***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: OBJECTIVES To apply and evaluate the effects of a program for computer generated physician reminders , integrated with an electronic patient record ( EPR ) system , for opportunistic health screening in elderly patients . DESIGN A pilot study design ed as a 20-month clinical trial with a control group and a 20-month non-intervention follow-up using a computer reminder program that selects patients for screening in five intervention areas ( diabetes , hypertension , cobalamin deficiency , hypothyroidism and anaemia ) . SETTING Four primary health care ( PHC ) centres in suburban Stockholm . SUBJECTS The intervention was design ed for patients 70 years or older from one health care centre who visited a general practitioner ( GP ) during the first 20-month period . Patients from the three remaining centres served as controls . MAIN OUTCOME MEASURES The number of patients who underwent the tests , who had pathological test results , new diagnoses and new pharmacological treatments in both patient groups . RESULTS In total , 602 patients underwent screening and 1989 were controls . There was a statistically significant , moderate or marked increase ( 13 - 75 % ) in the number of patients who were tested in all five intervention areas . An increase in pathological test results ( 1 - 8 % ) was found in two areas : hypertension and cobalamin deficiency . There was an increase in the number of patients with the diagnosis of cobalamin deficiency during the study . At follow-up a decrease in new diagnoses for anaemia was found . CONCLUSION The system seems to be associated with a moderate to large increase in laboratory and manual screening tests for both established and new screening areas . The effect on clinical outcomes was found mainly in a not-yet-established screening area ( cobalamin deficiency ) , indicating that the system may be clinical ly useful when introducing new screening services Abstract Background The objective of this article is to describe the design of an evaluation of the cost-effectiveness of systematic home visits by nurses to frail elderly primary care patients . Pilot objectives were : 1 . To determine the feasibility of postal multidimensional frailty screening instruments ; 2 . to identify the need for home visits to elderly . Methods Main study : The main study concerns a r and omized controlled in primary care practice s ( PCP ) with 18 months follow-up and blinded PCPs . Frail persons aged 75 years or older and living at home but neither terminally ill nor demented from 33 PCPs were eligible . Trained community nurses ( 1 ) visit patients at home and assess the care needs with the Resident Assessment Instrument-Home Care , a multidimensional computerized geriatric assessment instrument , enabling direct identification of problem areas ; ( 2 ) determine the care priorities together with the patient ; ( 3 ) design and execute interventions according to protocol s ; ( 4 ) and visit patients at least five times during a year in order to execute and monitor the care-plan . Controls receive usual care . Outcome measures are Quality of life , and Quality Adjusted Life Years ; time to nursing home admission ; mortality ; hospital admissions ; health care utilization . Pilot 1 : Three brief postal multidimensional screening measures to identify frail health among elderly persons were tested on percentage complete item response ( selected after a literature search ): 1 ) Vulnerable Elders Screen , 2 ) Strawbridge 's frailty screen , and 3 ) COOP-WONCA charts . Pilot 2 : Three nurses visited elderly frail patients as identified by PCPs in a health center of 5400 patients and used an assessment protocol to identify psychosocial and medical problems . The needs and experiences of all participants were gathered by semi-structured interviews . Discussion The design holds several unique elements such as early identification of frail persons combined with case-management by nurses . From two pilots we learned that of three potential postal frailty measures , the COOP-WONCA charts were completed best by elderly and that preventive home visits by nurses were positively evaluated to have potential for quality of care improvement Aims : In controlled intervention studies , a selective non-response or refusal to participate at baseline may bias measurable effects of the intervention . The aim of this study was to compare mortality and nursing home admission among older persons who accepted ( participants ) and older person who declined ( non- participants ) to join a controlled feasibility trial , and to describe and evaluate defined subgroups of non- participants . Methods : Prospect i ve controlled three-year intervention study ( 1999—2001 ) in 34 Danish municipalities with five-year follow-up . R and omization and intervention ( education of municipality employees ) was done at municipality level . In total 5,788 home-dwelling 75- and 80-year-olds living in these municipalities were invited to participate in the study . Written consent was obtained from 4,060 persons ( participation rate 71 % ) . Results : During five-year follow-up non- participants had a higher mortality rate ( survival analysis risk ratio RR=1.5 , 95 % CI=1.3—1.7 , p<0.0001 ) and a higher rate of nursing home admissions ( RR=1.7 , 95 % CI=1.3— 2.1 , p<0.0001 ) compared with participants . Subgroups of non- participants describing themselves as ` ` too ill ' ' and persons ` ` not reached ' ' had a significantly higher mortality rate and risk of admission to nursing home than participants , whereas the subgroups of non- participants describing themselves as ` ` too healthy ' ' and having ` ` another reason for refusal ' ' did not differ from the participants . There was no difference in mortality rates between non- participants living in intervention municipalities compared with non- participants living in control municipalities . Conclusions : Mortality and nursing home admissions were higher among non- participants . Selection participation bias was of no clinical importance since subgroups of non- participants eligible for the intervention did not differ from the participants Objective : To improve the delivery of preventive care in a medical clinic , a controlled trial was conducted of two interventions that were expected to influence delivery of preventive services differently , depending on level of initiative required of the physician or patient to complete a service . Design : A prospect i ve , controlled trial of five-months ’ duration . Setting : A university hospital-based , general medical clinic . Participants : Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study .Intervention : A computerized reminder system for physicians and a patient question naire and educational h and out on preventive care . Measurements and main results : Delivery of five of six audited preventive services improved significantly after the interventions were introduced . The computerized reminder alone increased completion rates of services that relied primarily on physician initiative ; the question naire alone increased completion rate of the service that depended more on patient compliance as well as on some physician-dependent services . Both interventions used together were slightly less effective in improving performance of physician-dependent services than the computerized reminder used alone . Conclusions : These interventions can improve the delivery of preventive care but they differ in their impacts on physician and patient behaviors . Overall , the computer reminder was the more effective intervention A study of hypertension in an industrial setting allowed us to confirm and explore an earlier retrospective finding that the labeling of patients as hypertensive result ed in increased absenteeism from work . After screening and referral , we found that absenteeism rose ( mean + /- 1 S.E. ) 5.2 + /- 2.3 days per year ( P less than 0.025 ) ; this 80 per cent increase greatly exceeded the 9 per cent rise in absenteeism in the general employee population during this period . The main factors associated with increased absenteeism were becoming aware of the condition ( P less than 0.01 ) and low compliance with treatment ( P less than 0.001 ) . Subsequent absenteeism among patients unaware of their hypertension before screening was not related to the degree of hypertension , whether the worker was started on therapy , the degree of blood-pressure control achieved or exposure to attempts to promote compliance . These results have major implication s for hypertension screening programs , especially since absenteeism rose among those previously unaware of their condition , regardless of whether antihypertensive therapy was begun The results of a four year demonstration project of preventive services for Medicare managed care enrollees suggest that health promotion programs can impact health behaviors and outcomes . The study provided selected preventive services to 1,800 Medicare enrollees in a managed care environment . Participants were r and omly assigned to control and experimental groups with the experimental group receiving an intervention service package and the control group usual care . The results included enhanced health behavior practice s , lower depression , and higher immunization rates among those individuals in the experimental group . This study suggests that selected preventive services can be provided in a managed care environment to Medicare enrollees with likely positive health status and utilization outcomes Medicare beneficiaries enrolled in a health maintenance organization ( HMO ) were r and omized to a preventive services benefit package for 2 years or to usual care . At 24- and 48-month followups , the treatment group had completed more advance directives , participated in more exercise , and consumed less dietary fat than the control group . Unexpectedly , more deaths occurred in the treatment group . Surviving treatment-group enrollees reported higher satisfaction with health , less decline in self-rated health status , and fewer depressive symptoms than surviving control participants . Despite these changes , the intervention did not yield lower cost per quality -adjusted life year in this historically prevention-oriented HMO INTRODUCTION Self-reported health has been shown to predict mortality . We lack knowledge on whether a lifestyle intervention can improve self-reported mental and physical health in a general population . METHODS Inter99 , Denmark ( 1999 - 2006 ) is a r and omised population -based intervention study . We screened for ischemic heart disease and repeatedly offered advice and assistance to obtain a healthier lifestyle .  Health related quality of life was measured by Short Form 12 ( SF-12 ) ; completed by 9322 at baseline and 7719 at five-year follow-up . In linear mixed models we investigated the effect of the intervention on self-reported health over time . RESULTS At baseline men had higher physical health-component scores ( PCS ) than women . Living with a partner , being employed , and being healthy was associated with high PCS . The mental health-component scores ( MCS ) showed the same socio-demographic differences , except that MCS increased with age . Significantly fewer participants in the intervention groups had decreased their PCS and MCS compared with the control group . Adjusted multilevel analyses confirmed that the intervention significantly improved physical- ( p=0.008 ) and mental health ( p<0.001 ) over time compared with the control group . CONCLUSION Screening for ischemic heart disease and offering lifestyle intervention had a significantly beneficial effect on mental and physical self-reported health in the long term in a general population In a prospect i ve study of 7735 middle-aged men , both current and ex-cigarette-smokers had a risk of a major IHD event , within an average 6.2 years of screening , more than twice that in men who had never smoked cigarettes ; men who had given up smoking more than 20 years ago still had an increased risk . This excess risk among ex-smokers is only to a small extent explained by their higher blood pressure , serum total cholesterol , and body-mass index . An increased prevalence of IHD in men who had recently given up smoking also made a small contribution to excess risk . In both current and former cigarette smokers , the number of years a man had smoked cigarettes ( " smoking-years " ) was the clearest indicator of IHD risk due to cigarettes . The major benefit of giving up smoking may lie in halting the accumulation of smoking years OBJECTIVE Can indicative prevention of home-visiting nurses be effective when targeted at a frail senior population using multidimensional geriatric assessment s and personalized care plans ? METHODS We performed an individually r and omized controlled trial in 33 blinded primary care practice s over 18 months . The 651 participants were aged 75 years or older , lived at home , and were frail but neither terminally ill nor demented . A score in the lowest quartile on at least two of six self-reported functional health domains ( COOP-WONCA charts ) , defined frail health . We compared usual care with proactive home visits by trained community nurses . The nurses ( a ) assessed the care needs with a multidimensional computerized geriatric instrument , which enabled direct identification of health risks ; ( b ) determined care priorities together with the person ; ( c ) design ed and executed individually tailored interventions ; and ( d ) monitored participants by telephone and on average three home visits . Primary outcome measures were functional health and instrumental activities of daily living disability . Secondary outcomes were acute hospital admittance ( time until ) , institutionalization , and mortality . RESULTS We found no significant differences between intervention and usual care group on any of the outcome measures . Predefined subgroup analyses revealed a higher risk of hospital admission for persons with poor health in the intervention group . CONCLUSIONS We could not demonstrate preventive effects of home visits by nurses in vulnerable older persons . Hospital admissions increased in the frailest group . The search for effective interventions for vulnerable persons requires further investigation . Future efforts may focus on improved integrated approaches Background This paper describes the study protocol , the recruitment , and base-line data for evaluating the success of r and omisation of the PRO-AGE ( PRevention in Older people – Assessment in GEneralists ' practice s ) project . Methods / Design A group of general practitioners ( GPs ) in London ( U.K. ) , Hamburg ( Germany ) and Solothurn ( Switzerl and ) were trained in risk identification , health promotion , and prevention in older people . Their non-disabled older patients were invited to participate in a r and omised controlled study . Participants allocated to the intervention group were offered the Health Risk Appraisal for Older Persons ( HRA-O ) instrument with a site-specific method for reinforcement ( London : physician reminders in electronic medical record ; Hamburg : one group session or two preventive home visits ; Solothurn : six- 
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We did not find an effect on admission to hospital , disability , worry , additional visits to the physician , or absence from work , but most of these outcomes were poorly studied .
We did not find useful results on the number of referrals to specialists , the number of follow-up tests after positive screening results , or the amount of surgery .
AUTHORS ' CONCLUSIONS General health checks did not reduce morbidity or mortality , neither overall nor for cardiovascular or cancer causes , although the number of new diagnoses was increased .
With the large number of participants and deaths included , the long follow-up periods used , and considering that cardiovascular and cancer mortality were not reduced , general health checks are unlikely to be beneficial