***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: Vietnamese Americans are a rapidly growing minority group in the United States , yet little is known about their health status . Chronic medical conditions and self-rated health of older Vietnamese Americans were compared with those of non-Hispanic white adults living in California using the 2001 and 2003 California Health Interview Surveys ( CHISs ) . The CHIS employed a r and om-digit-dial telephone survey , and its sample is representative of California 's noninstitutionalized population . The sample included 359 Vietnamese and 25,177 non-Hispanic white adults aged 55 and older . Vietnamese and non-Hispanic white adults were compared in terms of limitations in activities of daily living , chronic medical conditions ( diabetes mellitus , hypertension , heart disease , asthma ) , mental health care , and self-reported health , adjusting for age , sex , and education . Vietnamese were more likely than white participants to report needing help for mental health problems ( adjusted odds ratio (aOR)=2.1 , 95 % confidence interval (CI)=1.4 - 3.1 ) but less likely to have had their medical providers discuss their mental health problems with them ( aOR=0.3 , 95 % CI=0.1 - 0.5 ) . In addition , Vietnamese participants reported significantly worse health than white adults on five of eight domains of the Medical Outcomes Survery 12-item Short Form survey ( P<.006 ) . Clinicians caring for older Vietnamese individuals should be aware of the high risk for mental health needs in this population and should initiate discussion s about mental health with their patients . Further research is needed to better underst and why older Vietnamese Americans are at higher risk for worse self-reported health than older white adults OBJECTIVE Despite the importance of self-management support ( SMS ) , few studies have compared SMS interventions , involved diverse population s , or entailed implementation in safety net setting s. We examined the effects of two SMS strategies across outcomes corresponding to the Chronic Care Model . RESEARCH DESIGN AND METHODS A total of 339 out patients with poorly controlled diabetes from county-run clinics were enrolled in a three-arm trial . Participants , more than half of whom spoke limited English , were uninsured , and /or had less than a high school education , were r and omly assigned to  usual care , interactive weekly automated telephone self-management support with nurse follow-up ( ATSM ) , or monthly group medical visits with physician and health educator facilitation ( GMV ) . We measured 1-year changes in structure ( Patient Assessment of Chronic Illness Care [ PACIC ] ) , communication processes ( Interpersonal Processes of Care [ IPC ] ) , and outcomes ( behavioral , functional , and metabolic ) . RESULTS Compared with the usual care group , the ATSM and GMV groups showed improvements in PACIC , with effect sizes of 0.48 and 0.50 , respectively ( P < 0.01 ) . Only the ATSM group showed improvements in IPC ( effect sizes 0.40 vs. usual care and 0.25 vs. GMV , P < 0.05 ) . Both SMS arms showed improvements in self-management behavior versus the usual care arm ( P < 0.05 ) , with gains being greater for the ATSM group than for the GMV group ( effect size 0.27 , P = 0.02 ) . The ATSM group had fewer bed days per month than the usual care group ( −1.7 days , P = 0.05 ) and the GMV group ( −2.3 days , P < 0.01 ) and less interference with daily activities than the usual care group ( odds ratio 0.37 , P = 0.02 ) . We observed no differences in A1C change . CONCLUSIONS Patient-centered SMS improves certain aspects of diabetes care and positively influences self-management behavior . ATSM seems to be a more effective communication vehicle than GMV in improving behavior and quality of life OBJECTIVE To examine the relationship between  communication skills training  for patients and their compliance with recommended  treatment . DESIGN A r and omized control design was used , with patients nested within physicians . Each physician was audiotaped with 6 patients , 2 patients in each of the 3 intervention conditions : ( 1 ) a trained group ( n = 50 ) received a training booklet in the mail 2 to 3 days prior to the scheduled appointment , ( 2 ) an informed group ( n = 49 ) received a brief written summary of the major points contained in the training booklet while in the waiting room prior to the scheduled appointment , and ( 3 ) an untrained group ( n = 51 ) did not receive any form of communication skills intervention . SETTING Participants included physicians and patients from 9 different primary care , family practice locations . Two locations were clinics associated with a large , university-based medical school and hospital , while 7 were private practice offices in the community . PARTICIPANTS The sample included 25 family physicians ( averaging 11 years postresidency ) and 150 patients . Patients were r and omly selected from appointment records and r and omly assigned to 1 of 3 intervention conditions . INTERVENTION A training booklet design ed to instruct patients in information seeking , provision , and verification . MAIN OUTCOME MEASURE Patients ' compliance with medications , behavioral treatment ( e.g. , diet , exercise , smoking cessation ) , and /or follow-up appointments and referrals . RESULTS Trained patients were more compliant overall than untrained or informed patients . Training positively influenced compliance with behavioral treatments and follow-up appointments and referrals . CONCLUSION Training patients in communication skills may be a cost-effective way of increasing compliance and improving the overall health of patients Abstract OBJECTIVE : To examine how Asian race/ethnicity affects patients ’ health care experiences and satisfaction with care . DESIGN : Telephone interview using r and om-digit dialing , stratified to over- sample adults living in areas with disproportionately large numbers of minorities . PARTICIPANTS AND SETTING : White ( N=3,205 ) and Asian-American ( N=521 ) respondents , weighted to represent all such adults living in the continental U.S. in telephone households . MEASUREMENTS : Reports of health care experiences and trust in the doctor at the last visit , and overall satisfaction with care and desire to change doctors in the last 2 years . MAIN RESULTS : Asian Americans were less likely than whites to report that their doctors ever talked to them about lifestyle or mental health issues ( P≤.01 ) . They were more likely to report that their regular doctors did not underst and their background and values ( P≤.01 ) . When asked about the last visit , they were more likely to report that their doctors did not listen , spend as much time , or involve them in decisions about care as much as they wanted ( all P≤.0001 ) . In multivariable analyses , Asian Americans were less likely than whites to report that they were very satisfied with care ( odds ratio [ OR ] , 0.64 , 95 % confidence interval [ CI ] , 0.42 to 0.99 ) . However , they were not significantly less likely than whites to trust their doctors ( OR , 0.79 , 95 % CI , 0.52 to 1.20 ) , or to change doctors ( OR , 0.93 , 95 % CI , 0.56 to 1.56 ) . CONCLUSIONS : In a national survey , Asian Americans were less likely to receive counseling and less likely to report positive interactions with their doctors than white respondents . More research is needed to determine the reasons for these differences Research on physician-patient communication has focused on the effect of physician communication training on health care outcomes . Much less is known about patient communication training , and even less about the impact of patient race on the effectiveness of patient communication interventions . One hundred and fifty patients of 25 family physicians were r and omly assigned to one of three groups : 14-page patient communication workbook received 2 - 3 days pre-visit , 2-page patient communication h and out received in the waiting room , or control group . Racial differences in the impact of  patient communication training communication variables , immediate and delayed recall of information , and adherence to treatment were analyzed by t-test and ANOVA techniques . Across analyses , workbook communication skills training had a strong and significant effect on white patients but minimal or no effect on African-American patients . Minimal differences in dependent variables between racial groups existed for the patient h and out and control groups . A partial correlation analysis was conducted to factor out the variance due to education . Results suggested that patient race accounted for the results over and above differences in education between racial groups . Our results suggested that the benefits of communication training can be enhanced by taking into account patient characteristics such as race and culture CONTEXT Pneumococcal immunization rates for elderly and high-risk patients are only one third to one half the target rate of 60 % established by the US Public Health Service . Limited or marginal literacy , which affects nearly 100 million Americans , especially the elderly , may contribute to these low rates of immunization . OBJECTIVE To determine whether the use of a simple , low-literacy educational tool enhances patient-physician dialogue about pneumococcal vaccination and increases rates of immunization . DESIGN A r and omized controlled trial conducted between May and June of 1998 . SETTING Ambulatory care clinic of a 900-bed public teaching hospital serving a predominantly indigent , low-literate , African American , inner-city population . PARTICIPANTS Of 433 patients who presented for routine primary care , had vaccine indications ( age > or = 65 years or chronic disease ) , and had not been previously vaccinated , 221 were r and omly assigned to the intervention group and 212 to the control group .  Of the total patient population ( mean age , 63 years ) , 280 ( 64.7 % ) had less than a high school education , 401 ( 92.6 % ) were African American , and 300 ( 69.3 % ) were female . INTERVENTION One-page , low-literacy ( below fifth- grade level ) educational h and out encouraging patients to " ask your doctor about the pneumonia shot " vs a control group ( 1 -page , low-literacy educational h and out conveying information about nutrition ) . MAIN OUTCOME MEASURES Vaccination rates ( documented by chart audit ) of patients who received pneumococcal vaccination and rates of patients who self-reported having discussed vaccination with their physicians . RESULTS Patients in the intervention group were 4 times more likely to have discussed the pneumococcal vaccine with their physicians than patients in the control group ( 87/221 [ 39.4 % ] vs 21/212 [ 9.9 % ] ; relative risk [ RR ] , 3.97 [ 95 % confidence interval [ CI ] , 2.71 - 5.83 ] ) , and were more than 5 times as likely to have received the pneumococcal vaccine than the control group ( 44/221 [ 19.9 % ] vs 8/212 [ 3.8 % ] ; RR , 5.28 [ 95 % CI , 2.80 - 9.93 ] ) . In a multivariate analysis controlling for race , sex , education , insurance status , age , level of physician training , health status , and vaccine indication , only assignment to the intervention group was statistically significantly related to the probability of being immunized or discussing the issue with their physicians ( P<.001 for both trends ) . CONCLUSIONS A simple , low-literacy educational tool increased pneumococcal vaccination rates and patient-physician discussion s about the vaccine in an elderly , low-literate , indigent , minority population It is important for patients to provide relevant information to the doctor in consultation and to make their own information requirements known . This requires patients to actively participate in the process , something they appear to be reluctant to do . Earlier patient intervention studies have successfully manipulated patient involvement and question asking , although , the latter has tended to be accompanied by increased tension and negative impact . The present study uses a patient education leaflet which uses a wide definition of patient activation . It emphasizes the role of the ' good ' patient as a provider of information extending beyond the recitation of symptoms to include insights to interpretation and meaning . Results showed that patients responded positively to the leaflet and a comparison of doctor ratings of communication quality showed the experimental group performed better than the controls . The findings are considered in terms of improved information exchange and the impact of making the ' rules ' of consultation explicit is also discussed BACKGROUND Active participation and asking questions are important ways in which patients can ensure they underst and what the doctor has said . This study evaluated a question prompt sheet design ed to encourage patients to ask questions in the cancer consultation . PATIENTS AND METHODS Patients ( n = 142 ) were r and omised to receive ( i ) a question prompt sheet or ( ii ) a general sheet informing patients of services available through the regional Cancer Council . Recall of information was assessed in a structured interview 4 - 20 days after the consultation . Question naires to assess patient satisfaction and adjustment to cancer were sent by mail . RESULTS The question prompt sheet had a significant effect in one content area : prognosis . Thirty-five percent of patients who received the question h and out asked questions about prognosis compared to 16 % of those receiving the information h and out . The prompt sheet did not increase the mean number of questions asked overall . Age , in/out-patient status , gender and involvement preference were predictive of both number and duration of patient questions . CONCLUSIONS A question prompt sheet has a limited but important effect on patient question asking behaviour in the cancer consultation This study examined the efficacy of a brief written intervention for primary care patients , design ed to increase their level of participation in the consultation . Patients given the intervention leaflet ( N = 59 ) were compared with those given a control leaflet ( N = 61 ) on various consultation process and outcome measures . Psychological and sociodemographic data were also obtained to determine whether these influenced the effects of the intervention . The results showed that the intervention group had significantly longer consultations and asked more questions than the controls . Younger patients and those from social classes 1 and 2 were more likely to benefit from 
    Output:
    
Interventions ranged from a leaflet encouraging patients to ask more questions , to more intensive face-to-face coaching before office visits .