522 e-Letters

published between 2019 and 2022

  • Supplementary file - response

    Thank you for your interest in our work. This paper reports the outcome variable measured by question 14.5 in the supplementary file. This was asked as part of a wider COVID vaccination survey.

  • Supplementary File

    The data collection form provided in the supplementary file is not related to this manuscript. The data collection form is primarily focusing on the COVID-19 vaccines rather than Influenza.

  • Concerns primarily related to the nationwide ongoing Anemia Mukt Bharat program guidelines and policies

    The current ongoing trial aims to evaluate the impact of implementation of one component of the nationwide Anemia Mukt Bharat program i.e. screening for anemia with point of care treatment, without interfering with the other ongoing elements. It is therefore imperative for the trial to use the iron doses used in the AMB program. The concerns raised by the author of the comment regarding the iron dosages provided to children thus primarily relate to the AMB program guidelines (simultaneous administration of the fortified foods and iron supplementation (prophylactic and therapeutic)) and not the trial design. Similarly, the concerns related to small difference in the TUL of children and adults as per the ICMR-NIN guidelines do not pertain to the trial. The concerns raised by the author of the comment are thus beyond the purview of the ongoing trial. She should approach the policy makers to seek clarification regarding the rationale for the layering of interventions in case of programs that are of indefinite duration and where careful monitoring of adverse effects is not possible.

    We wish to reiterate that as per the standard practice, the trial protocol has been evaluated and approved by the institutional ethics committee of ICMR-National Institute of Nutrition, Hyderabad, India as well as by the Data Safety Monitoring Board and Technical Advisory Group constituted by Indian Council of Medical Research. The intervention is of short duration and there is diligent moni...

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  • Understanding how the English inequalities strategy was implemented

    Holdroyd et al’s systematic review of the effectiveness of the English health inequalities strategy found that ambitious national targets set in 2001 for reducing inequalities in infant mortality and life expectation by 2010 were largely met. This is the only period in the last 50 years when inequalities in mortality between rich and poor have narrowed in England making this a considerable achievement and an historic result.

    If policy makers are to maximise learning from this achievement, it’s important that they have a clear understanding of the interventions undertaken. The factors determining the distribution of health are complex and multifactorial. In any complex system, a strategy aimed at influencing outcomes needs to be as much about the approach to intervention as about the content of the policies (1). The papers Holdroyd et al cite are incomplete descriptions of the strategy as they omit the key elements that were central to the, resourcing, cross-sectoral incentivisation, metric generation and harnessing of power. Key elements of the intervention strategy included:

    • The NHS Plan (2) that set out Government's commitment to the publication of national inequalities targets. The targets were published in February 2021. The detailed rational for the setting and construction of those targets was explained in a technical paper (3). Without knowing the exact impact of any one action the architects of the strategy believed that if inequalities...

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  • Possible patient overlap in the meta-analysis

    Dear Editor,
    I just read the research “Association between asthma and dry eye disease: a meta-analysis based on observational studies” written by Q Huang and colleagues. I appreciated their work about connecting and analyzing the association between the two diseases, and raising awareness for physicians in clinical practice.

    However, I have some concerns about the analysis process in this research. Among the six studies included in this meta-analysis, two studies [2,3] used data from NHIRD of Taiwan. In the study conducted by colleagues and me (as the first author), [2] we analyzed in the aspect of the immunologists. We retrospectively included the patients with and without the diagnosis of asthma between 1998-2010 in NHIRD. We found that patients with asthma were associated with dry eye disease (DED), and there were some risk factors, including females, comorbidities such as allergic rhinitis and urticaria, and prescriptions including LTRAs, antihistamines, and inhaled corticosteroids. In the study conducted by Wang and colleagues, [3] they investigated the comorbidities that patients with DED may have, in the aspect of the ophthalmologists. They retrospectively included patients with DED between 2005 to 2006. The authors found that patients with DED were more likely to have multiple comorbidities, including asthma.

    NHIRD is a representative database that included one million randomly sampled patients from all NHI enrollees. The database is for resear...

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  • Response to: COVID-19 pandemic and vitamin D: rising trends in status and in daily amounts of vitamin D provided by supplements

    Dear Editor,
    We welcome the recent study from McKenna and colleagues which shines a light on evolving vitamin D status in South Dublin and on the availability of high dose vitamin D supplements in Ireland. However, we believe that the suggested association between the increased availability of high dose supplements in Ireland and the proposed increase in prevalence of hypervitaminosis D amongst Irish adults is not supported by the presented data.
    As the authors acknowledge, there are no explicit data which show the extent to which these higher dose supplements are being bought or consumed by the Irish population, and specifically, there are no data reported on the extent to which these higher dose supplements are being consumed by the 2.1% of individuals identified to have hypervitaminosis D (serum 25(OH)D >125nmol/L) in this cohort. The reported rise in prevalence of hypervitaminosis D in this population is also ambiguous; the paper cites an increase from 1.7% to 2.1% of individuals with serum 25(OH)D >125nmol/L between April 2019-March 2020 and April 2020-March 2021, but data from the same centre describe a hypervitaminosis D prevalence of 4.8% in an audit of clinical samples obtained over a ten month period in 2013.1 The seasonality of sampling during the two time periods is also not reported, while recent Irish data suggest that the observed decline in samples from hospitalised patients between the two time periods may be a further confounder.2

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  • Dr Ethel Burns, author response in collaboration with co-authors to: Alexis Shub, Susan P Walker and Anthea Lindquist

    We thank you for your feedback and careful read of our paper “Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth”.
    Thank you for highlighting the reporting error regarding maternal parity in Table 2 and ensuing confusion. This table has been corrected. You also mentioned Lathrop’s paper as including ‘multiples’, however, the authors clearly stated ‘singleton’ in eligibility p.417. You flagged two papers ‘are listed as included in the meta-analysis in table 1 and listed as excluded in the supplementary material’. They were both excluded for being a duplicate because they were reprinted in two different journals. Therefore, we have used their data but excluded the reprints. Geissbühler, V., & Eberhard, J. (2000). Waterbirths: A comparative study. A prospective study on more than 2,000 waterbirths. Fetal Diagnosis And Therapy, 15(5), 291–300 was reprinted in Obstetric and Gynecologic Survey: May 2001 - Volume 56 - Issue 5 - p 260-262. Geissbuehler, V., Stein, S., & Eberhard, J. (2004). Waterbirths compared with landbirths: an observational study of nine years. Journal of perinatal medicine, 32(4), 308-314. https://doi.org/10.1515/JPM.2004.057 was reprinted from the German journal - Gynakologisch-Geburtshilfliche Rundschau - Volume 43, Issue 1, pp. 12-18. However, you are correct in noting a minor e...

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  • Spelling Error

    The word randomised is misspelled in the first line of Table 1 Study design Exclusion criteria box as radnomised. Correction is required.

  • Below Tolerable Upper Limit (TUL) but why?

    The provision of high iron dosages to non-anemic children aged 6 months to 36 months in an Indian clinical trial has provoked discussions (eletters on the protocol paper dated 2nd and 10th August 2022) in the scientific community [1]. The “Screen and Treat for Anemia Reduction” (STAR) trial provides iron supplements which are given monthly by the investigators in batches at a dose of 20 mg elemental iron, twice a week to non-anemic children (about half of all children in the trial) and therapeutic doses to mild and moderately anemic children (at 3 mg per kg body weight). In addition, a child aged 6 months to 36 months also receives take home ration provided by the state government, which is fortified as per the guidelines[2] with iron at 6 mg per 100 grams of food that is to be consumed every day. Thus, a non-anemic child receives 82 mg of elemental iron every week as part of daily rations of fortified food and biweekly syrups. The prophylactic iron doses from syrups themselves are twice than the WHO recommendations (see eletter dated 2nd August 2022 on the above protocol paper). A child will be receiving a maximum of 26 mg of elemental iron from these sources twice a week.
    This unusually high dose (82 mg) is higher than the dose given to adults and pregnant women (60 mg weekly dose under the prophylactic regimen)[1]. The dose received by the child aged 6 to 11 months per day is about 5 times higher than the Estimated Average Requirements (EAR) for Indian children (...

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  • Sauna use and sudden sensorineural hearing loss

    I was recently diagnosed with sudden sensorineural hearing loss and am on a course of steroids, both oral and injected in the ear. One week before my diagnosis, I began using a sauna daily: 20 - 25 mins at 194 degrees F. I asked my ENT if I could continue my sauna use and he said it should be fine, but reading this article suggests that my sauna use could be correlated with my hearing loss. I plan to discontinue my sauna use, while I'm undergoing treatment. Any thoughts on whether I'm being too conservative?