803 e-Letters

  • Incomplete examinations are irrelevant and all too frequent.
    Edward Archer

    Dear Editor: By design, incomplete examinations provide data that lead to superficial correlations, erroneous inferences, and poor public health policy. Schmidt et al.1, provide an exemplar of this increasingly frequent event. Physical inactivity is a leading cause of death worldwide as well as a principal underlying pathology in most major causes of morbidity and mortality.2 Inactivity affects cardiovascular disease3,4, c...

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  • A lack of data and questionable emphasis
    Peter S. Blair

    Dear Editor,

    The report by Carpenter et al [1] on whether there is a risk of SIDS associated with bed sharing when parents do not smoke fails to meet its stated objective because the data needed to resolve any uncertainty is not available from the studies presented. The over-arching argument is whether bed-sharing in itself poses a risk to infants or whether the risk is within the hazardous circumstances in whi...

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  • Maternal choice and macrosomia are likely significant contributors to CS rates
    Pauline M Hull

    In the UK, the rate of maternal request caesareans is also higher in private hospitals, and up until November 2011 (when NICE guidance[1] on Caesarean Section changed) maternal request was not on its own supported as an indication for CS in public (NHS) hospitals; therefore many women, who could afford to, paid for their maternal request caesarean privately.

    Unfortunately, despite the fact that NICE guidance now...

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  • Re:Maternal age as a confounder
    Kristjana Einarsdottir

    I think you very much for your comment on the article. In response to your comment I have now re-analysed the pre-labour caesarean section rates according to age group, ie for women under the age of 30 and women over 29.

    The separate results for these two age groups showed exactly the same pattern as for the groups combined. For example, the caesarean section rate for women over 29 years of age increased by...

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  • Omega-3, omega-6 and vitamin treatment for relapsing-remitting multiple sclerosis
    Oivind Torkildsen

    Dr. Pantzaris and colleagues (1) have recently performed a study on a dietary intervention consisting of omga-3, omega-6 and vitamin A and -E in various formulations in relapsing-remitting multiple sclerosis (RR-MS). The authors suggested that a special combination of omega-3, omega-6 and fat soluble vitamins could have profound effects on magnetic resonance (MR) disease activity and disease progression. The main problem i...

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  • Maternal age as a confounder
    Paul M McGurgan

    I acknowledge the authors attempts to correct for confounders such as placenta pravia and breech in this interesting paper, but also think that the significant known confounding effect of maternal age (some references below) and effects on mode of delivery should also have been addressed.

    Am J Obstet Gynecol. 1987 Feb;156(2):305-8. Maternal age and primary cesarean section rates: a multivariate analysis. Martel M,...

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  • Time Pressure: The Elephant in the Room
    Noor Ahmad

    This is excellent work, and something most of us, i would like to think,know for a very long time!

    Time pressures is the single most important factor, aside from lack of knowledge and skills, that results in acts of commission or omission, sometimes with harm ensuing. Something akin to "system error"

    A GMC backed study recently suggested, due to time pressures, GPs find it difficult to achieve the requ...

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  • Untangling over-treatment from over- diagnosis
    Santhanam Sundar

    The battle between proponents and opponents of breast screening has reached a well entrenched stalemate. (1). A new randomised trial which could confirm or refute breast screening benefits is not realistically feasible.

    The women's views in this study offers an elegant way forward. (2). We need to untangle the issue of over- treatment from over- diagnosis. Rather than concentrating on over- diagnosis, the optio...

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  • Should we be afraid of catecholamines?
    Sebastien Champion

    Lee and colleagues should be congratulated for their meticulous analysis of a large and complete database.1 They concluded from propensity score analyses in various settings (cardiac, surgical or medical ICU) that vasoactive agents were associated with increased in-hospital mortality. They state that their results are provoking and inconclusive, and we partly agree. Vasoactive treatments have already been associated with...

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  • The high cost of diarrhoeal illness for urban slum households - a cost- recovery approach: a cohort study.

    Dear editor, I refer to the article: The high cost of diarrhoeal illness for urban slum households - a cost- recovery approach: a cohort study. I appreciate this article since findings are exposing and could highly contribute to measures that can break the vicious cycle of poverty and illness. Slum populations are usually faced with many challenges; health being one of them. The vicious cycle of ill health is affecting man...

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