The abstract of the article entitled ' Hazardous alcohol consumption
among university students in Ireland: a cross-sectional study' reads "The
aim of this study is to investigate the prevalence and correlates of
hazardous alcohol consumption (HAC) among university students with
particular reference to gender and to compare different modes of data
collection in this population." in the abstract....
The abstract of the article entitled ' Hazardous alcohol consumption
among university students in Ireland: a cross-sectional study' reads "The
aim of this study is to investigate the prevalence and correlates of
hazardous alcohol consumption (HAC) among university students with
particular reference to gender and to compare different modes of data
collection in this population." in the abstract.
It should read "The aim of this study is to investigate the
prevalence of hazardous alcohol consumption (HAC) and the adverse
consequences associated with its use among university students in Ireland,
with particular reference to gender differences".
This was overseen when returning reviewer comments for previous
versions of the article.
Sir, complements for publishing the study by Robyn Kalan and
colleague, on usage of cell phone and messaging system in the usage. We
have conducted a study - Resident doctors and Smart Phone - How smart
they are.
How friendly Indian residents in Smart phone usage in day to day scenario
and decision making in hospital settings. One has to stop thinking of the
smart pho...
Sir, complements for publishing the study by Robyn Kalan and
colleague, on usage of cell phone and messaging system in the usage. We
have conducted a study - Resident doctors and Smart Phone - How smart
they are.
How friendly Indian residents in Smart phone usage in day to day scenario
and decision making in hospital settings. One has to stop thinking of the
smart phones as a phone, when dealing with its place in Internet Medicine/
emergency medicine in particular. One should give smart phone a credit
of a powerful mini-computer, with a state-of-the-art photo equipment.
Which can collect data as photograph of X- Rays, CT , and transfer the
data immediately to superiors, experts. And take the opinion of the
consultant who is sitting far .This is specially true for the countries
where the doctors , experts , patient ratio is not favorable. ( Taking
example of developing countries). Also conventional radiology have a very
limited role to play, being mainly restricted to chest x-rays and bedside
radiography ,USG facilities will double and CT scan and MRI will continue
to grow in an exponential way, with more and more indications being
included. (1) Thus increasing point of care investigation facility .Use
of point of care ultrasound in the MICU, in the hands of ultrasound
trained physicians, can reduce cost by reducing the number of chest x rays
and ct scans.(2) Same with the help of a smart phone can be transferred
immediately to superiors to get there opinion . One should be very careful
till the scientific community comes out with a clear-cut guidelines
keeping medico legal issues in such opinion. How ever as a first baby-
step to wards the use of this modality inour opinion has a promising
future. Keeping the above fact in mind we surveyed 500 plus doctors on
telephonic survey in a month and following promising pattern has emerged
.
Salient features
1. Number of Patients benefitted and photograph taken for sharing 491 out
of 502( 97.81 % ).
2. Common website used were e medicine, and medscape , 40(23.95%)and
127 (76.05%) respectively ,
3. We inferred that ,in the contemporary world, when doctors are
busy in learning new things through various means, the latest method of
learning and seeking advice from collegues/Seniors is using smart phone
and its applications.
4. Smart phones are gift to humanity in view of its current usages by
doctors for patient care and usage of their application for immediate
decision on the further management. The SPSR(Smart phone smart Residents)
study is retrospective study on the usage of smart phone and its
application for patient care and benefit.
5. In emergency hours, the crucial decision for patients disease
management is an important aspect which can be asked or shared with
seniors / taking help from authentic websites for expert opinion within
few minutes. This has made Residents life easier in terms of patient
management, as rarely patient presents with classical manifestation of a
disease.
We concluded that modernization and globalization has brought lot of
changes to medical world with the introduction of Telemedicine, a newly
emerging branch which would continue to benefit in patients care.
Smart phones when used smartly gives valuable scientific input in patient
care ,but one should be very alert in using the same.
References
1.Govindji R. Jankharia Commentary - Radiology in India: The Next Decade.
Indian J Radiol Imaging. 2008 August; 18(3): 189-191.
2 Margarita Oks, MD; Rubin Cohen, MD; Seth Koenig, MD; Mangala
Narasimhan, DO. The Use of Point of Care Ultrasound in the Medical
Intensive Care Unit Reduces Healthcare Cost and Patient Radiation Exposure
. Chest. 2013;144(4_MeetingAbstracts):542A
JohnLloyd (Immediate Past President, Institute of Health Promotion and Education)
23 November, 2015
Tanton et al conclude that over the past 20years, young people have
increasingly identified school lessons as their main source of information
about sex.(1) This is surprising given that the quality and access to sex
and relationships education(SRE) continues to give cause for concern.(2)
Recent evidence from inspectors found that SRE required improvement in
over a third of schools, and that some young people were being l...
Tanton et al conclude that over the past 20years, young people have
increasingly identified school lessons as their main source of information
about sex.(1) This is surprising given that the quality and access to sex
and relationships education(SRE) continues to give cause for concern.(2)
Recent evidence from inspectors found that SRE required improvement in
over a third of schools, and that some young people were being left
unprepared for the physical and emotional changes they were going to
experience.(2)
The findings from the national surveys support the need for improved
SRE in schools alongside greater involvement of parents and health
professionals.(1) Some of these important issues were also highlighted in
the chief medical officer's report "Our Children Deserve Better:
Prevention Pays".(3) Dame Sally Davies recommended that there needs to an
improvement in personal, social and health education (PSHE) and especially
sex education.(3)
The recently published Education Committee Report Life Lessons: PSHE
and SRE in Schools states that PSHE and SRE should be given statutory
status.(4) We fully endorse Graham Stuart, Chair of Education Committee,
who states that: "There is an overwhelming demand for statutory sex and
relationships education - from teachers, parents and young people
themselves. It's important that school leaders and governors take PSHE
seriously and improve their provision by investing in training for
teachers and putting PSHE lessons on the school timetable. Statutory
status will help ensure all of this happens." (4)
The Government has just announced that there will be new guidance on
an element of PSHE: materials on "consent" will be issued later this
year.(5) Although this small step is welcome, we feel strongly that this
is insufficient. Without statutory change, topics like consent will
continue to be taught in some places by untrained teachers and in many
schools squeezed from the timetable.
Until SRE is made a universal entitlement for all young people in
schools no matter how they are funded or organised, SRE will continue to
be poorly taught and accessible only to a fortunate minority. We believe
that children and young people deserve properly planned systematic SRE
taught by well trained, confident and competent teachers with appropriate
support from health professionals.
References
1) Tanton C, Jones KG, Macdowall W, et al. Patterns and trends in sources
of information about sex among young people in Britain: evidence from
three National Surveys of Sexual Attitudes and Lifestyles. BMJ Open
2015;5:e007834.
2) Ofsted. Not yet good enough: personal, social, health and economic
education in schools. 1 May 2013.
3) Department of Health. Annual Report of the Chief Medical Officer,
2012, Our Children Deserve Better: Prevention Pays. London: Department of
Health 2013.
4) Life Lessons: PSHE and SRE in Schools. Report of the Education
Select Committee 17th February 2015.
http://www.parliament.uk/business/committees/committees-a-z/commons-
select/education-committee/news/pshe-sre-report/
5) Woolf M. Rape classes for 11 year olds. Times on Sunday, page 16:
8th March 2015.
http://www.thesundaytimes.co.uk/sto/news/uk_news/Crime/article1528386.ece
Frederiksen et al conclude in their very interesting meta-analysis on
the efficacy of psychosocial interventions in infertile women and men that
psychosocial interventions for couples in treatment for infertility could
be efficacious in improving clinical pregnancy rates (1). As presented in
figure 2 of their paper, the mean risk ratio of all ten studies analysed
is 2,006 for pregnancy rates in favour of the psychosocial i...
Frederiksen et al conclude in their very interesting meta-analysis on
the efficacy of psychosocial interventions in infertile women and men that
psychosocial interventions for couples in treatment for infertility could
be efficacious in improving clinical pregnancy rates (1). As presented in
figure 2 of their paper, the mean risk ratio of all ten studies analysed
is 2,006 for pregnancy rates in favour of the psychosocial intervention
groups. Two of these studies (labelled "Domar 2000" and "Sarrel 1985" in
figure 2) appear to be outliers with risk ratios about 6 or more. In the
study of Domar et al (2), 26 pregnancies resulted in the cognitive-
behavioural intervention group (with 47 participants), 26 pregnancies in
the support group (with 48 participants), and 5 pregnancies in the control
group (with 25 participants). This gives a risk ratio of 2,766 for the
first intervention group and of 2,7083 for the second intervention group
(both compared to the control group). The combined risk ratio for the two
intervention groups is therefore 2,736. The same score was computed in the
meta-analysis of Haemmerli and colleagues (3). In the study of Sarrel
& DeCherney (4), six pregnancies were reported for the psychosocial
intervention group (with 10 participating couples), and one pregnancy in a
group of nine couples without a psychosocial intervention. This gives a
risk ratio of 5,400, which is also the score reported in the paper of
Haemmerli et al. The number of participants in the study of Sarrel &
DeCherney is therefore 38 and not 140 as indicated in figure 2 in (1). In
my opinion, the mean risk ratio for pregnancy rates in infertile couples
after psychosocial interventions is clearly overestimated in this meta-
analysis of Frederiksen et al. There are still insufficient systematic
studies indicating a rise in pregnancy rates following psychological
interventions (5).
1. Frederiksen Y, Farver-Vestergaard I, Skovgard NG, Ingerslev HJ,
& Zachariae R. (2015). Efficacy of psychosocial interventions for
psychological and pregnancy outcomes in infertile women and men: a
systematic review and meta-analysis. BMJ Open, 5(1) E-Pub.
2. Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, & Freizinger
M. (2000). Impact of group psychological interventions on pregnancy rates
in infertile women. Fertil Steril, 73(4), 805-811.
3. Haemmerli K, Znoj H, & Barth J. (2009). The efficacy of
psychological interventions for infertile patients: a meta-analysis
examining mental health and pregnancy rate. Hum Reprod Update, 15, 279-
295.
4. Sarrel PM, & DeCherney AH. (1985). Psychotherapeutic
intervention for treatment of couples with secondary infertility. Fertil
Steril, 43, 897-900.
5. Wischmann T. (2008). Implications of psychosocial support in
infertility - a critical appraisal. J Psychosom Obstet Gynecol, 29(2), 83-
90.
I have specific interest in this article, as my cancer was
misdiagnosed by ten to fifteen doctors, across three counties, over a
great number of years.
The backlog of complaints I made to The Department of Health (and
later many other health bodies), were either unanswered or answered
grossly inappropriately.
Instead of this complaint being used as the wake-up call it ought to
have been, it's (inc...
I have specific interest in this article, as my cancer was
misdiagnosed by ten to fifteen doctors, across three counties, over a
great number of years.
The backlog of complaints I made to The Department of Health (and
later many other health bodies), were either unanswered or answered
grossly inappropriately.
Instead of this complaint being used as the wake-up call it ought to
have been, it's (incontrovertible) contents have been rigorously kept
under wraps. This has resulted in on-going widespread hardship,
excruciating suffering,and loss on many all levels of life.
It highlights one of the most serious miscarriages of justice, on
the health front, in modern times, being meted out to a vast number of
physically ill people.
Therefore doctors across the board, need to take responsibility for
the catastrophic errors they are carrying out, even today, on a daily
basis.
To the Editor:
With great interest I read the paper by Miedema et al. entitled "Can
certified health professionals treat obesity in a community-based
programme? A quasi-experimental study" published in the BMJ Open 2015.
Authors identified that lifestyle interventions administered by trained
certified professionals improve health outcomes in obese participants. To
show the effectiveness of their programs, authors present...
To the Editor:
With great interest I read the paper by Miedema et al. entitled "Can
certified health professionals treat obesity in a community-based
programme? A quasi-experimental study" published in the BMJ Open 2015.
Authors identified that lifestyle interventions administered by trained
certified professionals improve health outcomes in obese participants. To
show the effectiveness of their programs, authors presented positive
results in heart rate, blood pressure, body mass index, waist
circumference and mental health among the participants who adhered to the
interventions. Their results further validate similar findings from
previous studies that diet and exercise are two major contributors to
better health and weight loss in obese patients. However, one of the key
aspects of this type of lifestyle intervention programs is the motivation
which has not been discussed in this paper. Similar to this study, review
of existing literature shows that in lifestyle intervention programs
including exercise and diet have had a high rate of attrition [1].
Therefore, individuals' motivation is the key to the success of this type
of intervention programs [2, 3]. Among the two types of motivation--
namely, autonomous and controlled-- to adhere to the intervention
programs, the former one is preferred because it is chosen by and
emanating from one's self, while the later one is experienced when they
pressured or forced by others [3]. Individuals tend to more competent when
they are autonomously motivated to endorse themselves to the intervention
programs and develop a strong willingness to do them. Previous studies
also show that individuals who perceive the health care providers more
autonomy supportive tend to maintain long-term intervention programs, and
autonomous supportiveness played a key role in the success of programs for
smoking cessation and adapting positive coping strategies for better
management of chronic diseases such as diabetes and overweight [4-6].
Therefore, the effectiveness of these non-pharmaceutical intervention
programs would be better evaluated if the autonomous motivation is also
examined.
References
1. Volkmar FR, Stunkard AJ, Woolston J and Bailey RA. High attrition
rates in commercial weight reduction programs. Arch Intern Med
1981;141(4): 426-428.
2. Andersson I, Rossner S. Weight development, drop-out pattern and
changes in obesity-related risk factors after two years treatment of obese
men. International Journal of Obesity & Related Metabolic Disorders
1997; 21:211-216.
3. Lantz H, Peltonen M, Agren L, & Torgerson JS. A dietary and
behavioural programme for the treatment of obesity. A 4-year clinical
trial and a long-term post-treatment follow-up. Journal of Internal
Medicine 2003; 254: 272-279.
4. Williams GC, Grow, VM, Freedman ZR, et al. Motivational
predictors of weight loss and weight-loss maintenance. Journal Personality
and Social Psychology 1996; 70:115-126.
5. Williams GC, Cox EM, Kouides R, & Deci EL. Presenting the
facts about smoking to adolescents: The effects of an autonomy supportive
style. Archives of Pediatrics and Adolescent Medicine 1999; 153:959-964.
6. Williams GC, Freedman ZR, & Deci EL. Supporting autonomy to
motivate glucose control in patients with diabetes. Diabetes Care 1998;
21:1644-1651.
The rapid acceleration of obesity rates worldwide and its
contribution as a major risk factor for many chronic and resource-heavy
diseases make it paramount for public health and health care research to
explore effective ways to manage it. Miedema et al. appropriately
utilized a quasi-experimental design to investigate the effectiveness of a
community-based exercise and education programme to tre...
The rapid acceleration of obesity rates worldwide and its
contribution as a major risk factor for many chronic and resource-heavy
diseases make it paramount for public health and health care research to
explore effective ways to manage it. Miedema et al. appropriately
utilized a quasi-experimental design to investigate the effectiveness of a
community-based exercise and education programme to treat people who are
obese in New Brunswick, Canada. (1) The authors acknowledged that the
multidimensional factors contributing to the development of obesity
require multidimensional treatment strategies to manage it. (1) The
described intervention was certainly appropriate based on current
literature, particularly the inclusion of group-mediated cognitive-
behavioural intervention (GMCBI). (1)
One of the study's stated hypotheses was "the intervention programme
and the GMCBI would improve the health and well-being of the
participants". (1) To assess the effectiveness of the multidisciplinary
programme, the authors chose the outcomes of blood pressure, resting heart
rate, weight and height (BMI), waist circumference and the mental health
scale of the SF-36v2 Health Survey. (1) They reported that they also
assessed other outcomes "related to physiological abilities, nutrition
knowledge and behaviour" which were not reported in the present paper.
(1) The programme was designed to assist people who are obese make the
behavioural changes necessary to positively manage their health and well-
being. Such multimodal approaches are similarly used in chronic disease
management (2) and chronic pain management (3) and are shown to be the
most effective in the long term.
Despite delivering an intervention that sought to change health
behaviour and improve overall wellness of people with obesity, the authors
chose to include outcomes that measure biomedical and psychological
constructs. These are insufficient to capture global latent variables as
complex as "health" or "well-being". The World Health Organization
defines health as "a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity." (4) The
ultimate goal of obesity management is not only weight loss, reduction in
blood pressure, and lower degrees of depression; it is also empowerment
through self-efficacy, control over health and life, and satisfaction in
social life. These all lead to overall increased quality of life. To
truly demonstrate that their programme made a lasting positive difference
in the participants' overall health, the study team should include
measures for overall function, quality of life, behavioural change, and
self-efficacy. Tackling a health issue as prevalent and complex as obesity
requires a population health approach; interventions and their evaluation
should reflect this.
Bibliography
1. Miedema, B, et al., et al. Can certified health professionals treat
obesity in a community-based programme? A quasi-experiemental study. BMJ
Open. [Online] 02 2015. http://bmjopen.bmj.com.qe2a-
proxy.mun.ca/content/5/2/e006650.long.
2. National standards for diabetes self-management education and support.
Haas, L, et al., et al. 2013, Diabetes Care, pp. S100-S108.
3. Interdisciplinary Chronic Pain Management: Past, Present, and Future.
Gatchel, Robert J, et al., et al. 2014, American Psychologist, pp. 119-
130.
4. World Health Organization. WHO definition. World Health Organization
Definition. [Online] 1948. www.who.int/about/definition/en/print.html.
It would have been better if the article titled 'What has happened to
suicides during the Greek economic crisis?' had been titled 'Suicide rate
increases in Greece during economic crisis'. BMJ Open is a scientific
journal not a collection of mystery stories.
Dimitrios Anyfantakis 1, Adelais Markaki 2, Emmanouil K Symvoulakis 3
1 Primary Health Care Centre of Kissamos, Chania, Crete, Greece
2 Department of Social Medicine, Faculty of Medicine, University of Crete,
Heraklion, Greece.
3 Private Family Practice Unit in Heraklion, Crete, Greece.
The study performed by Rachiotis et al. [1] reporting on the impact
of financial crisis on suicide rates in Greece was b...
Dimitrios Anyfantakis 1, Adelais Markaki 2, Emmanouil K Symvoulakis 3
1 Primary Health Care Centre of Kissamos, Chania, Crete, Greece
2 Department of Social Medicine, Faculty of Medicine, University of Crete,
Heraklion, Greece.
3 Private Family Practice Unit in Heraklion, Crete, Greece.
The study performed by Rachiotis et al. [1] reporting on the impact
of financial crisis on suicide rates in Greece was both timely and
intriguing. The researchers reported a significant increase of 35% of the
mean suicide rate between 2010 and 2012. Remarkably, an increase of
suicide mortality rates from 5.75 (2003-2010) to 7.43/100 000 (2011-2012;
p<0.01) was recorded among males [1]. A significant positive
association was also reported between rise in suicide rate and
unemployment in the group of working-age males [1]. The authors concluded
that austerity measures in Greece contributed significantly to the
increased suicide mortality [1].
In alignment with the above findings, previous research suggested a
positive association between austerity and rise of suicide rate (17% from
2007 to 2009) as well as adverse effects in various health indicators [2].
Remarkably, a reduction of blood and organ donor supply has also been
reported as a side-effect of the severe financial and humanitarian
constraints placed on the country's national health system [3].
However, despite growing debate on austerity's negative effects on
health [4], governmental and international agencies have been slow to
acknowledge this issue. In the past, some of the country's figures on
suicides, attempted suicides, use of antidepressants and need for mental
health services were met with skepticism, questioning earlier conclusions
on the health consequences of the Greek crisis [5].
The findings by Rachiotis et al.[1] underscore the impact of the
Greek financial crisis on health indicators and death by providing the
latest pragmatic data. Report of a 35% increase on the incidence of a
deadly outcome within a three-year period is reason for not just domestic
but global concern.
References
1. Rachiotis G, Stuckler D, McKee M, Hadjichristodoulou C. What has
happened to suicides during the Greek economic crisis? Findings from an
ecological study of suicides and their determinants (2003-2012). BMJ Open.
2015 Mar 25;5(3):e007295.
2. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler
D. Health effects of financial crisis: omens of a Greek tragedy. Lancet.
2011 Oct 22;378(9801):1457-8.
3. Symvoulakis EK, Markaki A, Morgan M, Jones R. Organ donation during
economic hardship: an untold end for Prometheus? BMJ 2011; 342:d982
http://www.bmj.com/content/342/bmj.d982/rapid-responses
4. Kentikelenis A, Karanikolos M, Reeves A, McKee M, Stuckler D. Greece's
health crisis: from austerity to denialism. Lancet. 2014 Feb
22;383(9918):748-53.
5. Liaropoulos L. Greek economic crisis: not a tragedy for health. BMJ.
2012 Nov 27;345:e7988.
Dear Editor,
The abstract of the article entitled ' Hazardous alcohol consumption among university students in Ireland: a cross-sectional study' reads "The aim of this study is to investigate the prevalence and correlates of hazardous alcohol consumption (HAC) among university students with particular reference to gender and to compare different modes of data collection in this population." in the abstract....
The Editor, British Medical Journal,
Sir, complements for publishing the study by Robyn Kalan and colleague, on usage of cell phone and messaging system in the usage. We have conducted a study - Resident doctors and Smart Phone - How smart they are. How friendly Indian residents in Smart phone usage in day to day scenario and decision making in hospital settings. One has to stop thinking of the smart pho...
Tanton et al conclude that over the past 20years, young people have increasingly identified school lessons as their main source of information about sex.(1) This is surprising given that the quality and access to sex and relationships education(SRE) continues to give cause for concern.(2) Recent evidence from inspectors found that SRE required improvement in over a third of schools, and that some young people were being l...
Frederiksen et al conclude in their very interesting meta-analysis on the efficacy of psychosocial interventions in infertile women and men that psychosocial interventions for couples in treatment for infertility could be efficacious in improving clinical pregnancy rates (1). As presented in figure 2 of their paper, the mean risk ratio of all ten studies analysed is 2,006 for pregnancy rates in favour of the psychosocial i...
I have specific interest in this article, as my cancer was misdiagnosed by ten to fifteen doctors, across three counties, over a great number of years.
The backlog of complaints I made to The Department of Health (and later many other health bodies), were either unanswered or answered grossly inappropriately.
Instead of this complaint being used as the wake-up call it ought to have been, it's (inc...
To the Editor: With great interest I read the paper by Miedema et al. entitled "Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study" published in the BMJ Open 2015. Authors identified that lifestyle interventions administered by trained certified professionals improve health outcomes in obese participants. To show the effectiveness of their programs, authors present...
To the Editor:
The rapid acceleration of obesity rates worldwide and its contribution as a major risk factor for many chronic and resource-heavy diseases make it paramount for public health and health care research to explore effective ways to manage it. Miedema et al. appropriately utilized a quasi-experimental design to investigate the effectiveness of a community-based exercise and education programme to tre...
It would have been better if the article titled 'What has happened to suicides during the Greek economic crisis?' had been titled 'Suicide rate increases in Greece during economic crisis'. BMJ Open is a scientific journal not a collection of mystery stories.
Conflict of Interest:
None declared
This study has been comprehensively refuted, with fatal errors found that invalidate the conclusion:
http://rhrealitycheck.org/article/2015/03/25/false-witnesses-publish-deeply-flawed-study-abortion-mortality-mexico/
Conflict of Interest:
None declared
Dimitrios Anyfantakis 1, Adelais Markaki 2, Emmanouil K Symvoulakis 3
1 Primary Health Care Centre of Kissamos, Chania, Crete, Greece 2 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece. 3 Private Family Practice Unit in Heraklion, Crete, Greece.
The study performed by Rachiotis et al. [1] reporting on the impact of financial crisis on suicide rates in Greece was b...
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