#Sinus Infection in Children

Acute Sinus Infection

A report by Caballero and colleagues in JAMA published July 25, 2023 reviewed research on acute bacterial sinusitis in children. This blog is based partially on that article.

Most upper respiratory infections in children are due to a virus and go away without an antibiotic. Symptomatic treatment is all that is needed. Only about “7.5% of upper respiratory infections are complicated by acute bacterial sinusitis.”

Bacterial sinusitis is suspected based on the “duration and severity of the symptoms.” So, it is mainly a clinical decision and normally does not involve testing.

For years it was thought that bacterial sinusitis should be considered if a nasal discharge is colored yellow or brown rather than clear. Recent research shows that the color does not predict a response to antibiotics.

Interestingly, research has also shown that “most cases of acute bacterial sinusitis do not require an antibiotic.” Typically, even bacterial infections show limited benefit from taking an antibiotic. They usually reduce the duration of the infection only by two days (7 days rather than 10). Symptoms also show only modest improvement with antibiotics.

It is also important to recognize potential side-effects from the use of antibiotics. There is a “two-fold risk of diarrhea.” Allergic reactions may occur, and the risk of bacterial resistance to the antibiotic will reduce its efficacy during future use. Given the minimal benefit from antibiotics, the added cost is another reason to limit its use except in more serious cases.

Finally, it is worth knowing that obtaining bacterial cultures is often not helpful. That is because the bacteria that can cause sinus infections are often found in the nose when there is no infection. This is called “colonization.” Also, the test can pick up “antigenic or genetic material” from a bacteria that was causing an infection but has cleared up.

The bottom line is that acute sinusitis in children is due to a virus most of the time. Antibiotics are not helpful. Only symptomatic treatment is indicated.

Even when the infection is due to a bacteria, antibiotics are usually not needed and should be reserved only for more serious infections.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

What would you change about modern society?

Angry arguements

Divisiveness. Our two largest political parties find it overly challenging to compromise on important issues, which leads to gridlock.

Disagreements on the internet too often erupt into name calling and threats. Cancel culture is now a thing.

Two modern philosophers have addressed this animosity and suggested that we adopt “epistemic humility.” That means we should be more humble about our claims and be more open to listening to one another.

I don’t think that means that we have to always change what we think, but we should be open to the possibility that our views on a given topic may not be as informed as we thought.

I am open to changing my mind about this. 🤔

Outdoor Work in the Heat

Working in the Heat

The U.S. Department of Labor has provided recommendations about fluid intake when working outdoors in the heat of summer. This is timely because of the heat wave in many parts of the country this summer.

The Department focused on what employers should do to limit the risk of dehydration among employees working in the heat. They point out that “proper hydration is essential to prevent heat related illness.”

Employers are urged to “provide cool water for workers to drink.” They state, “for short jobs, cool potable water is sufficient; workers should be encouraged to drink at least one cup (8 ounces) of water every 20 minutes while working in the heat not just when they are thirsty.”

If an employee is working for more than 2 hours in the heat, they should be provided “electrolyte-containing beverages such as sports drinks.” This is because “workers lose salt and other electrolytes when they sweat.”

Otherwise, they may “develop muscle cramps and other dangerous health problems.” Also, workers should take a break every hour, ideally in the shade.

Although the Department of Labor’s recommendations apply to responsibilities employers have for their employees who work in hot environments, this advice is relevant to anyone doing outside work in the heat. An example would be someone working on their own property.

#Non-Suicidal #Self-Injury

Depressed Teen

Some adolescents deal with negative emotions by causing injury to their body without intending to kill themselves. An example would be delicate, superficial self-cutting of a forearm or a leg.

This behavior is called Non-Suicidal Self-Injury (NSSI). About 3-7% of teens do this in an attempt to manage emotions that seem overpowering. Unfortunately, it is risky and does not provide long-term relief.

Therapists have developed a form of treatment that teaches these teens a safer and more adaptive way to deal with overwhelming emotions. It is called Emotion Regulation Therapy (ERT), which can be used in group therapy or for an individual.

Researchers in Sweden wanted to find out if a version of this therapy could be provided on the internet with oversight by a trained therapist. This therapy was added to standard care that the adolescents were also receiving.

Half of the teens had on-line Emotion Regulation Therapy plus standard care, and the other half only had standard care. Treatment was provided for 12 weeks.

The group who received ERT along with standard treatment had fewer episodes of NSSI than the group who only received standard treatment. These results suggest that an internet-based ERT treatment overseen by a trained therapist could be a cost-effective treatment for NSSI in teens with depression and/or anxiety.

Regardless, a teenager with NSSI would benefit from the addition of ERT therapy approaches designed to teach them less risky and more adaptive ways to manage strong negative emotions.

This blog was based on a research article by Bjureberg and colleagues in JAMA Network 2023; 6(7). To access the article use this doi:10.1001/jamanetworkopen.2023.22069

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Sugar Substitutes & #Weight Control

Sugar and Non-sugar Substitutes

The WHO states that regular use of these products may actually increase the risk of cardiovascular diseases, type 2 diabetes, and death.

More people worldwide are using sugar substitutes to control their weight or to manage non-infectious diseases. The World Health Organization (WHO) has released a warning against the use of these products.

The WHO director of nutrition and food safety stated that non-sugar sweeteners “are not essential dietary factors and have no nutritional value.”

Consuming too much sugar does contribute to obesity, which is linked with several diseases that are leading causes of death. Many people are aware of this and turn to sugar substitutes, which have few, if any, calories.

Unfortunately, it is unclear if their use actually aids weight loss. What the evidence does support is that they are associated with increased risk for various chronic diseases.

A review of 283 research studies by the WHO found that short term use (less than 3 months) of sugar substitutes – such as aspartame, saccharine, stevia, and sucralose – was associated with lower weight and body mass. However, using them for 6 to 18 months did not affect weight. Thus, there may be some weight loss over a 3 month period but use beyond that did not show a benefit.

In fact, studies showed that higher use of non-sugar sweeteners for up to a decade were associated with an increased risk of obesity, cardiovascular disease, stroke, and mortality.

Although the WHO has provided recommendations to avoid sugar substitutes and to minimize the use of high sugar products, they do acknowledge that their recommendations should be considered to be provisional. That is because they don’t consider the evidence to be conclusive.

My suggestion is to limit your intake of sugar and its substitutes, especially in children. If you don’t grow up eating and drinking very sweet products, you won’t crave them as adults. It is likely that limiting sugar and sugar substitutes is best for your health.

[The majority of this content was from an article by Melissa Suran, PhD in the July 3, 2023 JAMA Volume 330, Number 1, pp 9-10]

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Authority on Critical Race Theory

On what subject(s) are you an authority?

Available on Amazon

On the culture front, I wrote a book, pictured above, about a serious problem in our culture, racism. One effort to deal with it is Critical Race Theory (CRT).

There have been claims that elements of CRT are being taught in K-12 education. Some proponents say that is not true, and that CRT is a complex theory taught mainly in law schools.

I wondered who was right. So, I investigated it carefully. At the urging of others, I turned my research into a book that is now available on Amazon.

My editor pointed out that this is a contentious topic so I needed to use abundant references, which I did. Most of what is written is borrowed from people with expertise in various elements within the topic.

The book covers the origins of CRT beginning with Critical Theory from Germany and postmodern philosophy from France. Certain law school professors applied the principles of Critical Theory (informed by postmodern philosophy) to racism in America.

Not to give away too much, but a careful review found that derivatives of CRT are being taught in K-12 schools. Of course, the complex theories are not taught at that level.

The book points out that implicit bias is real and can be studied. Common sense suggests that using it to help with racial problems in the workplace should be helpful. Alas, research shows that it is largely ineffective in improving matters and can make them worse.

It turns out that the largest teacher’s union in the U.S. strongly endorsed teaching CRT in K-12 schools. Learn more about it in the book.

The book concludes with some recommendations to improve race relations in the U.S. It is based on scientific findings.

Peter M. Hartmann, MD

Great Teachers

What makes a teacher great?

Teaching and Learning

Here are 9 qualities of a great teacher:

1. Show that you care about your students as people.

2. Know your subject matter in more depth than will be expected of your students. Thus, you can answer difficult questions they may have.

3. Project your confidence that your students are capable of learning the material.

4. Teach critical thinking. Do not insist that they agree with you but be able to defend their position.

5. Help students understand and can use what they learn and not merely memorize things.

6. Be fair.

7. Teach students how to learn by telling them about research-proven methods.

8. Be interesting.

9. Maintain classroom decorum.

Peter M. Hartmann, MD

Family Medicine & Psychiatry