The Editor
It is indeed a research which needs to be widely circulated as the
biological science and ancient teachings of mindfulness are on the same
path of helping /alleviating human sufferings. The Indian ancient book
Bhagvad Gita ; the great teaching of Krishna to Arjuna in chapter II
verse 60 talks about how the turbulent senses attack the mind and lead it
astray .
The great wisdom of 'work must be done w...
The Editor
It is indeed a research which needs to be widely circulated as the
biological science and ancient teachings of mindfulness are on the same
path of helping /alleviating human sufferings. The Indian ancient book
Bhagvad Gita ; the great teaching of Krishna to Arjuna in chapter II
verse 60 talks about how the turbulent senses attack the mind and lead it
astray .
The great wisdom of 'work must be done without thought of reward' and 'an
individual may have a tranquil mind even in activity.' The tranquil mind
only be achieved by mindfulness and the rewards of such deeds will never
come into play in decision making thus negating the anxiety of rewards.
Similarly the teachings of Lord Buddha also stresses upon mindfulness.
Brain utilizes some 60% of the utilization of glucose by the whole
body in the resting state but in starvation, ketone bodies generated by
the liver partly replace glucose as fuel for the brain.(1) The brain's
functional connectivity is complex, has high energetic cost, and requires
efficient use of glucose, the brain's main energy source. In an articles
abstract published in which authors concluded that in a rich and
complex visual world the stimuli that are not cognitively accessed are
processed up to levels of perceptual interpretation(3) . The brain is
acting as supercomputer working through out our life , so by calming
down the activity of brain by mind fullness the best optimal utilization
of natures best computer (human brain ) can be achieved .
My sincere thanks to the authors for doing this research. And publishers
for presenting this to the world
(1).Berg JM, Tymoczko JL, Stryer L. Biochemistry. 5th edition. New
York: W H Freeman; 2002. Section 30.2, Each Organ Has a Unique Metabolic
Profile. Available from: http://www.ncbi.nlm.nih.gov/books/NBK22436/
( 2) Proc Natl Acad Sci. 2013;110(33):13642-7
( 3) J Cogn Neurosci. 2013 Nov 27
Umesh Chandra Ojha .MD,DTCD, B Sc., FCCP,FIMSA,FNCCP(I)
Director & Pulmonologist
Institute of Occupational Health & Research .
ESIC Hospital Basaidarapur
New Delhi
Sir, we read with interest the recent response to our study of
delirium point prevalence from Zieschang and colleagues, Heidelberg,
Germany[1]. Zieschang et al have described a delirium prevalence of 15.6%
in their study population of older hyponatraemic patients and
normonatraemic controls admitted to a step-down facility, and note that
our hospital-wide point prevalence was higher at almost 20%[2].
Sir, we read with interest the recent response to our study of
delirium point prevalence from Zieschang and colleagues, Heidelberg,
Germany[1]. Zieschang et al have described a delirium prevalence of 15.6%
in their study population of older hyponatraemic patients and
normonatraemic controls admitted to a step-down facility, and note that
our hospital-wide point prevalence was higher at almost 20%[2].
Although, both studies describe delirium prevalence, there are some
important methodological differences which may account for the small
difference in prevalence rates. Firstly, the two study populations are not
entirely comparable, as Zieschang et al concede. Our study assessed the
point prevalence of delirium over the course of one day across specialties
in a tertiary-referral acute general hospital (patient mean age 69 years),
whereas the German study cohort consisted only of elderly patients
(patient mean age 82 years) admitted to a post-acute care facility.
Although their population is older, patients admitted to post-acute care
should be, by definition, less unwell than those in an acute hospital, and
hence should have fewer delirium precipitating factors. Interestingly, a
previous study of delirium in post-acute care by Marcantonio et al, showed
prevalence rates of up to 23%[3], which is higher than the figure reported
by Zieschang and colleagues.
Zieschang et al used the Confusion Assessment Method (CAM) rated by
junior physicians as a screening method. Possible and definite cases of
delirium based on this assessment were confirmed by a specialist using DSM
-IV criteria. The sensitivity of the CAM as a screening tool has been
shown in previous studies to be as low as 50% when performed by
inexperienced raters[4]. Hence, it is entirely conceivable that delirium
may have been missed using the CAM method in this study. In our study, the
CAM was performed by experienced and rigorously trained Geriatric Medicine
registrars and was entirely independent of formal DSM-IV delirium
diagnosis. In addition, Zieschang et al do not outline the time delay
between CAM assessment and definitive delirium diagnosis. If the delay was
more than 24 hours, borderline cases may have resolved by that time. All
of these factors could account for the difference in prevalence figures.
Zieschang et al used an abbreviated version of the IQCODE-SF to
screen for prior cognitive status. Using this short screening tool, they
showed that prior cognitive impairment was an independent predictor of
delirium status (OR=17.7; 95%CI 6.8-46.8, p<0.001), which was very much
in keeping with our findings (adjusted OR=15.3; 95%CI 5.2-45.4,
p<0.001), using the 16-item IQCODE-SF. Zieschang et al suggest that
using the question "Compared with five years ago how is this person at
remembering things that have recently happened and how is this person
oriented in time and space?" may be an effective screening tool for
delirium in an older patient population. Although identifying prior
cognitive impairment is important for delirium risk assessment, and so
this question may indicate risk of delirium, this test is unlikely to be
useful as a daily delirium screening tool as it assesses changes over the
previous five years. Screening for delirium ideally should use a test that
indicates acute change from baseline cognitive or behavioural functioning.
It must be highly sensitive, given the consequences of untreated or late-
diagnosed delirium, but also should be specific in order to reduce the
need for unnecessary lengthy formal delirium assessments. Secondary
analysis from our study (manuscript in preparation) indicate that short
attention tests, such as the months of the year backwards or the spatial
span forwards, may be an efficient means of screening for delirium in the
acute hospital.
References
1. Zieschang T, Wolf M, Olster P, Kopf D. Prevalence and Predictors
of Delirium. In: BMJ open.
http://bmjopen.bmj.com/content/3/1/e001772.full/reply - bmjopen_el_6857;
2013.
2. Ryan D, O'Regan N, O Caoimh R, et al. Delirium in an adult acute
hospital population: predictors, prevalence and detection. BMJ Open
2013;3:e001772.
3. Marcantonio ER, Simon SE, Bergmann MA, Jones RN, Murphy KM, Morris JN.
Delirium symptoms in post-acute care: prevalent, persistent, and
associated with poor functional recovery. Journal of the American
Geriatrics Society 2003;51:4-9.
4. Ryan K, Leonard M, Guerin S, Donnelly S, Conroy M, Meagher D.
Validation of the confusion assessment method in the palliative care
setting. Palliative medicine 2009;23:40-5.
In their August 1, 2013 reply letter, the authors characterize as a
misunderstanding the conclusion of a 2012 meta-analysis (1) -- using many
of the same databases and with one of the same co-authors as the instant
study -- that only non-routine bed-sharing is associated with an increased
risk of SIDS. In this way they dismiss a critical limitation of their own
study, one which calls fundamentally into question the soundn...
In their August 1, 2013 reply letter, the authors characterize as a
misunderstanding the conclusion of a 2012 meta-analysis (1) -- using many
of the same databases and with one of the same co-authors as the instant
study -- that only non-routine bed-sharing is associated with an increased
risk of SIDS. In this way they dismiss a critical limitation of their own
study, one which calls fundamentally into question the soundness of the
suggestion that the medical profession "should take a more definite stand
against bed sharing." In fact no evidence has been produced against the
possibility that primary bed-sharing, which is to say an arrangement in
which the baby routinely spends most of every night in the parental bed,
might be the safest sleeping arrangement of all. In the absence of such
evidence, it is a terrible disservice to warn non-smoking parents against
establishing the bed-sharing routine from birth.
The 2012 meta-analysis cited two papers -- a 1993 article based on
New Zealand data (2) and a 2009 article based on the German 1998-2001 SIDS
Study (3) -- for the proposition that "routine bed-sharing did not
increase the risk of SIDS." The authors now say that those two studies in
fact prove the opposite, that bed-sharing on the last night is a risk
factor whether or not it is routine.
The New Zealand study found with respect to non-smoking mothers that
"the measure of bed sharing in the last sleep had no increase in risk," so
it hardly supports the present claims. As for the 2009 German paper, a
closer examination reveals acute methodological limitations with respect
to the question of routine vs. non-routine bedsharing. Those limitations
explain how two subsequent interpretations could reach opposite
conclusions on this essential point. They further illustrate dramatically
the fact that warnings against primary bed-sharing to the present day lack
evidentiary foundation.
The problem arises from the classification of families where parents
occasionally allow the infant into the parental bed as "usual" bed-
sharers. Among parents who flex their sleeping arrangement this way,
certainly one reason for taking the infant into the parental bed would be
for comforting or settling when something seems "wrong." One might then
see elevated instances of SIDS occurring in the parental bed not because
the sleep location was a causative factor, but because that something
"wrong" elevated both the probability of the infant being taken into the
parental bed and the risk of SIDS.
The only way to avoid this methodological problem would be to break
out families which engage in "primary" bed-sharing, which is to say
families in which the infant is in the parental bed for most of every
night.
According to the 2009 paper on the German SIDS Study data set, of 333
cases only 26 families responded "parental bed" when asked what bed the
child usually used in the last 4 weeks. But the researchers created an
additional division of families into two groups, those who stated that
their infants were never in the parental bed, and those who stated that
they were in the parental bed either "sometimes" or "every night." There
were 146 families of SIDS cases coded as being in the latter category.
(Among the "sometimes/every night" control families, less than a quarter
had the infant in the parental bed at the time of the reference sleep,
emphasizing the fact that this grouping was in no way composed of primary
bed-sharers.)
It was this larger group of 146 families, the group whose choice to
take the infant into the parental bed on the last night might have been
influenced by the perception of something wrong, which somewhat exceeded
the control group in the percentage of infants sharing a bed during their
last sleep, thereby giving rise to the finding about increased risk for
"bed sharing usual and bed shared during last sleep." Among the smaller
group of 26 families who reported the parental bed as the child's primary
place of sleep, there was no increase seen in the risk of SIDS.
This latter result seems the more relevant one on the question of
"routine" bed-sharing. At the very least it appears we have come a long
way down the path of warning parents against the family bed without having
resolved one of the most fundamental issues. The current study continues
this unfortunate pattern.
Elizabeth S.Bernstein
Bisbee, Arizona, United States
REFERENCES
1. Vennemann MM, Hense H-W, Bajanowski T, et al. Bed sharing and the
risk of sudden infant death syndrome: Can we resolve the debate? J Pediatr
2012;160: 44-8.
2. Scragg R, Mitchell EA, Taylor BJ, Stewart AW, Ford RP, Thompson
JM, et al. Bed sharing, smoking, and alcohol in the sudden infant death
syndrome. New Zealand Cot Death Study Group. BMJ 1993;307:1312-8.
3. Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C,
Mitchell EA. Sleep environment risk factors for sudden infant death
syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics
2009;123:1162-70.
Editor,
The meta-analysis conducted by Yamada et al (2013) has established the
association between baldness and coronary heart disease (CHD). The authors
have concluded that vertex baldness among young men is closely related to
atherosclerosis.
Another factor that deserves mention in this context is smoking. We have
many a times come across patients with severe arterial disease who have
baldness and gray hair and on histo...
Editor,
The meta-analysis conducted by Yamada et al (2013) has established the
association between baldness and coronary heart disease (CHD). The authors
have concluded that vertex baldness among young men is closely related to
atherosclerosis.
Another factor that deserves mention in this context is smoking. We have
many a times come across patients with severe arterial disease who have
baldness and gray hair and on history are found to be smokers or tobacco
users, a practice very common in Indian subcontinent.1, 2 Several studies
have analyzed the association between smoking and androgenetic alopecia
(AGA) and the results are found to be conflicting. Su et al (2007) carried
out a community based survey in Asian men to evaluate the association of
AGA with smoking and found a positive association.3 Smoking status,
current amount of cigarette smoking, and smoking intensity were
statistically significant factors responsible for AGA. Similar results
were found in a cross sectional survey conducted by Mosley and Gibbs.4
Smoking causes hair loss by several mechanisms. Genotoxicants in smoke
affect the microvasculature as well as DNA of the dermal hair papilla.
Smoking induces oxidative stress that leads to release of proinflammatory
cytokines which, in turn, cause inflammation and fibrosis of hair
follicle. Smoking also causes hydroxylation of estradiol thereby inducing
a relative hypoestrogenic state.5
Mosley and Gibbs also found a significant relation between gray hair and
smoking. The relation was consistent for all age groups in both sexes. One
hypothesis proposed for this could be that smoking causes severe disease,
which in turn causes biological aging and hence the graying of hair. The
authors however did not study the dose-response relation. In another study
by Kocaman SA et al, 213 men with suspicion of coronary artery disease
(CAD) were evaluated in terms of age, demographical properties and CVRFs
(cardiovascular risk factors).6 They found that the degree of gray/white
hairs is related to extent of CAD. The authors also suggested that hair
graying is a risk factor for CAD independent of age and other risk
factors.
These studies indicate the need for evaluation of cardiovascular risk
factors, particularly smoking and tobacco habits, in younger men with
vertex baldness, and men and women with premature graying. Such patients
should be encouraged to quit tobacco chewing/smoking to improve their
cardiovascular health. The potential relationship between smoking and
premature graying and baldness should be further investigated and proper
screening test designed to detect patients with asymptomatic CAD.
References
1. Dwivedi S, Jhamb R. Cutaneous markers of cutaneous artery disease.
World J Cardiol 2010; 2(9):1-8.
2. Dwivedi G, Dwivedi S. Betel quid seller syndrome. Occup Environ Med
2010; 67:144.
3. Su LH, Chen TH. Association of androgenetic alopecia with smoking and
its
prevalence among Asian men: a community-based survey. Arch Dermatol. 2007
Nov; 143(11):1401-6.
4. Mosley JG, Gibbs AC. Premature grey hair and hair loss among smokers: a
new opportunity for health education? BMJ. 1996; 313(7072):1616.
5. Tru?eb RM. Molecular mechanisms of androgenetic alopecia. Exp Gerontol.
2002;
37(8-9):981-990.
6. Kocaman SA, ?etin M, Durako?lugil ME, Erdo?an T, ?anga A, ?i?ek Y et
al. The degree of premature hair graying as an independent risk marker for
coronary artery disease: a predictor of biological age rather than
chronological age. Anadolu Kardiyol Derg. 2012 Sep; 12(6):457-63.
Thank you for this work which is very helpful for clinical trials
site selection. We would like to inform about a work done in France on
Clinical Research Attractiveness since 2002, and published early 2013 in
Therapie Journal (Therapie 2013 Janvier-Fevrier;68 (1):1-18). A new Survey
is on-going and the results will be available at the end of 2014 and then
published.
The abstract of the last publication is: Since 2002, th...
Thank you for this work which is very helpful for clinical trials
site selection. We would like to inform about a work done in France on
Clinical Research Attractiveness since 2002, and published early 2013 in
Therapie Journal (Therapie 2013 Janvier-Fevrier;68 (1):1-18). A new Survey
is on-going and the results will be available at the end of 2014 and then
published.
The abstract of the last publication is: Since 2002, the Leem (French
Association of Pharmaceutical Companies) has conducted a Survey every two
years to update the attractiveness of France for international clinical
trials. Thirty companies (68% of the french market) have participated in
this 6th Survey which involved 79 countries, a greater number of phases
I/II, II and III studies (420 versus 352 in 2010), a relatively stable
number of included patients (246,895 versus 249,704 in 2010) and a greater
number of centers (32,965 versus 24,337 in 2010). The evolution of time-
lines for the go-ahead by French Authorities is heterogeneous (shorter
time-lines by the French National Agency of Drug and Health Products but
longer time-lines by Research Ethics Comittees. The time-lines for first
hospital contracts remain stable. France ranks at an average position
among European countries in regards to quantitative and qualitative data,
and its state-of-art in early stages is still recognized. Its good
performance in oncology and orphan diseases are major assets of
competitiveness.
Conflict of Interest:
Leem is the French Association of Pharmaceutical companies
While I am pleased with the general research, its significance and
findings in part, it is my humble concern that there may have been a
systematic error in the sampling design. The researchers set out to
measure both attitude towards and compliance with the smoking ban. In
measuring attitudes, the researcher correctly identifies the school
students as the population and randomly picks classes on which the
instrument is...
While I am pleased with the general research, its significance and
findings in part, it is my humble concern that there may have been a
systematic error in the sampling design. The researchers set out to
measure both attitude towards and compliance with the smoking ban. In
measuring attitudes, the researcher correctly identifies the school
students as the population and randomly picks classes on which the
instrument is administered. This is alright, in my estimation. However, in
measuring compliance, the same sampling frame is used. As a result, only
6.4% of occasional smokers and 4.7% of ex-smokers are represented. It is
my opinion that for compliance, purposive sampling would have been used so
as to get a more representative sample of those who needed to comply. To
measure compliance to the smoking ban, the researchers use classes as the
sampling frame rather than just the smoking population at the university.
What confidence can we then have that the tool does indeed give a
representative or accurate picture of compliance levels? On this basis, I
would like to propose that the research did justice to measuring attitudes
towards the ban but may not have accurately portrayed compliance levels to
the ban at the university.
I congratulate the authors for their cost-effectiveness analysis.
Nevertheless, I believe that their work will need at least three
clarifications.
Compared to LNG the UPA's superiority in efficacy reaches statistical
significance only after a process of adjustment of data. Raw data does not
indicate statistically significant superiority of UPA for any temporal
interval of administration (1).
I think the authors should have...
I congratulate the authors for their cost-effectiveness analysis.
Nevertheless, I believe that their work will need at least three
clarifications.
Compared to LNG the UPA's superiority in efficacy reaches statistical
significance only after a process of adjustment of data. Raw data does not
indicate statistically significant superiority of UPA for any temporal
interval of administration (1).
I think the authors should have an extra caution in designing economic
savings from UPA after the entire medical literature indicates the absence
of detectable effects of post-coital LNG in reducing unwanted pregnancies
and abortions at a population level (2).
Finally, although this is not at all the first paper on the subject I am
not sure a cost-saving analysis is suitable to unplanned pregnancies.
Albeit mistimed, unintended or even unwanted embryos and fetuses are not
infectious agents; no disease classification include pregnancy whatever
its level of planning. Although probably more disadvantaged and
problematic, children born after an unplanned pregnancy are not only
burdens, they are also resources for society. Steve Jobs was one of them.
Whoever will celebrate Christmas next week will not deny that his joy has
to do with the unplanned pregnancy by the Holy Mary.
References:
1) Glasier AF, Cameron ST, Fine PM, Logan SJ, Casale W, Van Horn J, Sogor
L, Blithe DL, Scherrer B, Mathe H, Jaspart A, Ulmann A, Gainer E.
Ulipristal acetate versus levonorgestrel for emergency contraception: a
randomised non-inferiority trial and meta-analysis. Lancet. 2010;
375(9714): 555-62.
2) Rodriguez MI, Curtis KM, Gaffield ML, Jackson E, Kapp N. Advance supply
of emergency contraception: a systematic review. Contraception. 2013;
87(5) :590-601.
I would like to commend the authors of this work for the diarrhoeal
issue is timely. The paper has clearly and objectively demonstrated how
costly diarrhoeal illnesses are for the poor in urban slums. Diarrhoeal
illnesses just like any other illness slows down development pace of a
community either through people becoming sick or taking care of the sick
thus rendering one unable to work or be productive, this in turn tri...
I would like to commend the authors of this work for the diarrhoeal
issue is timely. The paper has clearly and objectively demonstrated how
costly diarrhoeal illnesses are for the poor in urban slums. Diarrhoeal
illnesses just like any other illness slows down development pace of a
community either through people becoming sick or taking care of the sick
thus rendering one unable to work or be productive, this in turn trickles
down or has a negative effect to the country's economic development.
According to this paper, 16.5% of the households lost some wages from
income earning employment due to diarrhea, either by being sick or taking
care of the sick.
This research also found out that poor infrastructure and living
conditions leads to diarrhoeal illnesses as much as hand hygiene is
observed with 86% of households washing their hands before eating and 90%
washing their hands after defecating.
If all the lost wages were to be put together, they can actually be
utilized to improve infrastructure. Among the recommendations cited,
combined interventions would actually reduce diarrhoeal illnesses; these
include improved water supply and quality as well as improved sanitation
and hygiene.
However, a few issues could be considered in the data collection
process and final paper. The fact that the study utilized locally
available community based researchers this enhanced participation of the
community. The only limitation would be that the enumerators being locals
of the study site may influence the outcome of the study, either by
biasness or wanting the outcome to follow a certain direction or pattern.
It is also commendable that a team member would accompany the enumerators
to oversee the whole process but then again, we recognize the enumerator
used the local language which the accompanying team member may not have
understood. The study team would have actually conducted a validation of
the findings by selecting a percentage of the households interviewed to
ensure that the data they collected was reliable.
An additional recommendation that can also be included in the paper was to
have awareness creation through capacity building of the affected
population on diarrhoeal causes, short and long term effects, prevention
and possibly first aid treatment at home. This would go a long way in
reducing the diarrhoeal illness incidences as well as reducing the cost
associated. The community can also partner with service providers, the
political leaders including all other stakeholders and together find a
solution to infrastructure improvement.
Thank you very much for your interest in our paper, and for the
interesting comments.
I'd appreciate learning more about the situation of clinical trials in
France. Please, email your reply to me at
giuseppe.ambrosio@ospedale.perugia.it
The editor,
Thank you for the paper titled 'Seroprevalence of syphilis among HIV-
infected individuals in Addis Ababa, Ethiopia: a hospital-based cross-
sectional study'
I agree with the finding from this study which shows that there is
relationship between HIV infection and syphilis transmission. One reason
could be that a person who has HIV infection has lowered body immunity
and is likely to have develo...
The editor,
Thank you for the paper titled 'Seroprevalence of syphilis among HIV-
infected individuals in Addis Ababa, Ethiopia: a hospital-based cross-
sectional study'
I agree with the finding from this study which shows that there is
relationship between HIV infection and syphilis transmission. One reason
could be that a person who has HIV infection has lowered body immunity
and is likely to have developed wounds in their genital tracks that
increase their chances of acquiring syphilis infection transmission
during unprotected sexual intercourse. However I am a bit concerned that
there was no difference in syphilis infection among those who were on
Antetroviral Therapy (ART) compared to the those ART naive. A recent study
by Centers for Diseases Control and Prevention (CDC), a multisite clinical
trial in Africa and other continents among HIV discordant couples - HIV
Prevention Trial Network (HPTN 052) revealed that individuals in HIV
discordant sexual relationships had more than 95% reduced chances of HIV
transmission to their negative partners if the HIV positive partner is on
ART compared to couples where the HIV positive partner was not on ART. It
also found out that there was reduction in tuberculosis incidence among
HIV positive participants on ART. Even though this syphilis study looks
different, there could be some comparisons that could be made with the
findings from the HPTN 052 discordant study. Studies have shown that
taking ARVs by HIV positive individuals is positively associated with
improved quality of life including improved body immunity which
eventually reduces co-infections including Sexually Transmitted
Infections such as syphilis.
The Editor It is indeed a research which needs to be widely circulated as the biological science and ancient teachings of mindfulness are on the same path of helping /alleviating human sufferings. The Indian ancient book Bhagvad Gita ; the great teaching of Krishna to Arjuna in chapter II verse 60 talks about how the turbulent senses attack the mind and lead it astray . The great wisdom of 'work must be done w...
Sir, we read with interest the recent response to our study of delirium point prevalence from Zieschang and colleagues, Heidelberg, Germany[1]. Zieschang et al have described a delirium prevalence of 15.6% in their study population of older hyponatraemic patients and normonatraemic controls admitted to a step-down facility, and note that our hospital-wide point prevalence was higher at almost 20%[2].
Although,...
In their August 1, 2013 reply letter, the authors characterize as a misunderstanding the conclusion of a 2012 meta-analysis (1) -- using many of the same databases and with one of the same co-authors as the instant study -- that only non-routine bed-sharing is associated with an increased risk of SIDS. In this way they dismiss a critical limitation of their own study, one which calls fundamentally into question the soundn...
Editor, The meta-analysis conducted by Yamada et al (2013) has established the association between baldness and coronary heart disease (CHD). The authors have concluded that vertex baldness among young men is closely related to atherosclerosis. Another factor that deserves mention in this context is smoking. We have many a times come across patients with severe arterial disease who have baldness and gray hair and on histo...
Thank you for this work which is very helpful for clinical trials site selection. We would like to inform about a work done in France on Clinical Research Attractiveness since 2002, and published early 2013 in Therapie Journal (Therapie 2013 Janvier-Fevrier;68 (1):1-18). A new Survey is on-going and the results will be available at the end of 2014 and then published. The abstract of the last publication is: Since 2002, th...
While I am pleased with the general research, its significance and findings in part, it is my humble concern that there may have been a systematic error in the sampling design. The researchers set out to measure both attitude towards and compliance with the smoking ban. In measuring attitudes, the researcher correctly identifies the school students as the population and randomly picks classes on which the instrument is...
I congratulate the authors for their cost-effectiveness analysis. Nevertheless, I believe that their work will need at least three clarifications. Compared to LNG the UPA's superiority in efficacy reaches statistical significance only after a process of adjustment of data. Raw data does not indicate statistically significant superiority of UPA for any temporal interval of administration (1). I think the authors should have...
I would like to commend the authors of this work for the diarrhoeal issue is timely. The paper has clearly and objectively demonstrated how costly diarrhoeal illnesses are for the poor in urban slums. Diarrhoeal illnesses just like any other illness slows down development pace of a community either through people becoming sick or taking care of the sick thus rendering one unable to work or be productive, this in turn tri...
Dear Dr Silbenair,
Thank you very much for your interest in our paper, and for the interesting comments. I'd appreciate learning more about the situation of clinical trials in France. Please, email your reply to me at giuseppe.ambrosio@ospedale.perugia.it
Thank you
Conflict of Interest:
None declared
The editor, Thank you for the paper titled 'Seroprevalence of syphilis among HIV- infected individuals in Addis Ababa, Ethiopia: a hospital-based cross- sectional study'
I agree with the finding from this study which shows that there is relationship between HIV infection and syphilis transmission. One reason could be that a person who has HIV infection has lowered body immunity and is likely to have develo...
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