***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: We prospect ively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men ( N = 2297 ) participating in the Kuopio Ischemic Heart Disease Risk Factor Study ( KIHD ) . Alexithymia , impairment in identification , processing , and verbal expression of inner feelings , was assessed by the vali date d  Toronto Alexithymia Scale ( TAS ) In age-adjusted survival analyses , men in the highest alexithymia quintile had a twofold greater risk of all-cause death ( p < 0.001 ) and a threefold greater risk of death from accidents , injury , or violence ( p < 0.02 ) relative to the men in the three lowest alexithymia quintiles . There was little evidence for confounding by behavioral factors ( smoking , alcohol consumption , physical activity ) . physiological risk factors ( LDL , HDL , body mass index , hypertension ) , socioeconomic status , marital status , perceived health , prior diseases and diagnoses , depressive symptoms or social connections . Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup ( N = 1650 ) . Why difficulties in dealing with emotions associate with increased mortality remains unclear . Our findings suggest that the association is independent from the effect of well-known behavioral , biological , and psychosocial risk factors This study explored the relative strength of two patient characteristics , psychological mindedness ( PM ) and alexithymia , as predictors of psychotherapy outcome . Data were provided by two comparative trials of interpretive versus supportive therapy . One involved  short-term group therapy for 107 out patients with complicated grief . The other involved short-term individual therapy for 144 out patients of mixed diagnoses . Prior to beginning therapy , patients were assessed for PM using the  Psychological Mindedness Assessment Procedure  and for alexithymia using the  20-item Toronto Alexithymia Scale . For both trials , the association between PM and alexithymia was small and non-significant . The therapy approach ( interpretive vs. supportive ) did not differentially affect the relationship between either predictor variable and outcome . There were significant direct relationships between PM and favourable outcome , and between alexithymia and favourable outcome in both trials . There was an additive relationship between PM and alexithymia in predicting outcome . Implication s of these results are discussed In the present study , the potential role of alexithymia in predicting the long-term treatment outcome was investigated prospect ively in 30 patients with DSM-III-R somatoform disorders and anxiety disorders . Using SCID interviews , diagnoses were assessed before inpatient treatment and 2 years after discharge .  Patients who met criteria for DSM-III-R undifferentiated somatoform disorder at follow-up exhibited higher pretreatment alexithymia scores ( as measured by the TAS ) as compared with patients who showed remission of their somatoform disorder or patients who never had met criteria for a somatoform disorder . As a result stepwise logistic regression analyses , high alexithymia scores emerged as a significant predictor of persistent somatization , independent of other measures of psychopathology , sociodemographic variables , and measures of illness severity The relationship of alexithymia to posttraumatic stress disorder ( PTSD ) symptomatology was examined cross-sectionally in 166 urban police officers surveyed between 1998 and 1999 and prospect ively in 54 of these officers who participated in a follow-up survey after the September 11 , 2001 ( 9/11 ) terrorist attacks . In cross-sectional analyses , alexithymia scores were positively associated with PTSD symptom levels and self-reported childhood emotional abuse -- neglect , but not with cumulative level of critical incident exposure . Alexithymia scores accounted for 11.2 % of the variance in PTSD symptoms prior to accounting for additional predictors , but did not retain significance in the final model . In prospect i ve analyses , alexithymia scores significantly predicted 9/11-related PTSD symptom severity over and above pre-9/11 PTSD symptoms The goal was to examine prospect ively the relation of psychological factors to the outcome after  in vitro fertilization ( IVF ) in a sample of Greek women . Previous studies investigating the relation of IVF outcome to anxiety and depression have yielded contradictory results ; other psychological dimensions have not been studied . 81 women who followed an IVF program during a 6-mo . period were prospect ively evaluated . Demographic and gynecological data were assessed and women completed question naires measuring anxiety , depression , narcissistic traits , over-dependency , self-esteem , hostility , and alexithymia . Multiple logistic regression analysis showed that successful IVF outcome correlated with more alexithymic characteristics and younger age . Correlation between alexithymia and successful IVF outcome is demonstrated . This might be explained by the “ operational ” nature of IVF techniques , to which alexithymic individuals would respond better OBJECTIVE Most studies focusing on risk factors for posttraumatic stress disorder ( PTSD ) have used retrospective study design s. Only a small number of studies have prospect ively examined risk factors in the immediate aftermath of trauma exposure in predicting PTSD symptoms . The purpose of this study was to identify predictive risk factors for posttraumatic stress symptoms and comorbid psychopathological symptoms present during the time before exposure to traumatic stress in a high-risk population . METHOD Forty-three professional firefighters were assessed immediately after basic training  ( baseline ) and at 6 , 9 , 12 , and 24 months after entry into firefighter service .  Subjects were screened for psychopathological symptoms , including symptoms of PTSD , depression , and anxiety . Subjects were also characterized with regard to personality traits such as self-efficacy , hostility , and alexithymia . Neuroendocrine activity was assessed by examination of awakening and diurnal salivary cortisol profiles and 24-hour urinary catecholamine excretion . Multiple linear regression analysis was used to analyze posttraumatic stress symptoms at 24-month follow-up as a function of pretraumatic characteristics . RESULTS A high level of hostility and a low level of self-efficacy at baseline accounted for 42 % of the variance in posttraumatic stress symptoms after 2 years . Subjects who had both risk factors at baseline showed a significant increase in measures of PTSD symptoms , depression , anxiety , general psychological morbidity , global symptom severity , and alexithymia during the 2-year period . Biological characteristics were not predictive of the development of psychopathological symptoms . CONCLUSIONS These results suggest that specific personality traits may constitute markers of vulnerability to the development of psychopathological symptoms after trauma exposure . Early identification of preexisting risk factors is needed to provide effective prevention and intervention for individuals who are at risk of developing trauma-related disorders Patient treatment matching hypotheses were tested for substance users r and omly assigned to a group cognitive behavioral therapy ( CBT ; n= 114 ) or a group motivational intervention ( GMI ; n= 116 ) . Treatment was scheduled twice weekly for 10 weeks . Using a patient attribute by treatment interaction design with a 15-week follow-up , the study predicted that alexithymia , antisocial personality disorder ( ASPD ) , and network support for alcohol and drug use would be associated with less substance use for CBT subjects and that hostility and lower treatment motivation would be associated with less substance use for GMI subjects . Three of the hypothesized moderators were empirically supported : alexithymia , network support for alcohol , and ASPD . Results indicate the use of assessing specific patient attributes to better inform treatment recommendations Purpose . To date , there are no studies that have investigated the role of alexithymia in respiratory rehabilitation . We aim ed to observe the prevalence of alexithymia in patients attending respiratory rehabilitation  and to verify the presence of a difference between alexithymics and non-alexithymics responsiveness to the respiratory rehabilitation st and ard protocol . Methods . A prospect i ve cohort study evaluating the influence of alexithymia on functional recovery of in- patients afferent to the Respiratory Rehabilitation Unit of IRCCS San Raffaele Pisana . Sixty patients were consecutively enrolled into the study and evaluated for alexithymia , anxiety and depression . Functional recovery was assessed with the  six-minute walking test ( 6MWT ) . Prior and post-completion of this test dyspnoea , oxygen saturation and cardiac frequency were recorded . Results . Alexithymia was not found to be significantly affecting the functional recovery of participants in respiratory rehabilitation . The distance walked at the 6MWT ( 6MWD ) increased in both alexithymics and non-alexithymics ( palexithymics = 0.014 ; pnon-alexithymics < 0.0001 ) . Dyspnoea strongly improved among non-alexithymics , although a signal for improvement was also found in alexithymics ( palexithymics = 0.046 ; pnon-alexithymics = 0.0001 ) . Conclusions . These findings suggest that alexithymia did not have a significant impact on functional recovery of patients in respiratory rehabilitation Background : Alexithymia refers to a set of cognitive and emotional deficits . Its effect on surgical outcome has been demonstrated but no studies have been published on colorectal cancer patients . Study Design : A series of 60 consecutive colorectal cancer patients were enrolled in a 3-year prospect i ve study on quality of life by using the SF-36 test and Toronto Alexithymia Scale question naires . Patients were investigated pre- and postoperatively ( before discharge and then 1 and 3 months thereafter ) . The control group consisted of patients undergoing laparoscopic cholecystectomy for cholelithiasis .  These two groups were divided into two subsets : high-level alexithymia ( HA ) and low-level alexithymia ( LA ) . The prevalence of HA was 34 % in colorectal patients and 35 % in cholelithiasis patients . Results : During the postoperative period , in the colorectal group the SF-36 score was significantly higher in HA than in LA subsets . This result was confirmed in the cholelithiasis group . During follow-up , a progressive reduction of the SF-36 score was observed in both HA population s. Discussion : Results emerging from this investigation demonstrate that surgery significantly improves the quality of life in HA patients . These findings suggest that alexithymia might be advantageous in evaluating the adaptation after surgery in the short follow-up period OBJECTIVE Longitudinal studies have shown that alexithymic features can interfere with treatment response in eating disorders . However , an alternative hypothesis could be that clinicians faced with alexithymic patients chose different treatment options according to their perceptions of these patients . The aim of this investigation was to explore the relationships between alexithymic features and treatment options provided by professionals in a naturalistic prospect i ve study of eating disorders . METHODS We conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV Eating Disorder patients with the Toronto Alexithymia Scale ( TAS-20 ) . All treatments received during follow-up were recorded and recoded dichotomously , and crossed with the variation of alexithymic categories ( cut-off≥56 ) between inclusion and follow-up . RESULTS Patients received different treatments according to their alexithymic profile , in terms both of number and type of treatment received . Patients with high , stable levels of alexithymia received overall more treatments , and significantly more antidepressants , than non-alexithymic patients . Patients who became alexithymics during follow-up were more often rehospitalized and received fewer regular psychotherapies than the non-alexithymic patients . CONCLUSIONS Professionals should carefully monitor these personality features and be aware of the potential impact of alexithymic features on treatment compliance and on treatment choice for eating disordered patients Background : Alexithymia as a predictor of treatment outcome in psychotherapy has often been discussed but rarely evaluated in prospect i ve studies . The present study evaluated the absolute and relative stability of alexithymia in patients with obsessive-compulsive disorder ( OCD ) , and the predictive value of alexithymia for the outcome of treatment . Methods : We conducted a prospect i ve study with 42 in patients receiving intensive , multimodal cognitive-behavioral therapy ( CBT ) .  Patients were assessed for alexithymia at pre- and post-treatment with the 20-item Toronto Alexithymia Scale ( TAS-20 ) , for obsessive-compulsive symptoms and depression with the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and the 21-item Hamilton Depression Rating Scale ( HDRS ) . Results : OCD and comorbid depression showed a highly significant symptom-reduction from pre- to post-treatment while no absolute changes in the TAS-20 total scores and its factors 1 and 3 occurred . Only factor 2 scores decreased significantly , but with a smaller effect size than the effect sizes for the changes in Y-BOCS and HDRS . Alexithymia scores at pre-treatment correlated significantly with alexithymia scores at the end of treatment , indicating its relative stability . In the linear regression analyses , no variables were identified that predicted significantly the outcome of treatment . Conclusions : Our findings support the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon in obsessive-compulsive patients . Alexithymia scores do not predict response to multimodal CBT in OCD . It might be an effect of CBT that patients could at least partly regain or newly 
    Output:
    
In conclusion , epidemiological evidence regarding alexithymia as a prognostic risk factor for health problems remains un-established .
Even though alexithymia is considered to be an unfavorable characteristic for disease control and health promotion overall , some beneficial aspects are suggested .