P agi A 6 J uly 3, 1996 • I'm P ori land O bserver Strep And Rheumatic Fever A group streptococcal infection in the throat is called streptococcal pharyngitis or strep throat Strep throat is not caused by vi­ ruses. It is caused by streptococcus bacteria. Strep throat should be diagnosed by a pediatrician or family physi­ cian using a throat culture. Strep throat should be treated with penicillin, as recommended in the June 1996 supplement o f PEDI­ ATRICS and by the American Acad­ emy o f Pediatrics, the World Health Organization and American Heart Association. Penicillin is also available as a single injection, which is preferable when adherence to a ten-day regi­ men o f oral penicillin might be dif­ ficult. Strep throat can be distinguished from other sore throats by its sud­ denness and trademark high fever (over 101), redness and swelling at the back o f the mouth, swollen, ten­ der lymph nodes on the neck, and the possible absence of a runny nose and coughing. Strep throat can lead to rheumatic fever in as little as two weeks if the strep is not properly diagnosed and treated. Children between five and 15 are most commonly affected. Symptoms include fever with pain, inflammation and swelling in one or more joints. Heart damage can de­ velop slowly, often resulting in a thickening and scarring o f the heart valves that can eventually require surgery. Symptoms o f rheumatic fever in­ clude continued fever, swollen wrists, kneesorankles, a warm feeling in the swollen joints, and swelling migrat­ ing from joint to joint. Treatment for rheumatic fever in­ cludes penicillin and bed rest for more than a month To avoid anoth­ er attack, a child must receive pre­ ventative treatment with penicillin once every month until he or she is 18 years old or older. Rheumatic fever and other com ­ plications of group A strep infec­ tions are now more of a concern for health care providers because seri­ ous group A streptococcal infec­ tions have reemerged during the last ten years as a public health problem. Many current strains o f group A strep may be virulent and result in a higher risk o f mortally for both children and adult. Other complications o f group A strep include streptococcal toxic shock syndrome and tissue infec­ tions such as necrotizing fascitis, the flesh eating virus, both o f which have a reported mortality rate o f 30 percent or higher. Van Pelt Elected To Catholic Health Association Board Greg Van Pelt, Chief Executive, Providence Health Plans—Sisters of Providence, Portland, OR, has been elected to serve a three-year term on the Board of T rustees o f the Cathol ic Health Association of the United States (CHA). He was installed during CH A ’s yearly business meeting at the 8 1 st Annual Catholic Health Assembly in San Antonio. Van Pelt has been with the Sisters o f Providence since 1975 where he has held numerous executive posi­ tions. He is currently a member ofthe American College o f Healthcare Executives, Oregon Association of Hospitals, Providence St. Vincent Medical Center Foundation Council o f Trustees, Good Health Plan o f Oregon Board o f Directors, Jesuit High School Board, Rotary Club of Gregory Van Pelt Portland, and Youth Employment/ Empowerment Coalition Board of Directors. Van Pelt received a bachelor’s degree in economics from Villanova University, Philadelphia, PA, where he graduated magna cum laude. He attended St Louis University and received a master’s degree in health care administration and was the re­ cipient ofthe Rev. John J Flanagan, S.J. Scholarship. He also did post-graduate work at Western Network Institute for Health Care Executives, University o f Cal­ ifornia, Berkeley, and Kennedy In­ stitute o f Ethics-Intensive Bioethics at Georgetown University, W ashing­ ton, DC Celebrating its 81st anniversary, the Catholic Health Association of the United States represents more than 1,200 Catholic-sponsored facil­ ities and organizations. The members make up the na­ tion’s largest group o f not-for-profit healthcare facilities under a single form o f sponsorship. California Children Have More Cavities, Survey Finds California children ages six to eight are far more likely to have cavities than youngsters in the rest o f the nation, according to data from a statewide survey. Known as the “California Oral Health Needs Assessment o f Chil­ dren,” the survey found that 73 per­ cent ofthe state’s children in this age group examined during 1993-94 had experienced cavities in their teeth. This compares to 53 percent nation­ wide in the same age range accord­ ing to a National Institute o f Dental Research survey in 1986-87. Both figures are far from the goal o f a prevalence rate o f no more than 35 percent for children o f this age proposed by the U.S. Public Health Service, says Howard Pollick, BDS, MPH, Principal Investigator for the California Assessment Survey and a clinical professor in the Department o f Dental Public Health and Hygiene o f the UC-San Fransisco School o f Dentistry. The USPHS goal was published in 1991 as part o f a special report titled. Healthy People 2000.” Pollick recently presented a pre­ liminary summary o f some o f the California data at the International Association for Dental Research annual meeting in San Francisco. The full report is expected to be published in the fall. The C alifornia assessm ent in­ volved 6,643 children in three age groups: pre-school, elementary (K- 3), and high school (grade 10). It was conducted by The Dental Health Foundation, a private nonprofit group, under contract with the Ma­ ternal and Child Health Branch of the California Department o f Health Services with additional funding from. The California Wellness Foun­ dation. Pollick says the high prevalence oftooth decay in California children is related to the state’s past lack of commitment to fluoridating drinking water. Until last year, Califomiacom- munities could choose whether to add fluoride to waterand m ostdidn’t. However, recent legislation requires the majority ofCalifornia communi­ ties to fluoridate when funding be­ comes available. “Only 15.7 percent ofCalifornians have access to fluoridated water now,” says Pollick. “ We’re 47th out o f all the states.” The statewide assessment includ­ ed data on 391 15-year-olds in 30 California public schools. “Here, the figure was more com­ parable to the national average,” Pollick says. Seventy-one percent of More Than 5,300 Immunizations More than 5,300 young Orego­ nian’s received immunizations at over 120 Free clinic sites during the week long statewide “ Immu­ nize ’96 Campaign." The “ Immunize ’96 Campaign’ was the third annual effort by the Oregon Preschool Immunization Consortium (OPIC) to help increase immunization awareness and per­ centages o f adequately immunized infants and children. All counties in Oregon offered FREE clinics during April 21 - 27, which was “National Infant Immu­ nization Week.” “We at OPIC are determined to make sure all O regon’s children are protected from vaccine-preventable diseases, and this year we took an­ other major step forw ard,” said Megan Osborn, chairperson for the Campaign. “ With each immuniza­ tion campaign, we are getting closer to our goal, which is to fully immu­ nize 90 percent of Oregon’s two year olds by the year 2000.” About 27,000 ofOregon’s children have not received adequate immuni­ zations before their second birthday. Age appropriate immunizations protect against ten serious diseases: measles, diphtheria, tetanus, pertussis (whooping cough), polio, mumps. rubella (German measles), hepati- tis-B, hemophilus influenza type-b (common cause o f meningitis) and chickenpox. This year’s campaign includes a partnership with over 150 Mc­ Donald’s restaurants throughout the state. Each McDonald’s provided in-store education materials on the importance of immunizations and local clinic information as well as special immunization record cards and bandaids to clinic sites. “M cdonald’s have helped us get our important message out to fam­ ilies all over O regon,” added Osborn. Minority Medical Students Gain Support To Fill Critical Healthcare Gap Check the yellow pages under “Physician" in most inner cities or rural communities, and you'll quick­ ly see why it’s dangerous to get sick there. Your chances o f seeing a doc­ tor are slim. The critical shortage o f skilled doctors in poor urban and outlying rural areas—now reaching crisis pro­ portions in the U .S .-has been the subject o f recent articles in The Wall Street Journal and USA Today. Both papers noted one glimmer o f hope in order to practice their life's work and give something back to their commu­ nities. But this potential solution to the urban/rural doctor shortage has an inherent snag. Due to environmental circumstances-such as personal fi­ nances. fam i ly issues or lack o f expo­ sure to accelerated exam methodolo­ gy in their early schooling—minority students are sometimes impeded in their performance on the U.S. Medi­ cal Licensing Boards. Although they possess the keen medical and clinical knowledge required to be fine doc­ tors, these students need practice with question types, answer patterns and how to battle test fatigue, skills that their peers from more affluent school districts developed in high school. That’s where ArcVentures Medical Education Services steps in to help level the playing field. ArcVentures Medical Education Services is a study assistance pro­ gram affiliated with Rush-Presbyte- rian-St. Luke’s Medical Center in C hicago-one of the nation’s most prestigious non-profit healthcare in­ stitutions. It istheonly hospital-spon­ sored study program in the nation. By drilling these bright, accom­ plished students in the art o f test­ taking strategies, ArcVentures helps to bridge the “testing gap” left from their early schooling-and booststheir confidence along with their test scores. A rcV en tu res’ com m itm ent to helping remove one ofthe barriers to minority doctors is heartily endorsed by the Student National Medical Association (SNMA), an organiza­ tion founded 3 1 years ago to promote timely matriculation for medical stu­ dents o f color. “The shortage o f minority doctors is a critical piece o f the healthcare puzzle that severely impacts care," says Jason Denny, immediate past Chairman o fth e Board o f Directors ofSNM A, and himself, a fourth-year medical student at Mt. Sinai Medical School in New York City. "W e are more likely to go back to our own communities to serve, where the need is greatest. If you understand the community where a patient came from, you have more com passion- you see them as your grandmother, your brother, your aunt—and you better understand how they view the medical profession through the prism o f their own culture.” Founded in 1988 at the request of students who wanted a hospital-spon­ sored study course, ArcVentures has grown in direct response to the short­ age o f affordable healthcare profes­ sionals in the U.S. The program cur­ rently sponsors 38 medical review courses at 20 medical schools year round, located in the U.S., San Juan, Puerto Rico, and Guadalajara, Mex­ ico. C o u rse s are also o ffe re d at ArcVentures’ satellite locations in Chicago, Houston, Los Angeles, Miami, New York City, Washing­ ton, D C. and Clifton, New Jersev. Faculty members are professors from major medical schools and practic­ ing physicians, and are selected strict­ ly for their teaching experience, en­ thusiasm and reputation. To date, ArcVentures has helped more than 14,000 American medical students and foreign-trained physicians pre­ pare for top scores on their Boards. • ** What is the use o f running w h en y o u are o n th e w ron g road? — Old saying these teens had experienced cavities, compared to 78 percent nationwide in 1986-87. The Healthy People 2000 goal is no more than 60 percent. The survey also found that dental health varied widely depending on the socio-economic and ethnic status o f the children. Among the 6 to 8 year-olds, 86 percent o f children whose parents had less than a high school education had experienced tooth decay, while 70 percent o f the African-American, 84 percent of Hispanic/Latino, 90 percent o f Asian and 6 1 percent o f white children had known cavities. In addition, the survey looked at the number of children whose teeth are protected by dental sealants. Again, Pollick draws a correlation between fluoridation and dental health. "Our study found that in the fluori­ dated areas we went to in San Fran- cisco, the East Bay and Long Beach, a higher proportion of children received sealants,” he says. “This is because sealants are applied to healthy teeth when a child gets hisor her first perma­ nent molars around age 6. A sealant is no, applied if a tooth has already de­ veloped a cavity, as it is more likely in an untluoridated area.” "W e believe this isconsistentwith the idea that you apply sealants to protect the teeth,” he adds. "It’s a preventive modality. I think fluori­ dation will help us achieve our goals for sealants.” O fthe 776 8-year-olds in the Cal­ ifornia survey in 1993-94,10 percent had one or more sealants on their first molars, compared to 11 percent na­ tionwide in 1986-87. The Healthy People 2000 goal is 50 percent. The prevalence o f sealants in Cal­ ifornia varied widely, Pollick notes. ranging from a high o f 54.5 percent for c h i I dren whose fam i I ies were not poor and who lived in fluoridated urban areas, to a low o f 0.6 percent for Latino children from all income groups living in rural areas. Among California 15-year-olds, the survey found a total o f 12.6 per­ cent had sealants, with a range in fluoridated urban areas from 37.8 percent for wh ite students, to a low of zero for Asian students. The national survey showed 8 percent o f 14-year- olds had sealants in 1986-87. Co-investigators ofthe assessment project are Patricia Kipnis o f Kaiser- Perm anente in O akland, Calif., Joanne Wellman and Robert Isman o f the California Departm ent of Health Services, James Ellisonofthe UCSF School o f Dentistry, and Jared Fine o f the Alameda County Health Care Services Agency. Hypertension-Complicated Pregnancies African-American women suffer­ ing from a common condition o f preg­ nancy, maternal hypertension, expe­ rience serious complications at a far higher rate than women o f other ethnicities. This was discovered in a a five-year, nationwide retrospective study by the Morehouse Treatment Effectiveness Center (M TEC) at M orehouse School o f M edicine (MSM). African-American women were more than four times more likely than other women with hypertension to suffer inadequate fetal growth; three times more likely to experience serious bleeding before going into labor; and twice as likely to deliver early. The study was published in the April issue o f Obstetrics and Gyne­ cology. “The higher incidence o f maternal hypertension and the increased risk of pregnancy complications shown by our research may explain why African-American infants experience a lower average birth weight, more premature deliveries, and more in­ fant illness and death than other A merican babies,” said A ziz R Samadi, M.D., M.P.H., lead investi­ gator o f the study. Providence Run For Good Health And Family Fitness Fair One of Portland’s premier running and walking events is set for Sunday, July 14. Providence Health System is sponsoring the Providence Run for Good Health and Family Fitness Fair. After crossing the finish line, peo- pie can join in the fun in Pioneer Courthouse Square. From 8 a m. until noon. Providence will sponsor music, clowns, bike safety and informational booths focusing on good health, plus an awards ceremony. Entry fees are $6 (without shirt) and $15 (with shirt) beforeJuly 14. The fees will be $8 and $ 17, respectively, the day ofthe race. Maybe we can’t make Northeast Portland a perfect place to live. But w e’re making hundreds of improvements. Frimds