***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 
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    ***EXAMPLES*** 
    Input: Background The effectiveness of bracing patients with IS has not yet been convincingly established due to a lack of RCTs . Some authors suggest that their results confirm that bracing is effective ; others conclude that the effectiveness of bracing is doubtful or recommend a RCT . The aim of this study was to establish whether bracing patients with idiopathic scoliosis ( IS ) in an early stage will result in at least 5 degrees less mean progression of the curvature compared to the control group after two years of follow-up . Methods A r and omized controlled trial was design ed . Eligible patients are girls and boys in the age group 8–15 years whose diagnosis of IS has been established by an orthopedic surgeon , who have not yet been treated by bracing or surgery , and for whom further growth of physical height is still expected based on medical examination and maturation characteristics ( Risser ≤ 2 ) . The Cobb angle of the eligible patient should either be minimally 22 and maximally 29 degrees with established progression of more than 5 degrees , or should be minimally 30 and maximally 35 degrees ; established progression for the latter is not necessary . A total of 100 patients will be included in this trial . The intervention group will be treated with full-time Boston brace wear ; the control group will not be braced . Every four months , each patient will have a physical and an X-ray examination . The main outcomes will be the Cobb angle two years after inclusion and health-related quality of life . Discussion The results of this trial will be of great importance for the discussion on early treatment for scoliosis . Furthermore , the result will also be important for screening for scoliosis policies . Trial registration Nederl and s Trialregister IS RCT Study Design . A consecutive series of female patients with adolescent idiopathic scoliosis treated between 1968 and 1977 , either with distraction and fusion using Harrington rods ( n = 145 ) or with a brace ( n = 122 ) , were followed for at least 20 years after completion of the treatment . Objectives . To determine the long-term outcomes of childbearing and sexual life in women treated for adolescent idiopathic scoliosis , as compared with matched control subjects who did not have scoliosis . Summary of Background Data . The effect of pregnancy on curve progression is not established , and results are contradictory . Few reports exist on the social life ( marriage , childbearing , and sexual function ) of formerly treated individuals with scoliosis . Methods . In this study , 136 surgically treated women ( 94 % ) and 111 brace-treated women ( 91 % ) completed the Scoliosis Research Society (SRS)/MODEM ’s question naire concerning childbearing and sexual life as a part of an unbiased personal follow-up examination . Of these , 129 surgically treated and 105 brace-treated women also underwent a radiographic examination . The Cobb method was used to measure curve size in present and earlier examinations . An age-matched control group of 90 women was r and omly selected and subjected to the same examinations . Results . The mean age for all the groups was 40 years . Of the surgically treated and brace-treated women , 85 % were or had been married  , as compared with 82 % of the control women . In the total cohort , 628 pregnancies had occurred . No significant mean difference existed between the groups in the number of children born ( 1.8 for the surgically treated , 1.9 for the brace-treated , and 2 for the control women ) ( P = 0.25 ) . The patients in the brace-treated group had a significantly higher mean age at first pregnancy ( 28 years ) than the control subjects ( 25.9 years ) ( P = 0.011 ) , whereas the age for the surgically treated women ( 26.6 years ) did not differ significantly from that for the brace-treated women . There were no significant differences between the groups in rates for low back pain ( 35 % for the surgically treated , 43 % for the brace-treated , and 28 % for the control group ) or for cesarean section ( 19 % for the surgically treated , 14 % for the brace-treated , and 18 % for the control group ) during the first pregnancy . The rate of vacuum extraction s was higher in the surgically treated group ( 16 % ) than in thecontrol group ( 5 % ) ( P = 0.036 ) or the brace-treated group(8 % ) . Limitation of sexual function from the back was admitted by 33 % of the surgically treated , 28 % of the brace-treated , and 15 % of the control women : surgically treated vs control subjects ( P = 0.0042 ) , brace-treated vs control subjects ( P = 0.026 ) , and brace-treated vs surgically treated subjects ( P = 0.57 , a nonsignificant difference ) . These limitations were largely because of difficulties participating physically in activities or self-consciousness about appearance . Pain was a minor reason for limitation . There was no correlation between progression of the major or lumbar curve and number of pregnancies , or between curve progression and age at first pregnancy . Conclusions . Patients treated for adolescent idiopathic scoliosis appeared to function well with regard to marital status and number of children . The scoliotic curve did not seem to increase as a result of childbearing . Minor problems occurred during pregnancy and delivery . Some patients , however , experienced a slight negative effect in their sexual life Abstract In a 5-year prospect i ve study on idiopathic scoliosis , an attempt was made to eluci date the natural history of the disease and to determine which factors contribute to curve progression . A total of 85,622 children were examined for scoliosis in a prospect i ve school screening study carried out in northwestern and central Greece . Curve progression was studied in 839 of the 1,436 children with idiopathic scoliosis of at least 10 ° detected from the school screening program .  Each child was followed clinical ly and roentgenographically for one to four follow-up visits for a mean of 3.2 years . Progression of the scoliotic curve was recorded in 14.7 % of the children . Spontaneous improvement of at least 5 ° was observed in 27.4 % of them , with 80 children ( 9.5 % ) demonstrating complete spontaneous resolution . Eighteen percent of the patients remained stable , while the remaining patients demonstrated nonsignificant changes of less than 5 ° in curve magnitude . A strong association was observed between the incidence of progression and the sex of the child , curve pattern , maturity , and to a lesser extent age and curve magnitude . More specifically , the following were associated with a high risk of curve progression : sex ( girls ) ; curve pattern ( right thoracic and double curves in girls , and right lumbar curves in boys ) ; maturity ( girls before the onset of menses ) ; age ( time of pubertal growth spurt ) ; and curve magnitude ( ≥ 30 ° ) . On the other h and , left thoracic curves showed a weak tendency for progression . In conclusion , the findings of the present study strongly suggest that only a small percentage of scoliotic curves will undergo progression . The pattern of the curve according to curve direction and sex of the child was found to be a key indicator of which curves will progress BACKGROUND CONTEXT The value of scoliosis screening has been recently shown in a multicenter r and omized controlled trial . However , the long-term sustainability of the clinical effectiveness of scoliosis screening as a routine health service remains unknown . PURPOSE The aim of this study was to assess the sustainability of the clinical effectiveness of  school scoliosis screening .  STUDY DESIGN / SETTING A large population -based cohort study with a 10-year follow-up was conducted . PATIENT SAMPLE A total of 394,401 students who were in the fifth grade during the five academic years from 1995/1996 to 1999/2000 formed five consecutive annual cohorts . The students were eligible for the Hong Kong scoliosis screening program , with their screening history and medical records until their nineteenth birthdays being assessed . OUTCOME MEASURES The outcome measures considered in the study were development of adolescent idiopathic scoliosis by the 19 years of age and the Cobb angle . METHODS The clinical effectiveness of  scoliosis screening  was assessed by referral rate for radiographic diagnosis , sensitivity , specificity , and predictive values . RESULTS A total of 306,144 students ( 78 % ) participated in scoliosis screening , which used a two-tier system . The prevalence of curves of 20 ° or greater was 1.8 % ( 95 % confidence interval [ CI ] , 1.7 - 1.8 % ) , whereas the referral rate for radiography , the sensitivity , and the positive predictive value ( PPV ) for curves of 20 ° or greater were 4.1 % ( 95 % CI , 4.0 - 4.2 % ) , 91 % ( 95 % CI , 90 - 92 % ) , and 40 % ( 95 % CI , 39 - 41 % ) , respectively . Across the five consecutive annual cohorts , the prevalence and sensitivity for curves of 20 ° or greater increased by 0.23 % ( 95 % CI , 0.21 - 0.25 % ; p<.001 ) and 0.76 % ( 95 % CI , 0.43 - 1.04 % ; p<.001 ) per year , respectively ; however , the PPV was reduced by 1.71 % ( 95 % CI , 1.09 - 2.33 % ; p<.001 ) per year . CONCLUSIONS This report describes the first large population -based study with a long-term follow-up indicating that a scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation . As the prevalence of adolescent idiopathic scoliosis increases , scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy Abstract . No results on long-term outcome in terms of health-related quality of life ( HRQL ) have previously been presented for patients treated for adolescent idiopathic scoliosis . A consecutive series of patients with adolescent idiopathic scoliosis , treated between 1968 and 1977 before the age of 21 , either with distraction and fusion using Harrington rods [ surgical treatment group ( ST ) , n=156 ; 145 females and 11 males ] or with a brace [ brace treatment group ( BT ) , n=127 ; 122 females and 5 males ] were followed at least 20 years after completion of the treatment . Ninety-four percent of ST and 91 % of BT patients filled in a question naire comprising the SF-36 , Psychological General Well-Being Index ( PGWB ) , Oswestry Disability Back Pain Question naire , parts of SRS/MODEM 'S question naire and study -specific questions concerning the treatment , as a part of an unbiased personal follow-up examination including radiography and clinical examination . An age- and sex-matched control group of 100 persons was r and omly selected and subjected to the same examinations . The results showed no differences in terms of sociodemographic data between the groups . Both ST and BT patients had a slightly , but significantly , reduced physical function using the SF-36 subscales , SF-36/Physical Component Summary ( PCS ) score as well as the Oswestry Disability Back Pain Question naire compared to the controls . Neither the mental subscales and the Mental Component Summary ( MCS ) score of SF-36 nor the PGWB index showed any significant difference between the groups . Forty-nine percent of ST , 34 % of BT and 15 % of controls admitted limitation of social activities due to their back [ P<0.001 ST vs controls , P=0.0010 BT vs controls , and n.s . ( P=0.024 ) ST vs BT ] , mostly due to difficulties with physical participation in activities or self-consciousness about appearance . Pain was a minor reason for limitation . No correlation was found between the outcome scores and curve size after treatment , curve type , total treatment time or age at completed treatment .  Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population . A minority of the patients ( 4 % ) had a severely decreased psychological well-being , and a few ( 1.5 % ) were severely physically disabled due to the back In a study conducted by the Scoliosis Research Society , 159 girls with a mean age of thirteen years ( range , ten to fifteen years ) who had adolescent idiopathic scoliosis were followed prospect ively until skeletal maturity or until the curve had increased 6 degrees or more . All patients had had an initial curve of 25 to 35 degrees and an apical level between the eighth thoracic and first lumbar vertebrae , inclusive . Of the 159 patients , 120 were observed without treatment and thirty-nine were managed with lateral electrical surface stimulation .  The curve progressed at least 6 degrees in eighty patients . There was no apparent difference in the outcome between the patients who were managed with observation only and those who were given electrical stimulation .  Logistic regression analysis was performed to determine which of eleven factors were predictive of progression of the scoliotic curve . A Risser sign of 0 or 1 , an apical level cephalad to the twelfth thoracic vertebra , and an imbalance of ten millimeters or less were found to be independently prognostic of progression of more than 6 degrees . A prognostic model that included these three factors and chronological age allowed correct classification of the curve as either progressive or non-progressive in 81 per cent of these patients who had a thoracic or thoracol 
    Output:
    
There was no evidence on the effect of AIS screening on adult health outcomes .
Conclusions and Relevance Screening can detect AIS .
Bracing and possibly exercise treatment can interrupt or slow progression of curvature in adolescence .
However , there is little or no evidence on long-term outcomes for AIS treated in adolescence , the association between curvature at skeletal maturity and adult health outcomes , the harms of AIS screening or treatment , or the effect of AIS screening on adult health outcomes