589 e-Letters

published between 2017 and 2020

  • Response to “High prevalence of postpartum glucose intolerance in women with gestational diabetes mellitus: Another reason to encourage exclusive breastfeeding?” Shivashri Chockalingam et.al

    Thank you for your interest, comments, and questions in our study!
    In our study, there was a relatively good adherence for postpartum glucose test or attend the postpartum OGTT as compared to evidence from other literatures (1, 2). It was happening due to frequent contact and closely following of study participants from pregnancy to postnatal period and sending a reminder for post-partum oral glucose test. However, for few women who did not attend the postpartum OGTT, we found the major reasons are changed their usual residence or left the city, perceived they will not have postpartum glucose intolerance, or it will be very mild, some of women delivered outside the study area, women either declined to participate, women could not be contacted (unreachable by phone contact) because they changed their contact information and some unknown reasons. We have also checked the presence or absence baseline differences among the two groups, we found that there is no any statistically baseline difference between the two groups (attended vs did not attend the postpartum OGTT). Though there is evidence that women with higher cardiovascular risk factors tend not to attend for the OGTT, but as we clearly stated in our baseline survey (3), pregnant women who had chronic diseases including known cardiovascular disorder were excluded at initial commencement. Hence, our participants had not any revealed higher cardiovascular risk factors tend not to attend the OGTT.

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  • AIDS Research - Missed Opportunity

    Dear Editor,
    I am writing this letter in reference to the article "Missed opportunities for earlier diagnosis of
    HIV in patients who presented with advanced HIV disease: a retrospective cohort study". Levy I,
    Maor Y, Mahroum N, et al. (2016). The article sufficiently highlights the risk of a patient being
    diagnosed with HIV in the advanced or late stages and also emphasizes that the stigma
    surrounding the disease proves to be a sizable barrier to early detection and treatment.
    The author of this study highlights that a vast majority of patients are diagnosed with HIV at a
    late stage. I appreciate that the article used statistical results to support this factor. This late
    diagnosis is often due to the misidentification of patients as many of the patients did not present
    to their general practitioner with symptoms akin to HIV and are not classified with the common
    risk group, thus they were not tested for the disease. These individuals in question repeatably go
    through the healthcare system, until they are finally diagnosed with the disease, the author
    highlights this in the study as, all patients who had participated within the study frequently
    visited the Sheba Medical Centre before their final result. These results from the study
    emphasizes the importance of consulting the established risk factors of
    What I have found extremely interesting is the stigma around the d...

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  • Re: Screening Nursing Students to Identify Those at High-Risk of Poor Mental Health: A Cross-Sectional Survey

    Dear Editor: This response is in relations to the article captioned above, published on June 9, 2019. I opt to initiate by noting how pertinent, and utterly engaging such information relayed are; especially since I, myself, am a nursing student. Results from this study indicated that there were existing participants who were identified as being at-risk regarding their mental health, which is very much expected. Just as it was mentioned within this article, when compared to other non-nursing affiliated undergraduates or major programs, nursing students have a greater vulnerability regarding matters like depression and stress due to encounters with skills examinations, mandated clinical practicums, and other heavy loads that come with being a baccalaureate nursing student (Cheung et. al 2016). I found myself agreeing that early identification and intervention executions are indeed critical aspects, and that ensuring the well-being of such individuals presently ensures their well-being of the future. The article listed several factors which increase an individuals’ likelihood of undergoing mental health symptoms such as academic stress, poor relationships with both parents, not having clear college goals etc. Though valid, I would have liked to see the aspect of social relations regarding other interpersonal forces, meaning the negative relations between nursing students and staff members, patients, lecturers and other nursing peers especially. (Pulido-Criollo et. al. 2018)....

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  • Protect future nurses

    Dear Editor,
    I write to express my views on the article “Prevalence of bullying in the nursing workplace and determinant factors: a nationwide cross-sectional Polish study survey” by Serafin, LI and Czarkowska-Pączek, B. Published on December 19, 2019. I found this article to be quite interesting and timely as I am a 4th year nursing student that may or may not be subjected to this in the near future. The article entailed pertinent information regarding the pervasiveness of Polish nurses bullying, the risk factors that influence bullying and their poor outcomes.
    According to the study, one may perceive that nurse bullying is indeed prevalent in Poland as more than half of the participants admitted having experienced some act of bullying on the job. Additionally, it is stated that seniority was notably congruent with workplace bullying. Similarly, in another article, Simons and Mawn (2010) notes that some nurse supervisors exhibit bullying by unjust scheduling and unmanageable nurse- patient workloads to which they classified as ‘structural bullying’. These actions not only adversely affect nurses but may ultimately impact the level of care a patient receives. As your article suggests, prolonged bullying can lead to physical and/ or psychological symptoms. The concept of ‘nurses eating their young’ is a relevant implication in nurse bullying. Nurse managers and other staff nurses tend to treat young graduate nurses unfairly as a strategy to prepare them for the...

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  • RE: How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study

    Dear Editor,
    I am writing in response to your article discussing nursing students’ experience in the clinical learning environment. I found this article immensely enlightening and interesting. I am currently a fourth-year nursing student and can concur that this is an imperative subject that needs explication and evaluation. The results of this study provided a detailed standpoint, from nursing students, on the difficulties faced during clinical rotations. The fear experienced during clinicals and inappropriate treatment toward nursing students result in the loss of motivation to continue a profession that is ever in demand and simultaneously in shortage.
    As a nursing student who has personally experienced hostile attitudes in a clinical setting, I can relate to many of the responses given in the interviews of this study. I would appreciate this issue being addressed within nursing educational programs among those responsible. The negative attitude and willingness to assist promising nurses affects students’ learning, mental health, and most importantly, relationship with their patients. As stated in another research, Bradbury-Jones et al., (2011) empowerment of nursing students in clinical practice is essential for nursing students to foster the confidence and self-efficacy necessary to care for their patients. Other studies have mentioned that nurses displaying a negativing attitude and bullying student nurses is a common occurrence without a practical solu...

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  • RE: Long term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32 year follow up study

    Anischka Devilas, Nursing Student at the University of The Bahamas
    Dear Editor,
    It is quite insightful that Probert-Lindstrom et al. (2020) conducted this 21-32-year follow-up study despite the uncertainty whether the manipulation of such variables would alter the overall course of the research. The purpose which was meant to evaluate the differences in risk factors for suicide attempts less than 5 years compared to more than 5 years was evident throughout. However, it is unclear if this purpose is the original aim that prompted the commencement of the original research in 1987- 1998. The article was both informative and brought awareness in correlation to mental illness and suicide. This is something the authors depicted well without bias considering the implication of other variables. Brown et al. (2000) leading risk factors were also linked to mental disorders despite not comparing time.
    Moreover, the authors stressed that the risk factors of suicide beyond the suicide index such as 20 years are not typically assessed in other prospective studies. This insinuates that perhaps extensive research must be conducted so the evaluation of long-term risk can be better understood to provide substantial data required for diagnosing purposes. Although risk factors less than five years and more than five years pose corresponding risk for possible suicide, what is the distinct correlation of risk factors beyond 20 plus years that is problematic?


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  • Costs in the last year of life

    This is yet another study emphasizing the important role of nearness to death in lifetime health care costs. This study looked at the whole of Scotland, however, what is not widely appreciated is that the absolute number of deaths (which drive the costs) are highly variable from one year to the next [1]. This then means that the marginal change in costs is also highly variable [2-4]. When these costs are broken down into smaller areas such as Area Health Boards the deaths become even more volatile and so do the marginal costs arising out of end of life. It has been traditional in the UK NHS to blame the AHB or CCG for the ensuing cost variances, which, is entirely unjustified. It is the inflexibility in the funding formula which is the essential problem.


    1. Jones R. End of life care and volatility in costs. Brit J Healthc Manage 2012; 18(7): 374-381.

    2. Jones R. Why is the ‘real world’ financial risk in commissioning so high? Brit J Healthc Manage 2012; 18(4): 216-217.

    3. Jones R. Volatile inpatient costs and implications to CCG financial stability. BJHCM 18(5): 251-258.

    4. Jones R. Cancer care and volatility in commissioning. Brit J Healthc Manage2012; 18(6): 315-324.

  • Article Review

    I have recently come across this article, “Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis” and it has piqued my interest. Not only is it a new topic for me in a field I love, but it also broadens my thinking and understanding to another level, exploring challenges in different countries, especially Ethiopia. The study was able to investigate the true background of maternal waiting homes, looking at different standpoints and drawing conclusions based of the data collected. Maternity is a large topic that often gets neglected in the world, and this study helps to shine a brighter light on the peril women suffer through childbirth and pregnancy. Although it was a new topic for me, I was able to gain a sense of understanding on the topic, gathering information and connecting ideas and thoughts as I delve deeper into the study. Hopefully, I would be able to experience more research articles in this field that contains the same raw components as the current article.

  • Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial

    Latavia Ward
    4th year nursing student
    Terry Campbell
    Other Contributor, Associate Lecturer

    Dear Editor,
    I understand the purpose of this study was to analyze unpublished data on mask washing and the performance of two-layered cotton mask used by health care workers compared to the medical mask. However, I want to address the statement “Cotton is not a suitable fabric for the outer layer of the masks, as it is absorbent, can become damp and a pose risk of contamination if not cleaned daily´´According to American Ceramic Society Bulletin (2020), Cotton masks are breathable but only blocks 20% of small particles. However, to show scientific measures or proof of differentiating both the cotton and medical mask, it is noted that a combination of filter effectiveness and pressure drop can determine the effectiveness of both masks. To demonstrate, Surgical mask has 95.4 % of filtration rate, 9.0 initial pressure drop, 5 to 5.5 filter quality factor k/pa. Whereas, cotton mask has 5 to 26 % filtration rate, 14.5 Initial pressure drop, and 5 to 8 filter quality factor k/pa. In terms of addressing the importance of washing the cotton mask to be effective and the need to used fine weave and water resistant fibers it is then important to adress those scientific factors such as filtration rate, initial drop and filter quality factor percentage when determining the effectiveness of both mask in the unpublished data.

    How effective i...

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  • Assessing the effect of Michigan's smoke-free law on air quality inside restaurants and casinos

    Dear Editors:

    This response is in reference to the study Assessing the Effects of Michigan’s Smoke-free Air Law on Air Quality Inside Restaurants and Casinos. I thoroughly enjoyed this study as it evinced the effectiveness of the law in an organized and detailed manner. Öberg et.al (2010) reported that “ 93% of the world population is still living in countries not covered by smoke-free public health regulations, and exposure to SHS in the home is still common” (para 1). Consequently, I anticipate that the findings of this study should influence countries to enact smoke-free air laws to aid in the reduction of health effects of secondhand smoke cases as these laws are conclusively effective.

    The purpose of the smoke-free air law is to improve the health of employees and patrons; hence, the restriction of smoking in facilities. Since there are three casinos exempted from the law, their employees and patrons are at an incredibly high risk for cardiovascular and respiratory illnesses compared to facilities that were not exempted. This now prompts the question, how are these individuals protected? I wonder, what were the justifications that prompt the exemptions of the casinos? However, I too agree that the only way to ensure improved health of people is to enforce the law without any exemption.

    Lastly, inasmuch as there are various sources that contain particulate matter such as the smoke from grills, I presume restaurants should require chefs t...

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