Handgrip strength (HGS) and Timed Up and Go (TUG) tests are established measures of physical capacity and widely utilized in geriatric assessments. We aimed to assess their independent and combined association with activity of daily living (ADL) and psychological life satisfaction (LS). Data were analysed from 684 community-dwelling aging women (mean age 81.2 years [SD 2.5]) in the 30-year follow-up (2019) of the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE). Relationships of physical capacity measures (HGS: low < 16 kg vs. normal ≥ 16 kg; TUG: slow ≥ 20 s vs. normal < 20 s; both also analyzed continuously) with ADL and LS were examined using independent-samples t-tests, multiple linear regression and restricted cubic spline models. Combined associations were assessed using a four-level combined HGS–TUG variable. After adjustments, both low HGS and slow TUG were associated with lower ADL scores (HGS: B = -1.97; TUG: B = -2.98; both p < 0.001) and worse LS (HGS: B = 0.69; TUG: B = 0.96; both p < 0.05). Combined physical capacity impairments (i.e. HGS and TUG) showed the largest deficits in ADL (B = -4.09, p < 0.001) and LS (B = 1.42, p < 0.05). Among women in their eighties, reduced HGS and slower TUG were associated with poorer functional independence and subjective well-being, with the largest effect estimates observed when both were impaired. Longitudinal and intervention studies are needed to clarify the direction and clinical relevance of these associations.

BACKGROUND:Initial studies suggest vitamin D (VD) supplementation may aid in treating major depressive disorder, but rigorous randomised controlled trials are needed. TRIAL DESIGN:DepFuD trial was a six-month, double-blinded, parallel-group, randomised controlled superiority design trial with a 1:1 allocation ratio. Outpatients with mild to severe depression episode, aged 18-65 years, were included. METHODS:The primary aim was to compare the effects of low-dose versus high-dose VD as adjunctive to participants' existing depression treatments, hypothesising that the high-dose group would show greater symptom reduction over six months. Participants were randomised to receive either 100 μg (4000 IU) or 10 μg (400 IU) of VD (cholecalciferol) daily for six months. The primary outcome was measured by between-group differential change over six months in the Montgomery-Åsberg Depression Rating Scale (MADRS) score (range: 0-60). Data was collected in Finland between November 2015 and December 2020. RESULTS:A total of 281 participants were randomised: 142 in the low-dose and 139 in the high-dose group. At baseline, 46% of the participants in low-dose and 42% in high-dose group had VD deficiency (<50 nmol/l). Primary outcome data were available for 234 participants (116 in low-dose and 118 in high-dose). The standardised adjusted MADRS mean difference was small and non-significant (Cohen's d = -0.09; 95% CI -0.32 to 0.14). CONCLUSIONS:The six-month trial demonstrated no superior effect of the higher VD supplementation compared to the lower VD supplementation on depressive symptoms. REGISTRATION:ClinicalTrials.gov: NCT02521012. DepFuD was supported by Finnish State Research Funding (VTR).

INTRODUCTION:Although a vast amount of magnetic resonance imaging (MRI) data are collected for health care delivery, generating real-world evidence (RWE) in Alzheimer's disease and related dementias (ADRD) research is substantially limited by lack of methods and results showing how routine MRI scans can be used for ADRD imaging studies. METHODS:We compared three established ADRD biomarkers (total gray matter, hippocampal, and ventricular volumes) in four groups (normal, subjective complaints, mild cognitive impairment [MCI], and dementia) between the general population of women born in 1932-1941 in the Kuopio region of Eastern Finland (population-based Kuopio Osteoporosis Risk Factor and Prevention Study [OSTPRE] cohort, N = 14220) and a well-characterized research cohort (Alzheimer's Disease Neuroimaging Initiative [ADNI]). RESULTS:A total of 2434 brain MRI scans for 1885 women were collected between 2003 and 2022 by the public health care provider covering all residents in the region. The established biomarkers were overall aligned between these cohorts. DISCUSSION:Typical biomarkers extracted from real-world brain MRI scans collected over 20 years are suitable for generating RWE in ADRD research. HIGHLIGHTS:Real-world brain magnetic resonance imaging (MRI) is applicable for generating evidence in Alzheimer's disease and related dementias (ADRD) research. This is the first study comparing a real-world MRI cohort with an established research cohort reference. Provides a methodological framework for real-world evidence (RWE) ADRD studies that utilize routinely collected MRI scans.

INTRODUCTION While a vast amount of MRI data are collected for healthcare delivery, generating real-world evidence (RWE) in Alzheimer’s and related diseases (ADRD) research is substantially limited by lack of methods and results showing how routine MRIs can be used for ADRD imaging studies. METHODS We compared three established ADRD biomarkers (total gray matter, hippocampal and ventricular volumes) in four groups (normal, subjective complaints, mild cognitive impairment, and dementia) between the general population of women born in 1932-1941 in the Kuopio region of eastern Finland (population-based OSTPRE cohort, N=14220) and a well-characterized research cohort (ADNI). RESULTS A total of 2434 brain MRIs for 1885 women were collected between 2003-2022 by the public healthcare provider covering all residents in the region. The established biomarkers were overall aligned between these cohorts. DISCUSSION Typical biomarkers extracted from real-world brain MRI scans collected over 20 years are suitable for generating RWE in ADRD research. Highlights ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research has been supported by grants 346934, 358944 (Flagship of Advanced Mathematics for Sensing Imaging and Modeling) from the Research Council of Finland; grant 351849 from the Research Council of Finland under the frame of ERA PerMed ("Pattern-Cog"): grant 6671 from Ane and Signe Gyllenberg's Foundation; and grant 101132933 from the EU Innovative Health Initiative Joint Undertaking (IHI JU) AD-RIDDLE. Data collection and sharing for this project was funded in part by the Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: AbbVie, Alzheimer's Association; Alzheimer's Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen; Bristol-Myers Squibb Company; CereSpir, Inc.; Cogstate; Eisai Inc.; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICO Ltd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Lumosity; Lundbeck; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Takeda Pharmaceutical Company; and Transition Therapeutics. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of Kuopio University Hospital gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

BACKGROUND:There is developing evidence of excess mortality among people with mental disorders. This protocol presents the methodology to undertake a systematic review to definitively examine the current evidence on the risk of all-cause and cause-specific mortality in people with mental disorders (mood, anxiety, substance use, eating, personality and psychotic disorders) compared with populations without mental disorders in broadly representative studies of general populations worldwide. In addition, we seek to understand whether the excess mortality has increased further over time, and if the COVID-19 pandemic exacerbated the excess mortality in people with mental disorders. METHODS:A systematic review of cohort studies will be conducted. The search strategy to yield peer-reviewed (in Medline Complete, CINAHL Complete, Embase and APA PsycInfo) and published grey literature will be developed in consultation with a liaison librarian. A preliminary scope of peer-reviewed literature in Medline Complete using the EBSCOhost platform was conducted on 20 November 2023. Epidemiological cohort or case-control studies will be eligible if they examine (1) diagnoses of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases classification systems) and (2) risk of all-cause and/or cause-specific mortality. A critical appraisal of the included studies will be undertaken. A synthesis of the findings will include the characteristics of the included studies, critical appraisal and a summary of the key findings in texts and visually in tables. Where appropriate, meta-analyses and subgroup analyses will be performed. ETHICS AND DISSEMINATION:This study is exempt from ethics approval, as it does not include identifiable human data. The outcomes of the proposed review will be shared in national/international conferences, published in a peer-reviewed journal and disseminated to new and existing networks. PROSPERO REGISTRATION NUMBER:CRD42023477494.

Polypharmacy has previously been found to increase and exercise interventions to reduce the risk of falls and fall-related injuries. In this study, women who had four or more regular medications benefitted the most from the exercise intervention and had the lowest fall risk compared to the reference group. Fall injuries among older people cause significant health problems with high societal costs. Previously, some exercise interventions have been found to reduce the number of falls and related injuries. We studied how different levels of medication use affect the outcome of an exercise intervention in terms of preventing falls. This exercise RCT involved 914 women born in 1932–1945 and randomly assigned to the intervention (n = 457) and control (n = 457) groups. Both groups participated in functional tests three times during the study. Baseline self-reported prescription drug use was trichotomized: 0–1, 2–3, and ≥ 4 drugs/day (i.e. polypharmacy group). We used Poisson regression for follow-up fall risk and Kaplan-Meier survival analysis for fractures. During follow-up, 1380 falls were reported, 739 (53.6%) resulting in an injury and pain and 63 (4.6%) in a fracture. Women with polypharmacy in the intervention group had the lowest fall risk (IRR 0.713, 95% CI 0.586–0.866, p = 0.001) compared to the reference group that used 0–1 medications and did not receive the intervention. Overall, the number of medications associated with the fall incidence was only seen in the intervention group. However, the number of medications was not associated with fractures in either of the groups. Weaker functional test results were associated with polypharmacy in the control group. The most prominent decrease in fall risk with exercise intervention was seen among women with polypharmacy. Targeting these women might enhance fall prevention efficacy among the aging population. Trial Registration: The study has been registered in ClinicalTrials.gov. Trial registration number NCT02665169. Register date 27/01/2016.

Introduction Sense of coherence (SOC) refers to the psychosocial aspects and origins of health. Sense of coherence is related to physical and psychological health and quality of life. Military studies on SOC are commonly related to military deployment or operations, military training, and military fitness. Sense of coherence is assessed using a self-report scale. The total score of the scale indicates the level of SOC. Psychometric research studies over 2 past decades, however, suggest that the SOC scale is a multidimensional measure, and the latent factors should be considered as separate dimensions of SOC. Thus far, there are no previous factorial structure studies of the SOC scale in military contexts or in military populations. The dimensions of SOC have not been investigated in relation to mental health and subjective well-being of soldiers, military personnel, or military recruits/conscripts.Materials and Methods This study examined the structure of the self-report SOC scale among 2614 military conscripts at military call-up (before obligatory military service) in Northern Finland. Confirmatory factor analysis was used to test 4 different structure models based on previous studies of the SOC scale (1-, 2-, or 3-factor models). The dimensions of SOC were investigated in relation to conscripts' self-reported past and/or present mental health problems. Demographic variables were explored. Nonparametric tests for group and pairwise analyses were used.Results The 11-item 2-factor model fitted the data best. The 2-factor structure represented the cognitive behavioral (comprehensibility and manageability) and motivational (meaningfulness) dimensions of SOC. The motivational dimension was higher among conscripts who reported past but no present mental health problems as compared to conscripts who reported past and present mental health problems. A similar difference was not found in the cognitive behavioral dimension. Both cognitive behavioral and motivational dimensions of SOC were higher among conscripts who reported not having past or present mental health problems.Conclusions SOC among conscripts is a 2-dimensional model. The experience of recovery from past mental health problems is related to a stronger motivational dimension (meaningfulness towards life), which shows upon obligatory military service and training. Sense of coherence motivational aspect may be useful when training recruits. Demographic variables, such as economic situation, family structure, and parents' employment, should be considered when assessing past and/or present mental health problems and SOC.

PURPOSE:Studies on the association of self-reported depressive and anxiety symptoms with release from compulsory military service at the military call-up and with social-communicative difficulties are scarce. MATERIALS AND METHODS:This study is a part of population-based cross-sectional 'Young Men in the North' project (N = 2614 men, mean age 18.1). The Finnish Defence Forces arranges compulsory military call-ups for all Finnish 18-year-old male citizens, where our study subjects and filled out questionnaire including Raitasalo's modification of the Short Form of Beck Depression Inventory (R-BDI) and Generalized Anxiety Disorder 7-item scale (GAD-7), and three questions on social-communicative difficulties based on the DSM-5 diagnostic criteria. Young men's fitness for military service (fit, permanent or temporary release) was obtained from the call-up board. RESULTS:Self-reported depressive symptoms were associated with permanent (OR = 6.6; 95% CI 3.88-11.20) and temporary (OR = 9.2; 95% CI 5.59-15.04) release from military service. These odds ratios for anxiety symptoms were 3.1 (95% CI 2.11-4.64) and 4.1 (95% CI 2.80-5.94). Depressive (OR = 5.7; 95% CI 3.88-11.20) and anxiety symptoms (OR = 3.2; 95% CI 2.47-4.17) were associated with self-reported social-communicative difficulties. CONCLUSIONS:Self-reported depressive and anxiety symptoms were associated with release from service as well as with social-communicative difficulties in young men. The early-onset mental health problems in young men seem to manifest at call-up as being unfit for the military service. Screening symptoms of depression and anxiety with self-reported scales defined those with mild, moderate or severe symptoms at risk for release from service.

Sarcopenia leads to a decrease in muscle mass, strength and physical performance. Dietary fibre and its exogenous biomarker acetate may be linked to measures of sarcopenia. Thus, we explored the relationships of dietary (soluble/insoluble) fibre and serum acetate with skeletal muscle health and body composition in women aged > 65 years. In this cross-sectional Osteoporosis Risk Factor and Prevention-Fracture Prevention Study (OSTPRE-FPS) study, we analysed with linear regression the associations of dietary fibre and serum acetate (measured by nuclear magnetic resonance spectroscopy) with measures of sarcopenia such as body mass index (BMI), total lean mass, fat mass, appendicular skeletal muscle index, gait speed, grip strength, chair stand test, leg extension strength and grip strength-to-BMI ratio. In model 3, adjusted for energy and protein intake, age, hormonal therapy, type 2 diabetes, physical activity and smoking, a negative association between dietary soluble fibre and BMI (β = −0.113, p  = 0.04) and a positive association between serum acetate concentrations and grip strength-to-BMI ratio (β = 0.093, p  = 0.04) were detected. Dietary fibre and serum acetate as a combined independent variable were linked with both BMI (β = −0.101, p  = 0.04) and grip strength-to-BMI ratio (β = 0.136, p  < 0.01). BMI was more strongly influenced by soluble fibre (β = −0.107, p  = 0.03), whereas grip strength-to-BMI ratio predominantly by insoluble fibre (β = 0.138, p  < 0.01). Future longitudinal studies are warranted to explore links between dietary fibre intake and serum or muscle acetate with muscle health in older adults.

INTRODUCTION:Several psychiatric disorders and medications used to treat them appear to be independently associated with skeletal deficits. As there is increasing evidence that lithium possesses skeletal protective properties, we aimed to investigate the association between lithium use and bone health in a group of women with bipolar disorder. METHOD:Women with bipolar disorder (n = 117, 20+ years) were recruited from south-eastern Australia. Bipolar disorder was confirmed using a clinical interview (SCID-I/NP). Bone mineral density (BMD; g/cm2 ) was measured at the spine, hip and total body using dual-energy x-ray absorptiometry and low bone mass determined by BMD T-score of <-1.0. Weight and height were measured, socioeconomic status (SES) determined and information on medication use and lifestyle factors self-reported. Linear and logistic regression were used to test associations between lithium and (i) BMD and (ii) low bone mass, respectively. RESULTS:Thirty-five (29.9%) women reported current lithium use. Lithium users and non-users differed in regard to SES and BMD; otherwise, groups were similar. After adjustments, mean BMD among lithium users was 5.1% greater at the spine (1.275 [95% CI 1.229-1.321] vs. 1.214 [1.183-1.244] g/cm2 , p = 0.03), 4.2% greater at the total hip (0.979 [0.942-1.016] vs. 0.938 [0.910-0.966] g/cm2 , p = 0.03) and 2.2% greater at the total body (1.176 [1.148-1.205] vs. 1.150 [1.129-1.171] g/cm2 , p = 0.08) compared to participants not receiving lithium. Lithium users were also less likely to have low bone mass (22.9% vs. 43.9%, p = 0.031). Associations persisted after adjustment for confounders. CONCLUSION:These data suggest lithium is associated with greater BMD and reduced risk of low bone mass in women with bipolar disorder. Research into the underlying mechanisms is warranted.

A self-report four-item Brief Resilient Coping Scale (BRCS) measures tendencies to cope with stress in a highly adaptive manner. We investigated the level of resilient coping and the psychometric properties of the BRCS among young men participating military call-up. The study sample consisted of a one-year military call-up sample (N = 2184) in the Northern Finland. Most of the participants were at the age of 17–18 years. They completed a study questionnaire including the BRCS and other psychosocial scales during the military call-up. The construct validity of the BRCS was assessed with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent and discriminant validity were assessed by relating resilient coping with self-reports of dispositional optimism (LOT-R), sense of coherence (SOC-13), perceived stress (PSS-10), general anxiety (GAD-7), and depression (R-BDI). The mean BRCS total score of the participants indicated good resilient coping and was related to specific sociodemographic factors, such as education, relationship status and family structure. The internal consistency of the BRCS was good. EFA and CFA showed that one-factor solution fitted to the data best. BRCS correlated positively with dispositional optimism and sense of coherence, and negatively with perceived stress, general anxiety, and depression. BRCS appears to be psychometrically adequate tool in assessing healthy young men's resilient coping before commencing their compulsory conscript service. The evaluation of resilient coping prior to military service is important to military forces.

Our aim was to evaluate whether alcohol use is associated with changes in the circulating metabolite profile similar to those present in persons with depression. If so, these findings could partially explain the link between alcohol use and depression. We applied a targeted liquid chromatography mass spectrometry method to evaluate correlates between concentrations of 86 circulating metabolites and self-reported alcohol use in a cohort of the non-depressed general population (GP) (n = 247) and a cohort of individuals with major depressive disorder (MDD) (n = 99). Alcohol use was associated with alterations in circulating concentrations of metabolites in both cohorts. Our main finding was that self-reported alcohol use was negatively correlated with serum concentrations of hippuric acid in the GP cohort. In the GP cohort, consumption of six or more doses per week was associated with low hippuric acid concentrations, similar to those observed in the MDD cohort, but in these individuals it was regardless of their level of alcohol use. Reduced serum concentrations of hippuric acid suggest that already moderate alcohol use is associated with depression-like changes in the serum levels of metabolites associated with gut microbiota and liver function; this may be one possible molecular level link between alcohol use and depression.

IntroductionWe conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs) in population-based studies, since these disorders are leading causes of disease burden worldwide.MethodsA search strategy of published, peer-reviewed and gray literature was developed in consultation with a liaison librarian and implemented for Embase, CINAHL Complete, Medline Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present and CORDIS and ProQuest Dissertations & Theses Global, respectively. The inclusion criteria were as follows: I) general population participants aged ≥15 years; II) self-report, probable PD based on positive screen, or threshold PD according to the DSM-IV/5 (groupings: any, Clusters A/B/C, specific PD) or ICD-10/11; III) MSDs identified by self-report or ICD criteria (arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis) and III) cohort, case-control, and cross-sectional study designs. Two reviewers independently screened articles and extracted the data. Critical appraisal was undertaken using the Joanna Briggs Institute checklists for systematic reviews of etiology and risk. A descriptive synthesis presents the characteristics of included studies, critical appraisal results, and descriptions of the main findings. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.ResultsThere were 11 peer-reviewed, published articles included in this review (n = 9 cross-sectional and n = 2 case-control studies); participants were ≥18 years in these studies. No published gray literature was identified. Semi-structured interviews were the most common method to ascertain PDs; all studies utilized self-reported measures to identify MSDs. Overall, we detected limited and conflicting evidence for associations between PDs and MSDs.DiscussionThe main result may be explained by lack of population-based longitudinal evidence, heterogenous groupings of PD, and few comparable cross-sectional and case-control studies. Strengths of the review include a comprehensive search strategy and a discussion of mechanisms underlying possible associations between PDs and MSDs.ConclusionsThe quality of most studies included in this review that examined associations between PD and MSDs in general population adults was high. However, the results demonstrated limited and conflicting evidence for these associations, in part, due to lack of comparable evidence, which should be addressed in future research.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021243094.

Background Previous follow-up studies have demonstrated the association between good health behavior and good sexual functioning for men, but the longitudinal relationship between multiple health behaviors and satisfaction with sex life remains understudied.Aim The aim of the study was to explore whether good health behavior associates with improved satisfaction with sex life for men and women in a follow-up of 9 years.Methods This cohort study utilized survey data from the population-based Health and Social Support study. It includes responses from 10 671 working-aged Finns. Using linear regression models, we examined a composite sum score representing 4 health behaviors (range, 0-4) in 2003 as a predictor of satisfaction with sex life in 2012. The analyses adjusted for various covariates in 2003, including satisfaction with sex life, living status, age, gender, education, number of diseases, and importance of sex life in 2012.Outcomes The outcome in the study was satisfaction with sex life in the year 2012.Results Participants who exhibited better health behavior at baseline demonstrated improved satisfaction with sex life when compared with those with poorer health behavior (beta = -0.046, P = .009), even when controlling for the aforementioned covariates. The positive effect of reporting all beneficial health behaviors vs none of them was greater than having none vs 3 chronic conditions. Furthermore, this was almost half the effect of how satisfaction with sex life in 2003 predicted its level in 2012. These findings were supported by an analysis of the congruence of health behavior in the observation period from 2003 to 2012 predicting changes in satisfaction with sex life.Clinical Implications The results could serve as a motivator for a healthy lifestyle.Strengths and Limitations The current study used a longitudinal large sample and a consistent survey procedure, and it explored the personal experience of satisfaction instead of sexual function. However, the study is limited in representing today's diversity of gender, since the options for gender at the time of survey were only male and female.Conclusion These findings indicate that engaging in healthy behaviors contributes to the maintenance and enhancement of satisfaction with sex life over time.

BackgroundAdherence to exercise is crucial for promoting health and maintaining functioning.AimsTo investigate predictors of adherence to exercise in the initially free supervised fall prevention RCT and its low-cost, self-sustained continuation among elderly women.MethodsIn the 2-year Kuopio Fall Prevention Study RCT, 457 women (aged 71-84) were offered a free initial 6-month supervised weekly training program (gym, Tai Chi) in the municipal facilities. Women's adherence during this period was categorized into high (≥80 %) and low (<80 %). In the next six months, their free access to the premises continued without supervision. For the second year, low-cost access was offered with unsupervised independent training in these facilities. The second-year adherence was based on purchasing(yes/no) a gym card to continue exercising. Information on baseline health, functioning, and lifestyle was obtained by mailed questionnaires and physical tests.ResultsFor the first six months, over 60% of the women had high adherence. Only 26% continued into the second year. For both follow-up years, active training history was related to better adherence. Initial predictors were related to mental health i.e. having less often fear of falls limiting one’s mobility, ability to cope with external, not internal hostility, and being in a loving relationship. In the second year, predictors were related to younger age, having less frequent fear of falls, better functional capacity i.e. better strengths (grip and leg extension) and faster Timed “Up and Go” -test.ConclusionBetter mental and physical health, better functional capacity and active training background were associated with higher adherence to exercise intervention in older women.

Promising initial studies on vitamin D (VD) supplementation as an adjunct treatment for major depressive disorder (MDD) require rigorously designed randomized controlled trials (RCTs). We aim to investigate the effects of augmenting standard MDD treatment with VD supplementation and examine factors influencing the treatment outcome. This article describes the study design, measures, and baseline characteristics. This multicenter RCT compares the efficacy of a six-month VD intervention at 100 micrograms/day versus 10 micrograms/day (mu g/day) (4000 IU (international units)/day vs. 400 IU/day) added to a standard treatment in outpatients aged 20-61 years with MDD. The primary outcome is change in the Montgomery-& Aring;sberg Depression Rating Scale (MADRS) score. Secondary outcomes are other indicators of mental health and functionality (BDI, SOC, 15-D, PSS10, LS-4, LOT-R, YSQ-S2-extended, CORE-OM, TAS-20, BRCS, TADS, SCL-90, DIAD, GAF), and circulating biomarkers. Intervention assessments are conducted at baseline, 3, and 6 months, and follow-ups at 18 months and 6 years post-baseline. The baseline sample had 319 subjects (74% women; median age 31 (inter-quartile range (IQR) 15), mean MADRS score 21.38 (SD 6.04)), with 281 assigned to the RCT. At present, the study continues as a follow-up study. DepFuD project will provide extensive information regarding the potential benefits of VD and enables to identify various biopsychosocial depression-associated risk factors.

Prolonged pause duration in speech is a typical phenomenon of schizophrenia. Despite this, however, studies have not previously focused on prolonged pause in clinical diagnostic interviews, nor has there been any consideration of whether silences occur within turns or in turn-transitions. The present study is based on videotaped semi-structured clinical diagnostic interviews with three persons with schizophrenia. We measured duration of silence or overlap in every turn-transition using Praat software. The participants differed considerably from each other. All of them seemed to display more delays in responding to manual-based questions taken from the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and to questions concerning supra-categories and proverbs. Qualitative analysis of the interview with the most dysfluent participant showed that topic-shifting and new-sequence-beginning questions caused more prolonged latencies than sequence-continuing questions. Moreover, questions that required more detailed description or reflection of psychotic experiences seemed to be problematic. We observed that the doctor adapted his tempo to the participant’s fluency. In addition, the doctor often produced expansions or tag questions when he noticed that the participant had difficulties in responding without a latency. Based on the measures and findings of the qualitative analyses, we presume that both individual psychopathology and contextual factors affect turn-transitional response patterns.

There is growing evidence of the comorbidity between personality disorder (PD) and musculoskeletal disorders (MSDs). However, there are no systematic reviews including critical appraisal and meta-analyses that identify, evaluate, and synthesize the available evidence on these associations. Therefore, we present here a protocol of the methodology to undertake a systematic review, with the objective to evaluate associations between PD and MSDs in epidemiological population-based studies. A systematic review of observational studies will be conducted. A complete search strategy will be developed in consultation with a health librarian. To identify peer-reviewed literature, the search will be translated for, and implemented in Medline Complete, CINAHL Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present. Gray literature will be identified. Studies will be eligible if they examine general population participants aged 15 years and over. Associations of interest are the presence of threshold or positive screen according to the DSM-V/5 (groupings: any, Clusters A, B, C, specific PD) or ICD-10 for PD in relation to arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis, and/or "any" of these MSDs. Data extraction and critical appraisal will be conducted in line with the Joanna Briggs Institute (JBI) guidance for systematic reviews of etiology and risk. The results from all studies will be presented in tables, text, and figures. A descriptive synthesis will present the characteristics of included studies, critical appraisal results, and descriptions of the main findings. Where appropriate, meta-analyses will be performed. If heterogeneity (e.g., I2 = 50%) is detected, subgroup/sensitivity analysis may be used to explore the possible sources. The systematic review does not require ethics approval. The proposed systematic review will strengthen the evidence base on what is known regarding associations between PD and MSDs by identifying, evaluating, and synthesizing the findings of existing observational studies including meta-analyses, where appropriate.

Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients' psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient's psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004-2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients' adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients' adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients.