539 e-Letters

published between 2017 and 2020

  • Re: Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students

    This is a response to the article written by Dost et al., 2020, on the way medical students perceive online teaching during the COVID-19 pandemic. Despite the possible bias within the sample, as a nursing student facing similar challenges, the study is intriguing. An article written by Hasan, et al., revealed that university students enjoy online teaching, primarily because of the associated flexibility with time and place. Nevertheless, the survey also disclosed the associated disadvantages, with network connection being the greatest. I was pleased to note that the beneficial and non-beneficial findings presented by Dost et al., 2020, well reflected previous works. These findings suggested that teaching via online platforms can effectively substitute face to face teaching however, there is a recognizable need for improvements.
    It is with great optimism, that the publication of this article raises awareness of the difficulties medical students face with virtual learning. Additionally, possible adverse effects from poor education delivery via online teaching, such as medical students feeling under prepared for work in their profession, were mentioned. Those effects, as well as the disadvantages, raised the questions: 1) Are medical students working as hard as they once were, with writing open-book examinations? 2) What is the effective alternative for clinical sessions?

    Conflict of Interest:
    None declared.

    Dost, S., Hossain, A., Sh...

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  • RE: Relationship of social and economic factors to mental disorders among population-based samples of Jamaicans and Guyanese

    Dear Editor,
    I wish to present my perspective concerning the relationship between social and economic factors to mental disorders among Jamaicans and Guyanese populations. Over recent years, there has been a dramatic rise in mental disorders, specifically depression, in the low-to-middle nations such as Jamaica and Guyana. This is a fundamental topic that needs crucial attention since, with regards to the article, “Relationship of social and economic factors to mental disorders among Jamaicans and Guyanese” Lacey et al, (2016), authors have affirmed that an individual socio-economic status is a fundamental determinant of individual mental health. Over the years, many individuals in Jamaica and Guyanese just like the article has affirmed are plagued mental health problems resulting from substance abuse.
    Perhaps the most vital information is that the authors have not indicated the possible sources of these problems, the primary source of mental health problems in these nations will be the socio-economic factors. The social environment helps individuals understand different sources of mental issues among Jamaica and the Guyanese population (Lacey et al 2016). For instance, individuals who have negative personal association and less social possessions tend to have adverse health outcomes. The negative personal relationships do not provide a foundation of coping to any individual suffering from stress, adverse events of life, and life's daily hustle.

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  • Re: Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

    Dear editor,
    This response is concerning your article exploring “Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the Uk”, published in 2020. The study is both informative and intriguing as it provided thorough information on what healthcare workers experienced during the pandemic. It is interesting to me because I am a nursing student who will be on the frontlines one day and possibly face similar circumstances like this. I empathize with healthcare workers who had to withstand the atrocious conditions of this ongoing pandemic.
    According to the results in your research, healthcare workers suffered increased anxiety from fear of contracting the virus and transmitting it to loved ones, lack of testing, had limited protective equipment as well as very few guidance on properly donning personal protective equipment and having to reuse them caused significant distress. It was stated in a similar study that nurses signed up to care for patients, however, being faced with this disease has brought many fears for the nurses and their families (Rolle, 2020). Additionally, it was also conveyed in your research that nurses were redeployed back into the workforce, and graduation was fast-tracked for medical students. This is in congruence with Nagesh & Chakraborty (2020) study stating that health departments and ministries reached out to retired medical staff and those who spend more time in research, to return to clinical work and tide...

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  • Re:Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India

    Dear Editor,
    This response is in relation to your article Women and substance use in Delhi India published on November 19th ,2017. Your article piqued my interest, because I am a female and also, a nursing student. The prevalence and effects of substance abuse amongst women is extremely important as it relates to the women’s health, reproductive health, mental health, sexual transmitted infections and childbearing.
    I agree that drug use among the female population is often stigmatized because it goes against female gender roles. The belief that women are only seen as nurturers, partners and mothers still exist today. Many cannot see beyond the soft femininity of women & gender roles that have been shaped by society from the beginning of time. According to, Hentchel et al (2019) men are characterized as more agentic than women, taking charge and being in control, and women are characterized as more communal than men, being attuned to others and building relationships.
    There are many factors that contribute to substance use in women. I understand the correlation made between substance use and socioeconomic demographics such as education, employment and financial income. Aside from socioeconomic demographics, abuse factors such as trauma and abusive relationships contribute to substance abuse. As stated in your article drug use pushes women into a chaotic lifestyle. According to Harvard Heath(2010) women face tougher challenges and tend to progress more...

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  • Re: Perception and Experience of Healthcare Workers During the COVID-19 Pandemic in the UK

    Dear Editor,
    I write in response to your article discussing the perception and experience of healthcare workers during the Covid-19 pandemic. Firstly, I want to state that I found this article to be very intriguing, as I am a healthcare provider working on the frontline during the Covid-19 pandemic. The results of this study revealed that many healthcare workers’ concerns were geared toward the inadequate training, the shortage of personal protective equipment (PPE), inconsistency in guidelines, and prolonged testing of healthcare workers (HCWs). In addition, the results highlighted an increase in anxiety levels as persons fear contracting the virus and infecting their relatives.
    Having been a healthcare provider working the frontline of the pandemic, I can relate to many of the negative factors stated in the study. In addition to inadequate training, prolonged results and the shortage of PPE’s, the mental impact and increased workload has also negatively affected the healthcare team. Furthermore, the article stated that some healthcare workers were relieved of their duties as a result of workers having to be quarantined. This is common in many facilities which leaves inadequate staff on the battlefield. Consequently, the shortage of staffing aids in work-related fatigue that also impacts mental health, thereby creating a crisis within a crisis. In another research, Mehdi et al. (2020) alluded to this by stating that in addition to the burnout and occupational...

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  • Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial

    Dear Editor,
    The sentiments shared in the article Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial raises important concerns relating to health care today.
    The world’s health care industry continues to grapple with the effects of the COVID 19 pandemic. Globally, this pandemic has created a significant shortage in Personal Protective Equipment (PPE). As it stands, the wearing of cloth masks during this pandemic in a hospital setting has ignited significant concerns. According to Bayona and Infantado (2020), “there is no direct evidence on the effects of cloth mask in preventing COVID-19 pandemic among health care workers …” (p. 2). Coupled with the aforementioned fact, many health care workers are further compromising their health, as well as the health of others when they improperly decontaminate these masks. I share similar sentiments with you on the basis that if hospitals have to utilize cloth masks then they should bear the burden of decontaminating them. Moreover, I strongly believe that policies need to be implemented and enforced when the use of cloth masks are required in the hospital. These polices should include the mandatory utilization of the facility’s laundry services and the wearing of cloth masks as stipulated by the institutional guidelines.
    The World Health Organizations (WHO) recently disseminated their recommendations regardi...

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  • Response

    Dear Professor Kawada,

    Thank you for your response and interest in our study!

    You refer to the studies by Tidemalm et al (1) and Beckman et al (2), both very interesting and important studies who comment on risk factors for suicide in the long term.

    Tidemalm et al. (1) investigate suicide risk in suicide attempters with a specific focus on psychiatric disorders. We refer repeatedly to this study and make similar findings in regard to diagnoses, though our scope of investigated risk factors was wider. Further, the diagnoses in Tidemalm et al:s study was assessed in psychiatric in-patient care, while in ours at a medical emergency unit. Their finding that health care efforts are of high importance in the first two years following the suicide attempt is in line with our finding that a large portion (53%) of individuals died within the first five years, though we did not analyse risk factors after two years specifically.

    Beckman et al. (2) make important conclusions of the long-term risk of suicide, though they investigate a somewhat different type of sample; self-harming young people (i.e. not specifically suicide attempters) admitted to in-patient care. We did not investigate self-harm defined more broadly and it is beyond the scope of our study to comment on the risk factors for suicide associated with this.

    Thank you once again for your comments!

    Kind regards,

    Sara Probert-Lindström, Jonas Berge, Åsa Westrin, Agneta Öjeha...

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  • Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers

    This response is in relation to the article discussing Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers, published on October 10, 2020. After reading the article, truly this is an intriguing and very timely article. The results from this indicates that frontline healthcare workers are more likely to experience anxiety, stress and sleep problems as compared with non-frontline healthcare workers. However, the results also presented that both frontline and non-frontline healthcare workers showed no significant differences in depression status. In addition, this study emphasized and seemed to be congruent with other studies in suggesting that the Covid-19 pandemic has increased the rate of depressive symptoms, anxiety and insomnia among healthcare workers. Research studies like Tan, B.Y.Q., Chew, N.W.S, Lee G.K.H., et al. (2020) which also discovered that the primary outcome of the impact of Covid-19 was the prevalence of depression, stress, and anxiety among healthcare workers.
    Furthermore, while being faced with the Covid-19 pandemic, there were various social limitations that were put into place including travel restrictions, quarantine, and curfews etc. These social restrictions and the fear of contracting Covid-19 was very stressful for me as a nursing student. I cannot imagine how this pandemic has impacted the mental health of frontline and non-frontline healthcar...

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  • Association between frailty and disability in rural community-dwelling older adults

    Siriwardhana et al. examined the association between frailty and disability in rural community-dwelling older adults, aged ≥ 60 years, in Sri Lanka (1). About 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 instrumental activities of daily living (IADL) limitations was 84.4% among frail adults. 38.7% of frail adults reported ≥1 basic activities of daily living (BADL) limitations. In addition, 58.3% reported both ≥1 physical and cognitive IADL limitations. Furthermore, the odds of being frail for having no IADL limitations significantly decreased. I have some concerns about their study.

    The same authors described the prevalence and associated sociodemographic factors of frailty and pre-frailty (2). They found a strong association of frailty and pre-frailty with aging. In addition, longest-held occupation had a strong association with frailty, and education level was strongly associated with pre-frailty. Furthermore, prevalence of frailty was relatively lower in high-income and upper middle-income countries, compared with prevalence in Sri Lanka. The same authors also evaluated the association of frailty status with overall and domain-specific quality of life (QoL) (3). The estimated reduction in the total quality of life (QoL) score was 7.3% for those frail and 2.1% for those with pre-frail. These reductions could be explained by 'health' and 'independence, control over life and freedom' QoL domains. I suppose that aging, ethnicit...

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  • Hololens and clinical teaching during the Covid 19 pandemic

    The survey reported by Dost et al [1] across 40 UK medical schools provides a thorough and valuable insight into medical students’ perceptions of the move to online teaching consequent upon the Covid 19 pandemic. Most respondents (75.99%; n=1842) felt that “online teaching had not successfully replaced the clinical teaching they had received via direct patient contact”. The authors conclude that clinical skills remain “ a pertinent barrier” to effective online teaching of medical students. [1] In anticipation of the challenges posed by the current pandemic to undergraduate medical education, Rose has asserted that “medical schools will need to be nimble and flexible in their response”.[2]
    Our initial experience of employing the Microsoft Hololens 2 for teaching of Final Year medical students indicates that certain of the “direct patient contact” elements can be provided remotely. Having a bedside clinician (wearing the Hololens) share a rendered mixed reality with remote students may also enable a degree of vertical or horizontal integration that would be difficult in the setting of a traditional bedside ward round. For instance, an image of a schematic depicting the Mallampati Classification for predicting difficulty with management of the upper airway can be “pinned” adjacent to the mouth of the person whose airway is being evaluated. Although our experience with mixed reality in this setting is limited, preliminary student and teacher feedback is positive. We...

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