rss

Recent eLetters

Displaying 1-10 letters out of 509 published

  1. Why to focus on men only? Hypertension is almost equally prevalent and equally pernicious for both genders.

    Dear Editor,

    I read with interest the article. However, it is hard to justify their conclusion as "Focusing on men, an intervention could be designed for lifestyle modification to curb the prevalence of hypertension".

    Firstly, it was not a study to study the role of risk factors for hypertension and prehypertension, secondly, why to focus on men only? As not much difference in the prevalence of non-normotension (for prehypertension 39% in men and 25% in women for hypertension 12.5% in men and 11.3% in women). Moreover, authors clearly mentioned in the paper " We hypothesised that observed sex differences in hypertension may be in part due to differences in risk factors, such as BMI, smoking, and physical activity. However, taking these factors into account had virtually no effect on the sex differences in hypertension. This suggests that the sex differences among young adults may be partly due to biological sex differences, but more research is needed to investigate other behavioural factors that may explain this early disparity".

    Yes, as reported earlier, the risk of the complications of arterial hypertension is greater in men than in women 1. Interestingly,in elderly groups; this difference between sexes is reduced, particularly the risk of cardiovascular complications, which is strikingly increased in women after menopause 2,3. In conclusion, my message is: prevention of hypertension is equally important for both genders.

    Reference:

    1. Messerli FH, Garavaglia GE, Schmieder RE, Sundgaard-Riise K, Nunez BD, Amodeo C. Disparate cardiovascular findings in men and women with essential hypertension. Ann Intern Med 1987; 107: 158-61.

    2. Nachtigall LE. Cardiovascular disease and hypertension in older women. Obstet Gynecol Clin North Am 1987; 14: 89-105.

    3. Rosenthal T, Oparil S. Hypertension in women. J Hum Hypertens 2000; 14: 691-704.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  2. Early Intervention to Prevent ARF and Prolonged Mechanical Ventilation

    To the Editor:

    Regarding the study of early intervention of patients at risk for acute respiratory failure and prolonged mechanical ventilation, I agree that a checklist, such as the PROOFCheck, aimed at the prevention of organ failure would be beneficial in lowering rates of mortality.

    The authors' report that often times the acuity and severity of patients' conditions often are not recognized in a timely manner. Rather than recognize and intervene with the signs and symptoms of ARF and acute organ failure on the general medical floors, health care works sometimes don't catch a patient spiraling downward until they are already moved to an intensive care unit. To my attest from working as a respiratory therapist, I have seen this countless times. As I am not sure of the stipulations of the six hospitals where this study is being conducted, I have witnessed many times that general floors are understaffed. The nursing to patient ratio is often times too low and therefore they cannot provide adequate care. In one of the facilities I was employed at, a general floor nurse could have as many as seven patients. Another problem I've seen is that while many of the critical care nurses are experienced nurses, a lot of the general floor nurses are new graduate nurses and therefore are still trying to learn as they go so may not have the knowledge or experience to spot a critical patient on the general floor and intervene or call the rapid response team in time before a patient gets worse.

    I commend the authors of this study for attempting to research whether or not an EMR-based alert system would be sufficient in preventing and recognizing ARF and acute organ failure. Both the APPROVE score and PROOFCheck, as well as a notification feature provided a patient may meet certain criteria for going into ARF all seem like they would be excellent tools for early detection and prevention.

    I thank you for your time and enjoyed reading the article, and I look forward to following up with the outcome of this study.

    Sincerely,

    Alexandria Erickson BAS Cardiopulmonary Science Student Physician Assistant - Nova Southeastern Fort Myers Fort Myers, FL ae633@nova.edu

    Read all letters published for this article

    Submit response
  3. To improve patients' uptake of diabetic retinopathy screening programme

    We read this article with great interest. We similarly aimed to explore barriers to patient engagement with diabetic retinopathy screening as part of a medical student service evaluation project. We explored reasons for non-attendance using a GP practice population that serves a large Asian community in Blackburn. We found that from June 2014 to June 2015, 81.2% (n=307) of the patients invited for screening attended and 18.8% (n=71) did not attend. We managed to conduct telephone interviews with 43 non-attenders to establish their understanding of screening and reasons for non-engagement. 33 (76.7%) patients who were interviewed cited other commitments, 3 (7%) did not recall receiving any invite letters, 3 (7%) were housebound, and the remaining 4 patients (9.3%) voiced a general lack of interest in attending medical appointments. Surprisingly, 23 (53.4%) patients were unaware of the need of attending screening appointments when visually asymptomatic and 8 (18.6%) stated that they did not believe that diabetes could damage eyes. As a result of these findings, we have now designed a patient information leaflet outlining the importance and rationale behind the diabetic retinopathy screening programme. This has now been adopted by the local CCG allowing GPs in the locality to provide these at the point of diagnosis and at routine diabetic review appointments to help promote uptake for the future. We plan to re-audit uptake rates following this intervention.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  4. Minor corrections in the conclusion section.

    My name is Damaris Kinyoki, I recently published with BMJ Open. Please note that the conclusion section of the article should be corrected to read as follows:

    Conclusion This study has demonstrated that wasting, stunting and underweight in children 6-59 months in Somalia share common risk factors with evidence of correlation in space (17,47). The emergency response funding is by nature short term. The spatial patterns and trends of wasting and stunting and information on seasonal variation, the age and gender of the child can be used to support effective interventions. Although emergency nutrition response in Somalia focuses on wasting, our evidence suggests implementation of a more joined-up program may be most effective. This will require political will, appropriate financing, policies and programmatic links between partners on the main indicators of malnutrition.

    Kind regards, Damaris

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  5. Some major error in the article

    A pooled SMD of 1.20 (95% CI 0.89 to 1.51; T2=0.27; I2=99%; p<0.00001) was observed (figure 3), equivalent to a prevalence of ?50% asymptomatic coronary stenosis of 32% (95% CI 19% to 47%).

    This paragraph mismatch the figure 3 in all numbers. Please correct it if possible.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  6. Good Concept ---- Design Issues

    The concept in this protocol is excellent. Cross country studies throw light on a emerging issue in HIV counselling, slowly becoming important over the globe.It is compounded by breaking of barriers socially. There are a few observations on the design issues in this protocol which if taken care of will bring out a nearly replicable results as impact research. These are 1) In such cross country results standardisation for cultural factors has to be taken care of.

    2) The impact being measured by seropositivity brings the necessity for training, quality control of kits including readers. 3. The protocol should incorporate data analysis plans in anticipation for outcomes

    4. There should be documentation of barriers and facilitating factors.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  7. Need for study in the reverse direction

    It would be interesting to know if any studies have been carried out in the reverse direction? That is, the effect of making complaints on those who have raised them. It would be useful to illuminate the stage at which the process becomes stressful, intimidating, perceived to be biased or untrustworthy; whether the process has been influenced by claims of being 'vexatious' and so on. Putting the two together would probably add to improving the process. But in truth the impact making or being the subject of a serious complaint on either 'side' is bound to cause a degree of distress as well as harm in many cases.

    Conflict of Interest:

    I have carried out work on complaints processes in the past but no competing interests

    Read all letters published for this article

    Submit response
  8. Re:Mood disturbance and depression in Arab women following hospitalisation from acute cardiac conditions: a cross-sectional study from Qatar

    Thank you so much for your comments on our report on the mood disturbance and depression in Arab women following hospitalisation from acute cardiac conditions. In this paper, we reported some findings from our cross-sectional study from Qatar in which we interviewed 1000 cardiovascular patients during their hospitalisation. After the first interview with these patients, we had also followed up with the 2nd and the 3rd interviews. We re-administered the survey questionnaires to these same patients by interviewing them face-to-face at the Cardiovascular Out- patient Clinic or by telephone when individual interview is not possible at two to four months and again at 12 months after discharge. In addition to conducting cross-sectional and longitudinal study, we had also conducted a qualitative study. Using a purposive sampling technique we conducted individual in-deep interviews with 34 health care providers (physicians, nurses, administrators, and others), 30 Arabic speaking male patients, and 25 Arabic speaking female patients from the study. From the qualitative study, we have gained insight on 1) how Arab men and women cardiovascular patients seek help for mental health problems, 2) what barriers and facilitators are for Arab men and women cardiovascular patients to seek mental health care services, and 3) what would be culturally and socially appropriate and effective intervention strategies for increasing awareness, prevention of, and treatment for depression in Arab cardiovascular patients. We hope to continue to publish our results which might address some of the great questions that you have raised in your comments.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  9. Re:A missing important factor: vitamin D deficiency

    Thank you for your comments on the role of vitamin D in the prevention and control of atherosclerotic cardiovascular disease (ASCVD). The primary aim of this study was to review interventions already in place at population levels for ischaemic heart disease within the sub-Saharan African context. However, with repeated searches, we were unable to find studies in the region, meeting our selection criteria, on the role of vitamin D. While we understand this as possibly another factor in the overall cardiovascular disease management, it further calls for more population-wide research in the region -made publicly available from which evidence-based conclusions may be drawn, which we already reported as a major limitation of our study. Thank you for the references.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  10. Mood disturbance and depression in Arab women following hospitalisation from acute cardiac conditions: a cross-sectional study from Qatar

    One of the many problems faced in health-care is the dissociation between treatment of mental and physical illnesses; and with the stigma and discrimination that exists as it relates to mental illness, it becomes even more difficult to increase the populations understanding of comorbidity. This article was very enlightening, seeking to explore the existence of a mood disturbance or depression (psychological condition) following admission from cardiovascular disease (a physical condition). While there are many studies that examine the relationship between depression and chronic illness it was very interesting that the author decided to focus on one particular chronic illness in a specific population. This is an interesting phenomena to examine as studies show that depression is often difficult to recognize or is easily overlooked in the presence of physical illnesses as it often conceals itself behind somatic (physical/bodily) complaints. [1]

    While it is a known fact that there is a strong association between depression or mental illness and chronic illnesses [2], it would have been really beneficial to have looked at the outcome and not the process of these patients with cardiovascular disease and depression. Was there an actual increase in morbidity and mortality in this population after hospitalization? Can we irrevocably state that these patients developed depression or a mood disturbance following hospitalization for cardiovascular disease or was the depression in existence prior to hospitalization without them admitting the fact? The National Institute of Mental Health states that the risk of developing some physical illnesses is higher in people with depression for example cardiovascular disease, stroke, diabetes, etc. So it would be of significance here to examine which came first, "the chicken or the egg?" and how did these individuals move forward in dealing with their comorbidities.

    With the strong association between stigma and mental illness, in this case depression, it is known that people are less likely to seek help for mental health conditions than they are for physiological illnesses. [3] In this study it was also noted that twice the number of females were affected from depression than men. These results depict what is supported by several studies, that females are twice more likely to suffer from depression than men. It is also essential to consider that men are less likely to report depressive symptoms or have high health seeking behaviours like their female counterparts. [3]

    Nevertheless a very important study as it supports information from other countries such as the United States and United Kingdom when it comes to understanding issues related to comorbidities of mental and physical illnesses. Findings from other studies, like this current study points to the importance of early screening and intervention for depression in persons diagnosed with chronic illnesses. [1]

    References:

    1) Diminic-Lisica I, Franciskovic, T, Janovic, S, Popovic, B, Klaric, M, Nemcic-Moro, I. Comorbid chronic diseases in depressed and non-depressed patients in family practice. Psychiatria Danubina, 2010; 22 (2), 236-240.

    2) National Institute of Mental Health. Chronic illness and mental health. National Institute of Mental Health, 2016.

    3) Oliver, MI, Pearson, N, Coe, N, Gunnell, D. Help-seeking behaviour in men and women with common mental health problems: cross- sectional study. The British Journal of Psychiatry, 2005; 186(4), 297-301;

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response

Don't forget to sign up for content alerts to receive selected information relevant to your specialty interests and be the first to know when the latest research is published.