Assessment of function and clinical utility of alcohol and other drug web sites: An observational, qualitative study

Background The increasing popularity and use of the internet makes it an attractive option for providing health information and treatment, including alcohol/other drug use. There is limited research examining how people identify and access information about alcohol or other drug (AOD) use online, or how they assess the usefulness of the information presented. This study examined the strategies that individuals used to identify and navigate a range of AOD websites, along with the attitudes concerning presentation and content. Methods Members of the general community in Brisbane and Roma (Queensland, Australia) were invited to participate in a 30-minute search of the internet for sites related to AOD use, followed by a focus group discussion. Fifty one subjects participated in the study across nine focus groups. Results Participants spent a maximum of 6.5 minutes on any one website, and less if the user was under 25 years of age. Time spent was as little as 2 minutes if the website was not the first accessed. Participants recommended that AOD-related websites should have an engaging home or index page, which quickly and accurately portrayed the site’s objectives, and provided clear site navigation options. Website content should clearly match the title and description of the site that is used by internet search engines. Participants supported the development of a portal for AOD websites, suggesting that it would greatly facilitate access and navigation. Treatment programs delivered online were initially viewed with caution. This appeared to be due to limited understanding of what constituted online treatment, including its potential efficacy. Conclusions A range of recommendations arise from this study regarding the design and development of websites, particularly those related to AOD use. These include prudent use of text and information on any one webpage, the use of graphics and colours, and clear, uncluttered navigation options. Implications for future website development are discussed

Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial

Background: Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified. Methods/design: This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants’ motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs. Discussion: This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified

Snow Control - An RCT protocol for a web-based self-help therapy to reduce cocaine consumption in problematic cocaine users

Background: Cocaine use has increased in most European countries, including Switzerland, and many states worldwide. The international literature has described treatment models that target the general population. In addition to supplying informative measures at the level of primary and secondary prevention, the literature also offers web-based self-help tools for problematic substance users, which is in line with tertiary prevention. Such programs, however, have been primarily tested on individuals with problematic alcohol and cannabis consumption, but not on cocaine-dependent individuals. Methods/Design: This paper presents the protocol of a randomised clinical trial to test the effectiveness of a web-based self-help therapy to reduce cocaine use in problematic cocaine users. The primary outcome is severity of cocaine dependence. Secondary outcome measures include cocaine craving, consumption of cocaine and other substances of abuse in the past month, and changes in depression characteristics. The therapy group will receive a 6-week self-help therapy to reduce cocaine consumption based on methods of Cognitive Behavioural Therapy, principles of Motivational Interviewing and self-control practices. The control group will be presented weekly psycho-educative information with a quiz. The predictive validity of participant characteristics on treatment retention and outcome will be explored. Discussion: To the best of our knowledge, this will be the first randomised clinical trial to test the effectiveness of online self-help therapy to reduce or abstain from cocaine use. It will also investigate predictors of outcome and retention. This trial is registered at Current Controlled Trials and is traceable as NTR-ISRCTN93702927

The promise and pitfalls of the internet for cognitive behavioral therapy

Internet-administered cognitive behavior therapy is a promising new way to deliver psychological treatment. There are an increasing number of controlled trials in various fields such as anxiety disorders, mood disorders and health conditions such as headache and insomnia. Among the advantages for the field of cognitive behavior therapy is the dissemination of the treatment, being able to access treatment from a distance, and possibilities to tailor the interventions. To date, studies in which large effects have been obtained have included patient support from a clinician. Recent trials suggest that this support may come from non-clinicians and that therapist effects are minimal. Since studies also suggest that internet-delivered cognitive behavior therapy can be equally effective as face-to-face cognitive behavior therapy, this is a finding that may have implications for CBT practitioners. However, there are other aspects to consider for implementation, as while clinicians may hold positive attitudes towards internet-delivered CBT a recent study suggested that patients are more skeptical and may prefer face-to-face treatment. In the present work, I argue that internet-delivered CBT may help to increase adherence to treatment protocols, that training can be facilitated by means of internet support, and that research on internet interventions can lead to new insights regarding what happens in regular CBT. Moreover, I conclude that internet-delivered CBT works best when support is provided, leaving an important role for clinicians who can incorporate internet treatment in their services. However, I also warn against disseminating internet-delivered CBT to patients for whom it is not suitable, and that clinical skills may suffer if clinicians are trained and practice mainly using the internet

Growth hormone axis in chronic kidney disease

Chronic kidney disease (CKD) in children is associated with dramatic changes in the growth hormone (GH) and insulin-like growth factor (IGF-1) axis, resulting in growth retardation. Moderate-to-severe growth retardation in CKD is associated with increased morbidity and mortality. Renal failure is a state of GH resistance and not GH deficiency. Some mechanisms of GH resistance are: reduced density of GH receptors in target organs, impaired GH-activated post-receptor Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling, and reduced levels of free IGF-1 due to increased inhibitory IGF-binding proteins (IGFBPs). Treatment with recombinant human growth hormone (rhGH) has been proven to be safe and efficacious in children with CKD. Even though rhGH has been shown to improve catch-up growth and to allow the child to achieve normal adult height, the final adult height is still significantly below the genetic target. Growth retardation may persist after renal transplantation due to multiple factors, such as steroid use, decreased renal function and an abnormal GH–IGF1 axis. Those below age 6 years are the ones to benefit most from transplantation in demonstrating acceleration in linear growth. Newer treatment modalities targeting the GH resistance with recombinant human IGF-1 (rhIGF-1), recombinant human IGFBP3 (rhIGFBP3) and IGFBP displacers are under investigation and may prove to be more effective in treating growth failure in CKD

Combining motivational and volitional approaches to reducing excessive alcohol consumption in pre-drinkers: A theory-based intervention protocol

Background: Pre-drinking refers to the consumption of alcohol at home or a private residence prior to attending a subsequent social event. We present the study protocol of an online theory-based intervention to reduce pre-drinking and related harm in pre-drinking undergraduates, using behavior change techniques targeting the motivational and volitional phases of behaviour. Design: A fully randomized 2 (autonomy support: present vs. absent) x 2 (implementation intention: present vs. absent) between-participants design will be used to ascertain the effectiveness of the intervention in reducing pre-drinking alcohol consumption and alcohol-related harm. Participants will complete a range of theory-based measures prior to being allocated to one of the four experimental conditions. Four weeks later, participants will complete a follow-up questionnaire comprised of theoretical and behavioral measures. Analyses: The main and interactive effects of the intervention components in reducing our primary dependent variables, namely, pre-drinking alcohol consumption and alcohol-related harm at four-week follow-up will be tested. Baseline alcohol consumption and demographic information will be included in the analysis as covariates. Discussion: This online intervention is the first to be developed to reduce pre-drinking alcohol consumption, a behaviour linked to increased risk of alcohol-related harm. The intervention targets motivational and volitional components of the behaviour change process and is therefore likely to lead to greater reductions in pre-drinking alcohol consumption and experience of alcohol-related harm compared to either approach in isolation. If successful, the intervention can be implemented across various contexts and in populations where pre-drinking is prevalent. © 2016 Caudwell et al

Eccentric Exercise Activates Novel Transcriptional Regulation of Hypertrophic Signaling Pathways Not Affected by Hormone Changes

Unaccustomed eccentric exercise damages skeletal muscle tissue, activating mechanisms of recovery and remodeling that may be influenced by the female sex hormone 17β-estradiol (E2). Using high density oligonucleotide based microarrays, we screened for differences in mRNA expression caused by E2 and eccentric exercise. After random assignment to 8 days of either placebo (CON) or E2 (EXP), eighteen men performed 150 single-leg eccentric contractions. Muscle biopsies were collected at baseline (BL), following supplementation (PS), +3 hours (3H) and +48 hours (48H) after exercise. Serum E2 concentrations increased significantly with supplementation (P<0.001) but did not affect microarray results. Exercise led to early transcriptional changes in striated muscle activator of Rho signaling (STARS), Rho family GTPase 3 (RND3), mitogen activated protein kinase (MAPK) regulation and the downstream transcription factor FOS. Targeted RT-PCR analysis identified concurrent induction of negative regulators of calcineurin signaling RCAN (P<0.001) and HMOX1 (P = 0.009). Protein contents were elevated for RND3 at 3H (P = 0.02) and FOS at 48H (P<0.05). These findings indicate that early RhoA and NFAT signaling and regulation are altered following exercise for muscle remodeling and repair, but are not affected by E2

Performance Assessment of Fragmentation Mechanisms for Vehicular Delay-Tolerant Networks

[EN] Vehicular Delay-Tolerant Networks (VDTNs) are a new approach for vehicular communications where vehicles cooperate with each other, acting as the communication infrastructure, to provide low-cost asynchronous opportunistic communications. These communication technologies assume variable delays and bandwidth constraints characterized by a non-transmission control protocol/internet protocol architecture but interacting with it at the edge of the network. VDTNs are based on the principle of asynchronous communications, bundle-oriented communication from the DTN architecture, employing a store-carry-and-forward routing paradigm. In this sense, VDTNs should use the tight network resources optimizing each opportunistic contact among nodes. Given the limited contact times among nodes, fragmentation appears as a possible solution to improve the overall network performance, increasing the bundle delivery probability. This article proposes the use of several fragmentation approaches (proactive, source, reactive, and toilet paper) for VDTNs. They are discussed and evaluated through a laboratory testbed. Reactive and toilet paper approaches present the best results. It was also shown that only the source fragmentation approach presents worst results when compared with non-fragmentation approaches.This study was partially supported by the Instituto de Telecomunicacoes, Next Generation Networks and Applications Group (NetGNA), Portugal, by the Euro-NF Network of Excellence of the Seventh Framework Programme of EU, in the framework of the Specific Joint Research Project VDTN, and by the INESC-ID multiannual funding through the PIDDAC program funds and National Funding from the FCT - Fundacao para a Ciencia e a Tecnologia through the PEst-OE/EEI/LA0008/2011 and PTDC/EEA-TEL/099074/2008 (MPSat) Projects.Dias, JAFF.; Rodrigues, JJPC.; Isento, JN.; Pereira, PRBA.; Lloret, J. (2011). Performance Assessment of Fragmentation Mechanisms for Vehicular Delay-Tolerant Networks. EURASIP Journal on Wireless Communications and Networking. 2011(195):1-14. https://doi.org/10.1186/1687-1499-2011-195S1142011195Tatchikou R, Biswas S, Dion F: Cooperative vehicle collision avoidance using inter-vehicle packet forwarding. In Presented at the IEEE Global Telecommunications Conference (IEEE GLOBECOM 2005). St. Louis, MO, USA; 2005.Park JS, Lee U, Oh SY, Gerla M, Lun DS: Emergency related video streaming in VANET using network coding. In The Third ACM International Workshop on Vehicular Ad Hoc Networks. (VANET 2006), Los Angeles, CA, USA; 2006:102-103.Buchenscheit A, Schaub F, Kargl F, Weber M: A VANET-based emergency vehicle warning system. Presented at the First IEEE Vehicular Networking Conference (IEEE VNC 2009), Tokyo, Japan 2009.Nekovee M: Sensor networks on the road: the promises and challenges of vehicular ad hoc networks and vehicular grids. In Proceedings of the Workshop on Ubiquitous Computing and e-Research. Edinburgh, UK; 2005.Blum J, Eskandarian A, Hoffmman L: Challenges of intervehicle ad hoc networks. IEEE Trans. Intell. Transport. Syst 2004, 5(4):347-351. 10.1109/TITS.2004.838218Yousefi S, Mousavi MS, Fathy M: Vehicular ad hoc networks (VANETs): challenges and perspectives. 6th International Conference on ITS Telecommunications (ITST 2006) 2006, 761-766.Füßler H, Torrent-Moreno M, Transier M, Festag A, Hartenstein H: Thoughts on a protocol architecture for vehicular ad-hoc networks. In Presented at the 2nd International Workshop on Intelligent Transportation (WIT 2005). Hamburg, Germany; 2005.Cerf V, Burleigh S, Hooke A, Torgerson L, Durst R, Scott K, Fall K, Weiss H: Delay-tolerant networking architecture. RFC 4838 2007. [Online] [ http://www.rfc-editor.org/rfc/rfc4838.txt ]Soares VNGJ, Farahmand F, Rodrigues JJPC: A layered architecture for vehicular delay-tolerant networks. In The Fourteenth IEEE Symposium on Computers and Communications (ISCC 2009). Sousse, Tunisia; 2009:122-127.Rodrigues JJPC, Soares VNGJ, Farahmand F: Stationary relay nodes deployment on vehicular opportunistic networks. In Mobile Opportunistic Networks: Architectures, Protocols and Applications. Edited by: Denko M. CRC Press, Taylor & Francis Group (hardcover); 2011:227-243.Postel J: Internet Protocol. RFC 791 1981. [Online] [ http://www.ietf.org/rfc/rfc791.txt ]Kent CA, Moguk JC: Fragmentation considered harmful. SIGCOMM Comput Commun Rev 1995, 25(1):75-87. 10.1145/205447.205456Kim B-S, Fang Y, Wong TF, Kwon Y: Throughput enhancement through dynamic fragmentation in wireless LANs. IEEE Trans Veh Technol 2005, 54(4):1415-1425. 10.1109/TVT.2005.851361Ginzboorg P, Niemi V, Ott J: Message Fragmentation in Disruptive Networks. Nokia Research Center, Technical Report; 2009.Legner M: Map-Based Geographic Forwarding in Vehicular Networks. Department of Informatic, University of Stuttgart; 2002.Li Q, Rus D: Sending messages to mobile users in disconnected ad-hoc wireless networks. 6th Annual International Conference on Mobile Computing and Networking, New York, USA 2000, 44-55.Vahdat A, Becker B: Epidemic Routing for Partially-Connected Ad-Hoc Networks. Duke University, Technical Report; 2000.Briesemeister L, Hommel G: Overcoming fragmentation in mobile ad-hoc networks. J Commun Netw 2000, 2(3):182-187.Liu H, Sheng H, Lv Z, Li L, Ma C: A cross layer design of fragmentation and priority scheduling in vehicular ad hoc networks. 7th World Congress on Intelligent Control and Automation (WCICA 2008) 2008, 6157-6160.Joshi HP: Distributed robust geocast: a multicast protocol for inter-vehicle communication. Master Thesis, North Carolina State University; 2006.Bachir A, Benslimane A: A multicast protocol in ad hoc networks: Inter-vehicles geocast. Proceedings of the 57th IEEE Vehicular Technology Conference, Korea 2003, 2456-2460.Mikko P, Ari K, Ott J: Message fragmentation in opportunistic DTNs. In 9th IEEE International Symposium on a World of Wireless, Mobile and Multimedia Networks (WOWMOM 2008). Newport Beach, CA, USA; 2008.Farrell S, Symington S, Weiss H: Delay-tolerant networking security overview. Internet Draft 2009. [Online] [ http://tools.ietf.org/html/draft-irtf-dtnrg-sec-overview-06 ]Magaia N, Pereira PR, Casaca A, Rodrigues J, Dias JA, Isento JN, Cervelló-Pastor C, Gallego J: Bundles fragmentation in vehicular delay-tolerant networks. 7th Euro-nf conference on next generation internet, Kaiserslautern, Germany 2011.Soares V, Rodrigues J, Farahmand F, Denko M: Exploiting node localization for performance improvement of vehicular delay-tolerant networks. In IEEE International Conference on Communications (ICC 2010). 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eHealth cognitieve gedragstherapie voor patiënten met chronische somatische aandoeningen

-based cognitive behavioral therapy for patients with chronic somatic conditions Many patients with chronic somatic conditions regularly experience impairments in physical and psychological functioning in their daily life. A way to support these patients is to offer online programs based on cognitive behavioral therapy (Internet-based cognitive behavioral therapy; ICBT). Although a substantial evidence base already exists regarding the effectiveness of ICBT in treating, for example, depressive symptoms, research on ICBT for chronic somatic conditions is still upcoming. In recent years, a growing number of randomized controlled trials were published that examined the effectiveness of ICBT in various chronic somatic conditions. To systematically and quantitatively evaluate the results of these studies, a metaanalysis was conducted, the results of which are discussed in this article. Results indicated that ICBT is also overall effective for chronic somatic conditions, with small to moderate effect sizes. Larger effects were occasionally found for disease-specific outcomes such as disease symptoms and disease-specific quality of life. A longer treatment duration was found to be marginally related to a larger decrease in depressive symptoms. In addition to the results of the meta-analysis, this article provides an overview of the recent literature regarding several clinically relevant ICBT topics: cost-effectiveness, guided ICBT interventions versus self-help, the role of treatment duration, and optimal design and implementation of eHealth interventions.FSW - Self-regulation models for health behavior and psychopathology - ou