959 e-Letters

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

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

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

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

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

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

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

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

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

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

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

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

    Some charismatic-type services are quiete...

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  • Low birth weight as a risk for thinness and obesity

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

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

    Dear Rosemary,

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

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

    The study reported by Ang and co-workers is of great interest to health care 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 the total inpatient length of stay, and diminish the expenses of care of patients [1].

    In Malaysia, we have an integrated care transitions programme that enables stable patients discharged from hospital admissions to undergo subsequent care and continuous treatment follow-ups at designated primary health centres. For more than a decade, Ministry of Health Malaysia has commenced a discharge referral service to ensure the continuity of care and supply of medications with minimal discrepancies when patients are transferred from hospitals to health clinics.

    Whilst the Guidelines for Inpatient Pharmacy Practice has been published to consolidate pharmaceutical care activities in both the outpatient and inpatient settings, little is known about the patterns of medications supplied to patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the information gap on the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health cl...

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  • Observation at the right time

    Dear editor,

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

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

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

  • Closing the stable door after the horse has bolted?

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

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

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

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

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

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

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  • Response to Heather Machin and the Global Alliance of Eye Bank Associations

    We thank Heather Machin for her thoughtful response to our paper. We congratulate the Global Alliance of Eye Bank Associations for their ethical stance and for taking measures to try to ensure that donated ocular material has been ethically procured. Barcelona Principle 9 regarding research and publication specifies a high standard, and if followed, would help to guarantee ethical practice in published research from the eye bank sector. It would be interesting to hear of examples of good practice where researchers have taken steps to verify the provenance of tissues from particular eye banks, and also to hear of any mechanisms adopted by journals to confirm that research was performed only on ethically procured materials. Have any instances of unethical practice been identified?
    We hope that this initiative by the eye banking community to ensure high ethical standards will serve as an example to other areas of organ and tissue procurement. Any publication of research on unethically procured human materials undermines trust in the organ and tissue sector, taints the literature, and facilitates ongoing harm to those whose tissues and organs are procured without consent.

  • Review of Riksät by the scientific ombudsman of the Karolinska Institute

    No more than one patient in five were treated to remission from an eating disorder in years 2012-2016 according to the data in the National Quality Register for Eating Disorders Treatment in Sweden (Riksät). But much higher remission rates have been publicized based on the same data [1]. The holders of Riksät justify these high remission rates by excluding patients lost to follow-up, typically more than 50%, from the calculation [2]. With this method of calculation remission rates increase as more patients are lost to follow-up [3]. The recently reported outcomes at the Stockholm Centre for Eating Disorders provide an example of this effect.

    Table 1. Number of patients treated, followed up and treated to remission at the Stockholm Centre for Eating Disorders in 2017 and 2018. Data from [4,5].

    Treatment 712 (2017) 623 (2018)
    Follow-up 160 (2017) 97 (2018)
    Remission 113 (2017) 81 (2018)
    Remission/treatment 15.9% (2017) 13.0% (2018)
    Remission/follow-up 70.6% (2017) 83.5% (2018)
    Lost to follow-up 77.5% (2017) 84.4%(2018)

    Table 1 shows that fewer patients were treated, followed up and treated to remission in 2018 than in 2017. These numbers yield a decrease in the rate of remission by 18.1% to 13% among all treated patients, an increase in the rate of remission by 21.8% to 83.5% among the patients followed up and an increase in the num...

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