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To test the hypothesis that the low socioeconomic population living is shanty towns in Porto Alegre presents different levels of poverty which are reflected on its health status, a cross-sectional study was designed involving 477 families living in Vila Grande Cruzeiro, Porto Alegre, Brazil. The poverty level of the families was measured by using an instrument specifically designed for poor urban populations. Children from families living in extreme poverty (poorest quartile) were found to have higher infant mortality rate, lower birth weights, more hospitalizations, and higher malnutrition rates, in addition to belonging to more numerous families. Thus, the shanty town population of Porto Alegre is not homogeneous, and priority should be given to the more vulnerable subgroups.

Background: Unaddressed age-related hearing loss is highly prevalent among older adults, typified by negative consequences for speech-in-noise perception and psychosocial wellbeing. There is promising evidence that group singing may enhance speech-in-noise perception and psychosocial wellbeing. However, there is a lack of robust evidence, primarily due to the literature being based on small sample sizes, single site studies, and a lack of randomized controlled trials. Hence, to address these concerns, this SingWell Project study utilizes an appropriately powered sample size, multisite, randomized controlled trial approach, with a robust preplanned statistical analysis., Objective: To explore if group singing may improve speech-in-noise perception and psychosocial wellbeing for older adults with unaddressed hearing loss., Methods: We designed an international, multisite, randomized controlled trial to explore the benefits of group singing for adults aged 60 years and older with unaddressed hearing loss (registered at clinicaltrials.gov, ID: NCT06580847). After undergoing an eligibility screening process and completing an information and consent form, we intend to recruit 210 participants that will be randomly assigned to either group singing or an audiobook club (control group) intervention for a training period of 12-weeks. The study has multiple timepoints for testing, that are broadly categorized as macro (i.e., pre- and post-measures across the 12-weeks), or micro timepoints (i.e., pre- and post-measures across a weekly training session). Macro measures include behavioural measures of speech and music perception, and psychosocial questionnaires. Micro measures include psychosocial questionnaires and heart-rate variability., Hypotheses: We hypothesize that group singing may be effective at improving speech perception and psychosocial outcomes for adults aged 60 years and older with unaddressed hearing loss-more so than participants in the control group., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Musicians create sound that is enjoyable to themselves and their audience, but this same sound also threatens their hearing health due to high sound pressure levels generated by their own and their fellow musicians' instruments. Here we seek to identify musicians' hearing health awareness in relation to their coping strategies. 370 professional and 401 amateur musicians in total responded to a questionnaire on hearing health, which included quantitative elements and open-ended questions. Findings reveal that musicians are generally aware of hearing health risks but also indicate a lack of discussion on that topic. However, inasmuch as respondents consider hearing protection as necessary, they articulate justified concerns about its potential impact on quality of performance and musical communication. In sum, musicians show literacy regarding their hearing health, but more guidance and training is needed to ensure effective protective measures., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To investigate the association of musical activity with mental health during the COVID-19 pandemic., Methods: A total of 3,666 participants reported their musical activity before and mental health indicators before and during the pandemic. Depression was assessed with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder scale. The association between mental health scores and musical activities was investigated using linear regression., Results: Within the last 12 months, 22.1% of the participants reported musical activity (15.1% singing, 14.5% playing an instrument). Individuals with frequent singing as their main musical activity had higher scores before the pandemic than non-musicians and the worsening during the pandemic was more pronounced compared to non-musicians. Instrumentalists tended to have slightly lower scores than non-musicians indicating a possible beneficial effect of playing an instrument on mental health., Conclusion: The pandemic led to a worsening of mental health, with singers being particularly affected. Singers showed poorer mental health before the pandemic. The tendency for instrumentalists to report lower depression scores compared to non-musicians may support the hypothesis that music-making has a beneficial effect on health., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Becher, Krist, Menzel, Fernholz, Keil, Kreutz, Schmidt, Streit, Willich and Weikert.)

Musical activities (MA) such as singing, playing instruments, and listening to music may be associated with health benefits. However, evidence from epidemiological studies is still limited. This study aims at describing the relation between MA and both sociodemographic and health-related factors in a cross-sectional approach. A total of 6717 adults (50.3% women, 49.7% men, median age: 51 years (IQR 43-60) were recruited from the study center Berlin-Mitte of the German National Cohort (NAKO), a population-based prospective study. This study is based on a sample randomly selected from the population registry of Berlin, Germany, aged 20 to 69 years. 53% of the participants had been musically active at least once in their life (56.1% women, 43.9% men). Playing keyboard instruments (30%) and singing (21%) were the most frequent MA. Participants listened to music in median 90 min per day (IQR 30.0-150.0). Musically active individuals were more likely to have a higher education, higher alcohol consumption, were less likely to be physically active, and had a lower BMI compared to musically inactive individuals. This large population-based study offers a comprehensive description of demographic, health, and lifestyle characteristics associated with MA. Our findings may aid in assessing long-term health consequences of MA., (© 2024. The Author(s).)

Previous works have suggested a high prevalence of painkiller intake (PI) among sport students but also improved health literacy (HL) for sports-active students than for sports-inactive students. Since health-related content also forms part of the sport science curriculum, the study focuses on these seemingly paradoxical results. Music students who are also physically active through their instrumental practice, who act in an area with increased PI and who have no health-related teaching content in their curriculum composed the comparison group. Therefore, this study investigated the prevalence of PI and HL in cohorts of sport (n = 222; 54.5% female) and music students (n = 89; 67.4% female) using a cross-sectional online survey in Lower Saxony, Germany. The hypothesis tests were validated by calculating frequentist and Bayesian statistics. The results show that 50.9% of sport and 28.1% of music students exhibit PI concerning their study programs, often for prophylactical purposes and in the presence of low HL levels. The weak negative correlation between PI and HL was not statistically confirmed and requires further research with improved test power. Regarding the possible health consequences of an inconsiderate PI, target group-specific prevention is indicated to increase general health awareness and HL., (© 2024. The Author(s).)

Hearing health, a cornerstone for musical performance and appreciation, often stands at odds with the unique acoustical challenges that musicians face. Utilizing a cross-sectional design, this survey-based study presents an in-depth examination of self-rated hearing health and its contributing factors in 370 professional and 401 amateur musicians recruited from German-speaking orchestras. To probe the nuanced differences between these groups, a balanced subsample of 200 professionals and 200 amateurs was curated, matched based on age, gender, and instrument family. The findings revealed that two-thirds of respondents reported hearing-related issues, prevalent in both professional and amateur musicians and affecting music-related activities as well as social interactions. The comparative analysis indicates that professionals experienced nearly four times more lifetime music noise exposure compared to amateurs and faced more hearing challenges in social contexts, but not in musical settings. Professionals exhibited greater awareness about hearing health and were more proactive in using hearing protection devices compared to their amateur counterparts. Notably, only 9% of professional musicians' playing hours and a mere 1% of amateurs' playing hours were fully protected. However, with respect to their attitudes toward hearing aids, professional musicians exhibited a noticeable aversion. In general, an increase in music-related problems (alongside hearing difficulties in daily life) was associated with a decrease in mental health-related quality of life. This research highlights the importance of proactive hearing health measures among both professional and amateur musicians and underscores the need for targeted interventions that address musicians' specific hearing health challenges and stigmatization concerns about hearing aids.

Objective: Previous research suggests differential effects of participant-selected (PS) vs. researcher-selected (RS) music on emotional responses to music listening. This study investigates whether such selection strategies, as well as gender, influence (1) stress and (2) mood responses. Additionally, we examine the role of (3) stimulus-induced emotions and (4) emotion regulation strategies., Methods: Participants (N = 61) listened to auditory stimuli (PS music, RS music, sound of lapping water (LW); randomized) on three days and underwent a cold pressor test (CPT) while listening. Stress parameters (subjective acute stress, heart rate, parameter RMSSD, salivary alpha-amylase, salivary cortisol), mood dimensions (calmness, valence, energetic arousal), emotions, and emotion regulation strategies were measured. Multilevel and mediation analyses were conducted., Results: (1) There were no direct effects of selection strategy or gender on stress responses, but interaction effects indicated that women showed the strongest subjective stress response and the longest HR recovery with PS music, while men showed the lowest HR response to the CPT with PS music. (2) No mood differences emerged between PS and RS music overall. Women showed stronger variability in calmness overall as well as perceived higher arousal when listening to PS music compared to men. (3) Higher stimulus-induced anger in men compared to women and with LW compared to PS was associated with lower calmness and valence, while no consistent pattern emerged for the stress responses. (4) Women scored higher on reappraisal, associated with a decrease in parasympathetic activity, whereas men scored higher on suppression, associated with an increase in endocrine activity., Conclusions: Music selection and gender appear to have no direct impact on stress and mood responses overall, although men tend to benefit more from self-selected music than women. Our findings provide first indications that avoiding music stimuli that induce anger may facilitate mood management via music. Furthermore, finding alternative emotion regulation strategies to the strategy of suppression may be a helpful approach to improve music-based stress management., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Empirical research of community-based music interventions has advanced to investigate the individual, social, and educational implications of arts-for-wellbeing practices. Here, we present the motivations, aims, hypotheses, and implications of this complex field of inquiry. We describe examples of recent large-scale investigations to reflect on the major methodological challenges. Community-based music interventions strike a balance between the empirical rigor of clinical trials and the demands of ecological validity. We argue that this balance should be viewed as an asset rather than a mere pragmatic compromise. We also offer some perspectives on best-practice models for effectively engaging in this type of work., (© 2022 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.)

Background: Various music interventions can evoke favorable behavioral responses or physiological reactions in people with disorders of consciousness (DOC), such as coma, unresponsive wakefulness syndrome (UWS), and minimally conscious state (MCS). However, it appears that no study thus far has investigated the effects of music on the endocrine system of people with DOC., Objective: This explorative study aimed to investigate the effects of biographical music and biographical language on the physiological and endocrine systems of people with UWS and MCS., Method: A cohort of 20 people with DOC (10 women, 10 men; age range 19-77) received 20 min of biographical music and biographical language. Before and afterward, they were exposed to silence. Physiological and hormonal measurements were conducted before, during, and after the interventions., Results: Paired t -tests showed a significant decrease of salivary cortisol in the condition with biographical language interventions., Conclusion: Biographical interventions can modulate reactions in the endocrine system in people with DOC. Further studies are needed to establish whether and how individuals living with DOC show psychoneuroendocrine responses to music and other arts-based interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Grimm, Groß, Nater, Summ and Kreutz.)

Recently, a large cluster-randomized controlled trial was designed-Music Interventions for Dementia and Depression in ELderly care (MIDDEL)-to assess the effectiveness of music interventions on depression in care home residents with dementia (ClinicalTrials.gov NCT03496675). To understand the pathophysiological mechanisms, we observed the effect of repeated music interventions on stress in this population since chronic stress was associated with depression and an increased risk for dementia. An exploratory study was designed to assess: (1) changes in hair cortisol concentrations as an indicator of longer-term stress; (2) whether baseline stress is a predictor of therapy outcome; (3) pre- and post-treatment effects on salivary α-amylase and cortisol response as an indicator of immediate stress in 180-200 care home residents with dementia and depressive symptoms who partake in the MIDDEL trial. Insights into mediatory effects of stress to explain the effect of music interventions will be gained. Hair cortisol concentrations were assessed at baseline and at 3, 6, and 12 months along with the Perceived Stress Scale. Salivary α-amylase and cortisol concentrations were assessed at 1, 3, and 6 months. Saliva was collected just before a session and 15 and 60 min after a session, along with a stress Visual Analogue Scale.

Infants show remarkable skills for processing music in the first year of life. Such skills are believed to foster social and communicative development, yet little is known about how infants' own preferences for music develop and whether social information plays a role. Here, we investigate whether the reactions of another person influence infants' responses to music. Specifically, 12-month-olds (N = 33) saw an actor react positively or negatively after listening to clips of instrumental music. Arousal (measured via pupil dilation) and attention (measured via looking time) were assessed when infants later heard the clips without the actor visible. Results showed greater pupil dilation when listening to music clips that had previously been reacted to negatively than those that had been reacted to positively (Exp. 1). This effect was not replicated when a similar, rather than identical, clip from the piece of music was used in the test phase (Exp. 2, N = 35 12-month-olds). There were no effects of the actor's positive or negative reaction on looking time. Together, our findings suggest that infants are sensitive to others' positive and negative reactions not only for concrete objects, such as food or toys, but also for more abstract stimuli including music., (© 2021 The Authors. Infancy published by Wiley Periodicals LLC on behalf of International Congress of Infant Studies.)

Learning to play a musical instrument is associated with different, partially conflicting emotions. This paper describes the development and psychometric properties of the Emotions while Learning an Instrument Scale (ELIS). In a longitudinal study with 545 German elementary school children factorial structure and psychometric properties were evaluated. Exploratory and confirmatory factor analyses confirmed a two-factor solution measuring Positive musical Emotions while Learning an Instrument (PELI) and Negative Emotions while Learning an Instrument (NELI). Both subscales yielded scores with adequate internal reliability (Cronbach's α = .74, .86) and relatively stable retest reliabilities over 18 months (r = .11 -.56). Preliminary evidence of congruent and divergent validity of the subscales is provided. Implications for future research of musical emotional experiences in children are discussed., Competing Interests: The authors have declared that no competing interests exist.

Background: There is only a limited number of studies on associations between musical activity and health issues. It seems that musical activity has physiological and psychological benefits, as well as effects on the mental capacity, but this has been studied only in a few clinical and epidemiological studies. One reason might be that no appropriate survey instrument assessing musical activity is available., Aim of the Study: Here we provide an overview of survey instruments that assess musicality and musical activity. One focus is the presentation of a newly developed German questionnaire (MusA), which assesses musical activity (active music making and music reception) and was specifically developed for the "German National Cohort", a German health study., Method: Through literature research, questionnaires were identified that assess musicality and / or musical activity. A new German questionnaire was developed from a panel of experts and tested in a small study (n=121, women and men age 18-70 years)., Results: In the literature research, 3 questionnaires were identified which focus on musicality and musical activity with different aspects (Gold-MSI, MUSE, MEQ). All 3 instruments may be characterized as large psychometric scales, which especially assess aspects of musicality in the English language. The Gold-MSI is additionally available in German. None of the existing questionnaires covers musical activities in detail. A new short German questionnaire consisting of 9 questions with a maximum filling time of 3-5 min has been developed., Conclusion: There are few questionnaires available for assessing musicality and musical activity with different aspects. The newly developed MusA in the German language focuses on the assessment of musical activity and is intended to be used in larger, population-based as well as clinical studies, to examine music activities and listening to music as independent factors in connection with prevention and therapy of chronic diseases., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Auditory stimulation training (AST) has been proposed as a potential treatment for children with specific language impairments (SLI). The current study was designed to test this assumption by using an AST with technically modulated musical material (ASTM) in a randomized control group design. A total of 101 preschool children (62 male, 39 females; mean age = 4.52 years, SD = 0.62) with deficits in speech comprehension and poor working memory capacity were randomly allocated into one of two treatment groups or a control group. Children in the ASTM group ( n = 40) received three 30-min sessions per week over 12 weeks, whereas children in the comparison group received pedagogical activities during these intervals ( n = 24). Children in the control group ( n = 37) received no treatment. Working memory, phoneme discrimination and speech perception skills were tested prior to (baseline) and after treatment. Children in the ASTM group showed significantly greater working memory capacity, speech perception, and phoneme discrimination skills after treatment, whereas children in the other groups did not show such improvement. Taken together, these results suggest that ASTM can enhance auditory cognitive performance in children with SLI.

Introduction: In older adults, dementia and depression are associated with individual distress and high societal costs. Music interventions such as group music therapy (GMT) and recreational choir singing (RCS) have shown promising effects, but their comparative effectiveness across clinical subgroups is unknown. This trial aims to determine effectiveness of GMT, RCS and their combination for care home residents and to examine heterogeneity of treatment effects across subgroups., Methods and Analysis: This large, pragmatic, multinational cluster-randomised controlled trial with a 2×2 factorial design will compare the effects of GMT, RCS, both or neither, for care home residents aged 65 years or older with dementia and depressive symptoms. We will randomise 100 care home units with ≥1000 residents in total across eight countries. Each intervention will be offered for 6 months (3 months 2 times/week followed by 3 months 1 time/week), with extension allowed if locally available. The primary outcome will be the change in the Montgomery-Åsberg Depression Rating Scale score at 6 months. Secondary outcomes will include depressive symptoms, cognitive functioning, neuropsychiatric symptoms, psychotropic drug use, caregiver burden, quality of life, mortality and costs over at least 12 months. The study has 90% power to detect main effects and is also powered to determine interaction effects with gender, severity and socioeconomic status., Ethics and Dissemination: Ethical approval has been obtained for one country and will be obtained for all countries. Results will be presented at national and international conferences and published in scientific journals., Trial Registration Numbers: NCT03496675; Pre-results, ACTRN12618000156280., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

There is growing evidence that singing can have a positive effect on language learning, but few studies have explored its benefit for children who have recently migrated to a new country. In the present study, recently migrated children ( N = 35) received three 40-min sessions where all students learnt the lyrics of two songs designed to simulate language learning through alternating teaching modalities (singing and speaking). Children improved their language knowledge significantly including on tasks targeting the transfer of grammatical skills, an area largely neglected in previous studies. This improvement was sustainable over the retention interval. However, the two teaching modalities did not show differential effects on cued recall of song lyrics indicating that singing and speaking are equally effective when used in combination with one another. Taken together, the data suggest that singing may be useful as an additional teaching strategy, irrespective of initial language proficiency, warranting more research on songs as a supplement for grammar instruction.

[This corrects the article DOI: 10.3389/fnbeh.2018.00153.].

Previous studies have suggested that there are complex psychobiological effects of amateur choral singing on well-being. Here, we investigate the influences of singing vs. non-singing on psychological and biological measurements, reflecting current positive and negative affect, perceived social connectedness, and physiological stress. We hypothesized that active singing leads to significant increases in these measurements compared to participating without singing. Amateur choristers (Exp. 1: N = 54, age range 18-85 years and Exp. 2: N = 49, age range 18-85 years) were tested in two experiments in which approximately half of the group was asked not to sing over periods of 30 (Exp. 1) and 60 min (Exp. 2), while the other half of the group sang. Dependent measures included scales for positive and negative affect and perceived social connectedness. In addition, saliva samples were collected to assess cortisol and alpha-amylase. The results revealed that singing activity had positive influences on affect measurements. However, significant increases in perceived social connectedness for singing were found only in Exp. 2. Biomarker changes were not significant across the experiments. Together, our findings suggest that both singing activity and duration of singing modulate psychological effects, with perceived social connectedness evolving over larger time spans than 30 min. Findings support the notion of beneficial psychological effects also for individuals, who report lower levels of general social support. The unexpected absence of biological effects warrants further investigation.

Background: Kreutz et al. (2008) developed the Music-Empathizing-Music-Systemizing (ME-MS) Inventory to extend Baron-Cohen's cognitive style theory to the domain of music. We sought to confirm the ME-MS construct in a German sample and to explore these individual differences in relation to music preferences. Methods: The German adaptation of the MEMS Inventory was achieved by forward and backward translation. A total of 1014 participants (532 male, age: 33.79 ± 11.89 years) completed the 18-item short version of the MEMS Inventory online. Confirmatory factor analysis (CFA) was performed and cut-off values were established to identify individuals who could be classified as ME, Balanced, or MS. Statistical analyses were used to examine differences in music preference based on music-related cognitive styles. Results: Confirmatory factor analysis (CFA) confirmed two factors, ME and MS, with sufficiently good fit (CFI = 0.87; GFI = 0.93) and adequate internal consistency (Cronbach's Alpha ME: 0.753, MS: 0.783). Analyses of difference scores allowed for a classification as either ME, Balanced, or MS. ME and MS differed in sociodemographic variables, preferred music genres, preferred reasons for music listening, musical expertise, situations in which music is listened to in daily life, and frequency of music-induced chills. Discussion: The German short version of the MEMS Inventory shows good psychometric properties. Based on the cut-off values, differences in music preference were found. Consequently, ME and MS use music in different ways, and the cognitive style of music listening thus appears to be an important moderator in research on the psychology of music. Future research should identify behavioral and neurophysiological correlates and investigate mechanisms underlying music processing based on these different cognitive styles of music listening.

Background: Music listening is wide-spread in amateur sports. Ergometer exercise is one such activity which is often performed with loud music. Aim and Hypotheses: We investigated the effects of electronic music at different intensity levels on ergometer performance (physical performance, force on the pedal, pedaling frequency), perceived fatigue and heart rate in healthy adults. We assumed that higher sound intensity levels are associated with greater ergometer performance and less perceived effort, particularly for untrained individuals. Methods: Groups of high trained and low trained healthy males ( N = 40; age = 25.25 years; SD = 3.89 years) were tested individually on an ergometer while electronic dance music was played at 0, 65, 75, and 85 dB. Participants assessed their music experience during the experiment. Results: Majorities of participants rated the music as not too loud (65%), motivating (77.50%), appropriate for this sports exercise (90%), and having the right tempo (67.50%). Participants noticed changes in the acoustical environment with increasing intensity levels, but no further effects on any of the physical or other subjective measures were found for neither of the groups. Therefore, the main hypothesis must be rejected. Discussion: These findings suggest that high loudness levels do not positively influence ergometer performance. The high acceptance of loud music and perceived appropriateness could be based on erroneous beliefs or stereotypes. Reasons for the widespread use of loud music in fitness sports needs further investigation. Reducing loudness during fitness exercise may not compromise physical performance or perceived effort.

Objectives: The effects of music interventions including active and receptive music therapy for people living with neurogenic disorders of consciousness (DOC) have been subject to empirical studies in the past. The aim of this systematic review was to find and analyse the current research about the effects of musical interventions on people with DOC., Methods: For this purpose, studies with music interventions and patients with DOC from the year 1900 to 2017 were searched in English, German, and French in different databases. Risk-of-bias-analyses were conducted for each study that fulfilled the inclusion criteria., Results: Twenty-two quantitative studies (three randomised controlled trials with more than 10 participants) were found eligible for review. They include a total of 329 participants living with either coma, unresponsive wakefulness syndrome, or minimally conscious state. Music interventions were associated with favourable behavioural and physiological responses in several studies, but methodological quality and outcomes were heterogeneous., Conclusions: More studies with a larger number of participants are needed as well as a consensus on key characteristics of effective short-term and long-term music interventions for DOC.

Every individual has a preferred musical tempo, which peaks slightly above 120 beats per minute and is subject to interindividual variation. The preferred tempo is believed to be associated with rhythmic body movements as well as motor cortex activity. However, a long-standing question is whether preferred tempo is determined biologically. To uncover the neural correlates of preferred tempo, we first determined an individual's preferred tempo using a multistep procedure. Subsequently, we correlated the preferred tempo with a general EEG timing parameter as well as perceptual and motor EEG correlates-namely, individual alpha frequency, auditory evoked gamma band response, and motor beta activity. Results showed a significant relation between preferred tempo and the frequency of motor beta activity. These findings suggest that individual tempo preferences result from neural activity in the motor cortex, explaining the interindividual variation., (Copyright © 2014 Society for Psychophysiological Research.)

Background: Hearing disorders have been associated with occupational exposure to music. Musicians may benefit from non-amplified and low-intensity music, but may also have high risks of music-induced hearing loss., Aims: To compare the incidence of hearing loss (HL) and its subentities in professional musicians with that in the general population., Methods: We performed a historical cohort study among insurants between 19 and 66 years who were employed subject to social insurance contributions. The study was conducted with data from three German statutory health insurance providers covering the years 2004-2008 with about 7 million insurants. Incidence rates with 95% CIs of HL and the subentities noise-induced hearing loss (NIHL), conductive HL, sensorineural HL, conductive and sensorineural HL, as well as tinnitus were estimated stratified by age, sex and federal state. A Cox regression analysis was conducted to estimate adjusted HRs and two-sided 95% CIs for HL and its subentities., Results: More than 3 million insurants were eligible, of whom 2227 were identified as professional musicians (0.07%). During the 4-year observation period, 283,697 cases of HL were seen, 238 of them among professional musicians (0.08%), leading to an unadjusted incidence rate ratio of 1.27. The adjusted hazard ratio of musicians was 1.45 (95% CI 1.28 to 1.65) for HL and 3.61 (95% CI 1.81 to 7.20) for NIHL., Conclusions: Professional musicians have a high risk of contracting hearing disorders. Use of already available prevention measures should reduce the incidence of HL in professional musicians., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

This study examined the effects of a school-based instrumental training program on the development of verbal and visual memory skills in primary school children. Participants either took part in a music program with weekly 45 min sessions of instrumental lessons in small groups at school, or they received extended natural science training. A third group of children did not receive additional training. Each child completed verbal and visual memory tests three times over a period of 18 months. Significant Group by Time interactions were found in the measures of verbal memory. Children in the music group showed greater improvements than children in the control groups after controlling for children's socio-economic background, age, and IQ. No differences between groups were found in the visual memory tests. These findings are consistent with and extend previous research by suggesting that children receiving music training may benefit from improvements in their verbal memory skills.

Objectives: The aim of this study was to describe the long-term occupational consequences of asthma in males of the ESTEV study, a French longitudinal cohort of working subjects aged 37-52 at inclusion., Methods: Medical data, self-perceived health status, sick leave, occupational social class and employment characteristics were recorded twice by occupational physicians in 1990 (12,233 subjects) and 1995 (10,608 subjects). Asthma was characterized as to its onset (childhood, i.e., before age 20 vs. adult) and to its past versus current status by the physician., Results: Of the 398 asthmatics, the onset was before age 20 for 226 and the asthma status was classified as current for 159 subjects. Unemployment was not higher before baseline or during follow-up, in asthmatics as compared to non-asthmatics, despite a significantly higher prevalence of sick leave in the previous year among current asthmatics (38.4% vs. 27.0%, P = 0.005). Being a blue collar worker in 1990 is negatively related to childhood asthma but not to the current asthma status. In 1995, current adult-onset asthmatics had stopped working due to disability more frequently than never-asthmatics., Conclusion: Our findings suggest that the major consequence of asthma on employment status is a selective exclusion, observed in childhood asthmatics at the beginning of their working life and in current adult-onset asthmatics at the end of their working life. Past unemployment was shown not to be higher in working asthmatics., ((c) 2008 Wiley-Liss, Inc.)

Aims: Cultural activities, including music, singing and dance, have often been conceptualised as enhancing well-being as well as promoting mental and physical health. This paper focuses on partnered dance in the context of 'cultures of fitness'. Its purpose was to investigate the dancers of tango Argentino, and to explore potential health benefits in this group., Methods: Participants (N=110) completed a self-developed inventory, which was, in part, based on interviews and observations as a participant observer. The inventory addresses educational, musical, and socio-economic background, motivation for and investment in dancing tango, and other leisure activities., Results: Dancers are characterized by high-level education and socio-economic status. Motivation appears to be predominantly driven by both hedonistic and social factors, accounting altogether for nearly 60% of the variance. The majority of individuals started dancing tango only in their 30s. Physical investment in terms of time and money indicate tango dancing as a highly important activity that seems to involve substantial opportunity of moderate physical exercise, social interaction and emotional reward. In consequence, tango dance was identified as the primary leisure activity., Conclusions: Tango dancers were identified as highly educated individuals, who are dedicated to the practice in many respects, including physical and emotional. They draw from similar motivations as compared to participants of other musical activities such as singing and listening to music. Notably, aspects of physical fitness are more prominent in this group. The intensity with which tango is practised seems to depend to some degree on individual lifestyles. Taken together, the results suggest a high degree of personal involvement in tango dance as a primary leisure activity. Implications of partnered dance for social, emotional, and physical well-being and health promotion demand further research.

Objectives: The Group for the Respect and Excellence in Science (GREES) has reviewed and updated their recommendations for clinical trials to evaluate the efficacy and safety of new chemical entities to be used in the treatment and prevention of glucocorticoid-induced osteoporosis (GIOP)., Methods: Consensus discussion of the committee., Results: With the exception of steroid use posttransplantation, there is no need to differentiate between underlying diseases. Prevention and treatment for GIOP are dependent on exposure to glucocorticoids rather than T-scores as in postmenopausal osteoporosis (PMO). If fracture data are obtained for PMO, it need not be repeated for GIOP, relying instead on bone mineral density (BMD) trials of at least 1 year. GREES recommends several changes in the previous guidance for GIOP. The committee saw no need to repeat preclinical studies if those have been previously done to assure bone quality in PMO. Similarly, phase I and phase II trials, if careful dose selection has been done for PMO, should not be repeated. The "prevention" and "treatment" claims should remain. Since the most recent evidence suggests significant increase in fracture risk for daily doses of prednisone of 5 mg/day or equivalent, clinical trials should concentrate on patients receiving at least this daily dosage. The emergence of bisphosphonates as the reference treatment, together with the rapid bone loss and high fracture incidence in glucocorticoid users, necessitates recommending a noninferiority trial design with lumbar spine BMD as the primary endpoint after 1 year., Conclusions: Registration of new chemical entities to be used in the management of GIOP should be granted, based on a 1-year noninferiority trial, using BMD as primary outcome and alendronate or risedronate as comparator. Demonstration of antifracture efficacy should have been previously demonstrated in PMO.

The present study investigates the effects of choir music on secretory immunoglobulin A (S-IgA), cortisol, and emotional states in members of a mixed amateur choir. Subjects participated in two conditions during two rehearsals 1 week apart, namely singing versus listening to choral music. Saliva samples and subjective measures of affect were taken both before each session and 60 min later. Repeated measure analyses of variance were conducted for positive and negative affect scores, S-IgA, and cortisol. Results indicate several significant effects. In particular, singing leads to increases in positive affect and S-IgA, while negative affect is reduced. Listening to choral music leads to an increase in negative affect, and decreases in levels of cortisol. These results suggest that choir singing positively influences both emotional affect and immune competence. The observation that subjective and physiological responses differed between listening and singing conditions invites further investigation of task factors.

Background: Recent innovations in the pharmaceutical drug discovery environment have generated new chemical entities with the potential to become disease modifying drugs for osteoarthritis (DMOAD's). Regulatory agencies acknowledge that such compounds may be granted a DMOAD indication, providing they demonstrate that they can slow down disease progression; progression would be calibrated by a surrogate for structural change, by measuring joint space narrowing (JSN) on plain X-rays with the caveat that this delayed JSN translate into a clinical benefit for the patient. Recently, new technology has been developed to detect a structural change of the OA joint earlier than conventional X-rays., Objective: The Group for the Respect of Ethics and Excellence in Science (GREES) organized a working party to assess whether these new technologies may be used as surrogates to plain x-rays for assessment of DMOADs., Methods: GREES includes academic scientists, members of regulatory authorities and representatives from the pharmaceutical industry. After an extensive search of the international literature, from 1980 to 2002, two experts meetings were organized to prepare a resource document for regulatory authorities. This document includes recommendations for a possible update of guidelines for the registration of new chemical entities in osteoarthritis., Results: Magnetic resonance imaging (MRI) is now used to measure parameters of cartilage morphology and integrity in OA patients. While some data are encouraging, correlation between short-term changes in cartilage structure observed with MRI and long-term radiographic or clinical changes are needed. Hence, the GREES suggests that MRI maybe used as an outcome in phase II studies, but that further data is needed before accepting MRI as a primary end-point in phase III clinical trials. Biochemical markers of bone and cartilage remodelling are being tested to predict OA and measure disease progression. Recently published data are promising but validation as surrogate end-points for OA disease progression requires additional study. The GREES suggests that biochemical markers remain limited to 'proof of concept' studies or as secondary end-points in phase II and III clinical trials. However, the GREES emphasizes the importance of acquiring additional information on biochemical markers in order to help better understand the mode of action of drugs to be used in OA. Regulatory agencies consider that evidence of improvement in clinical outcomes is critical for approval of DMOAD. Time to total joint replacement surgery is probably the most relevant clinical end-point for the evaluation of efficacy of a DMOAD. However, at this time, time to surgery can not be used in clinical trials because of bias by non disease-related factors like patient willingness for surgery or economic factors. At this stage, it appears that DMOAD should demonstrate a significant difference compared to placebo. Benefit should be measured by 3 co-primary end-points: JSN, pain and function. Secondary end-points should include the percentage of patients who are 'responder' (or 'failure'). The definition of a 'failure' patient would be someone with progression of JSN>0.5mm over a period of 2-3 years or who has a significant worsening in pain and/or function, based on validated cut-off values. The definition of the clinically relevant cut-off points for pain and function must be based on data evaluating the natural history of the disease (epidemiological cohorts or placebo groups from long-term studies). These cut-offs points should reflect a high propensity, for an individual patient, to later require joint replacement., Conclusion: GREES has outlined a set of guidelines for the development of a DMOAD for OA. Although these guidelines are subject to change as new information becomes available, the information above is based on the present knowledge in the field with the addition of expert opinion.

Study Objective: Stress is an emergent occupational problem in modern societies. Among workers, medical practitioners are particularly exposed. However, data objectifying stress levels during work time are scarce. The aim of this study was to establish diurnal salivary cortisol levels in a highly stressful work environment, the medical dispatch center of an emergency care unit., Methods: Eight emergency medical dispatchers agreed to be sampled every 2 hours from 9 AM to 7 PM during a usual day of work. Eight matched control subjects sampled during their leisure time were used as a control group., Results: Whatever the time of the day, emergency medical dispatchers showed significantly increased cortisol levels during their work time compared with levels found in the control group. There was a significant difference in the amount of daytime cortisol secretion between control subjects and emergency medical dispatchers (0.345 nmol/L; 95% confidence interval [CI] 0.04 to 0.93 nmol/L), with a mean daytime augmentation of 22.8% in emergency medical dispatchers compared with that in control subjects. In addition, among emergency medical dispatchers, the subjective perception of emotional stress was positively correlated with total cortisol concentrations per day (r =0.78; 95% CI 0.39 to 1)., Conclusion: Our data show that work tasks of emergency medical dispatchers led to a hypersecretion of cortisol. Because the damaging effects of persistent cortisol increases on health and cognitive functions are well recognized in human beings, it seems necessary to rapidly identify stressful work situations and targets for organizational improvements to minimize stress in these situations.

A revised version of the Declaration of Helsinki, issued in October, 2000, remains a vital expression of medical ethics, and deserves unanimous support. A strict interpretation of the declaration seems to rule out clinical trials that use a placebo control group whenever licensed therapeutic methods already exist, preferring active controls. Although the efficacy of some new medicines can be satisfactorily established without the use of a placebo, for others the judicious use of placebo remains essential to establish their effectiveness.

Pulmonary rehabilitation traditionally benefits COPD patients through physical training, optimization of medical treatment, education and nutritional advice. In this paper we introduce psychomotricity which provides these with a more global approach to pulmonary rehabilitation. This approach takles postural tone, mobility, anxiety and self-confidence in order to improuve control of breathing and perception of breathlessness. Consequently handicap is reduced and its adverse effects are curbed. Psychomotricity, through corporeal techniques and relaxation, complements the other components of pulmonary rehabilitation. We report on our experience with ninety patients. All the assessments were carried out before and after the program. This study showed significant improvement in many outcomes including psychomotricity assessments, quality-of-life questionnaire scores and visual analogue scales. Psychomotricity, when incorporated into a multi-disciplinary rehabilitation program, appears to help patients regain self-confidence and use their capacities in a better way. This technique gives patients better control over their handicap and allows them to face the future with more dignity.

The effect of repeated plasma exchanges on the steady state kinetics of digoxin (3 patients) and digitoxin (4 patients) was investigated in 7 patients. Plasma exchange was performed 3 times a week for 4 weeks up to 12 exchanges using a hollow fiber membrane. In each exchange, 4000 ml plasma were filtered within 1 to 2 h and replaced by an albumin containing (20 g/l) physiological electrolyte solution. Digoxin and digitoxin concentrations in blood and filtered plasma were measured by radioimmunoassay. The effects due to the amount eliminated by plasma exchange were distinguished from the effects due to hypoalbuminemia. The eliminative effect was confined to the plasma compartment. It resulted in a marginal decrease in the elimination half-life from 1.6 to 1.59 days for digoxin and 4.3 to 4.2 days for digitoxin. Theoretically, it can be calculated that the hypoalbuminemia caused an increase in the volume of distribution from 451 to 497 l (digoxin) and 35 to 50 l (digitoxin) and a further decrease in the elimination half-life from 4.2 to 4.1 days in the case of digitoxin (not digoxin). If given within 2 h prior to plasma exchange, 13 to 50% of the digitoxin dose (not digoxin) was eliminated. Alteration of digoxin and digitoxin dosage during repeated plasma exchanges is not recommended, but drugs should be given after, not before plasma exchange.

From the examinations may be concluded that the cellular immune response to the unspecific DNCB skin test correlates quite well with the survival time. With the quantification of the test reaction in after-testings comparisons may be rendered, so that by this means already pretty early conclusion may be made on the further course of the disease. For a definitive judgment, however, the numbers of cases got up to now are still too small.

The indication for digitalis treatment was investigated in a controlled and prospective study lasting 12 months in 110 patients on long-term haemodialysis. In ten patients, digitalis was needed because of tachyarrhythmia due to atrial fibrillation and in five because of recurrent pulmonary edema. In 57 patients receiving digitoxin, therapy was discontinued for 4 to 6 weeks, whereas 13 patients not yet treated with digitalis, received digitoxin for 4 weeks. Without digitoxin, trial fibrillation occurred in 4 patients, while no patient experienced atrial fibrillation with digitoxin (P = 0.002). In 13 patients, radiological findings (heart enlargement, pulmonary congestion) were better with digitoxin than without. Thus digitoxin appeared to be clearly indicated in 29% of the haemodialysed patients. Additionally, digitalis was indicated in 31 patients because of heart enlargement, pulmonary congestion and (or) previous pulmonary edema. Initially, 76% of the patients were receiving digitoxin, whereas, after the investigation, the rate was only 57% (P less than 0.001). The prospective frequency of clinically apparent digitoxin intoxication was low (3%) and so were the overall toxic plasma digitoxin levels (5%). Digitalis should be given deliberately but not restrictively to haemodialysis patients, since atrial fibrillation (13%) and heart failure (50%) are frequent and often concealed.