Monthly Archives: August 2010

Paying Attention to “Nature Deficit Disorder”

Having just spent a week on vacation in the beautiful mountains around Vail, Colorado, I was impressed how quickly and completely relaxed I felt once I entered the natural beauty of this area. In fact, my personal experience has been that whenever I am in a natural, non-built environment-forests, mountains, beaches, rivers – I feel calmer, more peaceful and usually quite happy.

So this invites a question – how important is a walk in the woods for our own sanity as humans and for our kids’ development?

Turns out, according to author Richard Louv, that this relaxation response I experienced in the lovely areas of Colorado, is quite common and explained by the fact that humans have an instinctive liking of nature (which is called the biophilia hypothesis) and that a nature-oriented existence is likely hard-wired into our brains. Louv authored the book “The Last Child In The Woods” and coined the term “nature deficit disorder” to describe this phenomena of children spending less time outdoors in natural environments and the resultant behavioral problems in children based on this lack of exposure. Children that spend less time in nature may experience higher rates of Attention Deficit Hyperactivity Disorder (ADHD) and depression. We know for example that lack of sun exposure can contribute to low mood via low vitamin D levels.

Causes for “nature deficit disorder” may include parental fears about kids getting hurt or lost in natural settings, restricted access to natural environments for many kids who live in cities, and the lure of indoor “screen” activities including video games, TV shows and surfing the internet on home computers.

Research studies examining the effects of nature exposure (and lack of it) on human behavior are fascinating. In one study of kids with ADHD, parents described their observation that their kids with ADHD generally exhibited less of the core ADHD symptoms (inattention, impulsivity, and hyperactivity) when in a natural environment than when in a “built” environment.

Although time in nature is not a “magic bullet” that will cure all behavioral challenges, parents should see woods, streams, lakes, and fields around their neighborhoods as a potential type of “therapy” to help keep kids focused, confident, healthy and balanced.

Here are some actions parents can take to prevent nature deficit disorder in their kids

  1. Be a role model. Show your children how much you enjoy outdoor activities in nature
  2. Plan a weekly or monthly surprise outdoor adventure for your family
  3. Limit kids to no more than 2 hours of total “screen time” per day on computer, TV or video game
  4. Take a nightly walk after dinner as a family in a natural area
  5. Get a map of local parks and trails and get out and explore them once or twice a month

How does your family take advantage nature to reduce stress and even manage behavioral challenges?

Tim Culbert, MD

Tim Culbert, MD, is the medical director of Children’s Integrative Medicine program. You can also read more about him in his first post to the Kids’ Health blog.

Epidemic: Talk to your teens about chlamydia

Imagine that there is a serious illness that caused over 14,000 people in our state to get sick last year.  Those who are most vulnerable to this infection are our children, between the ages of 15 and 24.  Some people who get it have relatively few symptoms, and some get sick enough to be admitted to the hospital.

It turns out that this is not an imagined scenario, but is a real epidemic.  It’s not H1N1 or some other new strain of flu.  It’s chlamydia.

Last week, I spent the day at the Minnesota Chlamydia Partnership Summit convened by the Minnesota Department of Health.  This was a gathering of professionals and young people who came together to discuss the chlamydia epidemic that is now affecting our state.

People don’t like to talk about chlamydia.  It’s a sexually transmitted infection (STI), and as a culture we don’t like to have sincere conversations about sex.  Chlamydia is a serious illness that can lead to serious complications such as tubal pregnancy, pelvic inflammatory disease, and infertility in both women and men.

In Minnesota, chlamydia is a problem across the entire state.  About 1/3 of infections occur in the city, 1/3 in the suburbs and 1/3 in rural areas.  Chlamydia affects young people between the ages of 15 and 24 at significantly higher rates than other age groups.

It’s hard to imagine this many people getting sick and having virtually no attention brought to it, particularly an illness that disproportionately affects young people.  Yet, despite the numbers, we see little media attention or public outcry about this disease.

As parents of teens, we need to take chlamydia seriously and include it as part of the conversation when talking with our children.  Teens should understand that if they engage in any kind of sexual activity, they are at risk of getting chlamydia.  Chlamydia is sneaky – it often has no symptoms until it has already caused damage to the reproductive organs, particularly in women.  If young people are already sexually active, they need to be regularly tested for this infection as well as for other STIs.  Chlamydia is can be treated with antibiotics, but only if it’s diagnosed.

You can help protect your kids by doing these things:

  • Talk, talk, and talk. Tell your teens about chlamydia and how it can affect them, as well as talking about sexual decision-making, and other topics related to reproductive health.
  • Make sure your teen’s doctor feels comfortable talking to your child about sex. Not all doctors do, and this is an important area of teen health.
  • Educate yourself. It will be easier to talk to your teen if you feel confident in your own knowledge.
  • Make sure your teen has other adults you know and trust. Sometimes with sensitive issues, teens may not talk with their own parents, but will talk with someone else.

We can make a dent in this epidemic, but it’s going to take all of us – parents, community leaders, religious leaders, doctors and nurses and not least of all the young people themselves.

Emily Scribner-O’Pray is the Community Services Supervisor at Teenage Medical Service. Read more about Emily.

Reflections on Primary Care Physicians and Healthcare Reform

In a recent article in JAMA by Robert H. Brook and Roy T. Young, April 21, 2010, Volume 303(15):1535-1536, the authors write a commentary entitled, “The Primary Care Physician and Healthcare Reform”. With changes coming from healthcare reform leading to more and more people being covered, the need for primary care physicians is actually increasing. Unfortunately the number of primary care physicians is decreasing. There are two main reasons for this:

  1. the scope of practice is being constricted for primary care physicians with their ability to do less and less procedures (think of less OB and procedures) and less and less in hospital care, (think of hospitalists), as well and more importantly
  2. the differential between what they get paid and what specialists get paid. The gap is substantial.

The median salary in large multi-specialty groups for primary care physicians is around $200,000. The median dermatologist salary is $351,000. Given this type of pay differential and the narrowed scope of practice, why should bright, hard-working, debt-ridden or even altruistic medical students choose primary care versus specialty.

In 2010 only 54.5% of 4,999 residency spots in internal medicine were filled, 44.8% in family medicine and in pediatrics 70.5%. In comparison at least 90% of physicians in neurosurgery, orthopedic surgery, and dermatology were filled by U.S. medical school graduates. Young clinicians are simply not willing to forfeit lifetime earnings of over $3 million.

To many of these students the authors state the primary care physician has become like the water boy on a football team, making sure that the really important members of the medical team do their work. Our dilemma is we don’t have great solutions. There could be no change and we could just let the inevitable decrease continue.

An alternative approach is to convince 50% of the students entering U.S. medical schools in 2010 to choose primary care as their professional career path. But, to do this we’ve go to change those other two variables. They need a different set of clinical responsibilities and skills, we should make them leaders in efforts to avoid preventable hospitalizations for patients with chronic diseases, eliminate inappropriate or equivocal surgery, radiological procedures, and help individuals die with the least pain and without expense for vast amounts of money.

Secondly we’ve got to come up with a way that they get paid more in comparison to specialists. Without these changes there is little hope of producing a healthcare system that provides high quality, affordable care to the U.S. population.

One thing these authors didn’t discuss is the use of advance practice nurses. Perhaps the future is that primary care physicians who want to stay in the field truly have to create systems where they work with advance practice nurses and becomes a conductor of a symphony of advance practice nurses in primary care.

I’d love to hear your thoughts on this.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.

Take it from me; tips to improve your child’s next appointment

The reality of having a child with chronic health care needs is that clinic appointments are a frequent event. One year I counted them all and from January to July we had 60 appointments alone.

I had to figure out how to make the best out of our appointment time.

For example, to get us in the right mindset, my son and I have a fun routine on the way to the clinic of listening to a tune by Elmo that goes “You have to be patient to be a patient.” This helps us both, but there are some other things that we could do as well.

So I’ve compiled a short list of tips that have helped me, and will hopefully help you get the most out of your next clinic visit with your child.

These ideas come from a lot of personal experience doing things the wrong way, leaving me frustrated, wondering what the doctor said, trying to recall when I am suppose to come back for a follow-up, and remembering that good question I wanted to ask heading home well after my visit, etc … you get the idea.

  1. Why are you there? This is important because it may determine how much time you have with the doctor. If it is a physical or well child check up you have about 15 minutes. If a sick child visit probably less time.
  2. How do we use this short amount of time wisely? Bring a list of questions and the first one should be the most pressing issue you have. This I learned after having a terrible time getting out the door, running late stuck in traffic, can’t find parking, or need a quick diaper change in the back seat, and then completely forgetting every question I had when the doctor arrives.
  3. Take notes if possible or ask the doctor to write things down, draw pictures, or what ever you prefer. Same list of troubles as #2 above happen when leaving and inevitably you cannot remember anything you talked about. You can also ask them to mail you a copy of the office visit notes. If you learn better visually tell the clinician that. If you don’t, save them the trouble of having to be a brilliant physician and an artist.
  4. Don’t forget prescriptions. If you need refills this is done more easily in person then tracking them down over the phone.
  5. Bring help. If you are able, have someone with you to care for your child while you are talking with the doctor. This can be very helpful.
  6. Get to know how the clinic operates. Surprises are not fun during after-hour emergencies. Educate yourself on what the after-hours procedures are, and what happens if your child ends up hospitalized or in the emergency department, or if your primary doctor is on vacation? I have learned that “call us if you need anything” is not as easy as it sounds.

As I also have said before, having your own personal health record is a great way to keep everything organized. I prefer an online version with the Children’s Medical Organizer, that I can then print out if needed.

Please add to this list. What tips have you learned coming to clinic appointments?

  Melissa Winger is a Children’s of Minnesota employee and long-time member (and former chair) of Children’s Family Advisory Council. Read more about Melissa in her first post to the Kids’ Health blog.