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: Adolescent immunization rates for human papillomavirus ( HPV ) are low and interventions within school-based health centers ( SBHCs ) may increase HPV uptake and series completion . We examined the effect of a parent health message intervention on HPV vaccination intent , first dose uptake and series completion among adolescents who received care at SBHCs . Via computer-assisted telephone interviews ( CATI ) , 445 parents of young adolescents were r and omly assigned to 2 two-level interventions using a 2 × 2 design ( rhetorical question ( RQ ) or no-RQ and one-sided or two-sided message ) . The RQ intervention involved asking the parent a question they were likely to endorse ( e.g. , “ Do you want to protect your daughter from cervical cancer ? ” ) with the expectation that they would then behave in a manner consistent with their endorsement ( i.e. , agree to vaccinate ) . For the one-sided message , parents were given information that emphasized the safety and effectiveness of HPV vaccine , whereas the two-sided message acknowledged that some parents might have concerns about the vaccine , followed by reassurance regarding the safety and effectiveness . At CATI conclusion , parents indicated intentions to have their adolescents vaccinated . Parents who endorsed any intent were sent a consent form to return and all adolescents with signed returned consents were vaccinated at SBHCs . Medical records were review ed for uptake/completion . Parents were 87 % female ; adolescents were 66 % male and racially/ethnically diverse . 42.5 % of parents indicated some intention to immunize , 51.4 % were unsure , and 6.1 % were not interested . 34 % ( n = 151 ) of adolescents received their first dose with series completion rates of 67 % ( n = 101 ) . The RQ component of the intervention increased intention to vaccinate ( RR = 1.45 ; 95%CI 1.16,1.81 ) , but not first dose uptake or series completion . The 1-sided and 2-sided messages had no effect . This brief , RQ health intervention enhanced intent , but did not impact vaccination rates , likely due to the time delay between the intervention and consent form receipt OBJECTIVE  Adolescent immunization rates  are suboptimal . Experts recommend provider prompts at health care visits to improve rates . We assessed the impact of either electronic health record ( EHR ) or nurse- or staff-initiated provider prompts on  adolescent immunization rates .  METHODS We conducted a r and omized controlled trial , allocating practice s in 1 of 2 practice -based research networks ( PBRN ) to provider prompts or st and ard-of-care control . Ten primary care practice s participated , 5 intervention and 5 controls , each matched in pairs on urban , suburban , or rural location and practice type ( pediatric or family medicine ) , from a PBRN in Greater Rochester , New York ( GR-PBRN ) ; and 12 practice s , 6 intervention , 6 controls , similarly matched , from a national pediatric continuity clinic PBRN ( CORNET ) . The study period was 1 year per practice , ranging from June 2011 to January 2013 . Study participants were adolescents 11 to 17 years attending these 22 practice s ; r and om sample of chart review s per practice for baseline and postintervention year to assess immunization rates ( n = 7,040 total chart review s for adolescents with > 1 visit in a period ) . The intervention was an EHR prompt ( 4 GR-PBRN and 5 CORNET practice pairs ) ( alert ) that appeared on providers ' computer screens at all office visits , indicating the specific immunizations that adolescents were recommended to receive . Staff prompts ( 1 GR-PBRN pair and 1 CORNET pair ) in the form of a reminder sheet was placed on the provider 's desk in the exam room indicating the vaccines due . We compared immunization rates , stratified by PBRN , for routine vaccines ( meningococcus , pertussis , human papillomavirus , influenza ) at study beginning and end . RESULTS Intervention and control practice s within each PBRN were similar at baseline for demographics and immunization rates . Immunization rates at the study end for adolescents who were behind on immunizations at study initiation were not significantly different for intervention versus control practice s for any vaccine or combination of vaccines . Results were similar for each PBRN and also when only EHR-based prompts was assessed . For example , at study end , 3-dose human papillomavirus vaccination rates for GR-PBRN intervention versus control practice s were 51 % versus 53 % ( adjusted odds ratio 0.96 ; 95 % confidence interval 0.64 - 1.34 ) ; CORNET intervention versus control rates were 50 % versus 42 % ( adjusted odds ratio 1.06 ; 95 % confidence interval 0.68 - 1.88 ) . CONCLUSIONS AND RELEVANCE In both a local and national setting , provider prompts failed to improve adolescent immunization rates . More rigorous practice -based changes are needed OBJECTIVES : To assess the effectiveness of in-person and webinar-delivered AFIX ( Assessment , Feedback , Incentives , and eXchange ) consultations for increasing  adolescent  vaccine coverage . METHODS : We r and omly assigned 91 primary care clinics in North Carolina , serving 107 443 adolescents , to receive no consultation or an in-person or webinar AFIX consultation .  We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011 . The state 's immunization registry provided vaccine coverage data for younger patients ( ages 11–12 years ) and older patients ( ages 13–18 years ) for 3 adolescent vaccines : tetanus toxoid , reduced diphtheria toxoid , and acellular pertussis ( Tdap ) ; meningococcal ; and human papillomavirus ( HPV ) vaccines ( ≥1 dose , females only ) . RESULTS : At the 5-month follow-up , AFIX consultations increased vaccine coverage among younger adolescents . Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap ( 3.4 % [ 95 % confidence interval ( CI ) : 2.2 to 4.6 ] ) , meningococcal ( 4.7 % [ 95 % CI : 2.3 to 7.2 ] , and HPV ( 1.5 % [ 95 % CI : 0.3 to 2.7 ] ) vaccines . Patients in the webinar versus control arm also experienced larger changes for these vaccines . AFIX did little to improve coverage among older adolescents . At 1 year , the 3 arms showed similar coverage changes . The effectiveness of in-person and webinar consultations was not statistically different at either time point ( all , P > .05 ) . CONCLUSIONS : Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents . AFIX consultations for adolescents need improvement to have a stronger and more durable impact , especially for HPV vaccine OBJECTIVE : To assess the effectiveness of reminder/recall ( R/R ) for immunizing adolescents in private pediatric practice s and to describe the associated costs and revenues . METHODS : We conducted a r and omized controlled trial in 4 private pediatric practice s in metropolitan Denver . In each practice , 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations ( tetanus-diphtheria-acellular pertussis , meningococcal conjugate , or first dose of human papillomavirus vaccine for female patients ) were r and omly selected and r and omized to intervention ( 2 letters and 2 telephone calls ) or  control  ( usual care ) groups . Primary outcomes were receipt of > 1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention . We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines . RESULTS : Eight hundred adolescents were r and omized to the intervention and 800 to the control group . Baseline rates of having already received tetanus-diphtheria-acellular pertussis , meningococcal conjugate , and first dose of human papillomavirus vaccine before R/R ranged from 33 % to 54 % . Postintervention , the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine ( 47.1 % vs 34.6 % , P < .0001 ) and receipt of all targeted vaccines ( 36.2 % vs 25.2 % , P < .0001 ) compared with the control group . Three practice s had positive net revenues from R/R ; 1 showed net losses . CONCLUSIONS : R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children . Practice s conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low OBJECTIVES Screening of immunization status at each health care encounter is recommended to improve immunization coverage rates but is often limited to primary care practice s. A pilot intervention study was performed to ascertain the immunization status of hospitalized children and determine if development of an immunization plan before discharge would improve the vaccination status for such children . METHODS On the basis of power calculations estimated to detect an increase in immunization status from 60 % to 70 % with 80 % power , 356 r and omly selected children were enrolled between March 6 , 2012 and June 14 , 2012 . Immunization records were obtained , immunization status determined , and parent/guardian informed if catch-up dose(s ) were needed . If parent requested vaccine dose(s ) , they were administered before discharge . RESULTS Vaccination status was current per Advisory Committee on Immunization Practice s guidelines in 73 % of hospitalized children , and 27 % children required catch-up dose(s ) ( 200 doses for 95 children ) . Human papilloma virus vaccine ( dose 1 ) , varicella zoster vaccine ( dose 2 ) , and meningococcal conjugate vaccine were the most commonly identified dose(s ) needed . Of those requiring catch-up dose(s ) , 25 % were caught up , increasing vaccination status to 80 % at 1-month post hospital discharge . CONCLUSIONS This is the first study to determine the immunization status of hospitalized pediatric patients of all ages , including adolescents , providing new data on the immunization status of the inpatient pediatric population . A pilot intervention consisting of obtaining immunization records , determining immunization status , and discussing catch-up dose(s ) before discharge result ed in improvement of immunization status , suggesting that the inpatient setting may be used along with many other national strategies to help address missed vaccination opportunities Abstract Objective : To examine human papillomavirus ( HPV ) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students . Participants : Females aged 18 to 26 attending a university health service gynecology clinic ( n = 256 ) . Methods : Participants were r and omized to receive either HPV-specific education with a mailed reminder or st and ard care . Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified . Results : At baseline , 41 % intended to undergo HPV vaccination . Participants who were currently sexually active and lacked supplemental health insurance had decreased intent . Perceived parental approval regarding HPV vaccination , perceived vulnerability to HPV infection , and belief in health benefits of HPV vaccine were associated with increased intent . HPV vaccine uptake was low ( 5.5 % ) and did not differ by study group . However , baseline intent was significantly associated with HPV vaccine uptake . Conclusions : Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination OBJECTIVE : To improve human papillomavirus ( HPV ) vaccination rates , we studied the effectiveness of targeting automated decision support to families , clinicians , or both . METHODS : Twenty-two primary care practice s were cluster-r and omized to receive a 3-part clinician-focused intervention ( education , electronic health record-based alerts , and audit and feedback ) or none . Overall , 22 486 girls aged 11 to 17 years due for HPV vaccine dose 1 , 2 , or 3 were r and omly assigned within each practice to receive family-focused decision support with educational telephone calls . R and omization established 4 groups : family-focused , clinician-focused , combined , and no intervention . We measured decision support effectiveness by final vaccination rates and time to vaccine receipt , st and ardized for covariates and limited to those having received the previous dose for HPV # 2 and 3 . The 1-year study began in May 2010 . RESULTS : Final vaccination rates for HPV # 1 , 2 , and 3 were 16 % , 65 % , and 63 % among controls . The combined intervention increased vaccination rates by 9 , 8 , and 13 percentage points , respectively . The control group achieved 
    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: Adolescent immunization rates for human papillomavirus ( HPV ) are low and interventions within school-based health centers ( SBHCs ) may increase HPV uptake and series completion . We examined the effect of a parent health message intervention on HPV vaccination intent , first dose uptake and series completion among adolescents who received care at SBHCs . Via computer-assisted telephone interviews ( CATI ) , 445 parents of young adolescents were r and omly assigned to 2 two-level interventions using a 2 × 2 design ( rhetorical question ( RQ ) or no-RQ and one-sided or two-sided message ) . The RQ intervention involved asking the parent a question they were likely to endorse ( e.g. , “ Do you want to protect your daughter from cervical cancer ? ” ) with the expectation that they would then behave in a manner consistent with their endorsement ( i.e. , agree to vaccinate ) . For the one-sided message , parents were given information that emphasized the safety and effectiveness of HPV vaccine , whereas the two-sided message acknowledged that some parents might have concerns about the vaccine , followed by reassurance regarding the safety and effectiveness . At CATI conclusion , parents indicated intentions to have their adolescents vaccinated . Parents who endorsed any intent were sent a consent form to return and all adolescents with signed returned consents were vaccinated at SBHCs . Medical records were review ed for uptake/completion . Parents were 87 % female ; adolescents were 66 % male and racially/ethnically diverse . 42.5 % of parents indicated some intention to immunize , 51.4 % were unsure , and 6.1 % were not interested . 34 % ( n = 151 ) of adolescents received their first dose with series completion rates of 67 % ( n = 101 ) . The RQ component of the intervention increased intention to vaccinate ( RR = 1.45 ; 95%CI 1.16,1.81 ) , but not first dose uptake or series completion . The 1-sided and 2-sided messages had no effect . This brief , RQ health intervention enhanced intent , but did not impact vaccination rates , likely due to the time delay between the intervention and consent form receipt OBJECTIVE  Adolescent immunization rates  are suboptimal . Experts recommend provider prompts at health care visits to improve rates . We assessed the impact of either electronic health record ( EHR ) or nurse- or staff-initiated provider prompts on  adolescent immunization rates .  METHODS We conducted a r and omized controlled trial , allocating practice s in 1 of 2 practice -based research networks ( PBRN ) to provider prompts or st and ard-of-care control . Ten primary care practice s participated , 5 intervention and 5 controls , each matched in pairs on urban , suburban , or rural location and practice type ( pediatric or family medicine ) , from a PBRN in Greater Rochester , New York ( GR-PBRN ) ; and 12 practice s , 6 intervention , 6 controls , similarly matched , from a national pediatric continuity clinic PBRN ( CORNET ) . The study period was 1 year per practice , ranging from June 2011 to January 2013 . Study participants were adolescents 11 to 17 years attending these 22 practice s ; r and om sample of chart review s per practice for baseline and postintervention year to assess immunization rates ( n = 7,040 total chart review s for adolescents with > 1 visit in a period ) . The intervention was an EHR prompt ( 4 GR-PBRN and 5 CORNET practice pairs ) ( alert ) that appeared on providers ' computer screens at all office visits , indicating the specific immunizations that adolescents were recommended to receive . Staff prompts ( 1 GR-PBRN pair and 1 CORNET pair ) in the form of a reminder sheet was placed on the provider 's desk in the exam room indicating the vaccines due . We compared immunization rates , stratified by PBRN , for routine vaccines ( meningococcus , pertussis , human papillomavirus , influenza ) at study beginning and end . RESULTS Intervention and control practice s within each PBRN were similar at baseline for demographics and immunization rates . Immunization rates at the study end for adolescents who were behind on immunizations at study initiation were not significantly different for intervention versus control practice s for any vaccine or combination of vaccines . Results were similar for each PBRN and also when only EHR-based prompts was assessed . For example , at study end , 3-dose human papillomavirus vaccination rates for GR-PBRN intervention versus control practice s were 51 % versus 53 % ( adjusted odds ratio 0.96 ; 95 % confidence interval 0.64 - 1.34 ) ; CORNET intervention versus control rates were 50 % versus 42 % ( adjusted odds ratio 1.06 ; 95 % confidence interval 0.68 - 1.88 ) . CONCLUSIONS AND RELEVANCE In both a local and national setting , provider prompts failed to improve adolescent immunization rates . More rigorous practice -based changes are needed OBJECTIVES : To assess the effectiveness of in-person and webinar-delivered AFIX ( Assessment , Feedback , Incentives , and eXchange ) consultations for increasing  adolescent  vaccine coverage . METHODS : We r and omly assigned 91 primary care clinics in North Carolina , serving 107 443 adolescents , to receive no consultation or an in-person or webinar AFIX consultation .  We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011 . The state 's immunization registry provided vaccine coverage data for younger patients ( ages 11–12 years ) and older patients ( ages 13–18 years ) for 3 adolescent vaccines : tetanus toxoid , reduced diphtheria toxoid , and acellular pertussis ( Tdap ) ; meningococcal ; and human papillomavirus ( HPV ) vaccines ( ≥1 dose , females only ) . RESULTS : At the 5-month follow-up , AFIX consultations increased vaccine coverage among younger adolescents . Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap ( 3.4 % [ 95 % confidence interval ( CI ) : 2.2 to 4.6 ] ) , meningococcal ( 4.7 % [ 95 % CI : 2.3 to 7.2 ] , and HPV ( 1.5 % [ 95 % CI : 0.3 to 2.7 ] ) vaccines . Patients in the webinar versus control arm also experienced larger changes for these vaccines . AFIX did little to improve coverage among older adolescents . At 1 year , the 3 arms showed similar coverage changes . The effectiveness of in-person and webinar consultations was not statistically different at either time point ( all , P > .05 ) . CONCLUSIONS : Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents . AFIX consultations for adolescents need improvement to have a stronger and more durable impact , especially for HPV vaccine OBJECTIVE : To assess the effectiveness of reminder/recall ( R/R ) for immunizing adolescents in private pediatric practice s and to describe the associated costs and revenues . METHODS : We conducted a r and omized controlled trial in 4 private pediatric practice s in metropolitan Denver . In each practice , 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations ( tetanus-diphtheria-acellular pertussis , meningococcal conjugate , or first dose of human papillomavirus vaccine for female patients ) were r and omly selected and r and omized to intervention ( 2 letters and 2 telephone calls ) or  control  ( usual care ) groups . Primary outcomes were receipt of > 1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention . We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines . RESULTS : Eight hundred adolescents were r and omized to the intervention and 800 to the control group . Baseline rates of having already received tetanus-diphtheria-acellular pertussis , meningococcal conjugate , and first dose of human papillomavirus vaccine before R/R ranged from 33 % to 54 % . Postintervention , the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine ( 47.1 % vs 34.6 % , P < .0001 ) and receipt of all targeted vaccines ( 36.2 % vs 25.2 % , P < .0001 ) compared with the control group . Three practice s had positive net revenues from R/R ; 1 showed net losses . CONCLUSIONS : R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children . Practice s conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low OBJECTIVES Screening of immunization status at each health care encounter is recommended to improve immunization coverage rates but is often limited to primary care practice s. A pilot intervention study was performed to ascertain the immunization status of hospitalized children and determine if development of an immunization plan before discharge would improve the vaccination status for such children . METHODS On the basis of power calculations estimated to detect an increase in immunization status from 60 % to 70 % with 80 % power , 356 r and omly selected children were enrolled between March 6 , 2012 and June 14 , 2012 . Immunization records were obtained , immunization status determined , and parent/guardian informed if catch-up dose(s ) were needed . If parent requested vaccine dose(s ) , they were administered before discharge . RESULTS Vaccination status was current per Advisory Committee on Immunization Practice s guidelines in 73 % of hospitalized children , and 27 % children required catch-up dose(s ) ( 200 doses for 95 children ) . Human papilloma virus vaccine ( dose 1 ) , varicella zoster vaccine ( dose 2 ) , and meningococcal conjugate vaccine were the most commonly identified dose(s ) needed . Of those requiring catch-up dose(s ) , 25 % were caught up , increasing vaccination status to 80 % at 1-month post hospital discharge . CONCLUSIONS This is the first study to determine the immunization status of hospitalized pediatric patients of all ages , including adolescents , providing new data on the immunization status of the inpatient pediatric population . A pilot intervention consisting of obtaining immunization records , determining immunization status , and discussing catch-up dose(s ) before discharge result ed in improvement of immunization status , suggesting that the inpatient setting may be used along with many other national strategies to help address missed vaccination opportunities Abstract Objective : To examine human papillomavirus ( HPV ) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students . Participants : Females aged 18 to 26 attending a university health service gynecology clinic ( n = 256 ) . Methods : Participants were r and omized to receive either HPV-specific education with a mailed reminder or st and ard care . Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified . Results : At baseline , 41 % intended to undergo HPV vaccination . Participants who were currently sexually active and lacked supplemental health insurance had decreased intent . Perceived parental approval regarding HPV vaccination , perceived vulnerability to HPV infection , and belief in health benefits of HPV vaccine were associated with increased intent . HPV vaccine uptake was low ( 5.5 % ) and did not differ by study group . However , baseline intent was significantly associated with HPV vaccine uptake . Conclusions : Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination OBJECTIVE : To improve human papillomavirus ( HPV ) vaccination rates , we studied the effectiveness of targeting automated decision support to families , clinicians , or both . METHODS : Twenty-two primary care practice s were cluster-r and omized to receive a 3-part clinician-focused intervention ( education , electronic health record-based alerts , and audit and feedback ) or none . Overall , 22 486 girls aged 11 to 17 years due for HPV vaccine dose 1 , 2 , or 3 were r and omly assigned within each practice to receive family-focused decision support with educational telephone calls . R and omization established 4 groups : family-focused , clinician-focused , combined , and no intervention . We measured decision support effectiveness by final vaccination rates and time to vaccine receipt , st and ardized for covariates and limited to those having received the previous dose for HPV # 2 and 3 . The 1-year study began in May 2010 . RESULTS : Final vaccination rates for HPV # 1 , 2 , and 3 were 16 % , 65 % , and 63 % among controls . The combined intervention increased vaccination rates by 9 , 8 , and 13 percentage points , respectively . The control group achieved 
    Output:
    