Method. This cross-sectional research was conducted on 82 shift-work personnel of 18 nursing workstations in Isfahan Al-Zahra Hospital, Iran, in 2012. Heat stress monitoring (WBGT) and photometer (Hagner Model) were used for measuring the thermal conditions and illumination intensity, respectively. To measure the sleep quality, visual tiredness, and thermal comfort, Pittsburg sleep quality index, eye fatigue questionnaire, and thermal comfort questionnaire were used, respectively. The data were analyzed with descriptive statistics, Student's t-test, and Pearson correlation. Results. Correlation between thermal comfort which was perceived from the self-reporting of people with eye tiredness was −0.38 (P = 0.002). Pearson correlation between thermal comfort and sleep quality showed a positive and direct relationship  but the correlation between thermal comfort, which was perceived from the self-reporting of shift nurses, and WBGT index was a weak relationship (r = 0.019). Conclusion. Based on the obtained findings, it can be concluded that a defect in environmental conditions such as thermal conditions and light intensity and also lack of appropriate managerial plan for night shift-work nurses are destructive and negative factors for the physical and mental health of this group of practitioners.Environmental conditions such as lighting and thermal comfort are influencing factors on sleep quality and visual tiredness. The purpose of this study was the determination of the relationship between thermal comfort and light intensity with the sleep quality and eye fatigue in shift nurses.  Nursing is a profession which, because of its stressful nature, is being faced with unforeseen situations, shifting, and organizational and personal factors, and these agents affected the mental and physical health of nurses. Different studies have reported that, in comparison with the mental and physical health of people of our country, the mental and physical health of this group of society is in a lower level . AlteredSome studies have reported that interns working 12 h consecutive night shifts demonstrated a reduction in visual memory capacity over the night shift . Other sFindings of a research in electrical industries of Tehran in 2004 denoted that the inadequate level of illumination intensity causes headache and neurosis . The resAmong the other variables of workplace, thermal comfort can be mentioned. The thermal comfort feeling of an individuals depends on their thermal stability. Thermal stability also depends on different parameters such as physical activity rate, garment, and atmospheric conditions . Thermal comfort based on ANSI/ASHRAE-SS 1981 Standard is described as a condition in which, a human being is mentally satisfied with thermal condition , 15. MenAmong the problems of night shift nurses, sleep quality can be named. In the past few years, nursing has been in the spotlight, because of its work injuries. In a research which was done on 2372 nurses in Baltimore, USA, it was shown that more than 1/4 of nurses work about 12 hours a day and more than half of them have more than one job; therefore, they become extremely tired and this causes work injuries . There iThe most important factors that can influence level of comfort of people in a building can be divided in to two sets: human factors and environmental factors . EnvironNurses, in comparison with others, experience disorders like misappropriate sleep quality, pressure, and stress . Based o2, and 9.7 (3.5) years, respectively. The inclusion criteria were having at least 1-year work record, not having cardiovascular or respiratory diseases, and not receiving any sedatives. Exclusion criteria were not willing to cooperate or not filling out the questionnaires completely (two of the participants were removed).In this study, 88 (74 men and 14 women) of 300 nurses of night shift nurses were chosen voluntarily and simple randomly; their average (standard deviation) of age, height, BMI, and work history were 30.75 (6.42) years, 74.04 (13.15) kg, 174.65 (8.38) cm, 24.17 (3.27) kg/mThis cross-sectional study was done on night shift nurses of Isfahan Al-Zahra Hospital, in 16 nursing workstation, in 2012. In the present study, illumination intensity was measured by luxmeter (Hugner model), visual fatigue was determined by eye fatigue questionnaire that is comprising 15 questions, and answers have been designed on 0–10 Likert range. Alpha coefficient of the questionnaire was 0.755 , and sler = −0.179) (r = 0.017). The yielded results of Pearson correlation between thermal comfort and WBGT index and the other variables represent that reverse. Pearson correlation between thermal comfort and WBGT indicator has a weak relation (r = 0.019). Pearson correlation between thermal comfort and eye fatigue shows a significant and reverse relation    . Finally, the Pearson correlation between age and thermal comfort indicates a reverse and weak relation (r = −0.065). The correlation between age and eye fatigue has shown a weak relation (r = 0.138).The mean (standard deviation) of WBGT indicator, for all workstations of hospital, was 20.67(0.55)°C (range 19.60–22.20°C). The mean (standard deviation) of light intensity for all hospital's workstations was 296 lux (range 70–680 lux). The mean (standard deviation) of thermal comfort score was 53.47 (17.15) (range 16.67–83.3). The mean (standard deviation) of eye fatigue score among these people was 29.06 (24.28). The results of Pearson correlation between illumination intensity and the other variables represent that eye fatigue has a reverse relation with illumination intensity ( −0.179) . Pearson= −0.38) . Pearson = 0.24) . Pearson= −0.66) . Among tAppropriate light intensity is essential and important in performance of work activities. As the results of the present study indicate too, light intensity and eye fatigue have a reverse relationship, and this indicates that with the increase of light intensity, the eye fatigue of night shift nurses diminished, and also statistical analysis of relations (Pearson correlation) in the present study shows that with the increase of light levels intensity, thermal comfort and sleep quality of nurses (even very little) has improved. These results are the same as the result of Hansen and Stevens 2012 study. In the mentioned study, with improving the light intensity of night nurses' workplace, their conciseness, performance, and comfort improved . Sleep disorder is one of the most important issues among shift nurses, especially night shift nurses. High stress and disarranged shifts are important effective factors on sleep disorders and sleep quality . The resAmong the important and interesting results of this study is the correlation between eye fatigue and sleep quality which is a reverse and significant relation. This relation indicates that the less the level of eye fatigue decreases, the more the level of their sleep quality increases. This is because of the following reason. When people in workplace face inadequate level of light intensity, they try to make up this defect by pressuring on their eye muscles and continue to their activities and complete their tasks. This leads to eye tiredness and frequent headaches which can be a negative effective factor on sleep quality itself . This deThermal condition is one of the other environmental factors influencing physical and mental health state of people. Pearson correlation results between eye fatigue and sleep quality and nurses' thermal comfort indicate that the increase in thermal comfort contributes to the decrease in eye fatigue of nurses and improvement in their sleep quality; therefore, it can be inferred that we can decrease eye fatigue of shift nurses and improve their sleep quality by improving thermal condition of work environment. Finally, it is presumed that the relationship between eye tiredness and sleep quality can be a mutual relationship. Level of light intensity can be an effective factor in removing eye tiredness and improving sleep quality of people, especially our shift nurses. Disorder in circadian rhythm as a consequence of inadequate level of daylight in work environment is the other reason for decrease in sleep quality of nurses which can lead to a decrease in the production of sleep hormone . Sleep quality and eye fatigue in night shift, especially in night shift nurses, can readily under the different factors including mental-psychological state, occupational and social factors, and environmental factors such as light intensity and thermal condition. Therefore, based on results of the present study, it can be said that we can diminish eye tiredness of these hard-working practitioners and improve their sleep quality by improving the workplace conditions such as light intensity and thermal condition. Thus, conducting the same and more comprehensive research is necessary and desirable to determine the relationship between other physical variables of work environment and diverse variables related to physical and mental health of this group of people more accurately.


Since siblings of pediatric cancer patients are at risk for emotional, behavioral, and social problems, there is considerable interest in development of early psychological interventions. This paper aimed at evaluating the effectiveness of a two-session psychological intervention for siblings of newly diagnosed pediatric cancer patients.Thirty siblings age 6-17 years were randomly assigned to an intervention group or an active control group with standard psychosocial care. The manualized intervention provided to siblings in the first 2 months after the cancer diagnosis of the ill child included medical information, promotion of coping skills, and a psychoeducational booklet for parents. At 4 to 6 weeks, 4 months, and 7 months after the diagnosis, all siblings and their parents completed measures (from standardized instruments) of social support, quality of life, medical knowledge, posttraumatic stress symptoms, and anxiety.At follow-up siblings in the intervention group showed better psychological well-being, had better medical knowledge, and reported receiving social support from more people. However, the intervention had no effects on posttraumatic stress symptoms and anxiety.The results of this pilot trial suggest that a two-session sibling intervention can improve siblings' adjustment, particularly psychological well-being, in the early stage after a cancer diagnosis.NCT00296907ClinicalTrials.gov  Having a brother or sister newly diagnosed with cancer is a distressing and challenging situation. The cancer diagnosis in the family has emotional, behavioral and social consequences for siblings . SiblingPrevious research on adjustment of siblings of children with cancer found most siblings' general adjustment to be within normal limits . HoweverGiven the difficult circumstances that childhood cancer causes for all family members, it is important to understand the consequences of the diagnosis for siblings and to develop appropriate interventions to reduce distress and promote psychological adjustment. It is important to identify the needs of siblings and to recommend and encourage appropriate treatments when problems are detected . HoweverThe present study aimed at assessing the effect of a two-session early psychological intervention for siblings of pediatric cancer patients using a randomized controlled pilot trial. This intervention was provided early, i.e., within the first two months of diagnosis, and was conducted in an individual format. We expected that this intervention would be effective in the sense of yielding evidence that siblings who receive the intervention suffer from fewer anxiety and PTSS, report better HRQoL, and receive more social support compared to a control group with standard care.Participants were recruited from June 2006 until October 2010 at two children's hospitals in Switzerland. Siblings had to meet all of the following criteria: (1) brother or sister with newly diagnosed childhood cancer, (2) medical treatment (inpatient or outpatient) necessary, (3) age of sibling from 6 to 17 years, (4) fluency in German. Families with a child who met criteria for inclusion were contacted within 1 month of diagnosis. If the family had several siblings who met the inclusion criteria, all willing siblings were included.2 = 0.72, p = .40), type of diagnosis , intensity of treatment , medical complications , and health-related restrictions .Forty-five siblings met the inclusion criteria and were asked to participate. Fifteen siblings and their families declined participation (33.3%); reasons were because siblings refused to participate (46.7%), because the study seemed too time-consuming (26.7%), or because parents thought the study would be an additional strain on the family (26.7%). Due to incomplete data at follow-up assessments (one drop-out), the final study sample comprised 29 siblings (response rate 64.4%) from 21 families  would be required to detect a statistically significant effect size of 0.9 in a single tail t-test with a power of 0.80 and Type I error rate set to .05 . ExpecteThe institutional review boards of both study sites approved the study. Written informed consent was obtained from parents and siblings older than 12 years. Assessments with all siblings were carried out at 4 to 6 weeks , 4 months , and 7 months  after the cancer diagnosis. The siblings were assessed by means of standardized individual interviews comprising the measures mentioned below. The interviews were conducted by trained psychologists. Questions were read aloud by the interviewer and corresponding answer scales were presented to siblings. The interviews lasted approximately 45 minutes, and most of them were conducted in the siblings' home; some were conducted at the hospital . Mothers and fathers were independently assessed at the same time using questionnaires. Medical variables were retrieved from the responsible physicians. In return for participation, families received 50 Swiss francs (approx. 41 EUR/54 USD) after completing all three assessments.The randomization list, stratified for sex, was generated by the program Rancode 3.6 . The study used a cluster randomization scheme. The 21 participating families were randomly assigned to the intervention or the control group. Although multiple siblings per family could participate, randomization per family occurred just once and all the siblings received the same intervention. The randomization was stratified according to sex of the sibling closest in age to the child with cancer. Standard psychosocial care with the psycho-oncologist on the ward was available for both study groups. The utilization of psychosocial care by the end of data assessment was equally distributed between control and intervention group .If the sibling was assigned to the intervention group, the first session of the intervention was conducted immediately after the T0 baseline assessment. The second intervention session was held 2 weeks after the first intervention session. A different interviewer, who was blind to the sibling's status in the project, conducted follow-up assessments at T1 and T2 with both control and intervention group.Medical knowledge about cancer was assessed using a scale that we developed. Siblings answered four questions: on name of the illness, medical understanding of the illness process, treatment options, and length of treatment. Using a comprehensive coding sheet, two clinical psychologists coded the answers together on a scale ranging from 0 to 2, with higher scores indicating better medical knowledge. Cronbach's alphas for the medical knowledge scores were satisfactory to poor, with α = 0.63 at T0, α = 0.50 at T1 and α = 0.34 at T2. In the current sample there was no correlation between age and medical knowledge at all time points and in both groups.The number of individuals providing social support was assessed using a scale that we developed. Siblings received a comprehensive list of individuals that were available to them and might be sources of social support, including mother, father, grandparents, siblings, relatives, godmother and godfather, neighbors, close friends, peers, and teachers. They then indicated whether or not these individuals provided social support. The score was the total number of people providing support.HRQoL was assessed using KIDSCREEN-27, a standardized questionnaire for children from 8 to 18 years of age . The KIDSiblings were interviewed about their illness-related posttraumatic stress symptoms using the UCLA PTSD Reaction Index (UCLA RI) . We alteThe Spence Children's Anxiety Scale (SCAS)  is a 44-Socio-economic status (SES) as assessed by mothers was calculated by means of a 6-point SES-score of both paternal occupation and maternal education. Three social classes were defined as follows: scores 2-5, lower class; scores 6-8, middle class; and scores 9-12, upper class. This measure was used in previous studies and was shown to be a reliable and valid indicator of SES in Switzerland .Intensity of treatment , Medical complications  and Health-related restrictions . The intensity of treatment and the medical complications items were used successfully in previous studies on children with cancer [The pediatric oncologist in charge was asked to rate the following three medical variables concerning the ill child on a 3-point scale: h cancer .Our intervention was provided within the first two months after the cancer diagnosis and therefore during a stage which has been shown to be the most vulnerable time for siblings' adjustment ,14. By tWe developed the standardized psychological intervention based on clinical experience, theoretical considerations, the relevant literature, and a qualitative pilot study that had gathered more information about siblings' experiences in this time period . In two The medical information part focused on the siblings' understanding of body functioning, the illness mechanism and location, and the cancer treatment, in particular chemotherapy. To accomplish this goal, pictures and storybooks were presented as aids. It was particularly emphasized that nobody was to blame for the development of cancer, nobody had done anything wrong, and cancer is not contagious. By learning more about the disease, treatment schedule, and side effects, siblings should gain a feeling of control over the situation which might reduce feelings of anxiety ,30 and eThe part on coping encouraged siblings to think of changes and particular stressful situations in their life since the cancer diagnosis. Siblings individually chose the three most significant stressors. These were looked at in detail, and helpful coping strategies were discussed. Results of the coping session were written down on a special list and handed out to siblings. At least one parent joined after this part of the intervention. With the sibling's agreement, parents were informed about the relevant topics of the intervention in order to get as much support from parents as possible. Cognitive behavior therapy was the therapeutic approach used during problem identification and discussion of coping strategies. Following the coping and stress model proposed by Lazarus and Folkman  siblingsIn the last part of the intervention, parents received a psychoeducational booklet developed by the authors containing information on the psychosocial situation of siblings of cancer patients in general and providing recommendations to parents on how to support siblings. At the end of each session there was time for questions from siblings and parents.Families in the control group received standard psychosocial care, which consisted of meetings with the psycho-oncologist on the ward, who was primarily responsible for the ill child and the parents but also met with siblings if necessary. After follow-up assessments were completed, the control group was offered individual sessions for siblings. Two siblings made use of this.p value < = .05 was considered significant. Kolmogorov-Smirnov Goodness of Fit Tests showed normality for all outcome measures. To compare nominal and ordinal scales, χ2 analyses and, when cells were too small, Mann-Whitney U tests were used. Normally distributed continuous data were analyzed using independent t-tests. To determine the effectiveness of the intervention, two-factor repeated measures analysis of variance (ANOVA) were performed. In the statistical analysis, siblings' adjustment variables were compared with respect to group, time, and group × time interaction. Post-hoc analysis for significant time effects was corrected for multiple comparisons using Bonferroni adjustment. If significant mean differences were detected, effect sizes (d) were calculated following Cohen [For data analysis we used statistical package SPSS for Windows, release 16 . All analyses were performed with two-sided tests. A ng Cohen .Table At baseline the total sample did not differ from community norms on mother-reported HRQoL  and anxiety . But self-reported HRQoL at baseline was significantly lower than in the Swiss norm population . Further, the initial assessment identified 7 out of 30 siblings (23.3%) with a full and 13 (43.3%) with a partial DSM-IV related PTSD.Table int = 1.62, SDint = 0.36; Mcontrol = 1.37, SDcontrol = 0.27; t = 2.20, p = .04). Effect sizes concerning the group differences at T2 were in the medium range (T2: d = .78). No significant mean differences were found between groups at T0 and T1.Results for the medical knowledge scale showed a main time effect (p = .01) with significant increase of knowledge from T1 to T2 (Table A significant main effect for group (p = .04) was found for the number of persons providing support, with the intervention group having a higher number of persons available. Time and group × time showed no effect on the social support measure. Effect sizes related to group differences were in the medium range .The KIDSCREEN child report total score revealed a significant time effect (p = < .001), with improvement of HRQoL from T0 to T1, T1 to T2, and T0 to T2 in both groups. The intervention had no significant influence on the KIDSCREEN total score as reported by siblings. However, the KIDSCREEN self-report subscale "psychological well-being" showed a significant main effect of group (p = .03) as well as a significant time effect (p = < .001), indicating improvements over time in both groups, but with siblings in the intervention group demonstrating better psychological well-being as compared to the control group. Effect sizes related to group differences were large for T1 (d = .99) and rather small for T2 (d = .26). Main effects of the intervention or effects of intervention × time interactions could not be found in any other subscale of the KIDSCREEN. Two more KIDSCREEN subscales in the child version showed significant improvements over time: "Autonomy and parents"  and "school environment" .For the parent version of the KIDSCREEN no significant effect was noted with respect to group and group × time interaction. But the analyses showed a significant time effect with significant improvement of HRQoL from T1 to T2 and T0 to T2.ANOVA results showed a significant time effect (p = .02) in both groups on the UCLA RI scales. However, the time effect was no longer significant in the post-hoc pairwise comparisons using Bonferroni tests. There was no main effect for group in posttraumatic stress symptoms. Full PTSD diagnosis decreased in the whole sample, with 5 siblings (16.7%) that met full diagnosis criteria at T1 and 3 siblings (10%) at T2.Siblings' anxiety showed a time effect (p = .02) with a significant reduction of anxiety in both groups from T1 to T2. No group or time × group effect could be found. A look at the baseline T0 scores of anxiety and PTSS shows that the intervention group starts out with a considerably higher level although not statistically significant. We therefore also conducted repeated measures ANCOVAS with T0 scores of anxiety and PTSS as covariates. But still no group effect could be shown.The aim of this pilot trail was to evaluate the effectiveness of an early psychological intervention with siblings of newly diagnosed pediatric cancer patients. Although generalizability of our results is restricted due to the small sample size, this study provides preliminary evidence that a two-session sibling intervention has a positive impact on psychological well-being, social support and medical knowledge of siblings. However, no intervention effect could be found with regard to proxy-rated HRQoL, PTSS, and anxiety.Since children often rely on their own interpretations of illness and sometimes have a distorted picture of it, it is crucial to provide age-appropriate medical information . We founThe number of individuals available for social support was elevated for siblings who took part in the intervention. This improvement could possibly be related to the coping part of our intervention, where many of the coping skills discussed involved looking for social support. Moreover, the psychoeducational booklet provided to parents covered social support issues. Although having a higher number of available individuals does not necessarily mean better social support, but having a greater number of available potential partners increases chances of receiving helpful social support, especially for our population, which is confronted with decreased social resources in the core family due to the cancer diagnosis . Other sSiblings' self-reports indicated a better psychological well-being after the intervention. Even though this was the only subscale of the KIDSCREEN questionnaire showing group differences, well-being represents an essential part of siblings' psychological adjustment . Positive effects on HRQoL were also found in two other studies ,38. NotaContrary to our hypothesis, anxiety and PTSS were not improved by the intervention, although trends in the desired directions could be observed. Anxiety was not clinically increased in our sample compared to norms, a finding also seen in previous studies ,35,36, aAlternative explanations for absent intervention effects should also be considered. It is possible that families' involvement in the study and the data collection itself increased and perhaps improved communication between parents and siblings  and therThis study has a number of limitations. First, the fact that our intervention was for the early time period after diagnosis made recruitment more difficult and resulted in a rather small sample. The study has therefore limited power to detect group differences and we were not able to perform subgroup analyses . Therefore, findings of this pilot study are preliminary and exploratory and should be interpreted with caution. Second, we developed the measures for social support and medical knowledge ourselves. Internal consistencies of these measures were rather poor and further psychometric criteria were not evaluated. Third, The KIDSCREEN-27 scale is not validated for children below eight years of age and the youngest study participants of our study were six years old. However, since the KIDSCREEN-27 questionnaire was included in an interview, the interviewer could pay special attention to language skills. Advantages of the KIDSCREEN-27 are the little number of items, the availability of a parent version, existence of a German version and Swiss norms. Finally, families with lower socio-economic status were not represented in the sample. This might be due to the inclusion criterion of fluency in German, which excluded families with an immigrant background.Despite these limitations, this study has several strengths, including its randomized controlled prospective design and the manualized intervention for the early stage after diagnosis. Moreover, statistical conditions were good, with no socio-demographic differences between study participants and non-participants, no differences between intervention and control groups on all baseline scores, and almost no attrition.The early, two-session individual psychological intervention evaluated here is a promising approach for siblings in several respects. Efforts to provide medical information to siblings, to enhance their coping skills, and to inform parents about their situation seemed to be rewarded by increased medical knowledge, increased sibling-reported psychological well-being and more social support resources. No intervention effects could be found with regard to anxiety, PTSS, and parent-reported HRQoL. To overcome the problem of small sample size, future research should aim for multicentric studies. Also, based on the considerably high rates of PTSS, interventions should be more trauma-focused.The authors declare that they have no competing interests.AP was involved in the conception and design of the study, in data collection, conducted the interventions, performed the data analysis and drafted the manuscript. AG made contributions to design of the study and the acquisition of data. EB participated in data acquisition and revised the manuscript for pediatric content. MAL made substantial contributions to conception and design, supervised all aspects of the study and revised the final draft of the manuscript. All authors read and approved the final version of the report.


N = 19) and matched healthy controls (N = 33) were compared using tone discrimination tasks, an AP task, and clinical measures. Relatives were slower at identifying emotions on the AP task (p = 0.002), with secondary analysis showing this was especially so for happy (p = 0.014) and neutral (p = 0.001) sentences. There was a significant interaction effect for pitch between tone deviation level and group (p = 0.019), and relatives performed worse than controls on amplitude discrimination and duration discrimination. AP performance for happy and neutral sentences was significantly correlated with amplitude perception. Lastly, AVH proneness in the entire sample was significantly correlated with pitch discrimination (r = 0.44) and pitch perception was shown to predict AVH proneness in the sample (p = 0.005). These results suggest basic impairments in auditory processing are present in relatives of AVH patients; they potentially underlie processing speed in AP tasks, and predict AVH proneness. This indicates auditory processing deficits may be a core feature of AVHs in schizophrenia, and are worthy of further study as a potential endophenotype for AVHs.Research on auditory verbal hallucinations (AVHs) indicates that AVH schizophrenia patients show greater abnormalities on tasks requiring recognition of affective prosody (AP) than non-AVH patients. Detecting AP requires accurate perception of manipulations in pitch, amplitude and duration. Schizophrenia patients with AVHs also experience difficulty detecting these acoustic manipulations; with a number of theorists speculating that difficulties in pitch, amplitude and duration discrimination underlie AP abnormalities. This study examined whether both AP and these aspects of auditory processing are also impaired in first degree relatives of persons with AVHs. It also examined whether pitch, amplitude and duration discrimination were related to AP, and to hallucination proneness. Unaffected relatives of AVH schizophrenia patients ( Auditory verbal hallucinations (AVHs) are a phenomenon in which people experience hearing speech in the absence of appropriate sensory stimulation and with the full sense of reality of a true perception. Although occurring in a range of populations, AVHs are most frequently associated with schizophrenia, affecting approximately 75% of the schizophrenia population during a 1-year period  cues, compared with controls  and 19 first-degree relatives  of schizophrenia patients who experience AVHs were recruited for this study, with an age range of 18–65 years. Relatives comprised parents, siblings, and offspring of schizophrenia patients who had experienced AVHs during the course of their illness. That is, had frequent AVH  and were classified as persons with chronic schizophrenia (illness durations of 5 years plus). Participants were recruited using the Monash Alfred Psychiatry Research Center (MAPrc) participant registry, advertisements, and convenience sampling.Participants from both groups were excluded if they reported significant hearing impairment such as tinnitus, or failed a basic auditory threshold testing frequencies of 500, 1000, 1500, 2000, 3000, 4000, and 6000 Hz, with 25 dB used as the threshold of normal hearing for inclusion in the study. Controls were excluded if they currently suffered from an Axis I disorder, or if they had a first-degree relative with a psychotic disorder. Relatives were excluded if they had a history of a psychotic disorder, met criteria for schizophrenia, were taking antipsychotic medication, or if their relative with schizophrenia had never experienced AVHs in the course of their illness. Participants were paid a gratuity of $30 for their time and travel expenses.To screen for Axis I disorders, as classified by the DSM-IV TR, a Mini International Neuropsychiatric Interview (MINI) screen and if necessary, MINI interview 5.0.0  was utilized via laptop computer, using headphones. Three tone discrimination tasks (TDTs) were created to assess individuals' ability to perceive differences in pitch (TDT-P), amplitude (TDT-A), and duration (TDT-D). They were closely modeled on TDTs from earlier studies . Based on this information, the range of amplitude for the differing tones in the TDT-A varied from 35 to 105 dB. For the TDT-D, duration of differing tones ranged from 75 to 225 ms in length. The pitch of differing tones in the TDT-P varied from 750 to 2250 Hz. The variables used for analysis was accuracy (measured as a percentage correct) for the same condition and each of the abovementioned levels of deviation, leaving six variables for each TDT. Participants were required to identify whether they believed each pair of tones were the same or different, using allocated keys on the laptop keyboard.The AIT was developed to assess participants' ability to identify emotion based on AP. It consisted of 24 semantically neutral sentences  which were spoken by both male and female actors (12 sentences per gender) in one of the following emotions: happy, sad, fearful, and neutral. Each sentence is approximately 3 s long. Sentences were presented in a randomized order. During the AIT, participants were required to indicate which emotion they believed the sentence was spoken in from the above options by pressing the corresponding key on the keyboard. Participants were measured on accuracy (percentage of correct guesses) and RT (ms) for each of the four emotions.T-score was generated for this task and was the variable used in the analyses.Attention was measured using CPT-IP , participants completed a demographics questionnaire measuring participants' gender, age, date of birth, whether they had a relative with a psychiatric disorder, educational and employment information. Auditory tasks were alternated with the other questionnaires and the CPT to avoid participant fatigue. All of the activities undertaken to complete this paper was approved by the La Trobe University Faculty of Science, Technology and Engineering Human Ethics Committee, Approval Number FHEC09/R71, and the University of Melbourne Human Research Ethics Committee, Approval Number 0714996.1.z-scores of the skewness and kurtosis levels. A single outlier, in years of education, was reduced to the maximum score of three interquartile ranges from the mean. LSHS-HF violated assumptions of normality and was transformed using log transformation. Untransformed means are presented in tables for ease of interpretation.Each of the variables was screened for normality using For the TDTs, scores were derived for the degree of difference between tones, (collapsing data from increased and decreased deviation levels), expressed as 6% level differences for each TDT. Each of the TDTs had a violation of normality for at least one of the percentage levels. The data were converted to error scores, and log-transformation of these scores successfully normalized the data to meet the assumptions required for the analyses.The AIT overall accuracy variables for happy, sad and fear all violated normality and were log-transformed. No transformation normalized neutral sentences, and untransformed variables were used.post-hoc One-Way analyses of variance. These ANCOVAs were conducted at each percentage level to determine where differences were occurring, with age being again used as a covariate. Similarly, to examine for group differences across the different emotional categories on the AIT, for the accuracy data, a 2 × 3 mixed design ANCOVA was conducted for happy, sad, and fear, with group being a between subjects factor and emotion being a within subjects factor, with age again being used as a covariate. An independent samples t-test was used to explore group differences for the neutral condition of the AIT for accuracy . For RTs, a 2 × 4 mixed design ANCOVA was used. Bonferroni corrections were not adopted to account for multiple comparisons for the TDT and AIT data, due to the small sample sizes. Mean effect sizes and observed power were calculated to aid interpretation of results. As noted in the introduction, group differences when examining RT data, could be due to poor attention. Therefore, a One Way ANCOVA was conducted to examine for group differences on the CPT task, which was followed up with a correlation between CPT RT and the overall RT on the AIT.Demographic variables were compared across groups using analysis of variance (ANOVA) or Chi squared, as appropriate. For each TDT, there were a total of 6% levels of difference , with 2 and 5% representing the most difficult conditions. To explore group-based differences across the whole task, and to examine for interactions with different levels, each of the TDTs were analyzed using a 2 × 6 mixed design ANCOVA with group as the between subjects factor and degree of difference between tones as the within subjects factor. Given that age was shown to be significantly different across the groups, age was included as a covariate. Further, significant differences reported on the ANCOVAs were followed up with To explore the relationship between acoustic processing and AP, a correlation was conducted on the entire sample using deviation levels for the three TDTs  and accuracy on the four emotions of the AIT. To further confirm whether relationships between variables were related to AVH or psychosis proneness, LSHS-HF and O-LIFE-NH were included. These correlations are reported in Table The variable that was most highly correlated with LSHS-HF in the abovementioned correlational analysis was then entered into a hierarchical regression for the whole sample. Age and group were entered at the first step, and appropriate TDT variable was entered at the second step to assess whether acoustic processing predicted AVH proneness. An identical hierarchical regression was conducted using O-LIFE-NH instead of LSHS-HF to further establish whether acoustic processing deficits also predict psychosis proneness, or are specific to AVH proneness.2  = 2.43, p = 0.12, but age was found to differ significantly between the groups, t(50) = −2.20, p = 0.033, so age was entered as a covariate for subsequent analyses. Demographic variables are presented in Table The proportion of males and females did not differ between the groups, χ2 , N = 52 Table F = 17.42, p < 0.001, but no main effects were observed for age  or group . There was an interaction between degree of difference between tones and group, F = 3.05, p = 0.019, with relatives making more errors than controls for the more difficult deviation levels and fewer errors than controls for the easier deviation levels. An interaction between degree of difference between tones and age F = 2.54, p = 0.042, was also observed. Post-hoc analyses established a trend difference at 2%, where relatives appear to make more errors than controls  = 16.91, p < 0.001, but no overall main effect for group or age were observed, nor were any interaction effects observed.Results from the mixed design ANCOVA reveal that there was a within subjects main effect for the degree of difference in tone amplitude, post-hoc follow-up One Way analyses of variance indicated that controls and relatives differed when discriminating between tones that differed by 2, 5, and 10%, with group differences approaching significance at 25%.However, F = 8.52, p < 0.001, but no between subjects main effects for group or age. Trends for interactions between degree of difference between tones and both group  and age  were observed. Table The mixed design ANCOVA for the TDT-D revealed a within subjects main effect for degree of difference in duration F = 2.71, p = 0.106, as did the effect for emotion, F = 2.85, p = 0.068. No interactions were found between emotion and age  or emotion and group . The t-test performed on the neutral emotion on the AIT revealed no group differences in the ability to detect neutral sentences, t(47) = −1.36, p = 0.18. Group performances on the AIT, measured by accuracy, can be found in Figure The hypothesized effect of group fell outside statistical significance, F, 46 = 2.F = 10.77, p = 0.002, as well as a main effect of age, F = 11.39, p = 0.002. There was no main effect for emotion, F = 1.31, p = 0.282, although there were trends for an interaction between emotion and group, F = 2.25, p = 0.095, and an interaction between emotion and age, F = 2.38, p = 0.082. Group mean RTs for each emotion on the AIT are in Table F = 6.53, p = 0.014] and neutral  conditions.For emotion identification RT, there was a significant main effect of group, F = 3.99, p = 0.056, with relatives exhibiting lower T-scores (M = 42.24) than controls (M = 48.86). A correlation analysis was conducted between attention and RT on the AIT to determine whether slower RT was associated with impaired attention on the CPT; no correlations were significant.A univariate ANCOVA revealed that group differences in attention approached significance, A further correlation analysis was conducted to examine the relationships between acoustic processing and AP, and the relationships between acoustic processing and AVH and psychosis proneness Table . The corThis analysis indicates that recognition accuracy for happy and neutral sentences was moderately correlated with accuracy in amplitude discrimination . Recognition accuracy for happy sentences was also correlated with pitch discrimination at the 2% level. Affective identification appeared unrelated to duration discrimination. Variables measuring AVH and psychosis proneness are also presented in Table F = 5.74, p = 0.002 and accounting for 23% of the total variance. A similar regression was performed using the same predictor variables and the O-LIFE-NH. This model was not significant.As AVH proneness was most significantly correlated with the TDT-P at 2%, this variable was chosen as the best predictor to enter into the regression analyses. The regression analysis conducted for AVH proneness is found in Table The aim of the current study was to empirically investigate acoustic processing and AP in a sample of controls and relatives. Further, this study aimed to determine whether pitch perception was related to AP, and whether pitch perception predicted AVH proneness. We present preliminary data addressing these aims.In examining acoustic processing, our main hypothesis was that relatives would make significantly more errors in pitch discrimination on the TDT-P. This hypothesis was not supported. The literature regarding amplitude and duration discrimination is more limited, therefore, no predictions were made with regards to differences between controls and relatives on both the TDT-D and TDT-A. However, groups were shown to differ on the TDT-A at 2, 5, and 10%, whilst they differed on the TDT-D at 25%.Pitch perception is the element of acoustic processing most consistently found to be impaired in schizophrenia patients , or whether RT reflected task difficulty for relatives. Results showed that attention was not significantly correlated with RT for any of the emotions, indicating no systematic relationship between these factors. This is consistent with Kee et al.  at 2%. Therefore, pitch perception appears to be closely related to AVH proneness.In the current study, pitch perception was shown to be linked with AP perception, with AP perception previously found to be more impaired in AVH schizophrenia patients than non-AVH patients (Rossell and Boundy, The most obvious limitations of the current investigation are those of a small sample size, and unequal group sizes. Thus, our data can only be classified as preliminary. For example, the small sample size prevented us from running separate regressions for controls and relatives when exploring the link between pitch perception and hallucination proneness. It is likely that if this analysis was re-run separately for each group, with an increased sample size, the model predicting hallucination proneness would likely have explained more of the variance for relatives than for controls. Furthermore, no corrections were made for the number of secondary analyses conducted for the TDTs or AIT, increasing the likelihood of a Type II error. Nonetheless, a number of promising results were recorded and effect sizes were calculated to support effects that were detected. Furthermore, the description of endophenotypes for schizophrenia outlined by the Consortium on the Genetics of Schizophrenia (Gur et al., The current investigation decided to utilize parents, siblings and offspring of schizophrenia patients with AVHs in the first-degree relatives group, which is consistent with each of these groups being used in the previous literature [siblings (Condray and Steinhauer, We suggest possible endophenotypes in relatives of schizophrenia patients with AVHs compared with controls. However, these skills need to be investigated in first degree relatives of schizophrenia patients who have never experienced AVHs. If no evidence of these deficits is found in the second schizophrenia relative cohort, then it is reasonable to suggest that the endophenotypes that this investigation has potentially uncovered are indeed related to AVHs specifically, and are not endophenotypes for schizophrenia in general.The results from the current investigation contribute to the literature regarding endophenotypes in schizophrenia. Impaired pitch perception was related to slower performance on the AIT and predicted AVH proneness in relatives, suggesting it may be a potential endophenotype for AVHs in schizophrenia and strengthens the argument that auditory processing is a fruitful area to investigate in endophenotype research. The endophenotypes identified are, as far as we are aware, the first to be investigated in relation to AVHs specifically. More research needs to be conducted to determine whether these endophenotypes are limited to relatives of patients with AVHs, or whether they are present in all schizophrenia relatives. To further confirm that pitch perception deficits are related to predisposition to AVHs specifically, it would be prudent to conduct a similar study that includes AVH and non-AVH patients, relatives of AVH and non-AVH patients, and controls. Confirmation of an endophenotype for AVHs centered on acoustic processing could lead to the establishment of assessment and pre-screening of individuals, to identify those who are at increased risk of developing AVHs, thus adding to the prevention and early intervention approach already shown to be successful in the treatment of schizophrenia.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Fibromyalgia is a chronic syndrome characterized by generalized pain, joint rigidity, intense fatigue, sleep alterations, headache, spastic colon, craniomandibular dysfunction, anxiety, and depression. The purpose of the present study was to determine whether massage-myofascial release therapy can improve pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. A randomized controlled clinical trial was performed. Seventy-four fibromyalgia patients were randomly assigned to experimental  and placebo (sham treatment with disconnected magnotherapy device) groups. The intervention period was 20 weeks. Pain, anxiety, quality of sleep, depression, and quality of life were determined at baseline, after the last treatment session, and at 1 month and 6 months. Immediately after treatment and at 1 month, anxiety levels, quality of sleep, pain, and quality of life were improved in the experimental group over the placebo group. However, at 6 months postintervention, there were only significant differences in the quality of sleep index. Myofascial release techniques improved pain and quality of life in patients with fibromyalgia. Fibromyalgia (FMS) is a chronic syndrome characterized by generalized pain, joint rigidity, and intense fatigue. Other frequently associated symptoms are sleep alterations, headache, spastic colon, craniomandibular dysfunction, anxiety, and depression. Fibromyalgia has a negative effect on the quality of life of patients, who often feel incapable of performing such basic daily life activities as walking, going up stairs, or lifting objects, increasing their disability index and utilization of health services , 2.The etiology of the disease is currently unknown but several hypotheses have been developed, given that fibromyalgia syndrome is a multidisciplinary problem approached from different perspectives. Histological and histochemical studies have demonstrated that it is not an inflammatory process . The mos Modifications of adrenocorticotropic hormone levels and a decrease in plasma serotonin have been reported in some of these patients, indicating central nervous system (CNS) involvement and neurohormonal axis changes. In this regard, there is evidence of interaction between low sleep quality and low plasma levels of serotonin, a neurotransmitter that functions in the neuromodulation of sleep, pain, and mood –10. Vari There is no evidence of muscle disease in FMS but there are reports of dysfunction in intramuscular connective tissue or fascia; fascial inflammation triggers a peripheral nociceptive stimulus that leads to central sensitization in FMS –18. ImmuBecause the cause of FMS syndrome remains unknown, treatment is usually in response to symptoms. However, the effectiveness of pharmacological and nonpharmacological treatments has been limited. The purpose of this study was to determine the benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with FMS.A randomized controlled trial was performed, with placebo group (FMS patients subjected to a sham protocol of magnotherapy) and experimental group . The study period was from January 1 2009 to January 31 2010.We recruited patients diagnosed with FMS (by clinicians according to the criteria of the American College of Rheumatology)  who belon  =  32) or placebo (n  =  32) group by using sealed envelopes. Informed consent of patients was obtained, fulfilling the ethical criteria established in the Helsinki Declaration, modified in 2000, for research projects. In Spain, the current legislation for clinical trials is gathered in Real Decreto 223/2004 of February 6. The study was approved by the ethics and research committee of the University of Almeria. Out of the 231 accessible patients with a medical diagnosis of FMS, 35 were unable to participate due to incompatibility with their work schedule and the remaining 196 were subjected to a randomization process to select a sample of 100 patients; 36 of these did not meet study inclusion criteria, and the remaining 64 were randomly assigned to an experimental , which assesses the pain intensity and degree of relief experienced by the patient . Painful sensitive points were assessed by means of a pressure algometer (Wagner FPI 10-USA), exerting a pressure of 4 kg. This instrument consists of a sphere, on which the pressure measurements (10 levels of 0.5 Kg each) are shown, with a rubber end for exertion of the pressure. The 18 painful sensitive points described by the American College of Rheumatology were evaluated . The ind Anxiety levels were determined with the 40-item State-Trait Anxiety Inventory (STAI), which measures anxiety as a stable dimension of personality (trait or tendency to anxiety) and also includes a state subscale to detect anxiety behaviors. Subjects report their feelings in general for the trait scale and how they feel at the time of questionnaire completion for the state anxiety scale. The state anxiety scale indicates the feelings or sensations of anxiety  at a specific moment in time. The trait anxiety scale indicates the frequency with which anxiety is experienced . Factorial analyses identified four factors related to the presence or absence of anxiety in each scale: presence of state anxiety, absence of state anxiety, presence of trait anxiety, and absence of trait anxiety. The index of internal consistency is 0.90–0.93 for the measurement of state anxiety and 0.84–0.91 for trait anxiety .The state of depression was determined with the Beck Depression Inventory (BDI), a self-applied 21-item questionnaire that assesses a wide spectrum of depressive symptoms. It focuses on the cognitive components of depression, which represent around 50% of the total questionnaire score. Out of the 21 items, 15 refer to ecological-cognitive symptoms and 6 to somatic-vegetative symptoms; each item has four response options in order of increasing symptom severity . The aim The Pittsburgh Quality of Sleep Index Questionnaire (PSQI) was used to study the quality of sleep. It comprises 24 items; the subject responds to 19 of these items, and an individual living in the same dwelling  responds to the remaining 5. Scores are obtained on each of seven components of sleep quality: subjective quality, sleep latency, sleep duration, habitual sleep efficiency, sleep perturbations, use of hypnotic medication, and daily dysfunction. Each component is scored from 0 to 3 . Hence the total score (adding component scores) ranges from 0 to 21. The reliability coefficient of the PSQI is 0.78 , 29.  Quality of life was assessed with the 36-item SF-36 Quality of Life Questionnaire on functional state, emotional well-being, and general health. Functional state is represented by the dimensions of physical function (10 items), social function (2 items), role limitations due to physical problems (4 items), and role limitations due to emotional problems (3 items). Emotional well-being includes mental health (5 items), vitality (4 items), and pain (2 items). Finally, perception of general health (5 items) and changes in health over time  were assessed. For each dimension of the SF-36, items were codified, aggregated, and transformed into a scale ranging from 0  to 100 . Thus, a higher score in the different dimensions indicate a better health status and/or quality of life. The Chronbach's alpha coefficient for this questionnaire is 0.78–0.96 .The experimental group was formed by 30 patients and the control group by 29. In all subjects, pain, anxiety, depression, quality of sleep, and quality of life scores were determined before (baseline) and immediately after the 20-week intervention and again at one month and 6 months. The experimental group underwent a protocol of massage-myofascial release therapy during a weekly 90-minute session for 20 weeks. The treatment was applied by a physiotherapist specialized in massage-myofascial therapy and aimed to release myofascial restrictions at the sites of the 18 painful points reported by the American College of Rheumatology. The protocol was as follows: massage-myofascial release at insertion of the temporal muscle, release of falx cerebri by frontal lift, release of tentorium cerebelli by synchronization of temporals, assisted release of cervical fascia, release of anterior thoracic wall, release of pectoral region, lumbosacral decompression, release of gluteal fascia, transversal sliding of wrist flexors and fingers, and release of quadriceps fascia . The placebo group underwent a weekly 30-minute session of disconnected magnetotherapy for 20 weeks. With the patient in prone position, magnotherapy was applied on the cervical area (15 min) and lumbar area (15 min). Placebo group patients were unaware that they were receiving a sham treatment.t-tests were used to compare baseline demographic characteristics between participants and drop-outs and between the experimental and placebo groups (randomization test).SPSS version 18.0 was used for the data analyses. After a descriptive study of the demographic variables, the normal distribution of variables was examined by means of the Kolmogorov-Smirnov test. We calculated an imputed score for standardized scales missing ≤10% of responses. Independent t-test for paired measures was used to determine the effectiveness of treatments. Differences between study groups were analyzed with a Student's t-test for independent samples. P < .05 was considered significant in all tests. Changes in scores for anxiety, pain, depression, and quality of life were analyzed by using a 2  ×4  repeated-measures analysis of variance (ANOVA). A Student's P < .087), trait anxiety (P < .074), state anxiety (P < .064), BDI (P < .081), sensitive points, any SF-36 dimension except for emotional role (P < .049), or any dimension of the PSQI except for sleep duration (P < .047).Out of the sixty-four patients enrolled in the study, two were lost from the experimental group for starting another treatment and three dropped out of the control group due to family and personal problems . TherefoP < .043,) versus baseline and in comparison to the control group (P < .023), right gluteal muscle (P < .038), left gluteal muscle (P < .043) and right greater trochanter (P < .039). No changes were observed in the placebo group. Tables Postintervention, the experimental group showed a significant improvement in VAS score for pain  versus baseline and in comparison to the placebo group. There were no differences in state anxiety or BDI versus baseline or between groups (P < .007), physical role (P < .039), body pain (P < .043), and social function (P < .048) versus baseline. versus baseline in sleep latency (P < .041) and sleep duration (P < .039) in the PSQI, while no changes were observed in the placebo group.  The experimental group also showed a significant improvement in trait anxiety (n groups . Among tP < .043) versus baseline and in comparison to the control group , right gluteal muscle (P < .039), and right greater trochanter (P < .044). No changes were observed in the placebo group.One month postintervention, the experimental group showed a significant improvement in VAS score for pain (ol group  and a siP < .043) but no significant differences were found between groups (P < .01), while no changes were observed in the placebo group. versus baseline (P < .045), while no changes were observed in the placebo group. F = 0.396; P < .047), trait anxiety , physical function , physical role , and body pain  dimensions of the SF-36. The experimental group showed a significant improvement in trait anxiety (n groups . No diffP < .047) in sleep duration (PSQI) and for a tender point at right greater trochanter (P < .048). Tables At 6 months postintervention, the experimental group showed a significant improvement versus baseline (In this study, a 20-week massage-myofascial release program significantly improved the pain, anxiety, quality of sleep, and quality of life in FMS patients. The treatment reduced the sensitivity to pain at sensitive points, mainly at the lower cervicals, gluteal muscles, and right greater trochanter. Fascial entrapment patterns can appear when a body segment stops receiving appropriate stimuli, establishing a pathological process with deficient circulation and limitation in nutrient supply to the fundamental substance of connective tissue, with its consequent densification. Because dense tissue is hypomobile, this situation leads to movement limitations . Fat accviceversa [In the present study, massage-myofascial release therapy produced no changes in BDI scores. A follow-up period of more than six months is probably necessary for a more exhaustive analysis of the bidirectional relationship between pain and depression in FMS. The presence of depression may facilitate the expression of active trigger points and iceversa , 18. Muliceversa –37. The iceversa .The significant improvements in SF-36 dimensions, physical function, and body pain observed after myofascial release therapy were also reported after aerobic exercise and multidisciplinary interventions in FMS patients –44. Thes One study limitation is the exclusion of 35 of the 231 eligible participants due to incompatibility with their work schedules. A further limitation is that patients with less severe pain may have been able to improve more rapidly.This study demonstrated that massage-myofascial release therapy reduces the sensitivity to pain at tender points in patients with fibromyalgia, improving their pain perception. Release of fascial restrictions in these patients also reduces anxiety levels and improves sleep quality, physical function, and physical role. Massage-myofascial program can be considered as an alternative and complementary therapy that can achieve transient improvements in the symptoms of these patients.


Road dust continues to be a major potential reservoir of Pb in the urban environment, and an important potential component of child Pb exposure. This study presents ICP-AES analyses of metals in 72 samples of road dust (<250 µm) collected in the urban core of Atlanta, Georgia. In the Downtown area, median Pb concentrations are ~63 mg/kg Pb, with high values of 278 mg/kg. For comparison, median Pb values in a nearby residential neighborhood  were ~93 mg/kg, with a high of 972 mg/kg. Geospatial variability is high, with significant variation observed over tens to hundreds of meters. Spearman Rank Correlation tests suggest that Pb and other metals  are associated with iron and manganese oxide phases in the residential area, as reported in other cities. However, Pb in the Downtown area is not correlated with the others, suggesting a difference in source or transport history. Given these complexities and the expected differences between road dust and soil Pb, future efforts to assess exposure risk should therefore be based on spatially distributed sampling at very high spatial resolution. Significant progress has been made worldwide over the past half century in reducing child Pb poisoning rates. In the US, for example, estimates of children and pregnant women with high blood Pb levels have dropped significantly in recent decades . Despite4 or lead carbonate, PbCO3) [The most common Pb exposure pathways for children are ingestion or inhalation of Pb-bearing particulate matter, whether in the household or outdoor environment ,10,11. T, PbCO3) ,13 and g, PbCO3) . Chronic, PbCO3) ,16. In tNumerous studies have shown the importance of the soil Pb reservoir in the cycling of Pb in the urban environment ,19,20,21The purpose of this paper is to report the preliminary results of analyses of road dust metal contents in two urban neighborhoods of Atlanta, GA, USA . The worIn May, 2011, two neighborhoods were sampled near the heart of the urban core of Atlanta. The first area is known locally as “Downtown”, and is comprised largely of high-rise buildings in a commercial setting. The second area is comprised of the western two thirds of Atlanta’s Neighborhood Planning Unit V (NPU-V). The neighborhood is within 1 km of Downtown, and is a residential neighborhood with mostly early to mid-20th century construction; the neighborhood has a history of mixed residential and light commercial use. Both neighborhoods are adjacent to major transportation arteries. Seventy two (72) samples of road dust were collected by sweeping a 1 m × 1 m square area and collecting the dust in plastic bags. The two neighborhoods were selected because they are in the urban core of Atlanta, but they have different land uses. Individual sample sites were located randomly in a grid across the area, with added complexity of problems of access and several samples that did not contain enough fine material for analysis. These samples were excluded from the analysis. All analyzed samples are reported here.In the lab, samples were sieved at 250 µm, and shipped to ALS Chemex  for geochemical analysis. Samples were pulverized and digested in nitric, perchloric, hydrofluoric, and hydrochloric acid, and analyzed by inductively coupled plasma atomic emission spectrometry. Analytical precision is in all cases less than 10% of the reported values. Metal abundances were treated as non-parametric data; correlations among the analytes were determined by Spearman Rank Correlation coefficent calculated using SPSS (v. 18). Geospatial analysis of the results was done using the Geostatistical Analysis tool in ArcGIS Desktop.Road dust Pb concentrations are highly variable in both neighborhoods . In the p < 0.005) Spearman Rank correlations are found among several metals , associated deposits are often rich in metals such as Zn and Cu that have other automobile sources such as tire or brake dust [The lack of strong correlation with other metals in the Downtown road dust is surprising, and contrary to results found in other studies, especially those that focused on soil Pb . The assake dust . et al. [et al. [et al. [In a chemical speciation study, Wang et al.  showed t [et al.  found si [et al. . The Atl [et al. .Initial prediction maps were constructed using various approaches including ordinary kriging and inverse distance weighting. However, autocorrelation analysis using Moran’s I (ArcGIS for Desktop 10 Advanced) revealed no discrete spatial correlation; therefore a weighted geospatial prediction map was not appropriate . The preRoad dust samples in the northwest of the Downtown area have elevated Pb concentrations A. The DoIn NPU-V, high Pb content is found in the road dust in the southern portion of the sampled area, reaching a maximum of 972 mg/kg. A steep north-south gradient is observed B. In addi.e., transportation patterns and land use), road dust Pb is more susceptible to remobilization compared to soil Pb. Mobilization and transport of road dust Pb is not well understood, but the relatively impervious surface of roadways would make transport easier by both wind and episodic water action . It seems likely that impervious surfaces and a lower levels of organic and mineral matter make road dust Pb more mobile than soil Pb. This may account for the significant drop found in studies of Hong Kong road dust between 1986 and 2000 [The complexities in the road dust Pb distribution reflect the complex natural and anthropogenic processes at play in the road environment. In addition to the potential complexities of Pb source location across space and time (and 2000 . Over tiand 2000 .Road dust in the NPU-V and Downtown Atlanta neighborhoods has median Pb concentrations of about 85 mg/kg. Values in the northwest of the Downtown area reach a high of 278 mg/kg Pb, whereas high samples in the southern part of NPU-V reach 972 mg/kg Pb. These results suggest that despite the complexities of resuspension and transport of Pb-bearing particulates by wind and water in the road environment, substantial Pb remains in road dust decades after Pb-containing gasoline was banned, just as it is well known to persist in urban soils. This may be due to limits on rates of Pb removal from road dust, or other continuing sources of Pb in the urban environment. Geospatial variation can be observed at the scale of tens to hundreds of meters, and probably at even finer scales. Very high resolution of sampling is therefore required to adequately assess Pb exposure risks due to road dust, as well as other sources of Pb in the urban setting.


To estimate trends in leisure time physical activity and physical fitness between 1987-2006 in older Spanish people.We analyzed data collected from the Spanish National Health Surveys conducted in 1987 , 1993 , 1995-1997 , 2001 , 2003 , and 2006 . The number of subjects aged ≥ 65 years included in the current study was 29,263 . Main variables included leisure-time physical activity and physical fitness. We analyzed socio-demographic characteristics, self-rated health status, lifestyle habit and co-morbid conditions using multivariate logistic regression models.Women exhibited lower prevalence of leisure time physical activity and physical fitness compared to men (P < 0.05). The multivariate analysis for time trends found that practising leisure time physical activity increased from 1987 to 2006 (P < 0.001). Variables associated with a lower likelihood of practicing leisure time physical activity were: age ≥ 80 years old, ≥ 2 co-morbid chronic conditions, and obesity. Variables associated with lower physical fitness included: age ≥ 80 years, worse self rated health; ≥ 2 medications , and obesity.We found an increase in leisure time physical activity in the older Spanish population. Older age, married status, co-morbid conditions, obesity, and worse self-perceived health status were associated with lower activity. Identification of these factors can help to identify individuals at risk for physical inactivity. In recent years, there has been an increase of aging in the society . The agiPhysical activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure . NeverthStudies conducted in the USA , AustralIn Spain, more than 40% of older adults are sedentary -37. AlthNo previous study has examined the time trends of physical activity in the last 20 years in older Spanish people. Therefore, the current study examines time trends in prevalence of PA for adults aged 65 and over using Spanish National Health Surveys (SNHS) conducted in the period 1987-2006. The objectives of this study were: 1) to describe the prevalence of LTPA and physical fitness among the Spanish elderly population in the period 1987-2006; 2) to determine socio-demographic features, self-perceived health status, co-morbidity, and lifestyle-related habits associated with LTPA and physical fitness in older people; and, 3) to analyze time trends in prevalence of LTPA and physical fitness in the period 1987-2006 in Spanish older people.As this analysis was conducted on a de-identified, public-use dataset it was not necessary to have the approval of an ethics committee according to Spanish legislation.We conducted a cross-sectional study using individualized data obtained from the SNHS done in 1987, 1993, 1995, 1997, 2001, 2003, and 2006. The SNHS is an ongoing, home-based personal interview examining a national representative sample of non-institutionalized population residing in main family dwellings (households) of Spain and is mainly performed by the Ministry of Health and Consumer Affairs and the National Statistics Institute . The SNHS uses a multistage cluster sampling, with proportional random selection of primary and secondary sampling units , with the final units  being selected by means of random routes and sex- and age-based quotas.Surveyors were previously trained about basic communication skills, procedures and the used questionnaire. Informed consent was signed by all participants before they answered the survey. In order to meet the surveys' stated aim of being able to furnish estimates with a certain degree of reliability at both national and regional levels the following samples of adult aged 15 years and older were selected in the SNHS: 29,647 in 1987; 20,707 in 1993; 21,058 in 2001; 21,650 in 2003; and 29,478 in 2006. Surveys conducted in 1995 and 1997 were based on smaller sample sizes , therefore these two databases were joined and analyzed together. The number of subjects aged ≥ 65 years included in the study along the entire period was 29,263 . More details about the SNHS methodology are described elsewhere ,39.For the purpose of the current study, we included answers from adults aged 65 years and older from these 7 SNHS. The variables included in the current study were created on the basis of several questions included in the questionnaires and identical in all surveys. The dependent variables were: 1, LTPA, which was collected using the following question: "Do you practice any physical activity during your leisure time?", with 2 possible answers: "none" or "once a month or more", and 2, physical daily fitness, which was assessed with 2 questions: "Can you walk up 10 steps without help?" and, "Can you keep walking for one hour without rest?." The answer to both questions could be "yes" or "no". These last two questions were first collected within the 1993 survey.We also analyzed socio-demographic characteristics such as age , marital status , and educational level .Self-perceived health status was assessed with the following question: "How did you self-perceive your health status over the previous 12 months?" Subjects described their health status as very good, good, fair, poor, very poor. The answer was dichotomized into very good/good or fair/poor/very poor self-perceived health status. We also collected the number of medical doctor diagnoses of co-morbid chronic conditions  as follows: none, one, two, or more. The number of prescribed medications for any of these chronic conditions was also categorized as none, one, two or more. Body mass index (BMI) was calculated from self-reported body weight and height. Individuals with a BMI ≥ 30 were classified as obese, those with BMI between 25 and 29.9 were classified as overweight and those with BMI < 25 were considered to have normal weight. Individuals with BMI < 18.5 or incomplete data on height and weight were excluded for the analysis.Regarding lifestyle habits, smoking habits differentiated between current smokers, non-smokers or ex-smokers. Finally, sleep habits were divided into subjects sleeping > 8 hours per day and those sleeping < 8 hours per day.In this study we analyzed physical activity and physical fitness separately for men and women and we excluded respondents with missing data for any outcome. We calculated descriptive measures for all variables of interest by aged-group and SNHS. Second, we compared the reported prevalence for the dependent variables and age group according to the SNHS. Third, we fit logistic regression models by gender to assess factors independently associated for each dependent variable. Finally, to evaluate the time trend across the period 1987-2006, adjusted odds ratios (ORs) with their confidence intervals were estimated using multivariate logistic regression models. Models were initially adjusted by age and by those variables that yield significant associations within the bivariate analysis. We assessed significant interaction terms in fully adjusted models; for significant effects, we stratified the fully adjusted models by the relevant factor. The estimates were made using the "svy" (survey command) functions of the STATA program, which allowed us to incorporate the study design and weights in all our statistical calculations. Statistical significance was established at P < 0.05 .The mean age increased significantly from 72.3 to 74.8 years for women and from 72.2 to 74.5 years for men across the study period (P < 0.05). Women were slightly, but significantly older than men in all surveys (P < 0.05). Tables Among women, the prevalence of those married, higher education, higher number of chronic conditions and medications, obesity and smoking habit significantly increased along the period 1987-2006 (P < 0.01). Among men, the evolution was very similar to women except for smoking habits that decreased from 33.8% to 15.4% (P < 0.01).Time trends for LTPA, capacity to walk up ten steps without help and to walk for one hour without rest by aged-group and gender are summarized in Table Crude time trends analysis by aged-group and gender revealed an increase in the prevalence of LTPA over time among women and men in all aged-groups (P < 0.001). On the contrary, no significant changes for physical fitness during the time period by gender or aged-group were found (P > 0.05).The multivariate analysis for time trends in women found that LTPA increased significantly from 1987 to 2006  and training sports among 75 years and over . The resWe have also found that women exhibit lower prevalence of LTPA and physical fitness as compared to men in all surveys, which is in agreement with the results by Stamatakis et al . The CarThe decreased prevalence of LTPA among women can be attributed to monitorization of daily transports . GallantWe found that age ≥80 years, to be married, ≥ 2 co-morbid chronic conditions and obesity were associated with a lower likelihood of reporting LTPA in both genders, which is in agreement with previous studies conducted in Australia  and USA The current study also found that education level (primary or over) was related with LTPA and fitness activity, which agrees with previous studies ,17,32. TAmong behavioral factors, smoking and BMI > 28 were negatively associated with LTPA. These results agree with previous studies showing that obesity was associated with lower activity ,46. In tOur results provide evidence that older people reporting a fair/poor/very poor self-rated health status have difficulties in walking and climbing stairs. Self-perceived health status is considered as a reliable predictor of PA, walking decline and mortality in older people . In factOur study has revealed an increase in LTPA during the last 20 years, but not for the capacity to walk up ten steps or walk for one hour. The tendency to respond affirmatively to LTPA can be explained because older people sometimes have a negative opinion of those inactive, and have their own beliefs about the effects of PA . In addiFinally, we should recognize some limitations of our study. First, discrepancies between trends of increase or decrease in PA among studies may be related to the definition and measurement of LTPA and physical fitness , study dOur study revealed an increase in LTPA, but not in physical fitness, from 1987 to 2006 in older Spanish people. Older people (age ≥ 80 years), married, with a greater number of co-morbid chronic conditions and obese exhibited a relatively lower LTPA. Similarly, older people (age ≥ 80 years, those taking a greater number of medications for chronic conditions, obese, and with worse self-perceived health status tended to have a relatively lower physical fitness. These results have potential implications for health services, as identification of these factors can help to prevent physical inactivity and improve the health status of older people in SpainPA: Physical activity; LTPA: Leisure time physical activity; SNHS: The Spanish National Health Surveys; ORs: Odds ratios.The authors declare that they have no financial competing interests and non-financial competing interests.: The manuscript, or parts of it, have not been and will not be submitted elsewhere for publication.Conflict of interestRole of the funding source: We have not financial interest and we have not received direct o indirect funding, and there is not conflict of interest.DPC conceived of the study, and participated in its design and coordination and draft the manuscript. CAB carried out the acquisition of the data, analysis and interpretation of data. She has been involved in revising it critically. VHB participated in the design of the study and performed the statistical analysis. PCG carried out the acquisition of the data, analysis and interpretation of data. She has been involved in revising it critically. RJG participated in the design of the study and performed the statistical analysis. EPM carried out the acquisition of the data, analysis and interpretation of data. She has been involved in revising it critically. CFP conceived of the study, and participated in its design and coordination and helped to draft the manuscript.All authors read and approved the final manuscript.NoneThe pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/799/prepub


The association between striking life events, an important stress and acute anxiety disorder, and the occurrence of primary breast cancer is unclear. The current meta-analysis was designed to assess the relationship between striking life events and primary breast cancer incidence in women.breast cancer, breast tumor, cancer of breast, mammary carcinoma, life events, life change events, case–control studies, case-base studies, cohort study, and cohort analysis and identified a total of 307 papers published from January 1995 to April 2012. Following evaluation of methodological quality with the Downs & Black criteria, seven case–control or cohort studies were selected and the association between striking life events and primary breast cancer incidence in women was measured using random effect or fixed-effect odds ratios combined with 95% confidence interval.Systematic computerized searching of the PubMed, ScienceDirect, Embase, and BMJ databases with the combinations of controlled descriptors from Mesh, including P = 0.003), indicating that women with striking life events were at 1.5-fold greater risk of developing breast cancer. The pooled OR for severe striking life events and breast cancer was 2.07 (95% CI 1.06 - 4.03), indicating that women with severe striking life events were at 2-fold greater risk of developing breast cancer.The seven studies included in the final meta-analysis included 99,807 women. A meta-analysis showed that the pooled OR for striking life events and breast cancer was 1.51 (95% CI 1.15 - 1.97, The current meta-analysis showed significant evidence for a positive association between striking life events and primary breast cancer incidence in women. Primary breast cancer is one of the main public health problems worldwide. Over 1.3 million women are diagnosed annually with primary breast cancer and approximately 458,000 will die from the disease ,3, with An important stress disorder, called striking life events, has been classified as an acute anxiety disorder. This disorder is characterized by aversive anguishing experiences and physiological responses that develop after exposure to stressful life events, including change in marital status, such as separation, divorce, or widowhood; death of a spouse, child, or close relative; a friend’s illness; personal health problems; and change in financial status. This disorder has short-term features, distinguishing it from chronic or delayed-onset stress disorder -13. A prConflicting results regarding the association between stressful life events and breast cancer may be due to differences in subject population, number of subjects, study type, and sample type. These findings suggested the need for a meta-analysis examining the relationship between striking life events and primary breast cancer incidence in women.A systematic review and meta-analysis of primary cohort and case–control studies addressed whether women exposed to stressful life events are at increased risk of developing breast cancer. Hence, the objective was to evaluate the association between striking life events and primary breast cancer in women. The use of human materials was approved by the Peking Union Medical College Hospital Medical Ethics Committee (No.S-406).breast cancer, breast tumor, cancer of breast, mammary carcinoma, life events, life change events, case–control studies, case-base studies, cohort study, and cohort analysis. The reference lists of the retrieved articles were also reviewed to identify additional articles missed by this search.Eligible studies were identified by systematic computerized searching of the PubMed, Science Direct, Embase, and BMJ databases for relevant reports published from January 1995 to April 2012. The database search strategy used combinations of controlled descriptors from Mesh, including The following inclusion criteria were adopted for the studies: (a) type of study – prospective and historical cohort and case–control studies; (b) type of sample – women aged 20 years or older at first occurrence of breast cancer in cohort studies and women with the appearance of first breast cancer in case–control studies; (c) mean follow-up time – a minimum of ten years in cohort studies, with no limit between exposure and diagnosis in case–control studies; (d) type of variables – studies in which the stress variable was measured quantitatively, using a numerical scale, questionnaire, or checklist, with stress assessed by measuring the frequency of exposure and intensity of the event; (e) statistical type and analysis – studies that calculated relative risk (RR) for the first episode of breast cancer in relation to the stress variable, adjusting for confounding factors, including age, use of oral contraceptives, any type of hormone replacement, menopause, alcohol intake, smoking, socioeconomic status, and family history of breast cancer.Studies were excluded if: (a) the articles which not had English version; (b) the articles addressed life style and daily stress; (c) stress was assessed in women with a psychiatric history; or (d) breast cancer recurrence or other diseases of the breast were measured. In addition, review articles and editorials were excluded.The article titles and abstracts were initially evaluated by three reviewers to verify that each primary study addressed the underlying question of the systematic review. The abstracts were grouped into selected versus not selected. The selected articles were retrieved, read in full, and screened for those indexed in more than one source or in another language.In the next phase, data from the selected studies were assigned to an instrument to verify whether they met the inclusion and exclusion criteria, with discrepancies resolved by discussion and consensus. Studies lacking a consensus for inclusion were analyzed by a fourth reviewer.Data from the case–control and cohort studies were assigned to a structured form, which included the last name of the first author, the year of publication, country of origin, type of study, adjustment for confounding factors, and odds ratios (ORs) and 95% confidence interval (CI). The data were reviewed by the four reviewers.P < 0.05 as described [p < 0.05.Statistical analysis was performed preferentially using Cochrane Review Manager Software (version 5.1). For categorical variables, weighted risk ratios and their 95% CIs were calculated using RevMan 5.1 software . Resultsescribed . A fixedThe search strategy identified 307 titles and abstracts. Of these, 284 were excluded after reading the titles and abstracts. Our inclusion and exclusion criteria were applied to the remaining 23 articles describing case–control and cohort studies. A higher intensity of psychological events resulting from severe, major life, stressful, and overall life events were described and classified to calculate the ORs in these articles.Of the 23 articles, seven, containing sufficient data, were included in our meta-analysis Table . Most ofOf the seven studies included in our meta-analysis, four were case–control studies -20 and tThe remaining 16 identified articles not included in our meta-analysis were examined. Risk factors related to psychiatric, psychological, and social disorders have been described . In addiORs for primary breast cancer occurrence related to striking life events are shown in Table p < 0.00001, Figure p = 0.003). As shown in forest plots, rhombus shapes that represent the studied variable appeared on the right side of invalid line, suggesting the studied variable was a strong pathogenic factor. Interestingly, the rhombus shape suggested that the variable had not been characterized. The OR was far from the midline and differed markedly from other studies. The weight ratio depended on the model used for analysis, with a minimum weight box displayed in the forest plots. The maximal weight box did not represent those reported previously and included the highest number of samples , although others had difference perspectives . Although both were prospective cohort studies, subject age was limited from 50 to 79 years, with no specific age limitations.The consistency of the seven studies was poor and varied markedly , suggesting that individuals with severe striking life events would be at two-fold greater risk of developing breast cancer than individuals without these severe striking life events . A forest plot showed a diamond shape, with striking life events on the right side of the invalid line, suggesting that striking life events were strongly associated with the incidence of primary breast cancer. However, although our results indicated that striking life events were positively associated with breast cancer occurrence, the OR was not high and the lower limit of the 95% CI was only 1.15.More importantly, our meta-analysis found that women with a severe degree of striking life events had an OR of 2.07 (95% CI 1.06 - 4.03) of developing breast cancer, suggesting that more severe striking life events contribute to a higher risk of primary breast cancer in women. Our findings suggest that psychological treatment of striking life events may reduce breast cancer occurrence. Discrepancies over the definition of striking life events would change the association between these events and the risk of developing breast cancer.Although studies have yielded contradictory results on the association between stress and breast cancer development, our results confirm that high-intensity stress has a borderline association with the development of breast cancer. However, relative to the findings in most of studies that stress can increase the risk of breast cancer, whether those women who had the most aggressive form of breast cancer also had the highest stress levels was unclear, and there is no real way to tell how much stress the women were under before their diagnosis of breast cancer. Obviously, based on that it’s not clear what’s driving the association between stress and breast cancer development, future studies are necessary to elucidate this relationship.YL and CW contributed equally to this work. Both designed the study, collected and analyzed data, and wrote the manuscript. YZ, XH, and LP participated in the collecting and analyzing data. GS and KW performed statistical analyses. QS conceived the study, participated in its design, and helped to draft the manuscript. All authors read and approved the final manuscript.The authors declare that they have no competing interests.