***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 Veterans who served in Operation Enduring Freedom ( OEF ) and Operation Iraqi Freedom ( OIF ) commonly experience alcohol misuse and symptoms of posttraumatic stress disorder ( PTSD ) following their return from deployment to a war zone . We conducted a r and omized clinical trial to evaluate the efficacy of a newly developed , 8-module , self-management web intervention ( VetChange ) based on motivational and cognitive-behavioral principles to reduce alcohol consumption , alcohol-related problems , and PTSD symptoms in returning combat veterans . METHOD Six hundred participants , recruited through targeted Facebook ads , were r and omized to either an Initial Intervention Group ( IIG ; n = 404 ) or a Delayed Intervention Group ( DIG ; n = 196 ) that waited 8 weeks for access to VetChange . Primary outcome measures were Drinks per Drinking Day , Average Weekly Drinks , Percent Heavy Drinking Days , and PTSD symptoms . Intent-to-treat analyses compared changes in outcome measures over time between IIG and DIG as well as within-group changes . RESULTS IIG participants demonstrated greater reductions in drinking ( p < .001 for each measure ) and PTSD symptoms ( p = .009 ) between baseline and end-of-intervention than did DIG participants between baseline and the end of the waiting period . DIG participants showed similar improvements to those in IIG following participation in VetChange .  Alcohol problems were also reduced within each group between baseline and 3-month follow-up . CONCLUSIONS Results indicate that VetChange is effective in reducing drinking and PTSD symptoms in OIF/OEF veterans . Further studies of VetChange are needed to assess web-based recruitment and retention methods and to determine VetChange 's effectiveness in demographic and clinical sub- population s of returning veterans BACKGROUND Drinking Less ( DL ) is a 24/7 free-access anonymous interactive web-based self-help intervention without therapeutic guidance for adult problem drinkers in the community . In a r and omized controlled trial ( referred to here as DL- RCT ) , DL has been shown effective in reducing risky alcohol consumption . OBJECTIVE To assess whether the findings of DL- RCT are generalizable to a naturalistic setting ( DL-RW ) in terms of ability to reach the target group and alcohol treatment response . METHODS Pretest-posttest study with 6-month follow-up . An online survey was conducted of 378 of the 1,625 people who used DL-RW from May to November 2007 . Primary outcome measures were ( 1 ) problem drinking , defined as alcohol consumption in the previous 4 weeks averaging > 21 or > 14 st and ard units ( male/female ) per week or > or=6 or > or=4 units ( m/f ) on 1 or more days per week ; and ( 2 ) mean weekly alcohol consumption . DL-RW and DL- RCT data were compared and pooled . Intention-to-treat ( ITT ) analysis was performed to analyze and compare changes in drinking from baseline to follow-up . RESULTS In the DL-RW group , 18.8 % ( n = 71 ) were drinking successfully within the limits of the Dutch guideline for low-risk drinking ( p < 0.001 ) 6 months after baseline ( ITT ) . The DL-RW group also decreased its mean weekly alcohol intake by 7.4 units , t(377 ) = 6.67 , p < 0.001 , d = 0.29 . Drinking reduction in DL-RW was of a similar magnitude to that in the DL- RCT condition in terms of drinking within the guideline [ chi(2)(1 ) = 1.83 , CI : 0.82 - 3.00 , p = 0.18 , RD = 0.05 , OR = 1.55 ] and mean weekly consumption ( a negligible difference of d = 0.03 in favor of DL-RW group ) . CONCLUSION The results from DL- RCT and DL-RW were similar , and they demonstrate that web-based self-help without therapeutic guidance is feasible , well accepted , and effective for curbing adult problem drinking in the community Background Online self-help interventions for problem drinkers show promising results , but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined . Objective The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers , with the hypotheses that e-therapy would ( 1 ) reduce weekly alcohol consumption , and ( 2 ) improve health status . Reasons for dropout were also systematic ally investigated . Method In an open r and omized controlled trial , Dutch-speaking problem drinkers in the general population were r and omly assigned ( in blocks of 8 , according to a computer-generated r and om list ) to the 3-month e-therapy program ( n = 78 ) or the waiting list control group ( n = 78 ) . The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously , via the Internet only . Participants in the waiting list control group received “ no-reply ” email messages once every 2 weeks . The primary outcome measures were ( 1 ) the difference in the score on weekly alcohol consumption , and ( 2 ) the proportion of participants drinking under the problem drinking limit . Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up . A dropout question naire was sent to anyone who did not complete the 3-month assessment . Reasons for dropout were independently assessed by the first and third author . Results Of the 156 individuals who were r and omly assigned , 102 ( 65 % ) completed assessment at 3 months . In the intention-to-treat analyses , the e-therapy group ( n = 78 ) showed a significantly greater decrease in alcohol consumption than those in the control group ( n = 78 ) at 3 months . The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group , a difference in means of 25.6 units on a weekly basis ( 95 % confidence interval 15.69 - 35.80 , P < .001 ) . The between-group effect size ( pooled SD ) was large ( d = 1.21 ) . The results also showed that 68 % ( 53/78 ) of the e-therapy group was drinking less than 15 ( females ) or 22 ( males ) units a week , compared with 15 % ( 12/78 ) in the control group ( OR 12.0 , number needed to treat 1.9 , P < .001 ) . Dropout analysis showed that the main reasons for dropouts ( n = 54 ) were personal reasons unrelated to the e-therapy program , discomfort with the treatment protocol , and satisfaction with the positive results achieved . Conclusions E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem . Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts . Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program . Trial registration IS RCT N39104853 ; http://controlled-trials.com/IS RCT N39104853/IS RCT N39104853 ( Archived by WebCite at http://www.webcitation.org/5uX1R5xfW The goal of this research was to underst and why some people use online interventions for  drinking problems , whereas others with comparable access to the interventions do not . As part of a r and omized controlled trial , 92 participants in the experimental condition were provided access to a password-protected version of a Web-based personalized feedback intervention ( the Check Your Drinking [ CYD ] screener , www.CheckYourDrinking.net ) . Information collected at baseline was compared between those who accessed the Web site and those who did not . Those who accessed the Web site tended to be more frequent users of the Internet , to drink less , and to perceive that others of the same age and gender drank less as compared with those who did not access the intervention . Some of these results are troubling as the preferred target of this type of intervention would be those who drink more and perceive that others are also heavy alcohol consumers Background Brief interventions via the internet have been shown to reduce university students ’ alcohol intake . This study tested two smartphone applications ( apps ) targeting drinking choices on party occasions , with the goal of reducing problematic alcohol intake among Swedish university students . Methods Students were recruited via e-mails sent to student union members at two universities . Those who gave informed consent , had a smartphone , and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test ( AUDIT ) were r and omized into three groups . Group 1 had access to the Swedish government alcohol monopoly ’s app , Promillekoll , offering real-time estimated blood alcohol concentration ( eBAC ) calculation ; Group 2 had access to a web-based app , PartyPlanner , developed by the research group , offering real-time eBAC calculation with planning and follow-up functions ; and Group 3 participants were controls . Follow-up was conducted at 7 weeks . Results Among 28574 students offered participation , 4823 agreed to join ; 415 were excluded due to incomplete data , and 1932 fulfilled eligibility criteria for r and omization . Attrition was 22.7–39.3 percent , higher among heavier drinkers and highest in Group 2 .  Self-reported app use was higher in Group 1 ( 74 % ) compared to Group 2 ( 41 % ) . Per- protocol analyses revealed only one significant time-by-group interaction , where Group 1 participants increased the frequency of their drinking occasions compared to controls ( p = 0.001 ) . Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week ( p = 0.001 ) , but not among women . Among all participants , 29 percent showed high-risk drinking , over the recommended weekly drinking levels of 9 ( women ) and 14 ( men ) st and ard glasses . Conclusions Smartphone apps can make brief interventions available to large numbers of university students . The apps studied using eBAC calculation did not , however , seem to affect alcohol consumption among university students and one app may have led to a negative effect among men . Future research should : 1 ) explore ways to increase user retention , 2 ) include apps facilitating technical manipulation for evaluation of added components , 3 ) explore the effects of adapting app content to possible gender differences , and 4 ) offer additional interventions to high-risk users . Trial registration clinical trials.gov : NCT01958398 Background Self-help strategies offer a promising way to address problems with access to and stigma associated with face-to-face drug and alcohol treatment , and the Internet provides an excellent delivery mode for such strategies . To date , no study has tested the effectiveness of a fully self-guided web-based treatment for cannabis use and related problems . Objectives The current study was a two-armed r and omized controlled trial aim ed at testing the effectiveness of Reduce Your Use , a fully self-guided web-based treatment program for cannabis use disorder consisting of 6 modules based on cognitive , motivational , and behavioral principles . Methods 225 individuals who wanted to cease or reduce their cannabis use were recruited using both online and offline advertising methods  and were r and omly assigned to receive : ( 1 ) the web-based intervention , or ( 2 ) a control condition consisting of 6 modules of web-based educational information on cannabis . Assessment s of cannabis use , dependence symptoms , and abuse symptoms were conducted through online question naires at baseline , and at 6-week and 3-month follow-ups . Two sets of data analyses were undertaken — complier average causal effect ( CACE ) modeling and intention to treat ( ITT ) . Results Two thirds ( 149 ) of the participants completed the 6-week postintervention assessment , while 122 ( 54 % ) completed the 3-month follow-up assessment . Participants in the intervention group completed an average of 3.5 of the 6 modules . The CACE analysis revealed that at 6 weeks , the experimental group reported significantly fewer days of cannabis use during the past month ( P=.02 ) , significantly lower past-month quantity of cannabis use ( P=.01 ) , and significantly fewer symptoms of cannabis abuse ( P=.047 ) relative to controls . Cannabis dependence symptoms ( number and severity ) and past-month abstinence did not differ significantly between groups ( Ps>.05 ) . Findings at 3 months were similar , except that the experimental group reported significantly fewer and less severe cannabis dependence symptoms ( Ps<.05 ) , and past-month quantity of cannabis consumed no longer differed significantly between groups ( P=.16 ) . ITT analyses yielded similar outcomes . Conclusion Findings suggest that web-based interventions may be an effective means of treating uncomplicated cannabis use and related problems and reducing the public health burden of cannabis use disorders . Trial registration ACTRN12609000856213 , Australian New Zeal and Clinical Trials Registry Background Alcohol problems are a serious public health concern , and few problem drinkers ever seek treatment . The Internet is one means of promoting access to care , but more research is needed to test the best types of interventions to employ . Evaluation of Internet-based interventions that contain a variety of research -vali date d cognitive-behavioral tools , which have been shown to be helpful to those with more severe alcohol concerns , should be a priority . Objective To evaluate whether providing access to an extended Internet intervention for alcohol problems offers additional benefits in promoting reductions in alcohol consumption compared with a brief Internet intervention . The hypothesis for the current trial was that respondents who were provided with access to an extended Internet intervention ( the Al 
    Output:
    
Online interventions seem promising and appear to meet the needs of participants who are in the workforce and seeking help for the first time .