Translation and validation of the greek Psoriatic Arthritis Quality of Life Scale.

Psoriatic arthritis (PsA) is a chronic inflammatory disease that has a significant impact on patients' quality of life (QoL). The Psoriatic Arthritis Quality of Life (PsAQoL) Scale was developed in the UK to be specific to PsA patients and adopts the needs-based model of QoL. As a disease-specific measure, the PsAQoL is superior to generic measures of QoL in terms of relevance and sensitivity. The measure, which has been adapted into 50 languages, has not previously been available for use with Greek PsA patients. The aim of the study was to produce a Greek version of the PsAQoL that was suitable for native Greek speakers and that had comparable psychometric properties to the original UK version. The adaptation of the Greek PsAQoL consisted of three stages; translation, assessment of face and content validity and analysis of its psychometric properties. The translation stage adopted the dual panel methodology -a bilingual panel followed by a lay panel- to ensure conceptual equivalence of the scale to the original version. Cognitive debriefing interviews were conducted to determine the applicability and relevance of the adapted scale to patients. Finally, a postal validation survey was conducted to assess the psychometric properties of the draft measure, using the Nottingham Health Profile (NHP) as a comparator instrument. Non-parametric statistical analyses were performed to establish the reliability and construct validity of the PsAQoL. The translation panels produced a language version that sounded natural to native Greek speakers. Interviews revealed that patients found the measure comprehensible and appropriate. Only minor grammatical changes were made to the measure following these interviews. The Greek PsAQoL demonstrated good internal consistency (Cronbach's α=0.88) and excellent test-retest reliability (r=0.98). As expected, the measure correlated moderately highly with the Physical Mobility and Pain sections of the NHP and correlated moderately with other sections, indicating convergent validity. Known group validity was established by the ability of the measure to distinguish between patients who differed according to their perceived general health and disease severity. No significant differences in PsAQoL scores were observed between males and females or older and younger patients. The Greek PsAQoL was well-received by patients and demonstrated sound psychometric properties. It forms part of a growing body of disease-specific measures that are available in Greece. It is recommended for use in routine clinical practice, international clinical trials and research studies as a valid and reliable measure of QoL in PsA patients.

Greek adaptation and validation of the Ankylosing Spondylitis Quality of Life (ASQoL) measure.

BACKGROUND: Ankylosing Spondylitis (AS) is a chronic rheumatic disease that has a significant impact on patient's quality of life (QoL). The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific patient-reported outcome measure for assessing QoL in AS. While the ASQoL has been adapted for use in 46 countries worldwide, a Greek language version of the measure has not been available and was required for an international clinical trial. AIM: The aim was to develop and assess the psychometric properties of a Greek language version of the ASQoL. METHODS: The adaptation of the ASQoL into Greek involved three procedures: translation, assessment of face and content validity, and formal validation. The measure was translated into Greek using two translation panels. Cognitive debriefing interviews were employed to determine face and content validity. Finally, the translation's psychometric properties were examined by administering it on two occasions, with a 14-day interval. The Nottingham Health Profile (NHP) was used as a comparator measure. RESULTS: The ASQoL proved straightforward to translate into Greek and interviewees found it relevant, comprehensible and easy to complete.  The measure had good internal consistency (α =0.92) and test-retest reliability (r =0.98). Predicted correlations with the NHP provided evidence of the convergent validity of the two measures. Construct validity was confirmed by the measure's ability to distinguish groups of AS patients varying by perceived disease severity and general health. CONCLUSIONS: The Greek ASQoL has been shown to be well-accepted, reliable and valid and can be recommended for use in clinical studies and routine clinical practice in AS. Hippokratia 2015; 19 (2):119-124.

Novel SNP development and analysis at a NADP+ -specific IDH enzyme gene in a four species mixed oak forest.

Closely related Quercus species generally exhibit low levels of genetic differentiation despite their ecological and morphological differences. However, at a few so-called 'outlier' loci they seem to remain genetically distinct. Isocitrate dehydrogenases (IDH) are key enzymes involved in the metabolic pathway of the citrate cycle. IDH has also been characterised as an 'outlier' marker, significantly differentiating the closely related Q. robur and Q. petraea with the isozyme technique. This ability to differentiate the species was tested here at molecular level: 13 single nucleotide polymorphism (SNP) markers were identified and developed within a NADP(+) -specific IDH gene in Quercus spp. and applied as molecular markers in a four species mixed oak forest in eastern Europe, where Q. robur, Q. petraea, Q. pubescens and Q. frainetto naturally co-exist. From the 13 developed SNPs, three groups were formed: non-synonymous, synonymous and non-coding SNPs. The levels of total gene diversity were moderate for all species investigated. The non-synonymous SNPs showed lower levels of gene diversity. Overall, the four closely related Quercus spp. were significantly differentiated (except Q. petraea with Q. frainetto). Analysis of non-random association of alleles revealed no clear physical clustering of the SNP sites in significant linkage disequilibrium (LD). However, separate LD analysis for each species showed a lower number of sites in significant LD for Q. robur than for the other species, possibly reflecting the history of the species in this specific geographical site and less efficient recombination effect due to the larger effective population size of Q. robur. Eleven statistically significant associations were found between seven SNPs and morphological traits that are commonly used to differentiate oak species.

Remission rates with venlafaxine extended release in Greek outpatients with generalized anxiety disorder. A double-blind, randomized, placebo controlled study.

The primary endpoints in this study were the remission rates [final Hamilton Rating Scale for Anxiety (HAM-A) total score < or =7] and reduction from baseline in the HAM-A total score in patients with generalized anxiety disorder (GAD) and no associated depression. Patients with GAD (DSM-IV and HAM-A total score >18) were randomly assigned to treatment with venlafaxine XR or placebo for 8 weeks. A 1-week placebo run-in period preceded the double-blind phase. Patients with a >20% drop in their total HAM-A score during the run-in period, were excluded from the double-blind phase. All patients started therapy with 75 mg/day venlafaxine XR or matched placebo. Patients with less than 30% decrease in their HAM-A total score at the end of the second week, doubled their dose. Patients on the 150 mg/day dose underwent a 1-week taper period. Of the 24 patients in the venlafaxine XR group, 62.5% achieved remission versus 9.1% in the placebo group (P=0.0006). The mean decrease from baseline in HAM-A total score was 19.2 points for the venlafaxine XR group and 10.8 points for the placebo group (P<0.001). Eleven placebo-treated patients and seven venlafaxine XR treated patients doubled their dose at the end of the second week of double-blind treatment. No patient interrupted therapy because of side-effects. No changes in systolic or diastolic blood pressure were observed. Venlafaxine XR 75-150 mg/day was well tolerated. The remission rates achieved with venlafaxine 75-150 mg/day in non-depressed GAD patients were high with good tolerability.

Euthanasia in Greece: moral and ethical dilemmas.

Euthanasia as a concept and a practice has led to enormous debate in Greece, as well as in other countries. In this study, we examined the views of the public and of professionals on the issue of euthanasia. A self-administered questionnaire of 28 items was completed by 417 subjects, and provided information about attitudes towards the moral and ethical problems of euthanasia. Psychiatric speculations which arose during the approach of this issue were seen in the majority of the responses (88.3%). Psychodynamic unconscious processes reinforced and violated mechanisms and motives in favour of, or against euthanasia. Of the respondents, 44.3% were against life extension with mechanical devices. Putative main risk factors for suicidal ideation and the desire for death were: pain 66.2%, despair 60.2%, depression 59.7%, and psychopathology 38.6%. This study thus revealed that apart from pain, psychosocial factors play a key role in leading people to ask for euthanasia. On the other hand, the knowledge of the public and professionals regarding this issue is not sufficient, and thus discussion of euthanasia by Medical Societies is needed and necessary.

Is day hospital treatment effective, and can success be predicted?

Clinical improvement is demonstrated in a group of 41 day patients of mixed diagnosis by changes in measures of depression, self-esteem, loquacity and sociability over a period of six weeks. Staff predictions of success, made after 2 weeks, correlated positively (Spearman's rho = 0.53) with an overall assessment of success after 6 weeks, which itself was positively correlated with improvements in scores on depression (rho = 0.58) and sociability (rho = 0.66 and 0.60). The patients for whom staff predicted least success were in 6 cases out of 7 men aged 20-51.

Effect of N-REM sleep on the cortical SEPs in early life.

Cortical and cervical somatosensory evoked potentials (SEPs) were studied by the averaging method in twenty healthy children, aged 20 days to 3 years. The stimulus was applied to the median nerve at the wrist and SEPs were recorded by electrodes placed on to the contralateral parietal scalp region as well as over the skin at the C6-7 vertebral region. The reference electrode was placed at the Fz. All subjects were studied during the awake state as well as during the N-REM sleep. The results indicate that N-REM sleep influenced the latency and the duration of SEPs, especially in children aged less than one year. This finding probably reflects a variable rate of maturation of the somatosensory pathway. The state of wakefulness must therefore be taken into account when assessing the pathological relevance of SEP recording in young children.

Self poisoning: could psychiatric management be improved?

A retrospective case note study was made of 93 cases of deliberate self-poisoning admitted to the Casualty Department of a busy District General Hospital. The population under investigation is described in terms of age, sex and substance overdosed; it is broadly similar to populations described in most other studies of overdose. Our results show a higher incidence of functional psychoses (19.4%) than other studies, due to an excess of depressive psychosis in females. The main finding is that 84% of patients referred for psychiatric out-patient treatment either failed to attend or failed to complete the treatment. These results are discussed and suggestions made.

Factors influencing effectiveness of day hospital treatment.

One hundred consecutive admissions to a Psychiatric Day Hospital were studied. Outcome was assessed in terms of regularity and duration of Day Hospital attendance, transfer to inpatient care, and return to employment of unemployed patients. None of these outcome measures showed significant differences when groups of patients were compared according to age, sex or diagnosis. Similarly, no differences were found when patients living alone were compared with patients living with families, between employed and unemployed patients, between patients referred from in-patient care and those referred from out-patients, or when patients were compared according to their preferred types of Day Hospital activity.