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: OBJECTIVE To examine posttraumatic stress disorder ( PTSD ) in mothers of survivors of childhood cancer . Comorbidity of anxiety and depressive disorders , prevalence of sub clinical PTSD , and the utility of a self-report measure as a screening instrument for PTSD were also investigated . METHOD Mothers ( n = 65 ) completed a question naire self-report PTSD checklist ( PCL-C ) .  Mothers were administered several modules of the SCID : nonpatient edition by telephone , including the PTSD , Generalized Anxiety , and Major Depressive Disorder modules . RESULTS We diagnosed 6.2 % of the sample with current PTSD . An additional 20 % had sub clinical PTSD . One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder . The PCL-C evidence d diagnostic utility as a screening instrument . However , a moderate number of false-positives would result if the recommended cut-off on the instrument was used . CONCLUSIONS The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors . The presence of comorbid diagnoses such as anxiety and depression should be examined Adolescents and young adults ( AYAs ) with cancer are at risk for depression due to disruptions in their developmental trajectory , greater physical symptom burden , and increased likelihood of developing aggressive disease . Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults . Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression . Previous research suggests that psychosocial interventions specifically design ed for AYA patients are promising , but studies of psychopharmacology treatments for depression are lacking . There is a pressing need for prospect i ve studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group Purpose Although most childhood cancer survivors see a primary care provider ( PCP ) , little is known about these encounters . We explored themes related to survivors ’ ( 1 ) experiences with primary care , ( 2 ) communication with their PCPs about their cancer , and ( 3 ) their knowledge and impressions about follow-up care , including their interest in a survivor care plan ( SCP ) . Methods From April to July 2012 , we conducted in-depth , semi-structured telephone interviews with 53 adult survivors recruited from the Utah Cancer Surveillance , Epidemiology , and End Results ( SEER ) Registry . Participants were r and omly selected from sex , age , and rural/urban strata and were younger than 21 years at the time of diagnosis . Participants were asked if they had a PCP and whether they discussed their cancer history with their provider and their interest in a SCP . Interviews were recorded , transcribed , and content-analyzed . Results The average age at interview was 39.1 years ( SD = 11.2 ) . Most survivors had a current PCP ( 83.0 % ) . Almost half were not worried about their health despite having had cancer . Detailed discussion s about cancer history with PCPs were generally rare . Few survivors had a follow-up care plan , but over half thought a SCP could empower their medical decision making . However , one-third of the survivors were skeptical about the usefulness of a SCP and some were worried about health-care costs . Conclusions Childhood cancer survivors need better care coordination . Of concern is that many do not discuss their cancer history with their current PCPs and most have no SCP BACKGROUND Since 75 % of children with cancer will become long-term survivors , late effects of treatment are an ever increasing issue for patients . Paediatric oncologists generally agree that cancer survivors should be followed up for the remainder of their lives , but they might not be the most suitable health-care providers to follow up survivors into late adulthood . We design ed a 3-year study to assess whether shared-care by paediatric oncologists and family doctors in the long-term follow-up of survivors of childhood cancers is feasible , whether a shared-care model is compatible with collection of data needed for registration of late effects , and how a shared-care model is assessed by survivors and family doctors . METHODS In 2004 and 2005 , adult survivors of childhood cancers were r and omly chosen from eligible patients diagnosed with childhood cancer ( excluding CNS tumours ) or Langerhans-cell histiocytosis between January , 1968 , and December , 1997 , and recalled to the long-term follow-up ( LTFU ) clinic at the University Medical Centre Groningen , Groningen , Netherl and s , where they underwent physical and clinical assessment s by an on-site family doctor ( visit 1 ) . At this visit , assessment s were done according to guidelines of the UK Children 's Cancer Study Group Late Effects Group , and late effects were grade d by use of Common Terminology Criteria for Adverse Events ( version 3 ) . Follow-up assessment s were done 1 year later in 2005 and 2006 by local family doctors ( visit 2 ) , who were asked to return data to the LTFU clinic . At this visit , the local family doctors were asked to complete a three-item question naire and patients were asked to complete a seven-item question naire about their satisfaction with the shared-care model . At the next consultation , which was planned for the end of the study ( visit 3 ) , the on-site family doctor advised patients about future follow-up on the basis of their individual risk of late effects . Main endpoints were numbers of participants , satisfaction ratings , and proportions of local family doctors who returned data that they obtained at visit 2 to the LTFU clinic . FINDINGS 133 individuals were chosen at r and om from 210 enrolled adult survivors . 123 of 133 ( 92 % ) r and omly selected survivors and 115 of 117 ( 98 % ) of their family doctors agreed to participate in the share-care programme . 103 of 115 ( 90 % ) family doctors returned data to the LTFU clinic at visit 2 . 89 of 101 ( 88 % ) of survivors were satisfied with this shared-care model , as were 94 of 115 ( 82 % ) family doctors ; 18 of 115 ( 16 % ) family doctors had no views either way ; and three of 115 ( 3 % ) family doctors were dissatisfied . INTERPRETATION Shared-care by paediatric oncologists and family doctors is feasible for long-term follow-up of adult survivors of childhood cancers CONTEXT Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status . OBJECTIVES To compare the health status of adult survivors of childhood cancer and siblings  and to identify factors associated with adverse outcomes . DESIGN , SETTING , AND PARTICIPANTS Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study , a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986 . A r and omly selected cohort of the survivors ' siblings ( n = 2916 ) served as a comparison group . MAIN OUTCOME MEASURES Six health status domains were assessed : general health , mental health , functional status , activity limitations , cancer-related pain , and cancer-related anxiety/fears . The first 4 domains were assessed in the control group . RESULTS Survivors were significantly more likely to report adverse general health ( odds ratio [ OR ] , 2.5 ; 95 % confidence interval [ CI ] , 2.1 - 3.0 ; P<.001 ) , mental health ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) , activity limitations ( OR , 2.7 ; 95 % CI , 2.3 - 3.3 ; P<.001 ) , and functional impairment ( OR , 5.2 ; 95 % CI , 4.1 - 6.6 ; P<.001 ) , compared with siblings . Forty-four percent of survivors reported at least 1 adversely affected health status domain . Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female ( OR , 1.4 ; 95 % CI , 1.3 - 1.6 ; P<.001 ) , lower level of educational attainment ( OR , 2.0 ; 95 % CI , 1.8 - 2.2 ; P<.001 ) , and annual income less than 20 000 dollars ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) . Relative to those survivors with childhood leukemia , an increased risk was observed for at least 1 adverse health status domain among those with bone tumors ( OR , 2.1 ; 95 % CI , 1.8 - 2.5 ; P<.001 ) , central nervous system tumors ( OR , 1.7 ; 95 % CI , 1.5 - 2.0 ; P<.001 ) , and sarcomas ( OR , 1.2 ; 95 % CI , 1.1 - 1.5 ; P = .01 ) . CONCLUSION Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status , especially among females , those with low educational attainment , and those with low household incomes BACKGROUND Although survivors of childhood , adolescent , and young adult ( AYA ) cancer are at risk for late psychological sequelae , it is unclear if they are more likely to be prescription antidepressant users than their peers . PROCEDURE All 5-year survivors of childhood or AYA cancer diagnosed before age 25 years in British Columbia from 1970 to 1995 were identified . Those with complete follow-up in the provincial health insurance registry from 2001 to 2004 were included ( n = 2,389 ) . A birth-cohort and gender-matched set of population controls 10 times the size of the survivor group was r and omly selected ( n = 23,890 ) . All prescriptions filled between 2001 and 2004 were identified through linkage to the provincial prescription drug administrative data base . Logistic regression analyses determined the impact of cancer survivorship on the likelihood of ever filling an antidepressant prescription . RESULTS After adjusting for sociodemographic factors , survivors of childhood and AYA cancer were more likely to have filled an antidepressant prescription compared to controls ( OR 1.21 , 95 % CI 1.09 - 1.35 ) . Cancer survivors had an increased likelihood of using all categories of antidepressants , and of using drugs from two or more antidepressant categories , compared to peers ( OR 1.31 , 95 % CI 1.11 - 1.55 [ ≥2 antidepressant categories ] ) . Treatment was not a significant predictor of antidepressant use . Female survivors , those in young adulthood and those more than 20 years post-treatment had increased antidepressant use . CONCLUSIONS Survivors of childhood and AYA cancer are more likely to fill antidepressant prescriptions compared to peer controls . This may indirectly reflect an increased underlying prevalence of mental health conditions among survivors 
    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: OBJECTIVE To examine posttraumatic stress disorder ( PTSD ) in mothers of survivors of childhood cancer . Comorbidity of anxiety and depressive disorders , prevalence of sub clinical PTSD , and the utility of a self-report measure as a screening instrument for PTSD were also investigated . METHOD Mothers ( n = 65 ) completed a question naire self-report PTSD checklist ( PCL-C ) .  Mothers were administered several modules of the SCID : nonpatient edition by telephone , including the PTSD , Generalized Anxiety , and Major Depressive Disorder modules . RESULTS We diagnosed 6.2 % of the sample with current PTSD . An additional 20 % had sub clinical PTSD . One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder . The PCL-C evidence d diagnostic utility as a screening instrument . However , a moderate number of false-positives would result if the recommended cut-off on the instrument was used . CONCLUSIONS The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors . The presence of comorbid diagnoses such as anxiety and depression should be examined Adolescents and young adults ( AYAs ) with cancer are at risk for depression due to disruptions in their developmental trajectory , greater physical symptom burden , and increased likelihood of developing aggressive disease . Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults . Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression . Previous research suggests that psychosocial interventions specifically design ed for AYA patients are promising , but studies of psychopharmacology treatments for depression are lacking . There is a pressing need for prospect i ve studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group Purpose Although most childhood cancer survivors see a primary care provider ( PCP ) , little is known about these encounters . We explored themes related to survivors ’ ( 1 ) experiences with primary care , ( 2 ) communication with their PCPs about their cancer , and ( 3 ) their knowledge and impressions about follow-up care , including their interest in a survivor care plan ( SCP ) . Methods From April to July 2012 , we conducted in-depth , semi-structured telephone interviews with 53 adult survivors recruited from the Utah Cancer Surveillance , Epidemiology , and End Results ( SEER ) Registry . Participants were r and omly selected from sex , age , and rural/urban strata and were younger than 21 years at the time of diagnosis . Participants were asked if they had a PCP and whether they discussed their cancer history with their provider and their interest in a SCP . Interviews were recorded , transcribed , and content-analyzed . Results The average age at interview was 39.1 years ( SD = 11.2 ) . Most survivors had a current PCP ( 83.0 % ) . Almost half were not worried about their health despite having had cancer . Detailed discussion s about cancer history with PCPs were generally rare . Few survivors had a follow-up care plan , but over half thought a SCP could empower their medical decision making . However , one-third of the survivors were skeptical about the usefulness of a SCP and some were worried about health-care costs . Conclusions Childhood cancer survivors need better care coordination . Of concern is that many do not discuss their cancer history with their current PCPs and most have no SCP BACKGROUND Since 75 % of children with cancer will become long-term survivors , late effects of treatment are an ever increasing issue for patients . Paediatric oncologists generally agree that cancer survivors should be followed up for the remainder of their lives , but they might not be the most suitable health-care providers to follow up survivors into late adulthood . We design ed a 3-year study to assess whether shared-care by paediatric oncologists and family doctors in the long-term follow-up of survivors of childhood cancers is feasible , whether a shared-care model is compatible with collection of data needed for registration of late effects , and how a shared-care model is assessed by survivors and family doctors . METHODS In 2004 and 2005 , adult survivors of childhood cancers were r and omly chosen from eligible patients diagnosed with childhood cancer ( excluding CNS tumours ) or Langerhans-cell histiocytosis between January , 1968 , and December , 1997 , and recalled to the long-term follow-up ( LTFU ) clinic at the University Medical Centre Groningen , Groningen , Netherl and s , where they underwent physical and clinical assessment s by an on-site family doctor ( visit 1 ) . At this visit , assessment s were done according to guidelines of the UK Children 's Cancer Study Group Late Effects Group , and late effects were grade d by use of Common Terminology Criteria for Adverse Events ( version 3 ) . Follow-up assessment s were done 1 year later in 2005 and 2006 by local family doctors ( visit 2 ) , who were asked to return data to the LTFU clinic . At this visit , the local family doctors were asked to complete a three-item question naire and patients were asked to complete a seven-item question naire about their satisfaction with the shared-care model . At the next consultation , which was planned for the end of the study ( visit 3 ) , the on-site family doctor advised patients about future follow-up on the basis of their individual risk of late effects . Main endpoints were numbers of participants , satisfaction ratings , and proportions of local family doctors who returned data that they obtained at visit 2 to the LTFU clinic . FINDINGS 133 individuals were chosen at r and om from 210 enrolled adult survivors . 123 of 133 ( 92 % ) r and omly selected survivors and 115 of 117 ( 98 % ) of their family doctors agreed to participate in the share-care programme . 103 of 115 ( 90 % ) family doctors returned data to the LTFU clinic at visit 2 . 89 of 101 ( 88 % ) of survivors were satisfied with this shared-care model , as were 94 of 115 ( 82 % ) family doctors ; 18 of 115 ( 16 % ) family doctors had no views either way ; and three of 115 ( 3 % ) family doctors were dissatisfied . INTERPRETATION Shared-care by paediatric oncologists and family doctors is feasible for long-term follow-up of adult survivors of childhood cancers CONTEXT Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status . OBJECTIVES To compare the health status of adult survivors of childhood cancer and siblings  and to identify factors associated with adverse outcomes . DESIGN , SETTING , AND PARTICIPANTS Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study , a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986 . A r and omly selected cohort of the survivors ' siblings ( n = 2916 ) served as a comparison group . MAIN OUTCOME MEASURES Six health status domains were assessed : general health , mental health , functional status , activity limitations , cancer-related pain , and cancer-related anxiety/fears . The first 4 domains were assessed in the control group . RESULTS Survivors were significantly more likely to report adverse general health ( odds ratio [ OR ] , 2.5 ; 95 % confidence interval [ CI ] , 2.1 - 3.0 ; P<.001 ) , mental health ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) , activity limitations ( OR , 2.7 ; 95 % CI , 2.3 - 3.3 ; P<.001 ) , and functional impairment ( OR , 5.2 ; 95 % CI , 4.1 - 6.6 ; P<.001 ) , compared with siblings . Forty-four percent of survivors reported at least 1 adversely affected health status domain . Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female ( OR , 1.4 ; 95 % CI , 1.3 - 1.6 ; P<.001 ) , lower level of educational attainment ( OR , 2.0 ; 95 % CI , 1.8 - 2.2 ; P<.001 ) , and annual income less than 20 000 dollars ( OR , 1.8 ; 95 % CI , 1.6 - 2.1 ; P<.001 ) . Relative to those survivors with childhood leukemia , an increased risk was observed for at least 1 adverse health status domain among those with bone tumors ( OR , 2.1 ; 95 % CI , 1.8 - 2.5 ; P<.001 ) , central nervous system tumors ( OR , 1.7 ; 95 % CI , 1.5 - 2.0 ; P<.001 ) , and sarcomas ( OR , 1.2 ; 95 % CI , 1.1 - 1.5 ; P = .01 ) . CONCLUSION Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status , especially among females , those with low educational attainment , and those with low household incomes BACKGROUND Although survivors of childhood , adolescent , and young adult ( AYA ) cancer are at risk for late psychological sequelae , it is unclear if they are more likely to be prescription antidepressant users than their peers . PROCEDURE All 5-year survivors of childhood or AYA cancer diagnosed before age 25 years in British Columbia from 1970 to 1995 were identified . Those with complete follow-up in the provincial health insurance registry from 2001 to 2004 were included ( n = 2,389 ) . A birth-cohort and gender-matched set of population controls 10 times the size of the survivor group was r and omly selected ( n = 23,890 ) . All prescriptions filled between 2001 and 2004 were identified through linkage to the provincial prescription drug administrative data base . Logistic regression analyses determined the impact of cancer survivorship on the likelihood of ever filling an antidepressant prescription . RESULTS After adjusting for sociodemographic factors , survivors of childhood and AYA cancer were more likely to have filled an antidepressant prescription compared to controls ( OR 1.21 , 95 % CI 1.09 - 1.35 ) . Cancer survivors had an increased likelihood of using all categories of antidepressants , and of using drugs from two or more antidepressant categories , compared to peers ( OR 1.31 , 95 % CI 1.11 - 1.55 [ ≥2 antidepressant categories ] ) . Treatment was not a significant predictor of antidepressant use . Female survivors , those in young adulthood and those more than 20 years post-treatment had increased antidepressant use . CONCLUSIONS Survivors of childhood and AYA cancer are more likely to fill antidepressant prescriptions compared to peer controls . This may indirectly reflect an increased underlying prevalence of mental health conditions among survivors 
    Output:
    