7 e-Letters

published between 2020 and 2023

  • Discrepancies in Mental Health Impacts

    While the data that this article studied and the results that were produced show a change in the mental health status and medication behaviors of Portugal, it does not support the change in mental health status captured in much of the literature around the world. When the COVID-19 virus was declared a pandemic, there was global unrest. It is natural for people to feel fear, anxiety, and panic in the face of an unknown pandemic (Usher, Durkin, & Bhullar, 2020). The article addresses some of the discrepancies between the literature coming out that has been showing increases in anxiety and depressive symptoms in the Discussion section. However, these discrepancies do not align with the data presented in the paper. Further explanation and research is needed as to why rates of some prescription medications to manage mental health symptoms are declining when there is evidence showing that mental illnesses have increase as a result of the pandemic.
    The article discussed a reduction of prescriptions for anxiolytics, sedatives, and hypnotics in children, adolescents, and elderly women. These medications would address the symptoms of anxiety, stress, and other symptoms that a global pandemic may cause (Javed, Sarwer, Soto, & Mashwani, 2020). The authors suggested that perhaps people have been going to see the doctor less frequently due to quarantines and fear of contracting the virus. However, some of the medications are long-term, so it does not make sense that, duri...

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  • The importance of ethnicity and race variables in epidemiology and public health

    The authors, Cifuentes MP, Rodriguez-Villamizar LA, Rojas-Botero ML, et al [1], present an article that, owing to a lack of rigor in the creation and application of ethno-racial categories, ends up employing an analysis method that, although intended to allow proving inequalities, ends up disguising or attenuating them.

    Raj Bhopal published a seminal article in this journal in 2004 demonstrating the importance of ethnicity and race variables in epidemiology and public health. Bhopal pointed out that, at a minimum, researchers should explain their understanding of the concepts of race or ethnicity and the classification they use, even more so when we know that they need development in terms of geographic specificity, scope, and precision for different contexts [2]. Similar recommendations are made by Janeth Mosquera in her analysis about the use of the ethnic-racial category in the research published by the three most important scientific journals of Public Health in Colombia [3].

    The paper does not present a comprehensive and helpful description of the categories that assist the reader in understanding the ethnic-racial composition of the Colombian population and correctly analyze the regularly available data for public health surveillance. The Colombian surveillance system employs the census ethnic-racial categories. Among these Census categories, the "white-mestizo" used by the authors is not defined and thus is not used for public health surveill...

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  • ICNIRP Response to: John William Frank “Electromagnetic fields, 5G and health: what about the precautionary principle?”

    Frank’s essay contains several statements about 5G, its relation to the radiation protection science, and related to this, ICNIRP’s guidance and integrity more generally. ICNIRP considers this to be seriously inaccurate and in need of correction for the sake of both scientific accuracy and development of effective public health policy. However, due to journal word limits we must restrict our response to Frank’s misleading claims about ICNIRP’s integrity (for full response see https://www.icnirp.org/en/activities/news/index.html).

    Frank’s essay accuses ICNIRP of unmanaged conflict of interests, and uses this accusation to attempt to throw doubt on ICNIRP’s scientific evaluations. However, ICNIRP has a very rigorous procedure to avoid conflicts of interest (https://www.icnirp.org/en/about-icnirp/commission/index.html), and Frank did not provide any evidence in support of his statement - he merely referred to ‘persistent allegations’ from the Swedish epidemiologist Lennart Hardell. For example, Frank repeats claims made by Hardell that “ICNIRP’s membership includes over-representation of vested interests, especially the giant multinational telecommunications firms who are heavily invested in the roll out of 5G systems internationally”, and no supporting evidence was provided by either author. To be clear, there are no industry r...

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  • Antidepressants and suicidality

    Hengartner et al. conducted a meta-analysis on suicide risk with selective serotonin reuptake inhibitors (SSRI) and other new-generation antidepressants in adults (1). Although the pooled relative risks (RRs) of SSRI for suicide risk including suicide and suicide attempt in patients with depression and in patients with all indications did not reach the level of significance, the pooled RR (95% confidence intervals [CIs]) of any new-generation antidepressant for suicide risk in patients with depression and in patients with all indications were 1.29 (1.06-1.57) and 1.45 (1.23-1.70), respectively. The authors presented information on the different suicide risk between SSRI and other new-generation antidepressants , and I present additional information regarding the relationship.

    First, Sharma et al. conducted a meta-analysis on the association of SSRI and serotonin-norepinephrine reuptake inhibitors with suicidality and other mental indicators (2). Although the pooled odds ratios (ORs) of antidepressant treatment for suicidality and aggression did not reach the level of significance in adults, the pooed ORs (95% CIs) of antidepressant treatment for suicidality and aggression were 2.39 (1.31-4.33) and 2.79 (1.62-4.81) in children/adolescents. The suicide risk differed in different generations, and suicide risk estimation should be conducted by stratification with generation and type of anti-depressants.

    Second, Hengartner and Plöderl reported that odds ratios (OR...

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  • Back to the topic: high cardiovascular mortality in Russia

    The question “Why does Russia have such high cardiovascular (CV) mortality rates?”1 can be answered by a pathologist who practiced during the Soviet time.2 Since then, the quality of post mortem examinations has decreased especially during the 1990s: autopsies were sometimes made perfunctorily. The deterioration in anatomic pathology and the health care in general during the 1990s coincided with the increase in the registered CV mortality. A tendency to over-diagnose CV diseases is generally known to exist also for people dying at home and not undergoing autopsy. If a cause of death is not entirely clear, it has been usual to write on a death certificate: “Ischemic heart disease with cardiac insufficiency” or a similar formulation.2 Concerning the relatively high CV mortality in Russia, it should be commented that irregular treatment of hypertension,3 diabetes and other chronic diseases continues to be a problem. Considering the above, the differences between Norwegian and Russian cohorts1 can be better understood. The levels of serum lipids were comparable between Russia and Norway being slightly higher in the latter possibly due to better nutrition. Interestingly, N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and high-sensitivity C-reactive protein (hsCRP) were higher in Russia.1 It can be reasonably assumed that average levels of these markers inversely correlate with a nation’s health reflected by the life expecta...

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  • Role of presymptomatic transmission of COVID-19: evidence from Beijing, China- A Response

    We read with interest, intrigue and concern the findings reported in this short report. if the findings are validated from larger and multicentric data this may have huge implications in the way we trace and isolate the COVID-19 contacts. Pre symptomatic transmission from index cases 5 days prior to the onset of symptoms is a huge logistical nightmare in terms of containment strategies. This would imply at practical impossibility and futility of these strategy especially in setting of cluster or community transmission. This also highlights the virtues of basic but universal measures like physical distancing, hygiene and use of mask at all times under specific settings.

  • Are Associations Between Television Viewing and Mortality Due to Confounding?

    We read with great interest the report from Hamer and colleagues that examined the hypothesis that associations between television (TV) viewing and mortality from heart disease (HD) are due to confounding (1). They employed a negative control approach (2) and report evidence of associations between TV viewing and HD mortality (HR=1.09 [1.06, 1.12] per 1 hr/day increase in TV) and accidental deaths (the negative control outcome; HR=1.06 [0.98, 1.15]) after adjusting for age, sex, smoking, education, and prevalent HD (1)

    The positive association between TV and accidental deaths was interpreted as evidence that the TV-HD mortality association was due to confounding. Although key study limitations were noted including a small number of accidental deaths and limited adjustment for confounding, the authors concluded that “observed associations between TV and HD are likely to be driven by confounding”. Although we agree that confounding is a worrisome threat to the internal validity of epidemiologic studies, we believe that the conclusion in the Hamer report is overstated.

    A critical additional strategy to understand bias due to confounding, one that was not employed in the current study, is to examine relevant results from published studies conducted in different study populations using different methods. (2) We previously reported results in two studies that examined associations for accidental deaths and HD mortality with TV viewing (3) and leisure-time sitti...

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