***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: BACKGROUND In polycystic ovary syndrome ( PCOS ) , changes in physical appearance , menstrual disturbances and infertility result in psychological distress and reduced quality -of-life .  Metformin improves biochemical , clinical and reproductive parameters in PCOS women . In a prospect i ve , observational study , we analysed the effects of metformin treatment on health-related quality -of-life ( HRQL ) , emotional well-being and sexuality in PCOS . No placebo-treated control group was included . METHODS Before , during and after 6 months of treatment , changes in clinical and endocrine parameters , quality -of-life , psychological disturbances and sexuality were assessed in 64 PCOS patients using vali date d question naires ( SF-36 , SCL-90-R ) and visual analogue scales . Patients were also compared with published normative data for the vali date d question naires . RESULTS During treatment , HRQL , particularly the psychosocial aspects ( indicated by significant increases in SF-36 scales Vitality , Social Function , Emotional Role Function , Mental Health , Psychological Sum scale ) and emotional well-being ( reflected by significant lowering of SCL-90-R scales ) improved . These improvements in HRQL were significantly correlated with a reduction in body weight and significantly more pronounced in patients with normalized menstrual cycles . In addition , PCOS women were significantly more satisfied with their sex life and reported higher frequencies of sexual intercourse following treatment . CONCLUSION Treatment can improve the psychosocial , emotional and psychosexual situation of PCOS patients . Although at least some of these effects may be related to the reduction of individual clinical symptoms ( i.e. weight loss , normalization of menstrual disturbances , improvement of acne ) , this observational study does not allow us to clearly discern the role of symptom constellation and does not preclude non-specific and /or placebo effects . Nevertheless , emotional distress and reduced quality -of-life are clearly not an inevitable consequence of PCOS and should be considered as adjunct treatment goals in future studies BACKGROUND Ovulation induction with gonadotrophins is the st and ard treatment strategy for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome ( PCOS ) .  Laparoscopic electrocautery of the ovaries is an alternative treatment modality , leading to a comparable cumulative pregnancy rate . In deciding which treatment to opt for , women 's health-related quality of life ( HRQoL ) should be taken into account . METHODS A total of 168 CC-resistant women with PCOS were r and omly assigned to receive either the electrocautery strategy , entailing laparoscopic electrocautery of the ovaries followed by CC and recombinant FSH ( rFSH ) if anovulation persisted , or ovulation induction with rFSH . We assessed women 's HRQoL with the st and ard question naires Short Form-36 , Rotterdam Symptom Checklist and Center for Epidemiological Studies Depression Scale , administered before r and omization and 2 , 12 and 24 weeks thereafter . RESULTS The intention to treat analysis revealed no significant differences between the treatment groups on any of the scales at any point during follow-up . In women without an ongoing pregnancy , those treated with rFSH showed significantly more depressive symptoms than women allocated to the electrocautery strategy , with or without CC , although differences were small . CONCLUSIONS Overall , HRQoL was not affected in both groups . In women still under treatment , rFSH was slightly more burdensome for women 's HRQoL than electrocautery with or without CC Skin diseases such as acne are sometimes thought of as unimportant , even trivial , when compared with diseases of other organ systems . To address this point directly , vali date d generic question naires were used to assess morbidity in acne patients and compare it with morbidity in patients with other chronic diseases . For 111 acne patients referred to a dermatologist , quality of life was measured using the  Dermatology Life Quality Index  ,  Rosenberg 's measure of self‐esteem  , a version of the General Health Question naire ( GHQ‐28 ) and the  Short Form 36 ( SF‐36 ) . Clinical severity was measured using the Leeds Acne Grade . Population quality of life data for the SF‐36 instrument were available from a r and om sample of adult local residents ( n = 9334 ) some of whom reported a variety of long‐st and ing disabling diseases . All quality of life instruments showed substantial deficits for acne patients that correlated with each other but not with clinical ly assessed acne severity . The acne patients ( a relatively severely affected group ) reported levels of social , psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma , epilepsy , diabetes , back pain or arthritis . Acne is not a trivial disease in comparison with other chronic conditions . This should be recognized in the allocation of health care re sources OBJECTIVE This study was design ed to evaluate the reliability , validity , and responsiveness of a newly developed , health-related quality -of-life measure . STUDY DESIGN A total of 137 women ( 122 from a Phase III clinical trial and 15 from a private practice setting ) with endometriosis completed the question naire several times . RESULTS Reproducibility and internal-consistency reliability were acceptable with intraclass correlation coefficients ranging from 0.94 to 1.00 and Cronbach 's alpha coefficients ranging from 0.84 to 0.97 . Construct validity was demonstrated on the basis of correlations between items and scales . Health-related quality of life varied in a consistent manner according to clinician-rated measures of pelvic pain and dysmenorrhea and patient-reported levels of endometriosis pain , but no relationship emerged according to the revised American Fertility Society classification . In general , the question naire was moderately to highly responsive to change . CONCLUSION This is the first comprehensive health-related quality -of-life question naire available for use with endometriosis patients that has demonstrated reliability , validity , and responsiveness We hypothesized that the administration of troglitazone , an insulin-sensitizing agent of the thiazolidinedione class , would improve the ovulatory dysfunction ,  hirsutism  , hyper and rogenemia , and hyperinsulinemia of polycystic ovary syndrome ( PCOS ) patients . Four hundred and ten premenopausal women with PCOS in a multicenter , double blind trial were r and omly assigned to 44 weeks of treatment with placebo ( PBO ) or troglitazone [ 150 mg/day ( TGZ-150 ) , 300 mg/day ( TGZ-300 ) , or 600 mg/day ( TGZ-600 ) ] . We compared changes in ovulatory function ( by monitoring the urinary level of pregnanediol-3-glucuronide daily ) , hirsutism ( by a modified Ferriman-Gallwey scoring method ) , hormonal levels ( total and free testosterone , and rostenedione , sex hormone-binding globulin , LH , FSH , and the LH/FSH ratio ) , and measures of glycemic parameters ( fasting levels of glucose , insulin , hemoglobin A(1c ) , and the glucose and insulin areas under the curve during an oral glucose challenge ) among study groups . Of the 410 patients recruited , 305 ( 74.4 % ) met evaluability criteria and were included in the analyses . The patients ' baseline characteristics were similar across all treatment arms . Ovulatory rates were significantly greater for patients receiving TGZ-300 and TGZ-600 than for those receiving PBO ( 0.42 and 0.58 vs. 0.32 ; P < 0.05 and 0.0001 , respectively ) . Of PCOS patients treated with TGZ-600 , 57 % ovulated over 50 % of the time compared with 12 % of placebo-treated patients . There was a significant decrease in the Ferriman-Gallwey score with TGZ-600 compared with PBO ( 0.22 + /- 0.53 vs. -2.21 + /- 0.49 ; P < 0.05 , respectively ) . Free testosterone decreased and sex hormone-binding globulin increased in a dose-related fashion with troglitazone treatment , and all three troglitazone treatment groups were significantly different from placebo . Nearly all glycemic parameters showed dose-related decreases with troglitazone treatment . The total number and severity of adverse events ( including elevations in liver enzymes ) and the proportion of patients withdrawn from the study due to the development of adverse effects were similar between treatment groups . Troglitazone improves the ovulatory dysfunction , hirsutism , hyper and rogenemia , and insulin resistance of PCOS  in a dose-related fashion , with a minimum of adverse effects Women who undergo treatment for infertility frequently report depression , but it is crucial to distinguish between subjective distress , symptoms , and clinical depressive disorders . In the initial assessment of a prospect i ve , longitudinal study , 59 women presenting for infertility treatment were compared with 35 women presenting for routine gynecological care . Infertility patients and controls were not significantly different on self-report measures of partner satisfaction , sexual functioning , or self-esteem . There was also no difference in psychiatric symptomatology , or in the percentage of subjects who were currently experiencing or had ever experienced a major depressive episode . However , the infertility patients perceived themselves to have been already quite affected by their inability to conceive . For instance , 49.2 % reported changes in their sexual functioning and 74.6 % reported changes in their mood Background Facial hirsutism is one of the characteristic features of polycystic ovary syndrome ( PCOS ) , and this can lead to high levels of depression and anxiety . OBJECTIVE To develop a self-administered question naire for measuring health-related quality of life ( HRQL ) in women with polycystic ovary syndrome ( PCOS ) . METHODS We identified a pool of 182 items potentially relevant to women with PCOS through semistructured interviews with PCOS patients , a survey of health professionals who worked closely with PCOS women , and a literature review . One hundred women with PCOS completed a question naire in which they told us whether the 182 items were relevant to them and , if so , how important the issue was in their daily lives . We included items endorsed by at least 50 % of women in the analysis plus additional items considered crucial by clinicians and an important subgroup of patients in a factor analysis . We chose items for the final question naire taking into account both item impact ( the frequency and importance of the items ) and the results of the factor analysis . RESULTS Over 50 % of the women with PCOS labelled 47 items as important to them . Clinicians chose 5 additional items from the infertility domain , 4 of which were identified as important by women who were younger , less educated , married , and African-American . The Cattell 's Scree plot from a factor analysis of these 51 items suggested 5 factors that made intuitive sense : emotions , body hair , weight , infertility , and menstrual problems . We chose the highest impact items from these 5 domains to construct a final question naire , the Polycystic Ovary Syndrome Question naire ( PCOSQ ) , which includes a total of 26 items and takes 10 - 15 minutes to complete . CONCLUSIONS We have used established principles to construct a question naire that promises to be useful in measuring health-related quality of life . The question naire should be tested prior to , or concurrent with , its use in r and omized trials of new treatment approaches OBJECTIVE We examined the measurement properties of a question naire ( PCOSQ ) measuring health-related quality of life ( HRQOL ) in women with the polycystic ovary syndrome ( PCOS ) . STUDY DESIGN This multicenter prospect i ve r and omized placebo-controlled blinded study enrolled 393 patients with PCOS at tertiary care sites . Participants were r and omized to placebo or troglitazone ( 150 mg/d , 300 mg/d , or 600 mg/d ) . At baseline ( n=393 ) and after 44 weeks of treatment ( n=284 ) the proportion of normal menstrual cycles , the free testosterone ( T ) level , four objective measures of facial hair growth ( hair density and hair growth rate by photography , and hair diameter and hair growth rate using plucked hairs ) , and a subjective assessment of the degree of hirsutism , the modified Ferriman-Gallwey ( F-G ) score , were determined . At both visits , patients also completed the PCOSQ . Since the trial was conducted , troglitazone has been removed from the market because of toxic effects . The PCOSQ includes 26 questions ( items ) that address five areas of concern ( domains ) , including emotions , body hair , body weight , fertility , and menstruation rated on a seven-point scales in which lower scores denote higher degrees of patient concern and a lower HRQOL . RESULTS Cronbach 's alpha was > 0.7 for four of five domains . Factor analysis provided moderate to strong support for the five-domain structure of the PCOSQ . Cross-sectional correlations were weak with all measures but the F-G score and hair growth ( r=-.46 , P < .01 ) . The change in the F-G score showed a statistically significant ( P < .01 ) correlation with changes in PCOSQ hair growth ( r=-.22 ) , weight ( r=-.17 ) , infertility ( r=-.20 ) , and menstruation ( r=-.20 ) . Changes in the proportion of normal menstrual cycles correlated with change in the infertility domain ( r=.14 , P < .03 ) and with the change in the menstruation domain ( r=.31 , P 
    Output:
    
Although a meta- analysis was not possible , it appears that weight concerns have a particular negative impact upon HRQoL , although the role of body mass index in affecting HRQoL scores is inconclusive from the available evidence .
Despite the benefits of HRQoL measures in research , few are being used to evaluate the outcomes of treatment for PCOS upon the subjective health status of women with the condition