458 e-Letters

published between 2020 and 2023

  • Comment on "Are better existing WASH practices in urban slums associated with a lower long-term risk of severe cholera? A prospective cohort study with 4 years of follow-up in Mirpur, Bangladesh"

    To the editor,

    Overall, I thoroughly enjoyed reading “Are better existing WASH practices in urban slums associated with a lower long-term risk of severe cholera? A prospective cohort study with 4 years of follow-up in Mirpur, Bangladesh” and gained an abundance of understanding about the topic of how WASH practices impact severe cholera incidence. As someone who studies cholera in a microbiology lab setting, I did not have ample prior knowledge of specific WASH practices and the difficulties of implementing interventions in urban communities. I was curious about why cholera-endemic communities do not just attempt to control outbreaks through improved sanitation and water treatment, but now I know that this is likely due to low feasibility and poor acceptance by communities based on cultural differences. In addition, I appreciated how extensive the introduction section was and think the discussion of the increase in urban populations helped the reader understand the significance of the study.
    One of the main aspects of the paper that interested me was the lack of an association found between WASH practices and severe cholera in the original cluster randomized trial (CRT). I feel as though the authors could have explained this result more as I was curious as to why there would be a reduced risk of severe cholera when “better” WASH practices were present in the non-intervention group but not in either of the intervention groups from the original CRT. Furthermore...

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  • Re: Study protocol to explore the social effects of environmental exposure and lifestyle behaviours on pregnancy outcome: an overview of cohort of pregnant women study

    An excellent article addressing the effect of environmental exposure (Exposome) on pregnancy outcome, studying (1) short-term exposure to atmospheric pollution (MobiFem project) and (2) pregnancy lifestyle (EnviFem project). Exposure to environmental air pollution ( PM1.0. 2.5) has an adverse effect on pregnancy outcomes1. We have independently studied the effect of urban particulate matter ( UPM) on placental function, investigating their roles in trophoblast invasion and differentiation. Prelim findings from our study showed that UPM inhibited trophoblast invasion and altered the epigenetic landscape in the exposed cells2. The placenta is fundamentally the most crucial organ supporting pregnancy. A compromise in its function can affect the feto-maternal cross-talks and, therefore, fetal development. Developing LMIC nations have one of the world's highest burdens of air and water pollution. The stakes are even higher for countries like India, which is slowly turning into a global manufacturing hub ( like China), with several of the Indian cities ranking amongst the top in poor air quality index. Chronic exposure to air pollutants is associated with an elevated inflammatory response& oxidative stress(3), poor pregnancy outcome, and maternal depression(4.) The postnatal outcome is also affected, as evident by increased incidence of ASD, and other developmental delays(5) . In brief, there are enough pieces of evidence to prove that exposure to environmental pollu...

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  • Opinion on the article

    This remark is in regard to the above article that was published on November 2, 2022. The relationship between the healthcare system and blood pressure control was emphasized in the paper, which was quite compelling. Factors including socio-demographics, use of medications, and knowledge of hypertension were mentioned by the authors. Reading the article gave me a better understanding of how the healthcare system affects how people are informed about their diagnoses, the knowledge that coexists with drugs, and how different demographics affect how Blood pressure is controlled, whether through lifestyle modifications or medication. Although some primary healthcare providers in particular regions educate their patients on the necessary information to improve their health, there are still treatment gaps that may be related to the patient's readiness to learn or the manner in which the information is provided.

    Furthermore, regardless of how people are educated or how the information is presented, hypertension is a condition that is pervasive in our society and one of the main causes of illnesses throughout The Bahamas. People in "rural" areas continue to have poor nutritional habits, whether it's because of their socioeconomic situation (finances) or their resistance to taking medication. This is because eating "rich" foods that are high in salt and carbohydrates is stigmatized as a good meal and raises blood pressure measurements.


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  • Mrs

    “Lack of access to SARS-CoV-2 lateral flow testing (rapid antigen testing) results may result in misattribution of SARS-CoV-2 status in patients when reverse transcription PCR testing was not performed.”

    Long Covid Kids thank the authors for identifying this persistent problem in studies researching children and young people (CYP) living through this pandemic, and ask them to reflect if this “misattribution of SARS-CoV-2 status” is a significant problem big enough to render the findings inaccurate?

    CYP have contracted SARS-CoV-2 since the beginning of this pandemic, and many contracted SARS-CoV-2 before testing was available for children.
    CYP often experience asymptomatic COVID-19 and therefore miss the opportunity for testing.
    Poor public health messaging has resulted in families being unaware of when testing is appropriate. Paediatric symptoms can differ from those of adults and remain poorly recognised.
    Poor public health messaging informed families that children were unaffected by SARS-CoV-2. This false and unhelpful messaging resulted in parents/carers believing that testing for COVID-19 was unimportant and of no benefit.

    To mitigate harm to the Long Covid community we encourage the authors to recognise that untested can not be conflated with the absence of SARS-CoV-2 and consider how the protocol can be modified.

  • the results are stable

    Thank you for your comments.

    A sensitivity analysis has been performed in this meta-analysis and the results of the meta-analysis are stable, indicating that possible patient overlap does not affect the primary results.

    Furthermore, we excluded the article with a smaller sample size (study by Wang and colleagues), and the results remained stable. It suggests that even if there is patient overlap, it does not affect the meta results.

  • Re: Screening nursing students to identify those at high risk of poor mental health: a cross-sectional survey

    Dear Editor, I acknowledge the effort and time you have dedicated to investigate the prevalence of mental health among nursing students. As a nursing student myself, I am deeply touched by this article's findings as they disclose nursing students' plight regarding their susceptibility to developing mental health problems. While most of us perceive attending a nursing school as an exceptionally fulfilling and worthwhile fete, the experience can be troubling as we have to deal with considerable psychological problems. Nurses often toil to navigate the courses offered in the program and attain the grades required to graduate. These inevitable demands take a toll on them and predispose them to various mental health challenges, including increased risk for ultra-high risk (IRUHR), putative prepsychosis states (PPS), high trait anxiety (HTA), high state anxiety with genetic risk (HSAGR), and depression, which you have comprehensively addressed in the research.
    I have been alarmed by the findings that over one-fifth of the nursing students investigated in the study were at risk of developing at least a major mental health risk. This information should be conveyed to nursing school stakeholders, including students, faculty, mental health professionals, and policymakers. It is important that these interested parties build a mental wellness culture in nursing schools to ensure a positive learning environment. It is encouraging that you recognized the need to adopt ea...

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  • Reference no 19

    Dear Gritt Overbeck,
    We thank you for highlighting your concern regarding the reference to your study in our article. We of course agree with your assessment and plan to publish a correction to remove this sentence.
    Carl Michael Baravelli, PhD

  • Response by Dr. Yi Wan

    Thanks for Igor Paiva' pointing out the mistake sincerely. In the discussion section, the first sentence in first paragraph was inaccurately stated. The appropriate statement should be the following:

    Throughout the recent randomized clinical trials relating second-generation inhibitors, the median PFS (independent committee) times were 25.7 months with alectinib of ALEX study, 25.8 months with ensartinib of eXalt3 study, and 24.0 months with brigatinib of ALTA-1L study.

  • Question on clarification of conflicting statements

    Dear editor,

    In the article by Thuong et al.1 on Catastrophic health expenditure (CHE) in the Northern midlands and mountainous areas in Vietnam, the authors conducted a rigorous and tightly-structured cross-sectional research using national data, successfully measured the declining prevalence of CHE and impoverishment there and proposed guidance on further policy research. Furthermore, the study took the socio-economical status among groups into control in spite of the difficulties researchers usually encounter when analyzing such type of data. As a Global Health student generally keen in studies of Vietnam, I wholeheartedly appreciate the work of the research.

    However, I still have one major question regarding the explanations and statements of the paper. The first is on the lack of clarification of conflicted statements. On page 12 of the issue, the author stated that “household head by male were less likely to suffer CHE than female-headed households” when on page 8, in the section Determints of CHE, stated “female-headed households displayed a reduced risk of CHE”. Such statements is speculative and may be misinterpreted by readers. A negative trend has been shown in female-headed households in relation with a risk of CHE in China.2

    1. Thuong NTT, Huy TQ, Huy DN. Catastrophic health expenditure in the Northern midlands and mountainous areas and its determinants, Vietnam from 2014 to 2020: a cross-sectional study. BMJ Open 2022;12:e058849. doi:10...

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  • Response to: Inhaled corticosteroids are safe and crucial for treatment of asthma

    We thank dr. Liptzin for her nuanced response to our publication Association between use of systemic and inhaled glucocorticoids and changes in brain volume and white matter microstructure: a cross-sectional study using data from the UK Biobank.
    We agree with the author that inhaled glucocorticoids are still a crucial part of current asthma treatment and that for the large majority of patients, they are safe too. Nevertheless, various studies have shown that even inhaled glucocorticoids can have side effects, including neuropsychiatric symptoms, due to a (relatively small) systemic uptake of glucocorticoids [1-4]. Generally, physicians are aware that limiting glucocorticoid exposure as much as a patient’s condition allows is desirable, and as illustrated by dr. Liptzin, important efforts have already been made in that direction. Sometimes, however, a patient requires higher doses of inhaled or systemic glucocorticoids, for lack of a better alternative. Importantly, not all prescribers may be aware of the substantial differences in potency of inhaled glucocorticoids that are on the market [5].
    In our study, we show that systemic glucocorticoid use is associated with a decreased white matter integrity, and to a smaller extent a similar pattern was seen in patients using inhaled glucocorticoids. It is likely that the clinical significance of these effects is small, at least for most patients. Yet, we cannot rule out the possibility that these observations contribu...

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