***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes BACKGROUND Several studies have shown that e-mail counseling improves weight loss achieved in self-directed Internet programs . Computer-tailored feedback offers a population -based alternative to human e-mail counseling . METHODS One hundred ninety-two adults , aged 49.2 + /- 9.8 years , having a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 32.7 + /- 3.5 , were r and omized to 1 of 3 Internet treatment groups : No counseling , computer-automated feedback , or human e-mail counseling .  All participants received 1 weight loss group session , coupons for meal replacements , and access to an interactive Web site . The human e-mail counseling and computer-automated feedback groups also had access to an electronic diary and message board . The human e-mail counseling group received weekly e-mail feedback from a counselor , and the computer-automated feedback group received automated , tailored messages . RESULTS Retention was 82 % at 3 months and 80 % at 6 months for all 3 groups . At 3 months , completers in both the computer-automated feedback ( -5.3 + /- 4.2 kg ) and human e-mail counseling ( -6.1 + /- 3.9 kg ) groups had significantly greater weight losses compared with the no counseling group ( -2.8 + /- 3.5 kg ) and these groups did not differ from each other . At 6 months , weight losses were significantly greater in the human e-mail counseling group ( -7.3 + /- 6.2 kg ) than in the computer-automated feedback ( -4.9 + /- 5.9 kg ) or no counseling ( -2.6 + /- 5.7 kg ) groups . Intent-to-treat analyses using single or multiple imputation techniques showed the same pattern of significance . CONCLUSIONS Providing automated computer-tailored feedback in an Internet weight loss program was as effective as human e-mail counseling at 3 months . Further research is needed to improve the efficacy of automated computer-tailored feedback as a population -based weight loss approach Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Abstract Given that studies about the differential efficacy of existing treatments in fibromyalgia syndrome are scarce , the aim of this study was to compare the differential efficacy of a cognitive – behavioral and a pharmacological therapy on fibromyalgia . Using a r and omized controlled clinical trial , 28 fibromyalgic patients were assigned to one of following experimental conditions : ( a ) pharmacological treatment ( i.e. , cyclobenzaprine ) , ( b ) cognitive – behavioral intervention ( i.e. , stress inoculation training ) , ( c ) combined pharmacological and cognitive – behavioral treatment and ( d ) no treatment . The results show the superiority of  cognitive – behavioral intervention to reduce the severity of fibromyalgia both at the end of the treatment and at follow-up . We conclude that cognitive – behavioral interventions must be considered a primary treatment of fibromyalgia syndrome Background : Patients with chronic fatigue syndrome ( CFS ) often have concentration and memory problems . Neuropsychological test performance is impaired in at least a subgroup of patients with CFS . Cognitive behavioural therapy ( CBT ) for CFS leads to a reduction in fatigue and disabilities . Aim : To test the hypothesis that CBT results in a reduction of self-reported cognitive impairment and in an improved neuropsychological test performance . Methods : Data of two previous r and omised controlled trials were used . One study compared CBT for adult patients with CFS , with two control conditions . The second study compared CBT for adolescent patients with a waiting list condition .  Self-reported cognitive impairment was assessed with question naires .  Information speed was measured with simple and choice reaction time tasks . Adults also completed the symbol digit-modalities task , a measure of complex attentional function . Results : In both studies , the level of self-reported cognitive impairment decreased significantly more after CBT than in the control conditions . Neuropsychological test performance did not improve . Conclusions : CBT leads to a reduction in self-reported cognitive impairment , but not to improved neuropsychological test performance . The findings of this study support the idea that the distorted perception of cognitive processes is more central to CFS than actual cognitive performance OBJECTIVE To evaluate the efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain . METHODS Forty-seven participants ( 9 - 16 years of age ) were r and omly assigned to either an Internet-based treatment or a st and ard medical care waitlist . Treatment employed a Web-based manual for children and parents with weekly therapist contact by telephone or e-mail . At 1- and 3-month follow-ups , participants were assessed on the outcome variables of pain and quality of life . A 50 % reduction in diary pain scores was considered clinical ly significant . RESULTS Significant between-group differences were found : 71 and 72 % of the treatment group achieved clinical ly significant improvement at the 1- and 3-month follow-ups , respectively , whereas only 19 and 14 % of the control group achieved the criterion . No significant differences were found on the quality of life variable . CONCLUSIONS Distance methods have considerable potential for making effective treatments more accessible with lower associated costs Objective The aim of this study was to investigate if cognitive behavior therapy ( CBT ) provided via the Internet results in significant decreases of distress in individuals with tinnitus . Methods Participants were recruited through Web pages and newspaper articles and thereafter r and omly allocated to a CBT self-help manual in six modules or to a waiting-list control group ( WLC ) . All treatment and contact with participants were conducted via the Internet with Web pages and E-mail correspondence . Participants were 117 individuals with tinnitus of duration of more than 6 months . In the first r and omized controlled phase of the study , 26 completed all stages of treatment ( 51 % dropout ) , and 64 of the WLC group completed measures . At 1-year follow-up , all participants had been offered the program and 96 provided outcome measures ( 18 % dropout rate from baseline ) . Tinnitus-related problems were assessed before and after treatment and at the 1-year follow-up . Daily diary ratings were included for 1 week before and 1 week following the treatment period . Results Tinnitus-related distress , depression , and diary ratings of annoyance decreased significantly . Immediately following the r and omized controlled phase ( with a WLC ) , significantly more participants in the treatment group showed an improvement of at least 50 % on the Tinnitus Reaction Question naire . At the uncontrolled follow-up , 27 ( 31 % ) of all participants had achieved a clinical ly significant improvement . Conclusions CBT via the Internet can help individuals decrease annoyance associated with tinnitus . High dropout rates or delay in completing treatment can be a characteristic of treatment studies using the Internet but should be contrasted with the cost effectiveness and accessibility of the Internet Background : The small-group Chronic Disease Self-Management Program ( CDSMP ) has proven effective in changing health-related behaviors and improving health statuses . An Internet-based CDSMP was developed to reach additional chronic-disease patients . Objectives : We sought to determine the efficacy of the Internet-based CDSMP . Design : We compared r and omized intervention participants with usual-care controls at 1 year . We compared intervention participants with the small-group CDSMP at 1 year . Subjects : Nine-hundred fifty-eight patients with chronic diseases ( heart , lung , or type 2 diabetes ) and Internet and e-mail access were r and omized to intervention ( 457 ) or usual care control ( 501 ) . Measures : Measures included 7 health status variables ( pain , shortness of breath , fatigue , illness intrusiveness , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 3 utilization variables ( physician visits , emergency room visits , and nights in hospital ) , and self-efficacy . Results : At 1 year , the intervention group had significant improvements in health statuses compared with usual care control patients . The intervention group had similar results to the small-group  CDSMP participants . Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year . Conclusions : The Internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program A r and omized trial was conducted comparing 10 individual weekly sessions of cognitive behaviour therapy for panic disorder ( PD ) with or without agoraphobia with a 10-module self-help program on the Internet . After confirming the PD diagnosis with an in-person structured clinical interview ( SCID ) 49 participants were r and omized . Overall , the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail can be equally effective as traditional individual cognitive behaviour therapy . Composite within-group effect sizes were high in both groups , while the between-group effect size was small ( Cohen 's d=16 ) . One-year follow-up confirmed the results , with a within-group effect size of Cohen 's d=0.80 for the Internet group and d=0.93 for the live group . The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs Objective : The objective of this project was to test the short term ( 90 days ) efficacy of an automated behavioural intervention for smoking cessation , the “ 1 - 2 - 3 Smokefree ” programme , delivered via an internet website . Design : R and omised control trial . Subjects surveyed at baseline , immediately post-intervention , and 90 days later . Setting s : The study and the intervention occurred entirely via the internet site . Subjects were recruited primarily via worksites , which referred potential subjects to the website . Subjects : The 351 qualifying subjects were notified of the study via their worksite and required to have internet access . Additionally , subjects were required to be over 18 years of age , smoke cigarettes , and be interested in quitting smoking in the next 30 days . Eligible subjects were r and omly assigned individually to treatment or control condition by computer algorithm . Intervention : The intervention consisted of a video based internet site that presented current strategies for smoking cessation and motivational material s tailored to the user ’s race/ethnicity , sex , and age . Control subjects received nothing for 90 days and were then allowed access to the programme . Main outcome measures : The primary outcome measure was abstinence from smoking at 90 day follow up . Results : At follow up , the cessation rate at 90 days was 24.1 % ( n = 21 ) for the treatment group and 8.2 % ( n = 9 ) for the control group ( p = 0.002 ) . Using an intent-to-treat model , 12.3 % ( n = 21 ) of the treatment group were abstinent , compared to 5.0 % ( n = 9 ) in the control group ( p = 0.015 ) . Conclusions : These evaluation results suggest that a smoking cessation programme , with at least short term efficacy , can be successfully delivered via the internet Abstract The purpose of this study 
    Output:
    
The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments , and the same was true for interventions aim ed at headache .
The other interventions also showed some effects , although effects differed across target conditions .
Internet-delivered cognitive-behavioral interventions are a promising addition and complement to existing treatments .
The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems