Archives for March 2016

Ron Marino, DO, MPH, FAAP

THE POTENTIAL ROLE OF YOGA AND MEDITATION IN PEDIATRIC PRACTICE

Over the past several years, there has been increased attention to issues of physician burnout and a need from physicians to provide non-pharmacologic tools to help patients deal with emotional and physical issues.  New York Chapter 2 of the American Academy of Pediatrics is dedicated to both these principles and supports a group of pediatricians who actively promote Yoga and Meditative Practice.  Dr. Ron Marino has lectured at national meetings about the importance of Yoga as a tool for both pediatric practice and physician health.  He shares his knowledge with “INSIGHTS INTO CHILD HEALTH.”

Question: Why should your AAP Chapter publish an article about yoga?

Answer: Because pediatricians are concerned with enhancing health and well-being and the practice of yoga is a route to this and for both patients and practitioners.  When most people hear the word yoga they think of individuals in unobtainable postures which require superhuman strength and flexibility.  This is NOT yoga!  This is one component of yoga practice.

An individual’s yoga practice may focus more on the subtle meditative aspects, the philosophical aspects, or the physical aspects.  This diversity of approaches and practice makes studying the health benefits in a traditional Western scientific way very challenging.  However there are many studies concerning mindfulness meditation and a growing body of literature about yoga as well.

Question: What are some of the medical benefits of practicing yoga that have been studied?

Answer: More studies are being published which look at both the clinical and physiologic implications of yoga and other meditative practices.  How yoga works is still being explored, but evidence is mounting that yoga practice:

• Upregulates parasympathetic tone
• Decreases inflammatory mediators
• Increases immunoglobulin production
• Enhances telomere strength

Neuro-anatomically, MRI studies suggest yoga increases pre-frontal cortex and posterior cingulate activity and is associated with a decrease in size of the amygdala.

Question: What about clinical applications in clinical practice?

Each day, general pediatricians are being asked to provide more mental health care.  While our continuing medical education has rightly focused on learning how to manage common medicines used for these conditions.  I think Yoga and Meditative Practice can have a role.  Studies regarding the clinical application of yoga for patients have been useful for:

• Anxiety, Aggression and Pain
• Substance abuse
• Asthma and Irritable Bowel Syndrome
• Depression
• Insomnia

Question: Can Yoga help physicians dealing with issues of burnout?

Yes.  As physicians we are experiencing changing dynamics within the profession.  Daily we experience stress from a loss of autonomy, income and even societal respect.  These factors contribute to an increased burnout and feelings of depression by healthcare providers.  While there are many ways to modify burnout and support physician well-being, consistent yoga practice may help.  Physicians might consider yoga for themselves to take advantage of the health benefits.  But like any other activity yoga must be practiced consistently and mindfully.

Question: Yoga can seem intimidating, what advice do you have for someone interested, but wary?

Finding a teacher is a good place to start.  Given the remarkable diversity of offerings one may need to explore several yoga Studios and/or teachers prior to settling into a practice that’s a good fit for you. The Yoga Alliance is a certifying body that credentials teachers.  However as with many therapeutic arts, the credential may or may not yield the best experience for you.  As with therapists or personal trainers, word of mouth is also a great way to connect to a teacher.

Yoga, like medicine, is a lifetime practice.  Mindful consistent activity may yield physical and mental benefits and, in my opinion, the risk, when practiced mindfully, are worth the benefit.

(Dr. Ron Marino, DO, MPH, FAAP is a pediatrician and Associate Chairman and Director of General Pediatrics at Winthrop-University Hospital.  He is co-chairman of the Yoga and Meditation Committee of the New York State (District II), Chapter 2 (Long Island) of the American Academy of Pediatrics.)

AAP ANNOUCEMENT BLOG POST:

As an officer in your local chapter of the American Academy of Pediatrics, I often get asked the question, “What’s the Local AAP doing about X?”  Your local AAP Chapter, New York Chapter 2 (Long Island, Queen and Brooklyn) is among the most active, dynamic and engaged chapters in the 60,000+ membership of the AAP, and our primary goal is to ADD VALUE to your practice and chapter membership.  Under the leadership of current AAP chapter president, Dr. J. Abularrage, your chapter was the FIRST EVER to convene a strategic planning meeting.  The goal of the meeting was to give EVERY member of the local AAP chapter input into how to direct our efforts.

1. One theme of the strategic planning meeting was the need to work harder to promote Human Papillomavirus Virus (HPV) vaccination.  Nationally, the Centers for Disease Control report that rates of HPV vaccination are approximately 40% and 20% among adolescent females and males respectively – a rate which lags far behind the acceptance of other vaccinations (1).  Local pediatricians, just like our colleagues across the country, are having difficulty successfully promoting the benefits of HPV vaccination against the pushback and negative reactions from both parents and patients.  Reasons for vaccine refusal include parental unwillingness to accept or discuss their child’s sexual behavior, and the myth — debunked in 2012 and again in 2014 articles in Pediatrics — that receiving HPV vaccine will somehow lead to riskier sexual behavior (2, 3).  Local pediatricians are concerned that without sufficient HPV awareness, widespread HPV vaccination will not fulfill its potential in protecting our area’s children against HPV associated cancers and disease.  As January is National Cervical Cancer Awareness Month and February is National Cancer Prevention Month, we are using this post to update you on AAP efforts to promote HPV immunization.

“So what’s the AAP doing about HPV vaccination rates?”

At the National Level, the AAP has many resources available to help integrate and promote HPV awareness and immunization into your practice.  These include toolkits for your practice (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/HPV-Champion-Toolkit.aspx), Payer Advocacy materials (https://www.aap.org/en-us/Documents/payeradvocacy_hpv_recs_2015.pdf) and printable resources to help improve (and even get MOC Part IV Credit) for your HPV vaccination efforts.  For those practices with a large social medial presence, there are AAP-sponsored Facebook Messages (https://www.aap.org/en-us/Documents/hpvtoolkit_professionalFB_hpv_2015_August_2015.pdf).

• HPV Champion Toolkit – AAP.org
  www.aap.org – This toolkit has the best resources available to help you educate other healthcare professionals and discuss HPV vaccination with parents.

However, all these efforts aim to increase vaccination rates via parental or physician outreach. As we all know, adolescents are different and thus past approaches aimed at increasing immunization rates may not work as well since those vaccinations are administered at much younger ages. Data increasingly suggests adolescents rely on social media and text messaging for healthcare information (4).

Improving education efforts around the impact of HPV has also been shown to increase a desire for teens to be immunized (5). At the local level, your AAP chapter is merging these two principles by working with adolescents and young adults to create a social media campaign aimed at increasing awareness and interest in HPV vaccination.  The hope is that if HPV immunization hesitancy stems from parents, increasing the desire for vaccination among teens will promote more conversations regarding HPV prevention and ultimately, increase local immunization rates.

To do this, we’ve partnered with Inspire Bright (http://www.inspirebright.org ), a local non-profit founded by two Syosset, Long Island sisters while still in high school.  Inspire Bright has a history of working with adolescents on relevant issues in our chapter area.  The group raised funds to purchase high school musical instruments for schools affected by Super Storm Sandy and is currently donating SAT review books to under-privileged teens in New York City.

So how do we motivate adolescents to get vaccinated against HPV?

Your AAP Chapter and Inspire Bright have created a social media campaign designed to appeal specifically to adolescents and college-age children.  Health information regarding HPV vaccination will be widely disseminated on Twitter, Facebook and Instagram.  Messages promoting cervical cancer prevention were crafted to specifically appeal to 16-21 year olds and we will be monitoring the impact of the social media’s campaign.   To appeal to this age group, we built upon the successful AAP “I ADVOCATE FOR KIDS BECAUSE . . .” campaign, which generated significant interest across many forms of social media.  Inspire Bright created placards with the phrase, “HPV WON’T STOP ME.”  Together, we brainstormed 12 key messages which will appeal to kids, who can take a picture of themselves with a chose sign and broadcast the message via Facebook, Instagram, and Twitter.

We ask chapter members to participate in the campaign by making these placards available in your waiting room.  If you are on social media, please promote our key messages to your followers. Stay tuned for updates.

REFERENCES:

1. National, regional, state and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2014. MMWR Morb Mortal Wkly Rep 2015 / 64(29);784-792
2. BednarczykRA, Curran EA, Orenstein WA, Omer SB. Sexual activity-related outcomes after human papillomavirus vaccination of 11-to 12-year olds. Pediatrics 2012;130(5):798-805.
3. Mayhew A, Mullins TL, Ding L, Rosenthal SL, Zimet GD, Morrow C,Kahn  Risk perceptions and subsequent sexual behaviors after HPV vaccination in adolescents. Pediatrics. 2014;133(3):404-11.
4. O’Keeffe GS, Clarke-PearsonK; Council on Communications and Media. The impact of social media on children, adolescents, and families.  2011;127(4):800-4
5. Kessels SJ, Marshall HS, Watson M, Braunack-Mayer AJ, Reuzel R, Tooher RL. Factors associated with HPV vaccine uptake in teenage girls: a systematic review. 2012 May 21;30(24):3546-56.