***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: Latinos constitute the largest minority in the United States , and there is an increasing number of Latino patients with schizophrenia and other psychoses living into old age . However , few specific behavioral interventions have been developed aim ed at improving the functioning of this group . We evaluated a psychosocial intervention design ed to improve the everyday living skills of middle-aged and older out patients with very chronic psychotic disorders . Three psychiatric clinics , specializing in care of Latinos , were r and omly assigned to ( 1 ) a 24-session intervention entitled Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos ( PEDAL ) group therapy ( n = 21 ) targeting areas identified in our previous work as being problematic for this population ( e.g. , using public transportation ) or ( 2 ) a time-equivalent friendly support group ( SG ; n = 8) . Compared to the patients r and omized to SG ,  PEDAL-treated patients ' performance on everyday living skills improved significantly postintervention and was still significantly better at a 6-month maintenance follow-up period and at a 12-month no-treatment follow-up period . There was no significant change in psychopathology . Limitations of this pilot study are discussed . Results suggest that participation in this skills training program , design ed specifically for older Latino patients with long-st and ing psychotic disorders , has the potential to significantly increase the patients ' independence and improve functional skills Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States . Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs . Empirical research directly comparing these two systems of organizing outpatient services is needed . In this study the authors compared a  rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model . Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change ( 71 in the program that changed and 112 in the other ) were evaluated during both intervals . In the program that changed , competitive employment improved from 25.4 % to 39.4 % for all clients , and from 33.3 % to 55.6 % for those clients who had been regular attenders of day treatment during the baseline . Hours worked and wages earned similarly improved after the program change . For all work variables , clients who had not worked during the baseline year accounted for the improvements in outcome . Meanwhile , employment remained stable in the day treatment program .  No negative outcomes were detected . These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate Background The approximately 1100 medical journals now active in China are publishing a rapidly increasing number of research reports , including many studies identified by their authors as r and omized controlled trials . It has been noticed that these reports mostly present positive results , and their quality and authenticity have consequently been called into question . We investigated the adequacy of r and omization  of clinical trials published in recent years in China to determine how many of them met acceptable st and ards for allocating participants to treatment groups . Methods The China National Knowledge Infrastructure electronic data base was search ed for reports of r and omized controlled trials on 20 common diseases published from January 1994 to June 2005 . From this sample , a subset of trials that appeared to have used r and omization methods was selected . Twenty-one investigators trained in the relevant knowledge , communication skills and quality control issues interviewed the original authors of these trials about the participant r and omization methods and related quality -control features of their trials . Results From an initial sample of 37,313 articles identified in the China National Knowledge Infrastructure data base , we found 3137 apparent r and omized controlled trials . Of these , 1452 were studies of conventional medicine ( published in 411 journals ) and 1685 were studies of traditional Chinese medicine ( published in 352 journals ) . Interviews with the authors of 2235 of these reports revealed that only 207 studies adhered to accepted methodology for r and omization and could on those grounds be deemed authentic r and omized controlled trials ( 6.8 % , 95 % confidence interval 5.9–7.7 ) . There was no statistically significant difference in the rate of authenticity between r and omized controlled trials of traditional interventions and those of conventional interventions . R and omized controlled trials conducted at hospitals affiliated to medical universities were more likely to be authentic than trials conducted at level 3 and level 2 hospitals ( relative risk 1.58 , 95 % confidence interval 1.18–2.13 , and relative risk 14.42 , 95 % confidence interval 9.40–22.10 , respectively ) . The likelihood of authenticity was higher in level 3 hospitals than in level 2 hospitals ( relative risk 9.32 , 95 % confidence interval 5.83–14.89 ) . All r and omized controlled trials of pre-market drug clinical trial were authentic by our criteria . Of the trials conducted at university-affiliated hospitals , 56.3 % were authentic ( 95 % confidence interval 32.0–81.0 ) . Conclusion Most reports of r and omized controlled trials published in some Chinese journals lacked an adequate description of r and omization . Similarly , most so called ' r and omized controlled trials ' were not real r and omized controlled trials owing toa lack of adequate underst and ing on the part of the authors of rigorous clinical trial design . All r and omized controlled trials of pre-market drug clinical trial included in this research were authentic . R and omized controlled trials conducted by authors in high level hospitals , especially in hospitals affiliated to medical universities had a higher rate of authenticity . That so many non-r and omized controlled trials were published as r and omized controlled trials reflected the fact that peer review needs to be improved and a good practice guide for peer review including how to identify the authenticity of the study urgently needs to be developed OBJECTIVE Although skills training is a vali date d psychosocial treatment for schizophrenia , generalization of the skills to everyday life has not been optimal . This study evaluated a behaviorally oriented method of augmenting clinic-based skills training in the community with the aim of improving opportunities , encouragement , and reinforcement for out patients to use their skills in their natural environment . METHOD Sixty-three individuals with schizophrenia were r and omly assigned to 60 weeks of clinic-based skills training alone or of clinic-based skills training supplemented with manual-based generalization sessions in the community . Patients were also r and omly assigned to receive either haloperidol or risperidone . Therapists ' fidelity to the manuals was measured . Patients ' acquisition of the skills from pre- to posttraining was evaluated . The primary outcome measures were the Social Adjustment Scale-II and the Quality of Life Scale . RESULTS Seventy-one percent of the patients completed the trial . Only six participants experienced psychotic exacerbations during the trial . There was no evidence of a differential medication effect on social functioning . Social functioning improved modestly in both psychosocial conditions over time ; participants who received augmented skills training in the community showed significantly greater and /or quicker improvements . CONCLUSIONS Given judicious and effective antipsychotic medication that limited exacerbations to less than 10 % during the trial , a wide range of out patients with schizophrenia demonstrated substantial learning of illness management and social skills in the clinic . When clinic-based skills training was augmented by in vivo training and consultation , transfer of the skills to everyday life was enhanced . These benefits were established regardless of the medications prescribed Background : Outpatient-based treatments for patients suffering from chronic schizophrenia inadvertently exclude a significant proportion of subjects because they are often too poorly motivated to attend for treatment . In addition there are also concerns about whether the skills that are learnt in a hospital setting will generalise to situations when the individuals are at home . This study attempted to redress some of these potential deficiencies and followed on from an earlier local study which found that a community-based team met more of the needs of patients suffering from chronic schizophrenia . Method : Seventy-five patients suffering from chronic schizophrenia were allocated r and omly to receive traditional outpatient-based or home-based rehabilitation from a clinical psychologist and an occupational therapist . They were assessed before and after 9 months of treatment on a range of clinical , social and quality of life outcomes . Distress to carers was also assessed . Readmission to hospital was recorded for each subject . Results : There were significant reductions in socially embarrassing behaviour ( SBS ) , increases in interpersonal functioning and recreational activities and a trend for quality of life to improve in the home-based group . There were fewer admissions in the home-based group but the differences , although financially substantial , were not statistically significant . Conclusions : The home-based rehabilitation service was well received by the majority of patients suffering from chronic schizophrenia and led to some improvement in social behaviour , interpersonal functioning , recreational activities and quality of life Training in social skills has been shown to have a strong , positive impact , according to behavioral measures , on social skills , self-rated assertiveness , and the hospital discharge rate . It is important to establish a system of assessing social skills because it is necessary for the effects of social skills training to be assessed in Japan . In Project 1 , we devised a Japanese version of the role play test to quantify social skills using a st and ard method . We tested 30 patients attending the day hospital who were considered to need intensive rehabilitation . We found the role play test had high inter-rater and test-retest reliability , and had construct validity and criterion related validity . Thus , the role play test was thought to be a useful tool for assessing social skills . For Project 2 , eight in patients who were ready for discharge but who needed to improve their skills in self-managed medication participated in this study . The social skills of self-managed medication assessed using the role play test were significantly improved after the subjects participated in the Medication Management Module of the UCLA social and independent living skills program . Knowledge of self-managed medication also tended to improve after training . This study is preliminary and it should be confirmed that improved skills influenced by the medication management module decreases the relapse rates The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas Fifty female schizophrenic patients on the same locked ward were r and omly assigned to experimental and control groups . Experimental group subjects were given as much autonomy and freedom as possible ( they were permitted to leave the ward at will ) and were encouraged to take part in collective activities . The control group were not permitted to leave the ward and did not take part in these activities .  All patients were evaluated at enrollment and after six months-using Chinese versions of the Scale for Assessment of Negative Symptoms and the Brief Psychiatric Rating Scale-by psychiatrists who were blind to patients ' treatment status . After the six-month intervention the severity of all types of both negative and positive symptoms and the mean dosage of medication in the experimental group were significantly less than in the control group The feasibility of  day treatment with community care for  schizophrenic patients was tested by means of a longitudinal r 
    Output:
    
Currently there is no good evidence to suggest life skills programmes are effective for people with chronic mental illnesses .
More robust data are needed from studies that are adequately powered to determine whether life skills training is beneficial for people with chronic mental health problems