During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, patients who are deaf or hard of hearing face prolonged wait times and are often unable to fully express their medical needs and fully comprehend what is happening with their medical care. When patients cannot adequately communicate their health needs, they are unable to get the care they need, exacerbating existing inequities.
When health systems and society do not accommodate individuals with hearing loss, they contribute to social isolation. This isolation can manifest in poorer long-term health outcomes such as dementia and premature mortality.4
As the prevalence of unsafe listening practices in adolescents and young adults continues to grow5, we need to continue our advocacy efforts to optimize the health care environment so that persons who are deaf or hard of hearing can get the best medical care possible.
This includes not only access to timely and appropriate sign language interpretation but also captioning options, American Sign Language-translated videos, assistive devices that facilitate appointment scheduling and quiet environments that allow patients to better communicate with the providers.6
We also need better training for all members of the healthcare team to understand the nuances involved in caring for deaf and hard of hearing patients. These steps are useful not only in the medical setting but in all social settings so that the deaf and hard of hearing can be fully integrated in our society.
1. Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol. 2020 Oct 28:1-7. doi: 10.1080/17483107.2020.1822449. Epub ahead of print. PMID: 33112178.
2. Oyler AL. Untreated hearing loss in adults. Accessed from https://www.asha.org/Articles/Untreated-Hearing-Loss-in-Adults/#:~:text=... on December 1, 2022.
3. Emmett SD, Francis HW. The socioeconomic impact of hearing loss in U.S. adults. Otol Neurotol. 2015 Mar;36(3):545-50. doi: 10.1097/MAO.0000000000000562. PMID: 25158616; PMCID: PMC4466103.
4. Ciorba A, Bianchini C, Pelucchi S, Pastore A. The impact of hearing loss on the quality of life of elderly adults. Clin Interv Aging. 2012;7:159-63. doi: 10.2147/CIA.S26059. Epub 2012 Jun 15. PMID: 22791988; PMCID: PMC3393360.
5. Dillard LK, Arunda MO, Lopez-Perez L, et al. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Global Health 2022;7:e010501.
6. Tonelli M, Warick R. Focusing on the Needs of People With Hearing Loss During the COVID-19 Pandemic and Beyond. JAMA. 2022;327(12):1129–1130. doi:10.1001/jama.2022.3026
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely...
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely to be in global north institutions that can afford it. I believe this is one of the most important reasons why equity of access for authors and others involved in journal publication has not progressed more than it has, as shown in the current article.
A quick look through the first editions of RHM shows that we had a very international group of board members, authors and peer reviewers from a wide range of countries, including the global south (or what the authors of this article call LMIC countries). But like other journals, we did not have a policy to that effect at the beginning, only the politics of international feminism and women’s rights. This changed when one of the trustees put this subject on the agenda of an annual meeting, around 1997, and proposed that we develop written policy on equity, which we did. Its first and most important point was that any paper published about a specific country had to be by at least some authors from that country, not just as an afterthought at the end of the list or as people who were thanked for “helping with the research”. Together we enforced this policy throughout my editorship, which lasted 23 years. With each edition, I would do a count of how many authors and peer reviewers and countries were represented by the articles and from which parts of the world. I reported this to the annual meetings as well, though I can’t recall for how long.
We were very aware that few if any other journals did the same at the time, including the most important health-related journals, whose tables of contents I scoured regularly for news and partly with checking equity of authorship in mind.
When I left RHM in May 2015, its name, editorship, staff, boards, and publisher all changed. I don’t know if this policy has continued. I do know that real open access in most journals is far less available than we may be led to believe.
To,
The Editor,
We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical....
To,
The Editor,
We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical. This advocacy has worked and is exemplified by greater decrease in neonatal mortality. .
We declare no conflict of interest.
Phadke M. A1*, Nair R2*, Menon P3*, Jotkar R4*.
1*Sr. Adv Govt,UNICEF,Mumbai, India
2*Nutrition Specialist,UNICEF,Mumbai, Maharashtra, India
3*Asso. Prof, Pediatrics, MEDD, DY P. Med College, Pune, India
4*Sr. Consultant R.Jijau mission, DWCD,Govt of Mah Mumbai,India
References:
1.Deliberation-based learning: strengthening neonatal care in China http://orcid.org/0000-0001-5158-3267Yue Xiao1,
Yingpeng Qiu1, Lewis Husain2,Gerald Bloom2,
Liwei Shi1Correspondence to Dr. Yue Xiao; moonxy@126.com
The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine...
The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine (drug given in complicated Falciparum malaria) and rifampicin (1st line drug for Tuberculosis).
Adverse drug reactions under- reporting is very high in India.4 Doctors, Health Care Workers (HCWs) treating malaria patients, including peripheral areas must be encouraged to report ADRs and should be trained for drug reactions management. They should also provide data on adverse drug effects of antimalarial when given during pregnancy and lactation, fetal toxicity i.e. effect of cardiac malformation and skeletal defects due to some of anti-malarial drugs and lastly G-6 PD Deficiency and use of primaquine where a significant proportion of population has high prevalence of G6PD
deficiency. Drug efficacy is also affected by may complains and ADR reporting as time may help in proper m/m at local level and incorporation of important new points in malaria treatment guidelines. For malaria elimination, thus sharing of data demonstrating or exhibiting (a) Drug efficacy and bioavailability of drugs (b) Real time reporting of ADR of individual drugs (c) Drug interactions (d) Information regarding radical cure given to patients (especially in P vivax endemic regions) and compliance of primaquine, in digital dashboard will strengthen the system and definitely a country with highest P. vivax cases (India accounts for nearly 50% cases of Plasmodium vivax cases) should think about alternative to primaquine 5 .
Reference:
1. Rahi M, Sharma A. For malaria elimination India needs a platform for data integration BMJ Global Health 2020;5:e004198.
2. Shrivastva, S., Chakma, T., Das, A. and Verma, A.K. (2021), Digitisation and realtime sharing of unified surveillance tool and clinicopathological data for efficient management of disease outbreaks. Int J Health Plann Mgmt, 36: 1352-1354. https://doi.org/10.1002/hpm.3163
3. Sim IK, Davis TM, Ilett KF. Effects of a high-fat meal on the relative oral bioavailability of piperaquine. Antimicrob Agents Chemother. 2005 Jun;49(6):2407-11. doi: 10.1128/AAC.49.6.2407-2411.2005. PMID: 15917540; PMCID: PMC1140540.
4. Tandon, V. R., Mahajan, V., Khajuria, V., &Gillani, Z. (2015). Under-reporting of adverse drug reactions: a challenge for pharmacovigilance in India. Indian journal of pharmacology, 47(1), 65–71. https://doi.org/10.4103/0253-7613.150344
5. Wells, T. N., Alonso, P. L., &Gutteridge, W. E. (2009). New medicines to improve control and contribute to the eradication of malaria. Nature reviews. Drug discovery, 8(11), 879–891. https://doi.org/10.1038/nrd2972.
Sir ,Voluntary noise exposure can be avoided. Every country has laws for noise pollution but the ground reality? Just by one act of "Abolishing Horn facility in vehicles" can have unimaginable health benefits to humans and animals in the whole world. I even wrote to Shri Modiji,my beloved PM but I wonder if it reached his ears since he too must be a victim of noise pollution(on a lighter note ). Can Bmj reach out to tall leaders of all countries through this Rapid Response????
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, patients who are deaf or hard of hearing face prolonged wait times and are often unable to fully express their medical needs and fully comprehend what is happening with their medical care. When patients cannot adequately communicate their health needs, they are unable to get the care they need, exacerbating existing inequities.
When health systems and society do not accommodate individuals with hearing loss, they contribute to social isolation. This isolation can manifest in poorer long-term health outcomes such as dementia and premature mortality.4
As the prevalence of unsafe listening practices in adolescents and young adults continues to grow5, we need to continue our advocacy efforts to optimize the health care environment so that persons who are deaf or hard of hearing can get the best medical care possible.
This includes not only access to timely and appropriate sign language interpretation but also captioning options, American Sign Language-translated videos, assistive devices that facilitate appointment scheduling and quiet environments that allow patients to better communicate with the providers.6
We also need better training for all members of the healthcare team to understand the nuances involved in caring for deaf and hard of hearing patients. These steps are useful not only in the medical setting but in all social settings so that the deaf and hard of hearing can be fully integrated in our society.
1. Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol. 2020 Oct 28:1-7. doi: 10.1080/17483107.2020.1822449. Epub ahead of print. PMID: 33112178.
2. Oyler AL. Untreated hearing loss in adults. Accessed from https://www.asha.org/Articles/Untreated-Hearing-Loss-in-Adults/#:~:text=... on December 1, 2022.
3. Emmett SD, Francis HW. The socioeconomic impact of hearing loss in U.S. adults. Otol Neurotol. 2015 Mar;36(3):545-50. doi: 10.1097/MAO.0000000000000562. PMID: 25158616; PMCID: PMC4466103.
4. Ciorba A, Bianchini C, Pelucchi S, Pastore A. The impact of hearing loss on the quality of life of elderly adults. Clin Interv Aging. 2012;7:159-63. doi: 10.2147/CIA.S26059. Epub 2012 Jun 15. PMID: 22791988; PMCID: PMC3393360.
5. Dillard LK, Arunda MO, Lopez-Perez L, et al. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Global Health 2022;7:e010501.
6. Tonelli M, Warick R. Focusing on the Needs of People With Hearing Loss During the COVID-19 Pandemic and Beyond. JAMA. 2022;327(12):1129–1130. doi:10.1001/jama.2022.3026
Pardon my literary brevity, but this article does little in the way of actually helping poor communities . All you are
doing is changing words around to sugar coat widespread healthcare inequalities ( disparities ) in this country. Why not just call it what it is and do something about it, ipso facto ? It is dissapointing to read an article where the primary debate centers on linguistics or terminology and not practical solutions to real life health problems. So what if a country is 'developing', we used to call them "third world " what the hell is the difference? My bigger point is should we not concentrate on helping each other instead of finding different ways to be woke .
The article does not adequately take into account a crucial ethical and (by implication, legal) fact: the argument from proportionality does not justify arbitrary violations of the right to life or the removal of the right to free medical consent, for the following reasons.
Summary of the three strongest arguments against the ethical permissibility of vaccine mandates and why any medical procedure imposed by coercion must be refused.
1. Vaccine mandates imply that all humans are born in a defective, inherently harmful state that must be biotechnologically augmented to allow their unrestricted participation in society, and this constitutes discrimination on the basis of healthy, innate characteristics of the human race. (This point derives from my paper published here: https://jme.bmj.com/content/48/4/240).
2. Medical consent must be free – not coerced – in order to be valid. Any discrimination against the unvaccinated is economic or social opportunity coercion, precluding the possibility of valid medical consent. The right to free, uncoerced medical consent is not negotiable, under any circumstances, because without it we have no rights at all; every other right can be subverted by medical coercion. Crucially, by accepting any medical treatment imposed by coercion we would be acquiescing to the taking away of the right to free medical consent not just from ourselves but from our children and from futur...
The article does not adequately take into account a crucial ethical and (by implication, legal) fact: the argument from proportionality does not justify arbitrary violations of the right to life or the removal of the right to free medical consent, for the following reasons.
Summary of the three strongest arguments against the ethical permissibility of vaccine mandates and why any medical procedure imposed by coercion must be refused.
1. Vaccine mandates imply that all humans are born in a defective, inherently harmful state that must be biotechnologically augmented to allow their unrestricted participation in society, and this constitutes discrimination on the basis of healthy, innate characteristics of the human race. (This point derives from my paper published here: https://jme.bmj.com/content/48/4/240).
2. Medical consent must be free – not coerced – in order to be valid. Any discrimination against the unvaccinated is economic or social opportunity coercion, precluding the possibility of valid medical consent. The right to free, uncoerced medical consent is not negotiable, under any circumstances, because without it we have no rights at all; every other right can be subverted by medical coercion. Crucially, by accepting any medical treatment imposed by coercion we would be acquiescing to the taking away of the right to free medical consent not just from ourselves but from our children and from future generations, and we do not have the right to do this. Acquiescence to medical coercion is always unethical, even if the mandated intervention were a placebo.
3. Covid vaccines are known to occasionally cause deaths of healthy people. When an employee is required to receive Covid vaccination as a condition of employment, that employee is economically coerced to participate in an activity where some percentage of employees are expected to die ‘in the course of employment’ as a direct result of the mandated activity. This goes against the fundamental principles of medical ethics and workplace safety. It may be objected that Covid-19 also kills people, but these two categories of deaths are not ethically equivalent. Infection with SARS-CoV-2 is not mandated, whereas deaths resulting from mandatory vaccination are mandated deaths, a legalised killing of some people for the prospective benefit of the majority. Critically, any discrimination against the unvaccinated (or a privileged treatment of the vaccinated) amounts to a violation of the right to life, because a small percentage of the targeted population are expected to die as a result of this coercive treatment.
As the Australian economist Sanjeev Sabhlok said: “Governments are not authorised by law - by analogy - to burn down additional homes and kill unaffected people in order to save those who might be at risk of being engulfed in a bushfire.”
An earlier version of these arguments were formally submitted to the Inquiry into Public Health Amendment Bill 2021 (No 2) ACT, Australia:
We read the systematic review by Dong et al. [1] with great interest. The authors aimed to describe global seroprevalence estimates for B. burgdorferi s.l., the causal agent of Lyme disease.
First, estimating seropositivity for a target population (here, the global population) has two challenges we would like to address:
1) The age and sex distribution of the population providing sample(s) and the target population should correspond. The simple reason is that advancing age and male sex are well-established risk factors for a positive IgG antibody serostatus [2]. Therefore, one may not conclude the general population seropositivity from an aged sample with a large share of males if not corrected accordingly, e.g., by applying weights; otherwise, seropositivity may be overestimated. Unfortunately, the age and sex profiles of the individual studies were seemingly not considered or discussed for their final seropositivity estimates.
2) Then, as already stated in the first reply to this manuscript by A. Semper et al., the studies containing subjects with medical conditions or even patients with suspected or confirmed Lyme disease symptomatology are of little use for general population estimates of seropositivity (e.g., [3, 4], included by Dong et al.), as these populations do not correspond to the global population. Also, pooling seropositivity proportions for high-risk populations to obtain global estimates potentially introduces bias and, hence, should be a...
We read the systematic review by Dong et al. [1] with great interest. The authors aimed to describe global seroprevalence estimates for B. burgdorferi s.l., the causal agent of Lyme disease.
First, estimating seropositivity for a target population (here, the global population) has two challenges we would like to address:
1) The age and sex distribution of the population providing sample(s) and the target population should correspond. The simple reason is that advancing age and male sex are well-established risk factors for a positive IgG antibody serostatus [2]. Therefore, one may not conclude the general population seropositivity from an aged sample with a large share of males if not corrected accordingly, e.g., by applying weights; otherwise, seropositivity may be overestimated. Unfortunately, the age and sex profiles of the individual studies were seemingly not considered or discussed for their final seropositivity estimates.
2) Then, as already stated in the first reply to this manuscript by A. Semper et al., the studies containing subjects with medical conditions or even patients with suspected or confirmed Lyme disease symptomatology are of little use for general population estimates of seropositivity (e.g., [3, 4], included by Dong et al.), as these populations do not correspond to the global population. Also, pooling seropositivity proportions for high-risk populations to obtain global estimates potentially introduces bias and, hence, should be avoided [5].
Furthermore, one study [6] included by Dong et al. [1] considered US, UK, Australian, and German serosamples seems to match the exclusion criteria, as it does not provide participant categories corresponding to the samples. Also, this study aimed to compare assays and test results between laboratories, not to assess seroprevalence. According to [6], the samples considered partially were previously tested for Lyme disease or originate from endemic areas, which indicates that these samples may not be representative of the general population and, therefore, may not be suited for general population estimates.
Then, we perceive that Dong et al. [1] did not differentiate between IgG and IgM class antibodies for their global estimates, despite reported differences in seropositivity proportions for each antibody class (Fig 2). Ideally, IgG and IgM are considered separately and not pooled for global estimates, as IgM serostatus may underestimate long-term serostatus due to its short-term detectability compared to IgG [7].
We want to add the limitation that different serological tests used over time result in differing seropositivity due to varying sensitivity and specificity [8], i.e., hamper comparability, which may contribute to the heterogeneity found by Dong et al.
Finally, some minor remarks: it is not clear to us whether the authors only considered peer-reviewed papers, as indicated by the abstract, or also grey literature, as indicated in the methods section. Then, the search strategies presented in the abstract differ substantially from the strategies presented in Supplementary appendix 2. Further unclear aspects from the literature search are: 1) how the search could have started back in 1984, 2) how the last date of the literature lies past the article submission date, with no indication of an updated search during the review procedure, 3) why the authors considered literature with PCR testing methods, as these are not of use for antibody detection.
References
1 Dong Y, Zhou G, Cao W, et al. Global seroprevalence and sociodemographic characteristics of Borrelia burgdorferi sensu lato in human populations: a systematic review and meta-analysis. BMJ Glob Health 2022;7(6). doi: 10.1136/bmjgh-2021-007744
2 Wilking H, Fingerle V, Klier C, et al. Antibodies against Borrelia burgdorferi sensu lato among Adults, Germany, 2008-2011. Emerg Infect Dis 2015;21(1):107–10. doi:10.3201/eid2101.140009
3 Karatolios K, Maisch B, Pankuweit S. Suspected inflammatory cardiomyopathy. Prevalence of Borrelia burgdorferi in endomyocardial biopsies with positive serological evidence. Herz 2015;40 Suppl 1:91–95. doi:10.1007/s00059-014-4118-x
4 Dersch R, Sarnes A, Maul M, et al. Immunoblot reactivity at follow-up in treated patients with Lyme neuroborreliosis and healthy controls. Ticks Tick Borne Dis 2019;10(1):166–69. doi:10.1016/j.ttbdis.2018.09.011 [published Online First: 26 September 2018].
5 Spronk I, Korevaar JC, Poos R, et al. Calculating incidence rates and prevalence proportions: not as simple as it seems. BMC Public Health 2019;19(1):512. doi:10.1186/s12889-019-6820-3 [published Online First: 6 May 2019].
6 Best SJ, Tschaepe MI, Wilson KM. Investigation of the performance of serological assays used for Lyme disease testing in Australia. PLoS One 2019;14(4):e0214402. doi:10.1371/journal.pone.0214402 [published Online First: 29 April 2019].
7 Coors A, Hassenstein MJ, Krause G, et al. Regional seropositivity for Borrelia burgdorferi and associated risk factors: findings from the Rhineland Study, Germany. Parasit Vectors 2022;15(1):241. doi:10.1186/s13071-022-05354-z [published Online First: 4 July 2022].
8 Cook MJ, Puri BK. Commercial test kits for detection of Lyme borreliosis: a meta-analysis of test accuracy. Int J Gen Med 2016;9:427–40. doi:10.2147/IJGM.S122313 [published Online First: 18 November 2016].
This is a thought-provoking article and I can see similar tensions and themes in my own collaborative relationships. I would have liked to see more discussion of how the funding opportunity shaped and contributed to these tensions and what the role of the funder is in contributing to healthy equitable collaborations. Many of the decisions were driven by how to meet the expectations of the funder. It would also be interesting to examine these tensions in long-term collaborations that exist outside of any one specific funding opportunity.
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Show MoreApproximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely...
Show MoreTo,
Show MoreThe Editor,
We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical....
Dear Editor,
The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine...
Show MoreSir ,Voluntary noise exposure can be avoided. Every country has laws for noise pollution but the ground reality? Just by one act of "Abolishing Horn facility in vehicles" can have unimaginable health benefits to humans and animals in the whole world. I even wrote to Shri Modiji,my beloved PM but I wonder if it reached his ears since he too must be a victim of noise pollution(on a lighter note ). Can Bmj reach out to tall leaders of all countries through this Rapid Response????
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Show MoreApproximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
Pardon my literary brevity, but this article does little in the way of actually helping poor communities . All you are
doing is changing words around to sugar coat widespread healthcare inequalities ( disparities ) in this country. Why not just call it what it is and do something about it, ipso facto ? It is dissapointing to read an article where the primary debate centers on linguistics or terminology and not practical solutions to real life health problems. So what if a country is 'developing', we used to call them "third world " what the hell is the difference? My bigger point is should we not concentrate on helping each other instead of finding different ways to be woke .
The article does not adequately take into account a crucial ethical and (by implication, legal) fact: the argument from proportionality does not justify arbitrary violations of the right to life or the removal of the right to free medical consent, for the following reasons.
Summary of the three strongest arguments against the ethical permissibility of vaccine mandates and why any medical procedure imposed by coercion must be refused.
1. Vaccine mandates imply that all humans are born in a defective, inherently harmful state that must be biotechnologically augmented to allow their unrestricted participation in society, and this constitutes discrimination on the basis of healthy, innate characteristics of the human race. (This point derives from my paper published here: https://jme.bmj.com/content/48/4/240).
2. Medical consent must be free – not coerced – in order to be valid. Any discrimination against the unvaccinated is economic or social opportunity coercion, precluding the possibility of valid medical consent. The right to free, uncoerced medical consent is not negotiable, under any circumstances, because without it we have no rights at all; every other right can be subverted by medical coercion. Crucially, by accepting any medical treatment imposed by coercion we would be acquiescing to the taking away of the right to free medical consent not just from ourselves but from our children and from futur...
Show MoreWe read the systematic review by Dong et al. [1] with great interest. The authors aimed to describe global seroprevalence estimates for B. burgdorferi s.l., the causal agent of Lyme disease.
First, estimating seropositivity for a target population (here, the global population) has two challenges we would like to address:
Show More1) The age and sex distribution of the population providing sample(s) and the target population should correspond. The simple reason is that advancing age and male sex are well-established risk factors for a positive IgG antibody serostatus [2]. Therefore, one may not conclude the general population seropositivity from an aged sample with a large share of males if not corrected accordingly, e.g., by applying weights; otherwise, seropositivity may be overestimated. Unfortunately, the age and sex profiles of the individual studies were seemingly not considered or discussed for their final seropositivity estimates.
2) Then, as already stated in the first reply to this manuscript by A. Semper et al., the studies containing subjects with medical conditions or even patients with suspected or confirmed Lyme disease symptomatology are of little use for general population estimates of seropositivity (e.g., [3, 4], included by Dong et al.), as these populations do not correspond to the global population. Also, pooling seropositivity proportions for high-risk populations to obtain global estimates potentially introduces bias and, hence, should be a...
This is a thought-provoking article and I can see similar tensions and themes in my own collaborative relationships. I would have liked to see more discussion of how the funding opportunity shaped and contributed to these tensions and what the role of the funder is in contributing to healthy equitable collaborations. Many of the decisions were driven by how to meet the expectations of the funder. It would also be interesting to examine these tensions in long-term collaborations that exist outside of any one specific funding opportunity.
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