***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: The authors prospect ively assessed anxiety , depression , and behavior in children with st and ard‐risk acute lymphoblastic leukemia ( SR‐ALL ) during the first year of therapy and identified associated risk factors AIMS To evaluate the relationship between parent- and child-report Health-Related Quality of Life ( HRQL ) and demographic , tumour and family variables in children with a brain tumour in the first year after diagnosis and to identify determinants of HRQL at 12 months . PROCEDURE Longitudinal prospect i ve study : Semi-structured interviews took place approximately 1 , 6 and 12 months after diagnosis . HRQL was measured using the self- and parent-report PedsQL 4.0 Total Scale Score . Tumour and treatment variables considered included tumour site and grade , hydrocephalus at diagnosis , chemotherapy and radiotherapy . Family variables included measures of family function , family support and family stress , the primary carer 's coping strategies and symptoms of depression and anxiety . Univariate analyses were used at all three time points , and to identify potential early predictors of HRQL at 1 year . Regression analysis was then used to identify the most important determinants of HRQL at 1 year . RESULTS Thirty-five patients completed the 12-month interviews . There were consistent significant negative correlations between concurrent family impact of illness and parent and self-report HRQL , and positive correlations between concurrent family support and parent-report HRQL . Treatment with radio- or chemotherapy correlated with child-report HRQL only at some time points . Multivariate analysis showed infratentorial tumour site , and poor HRQL at 1 month best predicted poor self- and parent-report HRQL at 12 months . CONCLUSION Children with infratentorial tumours and poor HRQL early after diagnosis tend to have poor HRQL at 1 year . While family factors are important modulators of concurrent HRQL , they do not appear important in predicting HRQL OBJECTIVE To examine the association of family organization with metabolic control in adolescents with type 1 diabetes through the mechanisms of family self-efficacy for diabetes and disease management . METHOD Data from the baseline assessment of a longitudinal RCT were used , wherein 257 adolescent-parent dyads ( adolescents aged 11 - 14 ) each completed the  family organization subscale of the Family Environment Scale , the self-efficacy for Diabetes Self-Management Scale , the Diabetes Behavior Rating Scale , and 2 24-hr diabetes interviews  . RESULTS Structural equation modeling showed greater family organization was associated indirectly with better disease management behaviors via greater family self-efficacy ( β = .38 , p < .001 ) . Greater self-efficacy was indirectly associated with better metabolic control via better disease management both concurrently ( β = -.37 , p < .001 ) and prospect ively ( β = -.26 , p < .001 ) . The full model indicates more family organization is indirectly associated with better metabolic control concurrently and prospect ively through greater self-efficacy and better disease management ( β = -.13 , p < .001 ) . CONCLUSIONS Underst and ing the mechanisms by which family organization is associated with metabolic control provides insight into possible avenues of prevention/intervention for better diabetes management Risk- and -resistance models identify factors that predict psychosocial adjustment to pediatric chronic illness , including sickle cell disease ( SCD ) , but have not been applied to underst and health outcomes . The study objectives were to examine prospect ively the relationship of coping and family functioning with health outcomes for adolescents with SCD , accounting for sociodemographic and psychosocial risk . Forty-one adolescents and their families ( 41 primary caregivers , 9 second caregivers , and 15 healthy siblings ) completed paper- and -pencil measures of coping and family functioning at a baseline assessment ( time 1 ) . At both time 1 and time 2 ( 1 y later ) , disease severity , SCD complications , healthcare utilization , and average hemoglobin level were derived from medical file review s. Time 1 disease-related parenting stress predicted time 2 health outcomes ; however , there were no significant associations for coping . Families concordant in reporting lower family functioning had teens with increased disease severity and greater healthcare utilization . Examination of moderation of disease-related parenting stress by a risk index showed main effects for risk and for disease-related parenting stress for time 2 disease severity and time 2 healthcare utilization . Interaction effects were not significant . Efforts to explore specific mechanisms by which adaptive family functioning contributes to health outcomes for adolescents with SCD should continue , with particular attention to addressing the potential role of multiple sociodemographic and psychosocial risk variables Post-transplant immunosuppressant ( IS ) medication adherence is essential for long-term graft survival and relatively little is known about psychosocial barriers that interfere with optimum medication adherence in pediatric kidney transplant patients . The objective of this prospect i ve observational cohort study was to assess the impact of modifiable psychosocial variables on medication adherence . Our hypothesis was that parental stress , dysfunctional parent-child interactions and child behavior problems would be associated with poorer medication adherence . Thirteen pediatric kidney transplant patients and their caregivers were enrolled . Transplant recipients who were able to read and caregivers of all the transplant recipients completed behavioral and attitudinal surveys . A subgroup of seven families dispensed their primary IS medication from an electronic monitoring vial ( MEMS Smart Cap ) . For these patients , medication adherence was calculated by computing a ratio of the medication taken divided by the prescribed dose . In addition , for the entire group , serial IS levels were review ed by two board certified pediatric nephrologists who categorized all 13 transplant recipient families as either ' probably adherent ( PA ) ' or ' possibly non-adherent ( PNA ) ' . Pearson correlation coefficients and independent sample s Student t-tests were used to assess the association between medication adherence and psychosocial variables measured by st and ardized question naires . In this study , elevated parental stress , dysfunctional parent-child interactions , and child behavior problems were associated with poorer medication adherence . In addition , we found evidence to support the relationship between subjective dissatisfaction with appearance and poorer medication adherence . These findings suggest that pre-transplant recipient evaluations of risk factors for poor adherence are warranted 
    Output:
    
Significant correlations also were found between dimensions of family functioning and children 's problem behaviors , social competence , quality of life , and , to a lesser extent , adherence and physical health .
Of the family dimensions , cohesion and conflict were associated most strongly with child outcomes .