eLetters

83 e-Letters

published between 2017 and 2020

  • Letter to the Editor Regarding Global health education in UK medical schools: a review of undergraduate university curricula

    I congratulate the authors who successfully conducted a survey on the current provision of global health education (GHE) in United Kingdom (UK) medical schools.1 Their findings are in keeping with a recent cross-sectional study into the timetables of UK medical schools.2 In the methods section of the paper, the global health learning outcomes and competencies surveyed were listed. However, global surgery was neither surveyed nor discussed in this paper.

    This occurred despite global surgery being added as a mandatory learning objective to the national undergraduate curriculum in surgery by the Royal College of England in 2015.3 Post 2015, GHE studies2 and study protocols4 have typically strived to ensure that global surgery is assessed within their study designs. This is particularly important as global surgery often becomes the ‘neglected stepchild of global health’.5 It is easy to see why given that approximately two-thirds of UK medical courses are reported not to cover this topic within their core curriculum.2 It is not in the best interests of the population for a subject of such importance to be ignored by global health researchers and educational institutions.

    Therefore, whilst it is encouraging that a study has been done with the aim of identifying gaps in GHE teaching in UK medical schools, the study design in and of itself has resulted in the researchers missing gaps.2 This exemplifies the importance of having a diverse range of stakeholders involve...

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  • Citation rates of Retracted Publications

    Candal-Pedreira and colleagues showed that for 304 retracted papers, overall citations increased not decreased following retraction, but citations did seem to decrease for retracted papers in higher impact journals and those with higher citation rates, although that decrease might have been temporary.1 It is disturbing that retracted papers continue to be cited.

    We approached the issue of changes in citations rates after retraction in a different way. We assessed citation rates of retracted and unretracted publications from individuals with more than one retracted publication in the Retraction Watch database.2 Using this approach, we found that, overall, citations for 989 retracted publications declined after the retraction and citations for 9671 unretracted papers also declined after the author’s first retraction, but the decline was greater for retracted papers. For example, for retracted publications, 671 papers had 3566 citations in the 3rd year before their retraction and 831 papers had 1575 citations in the 3rd year after their retraction. In contrast, 5311 unretracted papers had 17935 citations in the 3rd year before the author’s first retraction, and 7388 papers had 17252 citations in the 3rd year after the author’s first retraction.

    Part of the difficulty in conducting and interpreting such analyses is the different lengths of time pre-and post-retraction for different papers. To try to address that issue, we calculated the slope of the citations/yea...

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  • Syrian Healthcare Workers Choose the Wrong Destination

    Editor, the commentary highlights the sad situation the Levant region in the middle east has reached. The Syrian healthcare workers are most needed in Syria and not in Germany. It is their very country which is in most need for their services. Syria now has shortage of trained doctors and nurses to help fellow country men and women recover from war injuries and myriad of infectious and non-communicable diseases. Integrating in Europe is never easy for a people from Muslim countries, even if the were professionals (https://www.dailymail.co.uk/news/article-8854519/Muslim-doctor-refused-s...). I have lived in London for over 30 years and still feel an outsider in the UK. How will these refugees cope with the threat of their children losing their Arabic language or Muslim identity. Careers are not everything. It just baffles me why the Syrians who came to Europe could not seek refuge in rich Arab nations. Something terribly wrong is going on in the middle east and coming to Germany is not the answer. Syrian refugees are looking for a quick fix, but they should go back to their own country and tough it out to rebuild what was demolished before someone else comes and takes their places! Britons and Germans did not run away from their countries during the two world wars! Did millions of Britons leave to America to escape WWII? Why have did almost...

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  • Building on narrative rather than changing narrative

    A few thoughts on the paper.

    In relation to SAM terminology. No one could argue with the logic of acute v chronic. However, SAM is well understood at a policy level. It is however understood at above six months. The work that ENN and MAMI have done on identifying wasting at birth is a narrative change which can lay the foundation for the bridging language that the paper talks about.

    Narrative is a story that people can understand.
    As pointed out, consistency is important, but consistency must hover across the 1000 day window. Currently, our terminology for narrating fetal undernutrition is very weak. While simplistic, if children are being born wasted, then they are also wasted in utero. To fully open the curtains, we would suggest that the SAM terminology be adapted to include fetal malnutrition. The narrative neither stops nor begins at birth regardless of the terminology we use.
    In relation to the false positives and visa versa. Given current programming capacity and coverage rates well below 20% for CMAM false negatives represent only a tiny fraction of those who need treatment and do not receive it. Focus on false positives takes away from the substantive issue of low coverage rates for Essential Nutrition Actions across the 1000 day window.

    On a broader theme, it would be helpful to explore how the food system and the food system summit support people in immediate need.

    A conversation starter
    The food system belongs to...

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  • The role of AuthorAID in providing Pre-Publication Support Services for authors in low-income and middle-income countries

    We have read this excellent article with interest. As physicians based in Pakistan: a low-middle income country and not having English as our first language, we could relate to the challenges mentioned in this manuscript. Authors have very rightly pointed out that the issue with most of the researchers based in the low-income (LIC) and middle-income countries (LMIC) is not of poor or low-quality science. We need data and experience sharing from all parts of the world in order to complete the bigger picture and understand the issues that we face today in health, environment, and social sciences. One of the main challenges authors based in the LIC and LMIC face is the issue of presentation of that data i a presentable form. Due to the lack of training opportunities, many authors are unable to write manuscripts that meet the high standards of global scientific journals. This deprives these authors of an opportunity to publish in journals with a global audience and the world misses out on reading a different perspective from the LIC or LMIC. In this context, the introduction of PREPSS is an excellent and welcome initiative that must be supported and promoted.
    In this context, we would like to highlight the role of AuthorAID: a global platform of more than 17,000 researchers from all around the globe. We have been extensively using this platform for more than a decade to learn and now collaborate and teach other researchers based in the LIC and LMIC. AuthorAID also pr...

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  • A commentary on Global Health Security Index-A guiding tool for preparing for the next pandemic

    Introduction and Brief Overview
    The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR [2005])1. The GHS Index takes into account countries’ capability to prevent, detect, and respond to public health emergencies while also assessing the robustness of the healthcare system in each country. This index is comprehensive since it has the ability to consider political and socioeconomic risks, as well as adherence to international norms, which can influence countries’ abilities to stop outbreaks1,2. The GHS Index has been the creation of Open Philanthropy Project, the Bill & Melinda Gates Foundation and the Robertson Foundation1.
    The GHS Index treats biosafety and biosecurity as critical components of global health security. As such, the tool includes numerous indicators measuring country capacities and accounts for differences in priorities between high income and low/middle income countries. The GHS index is based on 6 categories, 34 indicators, and 85 sub-indicators. The six categories comprise prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment5.
    This article describes the practical value of the GHS Index and also explains how the methodology of assigning country ranks and scores is helpful in aidin...

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  • MITIGATION MEASURES TO PREVENT THE NEXT PANDEMIC

    We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1

    COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2

    Airborne or droplet borne. The infectious...

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  • A need for better understanding old-age mortality dynamics

    A need for better understanding old-age mortality dynamics
    Sergi Trias-Llimós* & Iñaki Permanyer
    Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
    * Corresponding author. Email: strias@ced.uab.cat

    Correspondence letter in response to:
    Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.

    Word count: 492

    The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
    Despite their enormous interest, these findings should be interpreted with caution. As the authors...

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  • Human rights based approach for addressing structural violence

    To the editor
    We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
    global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
    bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.

    The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportio...

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  • Tranexamic acid in patients with moderate or severe traumatic brain injury

    Williams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.

    Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).

    There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the...

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