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We congratulate Wilkinson et al. for their excellent piece of work that assessed the burden of academic spam emails (ASEs) received by the academic grant receivers.1 This paper is very relevant in the current scenario when ‘predatory academia’ is emerging as a potential threat to the ethos and virtuosity of medical research.
We are all aware of the unsolicited ASEs adorned with flowery language that we routinely receive. On a closer look, these emails follow a certain predictable pattern. These are replete with grammatical errors, are usually asking authors to submit one ‘eminent article’ in order to complete/ inaugurate an issue of their journal, or inviting to be a part of their editorial board or a chairperson in an upcoming conference. These can be quite intimidating when received and read for the first time, and a naïve researcher might in fact like the manner in which these emails are addressed. A little discussion with the senior colleagues and mentors, and a quick trip to the hastily put together, incomplete websites with dual addresses (one of which is usually located in developing countries) and fake editorial boards (usually with pictures of prominent physicians/ surgeons from different specialties put together) shall however, soon make things clear for these young researchers.
Predatory journals have been now present for more than a decade.1 Previously, the researchers were exposed to these journals, either through their colleagues or, themselve...
We congratulate Wilkinson et al. for their excellent piece of work that assessed the burden of academic spam emails (ASEs) received by the academic grant receivers.1 This paper is very relevant in the current scenario when ‘predatory academia’ is emerging as a potential threat to the ethos and virtuosity of medical research.
We are all aware of the unsolicited ASEs adorned with flowery language that we routinely receive. On a closer look, these emails follow a certain predictable pattern. These are replete with grammatical errors, are usually asking authors to submit one ‘eminent article’ in order to complete/ inaugurate an issue of their journal, or inviting to be a part of their editorial board or a chairperson in an upcoming conference. These can be quite intimidating when received and read for the first time, and a naïve researcher might in fact like the manner in which these emails are addressed. A little discussion with the senior colleagues and mentors, and a quick trip to the hastily put together, incomplete websites with dual addresses (one of which is usually located in developing countries) and fake editorial boards (usually with pictures of prominent physicians/ surgeons from different specialties put together) shall however, soon make things clear for these young researchers.
Predatory journals have been now present for more than a decade.1 Previously, the researchers were exposed to these journals, either through their colleagues or, themselves while actively trying to search a journal suitable to submit their manuscript (especially in situations where a publication could help land a much-coveted grant, promotion or residency spot).2,3 The practice of sending such unsolicited, inviting and tempting emails, however, seems recent; and can be attributed to relatively easy and unhindered access to internet and email ids, which makes it possible for these journals to actively contact a large number of scientists.
Wilkinson et al1 noted that the amount of time spent in addressing the ASEs had a significant negative correlation with the number of articles authored in peer-reviewed journals. Of the people who did not spend any time responding to such emails; all had >20 publications. Negative correlation was also observed between the time spent in addressing such mails and previous history of publishing in journals with open access (OA) policy; and may suggest the negative experience garnered through the whole process of publication in the predatory OA journals, that ultimately lead to not devoting further time or attention to these emails. We, however, feel that it could have been better to specifically address the type of OA journals the participants were asked about.
No association was observed between time spent on addressing these emails and the presence/ absence of spam filters.1 Rather, a positive association was observed between the feeling of being left behind (if these ASEs were not read) and time spent on addressing the emails; which again has a bearing on the overall growth, maturity, learning and experience that comes over time with publishing in academia; and guides one to when and how ignore these ASEs. Despite receiving the ASEs, Wilkinson et al observed that 69% of participants actually did not respond back to these emails, suggesting that though researchers are actually spending their time reading these emails, the actual response rate to such mails is less.
A comparison of the number of such ASEs received by grant receivers vs non-receivers; corresponding vs other authors; senior authors vs junior authors; junior authors with more publications vs senior authors with lesser publications; and those working in different specialties shall better explain the variables and targets that predatory agencies have in mind when these ASEs are actually being distributed.
ASEs represent an active effort on the part of predatory agencies to expose an ever-increasing number of researchers to predatory journals and conferences. Future studies should try to define the particular subgroups of researchers; a) those who receive such emails more, b) those who spend more time reading these, and c) those who actually succumb to the naivety or the pressure to publish, and therefore end up responding to such emails. Accurate identification of this shall help in risk stratification, and appropriate division and dedication of the valuable efforts needed to curb this predatory academia in a more efficient manner. Needless to say, faculty members at various institutions have the most important role to play, and they should proactively warn and guide their residents about the presence and pitfalls of these predatory journals and conferences. To conclude, always follow this initiative: think, check and submit.4
References
1. Wilkinson TA, Russell CJ, Bennett WE, Cheng ER, Carroll AE. A cross-sectional study of predatory publishing emails received by career development grant awardees. BMJ Open. 2019;
2. Gasparyan AY, Yessirkepov M, Diyanova SN, Kitas GD. Publishing ethics and predatory practices: A dilemma for all stakeholders of science communication. J Korean Med Sci. 2015;
3. Beall J. Predatory journals, peer review, and education research. New Horizons Adult Educ Hum Resour Dev. 2017;
4. Beall J. Best practices for scholarly authors in the age of predatory journals. Ann R Coll Surg Engl. 2016;
Keshavamurthy Vinay, M.D, F.R.C.P
Department of Dermatology
Postgraduate Institute of Medical
Education and Research,
Sector 12, Chandigarh, India
With great interest I read the study protocol by Ayre et al. (2019). In contrast to the standard double-randomized design (ref. [21] in the paper), this study includes a third arm in the first stage, the screened arm (in addition to the random arm and the choice arm). What I missed in the protocol, however, is a critical discussion of an important difference between a choice arm and a screened arm: While the choice arm simply reflects the preference of a study participant, the screened arm seeks to diagnose a participant's condition, here health literacy, based on a screening test. Consequently, the allocation depends on the test's diagnostic accuracy. This is nowhere mentioned in the protocol.
A paper discussing this in the context of the (similarly structured) biomarker strategy design is Kunz, CU, Jaki, T, Stallard, N. An alternative method to analyse the biomarker‐strategy design. Statistics in Medicine. 2018; 37: 4636– 4651. https://doi.org/10.1002/sim.7940
It may be worthwile to have a look into this article and to discuss this issue when analyzing and reporting the study.
In a recent issue, Graham et al [1] compared the transferability for blood lactate measurement between two assays. These authors raised two conclusions. First, a poor agreement between blood capillary and venous lactate measurements was reported; second, the use of blood capillary lactate measurement for diagnosis purposes was discouraged. From our point of view, this paper presents some methodological bias which do not allow the authors to draw those conclusions. We would like to advance three important considerations to support this claim.
Firstly, in the same way that laboratory analysers, handheld analysers must be tested for their analytical performances and submitted to periodic quality control check to ensure proper functioning of the equipment, accuracy of measurement and consistent readings. In the report [1], neither analytical performance nor quality control have been mentioned for the handheld analysers.
Secondly, to confirm a correct agreement between the measurements provided by different devices, the number of patients enrolled appears quite low. Indeed, the devices measurement range must be taken into account [3]. Lactate values ranged from 0.7 to 5.38 mmol.l-1 , and 62.8% of the patients had lactate values < 2 mmol.l-1 while the devices had a measurement lactate range from 0.5 to 25 mmol.l-1. By this way, authors draw their conclusion only with the lower end of the range without considering high blood lactate values. We...
In a recent issue, Graham et al [1] compared the transferability for blood lactate measurement between two assays. These authors raised two conclusions. First, a poor agreement between blood capillary and venous lactate measurements was reported; second, the use of blood capillary lactate measurement for diagnosis purposes was discouraged. From our point of view, this paper presents some methodological bias which do not allow the authors to draw those conclusions. We would like to advance three important considerations to support this claim.
Firstly, in the same way that laboratory analysers, handheld analysers must be tested for their analytical performances and submitted to periodic quality control check to ensure proper functioning of the equipment, accuracy of measurement and consistent readings. In the report [1], neither analytical performance nor quality control have been mentioned for the handheld analysers.
Secondly, to confirm a correct agreement between the measurements provided by different devices, the number of patients enrolled appears quite low. Indeed, the devices measurement range must be taken into account [3]. Lactate values ranged from 0.7 to 5.38 mmol.l-1 , and 62.8% of the patients had lactate values < 2 mmol.l-1 while the devices had a measurement lactate range from 0.5 to 25 mmol.l-1. By this way, authors draw their conclusion only with the lower end of the range without considering high blood lactate values. We consider that the authors may conclude with a greater caution that their results exhibit a poor agreement between blood capillary lactate and references values.
Finally, the authors cited a report of Shapiro et al. to highlight the association between high blood lactate levels, severity of sepsis and poor outcome: low-risk of mortality < 2.2 mmol.l-1, intermediate-risk 2.3-5 mmol.l-1 and high-risk > 5 mmol.l-1 [4]. The latter classification has previously been used to evaluate the concordance between lactate handheld analysers and laboratory analysers for diagnosis purposes [5,6]. The authors might use this classification to verify the agreement between handheld analysers and blood gas analyser results for the risk of poor outcome occurrence.
Thus, these restrictions suggest that Graham et al. [1] might more carefully conclude that “[their] results do not currently support the use of capillary lactate measurement for diagnostic purposes”.
Sincerely,
Teddy Léguillier
References:
1 Graham CA, Leung LY, Lo RS, et al. Agreement between capillary and venous lactate in emergency department patients: prospective observational study. BMJ Open 2019;9:e026109. doi:10.1136/bmjopen-2018-026109
2 Nichols JH, Christenson RH, Clarke W, et al. Executive summary. The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guideline: evidence-based practice for point-of-care testing. Clin Chim Acta 2007;379:14–28; discussion 29-30. doi:10.1016/j.cca.2006.12.025
3 Vassault A, Grafmeyer D, de Graeve J, et al. Quality specifications and allowable standards for validation of methods used in clinical biochemistry. Ann Biol Clin (Paris) 1999;57:685–95.
4 Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005;45:524–8. doi:10.1016/j.annemergmed.2004.12.006
5 Léguillier T, Jouffroy R, Boisson M, et al. Lactate POCT in mobile intensive care units for septic patients? A comparison of capillary blood method versus venous blood and plasma-based reference methods. Clin Biochem 2018;55:9–14. doi:10.1016/j.clinbiochem.2018.03.006
6 Karon BS. Point-of-Care Lactate for Sepsis Detection: Reconsidering Accuracy, Precision, and Concordance Criteria. Point of Care 2017;16:131. doi:10.1097/POC.0000000000000141
After peer review, Cipriani et al were invited to provide a response to the research manuscript. Should Cipriani et al wish to respond to the article we will post their response here.
BMJ Open has received the comments from Bee Ping Teh and Norzahirah Ahmad on this paper. The authors of the paper have been contacted and have been asked to comment on the accuracy of their response.
We have read with great interest about Goldkuhle et al., ‘A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer’ (BMJ Open; accepted on 12 February 2018; doi:10.1136/bmjopen-2017-020869). Hereby we are writing this electronic responses to address the contents of article in following aspects: typographical errors and indistinguishable information highlighted by the original authors.
There are five typographical errors found in the article that we would like to draw your attention as these could cause confusion to your many readers. The said errors are presented with snapshot image from the original article.
1) First paragraph of ‘Characteristics of included SRs’ section, under ‘RESULTS’ section, page 5; a numerical value of ‘67/216’ (at line 15) has to be corrected to ‘67/215’ because the total number of included studies for high-impact journal reviews was only 215 studies instead of 216.
2) At 'Table 1’, under ‘RESULTS’ section, page 6; a numercal value of '318 (9.9)' has to be corrected to ‘318 (91.9)’ as compared to first paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 1. This is because the percentage value of 318 out of 346 is 91.9% (approximate) instead of 9.9.
3) At 'Results’ section, under ‘ABSTRACT’ section, page 1, line 15; a numerical value of ‘6.52 (range 0-143)’ is different from mean number of citations...
We have read with great interest about Goldkuhle et al., ‘A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer’ (BMJ Open; accepted on 12 February 2018; doi:10.1136/bmjopen-2017-020869). Hereby we are writing this electronic responses to address the contents of article in following aspects: typographical errors and indistinguishable information highlighted by the original authors.
There are five typographical errors found in the article that we would like to draw your attention as these could cause confusion to your many readers. The said errors are presented with snapshot image from the original article.
1) First paragraph of ‘Characteristics of included SRs’ section, under ‘RESULTS’ section, page 5; a numerical value of ‘67/216’ (at line 15) has to be corrected to ‘67/215’ because the total number of included studies for high-impact journal reviews was only 215 studies instead of 216.
2) At 'Table 1’, under ‘RESULTS’ section, page 6; a numercal value of '318 (9.9)' has to be corrected to ‘318 (91.9)’ as compared to first paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 1. This is because the percentage value of 318 out of 346 is 91.9% (approximate) instead of 9.9.
3) At 'Results’ section, under ‘ABSTRACT’ section, page 1, line 15; a numerical value of ‘6.52 (range 0-143)’ is different from mean number of citations reported in ‘Citations’ section, under ‘RESULTS’ section, page 5, line 3 & 4, i.e. ‘6.92, ranging from 0 to 143’.
4) At ‘Table 1’, under ‘RESULTS’ section, page 7; a numerical value of ‘(10-38,8)’ is reported in different format that the comma could confuse the readers of its true value.
5) At ‘Appendix table 1’, under ‘Online Supplementary Appendix’ document, page 2; a numerical value of ‘(#4 or#7)’ has to be corrected to ‘‘(#4 or#5)’ as this could confuse the readers of its true value.
The authors claim that there were Cochrane reviews that included none or one study; as reported in the following section that contradict to the value reported in ‘Table 1’ of original article.
1) Fourth paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 8 to 10;
2) Paragraph of ‘Principal findings’ section, under ‘DISCUSSION’ section, page 7, line 5 to 7; and
3) Second paragraph of ‘Strengths and weaknesses of this SR’ section, under ‘DISCUSSION’ section, page 7, line 7 to 9.
The number of included studies in Cochrane reviews is 6 (2–13) (median(interquartile range)) as in ‘Table 1’ of original article, in which it was reported that there were Cochrane reviews with two included studies minimally, instead of zero.
Apart from typographical errors, we would like to point out a controversy pertaining to a point of their discussion in the original article. Although their concern about the methodological quality and thoroughness review conducted by Cochrane and high-impact journal reviews are of great interest and highlighted the importance of it, we have to disagree on the potential risk of bias of co-published reviews that mentioned might interferes the authors’ findings (third paragraph of ‘Strengths and weaknesses of this SR’ section, under ‘DISCUSSION’ section, page 7). This is because co-published reviews have to be sorted from duplication during title, abstract and/or full text screening. Therefore, it is quite impossible to have duplicates in included reviews since duplicate removal was reported as in ‘Figure 1’ and ‘Figure 2’ of the original article.
I'm just a real person, commenting on much I've seen in my real life.
I enjoyed the article about Seizures that may be caused by strobe lights at club parties.
It should be noted that Photo-sensitive Epileptic seizures can also be caused by some types of religious services, including Pentecostal-type Christian church services. These services can also cause seizures with thumpy-thump trick-bass music, and certain types of incense or scented candles.
Church of God in Christ (COGIC),
Assembly of God,
United Pentecostal Church,
White Dove,
many non-demoninationals, etc., all make use of:
strobe lights;
other types of lights (various speeds and colors);
fast, thumpy, jittering or swaying musical rhythms;
fast, thumpy, jittering or swaying body-movement rhythms;
galloping floor pulses, sometimes combined with ultra-slow floor pulses, tricked out as if caused by a strobe-"Sound" machine (whether music-caused, or from a separate vibrating machine);
and/or sometimes scents,
in order to make the congregation ultra, extra excited to bring the people into the "Spirit".
I've visited some types of these services, partly out of curiosity, since I was a teen. Including even an Assembly of God funeral at which people started wiggling and laughing, I assume due to the bright flashing lights and percussion rhythms.
I'm just a real person, commenting on much I've seen in my real life.
I enjoyed the article about Seizures that may be caused by strobe lights at club parties.
It should be noted that Photo-sensitive Epileptic seizures can also be caused by some types of religious services, including Pentecostal-type Christian church services. These services can also cause seizures with thumpy-thump trick-bass music, and certain types of incense or scented candles.
Church of God in Christ (COGIC),
Assembly of God,
United Pentecostal Church,
White Dove,
many non-demoninationals, etc., all make use of:
strobe lights;
other types of lights (various speeds and colors);
fast, thumpy, jittering or swaying musical rhythms;
fast, thumpy, jittering or swaying body-movement rhythms;
galloping floor pulses, sometimes combined with ultra-slow floor pulses, tricked out as if caused by a strobe-"Sound" machine (whether music-caused, or from a separate vibrating machine);
and/or sometimes scents,
in order to make the congregation ultra, extra excited to bring the people into the "Spirit".
I've visited some types of these services, partly out of curiosity, since I was a teen. Including even an Assembly of God funeral at which people started wiggling and laughing, I assume due to the bright flashing lights and percussion rhythms.
Some charismatic-type services are quieter and milder than others.
As a teen, at a fairly mild United Pentecostal church (where women wear no makeup and never cut their hair), I spoke in "An unknown tongue," which, in my case, turned out to be the Yiddish a relative had spoken when I was a baby. I babbled and trembled for several days after. But I returned to my Baptist church, and cut my hair soon afterward. The girls who'd invited me assumed I was going to Hell.
I was more recently forced by a caregiver to attend a COGIC spirit service with bright strobe lights, painfully thumpy music, and everyone screaming in "Tongues".
Women, men, and children were skipping up to the altar, hugging each other, jumping up and down, screaming, defecating and urinating, fainting in joy and ecstasy. All caused by strobe lights and trick-bass drum music.
I'd already developed severe epilepsy- or at least finally been diagnosed with it. I've had seizures since I was quite small. I could never stand twinkling Christmas lights, for instance, which even at 4 years old made me so dizzy and NERVOUS I would start screaming.
(A gentle car ride would calm me down wonderfully, as would a vacuum cleaner in the next room).
I've been diagnosed with Vertigo;
Jacksonian, Partial-Complex, Petit Mal Seizures;
Constant Body-Wide Migraine Statous including severe nausea and blinding light sensitivity;
Hemi-Plegic Migraine;
Cluster headaches.
All triggered by bright lights;
fast-moving and/or flashing lights;
certain musical or dancing rhythms;
carnival rides including especially the Tea Cups and the Tilt-A-Whirl;
smells including ammonia and Musk perfume;
among other triggers including pesticide exposure.
I spent two hours hiding in the church bathroom, and managed to get out of the life situation fairly soon. The COGIC congregation was wonderfully friendly to me at other services and events. My body just couldn't stand their Rapture service.
The last 10 years (I'm 57), I seem to have developed Grand Mal. My head rolls around like The Exorcist. My tongue falls between my jaws (No dentures). I fall asleep, wake up weak.
My state's Medicaid won't give me proper diagnosis, or even medication, due to simple underfunding and rationing.
My seizures are mostly caused by TV antenna signals, even if not badly pixelated. I must ration TV, and sometimes even computer. Although I still get crazy, miserable reactions from all the boom cars in my apartment complex, Punk and Rap both full of Trick-Bass.
These types of seizure-causing, Charismatic Religious services may bring joy to some people. I've even heard rumors of people taking Ecstasy and Coke or Crack, Speed, etc, to boost their spiritual high. One woman stated to me,
"I would be willing to faint and die at the altar, if only I could die and be in God's Spirit forever".
The ministers and leaders of these highly physically emotional Spirit services possibly do understand the science of light and music and even smells they utilize to cause their desired result- just as regular Catholics, Presbyterians, Episcopalians, Lutherans, and Methodists, with their methods, understand how to bring simple peace and serenity to their congregations. Of course, most congregants, and even some leaders, prefer to think God is the only cause of what happens to them.
My friend is an Interpreter for the Deaf, whose job is to interpret at several Pentecostal and Spirit-type services through the week. She experiences severely disabling, blinding Ocular Migraine Auras and headaches, exacerbated, or maybe caused, by the overly-bright strobe lights at her job. She (and I) are also deeply affected by blinking fluorescent lights, especially Curly CFLs. She's constantly exposed to these lights at her M-F school interpretation job.
I spent plenty of time at Disco/Rock N Roll house parties in the 1970s, 80s. (No drinking- causes migraines, no drugs, just great, happy people). But I could never stand bars which played these same songs, since the Bass Boost was always turned up high, and made me "Nervous." Some of these clubs also had flashing colored Neon lights, with the speed turned up high. I got sick at America's Favorite Bar from the lights and music. Nauseated from dizziness.
I don't know enough to comment much about modern Orthodox/Hasidic Jewish services,
Druse or Sufi Islam services,
"Whirling Dervishes" (Isn't that Hindu?),
various Pagan rites, etc. I bet, at least in some cases, the same type of cathartic, soul-releasing effects may be brought about by certain methods such as strobe lights, thump music, thump dancing, and other effects, as occurs in Charismatic Christian rituals, or a 1990s Body-Slamming Punk Metal concert. While others like myself prefer a calmer type of religious joy.
(A PBS "Rick Steves" special, can't remember which country, portrayed a marvelous "Whirling Dervish" who slowly, steadily swirled and gyrated himself into a beautiful, deep, simple religious ecstasy. Calming for me to watch.)
As with a friend in White Dove, I wonder if some people already have Bi-Polar Mania, or seizures, or some neurological reaction which causes them to "Speak in tongues," have extra wiggly, shaky, excitable bodies, etc, that may make them feel more comfortable at ecstatic religious services or club parties, than at staid old sleepy services such as even Southern Baptist- which is not nearly as sleepy as some other Protestant services!
I myself like the "sleepiness," which relaxes my body and brain as well as medicine does.
If I broach the idea of "Seizures, or Mania" to certain people, they may even scream at me in denial.
"I'm just NERVOUS is why I'm wiggling and shaking and screaming at you! I need a church service!"
(That person HIT me while shaking and screaming.)
"I'm not babbling incoherently; I'm just speaking in tongues."
(Whether it's actually Bi-Polar word salad, or some type of seizure or neuro reaction.)
"No, don't let the Devil let you have seizures. God will heal you."
(This at a religious service which was rapidly worsening my seizures and Migraine.)
I guess giving medication to them is tantamount to taking away their religion.
To Each His Own.
I still think people should be taught what may happen to them at certain type of religious services, as well as these Rave, EDM, whatever, Pagan-type Club parties. Then let them make their own decisions, for themselves and for their minor children.
To the editor,
In a recent article, Chen et al.1 reported the association of low birth weight with future thinness and severe obesity. These findings are important for recognition of the risks of low birth weight, but further discussion of the underlying meaning is required.
Body mass index (BMI) generally increases rapidly during the first year of life, and then subsequently decreases and reaches a nadir at around 6 years of age. Thereafter, BMI increases again throughout childhood, and this second rise is referred to as the adiposity rebound2. Early adiposity rebound is a known risk factor for future obesity2,3, and even if BMI is low at the age of adiposity rebound, children who experience early adiposity rebound may become obese4. This means that a person can be thin in their youth and obese at an older age.
Low birth weight is also a known risk factor for early adiposity rebound5. Therefore, this phenomenon of changes in weight may be common among low birth weight infants, and some of the thin children in Chen et al.1 may ultimately become obese. To examine this hypothesis, it would be of interest to compare the mean ages and the distributions of subjects in Chen et al.1 who are thin and those with severe obesity. We believe that the thin subjects will have a younger mean age.
This information would help to explain the results of the study. A longitudinal study would then be warranted to develop a better understanding of the risks associated wi...
To the editor,
In a recent article, Chen et al.1 reported the association of low birth weight with future thinness and severe obesity. These findings are important for recognition of the risks of low birth weight, but further discussion of the underlying meaning is required.
Body mass index (BMI) generally increases rapidly during the first year of life, and then subsequently decreases and reaches a nadir at around 6 years of age. Thereafter, BMI increases again throughout childhood, and this second rise is referred to as the adiposity rebound2. Early adiposity rebound is a known risk factor for future obesity2,3, and even if BMI is low at the age of adiposity rebound, children who experience early adiposity rebound may become obese4. This means that a person can be thin in their youth and obese at an older age.
Low birth weight is also a known risk factor for early adiposity rebound5. Therefore, this phenomenon of changes in weight may be common among low birth weight infants, and some of the thin children in Chen et al.1 may ultimately become obese. To examine this hypothesis, it would be of interest to compare the mean ages and the distributions of subjects in Chen et al.1 who are thin and those with severe obesity. We believe that the thin subjects will have a younger mean age.
This information would help to explain the results of the study. A longitudinal study would then be warranted to develop a better understanding of the risks associated with a low birth weight.
References
1. Chen C, Jin Z, Yang Y, et al. Association of low birth weight with thinness and severe obesity in children aged 3–12 years: a large-scale population-based cross-sectional study in Shanghai, China. BMJ Open. 2019;9(5):e028738. doi:10.1136/bmjopen-2018-028738.
2. Rolland-Cachera MF, Deheeger M, Maillot M, Bellisle F. Early adiposity rebound: causes and consequences for obesity in children and adults. Int J Obes (Lond). 2006;30 Suppl 4:S11-7. doi:10.1038/sj.ijo.0803514.
3. Koyama S, Ichikawa G, Kojima M, Shimura N, Sairenchi T, Arisaka O. Adiposity rebound and the development of metabolic syndrome. Pediatrics. 2014;133(1). doi:10.1542/peds.2013-0966.
4. Ichikawa G. Persistence of Obesity from Early Childhood Onward. N Engl J Med. 2019;380(2):193-195. doi:10.1056/NEJMc1814961.
5. Shi H, Yang X, Wu D, et al. Insights into infancy weight gain patterns for term small-for-gestational-age babies. Nutr J. 2018;17(1):97. doi:10.1186/s12937-018-0397-z.
Many thanks for taking the time to read and respond to our recently published article: Protocol for Healthy Habits Happy Homes (4H) Scotland: feasibility of a participatory approach to adaptation and implementation of a study aimed at early prevention of obesity.
We agree that obesity prevention could and should start as early as reasonably possible (pre-conception/ peri-conception as recommended by WHO ECHO). We also feel (as did WHO ECHO) that we need to continue prevention efforts well beyond infancy and toddlerhood, and if that is the case then we need to have some prevention programmes to offer beyond infancy and toddlerhood: 4H is one potentially useful candidate prevention programme. It is not a question of intervening before/during infancy or later, we need both, with 4H contributing to the early childhood segment of future programmes.
The maternal and infant nutrition framework in Scotland offers opportunity for a wide range of preventative work to address childhood obesity. Using NHS Tayside (where 4H Scotland took place) as an illustration, the Health Visitor and Family Nurse services hold UNICEF UK baby friendly Gold award, the local neonatal unit hold the UNICEF UK baby friendly award and recently the use and promotion of healthy start vouchers and the breastfeeding friendly Scotland logo has increased. There is a local specialist weight management service offering prevention approaches at tier 1 and management programmes...
Many thanks for taking the time to read and respond to our recently published article: Protocol for Healthy Habits Happy Homes (4H) Scotland: feasibility of a participatory approach to adaptation and implementation of a study aimed at early prevention of obesity.
We agree that obesity prevention could and should start as early as reasonably possible (pre-conception/ peri-conception as recommended by WHO ECHO). We also feel (as did WHO ECHO) that we need to continue prevention efforts well beyond infancy and toddlerhood, and if that is the case then we need to have some prevention programmes to offer beyond infancy and toddlerhood: 4H is one potentially useful candidate prevention programme. It is not a question of intervening before/during infancy or later, we need both, with 4H contributing to the early childhood segment of future programmes.
The maternal and infant nutrition framework in Scotland offers opportunity for a wide range of preventative work to address childhood obesity. Using NHS Tayside (where 4H Scotland took place) as an illustration, the Health Visitor and Family Nurse services hold UNICEF UK baby friendly Gold award, the local neonatal unit hold the UNICEF UK baby friendly award and recently the use and promotion of healthy start vouchers and the breastfeeding friendly Scotland logo has increased. There is a local specialist weight management service offering prevention approaches at tier 1 and management programmes at tier 2 and 3 for all children and young people (upto age 15.9years) and there is an emerging child healthy weight strategy document.
As mentioned, the experiences and learning that comes from work linked to such projects will be valuable as will new evidence gained from feasibility or definitive trials that are currently ongoing linked to obesity prevention interventions. Of particular interest, is the whole –system approach to obesity prevention that is underway e.g in London and Leeds.
We look forward to writing, with an aim to publish, our own small but important contribution to the evidence with an evaluation of 4H Scotland processes and outcomes in the near future. As authors, we are grateful to members of the pre-birth and early years groups from NHS Tayside (including infant nutrition coordinator), local authority, education and third sector within Dundee city and importantly the community workers and families who supported our feasibility trial. .
Regards,
Jenny Gillespie on behalf of the 4H Scotland study authors
The study reported by Ang et al. is of great interest to healthcare providers, especially in view of its publication in a journal read by a general medical audience. It elegantly delineates two programmes that were launched in Singapore to facilitate the safe transition from acute hospital to the home of patients and aimed to decrease inpatient admissions and emergency department attendances, reduce total inpatient length of stay and diminish expenses of care of patients [1].
Accordingly, we would like to describe the integrated care transitions programme in Malaysia where stable patients discharged from hospital admissions are referred to designated primary health centres to undergo subsequent care and continuous treatment. For more than a decade, Ministry of Health Malaysia has commenced a service to allow patients to continue their treatment in other referred facilities to ensure patients can obtain continuous supply of their medications.
Despite the availability of standard guidelines, little is known about current patterns of medications supplied to this group of patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the need for information about the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health clinic in Selangor, Malaysia and examined the medications associated with the recommended treatment upon hos...
The study reported by Ang et al. is of great interest to healthcare providers, especially in view of its publication in a journal read by a general medical audience. It elegantly delineates two programmes that were launched in Singapore to facilitate the safe transition from acute hospital to the home of patients and aimed to decrease inpatient admissions and emergency department attendances, reduce total inpatient length of stay and diminish expenses of care of patients [1].
Accordingly, we would like to describe the integrated care transitions programme in Malaysia where stable patients discharged from hospital admissions are referred to designated primary health centres to undergo subsequent care and continuous treatment. For more than a decade, Ministry of Health Malaysia has commenced a service to allow patients to continue their treatment in other referred facilities to ensure patients can obtain continuous supply of their medications.
Despite the availability of standard guidelines, little is known about current patterns of medications supplied to this group of patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the need for information about the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health clinic in Selangor, Malaysia and examined the medications associated with the recommended treatment upon hospital discharge.
We derived data from all prescriptions of 20 tertiary referral hospitals between January 2017 and December 2017. The costs of medications were calculated based on the procurement price of medicines available at our facility during data collection. The overall costs spent on medications supplied to patients discharged from hospitals was (Malaysian Ringgit) RM39,304.00. The medications associated with the highest expenditure were metformin (RM5,990.40), gliclazide (RM5,939.60), metoprolol (RM2,265.50), perindopril (RM1,846.95) and human insulin (RM1,817.30). The medications with the lowest expenditure were allopurinol (RM75.80), haematinic (RM72.00), potassium chloride (RM54.20), sertraline (RM50.20) and digoxin (RM16.80). The most commonly dispensed medications included simvastatin (785,218 tablets), metformin (74,880 tablets), budesonide metered dose inhaler (49,444 canisters), gliclazide (28,440 tablets) and perindopril (21,780 tablets), whereas the most infrequently dispensed medications were fluvoxamine (360 tablets), sertraline (360 tablets), digoxin (120 tablets), allopurinol (75 tablets) and potassium chloride (54 tablets).
The use of high-value medicines (medications which are guideline-recommended and reasonably priced) should be a priority for all countries, particularly those with limited resources [2, 3]. High-value medicines are not preferentially prescribed in many healthcare settings and there is currently sparse evidence to demonstrate that higher-priced medications are more effective [3]. A greater emphasis on high-value medications will potentially alleviate financial burden of increasing rates of treatment and provide more value to the nation’s economy [2]. In this respect, meticulously designed large cost-effectiveness studies are warranted to ascertain disease specific medications which will yield beneficial outcomes to patients. The study sites must be a representative sample encompassing the entire country geographically. Discerning the higher-priced medications with established benefits from lower-cost alternatives can serve as a basis for high quality and cost-efficient care [3].
Future efforts and policies aimed at mitigating the burden of non-communicable diseases by paying particular attention to the role of primary healthcare centres will need to improve patient access to high-value medications, especially in low and middle-income countries.
References
1. Ang IYH, Tan CS, Nurjono M, et al. Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore. BMJ Open 2019;9:e027220. doi: 10.1136/bmjopen-2018-027220
2. Porter ME. A strategy for health care reform — toward a value-based system. N Engl J Med 2009;361:109─12. doi: 10.1056/NEJMp0904131
3. Su M, Zhang Q, Bai X, et al. Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey. Lancet 2017;390:2559─68. doi: 10.1016/S0140-6736(17)32476-5
Acknowledgement
We would like to thank the Director-General of Health Malaysia for his permission to publish this correspondence.
Funding
The research receives no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflicts of interest statement
The authors of this correspondence declare that they have no conflict of interest.
We congratulate Wilkinson et al. for their excellent piece of work that assessed the burden of academic spam emails (ASEs) received by the academic grant receivers.1 This paper is very relevant in the current scenario when ‘predatory academia’ is emerging as a potential threat to the ethos and virtuosity of medical research.
We are all aware of the unsolicited ASEs adorned with flowery language that we routinely receive. On a closer look, these emails follow a certain predictable pattern. These are replete with grammatical errors, are usually asking authors to submit one ‘eminent article’ in order to complete/ inaugurate an issue of their journal, or inviting to be a part of their editorial board or a chairperson in an upcoming conference. These can be quite intimidating when received and read for the first time, and a naïve researcher might in fact like the manner in which these emails are addressed. A little discussion with the senior colleagues and mentors, and a quick trip to the hastily put together, incomplete websites with dual addresses (one of which is usually located in developing countries) and fake editorial boards (usually with pictures of prominent physicians/ surgeons from different specialties put together) shall however, soon make things clear for these young researchers.
Predatory journals have been now present for more than a decade.1 Previously, the researchers were exposed to these journals, either through their colleagues or, themselve...
Show MoreWith great interest I read the study protocol by Ayre et al. (2019). In contrast to the standard double-randomized design (ref. [21] in the paper), this study includes a third arm in the first stage, the screened arm (in addition to the random arm and the choice arm). What I missed in the protocol, however, is a critical discussion of an important difference between a choice arm and a screened arm: While the choice arm simply reflects the preference of a study participant, the screened arm seeks to diagnose a participant's condition, here health literacy, based on a screening test. Consequently, the allocation depends on the test's diagnostic accuracy. This is nowhere mentioned in the protocol.
A paper discussing this in the context of the (similarly structured) biomarker strategy design is Kunz, CU, Jaki, T, Stallard, N. An alternative method to analyse the biomarker‐strategy design. Statistics in Medicine. 2018; 37: 4636– 4651. https://doi.org/10.1002/sim.7940
It may be worthwile to have a look into this article and to discuss this issue when analyzing and reporting the study.
Dear Editor,
In a recent issue, Graham et al [1] compared the transferability for blood lactate measurement between two assays. These authors raised two conclusions. First, a poor agreement between blood capillary and venous lactate measurements was reported; second, the use of blood capillary lactate measurement for diagnosis purposes was discouraged. From our point of view, this paper presents some methodological bias which do not allow the authors to draw those conclusions. We would like to advance three important considerations to support this claim.
Firstly, in the same way that laboratory analysers, handheld analysers must be tested for their analytical performances and submitted to periodic quality control check to ensure proper functioning of the equipment, accuracy of measurement and consistent readings. In the report [1], neither analytical performance nor quality control have been mentioned for the handheld analysers.
Secondly, to confirm a correct agreement between the measurements provided by different devices, the number of patients enrolled appears quite low. Indeed, the devices measurement range must be taken into account [3]. Lactate values ranged from 0.7 to 5.38 mmol.l-1 , and 62.8% of the patients had lactate values < 2 mmol.l-1 while the devices had a measurement lactate range from 0.5 to 25 mmol.l-1. By this way, authors draw their conclusion only with the lower end of the range without considering high blood lactate values. We...
Show MoreAfter peer review, Cipriani et al were invited to provide a response to the research manuscript. Should Cipriani et al wish to respond to the article we will post their response here.
BMJ Open has received the comments from Bee Ping Teh and Norzahirah Ahmad on this paper. The authors of the paper have been contacted and have been asked to comment on the accuracy of their response.
We will update the article if necessary.
We have read with great interest about Goldkuhle et al., ‘A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer’ (BMJ Open; accepted on 12 February 2018; doi:10.1136/bmjopen-2017-020869). Hereby we are writing this electronic responses to address the contents of article in following aspects: typographical errors and indistinguishable information highlighted by the original authors.
There are five typographical errors found in the article that we would like to draw your attention as these could cause confusion to your many readers. The said errors are presented with snapshot image from the original article.
1) First paragraph of ‘Characteristics of included SRs’ section, under ‘RESULTS’ section, page 5; a numerical value of ‘67/216’ (at line 15) has to be corrected to ‘67/215’ because the total number of included studies for high-impact journal reviews was only 215 studies instead of 216.
2) At 'Table 1’, under ‘RESULTS’ section, page 6; a numercal value of '318 (9.9)' has to be corrected to ‘318 (91.9)’ as compared to first paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 1. This is because the percentage value of 318 out of 346 is 91.9% (approximate) instead of 9.9.
3) At 'Results’ section, under ‘ABSTRACT’ section, page 1, line 15; a numerical value of ‘6.52 (range 0-143)’ is different from mean number of citations...
Show MoreI'm just a real person, commenting on much I've seen in my real life.
I enjoyed the article about Seizures that may be caused by strobe lights at club parties.
It should be noted that Photo-sensitive Epileptic seizures can also be caused by some types of religious services, including Pentecostal-type Christian church services. These services can also cause seizures with thumpy-thump trick-bass music, and certain types of incense or scented candles.
Church of God in Christ (COGIC),
Assembly of God,
United Pentecostal Church,
White Dove,
many non-demoninationals, etc., all make use of:
strobe lights;
other types of lights (various speeds and colors);
fast, thumpy, jittering or swaying musical rhythms;
fast, thumpy, jittering or swaying body-movement rhythms;
galloping floor pulses, sometimes combined with ultra-slow floor pulses, tricked out as if caused by a strobe-"Sound" machine (whether music-caused, or from a separate vibrating machine);
and/or sometimes scents,
in order to make the congregation ultra, extra excited to bring the people into the "Spirit".
I've visited some types of these services, partly out of curiosity, since I was a teen. Including even an Assembly of God funeral at which people started wiggling and laughing, I assume due to the bright flashing lights and percussion rhythms.
Some charismatic-type services are quiete...
Show MoreTo the editor,
Show MoreIn a recent article, Chen et al.1 reported the association of low birth weight with future thinness and severe obesity. These findings are important for recognition of the risks of low birth weight, but further discussion of the underlying meaning is required.
Body mass index (BMI) generally increases rapidly during the first year of life, and then subsequently decreases and reaches a nadir at around 6 years of age. Thereafter, BMI increases again throughout childhood, and this second rise is referred to as the adiposity rebound2. Early adiposity rebound is a known risk factor for future obesity2,3, and even if BMI is low at the age of adiposity rebound, children who experience early adiposity rebound may become obese4. This means that a person can be thin in their youth and obese at an older age.
Low birth weight is also a known risk factor for early adiposity rebound5. Therefore, this phenomenon of changes in weight may be common among low birth weight infants, and some of the thin children in Chen et al.1 may ultimately become obese. To examine this hypothesis, it would be of interest to compare the mean ages and the distributions of subjects in Chen et al.1 who are thin and those with severe obesity. We believe that the thin subjects will have a younger mean age.
This information would help to explain the results of the study. A longitudinal study would then be warranted to develop a better understanding of the risks associated wi...
Dear Rosemary,
Many thanks for taking the time to read and respond to our recently published article: Protocol for Healthy Habits Happy Homes (4H) Scotland: feasibility of a participatory approach to adaptation and implementation of a study aimed at early prevention of obesity.
Show MoreWe agree that obesity prevention could and should start as early as reasonably possible (pre-conception/ peri-conception as recommended by WHO ECHO). We also feel (as did WHO ECHO) that we need to continue prevention efforts well beyond infancy and toddlerhood, and if that is the case then we need to have some prevention programmes to offer beyond infancy and toddlerhood: 4H is one potentially useful candidate prevention programme. It is not a question of intervening before/during infancy or later, we need both, with 4H contributing to the early childhood segment of future programmes.
The maternal and infant nutrition framework in Scotland offers opportunity for a wide range of preventative work to address childhood obesity. Using NHS Tayside (where 4H Scotland took place) as an illustration, the Health Visitor and Family Nurse services hold UNICEF UK baby friendly Gold award, the local neonatal unit hold the UNICEF UK baby friendly award and recently the use and promotion of healthy start vouchers and the breastfeeding friendly Scotland logo has increased. There is a local specialist weight management service offering prevention approaches at tier 1 and management programmes...
The study reported by Ang et al. is of great interest to healthcare providers, especially in view of its publication in a journal read by a general medical audience. It elegantly delineates two programmes that were launched in Singapore to facilitate the safe transition from acute hospital to the home of patients and aimed to decrease inpatient admissions and emergency department attendances, reduce total inpatient length of stay and diminish expenses of care of patients [1].
Accordingly, we would like to describe the integrated care transitions programme in Malaysia where stable patients discharged from hospital admissions are referred to designated primary health centres to undergo subsequent care and continuous treatment. For more than a decade, Ministry of Health Malaysia has commenced a service to allow patients to continue their treatment in other referred facilities to ensure patients can obtain continuous supply of their medications.
Despite the availability of standard guidelines, little is known about current patterns of medications supplied to this group of patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the need for information about the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health clinic in Selangor, Malaysia and examined the medications associated with the recommended treatment upon hos...
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