1082 e-Letters

  • TV is one sedentary activity

    Increased TV watching is dangerous to your CV health. What about other sedentary activities, such as reading? In particular, reading medical journal articles?

  • Issue with the design

    The study is clearly an explanatory sequential design using a QUANT and a QUAL phase. However, the title and the abstract design states that this is an exploratory study. Looking further down at the methods section, the authors state that "This mixed-methods study used an explanatory sequential design and involved two phases "

  • Response to professor Kawada

    We thank professor Kawada for the constructive remarks.
    Indeed, women presented with more subthreshold or clinical insomnia than men (14.9% and 6.3%, vs. 11.6% and 4.4%, p=0.003, while men presented more frequently with depression (14.0% vs 10.1%, p=0.001). We ran the multivariable models stratifying on gender, and we assessed possible interactions between gender and insomnia / depression. The results show no significant (p<0.05) interaction, although a trend for a higher OR among women was noted for depression when fatigue was categorized using the threshold of 5 of the fatigue scale questionnaire (Table provided upon request). Hence, we believe that the results obtained using the model adjusting for gender are adequate.

    Regarding sleep duration, we agree it is an important issue and that future studies on fatigue should include an adequate estimation of the mean sleep duration.

    Pedro Marques-Vidal, on behalf of all authors

  • Systematic reviews should include discussion on the correlation of review findings with clinical experience and other evidence, especially when the findings don’t match clinical experience

    I read the recently published systematic review on Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis published in BMJ Open[1] with interest. It follows hot on the heels of 6 other previous published systematic reviews on the same subject, 3 on exactly the same subject of injection therapy in base of thumb osteoarthritis[2–5] and 3 others that included injections amongst all non-surgical or conservative therapies[6–8]. The conclusion of all 7 reviews is, not surprisingly, consistent in determining the level of evidence is poor, a conclusion which we can all agree on, however the other conclusion that there is no evidence steroid injections confer any benefit, is in contrast to the outcomes of non-randomised studies and with clinical experience.
    I believe the disconnect occurs due to the long-term outcome measures used in the assessment of outcomes usually recorded at 26 weeks. Longitudinal studies of the effect of steroid injections in base of thumb osteoarthritis (CMCJ OA) accord with clinical experience in that that the best outcomes were measured at 4 weeks (76% better at 4 weeks[9], with 2/3 better at 8 weeks, ½ at 12 weeks but only 1/6 at 26 weeks[5],. So, by assessing outcomes at 26 weeks, the pain-relieving effects of steroid have already dissipated.
    Another variation that needs to be considered but was not discussed is the different formulations and doses of corticosteroids used in the study as these vary in anti-i...

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  • RE: Disability discrimination and well-being in the United Kingdom

    Hackett et al. conducted a prospective study to evaluate the association between disability discrimination and well-being (1). Adjusted odds ratio (95% confidence interval [CI]) of disability discrimination for depression and fair/poor self-rated health were 5.40 (3.25 to 8.97) and 2.05 (1.19 to 3.51), respectively. In addition, standardized regression coefficients (95% CI) of disability discrimination for psychological distress, mental functioning, and life satisfaction were 3.28 (2.41 to 4.14), -7.35 (-9.70 to -5.02) and -1.27 (-1.66 to -0.87), respectively. Prospectively, disability discrimination was also significantly associated with increased psychological distress and poorer mental functioning by adjusting for baseline scores. I have some concerns about their study.

    Gill et al. conducted a prospective study to evaluate potential risk factors for severe disability (2). Hazard ratio (HR) (95% CI) of persons with ≥85 years old, hearing impairment, frailty, cognitive impairment, low functional self-efficacy and low peak flow for progressive disability were 1.6 (1.1-2.4), 1.7 (1.0-2.8), 2.4 (1.6-3.7), 2.0 (1.3-3.1), 1.8 (1.2-2.8), and 1.7 (1.2-2.4), respectively. In addition, HR (95% CI) of persons with visual impairment, hearing impairment, poor physical performance, and low peak flow for catastrophic disability were 1.4 (1.1-1.8), 1.3 (1.0-1.7), 1.8 (1.3-2.5), 1.3 (1.0-1.7), respectively. To avoid severe disability, appropriate interventions for modifiable facto...

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  • RE: Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies

    Barker et al. conducted a review to investigate risk-benefit assessment of aspirin for fracture (1). Pooled odds ratio (95% CI) of aspirin use for any fracture was 0.83 (0.70 to 0.99). There was a tendency of the association between aspirin use and total hip bone mineral density (BMD). Similar results were observed for lumbar spine BMD. I have some concerns about their study.

    I understand that fracture risk includes BMD, but other psycho-physiological factors also attribute to fracture such as physical balance, muscle strength and mental instability. Aspirin use might modify the level of physical fitness and lead to the benefits of reduced fracture risk and increased trend of BMD. Barker et al. included a cross-sectional study by Bonten et al., to evaluate the effect of low-dose aspirin on BMD (2). There was no difference between aspirin users and non-users for vertebral BMD in men and women. They speculated that the risk of fractures observed in aspirin users in previous studies might not be directly related to BMD.

    Chin summarized the effect of aspirin use on bone health (3). Although aspirin could prevent bone loss in animal models of osteoporosis, human epidemiological studies regarding aspirin used and fracture risk were limited, and the effect of aspirin use on fracture prevention has been inconclusive. On this point, Barker et al. presented precise information on the relationship. Each component of a meta-analysis should be added for stable estimation....

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  • Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome: cohort study with record linkage

    We thank Professor Kawada for his interest in our study.(1) We agree that the three recent papers he quotes are interesting studies that make important contributions. We do not agree with his expression of concerns about our study as they seem to reflect an assumption that different reporting to the papers he quoted were the concerns; these studies are not comparable to ours.

    Oppewal et al. studied only elderly people,(2) whilst our study was of adults aged 16 years and over; their study included people using three care providers, whilst ours was population based. Oppewal et al. gathered cause of death information from medical case-files, and acknowledged, amongst other limitations, that information on cause of death in these files was sometimes limited which was beyond their control. Indeed they reported immediate and primary (underlying) cause of death, but not contributing causes of death, raising the question of whether it was possible for them to distinguish underlying and contributing causes of death from the case-files. We found the most common underlying causes of death for the adults with Down syndrome were dementia (35.1%), then other infection (12.3%); but when considering all contributing causes of death (not just the underlying cause), we found the most common after Down syndrome to be dementia (42.1%), and respiratory infection (38.6%) (reported in our table 5).

    In a study published in the same month as ours, De Campos Gomes et al. reported hig...

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  • 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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