human
***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: Abstract Objective To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation . Design R and omised controlled trial . Setting Five general practice s in three setting s in the United Kingdom . Participants 636 consecutive patients , aged 16 - 80 years , r and omised to receive a general leaflet , a depression leaflet , both , or neither . Main outcomes Mean item score on the medical interview satisfaction scale , consultation time , prescribing , Rerral , and investigation . Results The general leaflet  increased patient satisfaction and was more effective with shorter consultations ( leaflet 0.64 , 95 % confidence interval 0.19 to 1.08 ; time 0.31 , 0.0 to 0.06 ; interaction between both −0.045 , −0.08 to—0.009 ) , with similar results for subscales related to the different aspects of communication . Thus for a 10 minute consultation the leaflet increased satisfaction by 7 % ( seven centile points ) and for a five minute consultation by 14 % . The leaflet overall caused a small non-significant increase in consultation time ( 0.36 minutes , −0.54 to 1.26 ) . Although there was no change in prescribing or Rerral , a general leaflet increased the numbers of investigations ( odds ratio 1.43 , 1.00 to 2.05 ) , which persisted when controlling for the major potential confounders of perceived medical need and patient pRerence ( 1.87 , 1.10 to 3.19 ) . Most of excess investigations were not thought strongly needed by the doctor or the patient . The depression leaflet had no significant effect on any outcome . Conclusions Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication , particularly in short consultations . Doctors do , however , need to elicit expectations to prevent needless investigations BACKGROUND Asthma continues to be a substantial cause of morbidity in pediatric population s. New strategies are needed to provide cost-effective educational interventions for children with asthma , particularly those in the inner city . OBJECTIVE To assess the effectiveness of a multimedia educational software program about asthma . SETTING A hospital-based primary care clinic and an affiliated neighborhood health center . DESIGN R and omized , controlled trial . POPULATION Children 3 to 12 years old with physician-diagnosed asthma . INTERVENTION An interactive educational computer program , Asthma Control , design ed to teach children about asthma and its management . Using a graphic display of a child going through simulated daily events , the game emphasizes : 1 ) monitoring ; 2 ) allergen identification ; 3 ) use of medications ; 4 ) use of health services ; and 5 ) maintenance of normal activity . Control group participants review ed printed educational material s with a research assistant . OUTCOMES Acute health care use ( emergency department and outpatient ) was the primary outcome . Secondary outcome measures included maternal report of asthma symptom severity , child functional status and school absences , satisfaction with care , and parental and child knowledge of asthma . RESULTS A total of 137 families were enrolled in the study ( 76 intervention , 61 control ) . Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period . Aside from improvement in knowledge after use of the computer program , no differences were demonstrated between the 2 groups in primary or secondary outcome measures . Children reported enjoyment of program use . CONCLUSIONS This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written material s. Because both groups showed substantial improvement over baseline , computer-based education may be more cost-effective . Alternatively , improvements in illness severity over time may overshadow the effects of such interventions . Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma Background Depression is a highly prevalent condition , affecting more than 15 % of the adult population at least once in their lives . Guided self-help is effective in the treatment of depression . The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms . Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions . Methods This study is a r and omized controlled trial with three conditions : two treatment conditions and one waiting list control group . The two treatment conditions are Internet-based cognitive behavior therapy and Internet-based problem-solving therapy . They consist of 8 and 5 weekly lessons respectively . Both interventions are combined with support by e-mail . Participants in the waiting list control group receive the intervention three months later . The study population consists of adults from the general population . They are recruited through advertisements in local and national newspapers and through banners on the Internet . Subjects with symptoms of depression ( ≥ 16 on the Center for Epidemiological Studies Depression scale ) are included . Other inclusion criteria are having sufficient knowledge of the Dutch language , access to the Internet and an e-mail address . Primary outcome is depressive symptoms . Secondary outcomes are anxiety , quality of life , dysfunctional cognitions , worrying , problem solving skills , mastery , absence at work and use of healthcare . We will examine the following variables as potential mediators : dysfunctional cognitions , problem solving skills , worrying , anxiety and mastery . Potential moderating variables are : socio-demographic characteristics and symptom severity . Data are collected at baseline and at 5 weeks , 8 weeks , 12 weeks and 9 months after baseline . Analyses will be conducted on the intention-to-treat sample . Discussion This study evaluates two Internet-based treatments for depression , namely cognitive behavioral therapy and problem-solving therapy . The effectiveness of Internet-based problem-solving therapy suggest that this may be a worthwhile alternative to other more intensive treatment options . Strengths and limitations of this study are discussed . Trial registration Current Controlled Trials IS RCT Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition Many chronically ill older patients in the Netherl and s have a combination of more than one chronic disease . There is therefore a need for self-management programs that address general management problems , rather than the problems related to a specific disease . The Chronic Disease Self-Management Program ( CDSMP ) seems to be very suitable for this purpose . In evaluations of the program that have been carried out in the United States and China , positive effects were found on self-management behaviour and health status . However , the program has not yet been evaluated in the Netherl and s. Therefore , the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherl and s. One hundred and thirty-nine people aged 59 or older , with a lung disease , a heart disease , diabetes , or arthritis were r and omly assigned to an intervention group ( CDSMP ) or a control group ( care-as-usual ) .  Demographic data and data on self-efficacy , self-management behaviour and health status were collected at three measurement moments ( baseline , after 6 weeks , and after 6 months ) . The patients who participated rated the program with a mean of 8.5 points ( range 0 - 10 ) , and only one dropped out . However , our study did not yield any evidence for the effectiveness of the  CDSMP  on self-efficacy , self-management behaviour or health status of older patients in the Netherl and s. Because the patients who participated were very enthusiastic , which was also indicated by 
    Output:
    
agent
***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: Abstract Objective To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation . Design R and omised controlled trial . Setting Five general practice s in three setting s in the United Kingdom . Participants 636 consecutive patients , aged 16 - 80 years , r and omised to receive a general leaflet , a depression leaflet , both , or neither . Main outcomes Mean item score on the medical interview satisfaction scale , consultation time , prescribing , Rerral , and investigation . Results The general leaflet  increased patient satisfaction and was more effective with shorter consultations ( leaflet 0.64 , 95 % confidence interval 0.19 to 1.08 ; time 0.31 , 0.0 to 0.06 ; interaction between both −0.045 , −0.08 to—0.009 ) , with similar results for subscales related to the different aspects of communication . Thus for a 10 minute consultation the leaflet increased satisfaction by 7 % ( seven centile points ) and for a five minute consultation by 14 % . The leaflet overall caused a small non-significant increase in consultation time ( 0.36 minutes , −0.54 to 1.26 ) . Although there was no change in prescribing or Rerral , a general leaflet increased the numbers of investigations ( odds ratio 1.43 , 1.00 to 2.05 ) , which persisted when controlling for the major potential confounders of perceived medical need and patient pRerence ( 1.87 , 1.10 to 3.19 ) . Most of excess investigations were not thought strongly needed by the doctor or the patient . The depression leaflet had no significant effect on any outcome . Conclusions Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication , particularly in short consultations . Doctors do , however , need to elicit expectations to prevent needless investigations BACKGROUND Asthma continues to be a substantial cause of morbidity in pediatric population s. New strategies are needed to provide cost-effective educational interventions for children with asthma , particularly those in the inner city . OBJECTIVE To assess the effectiveness of a multimedia educational software program about asthma . SETTING A hospital-based primary care clinic and an affiliated neighborhood health center . DESIGN R and omized , controlled trial . POPULATION Children 3 to 12 years old with physician-diagnosed asthma . INTERVENTION An interactive educational computer program , Asthma Control , design ed to teach children about asthma and its management . Using a graphic display of a child going through simulated daily events , the game emphasizes : 1 ) monitoring ; 2 ) allergen identification ; 3 ) use of medications ; 4 ) use of health services ; and 5 ) maintenance of normal activity . Control group participants review ed printed educational material s with a research assistant . OUTCOMES Acute health care use ( emergency department and outpatient ) was the primary outcome . Secondary outcome measures included maternal report of asthma symptom severity , child functional status and school absences , satisfaction with care , and parental and child knowledge of asthma . RESULTS A total of 137 families were enrolled in the study ( 76 intervention , 61 control ) . Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period . Aside from improvement in knowledge after use of the computer program , no differences were demonstrated between the 2 groups in primary or secondary outcome measures . Children reported enjoyment of program use . CONCLUSIONS This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written material s. Because both groups showed substantial improvement over baseline , computer-based education may be more cost-effective . Alternatively , improvements in illness severity over time may overshadow the effects of such interventions . Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma Background Depression is a highly prevalent condition , affecting more than 15 % of the adult population at least once in their lives . Guided self-help is effective in the treatment of depression . The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms . Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions . Methods This study is a r and omized controlled trial with three conditions : two treatment conditions and one waiting list control group . The two treatment conditions are Internet-based cognitive behavior therapy and Internet-based problem-solving therapy . They consist of 8 and 5 weekly lessons respectively . Both interventions are combined with support by e-mail . Participants in the waiting list control group receive the intervention three months later . The study population consists of adults from the general population . They are recruited through advertisements in local and national newspapers and through banners on the Internet . Subjects with symptoms of depression ( ≥ 16 on the Center for Epidemiological Studies Depression scale ) are included . Other inclusion criteria are having sufficient knowledge of the Dutch language , access to the Internet and an e-mail address . Primary outcome is depressive symptoms . Secondary outcomes are anxiety , quality of life , dysfunctional cognitions , worrying , problem solving skills , mastery , absence at work and use of healthcare . We will examine the following variables as potential mediators : dysfunctional cognitions , problem solving skills , worrying , anxiety and mastery . Potential moderating variables are : socio-demographic characteristics and symptom severity . Data are collected at baseline and at 5 weeks , 8 weeks , 12 weeks and 9 months after baseline . Analyses will be conducted on the intention-to-treat sample . Discussion This study evaluates two Internet-based treatments for depression , namely cognitive behavioral therapy and problem-solving therapy . The effectiveness of Internet-based problem-solving therapy suggest that this may be a worthwhile alternative to other more intensive treatment options . Strengths and limitations of this study are discussed . Trial registration Current Controlled Trials IS RCT Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition Many chronically ill older patients in the Netherl and s have a combination of more than one chronic disease . There is therefore a need for self-management programs that address general management problems , rather than the problems related to a specific disease . The Chronic Disease Self-Management Program ( CDSMP ) seems to be very suitable for this purpose . In evaluations of the program that have been carried out in the United States and China , positive effects were found on self-management behaviour and health status . However , the program has not yet been evaluated in the Netherl and s. Therefore , the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherl and s. One hundred and thirty-nine people aged 59 or older , with a lung disease , a heart disease , diabetes , or arthritis were r and omly assigned to an intervention group ( CDSMP ) or a control group ( care-as-usual ) .  Demographic data and data on self-efficacy , self-management behaviour and health status were collected at three measurement moments ( baseline , after 6 weeks , and after 6 months ) . The patients who participated rated the program with a mean of 8.5 points ( range 0 - 10 ) , and only one dropped out . However , our study did not yield any evidence for the effectiveness of the  CDSMP  on self-efficacy , self-management behaviour or health status of older patients in the Netherl and s. Because the patients who participated were very enthusiastic , which was also indicated by 
    Output:
    