eLetters

1568 e-Letters

  • Letter to the Editor

    Dear Editor,
    I am writing in response to the article, “Association between sleep quality and uncertainty stress among healthcare professionals in hospitals in China,” recently published in BMJ Open. The study reveals the high prevalence of insomnia and uncertainty stress among healthcare workers, which is an important contribution. Furthermore, the use of validated tools such as the Athens Insomnia Scale (AIS) enhances the reliability of the findings, offering solid evidence for the urgent need to address healthcare workers’ mental well-being.

    However, I would like to offer some additional suggestions that could make a further discussion.

    Firstly, regional and hospital-level differences are important factors that cannot be overlooked. The study covers only three provinces, yet healthcare resources within these provinces vary significantly, which introduces potential variability in stress sources. For instance, tertiary hospitals in major cities, such as Hangzhou in Zhejiang province, often experience high levels of stress due to large patient volumes and complex cases. In contrast, healthcare professionals in less resourced areas, such as Lishui in Zhejiang province, are facing chronic stress from staff shortages and inadequate infrastructure. Understanding these regional disparities can provide a more detailed view of how healthcare environments influence sleep quality.

    Secondly, the timing of data collection also affects the study’s findings. T...

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  • Protocol amendment - The inclusion of a single case study

    The initial mixed methods study as described in this published protocol (Hansen et al., 2021) had two components: a prospective quantitative and qualitative study. Since publication of this protocol, two changes were made from the described study design which occurred as a result of low recruitment in the prospective studies, and challenges related to accessing the study site for data collection throughout the COVID-19 pandemic due to Government enforced ‘lockdowns’. The ‘lockdowns prevented all non-essential access to the hospital and as a consequence further recruitment to the study was not possible. This rapid response outlines the required key changes to the study design, approved by the University of Newcastle Human Research Ethics Committee and the participating organisation.

    The first change to the protocol involved the inclusion of a retrospective quantitative study which commenced on August 2, 2022. A file audit was conducted which included all women admitted to the study site between 01/01/2016 and 30/04/2021. These dates were chosen to allow the collection of five years of data preceding the commencement of the prospective study. Inclusion criteria included all women admitted to the study site during the study timeframe comprising women who did and who did not experience seclusion during their admission. Following ethical approval, a de-identified electronic list of women admitted during the study timeframe was provided to the first author from the study...

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  • Response to Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study

    Dear Editor,

    We recently read “Barriers and facilitators to use of digital health tools by healthcare practitioners and their patients, before and during the COVID-19 pandemic: a multimethods study,” which explores the critical question of how healthcare professionals adopt and use digital health technologies (DHTs).

    The authors’ examination of barriers to DHT access and use on organisational and individual levels was a particularly valuable finding for their future implementation. We found the observation that some healthcare professionals (HCPs) acted as gatekeepers for patients’ access to DHTs particularly compelling. This highlights the importance of addressing biases and assumptions about the type of patients who could use and benefit from DHTs, to avoid unintentionally increasing digital health inequity. While this was not the primary focus of the study, we believe it is an important finding that should be further explored to understand how HCPs made such judgments and how they compare with patients’ perceptions. Understanding the underlying factors shaping professionals’ assumptions may provide a deeper understanding of the barriers to using digital tools. Additionally, it would have been interesting to further investigate usage patterns within the participants' geographic regions. The characteristics of these regions (e.g. socioeconomic status, demographics, digital access levels) may be associated with different adoption rates of DHTs by profe...

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  • The potential of web assisted interventions for diabetes management in tribal settings

    We have read the article by Murray et al interestingly, the article was engaging and thought provoking [1]. With the advancements of digitalization technology in the health sector, diabetes care and management have also experienced modifications and betterment. Various newer technologies cater to individual conditions & needs and provide personalized treatment. Device-based technologies such as continuous glucose monitoring (CGM) linked to closed-loop insulin delivery systems, insulin pumps, and wearable devices linked with mobile apps have made the self-management of diabetes possible regularly. The web assisted interventions can be an asset for diabetes management in a developing country like India where the number of people with diabetes are currently is around 40.9 million and is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken [2]. The prevalence in the recent report by the Indian Council of Medical Research- India Diabetes (ICMR-INDIAB) study was observed to be 11.4% [3]. The scenario in the tribal population of India is more or less similar as the diabetes prevalence in tribal areas was observed to be from 0.7-10.1% [4] which is an alarming figure, but still, a systematic tribe-wise prevalence data is meager. Also, land alienation, lack of health management infrastructure, low connectivity, and technological challenges add up to their condition. While various technologies are challenging to implement due to electricity, network...

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  • RE: Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study

    Dear Editor,

    The recent paper “Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study” generates insights into the health literacy characteristics of patients. We commend the authors for their efforts to enhance health equity by examining the types of patients who may require additional health literacy support when hospitalised. The authors’ comprehensive analysis of both health literacy and digital health literacy offers a strong foundation for future research, particularly in enhancing health equity by identifying vulnerable populations in hospital settings. This rapid response aims to emphasise two key areas of the analysis where further elaboration could enhance the study's quality and insights: the potential influence of the study's context on the findings and the practical implications of the generated clusters.

    Health literacy refers to an individual’s ability to maintain health through knowledge, self-management, and collaboration with health professionals [1]. The paper defines health and digital health literacy as involving “access, understanding, appraisal, and use” of health information. The measurement tools reflect this broad perspective. Data was collected from a single clinical setting, and while the authors note limited generalisability, more discussion on the influence of contextual factors would have been helpful. The field would benefit from further c...

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  • Lessons Learnt - The 'Big Five' in South Africa
    Haaritha Boltman

    I feel that this study leaves me with a sense of being on safari to catch a glimpse of the 'Big Five' - as a health professional from South Africa I recognize that it is only but interesting to note the first world trends in pre-eclampsia, but it does not provide any sustainable short or long term treatment modalities, where it is so urgently required.

    Hypertension during pregnancy has been attributed to one of t...

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  • Life expectancy record holders have about average life disparity levels at each life expectancy level
    Alyson A. van Raalte

    Alyson A. van Raalte, James W. Vaupel, Zhen Zhang

    Monden and Smits raise a valid point that "the countries that reached a certain e(0) first are not the most equal countries at that level of e(0)" [1]. We do not dispute this. In fact, we performed a similar analysis in the supporting material (Figure S4) [2]. At each e(0) level, our figure compared the life disparity level of e(0) leaders to the average life...

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  • Raw data available in DRYAD repository
    Richard J Sands

    Data files that support this article are available at the Dryad repository:

    BMJ open Access MHRA Field Safety Notices 2006_2010 MHRA Field safety notices_FDA 19_5_11

    When using this data, please cite the original article and the Dryad data package. The data package should be cited as follows:

    Heneghan C, Thompson M, Billingsley M, Cohen D (2011) Data from: Medical-device recalls in the UK an...

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  • RE: Factors influencing the inclusion of complementary and alternative medicine (CAM) in undergraduate medical education
    Charles F Omondi

    In this article KR Smith makes three important points in the conclusion. Firstly, that it may be useful for the General Medical Council to clarify the extent to which Complementary and Alternative Medicine (CAM) should be incorporated into the curriculum. Secondly, he suggests that current CAM education appears to exist primarily as a means of educating future doctors on the modalities that their patients may use or reque...

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  • Things May Not Be As They Seem
    Jose Maria Lopez Lozano

    Sir, In their recent study from Oxfordshire, Wyllie and colleagues questioned the role that intensive infection control measures have played in controlling the epidemic of MRSA in hospitals in their region. [1] The authors suggest that effects of introducing intensive interventions for MRSA may have been limited, given that stabilization and subsequent declines in rates of MRSA occurred prior to such measures, and were...

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