Using Mendelian randomization to evaluate the causal relationship between serum C-reactive protein levels and age-related macular degeneration

Serum C-reactive protein (CRP), an important inflammatory marker, has been associated with age-related macular degeneration (AMD) in observational studies; however, the findings are inconsistent. It remains unclear whether the association between circulating CRP levels and AMD is causal. We used two-sample Mendelian randomization (MR) to evaluate the potential causal relationship between serum CRP levels and AMD risk. We derived genetic instruments for serum CRP levels in 418,642 participants of European ancestry from UK Biobank, and then conducted a genome-wide association study for 12,711 advanced AMD cases and 14,590 controls of European descent from the International AMD Genomics Consortium. Genetic variants which predicted elevated serum CRP levels were associated with advanced AMD (odds ratio [OR] for per standard deviation increase in serum CRP levels: 1.31, 95% confidence interval [CI]: 1.19–1.44, P = 5.2 × 10−8). The OR for the increase in advanced AMD risk when moving from low (< 3 mg/L) to high (> 3 mg/L) CRP levels is 1.29 (95% CI: 1.17–1.41). Our results were unchanged in sensitivity analyses using MR models which make different modelling assumptions. Our findings were broadly similar across the different forms of AMD (intermediate AMD, choroidal neovascularization, and geographic atrophy). We used multivariable MR to adjust for the effects of other potential AMD risk factors including smoking, body mass index, blood pressure and cholesterol; this did not alter our findings. Our study provides strong genetic evidence that higher circulating CRP levels lead to increases in risk for all forms of AMD. These findings highlight the potential utility for using circulating CRP as a biomarker in future trials aimed at modulating AMD risk via systemic therapies.     

Mode of Action and Growth Toxicity of Arsenic to Tilapia Oreochromis mossambicus Can Be Determined Bioenergetically

We present a bioenergetics-based approach to analyze the chronic effects and growth toxicity mode of action in tilapia Oreochromis mossambicus exposed to waterborne As and to predict fish growth under different exposure scenarios. 7-day exposure bioassays showed that tilapia accumulate As when exposed to waterborne As. We conducted growth bioassays to assess chronic As toxicity to tilapia. We incorporated a universal ontogenetic growth model with the DEB_tox theory to explore the mode of action of As toxicity. Our results show that the specific growth rates of exposed tilapia are inversely proportional to As concentrations and are calculated as 0.76% d⁻¹ in 0 μg mL⁻¹, 0.57% d⁻¹ in 1 μg mL⁻¹, 0.2 % d⁻¹ in 2 μg mL⁻¹, and 0.04% d^–1 in 4 μg mL⁻¹ As, respectively. We showed that the internal threshold concentration did not change significantly with time, demonstrating that the critical body residue approach is applicable for As toxicity assessment. We distinguished between three modes of action of As, including direct effects on growth and indirect effects by way of maintenance and food consumption. Our results support that decreased feeding accounts for the growth decrease in the case of feeding ad libitum. The feeding decrease model also illustrates the growth trajectories of tilapia during the entire whole life span, suggesting that the maximum biomass of tilapia are 1038.75 g in uncontaminated water and 872.97 g in 1 μg mL⁻¹, 403.06 g in 2 μg mL⁻¹, and 336.65 g in 4 μg mL⁻¹ As, respectively. We suggest that considering modes of action in ecotoxicology not only improves our understanding of the toxicities of chemicals, it is also useful in setting up models and avoiding pitfalls in species- and site-specific environmental risk assessment. This proposed framework for tilapia gives preliminary information relevant to aquacultural and ecologic management.     

Progress in the science of probiotics: from cellular microbiology and applied immunology to clinical nutrition

Summary Background Bioavailability of fat–soluble vitamins from conventional oral supplements is insufficient in some conditions in which fat digestion and absorption are chronically impaired (e. g. cystic fibrosis). Aim of the study We used a water–soluble form of fatsoluble vitamin E (AQUANOVA^? solubilisate) to create a nutritional supplement (NS) in the form of vitaminized gummi bears (with micellised water–soluble α–tocopheryl acetate (100 IU) and 400 mg crystalline vitamin C). We assessed the bioavailability of the NS in comparison to conventional preparations. Methods The trial consisted of three study days (d0: NS sucked; d10: NS swallowed; d20: reference products swallowed). A total of 14 subjects (6 male/8 female), aged 25.3 (22.7–35.3) years, BMI 24.3 (19.0–31.7) kg/m² participated in the study. They had blood samples drawn after fasting for ≥12 hours and then 1, 5, 15, 30, 60, 120, 180, 240, 300 and 320 minutes after ingesting the vitamins. HPLC and a colorimetric method were used to determine vitamin E and vitamin C, respectively. Areas under the curve (AUC_0–320min) and maximum increases in plasma concentrations (Δ concentration) were calculated to assess bioavailability. Results The AUCs_0–320min of α–tocopherol from d0 were significantly larger (p = 0.016) when compared to d20. Moreover, the maximum increase in α–tocopherol plasma concentrations was significantly higher for d0 (p = 0.023) and d10 (p = 0.002) when compared to d20. Conclusions Short–term bioavailability of AQUANOVA^? micellised fat–soluble vitamin E from our NS was significantly higher than from regular supplements. The NS will now be tested for its clinical efficacy in a randomized double–blind controlled intervention trial with CF patients.     

Trends in research related to “Shinrin-yoku” (taking in the forest atmosphere or forest bathing) in Japan

“Shinrin-yoku”, which can be defined as “taking in the forest atmosphere or forest bathing”, has been receiving increasing attention in Japan in recent years for its capacity to provide relaxation and reduce stress. Since 2004, the authors of this paper have been involved in an investigation designed to ascertain the physiological effects of “Shinrin-yoku” within the framework of the “Therapeutic Effects of Forests” project. We have conducted physiological experiments, both in actual forests and in the laboratory, to elucidate the physiological effects on individuals of exposure to the total environment of forests or to only certain elements of this environment, such as the odor of wood, the sound of running stream water, and the scenery of the forest. We have obtained physiological measurements of central nervous activity, autonomic nervous activity, and biomarkers reflecting stress response that can be applied in this line of approach. Using these measurements, we have summarized the separate elements of forests in terms of the five senses. We have also reviewed a selection of field studies and introduced a number of results from ongoing projects as well as those from early studies. Future perspectives are also discussed.     

Applying logics of change to the evaluation of community development in health promotion

Evaluation of community-oriented health promotion programs requirethat professional evaluators clearly distinguish between exogenouslyand endogenously defined goals and definitions of ‘success’.Acknowledging the different dynamics which underpin community-ledchange and externally initiated health programs and interventionsis essential to this task. It will be argued that the intersectionof, and boundaries around, exogenous and endogenous change canbest be understood and clarified through the application of‘logics of rationality’, adapted from social theory.Community activity is characterised by what we have called ‘lifeworldrationality’ community-based health promotion interventionsare characterised by ‘formal ratonality’. In addition,we suggest that the value dimensions (‘substantive rationality’)underpinning programs and interventions may be overlooked bypolicy makers, program planners and professional evaluatorsunder pressure to demonstrate cost-effectiveness and efficiency.Key requirements for successful and appropriate evaluation ofcommunity-based programs which are sensitive to the needs andsuccess criteria of communities include a shared understandingby the researchers, program sponsors and community actors ofthe nature of the changes sought. The co-production of healthpromotion standards and of indicators to judge the performanceof the program or intervention by all stakeholders should bepreferred over the trend for establishing community-controlledprocess evaluations to coexist alongside expert-controlled impactevaluations. It is argued that current approaches to standardsetting and indicator development to judge the processes andimpacts of interventions are inadequate and several principlesfor improving their content are given. A locally controlledethnographic approach to evaluate endogenous community-led changeis described in the hope that program planners and evaluatorsmay become more sensitive and receptive to local knowledge.We suggest that engagement with what we have termed the ‘communitystory’ should be a fundamental requirement for the planningand evaluation of community health programs.     

Population-Based Assessment of the Risk of Primary Cesarean Delivery Due to Excess Prepregnancy Weight Among Nulliparous Women Delivering Term Infants

Objective: To estimate the risk of cesarean delivery due to excess prepregnancy body mass index (BMI) in a multistate, US population-based sample. Methods: We analyzed data from the population-based Pregnancy Risk Assessment Monitoring System (PRAMS) on 24,423 nulliparous women with single, term infants delivered between 1998 and 2000 in 19 states. We calculated BMI from self-reported weight and height. We assessed interactions between prepregnancy BMI and other risk factors. We estimated weighted relative risks and 95% confidence intervals for the association between prepregnancy BMI and cesarean section from multiple logistic regression models adjusting for demographic and medical risk factors from the PRAMS questionnaire or birth certificates. Results: The incidence of cesarean delivery increased with increased prepregnancy BMI, from 14.3% (0.8 standard error (SE)) for lean women (BMI < 19.8) to 42.6% (2.0 SE) for very obese women (BMI ≥ 35). The risk of cesarean section differed by presence of any medical, labor and/or delivery complication. Among women with any complication, the estimated adjusted RR for cesarean delivery was 1.1 (95% confidence interval (CI) 1.0–1.2) among overweight women, 1.3 (95% CI 1.1–1.4) among obese women, and 1.4 (95% CI 1.2–1.6) among very obese women compared with normal weight women. Among women without any complications, the estimated adjusted RR was 1.4 (95% CI 1.0–1.8) among overweight women, 1.5 (95% CI 1.1–2.1) among obese women, and 3.1 (95% CI 2.3–4.8) among very obese women. Conclusion: Excess prepregnancy weight increases the risk of cesarean delivery among nulliparous women giving birth to single, term infants, especially among very obese women without any complications.     

Behavior and lifestyle factors related to quality of life in junior high school students

Objectives To analyze actual conditions of the quality of life (QOL) in junior high school students, we developed a questionnaire based on the PRECEDE-PROCEED model, and we conducted a survey by using this questionnaire. Methods We conducted a workshop organized with 29 specialists on school health and community health to develop the questionnaire. The QOL outcome was assessed by the QOL Profile-Adolescent Version (QOLPAV). The subjects of the questionnaire surveys were 1600 general students in four junior high schools. To investigate a correlation between QOLPAV, behaviors and three enhancing factors, two different multiple regression models were constructed. Results The question battery for QOLPAV was found to be a high value of Chronbach’s α. Among present subjects, 16.5% were categorized as “problematic” or “very problematic” classified by QOLPAV scores. In the first multiple regression model, significantly high odds ratios were obtained between the QOLPAV and 4 questions for behaviors, such as “studying with high motivation” (OR 1.64), “getting along well with my friends” (2.72), “having things I am interested in” (1.70), and “making my own decisions” (1.80). In the second model, significantly high odds ratios were obtained commonly between the above 4 questions about behaviors and 2 questions on enabling factors, such as “easy to understand lessons” (1.32–1.71) and “speaking to friends easily” (1.30–3.22). Conclusions 1) We developed a questionnaire to analyze the actual condition of QOL in junior high school students with sufficient validity and availability. 2) Among the present subjects, 16.5% were found to be problematic QOLPAV, 3) Among the factors of behaviors, those representing positive willing and high coping ability with the elements of each school life contributed significantly to the QOLPAV. And among enhancing factors, “enabling factors” and “reinforcing factors” were stronger contributors to the behaviors strongly related to the QOLPAV than that of “predisposing factors”.     

Willingness to pay for a reduction in mortality risk after a myocardial infarction: an application of the contingent valuation method to the case of eplerenone

In order to allocate health care resources more efficiently, it is necessary to relate health improvements provided by new medicines to their cost. It is necessary to ascertain when the additional cost of introducing a new health technology is justified by the additional health gain produced. Eplerenone is a new medicine that reduces the risk of death after myocardial infarction (MI) but produces additional cost to the health system. The contingent valuation approach can be used to measure the monetary value of this risk reduction and to estimate society’s willingness to pay (WTP) for a new medicine that reduces the risk of death after MI by 2% points. We used a contingent valuation approach to evaluate WTP amongst members of the general population. We used the ex-ante and the ex-post approach. In the ex-ante approach, subjects are asked if they would accept an increase in their taxes in order to have access to eplerenone should they need it in the future. In the ex-post approach, subjects are asked if they would pay a certain amount of money as co-payment per month during 5 years if they suffered an MI. We used the dichotomous choice method, using five bids in each approach. The WTP was estimated using both single-bound and double-bound dichotomous choice (SBDC, DBDC). Extensive piloting (n = 187) preceded the final survey (n = 350). The WTP in the ex-ante case was €58 per year under both SBDC and DBDC. In the ex-post case, monthly WTP was €141 for the SBDC and €85 for the DBDC. Subjects with higher income and subjects with a higher perception of risk showed a higher WTP (P < 0.05). Society is willing to pay an additional amount of money in order to give eplerenone to present and future patients. We estimate that €85 per month is a conservative estimate of the monetary value of a 2% risk reduction in mortality after MI and to spend this additional amount of money in Eplerenone can be considered an efficient policy.     

How to reveal disguised paternalism

In a Swedish setting physicians are unlikely to give explicitly paternalistic reasons when asked about their attitudes towards patients’ involvement in decision-making. There is considerable risk that they will disguise their paternalism by giving ‘socially correct answers’. We suggest that disguised paternalism can be revealed with the help of indexes based on certain responses in postal questionnaires. The indexes were developed using material from a study examining attitudes of Swedish physicians to physician-assisted suicide (PAS). Apart from being asked about their attitudes, they were asked to prioritise between different arguments for and against PAS. One argument for PAS was: “PAS should be permitted out of respect for patients’ autonomy”. One argument against PAS was: “PAS should not be permitted since the non-maleficence principle in this case takes precedence over respecting patients’ autonomy”. Responses to the latter argument formed the cornerstone of a disguised-paternalism index, while an autonomy index was based on answers to the former argument. Applying our indexes to data from the PAS survey, we found that female GPs, surgeons, and older male physicians were least paternalistic. Among female physicians one finds both the most autonomy-respecting groups (female surgeons and GPs) and the least autonomy-respecting groups (female oncologists and psychiatrists); together with older male physicians in general, female GPs are the group displaying least disguised paternalism. We suggest that questionnaires exploring paternalism might be improved by including case-specific questions or statements by which to explore disguised paternalism. Here our indexes might be useful tools.     

Blood benzene concentrations in workers exposed to oxygenated fuel in Fairbanks,Alaska

 Objective: In November 1992 residents of Fairbanks, Alaska became concerned about the potential health effects of an oxygenated fuel program during which 15% (by volume) methyl tertiary butyl ether (MTBE) was added to gasoline. To address those concerns, we earlier completed a survey of occupational exposure to MTBE. We conducted a follow-up survey of workers’ exposure to benzene from gasoline in Fairbanks. Design: Cross-sectional exposure survey. Methods: We examined blood concentrations of benzene from a convenience sample of workers taken in December 1992 during the oxygenated fuel program and from another convenience sample of workers taken in February 1993 after the program was suspended. Results: In December, the median blood benzene concentration of samples taken from four mechanics after their workshift (postshift) was 1.32  μg/l (range, 0.84–2.61 μg/l), and seven nonmechanics (drivers and other garage workers) had a median postshift blood benzene concentration of 0.27 μg/l (range, 0.09– 0.45 μg/l). In February, nine mechanics had a median postshift blood benzene concentration of 1.99 μg/l (range, 0.92–3.23 μg/l), and nine nonmechanics had a median postshift blood benzene concentration of 0.26 μg/l (range, 0.2–0.46 μg/l). Conclusion: Mechanics had higher blood benzene concentrations than did nonmechanics, but further study is needed to determine the impact of the oxygenated fuel program on exposure to benzene. Received: 6 November 1995/Accepted: 2 April 1996     

Occupational exposure to sevoflurane during sedation of adult patients

Objectives: In a field study we evaluated the workplace pollution occurring during conscious sedation with sevoflurane in adults. Methods: Sevoflurane was given in 100% oxygen at a fresh gas flow rate of 3 l/min via a nasal mask. This was conducted in 25 patients scheduled for surgical procedures performed under regional anesthesia. Trace concentrations of sevoflurane were directly measured every minute in the breathing zone by means of a photoacoustic infrared spectrometer in an operating room with an air turnover of 20 changes/h. Results: The mean sedation time was 49.6 ± 20.4 min. The average vaporizer setting of the anesthesia machine was 1.63 ± 0.6 vol%, resulting in a patient's mean end-tidal sevoflurane concentration of 0.78 ± 0.2 vol%. The 8-h time-weighted average was calculated to be 0.58 ppm sevoflurane. Conclusions: The trace gas concentrations were low and comparable with values obtained under inhalation induction in adults and children. Although no occupational standard for sevoflurane is currently defined, the measured values are clearly under the standards recommended for enflurane (20 ppm) and isoflurane (10 ppm) by the European health authorities. We conclude that the new anesthesiologic method of conscious sedation with sevoflurane in adults using a nasal mask would not result in a violation of occupational standards, provided that the future value set for sevoflurane would be similar to those recommended for isoflurane or enflurane. Received: 3 August 1998 / Accepted: 14 November 1998     

The relative contributions of race/ethnicity, socioeconomic status, health, and social relationships to life satisfaction in the United States

Purpose  To evaluate racial/ethnic disparities in life satisfaction and the relative contributions of socioeconomic status (SES; education, income, employment status, wealth), health, and social relationships (social ties, emotional support) to well-being within and across racial/ethnic groups. Methods  In two cross-sectional, representative samples of U.S. adults (the 2001 National Health Interview Survey and the 2007 Behavioral Risk Factor Surveillance System; combined n > 350,000), we compared life satisfaction across Whites, Hispanics, and Blacks. We also evaluated the extent to which SES, health, and social relationships ‘explained’ racial/ethnic group differences and compared the magnitude of variation explained by life satisfaction determinants across and within these groups. Results  Relative to Whites, both Blacks and Hispanics were less likely to be very satisfied. Blacks were somewhat more likely to report being dissatisfied. These differences were reduced or eliminated with adjustment for SES, health, and social relationships. Together, SES and health explained 12–15% of the variation in life satisfaction, whereas social relationships explained an additional 10–12% of the variance. Conclusions  Racial/ethnic life satisfaction disparities exist for Blacks and Hispanics, and these differences are largest when comparing those reporting being ‘satisfied’ to ‘very satisfied’ versus ‘dissatisfied’ to ‘satisfied.’ SES, health, and social relationships were consistently associated with life satisfaction, with emotional support having the strongest association with life satisfaction.     

Using State Lead Poisoning Surveillance System Data to Assess False Positive Results of Capillary Testing

Objective: The purpose of this study was to determine the false positive percentage of capillary blood lead screening in a statewide surveillance system and to explore potential predictors of false positive results. Methods: Data were all blood lead tests of 0–5 year old children in Maine during 2002–2003. We determined the proportion of children with elevated (≥10 μg/dL) capillary test results who received a venous confirmatory test, and calculated the percentage of false positive tests, defined as a capillary test of ≥10 μg/dL with a confirmatory venous test of <10 μg/dL. Multivariable binomial regression was used to determine whether capillary blood lead level and length of time between capillary and venous tests predicted false positive results, after controlling for potential confounders. We also examined the positive bias of the capillary test among both false positive and true positive results. Results: Seventy-three percent of elevated capillary screening tests (2.2 percent of all capillary screening tests) were false positives. False positive results were less likely for capillary levels of 15–19 μg/dL (RR=0.78; 95% CI 0.5–0.92) and 20 μg/dL or above (RR=0.83; 95% CI 0.71–0.96) compared to 10–14 μg/dL. The percentage of false positives did not vary by interval between screening and confirmatory tests. The capillary test exhibited a positive bias compared to the venous test, even among true positive results. Conclusions: False positive results may have been caused by sample contamination, rather than laboratory error or true variation in blood lead level between screening and confirmatory tests. Capillary screening could be improved by training in proper sample collection methods.     

Carnosic acid reduces cytokine-induced adhesion molecules expression and monocyte adhesion to endothelial cells

Background  Expression of cell adhesion molecules on the endothelium and the attachment of monocytes to endothelium may play a major role in the early atherogenic process. Aim of the study  We investigated the effects of carnosic acid on the adhesion of U937 cells to IL-1β-treated human umbilical vein endothelial cells (HUVECs), as well as on the expression of adhesion molecules. Results  Our data showed that pretreatment with 10 and 20 μmol/l carnosic acid significantly reduced the number of U937 cells adhering to IL-1β-treated HUVECs. In addition, we found that 20 μmol/l carnosic was more effective than 10 μmol/l carnosic acid at inhibiting expression of cell adhesion molecules (ICAM-1, VCAM-1, and E-selectin), the nuclear translocation of NF-κB subunits p65 and p50, and the production of ROS in IL-1β-stimulated HUVECs. Conclusions  We conclude that carnosic acid inhibits IL-1β-induced ICAM-1, VCAM-1 and E-selectin expression in HUVECs through a mechanism that involves NFκB. We propose that the reduction in binding of human monocytic cell line U937 to IL-1β-treated HUVECs is due to the anti-inflammatory properties of carnosic acid.     

Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students

Examining the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students. This cross-sectional study was conducted among 240 university students (mean age 21.5 years; 86.7% female). Mental health was evaluated using validated Persian versions of the 12-item general health questionnaire (GHQ-12) and the 21-item depression, anxiety, and stress scale (DASS-21). The lower the subjects’ scores on these questionnaires, the better their mental health. Usual past-year dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. The DASH score was computed based on energy-adjusted intakes of eight major dietary components emphasized or minimized in the DASH pattern. The higher the DASH score of a subject, the greater his/her adherence to the DASH pattern. The Pearson’s correlation coefficients of DASH score with GHQ-12 total score, DASS-21 total score, and DASS-21 depression, anxiety, and stress subscale scores were − 0.431, − 0.441, − 0.434, − 0.325, and − 0.408, respectively (all P < 0.001). Compared to those in the lowest tertile, subjects in the highest tertile of DASH score had lower means of GHQ-12 total score (mean difference − 4.6; P < 0.001), DASS-21 total score (mean difference − 9.1; P < 0.001), and DASS-21 depression, anxiety, and stress subscale scores (mean differences for depression, anxiety, and stress − 3.6, − 2.4, and − 3.2, respectively; all P < 0.001). The findings indicate that greater adherence to the DASH dietary pattern is associated with better mental health in Iranian university students. However, prospective studies of sufficient methodological quality are needed to confirm these findings.     

PAM Fluorometry in the Determination of the Sensitivity of Chlorella vulgaris, Selenastrum capricornutum, and Chlamydomonas reinhardtii to Copper

The pulse-amplitude-modulation (PAM) fluorometric method was used in the past as a sensitive and rapid method for assessing toxic effect of pollutants in plants. Here, we used the advantages of this method to evaluate the difference in sensitivity of Chlorella vulgaris, Selenastrum capricornutum, and Chlamydomonas reinhardtii to copper toxicity. We found by using the PAM-fluorescence parameters (φ_M, φ′_M, Q_P, and Q_N), that C. reinhardtii is the most sensitive species, followed by S. capricornutum and C. vulgaris. Indeed, the copper 5-, 48-, and 96-h EC₅₀ for φ_M, φ′_M, and Q_P vary between 11 and 34 μg/L for C. reinhardtii, while for S. capricornutum this value is between 25 and 50 μg/L. However, the same parameters obtained from C. vulgaris did not show susceptibility to copper, even at very high concentrations (100 μg/L). In this study, the estimated 5-h EC₅₀ for C. reinhardtii and S. capricornutum are lower than the 24-h EC₅₀ reported earlier for these species with other bioassays, indicating that the use of PAM fluorometry in copper bioassay provides a more sensitive method than the other biotests in aquatic toxicology. Received: 31 December 2000/Accepted: 5 August 2001     

Empirical Models to Predict Parsimoniously the Mass and Number Concentrations of Ultrafine Particulate in Ambient Atmosphere

The main objective of this study was to develop parsimonious empirical models for predicting the mass and number concentrations of ultrafine particulate (UFP, aerodynamic diameter < 0.1 or 0.18 μm) in the atmospheric environment. We found strong correlations existed between the mass/number concentration of UFP and the mass concentration of PM_2.5 (aerodynamic diameter < 2.5 μm) by fitting the experimental data. Therefore, we were easily able to obtain UFP mass and number concentrations by using the presented empirical models. The empirical equations should be used with care since limitations existed.     

Acute Toxicity of Nitrite and Ammonia to Daphnia similoides of Different Developmental Stages: Using the Modified Gaussian Model to Describe

To gain an insight into the tolerance of Daphnia to nitrite and ammonia, a modified Gaussian model was used to describe the trends of changes in LC50s of nitrite and ammonia to Daphnia similoides at different developmental stages. LC50s of NO₂–N and NH₃–N increased with age before maturation and then decreased at maturation. A modified Gaussian model provided an accurate fit for the changes in LC50s of NO₂–N and NH₃–N, in which the parameters have definite biological meanings. From this model, we can gain an insight into the maximum LC50 and the age that has the maximum LC50 and predict LC50s at any specific ages. We suggest that such a model might be used to describe the trend in acute toxicity of some other zooplankton species at different stages.     

The Greek Version of the Quality of Life in Epilepsy Inventory (QOLIE-31)

This study is presenting the translation and cultural adaptation into Greek of the Quality of Life in Epilepsy Inventory (QOLIE-31). We adapted the QOLIE-31 to Greek through a procedure of translation–back-translation. Sixty-three patients were interviewed and completed the QOLIE-31 and the GHQ questionnaires. We re-examined a subset of them after a period of 2–5 weeks to evaluate the test–retest reliability of the questionnaire. We assessed the convergent validity by comparison of the QOLIE-31 and the GHQ and QOLIE-31 subscales and external measures. Discriminative validity was evaluated using the method of known-groups comparisons. The internal consistency was high for the QOLIE-31 and its’ subscales (Cronbach’s α 0.92 and 0.59–0.83 respectively). Test–retest reliability was acceptable (intra-class correlation coefficient 0.49–0.89 and Pearson’s coefficient 0.53–0.92) for the group of patients who were re-examined. Comparison of the QOLIE-31 and GHQ scores showed agreement between the two questionnaires (Pearson’s coefficient −0.61). We demonstrated the discriminative validity by the difference in the QOLIE-31 scores between patients with different seizure frequencies and different employment status. We concluded that the Greek version of the QOLIE-31 has psychometric properties equivalent to those of the original American-English version and is a valid and reliable instrument.     

Integrated care for homeless people--sharing knowledge and experience in practice, education and research: results of the networking efforts to find homeless health workers

‘Everything we do, is a drop in the ocean. But, if wedon't do it, that drop will be lost for ever’                 MotherTeresa

Over the last dozen years, as doctors for homeless peoplein Pittsburgh, USA and Amsterdam, the Netherlands, we have beennetworking internationally and travelled the streets to findsocial and medical workers who bring care to homeless people.We felt the need to reach out on the streets to meet homelesspeople and their problems, and to reach into mainstream services,academic centres and research institutes, to meet the needsof professionals in housing, social and medical work to deliverintegrated care.^1,2 We sought knowledge and experience to beintegrated in practice, education and research, to better servehomeless people.^3–6