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 a r and omized experiment , women ( N = 441 ) watched either a loss- or gain-framed video emphasizing the prevention or detection functions of the Pap test to test the hypothesis that loss- and gain-framed messages differentially influence health behaviors depending on the risk involved in performing the behavior . As predicted , loss-framed messages emphasizing the costs of not detecting cervical cancer early ( a risky behavior ) and gain-framed messages emphasizing the benefits of preventing cervical cancer ( a less risky behavior ) were most persuasive in motivating women to obtain a Pap test This study compared the effectiveness of 4 videotaped educational programs design ed to motivate HIV testing among low-income , ethnic minority women . Four hundred eighty women were assigned r and omly to watch one of 2 gain-framed or 2 loss-framed videos . Consistent with prospect theory , participants ' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure . Among participants who reported being certain of the test 's outcome , those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message . Among women who perceived the outcome of HIV testing as relatively uncertain , gain- and loss-framed videos led to similar rates of self-reported testing , with some advantage for the loss-framed message The effects of alternatively framed messages and dispositional optimism on follow-up for abnormal Papanicolaou tests were studied . Participants ( N = 116 ) had a mean age of 24 ; 94 % were black , 67 % had a high school education , and 82 % received public assistance .  A message about losses without follow-up or gains with follow-up was r and omly given . Optimism was measured with the Life Orientation Test and attendance was defined as coming or not coming within 6 weeks of contact . Logistic regressions of attendance on framing and optimism did not reveal significant relationships . Exploratory analyses revealed that personal and familial history of disease were related to attendance . Explanations for the findings and implication s for research are delineated Background Different presentations of treatment effects can affect decisions . However , previous studies have not evaluated which presentations best help people make decisions that are consistent with their own values . We undertook a pilot study to compare different methods for doing this . Methods and Findings We conducted an Internet-based r and omized trial comparing summary statistics for communicating the effects of statins on the risk of coronary heart disease ( CHD ) . Participants rated the relative importance of treatment consequences using  visual analogue scales ( VAS ) and category rating scales ( CRS ) with five response options . We r and omized participants to either VAS or CRS first and to one of six summary statistics : relative risk reduction ( RRR ) and five absolute measures of effect : absolute risk reduction , number needed to treat , event rates , tablets needed to take , and natural frequencies ( whole numbers ) . We used logistic regression to determine the association between participants ' elicited values and treatment choices . 770 participants age 18 or over and literate in English completed the study . In all , 13 % in the VAS-first group failed to complete their VAS rating , while 9 % of the CRS-first group failed to complete their scoring ( p = 0.03 ) . Different ways of weighting the elicited values had little impact on the analyses comparing the different presentations . Most ( 51 % ) preferred the RRR compared to the other five summary statistics ( 1 % to 25 % , p = 0.074 ) . However , decisions in the group presented the RRR deviated substantially from those made in the other five groups . The odds of participants in the RRR group deciding to take statins were 3.1 to 5.8 times that of those in the other groups across a wide range of values ( p = 0.0007 ) . Participants with a scientific background , who were more numerate or had more years of education were more likely to decide not to take statins . Conclusions Internet-based trials comparing different presentations of treatment effects are feasible , but recruiting participants is a major challenge . Despite a slightly higher response rate for CRS , VAS is preferable to avoid approximation of a continuous variable . Although most participants preferred the RRR , participants shown the RRR were more likely to decide to take statins regardless of their values compared with participants who were shown any of the five other summary statistics . Trial Registration Controlled-Trials.com IS RCT We explored the interaction effects of individual attentional style ( high versus low monitoring ) and the framing of informational messages on the responses of women undergoing diagnostic follow-up ( colposcopy ) for precancerous cervical lesions . Prior to the colposcopic procedure , patients ( N=76 ) were r and omly assigned to one of three preparatory conditions : ( a ) Loss-framed message , which emphasized the cost of nonadherence to screening recommendations ; ( b ) Gain-framed message , which emphasized the benefit of adherence ; and ( c ) Neutrally-framed message . It was hypothesized that low monitors ( who are more positively biased about their health ) would show a more adaptive pattern of response to loss-framed information than high monitors ( who are more negatively biased about their health ) . The results of a series of hierarchical multiple regression analyses were consistent with this prediction . Low monitoring was associated with greater knowledge retention ( β=.61 , p<.05 ) and less canceling/rescheduling of follow-up appointments in the loss condition than in the neutral condition ( β=.82 , p<.002 ) . High monitoring , however , was associated with greater intrusive ideation when information was presented in the loss-oriented frame as compared to the neutral frame ( β=.99 , p<.01 ) . Knowledge retention and screening adherence were not affected by the framing manipulation . The differences between high versus low monitors as a function of loss or neutral frame suggest an interaction effect , wherein both the type of framing message and the individual 's attentional style lead to distinctive cognitive-affective and behavioral patterns . The findings may have clinical implication s for the tailoring of health messages to the individual 's signature style Persuasive health education messages can either stress the positive consequences of performing a healthy behaviour ( gain-frame ) or the negative consequences of not performing a healthy behaviour ( loss-frame ) . Based on studies on topics such as sun protection and breast self-examination there is evidence that messages in different action frames may differ in persuasive effects . Three r and omised controlled trials were conducted to test framing effects in nutrition education on specific nutrition-related attitudes and intentions . In study 1 , effects of gain-framed and loss-framed messages were studied among 152 adult education students on attitudes and intentions related to fat , fruit and vegetable consumption . In study 2 we confronted 149 regular students with differently framed messages related to a ( more or less fictive ) preventive dietary behaviour that was expected to be unknown to the study population , intake of flavonoids and risk for chronic disease . The impact on attitudes and intentions to use flavonoid-enriched spreads was studied . In study 3 we studied the effects of differently framed messages on attitudes and intentions related to more immediate and more personally relevant diet nutrition behaviour :  folic acid supplement use before and during pregnancy among 100 female students . No significant differences in attitudes or intentions to perform the preventive nutrition behaviours were found between the gain-frame conditions and the loss-frame conditions in all three studies . The ( lack of ) effects were not moderated by factors such as perceived personal relevance , credibility or novelty of the information , or the perceived importance of the topic addressed . The results of the present studies suggest that action-frame choice has a very limited impact on the effectiveness of nutrition education in changing pre caution ary motivation The study purpose was to determine whether the framing of treatment information influenced patients ' reported preferences  for participating in treatment decision making and for trial entry .  Ninety cancer patients  read either neutrally- , positively- , or negatively-framed infor mation about a chemotherapeutic treatment , then indicated their preferences for participating in the treatment decision , and whether they would participate in a clinical trial incorporating this protocol . There was no difference across information groups in preferences for partici pating in treatment decision making or willingness to enter such a clinical trial . Preference for participation in treatment decision making was significantly related to age ( t = 2.54 ; p = 0.022 ) , sex ( x2 = 3.89 ; p = 0.05 ) , and education ( t = 2.54 ; p = 0.018 ) ; trial entry preferences were unrelated to these demographic variables . These results imply that , in this clinical context , attitudes towards participation in treatment decision making may be asso ciated with characteristics of the patient , and attitudes towards trial entry may be dependent upon the clinical characteristics of a particular trial , but neither set of attitudes is influenced by the framing of protocol information . Key words : framing effect ; patients ' preferences ; quality of life ; decision making ; clinical trials . ( Med Decis Making 1995;15:4 - 12 Prospect theory suggests that people respond differentially to factually equivalent messages depending on how these messages are framed ( A. Tversky & D. Kahneman , 1981 ) . A. J. Rothman and P. Salovey ( 1997 ) relied on prospect theory to predict that messages highlighting potential " gains " should promote prevention behaviors such as sunscreen use best . This experiment compared the effectiveness of 4 differently framed messages ( 2 highlighting gains , 2 highlighting losses ) to persuade 217 beach-goers to obtain and use sunscreen . Attitudes and intentions were measured before and immediately following the delivery of the framed information , and after completing the question naire participants were given a coupon redeemable for a small bottle of sunscreen later that same day . People who read either of the 2 gain-framed brochures , compared with those who read either of the 2 loss-framed brochures , were significantly more likely to ( a ) request sunscreen , ( b ) intend to repeatedly apply sunscreen while at the beach , and ( c ) intend to use sunscreen with a sun protection factor of 15 or higher INTRODUCTION Although mammography is the most effective early detection breast cancer screening technology available , it is underutilized . This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use .  Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action . METHODS Participants were medically un- and underinsured women 50 - 64 years old who called one of two urban clinics r and omly selected based on demographic statistical equivalency . The women who participated telephoned to inquire about a mammogram during the 6-month study period . The group r and omly design ated as the experimental group received a loss-framed message conveyed by trained staff telephonically . Members of the comparison group received the " usual " communication , also conveyed telephonically . In the experimental group , 31 of 112 ( 27 % ) women who inquired received mammograms , whereas 157 of the 992 ( 16 % ) comparison group women who inquired received mammograms . RESULTS The odds of a mammogram , adjusted for race and breast cancer symptoms , significantly increased for the experimental ( odds ratio [ OR ] = 1.914 , chi2 = 7.48 , p = .0063 , 95 % confidence interval [ CI ] 1.20 - 3.05 ) versus comparison group . CONCLUSIONS A loss-framed , in-reach , minimal intervention approach holds promise as a mammography promotion strategy Background We conducted an Internet-based r and omized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease ( CVD ) for people with newly diagnosed hypertension to determine which framing presentation result ed in choices most consistent with participants ' values . Methods and Findings In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company , adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales ( VAS ) . Participants viewed information ( or no information ) to which they were r and omized and decided whether or not to take medication . We compared positive framing over 10 years ( the number escaping CVD per 1000 ) ; negative framing over 10 years ( the number that will have CVD ) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors . Finally , all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again . We calculated a relative importance score ( RIS ) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction . We used logistic regression to determine the association between participants ' RIS and their choice . 1,528 participants completed the study . The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values ( RIS ) increased as the RIS increased . Positively framed information lead to decisions most consistent with those made by everyone for the second , more fully informed decision . There was a statistically significant decrease in deciding to take antihypertensives on the second decision , both within groups and overall . Conclusions For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD ( 70 per 1000 over 10 years ) , both positive and negative framing result ed in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations . Trial Registration International St and ard R and omised Controlled Trial Number Register IS RCT N OBJECTIVES To examine the interactive effects of message frames and CVD risk factors on  women 's knowledge , beliefs , efficacy , and behavioral intentions . METHODS In a r and omized experiment , women ( n = 395 ) read either a loss- or gain-framed heart disease prevention message to test differential effects by risk factor status . RESULTS Messages significantly increased knowledge , self-efficacy and intervention efficacy beliefs , and behavioral intentions . 
    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 a r and omized experiment , women ( N = 441 ) watched either a loss- or gain-framed video emphasizing the prevention or detection functions of the Pap test to test the hypothesis that loss- and gain-framed messages differentially influence health behaviors depending on the risk involved in performing the behavior . As predicted , loss-framed messages emphasizing the costs of not detecting cervical cancer early ( a risky behavior ) and gain-framed messages emphasizing the benefits of preventing cervical cancer ( a less risky behavior ) were most persuasive in motivating women to obtain a Pap test This study compared the effectiveness of 4 videotaped educational programs design ed to motivate HIV testing among low-income , ethnic minority women . Four hundred eighty women were assigned r and omly to watch one of 2 gain-framed or 2 loss-framed videos . Consistent with prospect theory , participants ' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure . Among participants who reported being certain of the test 's outcome , those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message . Among women who perceived the outcome of HIV testing as relatively uncertain , gain- and loss-framed videos led to similar rates of self-reported testing , with some advantage for the loss-framed message The effects of alternatively framed messages and dispositional optimism on follow-up for abnormal Papanicolaou tests were studied . Participants ( N = 116 ) had a mean age of 24 ; 94 % were black , 67 % had a high school education , and 82 % received public assistance .  A message about losses without follow-up or gains with follow-up was r and omly given . Optimism was measured with the Life Orientation Test and attendance was defined as coming or not coming within 6 weeks of contact . Logistic regressions of attendance on framing and optimism did not reveal significant relationships . Exploratory analyses revealed that personal and familial history of disease were related to attendance . Explanations for the findings and implication s for research are delineated Background Different presentations of treatment effects can affect decisions . However , previous studies have not evaluated which presentations best help people make decisions that are consistent with their own values . We undertook a pilot study to compare different methods for doing this . Methods and Findings We conducted an Internet-based r and omized trial comparing summary statistics for communicating the effects of statins on the risk of coronary heart disease ( CHD ) . Participants rated the relative importance of treatment consequences using  visual analogue scales ( VAS ) and category rating scales ( CRS ) with five response options . We r and omized participants to either VAS or CRS first and to one of six summary statistics : relative risk reduction ( RRR ) and five absolute measures of effect : absolute risk reduction , number needed to treat , event rates , tablets needed to take , and natural frequencies ( whole numbers ) . We used logistic regression to determine the association between participants ' elicited values and treatment choices . 770 participants age 18 or over and literate in English completed the study . In all , 13 % in the VAS-first group failed to complete their VAS rating , while 9 % of the CRS-first group failed to complete their scoring ( p = 0.03 ) . Different ways of weighting the elicited values had little impact on the analyses comparing the different presentations . Most ( 51 % ) preferred the RRR compared to the other five summary statistics ( 1 % to 25 % , p = 0.074 ) . However , decisions in the group presented the RRR deviated substantially from those made in the other five groups . The odds of participants in the RRR group deciding to take statins were 3.1 to 5.8 times that of those in the other groups across a wide range of values ( p = 0.0007 ) . Participants with a scientific background , who were more numerate or had more years of education were more likely to decide not to take statins . Conclusions Internet-based trials comparing different presentations of treatment effects are feasible , but recruiting participants is a major challenge . Despite a slightly higher response rate for CRS , VAS is preferable to avoid approximation of a continuous variable . Although most participants preferred the RRR , participants shown the RRR were more likely to decide to take statins regardless of their values compared with participants who were shown any of the five other summary statistics . Trial Registration Controlled-Trials.com IS RCT We explored the interaction effects of individual attentional style ( high versus low monitoring ) and the framing of informational messages on the responses of women undergoing diagnostic follow-up ( colposcopy ) for precancerous cervical lesions . Prior to the colposcopic procedure , patients ( N=76 ) were r and omly assigned to one of three preparatory conditions : ( a ) Loss-framed message , which emphasized the cost of nonadherence to screening recommendations ; ( b ) Gain-framed message , which emphasized the benefit of adherence ; and ( c ) Neutrally-framed message . It was hypothesized that low monitors ( who are more positively biased about their health ) would show a more adaptive pattern of response to loss-framed information than high monitors ( who are more negatively biased about their health ) . The results of a series of hierarchical multiple regression analyses were consistent with this prediction . Low monitoring was associated with greater knowledge retention ( β=.61 , p<.05 ) and less canceling/rescheduling of follow-up appointments in the loss condition than in the neutral condition ( β=.82 , p<.002 ) . High monitoring , however , was associated with greater intrusive ideation when information was presented in the loss-oriented frame as compared to the neutral frame ( β=.99 , p<.01 ) . Knowledge retention and screening adherence were not affected by the framing manipulation . The differences between high versus low monitors as a function of loss or neutral frame suggest an interaction effect , wherein both the type of framing message and the individual 's attentional style lead to distinctive cognitive-affective and behavioral patterns . The findings may have clinical implication s for the tailoring of health messages to the individual 's signature style Persuasive health education messages can either stress the positive consequences of performing a healthy behaviour ( gain-frame ) or the negative consequences of not performing a healthy behaviour ( loss-frame ) . Based on studies on topics such as sun protection and breast self-examination there is evidence that messages in different action frames may differ in persuasive effects . Three r and omised controlled trials were conducted to test framing effects in nutrition education on specific nutrition-related attitudes and intentions . In study 1 , effects of gain-framed and loss-framed messages were studied among 152 adult education students on attitudes and intentions related to fat , fruit and vegetable consumption . In study 2 we confronted 149 regular students with differently framed messages related to a ( more or less fictive ) preventive dietary behaviour that was expected to be unknown to the study population , intake of flavonoids and risk for chronic disease . The impact on attitudes and intentions to use flavonoid-enriched spreads was studied . In study 3 we studied the effects of differently framed messages on attitudes and intentions related to more immediate and more personally relevant diet nutrition behaviour :  folic acid supplement use before and during pregnancy among 100 female students . No significant differences in attitudes or intentions to perform the preventive nutrition behaviours were found between the gain-frame conditions and the loss-frame conditions in all three studies . The ( lack of ) effects were not moderated by factors such as perceived personal relevance , credibility or novelty of the information , or the perceived importance of the topic addressed . The results of the present studies suggest that action-frame choice has a very limited impact on the effectiveness of nutrition education in changing pre caution ary motivation The study purpose was to determine whether the framing of treatment information influenced patients ' reported preferences  for participating in treatment decision making and for trial entry .  Ninety cancer patients  read either neutrally- , positively- , or negatively-framed infor mation about a chemotherapeutic treatment , then indicated their preferences for participating in the treatment decision , and whether they would participate in a clinical trial incorporating this protocol . There was no difference across information groups in preferences for partici pating in treatment decision making or willingness to enter such a clinical trial . Preference for participation in treatment decision making was significantly related to age ( t = 2.54 ; p = 0.022 ) , sex ( x2 = 3.89 ; p = 0.05 ) , and education ( t = 2.54 ; p = 0.018 ) ; trial entry preferences were unrelated to these demographic variables . These results imply that , in this clinical context , attitudes towards participation in treatment decision making may be asso ciated with characteristics of the patient , and attitudes towards trial entry may be dependent upon the clinical characteristics of a particular trial , but neither set of attitudes is influenced by the framing of protocol information . Key words : framing effect ; patients ' preferences ; quality of life ; decision making ; clinical trials . ( Med Decis Making 1995;15:4 - 12 Prospect theory suggests that people respond differentially to factually equivalent messages depending on how these messages are framed ( A. Tversky & D. Kahneman , 1981 ) . A. J. Rothman and P. Salovey ( 1997 ) relied on prospect theory to predict that messages highlighting potential " gains " should promote prevention behaviors such as sunscreen use best . This experiment compared the effectiveness of 4 differently framed messages ( 2 highlighting gains , 2 highlighting losses ) to persuade 217 beach-goers to obtain and use sunscreen . Attitudes and intentions were measured before and immediately following the delivery of the framed information , and after completing the question naire participants were given a coupon redeemable for a small bottle of sunscreen later that same day . People who read either of the 2 gain-framed brochures , compared with those who read either of the 2 loss-framed brochures , were significantly more likely to ( a ) request sunscreen , ( b ) intend to repeatedly apply sunscreen while at the beach , and ( c ) intend to use sunscreen with a sun protection factor of 15 or higher INTRODUCTION Although mammography is the most effective early detection breast cancer screening technology available , it is underutilized . This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use .  Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action . METHODS Participants were medically un- and underinsured women 50 - 64 years old who called one of two urban clinics r and omly selected based on demographic statistical equivalency . The women who participated telephoned to inquire about a mammogram during the 6-month study period . The group r and omly design ated as the experimental group received a loss-framed message conveyed by trained staff telephonically . Members of the comparison group received the " usual " communication , also conveyed telephonically . In the experimental group , 31 of 112 ( 27 % ) women who inquired received mammograms , whereas 157 of the 992 ( 16 % ) comparison group women who inquired received mammograms . RESULTS The odds of a mammogram , adjusted for race and breast cancer symptoms , significantly increased for the experimental ( odds ratio [ OR ] = 1.914 , chi2 = 7.48 , p = .0063 , 95 % confidence interval [ CI ] 1.20 - 3.05 ) versus comparison group . CONCLUSIONS A loss-framed , in-reach , minimal intervention approach holds promise as a mammography promotion strategy Background We conducted an Internet-based r and omized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease ( CVD ) for people with newly diagnosed hypertension to determine which framing presentation result ed in choices most consistent with participants ' values . Methods and Findings In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company , adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales ( VAS ) . Participants viewed information ( or no information ) to which they were r and omized and decided whether or not to take medication . We compared positive framing over 10 years ( the number escaping CVD per 1000 ) ; negative framing over 10 years ( the number that will have CVD ) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors . Finally , all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again . We calculated a relative importance score ( RIS ) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction . We used logistic regression to determine the association between participants ' RIS and their choice . 1,528 participants completed the study . The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values ( RIS ) increased as the RIS increased . Positively framed information lead to decisions most consistent with those made by everyone for the second , more fully informed decision . There was a statistically significant decrease in deciding to take antihypertensives on the second decision , both within groups and overall . Conclusions For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD ( 70 per 1000 over 10 years ) , both positive and negative framing result ed in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations . Trial Registration International St and ard R and omised Controlled Trial Number Register IS RCT N OBJECTIVES To examine the interactive effects of message frames and CVD risk factors on  women 's knowledge , beliefs , efficacy , and behavioral intentions . METHODS In a r and omized experiment , women ( n = 395 ) read either a loss- or gain-framed heart disease prevention message to test differential effects by risk factor status . RESULTS Messages significantly increased knowledge , self-efficacy and intervention efficacy beliefs , and behavioral intentions . 
    Output:
    