Perceived autonomy during childbirth predicts mothers' parental self-efficacy: A prospective cohort study.

Experience during childbirth is an important predictor of mothers' later well-being. Using the framework of Self-Determination Theory and, we hypothesized that the degree to which women felt autonomy over their choices during childbirth would be reflected in their later confidence as parents, termed Parental Self-Efficacy (PSE). We assessed PSE as well as depressive symptoms before birth (T1, approximately 36 weeks pregnant) and after birth (T2, approximately 5 weeks postpartum). Perceptions of autonomy during childbirth were measured at T2 using the Perceived Control in Childbirth scale. Using hierarchical linear regression, we found that mothers' perceived autonomy during childbirth predicted their postpartum PSE, controlling for prenatal PSE, pre- and postnatal depression, number of childbirth interventions, and overall birth satisfaction. These data suggest that care providers' support for women's autonomy in childbirth impacts how women feel about themselves as mothers in the postpartum months.

Perspectives of youth in Ireland on school-based mental health and suicide prevention: the MYSTORY study.

Anxiety, depression, and suicide are leading causes of disability and death among young people, globally. Schools are an ideal setting to target young people's mental health, yet young people's beliefs about and experiences with school mental health and suicide prevention are not well understood. This gap in knowledge contradicts both national and international youth mental health recommendations and the United Nations Convention on the Rights of the Child, which collectively advocate for understanding young people's perspectives on matters concerning them, including school mental health. Therefore, the Mental Health of Youth Story (MYSTORY) study explored young people's perspectives on school mental health and suicide prevention using a participatory-based approach incorporating photovoice. MYSTORY consisted of a community/university partnership involving young people as participants (n = 14) and advisors (n = 6). Experiential, reflexive thematic analysis (TA) within a critical approach generated three themes relating to young people's experiences with and beliefs about school mental health promotion and suicide prevention. Findings highlight the critical role of schools in impacting young people's mental health, with the need to amplify youth voice and involvement in school mental health evident. Our study addresses an important gap by employing participatory-based approaches to explore young people's perspectives on school mental health and suicide prevention. This is the first known study to explore young people's perspectives on their voice and involvement in school mental health. Findings have important implications for youth and school mental health and suicide prevention research, policy, and practice.

Exploring adolescents' perspectives on and experiences with post-primary school-based suicide prevention: a meta-ethnography protocol.

BACKGROUND: Globally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviors (STBs), PSSP effectiveness does not easily translate to school settings. Adolescents' perspectives on PSSP are particularly important for (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, yet there is a gap in understanding adolescents' experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesize adolescents' perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. METHODS: The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The protocol was guided by the seven-stage process for meta-ethnography proposed by Noblit and Hare. Searches of PsycINFO, MEDLINE, Web of Science, CINAHL, ERIC, Scopus, and study reference lists will identify peer-reviewed studies. Gray literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesized in line with Noblit and Hare's stages and evaluated using the Critical Appraisal Skills Program (CASP) checklist. DISCUSSION: To our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents' perspectives on engaging with PSSP interventions. Understanding adolescents' experiences of engaging with PSSP will impact the field of PSSP in several ways by (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022319424.

Female and male Leach's Storm Petrels (Hydrobates leucorhous) pursue different foraging strategies during the incubation period.

Reproduction in procellariiform birds is characterized by a single egg clutch, slow development, a long breeding season and obligate biparental care. Female Leach's Storm Petrels Hydrobates leucorhous, nearly monomorphic members of this order, produce eggs that are between 20 and 25% of adult body weight. We tested whether female foraging behaviour differs from male foraging behaviour during the ~ 44-day incubation period across seven breeding colonies in the Northwest Atlantic. Over six breeding seasons, we used a combination of Global Positioning System and Global Location Sensor devices to measure characteristics of individual foraging trips during the incubation period. Females travelled significantly greater distances and went farther from the breeding colony than did males on individual foraging trips. For both sexes, the longer the foraging trip, the greater the distance. Independent of trip duration, females travelled farther, and spent a greater proportion of their foraging trips prospecting widely as defined by behavioural categories derived from a Hidden Markov Model. For both sexes, trip duration decreased with date. Sex differences in these foraging metrics were apparently not a consequence of morphological differences or spatial segregation. Our data are consistent with the idea that female foraging strategies differed from male foraging strategies during incubation in ways that would be expected if females were still compensating for egg formation.

A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention.

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.

Research Review: The effect of school-based suicide prevention on suicidal ideation and suicide attempts and the role of intervention and contextual factors among adolescents: a meta-analysis and meta-regression.

BACKGROUND: Globally, suicide is the fourth highest cause of adolescent mortality (Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide). The effects of post-primary school-based suicide prevention (PSSP) on adolescent suicidal thoughts and behaviours (STBs) have not been comprehensively synthesised. We aim to estimate the population effect for PSSP interventions on adolescent STBs and explore how intervention effects vary based on intervention and contextual moderators. METHODS: Searches of PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials identified cluster randomised trials examining the effectiveness of PSSP on adolescent STBs. The Cochrane Risk of Bias tool assessed bias. Crude and adjusted back-transformed odds ratios (ORs) were calculated. Multilevel random-effects models accounted for dependencies of effects. Univariate meta-regression explored variability of intervention and contextual moderators on pooled effects. RESULTS: There were 19 and 12 effects for suicidal ideation (SI) and suicide attempts (SA). Compared with controls, interventions were associated with 13% (OR = 0.87, 95%CI [0.78, 0.96]) and 34% (OR = 0.66, 95%CI [0.47, 0.91]) lower crude odds reductions for SI and SA, respectively. Effects were similar for adjusted SI (OR = 0.85, 95%CI [0.75, 0.95]) and SA (OR = 0.72, 95%CI [0.59, 0.87]) models. Within-study (0.20-9.10%) and between-study (0-51.20%) heterogeneity ranged for crude and adjusted SA models and SI heterogeneity was 0%. Moderator analyses did not vary SA effects (ps > .05). CONCLUSIONS: This meta-analysis contributes to the PSSP evidence-base by demonstrating that PSSP targeting STBs as both primary intervention outcomes and with other health and well-being outcomes reduced SI and SA among 33,155 adolescents attending 329 schools, compared to controls. The number needed to treat estimates suggests the potential of reducing the incidence of SA and SI in one adolescent by implementing PSSP in 1-2 classrooms, supporting PSSP as a clinically relevant suicide prevention strategy. Although moderator analyses were nonsignificant and contained a small number of trials, larger SA effect sizes support particular effectiveness for interventions of a duration of ≤1 week, involving multiple stakeholders and with a 12-month follow-up.

Teacher Characteristics, Knowledge and Use of Evidence-Based Practices in Autism Education in Ireland.

Autism evidence-based practices (EBPs) are those with demonstrated improved outcomes for students with autism across a range of skill areas, yet issues persist in adopting these in classroom settings- particularly in general education (GE) settings. This research aimed to identify teacher training, years of experience, access to allied professionals and knowledge and use of autism EBPs in GE settings in Ireland. 369 mainstream primary school teachers reported their characteristics and their knowledge and use of EBPs. Results indicated that the majority of teachers received little initial teacher education training in autism, almost no continuous professional development (CPD) before educating a child with autism, and received little support from allied professionals. Knowledge and use of EBPs differed significantly across teacher characteristics, with findings discussed in relation to teacher training.

Cyanogenesis in cassava and its molecular manipulation for crop improvement.

While cassava is one of the most important staple crops worldwide, it has received the least investment per capita consumption of any of the major global crops. This is in part due to cassava being a crop of subsistence farmers that is grown in countries with limited resources for crop improvement. While its starchy roots are rich in calories, they are poor in protein and other essential nutrients. In addition, they contain potentially toxic levels of cyanogenic glycosides which must be reduced to safe levels before consumption. Furthermore, cyanogens compromise the shelf life of harvested roots due to cyanide-induced inhibition of mitochondrial respiration, and associated production of reactive oxygen species that accelerate root deterioration. Over the past two decades, the genetic, biochemical, and developmental factors that control cyanogen synthesis, transport, storage, and turnover have largely been elucidated. It is now apparent that cyanogens contribute substantially to whole-plant nitrogen metabolism and protein synthesis in roots. The essential role of cyanogens in root nitrogen metabolism, however, has confounded efforts to create acyanogenic varieties. This review proposes alternative molecular approaches that integrate accelerated cyanogen turnover with nitrogen reassimilation into root protein that may offer a solution to creating a safer, more nutritious cassava crop.

Mini-Review - Teaching Writing in the Undergraduate Neuroscience Curriculum: Its Importance and Best Practices.

In neuroscience and other scientific disciplines, instructors increasingly appreciate the value of writing. Teaching students to write well helps them succeed in school, not only because they perform better on assessments but also because well-structured writing assignments improve learning. Moreover, the ability to write well is an essential professional skill, because good clear writing in conjunction with good clear thinking results in increased success in fellowship applications, grant proposals, and publications. However, teaching writing in neuroscience classrooms is challenging for several reasons. Students may not initially recognize the importance of writing, teachers may lack training in the pedagogy of writing instruction, and both teachers and students must commit substantial time and effort to writing if progress is to be made. Here, we detail effective strategies for teaching writing to undergraduates, including scaffolding of teaching assignments, both within a class and across a curriculum; use of different types of writing assignments; early integration of writing into courses; peer review and revision of assignments; mentoring by student tutors; and use of defined rubrics. We also discuss how these strategies can be utilized effectively in the context of multicultural classrooms and labs.

Catatonia Due to Tacrolimus Toxicity 16 Years After Renal Transplantation: Case Report and Literature Review.

Tacrolimus, a potent posttransplant immunosuppressant, has been associated with major neuropsychiatric complications, including catatonia and psychosis. We report a novel case of tacrolimus-induced encephalopathy that developed 16 years after renal transplantation while the drug was at a therapeutic level. Discontinuation of tacrolimus and switching to an alternative immunosuppressant resulted in significant clinical improvement over 1 week. Our experience illustrates the possibility of acute neurotoxicity from tacrolimus even when the patient has tolerated the drug for 16 years and drug levels are within the therapeutic range. This case also highlights the importance of collaboration between psychiatry and transplant clinicians.

A Prolific Solvate Former, Galunisertib, under the Pressure of Crystal Structure Prediction, Produces Ten Diverse Polymorphs.

The solid form screening of galunisertib produced many solvates, prompting an extensive investigation into possible risks to the development of the favored monohydrate form. Inspired by crystal structure prediction, the search for neat polymorphs was expanded to an unusual range of experiments, including melt crystallization under pressure, to work around solvate formation and the thermal instability of the molecule. Ten polymorphs of galunisertib were found; however, the structure predicted to be the most stable has yet to be obtained. We present the crystal structures of all ten unsolvated polymorphs of galunisertib, showing how state-of-the-art characterization methods can be combined with emerging computational modeling techniques to produce a complete structure landscape and assess the risk of late-appearing, more stable polymorphs. The exceptional conformational polymorphism of this prolific solvate former invites further development of methods, computational and experimental, that are applicable to larger, flexible molecules with complex solid form landscapes.

Restricted reproductive rights and risky sexual behaviour: How political disenfranchisement relates to women's sense of control, well-being and sexual health.

Few studies have investigated the role of disenfranchisement and denial of agency in women's sexual health. To address this, a cross-sectional study of disenfranchisement, control (general and reproductive control) and health was conducted in Ireland, where abortion is severely restricted. Multiple mediation models ( N = 513 women) indicated that general but not reproductive control mediates the association between disenfranchisement and psychological well-being. Additionally, serial mediation shows disenfranchisement is associated with lower sense of control, which is linked to poorer well-being and risky sexual behaviour. Disenfranchisement arising from socio-political contexts may have important implications for women's sexual health.

Optimism and benefit finding in parents of children with developmental disabilities: The role of positive reappraisal and social support.

BACKGROUND: Researchers have consistently documented the relationship between optimism and benefit finding; however, there is a dearth of research on the psychological mechanisms mediating their association. AIM: This cross-sectional study sought to elucidate the mediating role of positive reappraisal and social support in the optimism-benefit finding relationship in parents caring for children with developmental disabilities by testing a parallel multiple mediation model. METHOD: One hundred and forty-six parents caring for children with developmental disabilities completed an online survey assessing optimism, positive reappraisal, social support and benefit finding. RESULTS: Optimism was not directly related to benefit finding but rather influenced it indirectly through positive reappraisal and social support. Specifically, higher levels of optimism predicted greater positive reappraisal and social support, which in turn led to greater benefit finding in parents. CONCLUSION: These results underscore the importance of targeting parents' perceptions of benefits through both positive reappraisal and social support in order to help them cope with the demands of the caregiving context.

Developing a recovery college: a preliminary exercise in establishing regional readiness and community needs.

BACKGROUND: Recovery orientated intervention has experienced a paradigm shift towards stakeholder training and education within recovery colleges. Such colleges are typically underpinned by a culture of emancipatory education that aims to facilitate recovery through educational choice. AIMS: The study aims to establish regional readiness for a recovery college. Specifically, we aim to uncover key stakeholder attitudes towards recovery, outline a contextual conceptualization of recovery and show how inductive, community-based research can incorporate stakeholder views with core fidelity markers of a recovery college. METHOD: A mixed methods approach, specifically a cross-sectional survey, was adopted to intersect quantitative scales of stakeholder attitudes and qualitative assessment of recovery concepts and community needs. RESULTS: Stakeholders' recovery attitudes were positive overall with some variation between participant groups. Concepts of recovery were developing independent abilities, establishing connectedness to support and as a journey. The needs cited by the stakeholders were largely correlated with the core fidelity markers of a recovery college. CONCLUSION: A community psychology approach offers a means to ascertain regional readiness for a recovery college, and uncover key development foci based on community needs. We recommend that service areas adopt a similar approach when considering recovery-orientated service developments.

Navigating the Waters of Unconventional Crystalline Hydrates.

Elucidating the crystal structures, transformations, and thermodynamics of the two zwitterionic hydrates (Hy2 and HyA) of 3-(4-dibenzo[b,f][1,4]oxepin-11-yl-piperazin-1-yl)-2,2-dimethylpropanoic acid (DB7) rationalizes the complex interplay of temperature, water activity, and pH on the solid form stability and transformation pathways to three neutral anhydrate polymorphs (Forms I, II°, and III). HyA contains 1.29 to 1.95 molecules of water per DB7 zwitterion (DB7z). Removal of the essential water stabilizing HyA causes it to collapse to an amorphous phase, frequently concomitantly nucleating the stable anhydrate Forms I and II°. Hy2 is a stoichiometric dihydrate and the only known precursor to Form III, a high energy disordered anhydrate, with the level of disorder depending on the drying conditions. X-ray crystallography, solid state NMR, and H/D exchange experiments on highly crystalline phase pure samples obtained by exquisite control over crystallization, filtration, and drying conditions, along with computational modeling, provided a molecular level understanding of this system. The slow rates of many transformations and sensitivity of equilibria to exact conditions, arising from its varying static and dynamic disorder and water mobility in different phases, meant that characterizing DB7 hydration in terms of simplified hydrate classifications was inappropriate for developing this pharmaceutical.

Education programmes for young children with Autism Spectrum Disorder: an Evaluation Framework.

Autism researchers have identified a common set of practices that form the basis of quality programming in ASD yet little is known regarding the implementation of these practices in community settings. The purpose of this paper was to outline an Evaluation Framework for use in evaluating ASD programmes of education that will provide valuable information as to the sensitivity of programmes to best practice, establish how programmes are operating and the programme effect on students and their families. The move towards more rigorous evaluation will provide quality information as to the degree of adoption of research led practices in the community setting which heretofore has been largely unavailable.

Lack of effect of the apolipoprotein E ε4 genotype on cognition during healthy aging.

BACKGROUND: The apolipoprotein E (APOE) ε4 genotype is associated with an increased risk of Alzheimer's disease. In community surveys, older adults with this genotype have been found to have lower scores on neuropsychological tests than those who do not. It is possible that this is the consequence of subclinical changes in cognition in those persons who later develop dementia. The aim of this research was to determine whether the effect of APOE genotype on cognition would remain if those who subsequently became demented were retrospectively removed from the analysis of the baseline test data from a sample of healthy adults. METHOD: A sample of 241 nondemented persons over the age of 65 for whom APOE genotyping was available were administered a range of neuropsychological tests at baseline and were followed up 10 years later. RESULTS: Significant differences between the ε4-present and ε4-absent groups were found for the delayed recall trial of the Rey Auditory Verbal Learning Test and the Trail Making Test. When those participants known to have developed dementia during the follow-up period were excluded from the analysis of the baseline data these differences disappeared. A total of 113 nondemented survivors from the original sample were retested, and no difference was found in the rate of decline on any measure between the ε4-present and ε4-absent groups. CONCLUSIONS: It is likely that the reported effect of the ε4 APOE genotype on cognition is the consequence of the ε4-present group containing persons whose cognition is subtly affected by the early stages of a dementing process. It is also unlikely that the presence of the ε4 allele by itself leads to a significantly accelerated rate of cognitive decline in the nondemented elderly.

Differences in erythrocyte folate concentrations in older adults reached steady-state within one year in a two-year, controlled, 1 mg/d folate supplementation trial.

Daily supplementation with folate increases erythrocyte folate concentrations; however, the time to reach steady-state concentrations has not been empirically demonstrated. Previous predictions of time to steady state or time to 90% steady-state concentration, based on modeling changes in erythrocyte folate during short-term trials, range widely from 40 to 86 wk. We sought to determine the time to steady-state erythrocyte folate concentrations following the initiation of daily folate supplementation using data collected from a 2-y, double-blind, placebo-controlled, randomized trial involving 276 participants aged 65 y or older. The daily supplement contained 1 mg of folate. Erythrocyte folate concentrations were measured, using a microbiological assay, at baseline and at 6, 12, 18, and 24 mo. The mean plasma and erythrocyte folate concentrations in the folate-supplemented group were higher than in the placebo group at 6, 12, 18, and 24 mo (P < 0.001). Adjusted for baseline differences, the difference in erythrocyte folate concentrations between the folate and placebo group at 6 mo was 1.78 µmol/L (95% CI: 1.62-1.95 µmol/L). The difference increased significantly to 2.02 µmol/L (95% CI: 1.85-2.18 µmol/L) at 12 mo. This difference (between the folate and placebo groups) did not significantly change after a further year of folate supplementation; at 18 mo, it was 2.09 µmol/L (95% CI: 1.92-2.27 µmol/L) and at 24 mo it was 1.98 µmol/L (95% CI: 1.18-2.15 µmol/L). Twelve months of daily folate supplementation with 1 mg is sufficient time to cause erythrocyte folate concentrations to reach a new steady state.

Reliable change indices for the ruff 2 and 7 selective attention test in older adults.

The assessment of suspected dementia often involves the analysis of change scores from neuropsychological tests administered on two occasions. Frequently, no information is available to allow the significance of a change to be evaluated. Our aim was to prepare data useful for estimating the statistical significance of retest changes for persons older than the age of 65 on the Ruff 2 and 7 Selective Attention Test, one of the few paper-and-pencil tests of attention available to the clinician. The sample tested was composed of 234 healthy adults taking part in a randomized double-blind trial of the effect on cognitive performance of lowering homocysteine using dietary supplements, during which no treatment effects were detected. The test was found to be sensitive to the effects of aging and was well tolerated by our sample of older adults. Retest reliability for the speed of visual search for digit targets (2 and 7) under both the same category (other digits) and different category (letter) distracter conditions was high, and the practice effects during a 12-month period were substantial. Test-retest data with a 1-year interval were used to estimate reliability coefficients and to calculate Reliable Change indices useful for evaluating persons with suspected dementia. The rate of decline in search speed as a function of age was the same for both distraction conditions, suggesting that older persons used a controlled serial search process for targets in both conditions of this test.

Homocysteine-lowering vitamins do not lower plasma S-adenosylhomocysteine in older people with elevated homocysteine concentrations.

Elevated plasma total homocysteine (tHcy) is a risk factor for vascular disease but lowering tHcy with B-vitamins, including folate, has generally not reduced vascular events in secondary prevention trials. Elevated plasma S-adenosylhomocysteine (AdoHcy) concentration may be a more sensitive indicator of vascular disease than plasma tHcy. However, unlike tHcy, plasma AdoHcy did not correlate with folate concentration in one study indicating that folate supplementation may not lower AdoHcy. Our aim was to determine whether providing B-vitamin supplements to healthy older people with elevated tHcy (>13 micromol/l) affects plasma AdoHcy and S-adenosylmethionine (AdoMet) concentrations. Healthy older participants (n 276; > or = 65 years) were randomised to receive a daily supplement containing folate (1 mg), vitamin B12 (500 microg) and vitamin B6 (10 mg), or placebo, for 2 years. Of these participants, we selected the first fifty participants in each treatment group and measured plasma AdoHcy and AdoMet. Plasma tHcy was 4.4 (95 % CI 3.2, 5.6; P < 0.001) micromol/l lower at 2 years in the vitamins group compared with the placebo group. At 2 years, there were no significant differences in plasma AdoMet (+4 % (95 % CI - 2, 11); P = 0.19), AdoHcy ( - 1 % (95 % CI - 10, 8); P = 0.61) or the AdoMet:AdoHcy ratio (0.22 (95 % CI - 0.04, 0.49); P = 0.10) between the two groups. In conclusion, B-vitamin supplementation of older people lowered plasma tHcy but had no effect on plasma AdoMet or AdoHcy concentration. If elevated plasma AdoHcy is detrimental, this may explain why B-vitamins have generally failed to reduce vascular events in clinical trials.