951 e-Letters

  • Editor's Note

    After peer review, Cipriani et al were invited to provide a response to the research manuscript. Should Cipriani et al wish to respond to the article we will post their response here.

  • Editor's Note

    BMJ Open has received the comments from Bee Ping Teh and Norzahirah Ahmad on this paper. The authors of the paper have been contacted and have been asked to comment on the accuracy of their response.

    We will update the article if necessary.

  • Re: A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer

    We have read with great interest about Goldkuhle et al., ‘A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer’ (BMJ Open; accepted on 12 February 2018; doi:10.1136/bmjopen-2017-020869). Hereby we are writing this electronic responses to address the contents of article in following aspects: typographical errors and indistinguishable information highlighted by the original authors.

    There are five typographical errors found in the article that we would like to draw your attention as these could cause confusion to your many readers. The said errors are presented with snapshot image from the original article.

    1) First paragraph of ‘Characteristics of included SRs’ section, under ‘RESULTS’ section, page 5; a numerical value of ‘67/216’ (at line 15) has to be corrected to ‘67/215’ because the total number of included studies for high-impact journal reviews was only 215 studies instead of 216.

    2) At 'Table 1’, under ‘RESULTS’ section, page 6; a numercal value of '318 (9.9)' has to be corrected to ‘318 (91.9)’ as compared to first paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 1. This is because the percentage value of 318 out of 346 is 91.9% (approximate) instead of 9.9.

    3) At 'Results’ section, under ‘ABSTRACT’ section, page 1, line 15; a numerical value of ‘6.52 (range 0-143)’ is different from mean number of citations...

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  • Photo-sensitive epilepsy caused by strobe lights, etc, at religious services

    I'm just a real person, commenting on much I've seen in my real life.

    I enjoyed the article about Seizures that may be caused by strobe lights at club parties.

    It should be noted that Photo-sensitive Epileptic seizures can also be caused by some types of religious services, including Pentecostal-type Christian church services. These services can also cause seizures with thumpy-thump trick-bass music, and certain types of incense or scented candles.

    Church of God in Christ (COGIC),
    Assembly of God,
    United Pentecostal Church,
    White Dove,
    many non-demoninationals, etc., all make use of:
    strobe lights;
    other types of lights (various speeds and colors);
    fast, thumpy, jittering or swaying musical rhythms;
    fast, thumpy, jittering or swaying body-movement rhythms;
    galloping floor pulses, sometimes combined with ultra-slow floor pulses, tricked out as if caused by a strobe-"Sound" machine (whether music-caused, or from a separate vibrating machine);
    and/or sometimes scents,
    in order to make the congregation ultra, extra excited to bring the people into the "Spirit".

    I've visited some types of these services, partly out of curiosity, since I was a teen. Including even an Assembly of God funeral at which people started wiggling and laughing, I assume due to the bright flashing lights and percussion rhythms.

    Some charismatic-type services are quiete...

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  • Low birth weight as a risk for thinness and obesity

    To the editor,
    In a recent article, Chen et al.1 reported the association of low birth weight with future thinness and severe obesity. These findings are important for recognition of the risks of low birth weight, but further discussion of the underlying meaning is required.
    Body mass index (BMI) generally increases rapidly during the first year of life, and then subsequently decreases and reaches a nadir at around 6 years of age. Thereafter, BMI increases again throughout childhood, and this second rise is referred to as the adiposity rebound2. Early adiposity rebound is a known risk factor for future obesity2,3, and even if BMI is low at the age of adiposity rebound, children who experience early adiposity rebound may become obese4. This means that a person can be thin in their youth and obese at an older age.
    Low birth weight is also a known risk factor for early adiposity rebound5. Therefore, this phenomenon of changes in weight may be common among low birth weight infants, and some of the thin children in Chen et al.1 may ultimately become obese. To examine this hypothesis, it would be of interest to compare the mean ages and the distributions of subjects in Chen et al.1 who are thin and those with severe obesity. We believe that the thin subjects will have a younger mean age.
    This information would help to explain the results of the study. A longitudinal study would then be warranted to develop a better understanding of the risks associated wi...

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  • Response to: 'closing the stable doors after the horse has bolted?'

    Dear Rosemary,

    Many thanks for taking the time to read and respond to our recently published article: Protocol for Healthy Habits Happy Homes (4H) Scotland: feasibility of a participatory approach to adaptation and implementation of a study aimed at early prevention of obesity.
    We agree that obesity prevention could and should start as early as reasonably possible (pre-conception/ peri-conception as recommended by WHO ECHO). We also feel (as did WHO ECHO) that we need to continue prevention efforts well beyond infancy and toddlerhood, and if that is the case then we need to have some prevention programmes to offer beyond infancy and toddlerhood: 4H is one potentially useful candidate prevention programme. It is not a question of intervening before/during infancy or later, we need both, with 4H contributing to the early childhood segment of future programmes.
    The maternal and infant nutrition framework in Scotland offers opportunity for a wide range of preventative work to address childhood obesity. Using NHS Tayside (where 4H Scotland took place) as an illustration, the Health Visitor and Family Nurse services hold UNICEF UK baby friendly Gold award, the local neonatal unit hold the UNICEF UK baby friendly award and recently the use and promotion of healthy start vouchers and the breastfeeding friendly Scotland logo has increased. There is a local specialist weight management service offering prevention approaches at tier 1 and management programmes...

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  • Retrospective evaluation of costs and types of medications dispensed to patients discharged from hospital to primary care clinic in Malaysia

    The study reported by Ang et al. is of great interest to healthcare providers, especially in view of its publication in a journal read by a general medical audience. It elegantly delineates two programmes that were launched in Singapore to facilitate the safe transition from acute hospital to the home of patients and aimed to decrease inpatient admissions and emergency department attendances, reduce total inpatient length of stay and diminish expenses of care of patients [1].

    Accordingly, we would like to describe the integrated care transitions programme in Malaysia where stable patients discharged from hospital admissions are referred to designated primary health centres to undergo subsequent care and continuous treatment. For more than a decade, Ministry of Health Malaysia has commenced a service to allow patients to continue their treatment in other referred facilities to ensure patients can obtain continuous supply of their medications.

    Despite the availability of standard guidelines, little is known about current patterns of medications supplied to this group of patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the need for information about the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health clinic in Selangor, Malaysia and examined the medications associated with the recommended treatment upon hos...

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  • Observation at the right time

    Dear editor,

    We read with great interest the article by Kentaro Watai et al. They describe Short-term active smoking in early adulthood may be associated with decreased lung function and AHR, even in patients with intermittent adult-onset asthma. However we would like to make one comment.

    There was a period from the first visits to a histamine airway challenge test. If never smokers were receiving treatment by the time of the test, ther AHR would be lower than expected.[1]This information bias will weaken their conclusion.

    1. Haahtela T, Jarvinen M, Kava T, et al : Efects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994 ; 331 : 700―705.

  • Closing the stable door after the horse has bolted?

    This study sounds like it will be very interesting, yet I wonder why we are beginning interventions to prevent obesity only at the age of 2, when healthy habits or otherwise are already set. Enabling responsive feeding so that the baby can learn to follow their internal hunger and satiety cues is crucial to set the pattern for years to come - whether that be breastfeeding, responsive and paced bottlefeeding and appropriate introduction to solids. I appreciate that the study is replicating one in the US, but it would have been so good to have begun working with these families from the beginning. Beginning at 2 makes it much harder to turn things round. Hopefully Scotland's commitment to the Baby Friendly Initiative will enable some of that support to be there, but it would have been good to gain evidence from this study.

  • Response to Trans Conversion Therapy Doesn’t Call Itself Conversion Therapy

    We would like to take the opportunity to thank the author for their correspondence and critique of our paper.

    In response to our conclusion about the “rarity” of the practice, the correspondence may be misleading. Our paper states “We found limited evidence in the research literature of the use of conversion therapies that aimed solely at suppressing or modifying what was considered by the therapist as abnormal gender identity”. Of course (as is the case for reviews of research into conversion treatments for LGB people), this does not presume that practices are not occurring in a wider context.

    We would like to further state that as in all systematic reviews, the search strategy must be agreed before the search begins. We spent considerable effort in discussing search terms, and based our search on previous reviews of LGB people and conversion/reparative approaches. This basis did not dictate the only search terms used however; we also used further terms which we believed would increase the yield in papers, these included “reparative” “non-affirming” and “repair”. We also included terms such as “barring” to account for covert attempts at hindering transition.

    We disagree that systematic reviews are counterproductive. Our aim was to assess how often and in what form conversion/reparative treatments for transgender and gender diverse people had been studied. We sought to examine critically any claims for effectiveness as well as understand the consequenc...

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