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 Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization . OBJECTIVE Our aim was to examine the effects of a guided disclosure protocol ( GDP ) of past traumas on symptoms and clinic visits among frequent clinic attenders . METHODS Forty-one frequent clinic attenders ( > or = 2 visits/3 months ) took part . Patients were r and omly assigned individually to either a casual content writing control group ( n = 19 ) or a trauma content writing experimental GDP group ( n = 22 ) . GDP patients wrote about an up setting event chronologically ( day 1 ) , verbally described their thoughts and feelings and described the event 's impact on life ( day 2 ) , and finally wrote about their current perspective on and future coping with the event ( day 3 ) . Three months later , patients were reassessed blindly for symptoms and clinic visits , and an average of 15 months later they were assessed blindly for clinic visits again . RESULTS Compared with controls , GDP patients reported lower symptom levels at 3 months ( 2.3 versus 5.2 ) , and made fewer clinic visits during the 3 ( 1.3 versus 3.0 ) and 15 month ( 5.1 versus 9.7 ) follow-ups . The percentage of GDP patients making > or = 10 visits during the 15 month follow-up was smaller ( 10 % ) than among controls ( 33 % ) . CONCLUSIONS The findings extend previous findings to frequent clinic users , using a new form of written disclosure aim ed at shifting trauma from implicit to explicit memory . The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users OBJECTIVE To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes . METHODS We r and omized 50 adolescents with asthma to write for 3 days at home about stressful events ( disclosure ) or control topics . At baseline and 2 months after writing , we assessed symptoms , affect , disability , internalizing behavior problems , and lung function ; parents independently rated internalizing behavior and disability . RESULTS Compared with control writing , disclosure writing led to improved positive affect and internalizing problems . Disclosure also decreased asthma symptoms and functional disability among adolescents with baseline elevations of these difficulties . Lung function was not changed . Disclosures with more negative emotion , insight , and causal words-- and increased causal or insight words over days -- predicted improved health . CONCLUSIONS Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma , particularly those whose writings suggest emotional processing and cognitive restructuring Abstract Objective : To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma . Design : Cluster r and omised controlled trial . Setting : Six high schools in rural Australia . Participants : 272 students with recent wheeze , recruited from a cohort of 1515 students from two school years ( mean age 12.5 and 15.5 years ) ; 251 ( 92.3 % ) completed the study . Intervention : A structured education programme for peers comprising three steps ( the “ Triple A Program ” ) . Main outcome measures : Quality of life , school absenteeism , asthma attacks , and lung function . Results : When adjusted for year and sex , mean total quality of life scores showed significant improvement in the intervention than control group . Clinical ly important improvement in quality of life ( > 0.5 units ) occurred in 25 % of students with asthma in the intervention group compared with 12 % in the control group ( P=0.01 ) . The number needed to treat was 8 ( 95 % confidence interval 4.5 to 35.7 ) . The effect of the intervention was greatest in students in year 10 and in females . Significant improvements occurred in the activities domain ( 41 % v 28 % ) and in the emotions domain ( 39 % v 19 % ) in males in the intervention group . School absenteeism significantly decreased in the intervention group only . Asthma attacks at school increased in the control group only . Conclusion : The triple A programme leads to a clinical ly relevant improvement in quality of life and related morbidity in students with asthma . Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in The aim of this study was to evaluate the impact of a new patient education programme on adults with asthma . This self-management programme included an individual assessment of patient 's needs and two educational group sessions . Teaching methods and session content are described as well as caregivers training programme . The training sessions included a written asthma action plan based on symptoms and personal peak expiratory flow . Patients ( n = 238 ) aged from 18 to 60 years were allocated to the intervention ( group A ) or control group ( group B ) . Patients filled during 1 year a daily diary and question naire and they were administered telephone interviews . 127 patients were included in the treatment program and 111 in the control group . There was a significant improvement in the educated group with regard to symptoms free days ( P = 0.03 ) , number of awakenings ( P = 0.04 ) , consumption of corticosteroids ( P = 0.03 ) , consumption of beta2-agonists ( P = 0.03 ) , and quality of life score ( P = 0.01 ) . In conclusion , this study vali date s a specific educational approach named " un souffle nouveau " Abstract Several behavioral medicine interventions ( eg , relaxation training and written emotional expression ) have been proposed as effective supplemental treatments for individuals with chronic illnesses such as asthma . Whether these treatments are feasible or effective in a manual-based , self-administered format is unclear , and few studies have examined the effectiveness of such treatments presented in a complementary format . We examined the feasibility and effectiveness of a 4 week stress management treatment compared with a matched placebo intervention in young adults with asthma . Both groups considered the workbooks credible treatment interventions and completed them conscientiously . The treatment group showed significant improvement in measures of lung function compared with the placebo group , but analysis revealed no differences in measures of perceived stress . These findings provide initial support for the feasibility of self-administered manual-based interventions and some evidence that they can produce health benefits in individuals with asthma and , perhaps other chronic conditions OBJECTIVE --To determine the extent to which symptom diaries of asthmatic patients are inaccurate or based on retrospective recall . DESIGN --Comparison of electronic and pencil and paper diaries . Both forms were completed twice daily at home for 14 days . SETTING --Outpatient clinic . SUBJECTS--24 asthmatic out patients also tested for severity of asthma and for anxiety . RESULTS --More sessions were missed in the evening than in the morning for both types of diaries . Significantly more retrospective entries were made in the evening ( 26 entries , 14 patients ) than in the morning ( 6 entries , 3 patients ) . Discrepant entries of peak expiratory flow accounted for 15 % of those made on the appropriate day , and three quarters of patients made at least one discrepant entry . Variation in peak expiratory flow was significantly related to number of discrepancies and number of missing days , and anxiety score was significantly related to number of missing days . About a fifth of written entries may have errors . CONCLUSION --Poor diary completion may result from having unreasonable expectations of patients and giving incomplete instructions . Electronic , time coded diaries could ensure better quality of records 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 CONTEXT Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness . Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports , well-being , and health care use in healthy individuals . OBJECTIVE To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using st and ardized quantitative outcome measures . DESIGN R and omized controlled trial conducted between October 1996 and December 1997 . SETTING Outpatient community residents drawn from private and institutional practice . PATIENTS Volunteer sample of 112 patients with asthma ( n = 61 ) or rheumatoid arthritis ( n = 51 ) received the intervention ; 107 completed the study , 58 in the asthma group and 49 in the rheumatoid arthritis group . INTERVENTION Patients were assigned to write either about the most stressful event of their lives ( n = 71 ; 39 asthma , 32 rheumatoid arthritis ) or about emotionally neutral topics ( n = 41 ; 22 asthma , 19 rheumatoid arthritis ) ( the control intervention ) . MAIN OUTCOME MEASURES Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinical ly examined by a rheumatologist . Assessment s were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition . RESULTS Of evaluable patients 4 months after treatment , asthma patients in the experimental group showed improvements in lung function ( the mean percentage of predicted forced expiratory volume in 1 second [ FEV1 ] improved from 63.9 % at baseline to 76.3 % at the 4-month follow-up ; P<.001 ) , whereas control group patients showed no change . Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity ( a mean reduction in disease severity from 1.65 to 1.19 [ 28 % ] on a scale of 0 [ asymptomatic ] to 4 [ very severe ] at the 4-month follow-up ; P=.001 ) , whereas control group patients did not change . Combining all completing patients , 33 ( 47.1 % ) of 70 experimental patients had clinical ly relevant improvement , whereas 9 ( 24.3 % ) of 37 control patients had improvement ( P=.001 ) . CONCLUSION Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinical ly relevant changes in health status at 4 months compared with those in the control group . These gains were beyond those attributable to the st and ard medical care that all participants were receiving . It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases RATIONALE Asthma prevalence and morbidity are especially elevated in adolescents , yet few interventions target this population . OBJECTIVES To test the efficacy of Asthma Self-Management for Adolescents ( ASMA ) , a school-based intervention for adolescents and medical providers . METHODS Three hundred forty-five primarily Latino/a ( 46 % ) and African American ( 31 % ) high school students ( mean age = 15.1 yr ; 70 % female ) reporting an asthma diagnosis , symptoms of moderate to severe persistent asthma , and asthma medication use in the last 12 months were r and omized to ASMA  , an 8-week school-based intervention , or a wait-list control group . They were followed for 12 months . MEASUREMENTS AND MAIN RESULTS Students completed bimonthly assessment s. Baseline , 6-month , and 12-month assessment s were comprehensive ; the others assessed interim health outcomes and urgent health care use . Primary outcomes were asthma self-management , symptom frequency , and quality of life ( QOL ) ; secondary outcomes were asthma medical management , school absences , days with activity limitations , and urgent health care use . Relative to control subjects , ASMA students reported significantly : more confidence to manage their asthma ; taking more steps to prevent symptoms ; greater use of controller medication and written treatment plans ; fewer night awakenings , days with activity limitation , and school absences due to asthma ; improved 
    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 Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization . OBJECTIVE Our aim was to examine the effects of a guided disclosure protocol ( GDP ) of past traumas on symptoms and clinic visits among frequent clinic attenders . METHODS Forty-one frequent clinic attenders ( > or = 2 visits/3 months ) took part . Patients were r and omly assigned individually to either a casual content writing control group ( n = 19 ) or a trauma content writing experimental GDP group ( n = 22 ) . GDP patients wrote about an up setting event chronologically ( day 1 ) , verbally described their thoughts and feelings and described the event 's impact on life ( day 2 ) , and finally wrote about their current perspective on and future coping with the event ( day 3 ) . Three months later , patients were reassessed blindly for symptoms and clinic visits , and an average of 15 months later they were assessed blindly for clinic visits again . RESULTS Compared with controls , GDP patients reported lower symptom levels at 3 months ( 2.3 versus 5.2 ) , and made fewer clinic visits during the 3 ( 1.3 versus 3.0 ) and 15 month ( 5.1 versus 9.7 ) follow-ups . The percentage of GDP patients making > or = 10 visits during the 15 month follow-up was smaller ( 10 % ) than among controls ( 33 % ) . CONCLUSIONS The findings extend previous findings to frequent clinic users , using a new form of written disclosure aim ed at shifting trauma from implicit to explicit memory . The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users OBJECTIVE To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes . METHODS We r and omized 50 adolescents with asthma to write for 3 days at home about stressful events ( disclosure ) or control topics . At baseline and 2 months after writing , we assessed symptoms , affect , disability , internalizing behavior problems , and lung function ; parents independently rated internalizing behavior and disability . RESULTS Compared with control writing , disclosure writing led to improved positive affect and internalizing problems . Disclosure also decreased asthma symptoms and functional disability among adolescents with baseline elevations of these difficulties . Lung function was not changed . Disclosures with more negative emotion , insight , and causal words-- and increased causal or insight words over days -- predicted improved health . CONCLUSIONS Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma , particularly those whose writings suggest emotional processing and cognitive restructuring Abstract Objective : To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma . Design : Cluster r and omised controlled trial . Setting : Six high schools in rural Australia . Participants : 272 students with recent wheeze , recruited from a cohort of 1515 students from two school years ( mean age 12.5 and 15.5 years ) ; 251 ( 92.3 % ) completed the study . Intervention : A structured education programme for peers comprising three steps ( the “ Triple A Program ” ) . Main outcome measures : Quality of life , school absenteeism , asthma attacks , and lung function . Results : When adjusted for year and sex , mean total quality of life scores showed significant improvement in the intervention than control group . Clinical ly important improvement in quality of life ( > 0.5 units ) occurred in 25 % of students with asthma in the intervention group compared with 12 % in the control group ( P=0.01 ) . The number needed to treat was 8 ( 95 % confidence interval 4.5 to 35.7 ) . The effect of the intervention was greatest in students in year 10 and in females . Significant improvements occurred in the activities domain ( 41 % v 28 % ) and in the emotions domain ( 39 % v 19 % ) in males in the intervention group . School absenteeism significantly decreased in the intervention group only . Asthma attacks at school increased in the control group only . Conclusion : The triple A programme leads to a clinical ly relevant improvement in quality of life and related morbidity in students with asthma . Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in The aim of this study was to evaluate the impact of a new patient education programme on adults with asthma . This self-management programme included an individual assessment of patient 's needs and two educational group sessions . Teaching methods and session content are described as well as caregivers training programme . The training sessions included a written asthma action plan based on symptoms and personal peak expiratory flow . Patients ( n = 238 ) aged from 18 to 60 years were allocated to the intervention ( group A ) or control group ( group B ) . Patients filled during 1 year a daily diary and question naire and they were administered telephone interviews . 127 patients were included in the treatment program and 111 in the control group . There was a significant improvement in the educated group with regard to symptoms free days ( P = 0.03 ) , number of awakenings ( P = 0.04 ) , consumption of corticosteroids ( P = 0.03 ) , consumption of beta2-agonists ( P = 0.03 ) , and quality of life score ( P = 0.01 ) . In conclusion , this study vali date s a specific educational approach named " un souffle nouveau " Abstract Several behavioral medicine interventions ( eg , relaxation training and written emotional expression ) have been proposed as effective supplemental treatments for individuals with chronic illnesses such as asthma . Whether these treatments are feasible or effective in a manual-based , self-administered format is unclear , and few studies have examined the effectiveness of such treatments presented in a complementary format . We examined the feasibility and effectiveness of a 4 week stress management treatment compared with a matched placebo intervention in young adults with asthma . Both groups considered the workbooks credible treatment interventions and completed them conscientiously . The treatment group showed significant improvement in measures of lung function compared with the placebo group , but analysis revealed no differences in measures of perceived stress . These findings provide initial support for the feasibility of self-administered manual-based interventions and some evidence that they can produce health benefits in individuals with asthma and , perhaps other chronic conditions OBJECTIVE --To determine the extent to which symptom diaries of asthmatic patients are inaccurate or based on retrospective recall . DESIGN --Comparison of electronic and pencil and paper diaries . Both forms were completed twice daily at home for 14 days . SETTING --Outpatient clinic . SUBJECTS--24 asthmatic out patients also tested for severity of asthma and for anxiety . RESULTS --More sessions were missed in the evening than in the morning for both types of diaries . Significantly more retrospective entries were made in the evening ( 26 entries , 14 patients ) than in the morning ( 6 entries , 3 patients ) . Discrepant entries of peak expiratory flow accounted for 15 % of those made on the appropriate day , and three quarters of patients made at least one discrepant entry . Variation in peak expiratory flow was significantly related to number of discrepancies and number of missing days , and anxiety score was significantly related to number of missing days . About a fifth of written entries may have errors . CONCLUSION --Poor diary completion may result from having unreasonable expectations of patients and giving incomplete instructions . Electronic , time coded diaries could ensure better quality of records 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 CONTEXT Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness . Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports , well-being , and health care use in healthy individuals . OBJECTIVE To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using st and ardized quantitative outcome measures . DESIGN R and omized controlled trial conducted between October 1996 and December 1997 . SETTING Outpatient community residents drawn from private and institutional practice . PATIENTS Volunteer sample of 112 patients with asthma ( n = 61 ) or rheumatoid arthritis ( n = 51 ) received the intervention ; 107 completed the study , 58 in the asthma group and 49 in the rheumatoid arthritis group . INTERVENTION Patients were assigned to write either about the most stressful event of their lives ( n = 71 ; 39 asthma , 32 rheumatoid arthritis ) or about emotionally neutral topics ( n = 41 ; 22 asthma , 19 rheumatoid arthritis ) ( the control intervention ) . MAIN OUTCOME MEASURES Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinical ly examined by a rheumatologist . Assessment s were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition . RESULTS Of evaluable patients 4 months after treatment , asthma patients in the experimental group showed improvements in lung function ( the mean percentage of predicted forced expiratory volume in 1 second [ FEV1 ] improved from 63.9 % at baseline to 76.3 % at the 4-month follow-up ; P<.001 ) , whereas control group patients showed no change . Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity ( a mean reduction in disease severity from 1.65 to 1.19 [ 28 % ] on a scale of 0 [ asymptomatic ] to 4 [ very severe ] at the 4-month follow-up ; P=.001 ) , whereas control group patients did not change . Combining all completing patients , 33 ( 47.1 % ) of 70 experimental patients had clinical ly relevant improvement , whereas 9 ( 24.3 % ) of 37 control patients had improvement ( P=.001 ) . CONCLUSION Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinical ly relevant changes in health status at 4 months compared with those in the control group . These gains were beyond those attributable to the st and ard medical care that all participants were receiving . It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases RATIONALE Asthma prevalence and morbidity are especially elevated in adolescents , yet few interventions target this population . OBJECTIVES To test the efficacy of Asthma Self-Management for Adolescents ( ASMA ) , a school-based intervention for adolescents and medical providers . METHODS Three hundred forty-five primarily Latino/a ( 46 % ) and African American ( 31 % ) high school students ( mean age = 15.1 yr ; 70 % female ) reporting an asthma diagnosis , symptoms of moderate to severe persistent asthma , and asthma medication use in the last 12 months were r and omized to ASMA  , an 8-week school-based intervention , or a wait-list control group . They were followed for 12 months . MEASUREMENTS AND MAIN RESULTS Students completed bimonthly assessment s. Baseline , 6-month , and 12-month assessment s were comprehensive ; the others assessed interim health outcomes and urgent health care use . Primary outcomes were asthma self-management , symptom frequency , and quality of life ( QOL ) ; secondary outcomes were asthma medical management , school absences , days with activity limitations , and urgent health care use . Relative to control subjects , ASMA students reported significantly : more confidence to manage their asthma ; taking more steps to prevent symptoms ; greater use of controller medication and written treatment plans ; fewer night awakenings , days with activity limitation , and school absences due to asthma ; improved 
    Output:
    