Sasidharan et al. conducted a prospective study to examine the risk factors for falls among community-dwelling elderly subjects in India (1). The incidence rate of falls was 31 per 100 person-years. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of female sex, movement disorders, arthritis, dependence in basic activities of daily living, not using antihypertensive medications, living alone during daytime, and a history of falls in the previous year for a fall in the following year were 1.48 (1.05 to 2.10), 2.26 (1.00 to 5.05), 1.48 (1.05 to 2.09), 3.49 (2.00 to 6.09), 1.53 (1.10 to 2.13), 3.27 (1.59 to 6.71), and 2.25 (1.60 to 3.15), respectively. I have some concerns about their study.
First, Tripathy et al. reported epidemiological findings of falls among older adults in India (2). The prevalence rate of fall episodes was 67 per 100 person-years. Adjusted OR (95% CI) of female sex, taking four or more medicines, and having poor body balance were 1.6 (1.0 to 2.8), 2.1 (1.2 to 3.5), 1.9 (1.0 to 3.4), respectively. Female sex was also a risk factor for fall in this study, and sex difference for predicting fall in the elderly should be specified by further studies.
Second, Susilowati et al. assessed the prevalence and related factors for falls in the past year in a sample of community-dwelling and institutionalized older Indonesians (3). The prevalence of falls in the past year was 29%, and women and institutionalized older adults had higher preval...
Sasidharan et al. conducted a prospective study to examine the risk factors for falls among community-dwelling elderly subjects in India (1). The incidence rate of falls was 31 per 100 person-years. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of female sex, movement disorders, arthritis, dependence in basic activities of daily living, not using antihypertensive medications, living alone during daytime, and a history of falls in the previous year for a fall in the following year were 1.48 (1.05 to 2.10), 2.26 (1.00 to 5.05), 1.48 (1.05 to 2.09), 3.49 (2.00 to 6.09), 1.53 (1.10 to 2.13), 3.27 (1.59 to 6.71), and 2.25 (1.60 to 3.15), respectively. I have some concerns about their study.
First, Tripathy et al. reported epidemiological findings of falls among older adults in India (2). The prevalence rate of fall episodes was 67 per 100 person-years. Adjusted OR (95% CI) of female sex, taking four or more medicines, and having poor body balance were 1.6 (1.0 to 2.8), 2.1 (1.2 to 3.5), 1.9 (1.0 to 3.4), respectively. Female sex was also a risk factor for fall in this study, and sex difference for predicting fall in the elderly should be specified by further studies.
Second, Susilowati et al. assessed the prevalence and related factors for falls in the past year in a sample of community-dwelling and institutionalized older Indonesians (3). The prevalence of falls in the past year was 29%, and women and institutionalized older adults had higher prevalence. The adjusted ORs (95% CIs) of older age, private elderly home setting, and male sex for falls were 1.89 (1.06 to 3.37), 2.04 (1.10 to 3.78), and 0.49 (0.30 to 0.82), respectively. There were some differences in risk factors for falls between community-dwelling and institutionalized older adults, and having a joint disorder or arthritis were risk for falls in the community setting. Living environment might be associated with many socio-economic factors, and risk assessment for falls in the elderly should be made by the combination of psycho-physio-social factors.
Finally, Yeong et al. determined the prevalence and associated factors of falls among community-dwelling elderly in rural Malaysia (4). The prevalence of falls in the past 1 year was 4.07%. Adjusted ORs (95% CIs) of indigenous elderly and living alone for falls were 6.06 (1.10 to 33.55) and 2.60 (1.04 to 6.50), respectively. In contrast, there was no significant association of falls with physical activity level, number of co-morbidities and number of medications used. Compared with other studies, the prevalence of falls was low. I suppose that place of residence might be closely related to the prevalence and risk factors of falls. Anyway, further studies are needed to prevent falls and fractures among elderly subjects.
References
1. Sasidharan DK, Vijayakumar P, Raj M, et al. Incidence and risk factors for falls among community-dwelling elderly subjects on a 1-year follow-up: a prospective cohort study from Ernakulam, Kerala, India. BMJ Open 202030;10(7):e033691.
2. Tripathy NK, Jagnoor J, Patro BK, et al. Epidemiology of falls among older adults: A cross sectional study from Chandigarh, India. Injury 2015;46(9):1801-5.
3. Susilowati IH, Nugraha S, Sabarinah S, et al. Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia. Malays Fam Physician 2020;15(1):30-38.
4. Yeong UY, Tan SY, Yap JF, et al. Prevalence of falls among community-dwelling elderly and its associated factors: A cross-sectional study in Perak, Malaysia. Malays Fam Physician 2016;11(1):7-14.
We are interested in the recent paper from New Zealand (NZ), describing the experiences of 15 patients with abnormal uterine bleeding, by Claire Henry and others [1]. We agree that abnormal uterine bleeding deserves more attention and have documented the rapid recent increase in endometrial cancer (EC) in NZ Pacifica women [2,3]. However, some of these authors’ statements are not supported by the data they cite. They state “Studies which report on EC prevalence in NZ often link the cause of advanced stage diagnosis to ‘late presentation’...”. For this, they cite one of our studies [2] and another NZ study [4]. However, neither of these papers mentions late presentation, and in another paper which Henry et al. cite [3], we report that Māori and Pacific women did not present with higher grade or stage EC compared to other NZ women. However, both Māori and Pacific women experienced a worse disease-specific survival, which was statistically significant in Pacific women.
More importantly, Henry et al. continue with reference to these studies “… placing women at fault for not having sought more timely medical intervention. We aimed to reframe these deficit narratives....”. We strongly object to these inaccurate claims and the implication that our papers are ‘deficit narratives’ is unacceptable. Nowhere in our papers do we “place women at fault”. We feel strongly that clinicians should be supportive and more alert to sympt...
We are interested in the recent paper from New Zealand (NZ), describing the experiences of 15 patients with abnormal uterine bleeding, by Claire Henry and others [1]. We agree that abnormal uterine bleeding deserves more attention and have documented the rapid recent increase in endometrial cancer (EC) in NZ Pacifica women [2,3]. However, some of these authors’ statements are not supported by the data they cite. They state “Studies which report on EC prevalence in NZ often link the cause of advanced stage diagnosis to ‘late presentation’...”. For this, they cite one of our studies [2] and another NZ study [4]. However, neither of these papers mentions late presentation, and in another paper which Henry et al. cite [3], we report that Māori and Pacific women did not present with higher grade or stage EC compared to other NZ women. However, both Māori and Pacific women experienced a worse disease-specific survival, which was statistically significant in Pacific women.
More importantly, Henry et al. continue with reference to these studies “… placing women at fault for not having sought more timely medical intervention. We aimed to reframe these deficit narratives....”. We strongly object to these inaccurate claims and the implication that our papers are ‘deficit narratives’ is unacceptable. Nowhere in our papers do we “place women at fault”. We feel strongly that clinicians should be supportive and more alert to symptoms and we note; “It has also been suggested that clinicians should be more alert to EC symptoms in obese and/or Pacific women in their normal line of work. Currently, young obese women may not be fully investigated when they present with traditional EC symptoms; however, further investigation of symptoms is now considered mandatory in this group given their high-risk profile” [2].
Abnormal bleeding is difficult to assess and treat and we agree with Henry and her colleagues that some patients may have difficulties in obtaining adequate care. But their study, based on 15 patients, only deals with some of the issues and seems to downplay the efforts being made to improve this situation.
References
(1) Henry C, Jefferies R, Ekeroma A, Filoche S. Beyond the numbers-understanding women's experiences of accessing care for abnormal uterine bleeding (AUB): a qualitative study. BMJ Open 2020; 10(11): e041853.
(2) Scott OW, Tin Tin S, Bigby SM, Elwood JM. Rapid increase in endometrial cancer incidence and ethnic differences in New Zealand. Cancer Causes Control 2019; 30(2): 121-127.
(3) Bigby SM, Tin Tin S, Eva LJ, Shirley P, Dempster-Rivett K, Elwood JM. Increasing incidence of endometrial carcinoma in a high-risk New Zealand community. Aust NZ J Obstet Gynaecol 2020; 60(2): 250-257.
(4) Meredith I, Sarfati D, Ikeda T, Atkinson J, Blakely T. High rates of endometrial cancer among Pacific women in New Zealand: the role of diabetes, physical inactivity, and obesity. Cancer Causes Control 2012; 23(6): 875-885.
Højlund et al. conducted a 1:4 matching case-control study to examine the association between use of second-generation antipsychotics (SGA) and the risk of chronic kidney disease (CKD) (1). They defined CKD as an estimated glomerular filtration rate below 60 mL/min/1.73 m2 for 3 months or more. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of ever and current SGA users for the risk of CKD were 1.24(1.12 to 1.37) and 1.26 (1.12 to 1.42), although there was no dose-response relationship. In addition, the adjusted ORs (95% CIs) of short-term and long-term SGA users for the risk of CKD were 1.22 (1.01 to 1.48) and 1.45 (1.19 to 1.76), respectively. Furthermore, clozapine presented the highest risk of CKD, and aripiprazole presented no significant risk of CKD. I have a comment about their study with special reference for the psychiatric diseases.
Wang et al. conducted a risk assessment of CKD between patients with schizophrenia using first and second-generation antipsychotics (2). They defined CKD as a kidney damage as albumin-to-creatinine ratio >30 mg/g or glomerular filtration rate below 60 mL/min/1.73 m2 for 3 months or more. The risks for CKD were significantly higher in patients with SGA, although the risk did not increase as the patients used SGA for longer period. As the information in the risk of CKD in patients with SGA is limited, further studies are recommended by specifying the psychiatric diseases and CKD-related comorbidities.
Højlund et al. conducted a 1:4 matching case-control study to examine the association between use of second-generation antipsychotics (SGA) and the risk of chronic kidney disease (CKD) (1). They defined CKD as an estimated glomerular filtration rate below 60 mL/min/1.73 m2 for 3 months or more. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of ever and current SGA users for the risk of CKD were 1.24(1.12 to 1.37) and 1.26 (1.12 to 1.42), although there was no dose-response relationship. In addition, the adjusted ORs (95% CIs) of short-term and long-term SGA users for the risk of CKD were 1.22 (1.01 to 1.48) and 1.45 (1.19 to 1.76), respectively. Furthermore, clozapine presented the highest risk of CKD, and aripiprazole presented no significant risk of CKD. I have a comment about their study with special reference for the psychiatric diseases.
Wang et al. conducted a risk assessment of CKD between patients with schizophrenia using first and second-generation antipsychotics (2). They defined CKD as a kidney damage as albumin-to-creatinine ratio >30 mg/g or glomerular filtration rate below 60 mL/min/1.73 m2 for 3 months or more. The risks for CKD were significantly higher in patients with SGA, although the risk did not increase as the patients used SGA for longer period. As the information in the risk of CKD in patients with SGA is limited, further studies are recommended by specifying the psychiatric diseases and CKD-related comorbidities.
References
1. Højlund M, Lund LC, Herping JLE, Haastrup MB, Damkier P, Henriksen DP. Second-generation antipsychotics and the risk of chronic kidney disease: a population-based case-control study. BMJ Open. 2020 Aug 11;10(8):e038247.
2. Wang HY, Huang CL, Feng IJ, Tsuang HC. Second-generation antipsychotic medications and risk of chronic kidney disease in schizophrenia: population-based nested case-control study. BMJ Open. 2018 May 24;8(5):e019868.
Abbie Lane et al. (1), reported a high level of distress among medical students.
However, in the report 15 students of 161 (9%) expressed a high level of objective stress and the major cause of stress was the exams.
We do not know when the questionnaire was offered to students in relation to the date of their exams. Indeed, before the exams it is normal that a majority of students are stressed and this situation is not specific to medical students. The authors omitted that some stress was necessary and could have positive impact to be competitive. Acute stress was not differentiated from chronic psychological stress which could impact cognitive functions by decreasing the arterial cerebral blood flow related to the persistent increase of high level of plasmatic cortisol (2; 3).
The authors reported that medical students were highly stressed, they thought that it was due to medical studies. Perhaps yes, perhaps no. Maybe this situation is comparable to that of other students of other disciplines or to other young people who are not students. The absence of control group in this study leaves the question unanswered.
In addition, the small number of participants (161), makes the results difficult to analyse. Furthermore, only 15 students had a high level of objective stress. What significance could be attributed to this small subgroup, whereas the authors conclude that medical students had a high level of stress like senior doctors. This conclusion cou...
Abbie Lane et al. (1), reported a high level of distress among medical students.
However, in the report 15 students of 161 (9%) expressed a high level of objective stress and the major cause of stress was the exams.
We do not know when the questionnaire was offered to students in relation to the date of their exams. Indeed, before the exams it is normal that a majority of students are stressed and this situation is not specific to medical students. The authors omitted that some stress was necessary and could have positive impact to be competitive. Acute stress was not differentiated from chronic psychological stress which could impact cognitive functions by decreasing the arterial cerebral blood flow related to the persistent increase of high level of plasmatic cortisol (2; 3).
The authors reported that medical students were highly stressed, they thought that it was due to medical studies. Perhaps yes, perhaps no. Maybe this situation is comparable to that of other students of other disciplines or to other young people who are not students. The absence of control group in this study leaves the question unanswered.
In addition, the small number of participants (161), makes the results difficult to analyse. Furthermore, only 15 students had a high level of objective stress. What significance could be attributed to this small subgroup, whereas the authors conclude that medical students had a high level of stress like senior doctors. This conclusion could not be drawn according the data of this study. Indeed, senior doctors were not investigated in this study.
Finally, we agree that medical studies are stressful because the competition is hard. For example, in France only approximately ten percent of the newly integrated medical students during the first year can pass to the second year. However, this situation is not specific to medical studies and randomized controlled studies are highlighted to evaluate and better manage the stress during medical studies.
References
1. Lane A, McGrath J, Cleary E, Guerandel A, Malone KM. Worried, weary and worn out: mixed-method study of stress and well-being in final-year medical students. BMJ Open. 2020 Dec 10;10(12):e040245. doi: 10.1136/bmjopen-2020-040245. PMID: 33303448.
2. von Dawans B, Strojny J, Domes G. The effects of acute stress and stress hormones on social cognition and behavior: current state of research and future directions. Neurosci Biobehav Rev. 2020 7:S0149-7634(20)30666-7.
3. Lutskyi IS, Evtuchenko SK, Skoromets AA. Mechanisms of chronic stress influence on the brain hemodynamic in persons with employment-related chronic stress. Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120:67-72.
Excellent study on a contemporary topic. If you are able, can I suggest you extend the study to a retrospective analysis of falls and nearness to death. I suspect that falls are one of a composite of indicators which can be used to estimate which persons are in the last year of life.
Jaleel Saunders, Nursing Student University of The Bahamas
Other Contributors:
Terry J Campbell, Lecturer
Dear Editor,
I am a fourth-year nursing student at the University of The Bahamas. I would like to share my views on “Childhood peer status and circulatory disease in adulthood, a prospective cohort study in Stockholm, Sweden.” Circulatory diseases have become somewhat of an epidemic within Bahamian society and your article enlightened me on how childhood peer status may increase the likelihood of circulatory diseases in adulthood. This study can provide some important knowledge to understanding why circulatory diseases like diabetes and hypertension are so prominent within The Bahamas.
This research on childhood experience should not be overlooked as it is quintessential to the development of an adult. Studies imply that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking (Vohra et al., 2015, p. 630). However, as socioeconomics are easily measurable, peer status amongst children is a multifaceted circumstance that one question cannot simply answer. The question used in this research to assess peer status “Whom do you best like working with at school?” can have skewed responses. The answer may have been based on a student wanting to have the best outcome in terms...
Jaleel Saunders, Nursing Student University of The Bahamas
Other Contributors:
Terry J Campbell, Lecturer
Dear Editor,
I am a fourth-year nursing student at the University of The Bahamas. I would like to share my views on “Childhood peer status and circulatory disease in adulthood, a prospective cohort study in Stockholm, Sweden.” Circulatory diseases have become somewhat of an epidemic within Bahamian society and your article enlightened me on how childhood peer status may increase the likelihood of circulatory diseases in adulthood. This study can provide some important knowledge to understanding why circulatory diseases like diabetes and hypertension are so prominent within The Bahamas.
This research on childhood experience should not be overlooked as it is quintessential to the development of an adult. Studies imply that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking (Vohra et al., 2015, p. 630). However, as socioeconomics are easily measurable, peer status amongst children is a multifaceted circumstance that one question cannot simply answer. The question used in this research to assess peer status “Whom do you best like working with at school?” can have skewed responses. The answer may have been based on a student wanting to have the best outcome in terms of a grade. This question could be used to find out who is the smartest amongst the children in that age bracket or grade.
Furthermore, findings from this article indicate an increased susceptibility of marginalized peers for circulatory disease in later life, which is in line with other studies that considered long-term impacts of peer integration (Miething & Almquist, 2020). Nevertheless, it does not consider factors that may lead to children to fall within the lower peer status group. A guide or system for categorization each tier for peer-status amongst children should be made clear to alert teachers and parents to help lift children out of this peer status, decreasing their chances of developing circulatory issues in adulthood.
Although, the article was concise and easy to read I had an issue with the way results were presented in charts. The use of graphs may be a bit easier to understand. Furthermore, the layout of the charts in a vertical view was inconvenient for readers on devices like laptops and mobile phones.
However, overall Miething & Almquist’s evaluation of childhood peer status and its relationship to adulthood circulatory disease is crucial to understanding why persons develop these kinds of diseases. Like they suggested it may be due to socioeconomics, or lower peer status, but the studies show a significant health risk for lower-status children. This should prompt invention from the schools or parents that can identify lower peer status children and give them the help they need.
Sincerely, J. Saunders
References
Miething, A., & Almquist, Y. (2020, September 01). Childhood peer status and circulatory disease in adulthood: A prospective cohort study in Stockholm, Sweden. Retrieved November 22, 2020, from https://bmjopen.bmj.com/content/10/9/e036095
Vohra, J., Marmot, M. G., Bauld, L., Hiatt, R. A., Vohra, J., Marmot, M. G., … Hiatt, R. A. (2016). in adulthood : a rapid-review. 70(6), 629–634.
Sylvenie Fleurimond
Nursing Student
University of The Bahamas
Nassau, The Bahamas Sylveniefleeurimond81@gmail.com
Other contributor:
Dr. Terry Campbell Lecture
November 18th 2020
Re: Does weight-related stigmatization and discrimination depend on educational attainment and
level income? A systematic review
The editor:
Dear editor am a fourth year nursing student at the University of The Bahamas, it is with gain
interest of the above caption article. I would to express that how the article made me
knowledgeable of how obesity within the Bahamian society where it is also a major concerned
like every elsewhere around the world and how its linked to so many health issues such as non
communicable diseases for example Hypertension and diabetes. Upon reading the article I was
able to understand the connection between the levels of education as it relate to obesity. The
article brought issues to light that persons with high level educational backgrounds always sees
that an obese person is from a low- income educational background and the stigma and
discrimination is always felt among them. Unfortunately society sees an obese person as lazy, in
has a low self-esteem and is of low income social background (Avena 2013). While it can be said
that persons who have a higher level of achievements do look down on...
Sylvenie Fleurimond
Nursing Student
University of The Bahamas
Nassau, The Bahamas Sylveniefleeurimond81@gmail.com
Other contributor:
Dr. Terry Campbell Lecture
November 18th 2020
Re: Does weight-related stigmatization and discrimination depend on educational attainment and
level income? A systematic review
The editor:
Dear editor am a fourth year nursing student at the University of The Bahamas, it is with gain
interest of the above caption article. I would to express that how the article made me
knowledgeable of how obesity within the Bahamian society where it is also a major concerned
like every elsewhere around the world and how its linked to so many health issues such as non
communicable diseases for example Hypertension and diabetes. Upon reading the article I was
able to understand the connection between the levels of education as it relate to obesity. The
article brought issues to light that persons with high level educational backgrounds always sees
that an obese person is from a low- income educational background and the stigma and
discrimination is always felt among them. Unfortunately society sees an obese person as lazy, in
has a low self-esteem and is of low income social background (Avena 2013). While it can be said
that persons who have a higher level of achievements do look down on persons that are obese
seeing these persons as less attractive. Not only over weight individuals faces the stigma during
the early years and also during adulthood when applying for jobs an obese individual is less to be
likely to get hired versus a person that is thin, big cooperation perceived an obese individual as
incompetent (Puhl &Brownell 2012). The research is timely due to the pressure of society that
being thin is better. As it relates to obesity over time the differences between income and
education level that exist further studies is needed to understand the reasons for the stigma and
discrimination with individuals that are obese. The importance to get a better view of the
negative effects on persons that obese and the expressions of stigma that is attached and the
ongoing efforts to change people’s attitude toward obese people. Overall I enjoyed reading the
article but I found it kind of difficult to understand the tables.
Conflict of interest:
None declared.
References:
Puhl, Rebecca, Brownell Kelly (September 2012) bias, discrimination and obesity.
Avena, Nicole (June 2013) psychology today, the negative social consequences of being obese.
Dear Editor,
This response is to the current approach to food platform that pays little heed to the increasing role of digital technology and the internet in everyday life and to the particularities of the digital world in influencing health and nutrition. Digital food environments encompass the digital components that may be part of food platform and influence health and nutrition.
Major activities enabled by social media include social interaction and social support, generating new or editing existing content, and engaging with content such as clicking a link, viewing, liking, and commenting on posts. One of the distinctive features of social media is the ability for anyone to create user-generated content and share it, compared to messages that have been traditionally delivered through a limited number of media gatekeepers: production studios, TV networks, and editorial staff. As mentioned in paragraph four (4) of the article, previous systematic reviews have examined how social media use impacts eating disorder outcomes, the digital marketing of unhealthy food and drink, and the use of social media interventions in weight management. Given the dynamic and large variety or social media platforms, there is a lack of standardized tools and methods to conduct social media research.
Mapping the works will serve to identify the available evidence on food and nutrition-related social media content, identify and analysed critical knowled...
Dear Editor,
This response is to the current approach to food platform that pays little heed to the increasing role of digital technology and the internet in everyday life and to the particularities of the digital world in influencing health and nutrition. Digital food environments encompass the digital components that may be part of food platform and influence health and nutrition.
Major activities enabled by social media include social interaction and social support, generating new or editing existing content, and engaging with content such as clicking a link, viewing, liking, and commenting on posts. One of the distinctive features of social media is the ability for anyone to create user-generated content and share it, compared to messages that have been traditionally delivered through a limited number of media gatekeepers: production studios, TV networks, and editorial staff. As mentioned in paragraph four (4) of the article, previous systematic reviews have examined how social media use impacts eating disorder outcomes, the digital marketing of unhealthy food and drink, and the use of social media interventions in weight management. Given the dynamic and large variety or social media platforms, there is a lack of standardized tools and methods to conduct social media research.
Mapping the works will serve to identify the available evidence on food and nutrition-related social media content, identify and analysed critical knowledge gaps, and examine how social media research on food and nutrition is being conducted. (Granheim et al, 2020). Further research is necessary to characterize and assess the extent of the impact of digital food environments on health and nutrition in different contexts and different population groups, as well as their linkages with the broader food system and policy implications.
Nevertheless, there is a rise in consumption of unhealthy food because the cost of nutrient-dense foods, like fruit, vegetables, and animal foods, are often significantly elevated, more so, than those of calorie-dense foods, making cost a barrier to the poor. Promoting enhanced production and also the productivity of healthy and nutritious foods will be important if we are to lower prices and increase the accessibility of healthy and sustainable diets as unhealthy snacking is not only due to influencer digital food marketing as mentioned in the article.
In the current climate of the world regarding social media use, adolescents are a group that this phenomenon disproportionately effects. Upon reading, with great interest, the article authored by Scott, Biello, & Woods (2019), I found this study’s results and findings very interesting and provocative. This type of study is especially stimulating given the current social climate of the world, in which social media-use has become an integral part of everyday life. Before this study, there had been little empricial evidence to show that sleep is disrupted by social media use. Most previous studies focused on “screentime” use of adolescents as a opposed to singling out social media use for study. The authors point out the need for this due to the UK’s lack of evidence-based decision making. The problem statement of this study highlights that in paediatric nursing practice, there is a lack of solutions brought forth to address adolescents’ lack of sleep (Hamilton et al., 2020). Thé findings of this study can now be used to address the current issue of adolescents sleeping patterns in public health policy which is usually neglected according to the authors. The culturally based aspect of this problem delineates the need to target this amongst adolescents specifically as opposed to the general public. The data analyses help ensure that the results are valid since they give an accurate depiction of the probability of occurrence for sleep loss due to social media use. The analy...
In the current climate of the world regarding social media use, adolescents are a group that this phenomenon disproportionately effects. Upon reading, with great interest, the article authored by Scott, Biello, & Woods (2019), I found this study’s results and findings very interesting and provocative. This type of study is especially stimulating given the current social climate of the world, in which social media-use has become an integral part of everyday life. Before this study, there had been little empricial evidence to show that sleep is disrupted by social media use. Most previous studies focused on “screentime” use of adolescents as a opposed to singling out social media use for study. The authors point out the need for this due to the UK’s lack of evidence-based decision making. The problem statement of this study highlights that in paediatric nursing practice, there is a lack of solutions brought forth to address adolescents’ lack of sleep (Hamilton et al., 2020). Thé findings of this study can now be used to address the current issue of adolescents sleeping patterns in public health policy which is usually neglected according to the authors. The culturally based aspect of this problem delineates the need to target this amongst adolescents specifically as opposed to the general public. The data analyses help ensure that the results are valid since they give an accurate depiction of the probability of occurrence for sleep loss due to social media use. The analyses processes, using separate binomial logistic regression models, increases the precision of the results as opposed to a simple correlation test.
While I agree with the study’s findings and dissemination of results, I believe that it is necessary to continue to do further studies in other regions where social media is popular amongst adolescents. Some studies, show that there is concern for adolescents’ social media use, however, there should be a distinction between social media use and social media stress when investigating the effects on adolescents (Schuur, Baumgarter, & Sumter, 2019). However, there are similar studies which confirm that social media use is a direct factor in causing adolescents to lose more sleep and even find a link to depression based on their family’s status (Hamilton, et al., 2020). Further, previous studies confirm the aforementioned study, indicating that adolescents’ sleep is indeed disrupted by both social media use and psychological problems which include depression (Woods & Scott, 2016). These results all correlate with the negative effects which parents wish to avoid their children being made privy to in the current social climate of the world. Therefore, this study gave important awareness for research and understanding of a current issue which is being faced worldwide along with the significant effects which the world cannot ignore.
References
Hamilton, J. L., Chand, S., Reinhardt, L., Ladouceur, C. D., Silk, J. S., Moreno, M., . . . Bylsma, L. M. (2020, August). Social media use predicts later sleep timing and greater sleep variability: An ecological momentary assessment study of youth at high and low familial risk for depression. Journal of Adolescence, 83, 112-130. doi:https://doi.org/10.1016/j.adolescence.2020.07.009
Schuur, W., Baumgarter, S. E., & Sumter, S. R. (2019). Social Media Use, Social Media Stress, and Sleep: Examining Cross-Sectional and. Health Communication, 34(5), 552-559. doi:https://doi.org/10.1080/10410236.2017.1422101
Scott, H., Biello, S. M., & Woods, H. C. (2019). Social media use and adolescent sleep. BMJ Open, 9, 1-9. doi: doi:10.1136/bmjopen-2019-031161
Woods, H. C., & Scott, H. (2016, August ). #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of Adolescence, 51, 41-49. doi:https://doi.org/10.1016/j.adolescence.2016.05.008
Fumagalli et al. conducted a retrospective cohort study to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients ≥18 years [1]. Significant predictors of mortality were increasing age, number of chronic diseases, respiratory rate, decreasing PaO2/FiO2, serum creatinine and decreasing platelet count of mortality. I have come concerns about their study with special reference to thrombocytopenia in COVID-19 patients.
There have been many meta-analyses of presenting severe health hazard of thrombocytopenia in COVID-19 patients. Three papers in British Journal of Haematology [2-4], two papers in European journal of Clinical Investigation [5,6], and one paper n Biomarker Research [7]. Although severe health hazards of thrombocytopenia in COVID-19 patients has been consistently reported by meta-analyses, a cohort study with minimum bias should also be conducted with special reference to comorbidity and aging.
References
1. Fumagalli C, Rozzini R, Vannini M, et al. Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study. BMJ Open. 2020 Sep 25;10(9):e040729.
2. Zhou M, Qi J, Li X, et al. The proportion of patients with thrombocytopenia in three human-susceptible coronavirus infections: a systematic review and meta-analysis. Br J Haematol. 2020 May;189(3):438-441.
3. Jiang SQ, Huang QF, Xie WM, et al. The association between severe COVID-19 and low platelet count: eviden...
Fumagalli et al. conducted a retrospective cohort study to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients ≥18 years [1]. Significant predictors of mortality were increasing age, number of chronic diseases, respiratory rate, decreasing PaO2/FiO2, serum creatinine and decreasing platelet count of mortality. I have come concerns about their study with special reference to thrombocytopenia in COVID-19 patients.
There have been many meta-analyses of presenting severe health hazard of thrombocytopenia in COVID-19 patients. Three papers in British Journal of Haematology [2-4], two papers in European journal of Clinical Investigation [5,6], and one paper n Biomarker Research [7]. Although severe health hazards of thrombocytopenia in COVID-19 patients has been consistently reported by meta-analyses, a cohort study with minimum bias should also be conducted with special reference to comorbidity and aging.
References
1. Fumagalli C, Rozzini R, Vannini M, et al. Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study. BMJ Open. 2020 Sep 25;10(9):e040729.
2. Zhou M, Qi J, Li X, et al. The proportion of patients with thrombocytopenia in three human-susceptible coronavirus infections: a systematic review and meta-analysis. Br J Haematol. 2020 May;189(3):438-441.
3. Jiang SQ, Huang QF, Xie WM, et al. The association between severe COVID-19 and low platelet count: evidence from 31 observational studies involving 7613 participants. Br J Haematol. 2020 Jul;190(1):e29-e33.
4. Maquet J, Lafaurie M, Sommet A, et al. Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19. Br J Haematol. 2020 Sep;190(5):e276-e279.
5. Figliozzi S, Masci PG, Ahmadi N, et al. Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis. Eur J Clin Invest. 2020 Oct;50(10):e13362.
6. Del Sole F, Farcomeni A, Loffredo L, et al. Features of severe COVID-19: A systematic review and meta-analysis. Eur J Clin Invest. 2020 Oct;50(10):e13378.
7. Danwang C, Endomba FT, Nkeck JR, et al. A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19). Biomark Res. 2020 Aug 31;8:37.
Sasidharan et al. conducted a prospective study to examine the risk factors for falls among community-dwelling elderly subjects in India (1). The incidence rate of falls was 31 per 100 person-years. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of female sex, movement disorders, arthritis, dependence in basic activities of daily living, not using antihypertensive medications, living alone during daytime, and a history of falls in the previous year for a fall in the following year were 1.48 (1.05 to 2.10), 2.26 (1.00 to 5.05), 1.48 (1.05 to 2.09), 3.49 (2.00 to 6.09), 1.53 (1.10 to 2.13), 3.27 (1.59 to 6.71), and 2.25 (1.60 to 3.15), respectively. I have some concerns about their study.
First, Tripathy et al. reported epidemiological findings of falls among older adults in India (2). The prevalence rate of fall episodes was 67 per 100 person-years. Adjusted OR (95% CI) of female sex, taking four or more medicines, and having poor body balance were 1.6 (1.0 to 2.8), 2.1 (1.2 to 3.5), 1.9 (1.0 to 3.4), respectively. Female sex was also a risk factor for fall in this study, and sex difference for predicting fall in the elderly should be specified by further studies.
Second, Susilowati et al. assessed the prevalence and related factors for falls in the past year in a sample of community-dwelling and institutionalized older Indonesians (3). The prevalence of falls in the past year was 29%, and women and institutionalized older adults had higher preval...
Show More15.12.2020
To the editors, BMJ Open
We are interested in the recent paper from New Zealand (NZ), describing the experiences of 15 patients with abnormal uterine bleeding, by Claire Henry and others [1]. We agree that abnormal uterine bleeding deserves more attention and have documented the rapid recent increase in endometrial cancer (EC) in NZ Pacifica women [2,3]. However, some of these authors’ statements are not supported by the data they cite. They state “Studies which report on EC prevalence in NZ often link the cause of advanced stage diagnosis to ‘late presentation’...”. For this, they cite one of our studies [2] and another NZ study [4]. However, neither of these papers mentions late presentation, and in another paper which Henry et al. cite [3], we report that Māori and Pacific women did not present with higher grade or stage EC compared to other NZ women. However, both Māori and Pacific women experienced a worse disease-specific survival, which was statistically significant in Pacific women.
More importantly, Henry et al. continue with reference to these studies “… placing women at fault for not having sought more timely medical intervention. We aimed to reframe these deficit narratives....”. We strongly object to these inaccurate claims and the implication that our papers are ‘deficit narratives’ is unacceptable. Nowhere in our papers do we “place women at fault”. We feel strongly that clinicians should be supportive and more alert to sympt...
Show MoreHøjlund et al. conducted a 1:4 matching case-control study to examine the association between use of second-generation antipsychotics (SGA) and the risk of chronic kidney disease (CKD) (1). They defined CKD as an estimated glomerular filtration rate below 60 mL/min/1.73 m2 for 3 months or more. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of ever and current SGA users for the risk of CKD were 1.24(1.12 to 1.37) and 1.26 (1.12 to 1.42), although there was no dose-response relationship. In addition, the adjusted ORs (95% CIs) of short-term and long-term SGA users for the risk of CKD were 1.22 (1.01 to 1.48) and 1.45 (1.19 to 1.76), respectively. Furthermore, clozapine presented the highest risk of CKD, and aripiprazole presented no significant risk of CKD. I have a comment about their study with special reference for the psychiatric diseases.
Wang et al. conducted a risk assessment of CKD between patients with schizophrenia using first and second-generation antipsychotics (2). They defined CKD as a kidney damage as albumin-to-creatinine ratio >30 mg/g or glomerular filtration rate below 60 mL/min/1.73 m2 for 3 months or more. The risks for CKD were significantly higher in patients with SGA, although the risk did not increase as the patients used SGA for longer period. As the information in the risk of CKD in patients with SGA is limited, further studies are recommended by specifying the psychiatric diseases and CKD-related comorbidities.
R...
Show MoreAbbie Lane et al. (1), reported a high level of distress among medical students.
Show MoreHowever, in the report 15 students of 161 (9%) expressed a high level of objective stress and the major cause of stress was the exams.
We do not know when the questionnaire was offered to students in relation to the date of their exams. Indeed, before the exams it is normal that a majority of students are stressed and this situation is not specific to medical students. The authors omitted that some stress was necessary and could have positive impact to be competitive. Acute stress was not differentiated from chronic psychological stress which could impact cognitive functions by decreasing the arterial cerebral blood flow related to the persistent increase of high level of plasmatic cortisol (2; 3).
The authors reported that medical students were highly stressed, they thought that it was due to medical studies. Perhaps yes, perhaps no. Maybe this situation is comparable to that of other students of other disciplines or to other young people who are not students. The absence of control group in this study leaves the question unanswered.
In addition, the small number of participants (161), makes the results difficult to analyse. Furthermore, only 15 students had a high level of objective stress. What significance could be attributed to this small subgroup, whereas the authors conclude that medical students had a high level of stress like senior doctors. This conclusion cou...
Excellent study on a contemporary topic. If you are able, can I suggest you extend the study to a retrospective analysis of falls and nearness to death. I suspect that falls are one of a composite of indicators which can be used to estimate which persons are in the last year of life.
Jaleel Saunders, Nursing Student University of The Bahamas
Other Contributors:
Terry J Campbell, Lecturer
Dear Editor,
Show MoreI am a fourth-year nursing student at the University of The Bahamas. I would like to share my views on “Childhood peer status and circulatory disease in adulthood, a prospective cohort study in Stockholm, Sweden.” Circulatory diseases have become somewhat of an epidemic within Bahamian society and your article enlightened me on how childhood peer status may increase the likelihood of circulatory diseases in adulthood. This study can provide some important knowledge to understanding why circulatory diseases like diabetes and hypertension are so prominent within The Bahamas.
This research on childhood experience should not be overlooked as it is quintessential to the development of an adult. Studies imply that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking (Vohra et al., 2015, p. 630). However, as socioeconomics are easily measurable, peer status amongst children is a multifaceted circumstance that one question cannot simply answer. The question used in this research to assess peer status “Whom do you best like working with at school?” can have skewed responses. The answer may have been based on a student wanting to have the best outcome in terms...
Sylvenie Fleurimond
Show MoreNursing Student
University of The Bahamas
Nassau, The Bahamas
Sylveniefleeurimond81@gmail.com
Other contributor:
Dr. Terry Campbell Lecture
November 18th 2020
Re: Does weight-related stigmatization and discrimination depend on educational attainment and
level income? A systematic review
The editor:
Dear editor am a fourth year nursing student at the University of The Bahamas, it is with gain
interest of the above caption article. I would to express that how the article made me
knowledgeable of how obesity within the Bahamian society where it is also a major concerned
like every elsewhere around the world and how its linked to so many health issues such as non
communicable diseases for example Hypertension and diabetes. Upon reading the article I was
able to understand the connection between the levels of education as it relate to obesity. The
article brought issues to light that persons with high level educational backgrounds always sees
that an obese person is from a low- income educational background and the stigma and
discrimination is always felt among them. Unfortunately society sees an obese person as lazy, in
has a low self-esteem and is of low income social background (Avena 2013). While it can be said
that persons who have a higher level of achievements do look down on...
Dear Editor,
Show MoreThis response is to the current approach to food platform that pays little heed to the increasing role of digital technology and the internet in everyday life and to the particularities of the digital world in influencing health and nutrition. Digital food environments encompass the digital components that may be part of food platform and influence health and nutrition.
Major activities enabled by social media include social interaction and social support, generating new or editing existing content, and engaging with content such as clicking a link, viewing, liking, and commenting on posts. One of the distinctive features of social media is the ability for anyone to create user-generated content and share it, compared to messages that have been traditionally delivered through a limited number of media gatekeepers: production studios, TV networks, and editorial staff. As mentioned in paragraph four (4) of the article, previous systematic reviews have examined how social media use impacts eating disorder outcomes, the digital marketing of unhealthy food and drink, and the use of social media interventions in weight management. Given the dynamic and large variety or social media platforms, there is a lack of standardized tools and methods to conduct social media research.
Mapping the works will serve to identify the available evidence on food and nutrition-related social media content, identify and analysed critical knowled...
In the current climate of the world regarding social media use, adolescents are a group that this phenomenon disproportionately effects. Upon reading, with great interest, the article authored by Scott, Biello, & Woods (2019), I found this study’s results and findings very interesting and provocative. This type of study is especially stimulating given the current social climate of the world, in which social media-use has become an integral part of everyday life. Before this study, there had been little empricial evidence to show that sleep is disrupted by social media use. Most previous studies focused on “screentime” use of adolescents as a opposed to singling out social media use for study. The authors point out the need for this due to the UK’s lack of evidence-based decision making. The problem statement of this study highlights that in paediatric nursing practice, there is a lack of solutions brought forth to address adolescents’ lack of sleep (Hamilton et al., 2020). Thé findings of this study can now be used to address the current issue of adolescents sleeping patterns in public health policy which is usually neglected according to the authors. The culturally based aspect of this problem delineates the need to target this amongst adolescents specifically as opposed to the general public. The data analyses help ensure that the results are valid since they give an accurate depiction of the probability of occurrence for sleep loss due to social media use. The analy...
Show MoreFumagalli et al. conducted a retrospective cohort study to develop a clinical risk score to predict the in-hospital mortality in COVID-19 patients ≥18 years [1]. Significant predictors of mortality were increasing age, number of chronic diseases, respiratory rate, decreasing PaO2/FiO2, serum creatinine and decreasing platelet count of mortality. I have come concerns about their study with special reference to thrombocytopenia in COVID-19 patients.
There have been many meta-analyses of presenting severe health hazard of thrombocytopenia in COVID-19 patients. Three papers in British Journal of Haematology [2-4], two papers in European journal of Clinical Investigation [5,6], and one paper n Biomarker Research [7]. Although severe health hazards of thrombocytopenia in COVID-19 patients has been consistently reported by meta-analyses, a cohort study with minimum bias should also be conducted with special reference to comorbidity and aging.
References
Show More1. Fumagalli C, Rozzini R, Vannini M, et al. Clinical risk score to predict in-hospital mortality in COVID-19 patients: a retrospective cohort study. BMJ Open. 2020 Sep 25;10(9):e040729.
2. Zhou M, Qi J, Li X, et al. The proportion of patients with thrombocytopenia in three human-susceptible coronavirus infections: a systematic review and meta-analysis. Br J Haematol. 2020 May;189(3):438-441.
3. Jiang SQ, Huang QF, Xie WM, et al. The association between severe COVID-19 and low platelet count: eviden...
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