1200 e-Letters

  • Falls among elderly subjects: a risk assessment

    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...

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  • Management of abnormal uterine bleeding: comment on Henry et al. 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...

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  • Second-generation antipsychotics and chronic kidney disease: a risk assessment

    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.


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  • Evaluation of psychological stress of medical students

    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...

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  • Falls and nearness to death

    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.

  • letter to the editor

    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...

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  • Obesity and Stigma

    Sylvenie Fleurimond
    Nursing Student
    University of The Bahamas
    Nassau, The Bahamas
    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...

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  • The emergence of the digital food market

    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...

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  • Sleep patterns response changes in adolescents

    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...

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  • Thrombocytopenia in COVID-19 patients

    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.

    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...

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