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Background Parent training (PT) programs have been implemented for neurodevelopmental disorders such as autism spectrum disorder (ASD) in recent years. However, in Southeast Asia, the diffusion of rehabilitation programs for children with ASD and that of PT as a parental support measure has been slow. Methods This study assessed the effectiveness of an online PT program that was developed in Japan and remotely delivered to Vietnamese parents of children with ASD residing in Vietnam. Sixteen parents of Vietnamese children with ASD participated in seven online Tottori University-style PT sessions. The online PT was conducted in real-time from Japan, considering the two-hour time difference between countries. Lectures and exercises were presented in Vietnamese with PowerPoint materials. Japanese staff provided explanations in Japanese, which were then simultaneously translated by a Vietnamese interpreter. Attendance, completion of homework assignments, and the number of statements on Zoom and social media were tallied. A pre-post-test design was employed to measure changes in parents' mental health factors and children's behavior. A post-intervention questionnaire was administered to assess participant's acceptance of PT. Results The findings showed that attendance and task completion rates were considerably high. The study found that the mental health scores of parents significantly improved after participating in online parenting training compared to before. However, there were no statistically significant improvements found in children's behavior. The study also confirmed high satisfaction with the cross-country online parenting training. Conclusion This study confirmed that TUPT, developed in Japan and implemented as an online PT for parents of children with ASD living in Vietnam, was effective in improving parental mental health. The program acceptability questionnaire also showed positive results. This study is the first step in the evaluation and dissemination of Internet-based, cross-country parent training for parental support in Asia. [ABSTRACT FROM AUTHOR]

Introduction. Internet-based psychological interventions are an effective option for treating mental health problems. Identifying the acceptability of these services makes it possible to improve their design and user adherence. However, only a few psychometric instruments exist to evaluate this acceptability. Objective. To design and evaluate the psychometric properties of an internet-based psychological interventions questionnaire, based on the theory of technology acceptance. Method. The study was divided into three parts: 1) Design of instrument items, 2) analysis of psychometric properties and exploratory factor analysis, and 3) confirmatory factor analysis. Results. The instrument proved to have adequate psychometric properties, with the following goodness-of-fit measurements: χ²/df = 168.92/74 = 2.28, CFI = .935, TLI = .920, RMSEA = .080, 95% CI [.64, .096]. The analysis of internal consistency found an α = .91 for the total scale, an α = .91 for the first factor, "Approval of use," an α = .79 for the second factor, "Perceived usefulness," and an α = .59 for the third factor, "Perceived risk." Discussion and conclusion. The evaluation of factors associated with greater acceptability is a potential tool for improving awareness of the use of online psychological interventions. [ABSTRACT FROM AUTHOR]

In the traditional offline context, the mental health industry suffers from poor local demand and a lack of trustworthy supply. Emerging digital platforms can solve this problem to a large extent by building network effects. How to build network effects is a primary issue for mental health platforms. This article explores this problem by investigating two cases from China. Platform firms can design mechanisms to increase user scale, multiply user roles, facilitate user engagement, and enhance user trust on platforms. The pioneer platform and the later entrant can implement different strategies for building network effects. [ABSTRACT FROM AUTHOR]

Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women's safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp²=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp²=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women's communication and patient safety in obstetrics. [ABSTRACT FROM AUTHOR]

Online markets for mental health care (OMMH) allow clients to connect remotely with counselors to receive psychological therapy. Rooted in signaling theory and in the specific context of an OMMH, we theorize relative credibility of signals as the boundary condition that determines whether the demonstration signal of responsiveness to client questions substitutes or complements the two description signals of professional qualifications and counseling style in predicting market demand for counselors from new clients in an OMMH. Based on a panel dataset of 823 observations from 309 counselors participating on YiXinLi, a leading OMMH in China, we tested our hypotheses using linguistic and sentiment analysis methods and zero-inflated negative binomial models. We found broad support for nine out of ten hypotheses. Findings are robust with respect to different measures of variables, potential endogeneity from the simultaneity of responsiveness and counselor demand, and potential selection bias from both observable and endogenous covariates. Our study extends the literature on signaling in online markets in the unique context of OMMH by showing that: (1) relative credibility of signals is the boundary condition that determines when a demonstration signal will complement and when it will substitute for a description signal, (2) previous clients’ feedback on counselors’ empathy and warmth was deemed not credible by new clients in the context of online counseling, and (3) responsiveness to client questions is the most influential predictor of market demand from new clients in an OMMH. [ABSTRACT FROM AUTHOR]

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]

To assess the reliability and quality of YouTube videos as an information source in Retinopathy of Prematurity (ROP) treatment. A YouTube search with the keyword "ROP treatment" was conducted. First 200 videos listed in the first 10 pages were evaluated. The upload sources, video length, days on YouTube, number of total views, likes, dislikes and comments were recorded. View ratio (VR), like ratio (LR) and video power index (VPI) were analyzed. Two ophthalmologists scored all videos using the DISCERN scoring system, Journal of the American Medical Association (JAMA) criteria, and Global Quality Score (GQS). Seventy-three videos were included in the study. The mean VR, LR, and VPI were 4.92±10.11, 83.88±33.98, and 4.55±9.25, respectively. The main upload sources were universities/non-profit professional organizations (36.99%) and physicians (31.51%). The 18 of the 55 videos on treatment procedures contained information on all treatment procedures, 37 videos contained information about at least one of treatment options. The mean DISCERN score, JAMA score and GQS were 42.32±17.51, 2.81±1.03, and 3.12±1.48, respectively. The category of all videos according to the mean DISCERN score was "fair". The overall quality of YouTube videos on ROP treatment was intermediate. Although one third of videos were classified as good quality, most YouTube videos provided poor quality information. Competent authorities and experts should upload carefully recorded videos with reliable and quality content on YouTube to educate and increase the awareness of parents, especially in ROP requiring treatment. [ABSTRACT FROM AUTHOR]

The demand for better health services has resulted in the advancement of remote monitoring health, i.e., virtual nursing systems, to watch and support the elderly with innovative concepts such as being patient-centric, easier to use, and having smarter interactions and more accurate conclusions. While virtual nursing services attempt to provide consumers and medical practitioners with continuous medical and health monitoring services, access to allied healthcare experts such as nurses remains a challenge. In this research, we present Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP), a new framework that provides a virtual nurse agent deployed on a senior citizen's home, workplace, or care centre to help manage their health condition on a continuous basis. Using this method, healthcare providers can assign various jobs to nurses by utilizing a general task definition mechanism, in which a task is defined as a combination of medical workflow, operational guidelines, and data gathered from a remotely monitored virtual nursing system. Practitioners are in charge of DBN-EP and make treatment decisions for patients. This allows a DBN-EP to act as a personalized full-time nurse for a client by carrying out practitioner support activities based on information gathered about the client's health. An electronic Personal Health Record (ePHR) system, such as a specialized web portal and mobile apps, could provide such patient information to elderly person family members and care centres. We created a prototype system using a DBN-EP system that allows traditional client applications and healthcare provider systems to collaborate. Finally, we demonstrate how this system may benefit the elderly through a result and debate. [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]

Methods: The Sickle Cell Transplantation Evaluation of Long-Term and Late Effects Registry (STELLAR) was designed to enroll patients with SCD =1 year post-HCT, their siblings without SCD, and nontransplanted controls with SCD to collect web-based participant self-reports of health status and practices by using the Bone Marrow Transplant Survivor Study (BMTSS) surveys, health-related quality of life (HRQOL) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Profile-25 or Pediatric Profile-29 survey, chronic graft-versus-host disease (cGVHD) using the symptom scale survey, daily pain using an electronic pain diary, the economic impact of HCT using the financial hardship survey, sexual function using the PROMIS Sexual Function SexFSv2.0 survey, and economic productivity using the American Time Use Survey (ATUS). We also piloted retrieval of clinical data previously submitted to the Center for International Blood and Marrow Transplant Research (CIBMTR); recorded demographics, height, weight, blood pressure, waist and hip circumferences, timed up and go (TUG) test, and handgrip test; and obtained blood for metabolic screening, gonadal function, fertility potential, and biorepository of plasma, serum, RNA, and DNA. Results: Of 100 eligible post-HCT patients, we enrolled 72 (72%) participants aged 9-38 (median 17) years. We also enrolled 19 siblings aged 5-32 (median 10) years and 28 nontransplanted controls with SCD aged 4-46 (median 22) years. Of the total 119 participants, 73 (61%) completed 85 sets of surveys and 41 (35%) contributed samples to the biorepository. We completed ATUS interviews of 28 (24%) participants. We successfully piloted retrieval of data submitted to the CIBMTR and expanded recruitment to multiple sites in the United States, Canada, the United Kingdom, and Nigeria. Conclusions: It is feasible to recruit subjects and conduct study procedures for STELLAR in order to determine the long-term and late effects of HCT for SCD. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) can increase mental and physical health in adults aged 50 years and older. However, it has been shown that PA guidelines are often not met within this population. Therefore, our research group developed 2 computer-tailored intervention programs in the last decade to stimulate PA: Active Plus and I Move. Although these programs were proven effective, positive effects diminished over time and attrition rates were relatively high. To respond to this, we will integrate 3 interactive mobile elements into the existing programs: activity tracker, ecological momentary intervention program, and virtual coach app. Objective: The goal of the research is to define systematic and evidence-based steps for extending our online computer-based PA intervention programs with 3 interactive mobile elements. Methods: Components often included in other (eHealth) design models were identified as key components and served as a base for the definition of systematic steps: exploration of context, involvement of the target population, prototype and intervention testing, and implementation. Based on these key components, 10 systematic steps were defined. The initial step is a literature search, with the results serving as a base for development of the low-fidelity prototypes in step 2. The pilot phase comprises the 3rd to 6th steps and includes semistructured interviews, pilot tests, and adaptations of the prototypes with intensive involvement of the target population of adults aged 50 years and older, where particular attention will be paid to lower educated persons. The 7th step is an effect evaluation in the form of a randomized controlled trial. During the 8th step, the most effective intervention programs will be selected and reinforced. These reinforced intervention programs will be used during the design of an implementation plan in the 9th step and the subsequent field study in the 10th step. Results: The project will be executed from December 2019 to December 2023. During this period, the systematic approach presented will be practically executed according to the methodological procedures described. Conclusions: Based on the 4 identified key components, we were able to design an evidence-based systematic design approach for separately adding 3 mobile elements to our existing online PA intervention programs. The 10 steps are presented as a useful approach to guide future eHealth design studies. [ABSTRACT FROM AUTHOR]

Background: Many people with young onset dementia (YOD) may feel isolated. Peer support has the potential to improve social health, but the inconsistent availability of age-appropriate, in-person (peer) support services for people with YOD suggests that many people with YOD miss out on the potential benefits. Online peer support could be useful, as it overcomes geographical barriers, offers a variety of options, and adjusts to various needs and preferences. Objective: Our study aims to develop evidence-based best practice guidance on online peer support for people with YOD and group facilitators to improve online peer support for people with YOD. Methods: Our mixed methods study consists of 4 phases and follows the guidelines of the Medical Research Council on complex interventions. Each phase consists of multiple substudies. The study focuses on the development stage of the Medical Research Council framework and additionally develops a plan for the feasibility/piloting, evaluation, and implementation stages. The participants are people living with YOD and peer support facilitators. The qualitative research methods include interviews, focus groups, and open questions in a web-based survey. The quantitative methods include a web-based survey consisting of existing outcome measures. Results: The study is funded by the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Actions - Innovative Training Networks (H2020-MSCA-ITN-2018; grant agreement number: 813196), and it received ethical approval from the London Bromley Research Ethics Committee (reference number: 21/LO/0248) in April 2021. Recruitment started in May 2021. Data collection and analysis are expected to be finished by September 2022. Conclusions: The best practice guidance can provide people with YOD with tailored and evidence-based information about online peer support, and it will be disseminated locally (in the United Kingdom) and internationally through dementia organizations, research networks, and academic institutions. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Objective: This protocol aims to provide an outline of the CanCope Study, a trial comparing the efficacy of a Unified Protocol-adapted internet-delivered intervention (CM) designed for cancer survivors compared with an active control condition--an internet-delivered healthy lifestyle intervention, CanCope Lifestyle (CL). The primary aim is to assess and compare the efficacy of both interventions in improving emotion regulation, anxiety and depressive symptoms, and quality of life. The secondary aims involve assessing the mechanisms of the CM intervention. Methods: This trial is a 2-arm randomized controlled trial that allocates cancer survivors to either CM or CL. Both interventions comprise 4 web-based modules and are expected to take participants at least 8 weeks to complete. Participants' mental and physical health will be assessed via self-reported surveys at baseline (T0), between each module (T1, T2, and T3), immediately after the intervention (T4), and at 3-month follow-up (T5). The study aims to recruit 110 participants who have completed T4. Results: The CanCope study began recruitment in September 2020. A total of 224 participants have been randomized to the CM (n=110, 49.1%) and CL (n=114, 50.9%) groups. Conclusions: This is one of the first trials to develop and investigate the efficacy of a web-based intervention for cancer survivors that specifically targets emotion regulation. [ABSTRACT FROM AUTHOR]

Background: Loneliness, or perceived social isolation, is prevalent in both the general population and clinical practice. Although loneliness has repeatedly been associated with mental and physical health, research on interventions that reduce loneliness effectively is still rather scarce. Objective: This study aims to evaluate the efficacy of a guided and an unguided version of the same internet-based cognitive behavioral self-help program for loneliness (SOLUS-D) for adults. Methods: A total of 250 participants will be randomly assigned to 1 of 2 intervention groups (SOLUS-D with guidance or SOLUS-D without guidance) or a wait-list control group (2:2:1 allocation ratio). Adult participants experiencing high levels of loneliness will be recruited from the general population. Individuals currently experiencing at least moderately severe depressive symptoms, an ongoing severe substance use disorder, previous or current bipolar or psychotic disorder, or acute suicidality will be excluded from the trial. Assessments will take place at baseline, 5 weeks (midassessment), and 10 weeks (postassessment). The primary outcome is loneliness assessed using the 9-item University of California, Los Angeles Loneliness Scale at the posttreatment time point. Secondary outcomes include depressive symptoms, symptoms of social anxiety, satisfaction with life, social network size, and variables assessing cognitive bias and social behavior. The maintenance of potentially achieved gains will be assessed and compared at 6 and 12 months after randomization in the 2 active conditions. Potential moderators and mediators will be tested exploratorily. Data will be analyzed on an intention-to-treat basis. Results: Recruitment and data collection started in May 2021 and are expected to be completed by 2022, with the 12-month follow-up to be completed by 2023. As of the time of submission of the manuscript, 134 participants were randomized. Conclusions: This 3-arm randomized controlled trial will add to the existing research on the efficacy of loneliness interventions. Furthermore, it will shed light on the role of human guidance in internet-based treatments for individuals with increased levels of loneliness and the possible mechanisms of change. If SOLUS-D proves effective, it could provide a low-threshold, cost-efficient method of helping and supporting individuals with increased levels of loneliness. [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]

This paper presents an efficient system using a deep learning algorithm that recognizes daily activities and investigates the worst falling cases to save elders during daily life. This system is a physical activity recognition system based on the Internet of Medical Things (IoMT) and uses convolutional neural networks (CNNets) that learn features and classifiers automatically. The test data include the elderly who live alone. The performance of CNNets is compared against that of state-of-the-art methods, such as activity windowing, fixed sample windowing, time-weighted windowing, mutual information windowing, dynamic windowing, fixed time windowing, sequence prediction algorithm, and conditional random fields. The results indicate that CNNets are competitive with state-of-the-art methods, exhibiting enhanced IoMT accuracy of 98.37%, which is the highest among the proposed solutions using the same dataset. [ABSTRACT FROM AUTHOR]

Importance: In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment.Objective: To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder.Design, Setting and Participants: A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020.Interventions: Participants randomized to the stepped-care group (n = 74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n = 78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment.Main Outcomes and Measures: The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS.Results: Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -∞ to 3.28]; P for noninferiority = .02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group).Conclusions and Relevance: Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings.Trial Registration: ClinicalTrials.gov Identifier: NCT03263546. [ABSTRACT FROM AUTHOR]

Background: Seeking online health information (OHI) has become a common practice globally. The information seekers could face health risks if they are not proficient in OHI literacy. The OHI-seeking behaviors and skills of Chinese college students, the largest proportion of college students in the world, are understudied. This study was aimed to describe OHI-seeking behaviors and skills of college students in Guangdong, China.Methods: College students in the Guangdong province with OHI-seeking experience were invited via WeChat, QQ, and Sina Weibo using QR code posters and flyers for participation in this online anonymized questionnaire-based study. Data on demographics, OHI literacy, information resources, search approaches, and behaviors were collected. The relationship between perceived OHI literacy and high-risk behaviors was investigated by bivariate logistic regression analysis.Results: Respondents were 1203 college students with a mean age of 20.6 years, females (60.2%), and undergraduates (97.2%). They sought health information via websites (20.3%), WeChat (2.6%), or both (77.1%). Baidu was the main search engine, and baike.baidu.com (80.3%), Zhihu.com (48.4%), and Zhidao.baidu.com (35.8%) were top three among 20 searched websites for information about self-care (80.7%), general health (79.5%), disease prevention (77.7%), self-medication (61.2%), family treatment (40.9%), drugs (37.7%), western medications (26.6%), hospitals (22.7%), physicians (21.4%), and Traditional Chinese Medicine (15.6%). Despite most respondents (78%) lacked confidence in the evidence quality and satisfaction with the results, only 32.4% further consulted doctors. Many (> 50%) would recommend the retrieved information to others. About 20% experienced hacking/Internet fraud. Cronbach's alpha for the internal consistency of OHI literacy was 0.786. Bivariate logistic regression analysis showed that students who believed they can judge the evidence level of OHI were more likely to self-diagnose (OR = 2.2, 95%CI, 1.6-3.1) and look for drug usage (OR = 3.1, 95%CI, 1.9-5.0).Conclusions: This study reveals Chinese college students' heavy reliance on OHI to manage their own and others' health without sufficient knowledge/skills to identify misinformation and disinformation. The apparent risky information-seeking behaviors of Chinese college students warrant the provision of regulated, accurate, and actionable health information; assurance of cybersecurity; and health information literacy promotion in colleges by concerned authorities. [ABSTRACT FROM AUTHOR]