***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Behavioral conditioned immunosuppression has been described in rodents as the most impressive demonstration of brain-to-immune system interaction . To analyze whether behavioral conditioned immunosuppression is possible in humans , healthy subjects in this double-blind , placebo-controlled study were conditioned in four sessions over 3 consecutive days , receiving the immunosuppressive drug cyclosporin A as an unconditioned stimulus paired with a distinctively flavored drink ( conditioned stimulus ) each 12 h. In the next week , re-exposure to the conditioned stimulus ( drink ) , but now paired with placebo capsules , induced a suppression of immune functions as analyzed by the IL-2 and IFN-gamma mRNA expression , intracellular production , and in vitro release of IL-2 and IFN-gamma , as well as lymphocyte proliferation . These data demonstrate for the first time that immunosuppression can be behaviorally conditioned in humans BACKGROUND This study aims to determine the role of patient expectations as potentially modifiable factor of side-effects , quality of life , and adherence to endocrine treatment of breast cancer . PATIENTS AND METHODS A 2-year prospect i ve clinical cohort study was conducted in routine primary care with postoperative patients with hormone-receptor-positive breast cancer , scheduled to start adjuvant endocrine treatment .  Structured patient-reported assessment s of side-effects , side-effect expectations , quality of life , and adherence took place during the first week post-surgery and after 3 and 24 months of endocrine treatment . RESULTS Of 111 enrolled patients , at 3 and 24 months , 107 and 88 patients , respectively , were assessed . After 2 years of endocrine treatment , patients reported high rates of side-effects ( arthralgia : 71.3 % , weight gain : 53.4 % , hot flashes : 46.5 % ) , including symptoms not directly attributable to the medication ( breathing problems : 28.1 % , dizziness : 25.6 % ) . Pre-treatment expectations significantly predicted patient-reported long-term side-effects and quality of life in multivariate models controlling for relevant medical and psychological variables . Relative risk of side-effects after 2 years of endocrine treatment was higher in patients with high negative expectations at baseline than in those with low negative expectations ( RR = 1.833 , CI 95 % , 1.032 - 3.256 ) . A significant interaction confirmed this expectation effect to be particularly evident in patients with high side-effects at 3 months . Furthermore , baseline expectations were associated with adherence at 24 months ( r = -0.25 , P = 0.006 ) . CONCLUSIONS Expectations are a genuine factor of clinical outcome from endocrine treatment for breast cancer . Negative expectations increase the risk of treatment-specific side-effects , nocebo side-effects , and non-adherence . Yet , controlled studies are needed to analyze potential causal relationships . Optimizing individual expectations might be a promising strategy to improve side-effect burden , quality of life , and adherence during longer-term drug intake . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT02088710 OBJECTIVE To further develop and trial a brief in-hospital illness perception intervention for myocardial infa rct ion ( MI ) patients . METHODS One hundred and three patients admitted with acute MI were r and omized to receive either st and ard care or st and ard care plus an illness perception intervention , which consisted of three half-hour patient sessions and one half-hour patient- and -spouse session delivered in hospital . Patients were followed up to 6 months . The main outcome was the difference between groups in rate of return to work . RESULTS The intervention group had a faster rate of return to work than the control group , and more patients in the intervention group had returned to full time work by 3 months than in the control group . At discharge , patients in the intervention group demonstrated changes in causal attributions regarding their MI and higher perceived underst and ing of their condition , which remained at the 6-month follow-up . They also reported a better underst and ing of the information given in hospital , higher intentions to attend cardiac rehabilitation classes , lower anxiety about returning to work , greater increases in exercise , and made fewer phone calls to their general practitioner about their heart condition at follow-up . CONCLUSION This study replicates the findings of an earlier trial that a brief in-hospital illness perception intervention can change perceptions and improve rates of return to work in MI patients . It increases the generalizability of the intervention to the current broader definition of MI and to patients who have had previous infa rcts The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms , although little is known about their role in different circumstances . In this study , we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure . We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone ( GH ) and cortisol did not have any effect on the secretion of these hormones . However , if a preconditioning was performed with sumatriptan , a 5-HT1B/1D agonist that stimulates GH and inhibits cortisol secretion , a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration , although opposite verbal suggestions were given . These findings indicate that verbally induced expectations have no effect on hormonal secretion , whereas they affect pain and motor performance . This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved , whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play , even though a conditioning procedure is performed We examined whether personality traits are differently associated with  coronary heart disease and stroke mortality . Participants were pooled from three prospect i ve cohort studies ( Health and Retirement Study , Wisconsin Longitudinal Study graduate and sibling sample s ; n = 24,543 men and women , mean age 61.4 years , mortality follow-up between 3 and 15 years ) . There were 423 coronary heart disease deaths and 88 stroke deaths  during 212,542 person-years at risk . Higher extraversion was associated with an increased risk of stroke ( hazard ratio per each st and ard deviation increase in personality trait HR = 1.41 , 95 % CI 1.10–1.80 ) but not with coronary heart disease mortality ( HR = 0.93 , 0.83–1.05 ) . High neuroticism , in turn , was more strongly related to the risk of coronary heart disease ( HR = 1.16 , 1.04–1.29 ) than stroke deaths ( HR = 0.95 , 0.78–1.17 ) . High conscientiousness was associated with lower mortality risk from both coronary heart disease ( HR = 0.74 , 0.67–0.81 ) and stroke ( HR = 0.78 , 0.63–0.97 ) . Cardiovascular risk associated with personality traits appears to vary between main cardiac and cerebral disease endpoints Background Illness perceptions have been shown to predict patient activities . Therefore , studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain ( CLBP ) are needed . Objective The purpose of this study was to compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLBP . Design This was a prospect ively registered r and omized controlled trial with an assessor blinded for group allocation . Setting The study was conducted in an outpatient rehabilitation clinic . Participants The participants were 156 patients ( 18–70 years of age ) with CLBP ( > 3 months ) . Intervention Patients were r and omly assigned to either a treatment group or to a waiting list ( control ) group . Trained physical therapists and occupational therapists delivered 10 to 14 one-hour treatment sessions according to the treatment protocol . Measurements The primary outcome measure was change in patient-relevant physical activities ( Patient-Specific Complaints question naire ) . The secondary outcome measures were changes in illness perceptions ( Illness Perceptions Question naire ) and generic physical activity level ( Quebec Back Pain Disability Scale ) . Measurements were taken at baseline ( 0 weeks ) and after treatment ( 18 weeks ) . Results A baseline-adjusted analysis of covariance showed that there were statistically significant differences between intervention and control groups at 18 weeks for the change in patient-relevant physical activities . This was a clinical ly relevant change ( 19.1 mm ) for the intervention group . Statistically significant differences were found for the majority of illness perception scales . There were no significant differences in generic physical activity levels . Limitations Longer-term effectiveness was not studied . Conclusions This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinical ly relevant improvements in patient-relevant physical activities at 18 weeks Background : Myocardial infa rct ion ( MI ) is one of the major causes of death and disability worldwide , which can reduces quality of life in patients . Some disabilities are depression and anxiety which delay returning to work . The aim of this study was to evaluate the effect of illness perception focused intervention on quality of life , anxiety , and depression in MI patients . Material s and Methods : A r and omized controlled trial study of 48 recently hospitalized MI patients was conducted ( 24 in intervention group and 24 in control group ) . Intervention group was trained to underst and the disease by a mental health counselor in three half-an-hour sessions for three consecutive days . Data were collected from three question naires : hospital anxiety and depression scale , the World Health Organization Quality of Life Question naire ( short form ) , and Illness Perceptions Question naire Brief at admission , 1.5 , and 3 months postdischarge . Data were analyzed with ANOVA repeated measure . Results : The mean duration of returning to work was 28.7 ± 8.1 days in intervention groups and 46 ± 7.6 days in control group which was statistically significant ( P < 0.001 ) . Moreover , anxiety , depression , and illness perceptions score were significantly decreased in intervention groups which were 8.3 ± 3.3 , 6.8 ± 3.5 , and 36.5 ± 5 in intervention groups and 15.8 ± 2.1(P < 0.001 ) , 17.1 ± 2.3 ( P < 0.001 ) , and 41.9 ± 4 ( P < 0.001 ) in control group , respectively . Mean of quality of life subscales scores just physical health subscale showed a significant reduction after 3 months in the control group . Conclusion : Training MI patients to underst and the disease in three half-an-hour sessions for 3 consecutive days can decrease the duration of returning to work , anxiety and depression , and increase illness perceptions which can make a better outcome Objective This study was design ed to examine whether a brief hospital intervention design ed to alter patients ’ perceptions about their myocardial infa rct ion ( MI ) would result in a better recovery and reduced disability . Design In a prospect i ve r and omized study , 65 consecutive patients with their first MI aged were assigned to receive an intervention design ed to alter their perceptions about their MI or usual care from rehabilitation nurses . Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital . Results The intervention caused significant positive changes in patients ’ views of their MI . Patients in the intervention group also reported they were better prepared for leaving hospital ( p < .05 ) and subsequently returned to work at a significantly faster rate than the control group ( p < .05 ) . At the 3-month follow-up , patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects ( 14.3 vs. 39.3 , p < .03 ) . There was no significant differences in rehabilitation attendance between the two groups . Conclusions An in-hospital intervention design ed to change patients ’ illness perceptions can result in improved functional outcome after MI Background Placebo effects contribute substantially to outcome in most fields of medicine . While clinical trials typically try to control or minimize these effects , the potential of placebo mechanisms to improve outcome is rarely used . Patient expectations about treatment efficacy and outcome are major mechanisms that contribute to these placebo effects . We aim ed to optimize these expectations to improve outcome in patients undergoing coronary artery bypass graft ( CABG ) surgery . Methods In a prospect i ve three-arm r and omized clinical trial with a 6 month follow-up , 124 patients scheduled for CABG surgery were r and omized to either a brief psychological pre-surgery intervention to optimize outcome expectations ( EXPECT ) ; or a psychological control intervention focusing on emotional support and general advice , but not on expectations ( SUPPORT ) ; or to st and ard medical care ( SMC ) . Interventions were kept brief to be feasible with a heart surgery environment ; “ dose ” of therapy was identical for both pre-surgery interventions . Primary outcome was disability 6 months after surgery . Secondary outcomes comprised further clinical and immunological variables . Results Patients in the EXPECT group showed significantly larger improvements in disability ( −12.6 ; −17.6 to −7.5 ) than the SMC group ( −1.9 ; −6.6 to + 2.7 ) ; patients in the SUPPORT group ( −6.7 ; −11.8 to 1.7 ) did not differ from the SMC group . Comparing follow-up scores and controlling for baseline scores of EXPECT versus SUP 
    Output:
    
Expectation optimization approaches yielded particularly promising results .
Conclusion This review highlights the potential of EFPI for optimizing treatment of patients with medical conditions .