Exposure to Dogs and Cats in the First Year of Life and Risk of Allergic Sensitization at 6 to 7 Years of Age

This study got big news today.  I jsut finished reading it.  HArd to know how to interpret it.  Take home messages for me:

  • Kids with one pet were just as likely to have allergies as kids with none
  • Kids with two pets did have fewer allergies
    • But
      • The kids in the study had pets when they were under 1 year of age
      • The kids were white and middle-class
      • Measured outcomes were at ~ 7 years of age.  No way to know what will happen after this age.
    • Soo
      • Don't go buy a pet.  Gotta buy two (!!)
      • Don't buy two based on this study alone.
        • Especially if the kid(s) are (is) no longer an infant

Studies like this are INTERESTTING .. but shouldn't really alter what we do.  Certainly, more research is needed.  The authors of the study proposed a mechansm for the findings .. but it's quite unclear WHY these findings demonstrated what they did .. or whether we can generalize the findings at all.

 

Anti-vaccination

Back from vacation .. with some catching up to do. 1st info tidbit is a reflection on the anti-vaccination movement .. looking back to the 1800's.  An interesting perspective on what we no know is an age-old dilemma.   Vaccinations are good.. No doubt about it.  But they can be bad too.  Cay you say "rotavirus?" .. all of this is amid a recent study that demonstrated that autistic kids were more likely to have an antibody to MMR.   As we all remember from statistics class .. correlation does not mean causality .. but this study does need to be understood fully before we all either discount it or accept it.  Will have to go to the library .. as I can't get the full text on-line.

 

Vacation

A picture named indlake.jpgI'll be on vacation for a week in Indian Lake, New York.  On an Island.  2 dogs, 2 kids.  No internet, pager or cellphone.  Agony/heaven.

medpundit

From the Weblog Directory EatonWeb, I found another medical Weblog today .. Medpundit.  Written by another family physician .. but she's using "not her real name."  I'm not sure why she thinks this is necessary.  My patients find this all of the time .. they seem to like it.  Indeed, the weblog a way for me to share patient information and interesting medical information with my patients.

Makes me more transparent to my patients .. which I think is OK.  I'm a human too.  The paternalistic separation of physicians from "real people" serves to distance us from those we serve .. and yet they have invited us into the most intimate, meaningful parts of their lives.   It's not too much, I think, to reveal our public commentary to them.

Hospital Infections Increasing

Last week, Tim e-mailed me about his posting on hospital infections.  It took me a while to listen to the show on Fresh Air that he was talking about.  This is complicated stuff that goes way back to Semmelweis .. and even the CDC has compelling tales to tell about this man who died before anyone could say "oops, you were right" and how relevant such tales remain today.

Hospital infections do seem to rise, but I'm not sure that there is one clear reason for it.  A few observations:

a) Patients in hospitals are sicker now than they ever have been.  This is a confounding variable that I'm not sure that Michael Berens (who was featured in the Fresh Air story) accounted for.  (His articles appear in the Chicago Tribune .. but it costs $$ to see them.)  

 We're doing a BETTER job in haircare in general.  No kidding.  Patients leave the hospital much sooner, and we are able to keep many patients OUT of the hospital altogether .. by managing their illness at home with the help of visiting nurses and/or frequent visits to (or from!) the physician.  So as the proportion of very ill patients to not-so-ill patients int he hospital increases, their susceptibility to infection increases dramatically.  Indeed, it is the very ill patients who are more likely to be the sources of resistant organisms.

b) Berens is right, however, that nurses are spread awfully thin in the hospital, and that people with much less training are doing work previously done by nurses.   The nurse of today cares for double the caseload of a nurse from 1975 … and we've done little to make the job easier with information technology. 

But hospitals aren't necessarily the villains here either.  Losing money is a tradition for most hospitals .. especially academic centers .. as the payers squeeze every last dollar out of the hospitals. 

c) Hand-washing can certainly increase, but there are other obstacles to infection control as well.  Our stethoscopes carry potentially dangerous organisms from patient-to-patient.  Yet no one has come up with a good method of cleaning them between patients (hmm .. the stethy-condom .. now there's a million-dollar idea!) ..

I don't want to come off as saying that Berens is blowing this all out of proportion .. but I will say that it's been over a year since a patient I've cared for in the hospital has become infected while they were an inpatient.  The nursing shortages are palpable and annoying, but I have not seen patient care significantly impacted.  The nurses I work with are dedicated and passionate about their work.  Do they make mistakes?  Of course they do .. as do all humans .. but I think that blaming the increase in infections on the structure of nursing care in hospitals is too simplistic. 

d) Finally, of course, is a reminder that antibiotics are overused.  If there was one smoking gun to the increasing rate of infections in hospitals, I would argue that it is over-treatment …both inpatient and outpatient … of infections that would likely respond to narrower-spectrum agents.