"Activity Matters was great - I now realize: if I move, I'm fitter.": development and process evaluation of a web-based program for persons with multiple sclerosis.

PURPOSE: Research shows that persons with mild to moderate multiple sclerosis are less physically active than healthy controls even though they would benefit from it. This study focusses on the feasibility testing and process evaluation of the pilot study of Activity Matters, a twelve-week web-based program, from Ireland, to increase physical activity in this population. MATERIALS AND METHODS: The intervention was adapted to local circumstances in Hamburg, Germany and consists of eleven modules incorporating behavior change techniques. After feasibility had been confirmed, 43 persons with multiple sclerosis participated in a pilot study with a pre-post, single-group intervention design. Qualitative data was collected with questionnaires and semi structured interviews. Physical activity level and stage of change was measured quantitatively. RESULTS: Participants had a mean age of 49.5 years (SD 9.29) and an average Patient Determined Disease Step Score of 2.2 (SD 1.47). Thirty-six participants answered the follow-up questionnaire. On average 9.8 modules were processed within 13 weeks. Each tool for behavior change was perceived as helpful except the chat group. Physical activity levels increased significantly from pre- to post intervention (p-value 0.042, Cohen's d = 0.35). CONCLUSIONS: The results indicate that Activity Matters is feasible and satisfactory and may change activity levels.

Activity Matters provides a twelve-week web-based self-management program to increase PA which is feasible and well accepted by middle aged, mild to moderately impaired persons with MS.Persons with MS in this online program were pleased with the overall content and the self-regulation strategies, however some were seeking for more personal contact and interaction with the study team and other participants.Stronger individualisation of web-based programs to the diverse needs of participants remains a challenge that has to be solved in the future.

Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study.

OBJECTIVE: The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). METHODS: ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. RESULTS: In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). CONCLUSIONS: EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.

Effectiveness of one-to-one peer support for patients with severe mental illness - a randomised controlled trial.

BACKGROUND: One-to-one peer support is a resource-oriented approach for patients with severe mental illness. Existing trials provided inconsistent results and commonly have methodological shortcomings, such as poor training and role definition of peer supporters, small sample sizes, and lack of blinded outcome assessments. METHODS: This is a randomised controlled trial comparing one-to-one peer support with treatment as usual. Eligible were patients with severe mental illnesses: psychosis, major depression, bipolar disorder or borderline personality disorder of more than two years' duration. A total of 216 patients were recruited through in- and out-patient services from four hospitals in Hamburg, Germany, with 114 allocated to the intervention group and 102 to the control group. The intervention was one-to-one peer support, delivered by trained peers and according to a defined role specification, in addition to treatment as usual over the course of six months, as compared to treatment as usual alone. Primary outcome was self-efficacy measured on the General Self-Efficacy Scale at six-month follow-up. Secondary outcomes included quality of life, social functioning, and hospitalisations. RESULTS: Patients in the intervention group had significantly higher scores of self-efficacy at the six-month follow-up. There were no statistically significant differences on secondary outcomes in the intention to treat analyses. CONCLUSIONS: The findings suggest that one-to-one peer support delivered by trained peer supporters can improve self-efficacy of patients with severe mental disorders over a one-year period. One-to-one peer support may be regarded as an effective intervention. Future research should explore the impact of improved self-efficacy on clinical and social outcomes.

The relationship between biogenetic attributions and desire for social distance from persons with schizophrenia and major depression revisited.

AIMS: Previous population-based studies did not support the view that biological and genetic causal models help increase social acceptance of people with mental illness. However, practically all these studies used un-labelled vignettes depicting symptoms of the disorders of interest. Thus, in these studies the public's reactions to pathological behaviour had been assessed rather than reactions to psychiatric disorders that had explicitly been labelled as such. The question arises as to whether results would have been similar if respondents had been confronted with vignettes with explicit mention of the respective diagnosis. METHODS: Analyses are based on data of a telephone survey in two German metropolises conducted in 2011. Case-vignettes with typical symptoms suggestive of depression or schizophrenia were presented to the respondents. After presentation of the vignette respondents were informed about the diagnosis. RESULTS: We found a statistically significant association of the endorsement of brain disease as a cause with greater desire for social distance from persons with schizophrenia. In major depression, this relation was absent. With both disorders, there was no statistically significant association between the endorsement of hereditary factors as a cause and social distance. CONCLUSIONS: Irrespective of whether unlabelled or labelled vignettes are employed, the ascription to biological or genetic causes seems not to be associated with a reduction of the public's desire for social distance from people with schizophrenia or depression. Our results corroborate the notion that promulgating biological and genetic causal models may not help decrease the stigma surrounding these illnesses.

[Health and competence: detection and decoding using comprehensive assessments in the Longitudinal Urban Cohort Ageing Study (LUCAS)]. / Grauzonen von Gesundheit und Handlungsfähigkeit: Erfassung und Aufschlüsselung durch erweiterte Assessments in der Longitudinalen Urbanen Cohorten-Alters-Studie (LUCAS).

PURPOSE: The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits. METHODS: After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered. RESULTS: Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness). CONCLUSION: Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.