eLetters

1065 e-Letters

  • It is important to consider the size and incident flow rate of particles tested here compare with the size and typical incident flow rate of respiratory droplets?

    Very nice work by the authors. Perhaps they could provide additional details about the methods used here to test particle filtration.

  • RE: Association between dairy intake and fracture in an Australian-based cohort of women: a prospective study

    Aslam et al. conducted a prospective study to assess the association between milk/total dairy consumption and major osteoporotic fracture (MOF) in women (1). The authors handled women aged ≥50 years, and MOFs (hip, forearm, clinical spine and proximal humerus) were confirmed radiologically. Consuming >500 mL/d of milk was not significantly associated with increased HR for MOF. In addition, adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) of Non-milk drinkers against drinkers consuming <250 mL/d of milk and consumption of ≥800 g/d total dairy against 200-399 g/d of total dairy for MOF were 1.56 (0.99 to 2.46) and 1.70 (0.99 to 2.93), respectively. They concluded that there was a trend for increased MOF in women with zero milk and higher total dairy consumption. I want to present results from recent meta-analyses.

    Malmir et al. summarized the association of milk and dairy intake with risk of osteoporosis and hip fracture (2). There was an inverse relationship of milk and dairy intake with risk of osteoporosis and hip fracture in cross-sectional and case-control studies. By meta-regression analysis, every additional 200-gram intake of dairy and milk were associated with a 22% and 37% reduced risk of osteoporosis, respectively. In addition, milk consumption was associated with a 25% reduced risk of hip fracture. In contrast, the significance disappeared in cohort studies, and a greater intake of milk and dairy products did not reduce the risk of osteo...

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  • RE: Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome

    Cooper et al. investigated clinical predictors of mortality in adults with intellectual disabilities (1). Standardized mortality ratios (SMRs) (95% confidence interval [CI]) in Down syndrome adults and adults without Down syndrome were 5.28 (3.98, 6.57) and 1.93 (1.68, 2.18), respectively. In addition, SMRs in males and females were 1.69 (1.42, 1.95) and 3.48 (2.90, 4.06), respectively. Aspiration/reflux/choking and respiratory infection were the most common causes of mortality in adults without Down syndrome, and dementia was the most common causes of mortality in Down syndrome adults. Mortality risk related to percutaneous endoscopic gastrostomy/tube fed, Down syndrome, diabetes, lower respiratory tract infection at cohort-entry, smoking, epilepsy, hearing impairment, increasing number of prescribed drugs, increasing age were related to mortality in adults with intellectual disabilities. I have some concerns about their study.

    First, Oppewal et al. also reported the cause-specific mortality of older Down syndrome adults with intellectual disability (2). The common cause of mortality was respiratory disease (51.1%), followed by dementia (22.2%), and this information was not consistent with data by Cooper et al. Methodological difference of survey, including definition, might contribute to the statistical information.

    Second, de Campos Gomes et al. analyzed mortality and related factors in individuals with Down syndrome in Brazil (3). They concluded that ethn...

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  • RE: Referral to Slimming World in UK Stop Smoking Services (SWISSS) versus stop smoking support alone on body weight in quitters

    Lycett et al. conducted an important intervention to avoid obesity in quitting smokers (1). There is a brain mechanism on the relationship between stop smoking and subsequent weight gain. Dietary modification is important, but food restriction is closely associated with stress and causes relapse of smoking. A commercial weight management program plus stop smoking support (treatment group) was compared with stop smoking support alone (control group) for the change in weight (kg) at 12 weeks. At 12 weeks weight gain was less in the treatment than the control group with an adjusted mean difference (95% CI) of -2.3 kg (-4.4 to -0.1). Craving scores were lower (Mood and Physical Symptoms Scale craving domain -1.6 (95%CI: -2.7 to -0.5)) and quit rates were higher in the treatment than the control group (32% vs 21%). Unfortunately, this trial could not present statistical superiority in cravings and quit rates. I have two concerns about their study.

    First, I previously reported that increased body mass index in quitting smokers had a tendency of decreasing after 8 years (2), although inconsistent results have also been reported (3). Anyway, continuous weight monitoring is important in quitting smokers (4).

    Second, relapse of smoking also happens after 12 weeks in their everyday life. Especially drinking habits should be paid with caution. In addition, risk assessment of weight gain by quitting different types of cigarette, heat-not-burn/e-cigarette, is needed (5)....

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  • RE: Comparative effectiveness and safety of low-strength and high-strength direct oral anticoagulants compared with warfarin

    Pratt et al. compared effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin (1). There was no significant difference in the risk of ischaemic stroke or bleeding between low-strength DOACs and warfarin. No increase of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban. For high-strength DOACs, no difference was found for ischaemic stroke, however, there was a significant reduction in risk of bleeding events and death, presenting hazard ratios (HRs) (95% confidence intervals [CIs]) of 0.63 (0.44 to 0.89) and 0.40 (0.28 to 0.58), respectively. I have two concerns about their study.

    First, Xian et al. examined the clinical effectiveness of DOACs against warfarin prescription at discharge after ischemic stroke in patients with atrial fibrillation (AF) (2). Adjusted HR (99% CI) of patients receiving DOACs for major adverse cardiovascular events was 0.89 (0.83-0.96). Other events were also significantly decreased in patients receiving DOACs, except gastrointestinal bleeding. The authors concluded that DOAC use at discharge was significantly associated with better long-term outcomes relative to warfarin. Pratt et al. classified DOACs into two dosages, and specified some different outcomes on effectiveness and safety. I suppose that randomized trials are needed to verify the effectiveness and safety of DOACs.

    Second, Pham et al. evaluated the risk of bleeding with DOACs...

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  • Simon C

    Is my understanding correct in thinking this study was never conducted? I would love to learn more about this!

  • Update: PROSPERO Registration

    Update: This systematic review was registered with PROSPERO on April 28, 2020. Registration number: CRD42020159050. Registration was submitted on November, 18, 2019.

  • RE: Influence of combined exposure to perceived risk at work and unstable employment on self-rated health

    Cho et al. investigated the combined effect of exposure to perceived risk at work and unstable employment on self-rated health (1). Among Korean employees, odds ratios (ORs) (95% confidence intervals [CIs]) of perceived risk at work and unstable employment for poor self-rated health were 2.00 (1.80 to 2.22) and 1.18 (1.09 to 1.28), respectively. In addition, OR (95% CI) of both perceived risk at work and unstable employment for poor self-rated health was 3.22 (2.72 to 3.81), and relative excess risk due to interaction (RERI) (95% CI) was 1.03 (0.48 to 1.58). Among European employees, ORs (95% CIs) of perceived risk at work and unstable employment for poor self-rated health were 3.20 (2.93 to 3.49) and 1.04 (0.97 to 1.13), respectively. In addition, OR (95% CI) of both perceived risk at work and unstable employment for poor self-rated health was 3.41 (2.93 to 3.98), and RERI (95% CI) was 0.18 (-0.36 to 0.71).There was a supra-additive interaction between perceived risk at work and unstable employment on poor self-rated health among Korean employees, and I have a query about data among Korean employees.

    Kim et al. reported that odds ratio of precarious employment for poor health was marginally significant, by adjusting socio-demographic covariates, job satisfaction, job insecurity, and monthly wage (2). Kwon et al. also evaluated the association between employment status and self-rated health (3). The percentage of non-permanent workers was 20.8 %, and OR of non-perma...

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  • RE: Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation

    Saji et al. intended a prospective study to know the effects of warfarin therapy and direct oral anticoagulants (DOACs) on cerebrovascular diseases and cognitive impairment (CI) in patients with non-valvular atrial fibrillation (NVAF) over an estimated duration of 36 months (1). I want to present some information.

    First, Mongkhon et al. investigated the risk of dementia/CI among newly diagnosed atrial fibrillation (AF) patients with and without oral anticoagulation (OAC) treatment over a mean follow-up of 5.9 years (2). Hazard ratios (HRs) (95% confidence intervals [CIs) of OAC treatment and antiplatelets for dementia/CI were 0.90 (0.85-0.95) and 0.84 (0.79-0.90), respectively. In contrast, HR (95% CI) of DOACs treatment against warfarin for dementia/CI was 0.89 (0.70-1.14). Furthermore, HR (95% CI) of dual therapy (OAC plus antiplatelets) for dementia/CI was 1.17 (1.05-1.31). Saji et al. set two clinical outcomes, and study period was shorter. In addition, safety evaluation on bleeding might also be required.

    Second, Diener et al. recommended randomized trials to evaluate whether OAC, including warfarin and DOACs, reduces dementia/CI in AF patients (3). Dementia/CI, including vascular dementia and Alzheimer's disease, might be related to ischemic stroke, cerebral micro-infarcts, cerebral hemorrhage, and reduced cerebral blood flow. Taken together, risk assessment of medications for dementia/CI in AF patients would be closely associated with types of cer...

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  • Response to the comments

    We thank Dr. Elizabeth A Pritts, Dr. David L Olive, and Dr. William H. Parker for their great interest in our study and for the very qualified comments. To investigate the influence of uterine fibroids on obstetrical outcomes is complex and can be viewed from different angles. - We aimed to investigate symptomatic uterine fibroids. Well conducted cohort studies are the best available substitutes when experiments are not possible. Methodological limitations need to be taken into consideration, and associations can be explored. We are fully aware that limitations must be relevantly discussed. David A Grimes 1 pointed out some important issues regarding cohort studies:
    1) The exposure should be clear: we argue to have a clearly defined exposure.
    2) The importance of potential confounders: we have been able to include important confounders using the directed acyclic graph, DAG.
    3) Awareness that the risk of a weak association (HR 0.5-2) is likely to be due to bias and not causation: We have clearly stated that we have found associations and further that the association could be interesting for further research, but we do not recommend changes in clinical recommendations.
    The risks of misclassification of exposure were related to the uterine fibroid diagnoses codes. The daily clinical coding may be incorrect or lacking due to various work-related distractions or variable individual interpretation of clinical cases. The low prevalence of uterine fibroids...

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