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Online health services are a rapidly growing coping resource for consumers to draw on in managing health‐related stressors. We apply a (dis)engagement coping lens to understand consumer coping, identify the distinct purposes of consumer coping captured in six coping scales, and develop an inventory (via multiple studies), to measure consumer positioning on these scales. In a final survey (N = 623), we assess the extent to which consumers use online health services, the ways in which they draw on these services as coping resources using the 6‐scale inventory and the influence of health status on coping efforts. We demonstrate that consumer engagement coping efforts with respect to health‐related stressors are largely directed toward direct management of health stressors (e.g., active planning). We also identify how consumers combine multiple ways of coping through distinguishing three coping profiles based on the enactment and perceived helpfulness of the six coping scales and current health status. Our profiles emphasize the need to understand the progress of health conditions as a determiner of coping efforts. Practitioners and policymakers can use this structured understanding of coping efforts to strategically plan future service provision, although some caution is noted with respect to health inequalities. [ABSTRACT FROM AUTHOR]

Background/Aim: Tooth avulsion (TA) is a severe form of traumatic dental injury. The tooth's prognosis depends on the immediate measures taken. First responders are often laypeople, and the Internet is a favored platform to access health‐related information. The aim of this descriptive study was to evaluate the accuracy, quality, readability, and popularity of patient‐oriented web information regarding the emergency management of TA. Methods: Three search engines (Google, Bing, and Yahoo.com) were browsed with six VPNs using "knocked out tooth," "fallen out tooth," and "tooth avulsion" as keywords. The top 20 results for each were evaluated. Webpages were included if they had information oriented to caregivers. They were analyzed for accuracy (cutoff ≥95%). Quality of web pages was assessed using DISCERN and the Journal of the American Medical Association (JAMA) benchmark. Readability was evaluated using Flesch‐Kincaid Grade Level (FKGL), Gunning Fog (FOG), Coleman–Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Popularity was assessed by Alexa Popularity Rank (APR). Accurate and inaccurate webpages were compared using chi‐square analysis and the Mann–Whitney U test. Spearman's correlation between the studied metrics was established. A p <.05 was considered significant. Results: Seventy‐two webpages were included, of which 23 (32%) were accurate. The median DISCERN ratings for accurate and inaccurate webpages were 3.0 [2.5–3.0] and 3.0 [2.0–3.0], respectively (p =.331). Ten (44%) accurate and 12 (24.5%) inaccurate webpages had high‐quality JAMA (p =.089). The median readability scores for accurate webpages were FKGL (8 [6.75–9.2]), FOG (10.6 [9.55–12.3]), CLI (7 [6–7]), SMOG (6.7 [6.15–7.5]), while scores for the inaccurate webpages were FKGL (7.85 [6.275–8.525]), FOG (10.55 [8.875–11.425]), CLI (7 [7–8.25]), and SMOG (7 [6.2–7.925]), with a higher CLI score for inaccurate webpages (p =.0035). The median APRs for accurate and inaccurate webpages were 1,02,538 [26,852–14,43,755] and 7,63,190 [2,19,799–29,92,067], respectively (p =.163). Accuracy had a positive correlation with quality (DISCERN: rho =.293, p =.013; JAMA: rho =.249, p =.036), while popularity (APR) was negatively correlated with quality (DISCERN: rho = −.330, p =.013; JAMA: rho = −.287, p =.032). Conclusion: Relevant webpages were limited and had low accuracy. This can impact the emergency management by laypeople and adversely affect the prognosis following avulsion. [ABSTRACT FROM AUTHOR]

Background and Aims: Alcohol consumption is increasing among older adults. Rethink My Drink is a brief internet-delivered intervention to reduce alcohol consumption and related harms, adapted specifically for older adults. This protocol for a large-scale randomised controlled trial will evaluate whether Rethink My Drink is effective in reducing alcohol consumption and cognitive decline in a sample of older risky drinkers, compared with an active control. Design: 1:1 parallel group, randomised controlled trial. Setting: Online trial in Australia. Participants: Hazardous or harmful drinkers (defined as those scoring =5 on the Alcohol Use Disorders Identification Test [AUDIT]) age 60 to 75 years old (n = 842). Participants will be recruited from August 2021 to August 2022 through online social media advertisements and community networks. Intervention and Comparator: Participants will be randomly allocated to receive access to Rethink My Drink (intervention) or Alcohol: The Facts (comparator), an online patient information booklet provided by New South Wales (NSW) Health. Measurements: Primary outcomes include (i) average weekly standard drinks and (ii) rate of cognitive decline. Secondary outcomes include (i) typical quantity of drinks per drinking day; (ii) heavy episodic drinking; (iii) age-specific risky drinking; (iv) alcoholrelated harms; (v) subjective cognitive complaints; and (vi) quality of life. All primary and secondary outcomes will be assessed at baseline, post-intervention (4 weeks) and 12 months. Effectiveness will be evaluated using multilevel linear regression, adjusting for baseline demographic differences. Bonferroni adjustments will be used to control for multiple comparisons. Multiple imputation, regression weighting and sensitivity analyses will assess the effect of attrition. Comments: This will be the first large-scale trial, internationally, to examine whether a brief internet-delivered intervention is effective in reducing alcohol consumption and cognitive decline among older adults. If successful, the intervention will provide an accessible and highly scalable treatment to reduce risky alcohol consumption in older adulthood. [ABSTRACT FROM AUTHOR]

Aims: To test the efficacy of a therapist‐guided high‐intensity internet intervention compared with an unguided low‐intensity internet intervention among individuals with alcohol use disorder. Design A three‐group randomized controlled trial with follow‐up assessments post‐treatment (12 weeks) and 6 months post‐randomization (primary end‐point). Settings General population sample in Sweden. Participants: A total of 166 on‐line self‐referred adults (49% males) with a score of 14 (females)/16 (males) or more on the Alcohol Use Disorders Identification Test, a preceding week alcohol consumption of 11 (females)/14 (males) or more standard drinks and an alcohol use disorder according to a diagnostic interview. Interventions and comparators: Both the high‐ (n = 72) and low‐intensity internet interventions (n = 71) consisted of modules based on relapse prevention. Controls were on a waiting‐list (n = 23), and were only followed until the post‐treatment follow‐up. Participants were randomized at a 7 : 7 : 2 ratio. Measurements: Primary outcome was self‐reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days at the 6‐month follow‐up. Findings Alcohol use disorders were largely in the severe category (74.7%), with the majority of participants having had alcohol problems for more than 5 years. Attrition was 13 and 22% at the post‐treatment and 6‐month follow‐up, respectively. At the 6‐month follow‐up, an intent‐to‐treat analysis showed no significant differences in alcohol consumption between the high‐ and low‐intensity interventions [standard drinks d = −0.17, 95% confidence interval (CI) = −0.50 to 0.16; heavy drinking days: d = −0.07, 95% CI = −0.40 to 0.26]. Prevalence of negative effects was somewhat low (8–14%) in both intervention groups, as was deterioration (3–5%). Conclusions: At 6‐month follow‐up, there were no significant differences between a therapist‐guided high‐intensity internet intervention and an unguided low‐intensity internet intervention in reducing alcohol consumption among individuals with an alcohol use disorder. [ABSTRACT FROM AUTHOR]

Abstract: The gradual transition of health care toward businesses during the past 50 years has converted passive patients into active customers. In our digital society, patients increasingly use online health communities to satisfy complex needs that healthcare professionals leave unmet, including the creation of cure‐oriented (i.e., functional) and care‐oriented (i.e., emotion) value. This research investigates patients’ reference frames (self versus other) as an information processing mechanism and their impact on value creation in online communities. The analysis of 1,687 online postings of a leading healthcare platform shows that self‐referencing is typical for information obtained through an individualistic, patient–doctor encounter; other‐referencing emerges when patients focus on the needs of their peers. Information gathered through the patient–doctor encounter and processed with a self‐referencing frame accordingly enhances cure‐related value, but limits care‐oriented value co‐creation. Other‐referencing does exactly the opposite: it creates a barrier to cure‐related value, but stimulates care‐related value. A patient's experience with the community largely moderates the impact of both self‐ and other‐referencing on cure‐ and care‐related value. These findings show that online health communities can identify and address unmet patient needs, but healthcare professionals still play a critical role in terms of ensuring information quality in online health communities. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Hoarding disorder (HD) is difficult to treat. In an effort to increase efficacy and engagement in cognitive‐behavioral therapy (CBT), we developed and evaluated a novel intervention comprising group CBT combined with between‐session Internet‐based clinician support for people with HD. Method: Twenty participants with HD received group CBT combined with an Internet‐support system enabling therapist–participant communication between group sessions. Results: The treatment was associated with a significant reduction on the Saving Inventory—Revised (SI‐R) and a large effect size (Cohen's d = 1.57) was found at posttreatment. Treatment gains were maintained at the 3‐month follow‐up. Group attendance was high and no participants dropped out from treatment prematurely. Between‐session motivational support from the therapist was most frequently mentioned as the main strength of the system. Conclusion: The results of this study support adding Internet‐based clinician support to group CBT for HD to increase treatment adherence and, potentially, improve the overall efficacy of CBT. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The present study aims to investigate the impact of help‐seeking self‐stigma on the preference and intention to seek psychological treatment delivered online compared to face‐to‐face. Design: This study uses survey data from two Swedish samples. Sample 1 consists of 267 students (78.7% women) with a mean age of 24.5 (SD = 6.1). Sample 2 consists of 195 primary care patients (56.9% women) with a mean age of 45.3 (SD = 17.7). Results: The number of participants who preferred online treatment was higher if seeking psychological help for a perceived stigmatized problem compared to mental health problems in general. The odds ratios for choosing treatment online over face‐to‐face were 6.41, 95% CI [4.05, 10.14] in Sample 1 and 11.19, 95% CI [5.29, 23.67] in Sample 2. In addition, findings suggest that higher levels of help‐seeking self‐stigma predicted higher intention to seek treatment online compared to face‐to‐face. Conclusions: Our results suggest that online interventions may facilitate help‐seeking among individuals deterred by stigma. [ABSTRACT FROM AUTHOR]

Abstract: Aim: YouTube™ is an open‐access, nonpeer‐reviewed video‐hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos. Method: A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. Results: The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for ‘experience of surgery’ (P < 0.001) and ‘experience of disease’ (P = 0.0015) themed videos were significantly higher than for ‘disease management’ themed videos. Conclusion: Crohn's disease patients use YouTube™ as a surgical information source. The content of patient‐sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient‐centred videos combined with clinical evidence may be a good model for future videos. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: The cost‐effectiveness of internet‐based smoking cessation interventions is difficult to determine when they are provided as a complement to current smoking cessation services. The aim of this study was to evaluate the cost‐effectiveness of such an alternate package compared with existing smoking cessation services alone (current package). Methods: A literature search was conducted to identify internet‐based smoking cessation interventions in the Netherlands. A meta‐analysis was then performed to determine the pooled effectiveness of a (web‐based) computer‐tailored intervention. The mean cost of implementing internet based interventions was calculated using available information, while intervention reach was sourced from an English study. We used EQUIPTMOD, a Markov‐based state‐transition model, to calculate the incremental cost‐effectiveness ratios [expressed as cost per quality‐adjusted life years (QALYs) gained] for different time horizons to assess the value of providing internet‐based interventions to complement the current package.). Deterministic sensitivity analyses tested the uncertainty around intervention costs per smoker, relative risks, and the intervention reach. Results: Internet‐based interventions had an estimated pooled relative risk of 1.40; average costs per smoker of €2.71; and a reach of 0.41% of all smokers. The alternate package (i.e. provision of internet‐based intervention to the current package) was dominant (cost‐saving) compared with the current package alone (0.14 QALY gained per 1000 smokers; reduced health‐care costs of €602.91 per 1000 smokers for the life‐time horizon). The alternate package remained dominant in all sensitivity analyses. Conclusion: Providing internet‐based smoking cessation interventions to complement the current provision of smoking cessation services could be a cost‐saving policy option in the Netherlands. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Millions of people world‐wide use websites to help them quit smoking, but effectiveness trials have an average 34% follow‐up data retention rate and an average 9% quit rate. We compared the quit rates of a website using a new behavioral approach called Acceptance and Commitment Therapy (ACT; WebQuit.org) with the current standard of the National Cancer Institute's (NCI) Smokefree.gov website. Design: A two‐arm stratified double‐blind individually randomized trial (n = 1319 for WebQuit; n = 1318 for Smokefree.gov) with 12‐month follow‐up. Setting: United States. Participants: Adults (n = 2637) who currently smoked at least five cigarettes per day were recruited from March 2014 to August 2015. At baseline, participants were mean [standard deviation (SD)] age 46.2 years (13.4), 79% women and 73% white. Interventions: WebQuit.org website (experimental) provided ACT for smoking cessation; Smokefree.gov website (comparison) followed US Clinical Practice Guidelines for smoking cessation. Measurements: The primary outcome was self‐reported 30‐day point prevalence abstinence at 12 months. Findings: The 12‐month follow‐up data retention rate was 88% (2309 of 2637). The 30‐day point prevalence abstinence rates at the 12‐month follow‐up were 24% (278 of 1141) for WebQuit.org and 26% (305 of 1168) for Smokefree.gov [odds ratio (OR) = 0.91; 95% confidence interval (CI) = 0.76, 1.10; P = 0.334] in the a priori complete case analysis. Abstinence rates were 21% (278 of 1319) for WebQuit.org and 23% (305 of 1318) for Smokefree.gov (OR = 0.89 (0.74, 1.07; P = 0.200) when missing cases were imputed as smokers. The Bayes factor comparing the primary abstinence outcome was 0.17, indicating ‘substantial’ evidence of no difference between groups. Conclusions: WebQuit.org and Smokefree.gov had similar 30‐day point prevalence abstinence rates at 12 months that were descriptively higher than those of prior published website‐delivered interventions and telephone counselor‐delivered interventions. [ABSTRACT FROM AUTHOR]

People commonly use the Internet to search for health information and tend to use the information they find without regard to source or credibility. Although regulation plays some role in minimizing false claims made by manufacturers of self-help products, effective communication with health professionals likely offers greater protection to the patient or consumer accessing self-help materials. In order to best serve patients (or healthcare consumers), providers should educate them about their healthcare needs, inquire about self-help product use, understand appropriate use, discuss the risks and benefits of use, monitor the patients' condition during use, and document these conversations. Although some people fear that patient use of brain-themed self-help will undermine the doctor-patient relationship, it is more likely to open another avenue of communication if providers are knowledgeable about self-help products. Given the rise in importance of the Internet as a source of information for people, opting out of these discussions is realistically not an option. [ABSTRACT FROM AUTHOR]

Background: Severe fatigue is a common and distressing symptom affecting approximately one in four survivors of breast cancer. The current study examined the efficacy of Internet-based cognitive behavioral therapy (ICBT) for severe fatigue in survivors of breast cancer compared with care as usual (CAU).Methods: The authors conducted a parallel-group randomized controlled trial. Severely fatigued, disease-free survivors of breast cancer who had completed cancer treatment at least 3 months previously were eligible. Participants were randomly allocated to ICBT or CAU using computer-generated stratified block randomization. The primary outcome of fatigue severity was assessed at baseline and after 6 months, as were the secondary outcomes of functional impairment, psychological distress, and quality of life. Statistical effects were tested with analyses of covariance (intention-to-treat analysis).Results: Participants were recruited between January 2014 and March 2016 and assigned to ICBT (66 patients) or CAU (66 patients). Compared with the participants who had received CAU, those who had received ICBT reported lower fatigue scores at 6 months (mean difference [Δ], 11.5; 95% confidence interval [95% CI], 7.7-15.3) and a large effect size (Cohen d = 1.0), with the majority of patients (73%) demonstrating clinically significant improvement. ICBT also was found to lead to lower functional impairment (Δ, 297.8; 95% CI, 145.5-450.1) and psychological distress scores (Δ, 5.7; 95% CI, 3.4-7.9) and higher quality-of-life scores (Δ, 11.7; 95% CI, 5.8-17.7) compared with CAU, with medium to large effect sizes (Cohen d = 0.6-0.8).Conclusions: ICBT appears to be effective in reducing severe fatigue and related symptoms and meets the current need for easy accessible and more efficient evidence-based treatment options for severely fatigued survivors of breast cancer. Cancer 2017;123:3825-34. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background and Aims Research has shown that internet interventions can be effective for dependent users of various substances. However, less is known about the effects of these interventions on users of opioids, cocaine and amphetamines than for other substances. We aimed to investigate the effectiveness of internet interventions in decreasing the usage of these types of substances. Methods We conducted a systematic literature search in the databases of PubMed, PsycINFO, Embase and the Cochrane Library to identify randomized controlled trials examining the effectiveness of internet interventions compared with control conditions in reducing the use of opioids, cocaine and amphetamines. No setting restrictions were applied. The risk of bias of the included studies was examined according to the Cochrane Risk of Bias assessment tool. The primary outcome was substance use reduction assessed through toxicology screening, self-report or both at post-treatment and at the follow-up assessment. Results Seventeen studies with 2836 adult illicit substance users were included. The risk of bias varied across the included studies. Internet interventions decreased significantly opioid [four studies, n = 606, g = 0.36; 95% confidence interval (CI) = 0.20-0.53, P < 0.001] and any illicit substance use (nine studies, n = 1749, g = 0.35; 95% CI = 0.24-0.45, P < 0.001) at post-treatment. Conversely, the effect of internet intervention for stimulant users was small and non-significant (four studies, n = 481, P = 0.164). Overall, internet interventions decreased substance significantly use at post-treatment (17 studies, n = 2836, g = 0.31; 95% CI = 0.23-0.39, P < 0.001) and at the follow-up assessments (nine studies, n = 1906, g = 0.22; 95% CI = 0.07-0.37; P = 0.003). Conclusions Internet interventions demonstrate small but significant effects in decreasing substance use among various target populations at post-treatment and at the follow-up assessment. However, given the small number of available studies for certain substances, the findings should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Aim To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. Design Cluster randomized factorial trial with 12-week implementation and measurement period. Setting Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. Participants A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. Interventions PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. Measurements The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. Findings During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11-2.53). Conclusions Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption. [ABSTRACT FROM AUTHOR]

Objective Anxiety and depression are highly prevalent in people with epilepsy ( PWE) and contribute to increased disability. Unfortunately, there are numerous barriers (e.g., cost, distance, and stigma) and service gaps (e.g., lack of services and trained clinicians) that prevent many PWE from accessing traditional face-to-face psychological services. The aim of the present study was to examine the feasibility of a new transdiagnostic Internet-delivered cognitive behavioral therapy ( iCBT) program, the Chronic Conditions Course, to simultaneously treat symptoms of anxiety, depression, and disability. Methods A single-group feasibility open trial was employed involving 27 adults with epilepsy. The program comprises five online lessons delivered over 8 weeks and is provided with weekly contact from a mental health professional via e-mail and telephone. Results High treatment completion rates and levels of satisfaction were reported. Evidence of significant improvements in our primary outcomes (within-group Cohen's d [d]; average [avg.] reductions) of anxiety (d ≥ 1.28; avg. reduction ≥ 54%), depression (d ≥ 1.24; avg. reduction ≥ 54%), epilepsy-specific depression (d ≥ 0.95; avg. reduction ≥ 35%), and disability (d ≥ 0.62; avg. reduction ≥ 33%) were observed at posttreatment, which were sustained at or further improved to 3-month follow-up. On our secondary outcomes there were significant improvements for life satisfaction (d ≥ 0.70; avg. improvement ≥ 26%) but not for perceived cognitive difficulties (d ≥ 0.48; avg. reduction ≥ 15%). Highlighting the potential of the approach, relatively little clinician time was required per participant (mean 80.62 min, standard deviation [ SD] 54.78), and the trial involved a broad range of geographically dispersed patients. Significance The findings of the current study support the feasibility and potential of transdiagnostic Internet-delivered treatments for adults with epilepsy. Further large-scale controlled trials are warranted. [ABSTRACT FROM AUTHOR]

Background: The chronicity status of breast cancer survivors suggests a growing need for cancer rehabilitation. Currently, the use of technology is a promising strategy for providing support, as reflected in the emergence of research interest in Web-based interventions in cancer survivorship.Methods: A randomized controlled trial was conducted that included a total of 81 participants who had completed adjuvant therapy (except hormone treatment) for stage I to IIIA breast cancer. Participants were randomly assigned to an 8-week Internet-based, tailored exercise program (n = 40) or to a control group (n = 41).The instruments used at baseline, 8 weeks, and 6-month follow-up were the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and its breast cancer module, the Brief Pain Inventory, the handgrip dynamometer, the isometric abdominal test, the back dynamometer, the multiple sit-to-stand test, and the Piper Fatigue Scale.Results: After the intervention, the telerehabilitation group had significantly improved scores for global health status, physical, role, cognitive functioning, and arm symptoms (all P < .01) as well as pain severity (P = .001) and pain interference (P = .045) compared with the control group. Significant improvements also were observed favoring the telerehabilitation group for affected and nonaffected side handgrip (both P = .006), abdominal, back and lower body strength (all P < .01), and total fatigue (P < .001). These findings were maintained after 6 months of follow-up, except for role functioning, pain severity, and nonaffected side handgrip. Analysis was based on an intention-to-treat principle.Conclusions: This program may improve adverse effects and maintain benefits in breast cancer survivors. The results of this study have encouraging implications for cancer care. Cancer 2016;122:3166-74. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Multivariate problems are found in all areas of knowledge. In chemistry and related disciplines, the chemometric community was developed in a joint effort to understand and solve problems mainly from a multivariate and exploratory perspective. This perspective is, indeed, of broader applicability, even in areas of knowledge far from chemistry. In this paper, we focus on the Internet: the net of devices that allow an interconnected world where all types of data can be shared and unprecedented communication services can be provided. Problems in the Internet or in general in networking are not very different from chemometric problems. Building on this parallelism, we review four classes of problems in networking: estimation, anomaly detection, optimization, and classification. We present an illustrative set of problems and show how a multivariate perspective may lead to significant improvements from state-of-the-art techniques. In the absence of a better name, we call the approach of treating these problems from that multivariate perspective networkmetrics. Networkmetric problems have their own specificities, mainly, their typical Big Data nature and the presence of unstructured data. We argue that multivariate analysis is, indeed, useful to tackle these specificities. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim Innovative e-health strategies are emerging, to tailor and provide convenient, systematic and high-quality survivorship care for an expanding cancer survivor population. This pilot study tests the application of an e-health platform, 'Healthy.me,' in a breast cancer survivor cohort at Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia. Methods Fifty breast cancer patients were recruited to use the Healthy.me website, designed by the Centre of Health Informatics at the University of New South Wales, over a 4-month period. Telephone and online questionnaires were used at 1 and 4 months and a face-to-face feedback at study completion, to gather qualitative and quantitative data regarding feasibility of Healthy.me. Results Healthy.me was reported to be a useful online resource by most users. Usage declined from 76% at 1 month to 48% at 4 months. Breast cancer survivors enjoyed a variety of tailored information regarding health and life-style issues. Positive aspects of Healthy.me were the convenient access to trusted information, and interaction with their peers and healthcare professionals. Barriers to usage contributing to usage decline were lack of reported patient time to re-access information, limited content updates and technical factors. Conclusions This pilot study suggested the potential of an e-health strategy such as Healthy.me in addressing the needs of a growing breast cancer survivor population. Ongoing development of a more robust e-health resource and integration with primary care models is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Several studies have shown that perseverative, worrisome thoughts are prospectively related to subjective health complaints (SHC) and that a short worry postponement intervention can decrease these complaints. As SHC and worry are prevalent and costly, we tested whether the intervention can be offered online to reduce these complaints in the general population.Design: A randomized parallel-group trial was conducted with self-selected participants from the general population.Methods: Via the research website, 996 participants were instructed to register their worrying for 6 consecutive days. The intervention group was instructed to postpone worry to a special 30-min period in the early evening. The Subjective Health Complaints inventory, as administered before and after the intervention, and daily worry frequency and duration were considered the primary outcomes.Results: Three hundred and sixty-one participants completed the study. Contrary to our expectation, the registration group (n = 188) did not differ from the intervention group (n = 163) in SHC (ηp² = .000, CI [0.000-0.003]), or in worry frequency or duration. Nevertheless, the different worry parameters were moderately related to SHC (r between .238 and .340, p ≤ .001).Conclusions: In contrast to previous studies using pen-and-pencil versions of the worry postponement intervention, this study suggests that a direct online implementation was not effective in reducing SHC and worry. Overall, participants had high trait worry levels and reported difficulty with postponing worrying. Reducing SHC and worries via the Internet might require more elaborate interventions that better incorporate the advantages of delivering interventions online.Statement Of Contribution: What is already known on this subject? The perseverative cognition hypothesis argues that perseverative cognition, such as worry and rumination, acts as a mediator by which psychosocial stress may produce negative health effects. Prior research has indeed shown that worry and subjective health complaints (SHC) are prospectively related, but causality studies - that is, showing that changes in worry induce changes in health outcomes - are scarce and have mainly been conducted in young samples. These studies showed that reducing worry, using a worry postponement intervention, can reduce daily worrying and SHC. What does this study add? Trait and daily worrying are associated with SHC. An online worry postponement intervention is ineffective in reducing worry and SHC. Paper-and-pencil interventions cannot directly be used as online interventions. [ABSTRACT FROM AUTHOR]

Aim The aim of this study is to ascertain the quality of information available to the public on the Internet regarding the apicoectomy procedure utilising common internet search terms. Materials and methods The five most widely used UK Internet search engines were utilised, searching for the term 'apicoectomy OR root end surgery'. The first 10 website links brought up on each search engine were then investigated for their contents. The indication for the procedure, details regarding the procedure technique, potential complications and treatment prognosis were all assessed. The topics were evaluated with a scoring system of 0-2 regarding the quality of information contained as compared with the apicoectomy information published on the British Association of Oral Surgeons ( BAOS) website. A Flesch Reading Ease Score was also used to assess readability. Results All 50 websites were easily accessible (100%). Two per cent had any form of accreditation by a healthcare website accreditation organisation. Eighty-two per cent were targeted at the general public rather than healthcare professionals. Seventy-two per cent had an unspecified author with no obvious affiliation. Eight per cent contained any form of reference. Generally, the complications and prognosis of the apicoectomy procedure were poorly covered, with the indications and technique scoring higher. Conclusions The information currently available to patients on the apicoectomy procedure is generally of substandard quality, lacking in terms of content and accreditation. Important facts which are central to the decision-making process for patients concerning potential complications and long-term outcomes are particularly poorly covered. [ABSTRACT FROM AUTHOR]

A variety of new psychotherapy modalities has arisen in which the contact between patient and therapist takes place via the internet. The main objective of this systematic review is to investigate the types of online psychotherapy (OP) conducted nowadays, and to describe their main characteristics to psychodynamic psychotherapists who may wish to better understand the current scientific literature on the subject. The review used two databases, EMBASE and PsycINFO. Fifty-nine studies were retrieved and the main online psychotherapy modalities identified were self-therapy programmes using contact via email or chat; videoconference; and therapy exclusively via chat or email. The result of these studies suggests that OP is more effective than a waiting list control group. When compared with face-to-face therapies, OP showed similar effects. Most studies involved cognitive behavioural therapy; only two studies involved a form of psychodynamic psychotherapy. Different forms of communication allow patient and therapist to establish different relationships and therapeutic possibilities. OPs may be feasible treatment alternatives; however, it remains unclear, especially in relation to psychodynamic treatments, if therapeutic technique in OP, which involves changes in comparison with face-to-face therapies, would be useful in severe cases. Psychodynamic psychotherapists should adopt a posture of constant reflection on the changes taking place in the world and their impact on the minds of individuals, without, nevertheless, idealizing the 'new'. [ABSTRACT FROM AUTHOR]

Aim To test the efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among young Swiss men aged 21 years on average. Design Two parallel-group randomized controlled trial with a 1 : 1 allocation ratio containing follow-up assessments at 1 and 6 months post-randomization Setting Internet-based study in a general population sample. Participants Twenty-one-year-old men from Switzerland with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly or Alcohol Use Disorders Identification Test (AUDIT) scores ≥ 8) Intervention IBI consisting of (1) normative feedback, (2) feedback on consequences of alcohol use, (3) calorific value of reported consumption, (4) computed blood alcohol concentration for reported consumption, (5) indication of risk, (6) information on alcohol and health and (7) recommendations indicating low-risk drinking limits. Control condition: no intervention (assessment only). Measurements At 1 and 6 months: quantity/frequency questions on alcohol use (primary outcome: number of drinks/week) and binge drinking prevalence; at 6 months: AUDIT score, consequences of drinking (range = 0-12). Findings Follow-up rates were 92% at 1 month and 91% at 6 months. At 6 months, participants in the intervention group ( n = 367) reported greater reductions in the number of drinks/week than participants in the control group ( n = 370) [treatment × time interaction, incidence rate ratio (RR) = 0.86, 95% confidence interval (CI) = 0.78; 0.96], but no significant differences were observed on binge drinking prevalence. There was a favourable intervention effect on AUDIT scores (IRR = 0.93, 95% CI = 0.88; 0.98), but not on the number of consequences (IRR = 0.93, 95% CI = 0.84; 1.03). Conclusions An internet-based brief intervention directed at harmful alcohol use among young men led to a reduction in self-reported alcohol consumption and AUDIT scores compared with a no-intervention control condition (assessment only). [ABSTRACT FROM AUTHOR]

Background This study extends previous direct-mail campaigns by evaluating the effectiveness of a marketing campaign promoting organ donation message strategies from the vantage point of organ donors, organ recipients, individuals on the waiting list, or a combination of these three frames. Methods Illinois residents were randomly assigned to one of four organ donation brochures disseminated via U.S. postal mail. Registrations occurred via the Internet and U.S. postal mail. Results Individuals register at a greater rate following exposure to the combination framed message compared to organ donor, organ recipient, and waiting list narratives. The campaign revealed that individuals are more likely to register via U.S. postal mail than the Internet. Conclusion Direct-mail marketing efforts were shown to be an effective approach to promote organ and tissue donation registrations. The results demonstrated a preference for the combination framed brochure. The results are discussed with an emphasis on the practical implications of utilizing direct-mail marketing efforts to promote organ donation among young adults. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a severe, highly prevalent mental disorder. Effective psychological treatments for BPD are available. However, most patients do not receive evidence-based treatments partly because of high treatment delivery costs and lack of specialized therapists. By integrating specialized e-health tools into BPD-specific treatments, treatment intensity can be increased, frequency of face-to-face sessions and burden for psychotherapists can be reduced, and implementation of new skills and experiences in the everyday life of these patients can be promoted. This bears great potential to increase the availability of evidenced-based psychotherapy for BPD patients and close the gap between demand and supply. In this article we present such an innovative e-health tool, priovi, which has been developed for schema therapy. The concept and application of priovi are described and illustrated with a case example. [ABSTRACT FROM AUTHOR]

The present study explored the targeting of a preventative information provision intervention delivered to children following accidental injury by assessing the impact of initial traumatic distress on response to treatment. Analyses were based on baseline and 6-month outcome of child traumatic stress in a control ( n = 28) and an intervention group ( n = 31). Moderation of treatment outcome by initial levels of child traumatic stress was assessed through multiple hierarchical regression analyses. Results indicated the interaction between treatment provision and initial level of posttraumatic stress significantly predicted 6-month outcome (β = −.42, p = .019). When initial distress was high, children in the control group demonstrated an increase in trauma symptoms, and had significantly higher trauma symptoms at follow-up than those in the treatment group ( d = 0.94, p = .008). When initial distress was not elevated, no significant differences were noted between the groups. These results indicate that a preventative early intervention may be best targeted at children presenting with the specific risk factor of high initial distress. [ABSTRACT FROM AUTHOR]

The purpose of the research is to explore the well-being/QOL of the ageing population in China. Specifically, the study investigates the experience/meaning of ageing and the strategies that consumers deploy to cope with ageing issues through internet communication. The results show that older people have found creative ways to cope with ageing by recalling the frugal experiences in the past, and purchasing small items as emotion enhancers. The findings also indicate that older Chinese bloggers have limited acquisition desire, do not wish to be a burden on their children, and worry greatly about their future financial status, especially given concerns about the healthcare system. [ABSTRACT FROM AUTHOR]

Aim This study examines the quality of websites providing information on ulcerative colitis, including treatment options and surgery. Method Two search engines (Google and Yahoo) and the search term 'surgery for ulcerative colitis' were used. The first 50 sites obtained with each search engine were assessed. Sites were evaluated for content and scored using the DISCERN instrument, which evaluates the quality of health information on treatment choices. Results One hundred sites were examined, of which 14 were duplicates. Of the remainder, 58 provided patient-orientated information for adults and one site provided information for surgery in children. The other 27 sites included six scientific articles, three blogs, three links, six resources for clinicians, five fora, two video links and two dead links. Of the 58 websites that provided patient information for adults, only 26 (44.8%) had been updated within the last 2 years. Only 13/58 (22.4%) were affiliated to hospitals and clinics. Most sites (38/58, 65.5%) were associated with private companies with commercial interests. Although most websites contained information on symptoms and treatment options for ulcerative colitis, 37 (63.8%) did not describe any of the risks of surgery. Overall, only seven (12.1%) websites were identified as being 'good' or 'excellent' using the DISCERN criteria. Conclusion The quality of patient information on surgery for ulcerative colitis is highly variable. There is potential for internet provision of valuable information and clinicians should guide patients with to access high-quality websites. [ABSTRACT FROM AUTHOR]

In the past decades, the Internet has become one of the most important tools to gather information and communicate with other people. Excessive use is a growing concern of health practitioners. Based on the assumption that excessive Internet use bears resemblance with addictive behaviour, we hypothesized alterations of the fronto-striatal network in frequent users. On magnetic resonance imaging scans of 62 healthy male adults, we computed voxel-based morphometry to identify grey matter ( GM) correlates of excessive Internet use, assessed by means of the Internet Addiction Test ( IAT) and functional connectivity analysis and amplitude of low-frequency fluctuation ( ALFF) measures on resting state data to explore the functional networks associated with structural alterations. We found a significant negative association between the IAT score and right frontal pole GM volume ( P < 0.001, family wise error corrected). Functional connectivity of right frontal pole to left ventral striatum was positively associated with higher IAT scores. Furthermore, the IAT score was positively correlated to ALFF in bilateral ventral striatum. The alterations in the fronto-striatal circuitry associated with growing IAT scores could reflect a reduction of top-down modulation of prefrontal areas, in particular, the ability to maintain long-term goals in face of distraction. The higher activation of ventral striatum at rest may indicate a constant activation in the context of a diminished prefrontal control. The results demonstrate that excessive Internet use may be driven by neuronal circuits relevant for addictive behaviour. [ABSTRACT FROM AUTHOR]

Persisting hemianopia frequently complicates lesions of the posterior cerebral hemispheres, leaving patients impaired on a range of key activities of daily living. Practice-based therapies designed to induce compensatory eye movements can improve hemianopic patients' visual function, but are not readily available. We used a web-based therapy (Eye-Search) that retrains visual search saccades into patients' blind hemifield. A group of 78 suitable hemianopic patients took part. After therapy (800 trials over 11 days), search times into their impaired hemifield improved by an average of 24%. Patients also reported improvements in a subset of visually guided everyday activities, suggesting that Eye-Search therapy affects real-world outcomes. [ABSTRACT FROM AUTHOR]

Objective Depression is the most prevalent psychiatric disorder in persons with epilepsy ( PWEs). Despite its major impact on quality of life and risk of suicide, most PWEs are not treated for depression. A current challenge in mental health care is how to close this treatment gap and increase access to psychological services. Psychological online interventions ( POIs) have shown efficacy in improving depression among individuals without neurologic disorders. This pilot study aimed to assess the feasibility and efficacy of a psychological online intervention for depression (Deprexis) in PWEs who have symptoms of depression. Methods Participants with self-reported epilepsy and subjective complaints of depressive symptoms were randomized to an intervention condition (Deprexis) or to a waiting list control ( WLC) condition. After 9 weeks, participants were invited to complete an online reassessment. Results Relative to the waiting list group, program users experienced a significant symptom decline on the Beck Depression Inventory - I ( BDI-I, primary outcome) with a moderate effect size in the complete observations analysis and a small effect size in the intention-to-treat analysis. Furthermore, there was a significant improvement with a moderate effect size on the 'energy/fatigue' subscale of the Quality of Life In Epilepsy Inventory - 31 ( QOLIE-31). Significance The results of this trial suggest that POIs may be a feasible and beneficial tool for PWEs who have comorbid depressive symptoms. [ABSTRACT FROM AUTHOR]

Hypersensitivity diseases are not adequately coded in the International Coding of Diseases ( ICD)-10 resulting in misclassification, leading to low visibility of these conditions and general accuracy of official statistics. To call attention to the inadequacy of the ICD-10 in relation to allergic and hypersensitivity diseases and to contribute to improvements to be made in the forthcoming revision of ICD, a web-based global survey of healthcare professionals' attitudes toward allergic disorders classification was proposed to the members of European Academy of Allergy and Clinical Immunology ( EAACI) (individuals) and World Allergy Organization ( WAO) (representative responding on behalf of the national society), launched via internet and circulated for 6 week. As a result, we had 612 members of 144 countries from all six World Health Organization ( WHO) global regions who answered the survey. ICD-10 is the most used classification worldwide, but it was not considered appropriate in clinical practice by the majority of participants. The majority indicated the EAACI- WAO classification as being easier and more accurate in the daily practice. They saw the need for a diagnostic system useful for nonallergists and endorsed the possibility of a global, cross-culturally applicable classification system of allergic disorders. This first and most broadly international survey ever conducted of health professionals' attitudes toward allergic disorders classification supports the need to update the current classifications of allergic diseases and can be useful to the WHO in improving the clinical utility of the classification and its global acceptability for the revised ICD-11. [ABSTRACT FROM AUTHOR]

Background Poor adherence to medication is an enormous problem. While many measures to improve adherence have been proposed, patients may be a good source of novel approaches. The Managing Meds Video Challenge was designed, by the U.S. Department of Health and Human Services ( HHS), in collaboration with the National Consumers League Script Your Future campaign, for patients to create short videos containing ideas on how to better take medications as directed. Purpose Determine what forms of technology patients use to help adhere to their medication regimens. Methods The 17 available videos from the Managing Meds Video Challenge were analyzed to determine what forms of technology patients use to help adhere to their medication regimens. Results Approaches to improve adherence included calendar and reminder applications, and third-party applications such as MedCoach Medication Reminder, Walgreens Pharmacy, and CVS/Pharmacy. Patients also improved adherence by using the Internet to access websites such as www.rememberitnow.com to manage medications, access electronic health records, and to order medications from online pharmacies. Limitations This study only analyzes the 17 available videos from the Managing Meds Video Challenge. Conclusions Patients are using a variety of technology to manage their medications. They appear to rely primarily on reminder systems. [ABSTRACT FROM AUTHOR]

To compare monopolar and bipolar transurethral resection of the prostate ( TURP) for clinical effectiveness and adverse events., We conducted an electronic search of MEDLINE, Embase, CENTRAL, Science Citation Index, and also searched reference lists of articles and abstracts from conference proceedings for randomised controlled trials ( RCTs) comparing monopolar and bipolar TURP., Two reviewers independently undertook data extraction and assessed the risk of bias in the included trials using the tool recommended by the Cochrane Collaboration., The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation ( GRADE) approach., From the 949 abstracts that were identified, 94 full texts were assessed for eligibility and a total of 24 trials were included in the review., No statistically significant differences were found in terms of International Prostate Symptom Score ( IPSS) or health-related quality of life ( HRQL) score., Results for maximum urinary flow rate were significant at 3, 6 and 12 months (all P < 0.001), but no clinically significant differences were found and the meta-analysis showed evidence of heterogeneity, Bipolar TURP was associated with fewer adverse events including transurethral resection syndrome (risk ratio [ RR] 0.12, 95% confidence interval [ CI] 0.05-0.31, P < 0.001), clot retention ( RR 0.48, 95% CI 0.30-0.77, P = 0.002) and blood transfusion ( RR 0.53, 95% CI 0.35-0.82, P = 0.004), Several major methodological limitations were identified in the included trials; 22/24 trials had a short follow-up of ≤1 year, there was no evidence of a sample size calculation in 20/24 trials and the application of GRADE showed the evidence for most of the assessed outcomes to be of moderate quality, including all those in which statistical differences were found., Whilst there is no overall difference between monopolar and bipolar TURP for clinical effectiveness, bipolar TURP is associated with fewer adverse events and therefore has a superior safety profile., Various methodological limitations were highlighted in the included trials and as such the results of this review should be interpreted with caution., There is a need for further well-conducted, multicentre RCTs with long-term follow-up data. [ABSTRACT FROM AUTHOR]

Burden of disease studies typically classify individuals with a body mass index ( BMI) ≥ 30 kg m−2 as a single group ('obese') and make comparisons to those with lower BMIs. Here, we review the literature on the additional economic burden associated with severe obesity or classes 3 and 4 obesity ( BMI ≥ 40 kg m−2), the fastest growing category of obesity, with the aim of exploring and disaggregating differences in resource use as BMI increases beyond 40 kg m−2. We recognize the importance of comparing classes 3 and 4 obesity to less severe obesity (classes 1 and 2) as well as quantifying the single sub-class impacts (classes 3 and 4). Although the latter analysis is the aim of this review, we include results, where found in the literature, for movement between the recognized subclasses and within classes 3 and 4 obesity. Articles presenting data on the economic burden associated with severe obesity were identified from a search of Ovid MEDLINE, EMBASE, EBSCO CINAHL and Cochrane Library databases. Data were extracted on the direct costs, productivity costs and resource use associated with severe obesity along with estimates of the multiplier effects associated with increasing BMI. Fifteen studies were identified, of which four disaggregated resource use for BMI ≥ 40 kg m−2. The multiplier effects derived for a variety of different types of costs incurred by the severely obese compared with those of normal weight (18.5 kg m−2 < BMI < 25 kg m−2) ranged from 1.5 to 3.9 for direct costs, and from 1.7 to 8.0 for productivity costs. There are few published data on the economic burden of obesity disaggregated by BMI ≥ 40 kg m−2. By grouping people homogenously above a threshold of BMI 40 kg m−2, the multiplier effects for those at the highest end of the spectrum are likely to be underestimated. This will, in turn, impact on the estimates of cost-effectiveness for interventions and policies aimed at the severely obese. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To present two successful cases of fetoscopic release of amniotic bands with umbilical cord involvement and provide a review of the literature on fetal intervention for amniotic band syndrome ( ABS). Methods Two cases of ABS were considered in conjunction with a review of the literature. A total of 14 fetuses with ABS underwent fetoscopic intervention between 1965 and 2012. Two of the authors independently completed literature searches in PubMed, Ovid and MEDLINE for articles related to ABS. Results Among 14 cases of ABS (12 published and our own two), 57% and 7% were complicated by preterm premature rupture of membranes and spontaneous preterm birth, respectively. Overall, fetoscopic intervention preserved limb function in 50% (7/14) of cases. Three cases involved intraoperative complications including intra-amniotic bleeding and uterine wall bleeding, and incomplete procedure due to ineffective equipment. Conclusion Fetoscopic release of amniotic bands with minimally invasive surgery may allow preservation of life and/or limb function in cases of ABS. The acceptable functional outcome in 50% of cases is reassuring, although more experience and further studies are needed to determine the selection criteria that will justify the risk of this invasive in-utero therapy for ABS. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To pool published data regarding the sensitivity and specificity of nuchal translucency ( NT) in the diagnosis of major congenital heart defects ( CHDs) in fetuses with normal karyotype. Methods MEDLINE and Scopus searches using combinations of the terms 'nuchal' and 'cardiac*' were complemented by perusal of references of the retrieved articles and an additional automated search using the 'search for related articles' function on PubMed. Only fetuses with normal karyotype and major CHDs were analyzed. Weighted estimates were made and summary receiver-operating characteristics curves were constructed. Results The analysis included 20 studies (205 232 fetuses; 537 cases with major CHDs). The pooled sensitivity and specificity of NT > 95th centile for diagnosis of major CHDs was 44.4% (95% CI, 39.5-49.5) and 94.5% (95% CI, 94.4-94.6), respectively. The pooled sensitivity and specificity of NT > 99th centile was 19.5% (95% CI, 15.9-23.5) and 99.1% (95% CI, 99.1-99.2), respectively. For the subgroup of studies in which NT was measured by Fetal Medicine Foundation-certified operators, the pooled sensitivity and specificity of NT > 95th centile was 45.6% (95% CI, 39.6-51.7) and 94.7% (95% CI, 94.6-94.9), respectively. The corresponding estimates for NT > 99th centile were 21.0% (95% CI, 16.5-26.1) and 99.2% (95% CI, 99.2-99.3). The pooled positive likelihood ratio for NT > 99th centile was 30.5 (95% CI, 24.3-38.6). There was high across-studies heterogeneity for most estimates. Conclusion Approximately 44% of chromosomally normal fetuses with CHDs have NT > 95th centile and 20% have NT > 99th centile. However, there is high heterogeneity across studies, which largely remains even in subgroup analyses of studies of apparently similar design, potentially indicating the presence of some residual unidentified bias. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Mesotherapy, which is the injection of substances locally into mesodermally derived subcutaneous tissue, developed from empirical observations of a French physician in the 1950s. Although popular in Europe for many medical purposes, it is used for local cosmetic fat reduction in the United States. This paper reviews manuscripts indexed in PubMed/ MEDLINE under 'mesotherapy', which pertains to local fat reduction. The history of lipolytic mesotherapy, the physiology of body fat distribution, the mechanism of action of different lipolytic stimulators and their increased efficacy in combination are reviewed. Mesotherapy falls into two categories. Lipolytic mesotherapy using lipolytic stimulators requires more frequent treatments as the fat cells are not destroyed and can refill over time. Ablative mesotherapy destroys fat cells with a detergent, causes inflammation and scarring from the fat necrosis, but requires fewer treatments. The historic and empiric mixing of sodium channel blocking local anaesthetics in mesotherapy solutions inhibits the intended lipolysis. Major mesotherapy safety concerns include injection site infections from poor sterile technique. Cosmetic mesotherapy directs the area from which fat is lost to improve self-image. Studies were of relatively small number, many with limited sample sizes. Future research should be directed towards achieving a Food and Drug Administration indication rather than continuing expansion of off-label use. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of school-based physical activity interventions on fitness, adiposity and cardiometabolic outcomes among schoolchildren. Medline, Embase, EBSCOhost CINAHL and ERIC databases were searched up to October 2012. Inclusion criteria: intervention delivered at school with controls having no intervention or usual physical education classes; participants aged 5-18 years; outcomes spanning some or all of the above. We assessed levels of evidence for identified trials based on methodological quality and sample size. Dose of the interventions (a total summary measure of intensity, frequency and duration) were considered. Eighteen randomized controlled trials ( RCTs, total participants = 6,207) were included, of which six were large, higher quality trials with high dose of the intervention. The intervention was consistent in increasing fitness with large, higher quality studies and high dose of intervention providing strong evidence. Dose of school-based physical activity is an important determinant of trial efficiency. Some large, higher quality RCTs provided strong evidence for interventions to decrease skin-fold thickness, increase fitness and high-density lipoprotein cholesterol. Evidence for body mass index, body fat and waist circumference, blood pressure and triglycerides, low-density lipoprotein cholesterol and total cholesterol remain inconclusive and require additional higher quality studies with high dose of interventions to provide conclusive evidence. [ABSTRACT FROM AUTHOR]

Aims This meta-analysis aims to compare the diagnostic performance of acoustic radiation force impulse ( ARFI) elastography and transient elastography ( TE) in the assessment of liver fibrosis using liver biopsy (LB) as 'gold-standard'. Methods PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases were searched for all studies published until 31 May 2012 that evaluated the liver stiffness by means of ARFI, TE and LB. Information abstracted from each study according to a fixed protocol included study design and methodological characteristics, patient characteristics, interventions, outcomes and missing outcome data. Results Thirteen studies (11 full-length articles and 2 abstracts) including 1163 patients with chronic hepatopathies were included in the analysis. Inability to obtain reliable measurements was more than thrice as high for TE as that of ARFI (6.6% vs. 2.1%, P < 0.001). For detection of significant fibrosis, ( F ≥ 2) the summary sensitivity (Se) was 0.74 (95% CI: 0.66-0.80) and specificity (Sp) was 0.83 (95% CI: 0.75-0.89) for ARFI, while for TE the Se was 0.78 (95% CI: 0.72-0.83) and Sp was 0.84 (95% CI: 0.75-0.90). For the diagnosis of cirrhosis, the summary Se was 0.87 (95% CI: 0.79-0.92) and Sp was 0.87 (95% CI: 0.81-0.91) for ARFI elastography, and, respectively, 0.89 (95% CI: 0.80-0.94) and 0.87 (95% CI: 0.82-0.91) for TE. The diagnostic odds ratio of ARFI and TE did not differ significantly in the detection of significant fibrosis [mean difference in rDOR = 0.27 (95% CI: 0.69-0.14)] and cirrhosis [mean difference in rDOR = 0.12 (95% CI: 0.29-0.52)]. Conclusion Acoustic radiation force impulse elastography seems to be a good method for assessing liver fibrosis, and shows higher rate of reliable measurements and similar predictive value to TE for significant fibrosis and cirrhosis. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Stress urinary incontinence ( SUI) affects 10-35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment., Management of SUI without face-to-face contact is possible, and Internet-based treatment is a new, promising treatment alternative., Objective To compare two treatment programmes for stress urinary incontinence ( SUI) without face-to-face contact: one Internet-based and one sent by post., Patients and Methods Randomised, controlled trial conducted in Sweden 2009-2011. Computer-generated block-randomisation, allocation by independent administrator. No 'blinding'., The study included 250 community-dwelling women aged 18-70 years, with SUI ≥1 time/week. Consecutive online recruitment., The women had 3 months of either; (i) An Internet-based treatment programme (124 women), including e-mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training., Primary outcomes: symptom-score ( International Consultation on Incontinence Questionnaire Short Form, ICIQ-UI SF) and condition-specific quality of life ( ICIQ- Lower Urinary Tract Symptoms Quality of Life, ICIQ- LUTSQoL). Secondary outcomes: (i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health-specific QoL ( EQ5 D- Visual Analogue Scale), and (v) Incontinence episode frequency. Follow-up after 4 months via self-assessed postal questionnaires., Results In all, 12% (30 women) were lost to follow-up. Intention-to-treat analysis showed highly significant improvements ( P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes. The mean ( sd) changes in symptom-score were: Internet 3.4 (3.4), Postal 2.9 (3.1) ( P = 0.27). The mean ( sd) changes in condition-specific QoL were: Internet 4.8 (6.1), Postal 4.6 (6.7) ( P = 0.52)., Compared with the postal-group, more participants in the Internet-group perceived they were much or very much improved (40.9% (43/105) vs 26.5% (30/113), P = 0.01), reported reduced usage of incontinence aids (59.5% (47/79) vs 41.4% (34/82), P = 0.02) and were satisfied with the treatment programme (84.8% (89/105) vs 62.9% (71/113), P < 0.001)., Health-specific QoL improved in the Internet-group (mean change 3.7 (10.9), P = 0.001), but not in the postal-group (1.9 (13.0), P = 0.13)., Overall, 69.8% (120/172) of participants reported complete lack of leakage or reduced number of leakage episodes by >50%., Conclusions Concerning primary outcomes, treatment effects were similar between groups whereas for secondary outcomes the Internet-based treatment was more effective., Internet-based treatment for SUI is a new, promising treatment alternative. [ABSTRACT FROM AUTHOR]

Aim Stercoral perforation is a rarely suspected life-threatening condition. Early diagnosis is difficult but essential. A comprehensive systematic review was performed to evaluate its presentation, diagnosis and treatment. Method A systematic review was carried out of Embase, MEDLINE, PubMed and Cochrane databases for all articles published between 1998 and 2011. Only studies describing stercoral perforation were included. Results Twenty-four relevant articles were found including 137 patients (median age = 62 years) with stercoral perforation, of whom 81% had chronic constipation. Stercoral perforation was diagnosed by CT scan in 90% of 31 patients, with the commonest findings being a combination of faecal impaction (84%) and subphrenic (90%) or extraluminal air (61%). The commonest site of perforation was the sigmoid colon (50%) followed by the rectosigmoid junction (24%). The overall mortality was 34%. Conclusion Stercoral perforation should be suspected in elderly and chronically constipated patients with unexplained abdominal pain and investigated appropriately with a CT scan to allow timely and optimal treatment. [ABSTRACT FROM AUTHOR]

Objective To examine the impact of psychotropic drugs on suicide and suicidal behaviors in bipolar disorders. Methods A Medline search of articles published from January 1960 to January 2013 was performed using relevant keywords to identify studies examining the relationship of psychotropic drugs to suicidal behaviors. The publications were further reviewed for relevant references and information. Additionally, the US Food and Drug Administration Center for Drug Evaluation Research website was searched. Results The available studies used differing methodologies, making interpretation of the findings difficult. Studies suggest that antidepressants may increase suicidal risk in bipolar disorder, this possibly being related to the induction of broadly defined mixed states. There is no evidence that antiepileptic drugs as a class increase suicidal risk in patients with bipolar disorder. Only lithium provides convincing data that it reduces the risk of suicide over the long term. There is little known regarding the effects of antipsychotics, as well as anti-anxiety and hypnotic drugs, on suicidal behavior. Conclusions The available evidence for the impact of psychotropics on suicidal risk in patients with bipolar disorder is largely methodologically flawed and, except for a few instances, clinically not useful at this point. Adequately powered, prospective randomized controlled studies are needed to assess the impact of each class of psychotropic and each psychotropic as well as common combination therapies. Until such studies have been carried out, clinicians are urged to exercise caution in using these drugs and rely on the traditional means of carefully assessing and monitoring patients with bipolar disorder who are at high risk for suicide. [ABSTRACT FROM AUTHOR]

Objectives Suicide is highly prevalent among individuals with bipolar disorder and understanding the factors that increase risk for suicide may help to develop targeted interventions to prevent attempts. Impulsivity is thought to be an influential factor associated with suicidality and is also discussed as a key construct of bipolar disorder. The aim of this paper was to systematically review the current evidence to examine the association between impulsivity and suicidality in bipolar disorder. Methods PsycInfo, Medline, and Web of Knowledge databases were searched for articles published up until March 2012. Papers were included if they assessed an adult sample of individuals with bipolar disorders, focused on suicidality (ideation with intent to die, suicide attempts, or completion), and used a validated measure to determine impulsivity. Result Sixteen papers were identified. Contrary to widespread belief, we found (i) a very inconsistent picture of results including positive, negative, and insignificant associations between impulsivity and suicidality; and (ii) some studies do not take into account important aspects such as state-trait or measurement issues. Conclusions The link between suicidality and impulsivity is less straightforward than often assumed. Drawing clear conclusions about the association is hampered by factors such as inconsistencies in defining suicidality, measuring impulsivity, and differentiating between impulsivity as a personality trait and impulsivity as a state (e.g., a consequence of substance use or premeditation of the attempt). We suggest that the association is less direct and that psychological models (e.g., Joiner's theory of suicidality) can help foster a more in-depth understanding regarding the relationship. [ABSTRACT FROM AUTHOR]

Objectives To review the psychosocial, neuropsychological, and neurobiological evidence regarding suicide and bipolar disorder ( BD), to enable the development of an integrated model that facilitates understanding, and to provide a useful framework for future research. Methods A two-stage literature review was conducted. First, an electronic literature search was performed using key words (e.g., bipolar disorder, suicide risk, and neuroimaging) and standard databases (e.g., MEDLINE). Second, theoretical suicide models were reviewed, and their evidence base and relevance to BD were evaluated in order to determine a guiding theoretical framework for contextualizing suicide in BD. Results Although accumulating clinical, cognitive, and neurobiological correlates of suicide have been identified in BD, extant research has been largely atheoretical. The Cry of Pain (CoP) and an adapted version of the model, the Schematic Appraisals Model of Suicide ( SAMS), provide a useful schema for examining vulnerability to suicide in BD, by taking into account biopsychosocial determinants of suicidality. In combination, these also provide a model within which the neural correlates of suicide can be integrated. Conclusions The proposed Bipolar Suicidality Model ( BSM) highlights the psychosocial precursors to suicidality in BD, while recognizing the key role of cognitive deficits and underlying functional neurobiological abnormalities. It usefully integrates our knowledge, and provides a novel perspective that is intended to meaningfully inform future research initiatives, and can lead to a better understanding of suicidality in bipolar disorder. Ultimately, it is hoped that it will facilitate the development of targeted interventions that diminish the risk of suicide in bipolar disorder. [ABSTRACT FROM AUTHOR]

Does PubMed Central--a government-run digital archive of biomedical articles--compete with scientific society journals? A longitudinal, retrospective cohort analysis of 13,223 articles (5999 treatment, 7224 control) published in 14 society-run biomedical research journals in nutrition, experimental biology, physiology, and radiology between February 2008 and January 2011 reveals a 21.4% reduction in full-text hypertext markup language (HTML) article downloads and a 13.8% reduction in portable document format (PDF) article downloads from the journals' websites when U.S. National Institutes of Health-sponsored articles (treatment) become freely available from the PubMed Central repository. In addition, the effect of PubMed Central on reducing PDF article downloads is increasing over time, growing at a rate of 1.6% per year. There was no longitudinal effect for full-text HTML downloads. While PubMed Central may be providing complementary access to readers traditionally underserved by scientific journals, the loss of article readership from the journal website may weaken the ability of the journal to build communities of interest around research papers, impede the communication of news and events to scientific society members and journal readers, and reduce the perceived value of the journal to institutional subscribers. [ABSTRACT FROM AUTHOR]

Aim Systematic reviews have the potential to map those areas where children are under-represented in surgical research. We aimed to describe and evaluate the quantity, coverage and the quality of conduct and reporting of systematic reviews of surgical procedures in children. Methods We searched four biomedical databases, a systematic review register, reference lists and conducted hand searching to identify relevant reviews. Two reviewers worked independently to critically appraise included studies and abstract data. We assessed reporting quality using the preferred reporting items for systematic reviews and meta-analysis statement and methodological quality using the Assessment of Multiple SysTemAtic Reviews tool. Results Fifteen systematic reviews were identified, representing 0.01% of all paediatric surgical citations in MEDLINE and Embase. Thirteen of the reviews were Cochrane reviews, and most reviews (12/15) addressed subspecialty interests such as otorhinolaryngology. The median number of included trials per systematic review was four (interquartile range 1 to 9.5), the median number of primary outcomes was 5.5 (interquartile range 3.5 to 7.5). In general, reporting and methodological quality was good although there were several omissions, particularly around completeness of reporting of statistical methods used, and utilisation of quality assessments in analyses. Outcomes were often not clearly defined and descriptions of procedures lacked sufficient detail to determine the similarities and differences among surgical procedures within the contributing trials. Conclusion Systematic reviews of surgical procedures in children are rarely published. To improve the evidence base and guide research agendas, more systematic reviews should be conducted, using standard guidelines for conduct and reporting. [ABSTRACT FROM AUTHOR]