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...
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, I understand why the authors decided to use the same data from the CRT for convenience and other factors, but I think this study could be strengthened by quantifying WASH practices, such as using a ranking or rating system for each household’s practices. In addition, although the study found that WASH variables such as distance to a source of drinking water and treatment of drinking water were important predictors of severe cholera, the authors do not specifically state how the knowledge of these variables can be used to design future interventions. For example, Arnold et al. (2009) suggested that future studies on the implementation of WASH interventions should focus on techniques to help create sustainable behaviors as their study found that their specific interventions were not effective long-term. After discussing difficulties in implementing interventions in previous studies, I believe that the authors could give more explicit future directions for how their findings can contribute to the implementation of successful WASH interventions since this study was not exactly novel.
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...
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 pollutants is detrimental in pregnancy(6).
1. Inoue K, Yan Q, Arah OA, Paul K, Walker DI, Jones DP, Ritz B. Air Pollution and Adverse Pregnancy and Birth Outcomes: Mediation Analysis Using Metabolomic Profiles. Curr Environ Health Rep. 2020 Sep;7(3):231-242. doi: 10.1007/s40572-020-00284-3. Erratum in: Curr Environ Health Rep. 2020 Dec;7(4):441. PMID: 32770318; PMCID: PMC7599041.
2. Rider CF, Carlsten C. Air pollution and DNA methylation: effects of exposure in humans. Clin Epigenetics. 2019 Sep 3;11(1):131. doi: 10.1186/s13148-019-0713-2. PMID: 31481107; PMCID: PMC6724236.
3. Tripathy S, Marsland AL, Kinnee EJ, Tunno BJ, Manuck SB, Gianaros PJ, Clougherty JE. Long-Term Ambient Air Pollution Exposures and Circulating and Stimulated Inflammatory Mediators in a Cohort of Midlife Adults. Environ Health Perspect. 2021 May;129(5):57007. doi: 10.1289/EHP7089. Epub 2021 May 17. PMID: 34014775; PMCID: PMC8136520.
4. Lin Y, Zhou L, Xu J, Luo Z, Kan H, Zhang J, Yan C, Zhang J. The impacts of air pollution on maternal stress during pregnancy. Sci Rep. 2017 Jan 18;7:40956. doi: 10.1038/srep40956. PMID: 28098225; PMCID: PMC5241869.( depression)
5. Costa LG, Cole TB, Dao K, Chang YC, Garrick JM. Developmental impact of air pollution on brain function. Neurochem Int. 2019 Dec;131:104580. doi: 10.1016/j.neuint.2019.104580. Epub 2019 Oct 15. PMID: 31626830; PMCID: PMC6892600.( ASD)
6. Shang L, Huang L, Yang L, Leng L, Qi C, Xie G, Wang R, Guo L, Yang W, Chung MC. Impact of air pollution exposure during various periods of pregnancy on term birth weight: a large-sample, retrospective population-based cohort study. Environ Sci Pollut Res Int. 2021 Jan;28(3):3296-3306. doi: 10.1007/s11356-020-10705-3. Epub 2020 Sep 11. PMID: 32914309; PMCID: PMC7788013
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.
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.
Blok (2022) emphasizes similar opinions that sociocultural attitudes and behaviors may have distinct effects on blood pressure regulation across ethnic minority populations with respect to socioeconomic level and uncontrolled hypertension. Although the author acknowledged these connections, the explanation as to why these elements have a substantial impact on uncontrolled hypertension. As a result, this study may serve as a foundation for future research.
“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.
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.
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...
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 easy-to-use screening tools to identify high-risk students as they are crucial to the entire healthcare industry. University leadership should identify the causes of students’ mental health breakdown and develop coping strategies for them. For example, it should emphasize the essence of self-care activities, such as getting sufficient sleep and exercise, eating healthy food, taking breaks, and fostering social relationships, to help manage these adverse symptoms.
Refrence
Cheung, T., Wong, S., Wong, K., Law, L., Ng, K., Tong, M., Wong, K., Ng, M., & Yip, P.
(2016). Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 13(8), 779. https://doi.org/10.3390/ijerph13080779
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.
Sincerely,
Carl Michael Baravelli, PhD
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.
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...
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:10.1136/ bmjopen-2021-058849
2. Wang Y, Liu M, Liu J. Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study. Nutrients. 2022 Sep 27;14(19):4014. doi: 10.3390/nu14194014. PMID: 36235667; PMCID: PMC9571178.
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...
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 contribute to neuropsychiatric symptoms in some patients using inhaled glucocorticoids. As for the reversibility of these associations, no conclusions can be drawn based on the present cross-sectional study. From studies in patients with Cushing disease, who have been exposed to very high levels of cortisol for a long period of time, we know that not all effects of glucocorticoid exposure on the brain are reversible upon normalization of cortisol levels [6-9]. However, patterns in Cushing disease cannot be directly compared to the daily practice of synthetic glucocorticoid use.
The danger of media attention for scientific research is that nuance can be lost, even though the discussion section of our paper tried to bring forward many nuances. It would be highly regrettable, and by no means in line with the intention of the paper, if patients or their parents refused essential glucocorticoid therapy out of fear of brain changes.
Our publication is part of a long process of unraveling the interaction between glucocorticoids and the brain. As such, it contributes to our basic understanding of our stress system, and also emphasizes – yet again – the need to dose glucocorticoids as low as possible until alternative treatment options are available. The future may even show the need of individualized approaches, given the differences in glucocorticoid sensitivity that exist between subjects [10]. Of course, many questions remain to be elucidated. Whether white and grey matter changes can also be observed in younger patients using inhaled glucocorticoids, as questioned by dr. Liptzin, is one of those questions that deserves attention in future research.
References
1. Savas M, Muka T, Wester VL, van den Akker ELT, Visser JA, Braunstahl GJ, et al. Associations Between Systemic and Local Corticosteroid Use With Metabolic Syndrome and Body Mass Index. J Clin Endocrinol Metab. 2017;102(10):3765-74.
2. Savas M, Vinkers CH, Rosmalen JGM, Hartman CA, Wester VL, van den Akker ELT, et al. Systemic and Local Corticosteroid Use Is Associated with Reduced Executive Cognition, and Mood and Anxiety Disorders. Neuroendocrinology. 2020;110(3-4):282-91.
3. Broersen LH, Pereira AM, Jørgensen JO, Dekkers OM. Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis. J Clin Endocrinol Metab. 2015;100(6):2171-80.
4. Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy: A systematic review and meta-analysis. Arch Intern Med. 1999;159(9):941-55.
5. Daley-Yates PT. Inhaled corticosteroids: potency, dose equivalence and therapeutic index. Br J Clin Pharmacol. 2015;80(3):372-80.
6. Bauduin S, van der Pal Z, Pereira AM, Meijer OC, Giltay EJ, van der Wee NJA, et al. Cortical thickness abnormalities in long-term remitted Cushing's disease. Transl Psychiatry. 2020;10(1):293.
7. Andela CD, van der Werff SJ, Pannekoek JN, van den Berg SM, Meijer OC, van Buchem MA, et al. Smaller grey matter volumes in the anterior cingulate cortex and greater cerebellar volumes in patients with long-term remission of Cushing's disease: a case-control study. Eur J Endocrinol. 2013;169(6):811-9.
8. Andela CD, van Haalen FM, Ragnarsson O, Papakokkinou E, Johannsson G, Santos A, et al. MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies. Eur J Endocrinol. 2015;173(1):R1-14.
9. van der Werff SJ, Andela CD, Nienke Pannekoek J, Meijer OC, van Buchem MA, Rombouts SA, et al. Widespread reductions of white matter integrity in patients with long-term remission of Cushing's disease. Neuroimage Clin. 2014;4:659-67.
10. Quax RA, Manenschijn L, Koper JW, Hazes JM, Lamberts SW, van Rossum EF, et al. Glucocorticoid sensitivity in health and disease. Nat Rev Endocrinol. 2013;9(11):670-86.
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.
Show MoreOne 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...
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...
Show MoreThis 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.
Bl...
Show More“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.
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.
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.
Show MoreI 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...
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.
Sincerely,
Carl Michael Baravelli, PhD
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.
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...
Show MoreWe 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.
Show MoreWe 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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