Interested readers should note a relevant Belgian study on this subject was not cited. It repetitively obtained COVID-19 vaccination intentions before and after vaccine introduction in Belgium in 2020 and 2021, and reported results in real time through reports and press releases (see www.corona-study.be), noting the high general vaccination intentions (in closer accordance with the official records of actual coverage than the pre-implementation references cited here) and most of the socioeconomic disparities reported here. These results were also published after peer review in January 2022 for the pre-implementation period in Flanders, the largest region of Belgium (see Valckx et al, Vaccine 2022 at https://www.sciencedirect.com/science/article/pii/S0264410X21014146 ).
Airagnes et al. examined the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU) (1). The effort–reward imbalance was calculated in quartiles, and the adjusted odds ratios (95% confidence intervals) of the third and fourth quartiles of effort-reward imbalance for incident LTBU over a 2-year follow-up period were 1.74 (1.17 to 2.57) and 2.18 (1.50 to 3.16), respectively. They also clarified a dose-dependent relationship and an
interaction of tobacco smoking on the relationship. I have a comment with special reference to the number of subjects with LTBU during follow-up in each sex.
About two thirds of subjects with LTBU during follow-up were women. The same authors reported that the prevalence of long-term prescribed benzodiazepine use in the French population was 2.8% in men and 3.8% in women in the year 2015 (2). Although the total percentage of subjects with LTBU during follow-up was under 1%, there are differences in the long-term prescription percentage between men and women. As the authors observed the interaction of tobacco smoking on the relationship, I recommend the additional analysis, which should be stratified by sex, according to their previous cross-sectional study (3).
References
1. Airagnes G, Lemogne C, Kab S, et al. Effort-reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort. J Epidemiol Community Health. 2019 Nov;73(11):993-1001.
2. Aira...
Airagnes et al. examined the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU) (1). The effort–reward imbalance was calculated in quartiles, and the adjusted odds ratios (95% confidence intervals) of the third and fourth quartiles of effort-reward imbalance for incident LTBU over a 2-year follow-up period were 1.74 (1.17 to 2.57) and 2.18 (1.50 to 3.16), respectively. They also clarified a dose-dependent relationship and an
interaction of tobacco smoking on the relationship. I have a comment with special reference to the number of subjects with LTBU during follow-up in each sex.
About two thirds of subjects with LTBU during follow-up were women. The same authors reported that the prevalence of long-term prescribed benzodiazepine use in the French population was 2.8% in men and 3.8% in women in the year 2015 (2). Although the total percentage of subjects with LTBU during follow-up was under 1%, there are differences in the long-term prescription percentage between men and women. As the authors observed the interaction of tobacco smoking on the relationship, I recommend the additional analysis, which should be stratified by sex, according to their previous cross-sectional study (3).
References
1. Airagnes G, Lemogne C, Kab S, et al. Effort-reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort. J Epidemiol Community Health. 2019 Nov;73(11):993-1001.
2. Airagnes G, Lemogne C, Renuy A, et al. Prevalence of prescribed benzodiazepine longterm use in the French general population according to sociodemographic and clinical factors: findings from the CONSTANCES cohort. BMC Public Health 2019;19(1):566.
3. Airagnes G, Lemogne C, Olekhnovitch R, et al. Work-related stressors and increased risk of benzodiazepine long-term use: Findings from the CONSTANCES population-based cohort. Am J Public Health. 2019;109(1):119-125.
The article by Kiely et al., which reported a higher risk of injection site reactions in women than men for both younger and older participants, is interesting. The risk of systemic reactions was also higher following influenza vaccination in women than in men, irrespective of age and vaccine type.1 These findings are a valuable addition to the literature. However, we have two concerning issues for the authors.
First, there is underreporting, which occurs in any adverse events following vaccine or drug studies based on spontaneous reporting.2 Underreporting is a problem in adverse events studies following vaccination using self-reported data. This may lead to a bias away from the null value, and they are susceptible to response bias, social desirability bias, and misclassification.3 Therefore, with underreporting, the conclusions may not be rigorous.
Second concern is the possibility of age and sex differences in adverse events following seasonal influenza vaccination. Previous studies have shown that elderly women have higher humoral responses against influenza than elderly men, but not young women compared with young men.4,5 Some authors have also reported sex and age differences in influenza vaccination. Elderly women typically suffered more frequently from local and systemic side effects because antibody induction is usually higher elderly women than in elderly men after vaccination. Consequently, the sex-related difference observed would not be the true di...
The article by Kiely et al., which reported a higher risk of injection site reactions in women than men for both younger and older participants, is interesting. The risk of systemic reactions was also higher following influenza vaccination in women than in men, irrespective of age and vaccine type.1 These findings are a valuable addition to the literature. However, we have two concerning issues for the authors.
First, there is underreporting, which occurs in any adverse events following vaccine or drug studies based on spontaneous reporting.2 Underreporting is a problem in adverse events studies following vaccination using self-reported data. This may lead to a bias away from the null value, and they are susceptible to response bias, social desirability bias, and misclassification.3 Therefore, with underreporting, the conclusions may not be rigorous.
Second concern is the possibility of age and sex differences in adverse events following seasonal influenza vaccination. Previous studies have shown that elderly women have higher humoral responses against influenza than elderly men, but not young women compared with young men.4,5 Some authors have also reported sex and age differences in influenza vaccination. Elderly women typically suffered more frequently from local and systemic side effects because antibody induction is usually higher elderly women than in elderly men after vaccination. Consequently, the sex-related difference observed would not be the true difference in the adverse events following seasonal influenza vaccination.
Although we have some concerns about the study by Kiely et al.1, we applaud the authors for their commendable work and hope that this study will benefit readers. We look forward to further work on the interaction between sex and age in the occurrence and reporting of adverse events following seasonal influenza vaccination, which will benefit high-risk parents.
Contributors YHL, TYY and GPJ wrote the manuscript. GPJ contributed to the final version of the manuscript. GPJ supervised the project.
Funding None.
Competing interests None declared.
Patient consent for publication Not applicable.
Provenance and peer review: Not commissioned; internally peer reviewed.
ORCID iDs
Gwo-Ping Jong http://orcid.org/0000-0002-7786-5497
References:
1. Kiely M, Tadount F, Lo E, et al. Sex differences in adverse events following seasonal influenza vaccines: a meta-analysis of randomised controlled trials. J Epidemiol Community Health. 2023;77:791-801.
2. Pierfitte C, Bégaud B, Lagnaoui R, Moore ND. Is reporting rate a good predictor of risks associated with drugs? Br J Clin Pharmacol 1999;47:329–31.
3. Escolano S, Hill C, Tubert-Bitter P. A new self-controlled case series method for analyzing spontaneous reports of adverse events after vaccination. Am J Epidemiol 2013;178:1496-504.
4. Engler RJM, Nelson MR, Klote MM, et al. Half- vs full-dose trivalent inactivated influenza vaccine (2004-2005): Age, dose, and sex Effects on immune responses. Arch Intern Med 2008;168:2405–14.
5. Giefing-Kröll C, Berger P, Lepperdinger G, et al. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell 2015;14:309–21.
6. Kini A, Morgan R, Kuo H, et al. Differences and disparities in seasonal influenza vaccine, acceptance, adverse reactions, and coverage by age, sex, gender, and race. Vaccine 2022;40:1643-54.
7. Plant EP, Eick-Cost AA, Ezzeldin H, et al. The effects of birth year, age and sex on hemagglutination inhibition antibody responses to influenza vaccination. Vaccines (Basel) 2018;6:39.
An article by Wei et al. reported the death of a child associated with an increased risk of incident atrial fibrillation (AF). The association was observed when the cause of death was both cardiovascular and non-cardiovascular diseases.1 These findings provide a valuable addition to the literature; however, some issues were not addressed by the authors.
First, several clinical risk factors are associated with incident AF, including concurrent medication, illegal drugs, obesity, sleep apnea, and hyperthyroidism.2-4 For example, we previously reported that insulin users had a higher risk of incident AF than non-users among the elderly patients’ cohort (1.58 odds ratio (OR); 95% confidence interval (CI): 1.37–1.82). Patients with dipeptidyl peptidase 4 inhibitor (OR 0.65; 95% CI: 0.45–0.93) intake had a lower risk of developing AF when compared with non-users.4 However, while associated evaluations were not presented, Wei et al. did not exclude individuals with these risk factors. Consequently, confounding effects may have contributed to the significant effects causing incident AF, thus, omitting these effects may improve study validation outcomes.
Second, the study initially enrolled 2,740,028 participants in the unexposed group and 64,216 participants in the exposed group at baseline, but missing data between groups (50.1% vs. 79.6%) were examined in further analyses. These missing data potentially affected data credibility in mediation analyses.5 Consequent...
An article by Wei et al. reported the death of a child associated with an increased risk of incident atrial fibrillation (AF). The association was observed when the cause of death was both cardiovascular and non-cardiovascular diseases.1 These findings provide a valuable addition to the literature; however, some issues were not addressed by the authors.
First, several clinical risk factors are associated with incident AF, including concurrent medication, illegal drugs, obesity, sleep apnea, and hyperthyroidism.2-4 For example, we previously reported that insulin users had a higher risk of incident AF than non-users among the elderly patients’ cohort (1.58 odds ratio (OR); 95% confidence interval (CI): 1.37–1.82). Patients with dipeptidyl peptidase 4 inhibitor (OR 0.65; 95% CI: 0.45–0.93) intake had a lower risk of developing AF when compared with non-users.4 However, while associated evaluations were not presented, Wei et al. did not exclude individuals with these risk factors. Consequently, confounding effects may have contributed to the significant effects causing incident AF, thus, omitting these effects may improve study validation outcomes.
Second, the study initially enrolled 2,740,028 participants in the unexposed group and 64,216 participants in the exposed group at baseline, but missing data between groups (50.1% vs. 79.6%) were examined in further analyses. These missing data potentially affected data credibility in mediation analyses.5 Consequently, the results should be interpreted with caution and not influence teaching or clinical practice before the findings are comprehensively replicated. We suggest performing sensitivity tests on parents of live-born children in 1991–2016, in the Danish Medical Birth Register, to improve study validation.
In conclusion, although we raised some concerns with Wei et al.1, we applaud the authors for their commendable work and hope this study will benefit readers, clinicians, and patients. We look forward to further work on the early prevention of incident AF and hope that early preventive approaches will benefit bereaved parents.
Contributors TKL, TYY and GPJ wrote the manuscript. GPJ contributed to the final version of the manuscript. TYY and GPJ supervised the project.
Funding None.
Competing interests None declared.
Patient consent for publication Not applicable.
Provenance and peer review: Not commissioned; internally peer reviewed.
References:
1. Wei D, Janszky I, Li J, et al. Loss of a child and the risk of atrial fibrillation: a Danish population-based prospective cohort study. J Epidemiol Community Health 2023;77:322-7.
2. Dai H, Zhang Q, Much AA, et al. Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990–2017: results from the Global Burden of Disease Study 2017. Eur Heart J Qual Care Clin Outcomes 2021;7:574–82.
3. Fauchier L, Clementy N, Babuty D. Statin therapy and atrial fibrillation: systematic review and updated meta-analysis of published randomized controlled trials. Curr Opin Cardiol 2013;28:7-18.
4. Chen HY, Yang FY, Jong GP, et al. Antihyperglycemic drugs use and new-onset atrial fibrillation in elderly patients. Eur J Clin Invest 2017;47:388-93.
5. Tsvetanova A, Sperrin M, Peek N, et al. Missing data was handled inconsistently in UK prediction models: a review of method used. J Clin Epidemiol 2021;140:149-58.
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...
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, during a particularly stressful event, these medications would decrease. In addition, the authors noted that there was an increase in overall prescription trends throughout the COVID-19 pandemic, especially in older adults and the elderly. This trend though shows that patients have continued to see their doctors and get prescribed medications for other ailments. This demonstrates that it is possible for patients to continue to receive necessary medications for mental illnesses, despite the hurdles of the pandemic.
In addition to the anxiety and stress that the pandemic may cause, it can also increase rates of depression. During the pandemic, especially in the earlier stages of when doctors and researchers were trying to learn more about it, people spent time at home, away from others. This resulted in people feeling isolated and distanced from other people (Usher, Durkin, & Bhullar, 2020). The distancing from other is one of the issues that can cause an increase in depression. The study showed increasing rates of antidepressant prescriptions before the pandemic began, but then they started to decline, which contradicts the increasing depressive symptoms brought on by the pandemic (Gallagher et al., 2020). The authors saw a trend of a drop in antidepressant prescription rates in male and female children, male adolescents, adults, older adults, and the elderly. However, there was no impact on the rate of prescriptions for antidepressants in women during COVID-19. This is interesting because COVID-19 is not something that impacts one gender more than the other. Additional research would be warranted to explain the gap of prescription rates between genders during the pandemic.
Many different factors can explain the conflicting data, including country studied, rate of medication use before COVID-19, etc. As more information continues to come out about COVID-19 and its impacts on mental health, we’ll more fully understand these discrepancies.
References
Gallagher, M. W., Zvolensky, M. J., Long, L. J., Rogers, A. H., & Garey, L. (2020). The impact of covid-19 experiences and associated stress on anxiety, depression, and functional impairment in American adults. Cognitive Therapy and Research, 44(6), 1043–1051. https://doi.org/10.1007/s10608-020-10143-y
Javed, B., Sarwer, A., Soto, E. B., & Mashwani, Z. U. (2020). The coronavirus (COVID-19) pandemic's impact on mental health. The International journal of health planning and management, 35(5), 993–996. https://doi.org/10.1002/hpm.3008
Usher, K., Durkin, J., & Bhullar, N. (2020). The COVID-19 pandemic and mental health impacts. International journal of mental health nursing, 29(3), 315–318. https://doi.org/10.1111/inm.12726
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...
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 surveillance. Besides, the authors do not define "white-mestizo."
The authors employ an official database published by Colombian national sanitary authorities and provide a link to it. However, as systematic users of the cited source, we must point out that three of the model's explanatory variables are not available on the authors-cited open data platform. Therefore, it is necessary to warn the reader that micro-data on social security affiliation, household's socioeconomic stratum, and area of residence are not available. Consequently, the results are not reproductible with publicly available data. The authors should indicate how they accessed this data and the ethical implications if they exist.
Finally, it is crucial to recognize that the paper implicitly assumes homogeneity in the group's distribution, risk exposure, and events. Authors should discuss whether it is possible, with the available data, to have a syndemic approach, as proposed early on by Bambra and collaborators [4]. This kind of analysis accounts for structural differences within the country and how ethnic groups relate to each other in the territories.
References
1. Cifuentes MP, Rodriguez-Villamizar LA, Rojas-Botero ML, et al. Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study. J Epidemiol Community Health 2021;75:610-615; DOI:10.1136/jech-2020-216275
2. Bhopal R. Glossary of terms relating to ethnicity and race: for reflection and debate. Journal of Epidemiology & Community Health 2004;58:441-445; DOI:10.1136/jech.2003.013466
3. Mosquera Becerra J. Unveiling what is said in the colombian public health journals about race and ethnicity. Rev.CS 2015;16:109-2; DOI: https://doi.org/10.18046/recs.i16.1939
4. Bambra C, Riordan R, Ford J, et al. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health 2020;74:964-968; DOI:10.1136/jech-2020-214401
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...
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 representations within ICNIRP; people working for industry are not permitted to be ICNIRP members, and ICNIRP does not receive any funding or in-kind contributions from industry. Moving beyond funding, Frank claims that the “the most damning evidence adduced by Hardell is a table of the cross-appointments held by six members of the WHO Monograph Group, across five major international advisory panels on the health effects of non-ionising radiation”. However, this merely reflects the relatively small EMF research community together with the high public interest that has resulted in many national and international advisory boards. Frank does not tell the reader why this would in any way bias ICNIRP’s work. Thus, the essay’s accusations of industry influence are not only incorrect, but also lack appropriate scientific scholarship.
In conclusion, ICNIRP fully supports and contributes to critical debate related to the 5G rollout, but would like to stress the importance of approaching such debate with appropriate scientific scholarship in order to support effective, evidence-based public health measures that provide appropriate protection to the public. For ICNIRP it is imperative to avoid situations whereby personal interests of its members could affect the independence of ICNIRP’s guidance, and so has strong conflict of interest procedures, including transparent reporting of members’ declarations of interest.
Acknowledgements
Rodney Croft (1), Tania Cestari (2), Nigel Cridland (3), Akimasa Hirata (4), Guglielmo d'Inzeo (5), Anke Huss (6), Ken Karipidis (7), Carmela Marino (8), Sharon Miller (9), Gunnhild Oftedal (10), Tsutomu Okuno (11), Eric van Rongen (12), Martin Röösli (13), Soichi Watanabe (14).
Correspondence to: International Commission on Non-Ionizing Radiation Protection, Dr Gunde Ziegelberger, ICNIRP c/o BfS, Ingolstaedter Landstr. 1, 85764 Oberschleissheim, Germany. info@icnirp.org
Affiliations of ICNIRP Collaborators
1. ICNIRP and Australian Centre for Electromagnetic Bioeffects Research, Illawarra Health & Medical Research Institute, University of Wollongong, Australia
2. ICNIRP and Hospital de Clínicas de Porto Alegre, Brazil
3. ICNIRP and Public Health England, United Kingdom
4. ICNIRP and Nagoya Institute of Technology, Japan
5. ICNIRP and La Sapienza University Rome, Italy
6. ICNIRP and Institute for Risk Assessment, Utrecht University, The Netherlands
7. ICNIRP and Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Australia
8. ICNIRP and Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Italy
9. ICNIRP
10. ICNIRP and Norwegian University of Science and Technology (NTNU), Norway
11. ICNIRP
12. ICNIRP and Health Council, The Netherlands
13. ICNIRP and Swiss Tropical and Public Health Institute, Basel, Switzerland
14. ICNIRP and National Institute of Information and Communications Technology (NICT), Japan
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...
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 (ORs) (95% confidence intervals [CIs]) of antidepressant treatment for suicides and suicide attempts were 2.83 (1.13-9.67) and 2.38 (1.63-3.61), respectively (3). By using the same database, Kaminski et al. reported that ORs (95% CIs) of antidepressant treatment for suicides and suicide attempts were 1.98 (0.71-5.50) and 1.63 (1.09-2.43), respectively (4). In case of rare events, the level of significance in OR differed by applying different analytical approaches. This means that marginal level of significance should be verified by further studies, and a meta-analysis with high quality of papers is recommended to confirm the association.
References
1. Hengartner MP, Amendola S, Kaminski JA, et al. Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies. J Epidemiol Community Health 2021 Mar 8. doi: 10.1136/jech-2020-214611. [Epub ahead of print]
2. Sharma T, Guski LS, Freund N, et al. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
3. Hengartner MP, Plöderl M. Newer-generation antidepressants and suicide risk in randomized controlled trials: A re-analysis of the FDA database. Psychother Psychosom 2019;88(4):247-248.
4. Kaminski JA, Bschor T. Antidepressants and suicidality: A re-analysis of the re-analysis. J Affect Disord 2020;266:95-99.
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.
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...
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 expectancy at birth. Indeed, elevated C-reactive protein is known to be associated with various inflammatory conditions. The natriuretic peptide (NP) plays an important role by opposing the vasoconstriction and sodium retention. A plasma NP elevation was found in essential hypertension, decreasing with effective antihypertensive therapy.4 Hs-cTnT is a biomarker for myocardial damage; but other conditions are also associated with its enhanced level: diabetes, COPD, decreased renal function, anaemia etc.5 The insufficient access to modern healthcare,1 higher consumption of alcohol and cigarettes in Russia vs. Norway (the data can be found in Wikipedia), as well as relatively poor quality of alcohol sold in Russia,6 have probably contributed to a higher morbidity. In conclusion, the valuable results by Dr. Iakunchykova and co-workers1 should motivate further search for associations between NT-proBNP, hs-cTnT and other markers with various pathological conditions.
REFERENCES
1. Iakunchykova O, Averina M, Wilsgaard T, et al. Why does Russia have such high cardiovascular mortality rates? Comparisons of blood–based biomarkers with Norway implicate non-ischaemic cardiac damage. J Epidemiol Community Health 2020;74:698–704.
2. Jargin SV. Cardiovascular mortality trends in Russia: possible mechanisms. Nat Rev Cardiol 2015;12:740.
3. Roberts B, Stickley A, Balabanova D, et al. The persistence of irregular treatment of hypertension in the former Soviet Union. J Epidemiol Community Health 2012;66:1079–82.
4. Hu W, Zhou PH, Zhang XB, Xu CG, Wang W. Plasma concentrations of adrenomedullin and natriuretic peptides in patients with essential hypertension. Exp Ther Med 2015;9:1901–908.
5. Wu W, Li DX, Wang Q, et al. Relationship between high-sensitivity cardiac troponin T and the prognosis of elderly inpatients with non-acute coronary syndromes. Clin Interv Aging 2018;13:1091–8.
6. Jargin SV. Vodka vs. Fortified Wine in Russia: Retrospective View. Alcohol Alcohol 2015;50:624–5.
Interested readers should note a relevant Belgian study on this subject was not cited. It repetitively obtained COVID-19 vaccination intentions before and after vaccine introduction in Belgium in 2020 and 2021, and reported results in real time through reports and press releases (see www.corona-study.be), noting the high general vaccination intentions (in closer accordance with the official records of actual coverage than the pre-implementation references cited here) and most of the socioeconomic disparities reported here. These results were also published after peer review in January 2022 for the pre-implementation period in Flanders, the largest region of Belgium (see Valckx et al, Vaccine 2022 at https://www.sciencedirect.com/science/article/pii/S0264410X21014146 ).
Airagnes et al. examined the association between effort–reward imbalance and incident long-term benzodiazepine use (LTBU) (1). The effort–reward imbalance was calculated in quartiles, and the adjusted odds ratios (95% confidence intervals) of the third and fourth quartiles of effort-reward imbalance for incident LTBU over a 2-year follow-up period were 1.74 (1.17 to 2.57) and 2.18 (1.50 to 3.16), respectively. They also clarified a dose-dependent relationship and an
interaction of tobacco smoking on the relationship. I have a comment with special reference to the number of subjects with LTBU during follow-up in each sex.
About two thirds of subjects with LTBU during follow-up were women. The same authors reported that the prevalence of long-term prescribed benzodiazepine use in the French population was 2.8% in men and 3.8% in women in the year 2015 (2). Although the total percentage of subjects with LTBU during follow-up was under 1%, there are differences in the long-term prescription percentage between men and women. As the authors observed the interaction of tobacco smoking on the relationship, I recommend the additional analysis, which should be stratified by sex, according to their previous cross-sectional study (3).
References
Show More1. Airagnes G, Lemogne C, Kab S, et al. Effort-reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort. J Epidemiol Community Health. 2019 Nov;73(11):993-1001.
2. Aira...
The article by Kiely et al., which reported a higher risk of injection site reactions in women than men for both younger and older participants, is interesting. The risk of systemic reactions was also higher following influenza vaccination in women than in men, irrespective of age and vaccine type.1 These findings are a valuable addition to the literature. However, we have two concerning issues for the authors.
Show MoreFirst, there is underreporting, which occurs in any adverse events following vaccine or drug studies based on spontaneous reporting.2 Underreporting is a problem in adverse events studies following vaccination using self-reported data. This may lead to a bias away from the null value, and they are susceptible to response bias, social desirability bias, and misclassification.3 Therefore, with underreporting, the conclusions may not be rigorous.
Second concern is the possibility of age and sex differences in adverse events following seasonal influenza vaccination. Previous studies have shown that elderly women have higher humoral responses against influenza than elderly men, but not young women compared with young men.4,5 Some authors have also reported sex and age differences in influenza vaccination. Elderly women typically suffered more frequently from local and systemic side effects because antibody induction is usually higher elderly women than in elderly men after vaccination. Consequently, the sex-related difference observed would not be the true di...
An article by Wei et al. reported the death of a child associated with an increased risk of incident atrial fibrillation (AF). The association was observed when the cause of death was both cardiovascular and non-cardiovascular diseases.1 These findings provide a valuable addition to the literature; however, some issues were not addressed by the authors.
Show MoreFirst, several clinical risk factors are associated with incident AF, including concurrent medication, illegal drugs, obesity, sleep apnea, and hyperthyroidism.2-4 For example, we previously reported that insulin users had a higher risk of incident AF than non-users among the elderly patients’ cohort (1.58 odds ratio (OR); 95% confidence interval (CI): 1.37–1.82). Patients with dipeptidyl peptidase 4 inhibitor (OR 0.65; 95% CI: 0.45–0.93) intake had a lower risk of developing AF when compared with non-users.4 However, while associated evaluations were not presented, Wei et al. did not exclude individuals with these risk factors. Consequently, confounding effects may have contributed to the significant effects causing incident AF, thus, omitting these effects may improve study validation outcomes.
Second, the study initially enrolled 2,740,028 participants in the unexposed group and 64,216 participants in the exposed group at baseline, but missing data between groups (50.1% vs. 79.6%) were examined in further analyses. These missing data potentially affected data credibility in mediation analyses.5 Consequent...
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.
Show MoreThe 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...
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...
Show MoreFrank’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...
Show MoreHengartner 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...
Show MoreWe 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.
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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