Challenges in recruiting older twins for the Sri Lankan twin registry

Conceptual framework for establishing twins prevention and continuous health promotion programme: a qualitative study

BACKGROUND

Twin registries and cohorts face numerous challenges, including significant resource allocation, twins' recruitment and retention. This study aimed to assess expert feedback on a proposed pragmatic idea for launching a continuous health promotion and prevention programme (HPPP) to establish and maintain twin cohorts.

DESIGN

A qualitative study incorporating an inductive thematic analysis.

SETTING

Tehran University of Medical Sciences.

PARTICIPANTS

Researchers with expertise in twin studies participated in our study.

ANALYSIS AND DESIGN

Expert opinions were gathered through focus group discussions (FGDs). Thematic analysis was employed to analyse the findings and develop a model for designing a comprehensive, long-term health promotion programme using ATLAS.ti software. Additionally, a standardised framework was developed to represent the conceptual model of the twin HPPP.

RESULTS

Eight FGDs were conducted, involving 16 experts. Thematic analysis identified eight themes and seven subthemes that encompassed the critical aspects of a continuous monitoring programme for twin health. Based on these identified themes, a conceptual framework was developed for the implementation of an HPPP tailored for twins.

CONCLUSION

This study presented the initial endeavour to establish a comprehensive and practical solution in the form of a continuous HPPP designed to tackle the obstacles of twins' cohorts.

The Sri Lankan Twin Registry: 2012 update

The Sri Lankan Twin Registry (SLTR), established in 1997, is a unique resource for twin and genetic research in a low- and middle-income country (LMIC). It comprises of a volunteer cohort of 14,120 twins (7,060 pairs) and 119 sets of triplets, and a population-based cohort of 19,040 (9,520 pairs) twins and 89 sets of triplets. Several studies have been conducted using this registry, including the Colombo Twin and Singleton Study (CoTaSS 1; 4,387 twins, 2,311 singletons), which have explored the prevalence and heritability of a range of psychiatric disorders as well as gene-environmental interplay. Currently, a follow-up study (CoTaSS 2) of the same cohort is underway, looking at the prevalence and interrelationship of key cardiovascular and metabolic risk markers (e.g., metabolic syndrome). A significant feature of CoTaSS 2 is the establishment of a biobank. Current SLTR work is extending beyond mental health and the interface between mental and physical health to new horizons, extending collaborations with the wider global twin research community. Ethics and governance have been given special emphasis in the initiative. Capacity building and public engagement are two crucial components. Establishment of a state-of-the-art genetic laboratory was a major accomplishment. SLTR is a classic showcase of successful North-South partnership in building a progressive research infrastructure in a LMIC.

Colombo Twin and Singleton Study (CoTASS): a description of a population based twin study of mental disorders in Sri Lanka

BACKGROUND

The Sri Lankan twin registry is one of the first to be established in a developing country, and its design has ensured sampling from a wide range of environmental conditions. It thus has great potential to examine environmental and genetic influences on diverse phenotypes, including psychiatric disorders, in the context of a diversity of environmental exposures, which may not have been fully explored in previous twin studies in developed countries. This paper presents the rationale for the study, describes its context, and the methods for twin ascertainment and data collection.

METHODS

A population-based twin register was established in the Colombo district of Sri Lanka using infrastructure designed to periodically update the electoral register. We invited a subsample from this register to participate in the project on common mental disorders, using random ascertainment. A separate non-twin sample was randomly selected from the geographical areas where twins were found. Home interviewers collected diagnostic information on common mental disorders, as well as environmental exposures including life events, socio-economic conditions, and the impact of the civil war and the Tsunami of 2004.

RESULTS

We identified 19,302 individuals in the creation of the population based twin register. We randomly selected a subsample, of whom 4,387 were eligible to participate and 4,024 agreed to be interviewed (including data on 1,954 complete pairs of twins and 5 sets of triplets). Those who refused consent had a similar mean age and sex ratio to those who were interviewed. We invited 2,485 singletons to participate and 2,019 were interviewed.

CONCLUSION

Initial exploration of the data suggests the samples are very representative of the Colombo district of Sri Lanka, so we have created a unique resource for understanding the influences on mental disorders in developing countries, and to compare to the influences found in developed countries.

Update from Sri Lankan Twin Registry: establishment of a population-based twin register and ongoing project on common mental disorders, alcohol abuse and suicidal ideations

The Sri Lankan Twin Registry began as a volunteer register in 1997. Previously, we have shown door-to-door surveys as the best option to build a population-based twin register of older, adult twins. Our aim was to build a population-based twin register in the Colombo district and use it for twin studies on common mental disorders. We aimed to identify a random sample of 4000 twins ascertained through the twin census. The Colombo district is divided into 13 divisional secretariat divisions (DSDs) and each division is further divided into Grama Niladari divisions administratively. Grama niladaris (GNs) are civil servants and visit each household in order to update the electoral register. GNs were used to do a census of twins while they updated the electoral register. The correlation between population density and twin rate among DSDs was .81, and between twin rate and the percentage of returned forms (from each DSD) was .74. We received 9648 forms notifying about twins and multiples. After removing the duplicates and information about twins who live in other districts, there were 17,406 multiples remaining. After incorporating twins and multiples from various other feasibility studies we now have 19,040 multiples with 8.46 twins per 1000 people in the Colombo district.

Revisiting "freely given informed consent" in relation to the developing world: role of an ombudsman

BACKGROUND

Establishment of Sri Lankan Twin Registry demanded development of ethical guidelines, as an effective ethical framework was not available in Sri Lanka.

DESIGN

Objectives were to find out whether the ombudsman concept exists in current informed consent practices and to investigate opinion about ombudsmen. We searched Pub Med, conducted a postal survey, and monitored Internet discussion.

RESULTS

The responses were categorized into current practices and existing models in informed consent process, reservations expressed about current practices, arguments supporting the concept, concerns and issues, alternatives, and how to implement the proposal. The concept of a third person is not entirely novel. How to find a truly independent person, the financial implication, confidentiality, obligations, and liabilities of ombudsmen, also emerged.

CONCLUSIONS

The concept of an ombudsman is conceptually and ethically sound and acceptable but the challenges posed by this very same solution to creating a better process of informed consent will have to be faced.

Capacity building through multi-disciplinary research: a report from Sri Lanka

Sri Lanka is an island situated close to the southern tip of the Indian subcontinent with a land area of about 65 000 km2. The population in 2001 was 18.5 million. It has an interesting genetic diversity, its five main populations revealing both European and Asian origins. Although Sri Lanka is a developing country, it has strengths that other developing countries do not have, mainly in health and education. However, Sri Lanka lacks a research culture and has inadequacies in its research capabilities; hence, capacity building is essential. Based on our research findings, we plan to achieve this by working with professionals, statutory services, policy-makers and the public. Our model is international collaboration based on our own research agenda. Such partnerships can produce high-quality research, with greater influence on national policy and practice (Costello & Zumla, 2000).