***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 : Although many studies have investigated the relationship between perfectionism , anxiety , and  depression  among the adults , little is known about the manifestations of perfectionism among schoolage youths . This study has investigated this relationship in an Iranian sample . METHODS : Using multistage cluster r and om sampling , 793 Iranian school students in 2007 were studied . Data of demographic characteristics , children 's depression inventory , revised children 's manifest anxiety scale , and the positive and negative perfectionism scales were obtained using question naires . RESULTS : The results indicated that both aspects of perfectionism are associated with depression and anxiety . Negative and positive perfectionism have positive and negative associations , respectively , with depression and anxiety . The interaction of anxiety and depression with perfectionism reveals that depression is in association with lower scores of positive perfectionism , whereas in students with higher scores of negative perfectionism , the anxiety scores are also higher . Moreover , the accompaniment of anxiety with depression is in association with relatively lower levels of negative perfectionism . CONCLUSIONS : It was concluded that negative perfectionism is a risk factor for both depression and anxiety , while positive perfectionism is a protective factor . However , the interventions which encourage the positive aspects of perfectionism and decrease its negative aspects may be able to diminish psychopathological subsequence OBJECTIVES Perfectionism is considered to be an underlying mechanism of relevance to a broad array of indicators of psychological distress . The current research examined the impact of a three-session intervention targeting perfectionism in children on perfectionism , self-criticism , and well-being . DESIGN The design of the current study can be considered quasi-experimental as the intervention and control classes were not r and omly allocated but decided by convenience factors at the school level . METHODS Students ( aged 10.08 - 12.79 years ) were allocated to the  intervention ( N = 107 , 41 boys ) or control condition ( N = 105 , 33 boys ) , completing self-report assessment s on perfectionism , self-criticism , and well-being at baseline , post-intervention , and 3-month follow-up . RESULTS At post-intervention , children in the intervention group had significantly lower perfectionism than the control group ( d = 0.35 , 95 % confidence intervals [ CI ] : 0.07 - 0.62 ) and at 3-month follow-up had significantly higher levels of well-being ( d = 0.33 , 95 % CI : 0.06 - 0.60 ) . As predicted by theory , decreases in perfectionism mediated the relationship between condition and improved well-being . CONCLUSIONS This exploratory study provides evidence for the usefulness of a brief universal prevention programme targeting perfectionism . Future research should use more robust design s , explore longer-term effects , and the impact on a wider range of variables , including scholastic achievement . PRACTITIONER POINTS Clinical implication s Perfectionism linked with negative outcomes in children can be decreased in a classroom setting . Decreasing perfectionism leads to improved well-being in children . Limitations More rigorous design s along with better assessment of perfectionism are required in further evaluations . The impact of perfectionism on scholastic achievement in children requires further investigation BACKGROUND A r and omized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing  eating disorder and obesity risk factors .  METHOD A total of 1316 grade 7 and 8 girls and boys ( mean age = 13.21 years ) across three Australian states were r and omly allocated to : Media Smart ; Life Smart ; the Helping , Encouraging , Listening and Protecting Peers ( HELPP ) initiative ; or control ( usual school class ) . Risk factors were measured at baseline , post-program ( 5 weeks later ) , and at the 6- and 12-month follow-ups . RESULTS Media Smart girls had half the rate of onset of clinical ly significant concerns about shape and weight than control girls at the 12-month follow-up . Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up . Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up . Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys . A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up , while a main effect for group found Media Smart participants reported less screen time than controls . CONCLUSIONS Media Smart was the only program to show benefit on both disordered eating and obesity risk factors . Whilst further investigations are indicated , this study suggests that this program is a promising approach to reducing risk factors for both problems The relationships between self-oriented and socially prescribed perfectionism ( SPP ) and maladaptive and adaptive coping strategies and their collective impact on depression symptoms were examined in the context of a r and omized controlled universal trial of the Aussie Optimism Positive Thinking Skills Program .  Five hundred and forty-one children aged 8–12 completed a battery of self-reports  , of which responses for measures of depression symptoms , perfectionism , and coping strategies were examined for the purpose s of this study . Structural equation modeling tested whether coping mediated the effects of perfectionism on depression . Results indicated that SPP had both a direct and an indirect relationship with depression symptoms through a moderate association with maladaptive coping . Implication s for prevention of depression were discussed and recommendations for future research were proposed OBJECTIVE The purpose of the current study was to evaluate the effectiveness of a life-skills promotion program design ed to improve body image satisfaction and global self-esteem , while reducing negative eating attitudes and behaviors and feelings of perfectionism , all of which have been identified as predisposing factors to disordered eating . METHOD A total of 258 girls with a mean age of 11.8 years ( intervention group = 182 and control group = 76 ) completed question naires before , and 1 week after , the six-session school-based program , and again 6 and 12 months later . RESULTS The intervention was successful in improving body image satisfaction and global self-esteem and in reducing dieting attitude scores at post intervention only . The gains were not maintained at the 12-month follow-up . DISCUSSION The need to assess the influence of health promotion programs on predisposing risk factors , compared with problem-based outcome measures , is discussed Research examining the social origins of perfectionism has focused on negative evaluative experiences in the family , with less attention to negative social evaluations in other context s and situations relevant for African American adolescents . The experience of racial discrimination is common for African American youth , and may trigger maladaptive perfectionistic beliefs if the youth perceive that they do not meet others ’ st and ards ( socially prescribed perfectionism ) or internalize discriminatory messages . Thus , the present study examined longitudinal associations among racial discrimination , socially prescribed perfectionism , and depressive symptoms among a community sample of urban and predominantly low income African American adolescents ( n = 492 ; 46.7 % female ) . In each of grade s 7 , 8 and 9 , participants reported their experiences with racial discrimination , perfectionistic beliefs , and depressive symptoms . Analyses revealed that experiences with racial discrimination in grade 7 were associated with socially prescribed perfectionism in grade 8 which , in turn , was linked with depressive symptoms in grade 9 . Results suggest that prospect i ve associations between the experience of racial discrimination and depressive symptoms are due , in part , to increased socially prescribed perfectionism . Implication s for interventions targeting  depression in African American are discussed R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community The anxious rearing model of perfectionism development proposes that children develop perfectionism in response to parental worry about their children being imperfect and parental behaviors such as overprotection from mistakes and focus on the negative consequences of mistakes . In the current study , perfectionistic rearing behaviors were experimentally manipulated during a copy task in clinical ly anxious children ( n = 42 ) and non-anxious children ( n = 35 ) . Children were r and omized to receive high or non-perfectionistic rearing behaviors from their parents during the copy task design ed to elicit child perfectionistic behaviors . Results showed that self-reported self-oriented perfectionism ( SOP ) was significantly higher in the anxious group compared with the non-anxious group . All children showed an increase in observed SOP in response to high perfectionistic rearing behaviors . Despite this increase in SOP in the high perfectionistic rearing condition , it was children in the non-perfectionistic rearing condition that improved significantly in task accuracy performance . Non-anxious children declined in task-related striving for perfectionism when they experienced non-perfectionistic rearing behaviors from their parents . Anxious children , however , did not show a decline in task-related striving following non-perfectionistic rearing . Results support the perfectionistic rearing model and parental perfectionistic behaviors ' impact on children 's observed and self-reported SOP and task performance 
    Output:
    
Preliminary support with respect to reliability and validity was established for each of these measures , and there was evidence supporting the existence of both perfectionistic striving and perfectionistic concerns in this population .