***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: Abstract South Africa has one of the highest rates of both rape and HIV infections . Of great concern is the possibility of HIV transmission during the assault , but adherence to post-exposure prophylaxis ( PEP ) has been varied and low . We developed a telephonic psycho-social support , leaflet and adherence diary intervention for rape victims and tested its impact on adherence to PEP . A r and omised control trial was conducted in the Western and Eastern Cape and 279 rape survivors were enrolled in two arms . The intervention involved the providing of an information leaflet including an adherence diary and follow-up support through telephone calls by a counsellor during the 28 days of taking the PEP . The controls received the leaflet . Follow-up interviews and tablet checks were done with 253 participants to assess adherence . The primary outcome was completion of 28 days of PEP with no more than three missed doses ( 94 % adherence ) . There was more adherence in the intervention arm ( 38.2 % vs. 31.9 % ) , but the estimated intervention effect of 6.5 % ( 95 % CI : −4.6 to 17.6 % ) was not statistically significant , p=0.13 . The intervention was associated with the reading of the pamphlet  ( p=0.07 ) and an increased use of the diary ( p=0.01 ) , but did not reduce depressive psychopathology . Overall adherence was greater amongst those who read the leaflet and used the medication diary . The study showed that the intervention was not effective in significantly improving adherence and adherence levels were low in both study arms . Further research to underst and reasons for non-adherence is needed before further interventions are developed Background The number of routine antenatal visits provided to low risk nulliparous women has been reduced in the UK , acknowledging this change in care may result in women being less satisfied with their care and having poorer psychosocial outcomes . The primary aim of the study was to investigate whether the provision of proactive telephone support intervention ( TSI ) with and without uterine artery Doppler screening ( UADS ) would reduce the total number of antenatal visits required . A secondary aim was to investigate whether the interventions affected psychological outcomes . Methods A three-arm r and omised controlled trial involving 840 low risk nulliparous women was conducted at a large maternity unit in North East Engl and . All women received antenatal care in line with current UK guidance . Women in the TSI group ( T ) received calls from a midwife at 28 , 33 and 36 weeks and women in the telephone and Doppler group ( T + D ) received the TSI and additional UADS at 20 weeks ’ gestation . The main outcome measure was the total number of scheduled and unscheduled antenatal visits received after 20 weeks ’ gestation . Results The median number of unscheduled ( n = 2.0 ) , scheduled visits ( n = 7.0 ) and mean number of total visits ( n = 8.8 ) were similar in the three groups . The majority ( 67 % ) of additional antenatal visits were made to a Maternity Assessment Unit because of commonly occurring pregnancy complications . Additional TSI+/–UADS was not associated with differences in clinical outcomes , levels of anxiety , social support or satisfaction with care . There were challenges to the successful delivery of the telephone support intervention ; 59 % of women were contacted at 29 and 33 weeks gestation reducing to 52 % of women at 37 weeks . Conclusions Provision of additional telephone support ( with or without UADS ) in low risk nulliparous women did not reduce the number of unscheduled antenatal visits or reduce anxiety . This study provides a useful insight into the reasons why this client group attend for unscheduled visits . Trial registration IS RCT BACKGROUND The growing dem and for cancer genetic services underscores the need to consider approaches that enhance access and efficiency of genetic counseling . Telephone delivery of cancer genetic services may improve access to these services for individuals experiencing geographic ( rural areas ) and structural ( travel time , transportation , childcare ) barriers to access . METHODS This cluster-r and omized clinical trial used population -based sampling of women at risk for BRCA1/2 mutations to compare telephone and in-person counseling for : 1 ) equivalency of testing uptake and 2 ) noninferiority of changes in psychosocial measures . Women 25 to 74 years of age with personal or family histories of breast or ovarian cancer and who were able to travel to one of 14 outreach clinics were invited to participate . R and omization was by family . Assessment s were conducted at baseline one week after pretest and post-test counseling and at six months . Of the 988 women r and omly assigned , 901 completed a follow-up assessment . Cluster bootstrap methods were used to estimate the 95 % confidence interval ( CI ) for the difference between test uptake proportions , using a 10 % equivalency margin . Differences in psychosocial outcomes for determining noninferiority were estimated using linear models together with one-sided 97.5 % bootstrap CIs . RESULTS Uptake of BRCA1/2 testing was lower following telephone ( 21.8 % ) than in-person counseling ( 31.8 % , difference = 10.2 % , 95 % CI = 3.9 % to 16.3 % ; after imputation of missing data : difference = 9.2 % , 95 % CI = -0.1 % to 24.6 % ) . Telephone counseling fulfilled the criteria for noninferiority to in-person counseling for all measures . CONCLUSIONS BRCA1/2 telephone counseling , although leading to lower testing uptake , appears to be safe and as effective as in-person counseling with regard to minimizing adverse psychological reactions , promoting informed decision making , and delivering patient-centered communication for both rural and urban women Context Lifestyle approaches for preventing gestational diabetes mellitus ( GDM ) have produced mixed results . Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [ healthy eating ( HE ) , physical activity ( PA ) , and both HE and PA ( HE+PA ) ] with usual care ( UC ) in reducing GDM risk . Design The present study was a multicenter r and omized controlled trial conducted from 2012 to 2014 [ the DALI ( vitamin D and lifestyle intervention for GDM prevention ) lifestyle study ] . Setting The study occurred at antenatal clinics across 11 centers in 9 European countries . Patients Consecutive pregnant women at < 20 weeks of gestation with a body mass index ( BMI ) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria ( n = 436 ) . For the intervention , women were r and omized , stratified by site , to UC , HE , PA , or HE+PA . The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . The coaches received st and ardized training and an intervention toolkit tailored to their culture and language . Main Outcome Measures The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [ homeostasis model assessment insulin resistance ( HOMA-IR ) ] at 24 to 28 weeks . Results We r and omized 108 women to HE+PA , 113 to HE , 110 to PA , and 105 to UC . In the HE+PA group , but not HE or PA alone , women achieved substantially less GWG than did the controls ( UC ) by 35 to 37 weeks ( -2.02 ; 95 % confidence interval , -3.58 to -0.46 kg ) . Despite this reduction , no improvements were seen in fasting or postload glucose levels , insulin concentrations , or HOMA-IR . The birthweights and large and small for gestational age rates were similar . Conclusions The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia . Thus , lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2 Background Obesity and poor sleep are highly prevalent among Black women . Purpose We examined whether a weight gain prevention intervention improved sleep among Black women . Methods We conducted a r and omized trial comparing a 12-month weight gain prevention intervention that included self-monitoring through mobile technologies and phone coaching to usual care in community health centers . We measured sleep using the Medical Outcomes Study Sleep Scale at baseline , 12 months , and 18 months . The scale examines quantity of sleep , sleep disturbance , sleep adequacy , daytime somnolence , snoring , shortness of breath , and global sleep problems ( sleep problem indices I and II ) . Results Participants ( n = 184 ) were on average 35.4 years and obese ( BMI 30.2 kg/m2 ) ; 74 % made < $ 30,000/year . At baseline , average sleep duration was 6.4 ( 1.5 ) hours . Controlling for weight change and sleep medication , the intervention group reported greater improvements in sleep disturbance [ −8.35 ( −16.24 , −0.45 ) ] and sleep problems at 12 months : sleep problem index I [ −8.35 ( −16.24 , −0.45 ) ] ; sleep problem index II [ −8.35 ( −16.24 , −0.45 ) ] . However , these findings did not persist at 18 months . Conclusions Preventing weight gain may afford clinical benefit on improving sleep quality .Trial Registration NumberThe trial was registered with the Clinical Trials.gov data base ( NCT00938535 Background Intimate partner violence ( IPV ) is a human rights violation and leading health burden for women . Safety planning is a hallmark of specialist family violence intervention , yet only a small proportion of women access formal services . A Web-based safety decision aid may reach a wide audience of women experiencing IPV and offer the opportunity to prioritize and plan for safety for themselves and their families . Objective The aim of this study was to test the efficacy of a Web-based safety decision aid ( isafe ) for women experiencing IPV . Methods We conducted a fully automated Web-based two-arm parallel r and omized controlled trial ( RCT ) in a general population of New Zeal and women who had experienced IPV in the past 6 months . Computer-generated r and omization was based on a minimization scheme with stratification by severity of violence and children . Women were r and omly assigned to the password-protected intervention website ( safety priority setting , danger assessment , and tailored action plan components ) or control website ( st and ard , nonindividualized information ) . Primary endpoints were self-reported mental health ( Center for Epidemiologic Studies Depression Scale-Revised , CESD-R ) and IPV exposure ( Severity of Violence Against Women Scale , SVAWS ) at 12-month follow-up . Analyses were by intention to treat . Results Women were recruited from September 2012 to September 2014 . Participants were aged between 16 and 60 years , 27 % ( 111/412 ) self-identified as Māori ( indigenous New Zeal and ) , and 51 % ( 210/412 ) reported at baseline that they were unsure of their future plans for their partner relationship . Among the 412 women recruited , retention at 12 months was 87 % . The adjusted estimated intervention effect for SVAWS was −12.44 ( 95 % CI −23.35 to −1.54 ) for Māori and 0.76 ( 95 % CI −5.57 to 7.09 ) for non-Māori . The adjusted intervention effect for CESD-R was −7.75 ( 95 % CI −15.57 to 0.07 ) for Māori and 1.36 ( −3.16 to 5.88 ) for non-Māori . No study -related adverse events were reported . Conclusions The interactive , individualized Web-based isafe decision aid was effective in reducing IPV exposure limited to indigenous Māori women . Discovery of a treatment effect in a population group that experiences significant health disparities is a welcome , important finding . Trial Registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : ACTRN12612000708853 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12612000708853 ( Archived by Webcite at http://www.webcitation/61MGuVXdK Background The use of long-acting reversible contraceptive ( LARC ) methods is very low in Pakistan with high discontinuation rates mainly attributed to method -related side effects . Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation . We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC— and within ‘ active ’ follow-up , we further compared a telephone versus home-based approach in rural Punjab , Pakistan . Methods This was a 12-month multicentre non-inferiority trial conducted in twenty-two ( 16 rural- and 6 urban-based ) franchised reproductive healthcare facilities in district Chakwal of Punjab province , between November 2013 and December 2014 . The study comprised of three groups of  LARC clients : a ) home-based follow-up , b ) telephone-based follow-up , and c ) passive or needs-based follow-up . Participants in the first two study groups received counselling on scheduled follow-up from the field workers at 1 , 3 , 6 , 9 , and 12 month post-insertion whereas participants 
    Output:
    
Few interventions were conducted with older women ( ≥ 60 years ) or in racially/ethnically diverse population s. There are few SRs in this area and limited evidence regarding newer telehealth modalities such as mobile-based applications or short message service/texting .