Noora Hirvonen

A Systematic Review and Meta-Analysis of Recovery in Schizophrenia

OBJECTIVE Our primary aims were (a) to identify the proportion of individuals with schizophrenia and related psychoses who met recovery criteria based on both clinical and social domains and (b) to examine if recovery was associated with factors such as gender, economic index of sites, and selected design features of the study. We also examined if the proportions who met our definition of recovery had changed over time. METHOD A comprehensive search strategy was used to identify potential studies, and data were extracted for those that met inclusion criteria. The proportion who met our recovery criteria (improvements in both clinical and social domains and evidence that improvements in at least 1 of these 2 domains had persisted for at least 2 years) was extracted from each study. Meta-regression techniques were used to explore the association between the recovery proportions and the selected variables. RESULTS We identified 50 studies with data suitable for inclusion. The median proportion (25%-75% quantiles) who met our recovery criteria was 13.5% (8.1%-20.0%). Studies from sites in countries with poorer economic status had higher recovery proportions. However, there were no statistically significant differences when the estimates were stratified according to sex, midpoint of intake period, strictness of the diagnostic criteria, duration of follow-up, or other design features. CONCLUSIONS Based on the best available data, approximately, 1 in 7 individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased.

Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis

BACKGROUND Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear. AIMS To analyse the associations between DUP and long-term outcomes of schizophrenia. METHOD A systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results. RESULTS We identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment. CONCLUSIONS The small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.

Family history of psychosis and social, occupational and global outcome in schizophrenia: a meta-analysis.

We aimed to investigate associations between family history of psychosis and long‐term occupational, social and global (i.e. combined occupational, social and clinical) outcome in schizophrenia.

Information behavior in stages of exercise behavior change

This study augments the transtheoretical model (TTM) of behavior change with the concepts of information behavior and employs this framework to understand young mens needs for and practices of obtaining and avoiding information on physical activity and exercise in relation to their readiness to change exercise behavior. The results, based on statistical analyses of a population-based survey (N = 616) conducted in Finland, indicate that health information behavior is influenced by an individual′s stage of change in the context of physical activity and exercise. In pre-action stages (precontemplation, contemplation, preparation) where individuals do not exercise regularly and are uninformed or lack motivation, commitment, or skills to change behaviors, information is most often encountered through the passive practice of nondirected monitoring. In the action stage, where individuals have recently changed their exercise behaviors, information is obtained most frequently by active seeking. In the maintenance stage, where individuals maintain earlier adopted behaviors, information is habitually obtained through active scanning. These results support the TTM in its postulation that individuals may benefit from stage-tailored health-communication strategies. The limitations of this study include self-reported behaviors, cross-sectional study design, and a possibly biased sample. Further research is needed to explore the role of information behavior in the process of behavior change in greater detail.

Long-term antipsychotic use and brain changes in schizophrenia – a systematic review and meta-analysis

The association between long‐term antipsychotic treatment and changes in brain structure in schizophrenia is unclear. Our aim was to conduct a systematic review and a meta‐analysis on long‐term antipsychotic effects on brain structures in schizophrenia focusing on studies with at least 2 years of follow‐up between MRI scans.

Everyday health information literacy among young men compared with adults with high risk for metabolic syndrome - a cross-sectional population-based study

This cross-sectional population-based study aims at identifying differences in the aspects of everyday health information literacy among young healthy men and adults with an increased risk for metabolic syndrome. Data were collected with a self-assessment-based 10-item screening tool administered at the Finnish Defence Force’s call-ups (n=2507, response rate 59%) and at health intervention study (n=571, response rate 98%). Adults with increased risk for metabolic syndrome seemed to value health information but had more difficulty in knowing who to believe in health issues and understanding the terminology used. The difficulties applied especially to respondents 35 years old or over. Men, and especially young men, had lower motivation than women to seek health information. Although the results are indicative, the everyday health information literacy screening tool seems to be useful in revealing areas that health communication should be focused on among different populations.

Effect of tailored, gamified, mobile physical activity intervention on life satisfaction and self-rated health in young adolescent men

BackgroundOnline behavior-change programs may increase physical activity in adolescents, but their effects on subjective health and wellbeing are not well known. PurposeWe investigated the effects of a mobile physical activity intervention on life satisfaction and self-rated health among young adolescent men. MethodsIn this population-based study, 496 men (17.8y, SD 0.6y) participated in a 6-month trial. They were randomized into an intervention (n=250) and a control group (n=246). Only the intervention group had access to a tailored mobile service. Life satisfaction and self-rated health were inquired about at baseline and at the end of the trial. ResultsLife satisfaction improved in the intervention (p<0.001) and control group (p=0.01). Life satisfaction was most likely to improve among men with low baseline satisfaction (OR 13.8; 95% CI 3.751.8) and mood-related exercise motive (2.5 (1.15.6)). There were no statistically significant changes in self-rated health, but those who reported poor health at baseline (OR 9.6; 95% CI 3.724.9) and improved self-rated fitness during the trial (4.2 (1.511.9)) were more likely to gain improvements in self-rated health. ConclusionIn this mobile physical activity intervention, improvements in self-rated health and life satisfaction were associated with low life satisfaction and poor self-rated health at baseline within the intervention group. Trial registrationThis randomized controlled trial is registered to the clinical trials register NCT01376986. A population-based, large sample size and a randomized controlled design.Effectiveness of a novel intervention on subjective wellbeing among adolescent men.Life satisfaction increased similarly regardless of the group allocation.Low baseline subjective wellbeing was associated with positive changes.

Individual factors affecting preferences for feedback message tactics in the contexts of physical activity.

Tailored feedback on personal physical activity behavior has been used to inform individuals and promote physical activity among different populations. This study aimed to increase the understanding of factors associated with young mens preferences for feedback message tactics in the context of physical activity and exercise. How preferences vary was analyzed in terms of the self-reported physical activity, stage of exercise behavior change, exercise self-efficacy, objectively measured physical health status, and sociodemographic characteristics of young Finnish men. Population-based survey data, including physiological measurements (n = 525), were collected at the Finnish Defence Forces’ call-ups in the city of Oulu, Finland, in September 2011. The results indicate that the stage of exercise behavior change, exercise self-efficacy, physical health status, and educational level are associated with a preference for normative and ipsative comparison. Multivariate logistic regression models show that an advanced stage of exercise behavior change and education in the academic track of an upper secondary school are independent predictors of preferring ipsative and normative physical activity feedback among young men. The study provides new insights into how the stage of behavior change influences health information behavior and is in line with studies emphasizing social factors—including education—as being important in shaping health-related behavior. These factors could form the basis for tailoring information when designing health promotion.

Health information literacy and stage of change in relation to physical activity information seeking and avoidance: a population-based study among young men

In this study we investigate young mens seeking and avoidance of physical activity and exercise information. Stage of exercise behavior change as identified in the Transtheoretical Model and everyday health information literacy are studied in relation to these actions. The data were collected with a questionnaire survey (n=1,040) administered at the Finnish Defence Forces’ call‐ups in September‐December 2013 in Oulu, Finland. Statistical analyses include analysis of variance and multivariate logistic regression analysis. The results indicate that stage of exercise behavior change is associated with information seeking on physical activity and exercise, but only vaguely with avoidance of information. By contrast, everyday health information literacy was associated with avoidance of information and not with information seeking. Future studies should look more carefully into the relationship between health information behavior and literacy. Moreover, information behavior in stages of behavior change should be studied in the context of other health behaviors and among other populations.

Gamified Persuasion: User Experiences of Online Activation Service

The authors have empirically examined the persuasive properties of digital games from a multidisciplinary perspective. Besides the relevant cultural and psychological theories related to the game phenomenon, the authors have included a case study where a persuasive online activation service was tested among young men N=280, average 17.9 year old in the promotion of physical and social activity. The emphasis of the article is on qualitative material, which is based on in-depth interviews of 10 individuals, as well as participant observation considering the user experiences regarding the activation service and gaming in general. The authors have concluded that games contain persuasive characteristics based on human culture and psychology and that these characteristics could effectively be utilized in physically and socially activating games.