Results suggest that an Internet-facilitated intervention is moderately effective in short-term weight loss and weight maintenance and yields a large reduction in binge eating. This study also demonstrates that weight management and reduction of eating disorder psychopathological features can be achieved simultaneously by using an easily disseminated, Internet-facilitated program.

Suicide behavior is a serious clinical problem worldwide, and understanding ways of reducing it is a priority. A systematic review and meta-analysis were carried out to investigate whether Cognitive-behavioral therapies (CBTs) would reduce suicide behavior. From 123 potential articles, 28 studies met the entry criteria. Overall, there was a highly significant effect for CBT in reducing suicide behavior. Subgroup analysis indicates a significant treatment effect for adult samples (but not adolescent), for individual treatments (but not group), and for CBT when compared to minimal treatment or treatment as usual (but not when compared to another active treatment). There was evidence for treatment effects, albeit reduced, over the medium term. Although these results appear optimistic in advocating the use of CBT in ameliorating suicidal thoughts, plans, and behaviors, evidence of a publication bias tempers such optimism.

BackgroundThe influence of early exposure to allergenic foods on the subsequent development of food allergy remains uncertain.ObjectiveWe sought to determine the feasibility of the early introduction of multiple allergenic foods to exclusively breast-fed infants from 3 months of age and the effect on breastfeeding performance.MethodsWe performed a randomized controlled trial. The early introduction group (EIG) continued breastfeeding with sequential introduction of 6 allergenic foods: cow's milk, peanut, hard-boiled hen's egg, sesame, whitefish (cod), and wheat; the standard introduction group followed the UK infant feeding recommendations of exclusive breastfeeding for around 6 months with no introduction of allergenic foods before 6 months of age.ResultsOne thousand three hundred three infants were enrolled. By 5 months of age, the median frequency of consumption of all 6 foods was 2 to 3 times per week for every food in the EIG and no consumption for every food in the standard introduction group (P < .001 for every comparison). By 6 months of age, nonintroduction of the allergenic foods in the EIG was less than 5% for each of the 6 foods. Achievement of the stringent per-protocol consumption target for the EIG proved more difficult (42% of evaluable EIG participants). Breastfeeding rates in both groups significantly exceeded UK government data for equivalent mothers (P < .001 at 6 and at 9 months of age).ConclusionEarly introduction, before 6 months of age, of at least some amount of multiple allergenic foods appears achievable and did not affect breastfeeding. This has important implications for the evaluation of food allergy prevention strategies.

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Study Objectives: This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). Methods: VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. Results: Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p < 0.05) and perceptions of relative advantage to existing CBT-I practices (β = 0.286, p < 0.01), compatibility with their own needs and values (β = 0.307, p < 0.01), and expectations about the complexity of the app (β = 0.245, p < 0.05). Two years after CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. Conclusions: Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value. I NTRO DUCTI O NCognitive behavioral therapy for insomnia (CBT-I) is an evidence-based psychotherapy shown to effectively treat chronic insomnia. Numerous randomized controlled trials, summarized in several meta-analyses, have demonstrated that CBT-I leads to significant decreases in symptoms of insomnia and improvement in sleep efficiency, sleep fragmentation, and sleep onset latency.

Background: Domestic water hardness and chlorine have been suggested as important risk factors for atopic dermatitis (AD). Objective: We sought to examine the link between domestic water calcium carbonate (CaCO 3) and chlorine concentrations, skin barrier dysfunction (increased transepidermal water loss), and AD in infancy. Methods: We recruited 1303 three-month-old infants from the general population and gathered data on domestic water CaCO 3 (in milligrams per liter) and chlorine (Cl 2 ; in milligrams per liter) concentrations from local water suppliers. At enrollment, infants were examined for AD and screened for filaggrin (FLG) skin barrier gene mutation status. Transepidermal water loss was measured on unaffected forearm skin. Results: CaCO 3 and chlorine levels were strongly correlated. A hybrid variable of greater than and less than median levels of CaCO 3 and total chlorine was constructed: a baseline group of low CaCO 3 /low total chlorine (CaL/ClL), high CaCO 3 /low total chlorine (CaH/ClL), low CaCO 3 /high total chlorine (CaL/ClH) and high CaCO 3 /high total chlorine (CaH/ClH). Visible AD was more common in all 3 groups versus the baseline group: adjusted odds ratio (AOR) of 1.87 (95% CI, 1.25-2.80; P 5 .002) for the CaH/ClL group, AOR of 1.46 (95% CI, 0.97-2.21; P 5 .07) for the CaL/ClH, and AOR of 1.61 (95% CI, 1.09-2.38; P 5 .02) for the CaH/ClH group. The effect estimates were greater in children carrying FLG mutations, but formal interaction testing between water quality groups and filaggrin status was not statistically significant. Conclusions: High domestic water CaCO 3 levels are associated with an increased risk of AD in infancy. The influence of increased total chlorine levels remains uncertain. An intervention trial is required to see whether installation of a domestic device to decrease CaCO 3 levels around the time of birth can reduce this risk.

Nonwhite ethnicity: • In general a nonsignificant reduc on in food allergy in nonwhite EIG compared with nonwhite SIG Sensi zed: (IgE ≥0.1 kU/l to one or more foods) • EIG 19.2% versus SIG 34.2% developed any food allergy* Visible eczema: (moderate SCORAD 15 to <40) • EIG 22.6% versus SIG 46.7% developed any food allergy* • EIG 16.1% versus SIG 43.3% developed an egg allergy* Sensi zed: (IgE ≥0.1 kU/l to egg) • EIG 20.0% versus SIG 48.6% developed an egg allergy* *p<0.05 EIG: Early Introduc on Group SIG: Standard Introduc on Group Distribu on of enrollment (3 months of age) risk factors associated with a higher risk of developing a food allergy: Sensi za on (IgE ≥ 0.1 kU/l to one or more foods), visible eczema (any) at the clinic visit and nonwhite ethnicity (n=1170) Nonwhite Sensi zed

Background: Food allergy is thought to develop through transcutaneous sensitization, especially in the presence of skin barrier impairment and inflammation. Regular moisturizer application to infant skin could potentially promote transcutaneous sensitization and the development of food allergy. Objectives: We tested this hypothesis in the Enquiring About Tolerance (EAT) study population. Methods: The EAT study was a population-based randomized clinical trial conducted from January 15, 2008, to August 31, 2015, and recruited 1303 exclusively breastfed 3-month-old infants and their families from England and Wales. At enrollment at 3 months, families completed a questionnaire that included questions about frequency and type of moisturizer applied, use of corticosteroid creams, and parental report of dry skin or eczema. Infants were examined for visible eczema at the enrollment visit. Results: A statistically significant dose-response relationship was observed between parent-reported moisturization frequency at 3 months of age and the subsequent development of food allergy. Each additional moisturization per week was associated with an adjusted odds ratio of 1.20 (95% CI, 1.13-1.27; P < .0005) for developing food allergy. For infants with no visible eczema at the enrollment visit, the corresponding adjusted odds ratio was 1.18 (95% CI, 1.07-1.30; P 5 .001) and for those with eczema at the enrollment visit, 1.20 (95% CI, 1.11-1.31; P < .0005). Moisturizer frequency showed similar dose-response relationships with the development of both food and aeroallergen sensitization at 36 months. Conclusions: These findings support the notion that regular application of moisturizers to the skin of young infants may promote the development of food allergy through transcutaneous sensitization.