***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: BACKGROUND In 1994 , Oregon implemented the Oregon Health Plan ( OHP ) , extending health care coverage under a system of capitated managed care to uninsured citizens living below the Federal Poverty Level ( FPL ) . We conducted a study to measure receipt of clinical preventive services among women newly enrolled in the OHP . METHODS Six hundred and sixty six women aged 52 - 64 , and living below the FPL in Oregon were r and omly selected from OHP enrollment rosters and interviewed by telephone . A follow-up survey was conducted 1 year later . The main outcome of interest was receipt of a screening mammogram during the first year in the OHP . RESULTS At enrollment 17 % ( 65/383 ) of participants had never had health care coverage . Sixty-six percent of the women ( 220/333 ) were overdue for a mammogram . Fifty-five percent ( 121/220 ) reported cost as the main reason they had not had this procedure . Mammography rates doubled under the OHP ( 21 % to 52 % , 95 % CI = 0.25 - 0.38 , p < 0.001 ) . Among women who were overdue for a mammogram at the time they enrolled , an expressed plan to get a mammogram ( OR3.0 , 95 % CI = 1.1 - 8.7 , p = 0.04 ) , citing cost as the main reason for being overdue ( OR3.0 , 95 % CI = 1.3 - 7.2 , p = 0.014 ) , receipt of a routine checkup ( OR9.5 , 95%CI = 3.7 - 24.9 , p < 0.001 ) , and health care provider 's ( HCP 's ) recommendation for mammography ( OR8.1,95 % CI = 2.9 - 23.0 , p < 0.001 ) were independently associated with receipt of a mammogram . CONCLUSION The OHP enrolled and successfully delivered clinical preventive services to a medically under served population . Even after removing the financial barrier , obstacles to mammography remain . These may be overcome by health systems changes to insure receipt of routine checkups and appropriate provider recommendations Patient compliance in returning fecal-hemoccult card packets has been studied in recent years but no specific interventions have been shown consistently to improve the return rate . It was wondered whether removing a small financial barrier for indigent patients would positively affect compliance . Therefore , the effect of prepaid postage on the rate of return was studied . Pre-prepared packets containing hemoccult cards with return envelopes were distributed in a r and omized fashion to indigent and private insurance patients in outpatient clinics . On half of the return envelopes return postage was applied . The main outcome measure was the rate of return of stamped and unstamped packets  stratified between indigent and private insurance patients . The overall rates of return were 117 of 159 ( 74 % ) for the stamped packets and 102 of 166 ( 61 % ) for unstamped packets ( p < 0.02 ) . After stratification , in the indigent patients ( n = 177 ) , 73 of 95 ( 77 % ) stamped packets were returned compared to 46 of 82 ( 56 % ) unstamped packets ( p < 0.006 ) . In the private insurance patients ( N = 148 ) , 44 of 64 stamped packets ( 69 % ) and 52 of 84 unstamped packets ( 62 % ) were returned ( p > 0.10 ) . Removing even small financial barriers ( eg , providing a postage stamp ) can enhance compliance for indigent patients Screening with the faecal occult blood test ( FOBT ) has been shown in r and omized control trials to be effective in reducing mortality from colorectal cancer . Compliance to this test recommendation , however , by the general population is usually low . To evaluate different methods of increasing compliance with FOBT , using mailed test kits or order cards , with or without information leaflets , subjects were r and omly assigned to receive a test kit or a kit request card . An information leaflet was included in half of the mailings . All participants were contacted for interview . Compliance was evaluated through the central computer system of the study 's FOBT laboratory . Self‐initiated compliance with FOBT in the year preceding the study was 0.6 % of the study participants . The overall compliance rate with the programme invitation was 17.9 % , with a somewhat higher , though non‐significant response to the mailed kit ( 19.9 % ) over the kit request card ( 15.9 % ) . Women complied with the test significantly more than men , older participants more than younger . Compliance to FOBT is low among the Israeli population aged 50–74 who receive a formal invitation to carry out this screening . Mailing a kit request card within the framework of a screening programme can achieve a substantial increase ( to 17.9 % ) in the level of compliance for the relatively low cost of postage . More effort is needed to study additional means of convincing the non‐responders to take part in this potentially life saving activity OBJECTIVE We conducted a cluster r and omized clinical trial to compare the benefit of offering on-site mobile mammography in addition to an outreach program design ed to increase mammography use by educating patients . SUBJECTS AND METHODS We recruited a consecutive volunteer sample of 499 women ranging in age from 60 to 84 years who had not undergone mammography in the previous year to participate in a cluster r and omized clinical trial about the benefit of on-site mobile mammography .  Subjects were recruited from 60 community-based sites where seniors gather . The intervention included a structured on-site multicomponent educational program with or without available on-site mobile mammography . The primary outcome measure was self-reported receipt of mammography within 3 months of the intervention . RESULTS Women in the group offered access to on-site mammography and health education were significantly more likely than those in the group offered health education only to undergo mammography  within 3 months ( 55 % vs 40 % , p = 0.001 ; adjusted [ for clustering ] odds ratio , 1.83 ; 95 % confidence interval , 1.22 - 2.74 ) . Gains from offering on-site  mammography  were shown for several ethnic and sociodemographic subgroups and were especially large for Asian American women . CONCLUSION Offering on-site mammography at community-based sites where older women gather is an effective method for increasing breast cancer screening rates among older women and may be particularly effective for some subgroups of women who traditionally have had low screening rates BACKGROUND We conducted a prospect i ve controlled clinical trial in an urban academic general medicine practice to test the effect of same-day mammography availability on adherence to physicians ' screening mammography recommendations . PATIENTS AND METHODS Participants were a consecutive sample of 920 female patients aged 50 years or older who had received a physician 's recommendation for screening mammography at an office visit and had no active breast symptoms , history of breast cancer , or a mammogram within the previous 12 months . Women were assigned to same-day screening mammography availability ( intervention group ) or usual screening mammography scheduling ( control group ) . MAIN OUTCOME MEASURES Three- , 6- , and 12-month rates of adherence to physicians ' recommendations for screening mammography .  RESULT Twenty-six percent of women in the intervention group obtained a same-day screening mammogram . At 3 months , 58 % of the women in the intervention group underwent the recommended screening mammography  compared with 43 % of the women in the control group ( P<.001 ) , increasing to 61 % and 49 % at 6 months ( P<.001 ) , and 268 ( 66 % ) of 408 vs 287 ( 56 % ) of 512 at 12 months ( P = .003 ) . The difference between the intervention and control groups 3-month adherence rates was most marked among women aged 65 years or older ( 58 % vs 34 % ; P<.001 ) , women who were not employed ( 54 % vs 36 % ; P<.001 ) , and women with a history of having had either no mammograms ( 39 % vs 20 % ; P = .02 ) or only 1 to 2 mammograms ( 57 % vs 38 % ; P<.001 ) within the last 5 years . CONCLUSIONS Same-day mammography availability increased 3- , 6- , and 12-month  screening mammography adherence rates in this urban academic general medicine practice . The effect was most marked among women aged 65 years or older , women who were not employed , and those who had had fewer than 3 mammograms in the last 5 years . The efficacy of this intervention in other setting s still needs to be demonstrated BACKGROUND This study tested a breast cancer education intervention for African American women with poor screening histories . Disparities in rates of later-stage disease and death may be related to lower screening rates due to behavioral ( e.g. , knowledge gap ) and structural ( e.g. , access ) barriers . METHODS 94 African American women ( low-income , poor screening histories ) were r and omly assigned for an educational and on-site screening intervention , or non-intervention status . Primary care sites were used for educational purpose s. Three-month post-intervention  mammography  was assessed . RESULTS The intervention group had significantly higher screening rates than the non-intervention group . The latter had a knowledge gap , poor screening history , cancer fears , and insurance differences relative to the screened women . Screening was predicted by behavioral , rather than structural factors . CONCLUSIONS Since low-income African American women face behavioral and structural barriers to breast cancer screening , an educational program that improves knowledge levels and is offered in primary care sites can effectively impact screening BACKGROUND Although colorectal cancer screening by using a fecal occult blood test ( FOBT ) , flexible sigmoidoscopy , colonoscopy , or barium enema x-ray reduces the incidence of and death from colorectal cancer , the rate of colorectal cancer screening in the general population is low . We conducted a r and omized trial consisting of direct mailing of FOBT kits to increase colorectal cancer screening among residents of Wright County , Minnesota , a community in which colorectal cancer screening was promoted . METHODS At baseline , we mailed a question naire about colorectal cancer screening to a r and om sample of Wright County residents aged 50 years or older who were r and omly selected from the Minnesota State Driver 's License and Identification Card data base ( estimated N = 1451 ) . The sample was r and omly allocated into three equal subgroups : one group ( control ) received only the question naire , one group received FOBT kits by direct mail with reminders , and one group received FOBT kits by direct mail without reminders . Study participants were sent a follow-up question naire 1 year after baseline . We used the responses to the question naires to estimate the 1-year change in self-reported screening rates in each group and the differences in the changes among the groups , along with the associated bootstrap 95 % confidence intervals ( CIs ) . RESULTS At baseline , the estimated response rate was 86.5 % , self-reported adherence to FOBT guidelines was 21.5 % , and overall adherence to any colorectal cancer screening test guidelines was 55.8 % . The 1-year rate changes in absolute percentage for self-reported adherence to FOBT use were 1.5 % ( 95 % CI = -2.9 % to 5.9 % ) for the control group , 16.9 % ( 95 % CI = 11.5 % to 22.3 % ) for the direct-mail-FOBT-with-no-reminders group , and 23.2 % ( 95 % CI = 17.2 % to 29.3 % ) for the direct-mail-FOBT-with-reminders group . The 1-year rate changes for self-reported adherence to any colorectal cancer screening test were 7.8 % ( 95 % CI = 3.2 % to 12.0 % ) for the control group , 13.2 % ( 95 % CI = 8.4 % to 18.2 % ) for the direct-mail-FOBT-with-no-reminders group , and 14.1 % ( 95 % CI = 9.1 % to 19.1 % ) for the direct-mail-FOBT-with-reminders group . CONCLUSION Direct mailing of FOBT kits combined with follow-up reminders promotes more rapid increases in the use of FOBT and nearly doubles the increase in overall rate of adherence to colorectal cancer screening guidelines in a general population compared with a community-wide screening promotion and awareness campaign Research ers in migrant health clinics in Washington state found cost to be the single most commonly reported reason given by foreign-born Hispanic women for never having had a mammogram . The true significance of this finding beyond self-report was unknown . A r and omized intervention trial design ed to test the effect of fully subsidized mammograms on utilization was conducted within this population . Women in the intervention group received st and ard clinic instruction plus a voucher for a free mammogram . Controls received st and ard clinic instruction alone . Eighty-seven percent of women receiving vouchers obtained a mammogram within 30 days , compared with 17.5 % of controls . Logistic regression analysis revealed that women receiving vouchers were 47 times more likely to obtain a mammogram than controls . This confirms women 's self-report that cost is a major barrier to accessing screening mammograms in this low-income migrant population , and 
    Output:
    
Evidence from these review s indicates that screening for breast cancer ( by mammography ) has been increased effectively by reducing structural barriers and by reducing out-of pocket client costs , and that screening for colorectal cancer ( by fecal occult blood test ) has been increased effectively by reducing structural barriers .