We appreciate the comment from Dr. Williams, highlighting some of the challenges when measuring patient-reported outcome measures. Patient-reported outcomes are often used as the primary outcome in clinical trials because patient perspectives remain critical to evaluate treatment response. However, as Dr. Williams points out, the psychometric properties of patient-reported outcome measures need to be evaluated in different cohorts and scrutinized carefully.
Knee injury and Osteoarthritis Outcome Score (KOOS) holds five subscales evaluating Pain, other Symptoms, ADL function, Sport and Recreation function and knee-related quality of life. To enhance clinical interpretation, scores are presented separately for each subscale. For statistical purposes, when one primary outcome is required, a composite score such as KOOS4 or KOOS5 can be used but should always be complemented by reporting of the 5 subscale scores as secondary outcomes (1). KOOS was constructed in the nineties using classic test theory and has been extensively subjected to testing of its psychometric properties. In a systematic review and meta-analysis performed in collaboration with authors from the COSMIN group and including data from 37 psychometric studies of the KOOS it was found that “KOOS has adequate internal consistency, test-retest reliability, and construct validity in young and old adults with knee injuries and/or osteoarthritis. The ADL subscale has better content validity for older patients...
We appreciate the comment from Dr. Williams, highlighting some of the challenges when measuring patient-reported outcome measures. Patient-reported outcomes are often used as the primary outcome in clinical trials because patient perspectives remain critical to evaluate treatment response. However, as Dr. Williams points out, the psychometric properties of patient-reported outcome measures need to be evaluated in different cohorts and scrutinized carefully.
Knee injury and Osteoarthritis Outcome Score (KOOS) holds five subscales evaluating Pain, other Symptoms, ADL function, Sport and Recreation function and knee-related quality of life. To enhance clinical interpretation, scores are presented separately for each subscale. For statistical purposes, when one primary outcome is required, a composite score such as KOOS4 or KOOS5 can be used but should always be complemented by reporting of the 5 subscale scores as secondary outcomes (1). KOOS was constructed in the nineties using classic test theory and has been extensively subjected to testing of its psychometric properties. In a systematic review and meta-analysis performed in collaboration with authors from the COSMIN group and including data from 37 psychometric studies of the KOOS it was found that “KOOS has adequate internal consistency, test-retest reliability, and construct validity in young and old adults with knee injuries and/or osteoarthritis. The ADL subscale has better content validity for older patients and Sport/Rec for younger patients with knee injuries, while the Pain subscale is more relevant for painful knee conditions” (2). The current study includes older people with osteoarthritis, a group for which KOOS has sufficient measurement properties (2).
We agree with Dr. Williams that item response theory (IRT), or modern test theory, is of great benefit when constructing patient-reported outcome measures. To apply IRT appropriately, large cohorts of patients are needed. A cohort of 1,392 older people with osteoarthritis undergoing total knee replacement (TKR) was used when applying IRT with the aim to construct a shorter version of the KOOS for use in joint registries (3,4). The authors arrived at a 12-item and 3-subscale version named KOOS-12 and found that internal consistency reliability was above 0.70 for all KOOS-12 scales and 0.90 or higher for the KOOS-12 Summary score. Validity and responsiveness of KOOS-12 Pain, Function and QOL scales were satisfactory and reached similar conclusions as comparable to full-length KOOS scales. The KOOS-12 Summary score was most responsive in discriminating between groups who differed in global ratings of post-TKR change in physical capabilities and had the highest effect sizes and standardized response means. It was concluded that KOOS-12 is a reliable and valid alternative to KOOS in TKR patients with moderate to severe osteoarthritis and provided three domain-specific and summary knee impact scores with substantially reduced respondent burden. Recently, another group of authors tested the performance of KOOS-12 using IRT in another cohort and found KOOS-12 to have good psychometric properties for capturing joint replacement outcomes including excellent responsiveness, although ceiling effects may limit monitoring of post-operative improvement (5). Ceiling effects were not found in the original TKR cohort, despite the KOOS-12 being developed using IRT. This suggests that even instruments developed using IRT may have its weaknesses, or, alternatively, that the multitude of qualitative decisions made during an IRT-process differ between author groups and may impact more than we would wish on the result. In summary, we do not believe that instruments constructed using classical test theory are obsolete, often the large number of studies available evaluating their psychometric properties (2) make us well aware of their strengths and shortcomings.
While we acknowledge that the results from clinical trials such as ours can be analyzed in different ways, we believe that the approach we have used (linear mixed-effects model) is appropriate for the data that we have. Besides being used in many previous trials published in high impact journals, this statistical model is also able to account for missing data with higher statistical precision than other commonly applied methods (6). Given that the analytical method was also used in previous reports at 12- and 24-months (7,8) of the current trial, it also allows us to compare the results at the different time points.
References
1. Roos EM, Engelhart L, Ranstam J, Anderson AF, Irrgang JJ, Marx RG, et al. ICRS Recommendation Document: Patient-Reported Outcome Instruments for Use in Patients with Articular Cartilage Defects. Cartilage. 2011 Apr;2(2):122–36.
2. Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM. Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis Cartilage. 2016 Aug;24(8):1317–29.
3. Gandek B, Roos EM, Franklin PD, Ware JE. Item selection for 12-item short forms of the Knee injury and Osteoarthritis Outcome Score (KOOS-12) and Hip disability and Osteoarthritis Outcome Score (HOOS-12). Osteoarthritis Cartilage [Internet]. 2019 May 1 [cited 2022 Dec 12];27(5):746–53. Available from: https://pubmed.ncbi.nlm.nih.gov/30593867/
4. Gandek B, Roos EM, Franklin PD, Ware JE. A 12-item short form of the Hip disability and Osteoarthritis Outcome Score (HOOS-12): tests of reliability, validity and responsiveness. Osteoarthritis Cartilage. 2019 May 1;27(5):754–61.
5. Ackerman IN, Soh SE, Harris IA, Cashman K, Heath E, Lorimer M, et al. Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery. Osteoarthritis Cartilage [Internet]. 2021 Jun 1 [cited 2022 Dec 12];29(6):815–23. Available from: https://pubmed.ncbi.nlm.nih.gov/33727118/
6. Ranstam J, Turkiewicz A, Boonen S, van Meirhaeghe J, Bastian L, Wardlaw D. Alternative analyses for handling incomplete follow-up in the intention-to-treat analysis: The randomized controlled trial of balloon kyphoplasty versus non-surgical care for vertebral compression fracture (FREE). BMC Med Res Methodol [Internet]. 2012 Mar 24 [cited 2022 Dec 12];12(1):1–12. Available from: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-1...
7. Skou ST, Rasmussen S, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, et al. The efficacy of 12 weeks non-surgical treatment for patients not eligible for total knee replacement: a randomized controlled trial with 1-year follow-up. Osteoarthritis Cartilage. 2015 Sep;23(9):1465–75.
8. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S, et al. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis Cartilage. 2018 Sep;26(9):1170–80.
Dear Authors, I'd like to raise a concern which I have in regards to the trial results. I believe there may be an error in your statistical display of the P-value for LDL-C for the butter group vs. the coconut oil & olive oil groups. Within the text, it is written that P <0.0001 when comparing LDL-C from butter vs. the coconut & olive oil groups (see Results - page 5). However, in Table 2 the P-value for the same outcome is <0.001 (see Table 2 - page 8). Please let me know if I am mistaken or if in fact there was a mistake made.
Best,
Melody
Tae Jun Kim, Department of Medical Sociology, University Medical Center Hamburg-Eppendorf
Re: “Income and Obesity: what is the direction of the relationship? A systematic review and meta-analysis”
Respected Editor,
This letter serves as a response to the article published on January 5, 2018, titled “Income and Obesity: what is the direction of the relationship? A systematic review and meta-analysis”. Firstly I would like to acknowledge the talented and intelligent authors of this research article and acknowledge their hard work with this research. Reviewing this article I was able to grasp an understanding of how low income environments contribute to obesity. On the downfall of this article it was made known that research covered the western societies excluding other regions thus leaving the possibility of assumption that risk and cause of obesity may differ in other regions.
According to the article and the cultivation theory by George Gerbner it is proposed that there is an ongoing stigma created by watching television and the media and getting the idea of being slim. Although the study focused on low income contributing and being a factor of obesity this research could have also looked at other factors that can be a risk factor of obesity.
Researchers did a good job executing this article topic, taking these points into consideration would he...
Tae Jun Kim, Department of Medical Sociology, University Medical Center Hamburg-Eppendorf
Re: “Income and Obesity: what is the direction of the relationship? A systematic review and meta-analysis”
Respected Editor,
This letter serves as a response to the article published on January 5, 2018, titled “Income and Obesity: what is the direction of the relationship? A systematic review and meta-analysis”. Firstly I would like to acknowledge the talented and intelligent authors of this research article and acknowledge their hard work with this research. Reviewing this article I was able to grasp an understanding of how low income environments contribute to obesity. On the downfall of this article it was made known that research covered the western societies excluding other regions thus leaving the possibility of assumption that risk and cause of obesity may differ in other regions.
According to the article and the cultivation theory by George Gerbner it is proposed that there is an ongoing stigma created by watching television and the media and getting the idea of being slim. Although the study focused on low income contributing and being a factor of obesity this research could have also looked at other factors that can be a risk factor of obesity.
Researchers did a good job executing this article topic, taking these points into consideration would help the article even more.
Thank You
Yours Sincerely,
Shanae Davis
University of The Bahamas Nursing Student
To the Editor: This response is in reference to the 2022 article entitled “Acupuncture for low back and/pelvic pain during pregnancy”. I am currently a nursing student enrolled at the University of The Bahamas and I found your article very intriguing. As a future nurse any advancements that can be made in the field of nursing and allied health profession is admirable. As we all know and you explained, pregnancy can be a very painful and tedious process so any advancement in medical treatment or procedures that can be done to reduce pain is considerably beneficial research in my opinion. The article was very informative and insightful especially considering that I knew very little about acupuncture prior to reading this article. The procedure not only relieves lower back and pelvic pain (LBPP) but it also will allow for expecting mothers to carry out activities of daily living (ADLS) without feeling pain closer to their expected due dates. I am not a mother myself however, my mother went through IVF a very painful process and she suffered from severe LBPP while carrying 3 babies without any relief, so thinking about her experience the acupuncture method of pain relief would have been beneficial to her and many others in the past. Your hard work in advancing the medical management of patients and their health is commendable. Thank you.
To the editor: This response is relevant to the earlier-mentioned 2017 article. I want to emphasise how important this subject is as a nursing student, who is concerned about the overall health of healthcare professionals. According to the article, the purpose is to estimate the obesity prevalence in healthcare workers. This is important because obesity can lead to many other health complications, like musculoskeletal disorders and mental health issues. From the investigation it indicated that obesity among nurses and other unregistered healthcare workers were more prevalent compared to other health professionals. The main question now is "Why is it most prevalent in nurses and unregistered care workers?". Whether it be lack of access to healthy food options, shift working etc, as health care providers one must take accountability. As nurses, they are aware of the complications of obesity, so being healthy should be one's priority.
We appreciate Chante' B Deal reading and commenting on our on our article titled "Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based cross-sectional study". We were intrigued to know about the linkages between diabetes and mortality among the population in The Bahamas. Deal has highlighted a few observations in our paper, which we would like to address on a point-by-point basis.
Firstly, Deal suggested that NCDs are an essential component of diabesity as their presence plays a vital role in the development and prognosis of diabetes and obesity; however, this was not emphasized in our work. The primary aim of our research was to identify the social determinants of diabesity; it is worth mentioning that all the regression models presented in our study were adjusted for the prominently occurring co-morbidities of diabetes and obesity. These included cancer, chronic heart disease, chronic obstructive pulmonary disorder, chronic renal failure, gastrointestinal disorders, high cholesterol, hypertension, stroke, and thyroid disorders. Also, for the secondary objective, the disease-specific relative risk estimates are presented after adjusting for other co-morbidities. Thus, we ensured that the co-morbidities were foregrounded in our work.
The second issue highlighted was the timing of the comorbid diseases that might have affected the prevalence of diabetes and obesity. We refrained f...
We appreciate Chante' B Deal reading and commenting on our on our article titled "Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based cross-sectional study". We were intrigued to know about the linkages between diabetes and mortality among the population in The Bahamas. Deal has highlighted a few observations in our paper, which we would like to address on a point-by-point basis.
Firstly, Deal suggested that NCDs are an essential component of diabesity as their presence plays a vital role in the development and prognosis of diabetes and obesity; however, this was not emphasized in our work. The primary aim of our research was to identify the social determinants of diabesity; it is worth mentioning that all the regression models presented in our study were adjusted for the prominently occurring co-morbidities of diabetes and obesity. These included cancer, chronic heart disease, chronic obstructive pulmonary disorder, chronic renal failure, gastrointestinal disorders, high cholesterol, hypertension, stroke, and thyroid disorders. Also, for the secondary objective, the disease-specific relative risk estimates are presented after adjusting for other co-morbidities. Thus, we ensured that the co-morbidities were foregrounded in our work.
The second issue highlighted was the timing of the comorbid diseases that might have affected the prevalence of diabetes and obesity. We refrained from adding temporality to our study, primarily because LASI is a cross-sectional dataset and provides a current body mass index status. As a result, more information on the onset of diabetes was required. Furthermore, the timings for all co-morbidities were not included in the dataset. We would love to explore temporal and directional networks for diabesity and its co-morbidities when data from the second wave of LASI is released.
Finally, we agree that the genetic predisposition is a primary determinant of diabesity, and it is essential to include it in any analysis related to NCDs. However, gathering this information is extremely difficult for any nationally representative survey. When dealing with a populous country like India, the problem becomes unfeasible and logistically impossible to address. We want to reaffirm that the data used in our work has been taken from a secondary cross-sectional dataset, the Longitudinal Ageing Study in India (LASI), 2017–18, which does not provide any information on genetic predisposition or other biological factors.
We are grateful that you brought up the points and gave us a chance to respond. It will also make our readers more aware of the reasons some crucial components were left out of our research. We value Chante's contributions and eagerly anticipate her further studies.
The authors have conducted a long-term follow-up study and collected valuable data. Unfortunately, the statistical analysis of these data does not do justice to their careful clinical work.
Subjective rating scales (including patient-reported or clinician-rated outcome measures - PROMs and CROMs) require 'psychometric' validation - because they tap people's opinions, not machine-measurable facts. However, "the psychometric measurement properties of KOOS are insufficient for use on patients 20 weeks subsequent to ACL reconstruction" (https://doi.org/10.1111/j.1600-0838.2007.00724.x)
'Psychometric' analysis of PROMs and CROMs also requires a form of estimation that takes into account the nature of their ratings (ordinal for scales which constrain answers to certain categories, such as 'none', 'mild', 'moderate', 'severe'; bounded for visual analogue scales). When researchers use 'ordinary least squares' methods, as here, the results may not be reliable (e.g. Liddell & Kruschke, 2018 "Analyzing ordinal data with metric models: What could possibly go wrong?", https://doi.org/10.1016/j.jesp.2018.08.009).
One appropriate form of analysis would be to construct a repeated-measures item-response-theory model (e.g....
The authors have conducted a long-term follow-up study and collected valuable data. Unfortunately, the statistical analysis of these data does not do justice to their careful clinical work.
Subjective rating scales (including patient-reported or clinician-rated outcome measures - PROMs and CROMs) require 'psychometric' validation - because they tap people's opinions, not machine-measurable facts. However, "the psychometric measurement properties of KOOS are insufficient for use on patients 20 weeks subsequent to ACL reconstruction" (https://doi.org/10.1111/j.1600-0838.2007.00724.x)
'Psychometric' analysis of PROMs and CROMs also requires a form of estimation that takes into account the nature of their ratings (ordinal for scales which constrain answers to certain categories, such as 'none', 'mild', 'moderate', 'severe'; bounded for visual analogue scales). When researchers use 'ordinary least squares' methods, as here, the results may not be reliable (e.g. Liddell & Kruschke, 2018 "Analyzing ordinal data with metric models: What could possibly go wrong?", https://doi.org/10.1016/j.jesp.2018.08.009).
One appropriate form of analysis would be to construct a repeated-measures item-response-theory model (e.g. https://doi.org/10.1016/j.ymeth.2022.01.005), which can include the treatment effects. Many variations of this basic IRT model are possible - e.g. hierarchical (multifactorial or bifactorial) estimation of severity, or treatment x sub-scale interactions.
It is puzzling that the Editors and reviewers of this article appear unaware of the appropriate methods for analysing PROMs and CROMs and did not draw the authors' attention to above difficulties. This points to a structural problem in biomedical research that may underlie the "replication crisis".
This reply is in reference to the above published article. It is evident that extensive research was conducted, and multiple studies were reviewed looking at both home midwife settings (planned homes and freestanding midwifery units) and obstetric units for the purpose of this study. There was also statistical support provided to further support the topic. This article gave insight on intrapartum interventions and the outcomes for both the mother and newborn after being immersed in water during labor and following waterbirth.
Apart from being informative, I found this article rather interesting because in The Bahamas, immersion in water during labor and waterbirths are practices that are not seen. Based on the evidence gathered from this research and the other studies that were referenced, it is clear that both the physiological and psychological benefits of intrapartum immersion in water and waterbirths outweighed the disadvantages for healthy women with noncomplicated pregnancies. Results presented in the article showed decreased use of epidural, injected opioids, maternal pain, episiotomy and postpartum hemorrhage, increased maternal satisfaction and an increased odd of an intact peritoneum. On the other hand, although the risk remained low, the odds of cord avulsion was seen as higher. Otherwise, there were no other adverse neonatal outcomes identified. For these reasons, I believe that intrapartum water emersions and waterbirths should be considered and imple...
This reply is in reference to the above published article. It is evident that extensive research was conducted, and multiple studies were reviewed looking at both home midwife settings (planned homes and freestanding midwifery units) and obstetric units for the purpose of this study. There was also statistical support provided to further support the topic. This article gave insight on intrapartum interventions and the outcomes for both the mother and newborn after being immersed in water during labor and following waterbirth.
Apart from being informative, I found this article rather interesting because in The Bahamas, immersion in water during labor and waterbirths are practices that are not seen. Based on the evidence gathered from this research and the other studies that were referenced, it is clear that both the physiological and psychological benefits of intrapartum immersion in water and waterbirths outweighed the disadvantages for healthy women with noncomplicated pregnancies. Results presented in the article showed decreased use of epidural, injected opioids, maternal pain, episiotomy and postpartum hemorrhage, increased maternal satisfaction and an increased odd of an intact peritoneum. On the other hand, although the risk remained low, the odds of cord avulsion was seen as higher. Otherwise, there were no other adverse neonatal outcomes identified. For these reasons, I believe that intrapartum water emersions and waterbirths should be considered and implemented as an alternative birthing method in The Bahamas; awarding pregnant mothers an alternative labor option and different experience.
Overall, the article was very informative; however, it would have been more beneficial if more articles were used that were related to the midwifery led setting to achieve more balanced results and determine if the interventions produces different outcomes as opposed to using far more articles related to the obstetric unit setting.
Dear Editor,
I read your article on acupuncture in pregnant women suffering from lower back and pelvic pain (LBPP). I found the read to be interesting and very informative. Firstly, I love how you explained thoroughly what acupuncture is and why it is usually used. The only information I have ever known about acupuncture was that people use it to lose weight, but I never really knew the main use was to relieve pain.
I found the study interesting because many pregnant women suffer from LBP0 especially first-time mothers because of their sudden body change. I myself too suffered from LBPP when I was pregnant with my first child. With a study like this, it can create a whole dynamic for mothers suffering from those painful episodes.
Your study can open door to new treatment that can help mothers around the world rather than just being told to take medication for the pain. As mentioned in your article, it will assist in mothers being able to complete daily tasks as well as attend work until the time to give birth.
LBPP is a very painful thing to experience as a pregnant woman, but with this research, door is now opened to new treatment to help assist in the relief of this pain. I think the research study was very successful. While it may not work for everyone, if it can help majority of women, it’s a good start. The research article was very interesting and I learn a lot from that good read. Thank you for your har...
Dear Editor,
I read your article on acupuncture in pregnant women suffering from lower back and pelvic pain (LBPP). I found the read to be interesting and very informative. Firstly, I love how you explained thoroughly what acupuncture is and why it is usually used. The only information I have ever known about acupuncture was that people use it to lose weight, but I never really knew the main use was to relieve pain.
I found the study interesting because many pregnant women suffer from LBP0 especially first-time mothers because of their sudden body change. I myself too suffered from LBPP when I was pregnant with my first child. With a study like this, it can create a whole dynamic for mothers suffering from those painful episodes.
Your study can open door to new treatment that can help mothers around the world rather than just being told to take medication for the pain. As mentioned in your article, it will assist in mothers being able to complete daily tasks as well as attend work until the time to give birth.
LBPP is a very painful thing to experience as a pregnant woman, but with this research, door is now opened to new treatment to help assist in the relief of this pain. I think the research study was very successful. While it may not work for everyone, if it can help majority of women, it’s a good start. The research article was very interesting and I learn a lot from that good read. Thank you for your hard work and dedication to your research study.
We appreciate the comment from Dr. Williams, highlighting some of the challenges when measuring patient-reported outcome measures. Patient-reported outcomes are often used as the primary outcome in clinical trials because patient perspectives remain critical to evaluate treatment response. However, as Dr. Williams points out, the psychometric properties of patient-reported outcome measures need to be evaluated in different cohorts and scrutinized carefully.
Knee injury and Osteoarthritis Outcome Score (KOOS) holds five subscales evaluating Pain, other Symptoms, ADL function, Sport and Recreation function and knee-related quality of life. To enhance clinical interpretation, scores are presented separately for each subscale. For statistical purposes, when one primary outcome is required, a composite score such as KOOS4 or KOOS5 can be used but should always be complemented by reporting of the 5 subscale scores as secondary outcomes (1). KOOS was constructed in the nineties using classic test theory and has been extensively subjected to testing of its psychometric properties. In a systematic review and meta-analysis performed in collaboration with authors from the COSMIN group and including data from 37 psychometric studies of the KOOS it was found that “KOOS has adequate internal consistency, test-retest reliability, and construct validity in young and old adults with knee injuries and/or osteoarthritis. The ADL subscale has better content validity for older patients...
Show MoreDear Authors, I'd like to raise a concern which I have in regards to the trial results. I believe there may be an error in your statistical display of the P-value for LDL-C for the butter group vs. the coconut oil & olive oil groups. Within the text, it is written that P <0.0001 when comparing LDL-C from butter vs. the coconut & olive oil groups (see Results - page 5). However, in Table 2 the P-value for the same outcome is <0.001 (see Table 2 - page 8). Please let me know if I am mistaken or if in fact there was a mistake made.
Best,
Melody
Nassau, Bahamas
November 30th 2022
Hamburg, Germany
November 30th 2022
Tae Jun Kim, Department of Medical Sociology, University Medical Center Hamburg-Eppendorf
Re: “Income and Obesity: what is the direction of the relationship? A systematic review and meta-analysis”
Respected Editor,
Show MoreThis letter serves as a response to the article published on January 5, 2018, titled “Income and Obesity: what is the direction of the relationship? A systematic review and meta-analysis”. Firstly I would like to acknowledge the talented and intelligent authors of this research article and acknowledge their hard work with this research. Reviewing this article I was able to grasp an understanding of how low income environments contribute to obesity. On the downfall of this article it was made known that research covered the western societies excluding other regions thus leaving the possibility of assumption that risk and cause of obesity may differ in other regions.
According to the article and the cultivation theory by George Gerbner it is proposed that there is an ongoing stigma created by watching television and the media and getting the idea of being slim. Although the study focused on low income contributing and being a factor of obesity this research could have also looked at other factors that can be a risk factor of obesity.
Researchers did a good job executing this article topic, taking these points into consideration would he...
To the Editor: This response is in reference to the 2022 article entitled “Acupuncture for low back and/pelvic pain during pregnancy”. I am currently a nursing student enrolled at the University of The Bahamas and I found your article very intriguing. As a future nurse any advancements that can be made in the field of nursing and allied health profession is admirable. As we all know and you explained, pregnancy can be a very painful and tedious process so any advancement in medical treatment or procedures that can be done to reduce pain is considerably beneficial research in my opinion. The article was very informative and insightful especially considering that I knew very little about acupuncture prior to reading this article. The procedure not only relieves lower back and pelvic pain (LBPP) but it also will allow for expecting mothers to carry out activities of daily living (ADLS) without feeling pain closer to their expected due dates. I am not a mother myself however, my mother went through IVF a very painful process and she suffered from severe LBPP while carrying 3 babies without any relief, so thinking about her experience the acupuncture method of pain relief would have been beneficial to her and many others in the past. Your hard work in advancing the medical management of patients and their health is commendable. Thank you.
Kind Regards
Christal Adderley
To the editor: This response is relevant to the earlier-mentioned 2017 article. I want to emphasise how important this subject is as a nursing student, who is concerned about the overall health of healthcare professionals. According to the article, the purpose is to estimate the obesity prevalence in healthcare workers. This is important because obesity can lead to many other health complications, like musculoskeletal disorders and mental health issues. From the investigation it indicated that obesity among nurses and other unregistered healthcare workers were more prevalent compared to other health professionals. The main question now is "Why is it most prevalent in nurses and unregistered care workers?". Whether it be lack of access to healthy food options, shift working etc, as health care providers one must take accountability. As nurses, they are aware of the complications of obesity, so being healthy should be one's priority.
We appreciate Chante' B Deal reading and commenting on our on our article titled "Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based cross-sectional study". We were intrigued to know about the linkages between diabetes and mortality among the population in The Bahamas. Deal has highlighted a few observations in our paper, which we would like to address on a point-by-point basis.
Show MoreFirstly, Deal suggested that NCDs are an essential component of diabesity as their presence plays a vital role in the development and prognosis of diabetes and obesity; however, this was not emphasized in our work. The primary aim of our research was to identify the social determinants of diabesity; it is worth mentioning that all the regression models presented in our study were adjusted for the prominently occurring co-morbidities of diabetes and obesity. These included cancer, chronic heart disease, chronic obstructive pulmonary disorder, chronic renal failure, gastrointestinal disorders, high cholesterol, hypertension, stroke, and thyroid disorders. Also, for the secondary objective, the disease-specific relative risk estimates are presented after adjusting for other co-morbidities. Thus, we ensured that the co-morbidities were foregrounded in our work.
The second issue highlighted was the timing of the comorbid diseases that might have affected the prevalence of diabetes and obesity. We refrained f...
Having read this protocol with great interest, I was wondering status on results?
The authors have conducted a long-term follow-up study and collected valuable data. Unfortunately, the statistical analysis of these data does not do justice to their careful clinical work.
Subjective rating scales (including patient-reported or clinician-rated outcome measures - PROMs and CROMs) require 'psychometric' validation - because they tap people's opinions, not machine-measurable facts. However, "the psychometric measurement properties of KOOS are insufficient for use on patients 20 weeks subsequent to ACL reconstruction" (https://doi.org/10.1111/j.1600-0838.2007.00724.x)
'Psychometric' analysis of PROMs and CROMs also requires a form of estimation that takes into account the nature of their ratings (ordinal for scales which constrain answers to certain categories, such as 'none', 'mild', 'moderate', 'severe'; bounded for visual analogue scales). When researchers use 'ordinary least squares' methods, as here, the results may not be reliable (e.g. Liddell & Kruschke, 2018 "Analyzing ordinal data with metric models: What could possibly go wrong?", https://doi.org/10.1016/j.jesp.2018.08.009).
One appropriate form of analysis would be to construct a repeated-measures item-response-theory model (e.g....
Show MoreThis reply is in reference to the above published article. It is evident that extensive research was conducted, and multiple studies were reviewed looking at both home midwife settings (planned homes and freestanding midwifery units) and obstetric units for the purpose of this study. There was also statistical support provided to further support the topic. This article gave insight on intrapartum interventions and the outcomes for both the mother and newborn after being immersed in water during labor and following waterbirth.
Apart from being informative, I found this article rather interesting because in The Bahamas, immersion in water during labor and waterbirths are practices that are not seen. Based on the evidence gathered from this research and the other studies that were referenced, it is clear that both the physiological and psychological benefits of intrapartum immersion in water and waterbirths outweighed the disadvantages for healthy women with noncomplicated pregnancies. Results presented in the article showed decreased use of epidural, injected opioids, maternal pain, episiotomy and postpartum hemorrhage, increased maternal satisfaction and an increased odd of an intact peritoneum. On the other hand, although the risk remained low, the odds of cord avulsion was seen as higher. Otherwise, there were no other adverse neonatal outcomes identified. For these reasons, I believe that intrapartum water emersions and waterbirths should be considered and imple...
Show MoreDear Editor,
Show MoreI read your article on acupuncture in pregnant women suffering from lower back and pelvic pain (LBPP). I found the read to be interesting and very informative. Firstly, I love how you explained thoroughly what acupuncture is and why it is usually used. The only information I have ever known about acupuncture was that people use it to lose weight, but I never really knew the main use was to relieve pain.
I found the study interesting because many pregnant women suffer from LBP0 especially first-time mothers because of their sudden body change. I myself too suffered from LBPP when I was pregnant with my first child. With a study like this, it can create a whole dynamic for mothers suffering from those painful episodes.
Your study can open door to new treatment that can help mothers around the world rather than just being told to take medication for the pain. As mentioned in your article, it will assist in mothers being able to complete daily tasks as well as attend work until the time to give birth.
LBPP is a very painful thing to experience as a pregnant woman, but with this research, door is now opened to new treatment to help assist in the relief of this pain. I think the research study was very successful. While it may not work for everyone, if it can help majority of women, it’s a good start. The research article was very interesting and I learn a lot from that good read. Thank you for your har...
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