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Introduction: Access to evidence-based psychological therapy for posttraumatic stress disorder (PTSD) is limited. Blended Trauma-focused Cognitive Therapy (bTF-CT), merging internet-modules with a few therapy sessions, may be a pathway to enhance treatment access while maintaining the benefits of face-to-face therapy. Objectives: This study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of bTF-CT for PTSD in routine care, as well as the feasibility of assessments and data collection. Method: A single-arm design was adopted. bTF-CT was provided to 17 participants across two psychiatric and one primary care clinic. Assessments were conducted pre, during, post and 6-months following treatment. We assessed feasibility and acceptability via self-report questionnaires, retention, and attrition rates. To estimate preliminary treatment effectiveness the PTSD Symptom Checklist (PCL-5) was used to assess PTSD symptom severity. Results: Treatment satisfaction was high with a mean score of 28.7 out of 32 on the Client Satisfaction Questionnaire (SD = 3.5). The dropout rate was low, with 88% treatment retention. Program adherence was satisfactory, with scores ranging from 2.13 to 3.13 out of 4 on the internet intervention patient adherence scale. On the PCL-5, 88% made a reliable change, 64% demonstrated a clinically significant change, and the mean change from pre to post was 24 points (d = 2.13). Some negative effects were reported, such as unpleasant memories, feelings, and disrupted sleep, but these were temporary according to symptom scales. Conclusions: bTF-CT appears to be acceptable, feasible, and potentially effective when delivered in routine care. A large-scale non-inferiority trial to assess effectiveness compared to a gold-standard treatment is warranted. Clinical Trial Registration: Clinicaltrials.gov, identifier NCT04881643.

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BACKGROUND: Students, as a representative of young adults, are at risk for engagement in unhealthy lifestyle behaviors such as unhealthy eating, unhealthy relationships, and drug abuse. Health-promoting lifestyle (HPL) largely depends on adequate knowledge of healthy behaviors and hence, education is a strategy with potential positive effects on lifestyle. This study aimed at evaluating the effects of web-based education (WBE) on HPL among first-year medical sciences students. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2020 with a single-group pretest-posttest design. Participants were 185 first-year bachelor's and doctoral medical sciences students selected from Babol University of Medical Sciences, Babol, Iran, through multistage sampling. Study intervention was a three-week web-based educational program on HPL. Educational videos about the different components of HPL were sent to participants through WhatsApp. Data were collected before, one month after, and three months after the study intervention through the Health-Promoting Lifestyle Profile (HPLP2) and the General Health Questionnaire (GHQ). The STATA software (v. 16.0) was used for data analysis. RESULTS: Among 185 participants, 154 (83.69%) participants completed the study. The mean scores of HPL and its health responsibility and stress management subscales significantly increased by 4.58 (95% CI: 0.12, 9.04), 1.77 (95% CI: 0.39, 3.15), and 0.71 (95% CI: 0.13, 1.26), respectively. However, the mean scores of the nutrition, interpersonal relations, physical activity, and self-actualization subscales of HPL and the mean score of general health did not significantly change (P > 0.05). CONCLUSION: WBE has significant positive effects on HPL and its health responsibility and stress management subscales. Therefore, WBE through social media can be used to improve HPL among young adults, particularly students.

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Objective: Digital interventions can be effective in preventing and treating common mental health conditions among university students. Incorporating student experiences and perspectives in the design and implementation of these programmes may improve uptake and engagement. This qualitative study explored university students' perspectives of a low-intensity video-based mental health intervention, their recommendations for implementing the programme in university settings, and their views and recommendations to address barriers to engagement. Methods: Participants (N = 115) were students (mean = 20.63 years, SD = 2.10) with elevated distress from 31 Australian universities drawn from a randomised controlled trial of the Uni Virtual Clinic-Lite (UVC-Lite). Data from students randomised to the intervention condition were collected via semi-structured interviews (n = 12) and open-ended questions during post-intervention surveys (n = 103). Data were analysed using content analysis. Results: Participants generally reported positive views of the intervention, and most felt it should be offered to students as a universal intervention. Multiple methods of disseminating the intervention were suggested, including through university counselling, official platforms (e.g. student support services) and informal channels (e.g. word-of-mouth promotion). Difficulty integrating the programme into everyday life, pre-existing beliefs about mental health and technology-related factors were highlighted as barriers to engagement. Conclusion: A low-intensity video-based mental health intervention was generally considered to be acceptable and appropriate for students with mild to moderate distress. Participants provided several suggestions to encourage uptake of the intervention and possible pathways to disseminate the intervention to students. The effectiveness of these should be examined in future trials.

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Qualitative investigations that openly explore changes and facilitators of changes from the patient's perspective might offer valuable insights on impacts of therapy and helpful and hindering aspects. Our aim for this study was to explore the perspective of patients on a transdiagnostic Internet-based intervention to understand (1) which changes (positive as well as negative effects) responders and non-responders experienced, and (2) which aspects of the intervention they found helpful or hindering in facilitating those changes. We interviewed 21 patients that showed response or non-response to treatment using the Change Interview Schedule following a 10-week Internet-based intervention based on the Unified Protocol. Interviews were analyzed using qualitative content analysis. Both responders and non-responders reported positive changes, with few negative changes mentioned. Across both groups, increased positive affect was reported most frequently (81%). Both groups reported helpful factors, with guidance mentioned most frequently across both responders and non-responders (85.7%). Mainly, aspects of the specific framework were perceived as hindering (e.g. lack of personalization) (66.7%). Overall, patients reported mostly positive impacts, even if they did not respond to treatment. Results highlighted that what patients find helpful or hindering is individual.

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OBJECTIVE: To assess the effectiveness of Internet-based self-help interventions in treating depression in adolescents and young adults. METHODS: A systematic search was conducted across six databases, including PubMed, to identify randomized controlled trials (RCTs) that satisfied the specified inclusion and exclusion criteria. The intervention measure consisted of Internet-based self-help interventions. RESULTS: A total of 23 randomized controlled trials (RCTs) were included in this analysis. Meta-analysis indicated that Internet-based self-help therapies significantly reduced depression scores in adolescents and young adults. (OR = -0.68, 95%CI [-0.88, -0.47], P < 0.001). We examined the effects of patient recruitment from various regions, medication usage, therapist involvement, weekly intervention time, and intervention duration. Patients selected from school, primary healthcare centers, clinics and local communities had better results. Intervention lasting 30 to 60 min and 60 to180 minutes per week were effective in the short term. CONCLUSION: The internet-based self-help intervention can be effective in treating depression in adolescents and young adults. However, factors such as patient recruitment locations, medication usage, Therapists' involvement, weekly intervention time, and intervention duration interacted with the outcome. Subgroup analysis on potential adverse effects and gender was impossible due to insufficient data from the included studies.

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Background: Poor mental health literacy (MHL) in the global population significantly contributes to the treatment gap associated with mental disorders. In the digital age, leveraging Internet-based MHL interventions offers scalability and broader accessibility. This meta-analysis aimed to evaluate the effects of Internet-based interventions in improving MHL and mental health. Method: Up to Feb 2024, seven databases were searched for Internet-based interventions on MHL (knowledge, stigma, help-seeking attitudes and intentions) and mental disorders (general distress, anxiety, and depressive symptoms). The random-effects meta-analyses at post-intervention and long-term follow-up assessments were performed. Results: Twenty-nine eligible studies involving 11,582 participants were included. Significant positive effects were observed across various domains: knowledge increase (immediate: g = 0.459, 95 %CI: 0.285 to 0.634; follow-up: g = 0.487, 95 %CI: 0.348 to 0.626), immediate stigma reduction (g = -0.332, 95 %CI: -0.479 to -0.186), immediate enhancement of help-seeking attitudes (g = 0.168, 95 %CI: 0.046 to 0.3291) and help-seeking intentions (g = 0.135, 95 %CI: 0.072 to 0.198), as well as immediate mental health improvements (g = -0.074, 95 %CI: -0.115 to -0.033). Conclusion: Overall, these findings underscore the promising effects of internet-based interventions in improving MHL and mental health, while maintaining these effects over time remains challenging, particularly in reducing stigma and promoting long-term help-seeking behaviors. Addressing methodological limitations, adopting a more interactive approach, and implementing targeted interventions are crucial to maximizing the effectiveness and advancing mental health care worldwide.

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OBJECTIVE: This study assessed perceived acceptability of online rural volunteer-led exercise classes among volunteer leaders and older people during the COVID-19 pandemic and interrogate differences in acceptability between older people who were currently participating in regular exercise and those who were not. METHOD: A case study was conducted of an existing volunteer-led exercise program using a cross-sectional preintervention survey (38 volunteer exercise leaders and 172 program participants). RESULTS: Thirty per cent (n = 11) of the volunteer leaders reported an interest in running the online classes. Motivations included providing opportunities for participants and keeping themselves and participants fit. Thirty-four per cent (n = 42) of the older participants reported an intent to join the online classes, which was primarily attributed to the desire to keep active and to socialise. However, over 60% of the respondents across both categories did not want to engage in online exercise classes. This was primarily attributed to a preference for face-to-face classes and lack of confidence in conducting or using online activities or services. Older participants who did not regularly exercise were statistically more likely to report perceived challenges attending an online class, and to identify the use of internet-based technologies as a barrier to attendance. CONCLUSION: Digital literacy was a challenge for the older respondents, particularly for those who were not currently engaged in regular exercise. Organisations implementing online exercise programs should recognise that this form of delivery will pose challenges to cohorts of rural older people who are not undertaking regular physical activity and address the individual and environmental barriers to digital uptake.

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BACKGROUND: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. OBJECTIVE: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. METHODS: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. RESULTS: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders' openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype's final version. The resulting intervention, named Mamá, te entiendo ("Mom, I get you"), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. CONCLUSIONS: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions.

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OBJECTIVES: This qualitative study examines the experiences of older adults with Empower@Home, an older adult-centered, layperson-supported internet-based cognitive behavioral therapy (iCBT) program for depression, with a focus on engagement-related factors. METHODS: Adults aged 50 or older with at least mild depressive symptoms were recruited from multiple resources. A random subset of participants was invited for a semi-structured qualitative interview during a post-intervention assessment conducted over the phone (N = 148). Interviews were recorded and transcribed verbatim. Transcripts were coded in a multi-phase, team-based approach utilizing inductive coding techniques, followed by thematic analysis to identify key themes. RESULTS: Six key themes regarding engagement emerged: the importance of a structured, skills-based, and self-paced approach; the essential role of weekly coaching for accountability, web interface's ease of use and accessibility; narrative engagement dynamics; enhanced learning through multimodal instruction; and tailoring challenges in iCBT. CONCLUSIONS: Older adult-centered, layperson-supported, and multimodal iCBT can effectively engage older adults in managing their mental health. CLINICAL IMPLICATIONS: iCBT programs can be integrated into various community aging settings. By leveraging each setting's strengths and involving a range of professionals, these programs can play an important role in enhancing older adults' mental health.

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BACKGROUND: Tinnitus presents a major public health challenge, impacting quality of life. With conventional therapies being often time-consuming and costly, interest in Internet-based treatments, such as auditory treatments and Internet-based cognitive behavioral therapy, has grown due to their improved patient adherence. This meta-analysis aims to review existing scientific literature to assess the effectiveness of Internet-based therapies (IBTs) in treating tinnitus. METHODS: Studies up to February 2024 using the Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), or Tinnitus Reactions Questionnaire (TRQ) to monitor tinnitus before and after IBTs were searched in PubMed, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials. Variation of the score with time was analyzed and a comparison was made with non-IBT studies. Treatment effects were analyzed using Cohen's d model. RESULTS: A total of 14 articles were considered, with a total of 1574 patients. Significant improvements in questionnaire scores were noted post-treatment. In the IBT group, THI and TFI decreased by 17.97 and 24.56 points, respectively (Cohen's d THI: 0.85; TFI: 0.80). In the control group, THI and TFI decreased by 13.7 and 4.25 points, respectively (Cohen's d THI: 0.55; TFI: 0.10). CONCLUSIONS: Internet-based therapies showed reliable effectiveness, possibly due to improved patient compliance, accessibility, cost-effectiveness, and customization.

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Background: Parent training (PT) programs have been implemented for neurodevelopmental disorders such as autism spectrum disorder (ASD) in recent years. However, in Southeast Asia, the diffusion of rehabilitation programs for children with ASD and that of PT as a parental support measure has been slow. Methods: This study assessed the effectiveness of an online PT program that was developed in Japan and remotely delivered to Vietnamese parents of children with ASD residing in Vietnam. Sixteen parents of Vietnamese children with ASD participated in seven online Tottori University-style PT sessions. The online PT was conducted in real-time from Japan, considering the two-hour time difference between countries. Lectures and exercises were presented in Vietnamese with PowerPoint materials. Japanese staff provided explanations in Japanese, which were then simultaneously translated by a Vietnamese interpreter. Attendance, completion of homework assignments, and the number of statements on Zoom and social media were tallied. A pre-post-test design was employed to measure changes in parents' mental health factors and children's behavior. A post-intervention questionnaire was administered to assess participant's acceptance of PT. Results: The findings showed that attendance and task completion rates were considerably high. The study found that the mental health scores of parents significantly improved after participating in online parenting training compared to before. However, there were no statistically significant improvements found in children's behavior. The study also confirmed high satisfaction with the cross-country online parenting training. Conclusion: This study confirmed that TUPT, developed in Japan and implemented as an online PT for parents of children with ASD living in Vietnam, was effective in improving parental mental health. The program acceptability questionnaire also showed positive results. This study is the first step in the evaluation and dissemination of Internet-based, cross-country parent training for parental support in Asia.

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BACKGROUND: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. OBJECTIVE: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. METHODS: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. RESULTS: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. CONCLUSIONS: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146.

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Background: To meet the growing health needs of older people, the Chinese government has introduced internet-based home care services. However, most rural older people have not yet benefited from such services, and the willingness to use these services and the factors influencing them remain unclear. Objective: We aim to investigate the current willingness of rural older people to use internet-based home care services and analyze the factors. Methods: We conducted a cross-sectional study across multiple centers using general information and self-developed questionnaires. Qualitative interviews, a literature review and the Delphi method were employed to develop the questionnaire. A total score of the questionnaire above 78 or higher indicates a high willingness to use internet-based home care services. Descriptive statistics, t-tests, one-way ANOVA, and multiple linear regression were used to explore the factors that influence the willingness of rural older people to use internet-based home care services. Results: We surveyed 349 rural older people. The total score of rural older people's willingness to use internet-based home care services was 84.49 ± 10.88, indicating high willingness, with the highest score for the dimension of perceived usefulness and lower scores for the dimension of perceived ease of use. Multiple linear regression analysis revealed that gender, education level, residence status, number of chronic diseases, and knowledge of internet-based home care services were the most important factors for rural older people (all p < 0.05). Conclusion: The willingness of rural older people to use internet-based home care services is high. Thus, it is recommended that county hospitals increase public awareness of such services, optimize the design of their interfaces, and support family and social resources from relevant departments that can maximize access, so as to provide a reference for later relevant departments to enhance willingness.

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The World Health Organization developed the "iSupport for Dementia" program for family caregivers of people with dementia. Objective: To explore studies on adaptation, randomized clinical trial protocols, and preliminary results of iSupport by unpaid caregivers of people living with dementia in different countries. Methods: Systematic review. Results: Ten cultural adaptation studies, eight randomized clinical trial protocols, and two preliminary results were included. Adaptation studies showed adjustments in terminology, design, and additional resources. Clinical trial protocols included burden as the primary outcome, and baseline, three months of intervention, and follow-up after six months. Studies with preliminary results found positive effects on the mental health and well-being of caregivers after using the program. Conclusion: iSupport is an online program of the World Health Organization in response to dementia in implementation in different countries.

A Organização Mundial da Saúde desenvolveu o programa "iSupport for Dementia" para cuidadores familiares de pessoas com demência. Objetivo: Explorar estudos sobre adaptação, protocolos de ensaio clínico randomizado e resultados preliminares do "iSupport" por cuidadores não remunerados de pessoas que vivem com demência em diferentes países. Métodos: Revisão sistemática. Resultados: Foram incluídos dez estudos de adaptação cultural, oito protocolos de Ensaio Clínico Randomizado e dois resultados preliminares. Os estudos de adaptação apresentaram os ajustes nas terminologias, design e recursos adicionais. Os protocolos de ensaio clínico incluíram a sobrecarga como desfecho primário, e com linha de base, três meses de intervenção e acompanhamento após seis meses. Os estudos com resultados preliminares encontraram efeitos positivos na saúde mental e bem-estar dos cuidadores após o uso do programa. Conclusão: O iSupport é um programa online da Organização Mundial da Saúde em resposta à demência na implantação em diferentes países.

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INTRODUCTION AND HYPOTHESIS: Enhancing women's knowledge, attitude, and practice (KAP) concerning urinary incontinence (UI) through diverse educational strategies has been a focal point for professionals in recent years. This study was aimed at assessing the impact of the educational application Continence App® on the KAP of postpartum women experiencing UI. We hypothesized that access to the app would lead to improved KAP among these women. METHODS: Postpartum women who had undergone vaginal birth, aged 18 years or above, literate, admitted in a maternity ward, delivered a full-term or large-for-gestational-age infant, and possessed a smartphone or compatible device for app usage were included. Changes in KAP were evaluated using a survey specifically designed for this purpose. The Mann-Whitney U test was employed to compare KAP scores between control and intervention groups, as well as between baseline and post-intervention assessments. RESULTS: Among the 542 women screened for eligibility, 349 were enrolled in the study, with 138 completing post-intervention assessments. The mean (standard deviation [SD]) age of participants was 25.9 (5.8) years. Post-intervention scores for knowledge and practice demonstrated a decline among non-app users, whereas a significant increase was observed among those in the intervention group. Attitudinal changes remained insignificant. CONCLUSIONS: The findings highlight the effectiveness of an app-based educational intervention in enhancing the knowledge and practice related to UI among postpartum women.

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OBJECTIVE: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in infancy. Early intervention is critical to improve the prognosis for these children. E-health interventions have tremendous potential. This review aimed to determine the status and effectiveness of family interventions for parents of children aged 0-6 years with ASD in the context of e-health. METHODS: The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Web of Science, and China National Knowledge Infrastructure were searched from inception to June 2022. The searches were limited to children with ASD of the age range between 0 and 6 years. We collated the available information and used descriptive statistics to analyze the synthesized data. RESULTS: Our initial search identified 3,672 articles, of which 30 studies met the inclusion criteria. The 30 articles selected were released between 2012 and 2022. All articles are in English. Most articles reviewed were from high-income countries (27/30, 90.0%), especially from the United States (16/30, 53.3%). Four major themes emerged from the 30 studies that matched the inclusion criteria, as follows: 1) type of e-health interventions, 2) duration of interventions, 3) clinical aspects of e-health interventions, and 4) evidence for intervention effectiveness, looking into the positive, negative, and mixed findings of previous studies. CONCLUSION: These findings suggest that a wide variety of e-health interventions may actually help support both children with ASD aged 0-6 years and their parents.

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BACKGROUND: Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain. OBJECTIVES: This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs. METHODS: Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis. RESULTS: Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources. CONCLUSION: Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.

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INTRODUCTION: The increase in risky sexual behaviors among adolescent students has sparked alarm and has become an area of research interest. As adolescents prioritize confidentiality and accessibility, digital interventions are becoming increasingly relevant in sex education. We therefore posed the following research question: Are digital application interventions effective to prevent risky sexual behaviors in school adolescents? DESIGN: A systematic peer review was conducted between January and December 2023 in five databases (PubMed, Web of Science, Scopus, EMBASE, and PsycINFO) without restricting for language or year of publication. METHOD: We included randomized control trials or quasi-experimental studies that measured the effectiveness of interventions targeting young people aged 10-19 years or their parents and developed in a school setting. Interventions aimed at young people with intellectual disabilities, learning difficulties, or any disease requiring a specific intervention were excluded. RESULTS: The search ultimately yielded 27 studies covering a total of 18 digital interventions that demonstrated positive effects, not maintained over time, on knowledge, attitudes, and behaviors, although the latter to a lesser extent. DISCUSSION: We have found very interesting digital interventions with effects, among others, on knowledge, attitudes, and contraceptive use in adolescents. In general, digital interventions have positive effects on knowledge and attitudes, but it is more difficult to modify behaviors with strictly digital interventions or combined with complementary face-to-face sessions or group class activities. CONCLUSION: We thus believe that digital interventions are adequate to reduce adolescent sexual risk behaviors, and our systematic review facilitates the implementation of these interventions by sharing existing digital interventions that have had positive effects, as well as the main characteristics a digital intervention should possess to reduce sexually risky behaviors in adolescents. CLINICAL RELEVANCE: Digital interventions with adolescents improve sexual behaviors and can be a valuable resource in education on this topic due to their accessibility and confidentiality, two key points for young people.

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The last decade has seen major advances and growth in internet-based surveillance for infectious diseases through advanced computational capacity, growing adoption of smart devices, increased availability of Artificial Intelligence (AI), alongside environmental pressures including climate and land use change contributing to increased threat and spread of pandemics and emerging infectious diseases. With the increasing burden of infectious diseases and the COVID-19 pandemic, the need for developing novel technologies and integrating internet-based data approaches to improving infectious disease surveillance is greater than ever. In this systematic review, we searched the scientific literature for research on internet-based or digital surveillance for influenza, dengue fever and COVID-19 from 2013 to 2023. We have provided an overview of recent internet-based surveillance research for emerging infectious diseases (EID), describing changes in the digital landscape, with recommendations for future research directed at public health policymakers, healthcare providers, and government health departments to enhance traditional surveillance for detecting, monitoring, reporting, and responding to influenza, dengue, and COVID-19.

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Our aim was to study enrollment and completion levels for the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention, for parents of young children with disruptive behavior before and after the COVID-19 lockdown period. Population-based screening was carried out on 39,251 children during routine check- ups at 4 years of age. The parents of children scoring at least 5 on the Strengths and Difficulties Questionnaire were assessed against inclusion and exclusion criteria. Associations with enrollment or completion were analyzed using logistic regression models. The effects of COVID-19 restrictions on these were estimated using interrupted timeseries analysis. Of 39,251 families, 4894 screened positive and met the eligibility criteria. Of those, 3068 (62.6%) decided to enroll in the SFSW program and 2672 (87.1%) of those families completed it. The highest level of disruptive behavior (OR 1.33, 95% CI 1.12-1.57, p < 0.001) and overall severity of difficulties (OR 2.22, 95% CI 1.91-2.57, p < 0.001) were independently associated with enrollment. Higher parental education was associated with enrollment and completion. Higher paternal age was associated with enrollment, and parent depressive symptoms with non-completion. The SFSW enrollment did not significantly change following the COVID-19 restrictions, while the completion rate increased (COVID-19 completion OR 1.75, 95% CI 1.22-2.50, p = 0.002). Guided digital parenting interventions increase the sustainability of services, by addressing the child mental health treatment gap and ensuring service consistency during crisis situations.