***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: Objective : To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests . We measured reactive oxygen metabolite ( d-ROM ) levels and biological antioxidant potentials ( BAPs ) associated with psychological stress . Methods : Fifty-nine patients with chronic stroke were r and omly assigned to either a forest group ( staying at a recreational forest site ) or to an urban group ( staying in an urban hotel ) ; the duration and activities performed by both groups were the same . Scores on the Beck Depression Inventory ( BDI ) , Hamilton Depression Rating Scale ( HAM-D17 ) , Spielberger State-Trait Anxiety Inventory ( STAI ) , d-ROMs and BAPs were evaluated both before and after the treatment programs . Results : In the forest group , BDI , HAM-D17 and STAI scores were significantly lower following treatment , and BAPs were significantly higher than baseline . In the urban group , STAI scores were significantly higher following treatment . Moreover , BDI , HAM-D17 and STAI scores of the forest group were significantly lower , and BAPs were significantly higher following treatment ( ANCOVA , p < 0.05 ) . Conclusion : Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke , and may be particularly useful in patients who can not be treated with st and ard pharmacological or electroconvulsive therapies Major depressive disorder ( MDD ) is prevalent after traumatic brain injury ( TBI ) ; however , there is a lack of evidence regarding effective treatment approaches . We conducted a choice-stratified r and omized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone ( CBT-T ) ( n = 40 ) or in-person ( CBT-IP ) ( n = 18 ) , compared with usual care ( UC ) ( n = 42 ) . Participants were recruited from clinical and community setting s throughout the United States . The main outcomes were change in depression severity on the clinician-rated 17 item Hamilton Depression Rating Scale ( HAMD-17 ) and the patient-reported Symptom Checklist-20 ( SCL-20 ) over 16 weeks . There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 ( treatment effect = 1.2 , 95 % CI : -1.5 - 4.0 ; p = 0.37 ) and a nonsignificant trend favoring CBT on the SCL-20 ( treatment effect = 0.28 , 95 % CI : -0.03 - 0.59 ; p = 0.074 ) . In follow-up comparisons , the CBT-T group had significantly more improvement on the SCL-20 than the UC group ( treatment effect = 0.36 , 95 % CI : 0.01 - 0.70 ; p = 0.043 ) and completers of eight or more CBT sessions had significantly improved SCL-20 scores compared with the UC group ( treatment effect = 0.43 , 95 % CI : 0.10 - 0.76 ; p = 0.011 ) . CBT participants reported significantly more symptom improvement ( p = 0.010 ) and greater satisfaction with depression care ( p < 0.001 ) , than did the UC group . In-person and telephone-administered CBT are acceptable and feasible in persons with TBI . Although further research is warranted , telephone CBT holds particular promise for enhancing access and adherence to effective depression treatment A method for assessing affect states among older people with Alzheimer 's disease was developed for use in a study design ed to evaluate a special care unit for such residents of a nursing home . The 6-item  Philadelphia Geriatric Center Affect Rating Scale was design ed for the use of research and other staff in assessing positive affect ( pleasure , interest , contentment ) and negative affect ( sadness , worry/anxiety , and anger ) by direct observation of facial expression , body movement , and other cues that do not depend on self-report , among 253 demented and 43 nondemented residents . Each affect scale was highly reliable , expressed in estimated portions of a 10-minute observation period when the affect expression occurred . Validity estimates were affirmative in showing discriminant correlations between the positive states and various independent measures of social and other outwardly engaged behavior and between negative states and other measures of depression , anger , anxiety , and withdrawal . Limited support for the two-factor dimensionality of the affect ratings was obtained , although positive and negative affect were correlated , rather than independent . Some hope is offered that the preference and aversions of Alzheimer patients may be better understood by observations of their emotional behaviors and that such methods may lead to a better ability to judge institutional quality PURPOSE To assess the effects of horticultural therapy ( HT ) on mood state and heart rate ( HR ) in patients participating in an inpatient cardiac rehabilitation program . METHODS Cardiac rehabilitation in patients ( n = 107 ) participated in the study . The  HT group consisted of 59 subjects ( 34 males , 25 females ) . The control group , which participated in patient education classes ( PECs ) , consisted of 48 subjects ( 31 males , 17 females ) . Both HT sessions and PEC are components of the inpatient rehabilitation program . Each group was evaluated before and after a class in their respective modality . Evaluation consisted of the completion of a Profile of Mood States ( POMS ) inventory , and an HR obtained by  pulse oximetry . RESULTS Changes in the POMS total mood disturbance ( TMD ) score and HR between preintervention and postintervention were compared between groups . There was no presession difference in either TMD score ( 16 + /- 3.6 and 19.0 + /- 3.2 , PEC and HT , respectively ) or HR ( 73.5 + /- 2.5 and 79 + /- 1.8 , PEC and HT , respectively ) . Immediately following the intervention , the  HT TMD was significantly reduced ( post-TMD = 1.6 + /- 3.2 , P < .001 ) , while PEC TMD was not significantly changed ( TMD = 17.0 + /- 28.5 ) . After intervention , HR fell in HT by 4 + /- 9.6 bpm ( P < .001 ) but was unchanged in PEC . CONCLUSION These findings indicate that HT improves mood state , suggesting that it may be a useful tool in reducing stress . Therefore , to the extent that stress contributes to coronary heart disease , these findings support the role of HT as an effective component of cardiac rehabilitation Objective : To evaluate the contribution of social communication abilities and affective/behavioral functioning to socialintegration outcomes for persons with traumatic brain injury ( TBI ) . Design : Prospect i ve cohort study . Participants : A total of 184 adults with TBI ( 72.8 % men ) evaluated at least 6 months postdischarge from acute care orinpatient rehabilitation hospitals and after living at least 3 months in the community postdischarge ( Mean = 7.84 monthspostinjury ) . Measures :  La Trobe Communication Question naire ( LCQ ) , Assessment of Interpersonal Problem-Solving Skills(AIPSS ) , Affective Behavioral subscale From the Problem Checklist of the Head Injury Family Interview ( AB-HIFI ) , Craig H and icap Assessment and Reporting Technique – Short Form Social Integration subscale ( CHART-SF-SI ) , Community Integration Question naireSocial Integration subscale ( CIQ-SI ) . Results : Social communication measures ( LCQ , AIPSS ) and self-reported behavioralfunctioning ( AB-HIFI ) contributed significantly to concurrently measured social integration outcomes after controlling for demographic and injury-related variables . Separate hierarchical multiple regression analyses revealed that social communication and behavioralvariables accounted for 11.3 % of variance in CIQ-SI and 16.3 % of variance in CHART-SF-SI . Conclusions : Social communication abilities and affective/behavioral functioning make a substantial contribution to social integration outcomes after TBI . The implication s of such evidence for clinical assessment and intervention are discussed BACKGROUND Severe mitral regurgitation ( MR ) is associated with frequent alteration of psychoemotional status ( PES ) , with anxiety and stress symptoms related to health-related quality of life ( HR-QOL ) . Yet , it is unknown whether surgical correction of MR leads to improvement or deterioration in PES and HR-QOL . METHODS We prospect ively performed comprehensive MR assessment and administered question naires assessing PES and HR-QOL in 131 patients ( aged 60 years ; 75 % men ) before and 6 months after operation for organic MR and compared them to 62 patients who did not undergo operation for mitral disease and 36 normal controls of similar age assessed with the same methods .  RESULTS Baseline PES was poorer preoperatively in patients undergoing mitral operation compared with patients who did not undergo mitral operation and normal controls ( anxiety and posttraumatic stress [ PTS ] ; both p < 0.01 ) with poorer physical HR-QOL ( p < 0.01 ) . Six months later , all these psychoemotional variables improved ( all p ≤ 0.02 ) in the patients who underwent mitral operation , whereas no change was observed in the other 2 groups ( all p > 0.1 ) . Improvement after mitral repair result ed in postoperative normalization of emotional and physical well-being , with similar scores among all groups ( all p ≥ 0.4 ) . At 6-month follow-up , no difference in improvement in PES and HR-QOL was noted according to the surgical approach ( robotic versus sternotomy , all p ≥ 0.2 ) . CONCLUSIONS Patients with severe organic MR present with frequent psychoemotional alterations and HR-QOL deterioration , in contrast to patients who do not undergo mitral operation and normal controls . After mitral operation , notable improvement results in normalization of emotional and physical well-being . Quantification of emotional and physical well-being provides important outcome measures in patients with organic MR and uncovers important benefits provided by surgical correction of MR 
    Output:
    
Evidence suggests that engaging with gardens , and gardening , can favourably impact the emotional and social health of people with dementia and , an explanatory theoretical model is proposed .