***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 To quantify the psychological impact of primary care based stepwise screening for type 2 diabetes . Design Controlled trial and comparative study embedded in a r and omised controlled trial . Setting 15 practice s ( 10 screening , five control ) in the ADDITION ( Cambridge ) trial in the east of Engl and . Participants 7380 adults ( aged 40 - 69 ) in the top fourth for risk of having undiagnosed type 2 diabetes ( 6416 invited for screening , 964 controls ) . Interventions Invited for screening for type 2 diabetes or not invited ( controls ) , incorporating a comparative study of subgroups of screening attenders . Attenders completed question naires after a r and om blood glucose test and at 3 - 6 months and 12 - 15 months later . Controls were sent question naires at corresponding time points . Non-attenders were sent question naires at 3 - 6 months and 12 - 15 months . Main outcome measures State anxiety ( Spielberger state anxiety inventory ) , anxiety and depression ( hospital anxiety and depression scale ) , worry about diabetes , and self rated health . Results No significant differences were found between the screening and control participants at any time — for example , difference in means ( 95 % confidence intervals ) for state anxiety after the initial blood glucose test was −0.53 , −2.60 to 1.54 , at 3 - 6 months was 1.51 ( −0.17 to 3.20 ) , and at 12 - 15 months was 0.57 , −1.11 to 2.24 . After the initial test , compared with participants who screened negative , those who screened positive reported significantly poorer general health ( difference in means −0.19 , −0.25 to −0.13 ) , higher state anxiety ( 0.93 , −0.02 to 1.88 ) , higher depression ( 0.32 , 0.08 to 0.56 ) , and higher worry about diabetes ( 0.25 , 0.09 to 0.41 ) , although effect sizes were small . Small but significant trends were found for self rated health across the screening subgroups at 3 - 6 months ( P=0.047 ) and for worry about diabetes across the screen negative groups at 3 - 6 months and 12 - 15 months ( P=0.001 ) . Conclusions Screening for type 2 diabetes has limited psychological impact on patients . Implementing a national screening programme based on the stepwise screening procedure used in the ADDITION ( Cambridge ) trial is unlikely to have significant consequences for patients ' psychological health . Trial registration Current Controlled Trials IS RCT N99175498 A study of hypertension in an industrial setting allowed us to confirm and explore an earlier retrospective finding that the labeling of patients as hypertensive result ed in increased absenteeism from work . After screening and referral , we found that absenteeism rose ( mean + /- 1 S.E. ) 5.2 + /- 2.3 days per year ( P less than 0.025 ) ; this 80 per cent increase greatly exceeded the 9 per cent rise in absenteeism in the general employee population during this period . The main factors associated with increased absenteeism were becoming aware of the condition ( P less than 0.01 ) and low compliance with treatment ( P less than 0.001 ) . Subsequent absenteeism among patients unaware of their hypertension before screening was not related to the degree of hypertension , whether the worker was started on therapy , the degree of blood-pressure control achieved or exposure to attempts to promote compliance . These results have major implication s for hypertension screening programs , especially since absenteeism rose among those previously unaware of their condition , regardless of whether antihypertensive therapy was begun PURPOSE Markers of genetic susceptibility to tobacco-related cancers could personalize harms of smoking and motivate cessation . Our objective was to assess whether a multicomponent intervention that included feedback about genetic susceptibility to lung cancer increased risk perceptions and rates of smoking cessation compared with a st and ard cessation intervention . EXPERIMENTAL DESIGN Our design was a two-arm trial with eligible smokers r and omized in a 1:2 ratio to Enhanced Usual Care or Biomarker Feedback ( BF ) .  Surveys were conducted at baseline , 6 , and 12 months later . The setting was an inner city community health clinic . African-American patients who were current smokers ( n = 557 ) were identified by chart abstract ion and provider referral . All smokers received a self-help manual and , if appropriate , nicotine patches . Smokers in the BF arm also were offered a blood test for genotyping the GST(3 ) gene ( GSTM1 ) , sent a test result booklet , and called up to four times by a health educator . Prevalent abstinence was assessed by self-report of having smoked no cigarettes in the prior 7 days at the 6- and 12-month follow-ups and sustained abstinence , i.e. , not smoking at either follow-up or in-between . RESULTS Smoking cessation was greater for the BF arm than the Enhanced Usual Care arm ( 19 % versus 10 % , respectively ; P < 0.006 ) at 6 months but not at 12 months . CONCLUSIONS Smokers agreed to genetic feedback as part of a multicomponent cessation program . Although the program increased short-term cessation rates compared with st and ard intervention , genetic feedback of susceptibility may not benefit smokers with high baseline risk perceptions Objective - To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme . Setting - A pilot mammographic screening programme in Melbourne , Australia . Method — The psychological consequences question naire ( PCQ ; a reliable and valid measure of the psychological consequences of screening mammography ) was used to measure the emotional , social , and physical functioning of women in a mammographic screening programme and a control community sample . A screening group ( in whom no abnormality was detected at initial screen ; n=142 ) had four measurements : at screening clinic ; before results were received ; one week after all-clear results were received ; and eight months after initial visit . The recall group ( who were recalled for further investigation which showed the detected abnormality to be benign ; n = 58 ) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic . A r and omly selected community control group ( n = 52 ) had measurements one week , two weeks , three weeks ; and eight months after consenting to participate . Results - Emotional , social , and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls . The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups . The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic , and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer ( emotional P < 0·001 ; physical P < 0·05 ) . This difference had disappeared eight months after the screening visit , when the level of emotional and physical functioning was similar to that of the screening and control groups . Social dysfunction scores did not change significantly over time and were similar for all three groups . Conclusions - Given that up to 10 % of women are recalled for further investigations on first round screening , significant numbers of women may have psychological consequences . This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate , and for counselling services to be available at recall assessment centres Background To assess the feasibility and uptake of a diabetes screening programme ; to examine the effects of invitation to diabetes screening on anxiety , self-rated health and illness perceptions . Methods R and omised controlled trial in two general practice s in Cambridgeshire . Individuals aged 40–69 without known diabetes were identified as being at high risk of having undiagnosed type 2 diabetes using patient records and a vali date d risk score ( n = 1,280 ) . 355 individuals were r and omised in a 2 to 1 ratio into non-invited ( n = 238 ) and invited ( n = 116 ) groups . A stepwise screening programme confirmed the presence or absence of diabetes . Six weeks after the last contact ( either test or invitation ) , a question naire was sent to all participants , including non-attenders and those who were not originally invited . Outcome measures included attendance , anxiety ( short-form Spielberger State Anxiety Inventory-STAI ) , self-rated health and diabetes illness perceptions . Results 95 people ( 82 % of those invited ) attended for the initial capillary blood test . Six individuals were diagnosed with diabetes . Invited participants were more anxious than those not invited ( 37.6 vs. 34.1 STAI , p-value = 0.015 ) , and those diagnosed with diabetes were considerably more anxious than those classified free of diabetes ( 46.7 vs. 37.0 STAI , p-value = 0.031 ) . Non-attenders had a higher mean treatment control sub-scale ( 3.87 vs. 3.56 , p-value = 0.016 ) and a lower mean emotional representation sub-scale ( 1.81 vs. 2.68 , p-value = 0.001 ) than attenders . No differences in the other five illness perception sub-scales or self-rated health were found . ConclusionS creening for type 2 diabetes in primary care is feasible but may be associated with higher levels of short-term anxiety among invited compared with non-invited participants .Trial registration IS RCT To evaluate the quality of life of patients following surgery for colorectal cancer , and to compare the quality of life between patients whose cancer was detected as a result of faecal occult blood screening  with that of patients whose cancer presented symptomatically , an analysis was conducted within the context of the r and omized controlled trial of colorectal cancer screening  , University Hospital , Nottingham , UK . A total of 418 survivors of the trial 's test and control groups and 33 r and omly selected cancer patients completed  quality of life question  naires ( Nottingham Health Profile and Health Measurement Question naire ) . The mode of entry to diagnosis and treatment ( screening vs. non-screening ) appeared to exert no major impact on post-intervention quality of life . The stage of cancer progression was not closely related to outcome life quality . A quality of life coefficient for surviving patients based on the Rosser classification was estimated to lie within the range 0.948–0.981 . This figure accords well with the estimates of other studies of interventions in population s of similar age . Overall , there are no grounds for belleving that faecal occult blood screening for colorectal cancer per se significantly influences patients ' post-intervention quality of life Background : Several studies have shown that faecal occult blood ( FOB ) screening reduces mortality from colorectal cancer . However , concern has been expressed that health screening may have adverse psychological effects , particularly for the group returning false positive tests . Objectives : To evaluate any adverse psychological effects associated with faecal occult blood screening . Setting : R and omised controlled trial of faecal occcult blood screening for colorectal cancer . Methods : Psychiatric morbidity was measured , using the  general health question naire ( GHQ ) before and 3 months after the offer of  screening for colorectal cancer with FOB testing . Scores were related to acceptance of the screening test . A smaller cohort , who had returned positive FOB tests , had anxiety levels measured , using the Spielberger anxiety inventory ( SAI ) , at different times during screening , investigation , and follow up . Results : A GHQ was sent to 2184 subjects before the offer of screening , and 1541 ( 70.6 % ) were returned . Of the 1693 subjects offered the GHQ 3 months after the offer of screening , 1303 ( 77 % ) returned it . A GHQ score of 5 or more , indicating possible psychiatric morbidity , was present in 454 subjects ( 29.5 % ) before screening and in 386 ( 29.6 % ) subjects 3 months after screening ( NS ) . Of the 454 subjects who scored 5 or more , 241 ( 53.1 % ) accepted screening and 213 ( 46.9 % ) refused . A total of 1081 subjects scored less than 5 , and of these 521 ( 48.2 % ) accepted screening and 560 ( 51.8 % ) refused ( NS ) . Anxiety scores were measured in 100 test positive patients and were highest after notification of a positive test and before investigation by colonoscopy . In patients with false positive results , scores fell the day after colonoscopy and remained low 1 month later . Conclusions : The receipt of a screening test does not cause sustained anxiety and the existence of psychiatric morbidity is not a factor affecting a person 's decision to accept or refuse a screening test for colorectal cancer BACKGROUND Opposing views have been published on the importance of ultrasound screening for abdominal aortic aneurysms . The Multicentre Aneurysm Screening Study was design ed to assess whether or not such screening is beneficial . METHODS A population -based sample of men ( n=67800 ) aged 65 - 74 years was enrolled , and each individual r and omly allocated to either receive an invitation for an abdominal ultrasound scan ( invited group , n=33839 ) or not ( control group , n=33961 ) . Men in whom abdominal aortic aneurysms ( > or =3 cm in diameter ) were detected were followed-up with repeat ultrasound scans for a mean of 4.1 years . S 
    Output:
    
ConclusionS creening does not appear to have adverse emotional impacts in the longer term ( > 4 weeks ) .
Too few studies assessed outcomes before four weeks to comment on the shorter term emotional impact of screening