Self help e-health applications as primart health care tools

With the ageing of the Australian population, the cost of the health care system is projected to grow substantially over the next 30 years [1]. According to the 2008 national e-health strategy maintaining Australia's current good health outcomes in the face of these pressure will require a fundamental change in the way health care is delivered.[2]. E-health technologies offer a promising means for addressing this problem, particularly with respect to delivering high quality evidence-based treatments direct to the consumer. The current report summarises the activities and outcomes of an APHCRI-funded visit to Australia by Dr Lee Ritterband, an international expert in the field of e-health self help technologies for improving health outcomes. In this report, primary health care is interpreted broadly to refer to the provision of first level care in any setting including the delivery of self-help e-health services direct to the public.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

The GoodNight study—online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial

BACKGROUND Cognitive Behaviour Therapy for Insomnia (CBT-I) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia. CBT-I also lowers levels of depression in this group. However, it is not known if targeting insomnia using CBT-I will lower depressive symptoms, and thus reduce the risk of major depressive episode onset, in those specifically at risk for depression. Therefore, this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression. METHOD/DESIGN A sample of 1,600 community-dwelling adults (aged 18-64), who screen positive for both subclinical levels of depressive symptoms and insomnia, will be recruited via various media and randomised to either a 9-week online insomnia treatment programme, Sleep Healthy Using The internet (SHUTi), or an online attention-matched control group (HealthWatch). The primary outcome variable will be depression symptom levels at the 6-month post-intervention on the Patient Heath Questionnaire-9 (PHQ-9). A secondary outcome will be onset of major depressive episodes assessed at the 6-month post-intervention using 'current' and 'time from intervention' criteria from the Mini International Neuropsychiatric Interview. DISCUSSION This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression. If effective, online provision of a depression prevention programme will facilitate dissemination. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), Registration number: ACTRN12611000121965.This study is supported by a grant from the National Health and Medical Research Council, Australia (GNT1005867)

Hand position-dependent modulation of errors in vibrotactile temporal order judgments:the effects of transcranial magnetic stimulation to the human posterior parietal cortex

The ability to decide which of the two stimuli is presented first can be probed using a temporal order judgment (TOJ) task. When the stimuli are delivered to the fingers, TOJ decisions can be confounded by the fact that the hands can be moved to different locations in space. How and where this confounded information is processed in the brain is poorly understood. In the present set of experiments, we addressed this knowledge gap by using single-pulse transcranial magnetic stimulation (TMS) to disrupt processing in the right or left posterior parietal cortex (PPC) during a vibrotactile TOJ task with stimuli applied to the right and left index fingers. In the first experiment, participants held their hands in an uncrossed configuration, and we found that when the index finger contralateral to the site of TMS was stimulated first, there was a significant increase in TOJ errors. This increase did not occur when stimuli were delivered to the ipsilateral finger first. In the second experiment, participants held their hands in a crossed configuration and the pattern of errors was reversed relative to the first experiment. In both the first two experiments, significant increases in TOJ error were present with TMS over either hemisphere, regardless of arm configuration; however, they were larger overall following TMS over the right PPC. Control experiments using sham TMS indicated the systematic modulation in error was not due to nonspecific effects of the stimulation. Additionally, we showed that these TMS-induced changes in TOJ errors were not due to a reduced ability to detect the timing of the vibrotactile stimuli. Taken together, these results demonstrate that both the right and left PPC contribute to the processing underlying vibrotactile TOJs by integrating vibrotactile information and proprioceptive information related to arm position in space

The Sleep Or Mood Novel Adjunctive therapy (SOMNA) trial: a study protocol for a randomised controlled trial evaluating an internet-delivered cognitive behavioural therapy program for insomnia on outcomes of standard treatment for depression in men

BACKGROUND: Insomnia is a significant risk factor for depression onset, can result in more disabling depressive illness, and is a common residual symptom following treatment cessation that can increase the risk of relapse. Internet-based cognitive behavioural therapy for insomnia has demonstrated efficacy and acceptability to men who are less likely than women to seek help in standard care. We aim to evaluate whether internet delivered cognitive behavioural therapy for insomnia as an adjunct to a standard depression therapeutic plan can lead to improved mood outcomes.METHODS/DESIGN: Male participants aged 50 years or more, meeting Diagnostic and Statistical Manual of Mental Disorders criteria for current Major Depressive Episode and/or Dysthymia and self-reported insomnia symptoms, will be screened to participate in a single-centre double-blind randomised controlled trial with two parallel groups involving adjunctive internet-delivered cognitive behavioural therapy for insomnia and an internet-based control program. The trial will consist of a nine-week insomnia intervention period with a six-month follow-up period. During the insomnia intervention period participants will have their depression management coordinated by a psychiatrist using standard guideline-based depression treatments. The study will be conducted in urban New South Wales, Australia, where 80 participants from primary and secondary care and direct from the local community will be recruited. The primary outcome is change in the severity of depressive symptoms from baseline to week 12. DISCUSSION: This study will provide evidence on whether a widely accessible, evidence-based, internet-delivered cognitive behavioural therapy for insomnia intervention can lead to greater improvements than standard treatment for depression alone, in a group who traditionally do not readily access psychotherapy. The study is designed to establish effect size, feasibility and processes associated with implementing e-health solutions alongside standard clinical care, to warrant undertaking a larger more definitive clinical trial.Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12612000985886.The study is supported by beyondblue: the national depression and anxiety initiative National Priority Driven Research Program and funded through a donation from the Movember Foundation

Keeping creative writing on track: Co-designing a framework to support behavior change

The application of persuasive technology in web-based and mobile phone-based systems is well established, particularly in the health domain. However, a greater understanding of the effectiveness of the techniques deployed is needed to facilitate the successful transfer of research findings into practical applications. The context explored here is that of creative writing and the potential use of persuasive technology to foster and support a productive writing routine. Employing a user-centered design approach, we conducted surveys and a co-creation workshop with writers. Goal setting and regular writing, combined with self-monitoring, were key indicators of an effective writing practice. Group and mentor support were also highlighted. Based on our findings, we developed the architecture for a mobile personal writing coach. We evaluated the architecture against existing frameworks, finding good congruence. This supports our long-term goal of creating a universal framework, applicable to a wider range of behavior change interventions, domains and users. The design considerations reported in this paper go some way towards that goal

Molecular characterization, biofilm analysis and experimental biofouling study of Fusarium isolates from recent cases of fungal keratitis in New York State

BACKGROUND: To characterize Fusarium isolates from recent cases of fungal keratitis in contact lens wearers, and to investigate fungal association with MoistureLoc solution. METHODS: We studied six fungal isolates from recent cases of keratitis in New York State. The isolates were characterized by nucleotide sequencing and phylogenetic analyses of multiple genes, and then typed using minisatellite and microsatellite probes. Experimental fungal biofilm formation was tested by standard methods. MoistureLoc solutions were tested in biofouling studies for their efficacy in elimination of Fusarium contamination. RESULTS: Fusarium solani – corneal ulcers (2 isolates), lens case (1 isolate), and F. oxysporum – corneal ulcer (1 isolate), eye (1 isolate), were recovered from five patients. An opened bottle of MoistureLoc solution provided by a patient also yielded F. solani. Two distinct genotypes of F. solani as well as of F. oxysporum were present in the isolated strains. Remarkably, F. solani strains from the lens case and lens solution in one instance were similar, based on phylogenetic analyses and molecular typing. The solution isolate of F. solani formed biofilm on contact lenses in control conditions, but not when co-incubated with MoistureLoc solution. Both freshly opened and 3-month old MoistureLoc solutions effectively killed F. solani and F. oxysporum, when fungal contamination was simulated under recommended lens treatment regimen (4-hr). However, simulation of inappropriate use (15 – 60 min) led to the recovery of less than 1% of original inoculum of F. solani or F. oxysporum. CONCLUSION: Temporary survival of F. solani and F. oxysporum in MoistureLoc suggested that improper lens cleaning regimen could be a possible contributing factor in recent infections

The effectiveness of web-based interventions designed to decrease alcohol consumption – a systematic review

OBJECTIVE To review the published literature on the effectiveness of web-based interventions designed to decrease consumption of alcohol and/or prevent alcohol abuse. METHOD Relevant articles published up to, and including, May 2006 were identified through electronic searches of Medline, PsycInfo, Embase, Cochrane Library, ASSIA, Web of Science and Science Direct. Reference lists of all articles identified for inclusion were checked for articles of relevance. An article was included if its stated or implied purpose was to evaluate a web-based intervention designed to decrease consumption of alcohol and/or to prevent alcohol abuse. Studies were reliably selected and quality-assessed, and data were independently extracted and interpreted by two authors. RESULTS Initial searches identified 191 articles of which 10 were eligible for inclusion. Of these, five provided a process evaluation only, with the remaining five providing some pre-to post-intervention measure of effectiveness. In general the percentage quality criteria met was relatively low and only one of the 10 articles selected was a randomized control trial. CONCLUSION The current review provides inconsistent evidence on the effectiveness of eIectronic screening and brief intervention (eSBI) for alcohol use. Process research suggests that web-based interventions are generally well received. However further controlled trials are needed to fully investigate their efficacy, to determine which elements are keys to outcome and to understand if different elements are required in order to engage low- and high-risk drinkers