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: In this study , the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective . Children ( aged 8 - 12 ) were recruited via primary schools , selecting children scoring as high-anxious on an anxiety screening question naire . Participating children and their parents were r and omized to a  child -- a parent-focused , or non-intervention group .  All groups completed a diagnostic interview and st and ardized cost-diaries at pretest , and 1- and 2-year follow-up . Incremental cost-effectiveness ratios per ' ADIS improved ' child ( based on diagnostic information ) were calculated and cost-effectiveness acceptability curves and frontiers were plotted . The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention , and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious . The child-focused intervention was dominant when analyses were performed from a healthcare perspective , for boys , and for children of grade s 7 - 8 of primary school This article reports the results of a study evaluating a book-supported primary prevention program “ Dominique ’s H and y Tricks ” for anxiety disorders in children aged 9–12 years . This cognitive-behavioural program is delivered using a combination of storybooks and workshop sessions . The originality of the program comes from the use of storybooks that were not developed specifically for anxiety management . Every session is based on a story describing characters facing common stressors and how they manage to cope with their daily problems . In our r and omized control trial with 46 children , participation in the program led to a significant improvement in coping skills , perceived self-efficacy , anxiety sensitivity , as well as in symptoms of anxiety and fear . The theoretical and practical elements underlying the delivery of this primary prevention program are described . Conclusion : It is suggested that such an approach , without any labelling specific to anxiety disorders , can be useful in primary prevention programs Consistent with a risk reduction model of targeted prevention , the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking . Members of a high risk cohort , defined by high levels of anxiety sensitivity and current daily smoking ( n=96 ) , were r and omly assigned to either ( 1 ) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or ( 2 ) a health information control condition of comparable length . Participants were followed for 6 months . Consistent with hypotheses , those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period . Limited evidence also suggested the intervention increased motivation to quit smoking . We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations CONTEXT Given the public health significance of late-life depression and anxiety , and the limited capacity of treatment , there is an urgent need to develop effective strategies to prevent these disorders . OBJECTIVE To determine the effectiveness of an indicated stepped-care prevention program for  depression and anxiety disorders in the elderly . DESIGN R and omized controlled trial with recruitment between October 1 , 2004 , and October 1 , 2005 . SETTING Thirty-three primary care practice s in the northwestern part of the Netherl and s. PARTICIPANTS A total of 170 consenting individuals , 75 years and older , with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders . INTERVENTION Participants were r and omly assigned to a preventive stepped-care program ( n = 86 ) or to usual care ( n = 84 ) . Stepped-care participants sequentially received a watchful waiting approach , cognitive behavior therapy-based bibliotherapy , cognitive behavior therapy-based problem-solving treatment , and referral to primary care for medication , if required . MAIN OUTCOME MEASURES The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview . RESULTS The intervention halved the 12-month incidence of depressive and anxiety disorders , from 0.24 ( 20 of 84 ) in the usual care group to 0.12 ( 10 of 86 ) in the stepped-care group ( relative risk , 0.49 ; 95 % confidence interval , 0.24 to 0.98 ) . CONCLUSIONS Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective The article presents the intervention model and primary outcomes of a preventive intervention design ed to reduce anxiety symptoms and prevent the onset of anxiety disorders  in the offspring of parents with anxiety disorders . Participants were 40 volunteer children ( mean age = 8.94 years ; 45 % girls ; 90 % Caucasian ) whose parents met criteria for a broad range of anxiety disorders . Families were r and omly assigned to an 8-week cognitive-behavioral intervention , the Coping and Promoting Strength program ( CAPS ; n = 20 ) or a wait list control condition ( WL ; n = 20 ) . Independent evaluators ( IEs ) conducted diagnostic interviews , and children and parents completed measures of anxiety symptoms . Assessment s were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment . On the basis of intent to treat analyses , 30 % of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0 % in the CAPS group . IE and parent-reported ( but not child-reported ) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group . Parental satisfaction with the intervention was high . Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders Background Generalized Anxiety Disorder ( GAD ) is a high prevalence , chronic disorder . Web-based interventions are acceptable , engaging , and can be delivered at scale . Few r and omized controlled trials evaluate the effectiveness of prevention programs for anxiety , or the factors that improve effectiveness and engagement . Objective The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults , and to determine the role of telephone and email reminders . Methods A 5-arm r and omized controlled trial with 558 Internet users in the community , recruited via the Australian Electoral Roll , was conducted with 6- and 12-month follow-up . Five interventions were offered over a 10-week period . Group 1 ( Active website ) received a combined intervention of psycho-education , Internet-delivered Cognitive Behavioral Therapy ( ICBT ) for anxiety , physical activity promotion , and relaxation . Group 2 ( Active website with telephone ) received the identical Web program plus weekly telephone reminder calls . Group 3 ( Active website with email ) received the identical Web program plus weekly email reminders . Group 4 ( Control ) received a placebo website . Group 5 ( Control with telephone ) received the placebo website plus telephone calls . Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale ( GAD-7 ) ( at post-test , 6 , and 12 months ) . Secondary measures were GAD caseness , measured by the Mini International Neuropsychiatric Interview ( MINI ) at 6 months , Centre for Epidemiologic Studies -Depression scale ( CES-D ) , Anxiety Sensitivity Index ( ASI ) , Penn State Worry Question naire ( PSWQ ) , and Days out of Role . Results GAD-7 symptoms reduced over post-test , 6-month , and 12-month follow-up . There were no significant differences between Group 4 ( Control ) and Groups 1 ( Active website ) , 2 ( Active website with telephone ) , 3 ( Active website with email ) , or 5 ( Control with telephone ) at any follow-up . A total of 16 cases of GAD were identified at 6 months , comprising 6.7 % ( 11/165 ) from the Active groups ( 1 , 2 , 3 ) and 4.5 % ( 5/110 ) from the Control groups ( 4 , 5 ) , a difference that was not significant . CES-D , ASI , and PSWQ scores were significantly lower for the active website with email reminders at post-test , relative to the control website condition . Conclusions Indicated prevention of GAD was not effective in reducing anxiety levels , measured by GAD-7 . There were significant secondary effects for anxiety sensitivity , worry , and depression . Challenges for indicated prevention trials are discussed . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 76298775 ; http://www.controlled-trials.com/IS RCT N76298775 ( Archived by WebCite at http://www.webcitation.org/6S9aB5MAq ) Background Family caregivers of dementia patients are at increased risk of developing depression or anxiety . A multi-component program design ed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers . However , the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated . This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients . Methods A r and omized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients . Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline . Participants were r and omized to the family meetings intervention ( n = 96 ) or usual care ( n = 96 ) condition . The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year . Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms ( primary outcomes ) , caregiver burden and quality of life ( secondary outcomes ) . Intention-to-treat as well as per protocol analyses were performed . Results A substantial number of caregivers ( 72/192 ) developed a depressive or anxiety disorder within 12 months . The intervention was not superior to usual care either in reducing the risk of disorder onset ( adjusted IRR 0.98 ; 95 % CI 0.69 to 1.38 ) or in reducing depressive ( r and omization-by-time interaction coefficient = −1.40 ; 95 % CI −3.91 to 1.10 ) or anxiety symptoms ( r and omization-by-time interaction coefficient = −0.55 ; 95 % CI −1.59 to 0.49 ) . The intervention did not reduce caregiver burden or their health related quality of life . Conclusion This study did not demonstrate preventive effects of family meetings on the mental health of family caregivers . Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose , when applied for therapeutic purpose s or targeted towards subgroups of caregivers . Trial Registration Controlled-Trials.com IS RCT BACKGROUND We tested whether a brief psychological intervention could prevent anxiety or depressive disorders among newly diagnosed cancer patients . PATIENTS AND METHODS Patients free of anxiety or depressive disorder were r and omised to receive immediate intervention ( start of cancer treatment ) , delayed intervention ( 8 weeks after starting treatment ) or usual care . They were stratified according to risk of developing anxiety or depressive disorders . Primary outcome was measured using a st and ardised psychiatric interview to detect any anxiety or depressive disorder at 6 and 12 months following the cancer diagnosis . Analyses used conditional odds logistic regression models adjusting for age , gender , concerns and past history to compare outcome of all intervention patients with usual care . RESULTS A total of 465 patients were recruited . In all , 313 ( 79 % ) of the 397 well enough to be interviewed completed the study . At 12 months , there was no difference between the groups receiving the intervention and usual care [ odds ratio ( OR ) = 0.69 , 95 % confidence interval ( CI ) 0.41 - 1.17 , P = 0.17 ] . In high-risk patients , those who received the intervention were less likely to develop an anxiety or depressive disorder compared with those who received usual care ( OR = 0.54 , 95 % CI 0.29 - 1.00 , P = 0.050 ) . In low-risk patients , there was no difference ( OR = 1.50 , 95 % CI 0.51 - 4.43 , P = 0.47 ) . CONCLUSION A brief intervention , delivered by nonspecialists , promoted adjustment among newly diagnosed cancer patients at high risk of developing anxiety or depressive disorders High social anxiety is a risk factor for the incidence of social anxiety disorder ( SAD ) . Early diagnosis and intervention may prevent more severe psychiatric courses . Self-help programs may be a convenient , accessible , and effective intervention . This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety . A total of 24 highly socially anxious individuals were r and omly assigned to a DVD-based self-help program or to a wait-list control group . The self-help program is based on the cognitive model according to Clark and Wells ( 1995 ; adapted to German by Stangier , Clark , & Ehlers , 20 
    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: In this study , the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective . Children ( aged 8 - 12 ) were recruited via primary schools , selecting children scoring as high-anxious on an anxiety screening question naire . Participating children and their parents were r and omized to a  child -- a parent-focused , or non-intervention group .  All groups completed a diagnostic interview and st and ardized cost-diaries at pretest , and 1- and 2-year follow-up . Incremental cost-effectiveness ratios per ' ADIS improved ' child ( based on diagnostic information ) were calculated and cost-effectiveness acceptability curves and frontiers were plotted . The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention , and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious . The child-focused intervention was dominant when analyses were performed from a healthcare perspective , for boys , and for children of grade s 7 - 8 of primary school This article reports the results of a study evaluating a book-supported primary prevention program “ Dominique ’s H and y Tricks ” for anxiety disorders in children aged 9–12 years . This cognitive-behavioural program is delivered using a combination of storybooks and workshop sessions . The originality of the program comes from the use of storybooks that were not developed specifically for anxiety management . Every session is based on a story describing characters facing common stressors and how they manage to cope with their daily problems . In our r and omized control trial with 46 children , participation in the program led to a significant improvement in coping skills , perceived self-efficacy , anxiety sensitivity , as well as in symptoms of anxiety and fear . The theoretical and practical elements underlying the delivery of this primary prevention program are described . Conclusion : It is suggested that such an approach , without any labelling specific to anxiety disorders , can be useful in primary prevention programs Consistent with a risk reduction model of targeted prevention , the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking . Members of a high risk cohort , defined by high levels of anxiety sensitivity and current daily smoking ( n=96 ) , were r and omly assigned to either ( 1 ) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or ( 2 ) a health information control condition of comparable length . Participants were followed for 6 months . Consistent with hypotheses , those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period . Limited evidence also suggested the intervention increased motivation to quit smoking . We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations CONTEXT Given the public health significance of late-life depression and anxiety , and the limited capacity of treatment , there is an urgent need to develop effective strategies to prevent these disorders . OBJECTIVE To determine the effectiveness of an indicated stepped-care prevention program for  depression and anxiety disorders in the elderly . DESIGN R and omized controlled trial with recruitment between October 1 , 2004 , and October 1 , 2005 . SETTING Thirty-three primary care practice s in the northwestern part of the Netherl and s. PARTICIPANTS A total of 170 consenting individuals , 75 years and older , with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders . INTERVENTION Participants were r and omly assigned to a preventive stepped-care program ( n = 86 ) or to usual care ( n = 84 ) . Stepped-care participants sequentially received a watchful waiting approach , cognitive behavior therapy-based bibliotherapy , cognitive behavior therapy-based problem-solving treatment , and referral to primary care for medication , if required . MAIN OUTCOME MEASURES The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview . RESULTS The intervention halved the 12-month incidence of depressive and anxiety disorders , from 0.24 ( 20 of 84 ) in the usual care group to 0.12 ( 10 of 86 ) in the stepped-care group ( relative risk , 0.49 ; 95 % confidence interval , 0.24 to 0.98 ) . CONCLUSIONS Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective The article presents the intervention model and primary outcomes of a preventive intervention design ed to reduce anxiety symptoms and prevent the onset of anxiety disorders  in the offspring of parents with anxiety disorders . Participants were 40 volunteer children ( mean age = 8.94 years ; 45 % girls ; 90 % Caucasian ) whose parents met criteria for a broad range of anxiety disorders . Families were r and omly assigned to an 8-week cognitive-behavioral intervention , the Coping and Promoting Strength program ( CAPS ; n = 20 ) or a wait list control condition ( WL ; n = 20 ) . Independent evaluators ( IEs ) conducted diagnostic interviews , and children and parents completed measures of anxiety symptoms . Assessment s were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment . On the basis of intent to treat analyses , 30 % of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0 % in the CAPS group . IE and parent-reported ( but not child-reported ) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group . Parental satisfaction with the intervention was high . Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders Background Generalized Anxiety Disorder ( GAD ) is a high prevalence , chronic disorder . Web-based interventions are acceptable , engaging , and can be delivered at scale . Few r and omized controlled trials evaluate the effectiveness of prevention programs for anxiety , or the factors that improve effectiveness and engagement . Objective The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults , and to determine the role of telephone and email reminders . Methods A 5-arm r and omized controlled trial with 558 Internet users in the community , recruited via the Australian Electoral Roll , was conducted with 6- and 12-month follow-up . Five interventions were offered over a 10-week period . Group 1 ( Active website ) received a combined intervention of psycho-education , Internet-delivered Cognitive Behavioral Therapy ( ICBT ) for anxiety , physical activity promotion , and relaxation . Group 2 ( Active website with telephone ) received the identical Web program plus weekly telephone reminder calls . Group 3 ( Active website with email ) received the identical Web program plus weekly email reminders . Group 4 ( Control ) received a placebo website . Group 5 ( Control with telephone ) received the placebo website plus telephone calls . Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale ( GAD-7 ) ( at post-test , 6 , and 12 months ) . Secondary measures were GAD caseness , measured by the Mini International Neuropsychiatric Interview ( MINI ) at 6 months , Centre for Epidemiologic Studies -Depression scale ( CES-D ) , Anxiety Sensitivity Index ( ASI ) , Penn State Worry Question naire ( PSWQ ) , and Days out of Role . Results GAD-7 symptoms reduced over post-test , 6-month , and 12-month follow-up . There were no significant differences between Group 4 ( Control ) and Groups 1 ( Active website ) , 2 ( Active website with telephone ) , 3 ( Active website with email ) , or 5 ( Control with telephone ) at any follow-up . A total of 16 cases of GAD were identified at 6 months , comprising 6.7 % ( 11/165 ) from the Active groups ( 1 , 2 , 3 ) and 4.5 % ( 5/110 ) from the Control groups ( 4 , 5 ) , a difference that was not significant . CES-D , ASI , and PSWQ scores were significantly lower for the active website with email reminders at post-test , relative to the control website condition . Conclusions Indicated prevention of GAD was not effective in reducing anxiety levels , measured by GAD-7 . There were significant secondary effects for anxiety sensitivity , worry , and depression . Challenges for indicated prevention trials are discussed . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 76298775 ; http://www.controlled-trials.com/IS RCT N76298775 ( Archived by WebCite at http://www.webcitation.org/6S9aB5MAq ) Background Family caregivers of dementia patients are at increased risk of developing depression or anxiety . A multi-component program design ed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers . However , the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated . This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients . Methods A r and omized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients . Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline . Participants were r and omized to the family meetings intervention ( n = 96 ) or usual care ( n = 96 ) condition . The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year . Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms ( primary outcomes ) , caregiver burden and quality of life ( secondary outcomes ) . Intention-to-treat as well as per protocol analyses were performed . Results A substantial number of caregivers ( 72/192 ) developed a depressive or anxiety disorder within 12 months . The intervention was not superior to usual care either in reducing the risk of disorder onset ( adjusted IRR 0.98 ; 95 % CI 0.69 to 1.38 ) or in reducing depressive ( r and omization-by-time interaction coefficient = −1.40 ; 95 % CI −3.91 to 1.10 ) or anxiety symptoms ( r and omization-by-time interaction coefficient = −0.55 ; 95 % CI −1.59 to 0.49 ) . The intervention did not reduce caregiver burden or their health related quality of life . Conclusion This study did not demonstrate preventive effects of family meetings on the mental health of family caregivers . Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose , when applied for therapeutic purpose s or targeted towards subgroups of caregivers . Trial Registration Controlled-Trials.com IS RCT BACKGROUND We tested whether a brief psychological intervention could prevent anxiety or depressive disorders among newly diagnosed cancer patients . PATIENTS AND METHODS Patients free of anxiety or depressive disorder were r and omised to receive immediate intervention ( start of cancer treatment ) , delayed intervention ( 8 weeks after starting treatment ) or usual care . They were stratified according to risk of developing anxiety or depressive disorders . Primary outcome was measured using a st and ardised psychiatric interview to detect any anxiety or depressive disorder at 6 and 12 months following the cancer diagnosis . Analyses used conditional odds logistic regression models adjusting for age , gender , concerns and past history to compare outcome of all intervention patients with usual care . RESULTS A total of 465 patients were recruited . In all , 313 ( 79 % ) of the 397 well enough to be interviewed completed the study . At 12 months , there was no difference between the groups receiving the intervention and usual care [ odds ratio ( OR ) = 0.69 , 95 % confidence interval ( CI ) 0.41 - 1.17 , P = 0.17 ] . In high-risk patients , those who received the intervention were less likely to develop an anxiety or depressive disorder compared with those who received usual care ( OR = 0.54 , 95 % CI 0.29 - 1.00 , P = 0.050 ) . In low-risk patients , there was no difference ( OR = 1.50 , 95 % CI 0.51 - 4.43 , P = 0.47 ) . CONCLUSION A brief intervention , delivered by nonspecialists , promoted adjustment among newly diagnosed cancer patients at high risk of developing anxiety or depressive disorders High social anxiety is a risk factor for the incidence of social anxiety disorder ( SAD ) . Early diagnosis and intervention may prevent more severe psychiatric courses . Self-help programs may be a convenient , accessible , and effective intervention . This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety . A total of 24 highly socially anxious individuals were r and omly assigned to a DVD-based self-help program or to a wait-list control group . The self-help program is based on the cognitive model according to Clark and Wells ( 1995 ; adapted to German by Stangier , Clark , & Ehlers , 20 
    Output:
    