***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 Because universal psychoeducational eating disorder prevention programs have had little success , we developed and evaluated two interventions for high-risk population s : a healthy weight control intervention and a dissonance-based intervention . METHOD Adolescent girls ( N = 148 ) with body image concerns were r and omized to one of these interventions or to a waitlist control group . Participants completed baseline , termination , and 1 , 3 , and 6-month follow-up surveys . RESULTS Participants in both interventions reported decreased thin-ideal internalization , negative affect , and bulimic symptoms at termination and follow-up relative to controls . However , no effects were observed for body dissatisfaction or dieting and effects diminished over time . DISCUSSION Results provide evidence that both interventions effectively reduce bulimic pathology and risk factors for eating disturbances This is the first long-term , controlled study evaluating the effectiveness of a prevention curriculum design ed to modify the eating attitudes and unhealthful weight regulation practice s of young adolescent girls . Nine hundred sixty-seven sixth and seventh- grade girls were r and omized to experimental healthy weight regulation curriculum or no-treatment control classes . A prevention intervention was developed around three principal components : ( 1 ) Instruction on the harmful effects of unhealthful weight regulation ; ( 2 ) promotion of healthful weight regulation through the practice of sound nutrition and dietary principles and regular aerobic physical activity ; ( 3 ) development of coping skills for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting . The intervention failed to achieve the hoped-for impact . We did observe a significant increase in knowledge among girls receiving the intervention and among high-risk students only , there was a small albeit statistically significant effect on body mass index . These findings question the wisdom of providing a curriculum directed at all young adolescents , most of whom are not at risk to develop an eating disorder . Rather than targeting the entire population , a healthy weight curriculum design ed to modify the eating attitudes and unhealthful weight regulation practice s of young adolescent girls might better focus on " at risk " students OBJECTIVE This study compared the efficacy of a media literacy program and a self-esteem program design ed to reduce general and specific risk factors for eating disorders . METHOD Four classes of 86 grade 8 students ( 53 boys and 33 girls ) , mean age of 13 years , were r and omly assigned to either a control condition or one of the two intervention conditions .  Assessment of general and specific risk factors was carried out at baseline , postintervention and 3-month follow-up . RESULTS At postintervention the media literacy group had lower mean scores on weight concern than the control group ( p = 0.007 ) but the self-esteem group did not . There were some differences on self-esteem measures at the 3-month follow-up . DISCUSSION Media literacy programs combined with an interactive , student-centered framework may potentially be a safe and effective way of reducing risk factors for eating disorders . The impact of teaching style needs to be further evaluated in prevention research Many studies document the high prevalence of dieting and abnormal eating behaviors in adolescents and young adults . The age of onset of eating disorders remains unclear because there are no published surveys of voluntary dieting and eating attitudes in young children . A total of 318 girls and boys were surveyed from two r and omly chosen schools in middle-income neighborhoods . The children were equally distributed among grade s 3 through 6 . The survey included a children 's version of the Eating Attitudes Test and a demographic and dieting question naire . Results showed that 45 % of the children wanted to be thinner , 37 % had already tried to lose weight , and 6.9 % scored in the anorexia nervosa range , closely matching the published results concerning teenagers and young adult women . Several questions were isolated by univariate and multiple regression analyses that accurately ( P less than .05 ) predicted children 's Eating Attitude Test scores . The fact that young children admit having diet preoccupation and atypical eating attitudes is shown in this study . It may be possible to improve early case identification of children at risk for anorexia nervosa and perhaps improve intervention strategies by focusing on the early development of dieting behavior in young children OBJECTIVE To determine the morbidity and mortality from childhood Haemophilus influenzae type b ( Hib ) meningitis in a well defined population . DESIGN Retrospective survey 1985 - 1987 and prospect i ve surveillance of hospital laboratories 1989 - 1990 . Information on outcome of meningitis was obtained from hospital records and attending physicians and , in 1989 - 1990 , from a survey of the children 's parents . SETTING Sydney Statistical Division , which had a population of children aged 0 - 4 years of 229,165 in 1986 and 263,758 in 1990 . PATIENTS Eligible children were aged from one month to four years and had clinical and microbiological evidence of Hib meningitis on st and ard criteria . RESULTS There were 229 eligible children . Twelve were excluded ( seven died and five had pre-existing neurological deficits ) . A neurological deficit was detected at the time of hospital discharge in 45 patients ( 21 % ) and persisted for 12 months or longer in 29 patients ( 13 % ) . Follow-up information was available for 165 ( 96 % ) children who were normal at the time of hospital discharge and persistent deficits were recorded in 12 ( 7 % ) of these children . Forty-one children ( 19 % ) had readily recognisable neurological or hearing problems : nine ( 4 % ) had persistent severe neurological deficits and seven ( 3 % ) had severe hearing loss requiring hearing aids or a cochlear implant . Age had a significant influence on outcome . The youngest children were significantly more likely to be admitted to intensive care . Severe neurological deficits showed a significant negative trend with increasing age ( P = 0.03 ) . Severe unilateral or bilateral sensorineural loss ( odds ratio [ OR ] 8.0 , 95 % confidence interval [ CI ] 1.5 - 81 ) and ataxia at discharge ( OR 13.3 , 95 % CI 2.8 - 128 ) were noticeably more common in children over two years of age , with a significant positive trend ( P < or = 0.001 ) with increasing age . Patients requiring intensive care were much more likely to have an adverse outcome , particularly if positive pressure ventilation was needed . CONCLUSIONS These data provide population -based estimates of the minimum incidence of adverse outcomes from Hib meningitis in an urban community with good access to medical services . This is important in assessing the impact of Hib vaccination , as meningitis is responsible for most of the long-term morbidity from childhood invasive Hib disease . Determination of the relationship between morbidity and age is important for assessing alternative vaccine strategies OBJECTIVE To evaluate a community-based intervention aim ed at the primary prevention of disordered eating among preadolescent girls . DESIGN Girl Scout troop members were r and omized into control and intervention groups . Program feasibility and effect at postintervention and 3-month follow-up were evaluated . SUBJECTS/ SETTING 226 girls ( mean age = 10.6 years , st and ard deviation = 0.7 ) from 24 Girl Scout troops . INTERVENTION Six 90-minute sessions focusing on media literacy and advocacy skills . MAIN OUTCOME MEASURES Evaluation focused on program satisfaction and short-term effect on dieting behaviors , body image attitudes , and media knowledge , attitudes , and habits . STATISTICAL ANALYSES Performed t tests , chi 2 tests , and analyses of covariance including troop as a r and om source of variation . RESULTS At baseline , 29 % of the girls were trying to lose weight . The program had a notable positive influence on media-related attitudes and behaviors including internalization of sociocultural ideals , self-efficacy to impact weight-related social norms , and print media habits . A modest program effect on body-related knowledge and attitudes was apparent at post-intervention ( i.e. , on body size acceptance , puberty knowledge , and perceived weight status ) but not at follow-up . Significant changes were not noted for dieting behaviors , but they were in the hypothesized direction . Satisfaction with the program was high among girls , parents , and leaders . APPLICATIONS/ CONCLUSIONS It is feasible to use community youth setting s , such as the Girl Scouts , to implement interventions to prevent disordered eating behaviors . The program led to positive trends in outcome variables ; however , longer and more intensive interventions are needed for lasting changes in body image and dieting behaviors OBJECTIVE The study compared the efficacy of self-help without and with guidance ( referred to as ' pure ' and ' guided ' self-help ) , using a cognitive behavioral self-help manual ( Fairburn , 1995 ) for binge eating . DESIGN AND METHODS A sample of 31 participants with bulimia nervosa , subthreshold bulimia nervosa and binge-eating disorder were assigned r and omly to one of the self-help levels for 16 weeks , after four weeks of baseline observations . RESULTS The results indicated that both forms of self-help treatments had a modestly positive and sustained effect on the participants ' eating problems . Intention-to-treat analyses showed that participants reduced their mean number of objective bulimic episodes and purging behaviour by 33 % and 17 % over the course of the treatment . The corresponding reduction levels for the treatment completers ( N = 18 ) were 58 % and 61 % , respectively . Furthermore , there were no significant differences between the pure and guided self-help groups in terms of outcome , reflecting the probable in significance of guidance for the broader group of individuals with binge-eating problems . At follow-up , no further significant improvement or deterioration was observed in the ensuing six months compared with the post-treatment data . CONCLUSION Given the heterogeneity of the diagnostic groups in the present study , result ing in high external validity , and the conservative nature of the analyses , self-help is discussed as a viable means of initial treatment for binge eating Many variables have been suggested as possible risk factors for eating disorders ( ED ) , although the validity of these suggestions has seldom been tested causally . The current study tested a pathway model for the development of ED using prospect i ve data from a r and omly selected sample of 807 women , aged 18 - 32 years , from the general population of Sweden . Data was collected using self-report question naires with well-established psychometric properties . The cardinal symptoms of binge eating , purging , and fear of weight gain according to the DSM-IV characterized ED . Data supported the hypothesized model suggesting that low self-esteem , low perceived social support from the family , high levels of body concern , and high relative use of escape avoidance coping constitute a risk profile for later development of ED . Given the results and the fact that these risk factors can be modified , their practical utility and clinical significance should be examined in prevention studies OBJECTIVE This study aim ed to evaluate the effect of a six-session psychoeducation ( PE ) program on young women with type 1 diabetes mellitus ( DM ) and disordered eating attitudes and behavior . METHOD Two hundred twelve young women attending a pediatric diabetes clinic were screened for signs of eating disturbance . Of these women , 130 passed the screening and were invited to participate in the intervention phase of the study . Eighty-five subjects were r and omized to the PE or treatment-as-usual group .  Assessment s were conducted before and after treatment and at 6-month follow-up . RESULTS Intention-to-treat group by time multivariate analyses of variance ( MANOVAs ) indicated significant reductions following PE treatment on the Restraint and Eating Concern subscales of the Eating Disorder Examination ( EDE ) and on the Drive for Thinness and Body Dissatisfaction subscales of the Eating Disorder Inventory ( EDI ) , but no improvement in frequency of purging by insulin omission or hemoglobin A1c levels . DISCUSSION The PE group was associated with reductions in eating disturbance , but not with improved metabolic control Subsequent to an epidemiological study on eating behaviour in adolescents , a prospect i ve study was carried out to examine the effect of health promotion lessons on disturbed eating behaviour . From the original sample ( t1 , n=1944 ) , a subgroup of 314 students of both sexes , 14–19 years of age , was selected . Participants came from a total of 20 classes in which a high percentage of students exhibited disturbed eating behaviour . Ten classes were then r and omly selected to receive health promotion lessons ( intervention group , high‐risk ; IGHR ) , while the other 10 classes served as controls ( control group , high‐risk ; CGHR ) . The Eating Attitudes Test ( EAT‐26 ) , the Giessen Physical Complaint List for Children and Adolescents ( GSCL‐C ) and the Self‐Report Symptom Check‐List ( SCL‐90‐R ) were administered shortly before ( t2 ) and 3 months after ( t3 ) the interventions . The three health promotion lessons dealt with issues concerning beauty ideals , gender differences in psychosexual maturation and body awareness , healthy eating behaviour , physiology of nutrition , early symptoms of eating disorders and therapeutic approaches . The data analyses revealed an improvement on all three symptom scales for both groups between t2 and t3 , but there were no significant differences between the IGHR and CGHR groups . When data from high‐scoring female participants only were analysed ( HRf‐IGHR and HRf‐CGHR ) , the multivariate analysis revealed a significant interaction between time and group ( 15.2 % 
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Trials must include a control group and at least one objective outcome measure ( eg .
However , there is insufficient evidence to conclude that this approach also demonstrated a significant impact on awareness of societal st and ards relating to appearance .
In relation to potential harmful effects , there is not sufficient evidence to suggest that harm result ed from any of the prevention programs included in the review .
REVIEW ER 'S CONCLUSIONS The one significant pooled effect in the current review does not allow for any firm conclusions to be made about the impact of prevention programs for eating disorders in children and adolescents , although none of the pooled comparisons indicated evidence of harm .