Archive for the 'children' Category

Ask Young Women One Key Question

Sunday, July 23rd, 2017

What can health-care providers, friends and parents do to help young women focus on their reproductive goals? Ask “one key question,” which is: “Would you like to become pregnant in the next year?”

Obviously this takes a special relationship with the women. That relationship is assumed with a doctor or other health-care provider, but may not be practical with some other relationships. However, if you do have such a relationship with a young woman, asking this question may help her clarify her goals.

One advantage of this question is that it is nonjudgmental. Furthermore, it doesn’t ask about the distant future, but only asks about the next 12 months. These are both reasons that it is a well-accepted way of opening an important conversation.

How have women responded? Apparently many women already have a pregnancy plan and know what their reproductive goals are for the next year. If the woman wishes to conceive, the discussion can then go toward having a healthy baby. Among other actions, she should start on prenatal vitamins, eat a healthy diet and avoid tobacco, alcohol and drugs.

If the woman responds that she does not want to become pregnant in the next year, or if she is unsure, there is a follow-up question: “Are you currently using a contraceptive method that you are satisfied with?” When the reply is, yes, she is happy with her birth control method, she is reminded about emergency contraception (EC). However, if a woman answers that she is not pleased with her contraceptive method, or is not using any birth control, this is a perfect time for contraceptive counseling—including a reminder about EC.

EC pills such as Plan B are now available without prescription and are safe, although not 100% effective. They are good up to 3 days after unprotected sex, and work best if taken within 12 hours of exposure. There is a relatively new EC pill, ella® (ulipristal); it has the advantage of being more effective (especially for heavy women), and works up to 5 days after sex. Neither of these will cause an abortion if a pregnancy is already established.

Most effective is an IUD which contains copper, such as the Paragard®. It works as EC for up to 5 days after sex—and can provide protection against pregnancy for as long as a decade.

Now you can now purchase Plan B and Ella® on the Internet! Go to www.prjktruby.com and you will find both of these are available (they sell a generic equivalent of Plan B). In addition, women can get “the pill” through this same website. The world of reproductive health is changing!

The yearly Pap smear is a thing of the past. Now women can go several years without seeing a provider for reproductive health care, if ever. Although this saves the embarrassment of a pelvic exam and saves money, it also means that women may not have the opportunity to update their knowledge about contraception. In addition, birth control pills are available without a provider visit, including at Planned Parenthood, through www.prjktruby.com and in some states.

Both Oregon and California have passed laws that allow women to purchase oral contraceptives (if they are in good health) just by speaking with a pharmacist. Do you remember when ibuprofen was only available with a prescription? Fortunately there is a way to petition to make a prescription medication available “over the counter”. This is what happened to Plan B as well as ibuprofen. Oral contraceptives are so safe that there is pressure on the FDA to make them available without prescription in all 50 states.

As the barriers to family planning are overcome it is important to be certain that women are aware of the method that is best for them. This is why the “one key question” is important. In Oregon, where this campaign got started, it is recommended that all family practice doctors and other practitioners who care for women of reproductive ages routinely inquire if they plan to conceive in the next year.

The birth rate in the USA is dropping, but still almost half of the pregnancies conceived are unplanned. This one key question could help to decrease the numbers of unintended pregnancies, and of abortions.

Recently a reader was kind enough to suggest that I write about “one key question”, and I am happy to follow up on the suggestion. I welcome feedback from readers, whether you like what I have written or hate it. My email address is: richard@population-matters.org; please remember the hyphen!

             © Richard Grossman MD, 2017

Keep Public Lands Public

Tuesday, May 30th, 2017

 

Preserve public lands for children yet to come

 We are fortunate to live in a beautiful part of the world, and also fortunate to have parts of the land preserved as national monuments. Several of these are under review, and it is concerning that the national parks and other protected areas may also be in political jeopardy. Protect them so our children can enjoy them.
Richard

Rio Grande Gorge by Daniel Schwen

You have fished for the trophy trout in the Rio Grande in the Rio Grande del Norte National Monument. Or perhaps you’ve hiked Sand Canyon, a bit west of Cortez, and enjoyed the wonderful walking, spring flowers and ancestral Puebloan ruins.

You can kiss these amazing places goodbye if some of today’s politicians have their way. Both the above public lands are controlled by the federal government, as is much of the land in the West. The feds don’t do a perfect job of stewardship, but at least a certain minimum standard of protection is enforced. National monuments restrict and control grazing and extractive industries.

When he was campaigning, Donald Trump pledged to keep public lands under federal control. Unfortunately, ! he is reneging on those promises.

Trump has asked Ryan Zinke, secretary of the Interior, to review 27 of the largest and most recently designated monuments. The idea would be to either abolish these monuments or to decrease their size. It appears that Trump’s motivation is to alter the special monument status for commercial reasons. Yet it is essential that humanity not lose our connection to our land and to our past.

In addition, there are threats to turn control of monuments over to state authorities. At first glance, local control sounds as though it might be a good idea. There would be local or state governments controlling these beautiful parts of our wonderful country. Furthermore, the responsible people wouldn’t need to contact Washington every time they need to buy a new pencil sharpener.

The downside of local control is that local people may! lose sight of the purpose of monuments; they might sell off rights during a time of economic difficulty. Furthermore, locals often don’t have the resources or expertise and would be unable to administer the monuments properly. Many states lack sufficient funds to run their state parks well, let alone take responsibility for national monuments!

National monuments come in all sizes, from a single historical house to the mammoth Papahanaumokuakea Marine National Monument. They were all created by decree by presidents of both parties, on territory that already belonged to the federal government. No president has ever ordered a review before.

Many of the 129 national monuments in the U.S. are of great aesthetic value. Their beauty attracts millions of visitors and is of great value to local economies. Exploration and drilling would spoil their bea! uty and trade short-run profit for long-run ruin.

Bears Ears National Monument was designated at the end of 2016 after years of consideration. It was established with the help of several Native American tribes, who are also involved in its administration. It is under intense scrutiny, probably because of a resolution passed by the Utah legislature “… urging the president to rescind the designation of Bears Ears National Monument designation.”

The response to Utah’s resolution was quick. Clothing giant Patagonia has moved the huge Outdoor Retailer trade show from Utah, where it has been held for 20 years. Other companies joined, and the trade show has announced that the next show will be in Denver. Conservation Colorado put advertisements in Utah papers saying, “We have stronger beer. We have taller peaks. We have higher recreation. But most of all we love our public la! nds.”

Establishing an! d protecting public lands (and oceans) became prudent as our population grew, and as we harvested increasing amounts of the bountiful resources. It is essential to have places for children to explore and for adults to reconnect to the land. In addition, some of the monuments memorialize cultural resources – for instance, Canyons of the Ancients protects more than 6,000 archaeological sites.

There are many good organizations that are monitoring and fighting the attempt to jeopardize public lands. I favor the San Juan Citizens Alliance (sanjuancitizens.org) and Conservation Colorado (conservationco.org). Both have information on their websites and advocate for public lands protection.

We are fortunate to live in a beautiful part of the world that also has copious resources. We should enjoy our surroundings and use the resources carefully but r! emember those who will come after us.

I would like my granddaughters to be able to fish the Rio Grande, hike Sand Canyon and camp in Bullet Canyon without the sounds of pump jacks and chainsaws.

Like you, I have explored parts of Cedar Mesa, which are now protected by Bears Ears National Monument – but perhaps we better hurry back while the monument is still undeveloped.

Or work harder now to preserve it.

© Richard Grossman MD, 2017

Give Children Every Advantage

Monday, November 28th, 2016

dislexia

            New parents hope that their children will be perfect. Unfortunately, there is often disappointment when reality sets in.

We have always cared about the welfare of our children, but now each child seems to matter more as family size is decreasing. Fortunately much can be done now to help children with disabilities. Difficulty with reading, dyslexia, is a good example.

Dyslexia is estimated to affect as many as 20% of people—that is one in five! Reading is an amazingly complex skill, so it is no wonder so many people have difficulty. As many females have dyslexia as males, but girls tend to stand out less. Dyslexic boys often act out in school, while girls with the same problem tend to become quiet and not call attention to themselves.

Teachers are recognizing dyslexia more now than when I was in school. I remember struggling with reading in first grade. I envied one of my classmates who read much better than I. Many years later at a reunion when I mentioned this to her, she replied “Didn’t you know I was repeating first grade?”

Probably both she and I suffered from dyslexia. I managed to squeak by until 7th grade when my English teacher realized that something was wrong. Mr. Johnson focused on the spelling part of the problem. I’m a pretty good speller now, but unfortunately I am still a slow reader.

My freshman year in college was rough. I was faced with large volumes of reading that I couldn’t plough through at my slow pace of 200 words-per-minute. Once again coaching helped me. Only recently have I realized that the basic problem is that I have mild dyslexia.

Unfortunately dyslexia is ignored frequently, as it was with me. Its treatment is time consuming and expensive, and it is best to start early. Although some adults are successful despite dyslexia, many are not so fortunate because they get off to a bad start in school. This can lead to poor self-esteem, dropping out of school and perhaps even to criminal activity. Two thirds of prisoners have poor reading skills, and many of these have been found to be dyslexic.

Research on dyslexia is ongoing, but two doctors developed an effective method of treating it. The Orton-Gillingham method employs multiple senses in its approach, including visual, auditory and kinesthetic pathways. A student will see a word, say the same word and write it at the same time so it gets firmly implanted in her brain. This is very intensive of teachers’ time since it involves one-on-one interaction, but amazingly successful in improving reading ability.

It is wonderful that our community has a school that offers education for dyslexics. In fact, it is so good and so well known that it has attracted families to move here. The Liberty School provides state-of-the-art instruction for kids from 1st through 8th grades. It also has programs to challenge children who are exceptionally bright. Often children will spend only a year or two at the school, to get an educational boost.

A friend sent two of her children to the Liberty School, not because they were doing poorly in the public schools but because she thought that they could do better. Indeed, they improved markedly! Her daughter went from performing at a 5th grade level in math to 12th grade—in just one year! The son hadn’t been writing well, but at Liberty wrote a great play together with classmates.

My friend couldn’t say enough good things about Liberty and the influence it had on her kids. She is a school psychologist as well as being an excellent, involved mother.

One of the keys of Liberty is integration: the older kids help the younger, and those who read well help the ones who don’t. I observed this when I visited the school recently. I interviewed several of the students; all were enthusiastic about their school and the progress they were making. I saw lots of smiling faces.

The Liberty School is building a new facility up Junction Creek Road. It will not only be state-of-the-art but also have wonderful land for recreation and nature studies. There was an excellent story about their campaign on the front page of the Herald 12 days ago.

            Being able to help a child afflicted with dyslexia succeed in life is just one advantage of a small family. Fortunately we live in a society that does not judge people by the number of children they have.

© Richard Grossman 2016

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.