***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: To determine the reliability and validity of a patient outcome question naire for chronic heart failure , a r and omized , double-blind , placebo-controlled , 3-month trial of pimobendan , an investigational medication with inotropic and vasodilator activities , was performed . Evaluated were 198 ambulatory patients with primarily New York Heart Association ( NYHA ) class III heart failure from 20 referral centers . Baseline therapy included digoxin , diuretics and , in 80 % , a converting enzyme inhibitor . Oral pimobendan at 2.5 ( n = 49 ) , 5.0 ( n = 51 ) , or 10 ( n = 49 ) mg daily or matching placebo ( n = 49 ) was administered . The Minnesota Living with Heart Failure ( LIhFE ) question naire was a primary outcome measure , along with an exercise test . Interitem correlations identified subgroups of questions representing physical and emotional dimensions . Repeated baseline scores were highly correlated ( r = 0.93 ) , as were the physical ( r = 0.89 ) and emotional ( r = 0.88 ) dimension scores . Placebo did not have a significant effect with median ( 25th , 75th percentile ) changes from baseline scores of 1 ( -3 , 5 ) , 1 ( -2 , 3 ) , and 0 ( -1 , 2 ) , respectively ( all p values greater than 0.10 ) . The 5 mg dose significantly improved the total score , 7.5 ( 0 , 18 ; p = 0.01 ) and the physical dimension , 4 ( 0 , 8 ; p = 0.01 ) , compared with placebo . Changes in the total ( r = 0.33 ; p less than 0.01 ) and physical ( r = 0.35 ; p less than 0.01 ) scores were weakly related to changes in exercise times , but corresponded well with changes in patients ' ratings of dyspnea and fatigue . ( ABSTRACT TRUNCATED AT 250 WORDS Objective We examine prospect ively the role of specific forms of self-efficacy in the physical and role function for patients with coronary heart disease after controlling for the effects of anxiety and depression . Methods A 6-month prospect i ve cohort study was conducted after  cardiac catheterization of 198 HMO members , demonstrating clinical ly significant coronary disease . Coronary disease severity was assessed through cardiac catheterization ; physical function , role function , anxiety , depression , and self-efficacy were assessed through question naires . Results The Cardiac Self-Efficacy Scale had two factors ( maintain function and control symptoms ) with high internal consistency and good convergent and discriminant validity . In multiple regression models , the self-efficacy scales significantly predicted physical function , social function , and family function after controlling for baseline function , baseline anxiety , and other significant correlates . Conclusions Self-efficacy to maintain function and to control symptoms helps predict the physical function and role function , after accounting for coronary disease severity , anxiety , and depression in patients with clinical ly significant coronary disease . Interventions to improve self-efficacy may have a broader applicability in the heart disease population than previously appreciated Purpose We examined whether changes in health-related quality of life ( HRQL ) predict subsequent mortality  among the Spanish elderly . Methods Prospect i ve cohort study of 2,373 persons , representative of the Spanish population aged 60 and older .  HRQL was measured in 2001 and 2003 using the SF-36 health question naire . Cox regression models were used to examine the association of changes in the physical and mental component summary ( PCS and MCS ) scores of HRQL from 2001 to 2003 with all-cause mortality through 2007 . Results Two hundred twelve deaths were ascertained from 2003 to 2007 . The hazard ratios for mortality across categories of PCS change were as follows : 2.12 ( 95 % confidence interval [ CI ] 1.39–3.24 ) for a > 10-point decline ; 1.51 ( 1.01–2.28 ) for a 6- to 10-point decline ; 1 for the reference category , a change of −5 to + 5 points ; 0.83 ( 0.51–1.34 ) for a 6- to 9-point improvement and 0.68 ( 0.42–1.09 ) for a > 10-point improvement ; P for linear trend < 0.001 . The associations between changes in the MCS and mortality showed the same direction , but were of a lower magnitude and attained statistical significance ( P < 0.05 ) only for a > 10-point decline in MCS . Conclusions Changes in HRQL predict mortality in the older adults . A decline in HRQL should alert to a worse vital prognosis and stimulate the search for the possible determinants of such decline BACKGROUND The application of health-related quality of life  ( HRQOL ) as a pediatric population health measure may facilitate risk assessment and re source allocation , the tracking of community health , the identification of health disparities , and the determination of health outcomes from interventions and policy decisions . OBJECTIVE To determine the feasibility , reliability , and validity of the 23-item PedsQL 4.0 ( Pediatric Quality of Life Inventory ) Generic Core Scales as a measure of pediatric population health for children and adolescents . DESIGN Mail survey in February and March 2001 to 20 031 families with children ages 2 - 16 years throughout the State of California encompassing all new enrollees in the State 's Children 's Health Insurance Program ( SCHIP ) for those months and targeted language groups . METHODS The PedsQL 4.0 Generic Core Scales ( Physical , Emotional , Social , School Functioning ) were completed by 10 241 families through a statewide mail survey to evaluate the HRQOL of new enrollees in SCHIP . RESULTS The PedsQL 4.0 evidence d minimal missing responses , achieved excellent reliability for the Total Scale Score ( alpha = .89 child;.92 parent report ) , and distinguished between healthy children and children with chronic health conditions . The PedsQL 4.0 was also related to indicators of health care access , days missed from school , days sick in bed or too ill to play , and days needing care . CONCLUSION The results demonstrate the feasibility , reliability , and validity of the PedsQL 4.0 as a pediatric population health outcome . Measuring pediatric HRQOL may be a way to evaluate the health outcomes of SCHIP 
    Output:
    
Self-efficacy – HRQOL associations were similar in strength across age groups , regardless of presence of cardiovascular surgery , and among patients diagnosed with different forms of CVD .
Conclusions / Implication s : General and exercise-specific self-efficacy are moderately related with HRQOL among people with CVD after surgery or during rehabilitation .