We explored whether a bilingual advantage in executive control is associated with differences in cultural and ethnic background associated with the bilinguals' immigrant status, and whether dialect use in monolinguals can also incur such an advantage. Performance on the Simon task in older non-immigrant (Gaelic-English) and immigrant  bilinguals was compared with three groups of older monolingual English speakers, who were either monodialectal users of the same English variety as the bilinguals or were bidialectal users of a local variety of Scots. Results showed no group differences in overall reaction times as well as in the Simon effect thus providing no evidence that an executive control advantage is related to differences in cultural and ethnic background as was found for immigrant compared to non-immigrant bilinguals, nor that executive control may be improved by use of dialect. We suggest the role of interactional contexts and bilingual literacy as potential explanations for inconsistent findings of a bilingual advantage in executive control. Regular use of two or more languages requires individuals to inhibit one language when using the other, to select the appropriate linguistic setting and individual words in the target language Green, . HabituaBecause random assignment is not possible in quasi-experimental studies comparing bilinguals with monolinguals, there remains the possibility that bilingualism covaries with other factors that can also affect executive functioning  monodialectal speakers of SSE, the English variety spoken by the Gaelic-English bilinguals, who resided in the same locale as the bidialectals, but reported not using Dundonian Scots despite having full comprehension of it and (3) monolingual speakers of Anglo-English, the same variety spoken in the South of England by the majority of the Asian Language-English bilinguals, and to whom Scots was unfamiliar and often unintelligible. We use the label monodialectal to refer to those monolingual participants who shared a geographical and cultural background with the bidialectal participants; however, it should be noted that these monolinguals also represent the most appropriate control group for the Gaelic-English bilinguals.A bilingual advantage in executive control may also be attenuated or aggravated by factors operating within monolinguals, such as using different dialectal varieties of a language. To date, little is known about the cognitive demands imposed by dialect use. Even though dialects are considered to be mutually intelligible, they still require management of competing phonetic and lexical variants. Compared to the relatively moderate differences between regional and social varieties of English in the USA and Canada, the countries from which the majority of monolingual controls have been recruited so far, Britain has considerable dialectal diversity: Speakers of British English are routinely exposed to many distinct varieties of English  in addition to the standard variety. Specifically, in Scotland, 85% of the population report using one of the local varieties of the Scots dialect to varying degrees  participated in the experiment. Sixteen bilingual participants (six men) were speakers of Gaelic and SSE. Sixteen bilingual participants (10 men) were speakers of English and either Bengali, Gujarati, Hindi, Malay, Punjabi or Urdu who had immigrated to the UK before 35 years of age. Sixteen bidialectal participants (seven men) were speakers and regular users of both SSE and Dundonian Scots. Sixteen monodialectal participants (five men) were monolinguals speakers of SSE who had regular exposure to and could comprehend (but did not use) Dundonian Scots. Finally, 16 monolingual participants (six men) were speakers of Anglo-English spoken in the South of England. The monodialectal and bidialectal participants were recruited from the Dundee area, the Gaelic-SSE bilinguals were recruited from the Western Isles and the West coast of Scotland, the English monolinguals were recruited from different parts of England and Scotland . The Asian language bilinguals were recruited from London and Dundee, and their age of arrival in the UK  was similar to the 21.5 years reported for the bilinguals in Salvatierra and Rosselli  revealed that the bilinguals' daily use of their non-English language(s) and the bidialectals' use of Dundonian Scots ranged between 30% and 70% of time. The monodialectals reported less than 25% use of Dundonian Scots. In addition to the 80 participants included in the final analysis, a number of other participants were tested but excluded for various reasons: Three participants reported predominantly using Dundonian Scots and, as it proved impossible to recruit further monodialectal speakers of this type, were excluded from the study. Nine bilinguals reported percentages of English use outside the 30–70% range. Two participants were excluded for having extremely low English proficiency as measured in the Vocabulary subscale of the WASI. Five participants were excluded for having an age of arrival in the UK greater than 40. Four participants failed to perform the Simon task correctly, and data for one participant were not recorded due to equipment malfunction.One background questionnaire inquired about the participants' educational background, the occupations they had held throughout their working lives, as well as daily usage of the different varieties of English and of other foreign languages; Scottish participants were also asked about their use of varieties of Scots.Bilinguals and bidialectals additionally received modified versions of the Language Experience and Proficiency Questionnaire . Participants first saw a fixation cross in the middle of the screen for 800 ms, followed by an interval of 250 ms. Colour assignment to key location was counterbalanced across participants. Then, a red or a blue square appeared either to the left or the right of the screen, subtending five degrees of visual angle. The squares were visible for 1,000 ms if there was no response. Timing began with the onset of the stimulus and was terminated with the response. The next item started after a 500 ms inter-stimulus interval. The experiment began with eight practice trials for which participants' received feedback, followed by randomised presentation of 28 critical trials presented without feedback.Results for the linguistic, cognitive and demographic variables as well as the reaction times (RTs) and error rates for the Simon task of the five participant groups are given in p = .62.Although all participants were over the age of 60 years, it is important to check that there were no age differences between the groups which was confirmed by a one-way analysis of variance (ANOVA), F = 91.0, p < .001. Post-hoc tests using Tamhane's T2 for unequal variances indicated that, as expected, both bilingual groups and the bidialectals reported significantly less use of English (i.e. only an average of 48% of time) than monolinguals and monodialectals, all p's < .001.A one-way ANOVA comparing the self-reported percentages of daily use of either Anglo-English or SSE yielded a significant effect of group, H(4) = 9.62, p = .047, with mean ranks of 29.0, 36.4, 39.6, 46.5 and 51.0 for bidialectals, Asian Language-English bilinguals, monodialectals, monolinguals and Gaelic-English bilinguals, respectively. A post-hoc test using a Bonferroni-corrected Mann–Whitney test showed that the only significant difference was that between bidialectals who had a significantly lower skill level than Gaelic-English bilinguals, U = 51, p < .005.We disregarded participant income as a measure of SES as 75% of the participants were retired. Instead, we used the 2010 Standard Occupation Classification  to categorise participants' occupations into one of four skill levels based in the amount of formal qualifications or work-based training estimated to be necessary to perform each occupational task. These skill levels ranged from 1  to 4 . A Kruskal–Wallis test revealed a significant difference between groups, p's > .39.WASI scores were missing for one monodialectal participant who was unable to complete the session. One-way ANOVAs comparing performance of the groups on the Vocabulary and Matrix subscales separately yielded no significant effects, all F = 24.04, p < .001, with incongruent trials yielding higher error rates than congruent trials, but no significant interaction between Trial Type and Language Group. For correct trials, reaction times >2.5 SD above the mean were excluded from the analysis, which affected an additional 57 (2.6%) trials. For the RTs  = 115.1, p < .001. The effect of Group fell short of significance, F = 2.23, p = .074, reflecting a trend towards slower RTs in the Asian Language-English bilinguals. There was no significant interaction between Group and Trial Type. An analysis using median RTs yielded similar results showing a main effect of Trial Type, F = 81.47, p < .001, and an effect of Group which fell short of significance, F = 2.43, p = .055. Inspection of the distribution of mean and median RTs across all participants revealed one slow outlier in the Asian Language-English bilingual group. Removal of this participant from the reaction time analysis confirmed the effect of Trial Type, F = 112.97, p < .001, and showed no other effects.Participants committed a total of 2.7% of errors. Error rates were submitted to a 5  × 2  ANOVA, which yielded a significant effect of Trial Type:  RTs see , a similF = 98.1, p < .001, but did not yield any other significant effects.Because higher SES has been associated with improved executive functioning  = 10.53, p < .01, but no effect of Group and no interaction between the two factors. In sum, as expected, all participants showed significantly slower RTs for incongruent trials in the Simon task confirming that inhibiting the incongruent spatial location of the stimulus required additional inhibitory effort. Crucially, the lack of an interaction suggests that there is no evidence for group differences in the magnitude of the Simon effect, and thus, no evidence for differences in inhibitory control between bilinguals, bidialectals and monolinguals.These results differ from the Bialystok et al.'s  study whn = 48) and two bilingual (n = 32) groups together and computed the Simon cost as the difference between RTs for congruent and incongruent trials. Using the Bayes Factor (BF) package in R  and for other executive processing components (e.g. response suppression, switching, monitoring and updating—for an overview over studies that do not replicate a bilingual advantage see Paap & Greenberg,


Treponema pallidum hemagglutination assay included Venereal Disease Research Laboratory and fluorescent Treponemal antibody absorption. Stepwise logistic regression model was used to identify positive syphilis serology. Prevalence of syphilis was 47 : 100,000, similar in men and women and increased significantly with age (P < 0.001). Native Israelis had the lowest prevalence rate of syphilis , while a significantly higher prevalence was found among immigrants from Africa, Eastern Europe, and South America . About 33.2% of the seropositive donors had evidence of recent infection, and 66.8% had past infections. Incidence rate reached 8 : 100,000 person-years. Coinfection with HIV, HCV, and HBV was calculated as 8%, 1.88%, and 0.37% for positive donations, respectively. The data support the need to continue screening blood donors in Israel for syphilis and employ preventive measures to populations at risk, in order to improve public health, blood safety, and quality. A subsequent study to assess blood donors' knowledge, attitude, and behavior is planned. In times of global migration this information may be useful to blood services worldwide.Data of 1,290,222 volunteer blood donors, in a 5-year period, was analyzed for prevalence and incidence of syphilis. Subsequent testing of donations positive in Treponema pallidum, which can also be transmitted via accidental direct inoculation, transplacenta during pregnancy, and, rarely, via blood transfusion [Syphilis is a sexually transmitted disease (STD) caused bynsfusion , 2.Although the value of routine serologic screening of blood donors for syphilis has been a question in debate for years –5, and rIn many parts of the world, the incidence and prevalence of syphilis still remain high in both volunteer and family/replacement blood donors –15. TherIn Israel, screening tests for syphilis are conducted in community STD clinics for the general and high-risk populations, by the National Blood Services on each blood unit donated , and also in all pregnant women. Confirmatory tests for all positive samples are performed exclusively by the Central National Reference Laboratory for Venereal Diseases of the Ministry of Health (MOH), thus forming a national registry for surveillance and followup.Data reported by the Israeli MOH to the WHO regional office in Europe showed that the incidence of syphilis in the general population in Israel was 2.52, 5.8, and a low 0.7 per 100,000 in 1996, 2001, and 2005, respectively . AlthougAll blood donors in Israel are nonremunerated volunteers. Units are collected throughout the country in mobile vehicles or in fixed-site donor rooms. Before donation each potential donor fills a detailed health history questionnaire, which includes data regarding age, gender, country of birth, and year of immigration (if applicable), and questions concerning the donor's general health, lifestyle and risk behavior, followed by a short private interview, blood pressure and hemoglobin determination, and physical examination. Donors may be disqualified and deferred from donating based on their written and verbal answers or on previous information in the MDABS database. Relevant deferral criteria include, among others, permanent deferral for known HIV or hepatitis, by past testing or self-report, men who have had sex with men (MSM) since 1977, and people who have been given money for sex (sex workers). A 12-month temporary deferral includes donors who were treated for syphilis or gonorrhea within the previous year and those who had sex with people mentioned above [ Treponema Pallidum hemagglutination assay (TPHA) of Biokit-Syphagen TPHA autoindirect hemagglutination test , performed on Olympus PK 7200 blood-typing equipment . Each initial reactive sample was further tested in duplicate, according to the manufacturer's instructions. If two out of three results were positive (Repeat Reactive), the unit was discarded and the sample was sent to the National Reference Laboratory for Venereal Diseases of the Israeli Ministry of Health for serological confirmation testing using a different TPHA hemagglutination assay, the nonspecific treponemal assay Venereal Disease Research Laboratory (VDRL), using BD VDRL Antigen , and fluorescent Treponemal absorption test (FTA-ABS) with Trepo-Spot IF, Fluoline H (Biomerieux France).Tests were done using a specific serological“Recent/Active Infection”: if confirmatory results were one of the following: VDRL+ TPHA+ FTA+; VDRL− TPHA− FTA+; VDRL+ TPHA− FTA+ or VDRL+ TPHA+ FTA−, the donors have not been treated and therefore may be infectious ;“Past Infection/Serological Scar”: if confirmatory results were VDRL− TPHA+ FTA+According to the confirmatory results donors were defined asThe test was defined as false positive when VDRL− TPHA+ and FTA−.Prevalence was defined as the number of TPHA positive donors in the total donors' population. Incidence was defined as the number of new TPHA positive donors in the total donors' population. Seroconversion was defined when the current donation from a previously seronegative repeat donor gave a seropositive confirmed reaction.Tests were performed at MDABS laboratories using chemiluminescentimmunoassay for human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV), and human T-lymphotropic virus (HTLV) , and Individual Unit Nucleic Acid Testing (ID-NAT) for HIV, HBV, and HCV using Procleix Ultrio .Seroprevalence was defined as the proportion of donors serologically confirmed as positives from the total number of donors and was given with 95% confidence intervals.The seroconversion rate per 100,000 person-years was calculated by the number of donors who seroconverted, divided by the total number of person-years between consecutive donations, multiplied by 100,000.Proportion comparisons were performed with the normal approximation. The chi-square test was used to test the association between categorical variables.P values are given for the significant variables, and estimates of the odds ratios with their corresponding 95% confidence intervals are given.Two models of stepwise logistic regression were used to investigate which variables are associated with total seropositivity (Yes/No) and with recent infection (Yes/No). We estimated the models with the following explanatory variables: age, country of birth , year of immigration , and the 2-way interactions between immigration year and country group. Country group was a categorical variable, with Israel as the reference category to each of the other five country groups. We used the forward conditional method for variable selection. The final models are presented. Data for analysis included a total of 1,290,222 valid blood donations, collected from 605,549 donors, with an average of 2.1 units/donor (range 1–57). About 69% of the donors were men and 31% were women. Median age was 29, ranging from 17 to 70 years. Mean age of the donors was 33 ± 12.4 years. About 79% of the blood donors were born in Israel, and 21% had emigrated from different countries .Out of the 605,549 volunteers who donated blood in 2005–2009, 283 were seropositive, indicating a prevalence of 47 per 100,000. Prevalence rates of all the syphilis seropositive donors (with both recent and past infection) analyzed by gender, age, country of origin, and time of immigration to Israel are depicted in P < 0.001) in the prevalence rate of syphilis with age: donors age 45 years and older, who donated about one-fifth of the total number of units, comprised 36.7% of the seropositives. Prevalence rates were 7.4, 6.5, and 3.7 times higher in donors age 45 or older, 35–44, and 25–35, respectively, compared to ≤24 years.Men and women had similar prevalence rates of syphilis of 45 and 49 per 100,000, respectively. There was a significant increase , when compared to native Israeli.Ninety-four of the 283 seropositive donors (33%) were diagnosed as Recent Infections by the National Reference Laboratory for Venereal Diseases, and 189/283 (67%) were defined as Past Infection/Serological Scars. The distribution of seropositives between donors defined as recent or past infections was similar between the two groups  includinThe logistic regression model  enables P < 0.001). The interaction of immigration year (above and below 1990) and country of birth group was also significant. More specifically, new immigrants (immigration year ≥ 1990) from Africa, Eastern Europe, and South America had a significantly higher risk for syphilis  compared to the risk of Israeli-born donors and those who immigrated before 1990. Similar results are presented for the recent infection model.Age increased the risk of syphilis in the given population of blood donors (controlling for the other variables in the model). Every additional year of age adds 6% to the risk of either total seropositivity or recent infection . In addition, 0.37% and 1.88% of the seropositive donors for hepatitis B and C, respectively, were positive for syphilis, compared with 0.046 and 0.045% among the negative donors for these two hepatitis viruses (P < 0.001 for each test).Coinfection of seropositivity for syphilis with other transfusion-transmitted diseases was found: two out of 25 HIV-positive donors were seropositive for syphilis (8%), compared to 0.046% among the HIV-negative blood donors : age of the donors, their country of origin, and the time of immigration to Israel.Age. The prevalence rates of syphilis increased with age. Donors. The 35–44 year age group and those older than 45 years had a 6.5-fold and 7.4-fold higher prevalence of syphilis, respectively, when compared to the younger donors (aged 24 years or less). This is in agreement with others with similar findings among blood donors (18) or who described an increase of primary and secondary syphilis in older adults in the USA [ the USA , 28. Country of Origin and Time of Immigration. Israel is a country that absorbs Jewish immigrants from all over the world. In particular, from 1990 to 2001 more than 900,000 immigrants came to the country , mostly from the former Soviet Union and from Africa [m Africa .Our study revealed that the new immigrants from Africa and from Eastern Europe who arrived in Israel after 1990 had a 19-fold and 10.8-fold (resp.) higher risk for syphilis seropositivity than donors born in Israel. The findings were similar to the prevalence in their countries of origin, as reported by the Israeli MOH  and the The study also depicted an association between syphilis and other transfusion-transmitted diseases such as HIV, hepatitis B, and C, when compared to the donor population that was seronegative for syphilis, and it concurred with our previous observations of higher prevalence of hepatitis C among blood donors who immigrated to Israel from the former USSR .It is worth mentioning that about 62% of the units were donated by native Israelis, with the lowest risk for recent infection, thus contributing to the safety of the national inventory.In view of the ongoing discussion regarding the recent FDA's draft Recommendation for Screening, Testing and Management of Blood Donors, and Blood Components Based on Screening Tests for Syphilis , our finGiven the high prevalence of syphilis in Israel allied with active immigration, special attention should be invested in targeting preventive measures to the blood donor populations and populations at risk. A future study is planned to assess the knowledge, attitude, and behavior of the volunteer blood donors' population. These measures will most probably improve public health and increase blood safety and quality.In times of global migration the reported information may be useful to blood services worldwide.


Although previous studies have provided strong evidence that Chinese individuals are exposed to secondhand smoke (SHS) and lack knowledge of its harmful effects, there has not been an in-depth exploration of the variability in exposure and knowledge by geographic region, occupation, and socioeconomic status. The objectives of this study were to examine: (1) the demographic factors associated with the level of knowledge of the harmful effects of smoking; (2) the factors related to implementation of in-home and workplace smoking bans; and (3) geographic differences in being exposed to SHS in government buildings, healthcare facilities, restaurants, public transportations, and schools. We used data from the 2010 Global Adult Tobacco Survey-China. Chi-square tests were used for statistical analysis. The results suggested that among Chinese citizens age 15 years and older, there is poor knowledge of the harmful effects of tobacco, and knowledge varies with region and socioeconomic status. Over three-quarters of the households had no smoking restrictions, and a large percentage of workers reported working in places with no smoking ban. In public places, exposure to SHS was high, particularly in rural areas and in the Southwest. These results suggest Chinese individuals are not well informed of smoking and SHS associated risks and are regularly exposed to SHS at home, work and public places. Secondhand smoke (SHS) exposure is known to cause adverse health outcomes among non-smokers . Since tAccording to the World Health Organization (WHO), among the one billion smokers worldwide, 80% live in low- and middle-income countries . In ChinBased on increasing awareness about the harmful effects of SHS exposure, many developed countries have made efforts to reduce SHS exposure in public places and in the home ,13,14,15Although the Chinese Government ratified the WHO’s Framework Convention on Tobacco Control (FCTC) in 2005, 72% of non-smokers aged 15 and older were still regularly exposed to SHS in 2010, with more than half exposed on a daily basis . SmokingDuring the past decade, many studies have reported on SHS exposure in China ,21,22,23We used data from 2010 Global Adults Tobacco Survey-China (GATS China) to examine: (1) the demographic factors associated with the level of knowledge of the harmful effects of smoking; (2) the factors related to implementation of in-home and workplace smoking bans; and (3) geographic differences in being exposed to SHS in government buildings, healthcare facilities, restaurants, public transportations, and schools.We used data from the 2010 GATS in China, which is a nationally representative household survey of the population aged 15 years and older. As a component of Global Tobacco Surveillance System (GTSS), during 2008 and 2010 the GATS used a standardized method to monitor tobacco use and tobacco control conditions across 16 low-and-middle income countries, including China. The 2010 GATS China used a multi-stage stratified cluster sampling design to produce nationally representative data. In total, 13,354 respondents completed the survey interviews, which are in-person interviews administered by interviewers using hand-held devices. The overall response rate was 96%. Key findings from and additional details of the survey methodology of GATS China are available in the GATS China fact sheet .Knowledge of the harmful effects of smoking was assessed with three core questions: “Based on what you know or believe, does smoking tobacco cause the following: Stroke /Heart attack/Lung cancer”? In addition, knowledge of the harmful effect of SHS was measured by questions: “Based on what you know or believe, does breathing smoke from other people’s cigarette cause the following: Heart disease in adult/Lung illness in children/lung cancer in adult”? Participants who answered all three questions correctly were defined as have good knowledge; those who answered any of two questions correctly were defined as having some knowledge, and the rest were defined as have little knowledge.In-home smoking bans were assessed by the sampled participant’s reporting of smoking rules inside the home. Participants who reported that smoking was not allowed inside the home were classified as having a total smoking ban; those who reported smoking was not allowed but with exceptions to that rule were classified as having partial smoking ban; and those who reported that smoking was allowed or had no rules were defined as having no ban. Participants who reported working indoors were asked to describe the smoking policy at work. Workplace smoking rules were classified as a full ban, a partial ban, and no ban.SHS exposure in public places was assessed by a set of questions that asked if participants had seen anyone smoking in government buildings, healthcare facilities, on public transportation, in restaurants and at schools during the past 30 days. Healthcare facilities were assessed by the questions that did anyone smoke inside of any “private/village health care facilities”, “hospital or community health care facilities” or “other health care facilities”. People who reported viewing smoking at any location above were defined as being exposed to SHS in public places.Smoking status was defined by the question: “Do you currently smoke any tobacco product on a daily basis, less than daily, or not at all?” An adult who currently smoked any tobacco product daily or less than daily was defined as current smoker. Demographics variables included age , gender, highest attained education level , region , urban/rural area, career type , and wealth index. Wealth index was measured by principal component analysis based on a set of questions about whether a household has certain items, including electricity, flush toilet, fixed telephone, cell phone, television, radio, refrigerator, car, moped/scooter/motorcycle, washing machine, and air conditioner/heater . Based oAll statistical analyses were conducted using the survey functions in Stata 12.0 . The data were properly weighted using the personal weights, and the survey design features such as strata and clustering were accounted for in the analyses.Descriptive statistics were calculated for the sample, by smoking status and gender. In addition, the knowledge level of the harmful effects of smoking and SHS exposure were assessed for the sample by demographic characteristics. The prevalence of in-home and workplace smoking bans were reported by household and geographic characteristics. In addition, the prevalence of viewing smoking in public places was estimated by geographic characteristics. Chi-square tests were used to analyze the differences in smoking and SHS related knowledge, smoking bans, and prevalence of viewing smoking in public places by corresponding dependent variables. Individuals who had incomplete information on wealth index variables, knowledge on smoking or SHS exposure, reported in-home or workplace smoking ban, or SHS exposure in public places were excluded from the corresponding analysis.Our study identified the factors related to better knowledge of the harmful effects of smoking and SHS exposure, smoking bans at home and workplaces and SHS exposure in public places. In addition to the existing studies on the topic, our study focused on geographic factors and socioeconomic status including education level, wealth index and career type.p = 0.002) and SHS (p < 0.001) compare to smokers. Approximately 23.0% of non-smokers had good knowledge of smoking, and 25.6% had good knowledge of SHS. Among current smokers, 19.6% and 22.1% had good knowledge of smoking and SHS, respectively.The information in p = 0.004) and SHS exposure (p < 0.001). Near 60% of people aged between 15 and 34 had some or good knowledge of SHS exposure, while among people greater than 60 years old, only 32.5% had some or good knowledge of SHS exposure. In general, the awareness of the harmful effects of smoking (p = 0.045) and SHS exposure (p = 0.044) among females was not as good as it was among males. People who were better educated tended to be more aware of the harmful effects of smoking (p < 0.001) and SHS (p < 0.001). Among people had attended primary school or less, 70.8% and 75.1% had little knowledge about smoking and SHS exposure, respectively. In contrast, among people had attended college or higher, 64.6% and 77.1% had some or good knowledge of smoking and SHS, respectively. Moreover, nearly 70% of agriculture workers had little knowledge of the harmful effects of smoking and SHS. In contrast, medical/health personnel and teachers had better knowledge, with the majority of medical/health personnel having good knowledge.Younger individuals appeared to have better knowledge of the harmful effects of smoking (p < 0.001) and higher income households (p < 0.001) had a higher prevalence of in-home smoking bans. The implementation of in-home smoking bans was not statistically different by regions (p = 0.142). At workplaces, the status of smoking bans did not differ by region or urban vs. rural areas. However, people who are equipment operators or technicians and people who work in business or the service industry were less likely to be protected by smoking bans at work. In contrast, medical/health personnel and teachers were more likely to report a full ban at work.vs. 33% in urban areas; 42.3% of respondents were exposed to smoking in public transportation vehicles in rural areas vs. 27% in urban areas. Exposure to smoking at restaurants and schools was not different in rural and urban areas. In addition, the Southwest region had the worst smoking environment at government buildings, healthcare facilities and public transportation, followed by the Mid-south and the Northeast.Among the various public places, the prevalence of viewing smoking in restaurants was the highest (89.4%), followed by government buildings (59.6%), healthcare facilities (38.8%), schools (37.7%) and public transportation vehicles (34.4%) . The preOur results indicate that, among Chinese citizens age 15 years and older, there is poor knowledge of the harmful effects of tobacco, and knowledge varies with region and socioeconomic status. As a consequence, perhaps, over three-quarters of households reported having no smoking ban and a substantial number of workers, especially equipment operators and business industry employees, reported that their workplaces had no restriction on smoking. In addition, SHS exposure in public places is a significant problem in China. Restaurants were the major places where people reported being exposed, followed by government buildings, health facilities, schools, and public transportation.Article 8 from the WHO FCTC requires parties to implement and enforce smoke-free policies to protect people from exposure to tobacco smoke . HoweverKnowing about the harmful effects of smoking and SHS exposure has been associated with adoption of in-home smoking bans; thus, this lack of knowledge that we found could partly explain our other finding that few homes had a complete in-home smoking ban . The stuThe finding of widespread secondhand exposure in public places also suggests the need for implementation and enforcement of clean indoor air laws. Nearly 90% of participants reported seeing smoking in restaurants, and smoking was reported to be seen in healthcare facilities, on public transportation and in schools. In general, the prevalence of SHS exposure in public places appeared to be higher in the Southwest, Northeast and rural areas. The high prevalence of SHS exposure in rural areas and Southwest China may be due to the imbalanced implementation of indoor smoking bans, cultural influences on smoking behavior and toleration of SHS exposure. China has a unique smoking culture. For instance, smoking and serving cigarettes is considered as good business manners; tobacco products are popular gifts of respect on both formal and informal occasions. Our finding that a majority of the business and service industry employees worked at places without any smoking restriction may also explain such smoking culture. In general, there is little social stigma against smoking, especially in rural areas, where people tend to have a lower educational level and a higher smoking prevalence . CulturaOur study supports previous findings and provides updated information. We used nationally representative GATS data from China. The overall response rate was 96%, which indicates a good representation of the Chinese population. However, we relied on self-reported data on people’s smoking behavior, their in-home and workplace smoking bans, and exposure to secondhand smoke in public places. Although there is no information on biomarkers of cigarette smoking or exposure to secondhand smoke, these self-reported measures have been found to be valid and reliable in population-based studies . In addiIn conclusion, this study suggests that Chinese individuals are not well informed of the risks associated with smoking and SHS and that they are regularly exposed to SHS at home, at work, and in other public places. Low knowledge and exposure are even more prevalent among people with a low socioeconomic status and those living in rural areas. The Chinese government needs to develop targeted educational and tobacco control programs to fit the cultural and social needs for Chinese citizens.


In the subgroup analysis, significant increased risk was detected in the U.S. studies  and in the studies with <10 years of follow-up , and the greatest increase in risk was observed in those studies without adjustment for smoking . There was some evidence of publication bias (P for Egger’s test = 0.03). Cumulative evidence from prospective studies suggests that coffee consumption is not associated with risk of gastric cancer. The observed positive results may be confounded by smoking and need further investigation.The potential role of coffee consumption in the development of various types of cancer has been extensively investigated in epidemiologic studies. How coffee consumption may modulate risk of gastric cancer, however, remains a subject open for investigation. To better quantify this relation, we quantitatively summarized evidence from prospective studies. Eligible studies were identified on PubMed databases. The summary risk estimates were obtained using the random-effects model. Subgroup, sensitivity and dose-response analyses were conducted. The present meta-analysis included 12 prospective cohort studies. A pooled analysis of these studies suggested that coffee consumption (highest  Gastric cancer is the fourth most common type of cancer and the second leading cause of cancer death . The incCoffee is one of the most widely consumed beverages globally, and its potential role in the development of many chronic diseases, including various types of cancer has received considerable attention over the past several decades ,4. How cetc. [The association of coffee consumption with risk of gastric cancer has been investigated in a number of epidemiologic studies, with ambiguous findings ,15,16,17etc. ,12, all etc. ,19,20,21Since the 2006 meta-analysis , 5 largeWe searched for potentially relevant publications published before June 2014 on PubMed and Embase databases using the search terms “coffee” or “caffeine” in combination with “gastric cancer” or “stomach cancer” or “cardia cancer”, with no language restrictions. We also carefully reviewed the reference lists of retrieved publications in order to identify any further studies. The title and abstract of the relevant studies were screened and then the full papers of potentially eligible studies were carefully accessed. To be included, the study had to meet the following criteria: (1) study design was prospective; (2) exposure of interest was coffee consumption; (3) outcome was gastric cancer; and (4) relative risks (RRs) with corresponding 95% confidence intervals (CIs) were available (either reported or could be estimated according to reported data).Two authors independently extracted data using a standardized data-collection form, and discussion would be performed if there were any disagreements. The following data were extracted from each included eligible study: the first author’s last name, year of publication, country of origin, years of follow-up, sex of subjects, number of cases and subjects, levels of consumption, range of consumption, RRs of gastric cancer with corresponding 95% CIs, and statistical adjustment in the analysis.I2 statistics [P-value of less than 0.1 was considered statistically significant heterogeneity. Potential publication bias was evaluated by use of Begg’s funnel plots and Egger’s regression asymmetry test [The RRs reflecting the greatest degree of control for confounders were used in the meta-analysis. The summary risk estimates were obtained with the method of DerSimonian and Laird using the assumptions of the random-effects model that takes into account both within-study and between-study variations . Statistatistics . For thetry test .Stratified analyses were performed for the following subgroups: geographic areas, length of follow-up, number of cases, sex, range of consumption, and adjustment for potential confounders. A sensitivity analysis was also conducted by omitting one study at each turn and pooling results from the remaining studies. Because the levels of consumption among individual studies differed substantially, A dose-response analysis using the method by Greenland and Longnecker was conducted . AccordiThe flow chart of literature search is shown in P = 0.07, I2 = 37.0%) , with moderate heterogeneity (= 37.0%) .et al. [The results of subgroup analysis stratified by geographic areas, length of follow-up, number of cases, sex, range of consumption, and adjustment for potential confounders are presented in et al.  was not et al. [The results of subgroup analysis stratified by geographic areas, length of follow-up, number of cases, sex, range of consumption, and adjustment for potential confounders are presented in et al.  was not P = 0.07, I2 = 41.4%)  . The RR P = 0.03), and the Begg’s funnel plots also showed some asymmetry , and a null association with gastric non-cardia cancer  was observed in the NIH-AARP study; but in the Singapore Chinese Health Study , the posPotential mechanisms whereby coffee may modulate cancer risk have been extensively studied, with both protective and adverse effects proposed. Coffee is a complex mixture of hundreds of chemicals, among which caffeine and polyphenols are suspected to affect cancer risk. Coffee is rich in phenolic compounds that have been found to inhibit several carcinogens . ExperimThe strengths of this meta-analysis, in addition to the inclusion of large number of cases that enhanced the statistical power of the study, the prospective design of all included studies also minimized the risk of selection bias and information bias, both of which are a common concern in case-control studies in which exposure was determined after the diagnosis of diseases. One may question the validity of information about coffee consumption in case-control studies because cases may have differentially recalled their diet intakes, or have reduced their coffee consumption due to the precursor conditions of gastric cancer .There are also several limitations that should be pointed out. As is mentioned above, the first one is the concern of insufficient adjustment. The second concern is non-differential misclassification of exposure resulting from measurement error, which may have attenuated any true relation. Third, none of the individual studies considered differences in preparation methods, which may affect the concentration of different compounds in coffee . FinallyIn conclusion, findings from this meta-analysis of prospective studies suggest that coffee consumption is not associated with risk of gastric cancer. Future prospective studies carefully accounting for potential confounders for gastric cancer are warranted.


Smartphone-based devices and applications (SBDAs) with cost effectiveness and remote sensing are the most promising and effective means of delivering mobile healthcare . Several SBDAs have been commercialized for the personalized monitoring and/or management of basic physiological parameters, such as blood pressure, weight, body analysis, pulse rate, electrocardiograph, blood glucose, blood glucose saturation, sleeping and physical activity. With advances in Bluetooth technology, software, cloud computing and remote sensing, SBDAs provide real-time on-site analysis and telemedicine opportunities in remote areas. This scenario is of utmost importance for developing countries, where the number of smartphone users is about 70% of 6.8 billion cell phone subscribers worldwide with limited access to basic healthcare service. The technology platform facilitates patient-doctor communication and the patients to effectively manage and keep track of their medical conditions. Besides tremendous healthcare cost savings, SBDAs are very critical for the monitoring and effective management of emerging epidemics and food contamination outbreaks. The next decade will witness pioneering advances and increasing applications of SBDAs in this exponentially growing field of mHealthcare. This article provides a critical review of commercial SBDAs that are being widely used for personalized healthcare monitoring and management. Intensified research has focused on the development of advanced smartphone-based devices and applications (SBDAs) that offer cost-effectiveness and personalized mHealthcare, regardless of time and place. Current smartphones are increasingly loaded with sophisticated features and a variety of sensors, including light detectors, cameras, proximity sensors and fingerprinting. Thus, SBDAs are the most prospective and effective means of delivering mHealthcare to remote, resource-poor, private and public settings. In telemedicine, real-time diagnostics with spatio-temporal and pertinent information provided by smart devices can be kept on a secure central server and are accessible by healthcare professionals from remote locations. This feature is very critical for the monitoring and effective management of emerging epidemics and individual emergency cases . i.e., 6.8 billion people, are cell phone subscribers, and about 2.7 billion subscribers are Internet users [Over 94% of the world population,et users  with 70% i.e., immunoassays [ in vitro diagnostics, which are under various stages of development. However, some of the mentioned SBDAs, such as those from GENTAG, Inc. , Mobile Assay, Inc.  and Nonin Medical, Inc. , were searched from the respective websites of these companies that were googled on the Internet using the keywords of the companies’ names. The relevant information pertaining to the features of the mentioned SBDAs were taken from the information provided on the respective websites, the published literature and the product manuals. The prices of most of the SBDAs were taken directly from the websites, while in some cases, such as the SBDAs from Nonin Medical, Inc and Artificial Life, Inc. , these were taken from the concerned persons in these companies.There are considerable growing applications of cell phone-based devices in bioanalytical sciences , i.e., inoassays ,6,7,8,9,noassays ,13,14,15noassays ,17,18,19noassays , microscnoassays ,23,24,25noassays ,27 and cnoassays . This maThe personalized monitoring of health by the determination of weight, activity, sleep, heart rate, blood glucose diet and other parameters is immensely useful for the management of important chronic health conditions, such as diabetes, obesity, depression, ageing and mental health ,55,56,57®. Cleared by the Food and Drug Administration (FDA) and Conformité Européenne (CE), the newer version is the wireless body analysis scale, consisting of four electronic sensors and a set of proprietary algorithms, to measure body compositions. This stand-alone device can simultaneously analyse the weight, body fat, lean mass, muscle mass, bone mass, body water, daily calorie intake, BMI and visceral fat rating of individuals. Both scales can be used by multiple users on all of the iOS and Android devices. The wireless body analysis scale and the wireless scale are sold for US$ 109.95 and US$ 69.95, respectively. The wireless BP monitor measures and tracks the systolic/diastolic values, heart rate and pulse wave. The results presented as visual charts are generated based on historical averages and World Health Organization (WHO) classifications. A BP dock is used for transforming an iOS device into a personalized BP monitor. The wireless BP monitor, with FDA clearance, ESH and EC Medical-certified CBD, can be attached to a small cuff on the wrist to serve as a motion sensor with high precision. The price of the wireless BP monitor, the wireless BP wrist monitor and the BP dock is US$ 99.95, US$ 79.95 and US$ 79.95, respectively. The iHealth MyVitals app monitors and shares the data pertaining to weight, blood pressure (BP), diet, physical activities and sleep. As an aid in personalized health management, it enables the users to set goals, view health trends, track progress, log food intake and activities and share the personalized information with families, friends and/or doctors. Additionally, it enables the creation of plans and the setting of reminders.iHealth Lab Inc.  provides in vitro blood glucose monitoring. Priced at US$ 29.95, the meter can be used with the iHealth Gluco-Smart App, which empowers the users to effectively manage their diabetes rather easily and conveniently. The user is simply asked to create a unique iHealth ID, enabling access to free and secure cloud services. The app allows the user to take and log glucose measurements anywhere to view the trends and statistics for up to 90 days. The glucose meter, powered by a built-in, rechargeable battery, is sufficient for up to 200 tests. This sleek meter with an easy-to-read light emitting diode (LED) display performs glucose measurements within the diabetic pathophysiological range of 1.1–33.3 mol/L in 5 s using 0.7 μL of fresh capillary whole blood. The meter is connected via Bluetooth to the smart app on iOS or Android devices equipped with personalized healthcare tools for tracking and effective management of blood glucose. The app automatically determines the remaining quantity of test strips in the vial and expiration information and alerts the user for a new vial. The patient saves up to 500 blood glucose test results on the meter offline, uploads the results to the iOS device app via the “upload” button to track the trends and to set up medication alerts and insulin reminders. It also alerts when the test strip expires, thereby preventing the potential error of false evaluation. The results can be shared with family members, friends and/or doctors. The most recently commercialized glucometer by iHealth is iHealth Align, which is FDA-cleared, CE-marked and can be purchased off the shelf for just US$ 16.95. This smallest glucometer plugs directly into the headphone jack of the smartphone and displays results instantly on the screen. It employs the same iHealth Gluco-Smart app and analytical features of the Wireless Smart Gluco-Monitoring System.Another recent product is the Wireless Smart Gluco-Monitoring System, cleared by the United Stated Food and Drug Administration (FDA) and Conformité Européenne (CE), which meets the ISO 15197:2003 requirements for® to the iHealth SpO2 app on iOS and Android devices, the user can view the trends and organize and share such information. SpO2 reflects the amount of oxygen carried out by the blood as a percentage of the maximum carrying amount. The normal SpO2 is 96%–99% for a healthy individual, but is affected by high altitudes and other factors. Similarly, the normal resting pulse rate of 60–100 bpm is also affected by physical activity, fitness level, body weight, emotional state, medication and body position. The SpO2 measuring range is 70%–99%, while the average root mean square accuracies for SpO2 ranges of 80%–99% and 70%–79% are ±2% and ±3%, respectively. Similarly, the pulse rate measuring range is 30–250 bpm, while the pulse rate accuracies for the pulse rate ranges of 30–99 bpm and 100–250 bpm are ±2 bpm and ±2%, respectively. The device is a very useful tool for athletes and patients with breathing difficulties (pulmonary dysfunction), COPD (chronic obstructive pulmonary disease), coronary heart diseases and other vascular health conditions.The Wireless Pulse Oximeter, sold at US$ 69.95, FDA-cleared and CE-marked, determines the blood oxygen saturation (SpO2) and the pulse rate (BPM) using a lightweight and portable device to perform non-invasive and rapid measurements at the fingertip. The technology involves the shining of two light beams into the small blood vessels or capillaries of a finger, to determine the amount of blood oxygen. It displays the measurement on the oximeter’s screen and records the result in the device’s memory. With wirelessly connection via Bluetooth i.e., latex- and PVC-free. The smart app enables the setting of goals and silent vibrating alarms apart from viewing the trends, organizing records and information sharing within a social network. As a true personalized healthcare tool, it enables the users to adapt their lifestyle by keeping track of the defined general health parameters with physical activities, diet and other measures.The iHealth Wireless Activity and Sleep Tracker, available for US$ 59.95, is a watch-shaped device that tracks the personalized daily activity and sleep. It is connected to the iHealth MyVitals app on iOS and Android devices via Bluetooth 4.0 with a low energy requirement. It is sweat, rain and splash proof and worn like a wrist watch or attached to the waist with a clip. It consists of a three-axis accelerometer to detect the 3D-motion patterns and provides information related to the steps taken by the users, burnt calories, travelled distance, sleeping hours and sleeping efficiency. The iHealth Tracker is powered by a rechargeable built-in battery that typically lasts over five days. With an accuracy of 95%–97%, the device is made of hypoallergenic and skin-friendly TPU rubber, i.e., AliveECG is running on the same smartphone unit. The AliveECG app is free to download for iPhone and Samsung users, but requires an initial account set-up. Personalized and encrypted ECG data and information are stored via cloud computing on a secure server, which can be remotely accessed as desired. The device runs on a 3-V coin cell battery that takes up to 10,000 ECGs of a 30-s duration. The Lead I ECG is generated by resting the electrodes on the fingers from each hand or on the chest. The app senses the skin contact with the sensors and initiates the ECG recording after establishing an acceptable connection. The AliveCor Heart Monitor employs a proprietary technology to convert electrical impulses to ultrasound signals, which are transmitted to the smartphone’s microphone. The enhanced filtering technology minimizes artefacts, yielding a high fidelity tracing comparable to the Lead I on standard ECG machines. This relatively cost-effective device can be used to evaluate the patient’s heart rate and rhythm. Its clinical accuracy has been demonstrated in several clinical trials; perhaps this is an educational tool for a subject with heart conditions to obtain rapid and accurate screening and recording of ECGs. The availability of a detailed arrhythmia library , diagrams of cardiac anatomy and a breakdown of the ECG waveform provides enriched heart information that motivates the users to take care of their heart health. The users bear no extra cost, since the device is paid for by Medicare and other private insurance companies in the U.S.AliveCor, Inc.  was foun®, enabling the reading of NFC-based sensors or other customized sensors from a distance of one inch to 15 miles. Wireless NFC SensorLinkers are portable, lightweight (74 g), battery-powered devices for home medical monitoring applications, smart homes and machine-to-machine applications , NFC sensors for temperature, radiation, chemicals and pressure, an NFC immunoassay for prostate cancer, smartphone-based home monitoring solutions, e.g., an NFC thermometer, NFC custom blister packs and medication sensors, remote wireless monitoring of elderly or at-risk patients directly in their homes by taking BP, fever and medication data, an NFC-Bluetooth® weight management kit and RR tags.The company utilizes NFC to develop disposable wireless skin patches, personal drug delivery systems and smartphone-based sensors . The wireless skin patches can be waterproof, showerproof and non-allergic. They have a unique ID and employ a low-cost passive technology (without any battery), an FDA-cleared adhesive lasting 1–2 weeks and a 13.56 MHz frequency, which is the most widely used global standard in healthcare. Employing a radar-responsive (RR) tag for precise wireless geo-tagging over several miles, “wide area non-GPS wireless geolocation and geofencing” technology may lead to several prospective applications. The RR tags are used with smart diagnostic skin patches to monitor and locate patients with special needs, such as Alzheimer’s dementia. The GENTAG capabilities include an NFC-radio frequency identification device (RFID) sensor, an NFC tag for preventing counterfeit drugs or products, NFC diagnostic skin patches for fever monitoring, drug delivery, glucose monitoring, post orthopaedic surgery/post-hospital discharge monitoring and the prevention of hospital errors  jointly developed a smartphone-based disposable immunoassay procedure for urine samples to diagnose prostate cancer using the proprietary PCADM-1 biomarker of MacroArray Technologies, LLC. It is a non-invasive and highly cost-effective consumer-based test for the frequent testing for prostate cancer. Since more frequent measurements are possible, this procedure might potentially replace the individual and isolated determination of the prostate-specific antigen (PSA)-based blood test during hospital screenings. Due to the influence of other physiological factors in a patient, the reliability of the PSA-based blood tests is questionable .GENTAG, Inc., has obtained a patent for a smartphone-based painless transdermal glucose sensing and monitoring system using disposable skin patches with wireless sensors . Such pa i.e., NFC reader and RR tags, offers software-based remote geolocation and monitoring.GENTAG, Inc., has also demonstrated a customizable spectroscopic radiation detection cell phone, based on the sensor technology from eV Products, Inc. , to discriminate hazardous γ-rays from normal γ-rays. The combination of this technology with GENTAG’s wireless sensing technologies,Botrytis cinerea, a fungus that causes significant damage to plants and flowers.Of interest is a cost-effective mobile diagnostic reader (mReader™) from Mobile Assay, Inc.  Figure , based oCellScope , a startHolomic LLC  was form® smart technology for the transmission of the heart rate from the chest strap (transmitter) to the smartphone. The chest strap also sends the signal at a transmission frequency of 5.3 kHz, compatible with most training devices in the gym, provided a separate Runtastic receiver (charged by lithium battery) is used. The transmitter, preferably with its contacts moistened by an ECG gel, is connected to the strap by two push buttons. The elastic strap is then adjusted so that the sensors contact the chest below the pectoral muscles. The Runtastic app needs to be downloaded on the smartphone in addition to the setting up of the personalized account before the monitor’s results appear on the smartphone. Once the Bluetooth connection is established between the monitor and the smartphone, the device displays heart rate real-time results during exercise via the Runtastic app. An alternative is to plug the Runtastic receiver into the headphone jack of the smartphone, which activates the receiver immediately to provide real-time results from the transmitter after enabling the receiver (ON) in the smartphone settings. The receiver battery lasts about 2.5 years with a daily operation of 1 h. The transmission can switch between coded and uncoded transmission modes by button pressing for 5 s. The encoded transmission is less susceptible to interference from other similar transmitters in operation. The uncoded transmission is ideal, as it employs a frequency used by most fitness equipment, such as treadmills and cross trainers. The chest strap might contain latex components that trigger allergic reactions, such as skin irritations and redness, and its use must be discontinued immediately in this situation.Runtastic GmbH  has deveThe Runtastic GPS Watch and the Heart Rate Monitor, sold at US$ 202, track pace, speed, duration, laps, calories and heart rate together with elevation change and target heart rate training zones. The watch has a battery life of up to 14 h, a reliable compass with navigation functions, a customizable display, a night light and other functions. Both the watch and the monitor are just 57.5 g and 60 g, respectively. The device, charged via a USB cable, transfers all of the fitness statistics and graphs to the user’s account on the Runtastic website  to a com i.e., low resistance, while bone and fat tissues have low conductivity or high resistance. The measurements are transferred from the scale to the smartphone or the tablet by energy-efficient Bluetooth® smart technology from a distance as far as 25 m via the Runtastic Libra app, freely available from the iTunes store. The scale accommodates up to eight users and automatically assesses their personal body metrics. It is composed of a highly resistant glass plate coated with indium tin oxide (ITO) electrodes, weighs 2.5 kg and employs 3 × 1.5 V AAA alkaline batteries. The users can log on to their account at the Runtastic website [The Runtastic LIBRA, sold at US$ 175, is a digital body analysis scale that measures the overall weight (up to 180 kg), body fat and water percentage, muscle and bone mass, BMI, basal metabolic rate (BMR) and active metabolic rate (AMR) . It is based on the principle of bioelectrical impedance analysis (BIA) for immediate measurements of body metrics using an imperceptible, completely harmless and safe alternating current. Muscle tissues and water have good electrical conductivity, website , to gene® II Model 9560 Finger Pulse Oximeter , the Health Device Profile (HDP) with security Mode 2 (service level enforced), IEEE11073 and Continua. It is certified to Microsoft® HealthVault®, a free online platform that communicates and receives data from the device for personalized healthcare management. The device complies with the IEC 60601-1-2 for electromagnetic compatibility, Part 15 of the Federal Communications Commission (FCC) Rules as a Class B digital device, and ISO 10993-1. However, Federal Law (USA) restricts this device to sale by or on the order of a licensed practitioner.The Bluetooth radio in OnyxArtificial Life, Inc. , has devThe company has also launched Opus-M™ Health: Neurodermatitis, which can be downloaded from the iTunes store for only US$ 0.99. It is an electronic diary and monitoring tool for patients and caregivers of those suffering from lichen simplex chronicus or neurodermatitis, a serious skin disorder. The users can create the entries of photos taken by the iOS device’s camera to keep track of the neurodermatitis-related information, such as itching, pain, redness and weep and visualize their condition and the healing process over time using the slideshow function. The software includes simple and easy-to-use data input for photo and text entries to provide an interactive graph for tracking and visualization. The PDF data summary can be transferred to a computer via iTunes sharing and forwarded by emails to responsible doctors and caregivers. The users also get the desired skin care tips that minimize the effect of neurodermatitis. Another product is Opus-M™ Health, a family of healthcare apps that meets various medical needs of the public, so that the patients and their caregivers can effectively manage and keep track of their medical conditions. It greatly facilitates communication between the patients, doctors, hospital and caregivers. The company is developing Opus-M™ HIV/AIDS, an application under Opus-M™ Health, dedicated to care management for HIV/AIDS patients and their community. etc., to develop innovative technologies for healthcare services. These on-going interdisciplinary research efforts will significantly expand the applications of smartphone-based mHealthcare and telemedicine technologies and pave the way to the next generation of personalized healthcare monitoring and management. SBDAs will enable the creation of a learning environment, where the end-users analyse the in vitro diagnostic (IVD) results and adjust their lifestyle to achieve visible and sustained health benefits. Therefore, they will critically improve healthcare by empowering the patient to become an active decision maker.SBDAs have demonstrated the successful convergence of various scientific disciplines, such as engineering, biomedical sciences, chemistry and physical sciences,The recent developments in mHealthcare and telemedicine have attracted considerable attention toward the use of smartphones as a platform for various mobile healthcare applications. There has been a significant increase in funding and a rapid growth in public interest for improved healthcare and better health management tools through various mHealthcare technologies. The most recent FDA clearance of the AliveCor Heart Monitor platform is a typical case of such significant achievements, which may inspire the development of other commercially-viable SBDAs in the coming years. Current efforts especially focus on overcoming the technical challenges associated with miniaturization, clinical validation, reproducibility, robustness, adaptability to various and rapidly evolving models of smartphones and compliance with industrial and healthcare requirements. The FDA-cleared LFA test strips are already commercially available for several disease-related biomarkers . Similarly, most of the POC glucose meters are also FDA-cleared. Therefore, the integration of such FDA-cleared or CE-marked devices with SBDA might enable the creation of new commercially-viable smartphone-based products.The described commercial SBDAs are being used by several millions of smartphone users worldwide, which have led to critically improved and sustainable health outcomes by providing better healthcare monitoring and management tools. This will lead to significant cost-savings, as the users can participate in effective disease prevention and management, such as for diabetes, obesity, coronary heart disease and even cancer, by lifestyle adjustment and nutritional intervention/selection. Ideally, SBDAs may contribute to the diminution of the financial burden for such Western lifestyle-associated diseases. Healthcare can be revolutionized by providing gigantic data via centralized cloud computing, to establish enriched information for more predictive healthcare monitoring and management in societies.The recent developments in cloud computing require a special mention here. Recent years have led to considerable advances in cloud computing for mHealthcare that can provide significant cost savings by reducing infrastructure costs . HoweverIt is highly expected that the next decade will witness a tremendous increase in the features of the smartphones, the next generation of mobile cloud computing and the contributing technologies. The much-awaited launch of iOS 8 in 2014 might include fitness and health tracking integration as a key feature in addition to the dedicated Healthbook application. Among various emerging breakthrough technologies, foldable screens and three-dimensional tracking will be integrated into the smartphone. Simultaneously, the cost of a smartphone continues to decrease owing to the growing number of smartphone users and Internet users. Such positive developments will pave the way toward improved healthcare in developing countries.


Narrative length and speech rate of traumatic recollections have been previously associated with different emotions and adjustment trajectories after trauma. However, the evidence is limited and the results are mixed. The present study aimed to evaluate length  and speech rate  in narratives of events with different valence  by 50 battered women (trauma group) and 50 non-traumatized women (controls). The results showed that traumatic narratives by the trauma group were longer than those by the control group. Moreover, they were inversely related to time since the event and anxiety during disclosure, whereas the speech rate was also inversely associated with anxiety, as well as with peritraumatic dissociation and avoidance. The shorter narratives for positive events and a decelerated speech pattern for traumatic experiences predicted psychological symptoms. Additionally, the individual’s emotional state predicted narrative aspects, with bidirectional effects. Our findings showed that linguistic characteristics of traumatic narratives  revealed information about how the victims elaborated autobiographical memories and coped with the trauma. The nature of trauma narratives and their relationship with posttraumatic symptoms have received growing interest aimed to prove psychological mechanisms involved in the memories of traumatic events and in the development of posttraumatic stress disorder (PTSD). Narrative studies focus on establishing the connection between adjusting after trauma and integrating the memory of the event within the autobiographical memory system .narrative length has received attention because it is considered to reveal particular aspects of psychological functioning after a traumatic experience [Among the structural aspects of traumatic memories, perience ,4. It isperience ,6. As a perience , 8. Furtperience –11. Moreperience , 13. ThiAlternatively, information-processing theories –16 indicRelated to these two perspectives, there are also discrepancies among the authors regarding the relationship between trauma narrative length and psychological adjustment –4. DekelConversely, Beaudreau  found thspeech rate of trauma narratives, although it could also reveal important information regarding memory processing and emotions. Specifically, a decrease in the speech rate has been associated with sadness and depression, and an accelerated speech has been associated with anxiety, and changes in the voice-style have proven to affect cardiovascular response [Furthermore, it is worth mentioning the limited attention paid in previous studies to the response . Additioresponse . Also, iresponse . These fIn sum, evidence regarding the narrative length of trauma memories is fragmented and controversial, and speech rate has hardly been considered. In fact, aspects such as narrative skills, strategies for addressing stress, or willingness to disclose likely have a considerable effect on how individuals report a negative experience . TherefoThe present study aimed to explore the following: (1) narrative length and speech rate in traumatized (trauma group) and non-traumatized subjects (controls) (after controlling narrative skills) across positive, and negative or traumatic events ; (2) relationships between the trauma narrative length and the speech rate, and several objective and subjective features of the traumatic event and coping mechanisms ; and (3) relationship between the trauma narrative length and the speech rate, and psychological adjustment .The Ethics Committee of the University approved this study and the informed consent. All of the participants provided their written informed consent.Fifty traumatized women (trauma group) and 50 non-traumatized women (control group) participated in the study. All of the participants were aged ≥18 years and were fluent in Spanish. Participants from the trauma and the control group were matched by age, according to three age ranges . The participants from the trauma group were recruited by clinics and centers that assist battered women. All of them had suffered violence by their intimate partners for at least 1 month. Referring counsellors evaluated the participants and considered them to be emotionally able to withstand the session. The control group was recruited by word-of-mouth advertising. All of the participants received a compensation of 15 €.n = 90 was needed to achieve a desirable power over .80 .Power analyses using G-Power software showed that neutral), the most distressing episode of maltreatment (trauma group) or the most stressful event (controls) (traumatic/negative), and the happiest event (positive). The order of episodes (negative and positive) was randomly counterbalanced across participants, although the neutral narrative was invariantly the first. They were requested to accurately recall the events, providing as much detail as possible. When the negative event, primarily the traumatic event, was the last, emotional support strategies were used to minimize any discomfort after the session. After each narrative, the participants were asked to rate their anxiety during disclosure using a 0–100 point visual-analogue scale. The narratives were uninterrupted, audio-recorded, and then transcribed verbatim. The assessment protocol was previously tested and improved using a pilot study with five psychology students.The assessment was conducted in a 1.5- to 2-hr session. After completing a semi-structured interview using different self-administered instruments, the participants were asked to narrate a normal day in their life , and details of the traumatic/negative event , and psychological treatment . In this interview, the participants were also asked to select the worst stressful event in their life (control group) or the worst episode of violence inflicted by their intimate partner (trauma group).Verbal intelligence was measured using the Vocabulary subtest of the Wechsler Adult Intelligence Scale-III (WAIS-III-V)  in whichThe Global Assessment of Posttraumatic Stress Questionnaire  in Spanish)  is a selThe Beck Depression Inventory-II (BDI-II)  is likelSimilarly, the Beck Anxiety Inventory (BAI)  is commoThe Centrality of Event Scale (CES)  measuresThe Autobiographical Memory Questionnaire (AMQ)  is a serThe Peritraumatic Dissociative Experiences Questionnaire-Self Report version (PDEQ) , 31 asseCalculating the narrative length was achieved using the Linguistic Inquiry and Word Count (LIWC) software ; Spanisht test or Mann-Whitney U tests for the continuous data were applied to compare the trauma and control groups, and anxiety during the disclosure of narratives with difference valence. The data were tested for normality using the Shapiro-Wilk test. The relationships between the narrative length and speech rate were explored using Pearson and point-biserial correlations. Additionally, both variables were correlated with the objective and subjective aspects of traumatic memories, coping strategies, and anxiety during disclosure.The descriptive statistics  were used to characterize the sample and study variables. The chi-squared tests for the categorical data and group (trauma vs. control group) as the between-subject factor and narrative valence (positive vs. traumatic/negative) as the within subject factor (2 × 2 design). The narrative length and speech rate for the neutral event were introduced as the covariance terms to control for potential confounds. Specifically, it allowed the narrative style to be controlled. Verbal intelligence was not considered as a covariance after being explored. The Bonferroni correction was used to adjust the confidence intervals.The differences between the narrative length and speech rate were analyzed using analyses of covariance (ANCOVAs) for repeated measures, with Finally, multiple linear regression analysis was used to examine whether the narrative length and speech rate for the positive and traumatic narratives explained the presence of psychological symptoms in the trauma group. Previously, Pearson correlations were examined. Because a bidirectional influence was expected, regression was also employed to examine whether the psychological aspects predicted the four narrative variables. In the distribution exploratory analysis, the quadratic relationships between variables were discarded. The stepwise discriminant function analysis was used to select the best predictors from the linear regression.M = 40.46; SD = 9.27). The control group was 92.0% Spanish (8.0% were Latin American), with ages ranging between 20 and 73 years . Both groups did not differ in nationality, educational level, or job situation; however, the groups did differ slightly in marital status (20.0% of the trauma group and 38.0% of the controls were married or living with their partners). This difference was justified given the specific nature of the traumatic experience in the trauma group. When verbal intelligence was analyzed, the results showed that there were no significant differences between the trauma and control groups in WAIS-III-V. The participants from the trauma group were, for the most part, Spanish (82.0%), and 18.0% of the participants were Latin American; ages ranged between 21 and 60 years (SD = 133.06), that is, over 11 years. Approximately 62.0% suffered physical aggressions in the worst episode of violence that they identified, 12.0% suffered sexual abuses, and all of them suffered psychological abuses (100.0%). Only 10.0% from the control group selected an aggression as the worst event lived. The most common events reported were the death or illness of a loved one . Other events included family abuse, job problems, abortion, or eviction. The difference between groups in the time distance of the negative/traumatic event was not statistically significant , for the positive narrative , and for the negative narrative . For the three narratives, the trauma group showed more anxiety, especially when the participants narrated the traumatic event. The means for the trauma group were 29.29 (SD = 30.05), 21.94 (SD = 29.26), and 72.45 (SD = 92.03), respectively; for the control group, the means were 10.10 (SD = 15.73), 7.72 (SD = 16.13), and 41.90 (SD = 29.33), respectively.In general, there was a high variability among anxiety perceived during disclosure by the participants. Between the groups, there were significant differences in anxiety reported for the neutral narrative , and that for words per minute was 144.71 (SD = 27.85) for the trauma group; for the controls, the mean word count was 200.34 (SD = 234.19) and that for words per minute was 130.56 (SD = 25.14). The descriptive characteristics for the positive and negative/traumatic narratives are shown in In line with previous studies , there F = 12.644, p = .001, η2partial = .115; and by Valence, F = 23.704, p = .001, η2partial = .196  = 12.177, p = .001, η2partial = .112, with high observed power (1 - β = .933). The post hoc tests with Bonferroni corrections revealed that the differences between the groups were only significant for the negative/traumatic narratives: the traumatic narratives by the trauma group were longer than the negative narratives by the controls (p < .001). According to previous literature, ANCOVA analysis, with the narrative length for the neutral event as covariate, showed that the word count differed by Group, l = .196 . The narAdditionally, because there were differences between groups in marital status, this variable was also introduced as covariate in further analysis, showing that it did not affect the significance of the differences previously found.p = .021) and less anxiety during disclosure (p = .034). For other measures, the correlations were not significant, although longer narratives were slightly related to an increase in memory elaboration (p = .066). The correlations showed also a significant and inverse association between speech rate and anxiety during disclosure (p = .004). Moreover, a lower number of words per minute was linked to more cognitive and behavioral avoidance (p = .006), but not avoidance thinking as assessed by the AMQ, and more peritraumatic dissociation (p = .012). Other correlations were not statistically significant.As shown in r = -.309, p = .029 for narrative length, and r = -.306, p = .030 for speech rate) and overall PTSD scores , avoidance and numbing symptoms , anxiety , and depression . Additionally, a lower speech rate was associated with more re-experiencing symptoms .The correlations between narrative length and speech rate for positive narratives and emotional symptoms showed that both variables in the trauma group were inversely associated with PTSD, depression, and anxiety. Subsequently, more symptoms were related to a lower word count and fewer words per minute in the description of the positive event. Specifically, the correlations for narrative length and speech rate were significant for PTSD diagnosis . However, a lower speech rate was related to more overall PTSD scores , re-experiencing , avoidance and numbing, , functioning , anxiety , and depression .A lower word count for the traumatic event was significantly associated only with more PTSD diagnosis  = 8.724, p = .001; for anxiety, it described 27.3% of the variance, due primarily to the positive word count F = 10.218, p < .001. The only predictor of depression was the positive narrative length, F = 12.195, p = .001  = 14.872, p < .001, with 22.8% of the explained variance  = 12.049, p = .001). The speech rate for traumatic events was predicted by the overall PTSD symptoms, F = 13.859, p = .001. No predictors were found for the traumatic narrative length. However, due to its significant correlation with time since the event and anxiety during disclosure, both variables were introduced in the regression model, explaining the second to be a modest 9% of variance, F = 5.575, p = .023. Additionally, because of its relationship with the speech rate of traumatic narratives, anxiety during disclosure, avoidance and peritraumatic dissociation were introduced as potential predictors with no significant results.The bidirectional effects were verified. For the positive narratives, narrative length was predicted by anxiety, The present study first specifically explored the trauma narrative length in victims seeking treatment. We only have knowledge of a study by Beaudreau , 4 that Consistent with the results found in the study by Beaudreau , the traFocusing only on the traumatized participants, a relationship was found between the word count of traumatic narratives and the time since the event. Therefore, although trauma leaves a strong imprint on the individual’s autobiographical memory, there was a tendency to decrease the narrative length over time according to previous research , which When adaptation trajectories in battered women were analyzed, the results showed that shorter traumatic narratives were associated with more PTSD diagnostics. The results are in the opposite direction than those reported in the work by Römisch et al.  who founContrary to expectations, the narrative length for the happiest event was a better predictor for the individual’s mental health than traumatic narrative length. Longer positive narratives predicted lower levels of PTSD symptoms and anxiety. Additionally, the speech rate for traumatic narratives impacted psychological distress, whereas depression was predicted by the speech rate of the positive narrative. The analyses also showed that the relationship between the narrative aspects and the emotional state after trauma was reciprocal and bidirectional.Altogether, the findings revealed that, although traditional research has focused on the traumatic narrative length, the speech rate (even though it tended to be correlated with it) could have a specific effect on the results. In accordance with the results of Römisch et al. , a decelNevertheless, the present study has several limitations. First, the sample was selective. The trauma group was homogeneous with regard to gender and type of event suffered. The focus on a specific class of traumatic experiences, however, is typical for other studies and helps prevent premature conclusions across types of events. Interpersonal violence is one of the most impactful traumatic events because of its chronicity and a feeling of betrayal of trust in others . FurtherData of this study showed that as a whole narratives of distressful events were longer (i.e. included more words) that those of positive relevant event; more specifically, narratives of violence episodes by intimate partner in battered women were longer than narratives of highly distressful life events in non-traumatized women. Even more, these differences did not related with difference in the speech rate (i.e. speed); actually speed showed high consistency both between types of narratives (positive vs. negative/traumatic) and groups (trauma vs. no-trauma).Among battered women, longer narratives of trauma were related to less anxiety during disclosure, and less time since the episode narrated, but not with other features such as centrality of the event, avoidance, or frequency of talking about the event; moreover, a quicker narration of the episode of violence was associated to less anxiety during disclosure, higher peritraumatic dissociation and more avoidance responses. Consequently, these aspects should to be taken into account when analyzing trauma narratives in this type of victims.Furthermore, the study revealed some relationships among narrative length and speech rate, both for trauma and positive events, and posttraumatic, anxiety and depression symptoms in women victims of repeated violence by their intimate partners. Interestedly, narrative length and speech rate for positive events showed higher association with symptoms severity that those for trauma event; even more, speech rate was more relevant than narrative length when trauma narrative was considered.All in all this study underlined the need to advance the study of narrative length but also of speech rate in both traumatic and positive narratives. Future research should explore linguistic aspects of narrative construction across different populations and autobiographical memories with different emotional impact. The way in which the victims express their personal experiences offers valuable information to gain a better understanding of the memory processes involved in the different adaptation trajectories after trauma.


Two studies have reported statistically significant associations between the use of cardiac glycosides (CGs) and an increased risk of lung cancer. However, these studies had a number of methodological limitations. Thus, the objective of this study was to assess this association in a large population-based cohort of patients.We used the United Kingdom Clinical Practice Research Datalink (CPRD) to identify a cohort of patients, at least 40 years of age, newly-diagnosed with heart failure, or supra-ventricular arrhythmia. A nested case–control analysis was conducted where each incident case of lung cancer identified during follow-up was randomly matched with up to 10 controls. Exposure to CGs was assessed in terms of ever use, cumulative duration of use and cumulative dose. Rate ratios (RRs) with 95% confidence intervals (CIs) were estimated using conditional logistic regression after adjusting for potential confounders.A total of 129,002 patients were included, and followed for a mean (SD) of 4.7 (3.8) years. During follow-up, 1237 patients were newly-diagnosed with lung cancer. Overall, ever use of CGs was not associated with an increased risk of lung cancer when compared to never use . In addition, no dose–response relationship was observed in terms of cumulative duration of use and cumulative dose with all RRs around the null value across quartile categories.The results of this large population-based study indicate that the use of CGs is not associated with an increased risk of lung cancer. Cardiac glycosides (CGs) are natural steroids, derived from digitalis, that share a chemical structure with estrogens and are therefore considered phytoestrogens. The CG family includes digoxin, digitoxin and lanatoside C which remain important drugs in the treatment of atrial fibrillation (AF), some types of heart failure (HF), atrial flutter (AFl) and other supra-ventricular tachycardia (SVT) , 2.Due to their ability to bind to estrogen receptors,  there haTo date, only two only observational studies have investigated the link between the use of CGs and lung cancer incidence. , 12 In oGiven the limited data assessing the association between the use of CGs and the risk of lung cancer, we conducted a large population-based study to investigate whether the use of these drugs are associated with an increased risk of lung cancer in patients newly-diagnosed with HF, AF, AFl and/or SVT.This study was conducted using the United Kingdom (UK) Clinical Practice Research Datalink (CPRD), formerly known as the General Practice Research Database. The CPRD is the world largest databank on primary care. Since its inception in 1987, it systematically records medical diagnoses and procedures, drug prescriptions issued by general practitioners, patient characteristics (such as body mass index [BMI]), and lifestyle factors .  CurrentlThe study protocol was approved by the Independent Scientific Advisory Committee of the CPRD and the Research Ethics Board of the Jewish General Hospital, Montreal, Quebec, Canada.Within the CPRD population, we identified all patients diagnosed for the first time with HF, AF, AFl and/or SVT, between January 1, 1988 and December 31, 2010, and followed until December 31, 2012. Cohort entry was defined as the date of any of the previously considered diagnoses, whichever appeared first in the patient’s medical record. The cohort was then restricted to patients at least 40 years of age at cohort entry, and those with at least two years of ‘up-to-standard’ medical history in the general practice prior to cohort entry. In order to identify new users of CGs during follow-up, we excluded all patients who previously received these drugs at any time prior to cohort entry. Finally, we excluded all patients previously diagnosed with any cancer (excluding non-melanoma skin cancer) at any time prior to cohort entry to ensure the identification of incident cases of lung cancer during follow-up, and to avoid the inclusion of patients with metastatic disease to the lung from other cancer sites. Patients meeting the study inclusion criteria were then followed until a first-ever diagnosis of lung cancer, death from any cause, end of registration with the general practice, or end of the study period , whichever came first.Within the cohort defined above, we conducted a nested case–control analysis, which produces odds ratios that are unbiased estimators of rate ratios (RRs) (i.e. no need for the rare disease assumption) .Cases consisted of all those newly-diagnosed with lung cancer during follow-up. Up to 10 controls were randomly selected from the case’s risk set (i.e. subset of the cohort still at risk of experiencing the outcome at the time of the case’s event date), after matching on year of birth (±1 year), sex, cohort entry date (±1 year), and duration of follow-up. The date of each case’s lung cancer diagnosis defined the index date, which was also assigned to the matched controls. All controls were alive, not previously diagnosed with lung cancer, and registered with their general practice when matched to a given case. All analyses were restricted to cases and matched controls with at least one year of follow-up in the risk set, which was necessary for latency considerations.We obtained all prescriptions for CGs received between cohort entry and index date. We excluded exposures initiated in the year immediately prior to index date in order to take into account a latency time window (lag time), and to minimize reverse causality, where initiation or termination of a treatment may have been influenced by early signs or symptoms of lung cancer.For the primary analysis, exposure to CGs was defined as receiving at least one prescription of digoxin, lanatoside C, digitoxin, or digitalis, between cohort entry and the year prior to index date. For the secondary analysis, we assessed whether there was a dose–response relationship in terms of CG cumulative duration of use and cumulative dose. Therefore, for patients deemed to have ever used CGs, we calculated their cumulative duration of use, defined as the sum of the specified durations of all CGs prescription received between cohort entry and index date. Cumulative dose was computed by multiplying the daily dose of each CG prescription by its specified duration of use and then summing the total quantities received between cohort entry and index date. Since CGs include four different drugs, we used the “defined daily dose” (DDD) equivalence to convert digitalis, digitoxin and lanatoside C in digoxin equivalents doses (the most commonly used CG). Thus, 250 micrograms of digoxin was equivalent to 0.1 milligrams of digitoxin, to 100 milligrams of digitalis, and to 1 milligrams of lanatoside C. Cumulative duration of use and cumulative dose were classified in quartile categories based on the distribution of use in the controls.Descriptive statistics were used to describe the characteristics of the cohort, cases and matched controls. We used conditional logistic regression to estimate RRs and 95% CIs. In the primary analysis, we assessed whether the use of CGs was associated with an increased risk of lung cancer. In the second analysis, we determined whether there was a dose–response relationship in terms of cumulative duration of use and cumulative dose.2, 18.50-24.99 kg/m2, 25.00-29.99 kg/m2, ≥ 30.00 kg/m2), indication of CG use , excessive alcohol use, history of tobacco-related conditions , history of lung diseases , and factors associated with sexual hormonal disorders . We also adjusted for drugs potentially associated with lung cancer incidence , which consisted of statins, aspirin, oral anticoagulants and antiplatelets, non-steroidal anti-inflammatory drugs, anti-hypertensives , oral bisphosphonates, anti-diabetic drugs , and amiodarone . Variables with missing information were coded with an ‘unknown’ category.In addition to the matching variables  on which the logistic regression was conditioned, the models were adjusted for the following potential confounders measured at least one year prior to index date: smoking status, BMI .A total of 129,002 patients met the study inclusion criteria . In the female subgroup, further adjustment for hormone replacement therapy and estrogen contraceptives did not materially change the results Table . FinallyThe results of this large population-based study indicate that the use of CGs and is not associated with an increased risk of lung cancer in patients newly-diagnosed with HF, AF, AFl or SVT. In addition, there was no evidence of a dose- or duration-response relationship. Overall, the results remained robust in sensitivity analyses.While our findings suggest no association between the use of CGs and lung cancer, two previous studies have reported increased risks. , 12 In tThe lack of an association observed in our study is supported by biological evidence. Estrogen receptors are found on normal lung tissue samples,  and thusin vitro, and some derivatives of CGs are currently being investigated for cancer therapies in clinical trials. [Moreover, recent studies have revealed potent anti-cancer activity of CGs  trials. , 19 CGs  trials. .Our study has a number of strengths. First, we assembled a cohort among patients newly-diagnosed with HF, AF, AFl, or SVT. This was to minimize confounding by indication, which was a limitation of the previous studies. , 12 SecoOur study also has some limitations. First, drug information in the CPRD represents prescriptions written by general practitioners. As such, it is unknown whether prescriptions were actually filled at the pharmacy and whether patients fully complied with the treatment regimen. However, difference in compliance in not thought to be differentially distributed among cases and controls and should not have biased the results. Second, a limitation of the CPRD is the lack of information on certain lung cancer risk factors, such as occupational exposures to carcinogens, exposure to second-hand smoking, socio-economic status, and family history of lung cancer. , 23 For In summary, the results of this large population-based study indicate that the use of CGs is not associated with an increased risk of lung cancer. These findings should provide reassurance to physicians and patients using these agents.All data were anonymized for research purposes and thus did not require patient informed consent.