***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: Abstract . To investigate whether age at onset of steroid-sensitive nephrotic syndrome ( SSNS ) is predictive of subsequent relapses , or influences outcome , we retrospectively studied 60 patients who were under 10 years of age at onset and were followed for over 10 years . They were divided into three groups according to age at diagnosis : group 1–3 ( 1.0–3.9 years at onset , n=24 ) , group 4–6 ( 4.0–6.9 years at onset , n=22 ) , and group 7–9 ( 7.0–9.9 years at onset , n=14 ) . In the 51 patients with long-term remission , defined as remaining relapse-free over 3 years , the total number of relapses was significantly more in group 1–3 ( n=18 ) than in group 4–6 ( n=19 ) , and the interval between onset and long-term remission was significantly longer . Group 4–6 and group 7–9 had fewer patients with active disease at 10 years , follow-up than group 1–3 , as assessed by the Kaplan-Meier method . These data suggest that the age at onset of SSNS influences the clinical course ( i.e. , frequency of relapses ) and the time to reach long-term remission . An age of less than 4 years at onset of SSNS is associated with greater likelihood for frequent relapses and a greater time interval to attain long-term remission Abstract We have examined , in a prospect i ve r and omized controlled trial , the effect of 8- and 16-week initial steroid treatment on the course of idiopathic nephrotic syndrome ( INS ) . Patients with a first episode of INS were r and omized to receive st and ard 8-week prednisolone ( 2 mg/kg daily for 4 weeks , then 1.5 mg/kg on alternate days for 4 weeks ) or prolonged 16-week prednisolone treatment ( 2 and 1.5 mg/kg daily each for 4 weeks , then 1.5 and 1 mg/kg on alternate days each for 4 weeks ) . Relapses were treated with prednisolone , 2 mg/kg daily for 2 weeks , then 1.5 mg/kg on alternate days for 4 weeks . Of 45 patients , 23 received st and ard therapy and 22 prolonged therapy . The mean duration of follow-up was 29.2 and 27.3 months in the st and ard and prolonged treatment groups , respectively . The time to first relapse was longer in the prolonged treatment ( mean 222.2 days , median 120.0 days ) than the st and ard group ( mean 134.3 days , median 96.5 days ) . The percentage of patients with no relapse at 6 and 12 months after prednisolone withdrawal was 40.9 % and 27.3 % in the prolonged treatment and 21.7 % and 8.7 % in the st and ard groups , respectively . The inability to show statistically significant differences between the two groups was probably related to the small number of patients studied . Prolonged therapy did not affect the subsequent relapse rates and proportion of patients with frequent relapses and steroid dependence . The mean dose of prednisolone received , for the initial episode and relapses during the next year , was higher and associated with significant steroid toxicity in the prolonged treatment group . Our findings suggest that 16-week prednisolone treatment for the initial episode of INS may delay occurrence of the first relapse , but results in significant side effects . Prolongation of initial therapy may be useful in developing countries where frequent infections often induce early relapses Two regimens of steroid treatment for the initial attack of idiopathic nephrotic syndrome ( NS ) in children were compared in a controlled prospect i ve multicentre study . Long prednisone therapy consisted of 60 mg/m2 per 24 h for 6 weeks , followed by alternate day 40 mg/m2 per 48 h for 6 weeks . The st and ard prednisone therapy was 60 mg/m2 per 24 h for 4 weeks , followed by 40 mg/m2 per 48 h for 4 weeks . A total of 71 children with an initial attack of idiopathic NS were allocated at r and om to the two groups . The cumulative rate of patients with sustained remissions after 2 years was significantly higher after the long course than after the st and ard treatment ( 49 % vs 19%,P=0.0079 ) . The mean relapse rate per patient at intervals of 3 , 6 and 12 months was lower in the long-course prednisone group than in the st and ard prednisone group , and the proportion of children with frequent relapses during any subsequent 6 months period was lower in the long-course group than in the st and ard group ( 29 % vs 57%,P=0.03 ) . Mild side-effects of corticosteroid therapy were observed more frequently after long-course prednisone treatment . It is concluded that long-course prednisone therapy of the initial attack of steroid responsive NS is preferable to the st and ard regimen because it reduces the rate of subsequent relapses without increasing the risk for severe steroidal side-effects Abstract Purpose The Strengths and Difficulties Question naire ( SDQ ) is a behavioural screening tool for children . The SDQ is increasingly used as the primary outcome measure in population health interventions involving children , but it is not preference based ; therefore , its role in allocative economic evaluation is limited . The Child Health Utility 9D ( CHU9D ) is a generic preference-based health-related quality of-life measure . This study investigates the applicability of the SDQ outcome measure for use in economic evaluations and examines its relationship with the CHU9D by testing previously published mapping algorithms . The aim of the paper is to explore the feasibility of using the SDQ within economic evaluations of school-based population health interventions . Methods Data were available from children participating in a cluster r and omised controlled trial of the school-based roots of empathy programme in Northern Irel and . Utility was calculated using the original and alternative CHU9D tariffs along with two SDQ mapping algorithms . t tests were performed for pairwise differences in utility values from the preference-based tariffs and mapping algorithms . Results Mean ( st and ard deviation ) SDQ total difficulties and prosocial scores were 12 ( 3.2 ) and 8.3 ( 2.1 ) . Utility values obtained from the original tariff , alternative tariff , and mapping algorithms using five and three SDQ subscales were 0.84 ( 0.11 ) , 0.80 ( 0.13 ) , 0.84 ( 0.05 ) , and 0.83 ( 0.04 ) , respectively . Each method for calculating utility produced statistically significantly different values except the original tariff and five SDQ subscale algorithm . Conclusion Initial evidence suggests the SDQ and CHU9D are related in some of their measurement properties . The mapping algorithm using five SDQ subscales was found to be optimal in predicting mean child health utility . Future research valuing changes in the SDQ scores would contribute to this research In this multicenter , open-label , r and omized controlled trial , we determined whether 2-month prednisolone therapy for steroid-sensitive nephrotic syndrome was inferior or not to 6-month therapy despite significantly less steroid exposure . The primary end point was time from start of initial treatment to start of frequently relapsing nephrotic syndrome . The pre-specified non-inferiority margin was a hazard ratio of 1.3 with one-sided significance of 5 % . We r and omly assigned 255 children with an initial episode of steroid-sensitive nephrotic syndrome to either 2 - or 6-month treatment of which 246 were eligible for final analysis . The total prednisolone exposure counted both initial and relapse prednisolone treatment administered over 24 months . Median follow-up in months was 36.7 in the 2-month and 38.2 in the 6-month treatment group . Time to frequent relaps was similar in both groups ; however , the median was reached only in the 6-month group ( 799 days ) . The hazard ratio was 0.86 ( 90 % confidence interval , 0.64–1.16 ) and met the non-inferior margin . Time to first relapse was also similar in both groups : median day 242 ( 2-month ) and 243 ( 6-month ) . Frequency and severity of adverse events were similar in both groups . Most adverse events were transient and occurred during initial or relapse therapy . Thus , 2 months of initial prednisolone therapy for steroid-sensitive nephrotic syndrome , despite less prednisolone exposure , is not inferior to 6 months of initial therapy in terms of time to onset of frequently relapsing nephrotic syndrome Objectives To compare the motives and experiences of different ethnic groups participating in a r and omised double blind placebo-controlled trial of montelukast in preschool wheeze , and to assess parents ’ or guardians ’ underst and ing of trial procedures and their implication s , including the collection of genetic material . Design Qualitative interviews with parents or guardians . Setting Interviews occurred in the homes of London children recruited to a national multicentre clinical trial following primary and secondary care attendance with wheeze . Participants 42 parents ( 20 of Bangladeshi origin , 10 white UK , 12 other ethnicities ) of preschool children enrolled in a clinical trial . Results Bangladeshi families were relatively reluctant to participate in the qualitative study , despite strong engagement with the parent study . Anxiety related to wheezing was a common primary motive for trial enrolment . Parents viewed the trial as a route to improved treatment . Verbal delivery of trial information appeared more effective than study literature , especially for Bangladeshi families , with low parental literacy and high levels of trust in medical professionals potential contributors to this effect . All ethnic groups expressed a low underst and ing and /or retention of essential study concepts such as r and omisation and genetic testing . Conclusions Bangladeshi families are particularly motivated to participate in clinical trials despite variable comprehension of study concepts . This motivation is more strongly contingent on strong research er-subject rapport than on the quality of study literature . Trial teams seeking to recruit from South Asian population s should emphasise face-to-face verbal explanation of trial concepts and procedures and consider modified trial literature A total of 184 children aged , 13 months to 11 years , suffering from their first attack of steroid-responsive nephrotic syndrome were included in a r and omized study . They were treated according to three treatment protocol s. All children received 1 - 2 mg of prednisone/kg body weight/day ( up to 80 mg daily ) for 4 weeks , and thereafter 1 mg/kg body weight/48 h for the next 4 weeks . Treatment was discontinued at this point in 44 children ( protocol A ) ; in 68 ( protocol B ) the dose was reduced by 25 % each week , tapering off to 0 at the end of the third month , while in 72 children ( protocol C ) , after the first 2 months of initial treatment the dose was reduced by 25 % each month and tapered off to 0 by the end of the sixth month . All patients completed a 2-year follow-up period after withdrawal of prednisone . Treatment results were expressed as : percentage of children relapse-free within the first 6 months and 2 years after withdrawal of treatment , and average number of relapses per patient per year . The best results were obtained in children who had been treated for 6 months ; 65.3 % of them remained relapse-free within the first 6 months and 50 % over the entire 2-year follow-up period ; the number of relapses per patient per year in this group was 0.49 . The respective values for children treated 2 and 3 months were : 36.4 % and 32.4 % for the 6-month period ; 27.3 % and 20.6 % for the 2-year period ; the numbers of relapses per patient per year were 0.79 and 0.77 , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS Ninety six patients aged from 6 months to 15 years and were admitted to Chilean hospitals with the diagnosis of primary nephrotic syndrome in a period of 30 months . These patients were r and omly separated in two groups , group A received prednisone for 8 weeks and group B received the same drug during 12 weeks . All patients were evaluated at 6 , 12 and 18 months after the end of treatment . The moment and number of relapses per patient , accumulated percentage of relapses , relapse rate per 100 patients , total number of relapses and complications were assessed . Frequent relapsers were subjected to a kidney biopsy , leaving in the protocol only those patients that had minimal changes . Patients resistant or dependent to steroid therapy were discarded . Thus we report the results of 56 treated patients followed during 18 months . No differences in analyzed parameters were observed between the two treatment groups . It is concluded that these preliminary results do not support the prolongation of prednisone treatment in children with primary nephrotic syndrome One hundred and fourteen children with primary nephrotic syndrome were followed up prospect ively for periods of between 5 and 14 years . Urine sample s from 94 of them became protein-free during the initial 8-week course of prednisone , and the outcome for these children was good : 74 of them have been free of symptoms for at least 3 years , 18 have had relapses during the last 3 years , and only one child still has proteinuria . All these children have normal renal function and blood pressure . One child died accidentally . Twenty children did not respond to the initial prednisone treatment . Thirteen of them had remissions later , of whom 2 have had relapses during the last 3 years . Seven were totally resistant to prednisone 4 of whom died in renal failure , the remaining 3 have persistent proteinuria with normal levels of creatinine ; one has high blood pressure too . Remission during the initial treatment indicated a good prognosis , but two-thirds of the 
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LIMITATIONS Study drug formulation may have prevented some younger children who were unable to swallow whole or crushed tablets from participating .
This trial has not shown any clinical benefit for EC prednisolone therapy in UK children .
The cost-effectiveness analysis suggested that EC therapy may be cheaper , with the possibility of a small QALY benefit .