***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 : In Italy , cervical cancer screening programmes actively invite women aged 25–64 years . Programmes are hindered by low participation . Methods : A sample of non-responder women aged 35–64 years , belonging to three different programmes ( in Rome , Florence and Teramo ) , was r and omly split into four arms : two control groups received st and ard recall letters to perform either Pap-test ( first group ) or human papillomavirus ( HPV ) test ( second group ) at the clinic . A third arm was sent letters offering a self- sample r for HPV testing , to be requested by phone , whereas a fourth group was directly sent the self- sample rs home . Results : Compliance with st and ard recall was 13.9 % ( N619 ) . Offering HPV test at the clinic had a nonsignificant effect on compliance ( N616 , relative risk (RR)=1.08 ; 95 % CI=0.82–1.41 ) . Self- sample r at request had the poorest performance , 8.7 % ( N622 , RR=0.62 ; 95 % CI=0.45–0.86 ) , whereas direct mailing of the self- sample r registered the highest compliance : 19.6 % ( N616 , RR=1.41 ; 95 % CI=1.10–1.82 ) . This effect on compliance was observed only in urban areas , Florence and Rome ( N438 , RR=1.69 ; 95 % CI=1.24–2.30 ) , but not in Abruzzo ( N178 , RR=0.95 ; 95 % CI=0.61–1.50 ) , a prevalently rural area . Conclusions : Mailing self- sample rs to non-responders may increase compliance as compared with delivering st and ard recall letters . Nevertheless , effectiveness is context specific and the strategy costs should be carefully considered Background : A r and omised trial to ascertain whether women who do not attend for cervical screening are more likely to respond to the opportunity to collect a self- sample for human papillomavirus ( HPV ) testing , or to a further invitation to attend for cervical screening . Methods : The study was carried out in a Primary Care Trust ( PCT ) in London between June 2009 and December 2009 . In total , 3000 women were r and omly selected from persistent non-responders ( i.e. , who had not responded to at least two invitations to attend for screening ) . The women were r and omised on a 1 : 1 basis to either receive an HPV self-sampling kit or a further invitation to attend for cervical cytology . The main outcome measures were ( 1 ) percentage of women attending for cervical cytology compared with those returning a self- sample HPV test or attending for cytology subsequent to receiving the kit and ( 2 ) percentage of those testing positive for HPV who attended further investigation . Results : The total response in the self-sampling group for screening was 10.2 % . Of the 1500 women in the control group sent a further invitation for cervical screening , 4.5 % attended for cytology screening . This difference is highly statistically significant ( P<0.0001 ) . Of the 8 women who tested positive for HPV , 7 attended for a cervical smear and had a concurrent colposcopy . Three of these ( 43 % ) had high- grade disease ( defined as CIN 2 + ) , with one found to have an invasive cancer ( stage 1b ) and one CIN 3 . Conclusions : The value of this intervention relies on the detection of high- grade CIN and early stage cancer with a good prognosis . The relatively high yield of abnormalities found is consistent with that expected among a hard to reach and relatively high-risk group of women . Our study suggests that self-sampling could increase participation among non-responders in Engl and , but further work is needed to ascertain whether the low response rate seen here is likely to be representative of the rest of the country . Other studies are needed to investigate the response to self-sampling in different demographic and geographic setting Background : The trial aim ed to investigate whether a general practitioner 's ( GP ) letter encouraging participation and a more explicit leaflet explaining how to complete faecal occult blood test ( FOBT ) included with the Engl and Bowel Cancer Screening Programme invitation material s would improve uptake . Methods : A r and omised controlled 2 × 2 factorial trial was conducted in the south of Engl and . Overall , 1288 patients registered with 20 GPs invited for screening in October 2009 participated in the trial . Participants were r and omised to either a GP 's endorsement letter and /or an enhanced information leaflet with their FOBT kit . The primary outcome was verified with return of the test kit within 20 weeks . Results : Both the GP 's endorsement letter and the enhanced procedural leaflet , each increased participation by ∼6 % – the GP 's letter by 5.8 % ( 95 % CI : 4.1–7.8 % ) and the leaflet by 6.0 % ( 95 % CI : 4.3–8.1 % ) . On the basis of the intention-to-treat analysis , the r and om effects logistic regression model confirmed that there was no important interaction between the two interventions , and estimated an adjusted rate ratio of 1.11 ( P=0.038 ) for the GP 's letter and 1.12 ( P=0.029 ) for the leaflet . In the absence of an interaction , an additive effect for receiving both the GP 's letter and leaflet ( 11.8 % , 95 % CI : 8.5–16 % ) was confirmed . The per- protocol analysis indicated that the insertion of an electronic GP 's signature on the endorsement letter was associated with increased participation ( P=0.039 ) . Conclusion : Including both an endorsement letter from each patient 's GP and a more explicit procedural leaflet  could increase participation in the English Bowel Cancer Screening Programme by ∼10 % , a relative improvement of 20 % on current performance Abstract BACKGROUND : R and omized controlled trials have demonstrated that fecal occult blood testing ( FOBT ) reduces colorectal cancer ( CRC ) mortality . However , patient compliance with FOBT is low and this is one of the major barriers to CRC screening . OBJECTIVE : To determine whether intensive patient education increases FOBT card return rates . DESIGN : R and omized controlled trial . SETTING : Department of Veterans Affairs primary care clinic . PARTICIPANTS : Seven hundred eighty-eight patients who were referred for FOBT . INTERVENTIONS : Patients were r and omly allocated to receive either intensive ( n=396 ) or st and ard ( n=392 ) patient education . Patients in the intensive education group received a one-on-one educational session by primary care nurses on the importance of CRC screening , were instructed on how to properly collect stool specimens for FOBT , and were given a 2-page h and out on CRC screening . Patients in the st and ard education group only received the FOBT cards and written instructions from the manufacturer on how to properly collect stool specimens for FOBT . RESULTS : Patients in the intensive education group were more likely to return the FOBT cards ( 65.9 % vs 51.3 % ; P<.001 ) and called the clinic with additional questions less often ( 1.5 % vs 5.9 % ; P=.001 ) than the st and ard education group . The median time to return the FOBT cards was significantly shorter in the intensive education group ( 36 vs 143 days ; P<.001 by log-rank test ) . However , the proportion of patients who had a positive FOBT did not differ in the two groups ( 4.6 % vs 6.0 % ; P=.51 ) . CONCLUSIONS : Intensive patient education significantly improved patient compliance with FOBT . Future studies to evaluate additional educational strategies to further improve patient compliance with CRC screening are warranted The Singapore Breast Screening Project was a nationwide study inviting a r and om sample of women between the ages of 50 and 64 years for mammography at one of two hospital-based screening centres over two years . The current study was undertaken to determine if ( 1 ) mailed health educational material alone , or ( 2 ) the same material delivered during a home visit made to the subject and her family would increase the uptake among Singapore women who had not responded to two previous invitations for mammographic screening as part of the Project . This r and omized trial employed a st and ard second reminder letter ( R ) , the same letter packaged with health education material design ed for the project ( RP ) and the addition of a home visit to make contact with the woman and her family ( RV ) . The outcome measure of interest was the proportion of women in each group subsequently attending for screening .  The study population comprised 1500 non-attenders whose names appeared consecutively in the data base of the larger screening centre in this Project . These were r and omized into three groups of 500 each . In total , they broadly resembled the national population in ethnic composition ( 72.3 % Chinese , 17.8 % Malays , 9.0 % Indians and 0.8 % Others ) . By the end of the project , 7.0 % of women in group R and 7.6 % in group RP responded to the invitation . In group RV , 428 homes were visited at least once and contact was made with the subject and her family member in 306 ( 71.5 % ) cases . Subsequently , 13.3 % of the women visited attended for screening . The rate ratio for attendance in group RP compared with group R was 1.09 ( 95 % CI 0.70 to 1.70 ) and for group RV compared with R , 1.90 ( 1.27 to 2.84 ) . When analyzed by groups originally assigned to , women in group RV remained significantly more likely to attend than those in groups R or RP . The marginal cost of a home visit , based on this study , was $ 25.04 per additional woman screened . Our results suggest that the response to a second reminder is generally low and that additional print material does not improve screening attendance in this group of initial non-attenders . Personal contact with the family through a home visit appears to increase uptake , and may be helpful particularly among women who have less frequent contact with the health care system Objectives –To assess the impact on compliance of three invitation methods , as well as the acceptability and efficacy of two bowel preparation regimens , for endoscopic screening in the general population . Methods –1170 subjects ( men and women aged 55 to 59 , in the rosters of a sample of general practitioners ( GPs ) in Turin ) , were r and omly allocated to one of three invitation groups ( A : personal letter , signed by GP , with a pre-fixed appointment ; B : same as for A + letter supporting the study by a well known scientist ; C : letter signed by the study coordinator , NS ) and two preparation regimens ( i : one enema , self administered at home two hours before the test ; ii : two enemas , administered the night before and two hours before the test ) . A postal reminder was mailed to non-attenders . A sample of non-responders was contacted for a telephone interview by a trained nurse . Written consent was obtained from all subjects undergoing the test . Results –A total of 278 subjects attended for sigmoidoscope screening .  An invitation from the GP alone produced the highest response rate ( compliance : A = 29.3 % ; B = 24.9 % ; C = 26.8 % ) . A single enema was as effective as two enemas in achieving satisfactory preparation for the test : the proportion of subjects invited to repeat the test was 8.1 % in the single enema group , and 9.6 % in the group receiving two enemas . Conclusions –Compliance with this screening procedure tends to be low . One enema , self administered two hours before sigmoidoscopy , can ensure a satisfactory bowel preparation We evaluated the effect of offering brush-based vaginal self-sampling for high-risk human papillomavirus ( hrHPV ) testing to non-attendees of the cervical screening program on response rate , compliance to follow-up and cervical intraepithelial neoplasia grade 2 or 3 ( CIN2+/CIN3 + ) yield . In addition , concordance of hrHPV test results between physician-taken cervical scrapes and vaginal self- sample s was determined . A total of 26,409 nonattending women were r and omly assigned to receive a vaginal brush device for hrHPV testing by Hybrid Capture-2 method ( i.e. , self-sampling group , n = 26,145 ) or a reinvitation for regular cytology-based screening ( i.e. , recall control group , n = 264 ) . hrHPV-positive self-sampling responders were invited for a physician-taken scrape for cytology and blinded hrHPV testing . If cytology was abnormal , women were referred for colposcopy . Response rate in the self-sampling group was significantly increased compared to the recall control group ( 30.8 % versus 6.5 % ; p < 0.001 ) . The concordance rate between hrHPV detection in self- sample s and corresponding physician-taken cervical scrape sample s was 68.8 % . Amongst women with CIN3 + and CIN2 + , the concordance rates in hrHPV positivity between both sample s were 95.5 % and 93.8 % , respectively . Adherence at baseline to cytology triage of hrHPV-positive self-sampling women ( 89.1 % ) and colposcopy referral of those with abnormal cytology ( 95.8 % ) was high . The CIN2+/CIN3+/carcinoma yields were 1.5 % , 1.0 % and 0.1 % , respectively , in self-sampling responders . In conclusion , 
    Output:
    
Conclusion Although some interventions did prove to be effective , some specific variables may influence their effectiveness in and applicability to organised population -based  screening programs