Gill Rapley makes some useful points about our recent paper (Daniels, L., Taylor, R.W., Williams, S.M., Gibson, R.S., Fleming, E.A., Wheeler, B.J., Taylor, B.J., Haszard, J.J. and Heath, A-L.M. (2018) Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial, BMJ Open, 8: e019036).
In particular, she points out that:
(a) While our Baby-Led Introduction to Solids (BLISS) intervention group was given specific advice on increasing iron intake, the Control group received only standard care.
(b) It is not clear whether the infants in the BLISS group would have had equivalent iron status to that of the Controls even without the additional advice.
(c) Infants following a traditional approach to infant feeding may also need advice to improve their iron intake, particularly now that complementary feeding should ideally be delayed to 6 months of age.
There are many interesting questions that can be asked about baby-led approaches to complementary feeding, and their impact on infant nutrient status. Each of these questions would need a different study design. In our case, we were interested in answering the pragmatic question – Is it possible to follow a baby-led approach to infant feeding instead of traditional feeding without negatively impacting on iron status? This required that we have an intervention group (our BLISS group) and a group representing the status quo, i.e. what is happening in the commu...
Gill Rapley makes some useful points about our recent paper (Daniels, L., Taylor, R.W., Williams, S.M., Gibson, R.S., Fleming, E.A., Wheeler, B.J., Taylor, B.J., Haszard, J.J. and Heath, A-L.M. (2018) Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial, BMJ Open, 8: e019036).
In particular, she points out that:
(a) While our Baby-Led Introduction to Solids (BLISS) intervention group was given specific advice on increasing iron intake, the Control group received only standard care.
(b) It is not clear whether the infants in the BLISS group would have had equivalent iron status to that of the Controls even without the additional advice.
(c) Infants following a traditional approach to infant feeding may also need advice to improve their iron intake, particularly now that complementary feeding should ideally be delayed to 6 months of age.
There are many interesting questions that can be asked about baby-led approaches to complementary feeding, and their impact on infant nutrient status. Each of these questions would need a different study design. In our case, we were interested in answering the pragmatic question – Is it possible to follow a baby-led approach to infant feeding instead of traditional feeding without negatively impacting on iron status? This required that we have an intervention group (our BLISS group) and a group representing the status quo, i.e. what is happening in the community without any intervention on our part (the Control group). This meant that the Control group needed to receive only the standard care currently offered to New Zealand families.
Dr Rapley is correct in saying that we do not know whether iron status would have been the same in the baby-led infants without our iron intervention. There are, however, some reasons to believe that it is likely their iron status would have been lower. In our earlier, small, observational study of Baby-Led Weaning (BLW), infants following unmodified BLW had significantly lower intakes of iron than their traditionally fed counterparts (Morison BJ, Taylor RW, Haszard JJ, Schramm CJ, Williams Erickson L, Fangupo LJ, Fleming EA, Luciano A, Heath A-LM (2016). How different are Baby-Led Weaning and conventional complementary feeding? A cross-sectional study of infants 6-8 months. BMJ Open 6:e010665). Also, BLISS infants were consuming more iron in the BLISS study than the BLW infants were in the earlier study. We do, however, agree that there is an urgent need to investigate iron status in infants following unmodified BLW. This study is needed so that we can determine whether it is necessary to roll out the intervention used in the BLISS study for parents following BLW.
The government-funded standard Well Child care provided to all New Zealand infants (including those in the BLISS study) includes advice on offering puréed sources of iron at six months – particularly iron-fortified infant cereal and red meat. Our two main approaches for increasing iron intake in the infants following BLISS were: specific advice on ways to offer iron-fortified infant cereal and red meat as handheld foods (i.e. making the standard Well Child advice feasible for infant self-feeding), and offering an iron-rich food with each meal. While one of our approaches was, therefore, a baby-led equivalent of current advice for the spoonfed infant, we would also be very interested to see whether encouraging parents to offer their traditionally spoonfed infant an iron-rich food with each meal would help improve their iron status. After all, 74% of the Control, as well as BLISS, infants had inadequate iron intakes at 7 months.
The difference in levels of sugar in very similar foods that this study has revealed is shocking, but it does show that if one manufacturer can reduce sugar levels in their products, then it is possible for other manufacturers to do the same. We now need the government to take stronger action and make it compulsory for food manufacturers and retailers to reduce sugar levels in their products. Eating too much sugar leads to overweight and obesity, which our latest cancer prevention report shows is a cause of 12 different types of cancer. Healthy lifestyle patterns depend not only on individual choices but also on governments creating an environment that encourages people to eat healthily and do more exercise. WCRF calls on the government to prioritise cancer prevention through the development and implementation of effective policies to address the rising burden of obesity and cancer in the UK.
Dear Sirs, Can I suggest that you apply a rolling 12-month average to the mortality rate and a rolling 12-month total to the raw deaths as a means of detecting possible step-like changes (on/off switching) in the mortality trends. I have recently identified that international deaths are subject to on/off switching which may indicate the hidden presence of infectious outbreaks of an unknown pathogen (possibly cytomegalovirus ????). I have published a number of studies on this topic which can be located in the relevant sections at http://www.hcaf.biz/2010/Publications_Full.pdf I hope this will stimulate further analysis of this fascinating data.
Dear Authors, Are you able to use your data to compare attendances/admissions/costs in the last year of life versus previous years. For some years I have been arguing that nearness-to-death is the key missing variable in healthcare demand planning, which currently, and misleadingly, mainly uses population demography. You can view my publications in this area at http://www.hcaf.biz/2010/Publications_Full.pdf - look in the sections dealing with hospital beds and the links between death and admissions. Hope this helps.
This is a useful study. The participants may not be aware that viruses like cytomegalovirus (CMV) interfere with both influenza vaccination and the immune response to influenza infection especially in the elderly. There is also some evidence that influenza may be interacting with outbreaks of an unknown agent (perhaps CMV?). See relevant references in the sections dealing with deaths and medical admissions and roles for CMV in human health at http://www.hcaf.biz/2010/Publications_Full.pdf
Dear authors,
Recently, the work “Women’s prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study” [1] was published in BMJ Open, it aims to study prepregnancy serum lipid levels and the association with the number of children. First, as part of the BMJ Open audiences, we thank for the work was presented to us. But, we think there are some problems on the tables of this study. When we firstly learn scientific knowledge, and the professor will tell us some rules on table and figure in scientific paper, and one of the most important is that table and figure should be “stand-alone” [2], that is, all important information should be presented, including table, figure, title, legend and footnotes etc. We found, although the “BMI” was given measurement unit as “kilogram/ (height in meters)2” in the text, but we did not find it in all of tables. In order to regulate writing rules, we raised the question.
Conflicts of interest
We declare that we have no conflicts of interest.
Reference
1. Pirnat A, DeRoo LA, Skjaerven R, et al. Women's prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study. BMJ open 2018;8(6): e021188.
2. Cargill M, O'Connor P. Writing Scientific Research Articles: Strategy and Steps [M] Writing Scientific Research Articles. Wiley John + Sons, 2013:1018.
This is another valuable study using the Scottish public health datasets. It confirms an unplanned hospital admission as an important indicator of deteriorating health that should prompt a review of the patient's overall health and plan of care. Such admissions are key triggers to help identify people whose declining health might otherwise have not been recognised. In our validation study of the SPICT (Supportive and Palliative Care Indicators Tool) in a Scottish acute hospital, unplanned admission was a frequent general indicator.
We would like to clarify that the Surprise Question is not part of the SPICT tool although some people use both tools. In Scotland, we have now adopted anticipatory care planning as a broader, person-held approach to future care planning and are increasingly moving away from the ‘prognostic paralysis’ associated with considering people for an integrated ‘palliative care approach’ only once they are thought to be in the last year of life.
Scottish Anticipatory Care Planning Programme: https://ihub.scot/anticipatory-care-planning-toolkit/
Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. (Development & evaluation of SPICT) BMJ Support Palliat Care Published Online First: 25 July 2013 doi:10.1136/bmjspcare-2013-000488.
Patients have long known the benefits to their well being of seeing the same doctor . GPs have described the relevance of continuity in academic studies. The benefits are described in literature (see Berger A Fortunate Man). The current organisation of and future plans envisaged for general practice by policy makers make it increasingly difficult for patients to receive continuity.Fewer GPs work with a personal list, the practise provides the continuity.
The research by Pereira Gray et al is the first study to give hard evidence that where used by doctors, continuity of cares associated with lower mortality rates. N.A.P.P. representing millions of UK patients in general practice, welcomes this research and hopes it can be replicated in other work.
Most importantly, patients and their organisations need to lobby policy makers and professionals to ensure that the importance of continuity of care is built into future plans for general practice.
Thank you for your comment. The sentence “a past systematic review reported that the most frequently cited barriers to abstract publication were a lack of time, although all studies included in that systematic review were conducted outside Japan.” should correctly read: “past studies reported that the most frequently cited barriers to abstract publication were a lack of time, although all studies were conducted outside Japan”.
Since publication, BMJ Open has received queries relating to the ethical approval statement in the article along with the reference number provided. We have asked the University of Bristol to investigate the accuracy of the statement and to confirm that the correct approval processes were followed. We are also in contact with the Health Research Authority, who are investigating the project.
Once we have clarification of the ethical approval process, we will post an update.
Gill Rapley makes some useful points about our recent paper (Daniels, L., Taylor, R.W., Williams, S.M., Gibson, R.S., Fleming, E.A., Wheeler, B.J., Taylor, B.J., Haszard, J.J. and Heath, A-L.M. (2018) Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial, BMJ Open, 8: e019036).
In particular, she points out that:
(a) While our Baby-Led Introduction to Solids (BLISS) intervention group was given specific advice on increasing iron intake, the Control group received only standard care.
(b) It is not clear whether the infants in the BLISS group would have had equivalent iron status to that of the Controls even without the additional advice.
(c) Infants following a traditional approach to infant feeding may also need advice to improve their iron intake, particularly now that complementary feeding should ideally be delayed to 6 months of age.
There are many interesting questions that can be asked about baby-led approaches to complementary feeding, and their impact on infant nutrient status. Each of these questions would need a different study design. In our case, we were interested in answering the pragmatic question – Is it possible to follow a baby-led approach to infant feeding instead of traditional feeding without negatively impacting on iron status? This required that we have an intervention group (our BLISS group) and a group representing the status quo, i.e. what is happening in the commu...
Show MoreThe difference in levels of sugar in very similar foods that this study has revealed is shocking, but it does show that if one manufacturer can reduce sugar levels in their products, then it is possible for other manufacturers to do the same. We now need the government to take stronger action and make it compulsory for food manufacturers and retailers to reduce sugar levels in their products. Eating too much sugar leads to overweight and obesity, which our latest cancer prevention report shows is a cause of 12 different types of cancer. Healthy lifestyle patterns depend not only on individual choices but also on governments creating an environment that encourages people to eat healthily and do more exercise. WCRF calls on the government to prioritise cancer prevention through the development and implementation of effective policies to address the rising burden of obesity and cancer in the UK.
Dear Sirs, Can I suggest that you apply a rolling 12-month average to the mortality rate and a rolling 12-month total to the raw deaths as a means of detecting possible step-like changes (on/off switching) in the mortality trends. I have recently identified that international deaths are subject to on/off switching which may indicate the hidden presence of infectious outbreaks of an unknown pathogen (possibly cytomegalovirus ????). I have published a number of studies on this topic which can be located in the relevant sections at http://www.hcaf.biz/2010/Publications_Full.pdf I hope this will stimulate further analysis of this fascinating data.
Dear Authors, Are you able to use your data to compare attendances/admissions/costs in the last year of life versus previous years. For some years I have been arguing that nearness-to-death is the key missing variable in healthcare demand planning, which currently, and misleadingly, mainly uses population demography. You can view my publications in this area at http://www.hcaf.biz/2010/Publications_Full.pdf - look in the sections dealing with hospital beds and the links between death and admissions. Hope this helps.
This is a useful study. The participants may not be aware that viruses like cytomegalovirus (CMV) interfere with both influenza vaccination and the immune response to influenza infection especially in the elderly. There is also some evidence that influenza may be interacting with outbreaks of an unknown agent (perhaps CMV?). See relevant references in the sections dealing with deaths and medical admissions and roles for CMV in human health at http://www.hcaf.biz/2010/Publications_Full.pdf
I hope this is helpful to the study.
Dear authors,
Recently, the work “Women’s prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study” [1] was published in BMJ Open, it aims to study prepregnancy serum lipid levels and the association with the number of children. First, as part of the BMJ Open audiences, we thank for the work was presented to us. But, we think there are some problems on the tables of this study. When we firstly learn scientific knowledge, and the professor will tell us some rules on table and figure in scientific paper, and one of the most important is that table and figure should be “stand-alone” [2], that is, all important information should be presented, including table, figure, title, legend and footnotes etc. We found, although the “BMI” was given measurement unit as “kilogram/ (height in meters)2” in the text, but we did not find it in all of tables. In order to regulate writing rules, we raised the question.
Conflicts of interest
We declare that we have no conflicts of interest.
Reference
1. Pirnat A, DeRoo LA, Skjaerven R, et al. Women's prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study. BMJ open 2018;8(6): e021188.
2. Cargill M, O'Connor P. Writing Scientific Research Articles: Strategy and Steps [M] Writing Scientific Research Articles. Wiley John + Sons, 2013:1018.
This is another valuable study using the Scottish public health datasets. It confirms an unplanned hospital admission as an important indicator of deteriorating health that should prompt a review of the patient's overall health and plan of care. Such admissions are key triggers to help identify people whose declining health might otherwise have not been recognised. In our validation study of the SPICT (Supportive and Palliative Care Indicators Tool) in a Scottish acute hospital, unplanned admission was a frequent general indicator.
We would like to clarify that the Surprise Question is not part of the SPICT tool although some people use both tools. In Scotland, we have now adopted anticipatory care planning as a broader, person-held approach to future care planning and are increasingly moving away from the ‘prognostic paralysis’ associated with considering people for an integrated ‘palliative care approach’ only once they are thought to be in the last year of life.
Scottish Anticipatory Care Planning Programme: https://ihub.scot/anticipatory-care-planning-toolkit/
Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. (Development & evaluation of SPICT) BMJ Support Palliat Care Published Online First: 25 July 2013 doi:10.1136/bmjspcare-2013-000488.
Patients have long known the benefits to their well being of seeing the same doctor . GPs have described the relevance of continuity in academic studies. The benefits are described in literature (see Berger A Fortunate Man). The current organisation of and future plans envisaged for general practice by policy makers make it increasingly difficult for patients to receive continuity.Fewer GPs work with a personal list, the practise provides the continuity.
The research by Pereira Gray et al is the first study to give hard evidence that where used by doctors, continuity of cares associated with lower mortality rates. N.A.P.P. representing millions of UK patients in general practice, welcomes this research and hopes it can be replicated in other work.
Most importantly, patients and their organisations need to lobby policy makers and professionals to ensure that the importance of continuity of care is built into future plans for general practice.
Dear Dr Lu
Dear Professor Yang
Dear Dr Ma
Thank you for your comment. The sentence “a past systematic review reported that the most frequently cited barriers to abstract publication were a lack of time, although all studies included in that systematic review were conducted outside Japan.” should correctly read: “past studies reported that the most frequently cited barriers to abstract publication were a lack of time, although all studies were conducted outside Japan”.
Best regards,
Junpei Komagamine
Since publication, BMJ Open has received queries relating to the ethical approval statement in the article along with the reference number provided. We have asked the University of Bristol to investigate the accuracy of the statement and to confirm that the correct approval processes were followed. We are also in contact with the Health Research Authority, who are investigating the project.
Once we have clarification of the ethical approval process, we will post an update.
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