Tamara Tuuminen has raised concerns that the members of the research team could have had conflicting interests by their affiliations. We did not regard any affiliation to cause conflicts of interest regarding this protocol article. One member of the research group (AV) works part-time as a medical expert in Social Insurance Institute of Finland (KELA) and OP Insurance Ltd, and another (KK) in Varma Mutual Pension Insurance Company. None of these institutions profits financially or non-financially from studying and publishing the methods and results of this intervention study. Moreover, as mentioned in the manuscript, neither the authors' institutions nor the funders have any authority over trial activities or preparing of the manuscript.
By submitting a protocol paper, our intention was to make our work as transparent as possible. Indoor air associated chronic, non-specific symptoms are perpetuated and exacerbated by various factors. The RCT intervention study compares treatments to reduce symptoms and improve quality of life, regardless of the mechanisms behind the symptoms.
There is a lack of effective treatments for chronic environment-related symptoms with disability. Thus, our study represents one of the few RCT protocols for these patients. The intention of all stakeholders in Finland is to prevent and reduce disability.
I have read with great interest this paper about retractions in journals of publisher BioMed Central (Moylan & Kowalczuk 2016). I noted an issue with the competing interests statement of the first author. I have contacted you for a copy of her ICMJE disclosure form. You responded with an invitation to submit an eletter. I present in this eletter: (i) a review of the paper, (ii) backgrounds about the...
I have read with great interest this paper about retractions in journals of publisher BioMed Central (Moylan & Kowalczuk 2016). I noted an issue with the competing interests statement of the first author. I have contacted you for a copy of her ICMJE disclosure form. You responded with an invitation to submit an eletter. I present in this eletter: (i) a review of the paper, (ii) backgrounds about the issue with the competing interests statement.
1.1 Introductory comments.
The paper documents 134 retractions published in the period 1 January
2000 - 31 December 2015 (the study period). The paper is easy to read and
to understand. The attached peer review history provides valuable
backgrounds and lists details which I was unable to find in the paper.
This attachment is towards my opinion not part of the paper. The details
in supplementary file 1 show that information about retractions from
outside the field of medical research is included. This is not mentioned
in the text. It is not listed in section 9 in supplementary file 2 that
bias is introduced because only one reason is reported for retractions
with multiple reasons for the retraction. This section 9 lists no details
on bias (in the number of retractions) caused by legal actions, for
example to prevent retractions (Elia et al. 2014). McCook (2016) reports
about a retraction in September 2016 in a BioMed Central journal of an
author who took such legal actions.
The main aim of the paper is 'to determine how transparent notices
were in terms of reason for retraction and information provided, and if
they complied with the COPE guidelines'. This was mostly the case. A
single event took place in the first half of 2015. This event refers to
the retraction of 43 papers (32%) with organized attempts to manipulate
the peer review process. This event limits at the moment a solid analysis
of trends (in the course of the years). An (irregular) occurrence of
events might well be a natural phenomenon, comparable to for example
strong effects of a severe winter on the annual mortality of the
Oystercatcher Haematopus ostralegus (Camphuysen et al. 1996).
The authors have used the search engine of the publisher, with 'the
search term "retraction" within the article title', to locate the
retractions. Using this search engine on 21 December 2016 revealed a note
with a doi which is not listed in supplementary file 1 (Anonymous 2012a).
The note contains two words ('abstract withdrawn'). The pdf version states
that it was published in a different journal (Anonymous 2012b). The note
refers to abstract 15, one of the 26 abstracts of lecture presentations at
a conference. The concatenated pdf (Zheng et al 2012) lists that only
abstract 15 was published in Scoliosis. Moylan & Kowalczuk (2016)
don't mention a definition for the term retraction. It is therefore unsure
if this note falls within their definition.
1.2 Remarks about the retraction policy.
The authors state: 'all BioMed Central journals have an overarching
retraction policy to retract articles where necessary so as to maintain
the integrity of the published literature'. That's almost all what I was
able to find about the retraction policy of the publisher and/or of its
journals. The authors mention several recommendations and proposals for
improvement. The paper provides not much insight how many of them are
already implemented. A timetable when all will be implemented is
appreciated.
The authors state in a response to reviewer 2: 'it has been BioMed
Central policy to publish all retraction notices as a separate retraction
article type, so they all start with "Retraction: xxxx".' Ten retraction
notes in BioMed Central journals are listed in their references, three
(20, 21, 22) don't have the term 'retraction' in the title listed in these
references. The title of the html version of three of these ten (20, 22,
25) starts with 'Erratum' and does not list the word retraction.The
authors state in the methods: 'All notices were classified using the
information given in the retraction notice alone (ie, no additional
information was used)'. A response to reviewer 2 indicates that additional
information was used.
The paper does not contain information about the membership of COPE
of the publisher and/or of one or more of its journals. A response to
reviewer 3 reveals that the publisher is member of COPE. This information
is also listed at the website of the publisher (
https://www.biomedcentral.com/about/standards-and-affiliations ). This url
provides no details about the date when the publisher joined COPE and
about the membership of COPE of one or more of its journals. A search at
http://publicationethics.org/category/publisher/biomed-central yields a
list of 334 BioMed Central journals which are member of COPE. The
publisher lists at https://www.biomedcentral.com/journals-a-z that they
publish 307 journals. The data on the number of journals were downloaded
on 17 December 2016. I propose that the authors sort out the
discrepancies. I propose that it is clearly state at a central entry of
the website which journals are member of COPE.
1.3 Not all raw research data are accessible.
The authors list that in total 190,514 articles were published in the
study period. I assume that this total includes articles from outside the
field of medical research. Figure 1 does not present the number of
articles for the years 2000-2002. It is not explained why these data are
not presented. The raw data for the annual number of published articles
are not listed in the text, in a table or in a supplementary file. It is
not mentioned if they are deposited in a public repository. The data
sharing statement does not list details about the availability of these
raw data and/or where they are stored.
The paper contains no details about the date when the publisher was
founded and/or started with publishing. The authors state in a response to
a comment of reviewer 3: 'BioMed Central first started publishing in
1999/2000.' There are no details about what was published in the year
1999. Supplementary file 1 lists that the first retraction was published
on 3 March 2003. This information seems not in line with a quote in
supplementary file 2 ('examine all BioMed Central retraction notices since
retractions started being published at BioMed Central from 2000 onwards').
The authors state: 'four retraction notices were not included because they
were published by other publishers before the journal was transferred to
BioMed Central'. Details are lacking. I propose that the authors provide a
table with the annual number of articles for the years 1999-2015 and
references for the four retractions.
1.4 Citations of retraction notes.
The authors state that 'retraction notices are rarely if ever cited'
and suggest 'readers are unaware of the article's retraction' as
explanation. The references of their own paper list 10 of the 134
retractions. It is not explained why only 10 are mentioned. For example
Klauer & Singmann (2015) refer to both the paper and the retraction. A
lack of research papers about retractions with (almost) no retraction
notes in their list of references is a plausible explanation why there are
(as yet) almost no (formal) citations of the retraction notes. Elia et al.
(2014), a paper of reviewer 2, documents for example 79 retractions. Not a
single one is listed in the references, although the paper is published in
a journal without restrictions on length and size and on the amount of
references. I propose that future studies on retraction notes will list in
the references all retractions, including retractions which were excluded
(see 1.3).
1.5 Some minor remarks.
The pdf version has no hyperlink to the doi of eight references (12,
20, 21, 29, 37, 39, 42 and 43). The doi of ref 30 is broken, ref 43 was
published in July 2015. Ref 1 is published as article with a doi in
several journals, for example as Wager et al. (2009). It is unclear why
the authors refer to a website. The last page of the pdf of Moylan &
Kowalczuk (2016) states that 'this article cites 28 articles, 6 of which
you can access for free'. This seems to imply that this quote does not
refer to their definition of an article. There are towards my opinion 29
'articles' (ref 42 was likely not identified), only one (ref 15) was
behind a pay wall on 24 December 2016. All 28 others were free to access
on that day.
Both authors are long-term employees of BioMed Central (ECM since
2004, MKK since 2006). The paper does not list that both authors are
member (since how long?) of its Research Integrity Group (
https://www.biomedcentral.com/about/who-we-are/research-integrity-group ).
The paper does not provide insight if the authors were involved in
processing retractions and/or in preparing texts for the retraction notes.
A comment posted on 17 September 2014 in reference 11 might indicate that
this was the case for ECM. It is not disclosed that MKK is an EiC of the
BioMed Central journal Research Integrity and Peer Review (Wager 2015).
The review of reviewer 1 contains only two words. A response from the
authors to reviewer 3 reveals that reviewer 1 has reviewed earlier
versions. Details are lacking.
1.6 Concluding comments.
The paper is a well documented study of (almost?) all retractions of
one publisher. I therefore agree with the final recommendation of reviewer
3. My comments are aimed to improve future studies about retractions. The
availability of the raw data implies that bias caused by only one reason
reported for retraction notes with multiple reasons is easy to repair. The
lack of insight in the amount of legal pressure implies that it is at the
moment not possible to assess its influence on the results. I propose that
researchers have free and unlimited access to all confidential data after
a fixed period of time.
2. The ICMJE disclosure form.
The manuscript was received on 30 March 2016. A revised version was
received on 1 September 2016. The paper was accepted on 26 September 2016.
The part with the competing interests states: 'Both authors have completed
the ICMJE uniform disclosure form and declare we are employed by BioMed
Central. Since the manuscript has been revised ECM has been co-opted as a
COPE Council Member, but this study did not involve COPE. We declare no
other relationships or activities that could appear to have influenced the
submitted work.' This text is identical to the text in the version of 30
March 2016.
I am in the possession of a biography of Dr. Moylan at the website
of COPE which was downloaded on 2 February 2016. This biography shows that
Dr. Moylan was at that moment already member of the Council of COPE. A
conflict of interest statement dated 7 January 2016 is attached to this
biography. These details are not in line with the information in the
paper. The ICMJE form of Dr. Moylan is not attached to the paper. I have
therefore asked you on 28 November 2016 for a copy of this form. You told
me the next day to look into this case. You responded on 15 December 2016
with an invitation to submit an eletter. A form was not received.
5. Data sharing statement.
The data that support the findings are available from the author.
There are no restrictions for the re-use of these data by others. Email
klaas.vdijk@hetnet.nl
Camphuysen C, Ens B, Heg D, Hulscher J, van der Meer J, Smit C. 1996.
Oystercatcher winter mortality in The Netherlands: the effect of severe
weather and food supply. Ardea 84A:469-492.
Elia N, Wager E, Tramer M. 2014. Fate of articles that warranted
retraction due to ethical concerns. Plos One 9:e85846. doi:
10.1371/journal.pone.0085846
Klauer K, Singmann H. 2015. Does global and local vision have an
impact on creative and analytic thought? Plos One 10:e0132885. doi:
10.1371/journal.pone.0132885
McCook A. 2016. Researcher who sued to stop retractions earns his
8th. http://retractionwatch.com/2016/09/15/researcher-who-sued-to-stop-
retractions-earns-his-8th/ (accessed Dec 2016).
Moylan E, Kowalczuk M. 2016. A retrospective cross-sectional study of
retraction notices at BioMed Central. BMJ Open 6:e012047 doi:
10.1136/bmjopen-2016-012047
Wager E, Barbour V, Yentis S, Kleinert S. 2009. Retractions: guidance
from the Committee on Publication Ethics. Journal of Critical Care 24:620-
622. doi: 10.1016/j.jcrc.2009.10.009
Wager E. 2015. Why we need a journal on research integrity and peer
review. https://blogs.biomedcentral.com/bmcblog/2015/09/28/journal-
research-integrity-peer-review/ (accessed Dec 2016).
Zheng H, Vassar B, Stetler C. 2012. Proceedings of the 2011
International Conference on Molecular Neurodegeneration. Molecular
Neurodegeneration 7(S1).
Conflict of Interest:
The author was employed as regional officer by BirdLife The Netherlands (Vogelbescherming Nederland) in 1995-2004 and was afterwards at intervals employed by Altenburg & Wymenga ecological consultants. The author is closely co-operating with the authors of Porter et al. (2015a,b). Legal representatives of three different stakeholders have contacted the author in regard to his efforts to retract Al-Sheikhly et al. (2013). COPE is one of these stakeholders.
Please note that BMJ Open has received the above response from Dr Tuuminen. In line with the guidelines of the Committee On Publication Ethics (COPE), we are investigating the issues raised and will follow-up as deemed appropriate.
The reliability of results presented by any scientific paper as a
rule is looked through the prism of conflicting interests. Those should be
informed by each author of the group without exceptions. ICMJE set the
internationally In the recent paper published in this journal by
Selinheimo S et al. Comparing cognitive-behavioural psychotherapy and
psychoeducation for non-specific symptoms associated wi...
The reliability of results presented by any scientific paper as a
rule is looked through the prism of conflicting interests. Those should be
informed by each author of the group without exceptions. ICMJE set the
internationally In the recent paper published in this journal by
Selinheimo S et al. Comparing cognitive-behavioural psychotherapy and
psychoeducation for non-specific symptoms associated with indoor air: a
randomised control trial protocol. BMJ Open. 2016 Jun 6;6(6):e011003. doi:
10.1136/bmjopen-2015-011003. The conflicting interests of Vuokko A,
Karvala K and probably of others were not disclosed. How this can be
qualified?
accepted guidelines to disclose any possible conflict.
Finnish patients of Vuokko A. and Karvala K. as well as many medical
colleagues are aware of the fact that Vuokko A. and Karvala K. are part-
time doctors within insurance companies. Usually they do not disclose
their conflicts of interest when they publish papers in Finnish, when
detailed questionnaires regarding the conflicts of interest are not a
routine.
In their paper published in Neurotoxicology (1) the same authors did
not inform their part-time affiliations within insurance companies either.
Our letter to the Editor of Neurotoxicology did not help resolve the
biased attitude of this group when dealing with indoor air problems (2,3).
In Finland, indoor air problems especially in mold infested buildings
cause a lot of morbidity among working people, at schools and even
kindergartens. Poor indoor air causes a plethora of diseases that are by
no means are medically unexplained symptoms. The format of this
communication does not allow me to go through a lengthy discussion
concerning the mechanisms of health hazard in a moldy environment. Toxic
molds do cause somatic diseases in the first place, and psychological
reactivity is secondary to ill health, loss of social security, loss of
jobs, loss of property etc; and last but not least by psychologizing the
problem imposed by Finnish Institute of Occupation Health.
As a proverb says "whose bread you eat those song you sing". The
policy of insurance companies as well as of Social Insurance Institute of
Finland (KELA) that sponsored this research is to minimize compensations
due to loss of health acquired in moldy environments. Instead
psychologizing and cognitive -behavioral therapies are offered without
success (1). Again this group published a new report hiding their
intentions. The results serve the intentions of insurance companies.
In my opinion BMJ Open is a prestigious journal that has a commitment
towards honest reporting. I advocate the Editor to comment on this misuse
of trust.
Competing interests: None
References
1. Vuokko A, Selinheimo S, Sainio M, Suojalehto H, J?rnefelt H,
Virtanen M, Kallio E, Hublin C, Karvala K. Decreased work ability
associated to indoor air problems--An intervention (RCT) to promote health
behavior. Neurotoxicology 2015;49:59-67.
2. Tuuminen T, Haggqvist C, Uusitalo A. Cognitive therapy in sick
building syndrome: Myths, believes or evidence. Neurotoxicology 2016;53:29
-30.
3. Vuokko A, Selinheimo S, Sainio M, Suojalehto H, J?rnefelt H,
Virtanen M, Kallio E, Hublin C, Karvala K. Reply to Letter to the Editor:
Cognitive therapy in Sick Building Syndrome: Myths, beliefs or evidence.
2016;52:186-7.
So far as I can see, (and apologies if I have missed something) in common with many others, the authors have failed to include the effect on GDP and taxes and welfare payments of replacement of sick workers by healthy unemployed workers and new workers entering the labour market. Similarly, if unemployed workers take jobs from those with diabetes no longer able to work, then their unemployment benefits will end and there will be a saving in welfare payments to the economy. The tax paid by those now working will offset the tax lost from those ceasing work.
Overall, the level of GDP in developed countries is more likely to be determined by the levels of domestic demand, world trading conditions, currency exchange rates etc. than by the availability of a relatively small number of workers with diabetes, if their employment could be continued.
Welfare payments and taxes are also conventionally treated in economics as transfer payments which have no overall effect on goods and services. If anything, additional welfare payments may benefit the economy in the short run as poorer people on benefits have a higher propensity to spend than richer tax payers. It is usually not acceptable to add direct resource costs for treatment to transfer payments.
I suggest the authors look at this again and at least include the potential effects of worker replacement, given the current levels of unemployment in Australia. They should examine the literature on the friction c...
So far as I can see, (and apologies if I have missed something) in common with many others, the authors have failed to include the effect on GDP and taxes and welfare payments of replacement of sick workers by healthy unemployed workers and new workers entering the labour market. Similarly, if unemployed workers take jobs from those with diabetes no longer able to work, then their unemployment benefits will end and there will be a saving in welfare payments to the economy. The tax paid by those now working will offset the tax lost from those ceasing work.
Overall, the level of GDP in developed countries is more likely to be determined by the levels of domestic demand, world trading conditions, currency exchange rates etc. than by the availability of a relatively small number of workers with diabetes, if their employment could be continued.
Welfare payments and taxes are also conventionally treated in economics as transfer payments which have no overall effect on goods and services. If anything, additional welfare payments may benefit the economy in the short run as poorer people on benefits have a higher propensity to spend than richer tax payers. It is usually not acceptable to add direct resource costs for treatment to transfer payments.
I suggest the authors look at this again and at least include the potential effects of worker replacement, given the current levels of unemployment in Australia. They should examine the literature on the friction costs of worker replacement.
If it helps the reader to think about it, consider retirement at 65 or 70. The apparent loss of wages and lost taxes and additional benefits paid out could appear to be crippling the economy if we exclude the effects of replacement workers. Should we ban retirement in the name of economic growth? Not while we have unemployed workers in sufficient numbers and with the right skills (which we may not always have, of course, but which can be remedied by immigration in many developed countries).
In common with others, the authors show that diabetes has big direct and indirect costs. I doubt there is a health minister in any developed country who is not aware, or who soon finds out, that diabetes is a BIG problem. Generating estimates of just how big is not particularly useful in my view, particularly when they tend to exaggeration.
We read the study "Influence of alcohol use on mortality and
expenditure during hospital admission: a cross-sectional study" by Y et
al. with great interest and appreciate the authors' efforts. The authors
demonstrated that patients with alcohol intoxication incurred
significantly higher expenditure of hospitalization than those without,
even after adjusting for several confounders including sex, age, and
comorbidities....
We read the study "Influence of alcohol use on mortality and
expenditure during hospital admission: a cross-sectional study" by Y et
al. with great interest and appreciate the authors' efforts. The authors
demonstrated that patients with alcohol intoxication incurred
significantly higher expenditure of hospitalization than those without,
even after adjusting for several confounders including sex, age, and
comorbidities. Here, we would like to raise four points of concern.
First, the confounding factors adjusted for in the two main outcomes
were different. We suggest that performing sensitivity analysis using the
same factors in each of the two outcomes would be more informative. In
addition, it is our understanding that blood alcohol concentration (BAC)
affects GCS, AIS and ISS. Therefore, GCS, AIS, and ISS should be treated
as intermediate factors rather than confounding factors. Inappropriate
adjustment for confounders could have distorted the statistical analyses
and indicated a false-negative association between alcohol intoxication
and mortality.
Second, we are concerned about the use of insufficient covariates to
calculate propensity score. The authors indicated that "use of propensity
score matching in this assessment helped to attenuate the confounding
effects of various patient characteristics and associated injury severity
on hospital mortality and expenditure" in the text. However, Table 1
indicates that trauma mechanisms were markedly different in BAC (+) and
BAC (?) patients. Since insufficient matching of propensity score items
may have distorted the results and trauma mechanisms are important
confounding factors, we suggest that the authors add trauma mechanisms
into the propensity score matching items and re-analyze the data.
Third, it is not always the case that patients who do not receive an
alcohol test are not intoxicated. Therefore, these patients may have been
categorized incorrectly, leading to bias due to misclassification.
Therefore, we suggest that the authors state the number of BAC-unmeasured
patients in the non-intoxicated group. If possible, the authors should
perform sensitivity analysis to both exclude these patients from the non-
intoxicated group and include them into the intoxicated group. If the
results do not change, then it can be concluded that the authors'
conclusion are robust.
Finally, we propose that this is not a cross-sectional study but
rather a retrospective cohort study because alcohol use as exposure and
mortality as outcome do not occur simultaneously; instead, mortality
occurs after alcohol use. We suggest that the authors reconsider stating
that their study was conducted under a cross-sectional design.
Thank you for taking the time to read and response to Wallstrom, S.,
Ulin, K., Omerovic, E., & Ekman, I. (2016). Symptoms in patients with
takotsubo syndrome: a qualitative interview study. BMJ open, 6(10),
e011820. I am glad you find the article informative and useful in
practice. I would, however, like to address your concerns. First,
regarding sample size, richness of data and saturation...
Thank you for taking the time to read and response to Wallstrom, S.,
Ulin, K., Omerovic, E., & Ekman, I. (2016). Symptoms in patients with
takotsubo syndrome: a qualitative interview study. BMJ open, 6(10),
e011820. I am glad you find the article informative and useful in
practice. I would, however, like to address your concerns. First,
regarding sample size, richness of data and saturation. I agree that it
seems like a contradiction to say that the sample size is small compared
to quantitative studies, and large for a phenomenological hermeneutic
study. The sample size is depending on the scientific method you use in
the respective study, in qualitative studies the meaning of phenomena is
in focus and not numbers and quantities. When conducting the interviews,
we had no specific number as a target. Instead we strived for rich
interviews and continued to conduct interviews until the research question
was answered. Saturation is not a concept usually referred to in
connection to phenomenological hermeneutics and that is why we have chosen
not to use the term in the article. Instead interviews are done until the
research question is adequately answered and this was also the case in
this study.
Second, regarding quotations. I am glad that you found the quotations
informative and helpful. I initially wanted to have more and longer
quotations but we had to make the hard choice to omit some in order to
make the article concise and not too long.
Last, thank you for your recommendation of Leventhal's Self-
Regulatory Model (Leventhal & Cameron, 1987). I will certainly look
into it and take it into consideration in future research.
This response is in relation to the above captioned article,
published October 14, 2016. I must state that this was quite an insightful
study. As I read the article, I began to realize with no doubt that there
are physical illnesses associated with the development of mental health
issues, particularly in children. I must agree with the author, that while
there are no direct links to diagnose a mental illness, there are fac...
This response is in relation to the above captioned article,
published October 14, 2016. I must state that this was quite an insightful
study. As I read the article, I began to realize with no doubt that there
are physical illnesses associated with the development of mental health
issues, particularly in children. I must agree with the author, that while
there are no direct links to diagnose a mental illness, there are factors
that increase the likelihood of developing a mental disorder such as
gender, age, and family history. Furthermore, the result shows a
correlation between children diagnosed with allergic diseases and
psychological conditions such as anxiety, emotional and behavioral
problems.
Despite the original study not being able to determine a direct
cause, a suggestion can be the child's perception of their appearance
which may affect the psychological development Because atopic diseases
impact outward appearance, it is likely to result in physical
embarrassment and social withdrawal among children. Like the captioned
study, research has pointed to the fact that the very nature of these
diseases, leaves the affected individual feeling irritated due to the pain
and discomfort experienced. Bronkhorst, Schellack, and Motswaledi (2016),
shared these thoughts when they identified five areas that were likely to
be impacted in a child with eczema including: mental, physical, and
emotional health, vitality, and social functioning. The authors also
stated that children with atopic eczema face challenges such as sleep
deprivation, increased behavioral problems and social isolation.
It must also be noted that there are distinct links between asthma
and psychological distress. In the captioned study, it was noted that
there was an increase in emotional problems related to asthma and
distress. Similarly, Van Lieshout and MacQueen (2012), found that
individuals with asthma display higher rates of depression and anxiety
than the general public. Van Lieshout and MacQueen also found that unlike
other chronic illnesses, asthma is more likely to be deleterious to
emotional well- being especially among children. Overtime as the illness
progresses, the individual develops anxiety and a state of learned
helplessness (Katon, Richardson , Lozano and McCauley, 2004).
This is quite a timely study that lends insight into the nature of
the association of mental disorders, emotional well-being, and the
physical illnesses as captioned. It provides evidence that children are in
fact affected emotionally by their outward appearance and this in turn
affects their levels of socialization. Effective steps therefore need to
be taken to protect the mental health of such a vulnerable group, through
peer and individual counselling as well as therapy. In addition, health
promotional strategies can be implemented to prevent further outbreaks and
effectively manage the symptoms of allergic diseases, thereby improving
emotional well-being.
References
Bronkhorst, E., Schellack, N., & Motswaledi, M. H. (2016).
Effects of childhood atopic eczema on the quality of life. Current Allergy
& Clinical Immunology, 29(1), 18-22.
Katon, W. J., Richardson, L., Lozano, P., & McCauley, E. (2004).
The relationship of asthma and anxiety disorders. Psychosomatic Medicine ,
66(3), 349-355
Van Lieshout, R. J., & MacQueen, G. M. (2012). Relations between
asthma and psychological distress: An old idea revisited. Chemical
Immunology and Allergy , 98,1-13. Doi: 10.1159/000336493
We were pleased to read Mr Halavrezos' reflections on our article.
Mr Halavrezos considers the number of patients treated at the German
telehealth centre impressive, however, he maintains that daily monitoring
could present an unnecessary burden or worse, a potential barrier to
enhancing patient autonomy, particularly in patients with a stable, well
controlled chronic condition. To support his claim, Mr Halavrezos quotes...
We were pleased to read Mr Halavrezos' reflections on our article.
Mr Halavrezos considers the number of patients treated at the German
telehealth centre impressive, however, he maintains that daily monitoring
could present an unnecessary burden or worse, a potential barrier to
enhancing patient autonomy, particularly in patients with a stable, well
controlled chronic condition. To support his claim, Mr Halavrezos quotes a
study by Hunting et al. (2015). This study identifies barriers to the use
of remote monitoring and stresses the importance of user-friendliness of
the equipment. However, Hunting et al. (2015) also state that 'For the
most part, patients and informal caregivers found the equipment
straightforward to use [...] As testament to this, many patients wanted to
purchase their own monitoring equipment before the end of their
participation in the program. Some highlighted that the technology was
intimidating at first, but with a technical demonstration and practice, it
was easily used. This finding contradicted a common assumption of other
stakeholders interviewed, that elderly people would likely resist
technology use or have difficulties with it due to intimidation.'
Thus, technology for remote monitoring is not per se a barrier in
telecare. Instead, technology, if well adapted to the patient's resources
and needs, complements the overall telecare service provision. Moreover,
Mr Halavrezos proposes that 'flexible telehealth nurses should be able to
provide support, education, and planning without daily self-reports of
data by patients'. We feel that this statement is somewhat sweeping,
particularly since daily monitoring can actually serve to enhance feelings
of safety in patients suffering from chronic conditions such as COPD
(Brunton et al., 2015).
Furthermore, the question that the correspondent is concerned with is not
one that we sought to address in our work. Instead, we chose to
investigate our research question in a setting that happened to include
daily monitoring. Our study should not be construed as an endorsement of
this practice. We prefer to look at the problem of daily remote monitoring
from a different angle: the question whether daily monitoring is necessary
and whether it is a burden or a blessing appears to be a matter of
personal needs and preferences. As such, rather than a blanket
recommendation, the issue requires consideration on an individual basis.
We thus take the opportunity afforded by this critique to point out that
an optimal care plan, including the decision on the extent of data
collection through technical means, should be developed within a person-
centred patient-healthcarer relationship as described by Ekman et al.
(2011). The true potential of telecare for a wide-range of patient
populations, including aboriginal populations, lies in the consideration
of an individual person's capabillities and goals in an equal therapeutic
partnership (Ekman et al., 2011). Person-centred, mutually agreed health
planning between the telehealth professional and patient renders the
question of whether all patients should or should not be monitored on a
daily basis obsolete.
Brunton, L., Bower, P., & Sanders, C. (2015). The Contradictions
of Telehealth User Experience in Chronic Obstructive Pulmonary Disease
(COPD): A Qualitative Meta-Synthesis. PLoS ONE, 10(10), e0139561.
http://doi.org/10.1371/journal.pone.0139561
Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink,
E., . . . Sunnerhagen, K. (2011). Person-centered care -- Ready for prime
time. European Journal of Cardiovascular Nursing, 10(4), 248-251.
Hunting, G., Shahid, N., Sahakyan, Y., Fan, I., Moneypenny, C. R.,
Stanimirovic, A., ... Rac, V. E. (2015). A multi-level qualitative
analysis of Telehomecare in Ontario: challenges and opportunities. BMC
Health Services Research, 15, 544. http://doi.org/10.1186/s12913-015-1196-
2
Dear Editor,
Tamara Tuuminen has raised concerns that the members of the research team could have had conflicting interests by their affiliations. We did not regard any affiliation to cause conflicts of interest regarding this protocol article. One member of the research group (AV) works part-time as a medical expert in Social Insurance Institute of Finland (KELA) and OP Insurance Ltd, and another (KK) in Varma Mutual Pension Insurance Company. None of these institutions profits financially or non-financially from studying and publishing the methods and results of this intervention study. Moreover, as mentioned in the manuscript, neither the authors' institutions nor the funders have any authority over trial activities or preparing of the manuscript.
By submitting a protocol paper, our intention was to make our work as transparent as possible. Indoor air associated chronic, non-specific symptoms are perpetuated and exacerbated by various factors. The RCT intervention study compares treatments to reduce symptoms and improve quality of life, regardless of the mechanisms behind the symptoms.
There is a lack of effective treatments for chronic environment-related symptoms with disability. Thus, our study represents one of the few RCT protocols for these patients. The intention of all stakeholders in Finland is to prevent and reduce disability.
On behalf of research group,
Sanna Selinheimo
Dear Editor,
I have read with great interest this paper about retractions in journals of publisher BioMed Central (Moylan & Kowalczuk 2016). I noted an issue with the competing interests statement of the first author. I have contacted you for a copy of her ICMJE disclosure form. You responded with an invitation to submit an eletter. I present in this eletter: (i) a review of the paper, (ii) backgrounds about the...
Please note that BMJ Open has received the above response from Dr Tuuminen. In line with the guidelines of the Committee On Publication Ethics (COPE), we are investigating the issues raised and will follow-up as deemed appropriate.
Adrian Aldcroft
Editor
BMJ Open
Dear Editor,
The reliability of results presented by any scientific paper as a rule is looked through the prism of conflicting interests. Those should be informed by each author of the group without exceptions. ICMJE set the internationally In the recent paper published in this journal by Selinheimo S et al. Comparing cognitive-behavioural psychotherapy and psychoeducation for non-specific symptoms associated wi...
So far as I can see, (and apologies if I have missed something) in common with many others, the authors have failed to include the effect on GDP and taxes and welfare payments of replacement of sick workers by healthy unemployed workers and new workers entering the labour market. Similarly, if unemployed workers take jobs from those with diabetes no longer able to work, then their unemployment benefits will end and there will be a saving in welfare payments to the economy. The tax paid by those now working will offset the tax lost from those ceasing work.
Overall, the level of GDP in developed countries is more likely to be determined by the levels of domestic demand, world trading conditions, currency exchange rates etc. than by the availability of a relatively small number of workers with diabetes, if their employment could be continued.
Welfare payments and taxes are also conventionally treated in economics as transfer payments which have no overall effect on goods and services. If anything, additional welfare payments may benefit the economy in the short run as poorer people on benefits have a higher propensity to spend than richer tax payers. It is usually not acceptable to add direct resource costs for treatment to transfer payments.
I suggest the authors look at this again and at least include the potential effects of worker replacement, given the current levels of unemployment in Australia. They should examine the literature on the friction c...
Show MoreWe read the study "Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study" by Y et al. with great interest and appreciate the authors' efforts. The authors demonstrated that patients with alcohol intoxication incurred significantly higher expenditure of hospitalization than those without, even after adjusting for several confounders including sex, age, and comorbidities....
Dear Ms Craigie,
Thank you for taking the time to read and response to Wallstrom, S., Ulin, K., Omerovic, E., & Ekman, I. (2016). Symptoms in patients with takotsubo syndrome: a qualitative interview study. BMJ open, 6(10), e011820. I am glad you find the article informative and useful in practice. I would, however, like to address your concerns. First, regarding sample size, richness of data and saturation...
This response is in relation to the above captioned article, published October 14, 2016. I must state that this was quite an insightful study. As I read the article, I began to realize with no doubt that there are physical illnesses associated with the development of mental health issues, particularly in children. I must agree with the author, that while there are no direct links to diagnose a mental illness, there are fac...
We were pleased to read Mr Halavrezos' reflections on our article. Mr Halavrezos considers the number of patients treated at the German telehealth centre impressive, however, he maintains that daily monitoring could present an unnecessary burden or worse, a potential barrier to enhancing patient autonomy, particularly in patients with a stable, well controlled chronic condition. To support his claim, Mr Halavrezos quotes...
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