The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins.

The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural-geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

Diversity of leisure-time sport activities in adolescence as a predictor of leisure-time physical activity in adulthood.

Because sustained physical activity is important for a healthy life, this paper examined whether a greater diversity of sport activities during adolescence predicts higher levels of leisure-time physical activity (LTPA) in adulthood. From sport activity participation reported by 17-year-old twins, we formed five groups: 1, 2, 3, 4, and 5+ different sport activities. At follow-up in their mid-thirties, twins were divided into four activity classes based on LTPA, including active commuting. Multinomial regression analyses, adjusted for several confounders, were conducted separately for male (N=1288) and female (N=1770) participants. Further, conditional logistic regression analysis included 23 twin pairs discordant for both diversity of sport activities in adolescence and LTPA in adulthood. The diversity of leisure-time sport activities in adolescence had a significant positive association with adulthood LTPA among females. Membership in the most active adult quartile, compared to the least active quartile, was predicted by participation in 2, 3, 4, and 5+ sport activities in adolescence with odds ratios: 1.52 (P=.11), 1.86 (P=.02), 1.29 (P=.39), and 3.12 (P=5.4e-05), respectively. Within-pair analyses, limited by the small sample of twins discordant for both adolescent activities and adult outcomes, did not replicate the association. A greater diversity of leisure-time sport activities in adolescence predicts higher levels of LTPA in adulthood in females, but the causal nature of this association remains unresolved.

Genetic architecture of motives for leisure-time physical activity: a twin study.

The aim of this study was to estimate the contribution of genetic and environmental influences on motives for engaging in leisure-time physical activity. The participants were obtained from the FinnTwin16 study. A modified version of the Recreational Exercise Motivation Measure was used to assess the motives for leisure-time physical activity in 2542 twin individuals (mean age of 34.1 years). Linear structural equation modeling was used to investigate the genetic and environmental influences on motive dimensions. The highest heritability estimates were found for the motive dimensions of "enjoyment" [men 33% (95% CI 23-43%), women 53% (95% CI 45-60%)] and "affiliation" [men 39% (95% CI 0.28-0.49%), women 35% (95% CI 0.25-0.43%)]. The lowest heritability estimates were found for others' expectations [men 13% (95% CI 0.04-0.25%), women 15% (95% CI 0.07-0.24%)]. Unique environmental influences explained the remaining variances, which ranged from 47% to 87%. The heritability estimates for summary variables of intrinsic and extrinsic motives were 36% and 32% for men and 40% and 24% for women, respectively. In conclusion, genetic factors contribute to motives for leisure-time physical activity. However, the genetic effects are, at most, moderate, implying the greater relative role of environmental factors.

Motives for physical activity among active and inactive persons in their mid-30s.

The purpose of this study was to examine the motives for leisure-time physical activity among active and inactive men and women in their mid-30s. We used both cross-sectional and longitudinal designs. Altogether, 2308 participants (mean age 33.9 years, 53.4% women) were identified from the population-based FinnTwin16 Cohort. Physically active and inactive individuals were identified on the basis of their leisure-time MET h/day. We evaluated participants' physical activity motivation with a modified version of the Recreational Exercise Motivation Measure. Comparisons between active and inactive individuals were analysed using the Wald test for equality of means, and effect sizes were calculated as Cohen's d. Motives related to mastery, physical fitness, social aspect of physical activity, psychological state, enjoyment, willingness to be fitter/look better than others, and appearance were significantly more important for the active than inactive participants. Conforming to others' expectations was the only item on which the inactive persons scored higher than active persons. The longitudinal results for physical activity were parallel to the cross-sectional results. This study supports the view that motivation factors differ between active and inactive persons, and that intrinsic motives are associated with consistent leisure-time physical activity.

Motives for and barriers to physical activity in twin pairs discordant for leisure time physical activity for 30 years.

Long-term persistent physical activity is important in the prevention of chronic diseases, but a large number of people do not participate in physical activity to obtain health benefits. The purpose of this study was to examine the motives and perceived barriers to long-term engagement in leisure time physical activity. Same-sex twin pairs (N=16, mean age 60) discordant for physical activity over 30 years were identified from the Finnish Twin Cohort. We evaluated participants' physical activity motivation with the 73-item Recreational Exercise Motivation Measure and assessed barriers to physical activity with a 25-item questionnaire. The characteristics of physical activity motivation and perceived barriers between the active and inactive co-twins were analysed using paired tests. Motives related to the sub-dimensions of enjoyment and physical fitness and psychological state were the most important reasons for participation in physical activity among all the twin individuals analysed. The sub-dimensions mastery (p=0.018, Cohen's d=0.76), physical fitness (p=0.029, Cohen's d=0.69), and psychological state (p=0.039, Cohen's d=0.65) differed significantly between active and inactive co-twins. More than half of the participants reported no reasons for not being physically active. If reasons existed, participation in physical activity was deterred mostly by pain and various health problems. This study found no differences in perceived barriers between active and inactive co-twins. We conclude from our results that the main factors promoting persistent leisure time physical activity were participants' wish to improve or maintain their physical skills or techniques, a feeling that exercise would improve their mental and physical health and that they found the activity enjoyable. This study helps us understand the importance of the role of motives and the minor role of perceived barriers for engagement in persistent physical activity.

Barriers to medication counselling for people with mental health disorders: a six country study / Barreras al consejo sobre medicamentos para personas con desordenes mentales: un estudio en seis países

Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders. Objective: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia. Methods: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students' Health Survey were content analysed using a directed approach. Students' responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0. Results: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries. Conclusion: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students (AU)

La provisión de información sobre medicamentos puede mejorar la adherencia y prevenir problemas relacionados con los medicamentos. Las personas con desordenes mentales normalmente reciben menos consejos sobre medicación de los farmacéuticos que la gente con otras enfermedades comunes de larga duración. Objetivo: El objetivo de este estudio fue comparar y contrastar las barreras que los estudiantes de farmacia perciben hacia proporcionar consejos de medicación para personas con desordenes mentales en Australia, Bélgica, Estonia, Finlandia, India y Letonia. Métodos: Se realizó un análisis de contenido de abordaje directo de las barreras identificadas pro estudiantes de tercero de farmacia como parte de la Encuesta de Salud de los Estudiantes de Farmacia. Las respuestas de los estudiantes se categorizaron como relativas al farmacéutico, relativas al paciente, relativas al sistema de salud, o relativas a aspectos sociales o culturales. Los datos cuantitativos se analizaron utilizando un SPSS versión 14.0. Resultados: Las encuestas fueron retornadas por 649 estudiantes. De los respondentes, 480 identificaron una o más barreras al consejo sobre medicación para personas con desordenes mentales. Los factores relativos al paciente representaron entre el 25,3% y el 36,2% de las barreras identificadas por los estudiantes. Los factores relativos al farmacéutico alcanzaron el 17,6% a 45,1% de las barreras identificadas. Los estudiantes de India eran más proclives a atribuir barreras al farmacéutico y a los aspectos sociales y culturales, y menos a los factores del sistema de salud que los estudiantes de otros países. Conclusión: La naturaleza de las barreras identificadas por los estudiantes de farmacia difirió entre los países estudiados. Los programas de formación pre y postgraduados en farmacia podrían tener que corregirse para encarar los malos entendidos comunes entre los estudiantes de farmacia (AU)

Effects of exercise training on oxygen uptake in coronary heart disease: a systematic review and meta-analysis.

It is not known to what extent exercise programs increase maximal oxygen uptake (VO(2max)) in patients with coronary heart diseases (CHD). The purpose of this study is to determine the effect of exercise interventions on VO(2max) in subjects with CHD. Database search of randomized controlled trials was conducted from PubMed. Studies were included that reported the characteristics and effects of exercise interventions in subjects with CHD, included a non-exercise control group and measured VO(2max) using direct measurement method. Eighteen studies were eligible. Exercise interventions increased VO(2max) by 2.6 +/- 1.6 and 0.3 +/- 1.4 mL/kg/min in the training and control groups, respectively. The net difference in the change of VO(2max) between the groups was 2.3 mL/kg/min with a standardized mean difference of 0.60 [95% CI 0.47, 0.74] (P<0.001). Aerobic training led to a larger difference in VO(2max) between the groups than other training modes. Over 6 months of training period and training started within 3 months after a cardiac event also had a significant effect on VO(2max). This analysis showed that a long exercise training period starting soon after a cardiac event improved VO(2max) in patients with CHD most effectively. In future studies, the training programs should be designed carefully as even larger improvements in VO(2max) may be possible.

Barriers to medication counselling for people with mental health disorders: a six country study.

UNLABELLED: Provision of medication information may improve adherence and prevent medication related problems. People with mental health disorders commonly receive less medication counselling from pharmacists than people with other common long term and persistent disorders. OBJECTIVE: The objective of this study was to compare and contrast barriers pharmacy students perceive toward providing medication counselling for people with mental health disorders in Australia, Belgium, Estonia, Finland, India and Latvia. METHODS: Barriers identified by third-year pharmacy students as part of the International Pharmacy Students' Health Survey were content analysed using a directed approach. Students' responses were categorised as pharmacist related, patient related, health-system related, or social or cultural related. Quantitative data were analysed using SPSS version 14.0. RESULTS: Survey instruments were returned by 649 students. Of the respondents, 480 identified one or more barriers to medication counselling for people with mental health disorders. Patient related factors accounted for between 25.3% and 36.2% of barriers identified by the pharmacy students. Pharmacist related factors accounted for between 17.6% and 45.1% of the barriers identified by the pharmacy students. Students in India were more likely to attribute barriers to pharmacist and social and cultural related factors, and less likely to health-system related factors, than students studying in other countries. CONCLUSION: The nature of barriers identified by pharmacy students differed according to the country in which they studied. Undergraduate and postgraduate pharmacy education programs may need to be amended to address common misconceptions among pharmacy students.

Determinants of mental health stigma among pharmacy students in Australia, Belgium, Estonia, Finland, India and Latvia.

BACKGROUND: Healthcare professionals commonly exhibit negative attitudes toward people with mental disorders. Few international studies have sought to investigate the determinants of stigma. OBJECTIVE: To conduct an international comparison of pharmacy students' stigma towards people with schizophrenia, and to determine whether stigma is consistently associated with stereotypical attributes of people with schizophrenia. METHOD: Students (n = 649) at eight universities in Australia, Belgium, India, Finland, Estonia and Latvia completed a seven-item Social Distance Scale (SDS) and six items related to stereotypical attributes of people with schizophrenia. RESULTS: Mean SDS scores were 19.65 (+/- 3.97) in Australia, 19.61 (+/- 2.92) in Belgium, 18.75 (+/- 3.57) in India, 18.05 (+/- 3.12) in Finland, and 20.90 (+/- 4.04) in Estonia and Latvia. Unpredictability was most strongly associated with having a high social distance in Australia (beta = -1.285), the perception that people will never recover in India (beta = - 0.881), dangerousness in Finland (beta = -1.473) and the perception of being difficult to talk to in Estonia and Latvia (beta = -2.076). Unpredictability was associated with lower social distance in Belgium (beta = 0.839). CONCLUSION: The extent to which students held stigmatizing attitudes was similar in each country, however, the determinants of stigma were different. Pharmacy education may need to be tailored to address the determinants of stigma in each country.

Attitudes of pharmacy students toward people with mental disorders, a six country study.

OBJECTIVE: To compare and contrast the extent to which pharmacy students in Australia, Belgium, Finland, India, Estonia and Latvia hold stigmatising attitudes toward people with schizophrenia and severe depression. METHOD: Data were collected as part of the International Pharmacy Students Health Survey, a census survey of third-year pharmacy students studying at eight universities in six countries. Respondents (n = 642) indicated how strongly they endorsed six stigmatising statements about patients with schizophrenia and severe depression. Coded data were analysed using the Statistical Package for the Social Sciences (Version 14.0). RESULTS: Between 52.5% (95% CI 46.2-58.9%) of students in Australia and 65.1% (95% CI 56.9-73.3) in Finland agreed that people with schizophrenia are a danger to others. Between 30.3% (95% CI 24.5-36.1%) of students in Australia and 60.0% (95% CI 48.5-71.5) in Estonia and Latvia agreed that people with schizophrenia are difficult to talk to. Between 9.8% (95% CI 4.0-15.6%) of students in Belgium and 43.8% (95% CI 35.3-52.3%) in Finland agreed that people with severe depression have themselves to blame. CONCLUSION: Sub-optimal attitudes toward people with schizophrenia and severe depression were common among pharmacy students in all countries. New models of pharmacy education are required to address the attitudes and misconceptions among pharmacy students.

Coronary heart disease complaints against health care personnel in Finland.

This study comprised all complaints submitted from 1980 to 1990 by coronary patients and their relatives to the Finnish National Board of Health (NBH). The purpose of this study was to determine the reasons for complaints and their consequences. The complaints were coded and the material was analysed using the statistical BMDP package. Only 59 of a total of 7,516 complaints dealt with coronary disease. The majority of complaints concerned professional technical competence. The NBH found negligence in ten cases and gave administrative counselling to the professionals at fault. The negligence was not deemed serious enough to warrant any penalties or the restriction of licences. Communication problems were difficult to prove and none of these complaints resulted in counselling. Treatment of coronary heart disease seldom results in a formal complaint and negligence is found only in a minority of cases. Patient dissatisfaction can well be studied by analysing complaints, but the general quality of coronary care has to be addressed with other methods.