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 Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies The words people use in  disclosing a trauma  were hypothesized to predict improvements in mental and physical health in 2 studies . The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health . Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health . Higher use of positive relative to negative emotion words was also associated with better health . An empirical measure that was derived from these data correlated with subsequent distress ratings . The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS . Cognitive change and empirical models predicted postbereavement distress at 1 year . Implication s of using computer-based text analyses in the study of narratives are discussed This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Background : Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease . Purpose : This study was a r and omized , controlled effectiveness trial with 4 arms : 2 active treatment writing groups , 1 inactive writing group , and 1 attention control group . It represents the first attempt to translate the expressive writing intervention into a low-cost , community-based intervention in the form of a videotaped program . Methods : Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients ( N = 373 ) . Results : The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs . Seventy-nine percent of eligible patients agreed to take the program home ; 49 % of these patients reported that they followed the protocol . Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program . Conclusions : Intent-to-treat analyses found no effect of the treatment . Pretreatment differences among the protocol -adherent patients complicated treatment outcome interpretation . The st and ard writing instructions did not yield an effect ; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results . Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed Background Coronary heart disease ( CHD ) is typically associated with many cardiovascular risk factors ( e.g. , elevated blood pressure ) , low health-related quality of life , depression , anxiety and psychological stress . Expressive writing ( EW ) has shown beneficial effects on such variables in both people from the community and in patients with a variety of chronic illnesses . However , no study to date has evaluated the physical and psychological effects of the expressive writing procedure on coronary patients referred to cardiac rehabilitation ( CR ) . Methods The clinical effectiveness of a 2-week disease-related expressive writing procedure ( writing about one 's deepest thoughts and feelings regarding the experience with heart disease ) compared with the st and ard writing task ( writing about one 's deepest thoughts and feelings about the most traumatic or negative event experienced in the life ) , a neutral writing condition ( writing about the facts regarding heart disease and its treatment ) and an empty control condition will be evaluated in a r and omized controlled clinical trial ( RCT ) with repeated follow-up measurements at 3 , 6 and 12 months after discharge from CR . The primary outcome is health-related quality of life ( SF-12 ) . Secondary outcome measures are depression ( BDI-II ) , anxiety ( BAI ) and post-traumatic growth ( PTGI ) . Furthermore , the study will explore the moderating effects of coping styles , type D personality , perceived emotional support and participants ' evaluative ratings of the writing interventions on the main experimental effects in order to identify sub-groups of patients showing different results . Discussion The WRITTEN-HEART study aims to explore and exp and the frontiers of the expressive writing research enterprise by investigating the feasibility , safety and clinical efficacy of brief and cost-effective  expressive writing interventions in patients with CHD referred to CR.Trial registration Clinical Trials.gov OBJECTIVE Little attention has been focused on Asian American breast cancer survivor 's psychological needs . No outcome -based psychosocial interventions have been reported to target at this population . Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer population s. This pilot study aim ed to test the cultural sensitivity , feasibility , and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors . METHODS Participants ( N = 19 ) were asked to write about their deepest thoughts and feelings , their coping efforts , and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks . Health outcomes were assessed at baseline , 3 , and 6 months after the intervention . A Community-Based Participatory Research Approach ( CBPR ) is used . RESULTS Expressive writing was associated with medium and large effect sizes ( η(p)² = 0.066∼0.208 ) in improving multiple health outcomes ( quality of life , fatigue , posttraumatic stress , intrusive thoughts , and positive affect ) at follow-ups . Participants perceived the study to be valuable . The study yielded high compliance and completion rates . CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors . In addition , CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied population s. Future studies employing r and omized , controlled trial design s are warranted The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint ( negative social responses to patients ' expressions of emotion regarding their cancer ) on distress . Cancer patients ( N=104 ) were r and omly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic . They completed question naires at baseline and 6 months postintervention . Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects . The present data reinforce the notion that interventions should be tailored to patients ' needs Objective : This pilot study explored the feasibility and the efficacy of a brief , well-defined psychosocial intervention ( expressive disclosure ) in improving behavioral , medical , immunological , and emotional health outcomes in men with diagnosed prostate cancer . Method : Thirty prostate cancer patients receiving outpatient oncology care were r and omized into  experimental ( disclosure ) and control ( non-disclosure ) groups . All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels .  Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment . Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning : physical and psychological symptoms ; health care utilization ; and immunocompetence . Results : Compared to controls , patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization , but not in psychological variables nor in disease relevant aspects of immunocompetence . Conclusions : Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer . The intervention was well accepted by this population , and participation/adherence was quite high . Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population . However , this pilot study may have lacked adequate power to detect possible intervention benefits . Further studies with larger sample s are needed to better assess the intervention 's impact on psychological well-being and immunocompetence AIMS This article is the report of a study aim ed at determining whether or not expressive writing improves the quality -of-life of early breast cancer survivors . An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results . BACKGROUND The risk of distress can extend well beyond the time of a breast cancer diagnosis . Emotional expression may assist in dealing with this . DESIGN R and omized controlled study . METHODS Participants ( n = 120 ) were r and omized into one of four groups : a control group ( no writing ) or one of three expressive writing groups : breast cancer trauma , any self-selected trauma and facts related to breast cancer . Participants wrote 20 minutes a day for 4 consecutive days . Their quality -of-life was measured , using the ' Functional Assessment of Cancer Therapy-Breast Cancer Version ' , at baseline and at 1 month and 6 months after writing . Paired t-tests , multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment , collected in 2006 . Intention-to-treat analysis was used . RESULTS / FINDINGS Expressive writing about one 's breast cancer , breast cancer trauma and facts related to breast cancer , significantly improved the quality -of-life outcome . CONCLUSION Expressive writing , focusing the instructions on writing about one 's living and dealing with a diagnosis of breast cancer , is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality -of-life Objective : Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy . Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study ( 1 ) . Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics . Methods : We conducted a r and omized , controlled trial of outpatient asthmatics recruited from hospitals and the community . Of the 137 adult patients with asthma who were r and omized , 117 began and 114 completed the study . Patients were r and omly assigned to write for 20 minutes , once per week , for 3 weeks about stressful experiences ( n = 41 ) , positive experiences ( n = 37 ) , or neutral experiences ( n = 36 ; control group ) . At baseline , postintervention , and 2-month follow up , patients were assessed by spirometry . Results : The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second ( FEV1 ) was 4.2 % in the stress-writing group , 1.3 % in the positive-writing group , and 3.0 % in the control group . In forced vital capacity ( FVC ) , there was 3.1 % improvement in the stress-writing group , 3.6 % in the positive-writing group , and 2.4 % in the control group . These changes were not statistically or clinical ly significant . Conclusions : The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients . FEV1 = forced expiratory volume in 1 second ; FVC = forced vital capacity ; VAPAHCS = Veteran Affairs Palo Alto Health Care System ; PTSD = posttraumatic stress disorder ; COPD = chronic obstructive pulmonary disease Patients at 
    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 Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies The words people use in  disclosing a trauma  were hypothesized to predict improvements in mental and physical health in 2 studies . The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health . Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health . Higher use of positive relative to negative emotion words was also associated with better health . An empirical measure that was derived from these data correlated with subsequent distress ratings . The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS . Cognitive change and empirical models predicted postbereavement distress at 1 year . Implication s of using computer-based text analyses in the study of narratives are discussed This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Background : Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease . Purpose : This study was a r and omized , controlled effectiveness trial with 4 arms : 2 active treatment writing groups , 1 inactive writing group , and 1 attention control group . It represents the first attempt to translate the expressive writing intervention into a low-cost , community-based intervention in the form of a videotaped program . Methods : Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients ( N = 373 ) . Results : The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs . Seventy-nine percent of eligible patients agreed to take the program home ; 49 % of these patients reported that they followed the protocol . Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program . Conclusions : Intent-to-treat analyses found no effect of the treatment . Pretreatment differences among the protocol -adherent patients complicated treatment outcome interpretation . The st and ard writing instructions did not yield an effect ; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results . Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed Background Coronary heart disease ( CHD ) is typically associated with many cardiovascular risk factors ( e.g. , elevated blood pressure ) , low health-related quality of life , depression , anxiety and psychological stress . Expressive writing ( EW ) has shown beneficial effects on such variables in both people from the community and in patients with a variety of chronic illnesses . However , no study to date has evaluated the physical and psychological effects of the expressive writing procedure on coronary patients referred to cardiac rehabilitation ( CR ) . Methods The clinical effectiveness of a 2-week disease-related expressive writing procedure ( writing about one 's deepest thoughts and feelings regarding the experience with heart disease ) compared with the st and ard writing task ( writing about one 's deepest thoughts and feelings about the most traumatic or negative event experienced in the life ) , a neutral writing condition ( writing about the facts regarding heart disease and its treatment ) and an empty control condition will be evaluated in a r and omized controlled clinical trial ( RCT ) with repeated follow-up measurements at 3 , 6 and 12 months after discharge from CR . The primary outcome is health-related quality of life ( SF-12 ) . Secondary outcome measures are depression ( BDI-II ) , anxiety ( BAI ) and post-traumatic growth ( PTGI ) . Furthermore , the study will explore the moderating effects of coping styles , type D personality , perceived emotional support and participants ' evaluative ratings of the writing interventions on the main experimental effects in order to identify sub-groups of patients showing different results . Discussion The WRITTEN-HEART study aims to explore and exp and the frontiers of the expressive writing research enterprise by investigating the feasibility , safety and clinical efficacy of brief and cost-effective  expressive writing interventions in patients with CHD referred to CR.Trial registration Clinical Trials.gov OBJECTIVE Little attention has been focused on Asian American breast cancer survivor 's psychological needs . No outcome -based psychosocial interventions have been reported to target at this population . Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer population s. This pilot study aim ed to test the cultural sensitivity , feasibility , and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors . METHODS Participants ( N = 19 ) were asked to write about their deepest thoughts and feelings , their coping efforts , and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks . Health outcomes were assessed at baseline , 3 , and 6 months after the intervention . A Community-Based Participatory Research Approach ( CBPR ) is used . RESULTS Expressive writing was associated with medium and large effect sizes ( η(p)² = 0.066∼0.208 ) in improving multiple health outcomes ( quality of life , fatigue , posttraumatic stress , intrusive thoughts , and positive affect ) at follow-ups . Participants perceived the study to be valuable . The study yielded high compliance and completion rates . CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors . In addition , CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied population s. Future studies employing r and omized , controlled trial design s are warranted The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint ( negative social responses to patients ' expressions of emotion regarding their cancer ) on distress . Cancer patients ( N=104 ) were r and omly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic . They completed question naires at baseline and 6 months postintervention . Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects . The present data reinforce the notion that interventions should be tailored to patients ' needs Objective : This pilot study explored the feasibility and the efficacy of a brief , well-defined psychosocial intervention ( expressive disclosure ) in improving behavioral , medical , immunological , and emotional health outcomes in men with diagnosed prostate cancer . Method : Thirty prostate cancer patients receiving outpatient oncology care were r and omized into  experimental ( disclosure ) and control ( non-disclosure ) groups . All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels .  Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment . Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning : physical and psychological symptoms ; health care utilization ; and immunocompetence . Results : Compared to controls , patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization , but not in psychological variables nor in disease relevant aspects of immunocompetence . Conclusions : Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer . The intervention was well accepted by this population , and participation/adherence was quite high . Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population . However , this pilot study may have lacked adequate power to detect possible intervention benefits . Further studies with larger sample s are needed to better assess the intervention 's impact on psychological well-being and immunocompetence AIMS This article is the report of a study aim ed at determining whether or not expressive writing improves the quality -of-life of early breast cancer survivors . An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results . BACKGROUND The risk of distress can extend well beyond the time of a breast cancer diagnosis . Emotional expression may assist in dealing with this . DESIGN R and omized controlled study . METHODS Participants ( n = 120 ) were r and omized into one of four groups : a control group ( no writing ) or one of three expressive writing groups : breast cancer trauma , any self-selected trauma and facts related to breast cancer . Participants wrote 20 minutes a day for 4 consecutive days . Their quality -of-life was measured , using the ' Functional Assessment of Cancer Therapy-Breast Cancer Version ' , at baseline and at 1 month and 6 months after writing . Paired t-tests , multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment , collected in 2006 . Intention-to-treat analysis was used . RESULTS / FINDINGS Expressive writing about one 's breast cancer , breast cancer trauma and facts related to breast cancer , significantly improved the quality -of-life outcome . CONCLUSION Expressive writing , focusing the instructions on writing about one 's living and dealing with a diagnosis of breast cancer , is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality -of-life Objective : Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy . Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study ( 1 ) . Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics . Methods : We conducted a r and omized , controlled trial of outpatient asthmatics recruited from hospitals and the community . Of the 137 adult patients with asthma who were r and omized , 117 began and 114 completed the study . Patients were r and omly assigned to write for 20 minutes , once per week , for 3 weeks about stressful experiences ( n = 41 ) , positive experiences ( n = 37 ) , or neutral experiences ( n = 36 ; control group ) . At baseline , postintervention , and 2-month follow up , patients were assessed by spirometry . Results : The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second ( FEV1 ) was 4.2 % in the stress-writing group , 1.3 % in the positive-writing group , and 3.0 % in the control group . In forced vital capacity ( FVC ) , there was 3.1 % improvement in the stress-writing group , 3.6 % in the positive-writing group , and 2.4 % in the control group . These changes were not statistically or clinical ly significant . Conclusions : The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients . FEV1 = forced expiratory volume in 1 second ; FVC = forced vital capacity ; VAPAHCS = Veteran Affairs Palo Alto Health Care System ; PTSD = posttraumatic stress disorder ; COPD = chronic obstructive pulmonary disease Patients at 
    Output:
    