the stark reality of failure. Some of those pushing for the passage of the bill already know but selfish-interest and corruption has blinded them. Nigeria is the second largest exporter of oil yet most of her citizens live below $1 a day. Poverty and diseases abound. Basic amenities are completely lacking. Health improvement is inextricably linked to other environmental, social, cultural and economic factors. Availability of basic amenities of life is related to good health.

             I am totally in support of revamping Primary Health care (PHC) and increase its funding. Communities should be empowered to take care of their health problems. Community participation and ownership should be key to sustainability and self reliance in health development. Having practiced medicine in both rural and urban settings in Nigeria, I am very convinced that PHC still remains the cornerstone of health system development in Nigeria and the key to the attainment of Health for all Nigerians.



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Informed Consent for Storage of Newborn Screening Specimens

August 17, 2011

Newborn screening (NBS) has long been considered an invaluable tool in determining genetic disorders, so much so that all states in the US have mandated the test (though parents may refuse based on religious grounds). This was because the burden on society that would otherwise be shouldered, due to the cost of care and decreased quality of life, is significantly decreased with early diagnosis and treatment, much of which is facilitated by NBS.

The specimen itself, however, is not discarded after screening is completed. Rather it is stored at state health department facilities for various purposes. These include further research for disorders that may be added to the NBS panel and confirming patient identity (there are several interesting anecdotes about this). All samples are stripped of patient identifiers, though there is some information still tied to them, like the ethnicity or birth weight, since those factors are likely to influence any testing results.

Parents receive little education about NBS to begin with. So it is not surprising that they are unaware their children’s blood (and consequently DNA) is being kept for reasons other than the immediate one for which it was drawn. Moreover, informed consent is not obtained from parents to explicitly allow such storage.

Different groups of stakeholders, all with different invested interests in the matter, agree that informed consent is necessary. However, what each group means by this can vary greatly, from having NBS be an “opt-in” program to having parents sign an actual form to changing storage policies. Thus far, state health departments have been slow to respond, if at all, to this public concern.

It is suggested that a policy advocacy group be formed to propose viable solutions to address this issue. Ideally, solutions will encompass realistic goals for implementation, clear storage policy guidelines, and/or alternate recommendations based on other similar programs.

Youth Smoking in Philadelphia: A renewed effort to reduce a resurgent trend

August 17, 2011

The NIH reports that nearly a quarter of high school students in the United States smoke cigarettes.   This compares with about 20% of teens aged 13 to 15 who smoke worldwide.

Several Philadelphia citations have restricted the sale or use of cigarettes as they relate to minors. Citation 9-622(1)(a) restricts anyone from giving or selling a cigarette product to a minor (less than 18 years old) and citation 10-602 prohibits smoking in enclosed areas including child care facilities or vehicles that may transmit children as public transportation for day care purposes.

Nonetheless, the Philadelphia Department of Health notes that among large U.S. cities in 2009, the percentage of Philadelphia youth smoking was higher than in any other large city.

In 2011, Mayor Nutter issued an executive order banning smoking in “public recreation centers, playgrounds, and pools,” citing just over 7% of high school students that smoke daily and 50% that have experimented with tobacco.

Many establishments that sell tobacco products are in unbelievably close proximity to schools making children easy targets for tobacco advertising.

Fortunately, the business establishment has become an important ally. In the past, there were concerns that smoking restrictions would seriously hurt business but, in fact, recent evidence proves just the opposite : after smoking bans at restaurants began in New York, more people felt comfortable going out to eat and business increased, with revenues increasing 8.7%. Restaurant and merchant associations should be applauded for their efforts to curtail smoking by minors.

Smoking advocates have suggested that attempts to get kids to stop smoking such as antismoking ads aimed at children, may backfire.   Yet, substantial evidence suggests that anti-smoking advertising, especially with visual media, is quite effective at reducing smoking among young people.

On December 2, 2010, Philadelphia City Council strengthened the law forbidding the sale of tobacco to minors. Today, City Council should go a few steps further in support of Mayor Nutter’s effort with  legislation providing more funding for anti-smoking campaigns aimed at parents, children and the general public and banning smoking and the sale of tobacco in many child-friendly spaces.

WHO sends mixed message to Africa on Maternal Health

August 17, 2011

In Uganda and most of Sub-Saharan Africa one in 35 women will die in childbirth, this statistic is over 1000 times higher a women risk in the industrialized world.  Post-partum hemorrhage (PPH) accounts for the greatest percentage of excess maternal mortality.  Oxytocin is an IV medication which is effective at decreasing PPH, but it is expensive medication and requires a cold chain for distribution.  Misoprostol has a similar action and is available in a generic, stable pill form.

Maternity Ward at District Hospital, Soroti Uganda

Misoprostol can also be used for gastric ulcers and abortions, thus religious, anti-abortion groups and the US government under the Bush administration have lobbied against its adoption. This May, after a prolonged battle, the WHO added Misoprostol to the list of essential medicines for women and children. Essential Medicines are ones that address priority health needs of a population and are to be available at all times. This list is an important guideline that countries and donor agencies use to assist their programing. However the WHO failed place it model medicine plans or priority list of citing that Oxytocin is cheaper and more effective when available. Yet in Uganda as is the case in most of sub-saharan african less than 40% of women give birth with a skilled attendant, far fewer in a hospital setting. Oxytocin is 10x more expensive in Uganda, not accounting for administration costs. Multiple studies have demonstrated the effectiveness and safety of Misoprostol with unskilled birth attendants, reducing post-partum hemorrhage by over 50%.

Oxytocin has an incremental benefit over Misoprostol, but is impractical in much of the developing world. The WHO’s recommendations demonstrate a failure to understand the realities of childbirth in sub-saharan africa or the undue influence of anti-abortion groups. Neither explanation appears adequate when considering the scope of the problem. Misoprostol is a medication that can promote primary health care now, and truly change the health and lives of women in Sub-Saharan Africa.

Breastfeeding Promotional Campaign: It’s good for infants & mothers, it’s good for business!

August 17, 2011

                    We have known for years that breastfeeding in the first year of life is extremely beneficial to the infant and the Mother.  Breastfed infants are protected against ear infections, allergies, respiratory problems, diabetes, and have a boost in their immune system.  Breastfeeding has been also shown to boost intelligence later in life, help with immunization responses in children, and reduce the risk of childhood obesity.

Studies show that women who breastfeed for at least six months to a year, have better postpartum recovery, better postpartum weight loss, have a lower chance of developing breast cancer, decreased risks of ovarian, uterine, and endometrial cancers, and lower occurrences of rheumatoid arthritis and osteoporosis.

Besides the health benefits the economic benefits of breastfeeding are astounding!  The 2001 USDA report states that if current breastfeeding levels (29% at six months) were increased to the U.S. surgeon General recommended levels (50% at six months), a minimum of $3.6 billion would be saved!

The Bay Area is the hub of innovative technology and scientific research, housing both the Silicon Valley and Biotech Bay, boasting such companies like Google and Genentech.  Hence the Bay Area is a great place to begin policy changes to promote childcare at the workplace.  As part of a breastfeeding promotional campaign in the Bay Area, the California Department of Public Health should encourage state policy makers to offer tax relief for employers that offer childcare for their employees.

The second part of this campaign should focus on extending the California maternity leave so that mothers can breastfeed exclusively longer and devote more time and energy in establishing breastfeeding before returning to work.

Employers getting tax breaks for offering childcare will benefit the whole community.  Mothers can establish breastfeeding while on maternity leave and once they return to work will be more likely to continue breastfeeding for the recommended six months and beyond since their childcare would be at work!  The new childcare centers will also provide jobs for many in a state where unemployment is currently at a high 12.1%!  Helping working mothers breastfeed is good for mothers and infants and it is good for the community!


For more information and references please see following links: