***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 effects of alternatively framed messages and dispositional optimism on follow-up for abnormal Papanicolaou tests were studied . Participants ( N = 116 ) had a mean age of 24 ; 94 % were black , 67 % had a high school education , and 82 % received public assistance .  A message about losses without follow-up or gains with follow-up was r and omly given . Optimism was measured with the Life Orientation Test and attendance was defined as coming or not coming within 6 weeks of contact . Logistic regressions of attendance on framing and optimism did not reveal significant relationships . Exploratory analyses revealed that personal and familial history of disease were related to attendance . Explanations for the findings and implication s for research are delineated OBJECTIVE --To investigate the numbers of visits required to obtain interviews with users and non-users of cervical screening  , and to determine the workload involved to enable an optimum visit plan to be developed . DESIGN --Case-control study of users and non-users of cervical screening  using a flexible visit plan that involved up to eight attempts at contact . Visits were made in mornings , afternoons , and evenings , the visit pattern being determined by information gained from local sources . PATIENTS --Altogether 660 non-users of cervical screening ( cases ) , aged 20 - 64 and registered with 23 r and omly selected general practitioners ( GPs ) , were identified from the Tayside computerised register of cervical smears . These women were selected from the computerised lists of 18 GPs in Dundee and five in Perth . A total of 417 women recorded as having a smear within the previous three years ( controls ) , matched by age and GP , were also identified from the computerised register . RESULTS --Altogether 1834 attempts were made to contact the cases , of whom 339 were interviewed , giving a workload of 18 interviews per 100 attempts . For the controls 1359 attempts were made at contact to yield 339 interviews , a workload of 25 interviews per 100 attempts . Refusals ( 19 % ) and incorrect addresses ( 23 % ) were the two major reasons for failing to achieve interview . Only for four ( 0.6 % ) of the cases and one ( 0.2 % ) of the controls was no information gained . The proportion of attempts which led to interview remained constant with increasing numbers of call-backs ( up to six for the cases and eight for the controls ) . CONCLUSIONS --A flexible approach to visit scheduling that takes account of local knowledge can lead to interviews with 66 % of non-users of health screening , when incorrect addresses are removed . It is preferable to plan for many ( up to six ) visits to achieve interview . This will minimise non-response bias without increasing the workload per successful interview OBJECTIVE --Firstly to compare the proportion of patients defaulting from follow up at a genitourinary medicine clinic with those attending other hospital based clinics . Secondly to determine which factors are associated with non attendance at a city centre genitourinary medicine clinic . METHODOLOGY --The proportion of patients who defaulted at a genitourinary medicine clinic , a general medical clinic , a general surgical clinic and a dermatology clinic during March 1995 were compared . A multivariate logistic regression analysis was performed comparing attenders and non attenders at the genitourinary medicine clinic with respect to time of appointment , diagnosis , previous contacts with clinic staff , potential domestic commitments and patient demographics in a prospect i ve case control study . RESULTS --The default rate at the genitourinary medicine clinic was 15 % compared with 13 % , 15 % and 14 % for medical , surgical and dermatology clinics respectively . Patients who defaulted from the genitourinary medicine clinic ( 167 ) were compared with 172 attenders and significant differences found for timing of appointments , area of residence , frequency of counselling by the health advisor and age of the patient . Other factors such as the diagnosis , whether a woman had children , sexual orientation , whether negative results had been given over the phone , source of referral , sex of patient , employment status and the weather were not found to be significantly associated with defaulting from an appointment . CONCLUSIONS --The time of the appointment and being seen by a health advisor were the only variables identified over which the clinic has control and therefore could potentially reduce non attendance rates A prospect i ve study of new female patients attending the Genitourinary Medicine Department in Doncaster was carried out to look at the value of colposcopic examination  at their first attendance . Of the 100 r and omized patients studied 41 showed evidence of colposcopically detected cervical abnormality . Twenty-seven patients had colposcopically directed biopsies .  These showed evidence of cervical intraepithelial neoplasia ( 3 cases ) , flat condyloma ( 16 cases ) , exophytic wart ( 2 cases ) , chronic inflammation ( 2 cases ) and normal epithelium ( 4 cases ) . Colposcopic cervical abnormalities were significantly associated , with a history of anogenital warts , sexual contact with anogenital warts and the presence of anogenital warts at presentation . Despite this , less than half the group showing colposcopic abnormalities had an association with anogenital warts . Demonstration of cervical abnormalities by colposcopy result ed in a greater patient compliance during follow-up . Screening or primary colposcopy may be incorporated into a genitourinary screen at the first visit . The procedure is both acceptable and beneficial to the patient , facilitating the detection of a range of cervical disease and enhancing the doctor – patient relationship BACKGROUND Although the incidence of precancerous conditions of the cervix has recently been increasing , prompt initial and long-term follow-up care can effectively reduce unnecessary morbidity and mortality . For example , the 4-year survival rates among those individuals at greatest risk for cervical cancer ( i.e. , minority women of low socioeconomic status ) approach 95 % with early detection . Women who present with advanced disease have a much poorer outlook ( 0%-39 % survival ) . Yet , high-risk individuals are least likely to adhere to recommended diagnostic regimens . PURPOSE We tested the effectiveness of a brief telephone counseling intervention directed to low-income , inner-city women after they had received an abnormal Pap smear result . The women were counseled on the importance of having an initial and 6-month repeat follow-up diagnostic procedure ( i.e. , colposcopic examination of the cervix ) . METHODS A r and omized trial design was used to compare the effects on these women of  telephone counseling with  ( n = 192 ) or without ( n = 203 ) a booster counseling telephone call prior to the appointment for a repeat colposcopy 6 months later , with a telephone appointment confirmation/reminder call ( n = 216 ) and with st and ard care ( i.e. , no telephone contact ) ( n = 217 ) . The telephone counseling protocol probed for and addressed three psychologic barriers to adherence ( i.e. , attendance at appointment for colposcopy examination ) : 1 ) encoding/expectancy ( e.g. , did the patient underst and her risk of developing cervical cancer ? ) ; 2 ) affective/emotional ( e.g. , was the woman worried about the condition and its consequences ? ) ; and 3 ) self-regulatory/practical ( e.g. , was the woman likely to forget medical appointments ? ) . Logistic regression was used to analyze the effects of the intervention group and the type of psychologic barriers elicited on colposcopy adherence . RESULTS The results of logistic regression analysis ( using those who received an appointment confirmation/reminder telephone call as the comparison group ) revealed that telephone counseling produced significantly higher adherence rates to the initial colposcopy visit compared with telephone confirmation ( 300 [ 76 % ] of 395 women versus 147 [ 68 % ] of 216 ; odds ratio [ OR ] = 1.50 ; 95 % confidence interval [ CI ] = 1.04 - 2.17 ) . Additionally , st and ard care result ed in significantly lower adherence rates than did telephone confirmation ( 109 [ 50 % ] of 217 women versus 147 [ 68 % ] of 216 ; OR = 0.47 ; 95 % CI = 0.32 - 0.73 ) . Regarding attendance at the 6-month repeat colposcopy appointments , the 80 patients who had received telephone counseling prior to the initial visit ( and were recommended for follow-up colposcopy ) were significantly more likely to adhere than were the 47 patients who had received telephone confirmation ( 49 [ 61 % ] of 80 women versus 17 [ 36.2 % ] of 47 ; OR = 2.70 ; 95 % CI = 1.15 - 6.51 ) . The 6-month adherence rates for patients in the telephone confirmation group and the st and ard care group ( n = 30 ) were low and did not differ significantly ( 17 [ 36.2 % ] of 47 women versus nine [ 30.0 % ] of 30 ; OR = 1.08 ; 95 % CI = 0.40 - 2.89 ) . Forgetting medical appointments ( OR = 0.31 ; 95 % CI = 0.19 - 0.51 ) and having scheduling conflicts ( OR = 0.45 ; 95 % CI = 0.28 - 0.72 ) were also associated with lower rates of adherence . CONCLUSION The use of telephone counseling appears to be an effective strategy for enhancing initial and long-term adherence to a follow-up cervical diagnostic procedure in a traditionally underserved population . Patients who respond to a positive Pap test result with a particular profile of psychologic barriers may require more intensive and targeted counseling interventions OBJECTIVE --To determine changes in the cervical screening service since the introduction of the new general practitioner contract on 1 April 1990 . DESIGN -- Analysis of computerised records of cervical screening both before and after introduction of the new contract . SETTING --General practice s in Perth and Kinross Unit , Tayside . PATIENTS --A total of 30,071 women aged 21 - 60 on 26 general practitioner partnership lists . MAIN OUTCOME MEASURES --Percentage average of target population for cervical screening in each practice for first three quarters on introduction of the contract . RESULTS --Perth and Kinross Unit completed a computerised cervical screening call programme in July 1989 , which produced an increase from 71 % to 78 % in the mean percentage of women aged  20 - 60 who had had cervical smear tests within 5.5 years . Six months after the introduction of the new general practitioner contract the mean population coverage was increased to 85 % in women aged 21 - 60 and only four practice s had not attained the 80 % upper target compared with 10 on 1 April 1990 . Detailed examination of r and omly selected practice s immediately before the new contract was introduced showed an average artificial list inflation of 4.3 % in health board records when compared with practice records , a hysterectomy rate of 6.2 % , and an additional 3 % of women who were considered to be ineligible for smear testing due to putative virginity or illness or infirmity , or both . There was a considerable shift away from use of well woman clinics ( 2.7 % of smears in 1990 compared with 5.6 % in 1988 ) for taking cervical smears , potentially threatening the long term viability of the clinics . CONCLUSION --The introduction of the new contract for general practitioners has brought about a further sustained increase in population coverage for cervical screening in a small Scottish unit with a stable population , well motivated general practitioners , and a fully integrated computerised call and recall system based on the community health index . To optimise the screening service revision of the targets levels is necessary OBJECTIVE Two consecutively occurring studies examined whether using a video colposcope to view this procedure or allowing the female adolescent to watch music videos would reduce anxiety and related body movements . STUDY DESIGN Female adolescents who underwent colposcopy were r and omly assigned to one of two groups , experimental and control . In study 1 , 27 female adolescents were r and omly assigned either to view the procedure on a television monitor or to be part of a control group ( no visual distraction ) . In study 2 , 30 female adolescents were r and omly assigned either to a music video group or to a control group . Studies were completed in a consecutive manner and used the same measures , colposcopic equipment , and professional staff , including physician . Multiple measures of anxiety were used ( heart rate , behavior observation , and paper and pencil ) before , during , and after the procedure . During each colposcopy the subject 's behavior across 10 dimensions was observed and coded . Data were analyzed by chi 2 , analysis of variance , and Student t tests . RESULTS Study 1 found no significant differences in body movements and anxiety ratings between the video colposcope group and controls . In study 2 , subjects who were allowed to watch the music videos demonstrated significantly fewer body movements indicative of pain , required less physician reassurance , and received fewer procedural explanations ( p < 0.05 ) . CONCLUSION Results suggest that allowing a female adolescent to watch music videos during a colposcopic examination appears to decrease body movements associated with discomfort OBJECTIVE To assess the adequacy of management of Sydney women with Papanicolaou ( Pap ) smears showing cervical intraepithelial neoplasia ( CIN ) grade s two and three . DESIGN A prospect i ve descriptive study of patient management . METHOD All 206 general practitioners ( GPs ) who sent Pap smears which were reported as CIN 2 or CIN 3 to three Sydney laboratories between January and June 1990 were included in the sample . The GPs were contacted and management 
    Output:
    
The intervention studies suggested a need to tailor the intervention to the population and the type of information to suit the individual .
It is question able if there is a need for interventions to increase compliance .
Where necessary , greater cooperation across the primary / secondary care interface and use of the extended primary care team may be a more cost-effective means of increasing compliance