***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: STUDY OBJECTIVE We evaluate a computer-based intervention for screening and health promotion in the emergency department and determine its effect on patient recall of health advice . METHODS This controlled clinical trial , with alternating assignment of patients to a computer intervention ( prevention group ) or usual care , was conducted in a university hospital ED . The study group consisted of 542 adult patients with nonurgent conditions . The study intervention was a self-administered computer survey generating individualized health information . Outcome measures were ( 1 ) patient willingness to take a computerized health risk assessment , ( 2 ) disclosure of behavioral risk factors , ( 3 ) requests for health information , and ( 4 ) remembered health advice . RESULTS Eighty-nine percent ( 470/542 ) of eligible patients participated . Ninety percent were black . Eighty-five percent ( 210/248 ) of patients in the prevention group disclosed 1 or more major behavioral risk factors including current smoking ( 79/248 ; 32 % ) , untreated hypertension ( 28/248 ; 13 % ) , problem drinking ( 46/248 ; 19 % ) , use of street drugs ( 33/248 ; 13 % ) , major depression ( 87/248 ; 35 % ) , unsafe sexual behavior ( 84/248 ; 33 % ) , and several other injury-prone behaviors . Ninety-five percent of patients in the prevention group requested health information . On follow-up at 1 week , 62 % ( 133/216 ) of the prevention group patients compared with 27 % ( 48/180 ) of the control subjects remembered receiving advice on what they could do to improve their health ( relative risk 2.3 , 95 % confidence interval 1.77 to 3.01 ) . CONCLUSION Using a self-administered computer-based health risk assessment , the majority of patients in our urban ED disclosed important health risks and requested information . They were more likely than a control group to remember receiving advice on what they could do to improve their health . Computer methodology may enable physicians to use patient waiting time for health promotion and to target at-risk patients for specific interventions BACKGROUND Brief interventions for  problem drinking  in medical setting s are effective but rarely conducted , mainly due to insufficient time . A stepped care approach ( starting with a very brief intervention and intensifying efforts in case of no success ) could save re sources and enlarge effectiveness ; however , research is lacking . The present study compares a full care brief intervention for patients with at-risk drinking , alcohol abuse or dependence with a stepped care approach in a r and omized controlled trial . METHODS Participants were proactively recruited from general practice s in two northern German cities . In total , 10,803 screenings were conducted ( refusal rate : 5 % ) . Alcohol use disorders according to DSM-IV were assessed with the Munich-Composite International Diagnostic Interview ( M-CIDI ) . Eligible participants were r and omly assigned to one of three conditions : ( 1 ) stepped care ( SC ) : a computerized intervention plus up to three 40-min telephone-based interventions depending on the success of the previous intervention ; ( 2 ) full-care ( FC ) : a computerized intervention plus a fixed number of four 30-min telephone-based interventions that equals the maximum of the stepped care intervention ; ( 3 ) an untreated control group ( CG ) .  Counseling effort in the intervention conditions and quantity/frequency of drinking were assessed at 12-month follow-up . RESULTS SC participants received roughly half of the amount of intervention in minutes compared to FC participants . Both groups did not differ in drinking outcomes . Compared to CG , intervention showed small to medium effect size for at-risk drinkers . CONCLUSIONS Study results reveal that a stepped care approach can be expected to increase cost-effectiveness of brief interventions for individuals with at-risk drinking Background Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results . Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale , there is a need for further study . Objective This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden . Methods Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question . These students ( N=1605 ) gave consent and were r and omized into a 2-arm parallel group r and omized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback . Results After 2 months , there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses , although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10 % reduction ( 95 % CI –30 % to 10 % ) in total weekly alcohol consumption . Also , differences in effect sizes between universities were seen with participants from a major university ( n=365 ) reducing their weekly alcohol consumption by 14 % ( 95 % CI –23 % to –4 % ) . However , lower recruitment than planned and differential attrition in the intervention and control group ( 49 % vs 68 % ) complicated interpretation of the outcome data . Conclusions Any effects of current national provision are likely to be small and further research and development work is needed to enhance effectiveness . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 02335307 ; http://www.is rct n.com/IS RCT N02335307 ( Archived by WebCite at http://www.webcitation.org/6ZdPUh0R4 ) 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 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 Too many young people engage in unhealthy behaviours such as eating unhealthily , being physically inactive , binge drinking and smoking . This study aim ed to estimate the short-term and long-term cost-effectiveness of a theory-based online health behaviour intervention ( “ U@Uni ” ) in comparison with control in young people starting university . Methods A costing analysis was conducted to estimate the full cost of U@Uni and the cost of U@Uni roll-out . The short-term cost-effectiveness of U@Uni was estimated using statistical analysis of 6-month cost and health-related quality of life data from the U@Uni r and omised controlled trial . An economic modelling analysis combined evidence from the trial with published evidence of the effect of health behaviours on mortality risk and general population data on health behaviours , to estimate the lifetime cost-effectiveness of U@Uni in terms of incremental cost per QALY . Costs and effects were discounted at 1.5 % per annum . A full probabilistic sensitivity analysis was conducted to account for uncertainty in model inputs and provide an estimate of the value of information for groups of important parameters . Results To implement U@Uni for the r and omised controlled trial was estimated to cost £ 292 per participant , whereas roll-out to another university was estimated to cost £ 19.71 , both giving a QALY gain of 0.0128 per participant . The short-term ( 6-month ) analysis suggested that U@Uni would not be cost-effective at a willingness-to-pay threshold of £ 20,000 per QALY ( incremental cost per QALY gained = £ 243,926 ) . When a lifetime horizon was adopted the results suggest that the full implementation of U@Uni is unlikely to be cost-effective , whereas the roll-out of U@Uni to another university is extremely likely to be cost-effective . The value of information analysis suggests that the most important drivers of decision uncertainty are uncertainties in the effect of U@Uni on health behaviours . Conclusions The study provides the first estimate of the costs and cost-effectiveness of an online health behaviour intervention targeted at new university students . The results suggest that the roll-out , but not the full implementation , of U@Uni would be a cost-effective decision for the UK Department of Health , given a lifetime perspective and a willingness-to pay threshold of £ 20,000 per QALY.Trial registration Current Controlled Trials IS RCT N67684181 Background Interventions delivered via the Internet have the potential to address the problem of hazardous alcohol consumption at minimal incremental cost , with potentially major public health implication s. It was hypothesised that providing access to a psychologically enhanced website would result in greater reductions in drinking and related problems than giving access to a typical alcohol website simply providing information on potential harms of alcohol . DYD- RCT Trial registration : IS RCT N 31070347 . Methodology /Principal Findings A two-arm r and omised controlled trial was conducted entirely on-line through the Down Your Drink ( DYD ) website . A total of 7935 individuals who screened positive for hazardous alcohol consumption were recruited and r and omized . At entry to the trial , the geometric mean reported past week alco 
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Thus , digital alcohol interventions produced broadly similar outcomes in these studies .
Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower .
Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness