***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 aim of this study was to investigate if cognitive behavior therapy ( CBT ) based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome ( IBS ) . Participants were recruited through self-referral . Eighty-six participants were included in the study and r and omized to treatment or control condition  ( an online discussion forum ) . One participant was excluded after r and omization . The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life , GI-specific anxiety , depression and general functioning . Participants were assessed at pre-treatment , post-treatment and 3 month follow-up ( treatment condition only ) . Four participants ( 5 % of total sample ) in the treatment condition did not participate in post-treatment assessment . Participants in the treatment condition reported a 42 % decrease and participants in the control group reported a 12 % increase in primary IBS-symptoms . Compared to the control condition , participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life ( Cohen 's d = 1.21 ) . We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating  IBS- patients  , alleviating the total burden of symptoms and increasing quality of life With limited efficacy of medications for symptom relief , non-medication treatments may play an important role in the treatment of irritable bowel syndrome ( IBS ) , the most common functional gastrointestinal ( GI ) disorder . This study aim ed to evaluate the efficacy of two self-regulation strategies for symptom relief and mood management in IBS patients . Thirty-five adult participants meeting ROME III criteria for IBS were enrolled , 27 of the 35 participants ( 77 % ) completed treatment and pre- and post-treatment visits ( 89 % women , 11 % men ; M ( SD ) age = 36 ( 13 ) ) , and 20 of the 27 ( 74 % ) completed a 6-month follow-up . Participants were r and omly assigned to 16 biweekly group sessions of Iyengar yoga or a walking program . Results indicated a significant group by time interaction on negative affect with the walking treatment showing improvement from pre- to post-treatment when compared to yoga ( p < .05 ) . There was no significant group by time effect on IBS severity . Exploratory analyses of secondary outcomes examined change separately for each treatment condition . From pre- to post-treatment , yoga showed significant decreases in IBS severity measures ( p < .05 ) , visceral sensitivity ( p < .05 ) , and severity of somatic symptoms ( p < .05 ) . Walking showed significant decreases in overall GI symptoms ( p < .05 ) , negative affect ( p < .05 ) , and state anxiety ( p < .05 ) . At 6-month follow-up , overall GI symptoms for walking continued to significantly decline , while for yoga , GI symptoms rebounded toward baseline levels ( p < .05 ) . When asked about self-regulated home practice at 6 months , significantly more participants in walking than in yoga practice d at least weekly ( p < .05 ) . In sum , results suggest that yoga and walking as movement-based self-regulatory behavioral treatments have some differential effects but are both beneficial for IBS patients , though maintenance of a self-regulated walking program may be more feasible and therefore more effective long term Irritable bowel syndrome ( IBS ) is a chronic disease that needs special self-care strategies . The current study aim ed at determining the effects of a self-care program on the severity of symptoms and quality of life of patients with IBS . In this r and omized controlled clinical trial , 119 patients were r and omly assigned to the experimental ( n = 60 ) and control ( n = 59 ) groups . Patients in both groups received the usual treatment of IBS by a gastroenterologist . The control group did not receive any intervention , whereas the experimental group was trained in the self-care program . The process of implementing the self-care program included design ing and determining the content validity of the self-care training package , individual training , the first follow-up call , group training , and the second follow-up call . The instruments for collecting data were IBS- Quality of Life and IBS-Symptom Severity Scale . Two sets of evaluations ( before and 2 months after the intervention ) were done for both groups . The data were analyzed using SPSS software , Version 16 . The results showed that there was not a significant difference between the two groups in the severity of symptoms and quality of life before the intervention ( p > .05 ) ; however , the 2 groups were significantly different after the intervention ( p < .0001 ) . Implementation of the self-care program result ed in the improvement of quality of life and reduction in the symptom severity in the experimental group after the intervention ( p < .0001 ) , whereas no significant changes were observed in the control group ( p > .05 ) . Hence , the data supports that self-care program was effective in improving the quality of life and reducing the severity of symptoms in patients with IBS OBJECTIVE : This study was design ed to develop and to test a home-based , guided imagery treatment protocol , using audio and video recordings , that is easy for health care professionals and patients to use , is inexpensive , and is applicable to a wide range of health care setting s. METHODS : Thirty-four children , 6 to 15 years of age , with a physician diagnosis of functional abdominal pain were assigned r and omly to receive 2 months of st and ard medical care with or without home-based , guided imagery treatment . Children who received only  st and ard medical care initially received guided imagery treatment after 2 months . Children were monitored for 6 months after completion of guided imagery treatment . RESULTS : All treatment material s were reported to be self-explanatory , enjoyable , and easy to underst and and to use . The compliance rate was 98.5 % . In an intention-to-treat analysis , 63.1 % of children in the guided imagery treatment group were treatment responders , compared with 26.7 % in the st and ard medical care – only group ( P = .03 ; number needed to treat : 3 ) . Per- protocol analysis showed similar results ( 73.3 % vs 28.6 % responders ) . When the children in the st and ard medical care group also received guided imagery treatment , 61.5 % became treatment responders . Treatment effects were maintained for 6 months ( 62.5 % responders ) . CONCLUSION : Guided imagery treatment plus medical care was superior to st and ard medical care only for the treatment of abdominal pain , and treatment effects were sustained over a long period BACKGROUND Recent guidelines for the treatment of irritable bowel syndrome ( IBS ) emphasize the need for research to facilitate home-based self-management for these patients in primary care . The aim of the current study was to test the efficacy of a manualized cognitive behavioural therapy (CBT)-based self-management programme for IBS in a pilot r and omized controlled trial ( RCT ) . METHOD Sixty-four primary -care patients meeting Rome criteria for IBS were r and omized into either self-management plus treatment as usual ( TAU ) ( n=31 ) or a TAU control condition ( n=33 ) . The self-management condition included a structured 7-week manualized programme that was self-administered in conjunction with a 1-hour face-to-face therapy session and two 1-hour telephone sessions . The primary outcome measures were the Subject 's Global Assessment ( SGA ) of Relief and the Irritable Bowel Syndrome Severity Scoring System ( IBS-SSS ) assessed at baseline , end of treatment ( 2 months ) , and 3 and 6 months post-treatment . RESULTS Analysis was by intention-to-treat . Twenty-three ( 76.7 % ) of the self-management group rated themselves as experiencing symptom relief across all three time periods compared to seven ( 21.2 % ) of the TAU controls [ odds ratio ( OR ) 12.2 , 95 % confidence interval ( CI ) 3.72 - 40.1 ] . At 8 months , 25 ( 83 % ) of the self-management group showed a clinical ly significant change on the IBS-SSS compared to 16 ( 49 % ) of the control group ( OR 5.3 , 95 % CI 1.64 - 17.26 ) . CONCLUSIONS This study provides preliminary evidence that CBT-based self-management in the form of a structured manual and minimal therapist contact is an effective and acceptable form of treatment for primary -care IBS patients Background / Aims This study was conducted with objectives of assessing subtypes of irritable bowel syndrome ( IBS  ) in children aged 10 - 16 years , their symptomatology and gender differences . Methods For this survey , 107 children who fulfilled Rome III criteria for IBS and 1,610 healthy controls were recruited from 8 r and omly selected schools , in 4 provinces in Sri Lanka . Data was collected using a previously vali date d , self administered question naire . Results Constipation predominant , diarrhea predominant and mixed type IBS were almost equally distributed ( 27%-28 % ) , while unsubtyped IBS had a lower prevalence ( 17.8 % ) . IBS was more common in girls ( 59.8 % vs 40.2 % in boys , P = 0.001 ) . Bloating , flatulence , burping , headache and limb pain were significantly higher in affected children ( P < 0.05 ) . Conclusions This study highlights the distribution of IBS subtypes among Sri Lankan children and adolescents and its female preponderance . This study also shows a higher prevalence of other intestinal-related and extraintestinal somatic symptoms among affected children Background Women with irritable bowel syndrome ( IBS ) report sexual dysfunction .  Comprehensive self-management ( CSM ) intervention has been shown to reduce gastrointestinal , psychological , and somatic symptoms in IBS women . Whether this intervention also reduces sexual dysfunction is not known . Aims We sought to compare demographic and clinical factors in IBS women with and without sexual dysfunction as defined by the Arizona sexual experiences scale ( ASEX ) and to test the effects of CSM treatment on sexual dysfunction scores and on the sexual relations subscale of an IBS quality of life ( IBSQOL ) scale which measures the effect of IBS on sexual QOL . Methods IBS ( Rome II ) women enrolled in a r and omized clinical trial of CSM treatment were characterized as having sexual dysfunction ( N = 89 ) or not ( N = 86 ) at baseline based on ASEX criteria . Baseline characteristics and symptoms were compared between the two groups . Post-intervention changes were compared between the CSM and the usual care arms of the r and omized trial . Results Women meeting ASEX criteria for sexual dysfunction were older , had higher lifetime depression and antidepressant use , more primary care/MD visits , fewer mental healthcare visits , and greater sleep disturbance than those without sexual dysfunction . No significant group differences in gastrointestinal or somatic symptoms were observed . Compared with usual care treatment , CSM increased sexual QOL scores and had a weaker effect on ASEX scores . Conclusions Severity of IBS symptoms at baseline did not differ between IBS women with or without sexual dysfunction . The CSM intervention can reduce the effect of IBS on sexual QOL Background Many patients with IBS suffer on-going symptoms . The evidence base is poor for IBS drugs but they are widely prescribed and advised in Guidelines . Cognitive Behavioural Therapy ( CBT ) can be helpful , but availability is poor in the NHS . We developed a web-based CBT self-management programme ( Regul8 ) in partnership with patients and trialled it and common IBS medications in an exploratory factorial RCT to test trial procedures and provide information for a larger trial . Methods Patients , 16 to 60 years , with IBS symptoms fulfilling Rome III criteria were recruited via GP practice s and r and omised to over-encapsulated mebeverine , methylcellulose or placebo for 6 weeks and to 1 of 3 website conditions : Regul8 with a nurse telephone session and email support , Regul8 with minimal email support , or no website . Results 135 patients recruited from 26 GP practice s.  Mean IBS SSS score 241.9 ( sd 87.7 ) , IBS-QOL 64 ( sd 20 ) at baseline . 91 % follow-up at 12 weeks . Mean IBS SSS decreased by 35 points from baseline to 12 weeks . There was no significant difference in IBS SSS or IBS-QOL score between medication or website groups at 12 weeks , or in medication groups at 6 weeks , or IBS-QOL in website groups at 6 weeks . However , IBS SSS at 6 weeks was lower in the No website group than the website groups ( IBS SSS no website = 162.8 ( 95 % CI 137.4 - 188.3 ) , website 197.0 ( 172.4 - 221.7 ) , Website + telephone support 208.0 ( 183.1 - 233.0 ) p = 0.037).Enablement and Subjects Global Assessment of relief ( SGA ) were significantly improved in the Regul8 groups compared to the non-website group at 12 weeks ( Enablement = 0 in 56.8 % of No website group , 18.4 % website , 10.5 % Website + support , p = 0.001 ) ( SGA ; 32.4 % responders in No website group , 45.7 % website group , 63.2 % website + support group , p = 0.035 ) . Conclusions This exploratory study demonstrates feasibility and high follow-up rates and provides information for a larger trial . Primary outcomes ( IBS SS and IBS 
    Output:
    
Overall , there is robust evidence supporting self-management interventions for improving short-term symptom management and improving quality of life , whereas longer term outcomes are variable .