***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: This study examined effects of web-based psychoeducation on self-efficacy , problem solving behavior , stress responses and job satisfaction . The program was based on social cognitive theory and was primarily aim ed at increasing knowledge of stress , self-efficacy , and the use of problem solving behavior . A total of 225 employees were invited to participate in the study . Participants were assigned to an intervention ( n=112 ) or waiting list control group ( n=113 ) . Those in the intervention group were asked to access the website and to complete learning within 1 month . To investigate the intervention effect , the change score in the outcome variable was calculated by subtracting the score at pre-intervention from that at post-intervention ( 1 week after completion of the learning period ) . Then , the difference in the scores between groups was examined using analyses of covariance ( ANCOVA ) with the pre-intervention score as the covariate . We detected a marginally significant difference between groups in changes in job satisfaction from pre- to post-intervention ( p=0.081 ) . Participants in the intervention group showed an increase in job satisfaction score , while those in the waiting list control group showed a decrease in it . No significant differences were detected between groups in the other indicators ( p>.10 ) . We detected significant or marginally significant intervention effects on self-efficacy , problem solving behavior , stress responses , and job satisfaction among males and younger individuals , and those who had initially higher job strain and higher interest in managing stress . Further research is required with longer time periods ( controlled follow-up ) and a broader sample to fully determine the intervention effect In web-based health promotion programs , large variations in participant engagement are common . The aim was to investigate determinants of high use of a  worksite self-help web-based program for  stress management . Two versions of the program were offered to r and omly selected departments in IT and media companies . A static version of the program including health screening tool , diary and information about stress was offered to the control group . Additional material s , i.e. interactive , cognitive-based and classical stress management exercises and a chat room , were offered to the intervention group . Baseline data regarding participants ' demographics , health ( self-ratings and biological measures ) , lifestyle , work-related factors and group membership were analyzed to study determinants of employees ' participation in the program during a period of 12 months . Multiple logistic regression analysis was used and found intervention group membership , being a woman , having at most a secondary education , regular physical exercise habits and having positive expectations of the program were significant predictors of high use . The findings demonstrate that the interactivity of a web-based program is an important factor for determining participation in a web-based worksite stress management  program . Implication s for those developing and implementing future web-based health promotion activities are discussed Background Stress is commonly experienced by many people and it is a contributing factor to many mental and physical health conditions , However , few efforts have been made to develop and test the effects of interventions for stress . Objective The aim of this study was to examine the effects of a Web-based stress-reduction intervention on stress , investigate mindfulness and procrastination as potential mediators of any treatment effects , and test whether the intervention is equally effective for females as males , all ages , and all levels of education . Methods We employed a r and omized controlled trial in this study . Participants were recruited online via Facebook and r and omly assigned to either the stress intervention or a control condition . The Web-based stress intervention was fully automated and consisted of 13 sessions over 1 month . The controls were informed that they would get access to the intervention after the final data collection . Data were collected at baseline and at 1 , 2 , and 6 months after intervention onset by means of online question naires . Outcomes were stress , mindfulness , and procrastination , which were all measured at every measurement occasion . Results A total of 259 participants were included and were allocated to either the stress intervention ( n=126 ) or the control condition ( n=133 ) . Participants in the intervention and control group were comparable at baseline ; however , results revealed that participants in the stress intervention followed a statistically different ( ie , cubic ) developmental trajectory in stress levels over time compared to the controls . A growth curve analysis showed that participants in the stress intervention ( unst and ardized beta coefficient [B]=–3.45 , P=.008 ) recovered more quickly compared to the control group ( B=–0.81 , P=.34 ) from baseline to 1 month . Although participants in the stress intervention did show increases in stress levels during the study period ( B=2.23 , P=.008 ) , long-term stress levels did decrease again toward study end at 6 months ( B=–0.28 , P=.009 ) . Stress levels in the control group , however , remained largely unchanged after 1 month ( B=0.29 , P=.61 ) and toward 6 months ( B=–0.03 , P=.67 ) . Mediation analyses showed nonlinear ( ie , cubic ) specific indirect effects of mindfulness and a linear specific indirect effect of procrastination on stress . In simple terms , the intervention increased mindfulness and decreased procrastination , which was related to lower stress levels . Finally , the effect of the stress intervention was independent of participants ’ gender , age , or education . Conclusions The results from this r and omized controlled trial suggest that a Web-based intervention can reduce levels of stress in a normal population and that both mindfulness and procrastination may be important components included in future eHealth interventions for stress . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 25619675 ; http://controlled-trials.com/IS RCT N25619675 ( Archived by Webcite at http://www.webcitation.org/6FxB1gOKY Background Most work sites engage in some form of health promotion programming design ed to improve worker health and reduce health care costs . Although these programs have typically been delivered through combinations of seminars and print material s , workplace health promotion programs are increasingly being delivered through the Internet . Objective The purpose of this research was to evaluate the effectiveness of a Web-based multimedia health promotion program for the workplace , design ed to improve dietary practice s , reduce stress , and increase physical activity . Methods Using a r and omized controlled trial design with pretest-posttest comparisons within each group , 419 employees of a human re sources company were r and omly assigned to the Web-based condition or to a condition that provided print material s on the same topics . All subjects were assessed at pretest and posttest through an online question naire containing multiple measures of health behavior and attitudes . The test period was 3 months . Question naire data were analyzed mainly by analysis of covariance and t tests . Results Retention rates were good for both groups—85 % for the Web-based group and 87 % for the print group . Subjects using the Web-based program performed significantly better than the print group on Attitudes Toward a Healthful Diet ( F1,415 = 7.104 , P = .008 ) and Dietary Stage of Change ( F1,408 = 6.487 , P = .01 ) , but there were no significant group differences on the five other dietary measures . Both groups also showed improvement from pretest to posttest on most dietary measures , as indicated by significant t tests . Within the Web-based group , dosage analyses showed significant effects of the number of times the subject accessed the program on measures of Dietary Self-Efficacy ( F2,203 = 5.270 , P = .003 ) , Attitudes Toward a Healthful Diet ( F2,204 = 2.585 , P = .045 ) , and Dietary Stage of Change ( F2,200 = 4.627 , P = .005 ) . No significant differences were found between the two groups on measures of stress or physical activity , although t tests of pretest-posttest changes indicated that both groups improved on several of these measures . The Web-based group gave significantly higher ratings to the program material s than the print group on all health topics and in their overall evaluation ( F1,410 = 9.808 , P = .002 ) . Conclusions The Web-based program was more effective than print material s in producing improvements in the areas of diet and nutrition but was not more effective in reducing stress or increasing physical activity . The higher ratings given to the Web-based program suggest that workers preferred it to the print material s. Both groups showed numerous pretest-posttest improvements in all health topics , although such improvements might be attributable in part to a Hawthorne effect . Results suggest that a multimedia Web-based program can be a promising means of delivering health promotion material to the workforce , particularly in the area of diet and nutrition Background Depression and anxiety are major causes of absence from work and underperformance in the workplace . Cognitive behavioural therapy ( CBT ) can be effective in treating such problems and online versions offer many practical advantages . The aim of the study was to investigate the effectiveness of a computerized CBT intervention ( MoodGYM ) in a workplace context . Method The study was a phase III two-arm , parallel r and omized controlled trial whose main outcome was total score on the Work and Social Adjustment Scale ( WSAS ) . Depression , anxiety , psychological functioning , costs and acceptability of the online process were also measured . Most data were collected online for 637 participants at baseline , 359 at 6 weeks marking the end of the intervention and 251 participants at 12 weeks post-baseline . Results In both experimental and control groups depression scores improved over 6 weeks but attrition was high . There was no evidence for a difference in the average treatment effect of MoodGYM on the WSAS , nor for a difference in any of the secondary outcomes . Conclusions This study found no evidence that MoodGYM was superior to informational websites in terms of psychological outcomes or service use , although improvement to subthreshold levels of depression was seen in nearly half the patients in both groups Background Recent studies have shown the potential of Web-based interventions for changing dietary and physical activity ( PA ) behavior . However , the pathways of these changes are not clear . In addition , nonusage poses a threat to these interventions . Little is known of characteristics of participants that predict usage . Objective In this study we investigated the users and effect of the Healthy Weight Assistant ( HWA )  , a Web-based intervention aim ed at healthy dietary and PA behavior . We investigated the value of a proposed framework ( including social and economic factors , condition-related factors , patient-related factors , reasons for use , and satisfaction ) to predict which participants are users and which participants are nonusers . Additionally , we investigated the effectiveness of the HWA on the primary outcomes , self-reported dietary and physical activity behavior . Methods Our design was a two-armed r and omized controlled trial that compared the HWA with a waiting list control condition . A total of 150 participants were allocated to the waiting list group , and 147 participants were allocated to the intervention group .  Online question naires were filled out before the intervention period started and after the intervention period of 12 weeks . After the intervention period , respondents in the waiting list group could use the intervention . Objective usage data was obtained from the application itself . Results In the intervention group , 64 % ( 81/147 ) of respondents used the HWA at least once and were categorized as “ users . ” Of these , 49 % ( 40/81 ) used the application only once . Increased age and not having a chronic condition increased the odds of having used the HWA ( age : beta = 0.04 , P = .02 ; chronic condition : beta = 2.24 , P = .003 ) . Within the intervention group , users scored better on dietary behavior and on knowledge about healthy behavior than nonusers ( self-reported diet : χ2 2 = 8.4 , P = .02 ; knowledge : F1,125 = 4.194 , P = .04 ) . Furthermore , users underestimated their behavior more often than nonusers , and nonusers overestimated their behavior more often than users ( insight into dietary behavior : χ2 2 = 8.2 , P = .02 ) . Intention-to-treat analyses showed no meaningful significant effects of the intervention . Exploratory analyses of differences between pretest and posttest scores of users , nonusers , and the control group showed that on dietary behavior only the nonusers significantly improved ( effect size r = −.23 , P = .03 ) , while on physical activity behavior only the users significantly improved ( effect size r = −.17 , P = .03 ) . Conclusions Respondents did not use the application as intended . From the proposed framework , a social and economic factor ( age ) and a condition-related factor ( chronic condition ) predicted usage . Moreover , users were healthier and more knowledgeable about healthy behavior than nonusers . We found no apparent effects of the intervention , although exploratory analyses showed that choosing to use or not to use the intervention led to different outcomes . Combined with the differences between groups at baseline , this seems to imply that these groups are truly different and should be treated as separate entities . Trial registration Trial ID number : IS RCT N42687923 ; http://www.controlled-trials.com/IS RCT N42687923/ ( Archived by WebCite at http://www.webcitation.org/5xnGmvQ9Y BACKGROUND Fatigue is a common complaint that may lead to long-term sick leave and work disability . AIMS To assess the efficacy of cognitive-behavioural therapy by general practitioners for unexplained , persistent fatigue among employees . METHOD A r and omised controlled trial , using a pre-r and omisation design in primary care , investigated 151 employees on sick leave with fatigue . Participants in the experimental group were offered five to seven 30 min sessions of cognitive-behavioural therapy by a general practitioner ; those in the control group were offered no treatment . Main outcome measures ( fatigue severity , self-reported absenteeism , registered absenteeism and clinical recovery ) were assessed at 4 months , 8 months and 12 months . RESULTS At baseline , 44 % of the patients already met research criteria for chronic fatigue syndrome . There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point . CONCLUSIONS Cognitive-behavioural therapy by general practitioners for 
    Output:
    
We found very low- quality evidence with conflicting results , when comparing the effectiveness of computer-based stress management interventions with in-person stress management interventions  in employees .