Racial disparities in ear infection treatment may contribute to antibiotic overuse

Black children are less likely to be diagnosed with and less likely to receive broad-spectrum antibiotics for ear infections than white children are, a new study has found. But the discrepancy in prescribing fewer broad-spectrum antibiotics means black children actually are more likely to receive care that aligns with the recommended guidelines for treating ear infections.

Two explanations for the observed disparities in care are overtreatment and overdiagnosis in white children, and undertreatment and underdiagnosis in black children. Addressing behaviors that contribute to these findings may cut down on differential care and antibiotic overuse, both significant public health concerns.

Led by researchers at the University of Utah, Emory University, and the Centers for Disease Control and Prevention (CDC), the study appears online in Pediatrics.

“These findings raise the possibility that physicians bring with them to the exam room cultural and racial biases that influence how they make a diagnosis and prescribe antibiotics,” says senior author Adam Hersh, M.D., Ph.D., assistant professor of pediatrics at the University of Utah School of Medicine.

Examination of medical records from across the nation shows that when children were brought to the doctor for upper respiratory infections that commonly lead to ear infections, 30 percent fewer black children (African-American and other black racial backgrounds) were diagnosed with ear infections compared to other children (95 percent white, 5 percent of other non-black racial backgrounds). Once diagnosed with an ear infection, black children were 20 percent less likely to receive a prescription for broad-spectrum antibiotics.

The results indicate that, whether intentional or not, black children are more likely to receive care that aligns with current ear infection treatment guidelines, which specifically recommend a prescription of narrow-spectrum antibiotics, rather than broad-spectrum antibiotics, as first-line treatment. What’s more, fewer ear infection diagnoses among black children suggest that in some cases, ear infections may be overdiagnosed in other children.

“These findings may indicate racial differences in the diagnosis of otitis media,” says first author Katherine Fleming-Dutra, M.D., pediatric emergency fellow at Emory University and Children’s Healthcare of Atlanta. “Additionally they may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children.”

Guidelines for treating ear infections have been updated in recent years in an effort to confront antibiotic overuse. Ear infections can be difficult to accurately diagnose, and it can be hard to distinguish bacterial from viral infections. Physicians sometimes err on the side of prescribing antibiotics when the diagnosis is uncertain, even though they are ineffective against viral infections. Overprescribing antibiotics, and unnecessary use of broad-spectrum antibiotics, can lead to adverse side effects such as severe diarrhea, and development of antibiotic-resistant bacteria.

“The use of antibiotics is the single most important driver of antibiotic resistance. Further, ear infections lead to more antibiotic prescriptions in the United States than any other diagnosis,” says co-author Lauri Hicks, D.O., medical director of Center for Disease Control’s Get Smart: Know When Antibiotics Work program. “By increasing our knowledge base about antibiotic prescribing behaviors, we can develop tools and interventions to improve antibiotic prescribing.”

The results were derived from a sample of 15,694 doctor visits for respiratory infections and 4,178 visits for ear infections made by children age 14 years and younger between the years 2008 to 2010. The samples extrapolate to a national estimate of 23.5 million, and 6.4 million annual visits, respectively.

Though not directly addressed by the study, one explanation for disparities in treatment are biases toward children and families of different races. “Overtreatment and overdiagnosis could result from the possibility that in some circumstances, parents may expect an antibiotic prescription, or physicians may perceive that they do,” says Hersh. “Physicians may tailor their diagnosis based on these perceptions of patient expectations.”

Another explanation, underdiagnosis of ear infection and undertreatment with broad-spectrum antibiotics, could result from a number of factors including differences in how frequently parents of black children seek care for their children with respiratory infections, or return for follow-up visits. Racial differences in the reported rate of medication allergies could also influence the choice of antibiotics.

The authors found that equal proportions of black children and children of other races made visits to the doctor for respiratory infections, suggesting that lower rates of ear infection diagnoses in black children are not the result of decreased access to care. But limitations to the analysis include an inability to determine whether the visits were first or follow-up visits, and whether patients had allergies, both of which could impact treatment.

“It is important to understand why certain children are not getting guideline-recommended antibiotics so that we can focus public health efforts to help providers improve their diagnosis and selection of antibiotics for children with otitis media,” says Fleming-Dutra.

http://www.medicalnewstoday.com/releases/285552.php

 

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Women’s finer sense of smell may be due to more brain cells

w research shows that women have more cells in the olfactory bulb – the area of the brain that is dedicated to sense of smell – than men. The authors of the study – published in PLOS ONE – suggest this may explain why women are reported to have a better sense of smell than men.

 

The study was led by a team from the Federal University of Rio de Janeiro in Brazil, where another group of researchers had developed the “isotropic fractionator” – a fast and reliable method of measuring the number of cells in a given brain region such as the olfactory bulb.

The olfactory bulb is the first region of the brain to receive signals about odors sensed via the nostrils. The ability to discriminate among odors and scents varies widely among individuals. Also, studies show marked differences between men and women, with women often outperforming men in many kinds of odor-sensing tests.

There are theories that sex differences in smell are due to cognitive and emotional influences rather than perceptual ability.

Previous studies that have looked for biological explanations for women’s apparent superior sense of smell have used brain scans to look for structural and volume differences. These have led to mixed results and left many questions still unanswered.

So Roberto Lent, a professor in the Institute of Biomedical Sciences at Rio’s Federal University, and colleagues set out to measure the biological evidence more directly – by counting the number of cells in women’s and men’s olfactory bulbs.

To this end they examined post-mortem brains from seven men and 11 women who were all healthy and aged over 55 when they died. None of the subjects had worked in jobs that required them to have exceptional sense of smell such as cookery or coffee-tasting.

Study found women’s brains have up to 50% more olfactory neurons

Using the isotropic fractionator, the team calculated the number of cells in the olfactory bulbs of these individuals and found that, on average, the women had 43% more cells in this brain region than the men. When they included only neurons in the count – that is leaving out other cells like glial or structural cells – this figure went up to nearly 50%.

The authors acknowledge that just finding this difference is not enough to prove that women have a superior sense of smell – it is not even enough to explain the findings of previous studies about differences in ability to differentiate, identify and remember scents and odors. However, Prof. Lent suggests:

“Generally speaking, larger brains with larger numbers of neurons correlate with the functional complexity provided by these brains. Thus, it makes sense to think that more neurons in the female olfactory bulbs would provide women with higher olfactory sensitivity.”

Since the brain does not accumulate many more cells as we grow, it would seem that women are equipped with these extra olfactory cells from the day they are born.

There are still many questions to explore, including why women should have this ability hard-wired into their brains, and what mechanism produces this greater quantity of olfactory cells in the female brain.

One theory is that a superior sense of smell helps mother and child to bond after birth; another is it also influences females’ selection of potential mates.

In October 2012, Medical News Today learned of another PLOS ONE study from the University of Pennsylvania that suggested losing sense of smell could be an early sign of Parkinson’s or Alzheimer’s disease, or another neurodegenerative disorder.

Written by Catharine Paddock PhD

http://www.medicalnewstoday.com/articles/284991.php