***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: Purpose The purpose of the study is to evaluate the feasibility of a self-help web-based intervention to alleviate sexual problems and fertility distress in adolescents and young adults with cancer . Methods Twenty-three persons with cancer ( 19 women and 4 men , age 18–43 , 1–5 years post-diagnosis of lymphoma , breast , gynecologic , central nervous system , or testicular cancer ) were recruited to test a 2-month web-based program targeting sexual problems or fertility distress . The programs were organized in modules with educational and behavior change content , including texts , illustrations , exercises , and video vignettes . The program also included a discussion forum and an “ ask the expert ” forum . In addition , the sexuality program offered two telephone consultations .  Feasibility ( regarding dem and , acceptability , preliminary efficacy , and functionality ) was evaluated with the website system data , telephone interviews , continuous online evaluations , and study -specific measures . Results Fifteen participants completed four modules or more . Most of the program features were used and well accepted by these “ committed users . ” The web-based format enabled flexible use by participants with diverse needs . Preliminary efficacy was indicated by self-reported increased knowledge and skill in h and ling sexual problems and fertility distress . The website was easy to use and functioned well technically . Conclusions The present study indicated that this web-based intervention was feasible for adolescents and young adults with cancer . The effectiveness of the intervention in decreasing sexual problems and fertility distress will be tested in a population -based r and omized controlled trial for adolescents and young adults with cancer . Trial registration : IS RCT N36621459 Background Brief self- assessment of sexual problems  in a clinical context has the potential to improve care for patients through the ability to track trends in sexual problems over time and facilitate patient – provider communication about this important topic . However , instruments design ed for research are typically too long to be practical in clinical practice . Objective To develop and vali date a single-item self-report clinical screener that would capture common sexual problems and concerns for men and women . Design We created three c and i date screener items , refined them through cognitive interviews , and administered them to a large sample . We compared the prevalence of responses to each item and explored the discrepancies between items . We evaluated the construct validity of the items by comparing them to scores on the Patient-Reported Outcomes Measurement Information System ® Sexual Function and Satisfaction ( PROMIS ® SexFS ) measure . Participants Local patients participated in two rounds of cognitive interviews ( n = 7 and n = 11 ) . A probability-based r and om sample of U.S. adults comprised the item-testing sample ( n = 3517).Main Measures The items were as follows : 1 ) a yes/no item on any sexual problems or concerns ( “ general screener ” ) , 2 ) a yes/no item on problems experienced for 3 months or more during the past 12 months , with a list of examples ( “ long list screener ” ) , and 3 ) an item identical to the long list screener except that examples appeared individually as response options and respondents could check all that applied ( “ checklist screener”).Key Results All of the screeners tested showed evidence for basic validity and had minimal missing data . Percentages of women and men endorsing the screeners were 10 % and 15 % ( general ) ; 20 % and 17 % ( long list ) ; and 38 % and 30 % ( checklist ) , respectively . Participants who endorsed the screeners had lower function compared to those who did not endorse them . Conclusions We recommend the checklist screener for its specificity and ability to identify specific problems associated with decreased sexual function Background Sexual dysfunction is a prevalent , long-term complication of breast cancer and its treatment and can be treated effectively with face-to-face sexual counselling . However , relatively few women actually opt for face-to-face sex therapy , with many women indicating that it is too confronting . Internet-based interventions might be a less threatening and more acceptable approach , because of the convenience , accessibility and privacy it provides . Recent studies have demonstrated the efficacy of internet-based programs for improving sexual functioning in the general population . The objective of the current study is to investigate the efficacy of an internet-based cognitive behavioral therapy ( CBT ) program in alleviating problems with sexuality and intimacy in women who have been treated for breast cancer . Methods / design In a multicenter , r and omized controlled trial we are evaluating the efficacy of an internet-based CBT program in reducing problems with sexuality and intimacy in breast cancer survivors . Secondary outcomes include body image , marital functioning , psychological distress , menopausal symptoms , and health-related quality of life . We will recruit 160 breast cancer survivors ( aged 18 - 65 years ) with a formal DSM-IV diagnosis of sexual dysfunction from general and academic hospitals in the Netherl and s. Women are r and omized to either an intervention or waiting-list control group . Self-report question naires are completed by the intervention group at baseline ( T0 ) , ten weeks after start of therapy ( T1 ) , post-treatment ( T2 ) , 3 months post-treatment ( T3 ) , and 9 months post-treatment ( T4 ) . The control group completes question naires at T0 , T1 and T2 . Discussion There is a need for accessible and effective interventions for the treatment of sexual dysfunctions in breast cancer survivors . This study will provide evidence about the efficacy of an internet-based approach to delivering a CBT intervention targeted specifically at these sexual health issues . If proven to be effective , internet-based CBT for problems with sexuality and intimacy will be a welcome addition to the care offered to breast cancer survivors . Hopefully this therapy will lower the barrier to seeking help for these problems , result ing in improved quality of life after breast cancer . Trial registration The study is registered at Clinical Trials.gov ( NCT02091765 ) Purpose We evaluated the effect of Internet-based cognitive behavioral therapy ( CBT ) on sexual functioning and relationship intimacy ( primary outcomes ) and body image , menopausal symptoms , marital functioning , psychological distress , and health-related quality of life ( secondary outcomes ) in breast cancer survivors ( BCSs ) with a DSM-IV diagnosis of a sexual dysfunction . Patients and Methods We r and omly assigned 169 BCSs to either  Internet-based CBT or a waiting-list control group . The CBT consisted of weekly therapist-guided sessions , with a maximum duration of 24 weeks . Self-report question naires were completed by the intervention group at baseline ( T0 ) , midtherapy ( T1 ) , and post-therapy ( T2 ) and at equivalent times by the control group . We used a mixed-effect modeling approach to compare the groups over time . Results Compared with the control group , the intervention group showed a significant improvement over time in overall sexual functioning ( effect size for T2 [ EST2 ] = .43 ; P = .031 ) , which was reflected in an increase in sexual desire ( EST1 = .48 and EST2 = .72 ; P < .001 ) , sexual arousal ( EST2 = .50 ; P = .008 ) , and vaginal lubrication ( EST2 = .46 ; P = .013 ) . The intervention group reported more improvement over time in sexual pleasure ( EST1 = .32 and EST2 = .62 ; P = .001 ) , less discomfort during sex ( EST1 = .49 and EST2 = .66 ; P = .001 ) , and less sexual distress ( EST2 = .59 ; P = .002 ) compared with the control group . The intervention group reported greater improvement in body image ( EST2 = .45 ; P = .009 ) and fewer menopausal symptoms ( EST1 = .39 ; P = .007 ) than the control group . No significant effects were observed for orgasmic function , sexual satisfaction , intercourse frequency , relationship intimacy , marital functioning , psychological distress , or health-related quality of life . Conclusion Internet-based CBT has salutary effects on sexual functioning , body image , and menopausal symptoms in BCSs with a sexual dysfunction Background The Internet should be suitable for delivery of interventions targeting young cancer patients . Young people are familiar with the technologies , and this patient group is small and geographically dispersed . Still , only few psycho-educational Web-based interventions are design ed for this group . Young cancer patients consider reproductive health , including sexuality , an area of great importance and approximately 50 % report sexual problems and fertility-related concerns following cancer treatment . Therefore , we set out to develop a self-help Web-based intervention , Fex-Can , to alleviate such problems . To improve its quality , we decided to involve patients and significant others as research partners . The first 18 months of our collaboration are described in this paper . The intervention will subsequently be tested in a feasibility study followed by a r and omized controlled trial . Objective The study aims to describe the development of a Web-based intervention in long-term collaboration with patient research partners ( PRPs ) . Methods Ten former cancer patients and two significant others participated in building the Web-based intervention , using a participatory design . The development process is described according to the design step in the holistic framework presented by van Gemert-Pijnen et al and evaluates the PRPs ’ impact on the content , system , and service quality of the planned intervention . Results The collaboration between the research group and the PRPs mainly took place in the form of 1-day meetings to develop the key components of the intervention : educational and behavior change content , multimedia ( pictures , video vignettes , and audios ) , interactive online activities ( eg , self-monitoring ) , and partial feedback support ( discussion forum , tailored feedback from experts ) . The PRPs influenced the intervention ’s content quality in several ways . By repeated feedback on prototypes , the information became more comprehensive , relevant , and underst and able . The PRPs gave suggestions concerning the number of exercises and pointed out texts and pictures needing revision ( eg , experienced as normative or stereotypical ) to increase the persuasiveness of the program . The system quality was improved by PRPs ’ feedback on design , technical malfunctions , and navigation on the website . Based on feedback about availability of professional support ( technical problems and program content ) , the organization for support was clarified , which increased service quality . The PRPs also influenced the research project on an overall level by suggesting modifications of inclusion criteria for the RCT and by question ing the implementation plan . Conclusions With suggestions and continuous feedback from PRPs , it was possible to develop a Web-based intervention with persuasive design , believed to be relevant and attractive for young persons with cancer who have sexual problems or fertility distress .  In the next step , the intervention will be tested in a feasibility study , followed by an RCT to test the intervention ’s effectiveness in reducing sexual problems and fertility distress . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 36621459 ; http://www.is rct n.com/IS RCT N36621459 ( Archived by WebCite at http://www.webcitation.org/6gFX40F6 T OBJECTIVE Within the United States , one third of married couples are distressed and almost half of first marriages ( and more than half of unmarried cohabiting relationships ) end in divorce/separation . Additionally , relationship distress has been linked to mental and physical health problems in partners and their children . Although couple therapy is effective in reducing relationship distress , it is utilized by less than one third of divorcing couples . Therefore , more accessible interventions for relationship distress are needed . METHOD This study tests the efficacy of the OurRelationship program , an 8-hr online program adapted from an empirically based , in-person couple therapy . In the program , couples complete online activities and have 4 15-min calls with project staff . Nationwide , 300 heterosexual couples ( N = 600 participants ) participated ; couples were generally representative of the US in terms of race , ethnicity , and education . Couples were r and omly assigned to begin the program immediately or to a 2-month waitlist control group . RESULTS Compared to the waitlist group , intervention couples reported significant improvements in relationship satisfaction ( Cohen 's d = 0.69 ) , relationship confidence ( d = 0.47 ) , and negative relationship quality ( d = 0.57 ) . Additionally , couples reported significant improvements in multiple domains of individual functioning , especially when individuals began the program with difficulties in that domain : depressive ( d = 0.71 ) and anxious symptoms ( d = 0.94 ) , perceived health ( d = 0.51 ) , work functioning ( d = 0.57 ) , and quality of life ( d = 0.44 ) . CONCLUSIONS In a nationally representative sample of couples , the OurRelationship program was effective in significantly improving both relationship and individual functioning , suggesting it can substantially increase the reach of current interventions through its low-cost , Web-based format Background Risky sexual behaviors of adolescents in Mexico are a public health problem ; 33.4 % of adolescent girls and 14.7 % of boys report not having used any protection at their first intercourse . The fertility rate is 77 births/1000 girls aged 15–19 years . The infrequent contact of adolescents with health services and the limited extent of school sex and reproductive health education require the support of innovative strategies . The objective of this paper is to present the design of an internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents . Methods A field trial with intervention and comparison group and with ex-ante and ex-post measurements will be conducted in two public secondary schools . Adolescents between 14 and 15 years of age will participate . The intervention will be conducted in one school and the second school will serve as a comparison group where the investigators will observe the usual sex education provided by the school . The intervention will be delivered using an internet web page that includes four educational sessions provided during a 4 week period . Follow-up will last 3 months . Information on the study variables will be obtained through an Internet-based self-applied question naire and 
    Output:
    
Conclusions Review ed studies showed a positive effect of mobile interventions on sexual health outcomes in chronic patients .
Additionally , mobile interventions can be more effective in combination with smartphone apps