***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 Brief interventions for  problem drinking  in medical setting s are effective but rarely conducted , mainly due to insufficient time . A stepped care approach ( starting with a very brief intervention and intensifying efforts in case of no success ) could save re sources and enlarge effectiveness ; however , research is lacking . The present study compares a full care brief intervention for patients with at-risk drinking , alcohol abuse or dependence with a stepped care approach in a r and omized controlled trial . METHODS Participants were proactively recruited from general practice s in two northern German cities . In total , 10,803 screenings were conducted ( refusal rate : 5 % ) . Alcohol use disorders according to DSM-IV were assessed with the Munich-Composite International Diagnostic Interview ( M-CIDI ) . Eligible participants were r and omly assigned to one of three conditions : ( 1 ) stepped care ( SC ) : a computerized intervention plus up to three 40-min telephone-based interventions depending on the success of the previous intervention ; ( 2 ) full-care ( FC ) : a computerized intervention plus a fixed number of four 30-min telephone-based interventions that equals the maximum of the stepped care intervention ; ( 3 ) an untreated control group ( CG ) .  Counseling effort in the intervention conditions and quantity/frequency of drinking were assessed at 12-month follow-up . RESULTS SC participants received roughly half of the amount of intervention in minutes compared to FC participants . Both groups did not differ in drinking outcomes . Compared to CG , intervention showed small to medium effect size for at-risk drinkers . CONCLUSIONS Study results reveal that a stepped care approach can be expected to increase cost-effectiveness of brief interventions for individuals with at-risk drinking STUDY OBJECTIVE This study compares the effect of a brief motivational intervention for alcohol plus a booster given to emergency department ( ED ) patients with subcritical injuries from a motor vehicle crash with the effect of brief motivational intervention for alcohol plus a booster in patients treated for non-motor vehicle crash-related injuries . METHODS A r and omized controlled trial ( n=539 ) was conducted at an urban Level I trauma center of brief intervention ( 1 ED session of brief intervention ) , brief motivational intervention for alcohol plus a booster ( 1 ED session plus booster session ) , or st and ard care for injured ED patients with an alcohol use problem who were being discharged home . At 12 months , alcohol-related negative consequences and injuries were measured . We performed a secondary analysis comparing motor vehicle crash-injured patients and non-motor vehicle crash-injured patients in the study sample . RESULTS Subcritically injured ED patients with harmful or hazardous alcohol use who received brief motivational intervention for alcohol plus a booster had fewer alcohol-related negative consequences and alcohol-related injuries than those receiving brief intervention or st and ard care at 12-month follow-up ( previously reported ) . A secondary analysis of this result showed that motor vehicle crash patients ( n=133 ) given brief motivational intervention for alcohol plus a booster ( n=34 ) had fewer alcohol-related injuries than those receiving st and ard care ( n=46 ; P = .001 ) . Moreover , there were no significant differences in alcohol-related injuries among the non-motor vehicle crash-injured patients who received brief intervention or st and ard care . CONCLUSION Brief motivational intervention for alcohol plus a booster is a useful intervention for subcritically injured ED patients with harmful or hazardous alcohol use . Its effects may be moderated by the cause of injury OBJECTIVE Alcohol screening and brief intervention ( SBI ) has gained widespread acceptance as an effective method for reducing problem drinking in at-risk population s. This study examines the cost and cost-effectiveness of an SBI pilot program delivered in an inner-city hospital emergency department ( ED ) to a traditionally underserved population . METHOD A total of 1,036 subjects were screened for problem drinking during their visit to an ED . Eligible participants ( N = 294 ) were r and omly assigned to either a brief intervention group or a control group . As the result of attrition , a final sample of 194 ( 90 brief intervention ; 104 control ) participants remained at follow-up . The intervention consisted of a brief counseling session and a health information packet . The control group received only the packet .  Intervention cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program . Selected outcomes at the 3-month follow-up included the raw Alcohol Use Disorders Identification Test score , average weekly number of drinks and engaging in heavy drinking in the past month ( > 6 drinks on one occasion for men , > 4 for women ) . Outcome differences between the intervention and control groups were estimated with both bivariate and multivariate techniques . RESULTS The average economic cost of the brief intervention was dollars 632 per subject , of which screening ( dollars 497 ) was the largest component . In all cases , intervention subjects had better 3-month outcomes than control subjects , but the differences were not always statistically significant . Cost-effectiveness ratios were relatively small for all three outcomes , suggesting this type of intervention has the potential to be cost-effective under full implementation . CONCLUSIONS The preliminary results demonstrate the potential advantage of further research in this area with larger sample s and a longer follow-up period AIM To establish the efficacy of a brief motivational intervention compared to feedback only when delivered in an emergency department for reducing alcohol use and problems among young adults . DESIGN Two-group r and omized controlled trial with follow-up assessment s at 6 and 12 months . SETTING Level I Trauma Center . PARTICIPANTS A total of 198 18 - 24-year-old patients who were either alcohol positive upon hospital admission or met screening criteria for alcohol problems . INTERVENTION Participants were assigned r and omly to receive a one-session motivational intervention ( MI ) that included personalized feedback , or the personalized feedback report only ( FO ) . All participants received additional telephone contact 1 month and 3 months after baseline . MEASUREMENTS Demographic information , alcohol use , alcohol problems and treatment seeking . FINDINGS Six months after the intervention MI participants drank on fewer days , had fewer heavy drinking days and drank fewer drinks per week in the past month than did FO patients . These effects were maintained at 12 months . Clinical significance evaluation indicated that twice as many MI participants as FO participants reliably reduced their volume of alcohol consumption from baseline to 12 months . Reductions in alcohol-related injuries and moving violations , and increases in alcohol treatment-seeking were observed across both conditions at both follow-ups with no differences between conditions . CONCLUSIONS This study provides new data supporting the potential of the motivational intervention tested to reduce alcohol consumption among high-risk youth AIMS This study aim ed at testing the effectiveness of a brief motivational intervention ( BI ) compared with a minimal intervention ( MI ) for reducing alcohol consumption in adult , alcohol-positive traffic casualties . METHODS Patients were recruited at the emergency room of a trauma hospital and screened for alcohol by a qualitative saliva test ( positive from a blood alcohol concentration of 0.02 g/l ) . Positive patients ( 13.3 % ) who accepted entering the study were r and omly allocated into BI and MI . Baseline assessment was the same for all patients . Blind telephone follow-ups were performed at months 3 , 6 , and 12 , and results were analysed by protocol and by intention-to-treat analysis . RESULTS After 1 year of follow-up , 67 % of the patients had reduced their consumption , the percentage of heavy drinkers had dropped by 47 % , and 62 % of baseline AUDIT-C positive patients ( hazardous drinkers ) had become negative . Binge drinking dropped significantly ( P < 0.05 ) . Results at month 12 were in line with the previous ones . CONCLUSIONS The effectiveness of BI compared with MI has not been verified , but a significant reduction in consumption has been observed in the whole sample , without significant differences by type of intervention . The persistence and dimension of changes suggest a real effect of both interventions , although the lack of a pure control group does not allow definitive conclusions . Traffic casualties are in a teachable moments to benefit from easy and cheap interventions Objectives : Brief intervention for excessive alcohol consumption is effective yet not implemented widely . Alcohol misuse is implicated in unsafe sex and sexually transmitted infections and is common in clients of sexual health services . Our aims were to assess feasibility , acceptability and effectiveness of screening and brief intervention for risky alcohol consumption by a nurse in a sexual health clinic . Methods : Patients completed the AUDIT question naire on h and held computers . Those scoring ⩾8 on AUDIT were asked to participate in the study and the 3 months ’ follow-up and were r and omised to intervention or control groups . The Drink-less package ( based on WHO vali date d methods ) was used to implement the brief intervention by a trained registered nurse . Results : Of 519 ( 87 % ) who completed screening , 204 ( 39 % ) scored ⩾8 on AUDIT ( eligible ) , 184 agreed to follow-up and 133 completed it . At follow-up , both groups showed significant reductions in AUDIT scores . Mean scores decreased from 13.7 to 11.5 ( control group ) and 14.0 to 10.7 ( intervention group ) ; most ( 94 % ) recalled the intervention and 62 % reported reducing drinking compared with 47 % of controls ( p<0.001 ) . The nurse screening and intervention process was reported acceptable by 74 % of patients at follow-up and a majority ( 71 % ) of staff . Conclusions : Screening and brief intervention in a sexual health clinic for risky alcohol consumption is feasible , acceptable and effective in producing significant reductions in drinking as measured by AUDIT . Both intervention and control  groups decreased consumption , suggesting that screening alone is sufficient to influence behaviour . Further study of brief intervention in this setting is appropriate OBJECTIVE To identify predictors of smoking cessation success or failure with and without  transdermal nicotine patch treatment . DESIGN Two independent r and omized , double-blind , placebo-controlled studies using the nicotine patch assessing outcome at the end of treatment and at 6-month follow-up ; each study used a different mode of adjuvant counseling . PATIENTS Subjects were daily smokers ( > or = 15 cigarettes per day ) , aged 21 to 65 years with expired air carbon monoxide levels of at least 10 ppm , and motivated to quit . Eighty-eight subjects participated in study 1 , and 112 subjects participated in study 2 . INTERVENTION Study 1 consisted of 8 weeks of 22-mg nicotine patch therapy with intensive group counseling . Study 2 consisted of 4 weeks of 22-mg nicotine patch therapy and 2 weeks of 11-mg nicotine patch therapy with brief individual counseling . MAIN OUTCOME MEASURES The prediction of smoking cessation ( at end of treatment and after 6 months ) based on pretreatment and intratreatment measures in smokers using  active or placebo nicotine patches . RESULTS Pretreatment markers , such as the Fagerstrom Tolerance Question naire score , number of cigarettes smoked per day , years smoked , expired air carbon monoxide level , or baseline blood nicotine and cotinine levels , showed no consistent relationship with successful smoking cessation across both studies . Of the intratreatment markers examined , withdrawal severity and nicotine replacement levels also were not consistently predictive of cessation success . However , any smoking during the second week of treatment was a consistent and powerful predictor of failure at the end of treatment and after 6 months . Among active nicotine patch patients who smoked at all during week 2 after quitting , 83 % and 97 % ( studies 1 and 2 , respectively ) were smoking at 6-month follow-up . Conversely , abstinence during the second week of treatment predicted successful smoking cessation . Among active nicotine patch patients who were totally abstinent during week 2 after quitting , 46 % and 41 % ( studies 1 and 2 , respectively ) were abstinent at 6-month follow-up . Of all nicotine patch patients in both studies who were smoking at 6-month follow-up , 74 % began smoking during week 1 or 2 . Among all placebo patch patients who were smoking at 6-month follow-up , 86 % began smoking during week 1 or 2 . CONCLUSIONS Smoking status ( abstinent or smoking ) during the first 2 weeks of nicotine patch therapy , particularly week 2 , was highly correlated with clinical outcome and can serve as a powerful predictor of smoking cessation . Early smoking behavior also predicted outcome among placebo patch users . Traditional measures of dependence are not consistently predictive of cessation success . Clinicians are advised to emphasize the importance of  total abstinence  after a quit attempt and to follow-up with patients within the first 2 weeks of quitting ; smoking during this critical time should be assessed and treatment may be altered as appropriate Risk factors associated with the progression from impaired glucose tolerance ( IGT ) to NIDDM were examined in data from six prospect i ve studies . IGT and NIDDM were defined in all studies by World Health Organization ( WHO ) criteria , and baseline risk factors were measured at the time of first recognition of IGT . The studies varied in size from 177 to 693 participants with IGT , and included men and women followed from 2 to 27 years after the recognition of IGT . Across the six studies , the incidence rate of NIDDM was 57.2/1,000 person-years and ranged from 35.8/1,000 to 87.3/1,000 person-years . Although baseline measures of fasting and 2-h postchallenge glucose levels were 
    Output:
    
Extended intervention when compared with brief intervention was associated with a non-significantly greater reduction in alcohol consumption ( mean difference = -28 , 95%CI : -62 to 6 grams/week , I2 = 0 % ) AUTHORS ' CONCLUSIONS Brief interventions consistently produced reductions in alcohol consumption .
When data were available by gender , the effect was clear in men at one year of follow up , but unproven in women .
Longer duration of counselling probably has little additional effect .