***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: Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers Child depression is an impairing condition for which psychotherapies have shown modest effects . Parental depression is a risk factor for development of child depression and might also be negatively associated with child depression treatment outcomes . To explore this possibility , we analyzed data from a study in which children were treated for depression after parental depressive symptoms had been assessed at baseline . Among children treated for depression in a r and omized controlled trial , we identified 31 who had child- and parent-report pre- and post-treatment data on child symptoms and parent-report of pre-treatment parental depressive symptoms . Children were aged 8–13 , 77 % boys , and 52 % Caucasian , 13 % African-American , 6 % Latino , and 29 % multi-racial . Analyses focused on differences in trajectories of change ( across weekly measurements ) , and post-treatment symptoms among children whose parents did ( n = 12 ) versus did not ( n = 19 ) have elevated depressive symptoms at baseline . Growth curve analyses showed markedly different trajectories of change for the two groups , by both child-report ( p = 0.03 ) and parent-report ( p = 0.03 ) measures : children of parents with less severe depression showed steep symptom declines , but children of parents with more severe depression showed flat trajectories with little change in symptoms over time . ANCOVAs showed lower post-treatment child symptoms for children of parents with less severe depression versus parents with more severe depression ( p = 0.05 by child report , p = 0.01 by parent report ) . Parental depressive symptoms predict child symptom trajectories and poorer child treatment response , and may need to be addressed in treatment BACKGROUND We evaluated the safety and efficacy of etanercept , a soluble tumor necrosis factor receptor (p75):Fc fusion protein , in children with polyarticular juvenile rheumatoid arthritis who did not tolerate or had an inadequate response to methotrexate . METHODS Patients 4 to 17 years old received 0.4 mg of etanercept per kilogram of body weight subcutaneously twice weekly for up to three months in the initial , open-label part of a multicenter trial . Those who responded to treatment then entered a double-blind study and were r and omly assigned to receive either placebo or etanercept for four months or until a flare of the disease occurred . A response was defined as an improvement of 30 percent or more in at least three of six indicators of disease activity , with no more than one indicator worsening by more than 30 percent . RESULTS At the end of the open-label study , 51 of the 69 patients ( 74 percent ) had had responses to etanercept treatment . In the double-blind study , 21 of the 26 patients who received placebo ( 81 percent ) withdrew because of disease flare , as compared with 7 of the 25 patients who received etanercept ( 28 percent ) ( P=0.003 ) . The median time to disease flare with placebo was 28 days , as compared with more than 116 days with etanercept ( P<0.001 ) . In the double-blind study , there were no significant differences between the two treatment groups in the frequency of adverse events . CONCLUSIONS Treatment with etanercept leads to significant improvement in patients with active polyarticular juvenile rheumatoid arthritis .  Etanercept is well tolerated by pediatric patients CONTEXT Increased concentrations of inflammatory biomarkers predict antidepressant nonresponse , and inflammatory cytokines can sabotage and circumvent the mechanisms of action of conventional antidepressants . OBJECTIVES To determine whether inhibition of the inflammatory cytokine tumor necrosis factor ( TNF ) reduces depressive symptoms in patients with treatment-resistant depression and whether an increase in baseline plasma inflammatory biomarkers , including high-sensitivity C-reactive protein ( hs-CRP ) , TNF , and its soluble receptors , predicts treatment response . DESIGN Double-blind , placebo-controlled , r and omized clinical trial . SETTING Outpatient infusion center at Emory University in Atlanta , Georgia . PARTICIPANTS A total of 60 medically stable out patients with major depression who were either on a consistent antidepressant regimen ( n = 37 ) or medication-free ( n = 23 ) for 4 weeks or more and who were moderately resistant to treatment as determined by the Massachusetts General Hospital Staging method . INTERVENTIONS Three infusions of the TNF antagonist infliximab ( 5 mg/kg ) ( n = 30 ) or placebo ( n = 30 ) at baseline and weeks 2 and 6 of a 12-week trial . MAIN OUTCOME MEASURES The 17-item Hamilton Scale for Depression ( HAM-D ) scores . RESULTS No overall difference in change of HAM-D scores between treatment groups across time was found . However , there was a significant interaction between treatment , time , and log baseline hs-CRP concentration ( P = .01 ) , with change in HAM-D scores ( baseline to week 12 ) favoring infliximab-treated patients at a baseline hs-CRP concentration greater than 5 mg/L and favoring placebo-treated patients at a baseline hs-CRP concentration of 5 mg/L or less . Exploratory analyses focusing on patients with a baseline hs-CRP concentration greater than 5 mg/L revealed a treatment response ( ≥50 % reduction in HAM-D score at any point during treatment ) of 62 % ( 8 of 13 patients ) in infliximab-treated patients vs 33 % ( 3 of 9 patients ) in placebo-treated patients ( P = .19 ) . Baseline concentrations of TNF and its soluble receptors were significantly higher in infliximab-treated responders vs nonresponders ( P < .05 ) , and infliximab-treated responders exhibited significantly greater decreases in hs-CRP from baseline to week 12 compared with placebo-treated responders ( P < .01 ) . Dropouts and adverse events were limited and did not differ between groups . CONCLUSIONS This proof-of-concept study suggests that TNF antagonism does not have generalized efficacy in treatment-resistant depression but may improve depressive symptoms in patients with high baseline inflammatory biomarkers . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00463580 Objectives Method ologically , to assess the feasibility of participant recruitment and retention , as well as missing data in study ing mental disorder among children newly diagnosed with chronic physical conditions ( ie , multimorbidity ) . Substantively , to examine the prevalence of multimorbidity , identify sociodemographic correlates and model the influence of multimorbidity on changes in child quality of life and parental psychosocial outcomes over a 6-month follow-up . Design Prospect i ve pilot study . Setting Two children ’s tertiary-care hospitals . Participants Children aged 6–16 years diagnosed in the past 6 months with one of the following : asthma , diabetes , epilepsy , food allergy or juvenile arthritis , and their parents . Outcome measures Response , participation and retention rates . Child mental disorder using the Mini International Neuropsychiatric Interview  at baseline and 6 months . Child quality of life , parental symptoms of stress , anxiety and depression , and family functioning . All outcomes were parent reported . Results Response , participation and retention rates were 90 % , 83 % and 88 % , respectively . Of the 50 children enrolled in the study , the prevalence of multimorbidity was 58 % at baseline and 42 % at 6 months . No sociodemographic characteristics were associated with multimorbidity . Multimorbidity at baseline was associated with declines over 6 months in the following quality of life domains : physical well-being , β=−4.82 ( –8.47 , –1.17 ) ; psychological well-being , β=−4.10 ( –7.62 , –0.58 ) and school environment , β=−4.17 ( –8.18 , –0.16 ) . There was no association with parental psychosocial outcomes over time . Conclusions Preliminary evidence suggests that mental disorder in children with a physical condition is very common and has a negative impact on quality of life over time . Based on the strong response rate and minimal attrition , our approach to study child multimorbidity appears feasible and suggests that multimorbidity is an important concern for families . Method ological and substantive findings from this pilot study have been used to implement a larger , more definitive study of child multimorbidity , which should lead to important clinical implication OBJECTIVE To describe the long-term psychosocial outcome in a prospect ively followed cohort of patients with juvenile chronic arthritis ( JCA ) , to assess the associations between psychosocial outcome and disease variables and to explore family stressors as predictors of long-term psychosocial and physical outcome . METHODS Fifty-two patients with JCA were assessed psychosocially at first admission to a pediatric rheumatology clinic and were reassessed 9 years later . Assessment methods included semi-structured psychiatric interviews and st and ardized parental question naires and self-reports . RESULTS At follow-up , 9 patients ( 17 % ) fulfilled the criteria for a psychiatric diagnosis and 8 ( 15 % ) had mild to moderate impairment in psychosocial functioning ( children 's or adult Global Assessment Scale ) . Mental health and psychosocial functioning were significantly improved from the first hospital admission to follow-up . In patients < 18 years of age ( n = 26 ) , psychosocial functioning at follow-up correlated with physical disability according to the Childhood Health Assessment Question naire ( r = -0.52 , p < 0.01 ) . Psychosocial outcome was unrelated to other measures of disease severity . Chronic family difficulties in the disease course predicted psychosocial functioning at follow-up in patients < 18 years old ( R2 = 0.22 ) . Chronic family difficulties at disease onset , together with gender and chronic family difficulties in the disease course , predicted psychosocial functioning at follow-up in patients > or = 18 years old ( R2 = 0.61 ) . Family stressors were unrelated to the physical outcome . CONCLUSION The long-term psychosocial outcome was favorable in most of the patients . Psychosocial outcome was predicted by chronic family difficulties , but was not closely related to disease severity at follow-up OBJECTIVE Children with arthritis experience frequent pain , but the predictors of daily pain variations are largely unidentified . The goal of this study was to examine sleep quality as a predictor of pain in children with arthritis and to determine whether mood moderates this relationship . METHOD In this prospect i ve , longitudinal study children with polyarticular arthritis ( n = 51 , ages 8 - 16 years ) tracked daily symptoms , including sleep quality over 2 months . Self-reported daily pain intensity , as indicated on a visual analog scale , was used as the primary outcome measure in multilevel models . RESULTS Poorer sleep quality was associated with higher next-day pain ratings ( p < .01 ) . Mood moderated this relationship such that as positive mood increased , the relationship between poor sleep quality and high pain weakened ( p < .01 ) . Daily pain did not predict nightly sleep quality ( p > .05 ) . CONCLUS 
    Output:
    
We found that JIA patients experience symptoms of depression and anxiety similar to other childhood chronic diseases and at higher rates than in healthy children .
Patients who experience these symptoms have worse quality of life , with some evidence pointing to depression and anxiety symptoms having a greater impact on quality of life than other disease features , such as active joint count .
Family members of JIA patients experience high rates of anxiety and depression symptoms which may impact their child 's mental health and pain symptoms related to JIA .