Why are health care interventions delivered over the internet? A systematic review of the published literature

Background: As Internet use grows, health interventions are increasingly being delivered online. Pioneering researchers are using the networking potential of the Internet, and several of them have evaluated these interventions. Objective: The objective was to review the reasons why health interventions have been delivered on the Internet and to reflect on the work of the pioneers in this field in order to inform future research. Methods: We conducted a qualitative systematic review of peer-reviewed evaluations of health interventions delivered to a known client/patient group using networked features of the Internet. Papers were reviewed for the reasons given for using the Internet, and these reasons were categorized. Results: We included studies evaluating 28 interventions plus 9 interventions that were evaluated in pilot studies. The interventions were aimed at a range of health conditions. Reasons for Internet delivery included low cost and resource implications due to the nature of the technology; reducing cost and increasing convenience for users; reduction of health service costs; overcoming isolation of users; the need for timely information; stigma reduction; and increased user and supplier control of the intervention. A small number of studies gave the existence of Internet interventions as the only reason for undertaking an evaluation of this mode of delivery. Conclusions: One must remain alert for the unintended effects of Internet delivery of health interventions due to the potential for reinforcing the problems that the intervention was designed to help. Internet delivery overcomes isolation of time, mobility, and geography, but it may not be a substitute for face-to-face contact. Future evaluations need to incorporate the evaluation of cost, not only to the health service but also to users and their social networks. When researchers report the outcomes of Internet-delivered health care interventions, it is important that they clearly state why they chose to use the Internet, preferably backing up their decision with theoretical models and exploratory work. Evaluation of the effectiveness of a health care intervention delivered by the Internet needs to include comparison with more traditional modes of delivery to answer the following question: What are the added benefits or disadvantages of Internet use that are particular to this mode of delivery? © Griffiths, Frances, Lindenmeyer, Antje, Powell, John, Thorogood, Margaret.

The impact of anticholinergic burden in Alzheimer's dementia-the LASER-AD study

Objective - to examine the effect of medications with anticholinergic effects on cognitive impairment and deterioration in Alzheimer's dementia (AD). Methods - cognitive function was measured at baseline and at 6- and 18-month follow-up using the Mini-Mental State Exam (MMSE), the Severe Impairment Battery (SIB) and the Alzheimer's Disease Assessment Battery, Cognitive subsection (ADAS-COG) in a cohort study of 224 participants with AD. Baseline anticholinergic Burden score (ABS) was measured using the Anticholinergic Burden scale and included all prescribed and over the counter medication. Results - the sample was 224 patients with Alzheimer's dementia and 71.4% were women. Their mean age was 81.0 years [SD 7.4 (range 55–98)]. The mean number of medications taken was 3.6 (SD 2.4) and the mean anticholinergic load was 1.1 (SD 1.4, range 0–7). The total number of drugs taken and anticholinergic load correlated (rho = 0.44; P < 0.01). There were no differences in MMSE and other cognitive functioning at either 6 or 18 months after adjusting for baseline cognitive function, age, gender and use of cholinesterase inhibitors between those with, and those without high anticholinergenic load. Conclusions - medications with anticholinergic effect in patients with AD were not found to effect deterioration in cognition over the subsequent 18 months. Our study did not support a continuing effect of these medications on people with AD who are established on them.

The role of resources in achieving target competitive positions

Competitive positioning has become an essential component of modern marketing management. For a firm to target effective positions for its products and services, it needs to decide on the market segment (where it will compete) as well as the differential advantage it will emphasise (how it will compete). Until recently, empirical research on positioning has received little attention, while substantial insight has been gained with respect to the concept of competitive positioning. Furthermore, Hooley, Moller and Broderick have highlighted the lack of empirical studies relative to theoretical ones related to positioning in general and to the relationship between positioning and the different components of each competitive positioning that a firm might choose. This study focuses on product competitive positioning in over-the-counter (OTC) pharmaceuticals in the British market. It was found that certain resources underpin specific competitive positions.

Impact of the fiber type and nonlinear management over the performance of a 16x40 Gb/s DWDM transmission system

We examine impact of the fiber type and nonlinear management over the performance of a 16x40Gb/s DWDM NRZ transmission system. The line is constituted of 3x100km of G.652 or G.655 fiber with hybrid Raman-EDFA amplification.

Postgraduate training offered to primary care pharmacists by schools of pharmacy - changes over the last five years

Poster session - A review of the postgraduate training courses offered by the 15 schools of pharmacy within Britain was undertaken - The training currently on offer was compared with that offered by the same schools of pharmacy five years ago - It was found that although the numbers of training courses offered by the 15 schools had significantly increased, the orientation of the courses remained more or less as it was five years ago - The increases in the number of courses had not reflected the increased roles that pharmacists currently have and are hoping to undertake in the future - Any new training offered will need to reflect a wider “modernising and managing NHS organisations” agenda

Community pharmacist perceptions of the loss of resale price maintenance

Focal points: This study was designed to elicit the views of community pharmacists on any perceived business and professional changes following the loss of resale price maintenance (RPM)A piloted, 22-point self-completion questionnaire containing open, closed and scaled response questions was distributed to 35 independent (<10 stores), 13 multiple group and three supermarket-based pharmacies, and 40 responses were obtained (29 independent, eight multiple and three supermarket)Theme analysis indicated that 20 respondents felt that an increased range of services was now provided, 27 reported a decreased sales potential and 25 thought that patients now purchased more medicinesThe average price at which eight common over-the-counter medicines were offered was found to be £4.34 in independents, £4.37 in multiples and £4.22 in the supermarket pharmacies, compared with an average standard list price of £4.32There are indications that removal of RPM may have instigated changes in community pharmacy

Maximization of a Linear Utility Function over the Set of the Housing Market Short-Term Equilibria

AMS subject classification: 90C05, 90A14.

The words of God: Religious texts and the Counter -Reformation in the Spanish world

This dissertation analyzes a variety of religious texts such as catechisms, confession manuals, ecclesiastical legislation, saints' lives, and sermons to determine the definitions of orthodoxy held by the Spanish clergy and the origins of such visions. The conclusion posited by this research was that there was a definite continuity between the process of Catholic reform in Spain and the process of Catholic expansion into the New World in that the objectives and concerns of the Spanish clergy in Europe and the New World were very similar. This dissertation also analyzes sources that predated the Council of Trent and demonstrates that within the Iberian context the Council of Trent cannot be used as a starting date for the attempts at Catholic reform. In essence, this work concludes the Spanish clergy's activities were influenced by humanist concepts of models and model behaviour which is reflected in their attempt to form model Catholics in Spain and the New World and in their impulse to produce written texts as standards. ^

Uvigerina spp. minor element and derived d18Oseawater records over the Mid-Pleistocene Transition (500-1500 kyr), DSDP Hole 94-607

During the Mid-Pleistocene Transition (MPT), the dominant glacial-interglacial cyclicity as inferred from the marine d18O records of benthic foraminifera (d18Obenthic) changed from 41 kyr to 100 kyr years in the absence of a comparable change in orbital forcing. Currently, only two Mg/Ca-derived, high-resolution bottom water temperature (BWT) records exist that can be used with d18Obenthic records to separate temperature and ice volume signals over the Pleistocene. However, these two BWT records suggest a different pattern of climate change occurred over the MPT-a record from North Atlantic DSDP Site 607 suggests BWT decreased with no long-term trend in ice volume over the MPT, while South Pacific ODP Site 1123 suggests that BWT has been relatively stable over the last 1.5 Myr but that there was an abrupt increase in ice volume at ~900 kyr. In this paper we attempt to reconcile these two views of climate change across the MPT. Specifically, we investigated the suggestion that the secular BWT trend obtained from Mg/Ca measurements on Cibicidoides wuellerstorfi and Oridorsalis umbonatus species from N. Atlantic Site 607 is biased by the possible influence of D[CO3]2- on Mg/Ca values in these species by generating a low-resolution BWT record using Uvigerina spp., a genus whose Mg/Ca values are not thought to be influenced by D[CO3]2-. We find a long-term BWT cooling of ~2-3°C occurred from 1500 to ~500 kyr in the N. Atlantic, consistent with the previously generated C. wuellerstorfi and O. umbonatus BWT record. We also find that changes in ocean circulation likely influenced d18Obenthic, BWT, and d18Oseawater records across the MPT. N. Atlantic BWT cooling starting at ~1.2 Ma, presumably driven by high-latitude cooling, may have been a necessary precursor to a threshold response in climate-ice sheet behavior at ~900 ka. At that point, a modest increase in ice volume and thermohaline reorganization may have caused enhanced sensitivity to the 100 kyr orbital cycle.

Annotated record of the detailed examination of Mn deposits from the R/V Rig Seismic Cruise 11 (BMR 66) in 1986 over the Great Australian Bight Basin area

Late Cretaceous and younger sediments dredged from the upper continental slope and canyon walls in the Great Australian Bight Basin between 126° and 136°E broadly confirm the stratigraphy which had been established previously from scattered exploration wells. Late Cretaceous to Early Eocene marine and marginal marine terrigenous sediments are overlain by Middle Eocene and younger pelagic carbonate (fine limestone and calcareous ooze). The samples provide the first evidence of truly marine Maastrichtian sedimentation, with abundant calcareous nannoplankton, on the southern margin of the continent. Other samples of interest include Precambrian sheared granodiorite on the upper slope south of Eyre Terrace, Paleocene phosphatic sediment in 'Eucla' Canyon at 128° 30'E, and terrigenous Early Miocene mudstone at 133° 20' and 134° 50'E. The mudstone is of note as an exception to the uniform pelagic carbonate wackestone and ooze which characterise Middle Eocene and younger sedimentation at all other sites. Fragments of alkali basalt lava of unknown age were recovered in 'Eucla' Canyon. Cores are mostly pelagic calcareous ooze, but those from submarine canyons include terrigenous turbidites.