The evidence base for internet-based cognitive behavioral therapy for insomnia (iCBT-I) is firm; however, little is known about iCBT-I’s health-economic effects.

This study aimed to evaluate the cost-effectiveness and cost-utility of iCBT-I in reducing insomnia among schoolteachers.

Schoolteachers (N=128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a wait list control group, both with unrestricted access to treatment as usual. Health care use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and a public health care perspective. Costs were related to symptom-free status (score <8 on the insomnia severity index) and quality-adjusted life years (QALYs) gained. Sampling error was handled using nonparametric bootstrapping.

Statistically significant differences favoring the intervention group were found for both health outcomes (symptom-free status yes or no β=.30; 95% CI 0.16-0.43; QALYs β=.019, 95% CI 0.01-0.03). From a societal perspective, iCBT-I had a 94% probability of dominating the wait list control for both health outcomes. From a public health care perspective, iCBT-I was more effective but also more expensive than the wait list control, resulting in an incremental cost-effectiveness ratio of €650 per symptom-free individual. selleck kinase inhibitor In terms of QALYs, the incremental cost-effectiveness ratio was €11,285. At a willingness-to-pay threshold of €20,000 per QALY gained, the intervention’s probability of being cost-effective was 89%.

Our trial indicates that iCBT could be considered as a good value-for-money intervention for insomnia.

German Clinical Trial Registry DRKS00004700; https//tinyurl.com/2nnk57jm.

RR2-10.1186/1745-6215-14-169.

RR2-10.1186/1745-6215-14-169.

The assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies.

We aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria.

We included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas ofreas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection.

A scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring.

The aim of this study was to investigate whether a year-long cloud platform-based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers’ health outcomes.

A total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest-exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.

The observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.

The U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment.

The aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events.

Shortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=vascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results.

ClinicalTrials.gov NCT01504191; https//clinicaltrials.gov/ct2/show/NCT01504191.

RR2-10.1186/s13063-015-0689-y.

RR2-10.1186/s13063-015-0689-y.