2018 - October Edition
Alice Kuo, MD, PhD, MBA, FAAP   President, AAP-CA2    2018 - 2020 
Fall is officially here! As the weather cools and children settle into school, we are approaching a number of family-friendly holidays in the next few months. It is also a tumultuous time in our nation's government as the current administration passes a number of policies and regulations that have tremendous impact on children and families in our country.
 
Perhaps one that will have widespread impact for those of us who care for immigrant children and families are the changes proposed regarding public charge. "Public charge" refers to the notion that an individual will be primarily dependent on the government for subsistence. Many children and parents rely on Medi-Cal in California for access to health care; young children and pregnant mothers receive extra nutrition benefits from the WIC program; and many single mothers receive cash assistance from the Temporary Assistance for Needy Families (TANF) to help cover living expenses. It is expensive to raise children in our country, and many immigrant families and families with lower incomes rely on government aid for support. We as front-line pediatricians should be aware of the increased anxiety that parents may feel accessing governmental services. As more about the public charge regulatory changes is known, our chapter will put together a brief FAQs reference guide as a member benefit to you. This guide should be available in the next few weeks.
 
Did you know that the fourth Tuesday in September is National Voter Registration Day? This year's Voter Registration Day was September 25, and a record 800,000+ Americans were registered to vote. Please consider incorporating a discussion about voter registration during preventive visits with your young adult patients over 18 years of age. And please remember your civic responsibility to vote yourselves on Election Day, November 6.
 
Our own AAP National and District elections will commence on November 2. This year, we have two Chapter members running for District office: Ed Curry is running for District Chair against Yasuko Fukuda from Chapter 1, and Paula Whiteman is running for District Vice-Chair against Eric Ball from Chapter 4. When you receive your email ballot on November 2, please take a few minutes to open the ballot and vote - it really is quick and painless!
 
If you are interested in proposing resolutions for the AAP Annual Leadership Forum, the deadline is November 15. Resolutions are suggestions from members about how the AAP leadership should dedicate resources to address emerging child health priorities. Please click here to find out more information, and be sure to see the ALF section below for the resolution guidelines and template. 
 
I hope to see some of you at the AAP National Conference and Exhibition annual meeting in Orlando, Florida on the weekend of November 2-6. If you will be there, we will have a District meeting from 7:00 to 8:15 AM with all four California Chapters on Sunday, November 4. Please check the program for the exact location.
 
Finally, our Annual Symposium on March 2, 2019 at the Sheraton Universal Hotel is shaping up and promises to be a great program of speakers, workshops and opportunities to network. We will also have a Chapter business meeting during the lunch hour and trainee posters and oral presentations. Please come and be a part of our Chapter community!!
 
Please check out the rest of our newsletter for information on Town Hall meetings and other CME opportunities, ways to get Maintenance of Certification (MOC) points with Quality Improvement (QI) projects, and statewide advocacy priorities that the AAP is working on behalf of children.

Thanks for all that you do on behalf of children in our communities!
 
Alice Kuo, MD, PhD, MBA, FAAP
Chapter President
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Elections -  National and District
National AAP Presidential Elections  
+   District IX Chair/Vice Chair 
 
The AAP National Nominating Committee has selected Sara "S ally
" H. Goza, M.D., FAAP, of   Fayetteville, Georgia, and George C. Phillips, M.D., M.B.A., FAAP, of Overland Park, Kansas, as candidates for AAP president-elect.  
 
In the same Ballot, California voting members will also be able to vote for the positions of District IX Chair and Vice Chair (DVC). You may read additional information about the candidates, including profiles and position statements online at www.aap.org/election (AAP login required). Voting will begin November 2, and end Dec 2, 2018
 
You may also preview the video of each District IX candidate's personal statement by clicking below. District IX will be sending these along with their bios in a separate communication.


ALF Resolutions
Annual Leadership Forum - Resolution Submission Process 
 
Marsha Spitzer, MD
AAPCA3 Chapter President
District IX CFMC representative
marshas@fhcsd.org
 
As an AAP member, you have the opportunity to advocate for and influence national AAP policy and priorities through the resolution process.  Any member or trainee can write a resolution on a topic of interest on which they'd like the AAP to act.  Some examples of "Top 10" resolutions in recent years addressed gun safety, immigrant health, safe dental anesthesia, and immunization strategies.   
 
The process for submitting a resolution starts with an idea... Read more
 

In The Community  
September 6, Town Hall -  Woodland Hills  
 
AAP-CA2 Member-At-Large Ken Saul, MD, FAAP hosted a Town Hall at Ruth's Chris Steak House, in Woodland Hills on September 6.  The lecturer was Dr. Saul himself who spoke on Prevention of RSV: Understanding the Importance of RSV - Immunoprophylaxis for Infants and Children at High Risk for Severe RSV Disease. 
AAP-CA2 Past President Paula Whiteman, MD, FACEP, FAAP spoke about the upcoming elections, candidates and process. 
 
A few Pearls from Dr. Ken Saul's lecture
  • Morbidity and mortality have gone up. RSV is causing more hospitalizations since the AAP 2014 recommendations to reduce the number of kids who are eligible for Synagis. 
  • It is an ongoing fight for practitioners to be advocates for our patients. While preventing illness is our focus, treating illness has become tougher now that medicine has gotten more disjointed.  A recent article in a British medical journal mentioned the morbidity and mortality going up for every number of doctors involved in a patient's care. 
  • The medical home is more important than ever. The more doctors, pharmacy-based clinics, telemedicine, urgent cares, hospitalists... all of these factors dilute the efforts of the pediatrician. Consequently, now more than ever we must focus on prevention.
  • Almost all children are exposed to RSV by age 2 years old, which is usually manifested by cold-like symptoms. In turn, an infected child may transmit RSV to a high-risk infant who then manifests RSV. 
  • Synagis is recommended for high-risk kids starting in November. 
  • Clinically, wheezing rarely responds to bronchodilators as it causes more bronchoedema than bronchospasm. 
Q. A child presents with RSV, has crackles and you think he has pneumonia. Do you give antibiotics? 
 
A. This is debatable. If you are a purist RSV pneumonia does not need antibiotics. That is the "test" answer; just as a lot of kids with RSV have fluid in their ears: The "test" answer is don't treat them. However, one must consider things like lobar pneumonia and secondary infections.
 
This event was generously sponsored by AstraZeneca. We thank Valerie Page for her ongoing support. 
 
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September 20, 2018 in Victorville -  Dinner/Lecture - Town Hall
 
Pediatricians in the High Desert met on September 20 at Thai Dawn Bistro for a Town Hall hosted by AAP-CA2 Vice President and San Bernardino High Desert Area Representative Damodara Rajasekhar, MD, FAAP. Dr. Rajasekhar provided an overview of Proposition 56 funds (Tobacco tax, passed in 2016) resulting in significant increased physician payments (for office visits and well-child care) that started in July 2018.
 
Guest speaker Jane M. Bork, MD, FAAP spoke on tuberculosis in children and its management. Dr. Bork is Associate Professor of Pediatrics in the Division of Pediatric Infectious Diseases at Loma Linda University School of Medicine.
 
AAP-CA2 Immediate Past President Edward Curry, MD, FAAP spoke about the upcoming elections, candidates and process.
 
A few Pearls from Dr. Bork's lecture:
  • This year there have been 3 cases of TB meningitis seen at Loma Linda University Medical Center.
  • 10% of infected persons with normal immune systems develop TB at some point in life. (HIV is the strongest risk factor for development of TB if infected.
  • Infants and adolescents with tuberculosis are more susceptible to extrapulmonary disease (Lymphadenitis).
  • In 2016, a total of 68.5% of reported TB cases in the United States occurred among non-U.S.-born persons. (14.7 cases per 100,000 persons), which was approximately 14 times higher than among U.S.-born persons (1.1 cases per 100,000 persons).
Tuberculin Skin Test
A 4 year old with 10 mm induration, no exposure history, no risk factors is considered Negative. 
 
Considerations for Positive TST tests:
5 mm induration

Has close contact with patient with TB

CXR consistent with active/previous TB

Receives Immunosupressive Tx or has HIV

10 mm induration

Younger than 4 yo

Exposed to TB

15 mm induration

4 years of age or older without any risk factors

 

The Tuberculin skin test is subjective and dependent upon the experience of the person measuring the induration. QuantiFERON  (An Interferon Gamma Release Assay test) requires less resources and is becoming the preferred test for 2 years of age and above. Quantiferon has a specificity > 99% in low risk individuals, and a sensitivity of 92% in individuals with active disease.
 
Universal TB Testing of school aged children is  NOT  a cost effective TB Control Program intervention.  Current recommendation is to implement the  TB risk assessment questionnaire.
    1. Has a family member or contact had tuberculosis disease?
    2. Has a family member had a positive tuberculin skin test result?
    3. Was your child born in a high-risk country? (countries other than the US, Canada, Australia, New Zealand, or Western/North European countries)
    4. Has your child traveled (had contact with resident populations) to a high-risk country for more than 1 week?
If all No, skin test not required.
If any is positive, send patient for a QuantiFERON test. (Neg, no action)
If Quanti is positive, then CXR and begin treatment accordingly.
If Latent TB (Neg CXR, asymptomatic), then it is non-reportable.
 
Q. When did the Red Book become so large?
A. After September 11, 2001, because of the reincorporation of Smallpox as a result of its availability in bioterrorism.

Q. If a child is exposed, what is the time frame to perform a reliable PPD test or QuantiFERON?
A. 10 weeks from the time of exposure. If the quant is done less than 10 weeks, then it has to be repeated (unless the Quant was positive).
Child Development Institute's PTMC Child Development Center
is now open!

We are located at 18411 Clark St. Suite 100 - in the Garden Plaza on the Campus of  Providence Tarzana Hospital. We will be hosting an Open House in late fall and are looking forward to introducing our new center to the community.

In addition to our comprehensive early intervention services, CDI offers specialized care for infants and their families following the NICU experience. T he Vulnerable Infant Parent (VIP) Program provides early intervention services for babies from birth to age three who are at risk for developmental delays due to medical conditions or complications during the pregnancy or birth.  
 
CDI has been providing comprehensive early intervention services, in-home and clinic based, throughout the San Fernando Valley for over 23 years.
CDI's range of services for infants and young children include:
 
If you have any patients who are at risk for developmental delays or have concerns  about their development, we are a one-stop-shop and can help. Contact CDI (818) 888-4559
CDI Flyer: In English - In Spanish

Immunization Coalition of Los Angeles County (ICLAC) 
 
Help ICLAC Better Understand the Barriers to Immunizations

The results of this survey will inform the development of a culturally and linguistically sensitive vaccine communication toolkit designed to help LA County doctors and health care providers answer common questions about the age-recommended vaccines and schedule.    The survey should only take 10 minutes to complete. 

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Upcoming AAP-CA2 Events
October 10, 2018 in Woodland Hills -  Town Hall / Dinner 
Ken Saul, MD, FAAP Member-At-Large 
 
Please join AAP-CA2 Member-At-Large Ken Saul, MD, FAAP for an evening of professional development and networking.
This event is at Maggiano's.
 
A Booster Update on Vaccines
 
SPEAKER: 
Laurene Mascola, MD
 
DATE: October 10, 2018 at 6:30 PM
LOCATION: Maggiano's Little Italy 
6100 Topanga Canyon Blvd, Woodland Hills, CA 91367
 
RSVP: Please email Dr. Saul at docksaul@aol.com 
October 20, 2018 in Long Beach
Leila Yoonessi, MD, MPH, FAAP
Member-At-Large
 
We are celebrating our grand opening by offering food, fun, music, and health education with the support from the Department of Health and our community partners .  Please RSVP in advance since we have limited space.  We look forward to seeing you soon to celebrate health and wellness together.

 
 
 
WELLNESS PARTY
   
DATE: October 20, 2018 - 11 AM to 1 PM
LOCATION: 720 Alamitos Avenue Long Beach, CA 90813
 
October 25, 2018  in Victorville -  Dinner/Lecture - Town Hall
 
Please join AAP-CA2 Vice President Damodara Rajasekhar, MD, FAAP for September' s AAP High Desert Area Townhall meeting.
Damodara Rajasekhar, MD, FAAP AAP-CA2 Vice-President, and Area Representative in San Bernardino County/High Desert
 
 
 
DATE:  Thursday,
October 25, 2018 @ 6.30pm 
NEW LOCATIONBangkok Cuisine
15800 Main Street, Unit 200,  Hesperia, CA 92345
Tel:  760-998-2898
 
1) Physician Burnout, and Mindfulness
Speaker: Paula Whiteman, MD, FACEP, FAAP
AAP-CA2 Past President (2014-2016)
 
2) Meditation - Overview
Speaker: Nirmal Murthy, MD, FAAP
 
Also, there will be an update on AAP, CMA, and SBCMS.
Please RSVP to drajasekharmd@gmail.com  
November 7, 2018 in San Luis Obispo
 
Pediatric Town Hall: 
Strengthening Our Developmental Screening & Referral Practices
 
Copeland Health Education Pavilion
French Hospital Medical Center
1911 Johnson Ave, San Luis Obispo
 
Presentations and a provider fair will focus on early identification, support, and referrals for children with developmental concerns. Pediatricians, family medicine physicians, and other pediatric providers are encouraged to attend.
5:30 PM Dinner & Resource Fair     6:00 PM Lecture
 
 
First 5 San Luis Obispo County is proud to be co-hosting the Town Hall in partnership with AAP-CA Chapter 2, the County of San Luis Obispo Health Agency Public Health Department, and Dignity Health/French Hospital Medical Center.   We are grateful for the generous support of two additional event sponsors - CenCal Health, and the San Luis Obispo Medical Education and Research Foundation. 
 
Click to View the FLYER 
Click to REGISTER  
November 15, 2018 in Los Angeles
 
Addressing the Health Needs of Immigrant Children
Half-Day Conference 
 
Please join the AAP-CA2 Immigrant Health Initiative group and the Los  Angeles County Office of Immigrant Affairs for an afternoon of discussion, collaboration, and networking on the topic of immigrant children separated from their families, their needs and ways to help them. Also in attendance will be representatives from various law firms (L.A. Justice Fund) sub-contracted by LA County to represent these children. Please join us!
 
TOPIC:
Addressing the Health Needs of Immigrant Children  
 
SPEAKERS:  County of Los Angeles Supervisor Hilda L. Solis, First District; Office of Immigrant Affairs Executive Director Rigo Reyes; Daniel Sharp, Esq. (Legal Director, CARECEN); Lindsay Toczylowski, Esq. Executive Director of the Immigrant Defenders Law Center; AAP-CA2  President
Alice Kuo, MD, PhD, MBA, FAAP; Immigrant Health Committee Chair Sural Shah, MD, FAAP; Bobby Verdugo, Mental Health Specialist - UCLA.  
 
DATE:
November 15, 2018
TIME:
12 - 4 PM
LOCATION:
East Los Angeles County Library 
 
December 6, 2018 in Victorville -  Dinner/Lecture - Town Hall
Please join AAP-CA2 Vice President Damodara Rajasekhar, MD, FAAP for September' s AAP High Desert Area Townhall meeting.
 
CME will be provided for this lecture 
Damodara Rajasekhar, MD, FAAP AAP-CA2 Vice-President, and Area Representative in San Bernardino County/High Desert
 
 
 
"New Advances in Eczema"
 
SPEAKER
Stuart A. Cohen MD
AAP District IX Chair 
 
DATE:  Thursday,December 6, 2018 @ 6.30pm 
LOCATION: Thai Dawn Bistro                        
14317 Bear Valley Road , Victorville, CA 92392
 
Please RSVP to drajasekharmd@gmail.com  
Save The Date -  2019
March 2, 2019
Saturday, March 2, 2019 at the Sheraton Universal Hotel
 
 
"Children in Immigrant Families: How to Be an Advocate."
    Julie M. Linton, MD, FAAP 
          • Clinical Associate Professor at the University of South Carolina School of Medicine Greenville and the Medical Director of the Perinatal Awareness for Successful Outcomes (PASOs)program in Greenville County. 
          • Co-Chair of the AAP Immigrant Health Special Interest Group
Co-Author, AAP Policy Statement:  " Detention of Immigrant Children"
 
"Pediatric Emergencies"
    Solomon Behar, MD
          • Pediatric emergency physician at Long Beach Memorial/Miller Children's Hospital and Children's Hospital Los Angeles
          • Senior medical editor and host of the Pediatric CME program Pediatrics Reviews and Perspectives (Peds RAP)
          • Volunteer faculty at UCI School of Medicine in the Department of Pediatrics
"Adolescent Depression and Anxiety"
 "Adolescent Marijuana Use/Vaping" 
  Dianne Tanaka, MD
 
 
Christine Thang, MD 
Call for Abstracts for AAP-CA2 Advances in Pediatrics Symposium
March 2, 2019 at the Universal Sheraton in Los Angeles, CA

Abstract Submission Deadline: January 4, 2019 at 11:59PM PST

General Information:
  • The AAP California Chapter 2 will accept abstracts on scholarly projects by pediatric and medicine-pediatric residents from CHLA, Harbor-UCLA, Kaiser LA, Loma Linda, UCLA, and USC.
  • New this year, students from medical schools in the Southern California counties of Kern, Los Angeles, Riverside, San Bernardino, San Luis Obispo, Santa Barbara and Ventura are also invited to submit their abstracts!
  • Abstracts can be on original research, quality improvement, clinical cases, or any other scholarly project conducted during residency training.
  • Abstracts will be accepted for poster or oral presentation.
 
Other Events  -  2019
January 12, 2019 in Los Angeles

CHLA Sports Medicine Conference
 
The Children's Orthopaedic Center at Children's Hospital Los Angeles is proud to present the 2019 Sports Medicine Conference.

Scheduled presenters for the event are Dr. Tracy Zaslow, Dr. Ryan Kelln, Dr. Rachel Goldstein, Dr. Bianca Edison, and Dr. Curtis VandenBerg. 
 
With our versatile list of topics we aim to provide a well round day of education and fun.  Special workshop presented by Positive Coaching Alliance (PCA).
 

UCLA QI Project - Free CME/MOC 
Join Us for a 6-Month Primary Care Practice Quality Improvement Offering for Medical Providers
 
Receive Free CME & MOC Credit and Help Transform Oral Health for 
LA County Children

Over half of California's children experience tooth decay by kindergarten. You can help reduce that number and improve oral health for Medi-Cal children. More LA Smiles (a UCLA Dental Transformation Initiative funded by the California Department of Health Care Services) is offering a   6-Month Primary Care Practice Quality Improvement for Medical Providers to integrate oral health services into well-child visits for children ages 0-6.
 
Eligible Medical Providers can participate in free onsite or virtual training to receive 30-50 CME and 20-25 MOC credits with six months of support from a dedicated Quality Improvement Specialist. 
 
Get social with us:
 
Follow us on Twitter   Like us on Facebook   View our profile on LinkedIn  
                        @moreLAsmiles
 

Immigrant Health Initiative   -  IHI  
 
Advocating for Immigrant Children: Join the AAP-CA2 Immigrant Health Initiative!
 
Join the AAP-CA2 chapter Immigrant Health Initiative (IHI)! The IHI will be a dynamic local network for advocacy, education and mentorship for chapter members caring for our diverse immigrant children. We will also partner with the national AAP Immigrant Health Special Interest Group to engage in national advocacy campaigns and share resources for promoting immigrant health.
 
Click here to join the IHI!
   
AAP-CA  Statewide Advocacy
LA-HPAC: Sac Capitol office
Have you visited the AAP-CA website lately?
Advocacy efforts on behalf of the four California Chapters is conducted from the office of AAP-CA CEO, Kris Calvin.

Advocacy Priorities
Universal ACCESS to quality, comprehensive pediatric care in a medical home, including access to vaccines and behavioral and mental health treatment for every child in California, including vulnerable populations such as children with special health care needs, foster children, children of immigrant families, LGBTQ youth and the list goes on.

Please visit AAP-CA.org/Advocacy to learn more about the current Advocacy Priorities and the list of High Priority Bills.
AAP-CA2 Video: We Are The AAP-CA Chapter 2 -  2017


CDC Updates & LAHAN Alerts
Join the CDC Listserv
The Centers for Disease Control and Prevention (CDC) is happy to offer a free email subscription service, which allows CDC.gov users to receive alerts by e-mail when new information is available. With a subscription profile, you get the updated information on the items of interest to you automatically without having to return to the Web site and check for changes. Click to Subscribe 

Join the LAHAN Listserv  
To receive communications from the Health Alert Network, Sign-up here.
It takes less than two minutes to sign up.  
 
Visit the LAHAN website.

Submitting Articles for Publication in Our Newsletter


 

Have you written original clinical work you would like to share?

Do you have any news that you would like to publish in our newsletter?


AAP-CA2 invites you to submit your ideas, accomplishments, news, pictures...

For article submission guidelines, please click here.

 

Advertise in Our Newsletter

AAP-CA2 invites you to advertise in our newsletter
AAP-CA2 publishes its electronic newsletter, Peds@CA2, which is emailed to its 1,700+ members on the first weekend every month. Chapter members and non-profit organizations receive a 50% discount. Please follow the link below for more information.

For advertisement rates and guidelines, please   click here.
If you are interested in advertising, please  email the Chapter.
Please Donate
AAP-CA2 is a 501(c)(3) non-profit organization. Please consider a tax-deductible charitable donation to one of our many programs
  • The Medicine-Biological Sciences Scholarship Program, which awards scholarships to exceptional high school students each year.
  • The Committee on Service, Education, and Mentoring, which awards scholarships to pediatric residents for outstanding research projects. 
  • The S. Michael Marcy Memorial Lecture, which helps sponsor a portion of our annual Advances in Pediatrics Conference in his honor.

PO Box 94127 Pasadena, CA 91109
(818) 422-9877
Please visit our website at  http://aapca2.org/