eLetters

55 e-Letters

published between 2000 and 2003

  • Learing from the TBA
    Cory Mermer

    Dear Editor

    Modern obstetritions in developed nations would do well to emulate Traditional Birth Attendents. These women are much less apt to cause iatrogenic injury, which is so often unknowingly done by OB/GYNs in modern actively managed births when the umbilical cord is clamped almost immediately. This prevents normal placental transfusion and causes hypoxia and hypovolemia in the newborn.

    For more i...

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  • New directions
    Guillermo Llanos

    Dear Editor

    I think it is time to renew ideas at PAHO. Drs Roses and Casas had been high level officers for many years, why did not they implemented their suggestions? Dr Sepúlveda is a bright public health man from Mexico, with an oustanding curriculum. Lets work towards improving PAHO's activities with new people.

  • Re: Psychosocial factors and Public Health. Authors' reply to the eLetter by John Macleod
    Tores Theorell
    Dear Editor

    The discussion triggered by this paper is a useful one. In general I agree with McLeod, and Davey Smith that we have to be careful when we make conclusions regarding etiology. Socioeconomic factors could certainly confound the relationships. Adjustment for socioeconomic factors could also conceal true relationships, however. In this literature (see the review by Schnall et al. 2000 which has been referred...

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  • Psychosocial factors and health: response by Macleod and Davey Smith to authors' reply
    John Macleod

    Dear Editor

    We are grateful to Peter and colleagues for taking the trouble to respond to our e-letter. They raise several issues that we will try to address briefly.

    First, they say effort-reward imbalance had no relation to socio-economic status in their study. We are unclear how they assessed this – the only SES measure they mention in their paper is a white-collar/blue- collar binary distinction. Effort–r...

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  • Re: Psychosocial factors and Public Health. Authors' reply to the e-letter by John Macleod
    Richard Peter

    Dear Editor

    We agree with John Macleod concerning the importance of a better understanding of social inequalities in health. Yet, the paper to which he refers (Peter et al., 2002) [1] was not primarily intended to explain social inequalities, but rather to demonstrate an improved prediction of CHD risk by combining standardized measures of two innovative theoretical concepts of psychosocial stress at work. M...

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  • Psychosocial factors and Public Health
    John Macleod

    Dear Editor

    Patterns of human health, particularly the inequalities in health associated with inequalities in social position, are not fully explicable in terms of the social distribution of established risk factors. This lack of understanding may hamper initiatives to ameliorate health inequalities – one of the most important contemporary social projects. The significance of these issues is reflected in the amount o...

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  • Are the blind leading the deaf in the globalization debate?
    J Jaime Miranda

    Dear Editor

    In the September 2001 issue of the JECH, the debate section was dedicated to the complex issue of globalisation. The introductory paper by Fran Baum [1] challenges us to “imagine a world in which the spread of globalization meant the world becoming a more just and equitable place.” Baum presents some reasons—raised at the People’s Health Assembly — that globalization has implied the maintenance of globa...

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  • Attributing causality to observed associations between psychosocial exposures and health: a response
    John Macleod

    Dear Editor

    We are glad that our paper has generated interest amongst readers of the Journal of Epidemiology and Community Health.

    We would like to respond first to the points made by Drs Singh-Manoux and Clarke. The first relates to the importance of theory and the need for a conceptual framework within which to consider how social disadvantage comes to be associated with poorer health (given that...

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  • Confusing confounding and causation
    A Singh-Manoux
    Dear Editor,

    Macleod et al[1] reported the influence of confounding by socioeconomic factors in observational epidemiology, questioning the role of psychosocial exposures in predicting ill-health. The authors concluded that the association between psychosocial exposures and health reported in the literature might be spurious, a result of the association between socioeconomic position and psychosocial exposures. We read wit...

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  • How does social class get under the skin?
    Hans Bosma

    Dear editor,

    With great interest we read the paper by Macleod and co-workers on the influence of psychosocial exposures on 21-year mortality. According to the authors, the small positive effects of stress on mortality became attenuated after control for social class. From this the authors concluded that the effects of psychosocial factors on health reported in a large number of studies from a number of populations...

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