***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: Background Research increasingly supports the conclusion that well- design ed programs delivered over the Internet can produce significant weight loss compared to r and omized controlled conditions . Much less is known about four important issues addressed in this study : ( 1 ) which recruitment methods produce higher eHealth participation rates , ( 2 ) which patient characteristics are related to enrollment , ( 3 ) which characteristics are related to level of user engagement in the program , and ( 4 ) which characteristics are related to continued participation in project assessment s. Methods We recruited overweight members of three health maintenance organizations ( HMOs ) to participate in an entirely Internet-mediated weight loss program developed by HealthMedia , Inc.  Two different recruitment methods were used : personal letters from prevention directors in each HMO , and general notices in member newsletters . The personal letters were sent to members diagnosed with diabetes or heart disease and , in one HMO , to a general membership sample in a particular geographic location . Data were collected in the context of a 2 × 2 r and omized controlled trial , with participants assigned to receive or not receive a goal setting intervention and a nutrition education intervention in addition to the basic program . Results A total of 2311 members enrolled . Bivariate analyses on aggregate data revealed that personalized mailings produced higher enrollment rates than member newsletters and that members with diabetes or heart disease were more likely to enroll than those without these diagnoses . In addition , males , those over age 60 , smokers , and those estimated to have higher medical expenses were less likely to enroll ( all P < .001 ) . Males and those in the combined intervention were less likely to engage initially , or to continue to be engaged with their Web program , than other participants . In terms of retention , multiple logistic regressions revealed that enrollees under age 60 ( P < .001 ) and those with higher baseline self-efficacy were less likely to participate in the 12-month follow-up ( P = .03 ) , but with these exceptions , those participating were very similar to those not participating in the follow-up . Conclusions A single personalized mailing increases enrollment in Internet-based weight loss . eHealth programs offer great potential for recruiting large numbers of participants , but they may not reach those at highest risk . Patient characteristics related to each of these important factors may be different , and more comprehensive analyses of determinants of enrollment , engagement , and retention in eHealth programs are needed Research into  computer-aided psychotherapy  is thriving around the world . Most of it concerns  computer-aided cognitive-behavioural therapy ( CCBT ) . A recent narrative review found 97 computer-aided psychotherapy systems from nine countries reported in 175 studies , of which 103 were r and omised controlled trials . The rapid spread of the mass delivery of psychotherapy through CCBT , catalysed in the UK by the National Institute for Health and Clinical Excellence 's recommendation of two CCBT programmes and the Department of Health 's CCBT implementation guidance , seems unprecedented . This editorial is a synopsis of the current status of CCBT and its future directions 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 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 BACKGROUND Major depression can be treated by means of cognitive-behavioural therapy , but as skilled therapists are in short supply there is a need for self-help approaches . Many individuals with depression use the internet for discussion of symptoms and to share their experience . AIMS To investigate the effects of an internet-administered self-help programme including participation in a monitored , web-based discussion group , compared with participation in web-based discussion group only . METHOD A r and omised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact ( plus participation in a discussion group ) with the effects of participation in a discussion group only . RESULTS Internet-based therapy with minimal therapist contact , combined with activity in a discussion group , result ed in greater reductions of depressive symptoms compared with activity in a discussion group only ( waiting-list control group ) . At 6 months ' follow-up , improvement was maintained to a large extent . CONCLUSIONS Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression Background Many depressed people do not receive help for their symptoms , and there are various barriers that impede help-seeking . The Internet may offer interesting alternatives for reaching and helping people with depression . Depression can be treated effectively with Internet-based cognitive behavioral therapy ( CBT ) , but a short intervention based on problem solving therapy ( PST ) could constitute a worthwhile alternative to CBT . Objective In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a  waiting list control group ( WL ) , and we determined the differences between the two treatments . Methods We conducted a 3-arm r and omized controlled trial to compare CBT , PST , and WL . The main inclusion criterion was presence of depressive symptoms ( ≥ 16 on the Center for Epidemiological Studies Depression scale ) . CBT and PST consisted of eight and five weekly lessons respectively . Participants were supported by email  . Self-report measures of depression , anxiety , and quality of life were completed at pretest and after 5 , 8 , and 12 weeks . Results A total of 263 participants were r and omized to the three conditions ( CBT : n=88 ; PST : n=88 ; WL : n=87 ) . Of the 263 participants , 184 ( 70 % ) completed question naires after 5 weeks , 173 ( 66 % ) after 8 weeks , and 151 ( 57 % ) after 12 weeks . Between-group effect sizes for depressive symptoms were 0.54 for CBT after 8 weeks ( 95 % confidence interval ( CI ) : 0.25 - 0.84 ) and 0.47 for PST after 5 weeks ( 95 % CI : 0.17 - 0.77 ) . These effects were further improved at 12 weeks ( CBT : 0.69 , 95 % CI : 0.41 - 0.98 ; PST : 0.65 , 95 % CI : 0.36 - 0.95 ) . For anxiety , effect sizes were also at a medium level . Effect sizes for quality of life were low . The number of participants showing clinical ly significant change at 12 weeks was significantly higher for CBT ( n = 34 , 38.6 % ) and PST ( n = 30 , 34.1 % ) , compared to WL ( n = 0 ) . Conclusions Both Internet-based treatments are effective in reducing depressive symptoms , although the effect of PST is realized more quickly . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 16823487 ; http://www.controlled-trials.com/IS RCT N16823487/16823487 ( Archived by WebCite at http://www.webcitation.org/5cQsOj7xf ) The object of this study was to examine the effectiveness of an Internet-based therapy ( IBT ) for bulimia nervosa ( BN ) as compared to a waiting list ( WL ) .  Sixty-two female BN patients , diagnosed according to DSM-IV criteria , were assigned to either the IBT or a WL .  The control participants ( WL ) were matched to the IBT  group in terms of age , duration of the disorder , number of previous treatments , and severity of the disorder . Assessment measures included the EDI , SCL-90-R , BITE , the TCI-R , and other clinical and psychopathological indices , which were administrated before and after the treatment . Considering the IBT , while the mean scores were lower at the end of the treatment for some EDI scales ( bulimic , interpersonal distrust , maturity fears , and total score ) and the BITE symptomatology subscale , the mean BMI was higher at posttherapy . Predictors of good IBT outcome were higher scores on the EDI perfectionism scale and EAT and a higher minimum BMI . Drop-out ( after IBT 35.5 % of cases ) was related to higher SCL-anxiety scores , a lower hyperactivity , a lower minimum BMI , and lower TCI-reward dependence scores . At the end of the treatment , bingeing and vomiting abstinence rates differed significantly between the two groups . Results suggest that an online self-help approach appears to be a valid treatment option for BN when compared to a WL control group , especially for people who present a lower severity of their eating disorder ( ED ) symptomatology and some specific personality traits Dropout from self-help cognitive-behavioral therapy for insomnia ( CBT-I ) potentially diminishes therapeutic effect and poses clinical concern . We analyzed the characteristics of subjects who did not complete a 6-week internet-based CBT-I program . Receiver operator characteristics ( ROC ) analysis was used to identify potential variables and cutoff for predicting dropout among 207 participants with self-report insomnia 3 or more nights per week for at least 3 months r and omly assigned to self-help CBT-I with telephone support ( n = 103 ) and self-help CBT-I ( n = 104 ) . Seventy-two participants ( 34.4 % ) did not complete all 6 sessions , while 42 of the 72 ( 56.9 % ) dropped out prior to the fourth session . Significant predictors of non-completion are total sleep time ( TST ) ≥ 6.82 h , Hospital An 
    Output:
    
Evidence suggested that female gender , higher treatment expectancy , sufficient time , and personalized intervention content each predicted higher adherence .
Age , baseline symptom severity , and control group allocation had mixed findings .
The majority of assessed variables however , did not predict adherence .