***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 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 Objective : Evaluating digital cognitive behavioral therapy ( dCBT ) for  insomnia  in a workplace environment . Methods : Within a r and omized controlled trial in a Fortune 500 company , we r and omized 270 self-identified poor sleepers [ 180 M/90 F : mean age 33.6 years ( 23 to 56 years ) ] to dCBT ( n = 135 ) or waiting list ( WL , n = 135 ) .  dCBT comprised six online sessions delivered by an animated therapist . Major assessment s were at baseline and posttreatment . Results : Sleep Condition Indicator ( SCI ) scores were significantly higher for the dCBT group [ interaction term : F ( 1,485 ) = 15.63 , P < 0.0001 ] , representing Cohen 's d of 1.10 following dCBT ( d = 0.34 for WL ) . On the Work Productivity and Impairment question naire , “ presenteeism ” demonstrated significant improvements following dCBT [ F(1,485 ) = 10.99 , P = 0.001 : d = 0.64 for dCBT , d = 0.09 for WL ] . Effects for “ abseenteeism ” failed to reach statistical significance ( P = 0.101 ) . Conclusions : dCBT is effective in improving sleep and work-based productivity in adults with insomnia Background Depression is highly prevalent in the working population and is associated with significant loss of workdays ; however , access to evidence -based treatment is limited . Objective This study evaluated the effectiveness of a Web-based intervention in reducing  mild to moderate depression and sickness absence .  Methods In an open-label r and omized controlled trial , participants were recruited from a large-scale statutory health insurance and were assigned to two groups . The intervention group had access to a 12 week Web-based program consisting of structured interactive sessions and therapist support upon request . The wait-list control group had access to unguided Web-based psycho-education .  Depressive symptoms were self-assessed at baseline , post-treatment , and follow-up ( 12 weeks after treatment ) using the  Patient Health Question naire ( PHQ-9 ) and Beck Depression Inventory ( BDI-II ) as primary outcome measures . Data on sickness absence was retrieved from health insurance records . Intention-to-treat ( ITT ) analysis and per- protocol ( PP ) analysis were performed . Results Of the 180 participants who were r and omized , 88 completed the post- assessment ( retention rate : 48.8 % , 88/180 ) . ITT analysis showed a significant between-group difference in depressive symptoms during post-treatment in favor of the intervention group , corresponding to a moderate effect size ( PHQ-9 : d=0.55 , 95 % CI 0.25 - 0.85 , P<.001 , and BDI-II : d=0.41 , CI 0.11 - 0.70 , P=.004 ) . PP analysis partially supported this result , but showed a non-significant effect on one primary outcome ( PHQ-9 : d=0.61 , 95 % CI 0.15 - 1.07 , P=.04 , and BDI-II : d=0.25 95 % CI −0.18 to 0.65 , P=.37 ) . Analysis of clinical significance using reliable change index revealed that significantly more participants who used the Web-based intervention ( 63 % , 63/100 ) responded to the treatment versus the control group ( 33 % , 27/80 ; P<.001 ) . The number needed to treat ( NNT ) was 4.08 . Within both groups , there was a reduction in work absence frequency ( IG : −67.23 % , P<.001 , CG : −82.61 % , P<.001 ) , but no statistical difference in sickness absence between groups was found ( P=.07 ) . Conclusions The Web-based intervention was effective in reducing depressive symptoms among adults with sickness absence . As this trial achieved a lower power than calculated , its results should be replicated in a larger sample . Further validation of health insurance records as an outcome measure for eHealth trials is needed . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 02446836 ; http://www.is rct n.com/IS RCT N02446836 ( Archived by WebCite at http://www.webcitation.org/6jx4SObnw BACKGROUND Web-based self-management programs offer a novel approach for self-insured employers seeking to improve and maintain employee health . METHODS We conducted a 6-month prospect i ve , cluster-r and omized controlled trial design ed to evaluate whether worksite access to an automated , web-based , self-management program result ed in better blood pressure control . The trial was conducted at 6 EMC Corporation worksites in Massachusetts , each of which had at least 600 employees ; 404 EMC employees with pre-hypertension or hypertension participated . Participants at 3 worksites received a home blood pressure cuff that uploaded readings to a Web site where they could view trends and read automated rules-based messages . Participants at 3 worksites received access to an onsite blood pressure cuff . Primary outcome measure was change in systolic blood pressure . Secondary outcome measures were change in diastolic blood pressure , proportion of participants achieving significant changes in systolic and diastolic blood pressure , and subject satisfaction . RESULTS Although the mean change in systolic blood pressure was not significantly different between intervention and control groups ( -1.69 vs. -0.86 mm HG , respectively , P = .49 ) the change in diastolic blood pressure between groups was significant . ( -1.08 vs. = 1.47 mm HG , respectively , P < .001 ) . Significantly more intervention participants experienced a > 10-mm Hg decrease in systolic blood pressure or > 5-mm Hg decrease in diastolic blood pressure compared to controls ( 22 % vs 17 % , P = .02 and 29 % vs 16 % , P = .03 , respectively ) . Intervention participants were twice as likely to report starting a new medication ( P = .02 ) and more likely to report improved communication with their doctor ( P = .02 ) . CONCLUSIONS Participation in an automated online self-management program result ed in improved blood pressure among employees with prehypertension or hypertension Background Distance lifestyle counseling for weight control is a promising public health intervention in the work setting . Information about the cost-effectiveness of such interventions is lacking , but necessary to make informed implementation decisions . The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aim ed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective . Methods A r and omized controlled trial comparing a program with two modes of intervention delivery against self-help . 1386 Employees from seven companies participated ( 67 % male , mean age 43 ( SD 8.6 ) years , mean BMI 29.6 ( SD 3.5 ) kg/m2 ) . All groups received self-directed lifestyle brochures . The two intervention groups additionally received a workbook-based program with phone counseling ( phone ; n=462 ) or a web-based program with e-mail counseling ( internet ; n=464 ) . Body weight was measured at baseline and 24 months after baseline . Quality of life ( EuroQol-5D ) was assessed at baseline , 6 , 12 , 18 and 24 months after baseline . Re source use was measured with six-monthly diaries and valued with Dutch st and ard costs . Missing data were multiply imputed . Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves . Results At two years the incremental cost-effectiveness ratio was € 1009/kg weight loss in the phone group and € 16/kg weight loss in the internet group . The cost-utility analysis result ed in € 245,243/ quality adjusted life year ( QALY ) and € 1337/QALY , respectively . The results from a complete-case analysis were slightly more favorable . However , there was 
    Output:
    
Although there was a high level of heterogeneity across these studies , significant improvements were found for a broad range of outcomes such as sleep , mental health , sedentary behaviours and physical activity levels .
St and ardized measures were not always used to quantify intervention impact .
All but one study result ed in at least one significantly improved health-related outcome , but attrition rates ranged widely , suggesting sustaining engagement was an issue .
Conclusions This review found modest evidence that digital-only interventions have a positive impact on health-related outcomes in the workplace .
High heterogeneity impacted the ability to confirm what interventions might work best for which health outcomes , although less complex health outcomes appeared to be more likely to be impacted .