The impact of COPD on patient’s quality of life is well established, but gender differences have received little attention.To describe factors associated with the health-related quality of life by gender: A cross-sectional observational study (NCT01007734) was conducted in COPD patients followed by pulmonologists. The first patient included had to be a woman. Data concerning the patient, COPD and their management were collected by the physician. The patient had to fill in several questionnaires: Saint-George Hospital respiratory Questionnaire (SGRQ-C), and motivation to quit smoking.Four hundred and thirty patients were included: mean age 63.9 ± 11.3 years; 57.4% were women. Women were significantly younger than men (61.9 vs. 66.6) and their tobacco use was lower (37.1 vs. 40.4 PY). Cardiovascular comorbidities were more frequent in men while osteoporosis, anxiety and depression were frequent in women. The frequency of cough, sputum and the severity of dyspnea did not differ significantly between genders. Lung function impairment was less severe in women than in men . Anxiety score was higher (score 9.8 vs. 7.1) and quality of life (SGRQ-C) more impaired in women  than in men. Moreover, in multivariate analysis, chronic sputum was associated with higher SGRQ-C scores in women but not in men.This study underlines that despite less airflow limitation, quality of life is more impacted by chronic sputum in women than in men. According to WHO, chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death and will become the third in 2020. Some studies have shown that prevalence of COPD is increasing faster among women than men with different geographic distributions. In industrialized countries, COPD is usually associated with the increase in active smoking in women ,2, probaAlthough COPD is the consequence of an interaction between genetic predisposition and environmental exposure, the influence of gender on the clinical expression of COPD has received limited attention. In general practice, COPD in women who smoke is often underdiagnosed ,6. PreviQuality of life is now a major component of the management of the disease, and valid criteria are needed to assess the efficacy of medication. Health status measurement is becoming an important issue for the day-to-day management of COPD patients in both primary and secondary health care . StudiesThe first objective of our study (NCT01007734) was to describe the main factors determining the quality of life related to respiratory status according to gender in patients with moderate-to-severe COPD. The second objective was to determine the characteristics of COPD by gender after adjusting on age and active smoking.This was a multicenter, descriptive, cross-sectional study conducted in France from September 2009 to November 2010.George Hospital Respiratory Questionnaire (SGRQ).Physicians were recruited by telephone at random among a database of French pulmonologists. Each pulmonologist recruited at least three consecutive patients once the first woman was included. Inclusion criteria were outpatients more than 40 years old, with a spirometric diagnosis of COPD according to GOLD guidelines with post-bronchodilator FEV1/FVC under 0.70 and FEV1 under 80% predicted. Patients might have been followed for COPD for at least three months. They provided written informed consent and had to be able to complete the Saint Exclusion criteria were as follows: recent exacerbation within 6 weeks, current or history of asthma, patients with long-term requirement of oxygen, non-invasive ventilation or tracheotomy, or participating in another trial. The physician filled in a medical questionnaire with demographics, comorbidities, COPD description, and COPD treatment concerning the patient. Chronic cough was defined as cough during 3 months and during two consecutive years, which the admitted definition of chronic bronchitis, the same definition was made for chronic sputum.SGRQ-C), the Hospital Anxiety and Depression Scale (HADS) and the Motivation to quit smoking .The BOD index was made with Body mass (<21 kg/m2), Obstruction (FEV1) and level of Dyspnea (MRC) without 6 minutes walking test (not available). Patients completed the following self-administered questionnaires, the  to 100  . A totalThe French translated version of SGRQ had been studied by Bourbeau et al.  and showThe HADS is scaled  from 0  were performed at baseline. We compared for clinical components and quality of life, men and women, then and after including significant factors, a multivariate model was used to determine factors related to quality of life, specifically for men and women, by stratifying by gender. Correlations were determined using Spearman correlation. Then, we correlated SGRQ total score with different variables using a multiple linear regression analysis using backward Wald criteria (p < 0.20), with those variables that significantly correlated with total SGRQ score. The criterion for statistical significance was 0.05. The software program used was SAS version 8.2.The protocol was approved in France by the Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé (CCTIRS) and the Commission National Computer and Freedoms (CNIL). All patients were informed about the objectives of the study, and agreed to participate and fill in the questionnaires. The study was conducted according to the recommendations of the declaration of Helsinki for investigation with human subjects.One hundred and forty-six physicians included 446 patients, among them 430 had data available for analysis. Mean age of physicians was 51.9 years (SD 7.9) and 77.3% of them were men. 60% of them were private practitioners and 40% were employed by hospitals.Among the patients, 57.4% of them were female and 42.6% male. Descriptive analysis Table  showed tThere was no difference between men and women regarding the frequency of cough and sputum and the severity of dyspnea Table . Women sIn active smokers, there was no difference in terms of motivation to quit smoking between men and women Table . Women wIn the multivariate model to determine factors associated with quality of life, we only included variables with less than 25% of data lacking, which decreased the size of the sample.Regarding factors associated with poor quality of life Table , the folThis study was conducted to assess clinical differences by gender in COPD patients and to determine factors related to quality of life in an outpatient setting in France.Our study describes the clinical profile of COPD in women and adds evidence for gender-related differences adjusted on COPD severity. Women with COPD were younger, had lower BMI, more unemployed and lived more alone than men. Despite the lower severity of the disease as assessed by GOLD staging, women with COPD had a worse quality of life compared to men, and were more impacted by chronic cough.In the large Muvice Study , lower BSkuliem et al. reported a greater proportion of women living alone compared to men . Social Cardiovascular comorbidities, dyslipidemia, alcoholism and sleep apnea syndrome were more frequent in men. By contrast, osteoporosis, past anxiety and depression were more frequent in women. In the large EPIDEPOC study , ischemiThere was no difference between men and women regarding the frequency of cough, sputum and dyspnea. However, with regard to the severity of the disease as assessed by FEV1, COPD was less severe in women. In other studies focusing on gender difference in patients with COPD, this was previously observed ,14,17 anFinally, despite the lower severity of the disease as assessed by GOLD staging, women with COPD had a worse quality of life as measured by the SGRQ questionnaire compared with men, as reported previously ,20. In aOur findings suggest that management of COPD should take psychological distress and socioeconomic status into account, particularly in women like those in our population, who were more unemployed than men and lived alone more. It is widely admitted in clinical practice that women feel uneasy about expectorating or eliminating sputum, or simply are unable to do so, but there is no published evidence. Among our COPD patients followed by specialists, there was the same proportion of patients with sputum in women and in men, while this is a key symptom of a lower quality of life mainly in women. Management with physiotherapy could improve quality of life in such women.Our study had some limitations. This could be due to the design of the study, because the first patient included had to be a woman so as to be sure that as many women as men were included. Secondly, in the final model to determine factors associated with quality of life, we only included variables with less than 25% of data lacking, which decreased the size of the sample. A causal inference cannot be drawn because of the cross sectional design of the study. Our sample was made by patients with COPD referred to pulmonologists, so we cannot generalize our results to the population of COPD patients followed in general practice.These findings show that although women experience less airflow limitation, their quality of life in COPD seems more impaired than that of men. Although FEV1 values were higher in women compared to men, COPD had a greater impact on them. It is too restrictive to assess COPD severity only by testing lung function. Assessment of COPD severity could take into account gender, co-morbidities and quality of life in order to obtain a composite severity score. Factors associated with quality of life differ according to gender, with a specific impact of chronic sputum in women. Management of women with COPD should incorporate these specific characteristics, the impact of the disease and gender-specific comorbidities in order to improve their quality of life.COPD: Chronic obstructive pulmonary disease; SGRQ-C: Saint-George Hospital respiratory Questionnaire; HADS: Hospital anxiety and depression scale; QMAT: Motivation to quit smoking; WHO: World Health Organization; BOD index: Body mass, Obstruction, dyspnea index.Chantal Raherison received speaker fees and congress invitations from the following companies: Novartis, Astra Zeneca, MundiPharma, Chiesi, Nycomed, Pierre Fabre. Isabelle Tillie-Leblond received speaker fees and congress invitations from the following companies: Novartis, Astra Zeneca, MundiPharma, Chiesi, Nycomed, GlaxoSmithKline. Camille Taillé received speaker fees and congress invitations from the following companies: Novartis, Astra Zeneca, GlaxoSmithKline, MSD, Chiesi, Teva. Anne Prudhomme received speaker fees and congress invitations from the following companies: Novartis, AstraZeneca, MundiPharma, GlaxoSmithKline. Elisabeth Biron received speaker fees and congress invitations from the following companies: AstraZeneca. Cecilia Nocent received speaker fess and congress invitations from the following companies: Astra Zeneca, Novartis, Merck Sharp & Dohme-Chibret, GlaxoSmithKline, ALK. Bénigne Mathieu and Juliette Ostinelli are full time employees of AstraZeneca France, Medical Department.All authors were involved in the study design, discussed the results. CR wrote the paper. All authors commented on the revised manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6874/14/31/prepub


Problematic Internet use (PIU) is a growing problem in Chinese adolescents. Little is known about associations of PIU with physical and psychological health. This study was designed to investigate the prevalence of PIU and to test the relationships between PIU and psychosomatic symptoms and life satisfaction among adolescents in mainland China.A cross-sectional survey was conducted comprising a large representative sample of 17 599 students in eight cities of China. PIU was assessed by the 20-item Young Internet Addiction Test (YIAT). The Multidimensional Sub-health Questionnaire of Adolescents and the Multidimensional Students' Life Satisfaction Scale were administered to obtain information on psychosomatic symptoms and life satisfaction. Demographics and Internet usage patterns were also collected. Logistic regression was used to assess the effects of PIU on psychosomatic symptoms and life satisfaction.P < 0.001), including lack of physical energy (P < 0.001), physiological dysfunction (P < 0.001), weakened immunity (P < 0.001), emotional symptoms (P < 0.001), behavioural symptoms (P < 0.001) and social adaptation problems (P < 0.001). Adolescents with PIU had lower scores on total and all dimensions of life satisfaction . Adjusted for the demographic and Internet-related factors, there was positive significant relationship between PIU and psychosomatic symptoms, but negatively related to life satisfaction.Approximately 8.1% of subjects showed PIU. Adolescents with PIU were associated with males, high school students, urban, eastern and western areas, upper self-report family economy, service type mostly used for entertainment and relieving loneliness and more frequency of Internet use. Compared with normal Internet users, adolescents with PIU were more likely to suffer from psychosomatic symptoms (PIU is common among Chinese students, and PIU was significantly associated with psychosomatic symptoms and life satisfaction. Effective measures are needed to prevent the spread of this problem and interventions to prevent the effects of PIU on psychosomatic symptoms and life satisfaction should be conducted as early as possible. The Internet has become an important tool for social interaction, information, and entertainment . HoweverAs an important period between childhood and adulthood, adolescence is encompassed by alterations in physical, psychological, and social development . During r = 0.43, P < 0.001). Ko et al [The negative impacts of PIU have progressively emerged. Recently, numerous studies had shown indulging in the use of the Internet is associated with a variety of problems. Kim et al  reportedKo et al  found thKo et al  reportedKo et al  found thAlthough many studies on the associations between PIU and physical and psychological health have been carried out, some questions remain. First, some studies have recruited participants on-line or used a convenience sample ,26. ThesFor these reasons, we carried out a large-scale, cross-sectional study in China. The main purpose was to investigate the prevalence of PIU among adolescents aged 10 to 24, and to test the relationships between PIU and psychosomatic symptoms and life satisfaction. This study will contribute to our understanding of PIU among Chinese adolescents and help in designing educational policies to prevent PIU.In March 2008, a school-based cross sectional survey was conducted in the high schools and college schools of eight cities in mainland China. According to geographic location and the level of economic development, the mainland China was classified three areas-- Eastern areas (high level of economic development), Middle areas (middle level of economic development) and Western areas (low level of economic development). In order to include the students with diversified socioeconomic backgrounds, the multi-stage stratified cluster sampling method was applied to obtain study subjects. Step 1, eight cities were samples from three areas. Based on a proportion of the population, three eastern cities, three middle cities and two western cities were selected. As follows: eastern ; middle , and western (Guiyang in Guizhou province and Chongqing) areas. Step 2, two junior high school , two senior high school  and one college in each city were randomly sampled as the target schools, and all the schools included were general junior and senior high schools and colleges . Step 3, two classes from grades 7,8,10 and 11 in each high school (excluding grades 9 and 12 because of entrance examinations) and two classes from grades 1 and 2 in each college were randomly selected for the study. Step 4, all students in the selected classes were invited to participate in this research. A total of 17 622 students were recruited to participant in the study. Exclusion criteria of participants in this study included being older than 25 years of age, younger than 9 years of age and missing responses for Internet usage. Ultimately, 17 599 adolescents , aged 10 to 24 years  were analyzed. Of these, 2 061did not use the Internet and the 15 538 who had Internet access provided usable information.We used data from a large school-based cohort of the National High Technology Research and Development Program ('863' Program) of China. Written informed consent was obtained from the presidents of the schools, the teachers and the students. Ethical approval was obtained from Biomedicine Ethical Committee in Anhui Medical University.A self-administered questionnaire containing information on socio-demographic indicators, Internet usage, psychosomatic symptoms and quality of life was filled in within a 20~30 min session in the classroom in the presence of the teachers, in order to minimize any potential information bias. The following socio-demographic characteristics were obtained: age, gender, grade, residential background , area and self-reported family economy. Internet usage pattern was assessed by examining the frequency of Internet use per week and the purpose of Internet use. The Young's 20-item Internet Addiction Test (YIAT) was applied in order to assess problematic Internet use. Each item is scored from 1 to 5, with 1 representing "not at all" and 5 representing "always". Hence, possible total scores range from 20 to 100. The following cut-off points were applied to the total YIAT score 1) Normal Internet use (NIU): scores 20~49; 2) Potential problematic Internet use (PIU): scores over 50 . The splPsychosomatic symptoms were measured using the Multidimensional Sub-health Questionnaire of Adolescents (MSQA), which is a multidimensional, self-report symptom inventory developed by Tao et al  in ChinaLife satisfaction was assessed by the Multidimensional Students' Life Satisfaction Scale (MSLSS) which is a self-report symptom inventory developed by Huebner et al  and trant test were used to compare the proportions and means of the independent variables versus dependent variables. Logistic regression analyses were performed to find out the effects of problematic Internet use (PIU) on psychosomatic symptoms and life satisfaction, controlling for gender, grade, residential background, area, self-report family economy, service type mostly used and frequency of Internet use. The independent (PIU) and dependent variables (psychosomatic symptoms and life satisfaction) were treated as a dummy variable coded 0 and 1 (0 for nonrisk and 1 for risk). The odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. P < 0.05 was considered significant for all tests.All the data were analyzed using SPSS version 13.0. Descriptive analyses were performed on all variables and the prevalence of PIU. Pearson chi-square test and independent-samples P < 0.001). High school students were significantly more likely to be PIUs than college students (P < 0.001). Urban students reported more PIU than rural (P < 0.001). Adolescents reported upper family economy were more likely to be PIUs  than adolescents reported normal family economy. The service type and frequency of Internet usage were also associated with PIU. The service type most often was entertainment (46.8%), followed by chatting (20.4%), information searching (14.7%), relieving loneliness (10.6%) and others (7.4%). Adolescents used Internet for relieving loneliness and entertainment were more likely to be PIUs and adolescents with more frequency of Internet use had a higher proportion of PIU .The general characteristics of the participants and the relationships between PIU and general characteristics were provided in Table χ2 tests . Compared with normal Internet use, adolescents with PIU were more likely to suffer from psychosomatic symptoms, lack of physical energy, physiological dysfunction, weakened immunity, emotional symptoms, behavioural symptoms and social adaptation problems.Table P < 0.001) , 31.45 (SD = 7.95), 38.29 (SD = 5.78), 29.21(SD = 7.40), 33.44 (SD = 7.02) and 31.51 (SD = 6.42), respectively. Not surprisingly, PIUs had significantly lower scores on total and all dimensions , depression, social anxiety, and substance dependence -48, in aSome strengths and limitations should be noted. First of all, it was a cross-sectional design, which does not allow for causality or the direction of relationships to be determined. However, appropriate analysis of cross-sectional data represents a useful initial step in identifying associations between PIU and psychosomatic symptoms, life satisfaction. Second, all information was obtained from a self-reported questionnaire, resulting in the possibility of response bias. Multiple assessments, interviews, and informants may have provided a richer and more thorough understanding of PIU. Third, since the survey was administered during class time, it is possible that some students, especially those addicted to the Internet, were absent from class when the questionnaire was administered. Therefore, the survey may have under-represented PIU by failing to record the responses of those who are so consumed by the Internet that they rarely leave their rooms, thus leading to an underestimation of the prevalence of PIU. Fourth, although the Young Internet Addiction Test (YIAT) is widely used to measure the severity of PIU, there is no data regarding psychometrics of the Chinese version of YIAT. So the cut-off of the YIAT identified among European population was used in this study, this may not be the same as that in Chinese population.Despite limitations, this study investigated the prevalence of PIU and examined the associations between PIU and psychosomatic symptoms and life satisfaction based on data from a nationally representative sample of adolescents in mainland China. This study suggested that PIU was fairly common among Chinese adolescents, especially among high school students, and that PIU was significantly associated with psychosomatic symptoms and life satisfaction. The health department of the China government has now recognised PIU as a serious public health problem. Arguably, it is time for the World Health Organization and health departments around the world to develop effective health policies to increase public awareness of PIU. If we fail to acknowledge PIU as a public health issue, then it will continue its silent, endemic spread, affecting millions of children and adults, and eventually affecting societies and economies.In the information age, Internet use is becoming increasingly significant in the acquisition of information and the sharing of knowledge. Internet use is now considered to form part of the culture of adolescents, and hence studying Internet use and its negative aspects is tremendously important to the creation of a sound youth culture. This requires studies on the relationships between PIU and physical and psychological health. This present study has demonstrated that PIU was common among Chinese students, and PIU was significantly associated with psychosomatic symptoms and life satisfaction. Effective measures are needed to prevent the spread of this problem and interventions to prevent the effects of PIU on psychosomatic symptoms and life satisfaction should be conducted as early as possible.CI: Confidence interval; OR: Odds ratio; χ2: Chi square.PIU: Problematic Internet use; NIU: Normal Internet use; PIUs: Problematic Internet users; YIAT: Young's Internet Addiction Test; MSQA: Multidimensional Sub-health Questionnaire of Adolescents; MSLSS: Multidimensional Students' Life Satisfaction Scale; ADHD: Attention deficit and hyperactivity disorder; The authors declare that they have no competing interests.HC performed the statistical analyses, interpreted the findings and drafted the manuscript. YS participated in study design, subjects' recruitment and data collection. YHW directed subjects' recruitment and data collection and participated in manuscript preparation. JHH participated in the statistical analyses and result interpretation. FBT obtained funding, designed the study, oversaw the study project, and participated in result interpretation and manuscript preparation.All authors read and approved the submitted manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/802/prepub


AbstractHimertosoma Schmiedeknecht, Himertosoma kuslitzkiisp. n., was discovered in Amamioshima Island, the Ryukyus. This new species resembles two Oriental species, Himertosoma philippense Chandra & Gupta and Himertosoma townesi Chandra & Gupta, in the colour pattern of the head and metasoma, number of flagellomeres, and the relatively slender first metasomal tergite, but can easily be distinguished from them by the nearly evenly punctate propodeum, different length/width ratio of the first metasomal tergite, different length of the ovipositor sheath, tricoloured mesosoma, and the whitish band along the posterior margin of the second and following metasomal tergites. A key to the Palaearctic and Oriental species of Himertosoma is also provided.A new species of the genus  Himertosoma Schmiedeknecht, 1900, is a large genus in the tribe Atrophini of the ichneumonid subfamily Banchinae, containing 58 described species  from Egypt, Israel, Syria and Uzbekistan, Himertosoma uchidai Kuslitzky, 2007  from Far East Russia and Japan (Kunashiri Island), and Himertosoma philippense Chandra & Gupta, 1977 and Himertosoma townesi Chandra & Gupta, 1977 from the Philippines. species . The genLepidoptera, i.e., Gelechiidae  and Yponomentidae (Prays oleae Bernard) for Himertosoma superbum, and Tortricidae (Cydia pomonella (Linnaeus)) for Himertosoma stramineum (Morley)  . Althougasitoids .Himertosoma uchidai from Kunashiri Is. (Kuslitzky 2007), we found a species of Himertosoma from Japan, collected on Amamioshima Island, the Ryukyus, which is described here as new to science. A key to all the described species of Himertosoma from the Palaearctic and Oriental Regions is also provided.In addition to In this paper, we describe the new species based on only a single specimen, for the three following reasons: 1) the specimen is in good condition, 2) we made intensive collecting efforts in the type locality and checked all major collections of Japanese ichneumonids, but we have not found any more specimens, and 3) we know that the ichneumonid fauna of the Ryukyus contains some biogeographically important species such as relict or endemic species e.g., .Himertosoma philippense (♀) and Himertosoma townesi (♀), deposited in the American Entomological Institute, were also examined for comparison. The character states of two Palaearctic species, Himertosoma superbum and Himertosoma uchidai, are taken from the descriptions by Schmiedeknecht (1907) and Himertosoma superbum are also available from the excellent figure in PageBreakA stereomicroscope (Nikon S800) was used for observation. Digital images were edited using Adobe Photoshop® CS3. Terminology for general morphology follows GenusSchmiedeknecht, 1900http://species-id.net/wiki/HimertosomaHimertosoma Yu and Horstmann (1997) for synonymy.Himertosoma and its most similar genus, Lissonota Gravenhorst, is still in dispute; Himertosoma can be separated from Lissonota only by a single character, the absence of the crease separating laterotergite of the fifth metasomal tergite. Their generic status should be reconsidered in future study.According to Himertosoma, hitherto known only from the Philippines in the Oriental Region  2.0 times as long as maximum diameter of lateral ocellus. Antenna with 31 flagellomeres; first flagellomere 6.7 times as long as apical width and 1.3 times as long as second flagellomere.Body length 6.5 mm; length of fore wing 4.5 mm. Head 0.6 times as long as wide in dorsal view; clypeus 0.7 times as long as wide, smooth excluding some punctures along weak supraclypeal suture, its profile gently convex in lateral view ; face 0.PageBreak by 0.6 times length of vein Cu–a; areolet absent; hind wing with distal abscissa of vein Cu1 much closer to vein 1A than to vein M, basal abscissa of vein Cu1 5.0 times as long as length of vein cu–a.Mesosoma 2.9 times as long as minimum distance between tegulae in dorsal view, polished, densely punctate excluding postero–lateral area of pronotum, mesonotum and postscutellum; epomia indistinct, obscurely present on collar ; mesoscuPageBreakmargin .Banchinae with excellent observations and to the faunal knowledge of ichneumonids in Far East Asia.This species is named after V. S. Kuslitzky, who has contributed to the classification of Himertosoma mentioned above and is distinguished from congeners by the combination of the following character states: flagellum with around 31 segments; propodeum nearly evenly punctate in front of posterior transverse carina (This species has all the characteristics of e carina ; first me carina ; second e carina ; oviposiHimertosoma philippense and Himertosoma townesi, in having similar colour patterns on the head and metasoma, the over 30–segmented flagellum and the relatively long first metasomal tergite, but can be easily distinguished from them as shown in the following key.This species resembles two Oriental species, Rodrigama Gauld, which occupies a basal branch in the Poemeninae, from Okinawajima Island in the Ryukyus and from Taiwan. In addition, a species of the genus Tossinola Viktorov, an atrophine genus with a fragmented Old World distribution, was discovered on the Yakushima, Tokunoshima and Okinawajima Islands in the Ryukyus as well as from Taiwan (While faunal information about ichneumonids in the Ryukyus is poor, several endemic or geographically important species are known from this archipelago e.g. . Recentlm Taiwan .Himertosoma in the Ryukyus suggests that this or closely related species should also be found in these biogeographically important areas.This archipelago is located on the border between the Palaearctic and the Oriental Regions. Some ichneumonids of the Ryukyus, including the above mentioned species, show a tendency towards having the same or closely related species distributed in adjacent areas, viz. Southern China, Taiwan and Southwestern Japan . The dis


We investigated the relationship among socioeconomic status factors, the risk of anemia, and iron deficiency among school-aged children in Korea.n = 717). Anthropometric and blood biochemistry data were obtained for this cross-sectional observational study. Anemia was defined as hemoglobin levels lower than 11.5 g/dl. Iron deficiency was defined as serum iron levels lower than 40 ug/dl. We also obtained data on parental education from questionnaires and on children's diets from 3-day food diaries. Parental education was categorized as low or high, with the latter representing an educational level beyond high school.The sample consisted of fourth-grade students aged 10 y recruited from nine elementary schools in Korean urban areas in 2008 (P = 0.0324) and iron deficiency (P = 0.0577) than were those with less educated mothers. This group consumed more protein (P = 0.0004) and iron (P = 0.0012) from animal sources than did the children of less educated mothers, as reflected by their greater consumption of meat, poultry, and derivatives (P < 0.0001). Logistic regression analysis revealed a significant inverse relationship between maternal education and the prevalence of anemia .Children with more educated mothers were less likely to develop anemia (As a contributor to socioeconomic status, maternal education is important in reducing the risk of anemia and iron deficiency and in increasing children's consumption of animal food sources. According to the World Health Organization, anemia is a public health problem in many developing countries, including Africa and Asia . Most stAnemia is an indicator of both poor nutrition and health , and it In addition to dietary factors, household characteristics such as hygiene, parental education, household income, and number of children in the family are also important determinants of nutritional knowledge and diet ,15. A stBecause childhood anemia and iron deficiency have a significant impact on life-long health, it is important to identify determinants of this condition early in the child's life. If the iron requirements of a growing child are not fulfilled, learning ability, work efficiency, and immune functioning will decline prior to the emergence of other signs of anemia. If the iron deficiency persists, it can also result in height and weight disturbances, retardation of behavior and learning, and disturbances in physical or mental growth . Early dn = 717) aged 10 y were recruited from nine elementary schools in the urban areas of Korea in 2008. This study was conducted as part of the Gwacheon Pediatric Cohort Study, which follows this student cohort from Gwacheon City in Kyunggi Province of Korea from their entry into elementary school at age 7 to their graduation at age 13. The objective of this pediatric cohort study was to identify early risk factors for obesity and associated metabolic diseases in urban Korean children. The sole inclusion criterion was enrollment in first grade, and no exclusion criteria were applied. This study was approved by the Institutional Review Board of Seoul-Paik Hospital of Inje University and by the Korean Center for Disease Control and Prevention (KCDC). Informed consent was obtained from the children's parents.Fourth-grade students  considers families to be middle class if their monthly income is 3,400,000 won. Thus, we categorized household income as low  or high .Height was measured by a trained technician using an automatic stadiometer . Weight was measured by bioimpedence analysis using a body composition analyzer . Body mass index (BMI) was calculated by dividing weight in kilograms by height in meters squared. All those with a BMI ≥85th percentile were classified as overweight  using daChildren's blood samples were collected from the antecubital vein and funneled into vacutainer tubes after a 12-h overnight fast. Hemoglobin (hb) concentrations, white blood cell counts (WBCs), and red blood cell counts (RBCs) were determined by flow-cytometry methods using the XE-2100D . Blood glucose was analyzed using the hexokinase method, and alanine aminotransferase (ALT) was measured using an enzymatic method with a Hitachi 7180 analyzer . Serum iron levels and unsaturated iron binding capacity (UIBC) were measured using the Ferrozine method  on a Cobas Integra 800 Analyzer . Total iron-binding capacity (TIBC) was calculated indirectly from the iron and the UIBC plus iron concentrations. We used an enzyme immunoassay (EIA) using the Human soluble transferring receptor (sTfR) immunoassay kit  to determine sTfR. Serum ferritin was measured with a Chemiluminescence Immunoassay (CLIA) Analyzer . Transferrin saturation (TS (%)) was calculated by dividing the concentration of serum iron by the TIBC. Anemia was defined as a hemoglobin concentration of <11.5 g/dl . We had The typical dietary intake of each child was estimated based on food records that were maintained by each child with help from his or her parents for 3 consecutive days . Parents were also asked to maintain 3-day food records for their children. Recipes of school meals (lunches) were provided to the parents. Dietary questionnaires, which were certified by Seoul-Paik Hospital, Inje University, were confirmed as eliciting sufficient dietary information. Before starting the study, guideline of food record was provided for meaningful reply to children and their parents. The guideline was as follows: 1) Record your typical diet. 2) Include all beverages, meals, snacks, and tastes in total intake. 3) Be as specific as possible about the foods and drinks-seasonings, ingredients, preparation methods, and other details. 4) Record portion size using kitchen utensils, nutrition facts label, and other measurements-volume , weight (5 grams), size , and count (two pieces of chocolate). Food intake was analyzed to nutrient intake using the CAN-pro 3.0  software program. The software was made for the purpose of easy and precise nutrition assessment and management by the Korean Nutrition Society. The software was included approximately 3,500 commonly consumed Korean foods and based on Korean Nutrient Database. To obtain the information for various nutrients in food, we entered food name, amount, and other details into the CAN-pro software and got the result of energy intake, macronutrients , vitamin, mineral, and other nutrients. A set reference values for the dietary intake of Koreans was released in 2005 ; this cochi-square tests. The rates of anemia according to maternal education and the factors comprising SES were analyzed with Fisher's exact test. Nutrient intake and food-group consumption by maternal education were analyzed with the GLM and adjusted for age and sex. Finally, logistic regression was used to analyze children's risk of anemia and iron deficiency according to maternal education level. Statistical analyses were performed with the Statistical Analysis System software package version 9.1 . Statistical significance was set at P < 0.05.General characteristics were stratified based on factors related to socioeconomic status (SES) . Relationships among BMI, biochemical variables, hematological variables, and the factors comprising SES were assessed using a generalized linear model (GLM) adjusted for age and sex. Sex distributions and the frequencies of low iron intake and food-consumption behaviors by maternal education were analyzed with P = 0.0005), ALT (P = 0.0320), SBP (P < 0.0001), and DBP (P = 0.0005). They also had lower indices of iron status, serum iron, TIBC, TS, and hb compared with children of more educated mothers, although the differences were not statistically significant. A rates of of anemia and iron deficiency were found among children of less educated mothers  than among children of more educated mothers. Overall, we observed a lower prevalence of iron deficiency than of anemia. Only two children had both low serum hb levels and low iron levels. Low hb and/or low iron levels were found in 10.5% of this population.Of the mothers, 1.88% had less than a middle school education, 32.9% had finished high school, and 65.2% had more than a high school education. Of the fathers, the respective percentages were 1.32%, 22.5%, and 76.2%. Parental education was classified as low (<12 years or less than a high school education) or high (>12 years or more than a high school education) (data not shown). Table vs. 1746.7 kcal, P = 0.0003), fat , carbohydrates , animal protein , vitamin B1 , niacin , zinc , phosphorus , animal iron , and fat derived from energy  than did children of more educated mothers. The opposite pattern was observed with regard to the intake of fiber, vitamin C, and folate. The mean iron intake w greater than the daily estimated average requirement set by the Korean iron EAR criteria. However, children of less educated mothers were less likely to surpass the iron EAR levels tha were children of more educated mothers . With respect to food-gro consumption, children of more educated mothers were less likely to consume vegetables . However, more meat, poultry, and their derived products  as well as more fish and shell fish  were consumed by children of more educated mothers.As shown in Table vs. 55.7%, P = 0.0061) and eating instant noodles . No significant differences were observed with regard to the consumption of fast food.Table Table We investigated the relationship between the factors comprising SES  and a school-aged children's diet, their risk for anemia, and their risk for iron deficiency in Korea. Overall, Korea's economy is classified between developing and developed. The rates of anemia and iron deficiency were 14.9% in the low-maternal-education group and 7.8% in the high-maternal-education group in Korea. The relationship between maternal education and anemia/iron deficiency has been evaluated in industrialized countries. Anemia and iron deficiency were found to be problems in industrialized nations . RecentlTo our knowledge, this study is the first to investigate the association of maternal education with dietary intake and indices of anemia/iron status in Korean school-aged children. Many studies have separately explored the association of the factors comprising SES with anemia or nutrient intake. In the present study, only maternal education was found to have a significant relationship with hb levels and the prevalence of anemia. Iron deficiency was also related to maternal education, although the differences were only marginally significant. In this study, paternal education and household income were not significantly associated with anemia, iron deficiency, or hb levels. Other studies have suggested that maternal education was more important than paternal education, health-service availability, and other factors related to SES ,29. In t1, niacin, zinc, phosphorus, and animal iron was significantly lower in the low-maternal-education group than in the high-material-education group. Additionally, children in the low-maternal-education group consumed more energy from carbohydrates and less energy from fat than did children in the high-maternal-education group.In terms of dietary factors, anemia is induced by lower levels of the consumption of dietary iron derived from foods such as meat and less intake of the nutrients involved in iron metabolism such as vitamins A and C. The presence of iron-absorption inhibitors   also plaAccording to the Korean National Health and Nutrition Examination Survey-III (KNHANES III), the major food sources of iron were almost exclusively derived from Korean plant sources. Rice was the primary source of iron; this is followed by radish leaves and kimchi  . SimilarOur study shows that children of mothers with more education were less likely to have unhealthy eating patterns  than were children of mothers with less education. Several studies have reported that a higher intake of carbonated drinks was associated with a higher intake of energy and carbohydrates as well as a lower intake of protein, vitamins and minerals . Thus, aIn this study, BMI was not affected by maternal education, but being overweight was a significant risk factor for anemia and iron deficiency in the unadjusted logistic regression model. Although some studies have reported an association between maternal education and the likelihood of a child being overweight ,35, no sWe found the maternal education plays important role in the nutritional status of children among SES factors in this study. Children with more highly educated mothers were less likely to suffer from anemia and iron deficiency than were children with less educated mothers. A higher level of maternal education leads to increased knowledge about health and nutrition, which, in turn, leads to an increase in the quality of the diets consumed by children . This stOur study has the following limitations. Data on parental education were obtained from parental self reports, which may have resulted in an overestimation bias. Additionally, because we could not inquire about mothers' knowledge of nutrition, we could not analyze the direct association between maternal education and nutrition-related knowledge. However, maternal education level was associated with children's dietary intake, food-consumption behaviors, and likelihood of suffering from anemia/iron deficiency. Maternal education was the strongest predictor of all of the factors comprising SES that we evaluated. We measured serum ferritin, sTfR, iron, TS, hb, and dietary iron intake to ascertain iron status. Because the majority of subjects was in good health and well nourished, iron deficiency was not easily detected. However, subjects with low hb levels were more prevalent than were subjects with low iron indices. Finally, our study was cross-sectional in design; additional studies using a prospective design and measurements before and after interventions are required to fully determine the causal relationships among maternal education, children's diet, and disease.Of the SES factors that we evaluated, only maternal education was related to children's hb levels and the prevalence of anemia and iron deficiency. More maternal education was positively associated with children's consumption of foods that affect the bioavailability of iron and reduce the risk of anemia and iron deficiency. To increase the absorption of iron and prevent anemia and iron deficiency, mothers should feed children foods that enhance iron absorption. The results of this study should be helpful in future investigations of anemia, nutrition, and SES.The authors declare that they have no competing interests.H-JC and H-BJ performed data analysis and produced the results and H-JC drafted the manuscript. H-JL and J-YP have been involved in critically revising the manuscript for important intellectual content. H-JL, J-HK, K-HP and JS contributed to the conception of the study and participated in the interpretation of the results and revision of the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/870/prepub


Little information exists on work and stress related health of medical doctors in non-EU countries. Filling this knowledge gap is needed to uncover the needs of this target population and to provide information on comparability of health related phenomena such as burnout across countries. This study examined work related characteristics, work-home and home-work interference and burnout among Serbian primary healthcare physicians (PHPs) and compared burnout levels with other medical doctors in EU countries.t-tests and Chi square tests.Data were collected via surveys which contained Maslach Burnout Inventory and other validated instruments measuring work and home related characteristics. The sample consisted of 373 PHPs working in 12 primary healthcare centres. Data were analysed using No gender differences were detected on mean scores of variables among Serbian physicians, who experience high levels of personal accomplishment, workload, job control and social support, medium to high levels of emotional exhaustion, medium levels of depersonalisation and work-home interference, and low levels of home-work interference. There were more women than men who experienced low job control and high depersonalisation. Serbian physicians experienced significantly higher emotional exhaustion and lower depersonalisation than physicians in some other European countries.To diminish excessive workload, the number of physicians working in primary healthcare centres in Serbia should be increased. Considering that differences between countries were detected on all burnout subcomponents, work-related interventions for employees should be country specific. The role of gender needs to be closely examined in future studies as well. Work characteristics and health problems such as burnout have been extensively researched in the Western countries, including the United Kingdom, the United States of America, Scandinavian countries and the Netherlands, to mention a few. Work characteristics are defined as job demands and resources at work , while bScarce knowledge exists with regards to expression of these variables in different cultural settings. One such underexplored case example is physician burnout in Serbia. We know very little about health and work characteristics of medical doctors in Serbia and the extent to which they manage to combine work and family related duties. In fact, Lešić and colleagues  acknowleIn Serbia, full-time employment and dual income families are the norm . Only 1%Regarding the health sector, there are 116 primary healthcare centres (PHC), where 31% of all doctors work . Unlike When examining work and health conditions of employees, including gender in the analysis is of paramount importance in order to provide a better understanding of men's and women's conditions of work and illness aetiology.Numerous evidence points to the connection between work circumstances and employees' health. For example, speed of work has increased in most countries since the last decade of the previous century , and thiBoth men and women can go on to develop stress, and subsequently burnout, in situations where work characteristics and WHI are unfavourable . The relIn this study, we focus on gender differences in the prevalence of work characteristics, work-home and home-work interference and burnout among Serbian physicians working in PHCs, and compare burnout findings with other international results. Given that this is an early explorative study of the situation in Serbia, more complex gender analyses and interrelationships with health outcomes will not be addressed here.To achieve the aim of the study, we will answer the following research questions:1. What is the level and prevalence of work characteristics among Serbian PHPs and are there any gender differences?2. What is the level and prevalence of home and childcare responsibilities, work-home and home-work interference among Serbian PHPs and are there any gender differences?3. What is the level and prevalence of burnout among Serbian PHPs and are there any gender differences?4. What is the level of physicians' burnout in comparison to other European countries, that is, the Netherlands, Hungary and Italy?A cross-sectional study based on a survey was conducted during the months of July and August 2008. Self-reported anonymous questionnaires were distributed by directors or head nurses to 850 doctors. To increase interest in participation in the study, personal contact was established with the directors and/or head nurses of the PHCs. The study was explained, and they were offered to receive a report with the findings and recommendations for practice, upon the end of the data collection. In this study, 12 PHCs (8 from Belgrade and 4 from other cities) took part. The mix of small and large PHCs was equally represented in Belgrade and other cities. All doctors working in the PHC were eligible to take part in the study. Excluded from participation were doctors who were on sick leave or holidays during the data collection period (approximately three weeks per institution). The response rate was 44%, that is, 373 respondents answered the questionnaire. All the participants were informed in writing that their participation was voluntary and that data provided were treated confidentially. By completing the survey, the physicians gave their consent to participate in the study. According to the Dutch law  our type of study based on paper and pencil survey does not require ethical committee approval.SD (men) = 10.15; SD (women) = 8.48). Of the total sample, 31% of physicians were aged 20-44 and the rest were in the age group 45-64, reflecting a greater proportion of older participants in this study. Most respondents (77%) had children; 61% of them lived with children and spouse or partner, 8% lived alone, 10% with the partner, 7% with children and 14% in some other form of family constitution. On average, participants had between 1 and 2 children  based on the Job Autonomy Questionnaire . The par. Responses ranged from 1 = not at all to 4 = very much.II. Job control was measured by four items (α = .72) of the Inventory of feelings of motivation and demotivation . ResponsIII. Work content was assessed via five items based on the Job Diagnostic Survey  and deveIV. Social support was measured by three five item scales deducted from the Questionnaire on Organizational Stress-Doetinchem (VOS-D), each assessing the social support received from supervisor/colleague, partner and family/friends . The scoV. Home and childcare responsibilities were each measured by a one item measure created for the purpose of this study: "What is the percentage of the household duties carried out by yourself?" and "What is the percentage of the childcare duties carried out by yourself?"VI. Work-home and home-work interference were assessed via two scales consisting of 13 items ,33. WorkVII. Burnout was measured using the Serbian translated version of the Maslach Burnout Inventory-General Survey , which ct-tests and chi-square tests were performed, respectively. To examine burnout differences between Serbian physicians and their colleagues in European countries, findings were compared to the studies of physician burnout in Hungary, the Netherlands and Italy. All studies used MBI as a measure of burnout. Studies in the Netherlands [t-tests were carried out. All the analyses were performed using SPSS 15.01 version.We started with the preliminary analyses . Since no Serbian national cut-off points exist for different levels of burnout, we used the cut-off points from the Utrechtse Burnout Schaal (UBOS) manual . No stanherlands  and Italherlands  were conherlands  includedMean levels of work characteristics, as well as gender differences and Pearson correlations are reported in Table (men) = 2.89 and (women) = 2.74), work content ((men) = 2.89 and (women) = 2.92) and low levels of lack of social support (men) = 1.66 and (women) = 1.74).We found that Serbian physicians had mostly favourable working conditions. No gender differences on mean levels of work characteristics were detected Table . PhysiciWe also looked at the prevalence of these variables and examined gender differences. These results are reported in Table Levels of home and childcare responsibilities, work-home and home-work interference and gender differences are reported in Table Analyses revealed that home and childcare responsibilities differed between men and women. Women in our sample carried out disproportionally more childcare than men (63.84% versus 43.37%), and more home chores than men (69.99% versus 51.71%).Regarding the balance of work and home duties, we found that WHI was higher than HWI for men and women Table . HoweverConcerning the prevalence of WHI, we saw that only 13.3% of female physicians and 10.3% of male physicians experienced high WHI Table . Prevalet(239) = .85, p ≥ .05. Men with older children had a mean level of WHI of 2.55, while men with younger children experienced the level of WHI of 2.24, t(40) = .99, p ≥ .05. We also found the same pattern of higher HWI for physicians with children older than 12, and again the difference between the two groups was non significant Women with older children had a mean score of 1.83 of HWI, while women with younger children had a mean score of 1.67 of HWI, t(238) = 1.71, p ≥ .05. Men with older children had a mean score of 1.73 of HWI, while men with younger children had a mean score of 1.44, t(30.44) = -1.95, p ≥ .05.Since the presence of young children involves more childcare duties, and can thus be associated with higher WHI and HWI, we carried out further analyses to examine this (results not reported in tables). Contrary to previous findings, the presence of younger children aged less than 12 years was not found to be related to WHI. In fact, having children older than age 12 produced slightly higher levels of WHI for both women and men. Women with older children experienced mean level of WHI of 2.71, while women with younger children experienced mean level of WHI of 2.61, 2(2) = 7.72, p = .02. Feelings of personal accomplishment at work were high for both men and women, with 78.5% of women, and 74.1% of men reporting high levels of personal accomplishment. No statistically significant gender differences were detected, but there was a tendency for greater proportion of women to experience low personal accomplishment than men (10% vs. 4%).Levels of burnout are reported in Table The findings on mean levels of physicians' burnout in the current study, Hungary, the Netherlands and Italy are reported in Table p = .000). Personal accomplishment is high among physicians in all countries, but differences between Serbian physicians and physicians in other countries have been detected. Level of personal accomplishment is significantly higher among Italian than Serbian physicians, (t(369) = -7.32, p = .00), but lower among Hungarian (t(369) = 2.35, p = .02) and Dutch physicians (t(369) = 2.12, p = .03).When comparing the current study with other European research carried out on similar samples in Hungary , the NetTo summarise, the cross-country results indicate that the current sample of Serbian physicians experienced the highest level of emotional exhaustion and lowest level of distancing from patients  when compared to other samples.Our results show that physicians in Serbia have favourable work characteristics in terms of high job control, favourable work content and social support, but face adversely high work demands. The indication of high job demands may not be surprising, considering that in Serbia, there are 281 primary healthcare physicians per 100, 000 people . As a coWomen physicians in our sample carry out more childcare and household duties than their male colleagues, confirming previous findings that female emancipation in Serbia has not yet translated fully into the home sphere ,38.In our study, levels of WHI were higher than levels of HWI. However, currently, WHI does not seem to be problematic; perhaps, a buffering factor against high WHI/HWI is the organization of the working time schedule. In Serbia, employees of PHCs do not have night duties and work either mornings or afternoons. Since offices are shared between physicians of different shifts, this prevents structural overtime. Unlike in some other countries, like the Netherlands, on-call duties are also not part of PHPs' work. Predictability is associated with lower stress levels , and sucLack of gender differences with respect to the levels of WHI/HWI is in line with the findings of Winants and colleagues . In our We found job demands to be high among our sample of participants. Based on job demands-resources model , high woDepersonalisation levels among Serbian physicians were lower than those of their colleagues in other countries. This indicates that Serbian physicians show less emotional distance  from patients than Hungarian, Dutch or Italian physicians. Such a finding may be a reflection of the specific cultural context. In Serbia, unlike in the Netherlands for example, it is less socially acceptable to have an emotional distance from the patients. However, whether in reality physicians are truly that involved with the clients is worth exploring further, since social desirability might have played a role in the findings.Unlike in other studies ,44, womePrevalence of personal accomplishment is generally high in international studies, indicating that physicians feel efficient in their work ,14,25. HOur findings show no gender differences on mean scores of work characteristics. However, gender differences were noted regarding higher percentage of women than men having low control, high levels of depersonalisation, and greater tendency for being represented in the low personal accomplishment group. This finding indicates that women may be a particularly vulnerable group. Future research could explore in more depth the underlying mechanisms and variables associated with such poorer work and health characteristics of women.The main drawback of our study is that no available data exist for burnout cut-off points in Serbia. As we utilized cut-off points standardized on a Dutch sample, the interpretation regarding the level of burnout should be done with caution because a different threshold for burnout might exist in the Serbian population. Scholars suggest using only nation-specific cut-off points . ConsideOur study shows that mean values for studying gender differences may not be sensitive enough to uncover complexities of gender expressions in relation to issues of work and health, which were detectable when examining levels of work characteristics, work-home duties or burnout components. It is being recommended that in future studies, it might be worth exploring the similarity or difference in mechanisms that operate in producing particular outcomes for men and women. This might provide a better understanding of gendered expressions of health . FurtherOur final remark concerns the need for research on the topic of work and health in different cultural settings. Considering that national differences were found on all burnout subcomponents, we call for further and more in-depth examination of work and health related issues across countries.We also formulate several main recommendations for policy and practice. First, given high workload, the number of physicians working in Serbian PHCs should be increased to help the physicians deal with the excessive work demands. Second, the position of female physicians in the workplace should be considered, given the finding that more women than men feel low control and high depersonalisation at work. More empowerment, trust and positive feedback may need to be communicated to these female employees. Finally, we make a call for culturally sensitive interventions, given the finding that all burnout subcomponents differ between Serbia and other countries. For example, targeting emotional exhaustion among Serbian physicians should be a priority, while among Dutch and Italian GPs depersonalisation is a more important symptom of burnout to be addressed. Furthermore, specific cultural norms and values may produce variant health outcomes across countries and insights on such differences/similarities can provide useful directions for proper implementation of work and health recommendations in different settings.We conclude that Serbian PHPs in this study experienced unfavourable conditions in terms of high workload and medium to high emotional exhaustion. They had a medium level of depersonalisation , but unlike many other studies, women tended to be more represented in the high depersonalisation group than men. Level of personal accomplishment was high among men and women, and across the countries. We saw however, inter-country differences on all burnout subcomponents, indicating that the role of nation-specific, cultural aspects might be important to consider in the future research.GP: General practitioner; PHC: Primary healthcare centre; PHP: Primary healthcare physician; WHI: Work-home interference; HWI: Home-work interferenceThe authors declare that they have no competing interests.KP and IH were responsible for the design of the study and this paper. KP carried out data collection and statistical analyses. KP and IH drafted and revised the manuscript and gave approval for the final version of the manuscript to be published.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/716/prepub


Similar clinical appearances prevent accurate diagnosis of two common skin diseases, clavus and verruca. In this study, electrical impedance is employed as a novel tool to generate a predictive model for differentiating these two diseases.C), resistance (eR), impedance magnitude (Z), and phase angle (θ). These values were combined with lesion thickness (d) to characterize the tissue specimens. The results from clavus and verruca were then fitted to a univariate logistic regression model with the generalized estimating equations (GEE) method. In model generation, log SDZ and SDθ were formulated as predictors by fitting a multiple logistic regression model with the same GEE method. The potential nonlinear effects of covariates were detected by fitting generalized additive models (GAM). Moreover, the model was validated by the goodness-of-fit (GOF) assessments.We used 29 clavus and 28 verruca lesions. To obtain impedance parameters, a LCR-meter system was applied to measure capacitance . A final predictive model is established with Z and θ indices. The model fits the observed data quite well. In GOF evaluation, the area under the receiver operating characteristics (ROC) curve is 0.875 (>0.7), the adjusted generalized R2 is 0.512 (>0.3), and the p value of the Hosmer-Lemeshow GOF test is 0.350 (>0.05).Significant mean differences of the index This technique promises to provide an approved model for differential diagnosis of clavus and verruca. It could provide a rapid, relatively low-cost, safe and non-invasive screening tool in clinic use. Verruca and clavus are two skin disorders commonly encountered in dermatological clinics. Verruca, also referred to as wart, is an infection by human papillomaviruses. Based on the involved site and morphology, verruca can be categorized into several clinical forms, such as verruca vulgaris, plantar and palmar warts, verruca plana, anogenital warts, condyloma, etc. Although verruca and clavus resemble each other in clinical symptoms, appearances and predilection sites, the latter unlike the former is not contagious. Clavus results from prolonged pressure and friction on the skin Differential diagnosis between verruca and clavus is mainly based on etiology, pathogenesis, treatment, and means of prevention. The standard treatment for verruca is liquid nitrogen cryotherapy. Other therapeutic modalities include curettage, surgical excision, chemical caustics, and immunotherapies. On the other hand, paring of central radix of corn and topical keratolytics are used in treating clavus Electrical impedance, known as a rapid, safe tool with a relatively low cost, has recently been used in measuring skin or stratum corneum hydration In this study, we employed electrical impedance to differentiate between clavus and verruca. The electrical properties of target tissues were measured after a small current or voltage had been applied to them. The resulting impedance values reflected well the different histological constituents of clavus and verruca. It appears quite promising that our study will help build an electrical impedance system for clinical use in the future to quickly and unequivocally discern between clavus and verruca.i.e. paring the outer part of the lesions, and applying triacetic acid solution and liquid nitrogen cryotherapy on clavus and verruca, respectively. All the samples were subjected to impedance measuring without any patient information, except the diagnosis. After measuring, all the samples were discarded and disinfected. No patient medical profiles were recorded, thus no linkage between the patients and the samples could be retrieved thereafter.On the basis of dermoscopic features, specimens were diagnosed and collected by dermatologists from clavus and verruca patients at out-patient clinic. A total of 57 lesions obtained from hands or feet of 29 patients consisted of 29 clavus and 28 verruca lesions. The criteria for a valid specimen were as follows: Each specimen was (1) diagnosed unequivocally under a dermoscope, (2) greater than 3 mm in diameter, (3) collected from a patient whose lesion has not been treated before, and, (4) regarded as independent if more than one lesion was removed from the same patient. All the samples were processed in accordance with standard treatment protocols for clavus and verruca at our hospital, C), resistance (eR), impedance magnitude (Z), and phase angle (θ). Additionally, the thickness (d) of the sample was measured by vernier caliper. Temperature and relative humility were recorded.To assemble an electrical impedance system, both sides of each specimen were sealed by two pieces of insulation tape, each with a 3 mm hole in the center. Two holes on each side of the insulation tape were allocated on opposing sides. Therefore, a controlled area of the specimen was used for measurement. This was followed by attaching a pair of pre-gelled electrodes  to the two tape holes. Next, the sample was placed in a shielding chamber to reduce noises. Its electrical properties were then measured by a commercial LCR-meter  under 1 V, at the frequencies of 50 Hz, 80 Hz, 100 Hz, 200 Hz, 1 kHz, 2 kHz, 5 kHz, 10 kHz, 100 kHz, and 1 MHz. The data acquisitions were immediately performed after setup, at 30 min and 60 min. The impedance indices include capacitance . These indices were then analyzed by fitting univariate logistic regression model with the generalized estimating equations (GEE) method for examination on the discrimination abilities between clavus and verruca data. Note that the use of the GEE method was to account for the correlations between the repeated measurements within subjects on the lesions.Statistical analysis of the electrical impedance system was performed using the R 3.0.2 software  SDZ and SDθ, were identified as predictive factors by a stepwise variable selection procedure. To validate the model, the basic model-fitting techniques were applied for (1) variable selection, (2) goodness-of-fit (GOF) assessment, and (3) regression diagnostics and remedies. The GOF assessments the estimated area under the receiver operating characteristic (ROC) curve, adjusted generalized R2, and the Hosmer-Lemeshow GOF test. In practice, the value of the c statistic (0≤c≤1)≥0.7 suggests an acceptable level of discrimination power. Adjusted generalized R2≥0.30 indicates an acceptable fit of a logistic regression model. And, larger p values of the Hosmer-Lemeshow GOF test indicate better fits. As regards to regression diagnostics, the non-linear effects of continuous covariates were detected by the generalized additive models (GAM), such that faults in the model can be exposed.To generate a best model with predictive factors, multivariate analysis was further performed by fitting multivariate logistic regression model with the same GEE method. The two indices, log p<0.001), except C and SDC. In θ index of clavus is higher than that of verruca. Moreover, eR and Z values of clavus are approximately ten times higher than those of verruca. These results indicate that high impedance is associated with clavus, whereas low impedance in verruca. Moreover, eR and Z indices can be used to best distinguish clavus and verruca.To discriminate the electrical properties between clavus and verruca, the measured and transformed indices of clavus at 80 Hz are compared with those of verruca in SDZ and SDθ, for the probability of being verruca respectively, but d and identified two appropriate cut-off points in discretizing. Therefore, one of the best models is selected  and 2.304 (p = 0.2406), respectively , and the p value of the Hosmer-Lemeshow GOF test is 0.350 (>0.05). These results all pass the tests for best model-fitting techniques. Overall, a model with log SDZ and SDθ as predictive factors is generated for differentiating verruca from clavus, and the validity of the model is determined by GOF method.As 5 (>0.7) , the adjImpedance is proposed in this study to reflect the different histological constituents of clavus and verruca, so as to assemble a new electrical impedance system for differentiating these two lesion types. Research have disclosed that the impedance/resistivity of stratum corneum is greater than those of other tissues in the human body To identify predictive factor from electrical impedance for model generation, this study discerns statistic differences between clavus and verruca, regarding resistance, impedance magnitude, phase angle, and thickness, but not capacitance. More importantly, resistance and impedance magnitude between clavus and verruca can differ by a factor of ten. However, only the model generated from the two parameters-impedance magnitude and phase angle-fits the data most. This can be explained by the following two equations X. The reason why impedance magnitude and phase angle are the two parameters for model generation is clear. Furthermore, the advantage of using these two parameters is that they are transformed and calibrated values and as a result of that the predictive procedure becomes far less complicated. It is worthy to note that the use of these two indices in model design has been revealed in previous research, though relating neither to clavus nor to verruca. Impedance magnitude is found to be one of the important indices in analyzing electrical impedance spectra Here, impedance is defined as total resistance of a biological conductor on alternating current. Simultaneously, it is comprised of two parts: one is resistance, and the other is reactance, defined as After discussion on the three indices in question, attention is driven to the parameters, thickness and capacitance. Thickness parameter, although showing capabilities in distinguishing between clavus and verruca, is observed to pose problems in impedance analysis, due partly to the difficulties in specifying measured locations, and due partly to its variations caused by biological factors and environmental conditions Last but not the least, the limitations of the model are detected by the GAM plots. Theoretically, the plots should be linear, but a partial linear is plotted. The non-linear effects of continuous covariates expose the inadequacies of the model. That is to say, misdiagnosis may occur, when lesions are not typical. Non-typical lesions include verruca with very thick corneal layer and few capillary proliferation, and clavus with exceeding hydration.SDZ and SDθ, were two predictive factors derived for estimating the probability of being verruca versus clavus. Moreover, the validity of the model was approved by GOF and GAM methods. In spite of certain limitations, this study provides a rapid, low cost, safe and non-invasive alternative modality for physicians' clinic practice. Further application on in vivo diagnosis and investigation on circuit design for size reduction are expected.In conclusion, we employed electrical impedance as a novel tool to postulate a predictive model for differential diagnosis of clavus and verruca. From electrical impedance, log Figure S1The stereoscopic features of (A) clavus and (B) verruca.(PDF)Click here for additional data file.Text S1Frequency selection.(PDF)Click here for additional data file.Text S2Final model selection.(PDF)Click here for additional data file.


N = 559) and their unaffected peers (N = 365), aged 6–11, in four parameters of MOXO-CPT performance: Attention, Timing, Hyperactivity and Impulsivity. Results have shown that despite improvement in CPT performance with age, ADHD children continued to demonstrate impaired performance as compared to controls. In most parameters, CPT performance of ADHD children matched that of 1–3 years younger normal controls, with a delay most prominent in older children. However, in the Hyperactivity parameter, ADHD children's performance resembled that of much younger healthy children, with almost no evidence for a developmental catch up. This study suggests that while some cognitive functions develop slower but normally, other functions  show a different trajectory.While data from behavioral, neuropsychological, and brain studies suggested that Attention-Deficit/Hyperactivity Disorder (ADHD) is related to a developmental lag that reduces with age, other studies have proposed that ADHD represents a deviant brain function. The present study used a cross-sectional approach to examine whether ADHD children show a developmental delay in cognitive performance measured by continuous performance test (CPT). We thus, compared six age groups of ADHD children ( Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorders of childhood, characterized by inattention, impulsivity and hyperactivity. Using the DSM-IV criteria [American Psychiatric Association (APA), Many children with ADHD have been described as having co-morbid developmental problems in motor coordination, language, behavior, sleep, and mood   in four parameters of CPT performance to determine whether the disorder is characterized by a delay in cognitive development.Participants in this study were 924 children aged 6–11 years, of them 539 boys and 385 girls. The ADHD group included 559 children diagnosed with ADHD and the control group included 365 children without ADHD. The children were divided into six age categories (6–11 years). For example, the category of “8 years” included children who were equal or older than 8 years old, but younger than 9 years old. Background variables are presented in Table Participants in the ADHD group were recruited from children referred to the out-patient paediatric clinics of a Neuro-Cognitive Center, based in a tertiary care university hospital. The children were referred through their paediatrician, general practitioner, teacher, psychologist, or directly by the parents.Each child met the criteria for ADHD according to DSM-IV-TR criteria APA, , as asseEach child scored above the standard clinical cut off values for ADHD symptoms on ADHD/DSM-IV Scales APA, .All children were drug naïve.Inclusion criteria for participants in the ADHD group were:Each child scored below the clinical cut off point for ADHD symptoms on ADHD/DSM-IV Scales APA, .Absence of academic or behavioral problems, as reported by parents and teachers.Participants in the control group were randomly recruited from pupils in regular classes at primary schools. Inclusion criteria for participants in the control group were:Exclusion criteria were intellectual disability, other chronic condition, chronic use of medications, and other primary psychiatric diagnosis . All participants agreed to participate in the study and their parents gave written informed consent to the study, approved by the Helsinki committee (IRB) of Hadassah-Hebrew University Medical Center .The parent and teacher forms of the Conner's ADHD/DSM-IV Scales were used to assess the level of children's ADHD behaviors Conners, .This study employed the MOXO-CPT versionThe total duration of the test was 15.2 min, and it is composed of eight levels . In each trial a stimulus (target/non-target) was presented for 500, 1000, or 3000 ms and then followed by a “void” period of the same duration  that may be confound with CPT performance  visual distractors ; (b) auditory distractors ; and (c) combination of both visual and auditory distractors .Overall, six different distractors were included, each of them could appear as pure visual, pure auditory or as a combination of them. Each distractor was presented for a different duration ranging from 3.5–14.8 s, with a fixed interval of 0.5 s between two distractors. Distractors' onset was not synchronized with target/non-target's onset and could be generated during target/non-target stimulus or during the void period. Visual distractors appeared at one of four spatial locations on the sides of the screen: down, up, left or right. Different levels of the MOXO-CPT were characterized by a different set of distractors: levels 1 and 8 did not include any distractors but only target and non-target stimuli, levels 2 and 3 contained pure visual stimuli, levels 4 and 5 contained pure auditory stimuli, and levels 6 and 7 contained a combination of visual and auditory stimuli. The sequence of distracters and their exact position on the display were constant for each level. The burden of the distracting stimuli increased at the odd number levels; in the 2nd, 4th, and 6th level only one distractor was presented at a time, while in the 3rd, 5th, and 7th level two distractors were presented simultaneously.Performance indices. The MOXO-CPT included four performance indices: attention, Timing, Impulsivity, and Hyperactivity. For detailed description of performance indices see Supplementary A.Attention. This index corresponded to the number of correct responses (a space bar keystroke in response to a target stimulus) performed during the stimulus presentation or the void period that followed it. This index was considered as a pure measure of sustained attention because it measured correct responses independently of the response time.Timing. The timing index was the number of correct responses given only during the time in which the target stimulus was present on the screen.Impulsivity. The impulsivity index was the number of commission responses performed only during the time in which a non-target stimulus was present on the screen.Hyperactivity. The hyperactivity index was the total number of commission responses that were not coded as impulsive responses .T-tests for independent samples and chi-square tests were used for examining group differences across demographic variables. Second, T-tests for independent samples were used to measure the effect of group on CPT indices. Then, each age category of ADHD children was matched to a group of typically developing children which had the closest mean value in the same parameter, by using Cohen's d measure  between ADHD children and their age-matched healthy peers were examined by two tailed p = 0.07 and p = 0.08, respectively) and at age 9 for impulsivity responses (p = 0.06). The rest of the comparisons did not yield significant group differences.As can be seen in Table In order to evaluate the developmental trajectories of the attention performance, each age category of ADHD children was matched to a group of typically developing children which had the closest mean value in the same parameter. The matched group was chosen by using Cohen's d measure   and many of them included only boys . Although CPT performance is often affected by gender  do not show a clear developmental trajectory. The cross-sectional approach chosen for this study allowed frequent evaluations of typically ADHD-related behavior, which is independent upon definition of remission and persistence. Thus, it was possible to trace small and non-linear changes in performance. One of the major difficulties in early diagnosis of ADHD is that decisions about the inappropriateness of behavior in young children are based on subjective judgments of the observers (Rousseau et al., Future research is needed to investigate the course of ADHD symptoms in wider spectrum of age, in specific sub-types of ADHD, and in response to psychostimulants. Moreover, it is important to examine the clinical and behavioral implications of improvement in CPT performance.Itai Berger suggested the study. Itai Berger, Merav Aboud, Julia Melamed, and Hanoch Cassuto collected the data. Itai Berger, Ortal Slobodin, and Hanoch Cassuto designed the study with assistance from Merav Aboud and Julia Melamed. Ortal Slobodin, Itai Berger, and Hanoch Cassuto performed the statistical analysis. Itai Berger, Ortal Slobodin, and Hanoch Cassuto wrote the manuscript. All of the authors contributed to interpret the findings and writing the manuscript, and read and approved the final manuscript.Itai Berger serves on the scientific advisory board of Neuro-Tech Solutions Ltd. All other authors declare no conflicts of interests.


Exercise may be effective in treating depression, but trials testing its effect in depressed women are rare.To compare the effect of exercise of preferred intensity with exercise of prescribed intensity in thirty-eight women living with depression.A Pragmatic RCT of 12 sessions of exercise at preferred intensity compared with 12 sessions at prescribed intensity. Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), General Health Questionnaire 12 (GHQ-12), heart rate (HR), Rating of Perceived Exertion Scale (RPE), Quality of Life in Depression Scale (QLDS), Multi-Dimensional Scale of Perceived Social Support (MDSPSS), SF12 Health Survey and exercise participation rates were compared between groups.t = 2.638, df = 36, p = 0.006, 95% mean (SD) 26.5 (10.7), CI-20.4 to -2.7, d = 0.86), GHQ-12  8.3 (3.7) 95% CI -6.5 to -1.5, d = 1.08), RSES  11.3 (5.8), 95% CI 0.3 -6.4, d = 0.25), QLDS  15.5 (7.9), 95% CI -12.2 -0.4, d = 0.27) RPE scores  9.2 (3.2), 95% CI -.5 - 5.2, d = 0.77) and attended more exercise sessions , 95% CI-0.3 -4.8, d = 0.58). SF-12, MSPSS and HR did not differ significantly between groups.Intervention participants had statistically better BDI (Exercise of preferred intensity improves psychological, physiological and social outcomes, and exercise participation rates in women living with depression.NCT00546221ClinicalTrials.gov:  People with mental illness are more likely to suffer physical health problems and die prematurely than comparable populations who do not have mental illness, with recent evidence showing that being mentally ill increases a person's risk of ill-health and may shorten their life by 10 years . PopulatWe used a Pragmatic RCT (PRCT). The intervention group received twelve sessions of treadmill aerobic exercise of preferred intensity in groups of up to five, three times per week for four weeks. Preferred intensity, chosen exertion level, was established using the RPE scale . The actIn addition to the pragmatic trial, we added a qualitative component to the study in the form of focus groups with participants from the intervention and active comparator arms of the study. The purpose of this component was to provide information on the processes that might help to explain the quantitative outcomes, a technique used and recommended by previous researchers conducting pragmatic trials . For reaFigure The research team set up a project website, carefully piloted and targeted at the sample group, with an automated system for acquiring more information about the project. A dedicated telephone line with a named member of the project team, a female, was also provided. A poster/flyer was designed to circulate widely, again carefully targeted to appeal to the intended participant group. We sent information letters to General Practitioners (GP) and secondary services , detailing the study and inviting clinicians to assist us in identifying potential participants. An assent form was included for each service/clinician to return if potential participants agreed to do this. Those services agreeing to engage with us received a pack containing a poster to display where potential participants could see it, a set of flyers to hand to potential participants, and a flow chart to guide each clinician through the inclusion criteria. Posters presented very clear information about eligibility criteria, to avoid any potential disappointment to interested parties. Clinicians were requested to hand the flyer out to every consecutive potential participant (to maximise opportunity for interested women to participate and minimise selection bias), having worked through the inclusion criteria. In the event of the potential participant wanting to ask further questions at this stage, the clinician was instructed to refer them to the project telephone hotline number provided on the flyer, where they could contact a named member of the project team. The clinicians' flow chart also included a reminder to the potential participant that this was a research study and not a course of prescribed treatment.In addition, our collaborating service user group and the local hub of the national Mental Health Research Network (MHRN) publicised the programme among its members and relevant independent and voluntary sector organisations and contacts, using the project promotional poster and information flyer. MHRN staff also made visits to interested organizations using a lay-language information sheet of their own design.U.S. National Institutes of Health clinical trials database . The study received a favourable ethical opinion from a local Research Ethics Committee and research governance approval from three participating healthcare Trusts.This study was adopted by the MHRN local hub and was registered with the Potential participants picked up an information flyer from a user group, saw the posters, or had a flyer handed to them by their clinician. The flyer/poster instructed them to visit the project website and/or to call a project telephone number if they were interested in participating. The researcher answering the phone screened the potential participant using the inclusion/exclusion criteria. Participants were invited to ask questions at this stage. Provided the potential participant indicated a continued desire to participate, their contact details were taken by the researcher, and a further information pack was sent out, describing the exercise programme in full with an acceptance slip to be completed and returned in a prepaid envelope. An important part of the pack was a reminder to participants to check with their GP prior to commencing the exercise programme if they had doubts about their fitness to participate. A standard letter to the participants' GP was included in the pack.Provided they were eligible, upon receipt of the acceptance slip, the researcher forwarded the assigned participant code to an independent operative at the MHRN. The MHRN staff filled in the participant code on the next available programme slot which could be intervention or control, decided at random. Participants were allocated to the gym appropriate to their home address (to minimise inconvenience in travelling). Upon attendance at the introductory session of the programme, participants were talked through the information sheet and issues around random allocation. They were invited to ask questions, reminded of their right to withdraw at any stage, and formal written consent was obtained. This two-stage consent procedure with consent-in-principle, followed by formal face-to-face written consent helped the team manage the logistics of random allocation along with convening the exercise programmes in a spread of geographical locations. Reminder telephone calls were made to participants one week before their programme was due to commence, letters were sent in the absence of a telephone, timed to arrive one week before. Participants were once again encouraged to raise any questions and reminded to check with their GP prior to commencing the programme.http://www.random.org. Following randomisation, three participants dropped out of the intervention arm, one person dropped out due to viral illness and two declined to continue, in the active comparator arm one reported the exercise as too taxing, and one declined to continue.Consenting participants were randomly allocated prior to inclusion into the intervention or active comparator by a research professional unconnected to the study, using a computer generated random sequence list from The BDI-II, the primary outcome measure, consists of 21 items to assess the likelihood and intensity of depression in clinical and non-clinical samples. Each item is a list of four statements arranged in increasing severity about a particular symptom of depression, scored on a scale from 0 to 3. The cut-offs are 0-13 - minimal depression; 14-19 - mild depression; 20-28 -moderate depression; and 29-63 - severe depression. Higher total scores indicate more severe depressive symptoms. We used the BDI as it is a measure of depression widely used in research where depression scores are a primary outcome measure and to allow us to better compare our results with previously published systematic reviews and trials.The GHQ-12 screens for non-psychotic psychiatric disorders and is recommended for research purposes. This study used Goldberg's original scoring bimodial method. In this method response categories score 0, 0, 1, and 1 respectively. This gives scores ranging from 0 to 12. A score of 4 or more is considered indicative of 'caseness' - mental health problems.The SF-12 is a self-reporting multipurpose scale used for assessing health-related quality of life for eight concepts of physical and mental health: physical functioning, role limitations due to physical health problems, role limitations due to emotional health problems, social functioning, emotional well-being, pain, energy and/or fatigue, and general health perceptions. SF-12 is a standardized measure of health status. Items are scored on Likert scales; a high score indicates poor health.The RSES is a standardized scale and was used to assess global self-esteem and self-acceptance. This is a ten item self-rating Likert scale with items answered on a four point scale, from strongly agrees to strongly disagree. The higher the score, the higher the self esteem, 14-25 is considered normal, below 14 indicates low self-esteem.The QLDS is a standard measure of needs-based quality of life of patients with depression. The theoretical basis for the instrument is that life gains its quality from the ability and capacity of the individual to satisfy his or her needs. The scale covers emotional reactions, social isolation, energy level, sleep, physical mobility, and pain. The QLDS, consists of 34 items related to depression, scored binomially (0-1); numerically higher scores depict lower QOL.The MSPSS is a 12-item questionnaire that assesses participants' perception of the role that friends, family and peers play in their lives. Respondents rate items on a seven-point Likert scale with higher scores corresponding to greater social support. The total social support score was used in this study.The RPE is a standard assessment of physical activity intensity. Perceived exertion is how hard you feel your body is working. It is based on the physical sensations a person experiences during physical activity, including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue. The scale ranges from 6 to 20, where 6 is "no exertion at all" and 20 "maximal exertion.Heart rate was measured by chest monitors and we recorded the number of exercise sessions each participant completed.Table As shown in table Table d = 0.58). An independent t-test showed that the difference between the groups was significant .Compared with the active comparator group, the preferred intensity group showed significantly lower depression levels, higher self-esteem levels, better general mental health, and improved quality of life. General health and perceived social support improved for both groups, but there was no statistically significant difference between them. Heart rate and perceived effort increased for both groups, but these differences were not statistically significant. However, at peak exertion, whilst the intervention group experienced less effort by the end of the exercise sessions, the active comparator group experienced significantly more exertion. The intervention group attended a greater number of exercise sessions (8 (66%) out of 12 sessions) than the active comparator group (6 (50%) out of 12 sessions), giving a mean difference of 2.3 sessions (95% CI -0.3 to 4.8). The effect size was medium (We have shown that exercise of preferred intensity improves depressive symptoms, general health and well-being and exercise adherence rates and this finding confirms the positive results shown by earlier studies of clinical populations . CalculaTo our best knowledge, no previous trials tested the effect of preferred intensity exercise. Our focus on preferred intensity has generated results that confirm the effects of exercise in reducing depression whether assessed by symptom severity or by measures such as BDI scores . The posAdherence rates range from 59% to 95%, an average of 82% . Our attThe addition of group aerobic exercise sessions, guided by a qualified exercise therapist with manualised psycho-educational interventions is seldom found in studies of clinical populations. In the UK, exercise has been introduced into services as a treatment for depression under exercise on prescription schemes, whereby patients receive vouchers from their GP, for example, to use at a local gym. A recent systematic review and comparative trial of these schemes has shown them to have limited effectiveness ,27. We hThis work impacts the science in this are in several ways. We have tested a preferred versus prescribed intensity exercise intervention with concomitant manualised psychosocial support, in a clinical population under-represented in previous studies against a range of mental and general health and well being outcomes, not captured in previous studies that have improved substantially as a result of the interventions we introduced. The exercise adherence rates are impressive in light of previous findings among healthy and help-seeking populations that show relatively poor adherence.The loss of participants once enrolled is common in exercise trials involving clinical populations, but is a limitation in this study, necessitated in part, by our attempts to minimise the inconvenience to our participants by localising where the programmes occurred. We were unable to follow up the participants formally due to funding constraints and this is a potential limitation. Finally, assessors of the outcome measures were not blinded to the allocation of participants to each arm of the trial. It is our view that this did not have a negative impact on findings, but it is a potential limitation.Preferred intensity exercise coupled with motivational education and support is likely to improve health and quality of life of women living with depression and improve their exercise adherence rates. The key to the improvements shown here is 'mentored' exercise, which included group motivational support and a low effort walking plan. Exercise tailored to preferred exertion levels, combined with support from others is a prescription designed to improve depressed women's overall health and well being.The authors declare that they have no competing interests.Patrick Callaghan is a Professor of Mental Health Nursing at the Faculty of Medicine and Health Sciences, University of Nottingham.Elizabeth Khalil is a Research Fellow at the Faculty of Medicine and Health Sciences, University of Nottingham.Ioannis Morres was formerly a Research Associate at the Faculty of Medicine and Health Sciences, University of Nottingham.Tim Carter is a PhD Student at the Faculty of Medicine and Health Sciences, University of Nottingham.PC, LK conceived of the study and participated in its design and coordination, and helped to draft the manuscript. IM conceived of the study and participated in its design and coordination. LK and IM ran the exercise interventions. TC helped to draft the manuscript. All authors read and approved the manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/465/prepub