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 Workers in wet work occupations have a risk for developing h and eczema . Prevention strategies exist , but compliance to the proposed recommendations is poor . Therefore , a multifaceted implementation strategy ( MIS ) is developed to implement these recommendations to reduce h and eczema among health care workers performing wet work . Methods / Design This study is a r and omised controlled trial in three university hospitals in the Netherl and s. R and omisation to the control or intervention group is performed at department level . The control group receives a leaflet containing the recommendations only . The intervention group receives the MIS which consists of five parts : 1 ) within a department , a participatory working group is formed to identify problems with the implementation of the recommendations , to find solutions for it and implement these solutions ; 2 ) role models will help their colleagues in performing the desired behaviour ; 3 ) education to all workers will enhance knowledge about ( the prevention of ) h and eczema ; 4 ) reminders will be placed at the department reminding workers to use the recommendations ; 5 ) workers receive the same leaflet as the control group containing the recommendations . Data are collected by question naires at baseline and after 3 , 6 , 9 and 12 months . The primary outcome measure is self-reported h and eczema . The most important secondary outcome measures are symptoms of h and eczema ; actual use of the recommendations ; sick leave ; work productivity ; and health care costs . Analyses will be performed according to the intention to treat principle . Cost-effectiveness of the MIS will be evaluated from both the societal and the employer 's perspective . Discussion The prevention of h and eczema is important for the hospital environment . If the MIS has proven to be effective , a major improvement in the health of health care workers can be obtained . Results are expected in 2014.Trial registration Background Childhood eczema , or childhood atopic dermatitis , causes significant distress to children and their families through sleep disturbance and itch . The main cause of treatment failure is nonuse of prescribed treatments . Objective The objective of this study was to develop and test a Web-based intervention to support families of children with eczema , and to explore whether support from a health care professional ( HCP ) is necessary to engage participants with the intervention . Methods We followed the PRECEDE-PROCEED model : regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this . LifeGuide software was used to write the intervention website . Carers of children with eczema were invited through primary care mail-out and r and omized to 3 groups : ( 1 ) website only , ( 2 ) website plus HCP support , or ( 3 ) usual care .  Patient-Oriented Eczema Measure ( POEM ) scores were measured online by carer report at baseline and at 12 weeks . Qualitative interviews were carried out with 13 HCPs ( primarily practice nurses ) and 26 participants to explore their experiences of taking part in the study . Results A total of 143 carers were recruited through 31 practice s. We found a decrease of ≥2 in follow-up compared with baseline POEM score in 23 of 42 ( 55 % ) participants in the website only group , 16 of 49 ( 33 % ) in the usual care group , and 18 of 47 ( 38 % ) in the website plus HCP group . Website use data showed that 75 of 93 ( 81 % ) participants allocated to the website groups completed the core modules , but less than half used other key components ( videos : 35 % ; regular text reminders : 39 % ) . There were no consistent differences in website use between the website only or the website plus HCP groups . Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in . However , HCPs reported productive consultations and that they found it helpful to use the website in consultations , while observing that some participants seemed to need more support than others . Qualitative interviews with participants suggested that HCP support was valued highly only by a minority , generally those who were less confident in their management of eczema or less confident using the Internet . Conclusions Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible . Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema . In this study population , HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 98560867 ; http://www.controlled-trials.com/IS RCT N98560867 ( Archived by WebCite at http://www.webcitation.org/6NcxvMtgN ) OBJECTIVES To study the clinical spectrum of psoriasis and the incidence in the general population and to identify risk factors associated with the occurrence of psoriasis . DESIGN Prospect i ve cohort study with nested case-control analysis . SETTING The data source was the United Kingdom General Practice Research Data base containing computerized clinical information entered by general practitioners ( GPs ) . PATIENTS The study population comprised patients receiving a first-ever diagnosis of psoriasis between January 1 , 1996 , and December 31 , 1997 , and free of cancer . INTERVENTIONS Diagnosis of psoriasis was vali date d in a r and om sample of 14 % of all ascertained cases requesting confirmation by the GPs . Nested case-control analysis included 3994 cases of psoriasis and a r and om sample of 10 000 controls frequency matched to cases by age , sex , and calendar year . MAIN OUTCOME MEASURES Incidence rate of psoriasis and estimates of the odds ratio ( OR ) and 95 % confidence interval ( CI ) for psoriasis as associated with selected risk factors . RESULTS The incidence rate of psoriasis was 14 per 10 000 person-years . Patients with antecedents of skin disorders and skin infection within the last year carried the highest risk of developing psoriasis ( OR , 3.6 [ 95 % CI , 3.2 - 4.1 ] , and OR , 2.1 [ 95 % CI , 1.8 - 2.4 ] , respectively ) . Also , smoking was found to be an independent risk factors for psoriasis ( OR , 1.4 [ 95 % CI , 1.3 - 1.6 ] ) . We did not find an association between risk of psoriasis and antecedents of stress , diabetes , hypertension , hyperlipidemia , cardiovascular disease , or rheumatoid arthritis . CONCLUSIONS The incidence rate in our study was higher than those published in other studies , probably owing to our case definition that considered cases recorded by the GPs independently of a specialist confirmation . Our results confirm the association between psoriasis , skin disorders , and smoking Background This study was part of a large national cost‐effectiveness analysis , and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board . Background Interest in health-related quality of life ( HRQoL ) outcome research in dermatology is increasing , especially in the systemic treatment of psoriasis with biologic agents . In other specialties , such as oncology , the application of a HRQoL intervention is considered to be an aid for monitoring disease and treatment over time , for the communication with the patient , and for improving treatment outcome . However , in dermatology practice , the application of this intervention is relatively new . Moreover , evidence on the effectiveness of a HRQoL intervention in dermatology is missing . It is hypothesized that the application of a HRQoL intervention in dermatology practice will have a positive impact on patients ’ HRQoL as well as on doctor-patient communication . Methods / design In a prospect i ve multicenter cluster r and omized controlled trial , patients diagnosed with moderate to severe psoriasis who receive biologic treatment , will be followed for 48 weeks . The study sites , and not the patients , will be r and omly allocated via a computer-based r and omization system to either the intervention ( treatment with etanercept and st and ardized HRQoL assessment and communication ) or the control group ( treatment with etanercept alone ) . The HRQoL intervention will include 1 ) the electronic assessment of the Skindex-29 , a well-studied dermatology-specific HRQoL question naire , and 2 ) the communication of the result ing Skindex-29 data with the patient . Prior to study start , dermatologists in the intervention group will be educated and trained in st and ardized HRQoL assessment and communication using the Skindex-29 . At six consecutive visits , patients at study sites in the intervention group will be asked to complete the  Skindex-29  on a desk-top pc at the clinic , just before their consultation with the dermatologist . A print-out of the completed question naire will be made and , guided by this print-out , feedback on the HRQoL scores will be given during the consultation . Primary outcome parameters are the impact of the HRQoL intervention on patients ’ HRQoL , and the effect of the HRQoL intervention on doctor-patient communication . Secondary outcomes include health status and disease severity . Trial registration The Netherl and s National Trial Register ( NTR ) : NTR1364 Abstract Objective To determine the effects of age related , structured educational programmes on the management of  moderate to severe atopic dermatitis in childhood and adolescence . Design Multicentre , r and omised controlled trial . Setting Seven hospitals in Germany . Participants Parents of children with atopic dermatitis aged 3 months to 7 years ( n = 274 ) and 8 - 12 years ( n = 102 ) , adolescents with atopic dermatitis aged 13 - 18 years ( n = 70 ) , and controls ( n = 244 , n = 83 , and n = 50 , respectively ) . Interventions Group sessions of st and ardised intervention programmes for atopic dermatitis once weekly for six weeks or no education ( control group ) . Main outcome measures Severity of eczema ( scoring of atopic dermatitis scale ) , subjective severity ( st and ardised question naires ) , and quality of life for parents of affected children aged less than 13 years , over 12 months . Results Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups ( total score for severity : age 3 months to 7 years - 17.5 , 95 % confidence intervals - 19.6 to - 15.3 v - 12.2 , - 14.3 to - 10.1 ; age 8 - 12 years - 16.0 , - 20.0 to - 12.0 v - 7.8 , - 11.4 ; - 4.3 ; and age 13 - 18 years - 19.7 , - 23.7 to - 15.7 v - 5.2 , - 10.5 to 0.1 ) . Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales , whereas parents of affected children aged 8 - 12 years experienced significantly better improvement in three of five quality of life subscales . Conclusion Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease Background Patient education in addition to st and ard treatment , with the aim of affecting care through courses , is a relatively new concept in dermatology . Here we introduce a r and omized controlled trial ( RCT ) regarding a previously described 12‐week educational programme for chronic skin diseases Abstract Background The incidence of occupational h and eczema is approximately 0.32 per 1,000 person years . The burden of the disease is high , as almost 60 % has eczema-related sick leave during the first year after notification , and 15 % are excluded from the workforce 12 years after disease onset . New treatments and prevention strategies are needed . Methods / Design Trial design : The PREVEX trial is a r and omised , parallel-group , superiority trial . Participants : All individuals from the Capital Region of Denmark and Region Zeal and with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial . Inclusion criteria are : self-reported h and eczema and informed consent . Exclusion criteria are : age < 18 years or > 65 years ; permanent exclusion from the workforce ; inability to underst and the Danish language ; any serious medical condition ; and lack of written informed consent . We plan to r and omise 742 participants . Interventions : The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to the participants ' specific occupation . Also , a telephone hotline is available and a subgroup will be offered a work-place visit . The experimental and the control group have access to usual care and treatment . All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work .  12 months after r and omisation follow-up is completed . Objective : To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational h and eczema . R and omisation : Participants are central ly r and omised according to a computer-generated allocation sequence with a varying block size concealed to investigators . Blinding : It is not possible to blind the participants and investigators , however , data obtained from registers , data entry , statistical analyses , and drawing of conclusions will be blinded . Outcomes : The three co- primary outcomes , assessed at 12 months , are : total number of self-reported days with sick leave ; health-related quality of life ; and subjective assessment of h and eczema severity . Explorative outcomes are : self-reported eczema-related sick leave , absence from work registered by the DREAM-register and by self-report , risk 
    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 Workers in wet work occupations have a risk for developing h and eczema . Prevention strategies exist , but compliance to the proposed recommendations is poor . Therefore , a multifaceted implementation strategy ( MIS ) is developed to implement these recommendations to reduce h and eczema among health care workers performing wet work . Methods / Design This study is a r and omised controlled trial in three university hospitals in the Netherl and s. R and omisation to the control or intervention group is performed at department level . The control group receives a leaflet containing the recommendations only . The intervention group receives the MIS which consists of five parts : 1 ) within a department , a participatory working group is formed to identify problems with the implementation of the recommendations , to find solutions for it and implement these solutions ; 2 ) role models will help their colleagues in performing the desired behaviour ; 3 ) education to all workers will enhance knowledge about ( the prevention of ) h and eczema ; 4 ) reminders will be placed at the department reminding workers to use the recommendations ; 5 ) workers receive the same leaflet as the control group containing the recommendations . Data are collected by question naires at baseline and after 3 , 6 , 9 and 12 months . The primary outcome measure is self-reported h and eczema . The most important secondary outcome measures are symptoms of h and eczema ; actual use of the recommendations ; sick leave ; work productivity ; and health care costs . Analyses will be performed according to the intention to treat principle . Cost-effectiveness of the MIS will be evaluated from both the societal and the employer 's perspective . Discussion The prevention of h and eczema is important for the hospital environment . If the MIS has proven to be effective , a major improvement in the health of health care workers can be obtained . Results are expected in 2014.Trial registration Background Childhood eczema , or childhood atopic dermatitis , causes significant distress to children and their families through sleep disturbance and itch . The main cause of treatment failure is nonuse of prescribed treatments . Objective The objective of this study was to develop and test a Web-based intervention to support families of children with eczema , and to explore whether support from a health care professional ( HCP ) is necessary to engage participants with the intervention . Methods We followed the PRECEDE-PROCEED model : regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this . LifeGuide software was used to write the intervention website . Carers of children with eczema were invited through primary care mail-out and r and omized to 3 groups : ( 1 ) website only , ( 2 ) website plus HCP support , or ( 3 ) usual care .  Patient-Oriented Eczema Measure ( POEM ) scores were measured online by carer report at baseline and at 12 weeks . Qualitative interviews were carried out with 13 HCPs ( primarily practice nurses ) and 26 participants to explore their experiences of taking part in the study . Results A total of 143 carers were recruited through 31 practice s. We found a decrease of ≥2 in follow-up compared with baseline POEM score in 23 of 42 ( 55 % ) participants in the website only group , 16 of 49 ( 33 % ) in the usual care group , and 18 of 47 ( 38 % ) in the website plus HCP group . Website use data showed that 75 of 93 ( 81 % ) participants allocated to the website groups completed the core modules , but less than half used other key components ( videos : 35 % ; regular text reminders : 39 % ) . There were no consistent differences in website use between the website only or the website plus HCP groups . Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in . However , HCPs reported productive consultations and that they found it helpful to use the website in consultations , while observing that some participants seemed to need more support than others . Qualitative interviews with participants suggested that HCP support was valued highly only by a minority , generally those who were less confident in their management of eczema or less confident using the Internet . Conclusions Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible . Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema . In this study population , HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 98560867 ; http://www.controlled-trials.com/IS RCT N98560867 ( Archived by WebCite at http://www.webcitation.org/6NcxvMtgN ) OBJECTIVES To study the clinical spectrum of psoriasis and the incidence in the general population and to identify risk factors associated with the occurrence of psoriasis . DESIGN Prospect i ve cohort study with nested case-control analysis . SETTING The data source was the United Kingdom General Practice Research Data base containing computerized clinical information entered by general practitioners ( GPs ) . PATIENTS The study population comprised patients receiving a first-ever diagnosis of psoriasis between January 1 , 1996 , and December 31 , 1997 , and free of cancer . INTERVENTIONS Diagnosis of psoriasis was vali date d in a r and om sample of 14 % of all ascertained cases requesting confirmation by the GPs . Nested case-control analysis included 3994 cases of psoriasis and a r and om sample of 10 000 controls frequency matched to cases by age , sex , and calendar year . MAIN OUTCOME MEASURES Incidence rate of psoriasis and estimates of the odds ratio ( OR ) and 95 % confidence interval ( CI ) for psoriasis as associated with selected risk factors . RESULTS The incidence rate of psoriasis was 14 per 10 000 person-years . Patients with antecedents of skin disorders and skin infection within the last year carried the highest risk of developing psoriasis ( OR , 3.6 [ 95 % CI , 3.2 - 4.1 ] , and OR , 2.1 [ 95 % CI , 1.8 - 2.4 ] , respectively ) . Also , smoking was found to be an independent risk factors for psoriasis ( OR , 1.4 [ 95 % CI , 1.3 - 1.6 ] ) . We did not find an association between risk of psoriasis and antecedents of stress , diabetes , hypertension , hyperlipidemia , cardiovascular disease , or rheumatoid arthritis . CONCLUSIONS The incidence rate in our study was higher than those published in other studies , probably owing to our case definition that considered cases recorded by the GPs independently of a specialist confirmation . Our results confirm the association between psoriasis , skin disorders , and smoking Background This study was part of a large national cost‐effectiveness analysis , and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board . Background Interest in health-related quality of life ( HRQoL ) outcome research in dermatology is increasing , especially in the systemic treatment of psoriasis with biologic agents . In other specialties , such as oncology , the application of a HRQoL intervention is considered to be an aid for monitoring disease and treatment over time , for the communication with the patient , and for improving treatment outcome . However , in dermatology practice , the application of this intervention is relatively new . Moreover , evidence on the effectiveness of a HRQoL intervention in dermatology is missing . It is hypothesized that the application of a HRQoL intervention in dermatology practice will have a positive impact on patients ’ HRQoL as well as on doctor-patient communication . Methods / design In a prospect i ve multicenter cluster r and omized controlled trial , patients diagnosed with moderate to severe psoriasis who receive biologic treatment , will be followed for 48 weeks . The study sites , and not the patients , will be r and omly allocated via a computer-based r and omization system to either the intervention ( treatment with etanercept and st and ardized HRQoL assessment and communication ) or the control group ( treatment with etanercept alone ) . The HRQoL intervention will include 1 ) the electronic assessment of the Skindex-29 , a well-studied dermatology-specific HRQoL question naire , and 2 ) the communication of the result ing Skindex-29 data with the patient . Prior to study start , dermatologists in the intervention group will be educated and trained in st and ardized HRQoL assessment and communication using the Skindex-29 . At six consecutive visits , patients at study sites in the intervention group will be asked to complete the  Skindex-29  on a desk-top pc at the clinic , just before their consultation with the dermatologist . A print-out of the completed question naire will be made and , guided by this print-out , feedback on the HRQoL scores will be given during the consultation . Primary outcome parameters are the impact of the HRQoL intervention on patients ’ HRQoL , and the effect of the HRQoL intervention on doctor-patient communication . Secondary outcomes include health status and disease severity . Trial registration The Netherl and s National Trial Register ( NTR ) : NTR1364 Abstract Objective To determine the effects of age related , structured educational programmes on the management of  moderate to severe atopic dermatitis in childhood and adolescence . Design Multicentre , r and omised controlled trial . Setting Seven hospitals in Germany . Participants Parents of children with atopic dermatitis aged 3 months to 7 years ( n = 274 ) and 8 - 12 years ( n = 102 ) , adolescents with atopic dermatitis aged 13 - 18 years ( n = 70 ) , and controls ( n = 244 , n = 83 , and n = 50 , respectively ) . Interventions Group sessions of st and ardised intervention programmes for atopic dermatitis once weekly for six weeks or no education ( control group ) . Main outcome measures Severity of eczema ( scoring of atopic dermatitis scale ) , subjective severity ( st and ardised question naires ) , and quality of life for parents of affected children aged less than 13 years , over 12 months . Results Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups ( total score for severity : age 3 months to 7 years - 17.5 , 95 % confidence intervals - 19.6 to - 15.3 v - 12.2 , - 14.3 to - 10.1 ; age 8 - 12 years - 16.0 , - 20.0 to - 12.0 v - 7.8 , - 11.4 ; - 4.3 ; and age 13 - 18 years - 19.7 , - 23.7 to - 15.7 v - 5.2 , - 10.5 to 0.1 ) . Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales , whereas parents of affected children aged 8 - 12 years experienced significantly better improvement in three of five quality of life subscales . Conclusion Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease Background Patient education in addition to st and ard treatment , with the aim of affecting care through courses , is a relatively new concept in dermatology . Here we introduce a r and omized controlled trial ( RCT ) regarding a previously described 12‐week educational programme for chronic skin diseases Abstract Background The incidence of occupational h and eczema is approximately 0.32 per 1,000 person years . The burden of the disease is high , as almost 60 % has eczema-related sick leave during the first year after notification , and 15 % are excluded from the workforce 12 years after disease onset . New treatments and prevention strategies are needed . Methods / Design Trial design : The PREVEX trial is a r and omised , parallel-group , superiority trial . Participants : All individuals from the Capital Region of Denmark and Region Zeal and with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial . Inclusion criteria are : self-reported h and eczema and informed consent . Exclusion criteria are : age < 18 years or > 65 years ; permanent exclusion from the workforce ; inability to underst and the Danish language ; any serious medical condition ; and lack of written informed consent . We plan to r and omise 742 participants . Interventions : The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to the participants ' specific occupation . Also , a telephone hotline is available and a subgroup will be offered a work-place visit . The experimental and the control group have access to usual care and treatment . All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work .  12 months after r and omisation follow-up is completed . Objective : To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational h and eczema . R and omisation : Participants are central ly r and omised according to a computer-generated allocation sequence with a varying block size concealed to investigators . Blinding : It is not possible to blind the participants and investigators , however , data obtained from registers , data entry , statistical analyses , and drawing of conclusions will be blinded . Outcomes : The three co- primary outcomes , assessed at 12 months , are : total number of self-reported days with sick leave ; health-related quality of life ; and subjective assessment of h and eczema severity . Explorative outcomes are : self-reported eczema-related sick leave , absence from work registered by the DREAM-register and by self-report , risk 
    Output:
    