***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 Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results OBJECTIVE To examine the long-term effects of an intervention combining teacher training , parent education , and social competence training for children during the elementary grade s on adolescent health-risk behaviors at age 18 years . DESIGN Nonr and omized controlled trial with follow-up 6 years after intervention . SETTING Public elementary schools serving high-crime areas in Seattle , Wash. PARTICIPANTS Of the fifth- grade students enrolled in participating schools , 643 ( 76 % ) were given written parental consent for the longitudinal study and 598 ( 93 % ) were followed up and interviewed at age 18 years . INTERVENTIONS A full intervention provided in grade s 1 through 6 of 5 days of in-service training for teachers each intervention year , developmentally appropriate parenting classes offered to parents when children were in grade s 1 through 3 and 5 through 6 , and developmentally adjusted social competence training for children in grade s 1 and 6 . A late intervention , provided in grade s 5 and 6 only , paralleled the full intervention at these grade s. MAIN OUTCOME MEASURES Self-reported violent and nonviolent crime , substance use , sexual activity , pregnancy , bonding to school , school achievement , grade repetition and school dropout , suspension and /or expulsion , and school misbehavior ; delinquency charges from court records ; grade point average ; California Achievement Test scores : and disciplinary action reports from school records . RESULTS Fewer students receiving full intervention than control students reported violent delinquent acts ( 48.3 % vs 59.7 % ; P=.04 ) , heavy drinking ( 15.4 % vs 25.6 % ; P=.04 ) , sexual intercourse ( 72.1 % vs 83.0 % ; P=.02 ) , having multiple sex partners ( 49.7 % vs 61.5 % ; P=.04 ) , and pregnancy or causing pregnancy ( 17.1 % vs 26.4 % ; P=.06 ) by age 18 years . The full intervention student group reported more commitment ( P=.03 ) and attachment ( P=.006 ) to school , better academic achievement ( P=.01 ) , and less school misbehavior ( P=.02 ) than control students . Late intervention in grade s 5 and 6 only did not significantly affect health-risk behaviors in adolescence . CONCLUSIONS A package of interventions with teachers , parents , and children provided throughout the elementary grade s can have enduring effects in reducing violent behavior , heavy drinking , and sexual intercourse by age 18 years among multiethnic urban children . Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods PURPOSE The purpose of this investigation was to assess the School-Based Adolescent Health Care Program , which provided comprehensive health-related services in 24 school-based health centers . METHODS The outcomes evaluation compared a cohort of students attending 19 participating schools and a national sample of urban youths , using logit models to control for observed differences between the two groups of youths . Outcome measures included self-reports concerning health center utilization , use of other health care providers , knowledge of key health facts , substance use , sexual activity , contraceptive use , pregnancies and births , and health status . RESULTS The health centers increased students ' access to health care and improved their health knowledge . However , the estimated impacts on health status and risky behaviors were inconsistent , and most were small and not statistically significant . CONCLUSIONS School-based health centers can increase students '  health knowledge and access to health-related services , but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors OBJECTIVES A theory-based curriculum design ed to delay the onset of intercourse and increase use of condoms was implemented in the classrooms of six Los Angeles middle schools . METHODS The curriculum activities were very interactive , emphasized skill building , and were implemented by well trained peer educators , including young HIV-positive males and teen mothers . To evaluate the impact of the curriculum , 102 classrooms of students were r and omly assigned to receive either the existing curriculum or the existing curriculum plus the intervention curriculum .  Students completed confidential question naires before program implementation , five months later , and 17 months later . A total of 1,657 students completed both the baseline and 17-month follow-up question naires . RESULTS Analyses of these data revealed that the curriculum significantly increased knowledge , significantly improved only two out of 21 attitudes or beliefs , and did not significantly change sexual or contraceptive behaviors . CONCLUSIONS Well implemented programs that are based on upon theory , use interactive activities , and utilize well-trained peer educators do not always change important sexual attitudes and behaviors among middle school youth PURPOSE To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade . METHODS During the fall of seventh grade and again in eighth grade , students were r and omly assigned by classroom to participate either in community youth service ( CYS ) or not ( controls ) . Service learning is an educational strategy that couples meaningful service in the community with classroom instruction . Students in both intervention and control conditions received classroom health lessons . Surveys were conducted at seventh grade baseline and at the end of 10th grade , approximately 2 years after intervention . Self-reported sexual behaviors  of youths who had participated in CYS  were compared with those of controls receiving classroom curriculum alone ( n = 195 ) . RESULTS CYS participants were significantly less likely than controls to report sexual initiation ( 2 years CYS , odds ratio [ OR ] = 0.32 ; 1 year , OR = 0.49 ) as well as recent sex ( 2 years CYS , OR = 0.39 ; 1 year CYS , OR = 0.48 ) . Among those who were virgins at seventh grade , 80 % of males in the curriculum-only condition had initiated sex , compared with 61.5 % who received 1 year of CYS , and 50 % who received 2 years . Among females , the figures were 65.2 % , 48.3 % , and 39.6 % , respectively . CONCLUSION A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents Postponing Sexual Involvement ( PSI ) is a widely implemented middle school curriculum design ed to delay the onset of sexual intercourse . In an evaluation of its effectiveness among seventh and eighth grade rs in California , 10,600 youths from schools and community-based organizations statewide were recruited and participated in r and omly assigned intervention or control groups ; the curriculum was implemented by either adult or youth leaders . Survey data were collected before the program was implemented , and at three months and 17 months afterward . At three months , small but statistically significant changes were found in fewer than half of the measured attitudes , behaviors and intentions related to sexual activity ; at 17 months , none of these significant positive effects of the PSI program had been sustained . At neither follow-up were there significant positive changes in sexual behavior ; Youths in treatment and control groups were equally likely to have become sexually active , and youths in treatment groups were not less likely than youths in control groups to report a pregnancy or a sexually transmitted infection . The evaluation suggests that PSI may be too modest in length and scope to have an impact on youths ' sexual behavior Conducted in diverse sociocultural communities in Los Angeles County , the project implemented and evaluated a family life education program design ed to prevent the negative outcomes of risky sexual behavior . A sample of 251 male and female early adolescents 9 through 14 years of age participated with their parents in this abstinence-based adolescent pregnancy prevention program . The project sought to improve parent-child communications and delay the onset of sex-related behaviors through direct involvement of parents in the education process . Naturally occurring community groups were r and omly assigned by site to treatment or delayed treatment conditions in a longitudinal quasi-experimental evaluation design . The evaluation demonstrated significant improvements in communication between parents and children immediately following the intervention ; however , these improvements were no longer present 12 months postintervention . The process and outcome evaluation methods employed in the study triangulated qualitative and quantitative data collection and analysis procedures . This combination provided other sources of data than the traditional outcome measures used in most evaluation studies , thus addressing some of the gaps in present program evaluations . Descriptions of the process evaluation , integrated with the outcome data , are intended to heighten nurses ’ awareness of the importance of this component of research and the rich qualitative data it may yield . The qualitative process components in the project captured the experience of the investigators when they encountered many of the complex challenges that confront research ers who implement and evaluate family life education programs among early adolescents . This experience provided the basis for suggested strategies that nurse clinicians and research ers can use in their work with early adolescents and their parents in clinical - , school- , and community-based setting PURPOSE We evaluated the impact of a positive youth development program on  adolescent pregnancy , sexual behavior , risky sex , and intentions in nonmetropolitan Florida high schools . METHODS Between 2012 and 2014 , the Teen Outreach Program ( TOP ) was compared to st and ard school curriculum content using a cluster r and omized controlled trial design with 7,976 youth in two cohorts . The majority of youth were 14 years old and in the ninth grade at baseline .  Treatment group youth received TOP in health-related classes . After using multiple imputation to account for missing data , we analyzed baseline and follow-up survey data using generalized linear mixed-effects models with logit link function . RESULTS In the cohort 1 sample , compared to the control condition , males and females receiving TOP showed lower odds of engaging in recent sex ( odds ratio [ OR ] , .71 ; 95 % confidence interval [ CI ] : .58-.86 ) compared to control males and females . Cohort 1 treatment females who did engage in recent sex were less likely to have risky sex ( OR , .54 ; 95 % CI : .32-.89 ) . There were fewer significant findings in cohort 2 , though TOP females and combined gender had lower odds of risky sex intentions ( OR , .53 ; 95 % CI : .33-.84 and OR , .65 ; 95 % CI : .44-.96 , respectively ) . Overall , cohort 1 females in the TOP condition were the group most likely to benefit from TOP . CONCLUSIONS Consistent with previous research , TOP was more effective regarding sexual health outcomes among female versus male youth ; this was especially true for the outcome of risky sex . However , results were not consistent across cohorts , prompting questions for future research OBJECTIVES To determine the impact of Positive Prevention PLUS , a school-based adolescent pregnancy prevention program on delaying sexual intercourse , birth control use , and pregnancy . METHODS I r and omly assigned a diverse sample of ninth grade students in 21 suburban public high schools in California into treatment ( n = 2483 ) and control ( n = 1784 ) groups that participated in a clustered r and omized controlled trial . Between October 2013 and May 2014 , participants completed baseline and 6-month follow-up surveys regarding sexual behavior and pregnancy . Participants in the treatment group were offered Positive Prevention PLUS , an 11-lesson adolescent pregnancy prevention program . RESULTS The program had statistically significant impacts on delaying sexual intercourse and increasing the use of birth control . However , I detected no program effect on pregnancy rates at 6-month follow-up . CONCLUSIONS The Positive Prevention PLUS program demonstrated positive impacts on adolescent sexual behavior . This suggests that programs that focus on having students practice risk reduction skills may delay sexual activity and increase birth control use This study evaluated All4You ! , a theoretically based curriculum design ed to reduce sexual risk behaviors associated with HIV , other STDs , and unintended pregnancy among students in alternative 
    Output:
    
Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls