1458 e-Letters

  • Response to comment from Dr. Jonathan H Williams concerning the publication “Five-year follow-up of patients with knee osteoarthritis not eligible for total knee replacement: results from a randomised trial”

    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...

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  • statistical error

    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.

  • Letter to the editor

    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,
    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...

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  • Acupuncture for low back and/or pelvic pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials

    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

  • Re:Obesity prevalence among healthcare professionals

    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.

  • Response to Comments:

    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...

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  • Was Review Completed?

    Having read this protocol with great interest, I was wondering status on results?

  • Dr

    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....

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  • Letter to the editor

    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...

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  • Letter to the Editor

    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...

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