***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 investigate how ethnically diverse women who are eligible for tamoxifen prophylaxis because of their breast cancer risk decide about tamoxifen use for risk reduction . DESIGN A qualitative intervention pilot study used focus groups to discuss the use of tamoxifen and to identify the concerns of ethnically diverse women about the preventive use of this drug . Focus group discussion involved exploration of the benefits and risks of tamoxifen prophylaxis , presentation of a st and ardized educational intervention , and focused discussion on attitudes about tamoxifen for prevention . Prominent themes emerged from iterative review of focus group transcripts . RESULTS Fear of breast cancer was not prominent , and participants were less inclined to take tamoxifen as preventive therapy after receiving information . Decisions were based on participants ' underst and ings of competing risks and benefits . Specifically , participants expressed limited willingness to take medication with potential serious side effects for risk reduction and were unwilling to discontinue hormone replacement therapy . Uneasiness about the reliability of scientific studies surfaced in the focus groups comprised of White and Latina women . African-American women described faith as important to prevention . CONCLUSIONS Women were wary of taking a drug for a disease they might not develop . Women felt they had options other than tamoxifen to reduce their risk of breast cancer , including early detection , diet , faith , and complementary and alternative therapies Women with germline BRCA1 or BRCA2 ( BRCA1/2 ) mutations are considered as an extreme risk population for developing breast cancer . Prophylactic mastectomy provides a valid option to reduce such risk , impacting however , the quality of life . Medical prevention by aromatase inhibitor that has also recently shown to have preventive effect may thus be considered as an alternative . LIBER is an ongoing double-blind , r and omized phase III trial to evaluate the efficacy of 5-year letrozole versus placebo to decrease breast cancer incidence in post-menopausal BRCA1/2 mutation carriers ( NCT00673335 ) . We present data on the uptake of this trial . We compared characteristics of women in the LIBER trial ( n = 113 ) to those of women enrolled in the prospect i ve ongoing national GENEPSO cohort ( n = 1,505 ) .  Uptake was evaluated through a survey sent to all active centres , with responses obtained from 17 to the 20 ( 85 % ) centres . According to the characteristics of the women enrolled in the GENEPSO cohort and the survey , approximately one-third of BRCA1/2 mutation carriers were eligible for the trial . Five hundred and thirty-four women eligible from chart review have been informed by mail about the prevention trial and were invited to an oral information by participating centres . Forty-four percentage of them came to the dedicated medical visit . Uptake of drug prevention trial was 32 % among women informed orally and 15 % of all the eligible women . The main reasons of refusal were : potential side effects , probability to receive the placebo  and lack of support from their physicians . Additionally , we noticed that prior prophylactic oophorectomy and previous unilateral breast cancer were more frequent in women enrolled in the LIBER trial than in the French cohort ( 93 % vs. 60 % and 50 % vs. 39 % , respectively ) . Based on an overall 15 % uptake among all eligible subjects , greater and wider information of the trial should be offered to women with BRCA1/2 mutation to improve recruitment . Women with previous unilateral breast cancer or prior prophylactic oophorectomy are more likely to enter a medical prevention trial Background Adherence to preventive medication is often poor , and current interventions have had limited success . Purpose This study was conducted to pilot a r and omised controlled trial aim ed at increasing adherence to preventive medication  in stroke survivors using a brief , personalised intervention . Methods Sixty-two stroke survivors were r and omly allocated to either a two-session intervention aim ed at increasing adherence via ( a ) introducing a plan linked to environmental cues ( implementation intentions ) to help establish a better medication-taking routine ( habit ) and ( b ) eliciting and modifying any mistaken patient beliefs regarding medication/stroke or a control group . Primary outcome was adherence to antihypertensive medication  measured objective ly over 3 months using an electronic pill bottle . Results Fifty-eight people used the pill bottle and were analysed as allocated ; 54 completed treatment . The intervention result ed in 10 % more doses taken on schedule ( intervention , 97 % ; control , 87 % ; 95 % CI for difference ( 0.2 , 16.2 ) ; p = 0.048 ) . Conclusions A simple , brief intervention increased medication adherence in stroke survivors , over and above any effect of increased patient contact or mere measurement . ( http://controlled-trials.com , number IS RCT N38274953 . Background Asthma is a common medical condition caused by chronic inflammation of the airways . Characteristic symptoms of the illness include attacks of shortness of breath , wheezing , tightness in the chest , and cough . Asthma is commonly treated by inhaled corticosteroids , which help to suppress inflammation of the airways and reduce the frequency of severe symptoms and attacks . This medication in the form of inhalers is known as preventer or controller medication and many patients also take short-acting bronchodilators to control acute symptoms ( reliever medication ) . In order to provide therapeutic benefit , preventer medication needs to be taken regularly on a daily basis . However , non-adherence to preventer medication is a common problem in patients diagnosed with asthma and these results in the overuse of reliever medication , increased asthma symptoms , more frequent asthma attacks , and hospital admissions ( Stern et al. , 2006 ) . Optimal adherence to inhaled corticosteroids requires patients to take their preventer medication on 80 % or more occasions , as this is associated with greatest asthma control ( Lasmar et al. , 2009 ) . Objective While effective preventative medication is readily available for asthma , adherence is a major problem due to patients ’ beliefs about their illness and medication . We investigated whether a text message programme targeted at changing patients ’ illness and medication beliefs would improve adherence in young adult asthma patients . Methods Two hundred and sixteen patients aged between 16 and 45 on asthma preventer medication were recruited from pamphlets dispensed with medication and e-mails sent to members of a targeted marketing website .  Participants were r and omized to receive individually tailored text messages based on their illness and medication beliefs over 18 weeks or no text messages . Illness and medication beliefs were assessed at baseline and at 18 weeks . Adherence rates were assessed by phone calls to participants at 6 , 12 , and 18 weeks and at 6 and 9 months . Results At 18 weeks , the intervention group had increased their perceived necessity of preventer medication , increased their belief in the long-term nature of their asthma , and their perceived control over their asthma relative to control group ( all p<0.05 ) . The intervention group also significantly improved adherence over the follow-up period compared to the control group with a relative average increase in adherence over the follow-up period of 10 % ( p<0.001 ) . The percentage taking over 80 % of prescribed inhaler doses was 23.9 % in the control group compared to 37.7 % in the intervention group ( p<0.05 ) . Conclusion A targeted text message programme increases adherence to asthma preventer inhaler and may be useful for other illnesses where adherence is a major issue BACKGROUND Exemestane can prevent breast cancer in postmenopausal women . Because of potential widespread use , we examined the safety of exemestane on bone health . METHODS In this nested safety sub study of the MAP.3 trial ( a r and omised , placebo-controlled , double-blind trial of exemestane 25 mg a day for the primary prevention of breast cancer ) , we included postmenopausal women from five centres who were eligible to participate in MAP.3 , not osteoporotic , not receiving drugs for bone-related disorders , with baseline lumbar spine , total hip , and femoral neck T-scores above -2·0 . The primary endpoint was percent change from baseline to 2 years in total volumetric bone mineral density ( BMD ) at the distal radius by high-resolution peripheral quantitative CT . The primary analysis was per protocol using a non-inferiority margin . This analysis was done earlier than originally planned because of the impending announcement of MAP.3 results and subsequent unmasking of patients to treatment assignment . This study is registered with Clinical Trials.gov , number NCT01144468 , and has been extended to 5 years of unmasked follow-up . FINDINGS 351 women ( 176 given exemestane , 175 given placebo ; median age 61·3 years [ IQR 59·2 - 64·9 ] ) met our inclusion criteria and completed baseline assessment . At the time of clinical cutoff , 242 women had completed 2-year follow-up ( 124 given exemestane , 118 given placebo ) . From baseline to 2 years , the mean percent change in total volumetric BMD at the distal radius was -6·1 % ( 95 % CI -7·0 to -5·2 ) in the exemestane group and -1·8 % ( -2·4 to -1·2 ) in the placebo group ( difference -4·3 % , 95 % CI -5·3 to -3·2 ; p<0·0001 ) . The lower limit of the 95 % CI was lower than our non-inferiority margin of negative 4 % ( one-sided test for non-inferiority p=0·70 ) , meaning the hypothesis that exemestane was inferior could not be rejected . At the distal tibia , the mean percent change in total volumetric BMD from baseline to 2 years was -5·0 % ( 95 % CI -5·5 to -4·4 ) in the exemestane group and -1·3 % ( -1·7 to -1·0 ) in the placebo group ( difference -3·7 % , 95 % CI -4·3 to -3·0 ; p<0·0001 ) . The mean percent change in cortical thickness was -7·9 % ( SD 7·3 ) in the exemestane group and -1·1 % ( 5·7 ) in the placebo group at the distal radius ( difference -6·8 % , 95 % CI -8·5 to -5·0 ; p<0·0001 ) and -7·6 % ( SD 5·9 ) in the exemestane group and -0·7 % ( 4·9 ) in the placebo group at the distal tibia ( difference -6·9 % , -8·4 to -5·5 ; p<0·0001 ) . Decline in areal BMD , as measured by dual-energy x-ray absorptiometry , in the exemestane group compared with the placebo group occurred at the lumbar spine ( -2·4 % [ 95 % CI -3·1 to -1·7 ] exemestane vs -0·5 % [ -1·1 to 0·2 ] placebo ; difference -1·9 % , 95 % CI -2·9 to -1·0 ; p<0·0001 ) , total hip ( -1·8 % [ -2·3 to -1·2 ] exemestane vs -0·6 % [ -1·1 to -0·1 ] placebo ; difference -1·2 % , -1·9 to -0·4 ; p=0·004 ) , and femoral neck ( -2·4 % [ -3·2 to -1·7 ] exemestane vs -0·8 % [ -1·5 to 0·1 ] placebo ; difference -1·6 % , -2·7 to -0·6 ; p=0·002 ) . INTERPRETATION 2 years of treatment with exemestane worsens age-related bone loss in postmenopausal women despite calcium and vitamin D supplementation . Women considering exemestane for the primary prevention of breast cancer should weigh their individual risks and benefits . For women taking exemestane , regular bone monitoring plus adequate calcium and vitamin D supplementation are important . To assess the effect of our findings on fracture risk , long-term follow-up is needed . FUNDING Canadian Breast Cancer Research Alliance ( Canadian Institutes of Health Research /Canadian Cancer Society ) Abstract Objective To investigate the effects of compliance and periodic telephone counselling by a pharmacist on mortality in patients receiving polypharmacy . Design Two year r and omised controlled trial . Setting Hospital medical clinic . Participants 502 of 1011 patients receiving five or more drugs for chronic disease found to be non-compliant at the screening visit were invited for r and omisation to either the telephone counselling group ( n = 219 ) or control group ( n = 223 ) at enrolment 12 - 16 weeks later . Main outcome measures Primary outcome was all cause mortality  in r and omised patients . Associations between compliance and mortality in the entire cohort of 1011 patients were also examined . Patients were defined as compliant with a drug if they took 80 - 120 % of the prescribed daily dose . To calculate a compliance score for the whole treatment regimen , the number of drugs that the patient was fully compliant with was divided by the total number of prescribed drugs and expressed as a percentage . Only patients who complied with all recommended drugs were considered compliant ( 100 % score ) . Results 60 of the 502 eligible patients defaulted and only 442 patients were r and omised . After two years , 31 ( 52 % ) of the defaulters had died , 38 ( 17 % ) of the control group had died , and 25 ( 11 % ) of the intervention 
    Output:
    
Uptake of therapeutic agents for the prevention of breast cancer is low , and long-term persistence is often insufficient for women to experience the full preventive effect .