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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.
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 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...
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 reported in ‘Citations’ section, under ‘RESULTS’ section, page 5, line 3 & 4, i.e. ‘6.92, ranging from 0 to 143’.
4) At ‘Table 1’, under ‘RESULTS’ section, page 7; a numerical value of ‘(10-38,8)’ is reported in different format that the comma could confuse the readers of its true value.
5) At ‘Appendix table 1’, under ‘Online Supplementary Appendix’ document, page 2; a numerical value of ‘(#4 or#7)’ has to be corrected to ‘‘(#4 or#5)’ as this could confuse the readers of its true value.
The authors claim that there were Cochrane reviews that included none or one study; as reported in the following section that contradict to the value reported in ‘Table 1’ of original article.
1) Fourth paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 8 to 10;
2) Paragraph of ‘Principal findings’ section, under ‘DISCUSSION’ section, page 7, line 5 to 7; and
3) Second paragraph of ‘Strengths and weaknesses of this SR’ section, under ‘DISCUSSION’ section, page 7, line 7 to 9.
The number of included studies in Cochrane reviews is 6 (2–13) (median(interquartile range)) as in ‘Table 1’ of original article, in which it was reported that there were Cochrane reviews with two included studies minimally, instead of zero.
Apart from typographical errors, we would like to point out a controversy pertaining to a point of their discussion in the original article. Although their concern about the methodological quality and thoroughness review conducted by Cochrane and high-impact journal reviews are of great interest and highlighted the importance of it, we have to disagree on the potential risk of bias of co-published reviews that mentioned might interferes the authors’ findings (third paragraph of ‘Strengths and weaknesses of this SR’ section, under ‘DISCUSSION’ section, page 7). This is because co-published reviews have to be sorted from duplication during title, abstract and/or full text screening. Therefore, it is quite impossible to have duplicates in included reviews since duplicate removal was reported as in ‘Figure 1’ and ‘Figure 2’ of the original article.
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.
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 quieter and milder than others.
As a teen, at a fairly mild United Pentecostal church (where women wear no makeup and never cut their hair), I spoke in "An unknown tongue," which, in my case, turned out to be the Yiddish a relative had spoken when I was a baby. I babbled and trembled for several days after. But I returned to my Baptist church, and cut my hair soon afterward. The girls who'd invited me assumed I was going to Hell.
I was more recently forced by a caregiver to attend a COGIC spirit service with bright strobe lights, painfully thumpy music, and everyone screaming in "Tongues".
Women, men, and children were skipping up to the altar, hugging each other, jumping up and down, screaming, defecating and urinating, fainting in joy and ecstasy. All caused by strobe lights and trick-bass drum music.
I'd already developed severe epilepsy- or at least finally been diagnosed with it. I've had seizures since I was quite small. I could never stand twinkling Christmas lights, for instance, which even at 4 years old made me so dizzy and NERVOUS I would start screaming.
(A gentle car ride would calm me down wonderfully, as would a vacuum cleaner in the next room).
I've been diagnosed with Vertigo;
Jacksonian, Partial-Complex, Petit Mal Seizures;
Constant Body-Wide Migraine Statous including severe nausea and blinding light sensitivity;
Hemi-Plegic Migraine;
Cluster headaches.
All triggered by bright lights;
fast-moving and/or flashing lights;
certain musical or dancing rhythms;
carnival rides including especially the Tea Cups and the Tilt-A-Whirl;
smells including ammonia and Musk perfume;
among other triggers including pesticide exposure.
I spent two hours hiding in the church bathroom, and managed to get out of the life situation fairly soon. The COGIC congregation was wonderfully friendly to me at other services and events. My body just couldn't stand their Rapture service.
The last 10 years (I'm 57), I seem to have developed Grand Mal. My head rolls around like The Exorcist. My tongue falls between my jaws (No dentures). I fall asleep, wake up weak.
My state's Medicaid won't give me proper diagnosis, or even medication, due to simple underfunding and rationing.
My seizures are mostly caused by TV antenna signals, even if not badly pixelated. I must ration TV, and sometimes even computer. Although I still get crazy, miserable reactions from all the boom cars in my apartment complex, Punk and Rap both full of Trick-Bass.
These types of seizure-causing, Charismatic Religious services may bring joy to some people. I've even heard rumors of people taking Ecstasy and Coke or Crack, Speed, etc, to boost their spiritual high. One woman stated to me,
"I would be willing to faint and die at the altar, if only I could die and be in God's Spirit forever".
The ministers and leaders of these highly physically emotional Spirit services possibly do understand the science of light and music and even smells they utilize to cause their desired result- just as regular Catholics, Presbyterians, Episcopalians, Lutherans, and Methodists, with their methods, understand how to bring simple peace and serenity to their congregations. Of course, most congregants, and even some leaders, prefer to think God is the only cause of what happens to them.
My friend is an Interpreter for the Deaf, whose job is to interpret at several Pentecostal and Spirit-type services through the week. She experiences severely disabling, blinding Ocular Migraine Auras and headaches, exacerbated, or maybe caused, by the overly-bright strobe lights at her job. She (and I) are also deeply affected by blinking fluorescent lights, especially Curly CFLs. She's constantly exposed to these lights at her M-F school interpretation job.
I spent plenty of time at Disco/Rock N Roll house parties in the 1970s, 80s. (No drinking- causes migraines, no drugs, just great, happy people). But I could never stand bars which played these same songs, since the Bass Boost was always turned up high, and made me "Nervous." Some of these clubs also had flashing colored Neon lights, with the speed turned up high. I got sick at America's Favorite Bar from the lights and music. Nauseated from dizziness.
I don't know enough to comment much about modern Orthodox/Hasidic Jewish services,
Druse or Sufi Islam services,
"Whirling Dervishes" (Isn't that Hindu?),
various Pagan rites, etc. I bet, at least in some cases, the same type of cathartic, soul-releasing effects may be brought about by certain methods such as strobe lights, thump music, thump dancing, and other effects, as occurs in Charismatic Christian rituals, or a 1990s Body-Slamming Punk Metal concert. While others like myself prefer a calmer type of religious joy.
(A PBS "Rick Steves" special, can't remember which country, portrayed a marvelous "Whirling Dervish" who slowly, steadily swirled and gyrated himself into a beautiful, deep, simple religious ecstasy. Calming for me to watch.)
As with a friend in White Dove, I wonder if some people already have Bi-Polar Mania, or seizures, or some neurological reaction which causes them to "Speak in tongues," have extra wiggly, shaky, excitable bodies, etc, that may make them feel more comfortable at ecstatic religious services or club parties, than at staid old sleepy services such as even Southern Baptist- which is not nearly as sleepy as some other Protestant services!
I myself like the "sleepiness," which relaxes my body and brain as well as medicine does.
If I broach the idea of "Seizures, or Mania" to certain people, they may even scream at me in denial.
"I'm just NERVOUS is why I'm wiggling and shaking and screaming at you! I need a church service!"
(That person HIT me while shaking and screaming.)
"I'm not babbling incoherently; I'm just speaking in tongues."
(Whether it's actually Bi-Polar word salad, or some type of seizure or neuro reaction.)
"No, don't let the Devil let you have seizures. God will heal you."
(This at a religious service which was rapidly worsening my seizures and Migraine.)
I guess giving medication to them is tantamount to taking away their religion.
To Each His Own.
I still think people should be taught what may happen to them at certain type of religious services, as well as these Rave, EDM, whatever, Pagan-type Club parties. Then let them make their own decisions, for themselves and for their minor children.
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...
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 with a low birth weight.
References
1. Chen C, Jin Z, Yang Y, et al. Association of low birth weight with thinness and severe obesity in children aged 3–12 years: a large-scale population-based cross-sectional study in Shanghai, China. BMJ Open. 2019;9(5):e028738. doi:10.1136/bmjopen-2018-028738.
2. Rolland-Cachera MF, Deheeger M, Maillot M, Bellisle F. Early adiposity rebound: causes and consequences for obesity in children and adults. Int J Obes (Lond). 2006;30 Suppl 4:S11-7. doi:10.1038/sj.ijo.0803514.
3. Koyama S, Ichikawa G, Kojima M, Shimura N, Sairenchi T, Arisaka O. Adiposity rebound and the development of metabolic syndrome. Pediatrics. 2014;133(1). doi:10.1542/peds.2013-0966.
4. Ichikawa G. Persistence of Obesity from Early Childhood Onward. N Engl J Med. 2019;380(2):193-195. doi:10.1056/NEJMc1814961.
5. Shi H, Yang X, Wu D, et al. Insights into infancy weight gain patterns for term small-for-gestational-age babies. Nutr J. 2018;17(1):97. doi:10.1186/s12937-018-0397-z.
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...
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 at tier 2 and 3 for all children and young people (upto age 15.9years) and there is an emerging child healthy weight strategy document.
As mentioned, the experiences and learning that comes from work linked to such projects will be valuable as will new evidence gained from feasibility or definitive trials that are currently ongoing linked to obesity prevention interventions. Of particular interest, is the whole –system approach to obesity prevention that is underway e.g in London and Leeds.
We look forward to writing, with an aim to publish, our own small but important contribution to the evidence with an evaluation of 4H Scotland processes and outcomes in the near future. As authors, we are grateful to members of the pre-birth and early years groups from NHS Tayside (including infant nutrition coordinator), local authority, education and third sector within Dundee city and importantly the community workers and families who supported our feasibility trial. .
Regards,
Jenny Gillespie on behalf of the 4H Scotland study authors
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...
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 hospital discharge.
We derived data from all prescriptions of 20 tertiary referral hospitals between January 2017 and December 2017. The costs of medications were calculated based on the procurement price of medicines available at our facility during data collection. The overall costs spent on medications supplied to patients discharged from hospitals was (Malaysian Ringgit) RM39,304.00. The medications associated with the highest expenditure were metformin (RM5,990.40), gliclazide (RM5,939.60), metoprolol (RM2,265.50), perindopril (RM1,846.95) and human insulin (RM1,817.30). The medications with the lowest expenditure were allopurinol (RM75.80), haematinic (RM72.00), potassium chloride (RM54.20), sertraline (RM50.20) and digoxin (RM16.80). The most commonly dispensed medications included simvastatin (785,218 tablets), metformin (74,880 tablets), budesonide metered dose inhaler (49,444 canisters), gliclazide (28,440 tablets) and perindopril (21,780 tablets), whereas the most infrequently dispensed medications were fluvoxamine (360 tablets), sertraline (360 tablets), digoxin (120 tablets), allopurinol (75 tablets) and potassium chloride (54 tablets).
The use of high-value medicines (medications which are guideline-recommended and reasonably priced) should be a priority for all countries, particularly those with limited resources [2, 3]. High-value medicines are not preferentially prescribed in many healthcare settings and there is currently sparse evidence to demonstrate that higher-priced medications are more effective [3]. A greater emphasis on high-value medications will potentially alleviate financial burden of increasing rates of treatment and provide more value to the nation’s economy [2]. In this respect, meticulously designed large cost-effectiveness studies are warranted to ascertain disease specific medications which will yield beneficial outcomes to patients. The study sites must be a representative sample encompassing the entire country geographically. Discerning the higher-priced medications with established benefits from lower-cost alternatives can serve as a basis for high quality and cost-efficient care [3].
Future efforts and policies aimed at mitigating the burden of non-communicable diseases by paying particular attention to the role of primary healthcare centres will need to improve patient access to high-value medications, especially in low and middle-income countries.
References
1. Ang IYH, Tan CS, Nurjono M, et al. Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore. BMJ Open 2019;9:e027220. doi: 10.1136/bmjopen-2018-027220
2. Porter ME. A strategy for health care reform — toward a value-based system. N Engl J Med 2009;361:109─12. doi: 10.1056/NEJMp0904131
3. Su M, Zhang Q, Bai X, et al. Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey. Lancet 2017;390:2559─68. doi: 10.1016/S0140-6736(17)32476-5
Acknowledgement
We would like to thank the Director-General of Health Malaysia for his permission to publish this correspondence.
Funding
The research receives no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflicts of interest statement
The authors of this correspondence declare that they have no conflict of interest.
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.
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.
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...
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 consequences of undergoing such treatments in terms of psychological health and well-being. We found no instance of a large cross-sectional or cohort design of people undergoing treatments and ended by suggesting the need for investigation of the experiences of transgender and gender non-conforming people at the population level. This is exactly the evidence the correspondent has suggested too. Out of interest, a study is currently underway at Coventry University, which fulfills our recommendation for further research (see: https://www.coventry.ac.uk/research/areas-of-research/innovative-researc...).
We also thank the author for contributing further discussion on Dr. Kenneth Zucker’s work and controversies. However, the other sources the correspondent cites were more at the level of discussion than data.
We thank the correspondent again for their thoughtful critique of our paper. No article is beyond reproach and/or scrutiny, and this correspondence enhances the discourse about conversion therapies in trans and gender diverse people.
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.
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.
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...
Show MoreI'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...
Show MoreTo the editor,
Show MoreIn 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...
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.
Show MoreWe 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...
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...
Show MoreDear 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.
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.
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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