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: BACKGROUND : A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously . OBJECTIVE : The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant , nulliparous women , and thereby construct a reference group for comparisons with parous women . STUDY DESIGN : This postal and World Wide Web – based question naire survey was conducted in 2014 . The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25‐64 years . Four independent age‐stratified , r and om sample s comprising 20,000 women were obtained from the total number of eligible nullipara ( n = 625,810 ) . A 40‐item question naire about pelvic floor symptoms , its severity , and its consequences were used . Age‐dependent differences for various aspects of urinary incontinence were analyzed with the youngest group ( 25‐34 years ) serving as reference . Crude and body mass index – adjusted prevalence and its 95 % confidence limits were calculated for each 10‐year category . RESULTS : The response rate was 52 % and the number of study participants was 9197 . Urinary incontinence increased > 5‐fold from 9.7 % in the youngest women with a body mass index < 25 kg/m2 to 48.4 % among the oldest women with a body mass index ≥35 kg/m2 . The prevalence of bothersome urinary incontinence almost tripled from 2.8‐7.9 % among all nulliparas . The proportion with bothersome urinary incontinence among incontinent women increased from 24.4 % in the youngest age group to 32.3 % in the age group 55‐64 years . Nocturia ≥2/night increased 4‐fold to 17.0 % and leakage ≥1/wk increased 3‐fold to 12.8 % among the oldest women . Mixed urinary incontinence increased from 22.9‐40.9 % among the oldest 0‐para with incontinence , whereas stress urinary incontinence decreased inversely from 43.6‐33.0 % . In the total cohort surgical treatment for urinary incontinence occurred in 3 per thous and . CONCLUSION : Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25‐64 years . This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth OBJECTIVE To evaluate the effect of a low‐intensity behavioral therapy program on urinary incontinence in older women . METHODS A r and omized clinical trial for community‐dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted . Women were r and omly assigned to a behavioral therapy group ( n = 77 ) or a control group ( n = 75 ) . The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules . The control group received no instruction but kept urinary diaries for 6 weeks . After this period , the control group underwent the behavioral therapy protocol . Using per‐ protocol analyses , t and χ2 tests were used to compare the treatment and control groups , and paired t tests were used to evaluate the efficacy of behavioral therapy for all women ( treatment and control groups before and after behavioral therapy ) . RESULTS Women in the treatment group experienced a 50 % reduction in mean number of incontinent episodes recorded on a 7‐day urinary diary compared with a 15 % reduction for controls ( P = .001 ) . After behavioral therapy , all women had a 40 % decrease in mean weekly incontinent episodes ( P = .001 ) , which was maintained over 6 months ( P < .004 ) . Thirty ( 31 % ) women were 100 % improved ( dry ) , 40 ( 41 % ) were at least 75 % improved , and 50 ( 52 % ) at least 50 % improved . There were no differences in treatment efficacy by type of incontinence ( stress , urge , mixed ) or group assignment ( treatment , control ) . CONCLUSION A low‐intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first‐line treatment for urinary incontinence in older women The efficacy of bladder training was evaluated in a r and omized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence . Subjects were urodynamically categorized as those with urethral sphincteric incompetence ( N = 88 ) and those with detrusor instability with or without concomitant sphincteric incompetence ( N = 35 ) . Bladder training reduced the number of incontinent episodes by 57 % ; the effect was similar for both urodynamic diagnostic groups . The quantity of fluid loss was reduced by 54 % . This was greater for patients with detrusor instability than for those without it . Diurnal and nocturnal voluntary micturitions were also reduced . The effect on nocturnal micturition , however , was not observed in subjects with unstable detrusor function . It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence . Provided prior comprehensive clinical evaluation is done , it can be prescribed without the need for urodynamic characterization Importance Electroacupuncture involving the lumbosacral region may be effective for women with stress urinary incontinence ( SUI ) , but evidence is limited . Objective To assess the effect of electroacupuncture vs sham electroacupuncture for women with SUI . Design , Setting , and Participants Multicenter , r and omized clinical trial conducted at 12 hospitals in China and enrolling 504 women with SUI between October 2013 and May 2015 , with data collection completed in December 2015 . Interventions Participants were r and omly assigned ( 1:1 ) to receive 18 sessions ( over 6 weeks ) of electroacupuncture involving the lumbosacral region ( n = 252 ) or sham electroacupuncture ( n = 252 ) with no skin penetration on sham acupoints . Main Outcomes and Measures The primary outcome was change from baseline to week 6 in the amount of urine leakage , measured by the 1-hour pad test . Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary ( 72-hour incontinence episodes ) . Results Among the 504 r and omized participants ( mean [ SD ] age , 55.3 [ 8.4 ] years ) , 482 completed the study . Mean urine leakage at baseline was 18.4 g for the electroacupuncture group and 19.1 g for the sham electroacupuncture group . Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group . At week 6 , the electroacupuncture group had greater decrease in mean urine leakage ( −9.9 g ) than the sham electroacupuncture group ( −2.6 g ) with a mean difference of 7.4 g ( 95 % CI , 4.8 to 10.0 ; P < .001 ) . During some time periods , the change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6 ( 95 % CI , 0.2 - 1.7 ; P = .01 ) , 2.0 episodes in weeks 15 to 18 ( 95 % CI , 1.3 - 2.7 ; P < .001 ) , and 2.1 episodes in weeks 27 to 30 ( 95 % CI , 1.3 - 2.8 ; P < .001 ) . The incidence of treatment-related adverse events was 1.6 % in the electroacupuncture group and 2.0 % in the sham electroacupuncture group , and all events were classified as mild . Conclusions and Relevance Among women with stress urinary incontinence , treatment with electroacupuncture involving the lumbosacral region , compared with sham electroacupuncture , result ed in less urine leakage after 6 weeks . Further research is needed to underst and long-term efficacy and the mechanism of action of this intervention . Trial Registration clinical trials.gov Identifier : NCT01784172 OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization OBJECTIVE To examine the effectiveness of a st and ardised Urinary Continence Physiotherapy Programme for older Chinese women with stress , urge , or mixed urinary incontinence . DESIGN A controlled trial . SETTING Six elderly community health centres in Hong Kong . PARTICIPANTS A total of 55 women aged over 65 years with mild-to-moderate urinary incontinence . INTERVENTIONS Participants were r and omly assigned to the intervention group ( n=27 ) where they received eight sessions of Urinary Continence Physiotherapy Programme for 12 weeks . This group received education about urinary incontinence , pelvic floor muscle training with manual palpation and verbal feedback , and behavioural therapy . The control group ( n=28 ) was given advice and an educational pamphlet on urinary incontinence . RESULTS There was significant improvement in urinary symptoms in the intervention group , especially in the first 5 weeks . Compared with the control group , participants receiving the intervention showed significant reduction in urinary incontinence episodes per week with a mean difference of -6.4 ( 95 % confidence interval , -8.9 to -3.9 ; t= -5.3 ; P<0.001 ) and significant improvement of quality of life with a mean difference of -3.93 ( 95 % confidence interval , -5.08 to -2.78 ; t= -6.9 ; P<0.001 ) measured by Incontinence Impact Question naire Short Form modified Chinese ( Taiwan ) version . The subjective perception of improvement , measured by an 11-point visual analogue scale , was markedly better in the intervention group ( mean , 8.7 ; st and ard deviation , 1.0 ; 95 % confidence interval , 8.4 - 9.1 ) than in the control group ( mean , 1.4 ; st and ard deviation , 0.7 ; 95 % confidence interval , 1.2 - 1.7 ; t=33.9 ; P<0.001 ) . The mean treatment satisfaction in the intervention group was 9.5 ( st and ard deviation , 0.8 ) as measured by an 11-point visual analogue scale . CONCLUSIONS This study demonstrated that the Urinary Continence Physiotherapy Programme was effective in alleviating urinary symptoms among older Chinese women with mild-to-moderate heterogeneous urinary incontinence OBJECTIVE To determine whether an avatar-based , online , self-management program is an effective therapeutic approach for women with overactive bladder ( OAB ) . OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life ( HRQOL ) . Behavioral interventions can produce substantial improvement in symptoms and HRQOL . Online education programs offer patients with OAB an alternative to face-to-face self-management instruction . Evidence suggests that avatars ( digital humans ) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors . METHODS In a 12-week , r and omized , controlled trial , women ( aged > 55 years ) with symptoms of OAB for at least 3 months were r and omized to 2 versions of a 3-part , online , self-management program . After collecting the baseline metrics , the intervention group viewed a generic avatar coach with a self-avatar peer mentor design ed to resemble the participant , and the control group viewed the identical online program with voice only . Participants viewed part 1 at week 1 and parts 2 and 3 at week 6 . Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1 , 6 , and 12 . RESULTS Forty-one women completed the study ( mean age = 61 years , st and ard deviation = 6 ) . The analysis of covariance of week-12 outcome 
    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: BACKGROUND : A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously . OBJECTIVE : The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant , nulliparous women , and thereby construct a reference group for comparisons with parous women . STUDY DESIGN : This postal and World Wide Web – based question naire survey was conducted in 2014 . The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25‐64 years . Four independent age‐stratified , r and om sample s comprising 20,000 women were obtained from the total number of eligible nullipara ( n = 625,810 ) . A 40‐item question naire about pelvic floor symptoms , its severity , and its consequences were used . Age‐dependent differences for various aspects of urinary incontinence were analyzed with the youngest group ( 25‐34 years ) serving as reference . Crude and body mass index – adjusted prevalence and its 95 % confidence limits were calculated for each 10‐year category . RESULTS : The response rate was 52 % and the number of study participants was 9197 . Urinary incontinence increased > 5‐fold from 9.7 % in the youngest women with a body mass index < 25 kg/m2 to 48.4 % among the oldest women with a body mass index ≥35 kg/m2 . The prevalence of bothersome urinary incontinence almost tripled from 2.8‐7.9 % among all nulliparas . The proportion with bothersome urinary incontinence among incontinent women increased from 24.4 % in the youngest age group to 32.3 % in the age group 55‐64 years . Nocturia ≥2/night increased 4‐fold to 17.0 % and leakage ≥1/wk increased 3‐fold to 12.8 % among the oldest women . Mixed urinary incontinence increased from 22.9‐40.9 % among the oldest 0‐para with incontinence , whereas stress urinary incontinence decreased inversely from 43.6‐33.0 % . In the total cohort surgical treatment for urinary incontinence occurred in 3 per thous and . CONCLUSION : Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25‐64 years . This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth OBJECTIVE To evaluate the effect of a low‐intensity behavioral therapy program on urinary incontinence in older women . METHODS A r and omized clinical trial for community‐dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted . Women were r and omly assigned to a behavioral therapy group ( n = 77 ) or a control group ( n = 75 ) . The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules . The control group received no instruction but kept urinary diaries for 6 weeks . After this period , the control group underwent the behavioral therapy protocol . Using per‐ protocol analyses , t and χ2 tests were used to compare the treatment and control groups , and paired t tests were used to evaluate the efficacy of behavioral therapy for all women ( treatment and control groups before and after behavioral therapy ) . RESULTS Women in the treatment group experienced a 50 % reduction in mean number of incontinent episodes recorded on a 7‐day urinary diary compared with a 15 % reduction for controls ( P = .001 ) . After behavioral therapy , all women had a 40 % decrease in mean weekly incontinent episodes ( P = .001 ) , which was maintained over 6 months ( P < .004 ) . Thirty ( 31 % ) women were 100 % improved ( dry ) , 40 ( 41 % ) were at least 75 % improved , and 50 ( 52 % ) at least 50 % improved . There were no differences in treatment efficacy by type of incontinence ( stress , urge , mixed ) or group assignment ( treatment , control ) . CONCLUSION A low‐intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first‐line treatment for urinary incontinence in older women The efficacy of bladder training was evaluated in a r and omized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence . Subjects were urodynamically categorized as those with urethral sphincteric incompetence ( N = 88 ) and those with detrusor instability with or without concomitant sphincteric incompetence ( N = 35 ) . Bladder training reduced the number of incontinent episodes by 57 % ; the effect was similar for both urodynamic diagnostic groups . The quantity of fluid loss was reduced by 54 % . This was greater for patients with detrusor instability than for those without it . Diurnal and nocturnal voluntary micturitions were also reduced . The effect on nocturnal micturition , however , was not observed in subjects with unstable detrusor function . It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence . Provided prior comprehensive clinical evaluation is done , it can be prescribed without the need for urodynamic characterization Importance Electroacupuncture involving the lumbosacral region may be effective for women with stress urinary incontinence ( SUI ) , but evidence is limited . Objective To assess the effect of electroacupuncture vs sham electroacupuncture for women with SUI . Design , Setting , and Participants Multicenter , r and omized clinical trial conducted at 12 hospitals in China and enrolling 504 women with SUI between October 2013 and May 2015 , with data collection completed in December 2015 . Interventions Participants were r and omly assigned ( 1:1 ) to receive 18 sessions ( over 6 weeks ) of electroacupuncture involving the lumbosacral region ( n = 252 ) or sham electroacupuncture ( n = 252 ) with no skin penetration on sham acupoints . Main Outcomes and Measures The primary outcome was change from baseline to week 6 in the amount of urine leakage , measured by the 1-hour pad test . Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary ( 72-hour incontinence episodes ) . Results Among the 504 r and omized participants ( mean [ SD ] age , 55.3 [ 8.4 ] years ) , 482 completed the study . Mean urine leakage at baseline was 18.4 g for the electroacupuncture group and 19.1 g for the sham electroacupuncture group . Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group . At week 6 , the electroacupuncture group had greater decrease in mean urine leakage ( −9.9 g ) than the sham electroacupuncture group ( −2.6 g ) with a mean difference of 7.4 g ( 95 % CI , 4.8 to 10.0 ; P < .001 ) . During some time periods , the change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6 ( 95 % CI , 0.2 - 1.7 ; P = .01 ) , 2.0 episodes in weeks 15 to 18 ( 95 % CI , 1.3 - 2.7 ; P < .001 ) , and 2.1 episodes in weeks 27 to 30 ( 95 % CI , 1.3 - 2.8 ; P < .001 ) . The incidence of treatment-related adverse events was 1.6 % in the electroacupuncture group and 2.0 % in the sham electroacupuncture group , and all events were classified as mild . Conclusions and Relevance Among women with stress urinary incontinence , treatment with electroacupuncture involving the lumbosacral region , compared with sham electroacupuncture , result ed in less urine leakage after 6 weeks . Further research is needed to underst and long-term efficacy and the mechanism of action of this intervention . Trial Registration clinical trials.gov Identifier : NCT01784172 OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization OBJECTIVE To examine the effectiveness of a st and ardised Urinary Continence Physiotherapy Programme for older Chinese women with stress , urge , or mixed urinary incontinence . DESIGN A controlled trial . SETTING Six elderly community health centres in Hong Kong . PARTICIPANTS A total of 55 women aged over 65 years with mild-to-moderate urinary incontinence . INTERVENTIONS Participants were r and omly assigned to the intervention group ( n=27 ) where they received eight sessions of Urinary Continence Physiotherapy Programme for 12 weeks . This group received education about urinary incontinence , pelvic floor muscle training with manual palpation and verbal feedback , and behavioural therapy . The control group ( n=28 ) was given advice and an educational pamphlet on urinary incontinence . RESULTS There was significant improvement in urinary symptoms in the intervention group , especially in the first 5 weeks . Compared with the control group , participants receiving the intervention showed significant reduction in urinary incontinence episodes per week with a mean difference of -6.4 ( 95 % confidence interval , -8.9 to -3.9 ; t= -5.3 ; P<0.001 ) and significant improvement of quality of life with a mean difference of -3.93 ( 95 % confidence interval , -5.08 to -2.78 ; t= -6.9 ; P<0.001 ) measured by Incontinence Impact Question naire Short Form modified Chinese ( Taiwan ) version . The subjective perception of improvement , measured by an 11-point visual analogue scale , was markedly better in the intervention group ( mean , 8.7 ; st and ard deviation , 1.0 ; 95 % confidence interval , 8.4 - 9.1 ) than in the control group ( mean , 1.4 ; st and ard deviation , 0.7 ; 95 % confidence interval , 1.2 - 1.7 ; t=33.9 ; P<0.001 ) . The mean treatment satisfaction in the intervention group was 9.5 ( st and ard deviation , 0.8 ) as measured by an 11-point visual analogue scale . CONCLUSIONS This study demonstrated that the Urinary Continence Physiotherapy Programme was effective in alleviating urinary symptoms among older Chinese women with mild-to-moderate heterogeneous urinary incontinence OBJECTIVE To determine whether an avatar-based , online , self-management program is an effective therapeutic approach for women with overactive bladder ( OAB ) . OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life ( HRQOL ) . Behavioral interventions can produce substantial improvement in symptoms and HRQOL . Online education programs offer patients with OAB an alternative to face-to-face self-management instruction . Evidence suggests that avatars ( digital humans ) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors . METHODS In a 12-week , r and omized , controlled trial , women ( aged > 55 years ) with symptoms of OAB for at least 3 months were r and omized to 2 versions of a 3-part , online , self-management program . After collecting the baseline metrics , the intervention group viewed a generic avatar coach with a self-avatar peer mentor design ed to resemble the participant , and the control group viewed the identical online program with voice only . Participants viewed part 1 at week 1 and parts 2 and 3 at week 6 . Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1 , 6 , and 12 . RESULTS Forty-one women completed the study ( mean age = 61 years , st and ard deviation = 6 ) . The analysis of covariance of week-12 outcome 
    Output:
    