***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: OBJECTIVE To evaluate the influence of an app-based approach in a protocol for domestic oral hygiene maintenance in a group of adolescent patients wearing fixed multibracket appliances . MATERIAL S AND METHODS Eighty adolescent patients scheduled to start an orthodontic multibracket treatment were r and omly divided into two groups of 40 .  Plaque index ( PI ) , gingival index ( GI ) , white spots ( WS ) , and caries presence were recorded in all patients , and they were instructed regarding domestic oral hygiene maintenance on the day of braces application ( t0 ) and every 3 months ( t1 , t2 , t3 , t4 ) during the first year of treatment . Study group ( SG ) patients were enrolled in a WhatsApp chat room-based competition and instructed to share monthly with the other participants two self-photographs ( selfies ) showing their oral hygiene status . RESULTS SG patient participation in the chat room was regular and active throughout the observation period . At t2 , t3 , and t4 , SG patients had significantly lower values of both PI and GI and a lower incidence of new WS and caries , compared with the control group . CONCLUSION Integration of new " social " technologies in a st and ard oral hygiene motivation protocol is effective in improving compliance of adolescent patients and in improving their oral health status during orthodontic multibracket treatment Evaluation of acceptability and preliminary efficacy of an Internet and short message service ( SMS ) intervention for promoting physical activity ( PA ) in Hong Kong Chinese school children . An 8-week quasi-experimental study non-r and omly assigned 78 school children ( mean age=12.8 years ) to ( a ) an intervention group that received a stage-matched , Internet PA program two times a week and tailored SMS messages daily ; or ( b ) a no-treatment control . Data were collected from September 2008 until June 2009 . Acceptability measures included exposure rate and participant 's satisfaction . Efficacy measures were changes in stage of motivational readiness ( SMR ) and self-reported PA level . Intervention participants demonstrated significant pre-post increments in SMR ( Z=-2.558 , p=0.011 ) and self-reported PA level [ F(1 , 76)=4.50 , p=0.04 ] . There was a non-significant trend between groups in both SMR ( p=0.24 ) and PA ( p=0.13 ) . Despite the similar ratings of satisfaction between Internet ( M=3.12±0.74 ) and SMS ( M=3.12±0.84 ) , participants displayed distinct patterns of exposure with 66 % exhibiting a weekly login rate of 0.5 times/person and an average of 3.75 minutes/visit/person . In contrast , 79 % of participants read an average of 1.3 SMS/person/week and 47 % voluntarily replied to ∼3.8 SMS/person . These findings demonstrate the acceptability and preliminary efficacy of an Internet-SMS-based intervention for promoting PA in Hong Kong school children . The divergent exposure rates between the Internet and SMS may be a unique pattern for adolescents in early SMR . Future research should be cognizant of the importance of SMR since it may influence utilization and /or adherence OBJECTIVE : To estimate whether women receiving daily text-message reminders have increased oral contraceptive pill adherence compared with women not receiving reminders . METHODS : This r and omized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users . Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection . During the study period , participants assigned the intervention received a daily reminder text message .  Eighty-two women were assigned r and omly to detect a 1.6±2.0 pill difference ( 90 % power , 5 % & agr ; , 15 % dropout ) . RESULTS : Participants were 79 % white , non-Hispanic , 99 % high school graduates , and 99 % nulliparous with a mean age of 22 years . Most reported condom use  with past coital activity , and more than half reported prior emergency contraception use . The mean number of missed pills per cycle did not differ significantly between the groups : 4.9±3.0 for the text-message group and 4.6±3.5 for the control group ( P=.60 ) . The number of missed pills per cycle increased over the course of the study , but this pattern did not increase differentially between the groups . Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries . Despite poor pill-taking , there were no pregnancies . CONCLUSION : Daily text-message reminders did not improve oral contraceptive pill adherence . Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group , the rate of missed pills when measured objective ly was still very high in both groups . CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT00733707 . LEVEL OF EVIDENCE : OBJECTIVE : To estimate whether daily educational text messages affect oral contraceptive pill ( OCP ) continuation at 6 months . METHODS : We r and omized young women electing OCPs at an urban family planning health center to either routine care or routine care plus 180 days of daily educational text messages .  Investigators masked to treatment allocation r and omized participants who were not masked to treatment . The primary outcome measure was self-reported OCP continuation through a telephone call at 6 months ( contacts between 5 and 8 months ) . RESULTS : We enrolled 962 participants ( 480 intervention and 482 routine care ) and obtained continuation data on 683 ( 346 and 337 , respectively ) . At the follow-up , 64 % of participants r and omized to the intervention were still OCP users compared with 54 % of the routine care group ( P=.005 ) . Continuation was highest in the intervention group if the interview took place while the intervention was ongoing ( 75 % compared with 54 % , P=.003 ) ; the effect of the intervention on continuation was less after the intervention ended ( 60 % compared with 54 % , P=.16 ) . Participants receiving the intervention were more likely to continue oral contraception than control participants at 6 months ( odds ratio 1.44 , 95 % confidence interval 1.03–2.00 ) in analyses adjusted for age , race or ethnicity , age at coitarche , pregnancy history , and OCP experience . CONCLUSION : The use of daily educational text messages improves OCP continuation at 6 months over routine care alone . Ten women would need to receive this simple intervention to improve continuation in one . This effect is strongest in the women whose follow-up took place while the text intervention was ongoing . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . Clinical Trials.gov , NCT00677703 . LEVEL OF EVIDENCE : PURPOSE To pilot test a text message ( SMS ) sex risk reduction program among at-risk young adult female patients discharged from an emergency department ( ED ) . METHODS A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and r and omized to the SMS program ( n = 23 ) or a control group ( n = 29 ) . All participants completed a web-based question naire in the ED and at 3-month follow-up . For 12 weeks , SMS participants were asked to report whether they had a risky sexual encounter in the past week , received theory-based feedback , and were asked if they were willing set a goal to refrain from having another risky encounter . RESULTS Thirty-nine percent of SMS participants completed all weeks of SMS reports , and noncompletion increasing from 12 % on week 1 to a 33 % by week 12 . Three-month follow-up was completed in 56 % of participants . In the intervention group , there was an increase in the proportion with condom use with last vaginal sex from 20 % ( 95 % CI 4%-48 % ) to 53 % ( 95 % CI 27%-79 % ) and an increase in always condom use over the past 28 days from 0 % ( 95 % CI 0%-22 % ) to 33 % ( 95 % CI 12%-62 % ) . These changes were not statistically different from control participants . CONCLUSIONS SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED . Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample Adolescent organ transplant recipients have an increased risk of developing skin cancer . The aim of this study was to evaluate the technical feasibility and acceptability of short messaging service-based sun protection recommendations for adolescent patients .  Sun-protective knowledge and behaviour were also evaluated using st and ardized question naires and telephone interviews . Twenty-six organ transplant recipients aged 13 - 22 years participated in face-to-face sun protection training . Subsequently , participants received sun protection reminders via text messages for 4 weeks . Of the participants 95 % reported that they checked text messages on a regular basis . Of the 26 organ transplant recipients 19 completed question naires before sun protection training and 4 weeks later ; 16 % ( 3/19 ) knew the meaning of the UV-index before training . After training , 74 % ( 14/19 ) remembered that the term UV-index describes the maximum daily level of local UV radiation .  Text message-based sun protection recommendations are well accepted and technically feasible in adolescent organ transplant recipients Background Practitioners who come into contact with the intoxicated , such as those in unscheduled care , often have limited re sources to provide structured interventions . There is therefore a need for cost-effective alcohol interventions requiring minimal input . This study assesses the barriers , acceptability and validity of text messaging to collect daily alcohol consumption data and explores the feasibility of a text-delivered intervention in an exploratory r and omised controlled trial . Methods Study I. Participants ( n = 82 ) completed the initial online screening survey  and those eligible were asked each day , for 157 days via text message , to reply with the number of alcohol units consumed the previous day . Analyses compared st and ard measures of hazardous consumption with self-report alcohol use . Attrition and sampling biases were examined . Study I included secondary exploratory analyses using data from 70 participants to determine associations between events ( including Christmas and other celebratory occasions ) and consumption . Study I further included the thematic analysis of semi-structured interview data and assessed the feasibility of and barriers to surveillance and interventions delivered through text messaging . Developing findings from Study I , Study II developed an exploratory r and omised control trial that delivered a single message on monthly alcohol expenditure in order to assess effect size and test generalisability . Results Self-report alcohol consumption data was significantly associated with FAST and AUDIT scores . Attrition from the study was not associated with greater alcohol use . Greater alcohol use was observed on Fridays , Saturdays and Wednesdays as were notable celebratory events . Interview data indicated that text messaging was acceptable to participants and preferred over email and web-based methods . The exploratory r and omised controlled trial suggested that a simple text delivered intervention might be effective in eliciting a reduction in alcohol consumption in a future trial . Conclusions The ubiquity of mobile telephones and the acceptability of text messaging suggests that this approach can be developed as a surveillance tool to collect high frequency consumption data to identify periods of vulnerability and that it can offer a platform through which targeted interventions can be delivered Background Smoking prevalence remains high , particularly among adolescents and young adults with lower educational levels , posing a serious public health problem . There is limited evidence of effective smoking cessation interventions in this population . Objective To test the efficacy of an individually tailored , fully automated text messaging ( short message service , SMS)–based intervention for  smoking cessation in young people . Methods A 2-arm cluster r and omized controlled trial , using school class as the r and omization unit , was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment -only control group .  Students who smoked were proactively recruited via online screening in vocational school classes .  Text messages , tailored to demographic and smoking-related variables , were sent to the participants of the intervention group at least 3 times per week over a period of 3 months . A follow-up assessment was performed 6 months after study inclusion . The primary outcome measure was 7-day smoking abstinence . Secondary outcomes were 4-week smoking abstinence , cigarette consumption , stage of change , and attempts to quit smoking . We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention . Both complete-case analyses ( CCA ) and intention-to-treat analyses ( ITT ) were performed . Subgroup analyses were conducted for occasional and daily smokers . Results A total of 2638 students in 178 vocational school classes in Switzerl and participated in the online screening . Overall , 1012 persons met the inclusion criteria for study participation , and 755 persons ( 74.6 % ) participated in the study ( intervention : n=372 ; control : n=383 ) . Of the 372 program participants , 9 ( 2.4 % ) unsubscribed from the program during the intervention period . Six-month follow-up data were obtained for 559 study participants ( 74.0 % ) . The 7-day smoking abstinence rate at follow-up was 12.5 % in the intervention group and 9.6 % in the control group ( ITT 
    Output:
    
Despite the promising feasibility and acceptability of text messaging and mobile phone apps in improving preventive behavior among adolescents , overall findings were modest in terms of efficacy .