***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 
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    Input: Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease , the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies . In this preliminary investigation of nutritional advice in a well population , subjects in one group practice were r and omized to receive either dietary instruction or simple follow up without instruction . The dietary recommendations were well received , and a substantial proportion of subjects reported altering their diets in accordance with them . There were modest beneficial changes in plasma lipid levels among men . Thus , using general practice as an avenue for promoting dietary change is feasible , and may be effective among men AIMS To assess the effect of regular diabetic health education on cardiovascular risk factors in Chinese Type 2 diabetic patients . METHODS This was a 1-year prospect i ve r and omized study . One hundred and eighty Type 2 diabetic subjects were recruited from three regional diabetic centres in Hong Kong . Ninety received additional structured reinforcement of diabetic health education by a trained nurse after the doctors ' consultations every 3 months ( intervention group ) . The others received the same medical care except no nursing reinforcement ( control group ) . Outcome measures included fasting plasma glucose , HbA(1c ) , body mass index , waist circumference , blood pressure and lipid profiles , which were assessed before the study and after 1 year . RESULTS Two of the controls defaulted follow-up . The intervention group and controls had similar age and sex distribution . At the end of study , the intervention group had reducted their waist circumference , diastolic blood pressure , HbA(1c ) , total cholesterol and low-density lipoprotein cholesterol levels . The controls had reduced their total cholesterol and low-density lipoprotein cholesterol levels . Other cardiovascular risk factors were not significantly changed in the controls . Addition of drugs and /or dosage increment of anti-diabetic drugs , lipid-lowering agents and anti-hypertensive agents were similar between the two groups . CONCLUSIONS Regular structured reinforcement with diabetic health education is useful . It helps to control more successfully some of the cardiovascular risk factors in Chinese Type 2 diabetic patients Cluster r and omization trials are increasingly being used in primary care research . The main feature of these trials is that patients are nested within large clusters such as physician practice s or communities and the intervention is applied to the cluster . This study design necessitates calculation of intraclass correlation coefficients in order to determine the required sample size . The purpose of this study is to determine intraclass correlation coefficients for a number of outcome measures at the primary care practice level . The CEART study is a  r and omized trial testing the effectiveness of translating ATP III guidelines into clinical practice , with primary care physician practice s as the unit of r and omization and patients as the unit of data collection . The intraclass correlation coefficient ( ICC ) was<0.02 and the design effect ranged from 1.0 to 2.3 , respectively , for weight , total cholesterol , LDL , non-HDL , glucose , creatinine , and % at non-HDL goal . For smoking status , body mass index , systolic blood pressure , HDL cholesterol triglycerides , total cholesterol/HDL ratio and % at LDL goal , the ICC was 0.02 - 0.047 and the design effect was 2.6 - 4.1 . The largest ICCs ( 0.05 - 0.12 ) and design effects ( 4.4 - 9.4 ) were found for height and diastolic blood pressure . These findings suggest that cluster r and omization may substantially increase the sample size necessary to maintain adequate statistical power for selected outcomes such as diastolic blood pressure studies compared with simple r and omization for most outcomes evaluated in this study where the design effect is small to moderate . Overall , the ICCs presented will be useful in calculating sample sizes at the primary care level A preventive nursing intervention to reduce coronary heart disease ( CHD ) risk was tested . The sample was 19 families composed of 58 first-degreed relatives of young ( age 30 - 55 years ) victims of sudden cardiac death . Families were r and omly assigned to control and experimental groups . The intervention at 3 - 5 months postdeath focused on assessment of health history , health behaviors , health beliefs , informing and educating about CHD risk factors , and methods for detecting and reducing these factors . The control group received mailed question naires and no intervention . The subject 's reduction of CHD risk was measured at 7 months by changes in high risk CHD behaviors , changes in health beliefs , and adherence to screening for serum cholesterol and blood pressure determination . Analysis of covariance ( covarying age and pretest scores ) demonstrated no differences between groups for health beliefs ; however , significant differences for health beliefs existed between the sibling subgroups . The intervention was correlated with a significant reduction in alcohol intake . Reductions in high fat meat consumption were in the desired direction . Greater percentages of subjects in the intervention group obtained blood pressure and cholesterol screening Subjects and design : The study was based on the total patient sample ( n=110 ) of a r and omized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice . Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables . Setting : Twenty-two general practice centres in the county of Hordal and , western Norway . Results : Self-efficacy of increased physical exercise was the only variable significantly related to exercise change . Age and self-efficacy were statistical significant predictors of smoking cessation success . None of the independent variables was statistically significantly related to blood pressure or cholesterol change . Educational level related negatively , although statistically insignificantly , with total risk change . Conclusion : The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change . Objectives : The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change ; predictors such as education , age , self-efficacy , doctors ' interpersonal skills , and number of appointments Of 22 r and omized trials of rehabilitation with exercise  after myocardial infa rct ion ( MI ) , one trial had results that achieved conventional statistical significance . To determine whether or not these studies , in the aggregate , show a significant benefit of rehabilitation after myocardial infa rct ion , we performed an overview of all r and omized trials , involving 4,554 patients ; we evaluated total and cardiovascular mortality , sudden death , and fatal and nonfatal reinfa rct ion . For each endpoint , we calculated an odds ratio ( OR ) and 95 % confidence interval ( 95 % CI ) for the trials combined . After an average of 3 years of follow-up , the ORs were significantly lower in the rehabilitation than in the comparison group : specifically , total mortality ( OR = 0.80 [ 0.66 , 0.96 ] ) , cardiovascular mortality ( OR = 0.78 [ 0.63 , 0.96 ] ) , and fatal reinfa rct ion ( OR = 0.75 [ 0.59 , 0.95 ] ) . The OR for sudden death was significantly lower in the rehabilitation than in the comparison group at 1 year ( OR = 0.63 [ 0.41 , 0.97 ] ) . The data were compatible with a benefit at 2 ( OR = 0.76 [ 0.54 , 1.06 ] ) and 3 years ( OR = 0.92 [ 0.69 , 1.23 ] ) , but these findings were not statistically significant . For nonfatal reinfa rct ion , there were no significant differences between the two groups after 1 ( OR = 1.09 [ 0.76 , 1.57 ] ) , 2 ( OR = 1.10 [ 0.82 , 1.47 ] ) , or 3 years ( OR = 1.09 [ 0.88 , 1.34 ] ) of follow-up . The observed 20 % reduction in overall mortality reflects a decreased risk of cardiovascular mortality and fatal reinfa rct ion throughout at least 3 years and a reduction in sudden death during the 1st year after infa rct ion and possibly for 2 - 3 years . With respect to the independent effects of the physical exercise component of cardiac rehabilitation , the relatively small number of " exercise only " trials , combined with the possibility that they may have had a formal or informal nonexercise component precludes the possibility of reaching any definitive conclusion . To do so would require a r and omized trial of sufficient size to distinguish between no effect and the most plausible effect based on the results of this overview The effects of cardiovascular risk reduction are typically assessed by self-reported behavior change and physiological outcomes . There is a need to enhance evaluation protocol s by including direct observation measures of targeted health behaviors . To improve the evaluation of a family-based diet and physical activity change program , families were observed during a planned visit to the San Diego Zoo . This st and ardized environment afforded many options for dietary intake and physical activity . Thirty families who had participated in a 1-year intervention program and 30 control families were observed . Caucasian and Mexican-American families were equally represented . Observations in this st and ard environment discriminated between intervention and control families , and the findings indicated that intervention effects generalized to this novel setting . Intervention families consumed fewer calories , ate less sodium , and walked further than did control families . Ethnic differences were noted Abstract Objectives : To estimate the extent to which changes in the main coronary risk factors ( serum cholesterol concentration , blood pressure , and smoking ) explain the decline in mortality from ischaemic heart disease and to evaluate the relative importance of change in each of these risk factors . Design : Predicted changes in ischaemic heart disease mortality were calculated by a ligistic regression model using the risk factor levels assessed by cross sectional population surveys , in 1972 , 1977 , 1982 , 1987 , and 1992 . These predicted changes were compared with observed changes in mortality statistics . Setting : North Karelia and Kuopio provinces , Finl and . Subjects : 14 257 men and 14 786 women aged 30–59 r and omly selected from the national population register . Main outcome measures : Levels of the risk factors and predicted and observed changes in mortality from ischaemic heart disease . Results — The observed changes in the risk factors in the population from 1972 to 1992 predicted a decline in mortality from ischaemic heart disease of 44 % ( 95 % confidence interval 37 % to 50 % ) in men and 49 % ( 37 % to 59 % ) in women . The observed decline was 55 % ( 51 % to 58 % ) and 68 % ( 61 to 74 ) respectively . Conclusion : An assessment of the data on the risk factors for ischaemic heart disease and mortality suggests that most of the decline in mortality from ischaemic heart disease can be explained by changes in the three main coronary risk factors OBJECTIVE To investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients . RESEARCH DESIGN AND METHODS This 6-month study , which included 6 months of follow-up , adopted a prospect i ve , multicenter , r and omized controlled design . Subjects were r and omized to two groups : one group used a blood glucose-monitoring device , kept a blood glucose/eating diary , and received st and ardized counseling ; the control group received nonst and ardized counseling on diet and lifestyle . The primary efficacy parameter was the change in HbA(1c ) . Secondary efficacy variables included changes in body weight , lipids , and microalbumin and changes in treatment satisfaction and well-being . RESULTS In the per- protocol analysis , the use of a self-monitoring blood glucose device significantly reduced HbA(1c ) levels by 1.0 + /- 1.08 % compared with 0.54 + /- 1.41 % for the control group ( P = 0.0086 ) ; subgroup analysis showed three types of responders . Body weight , total cholesterol , and microalbumin improved when using a glucometer , but there was no statistically significant difference between the two groups . Treatment satisfaction increased in both groups to a similar extent ( P = 0.9 ) . Self-monitoring result ed in a marked improvement of general well-being with significant improvements in the subitems depression ( P = 0.032 ) and lack of well-being ( P = 0.02 ) . CONCLUSIONS Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study . The finding of three types of responders will be important for future planning of counseling and educational interventions Lifestyle factors like weight , alcohol consumption , salt intake and physical activity have shown to be important in treating hypertension . There have been made some r and omised trials about the effects of lifestyle interventions , but the numbers of patients have been relatively small and the duration s of follow-ups have been short . No controlled trials assessing the effects of lifestyle intervention in a rehabilitation setting have been reported . In this study , the effects of multidisciplinary lifestyle intervention in rehabilitation centres among middle-aged hypertensive employees were described . A total of 731 hypertensives from 45 worksites were r and omised to lifestyle intervention in a rehabilitation centre or to usual care in an occupational or primary health-care centre for 12 months . St and ard measurements were conducted before the intervention and 1-year later . Blood pressure ( BP ) levels were clearly reduced in the intervention group , while only minor changes were observed in the control 
    Output:
    
Evidence suggests that health promotion interventions have limited use in general population