Category Archives: General Health

U-Sniff Test

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I remember back to college chemistry when one of my professors pondered what type of person would purposely delve into sulfur-related research. Similarly, I have wondered how some of my colleagues can put their nose right in the middle of a heavy-soiled diaper and use their olfactory sense to narrow the differential diagnosis.

Now, more research involving the olfactory sense has been published: “The development of an international odor identification test for children: the Universal Sniff Test” also called the U-Sniff test (VA Schriever et al. J Pediatr 2018; 198: 265-72) and fortunately it does not involve any offensive odors.

This multicenter (19 countries) with 1760 children age 5-7 years, validated the U-sniff with twelve odors.  Key finding: The U-Sniff “enabled discrimination between normoosmia and children with congenital anosmia with a sensitivity of 100% and specificity of 86%.”

Specific odors that are part of U-Sniff: lemon, banana, coffee, flower, strawberry, fish, cut grass, orange, onion, butter, apple, peach, chocolate, tomato, cheese, biscuit, and honey.

EMR Learning Curve -Long-term Benefits & Burnout Narrative

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  1. Electronic Health Records Associated With Lower Hospital Mortality After Systems Have Time To Mature
  2. Beyond Burnout Moving narrative on the issue of burnout (JAMA link from 33mail -Bryan Vartabedian)

Related blog posts on EMRs:

Related blog posts on burnout:

Common Sense Media Web Site

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“Common sense is not so common.” Voltaire,, Dictionnaire Philosophique 1764

A website that I learned about recently from the Journal of Pediatrics article, “The Elephant in the Examination Room: Addressing Parent and Child Mobile Device Use as a Teachable Moment:”  commonsensemedia.org

“Common Sense is the nation’s leading nonprofit organization dedicated to improving the lives of kids and families by providing the trustworthy information, education, and independent voice they need to thrive in the 21st century.”
This website has extensive resources for families regarding all forms of media.  This includes advice on apps, age for using smartphones, encouragement for device-free dinners, movie/TV reviews and more.
The AAP also has a media use plan tool: www.healthychildren.org/mediauseplan based on children’s ages.

Dietary Patterns in First Year of Life May Increase Risk of Celiac Autoimmunity

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M Barroso et al. Gastroenterol 2018; 154: 2087-96.

Background: “Western-like diets –mainly characterized by high intake of red and processed meats, refined grains, simple sugars, and saturated fats and low intake of fruits, vegetables, and whole grains– have been associated with low-grade chronic inflammation, which is involved in the etiology of inflammatory conditions.” Ref: Br J Nutr 2015; 114: 999-1012.

To examine how diet may influence the development of celiac autoimmunity, defined by TG2A positivity, the authors examined a subset of patients (n=1997) from the prospective Generation R study (Netherlands); 27 in this cohort developed celiac autoimmunity (1.4%).

Key finding:

  • Higher adherence to a “prudent” diet which had a higher intake of vegetables, vegetable oils, pasta, and grains and low consumption of refined cereals and sweet beverages at 1 year of age was associated with a lower odds of celiac autoimmunity at 6 years of age with an odds ratio of 0.67.

This study is limited by the relatively low number who had celiac autoimmunity and by its use of a food questionnaire.

My take: This study indicates that diet plays a role in the development of celiac along with other disease, but this likely involves a complex mix of components rather than a single toxic agent.

Related blog posts:

Digital Media Exposure and Well-Being

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Two studies show that increased digital media exposure (DME) is inversely related to a child’s well-being.

In the first study (S Ruest et al. J Pediatr 2018; 197: 268-74), the authors analyzed more than 64,000 U.S. children (2011-2012). ages 6-17 years.  Only 31% reported <2 hours per day of DME.  2-4 hrs/day of DME was noted in 36%, 4-6 hrs/day in 17%, and >6 hrs in 17%.  There was an inverse relationship between DME and 5 markers of well-being: completing homework, caring about academics, finishing tasks, staying calm when challenged, and showing interest in learning.

In the second study (P-Y Pin et al. J Pediatr 2018; 197: 262-7), the authors conducted a 1 year prospective trial with 1861 adolescents.  They found that 23% had internet addiction at baseline, with internet addiction based on the Chen Internet Addiction Scale. 59 students (3.9%) developed new self-harm/suicidal behaviors.  Internet addiction risk conferred a 2.41 relative risk of emerging self-harm/suicidal behaviors.

My take: These studies document a strong association between digital media exposure/internet addiction and worrisome behaviors/worsened well-being.

Pine Mountain Trail

Not Preparing for the Next Pandemic

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A terrific commentary (Bill Gates, NEJM 2018; 378: 2057-60) explains how we are NOT preparing for the next pandemic and what we should be doing and why.

Key points:

  • There has been incredible progress in many areas of global health and infectious diseases.  In fact, “child mortality has decreased by more than 50% since 1990.”  HIV is no longer “a certain death sentence” and there has been progress with malaria.
  • Yet, “there is a significant probability that a large and lethal modern-day pandemic will occur in our lifetime.”  Some recent events have alerted us to this risk, including swine flu in 2009, Ebola in 2014 as well as recent MERS (Middle East respiratory syndrome) and SARS (severe acute respiratory syndrome).
  • “We need better tools, an early detection system, and a global response system.”
  • “A simulation by the Institute for Disease Modeling shows what would happen if a highly contagious and lethal airborne pathogen, like the 1918 influenza, were to appear today.  Nearly 33 million people worldwide would die in just 6 months.” (see below)
  • Vaccine development holds some promise to protect against many pathogens.  One step to help with vaccines has been a public-private venture, Coalition for Epidemic Preparedness Innovations (CEPI).
  • Vaccines alone are not enough as they take time to stimulate immunity and often not enough people receive them.  “So we need to invest in other approaches, such as antiviral drugs and antibody therapies that can be stockpiled.”

My take (borrowed): “”If it were a military weapon [threat], the response would be to de everything possible to develop countermeasures.  In the case of biologic threats, that sense of urgency is lacking.  But the world needs to prepare for pandemics in the same serious way.”