Nowadays there are more concerns about drug treatment of methamphetamine abusers whereas quality of life (QOL) related supportive psychotherapy is less credited.This study aimed to evaluate the effects of family-centered empowerment model on social support and QOL of methamphetamine users and their families.This study was a randomized clinical trial; individuals were randomly allocated to three groups: a group for educating methamphetamine users in recovery (95 subjects), a group for educating a family member of methamphetamine users in recovery (95 subjects) and a control group (95 subjects). Data collecting instruments were standard questionnaires of social support and health-related quality of life (HRQOL). Data were analyzed using χ2-test, t-test, paired t-test, Pearson’s correlation and ANOVA.Mean scores of QOL and social support dimensions changed significantly in two intervention groups (P < 0.0001), but didn’t change in the control group (P > 0.05). Also, there was a positive significant relation (P < 0.05) between total social support and all dimensions of QOL for all study groups.Family-centered empowerment model, easily adapted to methamphetamine users and their families, leads to improved social supports and QOL. Methamphetamine, also known as crystal, meth, ice or glass is a group of psychoactive drugs. This highly addictive substance is increasingly available and its abuse has grown recently due to its easy manufacture in illegal laboratories . As repoAs defined by the World Health Organization, QOL is individuals’ perception of their position in life in the context of their culture and value systems, in which they live and in relation to their goals, expectations, standards and concerns . The conThis study aimed to evaluate the effects of the family-centered empowerment model on social support and QOL of methamphetamine abusers and their families.This was a randomized clinical trial with an educational intervention and a pre-post design involving methamphetamine-dependent individuals and their families. All subjects were in recovery and were admitted to clinics of Tehran University of Medical Sciences during a 12-month period in 2012-2013. Inclusion criteria for methamphetamine-dependent individuals were: age between 20-64, no longer than 10 years of abuse history, in recovery and passed detoxification step and willingness to participate in this study. Exclusion criteria were relapse and unwillingness to participate. Subjects were selected among methamphetamine dependent patients and their family members based on random numbers from the table and then randomly allocated to two intervention groups and a control group. Type of randomization was simple. Intervention groups include: one group for educating methamphetamine users in recovery (95 subjects), one group for educating a family member of methamphetamine users in recovery  (95 subjects) and the control group which included methamphetamine users in recovery with no intervention (95 subjects).In this study samples were chosen based on odds ratio and a study  that shoNote that TUMS clinics are equally located in northern, southern, western and eastern parts of the city and were representative of methamphetamine abusers from different regions of Tehran, willing to quit.Data collection instruments included: 1- demographic check list: age, gender , education level , marital status (single - married); 2- the Persian version of the Short Form Health Survey (SF-36) including 36 questions measuring eight dimensions of quality of life: physical functioning, social functioning, role limitation , bodily pain, mental health, vitality and general health. Each dimension has a score of 0-100, with higher scores indicating a better health status. The reliability and validity of the Iranian version has been approved by Montazeri et al. . The 3-pThe main purpose of this intervention program was improving social support, health  and quality of life in methamphetamine addicts and their families. Also, enhancing the patients’ social and psychoanalytical function, supporting self-confidence, informing them regarding the disease and its limitations, preventing reoccurrence of disease, empowering the patient against stressful situations and understanding social support and important supportive sources like family, important people in an individual's life like wife and friends.The general principles stated in this program were educating, ensuring, guidance, empathy, encouragement and the chance to express emotions to promote social support from others. The intervention program was performed in nine sessions as follows:Introducing group members, stating the purpose of applying treatment, definitions related to drugs, transfer ways and prevention,Definitions of quality of life and its dimensions,The importance of understanding supportive resources and optimal usage of these resources while treating addiction,Training problem solving methods in order to encounter life in a sane way, seeking opportunities to express emotions to group members according to identification of social support resources,Training relief techniques and positive visualization to reduce anxiety and internal tranquility,Analyzing the sense of sin and alleviating it, chances to express emotions for group members,Training methods of increasing confidence and self-esteem based on abilities and supporting them to do daily activities,Teaching the importance of purposes and targeting methods,Stating a summary of the last sessions' topics and presenting feedback by repeating emphasis statements.Ethical issues  have been completely observed by the authors. The Ethics Committee of Tehran University of Medical Sciences approved the study protocol. For ethical reasons, at the end of the study the control group was also educated. Informed consent  of all participants was obtained and the Declaration of Helsinki was followed throughout the study.The normality of data was tested and confirmed by Kolmogorov-Smirnov test. Descriptive statistics like mean and standard deviation were calculated and statistical procedures including χ2-test, t-test, paired t-test, Pearson’s correlation and ANOVA were conducted. Assumptions of homogeneity of variances were examined with Levin's test. Based on the results, assumptions of homogeneity of variances in variables total social support and total quality of life were approved in three groups under study (P > 0.05). Data was analyzed by SPSS 20.0 software. An α level less than 0.05 was considered significant.The mean age of patients and their families were 23.2 (SD = 12.8) and 31.1 (SD = 8.2), respectively. Most methamphetamine-dependent subjects in this study were 15-34 year old (69.5%) and 75.3% were males with an education level of high school or lower (63.7%). T-test and χ2 confirmed homogeneity of demographic variables including: age , gender  and education level , between intervention and control groups, before and after intervention 1. Independent t-test showed that mean scores of social support and QOL dimensions before intervention were not significantly different for intervention 1 and control groups  but after the intervention there was a significant difference   and 2 . As many experts pointed out, social support is a crucial component of health promotion interventions and its relation with QOL and health promoting behaviors has been investigated in various studies , 30. Soc


This study examined the influence of motor symptom asymmetry in Parkinson's disease (PD) on Grooved Pegboard (GP) performance in right-handed participants. The Unified Parkinson's Disease Rating Scale was used to assess motor symptoms and separate participants with PD into two groups  for comparison with a group of healthy older adults. Participants completed the place and replace GP tasks two times with both hands. Laterality quotients were computed to quantify performance differences between the two hands. Comparisons among the three groups indicated that when the nonpreferred hand is affected by PD motor symptoms, superior preferred hand performance  is further exaggerated in tasks that require precision . Regardless of the task, when the preferred hand is affected, there is an evident shift to superior left-hand performance, which may inevitably manifest as a switch in hand preference. Results add to the discussion of the relationship between handedness and motor symptom asymmetry in PD. Parkinson's disease (PD) is defined by asymmetric motor symptoms of tremor, rigidity, and bradykinesia , 2. ThisFor approximately forty years, scientific debate has existed surrounding whether the preferred limb is initially vulnerable in PD . AcknowlAlthough a relationship has been established, previous studies are limited in their scope of assessing handedness, using hand preference (questionnaires and self-report) as an exclusive means of measurement. Handedness is a multidimensional trait defined by performance and preference , 16. TheObserving measures of performance in relation to measures of hand preference, Brown and colleagues  identifiSage and colleagues  used theTo delineate whether differences in performance were a result of age or PD motor symptoms, a group of healthy older adults was included as a control. Although not to the same extent as observed in PD, the hand-arm system is altered in healthy aging. Decreases in muscle mass and strength have been shown to lead to slowness, increased variability in movement, and difficulties with coordination . Studiesage = 71.36, SD = 9.27) participants with PD and 103 right-handed  healthy older adults . The institution research ethics board approved the study and all participants signed informed consent before enrolling in the study.This study included 170 right-handed . The GP test was used as a performance-based measure of hand preference, to assess upper limb function. This included both place and replace components of the task. Hand preference was confirmed by self-report.n = 5, 4 male, 1 female) indicative of equivalent symptoms on each side were excluded from analyses. Although inclusion of these participants may be clinically relevant and likely warrants further investigation, assessment was beyond the scope of the current investigation . See The UPDRS , adminisn = 24 participants with PD). Missing data points resulting from the inability to test a limb during the GP task were coded as missing.Following GP  procedures outlined by Bryden and Roy , particiTo evaluate asymmetry of GP performance, a laterality quotient was computed for both GP tasks by taking the difference between the left and right hands as a function of the overall movement time of the two hands (L − R/L + R) and multiplying the result by 100. Thus, a positive laterality quotient is indicative of superior performance  with the right hand, and a negative laterality quotient is indicative of superior performance with the left hand. Subsequently, the absolute value of the laterality quotient corresponds to the magnitude of the performance difference between the hands.SPSS statistical software was used. A mixed analysis of variance test with repeated measures was used to assess laterality quotients computed from the GP task. The between subjects factor was group  and the within subjects factor was task .F = 26.06, p < .001, η2 = .095), such that there were greater laterality quotients  in place  compared to replace . Additionally, a main effect of group  = 32.256, p < .001, η2 = .206) revealed laterality quotients of all three groups differed. Both H-OA  and LSA-PD  groups had positive laterality quotients, indicative of superior right-hand performance; however, laterality quotients for the LSA-PD group were significantly greater than the H-OAs (p = .021). The RSA-PD  had a negative laterality quotient, indicative of superior left-hand performance. Finally, a significant interaction between group and task  = 12.591, p < .001, η2 = .092; see Analyses revealed a main effect of task  had a right versus left difference score of PD symptoms of at least 5 points, and 8.5% (n = 14) had a score of at least 10 points. These proportions are less than reports by Uitti and colleagues, where 46% of their participants had a right versus left difference score of at least 5 points and 12% had a difference score of at least 10 points [The current study identified 81 participants with PD as right-side affected and 89 as left-side affected using the UPDRS. Of these participants, 32% met the criteria for asymmetric disease, where 34.5%  may have implications for how rapidly the disease progresses and whether the motor symptoms are accompanied by other disorders such as in cognition. This question is beyond the scope of this paper but has been addressed in some of our other works .Taken together, our findings help clarify the complex interactions of handedness, motor symptom asymmetry, and progression on functional upper limb control. Overall, the observed results are similar to those recently discussed in the literature, noting the obvious effect of the disease on functional preferred hand use, as was demonstrated by poor performance on the GP task when the preferred hand was affected by PD. Results are clinically relevant, as they aid in our understanding of disease progression. Future studies should aim to include a comparable sample of right- and left-handed participants to examine similarities and differences in performance. Additionally, a handedness inventory, such as the Waterloo Handedness Questionnaire , should Participants with equivalent symptoms on each side  were excluded from analyses. Although inclusion of these participants was beyond the scope of the current investigation, analyses including them can be found in the supplementary material.


A number of studies have reported the association of sexual problems with ankylosing spondylitis (AS); however, the results have been conflicting. The present study aimed to investigate the impact of AS on sexual function. To develop a more comprehensive understanding of sexual function in patients with AS, a systematic review and meta-analysis of the literature up to 2013 was conducted. Studies that assessed the impact of AS on sexual function by adopting the International Index of Erectile Function or the Female Sexual Function Index (FSFI) scoring system were included. Statistical analysis was performed using Review Manager statistical software (version 5.2). The weighted mean differences were calculated by employing a fixed or random effects model. A total of 484 cases from five studies were identified as being well-documented and included in the meta-analysis. Compared with healthy controls, male patients with AS have a significant reduction in sexual function scores of erectile function (−3.07), orgasmic function (−1.17), sexual drive (−0.72) and intercourse satisfaction (−1.89). Female patients with AS have a lower FSFI score in domains of desire (−0.34) and arousal (−0.87). In conclusion, AS has a certain impact on the sexual function of male patients. AS appears to have a greater influence on the sexual function of males compared with that of females. However, the mechanism by which AS affects sexual function requires further evaluation by further studies of a larger population of patients. Ankylosing spondylitis (AS) is a systemic chronic rheumatic disease that presents with inflammatory back pain, asymmetrical peripheral arthritis, enthesitis and extra-articular features . Apart fThe effect of rheumatologic diseases, particularly AS, on sexual function has been explored ,6. A preThe aim of this study was to summarize the existing evidence and explore the effect of AS on sexual function by conducting a systematic review and meta-analysis.The meta-analysis was reported in accordance with the recommendations of the Preferred Reporting Items for Systemic Review and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) as closely as possible ,11.The following digital databases were searched to identify relevant trials: PubMed, Embase and the Cochrane Library. In addition, Chinese databases were searched, including the CNKI Scholar, VIP, Chinese BioMedicine (CBM) and WanFang databases. Up-to-date information regarding AS-related sexual function up to May 2013 was retrieved from these databases.Different search strategies were combined, as follows. For the English-language databases, free text such as ‘sexual activity’, ‘sexual function’, ‘impotence’ or ‘erectile dysfunction’ and ‘Marie-Struempell disease’ ‘Bechterew disease’ ‘ankylosing spondylarthritis’ or ‘ankylosing spondylitis’ were used. For the Chinese databases, free text terms were used, including the Chinese translations of terms meaning sexual function, erectile dysfunction and AS. In order to collect an adequate number of trials, the reference lists of relevant publications were also searched to identify additional studies.The focus of the analysis was on studies of sexual function in AS regardless of gender, publication status or language. Studies were selected for analysis if they satisfied the following criteria: i) Studies that assessed the association between sexual function and AS; ii) the subjects enrolled were diagnosed with AS according to modified New York criteria for AS ; and iiiFor repeated studies of the same data, authors of reports were contacted to clarify ambiguity. If the author could not be reached, the first published study was considered as original. Two reviewers selected articles independently. Based on the PRISMA requirements, a flow diagram of the study selection was generated.The relevant data was extracted by two independent investigators, and discrepancies between the two abstractors were resolved by consensus, or re-evaluated by a third reviewer. The validated Newcastle-Ottawa Scale instrument was adopted to independently assess the quality of each study . A star The IIEF index covers five domains: Erectile function , intercourse satisfaction , orgasmic function (OF), sexual drive (SD) and overall satisfaction (OS) (two questions each with a maximum score of 10). The FSFI index includes domains of sexual desire, arousal, lubrication, orgasm, satisfaction and pain during sexual intercourse. In case of vagueness or absence of outcomes in the articles, the authors were contacted and related data was extracted by consensus if the authors were unavailable.2, τ2 and Higgins I2 tests, and a P level <0.1 was considered significant. A Z score was adopted to assess the overall effect with significance set at P<0.05. Publication bias was evaluated by the Egger test and represented graphically by funnel plots when the number of included trials was ≥5. To minimize the clinical heterogeneity, subgroup analyses for male sexual function and female sexual function were conducted.The correlation of sexual function with AS was evaluated using Review Manager meta-analysis software . Weighted mean differences (MDs) and the 95% confidence interval (CI) were calculated for continuous data. A fixed-effect model was applied to combine these MDs to get an overall MD, also known as an effect estimate. A random-effects model was used if heterogeneity across studies was present. Heterogeneity was evaluated via the χA flowchart of the study selection process is shown in Three studies assessed the impact of AS on male sexual function, involving a total of 364 participants of which 172 were male patients with AS ,18,19. TAs the number of included studies in each subgroup was <5, funnel plot analysis and Egger tests were not conducted to test publication bias.The number of trial participants with AS ranged from 37 to 70. The statistical heterogeneity among the studies was found to be significant regarding the results for OF and OS (both P<0.1). Consequently, the random-effects model was applied to pool the results. The pooled results displayed statistical significance with the exception of OS . Significant differences were identified in scores of EF , OF , SD  and IS . Accordingly, the random-effects model was applied to combine these domains. The pooled results displayed no significant difference between patients with AS and healthy controls in sexual function, with the exception of desire  and arousal . However, no effects were found on total FSFI , lubrication , orgasm , satisfaction  and pain , OF (−1.17), SD (−0.72) and IS (−1.89). Compared with healthy controls, female patients with AS have a lower FSFI score in domains of desire (−0.34) and arousal (−0.87).AS may have a greater impact on male sexual function than on that of females. The possible reasons are as follow. Firstly, it has been reported that males are more often affected by AS than females ,23 and pThe pathogenesis of sexual problems in patients with AS is complicated and multifactorial. Several underlying mechanisms might be involved in the effect of AS on sexual function. Firstly, tumor necrosis factor α (TNF-α) plays a pivotal role in the pathogenesis of AS, and TNF-α concentrations are increased in the circulation  and synoSeveral limitations of the present study should be noted. Firstly, although the number of participants included in this meta-analysis is larger than that in an individual study, the sample size may be not large enough. In the current meta-analysis, numerous studies were excluded due to inconformity with the IIEF or FSFI scoring system. Secondly, all the participants were recruited from Turkish populations. The association of sexual problems and AS may differ in populations from other ethnic origins. Additionally, there was a considerable heterogeneity in the subgroup of female sexual function in AS. It is hypothesized that differences in the quality of studies, participant characteristics and disease activity are responsible for the heterogeneity. In view of this, all of the conclusions require careful consideration.In conclusion, there is an association between sexual problems and AS. AS appears to have a greater influence on the sexual function of males than that of females. Early diagnosis of sexual dysfunction is essential for AS patients with sexual problems. Therefore, physicians should be aware of the effect of AS on sexual health and it is recommended that special attention is given to all domains of life, not only disease activity and physical function.


Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB). World TB Day provides an opportunity to raise awareness about TB-related problems and solutions, and to support worldwide TB control efforts. For the second year, CDC joins the global Stop TB Partnership in adopting the World TB Day slogan, “Stop TB in My Lifetime.”Each year, World TB Day is observed on March 24. This annual event commemorates the date in 1882 when German bacteriologist Robert Koch announced his discovery of In 2012, a total of 9,951 new TB cases were reported in the United States, for a rate of 3.2 cases per 100,000 (http://www.cdc.gov/tb/events/worldtbday.CDC is committed to a world free of TB. Initiatives to improve awareness, testing, and treatment of latent TB infection and TB disease among high-risk groups are critical to reach the goal of TB elimination in the United States. Additional information about World TB Day and CDC’s TB elimination activities is available at


The amount of specific foods important for bone health consumed, such as milk and vegetables, increased significantly, both in male and female children (p < 0.05). The proposed educational program appears to be effective in modifying calcium intake in children, with a significant increase in the consumption of dairy products and vegetables, but without a significant change in the total caloric intake.Optimal peak bone mass and bone health later in life are favored by a sufficient calcium intake in infancy, childhood and adolescence. The purpose of this study was to test a new educational program created to monitor and to improve calcium and vitamin D intake in children. Nutritional habits in children were evaluated through a food frequency questionnaire (FFQ) to assess the intake of calcium, vitamin D, dairy products, and total caloric energy at baseline and after seven months of exposure to a unique educational program applied between November 2013 and May 2014 in 176 schoolchildren  attending the fourth and fifth grades of two selected primary schools in Florence, Italy. A significant increase of calcium (from 870 ± 190 to 1100 ± 200 mg/day,  Osteoporosis is a chronic disease characterized by low bone mass and deterioration of bone microarchitecture, leading to skeletal fragility and increased fracture risk . OsteopoBone is a living tissue, and bone cells have the same need for nutrients as the rest of the body, not just protein and energy supply, but also micronutrients, such as minerals  and vitamins  ,9,10,11.In a balanced Western-style diet, about 60% of dietary calcium comes from milk and dairy products, 20% from fresh vegetables, nuts and dried fruits, and the rest from drinking water or other discrete sources.Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione, Italian Research Institute for Foods and Nutrition) data report on the Food Consumption Survey 2005–2006 showed that children aged 10–17 years consume a mean of 170 g/day of milk, and 13.5 g/day of yogurt, which together represent 10%–12% of the total energy in the diet [While the intake of calcium and bone micronutrients is often inadequate in childhood and adolescence even in Mediterranean countries ,20,21,22the diet . Recent the diet . Indeed,the diet .Vitamin D is essential for the absorption of calcium and phosphate, and for enhancing bone mineralization, with sunlight exposure being the primary determinant of vitamin D status . Indeed,These data point to the need of developing nutritional education programs for children in order to improve the dietary intake of calcium, vitamin D, protein and vegetables, with the goal of achieving the optimal PBM necessary to prevent osteoporosis and consequent fragility fractures.Studying the eating behavior of children is certainly more difficult than assessing dietary patterns of adults, but it is a focal point for the primary prevention of chronic diseases.In recent years, several studies have been conducted with the aim of improving eating patterns and lifestyle in school-age children, in order to prevent the onset of many chronic diseases later in life. However, many of these studies are used to hinder overweight and obesity, not specifically to improve calcium and vitamin D intakes, and are often limited to solutions in the school environment, not influencing nutrition at home ,35,36,37The purpose of this pilot study was to investigate the effectiveness of a nutritional education program, specifically realized to improve calcium and vitamin D intake, in a reference group of healthy Italian primary schoolchildren (aged 9–11). The key feature of our study consisted in the use of new communication tools, able to convey the message of correct nutrition for healthy bones in a unique, simple and funny/gamified way, able to engage and empower the children.In November 2013, a group of 176 schoolchildren, 48% male and 52% female, aged 9–10 years, were recruited from two selected primary schools in Florence. This age range was selected because it is critical for the achievement of optimal PBM necessary to prevent the onset of osteoporosis. Moreover, at this age children are perfectly capable of cooperating in the collection of nutritional data and are able to take advantage of computer-based resources and tools.Participants were asked to complete a specific questionnaire in order to know their current eating habits. The children involved were not following any special diet, and were not taking any dietary supplements. Informed consent was obtained from their parents.In May 2014, the second step of the project was carried out. At this stage, nutritional data was collected from 156 of the 176 subjects in order to evaluate the project efficacy. Specifically, each participant who was present at school the day of the second, unannounced, evaluation was asked to complete the questionnaire for a second time, in order to estimate possible changes in nutritional behavior as a result of the educational program.The 7-month program took place during the school year, when food habits are presumed to be consistent.i.e., before and after the educational program, the study should be considered a “pre–post intervention study”, in which each interviewed subject is the control of his/herself.Since data were collected in two different steps, The study was authorized by the local Internal Review Board of the University Hospital of Florence/University of Florence  in September 2013 (project identification code: 79.13). The research was conducted in accordance with the Declaration of Helsinki, and written informed consent for collection of personal data was obtained from all participants.A twenty-one item questionnaire (FFQ), specifically validated for the assessment of calcium and important nutrients for bone health in children , was admSubjects were asked to report the frequency of consumption and portion size with the advice and supervision of two nutritionists. Color photographs to identify serving size were part of the questionnaire. Portions were classified in two sizes (B and C), displayed as a photograph for each item, corresponding to medium and large portions. The children could also indicate portions smaller than “B” or larger than “C”. Food frequency consumption of each item was evaluated using categories: daily, weekly (from once to six times a week), monthly (from one to three times a month), and never. Great attention was given by the nutritionists to explain how to complete the questionnaire, and the importance of a detailed and not manipulated response.®, a bony little boy, who is the hero of a cartoon game series and several online games, all produced to attract children to the project, and also to involve the entire family.The project was realized with the support of a novel instrument, specifically created with a publisher  dedicated to the production of schoolbooks for children. The project messages and materials featured Mister BoneThe detailed steps of the nutritional education program are summarized as follow:Step 1: Creation of a dedicated website  with theStep 2: Realization of the “Mister Bone Calendar”, an indispensable educational tool through which each child could check their physical activity and daily calcium intake.Step 3: A classroom session conducted by nutritionists to teach children the importance of the adequate intake of calcium and other nutrients necessary for healthy bones.Step 4: Delivery to the children of the “student kit”.Step 5: Nutritional survey to estimate the nutritional habits of the children. This was carried out through two survey steps, by providing the aforementioned questionnaire: (i) in November, to know the current eating habits of children; and (ii) in May, to evaluate the project efficacy.game section encompassed a game based on finding wrong and right behaviors of a cartoon character (Baby Bone) towards bone health, crosswords puzzle and quizzes about bone metabolism and good nutrition. The results of the total score obtained by each subjects were displayed and constantly updated on the homepage of the website.An interactive website was created to help the children build powerful bones, encompassing “online” games to teach a correct lifestyle for having a strong and healthy skeleton. The website featured a description of the project and an educational section on bone science and metabolism, along with information about nutrition for correct skeletal development especially developed and amusing for school-aged children. Two different levels of access were made possible, one for the general public, and another for the participants in the project. Visiting this website, children could learn how to increase calcium and vitamin D intake through both diet and physical activity, in an easy, gamified and amusing way. In particular, the ® as the first actor provided important advice about nutrition and bone health.A colorful “Mister Bone Calendar” allowed the children to track their calcium intake and physical activity by using thematic stickers, with active participation in daily progress. Each month, a graphic element with Mister BoneThe nutritional education project was carried out for one full school year, from November 2013 to May 2014, in the 4th and 5th grades of two selected primary schools in Florence. The first step was taken in November and was dedicated to nutritional education with particular emphasis on dairy nutrition and the importance of the adequate intake of calcium and other nutrients necessary for bone health. A 60-min seminar and discussion with the children was performed by dedicated nutritionists, focusing on optimal dietary calcium intake throughout childhood and adolescence, and its significance and impact on PBM. The presentation included: the basic concepts of physiology of bone; the importance of nutrition and physical activity for bone health; strategies for increasing calcium and vitamin D in the diet; appropriate calcium-rich food sources; the relevance of having a regular breakfast; the importance of exposure to sunshine; and the risk factors for PBM accrual. Slides included pictures of foods rich in calcium and vitamin D, and the Recommended Dietary Allowance (RDA) requirements for calcium and vitamin D for children. The slide show was followed by an interactive group discussion regarding doubts and questions.Children received a “student kit” which included the “Mister Bone Calendar”, an informative brochure describing the contents of the initiative, and a compact disc with all the project contents, including the games created for the project .A database was realized on the basis of the supplied questionnaires through a software program that included the Tables of Food Composition compiled by the Italian National Institute of Nutrition (WinFood 2.7-MediMatica). The nutritionists who performed the interview calculated the food and nutrient intake, using the questionnaires completed during the two-step survey.Data from 156 subjects  were analyzed to compare attitudes and consumption frequency before and after the educational program, with particular interest in the intake of total energy , calcium (mg/day), vitamin D (µg/day), protein (mg/day), lipids and carbohydrates (mg/day).i.e., micronutrients) were: starch, vitamin A, niacin, riboflavin, thiamin, vitamin B6, folic acid, purine, potassium, zinc, phosphorus, iron, energy, vitamin C, vitamin D, vitamin E, oxalic acid, selenium, sodium, fiber, magnesium, and copper.Additional calculated and analyzed variables  × a 2-levels between-factor .p-value was lower than 0.05.Results were considered as significant when the A preliminary statistical analysis was carried out to rule out any difference in the distribution of the average intake of nutrients between the two primary schools, before and after the nutritional education. No statistically significant differences were observed. This allowed the pooling of results from the two schools . = 4.94, p < 0.05). Mean calcium intake at baseline was 865 ± 190 mg/day in the female group and 890 ± 200 mg/day in the male group, far below the LARN (Level Assumption Recommended Nutrients) levels recommended by the Italian Nutrition Society (110–1300 mg/day)  .p = 0.344). In addition, no interaction effect between sex and the educational program was observed (p = 0.890)  . = 106.09, p < 0.001), vitamin D  = 19.25, p < 0.001), proteins  = 64.17, p < 0.001), phosphate  = 78.24, p < 0.001), magnesium  = 86.22, p < 0.001), water  = 101.47, p < 0.001), saturated fats  = 6.02, p < 0.05), insoluble fiber  = 26.57, p < 0.001) and soluble fiber  = 13.60, p < 0.001) was observed. The intake in males was statistically higher compared to the intake in females only in the case of calcium  = 4.13, p < 0.05) and saturated fats  = 4.06, p < 0.05). No interaction effects were observed for any nutrients under scrutiny.The intake of many macro and micronutrients increased significantly from the baseline levels to follow-up levels, ensuing from the educational program . As far In particular, mean calcium intake rose from 882 ± 184 mg/day to 1078 ± 233 mg/day, and vitamin D intake increased from 3.4 μg/day to 4.1 μg/day as a result of the educational program and the increased daily consumption of foods important for bone health, such as milk, fresh and hard cheeses, and vegetables . ChildreThe daily intake of fresh vegetables increased by about 50 g/day (from 160 ± 97 to 210 ± 94 g/day) during the educational program.p = 0.954) and there were no sex-related differences (p = 0.603). Monounsaturated fats decreased between baseline and follow-up measurements  = 5.66, p < 0.05) and there were no sex-related differences (p = 0.586) (Polyunsaturated fats did not change between baseline and follow-up (= 0.586) .p > 0.05) following application of the educational program  it is critical for achieving the optimal PBM required to prevent osteoporosis and its consequences; and (2) children at this age are fully competent in acquiring proper information and cooperating successfully in the reliable completion of questionnaires ,46.The results obtained from this study show that this nutrition educational program was effective in modifying the nutrition of children by increasing the intake of nutrients important for bone health intake, such as calcium, phosphate, and vitamin D, as well as polyvalent foods, such as dairy products , which contain many essential nutrients, such as protein and calcium, with effects on bone health exceeding the sum of the single elements.In particular, a significant increase in calcium intake before and after the educational program was demonstrated. This is a major achievement, considering that in the Italian population mean daily calcium consumption is about 76% of the average recommendation . In lineVitamin D is a key hormone for the regulation of bone growth and mineralization throughout life. Many studies show that deficiency or inadequacy of vitamin D in children and adolescents living in several regions of the world , with coIt is worth noting that all changes took place without variation in the total energy intake, and independently of the sex of the child.Evidence suggests a positive association between the amount of ingested proteins and bone mass gain in healthy children and adolescents of both sexes, with this association being particularly relevant in pre-pubertal children . As a reThe success of our educational program is highlighted by several observations on small but fundamental changes of dietary habits, with increased consumption of milk, fresh and hard cheeses, and vegetables. These results are important because the consumption of dairy products at a young age may influence dietary habits later in life. The increase in the consumption of a cheese like Parmesan, which can offer a good calcium intake option even for intolerant people, given the absence of lactose, is very important.Daily vegetable intake is very important for children, not only for vitamin and mineral intake, but also for their contribution in preventing renal calcium loss . SimilarThis all took place at an age (9–11 years) that is crucial, since the consumption of dairy products tends to decrease further during adolescence, with a consequent increase in the risk of fracture before puberty (a 2.6-fold higher risk has been reported), and possibly later in life ,51.So far, only one other pilot study applying a similar educational program for a small group of schoolchildren (12 subjects) with a similar aim  has been found in the literature . With renudgetheory [We acknowledge some limitations of this study do exist, such as the lack of a control group, the relative small number of subjects evaluated and enrolled in the program, the lack of anthropometric measurements and blood tests to assess vitamin D status and other metabolic parameters. Nonetheless, we also underline that this progressive program, realized through lessons, leaflets, and games, is unique, also from an educational point of view, developing and supporting automated positive behaviors according to the etheory . Exploitetheory ,55, thisetheory . As far For all the above-mentioned reasons, the Mister Bone educational program may be considered a new instrument of primary prevention to improve eating behaviors, increasing calcium and vitamin D intakes in larger groups of healthy schoolchildren. The findings ensuing from this pilot study may encourage school policies to promote educational strategies for the promotion of skeletal health.An original educational program of primary prevention carried out in Italian primary schools and specifically designed for children aged 9–10 years, has been demonstrated to be effective in improving good nutritional habits in particular aimed to sustain bone health. This has happened in an age range, which is crucial for bone accrual and prevention of osteoporosis later in life.This instrument can be further exploited and tested in different and larger backgrounds in order to increase knowledge and empower children about good choices for maintaining or improving their skeletal strength.


Background and aims: Barrett’s esophagus (BE) and colorectal neoplasms share similar risk factors. Previous studies have shown variable prevalence of colon polyps in patients with BE. Our aims were to determine the prevalence and incidence of colon polyps in patients with BE, compared to those without BE.Methods: In this case-control study, the study group included patients, aged 50–75 years, with biopsy-proven BE, who underwent colonoscopy at Cleveland Clinic from January 2002 to December 2011. The control group consisted of age- and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time period. Exclusion criteria for both groups were family- or personal previous history of colon cancer or polyps, prior colonic resection, inflammatory bowel disease and familial polyposis syndromes. Patient demographics, comorbidities, medication use and endoscopic and colonoscopic details were collected, including biopsy results.Results: A total of 519 patients were included in the study; 173 patients with BE in the study group and 346 without BE in the control group. Mean age at index colonoscopy was 61 ± 8 years and 75% of patients were male. On index colonoscopy, patients with BE were more likely to have polyps than controls . Patients underwent between one and five colonoscopies during the follow-up. On multivariate analysis—after adjusting for age, gender and diabetes—patients with BE were 80% more likely to have any type of polyp, and 50% more likely to have adenomas found during colonoscopy.Conclusions: Patients with BE had higher prevalence and incidence of colon polyps. This has important clinical implications for screening and surveillance in BE patients. Due to increased risk of esophageal adenocarcinoma (EAC) in patients with BE, routine surveillance is recommended. Besides EAC, BE is also reported to be associated with an increased risk of colon polyps and colorectal cancer (CRC). Sontag  and CRC . Since t and CRC , while o and CRC . Some of and CRC , 6. Even and CRC , 6–8, wh and CRC , 15. The and CRC , 9–13 an and CRC , 13. TheSince both CRC and EAC are rare occurrences, it may be more prudent to evaluate for any association between their more prevalent precursor conditions, i.e. colon polyps and BE. Our aims were therefore to determine (i) whether there is increased prevalence of colon polyps in patients with BE and (ii) whether there is an increased incidence of colon polyps in patients with BE whilst in a surveillance program.This was a case-control study, performed at the Cleveland Clinic between January 1, 2002 and December 31, 2011. The study group consisted of patients in the BE registry aged 50–75 years, who underwent a colonoscopy at the Cleveland Clinic. The control group was derived from patients aged 50–75 years who had, during the same study period, undergone both an esophagogastroduodenoscopy (EGD) that showed no evidence of BE and a colonoscopy. Groups were frequency matched (1:2), based on gender and age at first colonoscopy. Patients were excluded from either group if they were in a high-risk group , familial polyposis syndromes or prior history of colon polyps), or had a history of colectomy prior to the study period, incomplete colonoscopy or inadequate bowel preparation at colonoscopy. This study was approved by Cleveland Clinic Institutional Review Board.Each patient’s age, sex, body mass index (BMI), medication use, smoking history, alcohol history and comorbidities were recorded. BE was defined as the presence of columnar-appearing epithelium of any length in the esophagus on endoscopy with specialized intestinal metaplasia on biopsy. Endoscopic features were noted, such as length of BE, size of the hiatal hernia and histological findings. Also, from the colonoscopy reports, information was collected relating to the quality of bowel preparation, completeness of the procedure, number of polyps detected, size, location and histology of each polyp. Polyps were classified into hyperplastic and non-hyperplastic polyps, which included adenomas and sessile serrated adenomas. Adenomas included tubular adenomas, tubulovillous adenomas and adenomas with high-grade dysplasia. For statistical analysis, the proximal colon included the cecum, the ascending- and transverse colon, including the splenic flexure. The colon distal to this was defined as the distal colon.th and 75th percentiles) or n (%). For each patient, index colonoscopy findings were reported, as well as lifetime overall colonoscopy findings . A univariate analysis was performed to assess differences between subjects with and without BE. Analysis of variance (ANOVA) or the non-parametric Kruskal-Wallis tests were used for continuous or ordinal factors and Fisher’s exact test or Pearson’s chi-squared test were used to compare categorical variables. In addition, generalized linear models (GLM) with a logit link for binary outcomes were used to model the presence of polyps in any colonoscopy performed, while accounting for multiple procedures per patient. An autoregressive (AR1) covariance structure was used to model the intra-subject correlation. The presence of any polyp was modeled as the outcome with BE, age, gender and diabetes as the independent predictors. The same was done for presence of non-hyperplastic polyps, hyperplastic polyps, adenomas and SSA. A P-value <0.05 was considered statistically significant. All analyses were performed using SAS .Data were presented as mean ± standard deviation, median  or statin use and comorbidities such as hypertension model hyperlipidemia , followed by gastrointestinal bleeding (12.3%), abdominal pain (8.4%), diarrhea (7.8%), constipation (3.5%) and other (12.6%). The most common indication for EGD in control group was abdominal pain (23%), followed by gastroesophageal reflux disease (21%), gastrointestinal bleeding (12%), dyspepsia (9%), nausea (4%) and weight loss (4%). Mean length of BE was 3.3 ± 2.6 cm. Mean hiatal hernia size was 3.2 ± 1.6 cm. Patients with BE were more likely to be caucasian, to use proton pump inhibitors (PPI), and less likely to have ipidemia . Among tvs 31.8%, respectively; P = 0.003). Hyperplastic polyps were more common in patients with BE . Also, there was increased prevalence of both proximal and distal polyps in patients with BE. There were no significant differences in the prevalence of adenomas between study and control groups (On index colonoscopy (the first colonoscopy during study period), patients with BE were more likely than the controls to have polyps . Patients with BE had more polyps than controls, including hyperplastic polyps, adenomas and sessile serrated adenomas (SSA). The numbers of follow-up colonoscopies and findings are shown in Patients underwent one to five colonoscopies during the follow-up period. Subjects with BE were more likely than the controls to have two or more colonoscopies during follow-up  covariance structure and adjusting for age, gender and presence of diabetes. Patients with BE were 80% more likely to have any type of polyp, and 50% more likely to have adenomas .Table 6et al. [Our study showed that patients with BE are at greater risk than controls of developing colonic polyps. The relative risk for any type of colon polyps is 1.8 and for adenomas is 1.5. These findings parallel the recent study findings by Sonneberg et al. .P < 0.01) but the relationship became non-significant after adjustment for age and sex by a logistic regression model . In another case-control study of 72 consecutive patients with BE and 27 controls, colorectal adenomas were seen in 17 patients (24%) with BE and in 8 controls (30%). Using a logistic regression model with the occurrence of colonic adenoma as dependent and sex, age and occurrence of BE as explanatory variables, none of these was found to be a significant risk factor for the appearance of colonic adenoma [There are a few studies suggesting that BE is not associated with increased risk of colorectal neoplasms. In a case-control study of 104 patients with BE and 537 controls, adenomas were found in 26 Barrett’s patients (25%) and 75 controls (14%) . The preThere have been several potential explanations for the association between BE and colon polyps or CRC but the underlying mechanisms responsible for the higher prevalence of colon polyps in BE patients are not clearly understood. Patients with BE are more likely to have some of the same ‘environmental’ risk factors associated with CRC development, such as age, gender, obesity, alcohol consumption and smoking . The genThe strength of our study is the large cohort of patients with BE who underwent colonoscopy and had a long follow-up period. Previous studies did not follow patients over time and reported prevalence rates based on one-time colonoscopy results, or lacked a control group. Our control group included only patients who had an EGD that confirmed the absence of BE. In addition, our study and control groups are well matched in terms of confounding variables associated with colon polyps, such as BMI, smoking, alcohol use, aspirin, NSAID and statin use, thus ruling out any diagnostic bias.The main limitation of this study is that it is a single-center study from a tertiary referral center and, hence, results may not apply to the general population. There is also a small possibility of missing information about a few follow-up colonoscopies that were performed outside of our institution, but every effort had been made to have as complete data as possible. More patients with BE than controls had multiple follow-up colonoscopies, which may raise a question of diagnostic bias. However, this might be because of increased prevalence of colon polyps in BE patients, necessitating more surveillance colonoscopies. Another limitation is the absence of data on waist–hip ratio, which is reflective of central obesity. However, this may not be a confounding factor as there is no difference in BMI between the two groups.In conclusion, our study confirms the association between BE and colon polyps. BE patients have higher incidence of adenomas while under surveillance, than controls without BE. This association might have important implications for screening and surveillance in these patients. Further studies are needed to determine the appropriate screening and surveillance colonoscopy intervals for patients with BE.Conflict of interest: none declared.


Appetite and symptoms, conditions generally reported by the patients with cancer, are somewhat challenging for professionals to measure directly in clinical routine (latent conditions). Therefore, specific instruments are required for this purpose. This study aimed to perform a cultural adaptation of the Cancer Appetite and Symptom Questionnaire (CASQ), into Portuguese and evaluate its psychometric properties on a sample of Brazilian cancer patients.2/df), comparative fit index (CFI), goodness of fit index (GFI) and root mean square error of approximation (RMSEA) were used for fit model assessment. In addition, the reliability of the instrument was estimated using the composite reliability (CR) and Cronbach’s alpha coefficient (α), and the invariance of the model in independent samples was estimated by a multigroup analysis (Δχ2).This is a validation study with Brazilian cancer patients. The face, content, and construct  validities of the Cancer Appetite and Symptom Questionnaire, the study tool, were estimated. Further, a confirmatory factor analysis (CFA) was conducted. The ratio of chi-square and degrees of freedom . The model exhibited a low convergent validity (AVE = .32). The reliability was adequate (CR = .82 α = .82). The refined model showed strong invariance in two independent samples . A weak stability was obtained between patients undergoing chemotherapy and radiotherapy , and between patients undergoing chemotherapy combined with radiotherapy and palliative care .Participants included 1,140 cancer patients with a mean age of 53.95 (SD = 13.25) years; 61.3% were women. After the CFA of the original CASQ structure, 2 items with inadequate factor weights were removed. Four correlations between errors were included to provide adequate fit to the sample (χThe Portuguese version of the CASQ had good face and construct validity and reliability. However, the CASQ still presented invariance in independent samples of Brazilian patients with cancer. However, the tool has low convergent validity and weak invariance in samples with different treatments. Cancer patients may report changes in appetite . These cBoth the loss of appetite and the weight loss are common and troubling characteristics related to cancer patients, especially to patients with cancer in advanced stages, patients refractory to treatment, or patients without treatment options . QuintenAfter evaluating 3,047 cancer patients, Dewys et al. –10.It should be emphasized that appetite can be affected either by the disease, or by the treatment, which can cause symptoms such as nausea, vomiting, constipation, and changes in taste or pain –13.Given the importance that appetite has on the response to several treatments  and on tConsidering that appetite is a latent condition, i.e., not directly measurable, it is necessary to evaluate the psychometric properties of data gathered with this instrument before using it, by assessing its validity and reliability. Only then the data can be used with confidence ensuring the validity of the results and conclusions reached with that data , 19.Cancer Appetite and Symptom Questionnaire (CASQ). The CASQ is a one-factor instrument comprising 12 items that allow responses on a five-point Likert scale. The CASQ was proposed in English, for the UK population, and so far does not have versions in any other language. The CASQ was adapted from the Council on Nutrition Appetite Questionnaire (CNAQ) , 3519, 3Thus, this paper presents the results of a tool for assessment of appetite and symptoms in cancer patients, with adequate psychometric properties, and with an individualized proposal for calculating the final score. This may contribute to a more accurate diagnosis and, thus, a more resolute clinical management strategy.The Portuguese version of the CASQ presented good face and construct validity, and reliability. However, the CASQ still presented invariance in two independent samples of Brazilian patients with cancer. It has low convergent validity and weak invariance in samples with different treatments.S1 Appendix(DOCX)Click here for additional data file.S1 Dataset(SAV)Click here for additional data file.


Aim. This study aims to determine the knowledge level of the female primary healthcare workers about breast cancer and to reveal their attitude and behaviors about breast self-examination and mammography. Methods. This cross-sectional study was conducted on female primary healthcare workers who work in family health centres. 91% (n = 369) of female primary healthcare workers agreed to participate in the study. The questionnaire consisted of three parts: sociodemographic characteristics, knowledge about breast self-examination, and actual practice of breast self-examination. Results. The mean (SD) age of the female primary healthcare workers was 33.1 ± 6.8 . The healthcare workers who practiced breast self-examination had significantly higher knowledge level (P = 0.001) than those who had not. The respondents had high knowledge level of breast self-examination; however, the knowledge level of breast cancer and mammography screen was low. Conclusions. While the female primary healthcare workers in this study had adequate knowledge of breast self-examination, this is not reflected in their attitudes and practices. Emphasis should be laid on breast self-examination in undergraduate and postgraduate courses for primary healthcare workers, since they are mostly involved in patient education. Today, cancer is one of the most serious diseases threatening human life, and therefore global burnout is gradually growing . Breast Early detection plays a crucial role for BC. Breast self-examination (BSE), mammography, and clinical breast examination are screening methods, which are used to detect early BC. Special attention should be paid to BSE to enhance the possibility of early detection of change in breast tissue. Although BSE alone is not sufficient for early detection of BC, it allows women to be responsible for their own health, to recognize breast tissue, and to adopt preventive health behavior , 7. DespAlthough the efficiency of BSE is still unclear, BSE is an important screening practice and a simple, economical, and noninvasive screening method for early detection of BC . It appeThis study aims to determine the knowledge level of the female PHW about BC, a commonly seen and treatable cancer, and to reveal their attitude and behaviors about BSE and mammography.n = 369) of female PHW agreed to participate and the survey was carried out between 15 and 30 January 2015.This descriptive, cross-sectional study was conducted among female PHW who work in family health centres  in Diyarbakır, Turkey. The population of Diyarbakır was 1,635,048 in 2014. There were 428 family health clinics in the city and 407 female HW had been working at the time. We intended to reach the entire sample; thus we contacted these female HW via e-mails and telephones after receiving ethical approval from local health authority of Diyarbakır. Potential participants were informed about the aims of the study and they were asked if they would like to volunteer for participation. They were also informed that they could withdraw from the study at any time and that all information would be kept strictly confidential. The online questionnaire form was sent to all of the female PHW, and an immediate response was requested. 91% . The scores were examined by means of the test of Kolmogorov Smirnov, and the test of homogeneity was done. As a result of this examination, no normal distribution was observed. Therefore, Mann-Whitney P > 0.05). The other sociodemographic parameters are showed at P = 0.026); however, there is no significant difference between the doctors' and the others' knowledge level of BSE practice (P > 0.05) (r = 0.144 (P = 0.005). The attitudes and practices of female PHW in BSE according to their levels of knowledge are showed in P = 0.001) than those who had not. In addition, the participants who practice BSE at the right time (after menstruation) had significantly higher level of knowledge (P = 0.001) than those who practice it at the wrong time (n = 22) and cyst or lump was detected in 31.8% (n = 7) of them. The mean (SD) age of the female PHW was 33.1 ± 6.8 . The variables including age, level of education, personal history of breast problems, and family history of BC are not found to be significant in BSE practice ( > 0.05) . There iong time . The perBSE is an option for women starting in their 20s. Women should be informed about the benefits and limitations of BSE. Doing BSE regularly is one way for women to know how their breasts normally look and feel and to notice any changes. The goal, with or without BSE, is to report any breast-related changes to a doctor or nurse right away. At the same time, women should remember that these breast changes may not be an indicative of cancer most of the time .n = 101). Similarly, Akpinar et al. [The results of this study showed that 92.6% of the HW performed BSE, but the percentage of those who performed regular BSE was rather low  than those who did not (In the present study, the HW who practiced BSE had significantly knowledge level ( did not . This reThe results of this study indicate that although PHW performed BSE and had adequate knowledge, they did not perform BSE regularly and neither the knowledge level of BC nor their knowledge and attitudes about screening mammography were adequate. While the female PHW in this study had adequate knowledge of BSE, this is not reflected in their attitudes and practices. The HW, especially PHW, are role models for other people in society through their health protective behavior. The knowledge level and attitude of HW are important factors in the control of BC. It is obvious that health will improve in a society in which HW play an active role in health education.Emphasis should be laid on BSE in undergraduate and postgraduate courses for PHW, as they are mostly involved in patient education. Also, provision of BSE educational programs is necessary for all HW to increase their knowledge, attitude, behavior, performance, and teaching of BSE. Increasing the related knowledge and application success among HW will certainly affect the women in their service area. Therefore, continuous education and in-service education for HW should be planned to improve their knowledge and experience for BSE. The results in this study also reveal that additional studies are needed to investigate the relation between BC and the mammography application among the Turkish female HW. Further research is recommended to use a larger sample size of female PHW and may include attitudes, behaviors, knowledge about BC screening methods, early detection, and implementing preventive care.


The imbalance between testosterone (T) and cortisol (C) levels has been proposed as a possible marker of risk for intimate partner violence (IPV). Moreover, it could be related to a high probability of adopting risky behaviors such as alcohol abuse which, in turn, promotes the onset of IPV. This study tested the potential mediating effect of alcohol consumption on the relationship between baseline T/C ratio and anger expression in IPV perpetrators and non-violent controls. Alcohol consumption was higher in the former than controls. A high baseline T/C ratio was only associated with high anger expression in IPV perpetrators, and this association was mediated by high alcohol consumption. Thus, alcohol abuse may act as a catalytic factor in this relationship, high consumption promoting the onset of IPV. These findings contribute to the development of effective treatment and prevention programs, which could introduce the use of biological markers for preventing the onset, development and recidivism of IPV. An imbalance between testosterone (T) and cortisol (C) levels has been proposed as a marker of propensity to violence . Indeed,Comparing violent with non-violent social drinkers, the former were found to have higher T levels , and T lOn the other hand, imprisoned violent men after at least 24 hours of abstinence presented lower baseline C than unimprisoned violent men . In addiSeveral studies have analyzed the psychological profile of the IPV perpetrators and most used a psychological approach, with little interest in biological variables and their influence in the onset and perpetuation of this kind of violence . To addret al. [The final sample was composed of 37 healthy male volunteers: 16 IPV perpetrators and 21 control volunteers. The IPV perpetrators were recruited from the participants in the CONTEXTO psycho-educational and community-based treatment program  at the Department of Social Psychology, University of Valencia. They had been sentenced to less than two years in prison and had no previous criminal record, and therefore received a suspended sentence subject to the condition that they attend this type of intervention program . The expState-Trait Anger Expression Inventory-2 (STAXI-2), Alcohol Use Disorders Identification Test (AUDIT) and Millon Clinical Multiaxial Inventory-III (MCMI-III) alcohol dependence subscale. Finally, after this session, they completed a brief task appraisal questionnaire. Perceived stress and satisfaction were assessed using two items, and ranked on a 10-point Likert scale from 0 (low stress and dissatisfied) to 10 (high stress and satisfied). For further information see Romero-Martínez et al. [Each subject participated in three sessions in the psychobiology laboratories of the University of Valencia. In the first sessions, participants were interviewed to exclude any individuals with organic diseases. The second sessions all took place between 4:00 and 7:00 p.m. After arriving at the laboratory, participants were taken to a room where they signed informed consent forms and anthropometric data (height and weight) were obtained. Moreover, participants were informed that this study did not affect their criminal report or their status in the therapeutic group. Two saliva samples were collected (for assessing T levels and C levels). Finally, in the last session, participants completed the z et al. ,14.STAXI-2 [Anger expression was measured by an adapted version  of the SSTAXI-2 . This tevs. lifetime), and it seems to have broader applicability in that it identifies hazardous and harmful drinkers  rather than just those who are alcohol dependent [To assess alcohol consumption, the Spanish version of the AUDIT  was usedependent . The CroIn addition, the Alcohol Dependence scale of the MCMI-III  was usedet al. [Saliva was directly collected from the mouth using Salivette devices for C  and sterile glass tubes for T samples. In all cases, participants were informed about the need to follow the instructions for saliva sampling to obtain meaningful data and samples were collected in the same order, C then T, and frozen at –20 °C until analysis. Salivary T levels were assessed by chemiluminescence immunoassays using testosterone saliva ELISA kits (Diagnostics Biochem Canada) and salivary C levels by radioimmunoassay using Coat-A-Count cortisol kits . For more details see Romero-Martínez et al. ,14.t-tests with Levene’s test for equality of variances were used to check for significant differences in age, BMI (Body mass index), impulsivity and baseline T/C ratio levels between groups (IPV and controls).After confirming the normality of the data using the Kolmogorov—Smirnov test, To test the hypothesis that alcohol abuse mediates the relationship between baseline T/C ratio and their AEI, we conducted mediation analyses, including Preacher and Hayes’  procedurp ≤ 0.05 was considered significant. Average values are expressed as mean ± SEM.Data analyses were performed using SPSS 21.0 (SPSS IBM) and 2, respectively), or AEI . Moreover, there was no significant difference between groups in baseline T/C ratio . On the other hand, groups differed in AUDIT  and MCMI-III  scores, with IPV perpetrators obtaining higher scores for alcohol consumption than controls. Furthermore, IPV perpetrators reported to have similar appraisal scores than controls in satisfaction , but they perceived the TSST as less stressful than controls , being this difference significant .IPV perpetrators did not differ significantly from controls in age , BMI , as were the direct effects of alcohol abuse (AUDIT) and of baseline T/C ratio on their AEI . In addition, when accounting for the effect of sensitivity to alcohol abuse (AUDIT), the effect of baseline T/C ratio on AEI reduced to nonsignificance . Results of the bootstrap analysis indicate that mediation was present . Thus, it can be concluded that the association between baseline T/C ratio and AEI in IPV perpetrators was mediated by their high alcohol abuse, in terms of the AUDIT scores. The statistical power for the analysis was 0.96.First, considering alcohol abuse as indicated by AUDIT scores (displayed in p = 0.001), as were the direct effects of alcohol abuse (MCMI-III) on AEI  and of baseline T/C ratio on AEI . Likewise, when accounting for the effect of sensitivity to alcohol abuse (MCMI-III), the effect of baseline T/C ratio on their AEI reduced to nonsignificance . Results of the bootstrap analysis indicate that mediation was present . Thus, as with the AUDIT scores, the association between baseline T/C ratio and AEI in IPV perpetrators was mediated by their high alcohol consumption (MCMI-III). The statistical power for the analysis was 0.99.Second, considering alcohol abuse as reflected by MCMI-III scores shown in b, the sip = 0.651), alcohol abuse assessed by the AUDIT  and with the MCMI-III . Moreover, the AUDIT and the MCMI-III scores were unrelated with the AEI .All analyses were also carried out for controls, and there were no significant associations between T/C ratio with the AEI . There were, however, no differences between groups in the baseline T/C ratio levels. The observed power for the regression models was high (which ranged from 0.97 to 0.99), given the observed probability level, the number of predictors, the observed RIt is important to elucidate the role of alcohol in IPV due to the fact that a high percentage of IPV perpetrators assault their partners under its effects and/or have alcohol dependence ,22,23. OA limitation of our study is the cross-sectional and non-experimental design which does not allow causality to be addressed. Additionally, the lack of information about the IPV perpetrators’ current severity of alcohol dependence  limit the external validity of our findings. Moreover, it should be noted known that the STAXI-2 tends to asses anger expression in general (including IPV). Hence, it should be convenient employ instruments, which specifically measure the IPV perpetration. For this reason, future work should include replicating these findings considering the nature of the alcohol consumption and two additional groups of men with no history of IPV, one of consumers and another of non-consumers of alcohol.In conclusion, our study reveals that alcohol abuse mediates the positive relationship between baseline T/C ratio and anger expression in IPV perpetrators, but not in controls. Hence, the present data offer a wider explanation of IPV improving our understanding of the interactions of imbalances in HPG and HPA axes in IPV perpetrators with anger expression. Alcohol abuse may act as a catalytic factor in this relationship as high consumption promotes the onset of IPV. Due to the limited results obtained in psychotherapeutic programs developed for this population, it is worthwhile exploring a different approach based on biopsychosocial models that include psychobiological variables such as hormonal, immunological, psychophysiological and neuropsychological parameters. This wider perspective would contribute to the development of effective treatment and prevention programs based on the creation of better IPV perpetrators criminal profiles than the present profiles based exclusively on psychological variables. However, further confirmatory studies are needed.


Vision loss and blindness are among the top 10 disabilities in the United States, causing substantial social, economic, and psychological effects, including increased morbidity, increased mortality, and decreased quality of life.Data from the 2009–2013 ACS were used to obtain county-level estimates of SVL and poverty level among adults aged ≥18 years and to examine the geographic pattern of SVL and its association with poverty. ACS, conducted by the U.S. Census Bureau, is an ongoing survey sent to approximately 250,000 addresses monthly, providing annual and multiyear estimates of demographic, housing, social and economic characteristics to communities.The ACS county-level estimates of SVL and poverty level from the combined 2009–2013 surveys were used in this analysis.The prevalence of SVL among adults aged ≥18 years ranged from <1% to 18.4%, with a median of 3.1%. More than three quarters (77.3%) of the U.S. counties in the top quartile of SVL prevalence were located in the South, followed by 11.7% in the West, 10.7% in the Midwest, and 0.3% in the Northeast . The proVision loss often affects activities of daily living, leads to depression and social isolation, and increases the risk for falls and injuries. An estimated 4 million persons aged ≥40 years in the United States are either blind or have vision loss  and this number is projected to increase to 10 million by 2050.This report describes the geographic distribution of SVL across all U.S. counties. Using ACS 5-year county estimates, this analysis found 2.6% of adults aged ≥18 years reported SVL. Prevalence varied by county, ranging from <1% to 18.4%, and counties with high SVL were concentrated in southern states. The data show the county level correlation of SVL and poverty, indicating that counties with higher levels of poverty had higher levels of SVL. These findings are consistent with U.S. Census reports of lower earnings and higher poverty rates among persons with disabilities.¶¶A report on vision loss and work disability from the Institute of Medicine suggests that SVL can result in lower economic earnings . PreviouThe findings in this report are subject to at least three limitations. First, data regarding SVL are self-reported and subject to recall bias or social desirability bias, which might cause persons to claim that their vision is better than it is. Second, data are cross-sectional and do not allow conclusions on causality or biologic plausibility. However, these results are consistent with previous studies finding a correlation between poverty and vision loss. Vision loss could be a consequence of poverty . Alternatively, persons with SVL often have limited access to education and employment opportunities, which might in turn decrease their earning potential. Finally, the data represent crude estimates of SVL prevalence and the correlation between SVL and poverty, without accounting for other individual and county-level characteristics, such as race/ethnicity, age, and prevalence of related diseases.The results of this study suggest geographic disparity in SVL, with the South disproportionately bearing a higher prevalence of SVL and poverty. Counties with high prevalence of SVL tended to be those with high poverty levels. Further investigations are needed to better understand the socio-demographic disparities of vision loss, how to minimize risk factors associated with vision loss, and how to improve access and use of eye care services. To reduce risks for vision loss, counties with high rates of SVL can promote healthy eating, maintaining a healthy weight, not smoking, understanding one’s family eye health history, using proper eye-safety practices, and routine eye examinations.What is already known on this topic?Healthy People 2020 national health objectives. There are limited vision loss data and research at local levels.Vision loss often affects activities of daily living, leads to depression and social isolation, and increases the risk for falls and injuries. The U.S. government, in conjunction with the vision health communities, identified access to eye care services and the reduction of disparities in vision loss and as public health priorities in the What is added by this report?Distinct geographic patterns of severe vision loss prevalence were found at the county-level in the United States. The findings indicate a significant correlation between severe vision loss and poverty for U.S. counties. The highest prevalence of severe vision loss and poverty were found in the southern states.What are the implications for public health practice?To reduce risks for vision loss, counties with high rates of severe vision loss can promote healthy eating, maintaining a healthy weight, not smoking, understanding one’s family eye health history, using proper eye-safety practices, and routine eye examinations.