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: AIMS ( i ) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care . ( ii ) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption . DESIGN A three-arm cluster r and omized controlled trial . SETTING Seven general medical , six general surgical , one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area . PARTICIPANTS A total of 215 of 789 in- patients aged 18 - 75 years , who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary . INTERVENTIONS Participants were allocated to receive one of three interventions : ( i ) face-to-face self-efficacy enhancement ; ( ii ) a self-help booklet ; or ( iii ) usual care . MEASUREMENTS The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary . Secondary outcomes were change in : number of alcohol drinking days in last week ; the maximum units of alcohol consumed on any one day in last week ; and Drinking Refusal Self-efficacy Expectancy Question naire score . FINDINGS Compared to the usual care group the self-efficacy enhancement group ( -10.1 units 95 % CI -16.1 to -4.1 ) and the self-help booklet group ( -10.0 units 95 % CI -16.0 to -3.9 ) had greater reductions in self-reported weekly alcohol consumption . There was no evidence that self-efficacy enhancement was superior to the self-help booklet ( P = 0.96 ) . CONCLUSIONS Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption Seven hundred and thirty one men admitted to medical wards were interviewed to identify problem drinkers who had not received previous treatment for alcoholism and who had some social support . One hundred and sixty one met the diagnostic criteria ; 156 agreed to a follow up interview and were allocated to one of two groups . One group received a session of counselling about their drinking habits from a nurse while the other received only routine medical care . Both groups reported a reduction in alcohol consumption when interviewed 12 months later , but the counselled group had a significantly better outcome than the control group . It is concluded that systematic screening for alcohol consumption and related problems should become a routine part of medical assessment and that advice on drinking habits is effective if given before irreversible physical or psychosocial problems have developed BACKGROUND Brief motivational intervention ( BMI ) has shown promising results to reduce alcohol use in young adults . Knowledge on mechanisms that predict BMI efficacy could potentially improve treatment effect sizes through data that optimize clinical training and implementation . Particularly , little attention has been given to counselor influence on treatment mechanisms . METHODS We investigated the influence of counselors on  BMI efficacy in reducing alcohol use among non-treatment-seeking young men ( age 20 ) screened as hazardous drinkers . Participants were r and omly allocated to ( i ) a group receiving a single BMI from 1 of 18 counselors selected to maximize differences in several of their characteristics ( gender , professional status , clinical experience , and motivational interviewing [ MI ] experience ) or ( ii ) a control group receiving assessment only .  Drinking at 3-month follow-up was first compared between the BMI and control groups to assess efficacy . Then , the influence of counselors ' characteristics ( i.e. , gender , professional status , clinical experience , MI experience , BMI attitudes , and expectancies ) and within-session behaviors ( i.e. , measured by the Motivational Interviewing Skill Code ) on outcome was tested in regression analyses . RESULTS There was a significant ( p = 0.02 ) decrease in alcohol use among the BMI group compared to the control group . Counselors that were male , more experienced , that had more favorable BMI attitudes and expectancies , higher MI skills , but surprisingly less MI-consistent behaviors , had significantly better outcomes than the control group while their counterparts did not . CONCLUSIONS The current study demonstrated  BMI efficacy on alcohol use reduction within a sample of non-treatment-seeking young adult males . Moreover , BMI effect was related to interindividual differences among counselors , and results therefore provide recommendations for BMI training and implementation with similar population OBJECTIVES Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States ; binge drinking peaks at age 21 - 25 years . Underage drinking is associated with many negative consequences , including academic problems and risk of intentional and unintentional injuries . This study tested the effectiveness of pediatric emergency department ( PED ) screening and brief intervention to reduce alcohol consumption and associated risks . METHODS A three-group r and omized assignment trial was structured to test differences between intervention ( I ) and st and ard assessed control ( AC ) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control ( MAC ) group to adjust for the effect of assessment reactivity on control group behavior . Patients aged 14 - 21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test ( AUDIT ) or for binge drinking or high-risk behaviors . The MAC group received a re source h and out , written advice about alcohol-related risks , and a 12-month follow-up appointment . Patients in the AC group were assessed using st and ardized instruments in addition to the MAC protocol . The I group received a peer-conducted motivational intervention , referral to community re sources and treatment if indicated , and a 10-day booster in addition to assessment . Measurements included 30-day self-report of alcohol consumption and alcohol-related behaviors , screens for depression and posttraumatic stress disorder , and self-report of attempts to quit , cut back , or change conditions of use , all repeated at follow-up . Motor vehicle records and medical records were also analyzed for changes from baseline to 1-year follow-up . RESULTS Among 7,807 PED patients screened , 1,202 were eligible ; 853 enrolled ( I , n = 283 ; AC , n = 284 ; MAC , n = 286 ) , with a 12-month follow-up rate of 72 % . At 12 months , more than half of enrollees in Reaching Adolescents for Prevention ( RAP ) attempted to cut back on drinking , and over a third tried to quit . A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees , and there was a numerically but not significantly greater likelihood ( p = 0.065 ) among the I group for efforts to cut back on drinking . At 3 months , the likelihood of the I group making attempts to cut back was almost triple that of ACs . For efforts to quit , it was double , and for trying to be careful about situations when drinking , there was a 72 % increase in the odds ratio ( OR ) for the I group . Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful . Consumption declined in both groups from baseline to 3 months to 12 months , but there were no significant between-group differences in alcohol-related consequences at 12 months or in alcohol-related risk behaviors . We found a pattern suggestive of assessment reactivity in only one variable at 12 months : the attempt to cut back ( 73.3 % for the I group vs. 64.9 % among the AC group and 54.8 % among the MAC group ) . CONCLUSIONS Brief motivational intervention result ed in significant efforts to change behavior ( quit drinking and be careful about situations while drinking ) but did not alter between-group consumption or consequences Background Internet-based interventions for heavy drinkers show promising results , but existing research is characterized by few studies in nonstudent adult population s and few comparisons with appropriate control groups . Objective To test whether a fully automated Internet-based brief personalized feedback intervention and a fully automated Internet-based personalized brief advice intervention in a non-treatment-seeking population of heavy drinkers would result in a reduced alcohol intake . Methods We conducted a 3-arm parallel r and omized controlled trial in a general population -based sample of heavy drinkers . The 54,157 participants ( median age of 58 years ) were screened for heavy drinking . Of the 3418 participants who had a weekly alcohol consumption above 14 drinks for women and 21 drinks for men , 1380 ( 619 women ) consented to take part in the trial and were r and omly assigned to an Internet-based brief personalized feedback intervention group ( normative feedback , n = 476 ) , an Internet-based personalized brief advice intervention group ( n = 450 ) , or a nonintervention control group ( n = 454 ) . Follow-up after 6 and 12 months included 871 and 1064 participants , respectively , of all groups combined . The outcome measure was self-reported weekly alcohol consumption . We analyzed the data according to the intention-to-treat principle . To examine changes over time and to account for the multiple time measurements , we used a multilevel linear mixed model . To take attrition into account , we used multiple imputation to address missing data . Results The intervention effect of the Internet-based brief personalized feedback intervention , determined as the mean additional difference in changes in alcohol consumption in the Internet-based brief personalized feedback intervention compared with the control group , was –1.8 drinks/week after 6 months and –1.4 drinks/week after 12 months ; these effects were nonsignificant ( 95 % confidence interval –4.0 to 0.3 at 6 months , –3.4 to 0.6 at 12 months ) . The intervention effect of the Internet-based personalized brief advice intervention was –0.5 drinks/week after 6 months and –1.2 drinks/week after 12 months ; these effects were nonsignificant ( 95 % confidence interval –2.7 to 1.6 at 6 months , –3.3 to 0.9 at 12 months ) . Conclusions In this r and omized controlled trial we found no evidence that an Internet-based brief personalized feedback intervention was effective in reducing drinking in an adult population of heavy drinkers . Trial registration Clinical Trials.gov NCT00751985 ; http:// clinical trials.gov/ct2/show/NCT00751985 ( Archived by WebCite at http://www.webcitation.org/68WCRLyaP AIM To evaluate the effectiveness of different brief intervention strategies at reducing  hazardous or harmful drinking in the probation setting . Offender managers were r and omized to three interventions , each of which built on the previous one : feedback on screening outcome and a client information leaflet control group , 5 min of structured brief advice and 20 min of brief lifestyle counselling . METHODS A pragmatic multicentre factorial cluster r and omized controlled trial . The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test ( AUDIT ) at 6 months ( negative status was a score of < 8) . Secondary outcomes were AUDIT status at 12 months , experience of alcohol-related problems , health utility , service utilization , readiness to change and reduction in conviction rates . RESULTS Follow-up rates were 68 % at 6 months and 60 % at 12 months . At both time points , there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status . Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend ( 36 and 38 % , respectively ) than those in the client information leaflet group ( 50 % ) in the year following intervention . CONCLUSION Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet . The impact of more intensive brief intervention on reoffending warrants further research Motivational interviewing ( MI ) is a brief intervention that has been shown to reduce heavy drinking among college students . Because all college studies of MI to date have included a personalized feedback report , it remains unclear which of the components is necessary to produce behavior change . This study evaluated the separate and collective effects of MI and feedback among 122 “ binge ” drinking college students . Participants were r and omized to : 1 ) MI with feedback , 2 ) MI without feedback , 3 ) Mailed feedback only , 4 ) MI with mailed feedback , or 5 ) Assessment only control . At an eight-week follow-up , all groups reduced their consumption , peak BAC , consequences , and dependence symptoms . For females , there were reductions in consequences and dependence symptoms in groups that received feedback , as compared to groups that did not receive feedback . For females , there was an effect of the feedback on consequences and dependence symptoms , but was no overall effect of MI on any outcome measure This study evaluated the efficacy of two brief personalized feedback interventions ( PFIs ) using identical feedback and motivational interviewing strategies aim ed at reducing alcohol consumption and alcohol-related problems to two control conditions among a sample of high-risk drinking college students . Students ( N = 152 ) were r and omly assigned to a computer-delivered PFI with a video interviewer , a face-to-face PFI with a live interviewer , a comprehensive assessment condition , or a minimal assessment -only condition . At 10 weeks posttreatment , the face-to-face PFI significantly reduced weekly drinking quantity and peak and typical blood alcohol concentration compared with the comprehensive assessment and minimal assessment -only conditions ( d values ranged from 0.32 to 0.61 ) . No significant between-group differences were evidence d for the computer-delivered PFI condition , although effect sizes were comparable to other college drinking studies using computer-delivered interventions ( 
    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: AIMS ( i ) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care . ( ii ) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption . DESIGN A three-arm cluster r and omized controlled trial . SETTING Seven general medical , six general surgical , one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area . PARTICIPANTS A total of 215 of 789 in- patients aged 18 - 75 years , who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary . INTERVENTIONS Participants were allocated to receive one of three interventions : ( i ) face-to-face self-efficacy enhancement ; ( ii ) a self-help booklet ; or ( iii ) usual care . MEASUREMENTS The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary . Secondary outcomes were change in : number of alcohol drinking days in last week ; the maximum units of alcohol consumed on any one day in last week ; and Drinking Refusal Self-efficacy Expectancy Question naire score . FINDINGS Compared to the usual care group the self-efficacy enhancement group ( -10.1 units 95 % CI -16.1 to -4.1 ) and the self-help booklet group ( -10.0 units 95 % CI -16.0 to -3.9 ) had greater reductions in self-reported weekly alcohol consumption . There was no evidence that self-efficacy enhancement was superior to the self-help booklet ( P = 0.96 ) . CONCLUSIONS Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption Seven hundred and thirty one men admitted to medical wards were interviewed to identify problem drinkers who had not received previous treatment for alcoholism and who had some social support . One hundred and sixty one met the diagnostic criteria ; 156 agreed to a follow up interview and were allocated to one of two groups . One group received a session of counselling about their drinking habits from a nurse while the other received only routine medical care . Both groups reported a reduction in alcohol consumption when interviewed 12 months later , but the counselled group had a significantly better outcome than the control group . It is concluded that systematic screening for alcohol consumption and related problems should become a routine part of medical assessment and that advice on drinking habits is effective if given before irreversible physical or psychosocial problems have developed BACKGROUND Brief motivational intervention ( BMI ) has shown promising results to reduce alcohol use in young adults . Knowledge on mechanisms that predict BMI efficacy could potentially improve treatment effect sizes through data that optimize clinical training and implementation . Particularly , little attention has been given to counselor influence on treatment mechanisms . METHODS We investigated the influence of counselors on  BMI efficacy in reducing alcohol use among non-treatment-seeking young men ( age 20 ) screened as hazardous drinkers . Participants were r and omly allocated to ( i ) a group receiving a single BMI from 1 of 18 counselors selected to maximize differences in several of their characteristics ( gender , professional status , clinical experience , and motivational interviewing [ MI ] experience ) or ( ii ) a control group receiving assessment only .  Drinking at 3-month follow-up was first compared between the BMI and control groups to assess efficacy . Then , the influence of counselors ' characteristics ( i.e. , gender , professional status , clinical experience , MI experience , BMI attitudes , and expectancies ) and within-session behaviors ( i.e. , measured by the Motivational Interviewing Skill Code ) on outcome was tested in regression analyses . RESULTS There was a significant ( p = 0.02 ) decrease in alcohol use among the BMI group compared to the control group . Counselors that were male , more experienced , that had more favorable BMI attitudes and expectancies , higher MI skills , but surprisingly less MI-consistent behaviors , had significantly better outcomes than the control group while their counterparts did not . CONCLUSIONS The current study demonstrated  BMI efficacy on alcohol use reduction within a sample of non-treatment-seeking young adult males . Moreover , BMI effect was related to interindividual differences among counselors , and results therefore provide recommendations for BMI training and implementation with similar population OBJECTIVES Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States ; binge drinking peaks at age 21 - 25 years . Underage drinking is associated with many negative consequences , including academic problems and risk of intentional and unintentional injuries . This study tested the effectiveness of pediatric emergency department ( PED ) screening and brief intervention to reduce alcohol consumption and associated risks . METHODS A three-group r and omized assignment trial was structured to test differences between intervention ( I ) and st and ard assessed control ( AC ) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control ( MAC ) group to adjust for the effect of assessment reactivity on control group behavior . Patients aged 14 - 21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test ( AUDIT ) or for binge drinking or high-risk behaviors . The MAC group received a re source h and out , written advice about alcohol-related risks , and a 12-month follow-up appointment . Patients in the AC group were assessed using st and ardized instruments in addition to the MAC protocol . The I group received a peer-conducted motivational intervention , referral to community re sources and treatment if indicated , and a 10-day booster in addition to assessment . Measurements included 30-day self-report of alcohol consumption and alcohol-related behaviors , screens for depression and posttraumatic stress disorder , and self-report of attempts to quit , cut back , or change conditions of use , all repeated at follow-up . Motor vehicle records and medical records were also analyzed for changes from baseline to 1-year follow-up . RESULTS Among 7,807 PED patients screened , 1,202 were eligible ; 853 enrolled ( I , n = 283 ; AC , n = 284 ; MAC , n = 286 ) , with a 12-month follow-up rate of 72 % . At 12 months , more than half of enrollees in Reaching Adolescents for Prevention ( RAP ) attempted to cut back on drinking , and over a third tried to quit . A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees , and there was a numerically but not significantly greater likelihood ( p = 0.065 ) among the I group for efforts to cut back on drinking . At 3 months , the likelihood of the I group making attempts to cut back was almost triple that of ACs . For efforts to quit , it was double , and for trying to be careful about situations when drinking , there was a 72 % increase in the odds ratio ( OR ) for the I group . Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful . Consumption declined in both groups from baseline to 3 months to 12 months , but there were no significant between-group differences in alcohol-related consequences at 12 months or in alcohol-related risk behaviors . We found a pattern suggestive of assessment reactivity in only one variable at 12 months : the attempt to cut back ( 73.3 % for the I group vs. 64.9 % among the AC group and 54.8 % among the MAC group ) . CONCLUSIONS Brief motivational intervention result ed in significant efforts to change behavior ( quit drinking and be careful about situations while drinking ) but did not alter between-group consumption or consequences Background Internet-based interventions for heavy drinkers show promising results , but existing research is characterized by few studies in nonstudent adult population s and few comparisons with appropriate control groups . Objective To test whether a fully automated Internet-based brief personalized feedback intervention and a fully automated Internet-based personalized brief advice intervention in a non-treatment-seeking population of heavy drinkers would result in a reduced alcohol intake . Methods We conducted a 3-arm parallel r and omized controlled trial in a general population -based sample of heavy drinkers . The 54,157 participants ( median age of 58 years ) were screened for heavy drinking . Of the 3418 participants who had a weekly alcohol consumption above 14 drinks for women and 21 drinks for men , 1380 ( 619 women ) consented to take part in the trial and were r and omly assigned to an Internet-based brief personalized feedback intervention group ( normative feedback , n = 476 ) , an Internet-based personalized brief advice intervention group ( n = 450 ) , or a nonintervention control group ( n = 454 ) . Follow-up after 6 and 12 months included 871 and 1064 participants , respectively , of all groups combined . The outcome measure was self-reported weekly alcohol consumption . We analyzed the data according to the intention-to-treat principle . To examine changes over time and to account for the multiple time measurements , we used a multilevel linear mixed model . To take attrition into account , we used multiple imputation to address missing data . Results The intervention effect of the Internet-based brief personalized feedback intervention , determined as the mean additional difference in changes in alcohol consumption in the Internet-based brief personalized feedback intervention compared with the control group , was –1.8 drinks/week after 6 months and –1.4 drinks/week after 12 months ; these effects were nonsignificant ( 95 % confidence interval –4.0 to 0.3 at 6 months , –3.4 to 0.6 at 12 months ) . The intervention effect of the Internet-based personalized brief advice intervention was –0.5 drinks/week after 6 months and –1.2 drinks/week after 12 months ; these effects were nonsignificant ( 95 % confidence interval –2.7 to 1.6 at 6 months , –3.3 to 0.9 at 12 months ) . Conclusions In this r and omized controlled trial we found no evidence that an Internet-based brief personalized feedback intervention was effective in reducing drinking in an adult population of heavy drinkers . Trial registration Clinical Trials.gov NCT00751985 ; http:// clinical trials.gov/ct2/show/NCT00751985 ( Archived by WebCite at http://www.webcitation.org/68WCRLyaP AIM To evaluate the effectiveness of different brief intervention strategies at reducing  hazardous or harmful drinking in the probation setting . Offender managers were r and omized to three interventions , each of which built on the previous one : feedback on screening outcome and a client information leaflet control group , 5 min of structured brief advice and 20 min of brief lifestyle counselling . METHODS A pragmatic multicentre factorial cluster r and omized controlled trial . The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test ( AUDIT ) at 6 months ( negative status was a score of < 8) . Secondary outcomes were AUDIT status at 12 months , experience of alcohol-related problems , health utility , service utilization , readiness to change and reduction in conviction rates . RESULTS Follow-up rates were 68 % at 6 months and 60 % at 12 months . At both time points , there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status . Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend ( 36 and 38 % , respectively ) than those in the client information leaflet group ( 50 % ) in the year following intervention . CONCLUSION Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet . The impact of more intensive brief intervention on reoffending warrants further research Motivational interviewing ( MI ) is a brief intervention that has been shown to reduce heavy drinking among college students . Because all college studies of MI to date have included a personalized feedback report , it remains unclear which of the components is necessary to produce behavior change . This study evaluated the separate and collective effects of MI and feedback among 122 “ binge ” drinking college students . Participants were r and omized to : 1 ) MI with feedback , 2 ) MI without feedback , 3 ) Mailed feedback only , 4 ) MI with mailed feedback , or 5 ) Assessment only control . At an eight-week follow-up , all groups reduced their consumption , peak BAC , consequences , and dependence symptoms . For females , there were reductions in consequences and dependence symptoms in groups that received feedback , as compared to groups that did not receive feedback . For females , there was an effect of the feedback on consequences and dependence symptoms , but was no overall effect of MI on any outcome measure This study evaluated the efficacy of two brief personalized feedback interventions ( PFIs ) using identical feedback and motivational interviewing strategies aim ed at reducing alcohol consumption and alcohol-related problems to two control conditions among a sample of high-risk drinking college students . Students ( N = 152 ) were r and omly assigned to a computer-delivered PFI with a video interviewer , a face-to-face PFI with a live interviewer , a comprehensive assessment condition , or a minimal assessment -only condition . At 10 weeks posttreatment , the face-to-face PFI significantly reduced weekly drinking quantity and peak and typical blood alcohol concentration compared with the comprehensive assessment and minimal assessment -only conditions ( d values ranged from 0.32 to 0.61 ) . No significant between-group differences were evidence d for the computer-delivered PFI condition , although effect sizes were comparable to other college drinking studies using computer-delivered interventions ( 
    Output:
    