The Social Medicine Portal

Some reflections on how nutrition improves

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October blog                                                                                                            Claudio Schuftan

 

I was in Rome in early September. Not to see the Pope or the Piazza d’Espagna. But rather to contribute to our global efforts to bring the struggle for food sovereignty eventually a step closer to reality. The occasion was a meeting called by civil society, spearheaded by FIAN, to consolidate a civil society position towards the call by FAO’s Committee on World Food Security (CFS) to launch a Global Strategic Framework for Food Security and Nutrition (GSF) by October 2012. The GSF is meant become the framework to coordinate and guide joint actions by a wide range of actors regarding food policies at the global, regional and national levels.

Civil Society Organizations have consistently maintained that this GSF must be at the centre of joint action and see it as a much-needed global reference for policy-makers. For civil society organizations though, the GFS is above all about ensuring that policies are significantly more people-centred.

The result of our discussions were included in the first draft of the joint civil society political statement on the Global Strategic Framework and compiled by a civil society drafting team (of which I was part). The statement contains the vision and the demand of civil society that people who produce, distribute and need food must be in the centre of policies. The key role of food providers and consumers is highlighted in the draft, including that of social actors such as social movements and smallholder organizations of fisher folks, peasants, pastoralist, indigenous people and other. Finally, the Civil Society Statement stresses the need of setting clear accountability and monitoring responsibilities as a priority issue.

Most important was a back-to-back meeting to the above. It was about organising a Global Right to Food Network to strengthen worldwide efforts to end hunger and malnutrition by promoting better cooperation between likeminded partners and to voice our demands louder for the fulfilment of the right to nutrition. The call is for civil society to more proactively demand accountability through empowering its cadres to foster active community mobilization. The seed for the network was planted and we will certainly hear more about it in the future.

You will ask: Did you get to see the Coliseum and the Fontana di Trevi? Barely and passing by only. It was an intense 3 days…

 

Some reflections on how nutrition improves

 

Here is a quick summary of some actions that have been deemed relevant to nutrition in impoverished countries around the world:

 

• Equitable economic development is positively related to nutritional improvement, by way of its impact on poverty, equity, household food security and social expenditures. A threshold exists at around an average of $US 500 per capita income; above this, social expenditures rise significantly with rising income.
• Equitable growth strategies are a more efficient long-term means of alleviating poverty and indirectly improving nutrition, than are compensatory (targeted) poverty alleviation programmes  (as I said in my August column).
• Quantity, quality and distribution of social expenditures are central for the above to happen.
• Mutually reinforcing long-term effects on nutrition can be had by investing in women’s health and in their education, as well as in other women’s issues.
• Social discrimination against women is common in countries where nutrition has not improved as much as would be predicted by their economic growth.
• Nutrition programmes give visibility to nutrition, but may only promote broader awareness which is not the ultimate goal. Participatory processes in these programmes are as important as their activities as such.
• A mix of top-down and bottom-up interventions is the most pragmatic and effective approach often generating synergies.
• The most successful and sustainable nutrition programmes have strong community ownership. Decentralised decision-making power is crucial.
• Nutrition issues can and have influenced broader development policies. The availability of relevant disaggregated information, of democracy, and of a free press, do contribute to this.
• Development of an explicit nutrition policy is a vital prerequisite to the mobilisation of sectoral awareness and support.
• A synthesis of the recent lessons learned (pertaining to reasons behind real nutritional improvements) still leaves us with some apprehensions, because, when malnutrition (an outcome indicator) improves, it leaves no explicit track or trail of why it did so. It basically is still left to us to sort out the  reasons.

 

Finally, I do not think the Road Map for Scaling Up Nutrition (SUN) represents a set of nutrition-relevant actions that fulfils several, let alone many, of the criteria above. See my July column for why I think this.

 

ENABLING ENVIRONMENTS: HOW TO ACHIEVE THEM: ABOVE ALL, BY  LOCAL ACTION, COMMUNITY MOBILISATION, AND HOLDING AUTHORITIES TO ACCOUNT

 

‘Detective work’ done by honest and qualified researchers should sharpen our wits and improve our capacity to bring together all relevant elements of observed and sometimes puzzling ‘realities’. Only then can we decisively choose which nutrition-relevant actions are best in any given setting. Armed with this information, we can also oppose and even confront nutrition-irrelevant or anti-nutrition actions.

I have for long been convinced that people will feed themselves well, if their environments enable them to do so. The nature of enabling environments varies, of course. Governments and agencies – including non-governmental organisations – do not always foster enabling environments. They are usually either part of the problem, or else are neutral.

Sharing a common conceptual analytical framework has proven to be crucial to understand the causality of malnutrition, and to develop at least some beginnings of a shared political view. We have tried to do this since the 1980 UNICEF conceptual framework for nutrition as agreed and published by UNICEF. But this is only the first step. Creating political awareness of the problems of malnutrition is no longer enough. Our goal has to be to mobilise resources and people for action for nutrition-relevant actions.

The first requirement is a correct analysis of the relevant causes. Only then is it possible to intervene effectively. Engaging communities actively in service delivery, in capacity building and in their own empowerment, becomes central to the creation of enabling environments. What needs to come first is local. National or global environments are just as important, but are more remote to communities.

Fostering effective local democracy may well be a move to tackle the ominous health and nutrition consequences of non-enabling environments, and also to engage people in policy and political issues.

Outside agencies and agents can support effective local democracy. Governments – and other organisations – that say they respect and protect impoverished people’s entitlement to food, care and health, but do not positively and actively fulfil these obligations, should be openly confronted. Needed actions, include ensuring household food security, food sovereignty, the care of women and children, and the provision of basic health services, as well as environmental sanitation. Governments must be pressed to make needed interventions in these fields.

With encouragement, communities will be able to take on responsibilities. They will also be able to engage the resources they control in making their entitlements more attainable. Also, they will be better able to mobilise and to fight for resources that they do not control (This assumes that their government is not so repressive as to make this impossible). The key twin issues are community mobilisation and community empowerment. This is what creates an enabling environment, which is ultimately linked to the underlying and basic determinants of ill-health and malnutrition.

WHY WAITING FOR A PROMISED (BUT SELDOM REALIZED) ECONOMIC TRICKLE DOWN? ARE WE TO TRUST IT?

Here are two scenarios. The first is more down-to-earth:

Economic development is positively related to nutritional improvements. Economic growth – only if and when it trickles down – is said to help to prevent and control ill-health and malnutrition in poor countries. But the effects of such aggregate economic growth are not immediate (nor automatic) on poor households’ disposable income. This is thus an illusion. We should not be deceived.

A good road towards empowerment now, I believe, is a wide movement to promote education and income generation activities for women.

Income generation for women can short-cut the ‘waiting-for-trickle-down’ syndrome emptily promised by structural adjustment and by conventional donors. Income generation activities can generate more immediate needed additional modest household income – a true bottom-up solution.

In the poorest households, women’s income generation can result in sometimes quite significant increases in disposable household income, even if the total income is low.

As an intervention, income generation by women attempts to blend the technical with the political in the battle against malnutrition. It more directly deals with the basic causes underlying the ill-health and malnutrition that characterise poverty worldwide.

Income earned by women is, to a much higher degree than that of men, used for family well-being expenditures –nutrition included. Women’s modest, frequent income more directly affects the proportion of every increase in income that goes to consumables, including food and also basic services

Income generation by women does not of itself correct the immiserating impact of unfair political and economic systems. But women’s income generation can target some key determinants of ill-health and malnutrition. Also, it can organise and empower women in a way that prepares them for taking more active roles in participating in decisions and actions concerning food and nutrition in their families and in their communities.

Here is my more dreamy scenario:

Some of us have for too long lived surrounded by four walls, in an immutable environment, with the line of our professional horizon barely perceptible. Have we thus grown up inside an impenetrable armour of good manners and conventionality?

 

We have been trained to please and serve and, I’d say, have ended up limited by our own routines, the prevailing social norms and our hidden fears. Has, for too long, fear been our companion? Fear of authority and of what people will say, fear of the unknown and of what is different, fear of the unpredictability of social justice, fear of leaving the protected cocoon of our guild, fear of facing the dangers of the real world out there, fear of our own fragility and of the ultimate truth?

 

Could it be that our truth has been made up from omissions, courteous silences, well kept secrets, order and discipline? While masses of the impoverished share the same space and time with us, yet it is as if they existed separate from us. And under such circumstances, have our aspirations really been more to achieve virtuosity and recognition?

 

We do not know in what turn of the road traveled we lost the person we used to be. We are not sure any more, which of the causes we championed were meaningful, which we won and which we lost. If we made some mistakes and had uncertainties and fears about the future, we feel we have paid dearly for them already.

 

But also, I want to believe that we feel suddenly empowered. A new mood allowing us to make meaningful decisions in our professional lives is infusing us. We are willing to pay the consequences for it.  We do not owe an explanation to anyone for these changes.

 

This sense of optimism and commitment invades some of us, particularly in preparation for our upcoming Rio2012 congress. Our fears have dissolved as we have lost our fear of fear. We now find new strengths as we face new risks. We are finding new forces within ourselves that we always had, but did not know we had, because we had never used them. We are ready to join the growing number of explorer-doers seeking new ways out to the problems of the world. We feel pride as women and men who are reinventing equity in our work.

 

Some of us walk victorious, while others still carry disillusions mostly having suffered early defeats. But we feel we own our destinies, our future, and our irrevocable newly acquired dignity. We finally understand talk about liberation, about rights and empowerment, and about freedom from want in new ways and yearn to discuss with others what we see and feel about each of them.

 

We can now live each day without necessarily making worthless plans. We feel we have a blank sheet in front of us where we can write our new plans and, in the process, become whoever we want to become, without anybody judging our past. In short, we can be reborn. (1)

 

And then I woke up. Will post-Rio shatter this dream? It is up to us all! Dreaming is OK, but being naïf is not.

 

Yet, I hope I have here advanced some ideas that might provoke you to contribute to this movement, to get closer to the time when real democracy and the respect of human rights are no longer a dream.

 

Reference:

 

1          Allende I., The Daughter of Fortune, Plaza y Janes Editores SA, Barcelona,

1999, pp 296-301.

 

Please cite as: Schuftan C. Some reflections on how nutrition improves [Column] Website of the World Public Health Nutrition Association, October 2011. Obtainable at www.wphna.org

cschuftan@phmovement.org

www.phmovement.org

www.humaninfo.org/aviva

 

 

State-Sponsored Oppression: the unjust and outrageous life sentence of Dr. Binayak Sen

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On 24 December 2010 the court of Raipur, state capital of Chhattisgarh, India, rewarded the health and social justice life of pediatrician Dr. Binayak Sen not with honors, medals or an honorary degree, but with a sentence to life in prison.

The message from the Government of India: if you work as an advocate with the poor, you are against the government and will be punished severely. It is a message to any who would work toward a more just world, in accompaniment of the marginalized, stigmatized and poor.

Dr. Binayak Sen, who is vice-president of the Indian Human Rights organization PUCL (People’s Union for Civil Liberties) and is the recipient of the 2008 Jonathan Mann Global Health and Human Rights Award, was accused of transporting letters for a jailed Maoist leader who was under his medical care. Though the prosecution showed nothing but circumstantial evidence (better said, no evidence at all—all visits of Dr. Sen with the prisoner were attended by prison guards, none of whom saw any letters, and two of whom were declared “hostile” by the court when they testified that it would have been impossible for such an exchange of letters to happen), the judge ruled—using as the Lancet editorial (see below) notes “a section of the penal code first introduced by the British to quell political dissent and later used to convict Mahatma Gandhi”—that Dr. Binayak Sen is guilty of “sedition.”

Outrage at such treatment of a man many consider mentor, hero and teacher resounds globally in journals such as the Lancet (Lancet 377:98 on 8 January 2011, “Binayak Sen’s Conviction: A Mockery of Justice”) and British Medical Journal (BMJ 2010; 341:c7438 “Civil rights groups decry conviction of Indian paediatrician who pioneered community health”) and within the press in India.

See: Facts about the Dr Binayak Sen case – The Times of India http://timesofindia.indiatimes.co. m/india/Facts-about-the-Dr-Binayak-Sen-case/articleshow/7125220.cms#ixzz1AbSIjDmn

Physicians for Human Rights (PHR) has called for Dr. Binayak Sen’s release.          http://physiciansforhumanrights.org/library/news-2008-05-20.html

Dr. Binayak Sen has worked for many decades with the poorest of the poor. He is well known as an advocate for health and social justice, an outspoken critic of police brutality. Apparently, his effectiveness is such that the Indian Government feels the need to silence him.

Go to http://www.binayaksen.net/ to learn more about the intricacies of the case and the condemnation of the court ruling, including a recent article concerning Nobel Laureate Amartaya Sen in the Times of India, in which he is quoted as saying: as an Indian citizen and a human being, I must exercise my own judgment to ask if this is correct. Sedition means pulling the state down by violence. It cannot be suggested that Binayak did this. On the contrary, his writing indicates violence is wrong. There is a deep moral argument against sedition here [in Binayak Sen’s book]. Amartaya Sen goes on to say of the ruling against Binayak Sen: It has a threatening nature and seems to have political motivation. Any intelligent person would find that the judiciary acted very peculiarly. I hope the high court or Supreme Court quashes this.

Dr. Binayak Sen is a member of Jan Swasthya Abhiyan, the PHM (People’s Health Movement) India. He has touched the lives of many—and this is perhaps considered his greatest crime, the crime of being a positive example.

Dr. Binayak Sen was first arrested in 2007. Though he has severe cardiac disease, he was kept without adequate treatment for two years—until an international campaign, including several Nobel laureates, achieved his provisional release on bail.

When a government punishes work dedicated toward health and social justice, it is making a statement that is global in nature. Its action must then be denounced globally. Please consider acting now in solidarity with Dr. Binayak Sen. Address the government of India with its own shame, by signing the petition directed to The President of India, Rashtrapati Bhavan: http://www.petitiononline.com/sen2010/petition.html

Consider expressing in print your disappointment that this sentence, egregious and wrong, has happened. Inquire into the health, not just of Dr. Binayak Sen, but of the patients who he has not been and will not be able to attend to because of his sentence. Demand that, in the name of justice, as well as health, the sentence be refuted (still legally possible by the Supreme Court of India) and his work instead granted the affirmation it deserves.

Please share what is happening to Dr. Binayak Sen with colleagues, local community members and your own government representatives, no matter where you live. Consider writing to him yourself, to express your solidarity and your appreciation of his example.

Sydney Principles: Reducing Commercial Promotion of Foods and Beverages to Children

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Following our posting last week regarding the American Academy of Pediatrics and Baby Formula, our friend Claudio Schuftan emailed us about an initiative by the International Obesity Task Force to reduce the commercial promotion of foods and beverages to children.

In 2006, the IOTF elaborated a draft set of principles to address this issue, called the Sydney Principles. These were subjected to public criticism and a revised, final set of principles was adopted in 2007. The final principles are available on the IOTF website and were published in article from in Public Health Nutrition in May of 2008. Since this article cannot be downloaded for free, you may want to write the lead author, Boyd Swinburn, for a reprint. These principles were developed in collaboration with the WHO Collaborating Centre for Obesity Prevention.

Here are the seven principles:

The Sydney Principles

Actions to reduce commercial promotions to children should:

1. SUPPORT THE RIGHTS OF CHILDREN.

Regulations need to align with and support the United Nations Convention on the Rights of the Child and the Rome Declaration on World Food Security which endorse the rights of children to adequate, safe and nutritious food.

2. AFFORD SUBSTANTIAL PROTECTION TO CHILDREN.

Children are particularly vulnerable to commercial exploitation, and regulations need to be sufficiently powerful to provide them with a high level of protection. Child protection is the responsibility of every section of society – parents, governments, civil society, and the private sector.

3. BE STATUTORY IN NATURE.

Only legally-enforceable regulations have sufficient authority to ensure a high level of protection for children from targeted marketing and the negative impact that this has on their diets. Industry self-regulation is not designed to achieve this goal.

4. TAKE A WIDE DEFINITION OF COMMERCIAL PROMOTIONS.

Regulations need to encompass all types of commercial targeting of children (e.g. television advertising, print, sponsorships, competitions, loyalty schemes, product placements, relationship marketing, Internet) and be sufficiently flexible to include new marketing methods as they develop.

5. GUARANTEE COMMERCIAL-FREE CHILDHOOD SETTINGS. Regulations need to ensure that childhood settings such as schools, child care, and early childhood education facilities are free from commercial promotions that specifically target children.

6. INCLUDE CROSS BORDER MEDIA.

International agreements need to regulate cross-border media such as Internet, satellite and cable television, and free-to-air television broadcast from neighbouring countries.

7. BE EVALUATED, MONITORED AND ENFORCED.

The regulations need to be evaluated to ensure the expected effects are achieved, independently monitored to ensure compliance, and fully enforced.

Some thoughts:

It is interesting to use these principles as a benchmark to see how far commercial promotion to children has penetrated our society, particularly into the commercial-free childhood settings mentioned in the principles.

In 2003, New York City signed an agreement with Snapple Beverages, making Snapple “the exclusive provider via vending machines of water and fruit juices in the City’s 1,200 schools” and New York City’s official beverage. One wonders why New York City needed an official beverage. In addition:

As a part of its commitment to schools, Snapple has entered into a five-year agreement to exclusively vend bottled spring water and 100 per cent juices in all schools. Snapple, in cooperation with the Department of Education, will develop new products that meet the City’s strict nutrition guidelines. Snapple’s new product line ‘100% Juiced!’ will include four flavors, Green Apple, Orange Mango, Grape and Fruit Punch, with Vitamins A, C, D and Calcium.

I suppose this is an attempt to show that Snapple is promoting nutrition. But bottled water is not necessarily safer than public water, it is more expensive than tap water, and is much less ecologicaly friendly. Many of us feel that juice drinking is part of the obesity problem, not part of its solution. In short, this type of marketing gives a stamp of nutritional approval to corporate-friendly diets. When kids are thirsty, shouldn’t they be going to the drinking fountain?

And, of course, there is the promotion of food to children in healthcare settings. Perhaps the extreme form of this has been the placing of McDonald’s Restaurants in New York City Hospitals.

For background to this issue, the IOTF webpage offers several detailed reports.

Posted by Matt Anderson

Social Pediatrics at Montefiore

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The Residency Program in Social Pediatrics began at Montefiore in 1970. Our program is designed to train pediatricians who are interested in practicing medicine within underserved, disadvantaged communities. Since its inception the residency program has trained over 150 pediatricians, many who have gone on to leadership positions as advocates for impoverished children and families. Our residents are trained alongside residents in Montefiore’s categorical residency program¹. Inpatient training takes place within the Children’s Hospital at Montefiore. In addition to traditional didactics, residents in Social Pediatrics receive extensive training in the biopsychosocial aspects of medical care. They are exposed to a multi-disciplinary core curriculum, which includes training in:

• Family Dynamics and Intervention
• Advocacy & Community Organizing
• Clinical Research & Evidence Based Medicine
• Social Epidemiology
• Community Based Participatory Research
• Medical-Legal Advocacy
• Health Systems & Policy

Ambulatory education and clinical experience occurs at the Montefiore Comprehensive Health Care Center (CHCC) a federally-funded community health center located on 161^st street in the South Bronx, just a few blocks away from the world-famous, Yankee Stadium. CHCC is located in the 16^th congressional district–the poorest congressional district in the United States. The clinic serves more than 12,000 patients who make more than 71,000 visits annually and offers a variety of medical and ancillary services, such as medical, OB-GYN, dental, nutrition, health education, social work and WIC. Social Pediatrics is a three-year training program leading to board eligibility in pediatrics.

Intern Year

The main focus of the first year of social pediatrics training is the development of a strong general pediatric knowledge base and the advancement of inpatient skills. The intern year bears a a close resemblance to the first year of training in the categorical pediatrics program. For example, like the categorical residents, you spend one afternoon session a week in your ambulatory clinic at CHCC. However, there are important differences. One is that in the fall notable exception is:

Each social pediatrics intern attends a month-long intensive orientation to social medicine with the interns from Family Medicine and Social Internal Medicine. During this call-free month, you will be exposed to basic principles in social medicine, connect with the Bronx community, and begin to explore important issues that impact the health of this community. In addition, throughout the year interns attend the weekly social pediatrics rounds, schedule permitting, as described below.

Second and Third Years

In addition to the refinement of inpatient skills, the second and third year of the social pediatrics residency continues with an increased focus on ambulatory and community pediatrics. In the second and third years of training, At the beginning of the second year each social pediatric resident is paired with another social pediatric resident from the same year. The partners share a continuity panel and inpatient responsibilities. This allows residents to spend more time in the ambulatory setting, and continue quality inpatient training. Each pair divides call responsibility between themselves. Residents also participate in a school health rotation during the second and third years. During this rotation residents provide primary care services in a school- based health care center, interact with a community health team, learn to advocate for children in a school-based setting and learn the legal and political issues involving school-based health centers.

The social pediatrics’ schedule differs from the categorical schedule as it includes 3.5 blocks of full time clinic each year. There is also one call free elective during both second and third year.

In addition to clinical responsibilities, social pediatrics interns and residents are required to participate in community-related research, education, and advocacy activities.

Specific Program Components:

In addition to clinical responsibilities, social pediatrics interns and residents participate in a comprehensive core curriculum designed to provide instruction in the fundamentals of community-centered research, advocacy and epidemiology.

Social Pediatrics Rounds: This core conference is held weekly providing residents with on going exposure to important social pediatric-related topics such as foster care, cultural competency, homelessness, community organizing, domestic violence and health literacy.

Social Pediatrics Curriculum: During second and third year residents are given the opportunity to participate in varied curricular activities including research methods and design, social epidemiology, medical legal advocacy, medical Spanish, journal club, policy rounds and board review.

Social Pediatrics Project: Residents are required to complete a social medicine project during their three years in residency. These projects will provide practical hands-on community pediatrics experience.

Faculty

Peter Sherman, MD
Director, Residency Training Program in Social Pediatrics

David K. Appel, MD
Executive Director, School Health Program

Sandra Braganza, MD, MPH
Faculty, Residency Training Program in Social Pediatrics

Neal Hoffman, MD
Faculty, School Health Program

Natalie Langston-Davis, MD, MPH

Faculty, Residency Program in Social Pediatrics

Theresa Pinili-Ozuah, MD
Faculty, Residency Training Program in Social Pediatrics

Andrea Rich, MD
Medical Director, Comprehensive Health Care Center

Jennifer Rich, MD
Faculty, Residency Training Program in Social Pediatrics

Iman Sharif, MD, MPH
Associate Director, Residency Training Program in Social Pediatrics

Charles Strouthides, MD
Faculty, Residency Training Program in Social Pediatrics

Graduates

Many graduates of social pediatrics continue to fulfill their training mandate by practicing in inner city health centers, community hospitals and large, urban medical centers. Several of them serve as health policy makers, health administrators, and leaders in community medicine. Some help underserved children in rural health facilities. Others put their social pediatrics training to use in subspecialties, where there is often a need for a novel community-oriented approach.

Alumnae of the Residency Program in Social Pediatrics include:

Philip Ozuah, MD, PHD Chairman, Department of Pediatrics, Albert Einstein College of Medicine & Children’s Hospital at Montefiore

Jo Ivey Boufford, MD President, New York Academy of Medicine

David Appel, MD Director, Montefiore School Health Program

Andrew Goodman, MD Associate Commissioner, New York Department of Health

Steven Shevlov, MD Chairman, Pediatrics, Maimonides Medical Center

Sharon Joseph, MD Medical Director, New York Children’s Health Project-Children’s Health Fund

Research and Advocacy

Social Pediatrics residents and faculty have contributed significantly to scholarly dissemination and clinical research. Our department participates in several national and regional meetings each year including meetings of the American Academy of Pediatrics, the Association of American Medical Colleges, the Ambulatory Pediatric Association and the American Public Health Association. In addition, residents and faculty participate in local advocacy projects for the betterment of the community we directly serve.

Recent scholarly activities, research, presentations and publications of social pediatrics residents & faculty (resident names in bold):

Harris JC, Giddy J, Thomas M. QI: HIV Testing of the children of adult patients in an HIV treatment program. Presented at the Pediatric Academic Societies, Toronto, Canada, May 2007. Presented at the Eastern Society for Pediatric Research, Philadelphia, PA, March 2007.

Harris J, O’Connor K, Sharif I. Legal needs assessment of families accessing care at an inner-city community health center. Presented at the Pediatric Academic Societies, Toronto, Canada, May 2007. Presented at the Eastern Society for Pediatric Research, Philadelphia, PA, March 2007.

Langston-Davis N, Perez-Rivera B, Sarmiento A, Santana I. Impact of an electronic health record on the promotion of NIH asthma guidelines in the primary care setting. Presented at the American Public Health Association, Washington, DC, November 2007.

Scharbach K, Sharif I, Skae C. Resident knowledge and comfort with pediatric pain management. Presented at the Pediatric Academic Societies, Toronto, Canada, May 2007. Presented at the Eastern Society for Pediatric Research, Philadelphia, PA, March 2007.

Sharif I, Wills TA, Sargent JD. Does television viewing during middle-school lead to poorer school performance? Presented at the Pediatric Academic Societies, Toronto, Canada, May 2007. Presented at the Eastern Society for Pediatric Research, Philadelphia, PA, March 2007.

Tesher M, Siegel S, Sharif I, Campbell D. Resident knowledge and confidence about breastfeeding in a poor urban community. Presented at the Pediatric Academic Societies, Toronto, Canada, May 2007. Presented at the Eastern Society for Pediatric Research, Philadelphia, PA, March 2007.

Sherman PA, Rice A. Domestic violence and the family, In RA Hoekelman, ML Weitzman, HA Adam, NM Nelson, MH Wilson, eds. Primary Pediatric Care, 5th Edition. St. Louis: In Press.

Sherman PA, Pezzullo R. Homelessness and the family, In RA Hoekelman, ML Weitzman, HA Adam, NM Nelson, MH Wilson, eds. Primary Pediatric Care, 5th Edition. St. Louis: Mosby, In Press.

Sherman P, Cahill L. Sexual abuse in children in the context of domestic violence. Pediatrics in Review. American Academy of Pediatrics. 2006; 27: 339-345.

¹NOTE: Social Pediatrics is not listed separately in the Directory of Residency Training Programs, but it does have a separate matching number (listed under Montefiore programs match number 315332O