***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 Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers General practice is in an ideal position to encourage people to adopt healthier lifestyles . One way in which this might be achieved is through the offering of health checks . This paper sought to identify some of the factors which may be important in predicting the uptake of health checks . These were seen to fall into two broad areas --the way in which patients are invited and patients ' health beliefs . For the purpose s of the study , 299 middle-aged male patients registered at a single practice were r and omly allocated to be invited to a health check via two invitation methods . In the first , patients were sent an invitation letter with an appointment . In the second patients ' notes were tagged so that they could be invited opportunistically by their GP . After one year , 63.5 % of patients invited opportunistically had attended a health check compared with 61.2 % of patients sent an invitation letter . However , only 51.6 % of the opportunistic group had been invited after one year , meaning that the letter invitation method produced twice as many patients at the health check over the same period of time . Examination of health belief question naires sent to patients prior to the commencement of the health checks ( 50.2 % response rate ) indicated that attenders had a stronger initial intention to attend and placed a greater value on their health . More detailed analysis revealed intention to show strong relationships with beliefs about the benefits of , and barriers to , attendance at a health check . These results suggest that in order to increase uptake of health checks letter invitations need to be employed . ( ABSTRACT TRUNCATED AT 250 WORDS The 1990 contract for general practitioners in the UK offered incentives for them to organize health promotion clinics and required them to perform ' lifestyle ' checkups of their patients every 3 years , despite uncertainty about the impact of such checks on patient health . To address this lack of appropriate evaluation , a follow-up study to assess benefits in terms of patient behaviour and health result ing from the introduction of lifestyle checkups in general practice in a sample of more than 7000 patients aged 30 - 70 from 18 practice s in three FHSA areas ( in south London , Surrey and Yorkshire ) has been performed . Eighteen per cent of the r and om sample of patients reported having a health check in the previous year . A full health check comprising measurement of blood pressure , height and weight , urinalysis and question ing about smoking habits , alcohol consumption , exercise , diet and family illnesses had been given to 29 % of respondents reporting a health check of any kind . Respondents in less privileged socioeconomic groups were more likely to have had a health check , but less likely to have had a ' full ' check . Reactions to the checks were mainly positive ; 81 % regarded the check as helpful , and only 6 % reported it to be worrying and 6 % a waste of time . The implication s for the new health promotion b and ing system in the UK are discussed OBJECTIVE To study characteristics of importance for participation in a diet and physical exercise prevention programme . SETTING Primary Health Care , Sollentuna , and the Karolinska Hospital , Stockholm , Sweden . SUBJECTS A sample of 187 men , aged 35 - 60 , with increased risk factors for CHD , were invited to a 6-month  prevention programme .  Participants ( n = 158 ) were r and omized into a  diet group , a physical exercise group , a diet and physical exercise group , and a control group . Twenty-seven men , who declined participation , formed the group of non participants . DESIGN Participants and non participants were compared with respect to health beliefs , health knowledge , CHD risk factors , demographic and personality factors . MAIN OUTCOME MEASURES Characteristics of men participating and not participating in the intervention trial . RESULTS Non participants , compared with participants , believed less in the benefits of dietary change  and perceived the health threat of stroke and myocardial infa rct ion as less serious . Non participants had a better knowledge of a number of risk factors for cardiovascular disease . CONCLUSION Belief in treatment efficacy and perceived health threat , rather than health knowledge , predicted initial participation in a non-pharmacological intervention trial Background We describe the design and present the results of the first year of a population -based study of screening for type 2 diabetes in individuals at high risk of developing the disease . High risk is defined as having abdominal obesity . Methods Between 2006 and 2007 , 79,142 inhabitants of two Dutch municipalities aged 40–74 years were approached to participate in screening . Eligible participants had a self-reported waist circumference of ≥80 cm for women and ≥94 cm for men , and no known pre-existing diabetes . Of the respondents ( n = 20,578 ; response rate 26 % ) , 16,135 were abdominally obese . In total , 10,609 individuals gave written informed consent for participation and were r and omized into either the screening ( n = 5305 ) or the control arm ( n = 5304 ) . Participants in the screening arm were invited to have  their fasting plasma glucose ( FPG ) measured and were referred to their general practitioner ( GP ) if it was ≥6.1 mmol/L. In addition , blood lipids were determined in the screening arm , because abdominal obesity is often associated with cardiovascular risk factors . Participants in both arms received written healthy lifestyle information . Between-group differences were analyzed with Chi-square tests and logistic regression ( categorical variables ) and unpaired t-tests ( continuous variables ) . Results The screening attendance rate was 84.1 % . Attending screening was associated with age at r and omization ( OR = 1.03 , 95 % CI 1.02 - 1.04 ) , being married ( OR = 1.57 , 95 % CI 1.33 - 1.83 ) and not-smoking currently ( OR = 0.52 , 95 % CI 0.44 - 0.62 ) . Of the individuals screened , 5.6 % had hyperglycemia , and a further 11.6 % had an estimated absolute cardiovascular disease risk of 5 % or higher , according to the Systematic Coronary Risk Evaluation risk model . These participants were referred to their GP . Conclusions Self-reported home-assessed waist circumference could feasibly detect persons at high risk of hyperglycemia or cardiovascular disease . Continuation of the large-scale RCT is warranted to test the hypothesis that targeted population -based screening for type 2 diabetes leads to a significant reduction in cardiovascular morbidity and mortality . Trial registration IS RCT Objective To compare the effect of an invitation promoting informed choice for screening with a st and ard invitation on attendance and motivation to engage in preventive action . Design R and omised controlled trial . Setting Four English general practice s. Participants 1272 people aged 40 - 69 years , at risk for diabetes , identified from practice registers using a vali date d risk score and invited to attend for screening . Intervention Intervention was a previously vali date d invitation to inform the decision to attend screening , presenting diabetes as a serious potential problem , and providing details of possible costs and benefits of screening and treatment in text and pie charts . This was compared with a brief , st and ard invitation simply describing diabetes as a serious potential problem . Main outcome measures The primary end point was attendance for screening . The secondary outcome measures were intention to make changes to lifestyle and satisfaction with decisions made among attenders . Results The primary end point was analysed for all 1272 participants . 55.8 % ( 353/633 ) of those in the informed choice group attended for screening , compared with 57.6 % ( 368/639 ) in the st and ard invitation group ( mean difference −1.8 % , 95 % confidence interval −7.3 % to 3.6 % ; P=0.51 ) . Attendance was lower among the more deprived group ( most deprived third 47.5 % v least deprived third 64.3 % ; P<0.001 ) . Interaction between deprivation and effect of invitation type on attendance was not significant . Among attenders , intention to change behaviour was strong and unaffected by invitation type . Conclusions Providing information to support choice did not adversely affect attendance for screening for diabetes . Those from more socially deprived groups were , however , less likely to attend , regardless of the type of invitation received . Further attention to invitation content alone is unlikely to achieve equity in uptake of preventive services . Trial registration Current Controlled Trials IS RCT N 73125647 Objectives Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease ( CVD ) risk factor recording in primary care , uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup . Design Cross-sectional study . Setting Nine UK general practice s. Participants 7987 people aged 50–74 years with no CVD diagnosis . Methods CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records . Where there was insufficient information to calculate risk , patients were invited to attend a screening assessment . Analysis Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated ; proportion of patients invited to screening who attended ; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high ( > 20 % ) . For each outcome , a set of logistic regression models were run . Crude and adjusted ORs were estimated for person-level deprivation , age , gender and smoking status . We included practice -level deprivation as a continuous variable and practice as a r and om effect to account for clustering . Results People who had lower  Indices of Multiple Deprivation ( IMD ) scores ( less deprived ) had significantly worse routine CVD risk factor recording ( adjusted OR 0.97 ( 0.95 to 1.00 ) per IMD decile ; p=0.042 ) . Screening attendance was poorer in those with more deprivation ( adjusted OR 0.89 ( 0.86 to 0.91 ) per IMD decile ; p<0.001 ) . Among those who attended screening , the most deprived were more likely to have CVD risk > 20 % ( OR 1.09 ( 1.03 to 1.15 ) per IMD decile ; p=0.004 ) . Conclusions Our data suggest that those who had the most to gain from screening were least likely to attend , potentially exacerbating existing health inequalities . Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups Objective To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level . Design R and omised controlled community based trial . Setting Suburbs of Copenhagen , Denmark Participants 59 616 people aged 30 - 60 years r and omised with different age and sex r and omisation ratios to an intervention group ( n=11 629 ) and a control group ( n=47 987 ) . Intervention The intervention group was invited for screening , risk assessment , and lifestyle counselling up to four times over a five year period . All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits ( at baseline and after one and three years ) ; those at high risk of ischaemic heart disease , according to predefined criteria , were furthermore offered six sessions of group based lifestyle counselling on smoking cessation , diet , and physical activity . After five years all were invited for a final couns 
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Attitudes such as wanting to know of cardiometabolic disease risk , feeling responsible for , and concerns about one ’s own health were facilitators for participation .
Younger age , smoking , low education and attitudes such as not wanting to be , or being , worried about the outcome , low perceived severity or susceptibility , and negative attitude towards health checks or prevention in general were barriers .
Furthermore , practical issues such as information and the ease of access to appointments could influence participation .
Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous .
Hence , it is not possible to develop a ‘ one size fits all ’ approach to maximise the uptake .
Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions