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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]

The Dutch Fatigue In Teenagers on the interNET (FITNET) study claimed that after 6 months, internet based cognitive behaviour therapy in adolescents with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), led to a 63% recovery rate compared to 8% after usual care, and that this was maintained at long term follow up (LTFU). Our reanalysis shows that their post-hoc definition of recovery included the severely ill, the unblinded trial had no adequate control group and it used lax selection criteria as well as outcomes assessed via questionnaires rather than objective outcomes, further contributing to exaggerated recovery figures. Their decision not to publish the actometer results might suggest that these did not back their recovery claims. Despite these bias creating methodological faults, the trial still found no significant difference in recovery rates ("~60%") at LTFU, the trial's primary goal. This is similar to or worse than the documented 54-94% spontaneous recovery rates within 3-4 years, suggesting that both FITNET and usual care (consisting of cognitive behaviour and graded exercise therapies) are ineffective and might even impede natural recovery in adolescents with ME/CFS. This has implications for the upcoming costly NHS FITNET trial which is a blueprint of the Dutch study, exposing it to similar biases. [ABSTRACT FROM AUTHOR]

Background:Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients’ attitudes towards the use of eHealth solutions in IBD is lacking. Objective:The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management. Methods:A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken. Results:Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management. Conclusions:This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management. [ABSTRACT FROM PUBLISHER]

This paper explores the health information-seeking practices of healthy young adults and how they assess and rank sources of information through a qualitative study. The findings show that participants (a) are strongly committed to searching for information about health and lifestyle, especially via the Internet; (b) healthcare professionals were perceived as the most reliable source of health information and advice; (c) online health information, although frequently accessed and experienced as empowering, is seen as a potentially unreliable source. Findings evidence how becoming better informed about health-related topics plays a pivotal role in individuals’ lives, most notably by using the Internet. Participants were able to reflect about what it means to know about health. The construction of trust regarding health information involved a heuristic process vis-à-vis source reliability and perceived credibility that places doctors as the most trustworthy medium of medical advice and health information. We conclude that participants’ trust toward professionals suggests the preference and need for more personalized care; and it is a response to the ambiguity and uncertainty that permeates the health information landscape, particularly that which is web-based. [ABSTRACT FROM PUBLISHER]

Introduction: Hearing loss (HL) affects people worldwide, many of whom are children. Especially in developing countries, epidemiological data on the prevalence of HL are insufficient to implement effective health promotion programs. In this preliminary study with young adults, we describe and validate a tablet-based hearing screening test developed for interactive remote hearing screening and compare the performance of an audiometry screening tablet application with conventional audiometry. In addition, the sensitivity, specificity, and predictive values of the tablet-based method and the concordance between the two methods were analyzed. Methods: Thirty volunteers participated in a double-blind study assessing two auditory threshold screening methods: tablet-based hearing screening and sweep audiometry. For both methods, a correct response to a minimum of two tones out of three emitted at 20 dBHL for the frequencies of 1, 2, and 4 kHz and 30 dBHL for 0.5 kHz in both ears, was considered a negative screening result (normal hearing), whereas hearing impairment was considered a positive screening result. Results: According to both methods, 26 participants had normal hearing and four had HL. The Kappa coefficient indicated perfect concordance between methods. The tabletbased hearing screening method had a sensitivity of 100% (confidence interval [CI]: 30.5-100.0), a specificity of 100% (CI: 87.1-100.0), a positive predictive value of 100% (CI: 30.5-100.0), and a negative predictive value of 100% (CI: 87.1-100.0). Conclusions: The tablet-based hearing screening test was shown to be a reliable and an accurate method for hearing screening that can be used effectively in places with Internet access and where local audiologists are not available. [ABSTRACT FROM AUTHOR]

Background: With the introduction of online health screenings, guidelines describing how to communicate about a person's health need to be adapted for a digital setting. This study aimed to uncover older adults' preferences regarding such online messages. Materials and Methods: Thirty older adults (aged 65 to 75 years) viewed four versions of the results message of a screening aimed at identifying frailty: a standard, empathic, tailored, or both empathic and tailored message. After each version, they were interviewed about what they (dis)liked about the message. They also ranked the four versions according to preference. Ranks were analyzed with a Friedman's test and a Wilcoxon's signed-rank test. Results: There was no significant difference for message-type preference when the outcome was positive. For the prefrail or frail outcome, message-type preferences differed (χ² = 10.51, p = 0.02 and χ2 = 13.56, p < 0.01, respectively). Overall, for the prefrail and frail outcome, the tailored version was appreciated most. Participants commented that the tailored version made them feel appreciated more as a person. Some found the empathic additions comforting, others found these unnecessary. Conclusions: When communicating the results of an online health screening to older adults via the Internet, one should primarily tailor the message toward personal characteristics. The effect of empathic elements in results messages appeared to be limited. Whether a message should be adapted depends on whether the outcome is positive or negative. [ABSTRACT FROM AUTHOR]

Background: Avatar-assisted therapy (AAT) is a novel and emerging technology that uses the Internet to enable clinicians and clients in substance abuse treatment to participate in group counseling sessions from separate and remote locations in real time through the use of avatars and virtual environments.Objectives: The current study is a pilot proof-of-concept feasibility study involving individuals in outpatient substance abuse treatment. This report addresses two questions: (1) are individuals who present for substance abuse treatment interested in receiving AAT and (2) what factors are associated with better treatment success.Methods: Individuals who presented at the treatment clinic who met study eligibility criteria, and provided their written informed consent to participate, were included in the current study (N = 59; 78% male).Results: Twenty-eight (47.5%) participants completed 16 weeks of treatment and attended more sessions compared to non-completers (M = 14.3 vs. 7.5 p < .05). Those individuals who completed treatment were less likely to have a positive urine drug screen at baseline (21.5 vs. 78.6%; p < .05). Furthermore, those individuals who successfully completed treatment were less likely to have positive urine drug screens during treatment compared to those who did not complete (29.7% vs. 70.3%, p < .05). There were no arrests during treatment for completers and non-completers.Conclusion: Poor retention in substance use disorder treatment has long been a major problem for public health. AAT is a feasible approach that has the potential to expand treatment to individuals who might have difficulty accessing treatment. Moreover, AAT may be appealing to clients who are concerned about anonymity and confidentiality. [ABSTRACT FROM AUTHOR]

This study investigated whether several psychopathology variables, including suicidality, could predict the time people spend using the internet (hours online). Next, we examined a specific at-risk population (suicidal individuals) by their online behaviors, comparing suicidal individuals who went online for suicide-related purposes with suicidal individuals who did not go online for suicide-related purposes. An anonymous online sample of 713 (aged 18–71) reported hours online, psychiatric histories, and completed several standardized scales. After accounting for age and education, hierarchical regression modeling showed that the assessed psychopathology variables, including suicidality, did not explain significant variance in hours online. Hours online were better predicted by younger age, greater willingness to develop online relationships, higher perceived social support, higher curiosity, and lower extraversion. Suicidal participants, who did or did not go online for suicide-related purposes, did not differ on hours online. Multiple regression modeling showed that those who went online for suicide-related purposes were likely to be younger, more suicidal, and more willing to seek help from online mental health professionals. These findings revealed that hours online are not a valid indicator of psychopathology. However, studying online behaviors of specific at-risk groups could be informative and useful, including for suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Informal or family caregivers are important contributors to health and health care and require support to sustain their role and address particular challenges. An experience-based health website may be an accessible, effective way to offer caregivers peer support and ultimately better equip them to care for themselves and their loved ones.Objectives: This study investigated how caregivers access and use information on the Internet about caregiving and their perspectives on the design and features of a new personal health experiences (PHEx) website.Methods: This was a qualitative descriptive study that involved three focus groups of caregivers for a total of 16 participants in a university-affiliated hospital in Quebec. Thematic analysis was used with transcriptions of recorded sessions.Results: With respect to how participants accessed and used health information, three themes emerged: searching for and choosing health websites, empowerment through the use of online health information, and concerns about health information on the Internet. In terms of their views on a health experiences website, the two main themes were: factors important for first impressions and perceived needs and expectations.Conclusion: Caregivers accessed and chose health information in a similar manner to other people but still offered additional insights regarding online health information retrieval, usage, and other perspectives, which will be helpful for future web-based initiatives that aim to provide support to caregivers. [ABSTRACT FROM AUTHOR]

Framing of causal interdependencies and uncertainties is important due to factors bringing change to healthcare, such as increasing access to healthcare information via the Internet and increasing self-care. In this paper, it is explained how critical realism can provide a basis for framing causal interdependencies and causal uncertainties within healthcare. The need for critical realist framing of causal interdependencies and uncertainties in healthcare is explained from the perspectives of human to human communication and human to AI communication. An example is provided of critical realist framing for causal interdependencies. Also, an example is provided of critical realist framing for causal uncertainties. Implications are discussed for human to human communication and human to AI communication. Critical realism can provide framing that is easy to grasp and recall. Importantly, critical realist framing can encompass both causal specificity and holistic overview when integrating diverse healthcare options. Moreover, critical realist framing can encompass uncertainties across the “why”, “how”, and “what” of healthcare. These characteristics of critical realist framing are important as end-users become increasingly aware of healthcare diversity and uncertainty. [ABSTRACT FROM AUTHOR]

Background: Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS. Objectives: To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients. Methods: MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle. Results: A total of 171 patients were randomized to IPST (n = 85) or a wait list control (n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in depressive symptoms, but no differences were found between groups at T1 (d = 0.23; 95% confidence interval (CI) = (−4.03, 1.08); p = 0.259) and T2 (d = 0.01; 95% CI = (−2.80, 2.98); p = 0.953). Conclusion: We found no indication that IPST for MS patients with moderate or severe depression is effective in reducing depressive symptoms compared to a waiting list. Large improvements in the wait list control were unexpected and are discussed. [ABSTRACT FROM AUTHOR]

The emergence of the e-patient has resulted in many medical practitioners' being ill-equipped to deal with the 21st-century medical practice. This Guide is a teaching guide for medical educators so that they can prepare their students for the new environment that has resulted from the emergence of the e-patient. Within the context of theoretical perspectives, the Guide begins by defining the concept, and examining the history of the e-patient, detailing typical e-patient activities and some complexities raised by these activities. Finally, the Guide details the topic areas that should be covered in a course aimed at preparing medical students for e-patients. The result is a theoretical and practical teaching Guide that equips medical teachers and their students with the necessary background information, and also assists teachers in the teaching of that information so that their students may become health practitioners fully equipped to deal with the problems and potential of the e-patient. [ABSTRACT FROM PUBLISHER]

Introduction The necessity of culturally competent Internet Cancer Support Groups (ICSGs) for ethnic minorities has recently been highlighted in order to increase its attractiveness and usage. The purpose of this study was to determine the preliminary efficacy of a culturally tailored registered-nurse-moderated ICSG for Asian American breast cancer survivors in enhancing the women's breast cancer survivorship experience. Methods The study included two phases: (a) a usability test and an expert review; and (b) a randomized controlled pilot intervention study. The usability test was conducted among five Asian American breast cancer survivors using a one-month online forum, and the expert review was conducted among five experts using the Cognitive Walkthrough method. The randomized controlled pilot intervention study (a pre-test and post-test design) was conducted among 65 Asian American breast cancer survivors. The data were analysed using content analysis and descriptive and inferential statistics including the repeated ANOVA. Results All users and experts positively evaluated the program and provided their suggestions for the display, educational contents, and user-friendly structure. There were significant positive changes in the support care needs and physical and psychological symptoms ( p < 0.05) of the control group. There were significant negative changes in the uncertainty level of the intervention group ( p < 0.10). Controlling for background and disease factors, the intervention group showed significantly greater improvements than the control group in physical and psychological symptoms and quality of life ( p < 0.10). Discussion The findings supported the positive effects of ICSGs on support care needs, psychological and physical symptoms, and quality of life. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to improve the quality of diabetes control and evaluate the efficacy of an Internet-based integrated healthcare system for diabetes management and safety. Methods We conducted a large-scale, multi-centre, randomized clinical trial involving 484 patients. Patients in the intervention group ( n = 244) were treated with the Internet-based system for six months, while the control group ( n = 240) received the usual outpatient management over the same period. HbA1c, blood chemistries, anthropometric parameters, and adverse events were assessed at the beginning of the study, after three months, and the end of the study. Results There were no initial significant differences between the groups with respect to demographics and clinical parameters. Upon six-month follow-up, HbA1c levels were significantly decreased from 7.86 ± 0.69% to 7.55 ± 0.86% within the intervention group ( p < 0.001) compared to 7.81 ± 0.66% to 7.70 ± 0.88% within the control group. Postprandial glucose reduction was predominant. A subgroup with baseline HbA1c higher than 8% and good compliance achieved a reduction of HbA1c by 0.8 ± 1.05%. Glucose control and waist circumference reduction were more effective in females and subjects older than 40 years of age. There were no adverse events associated with the intervention. Discussion This e-healthcare system was effective for glucose control and body composition improvement without associated adverse events in a multi-centre trial. This system may be effective in improving diabetes control in the general population. [ABSTRACT FROM AUTHOR]

Introduction: As online education becomes more popular so does online assessment. Objectives: The aims of this study are to determine the students' experiences, preferences and perceptions of the online assessment. Methodology: The instrument consists of a selfanswered 45 items questionnaire. The online assessments refer to quizzes and tests from any of the courses listed in the academic plan and conducted using the i-learn platform. Data was collected from 248 students of Bachelor of Pharmacy (Honours) in Universiti Teknologi MARA (UiTM) from all level of study according to the quantity in the stratified sample. The respondents were given 10 minutes to answer the questionnaire before it was collected. The data were analyzed using SPSS version 21.0. Results: Majority of the students (65.3%) had attempted more than five online assessments, access it from home (64.1%) and use a notebook (84.3%) with a Google Chrome browser 65.7%). Slightly over a third (40.7%) experienced technical problem while attempting the assessment and a third (30.1%) of the problems were resolved within a day. Majority of the students rated their experience of online assessment ranging from 5-8 on a scale of 1-10 with speed of the internet connection as the most important factor to be considered. Most of the students gave a 'neutral' and 'agree' statement in terms of perceptions and tend to answer 'agree' and 'strongly agree' towards the statement on the preferences of online assessment. Conclusion: The neutral perceptions showed that there is room for improvement in conducting online assessment such as user-friendly interface, providing an accurate assessment of their knowledge and a challenging assessment for the course. [ABSTRACT FROM AUTHOR]

Background: Insomnia is common in primary care medical practices. Although behavioral treatments for insomnia are safe, efficacious, and recommended in practice guidelines, they are not widely-available, and their effects on comorbid medical conditions remain uncertain. We are conducting a pragmatic clinical trial to test the efficacy of two cognitive behavioral treatments for insomnia (Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi)) versus an enhanced usual care condition (EUC).Methods/design: The study is a three-arm, parallel group, randomized controlled trial. Participants include 625 adults with hypertension and insomnia, recruited via electronic health records from primary care practices affiliated with a large academic medical center. After screening and baseline assessments, participants are randomized to treatment. BBTI is delivered individually with a live therapist via web-interface/telehealth sessions, while SHUTi is a self-guided, automated, interactive, web-based form of cognitive behavioral therapy for insomnia. Participants in EUC receive an individualized sleep report, educational resources, and an online educational video. Treatment outcomes are measured at 9 weeks, 6 months, and 12 months. The primary outcome is patient-reported sleep disturbances. Secondary outcomes include other self-reported sleep measures, home blood pressure, body mass index, quality of life, health functioning, healthcare utilization, and side effects.Discussion: This randomized clinical trial compares two efficacious insomnia interventions to EUC, and provides a cost-effective and efficient examination of their similarities and differences. The pragmatic orientation of this trial may impact sleep treatment delivery in real world clinical settings and advance the dissemination and implementation of behavioral sleep interventions.Trial Registration: ClinicalTrials.gov (Identifier: NCT02508129 ; Date Registered: July 21, 2015). [ABSTRACT FROM AUTHOR]

Introduction Self-help computer-based programs are easily accessible and cost-effective interventions with a great recruitment potential. However, each program is different and results of meta-analyses may not apply to each new program; therefore, evaluations of new programs are warranted. The aim of this study was to assess the marginal efficacy of a computer-based, individually tailored program (the Coach) over and above the use of a comprehensive Internet smoking cessation website. Methods A two-group randomized controlled trial was conducted. The control group only accessed the website, whereas the intervention group received the Coach in addition. Follow-up was conducted by e-mail after three and six months (self-administrated questionnaires). Of 1120 participants, 579 (51.7%) responded after three months and 436 (38.9%) after six months. The primary outcome was self-reported smoking abstinence over four weeks. Results Counting dropouts as smokers, there were no statistically significant differences between intervention and control groups in smoking cessation rates after three months (20.2% vs. 17.5%, p = 0.25, odds ratio (OR) = 1.20) and six months (17% vs. 15.5%, p = 0.52, OR = 1.12). Excluding dropouts from the analysis, there were statistically significant differences after three months (42% vs. 31.6%, p = 0.01, OR = 1.57), but not after six months (46.1% vs. 37.8%, p = 0.081, OR = 1.41). The program also significantly increased motivation to quit after three months and self-efficacy after three and six months. Discussion An individually tailored program delivered via the Internet and by e-mail in addition to a smoking cessation website did not significantly increase smoking cessation rates, but it increased motivation to quit and self-efficacy. [ABSTRACT FROM AUTHOR]

Purpose: The primary purpose of this study was to examine the quality of sponsored and unsponsored asthma websites using the Brief DISCERN instrument and to evaluate whether the Health On the Net Code of Conduct (HONcode) logo was present, thereby indicating that the site met the criteria. The Internet is an important source of health information for patients and their families. The primary purpose of this study was to examine the quality of sponsored and unsupported asthma websites. A secondary aim was to determine the readability and reading ease of the materials for each website along with the grade level. Methods: We queried seven Internet search engines using the keyword "asthma." The websites were evaluated using the six-item Brief DISCERN instrument and by ascertaining whether the HONcode quality label was present. The websites were also evaluated for readability employing Flesch-Kincaid grade level and Flesch reading ease tools using Microsoft Office Word 2013 software. Results: A total of 22 unique websites were included in the study. Approximately 68% of the websites reviewed had a Brief DISCERN cutoff score of =16. The overall Brief DISCERN scores ranged from 6 to 30, and the mean score was 17.32 (SD =6.71). The Flesch-Kincaid grade level scores ranged from 2.9 to 15.4, and the average reading grade score was 9.49 (SD =2.7). The Flesch reading ease scores ranged from 17 to 82.7, with a mean reading ease score of 53.57 (SD =15.03). Sites with a HONcode quality label had significantly higher Brief DISCERN scores than those without one (t=2.3795; df=20; p=0.02). Conclusion: Brief DISCERN scores revealed that there is quality asthma information for children and their families available on the Internet. The grade level ranged between 2.9 and 15.4 among the websites. However, the mean grade level scores were 9.3-9.89, which is high for the average consumer. Access to accurate information via the Internet, with appropriate readability, may enable pediatric asthma patients and their caregivers to better control and manage asthma. [ABSTRACT FROM AUTHOR]

Background: An e-health care program has previously shown to have a positive effect on return to work, quality of life and pain in patients who underwent gynaecological surgery. Plausibly, providing the care program to a population undergoing other types of surgery will be beneficial as well. The objectives of this study are to evaluate patients' opinions, needs and preferences regarding the information and guidance supplied to patients during the perioperative period, to investigate whether e-health may be of assistance and to explore if gender specific needs exist.Methods: A questionnaire was sent to all patients between 18 and 75 years (n = 362), who underwent various forms of abdominal surgery between August 2013 to September 2014 in a university hospital in the Netherlands. The questionnaire contained questions about the current situation in perioperative care and questions about patients' preferences in an e-health care program. Gender differences were evaluated.Results: Two hundred seven participants (57.2%) completed the survey. The majority of the participants were relatively satisfied with the perioperative care they received (68.6%). Most reported shortcomings in perioperative care concerning the supply of information regarding the resumption of activities and guidance during the recovery course. An e-health care program was expected to be of added value in perioperative care by 78% of the participants; a website was reported as most useful. In particular practical functions on a website focusing on the preparation to surgery and monitoring after surgery were appraised to be highly valuable. Overall, women had slightly more needs for extra information and support during the perioperative course than men.Conclusions: In abdominal surgery, there is a need for an e-health care program, which should focus mainly on the supply of information about the resumption of activities as well as guidance in the postoperative course. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to evaluate the feasibility and effects of an internet-based information and self-help program with therapist contact for parents of children and adolescents with burns. The program aimed to reduce parents' symptoms of general and posttraumatic stress.Methods: Participants were parents of children treated for burns between 2009-2013 at either of the two specialized Swedish Burn centers. Sixty-two parents were included in a two-armed, randomized controlled trial with a six-week intervention group and a wait-list control group, including a pre and post-assessment, as well as a 3 and 12-month follow-up. The intervention contained psychoeducation, exercises and homework assignments, and the intervention group received weekly written feedback from a therapist. The main outcome was stress (post-traumatic stress, general stress and parental stress).Results: The program had a beneficial effect on posttraumatic stress in the short term, but did not affect general stress or parental stress. The parents rated the program as being informative and meaningful, but some of them thought it was time-consuming.Conclusion: The program has the potential to support parents of children with burns. The intervention is easily accessible, cost-effective and could be implemented in burn care rehabilitation. [ABSTRACT FROM AUTHOR]

Background: In the age of online communication, psychiatric care can now be provided via videoconferencing technologies. While virtual visits as a part of telepsychiatry and telemental health provide a highly efficient and beneficial modality of care, the implementation of virtual visits requires attention to quality and safety issues. As practitioners continue to utilize this technology, issues of clinician licensing, treatment outcomes of virtual visits versus in-person visits, and cost offset require ongoing study. Methods: This review provides an overview of the topics of technology, legal and regulatory issues, clinical issues, and cost savings as they relate to practicing psychiatry and psychology via virtual visits in an academic medical center. We review the telepsychiatry/telemental health effectiveness literature from 2013 to the present. Our literature searches used the following terms: telemental health effective, telepsychiatry effective, telepsychiatry efficacy, and telemental health efficacy. These searches produced 58 articles, reduced to 16 when including only articles that address effectiveness of clinician-to-patient services. Results: The technological, legal, and regulatory issues vary from state to state and over time. The emerging research addressing diverse populations and disorders provides strong evidence for the effectiveness of telepsychiatry. Cost savings are difficult to precisely determine and depend on the scope of the cost and benefit measured. Conclusion: Establishing a telepsychiatry program requires a comprehensive approach with up-to-date legal and technological considerations. [ABSTRACT FROM AUTHOR]

Among individuals with substance use disorders (SUDs), comorbidity with other psychiatric disorders is common and often noted as the rule rather than the exception. Standard care that provides integrated treatment for comorbid diagnoses simultaneously has been shown to be effective. Technology-based interventions (TBIs) have the potential to provide a cost-effective platform for, and greater accessibility to, integrated treatments. For the purposes of this review, we defined TBIs as interventions in which the primary targeted aim was delivered by automated computer, Internet, or mobile system with minimal to no live therapist involvement. A search of the literature identified nine distinct TBIs for SUDs and comorbid disorders. An examination of this limited research showed promise, particularly for TBIs that address problematic alcohol use, depression, or anxiety. Additional randomized, controlled trials of TBIs for comorbid SUDs and for anxiety and depression are needed, as is future research developing TBIs that address SUDs and comorbid eating disorders and psychotic disorders. Ways of leveraging the full capabilities of what technology can offer should also be further explored. [ABSTRACT FROM AUTHOR]

TheWorld Health Organization estimates that during a given 12-month period, approximately 34million people suffering frommajor depressive disorder go untreated in Europe and the Americas alone. Barriers to treatment include geographic distance, lack of mental health insurance, prohibitive cost of treatment, long wait-lists, and perceived stigma. Over the past two decades, Internet-based cognitive-behavioral therapy (iCBT) programs have proliferated. A growing body of research supports the efficacy of iCBT for depression and other psychiatric conditions, and these programs may help address barriers that hinder access to effective treatment. The present review describes common iCBT programs along with the evidence base supporting their efficacy in reducing symptoms of depression, reviews research on moderators of treatment response, and provides suggestions for future directions in research and care. [ABSTRACT FROM AUTHOR]

With the rapidly growing popularity of the delivery of health services through the Internet, it is timely to examine online health service (OHS) diffusion from the human decision process perspective for its development and diffusion. The health service possesses an offline-to-online nature; that is, its online service is an extension of its offline service. Therefore, we develop a research model to bridge offline healthcare and the OHS-decision, which is contingent on different levels of offline healthcare habits, drawing on user satisfaction literature, the Innovation Diffusion Theory, and the habit literature. Data were collected from 323 Internet users, and our empirical results show that high satisfaction on offline healthcare hinders the awareness of OHS and subsequently influences adoption intention. On the other hand, offline healthcare habits weaken the effects of offline health satisfaction on the OHS awareness. Discussions and implications are also proposed in the concluding sections of this research. [ABSTRACT FROM AUTHOR]

With the advances of machine learning algorithms and the pervasiveness of network terminals, the online medical prediagnosis system, which can provide the diagnosis of healthcare provider anywhere anytime, has attracted considerable interest recently. However, the flourish of online medical prediagnosis system still faces many challenges including information security and privacy preservation. In this paper, we propose an e fficient and privacy-preserving online medical prediagnosis framework, called eDiag, by using nonlinear kernel support vector machine (SVM). With eDiag, the sensitive personal health information can be processed without privacy disclosure during online prediagnosis service. Specifically, based on an improved expression for the nonlinear SVM, an efficient and privacy-preserving classification scheme is introduced with lightweight multiparty random masking and polynomial aggregation techniques. The encrypted user query is directly operated at the service provider without decryption, and the diagnosis result can only be decrypted by user. Through extensive analysis, we show that eDiag can ensure that users’ health information and healthcare provider's prediction model are kept confidential, and has significantly less computation and communication overhead than existing schemes. In addition, performance evaluations via implementing eDiag on smartphone and computer demonstrate eDiag's effectiveness in term of real online environment. [ABSTRACT FROM AUTHOR]

Background: Effective, accessible biopsychosocial treatments are needed to manage chronic knee pain on a population level. Objective: To evaluate the effectiveness of Internet-delivered, physiotherapist-prescribed home exercise and pain-coping skills training (PCST). Design: Pragmatic parallel-group randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12614000243617) Setting: Community (Australia). Patients: 148 persons aged 50 years or older with chronic knee pain. Intervention: The intervention was delivered via the Internet and included educational material, 7 videoconferencing (Skype [Microsoft]) sessions with a physiotherapist for home exercise, and a PCST program over 3 months. The control was Internet-based educational material. Measurements: Primary outcomes were pain during walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index) at 3 months. Secondary outcomes were knee pain, quality of life, global change (overall, pain, and functional status), arthritis self-efficacy, coping, and pain catastrophizing. Outcomes were also measured at 9 months. Results: Of participants enrolled, 139 (94%) completed primary outcome measures at 3 months and 133 (90%) completed secondary outcome measures at 9 months; multiple imputation was used for missing data. The intervention group reported significantly more improvement in pain (mean difference, 1.6 units [95% CI, 0.9 to 2.3 units]) and physical function (mean difference, 9.3 units [CI, 5.9 to 12.7 units]) than the control group at 3 months, and improvements were sustained at 9 months (mean differences, 1.1 units [CI, 0.4 to 1.8 units] and 7.0 units [CI, 3.4 to 10.5 units], respectively). Intervention participants showed significantly more improvement in most secondary outcomes than control participants. At both time points, significantly more intervention participants reported global improvements. Limitation: Participants were unblinded. Conclusion: For persons with chronic knee pain, Internet-delivered, physiotherapist-prescribed exercise and PCST provide clinically meaningful improvements in pain and function that are sustained for at least 6 months. [ABSTRACT FROM AUTHOR]

This study investigated a technology-enhanced training protocol to facilitate dissemination of therapist training on cognitive behavior therapy (CBT) for anxiety disorders. Seventy community clinicians received an online tutorial followed by live remote observation of clinical skills via videoconference. Impact of training on patient outcomes was also assessed. Training resulted in a significant increase in both trainee knowledge of CBT concepts and techniques and therapist competence in applying these skills. Patients treated by trainees following training had significant reductions in anxiety and depression. Ratings of user satisfaction were high. Results provide support for the use of these technologies for therapist training in CBT. [ABSTRACT FROM AUTHOR]

Purpose: Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). Patients and methods: A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients' medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. Results: In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and .30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45-65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P,0.001), and younger people and those with higher education were associated with more active use. Conclusion: Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this review is to systematically explore and summarise the validity and reliability of telerehabilitation (TR)-based physiotherapy assessment for musculoskeletal disorders. Method A comprehensive systematic literature review was conducted using a number of electronic databases: PubMed, EMBASE, PsycINFO, Cochrane Library and CINAHL, published between January 2000 and May 2015. The studies examined the validity, inter- and intra-rater reliabilities of TR-based physiotherapy assessment for musculoskeletal conditions were included. Two independent reviewers used the Quality Appraisal Tool for studies of diagnostic Reliability (QAREL) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool to assess the methodological quality of reliability and validity studies respectively. Results A total of 898 hits were achieved, of which 11 articles based on inclusion criteria were reviewed. Nine studies explored the concurrent validity, inter- and intra-rater reliabilities, while two studies examined only the concurrent validity. Reviewed studies were moderate to good in methodological quality. The physiotherapy assessments such as pain, swelling, range of motion, muscle strength, balance, gait and functional assessment demonstrated good concurrent validity. However, the reported concurrent validity of lumbar spine posture, special orthopaedic tests, neurodynamic tests and scar assessments ranged from low to moderate. Conclusion TR-based physiotherapy assessment was technically feasible with overall good concurrent validity and excellent reliability, except for lumbar spine posture, orthopaedic special tests, neurodynamic testa and scar assessment. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) is transforming the nature of almost everything that is connected to human life, e.g., employment, economy, communication, warfare, privacy, security, ethics, healthcare, etc. However, we are yet to see its evolution in the long term-whether it is leading humanity towards making this planet a better place to live in or a place which is full of disaster. Every technology has its advantages and disadvantages, but advantages always outweigh disadvantages for the technology to survive in the market. Nonetheless, for AI, we are not yet sure whether in the long term positive effects will always keep outweighing the negative effects, and if that is not the case, then we are in serious trouble. If we look around us, on the one hand, we seem to embrace the change being brought by technology, be it smart home, smart healthcare, Industry 4.0 or autonomous cars. On the other hand, we often find ourselves protesting against the government in the context of unemployment, taxes, privacy, etc. As AI development is speeding up, more robots or autonomous systems are being born and replacing human labor. This is the current situation; however, in the long term, results seem to get more interesting. This paper focuses on the major domains where human life is significantly affected by AI in both positive and negative ways. [ABSTRACT FROM AUTHOR]

Health education, which also includes medicine education, promotes social sustainability in society. Through the context of Internet-based intervention, this study reports on fourth graders' (N = 51, aged 10-11 years) perspectives on medicines, their use with common diseases and medicine-related information sources. The study was qualitative by nature. Data was collected in spring 2010, by audio recording students' group discussions during the study process and group interviews. After intervention, students were well aware of the proper use of medicines and how to find information both on medicines and health issues. The main challenge was finding websites that provide reliable and confidential information. The results of this study raise awareness of a concrete pedagogical approach to health education. The pedagogical approach conducted in the intervention could, to some extent, be transferred to any school setting. This study underlies the promotion of Internet-based health literacy and criteria, for evaluating online health information in the primary school context. [ABSTRACT FROM AUTHOR]

Background: The acceptability, feasibility and effectiveness of web-based interventions among criminal justice involved populations are understudied. This study is a secondary analysis of baseline characteristics associated with criminal justice system (CJS) status as treatment outcome moderators among participants enrolling in a large randomized trial of a web-based psychosocial intervention (Therapeutic Education System [TES]) as part of outpatient addiction treatment. Methods: We compared demographic and clinical characteristics, TES participation rates, and the trial's two co-primary outcomes, end of treatment abstinence and treatment retention, by self-reported CJS status at baseline: 1) CJS-mandated to community treatment (CJS-mandated), 2) CJS-recommended to treatment (CJS-recommended), 3) no CJS treatment mandate (CJS-none). Results: CJS-mandated ( n = 107) and CJS-recommended ( n = 69) participants differed from CJS-none ( n = 331) at baseline: CJS-mandated were significantly more likely to be male, uninsured, report cannabis as the primary drug problem, report fewer days of drug use at baseline, screen negative for depression, and score lower for psychological distress and higher on physical health status; CJS-recommended were younger, more likely single, less likely to report no regular Internet use, and to report cannabis as the primary drug problem. Both CJS-involved (CJS -recommended and -mandated) groups were more likely to have been recently incarcerated. Among participants randomized to the TES arm, module completion was similar across the CJS subgroups. A three-way interaction of treatment, baseline abstinence and CJS status showed no associations with the study's primary abstinence outcome. Conclusions: Overall, CJS-involved participants in this study tended to be young, male, and in treatment for a primary cannabis problem. The feasibility and effectiveness of the web-based psychosocial intervention, TES, did not vary by CJS-mandated or CJS-recommended participants compared to CJS-none. Web-based counseling interventions may be effective interventions as US public safety policies begin to emphasize supervised community drug treatment over incarceration. [ABSTRACT FROM AUTHOR]

eHealth interventions can be effective in treating health problems. However, adoption in inpatient routine care seems limited. The present study therefore aimed to investigate barriers and facilitators to acceptance of eHealth interventions and of online aftercare in particular in health professionals of inpatient treatment. A total of 152 out of 287 health professionals of various professional groups in four inpatient rehabilitation facilities filled out a self-administered web-based questionnaire (response rate: 53%); 128 individuals were eligible for further data analysis. Acceptance and possible predictors were investigated with a complex research model based on the Unified Theory of Acceptance and Use of Technology. Acceptance of eHealth interventions was rather low (M = 2.47, SD = 0.98); however, acceptance of online aftercare was moderate (M = 3.08, SD = 0.96, t(127) = 8.22, p < .001), and eHealth literacy was elevated. Social influence, performance expectancy, and treatment-related internet and mobile use significantly predicted overall acceptance. No differences were found between professional and age groups. Although acceptance of eHealth interventions was limited in health professionals of inpatient treatment, moderate acceptance of online aftercare for work-related stress implies a basis for future implementation. Tailored eHealth education addressing misconceptions about inferiority and incongruity with conventional treatment considering the systemic aspect of acceptance formation are needed. [ABSTRACT FROM AUTHOR]

Introduction: Internet based obesity prevention program is one approach in learning strategies to improve healthy behaviour. It has been advocated as one strategy to address the rising prevalence of childhood obesity; however, their efficacy is not seen consistently. Aim: The purpose of this study was to assess the efficacy of internet based obesity prevention program in Thai school children. Materials and Methods: Healthy children studying in public schools in one township of central Thailand were randomly assigned to either the intervention (internet based) program or the control group. Anthropometric characteristics were recorded at baseline and for the next four following months at monthly intervals. Changes in the percentage of overweight/obese children and changes in BMI at the end of study were considered as the primary and secondary outcome, respectively. Results: A total of 217 children, mean age of 10.7 years, were included into the final analysis. Baseline anthropometric parameters and percentages of overweight/obesity were not significantly different between groups. At the end of the study, the control group had a higher percentage of overweight/obesity than the intervention group (56.6% vs. 39.6%, respectively; p-value=0.009). Children in the control group had a significantly higher increase in net BMI gains than those in the intervention group (1.24kg/m² vs. 0.40kg/m², p-value=0.027). The intervention group had no changes in BMI z-score (-0.001, 95%CI-0.19 to 0.18, p-value=0.988), contrary to those in the control group, which had significant gain of BMI z-score at the end of study (0.45, 95%CI 0.27 to 0.63, p-value<0.001). Conclusion: Internet the based obesity prevention program was effective in modifying anthropometric outcome and helped to address the rising prevalence of overweight and obese status in Thai children. [ABSTRACT FROM AUTHOR]

Neglected disease drug discovery is generally poorly funded compared with major diseases and hence there is an increasing focus on collaboration and precompetitive efforts such as public–private partnerships (PPPs). The More Medicines for Tuberculosis (MM4TB) project is one such collaboration funded by the EU with the goal of discovering new drugs for tuberculosis. Collaborative Drug Discovery has provided a commercial web-based platform called CDD Vault which is a hosted collaborative solution for securely sharing diverse chemistry and biology data. Using CDD Vault alongside other commercial and free cheminformatics tools has enabled support of this and other large collaborative projects, aiding drug discovery efforts and fostering collaboration. We will describe CDD's efforts in assisting with the MM4TB project. [ABSTRACT FROM AUTHOR]

Background Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short-term adherence. Psoriasis is a chronic disease, and long-term adherence is an even bigger problem. Objectives To determine how well medication is used in the long-term topical treatment of psoriasis and to assess the potential of an internet-based reporting intervention to improve treatment adherence and outcomes. Methods An investigator-blinded, prospective study evaluated topical fluocinonide adherence in 40 patients with mild-to-moderate psoriasis over 12 months. Subjects were randomized in a 1 : 1 ratio to standard-of-care or internet-based reporting group. Adherence was objectively monitored with Medication Event Monitoring System® caps. Results Fifty per cent of subjects discontinued the treatment. Greater adherence was seen in the intervention group compared with the standard-of-care group (50% vs. 35%, P = 0·08). Psoriasis Area and Severity Index improved more in the intervention group at month 1 (1·61 vs. −0·12, P = 0·003), month 3 (2·50 vs. 0·79, P = 0·025) and month 12 (3·32 vs. 0·34, P = 0·038) than in the standard-of-care group. Conclusions This study likely underestimates the challenge of long-term adherence, as adherence tends to be better in research studies than in clinical practice. This study also did not fully account for primary nonadherence. Adherence to topical treatment is low in the short term and decreased further in the long term, a considerable challenge for dermatologists to address. A reporting intervention may be one of the ways we can improve our patients' treatment outcomes. [ABSTRACT FROM AUTHOR]

The ongoing transition to the patient-centred healthcare paradigm suggests that patients adopt an active role in managing their health conditions. As a result, the Internet is becoming an important source of health-related information. Internet-based health support groups allow patients to access diverse information relevant to their particular situation by participating in online discussions. The quality of such information may have effects on the patients' health outcomes. The purpose of the present study was to investigate the effects of knowledge construction in health support group online discussions on perceived information quality, information quality from the perspective of information consumers, and on information integrity, that is, validity from the point of view of the current state of scientific knowledge. It was hypothesised that knowledge construction results in better perceived information quality and in higher information integrity. A health support group online discussion site devoted to weight management was used as a source of data. Quantitative content analysis was used with a discussion thread as a unit of analysis. Based on the findings, the study suggested that moderators of health support group online discussions should promote explicitation or lower level knowledge construction by encouraging clarifications and refinements of health-related recommendations. Moreover, participation of qualified health practitioners is desirable to promote health-related behaviours based on evidence-based knowledge and to expose recommendations that have uncertain or even dangerous effects. [ABSTRACT FROM AUTHOR]

This study investigated moderators of intervention response in a fully automated Internet-based monitoring and feedback intervention (‘Featback’) with different levels of therapist support for individuals with eating disorder (ED) symptoms. This study was part of a randomized controlled trial comparing four conditions: 1) Featback, 2) Featback with low-intensity (weekly) therapist support, 3) Featback with high-intensity (three times a week) therapist support, and 4) a waiting list. A total of 273 participants completed baseline and post-intervention assessments. The outcome measure was ED psychopathology. Model-based recursive partitioning was applied. Baseline levels of ED psychopathology were found to moderate intervention response. Specifically, in terms of improvement in symptoms of anorexia nervosa, participants with higher baseline levels of anorectic psychopathology showed better outcomes in the waiting list condition and the Featback conditions with low- and high-intensity therapist support in comparison with Featback without therapist support. In terms of improvement in symptoms of bulimia nervosa, participants with mild to moderate bulimic symptoms had better outcomes in the Featback conditions compared with the waiting list. Thus, the fully automated Internet-based intervention with and without therapist support may be particularly suitable in improving mild to moderate bulimic psychopathology, whereas the intervention without therapist support may be less effective in improving severe anorectic psychopathology. Further investigating differential intervention responses is important, as this could help to optimize the delivery and dissemination of E-health interventions and therapist support, which in turn could help moving toward personalized (E-)care. [ABSTRACT FROM AUTHOR]

Objective: Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. Method: RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinicbased FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Results: Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. Conclusions: VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. [ABSTRACT FROM AUTHOR]

Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive-behavioral therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2,866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, odds ratios {ORs) = 3.10, 95% confidence interval (Cl) [2.21, 4.34], Clinical severity at pretreatment was related to lower odds, OR = 0.62,95% Cl [0.50, 0.77], and OR = 0.51, 95% Cl [0.51,0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, OR = 0.58, 95% Cl [0.35, 0.95], having at least a university degree, OR = 0.54, 95% Cl [0.33, 0.88], and being older, OR = 0.78, 95% Cl, [0.62, 0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition. Conclusion: Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers to reverse and prevent a negative treatment trend. [ABSTRACT FROM AUTHOR]

Based on Street’s (2003) ecological framework of communication in medical encounters, this study examined personal, interpersonal, and media factors that could influence patients’ use of the Internet to communicate with doctors. Results from data analysis of responses from the 2014 Health Information National Trends Survey showed that patient activation and ease of Internet access were two positive predictors of online doctor-patient communication. In addition, patients’ trust in doctors positively moderated the relationships between patient activation and online doctor-patient communication, and between perceived health status and online doctor-patient communication. Finally, the quality of patients’ past experiences communicating with doctors had a positive moderation effect on the association between health information seeking behavior and online doctor-patient communication. Implications and limitations are discussed. [ABSTRACT FROM PUBLISHER]

Antiphospholipid Syndrome (APS) is an autoimmune disease characterized by recurrent thromboses and fetal losses with the presence of antiphospholipid antibodies. The main treatment to prevent recurrent thrombotic events is oral anticoagulation with vitamin K antagonist (VKA), which requires frequent monitoring and dosage adjustments. Outpatient anticoagulation monitoring has its limitations, such as patients spending long hours between the testing procedure and waiting for the results to be adjusted. To optimize this adjustment and to improve APS patients-doctors relationship, we developed a website to help monitor APS patients, called Antiphospholipid Syndrome On Cloud or APSOnCloud. To test it, since March 2014 to March 2016, we registered 20 patients with APS that have inserted 132 international normalized ratio (INR) values. Sixty two percent were out of range and it took on average 7 hours for the doctor in charge to adjust these values. The mean time in therapeutic range was 58.1%. Our preliminary experience in monitoring VKA oral anticoagulation on APSOnCloud suggests that patients with APS might benefit from this web-based monitoring. [ABSTRACT FROM AUTHOR]

Introduction The internet is increasingly a source of healthcare information utilized by parents, especially in rarer pathologies such as vascular malformations. The quality, validity and thoroughness of these websites is variable and unregulated. The goal of this study was to evaluate the quality and understandability of websites related to vascular malformations. Methods The terms “hemangioma”, “vascular malformation”, and “vascular anomalies” were searched in Google. The first 30 websites meeting inclusion and exclusion criteria were evaluated. Quality and readability were assessed using the DISCERN criteria and the Flesh-Kincaid Reading Grade Level (FKGL), respectively. Date of last update, HONcode accreditation, and the website category were recorded. Results Most websites were owned by academic institutions (n = 19, 63.3%). The mean DISCERN score for all websites was 2.97, or a partially valid source of information on a 1–5 scale. The average reading level estimated by FKGL was grade 12; only one website was scored at less than a grade 9 level. Two websites were HONcode accredited. Of the 18 sites giving an explicit date of last update, 12 (67.7%) had been updated in the previous 12 months. Conclusions Websites relating information about vascular anomalies may not be understandable to the general public, including parents. Health care providers should be cognizant of the quality and availability of such information as it may impact parent perspectives and bias toward treatment options. [ABSTRACT FROM AUTHOR]

Patients increasingly search the Internet for information about health and potential treatments, but the content and accuracy of some websites are questionable. To evaluate the quality of information on maxillofacial trauma, we searched for the terms “jaw fracture” and “cheekbone fracture” on Google, Yahoo, and Bing. We assessed the first 10 results of each search and excluded duplicates or those that were unrelated. We then used the DISCERN tool and the JAMA (Journal of the American Medical Association) benchmarks to assess those that remained. Of the original 60 found, 38 were excluded (29 duplicates, 9 unrelated). The mean (range) DISCERN score for each search was 38.5 (27–57) for jaw fracture and 41.9 (26–61) for cheekbone fracture. No website achieved an excellent score (more than 63), and over three-quarters were categorised as poor (27–38) or fair (39–50). None met all the JAMA benchmarks, but most adhered to at least two. The standard of online information on maxillofacial trauma varies, but is generally of poor quality. Patients should therefore be advised to be cautious of online sources and should be directed towards higher-quality websites. [ABSTRACT FROM AUTHOR]

Background: Suicidal thoughts are common, causing distress for millions of people all over the world. However, people with suicidal thoughts might not access support due to financial restraints, stigma or a lack of available treatment offers. Self-help programs provided online could overcome these barriers, and previous efforts show promising results in terms of reducing suicidal thoughts. This study aims to examine the effectiveness of an online self-help intervention in reducing suicidal thoughts among people at risk of suicide. The Danish Self-help Online against Suicidal thoughts (SOS) trial is a partial replication of a previously conducted Dutch trial.Methods and Design: A randomized, waiting-list controlled trial with 1:1 allocation ratio will be carried out. A total of 438 people with suicidal thoughts will be recruited from the Danish suicide hotline, The Lifeline's, website and allocated to the intervention condition (N = 219) or the control condition (N = 219). The intervention condition consists of a 6-week, Internet-based self-help therapy intervention. The format of the intervention is self-help, but the participants can be guided by the trial manager. The control condition consists of a waiting-list assignment for 32 weeks. The primary outcomes are frequency and intensity of suicidal thoughts. Secondary outcome measures include depressive symptoms, hopelessness, worrying, quality of life, costs related to health care utilization and production loss. Number of deliberate self-harm episodes, suicides and deaths will, as well as the participant's evaluation of the intervention and the experience of negative effects, be investigated. Assessments will be conducted over the intervention website through self-report questionnaires at baseline, 2 weeks, 4 weeks, 6 weeks and 32 weeks (6 months post intervention).Discussion: If we find the intervention to be linked to reductions in suicidal thoughts, this will strengthen the evidence that online self-help interventions are relevant tools for people with suicidal thoughts.Trial Registration: ClinicalTrials.gov, NCT02872610 . Registered on 9 August 2016. [ABSTRACT FROM AUTHOR]

Background: Drug product data is available on the Web in a distributed fashion. The reasons lie within the regulatory domains, which exist on a national level. As a consequence, the drug data available on the Web are independently curated by national institutions from each country, leaving the data in varying languages, with a varying structure, granularity level and format, on different locations on the Web. Therefore, one of the main challenges in the realm of drug data is the consolidation and integration of large amounts of heterogeneous data into a comprehensive dataspace, for the purpose of developing data-driven applications. In recent years, the adoption of the Linked Data principles has enabled data publishers to provide structured data on the Web and contextually interlink them with other public datasets, effectively de-siloing them. Defining methodological guidelines and specialized tools for generating Linked Data in the drug domain, applicable on a global scale, is a crucial step to achieving the necessary levels of data consolidation and alignment needed for the development of a global dataset of drug product data. This dataset would then enable a myriad of new usage scenarios, which can, for instance, provide insight into the global availability of different drug categories in different parts of the world. Results: We developed a methodology and a set of tools which support the process of generating Linked Data in the drug domain. Using them, we generated the LinkedDrugs dataset by seamlessly transforming, consolidating and publishing high-quality, 5-star Linked Drug Data from twenty-three countries, containing over 248,000 drug products, over 99,000,000 RDF triples and over 278,000 links to generic drugs from the LOD Cloud. Using the linked nature of the dataset, we demonstrate its ability to support advanced usage scenarios in the drug domain. Conclusions: The process of generating the LinkedDrugs dataset demonstrates the applicability of the methodological guidelines and the supporting tools in transforming drug product data from various, independent and distributed sources, into a comprehensive Linked Drug Data dataset. The presented user-centric and analytical usage scenarios over the dataset show the advantages of having a de-siloed, consolidated and comprehensive dataspace of drug data available via the existing infrastructure of the Web. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of a video intervention, Managing Your Diabetes Medicines, on patient self-efficacy, problems with using medication, and medication adherence in a rural, mostly African American population.Methods: Patients selected their problem areas in medication use and watched one of nine 2-min videos with a research assistant at a clinic or pharmacy and were given an access code to watch all the videos at their convenience. Outcomes were measured at baseline and 3-month follow-up.Results: Fifty-one patients were enrolled; 84% were African American and 80% were female (mean age: 54 years). Seventy-three percent watched at least one module after the initial visit. Improved self-efficacy was associated with a decrease in concerns about medications (r=-0.64). Low literate patients experienced greater improvement in self-efficacy than more literate patients (t=2.54, p=0.02). Patients' mean number of problems declined from 6.14 to 5.03. The number of patients with high or medium adherence rose from 33% at baseline to 43% at 3-month follow-up.Conclusions: A practical, customized video intervention may help improve patient self-efficacy, reduce problems with medication use, and improve medication adherence in diabetes patients.Practice Implications: Providers should consider implementing technology-based interventions in the clinic to address common problems that patients have with self-management. [ABSTRACT FROM AUTHOR]

Background: War-torn populations are often hard to screen for mental health disorders. Classical data collection approaches, such as paper-based, online, or SMS-operated, are either infeasible or lack accuracy due to a variety of challenges associated with dynamics and consequences of war.Methods: In this paper, we introduce a novel approach for accurate and fast screening using free open-source software, Open Data Kit (ODK) mobile application. This approach was developed by the Palestine Children's Relief Fund (PCRF) to assess the mental health symptoms of 986 Palestinian children (age 6-18) in the aftermath of Israel's Operation Protective Edge (OPE) in 2014. The organization developed assessment questionnaires and trained local field workers on the use of the mobile application, and on recruiting and interviewing war victims.Results: War-affected children were found to suffer from several alarming symptoms associated with post-traumatic stress disorder (PTSD), depression, and somatic symptoms. Children with highest number of psychological symptoms were referred for further evaluation and treatment.Conclusions: The use of ODK mobile technologies facilitated efficient screening of affected children in war zones. The offline data collection capability was crucial for handling the difficult conditions associated with war-torn areas, enabling timely intervention for urgent cases. Further applications of the novel mobile technology are to be explored. [ABSTRACT FROM AUTHOR]