July • 2020
Journaling in July

Journaling in July
Members of our chapter have experiences to share that they stand by
From President, to VP, Communications, Outgoing MAL
To Committees and Event Attendees, what amazing morale!

President's Column
 Raelene Walker, MD, FAAP
July has always been my favorite month. It’s summer and the weather is warm and the days are long. The evening sunlight is magical and I love how the earthy smells of the day linger in the air. Summer fruit and harvests from gardens are abundant and delicious. It’s also my birthday month, and that always made it feel special to me too. It is a time of outside play, family time, and respite from the more hectic pace of the school year, a time for contemplation and reflection while watching the clouds change shape as they move in the sky. This July is also my one year anniversary as chapter president and while this summer feels unlike any other I’ve experienced, I think it is therefore even more important to take some time for contemplation and reflection and I invite you all to consciously do so this month. As I think about our chapter right now, I am so impressed with what we are doing and who we are. This newsletter is packed with information about our impressive projects and advocacy for children and families. Thank you all for the work you do. I appreciate and respect you tremendously. 
Vice President's Column
Nelson Branco, MD, FAAP
As pediatricians, we have struggled with our own emotions and with how to talk to children about recent events – the death of Black people at the hands of police, protests, the violence that has sometimes erupted and the aggressive policing tactics used against protesters and fellow Americans. 

All members of our chapter strive to care for the children in our practices while working to create healthy communities. The murder of George Floyd at the hands of a police officer and the subsequent protests have brought the topics of race, racism, violence and inequity to the forefront. These are difficult topics to discuss, but it’s imperative that we address them with each other, with the parents in our practices, and with children.
Upcoming Chapter Chat on Diversity, Equity and Inclusion
Tuesday, July 21 at 7:30-9:00 PM
Communications Column
Janice Kim, MD, MPH, FAAP
California Chapter 1 continues to build up our website to do what we can to help you all do your work caring for families. Our COVID-19 page is kept updated. 
Members of our chapter have been incredibly active recently. As a Chapter, we're trying to find ways to support you all so we've launched a Membership Spotlight page to share members' work on projects like CATCH and members' voices as they share ideas in the media. With so many emotions and ideas bubbling, we are starting an Op-Ed section so members' have a way to share and publish their ideas on our website. We're looking for a couple of volunteers to quick-turnaround edit submissions -- email Janice if interested! 
We had an evening with a social media marketing expert ( link to recording ) who reminded us that, be it as it may, many of our parents have grown up with social media and use it to get a sense of their pediatrician and for information. Check out our new Practice Support page to make posts easier for you, including National AAP's #CallYourPediatrician messaging and Back to School Graphics and help your efforts in connecting with families, especially when well visits are (over)due. 

You can communicate with your Member-At-Large or chapter office with any other needs or ideas, or if you'd like to share any articles or work that you're doing!
Outgoing San Mateo County Member-At-Large
Beth Grady, MD, FAAP
This month marks the end of my two year term as AAP California Chapter 1 Member-At-Large for San Mateo County. I was inspired to join the Board to have a chance to work with John Takayama, MD MPH FAAP , Past Chapter President, who has been a mentor to me since my residency at UCSF twenty eight (gasp) years ago. Along with Lucy Crain , MD, FAAP, John first introduced me to the AAP as a way to connect with other pediatricians interested in looking at childrens’ health beyond the exam room and using our collective voice to make a larger change than any of us could make as individuals.  

My time as a Member-At-Large has coincided with a rapid increase in the recognition of childhood adversity and toxic stress as pediatric medical problems. The Chapter has responded by creating the Mental Health Committee. Under the leadership of Diane Dooley, MD, FAAP and Renee Wachtel, MD FAAP, the chapter applied for and was awarded an ACEs Aware Communications grant from the State of California to help pediatric providers learn more about how to address toxic stress. 
ACEs Aware Communication Grant Announcement
Diane Dooley, MD, MHS, FAAP
This is a unique moment in history. Our patients, our healthcare partners and our own families are all experiencing heartbreaking stresses. In most cases, families and schools nurture children’s development and foster secure relationships and emotional strengths. Yet when witnessing a pandemic, an economic recession, and the raw unveiling of longstanding racial injustice and socioeconomic divides in our society, it’s hard not to worry. Is the ongoing cumulative stress going to overwhelm the ability of families to cope? Will we see harmful, persistent mental and physical health challenges because of the exposure to traumatic events and resultant toxic stress?

As part of an effort to help our members address heightened family stresses and disruptions, California Chapter 1, AAP recently received $75,000 in grant funds from the Office of the California Surgeon General (CA-OSG) and the Department of Health Care Services (DHCS) to participate in the state’s ACEs Aware initiative. Our Communications grant funds will be used to enhance our Chapter’s staffing and expertise in the area of toxic stress and develop messaging and informative materials that give providers the tools needed to identify adversities, discuss them with families in a therapeutic manner, and refer patients to resources and support when needed. 
The days seem to blur and speed by as all of us have been forced to adapt to new workflows and rhythms in the age of COVID and yet change and progress sometimes feels painfully slow--like we’re stuck in a time loop and are still having the same conversations over and over again.    

This current viral pandemic has highlighted for some what many of us as pediatricians and advocates have always known. Social inequities in one area, such as access to high quality education or nutritious food, do not stay neatly confined to that area. Rather inequities are interconnected, layering on top of each other, ultimately leading to some communities bearing a disproportionate share of the burden of this pandemic. And at the root of these inequities is a system of deeply ingrained structural racism making it clear that healthcare equity is only possible when we acknowledge and work towards dismantling those systems. It is in times like these that there are cracks of opportunity to make a meaningful impact on the lives of our patients, our colleagues and our communities. Legislators, school boards, city councils and other leaders are listening and this is a chance for pediatricians to make sure our voices are heard as we speak out and speak up for the families we serve. 

Advocacy is one way the AAP can help make sure your voice is heard. This year’s Advocating for Children Together (ACT) Conference is an opportunity to learn or expand on your advocacy skills. The conference’s theme this year will be COVID-19 and Health Equity, SAVE THE DATE, September 12, 2020 . The Advocacy Committee continues to have our quarterly meetings, though we, like everyone, have had to be flexible living in this new age of COVID. In that spirit of flexibility, we have decided to convert the ACT Conference to an entirely virtual format this year. With this new virtual format, we plan to preserve our most popular features from last year’s conference and also present new opportunities for sparking passion and building sustainable networks for change. View the trailer below and more to come!
If you are interested in the work of the advocacy committee or working on developing content for the ACT conference, please email either of the Advocacy Committee co-chairs, jraulg@gmail.com or heyman.oo@ucsf.edu , to be added to our listserv.  

Stay healthy, stay safe and stay engaged!
Crash Course on Life After Residency Program Reflection
Billy Burrough, MD
Medical education and training is a wild journey. Every day with something new to learn, consume, and experience. Just trying to keep your head afloat with the day-to-day tasks can be all consuming and it can be easy to lose the forest for the trees. As I approach my final year of pediatric residency I realize I’m about to step through that door to an entirely new adventure filled with its own rules, different logistical hurdles, and of course plenty of new 3-letter acronyms to learn along the way. This is why I was so thankful for my recent participation in the “ Life After Residency ” day long hosted by California Chapter 1, AAP (AAPCA1). 

In our new world of virtual meetings this was a day conference held entirely over Zoom. I enjoyed the liberty to accomplish some home tasks on my post-call day while receiving pointed tips and useful information on how to prepare and plan for those first few years out of residency. Hopeful that going forward in a post-COVID era, all conferences will have a call-in option to make them more accessible to everyone.
Committee on Substance Use and Prevention:
Risks of Vaping and Respiratory Infections or Lung Injury
Cathy McDonald, MD, MPH, FAAP
In light of the COVID-19 pandemic, the question on many physicians’ minds is how vaping can affect the risk and severity of COVID-19. 

While as of yet there have been no published scientific literature on how vaping may affect COVID-19 severity, many previous studies have shown that vaping in and of itself can be poisonous to the lungs.  

Because there are over 460 different brands of e-cigarettes of varying nicotine concentrations and mechanisms of action (see Figure 1), research into vaping effects can be challenging. However, a 2019 review of the respiratory effects of e-cigarettes analyzed animal studies, in vitro studies, and in vivo studies in teens and adults and found that “e-cigarette aerosol and its flavors can negatively affect multiple aspects of lung, cellular and organ physiology and immune function”(Gotts, 2019).  
Childhood Oral Habits: Ignorance is Not Bliss
Kim Nichelini, D.M.D.
Oral habits are common in pediatric patients and may be considered normal and useful behaviors temporarily, but may contribute to unfavorable anatomic changes or functional impairments over time. The degree to which malocclusion and functional deficit result from these habits is influenced by the intensity, frequency and especially the duration of forces generated. The oral habits reviewed in this article include pacifier use, thumb and finger sucking habits, mouth breathing and bruxism. 
The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH
SGA Chapter Representatives

Your SGA has been hard at work representing pediatricians! Last month, Governor Newsom released a budget that proposed to roll back Prop 56-funded Medi-Cal reimbursements and Loan Repayment programs. Thanks to the advocacy of pediatricians and our partner organizations, among others, the Senate draft budget did NOT include these rollbacks. It is still not over yet, as a final budget must be agreed upon by both chambers of the legislature and signed by the Governor, with a deadline of July 1st. 

AAP-CA released a statement supporting collaborative decision making among school districts and public health departments about when it is safe to re-open schools . AAP-CA also offered a statement of support for California’s Local Health Officers , who have been unfairly attacked and threatened for their evidence-based public health guidance to their communities. 

Additionally, SGA has been reviewing bills and offering letters to indicate our positions. There are too many to list, but highlights include the following:
  1. ACA 5 - We have written a letter of support for ACA 5, which, if passed, would be the first of many steps that could reduce statewide barriers to Affirmative Action. Proposition 209, which passed in 1996, amended the state constitution to prohibit state governmental institutions from considering race, sex, or ethnicity. In doing so, it significantly limited the ability of state institutions, including universities, to utilize Affirmative Action in admissions and hiring.
  2. SB 86We also have supported SB 86, which would require reporting of the use of chlorpyrifos, a toxic pesticide, in California. AAP national has long been advocating for a ban on chlorpyrifos, and this legislation is one step in the right direction. 
  3. SB 793 - We support SB 793, which would ban the sale of flavored tobacco products in California. 

For the most up to date information on AAP California bill positions, letters & outcomes from the current CA Legislative year, go to aap-ca.org/bill (See our new AAP-CA website!). For latest organizational advocacy updates follow @AAPCADocs on twitter. If you have questions and/or are interested in knowing more about a certain legislation, reach out to our State Government Affairs Chapter Representatives Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH at info@aapca1.org .
Opportunities for Your Benefit

California Perinatal Quality Care Collaborative - Henry C. Lee, MD, FAAP, Division of Neonatology
The Primary Care for Preterm Infants & Children Toolkit prepares the pediatric primary care provider with the skills and knowledge to care for preterm infants and children who are at increased risk for morbidity, serious illness, and hospitalization. The Toolkit combines key primary care recommendations and guidelines from the American Academy of Pediatrics (AAP), the Centers for Disease Control (CDC), and the Advisory Committee on Immunization Practices (ACIP) in one easily accessible reference. The accompanying Tip Sheet and Periodicity Chart summarize the information from the Toolkit in two easy to use formats that can be downloaded and used in a clinic setting.   

The Primary Care for Preterm Infants & Children Toolkit can be accessed from the California Perinatal Quality Care Collaborative (CPQCC) website . CPQCC is a statewide network of California’s NICUs and High Risk Infant Follow-up (HRIF) clinics housed at the Stanford University School of Medicine. CPQCC is committed to improving the quality of care for California’s mothers and most vulnerable infants. 

Update from Chapter Immunization Champion Dean Blumberg, MD, FAAP on HPV
The California HPV Vaccination Roundtable is a coalition of diverse stakeholders with a mission to work together to prevent HPV-attributable cancers and pre-cancers by increasing the California HPV vaccination rate to 80% by 2026. I’m pleased to share with you that The California HPV Vaccination Roundtable's Data Workgroup recently released a report containing county-level HPV vaccination data and county-level HPV attributable cancers data. This is the first time these data are compiled in one place and the first time some data have been publicly released. Included in the report are maps by county highlighting urban/rural disparities in vaccination.

The report can be found here: Assessment of Human Papillomavirus (HPV) Attributable Cancers and Vaccination Rates in California: Report of Findings of the California HPV Vaccination Roundtable on the Roundtable website. On the same page you will find a cover letter summarizing the report and two new infographics. The HPV vaccine prevents six different types of cancer and we want to ensure we keep all Californians healthy by vaccinating at least 80% of preteens. What action will you take today to get us one step closer to this goal?

Regional Centers and Early Start programs continue to be open!
Regional Centers and Early Start programs are operating and serving families during the COVID crisis. Although the Regional Center offices may be physically closed to visitors because of current stay at home orders, Regional Centers continue to operate and to provide services including Early Intervention services during this time, typically through remote service delivery or telehealth. Furthermore, Regional Centers continue to accept referrals and applications for Early Start and Lanterman (over age 3) programs as well as conduct assessments for program eligibility using telehealth. Please visit the website of your local Regional Center or the California Department of Developmental Services ( www.dds.ca.gov ) for more information. Please continue to refer children with suspected developmental delays or developmental disabilities to the Regional Center provides service in your area.

A Pediatrician’s Role in Oral Health
This study by Veronica Brandley, pediatric dental resident training in San Diego, CA at the San Ysidro Health Children’s Dental Clinic at Rady Children’s Hospital, seeks to learn more about pediatrician’s training in oral health care, the dental services provided in office, and the demographics of the practices and patients. As a current pediatrician and active member of the American Academy of Pediatrics, your participation via this survey will provide valuable data. The survey has been approved by the NYU Langone IRB. The survey is anonymous and will take no more than 10 minutes to complete. To participate, please click the following link: https://www.surveymonkey.com/r/RZRW7XW

For questions or concerns, contact Veronica Brandley, DMD at (619)205-1950 or at veronica.brandley@nyulangone.org .   
July 21, 2020: Chapter Chat on Diversity, Equity, and Inclusion - REGISTER
September 12, 2020: ACT 2020 CME Conference - SAVE THE DATE!
December 5, 2020: 5th Annual Pediatric Puzzles - SAVE THE DATE !

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.

President: Raelene Walker • Vice President: Nelson Branco
Secretary: Janice Kim • Treasurer : Nivedita More • Past President: John Takayama
Executive Director: Isra Uz-Zaman