***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: STUDY OBJECTIVE We evaluate a computer-based intervention for screening and health promotion in the emergency department and determine its effect on patient recall of health advice . METHODS This controlled clinical trial , with alternating assignment of patients to a computer intervention ( prevention group ) or usual care , was conducted in a university hospital ED . The study group consisted of 542 adult patients with nonurgent conditions . The study intervention was a self-administered computer survey generating individualized health information . Outcome measures were ( 1 ) patient willingness to take a computerized health risk assessment , ( 2 ) disclosure of behavioral risk factors , ( 3 ) requests for health information , and ( 4 ) remembered health advice . RESULTS Eighty-nine percent ( 470/542 ) of eligible patients participated . Ninety percent were black . Eighty-five percent ( 210/248 ) of patients in the prevention group disclosed 1 or more major behavioral risk factors including current smoking ( 79/248 ; 32 % ) , untreated hypertension ( 28/248 ; 13 % ) , problem drinking ( 46/248 ; 19 % ) , use of street drugs ( 33/248 ; 13 % ) , major depression ( 87/248 ; 35 % ) , unsafe sexual behavior ( 84/248 ; 33 % ) , and several other injury-prone behaviors . Ninety-five percent of patients in the prevention group requested health information . On follow-up at 1 week , 62 % ( 133/216 ) of the prevention group patients compared with 27 % ( 48/180 ) of the control subjects remembered receiving advice on what they could do to improve their health ( relative risk 2.3 , 95 % confidence interval 1.77 to 3.01 ) . CONCLUSION Using a self-administered computer-based health risk assessment , the majority of patients in our urban ED disclosed important health risks and requested information . They were more likely than a control group to remember receiving advice on what they could do to improve their health . Computer methodology may enable physicians to use patient waiting time for health promotion and to target at-risk patients for specific interventions BACKGROUND Women experiencing domestic violence ( DV ) frequent health care setting s , but DV is rarely identified . METHODS We conducted a r and omized controlled trial to determine the effect of computer screening on health care provider-patient DV communication  at 2 socioeconomically diverse emergency departments ( EDs ) . Consenting nonemergent female patients , aged 18 to 65 years , were r and omized to self-administered computer-based health risk assessment , with a prompt for the health care provider , or to " usual care " ; all visits were audiotaped . Outcome measures were rates of DV discussion , disclosure , and services . RESULTS Of 2169 eligible patients , 1281 ( 59 % ) consented ; 871 ( 68 % ) were successfully audiotaped , and 903 ( 71 % ) completed an exit question naire . Rates of current DV risk on exit question naire were 26 % in the urban ED and 21 % in the suburban ED . In the urban ED , the computer prompt increased rates of DV discussion ( 147/262 [ 56 % ] vs 123/275 [ 45 % ] ; P = .004 ) , disclosure ( 37/262 [ 14 % ] vs 23/275 [ 8 % ] ; P = .07 ) , and services provided ( 21 [ 8 % ] vs 10 [ 4 % ] ; P = .04 ) . Women at the suburban site and those with private insurance or higher education were much less likely to be asked about experiences with abuse . Only 48 % of encounters with a health care provider prompt regarding potential DV risk led to discussion s. Both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care . CONCLUSIONS Computer screening for DV increased but did not guarantee that DV would be addressed during ED encounters . Nonetheless , it is likely that low-cost interventions that allow patients the opportunity to self-disclose can be used to improve detection of DV Background : A pregnant woman 's psychological health is a significant predictor of postpartum outcomes . The Antenatal Psychosocial Health Assessment ( ALPHA ) form incorporates 15 risk factors associated with poor postpartum outcomes of woman abuse , child abuse , postpartum depression and couple dysfunction . We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among pregnant women than providers practising usual prenatal care . Methods : A r and omized controlled trial was conducted in 4 communities in Ontario . Family physicians , obstetricians and midwives who see at least 10 prenatal patients a year enrolled 5 eligible women each . Providers in the intervention group attended an educational workshop on using the ALPHA form and completed the form with enrolled women . The control group provided usual care . After the women delivered , both groups of providers identified concerns related to the 15 risk factors on the ALPHA form for each patient and rated the level of concern . The primary outcome was the number of psychosocial concerns identified . Results were controlled for clustering . Results : There were 21 ( 44 % ) providers r and omly assigned to the ALPHA group and 27 ( 56 % ) to the control group . A total of 227 patients participated : 98 ( 43 % ) in the ALPHA group and 129 ( 57 % ) in the control group . ALPHA group providers were more likely than control group providers to identify psychosocial concerns ( odds ratio [ OR ] 1.8 , 95 % confidence interval [ CI ] 1.1–3.0 ; p = 0.02 ) and to rate the level of concern as “ high ” ( OR 4.8 , 95 % CI 1.1–20.2 ; p = 0.03 ) . ALPHA group providers were also more likely to detect concerns related to family violence ( OR 4.8 , 95 % CI 1.9–12.3 ; p = 0.001 ) . Interpretation : Using the ALPHA form helped health care providers detect more psychosocial risk factors for poor postpartum outcomes , especially those related to family violence . It is a useful prenatal tool , identifying women who would benefit from additional support and interventions Objective To compare two different screening techniques for identifying women with a history of domestic violence or battering in the current pregnancy . Methods The five- question Abuse Assessment Screen was incorporated into routine social service interviews and applied prospect ively to all registrants for routine prenatal care at Women & Infants ' Hospital during an initial social service evaluation from September 7 through October 29 , 1993 . This group ( N = 143 ) was compared to a historical control group of all new registrants from July 12 through September 3 , 1993 ( N = 191 ) who had routine interviews by social services .  Demographic and medical data were compared , as well as the specific information addressed by the screen , including history of domestic violence , physical or sexual violence within the last year , violence during the current pregnancy , recent sexual abuse , and fear of partner . Results The median age of the study population was 23 years old , 50 % were white , 63 % were single , and 42 % had no insurance . There was a higher detection of violence in all categories using the Abuse Assessment Screen compared with the st and ard interview — any history : 41 versus 14 % ( relative risk [ RR ] 3.0 , 95 % confidence interval [ CI ] 2.0–4.5 ) ; recent history : 15 versus 3 % ( RR 5.6 , CI 2.2–14.5 ) ; during pregnancy : 10 versus 1 % ( RR 9.3 , CI 2.2–40.5 ) ; recent sexual abuse : 4 versus 0 % ( P = .006 ) ; and fear of abuser : 6 versus 3 % ( RR 1.8 , CI 0.6–5.0 ) . Conclusion Use of a structured screen improves detection rates of battering both before and during pregnancy , enabling clinicians to have a greater opportunity to intervene Although violence against women is recognized as a major public health problem , few interventions have been developed to reduce abuse . In this study , 132 pregnant women received three counseling sessions that were design ed to reduce further abuse . A comparison group of 67 abused women were offered wallet-sized cards listing community re sources for abuse . Women in both groups were followed at 6 months and 12 months post-delivery . Using repeated measures MANCOVA with entry scores as a covariate , we found significantly less violence reported by women in the intervention group than by women in the comparison group Objective To evaluate the effectiveness of an empowerment intervention in reducing intimate partner violence ( IPV ) and improving health status OBJECTIVE To examine the relationship between intimate partner violence ( IPV ) type , severity , and duration and abused women 's use of medical and legal services . METHODS Participants were 1509 r and omly sample d women from a large health plan who were interviewed by telephone to assess ( 1 ) self-reported lifetime exposure to IPV type ( physical , sexual , and psychological ) , severity , and duration and ( 2 ) women 's use of medical and legal services ( civil protection orders ) . RESULTS Compared with women who experienced psychological abuse only , sexually abused women were 1.3 times as likely to seek medical care , and women exposed to physical IPV or sexual IPV were 3.2 times and 1.6 times as likely , respectively , to seek legal services . Rates of medical and legal help seeking increased with increasing abuse severity among physically abused women , and rates of legal help seeking increased with abuse severity among sexually and psychologically abused women . Longer duration of physical and sexual IPV was also found to be associated with increased legal help seeking . CONCLUSIONS Abused women who sought formal help were more likely to be exposed to physical or sexual IPV , severe psychological IPV , and severe and long-lasting physical and sexual IPV . Efforts should be considered to improve the healthcare and legal system 's response to IPV OBJECTIVE Our goal was to identify the prevalence , determinants of , and barriers to  clinician-patient communication about intimate partner abuse . STUDY DESIGN We conducted telephone interviews with a r and om sample of ethnically diverse abused women . POPULATION We included a total of 375 African American , Latina , and non-Latina white women aged 18 to 46 years with histories of intimate partner abuse who attended 1 of 3 primary care clinics in San Francisco , California , in 1997 . OUTCOMES MEASURED We measured the relevance and determinants of past communication with clinicians about abuse and barriers to communication . RESULTS Forty-two percent ( 159 ) of the patients reported having communicated with a clinician about abuse . Significant independent predictors of communication were direct clinician question ing about abuse ( odds ratio [OR]=4.6 ; 95 % confidence interval [ CI ] 3.2 - 6.6 ) , and African American ethnicity ( OR=1.8 ; 95 % CI , 1.1 - 2.9 ) . Factors associated with lack of communication about abuse included immigrant status ( OR=0.6 ; 95 % CI , 0.3 - 1.0 ) and patient concerns about confidentiality ( OR=0.7 ; 95 % CI , 0.5 - 0.9 ) . Barriers significantly associated with lack of communication were patients ' perceptions that clinicians did not ask directly about abuse , beliefs that clinicians lack time and interest in discussing abuse , fears about involving police and courts , and concerns about confidentiality . CONCLUSIONS Clinician inquiry appears to be one of the strongest determinants of communication with patients about partner abuse . Other factors that need to be addressed include patient perceptions regarding clinicians ' time and interest in discussing abuse , fear of police or court involvement , and patient concerns about confidentiality OBJECTIVES National health care organizations recommend routinely screening patients for behavioral health risks , the effectiveness of which depends on patients ' willingness to disclose risky behaviors . This study aim ed to determine if primary care patients ' disclosures of potentially stigmatizing behaviors would be affected by ( 1 ) their expectation about whether or not their physician would see their disclosures and ( 2 ) the assessment method . METHODS One thous and nine hundred fifty-two primary care patients completed a question naire assessing human immunodeficiency virus ( HIV ) , alcohol , drug , domestic violence , tobacco , oral health , and seat belt risks ; half were told their responses would be seen by the research er and their physician and half were told that their responses would be seen by the research er only . Patients were r and omly assigned to one of five assessment methods : written , face-to-face , audio-based , computer-based , or video-based . RESULTS Across all risk areas , patients did not disclose differently whether or not they believed their physician would see their disclosures . Technologically advanced assessment methods ( audio , computer , and video ) produced greater risk disclosure ( 4%-8 % greater ) than traditional methods in three of seven risk areas . CONCLUSIONS These findings suggest patients are not less willing to disclose health risks to a research assistant knowing that this information would be shared with their physician and that a number of assessment methods can effectively elicit patient disclosure . Potentially small increases in risk disclosure must be weighed against other factors , such as cost and convenience , in determining which method ( s ) to use in different health care setting CONTEXT Screening for intimate partner violence ( IPV ) in health care setting s has been recommended by some professional organizations , although there is limited information regarding the accuracy , acceptability , and completeness of different screening methods and instruments . OBJECTIVE To determine the optimal method for IPV screening in health care setting s. DESIGN AND SETTING Cluster r and omized trial conducted from May 2004 to January 2005 at 2 each of emergency departments , family practice s , and women 's health clinics in Ontario 
    Output:
    
Contribution This r and omized trial found that when a computer-generated report detailing patients ' responses to questions about intimate partner violence and control was attached to medical charts , family practitioners asked about it and detected it more often .
Implication Computer-assisted screening for intimate partner violence and control led to improved detection in a busy ambulatory care setting .
Computer screening may help to overcome some of the barriers to discussing risk for IPV .