***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 evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus . DESIGN A r and omized pretest-posttest control group design was used . SUBJECTS/ SETTING Participants ( 48 experimental , 50 control ) were aged 65 years and older with type 2 diabetes for 1 year or longer ; 93 participants ( 95 % ) completed the study , conducted in an outpatient setting . INTERVENTION The intervention included 10 weekly group sessions led by a dietitian . Information processing , learning theory , and Social Cognitive Theory principles were used in program development and evaluation . MAIN OUTCOME MEASURES Participants ' knowledge , outcome expectations ( expected results of behavior ) , self-efficacy , and decision-making skills were assessed . Instrument validity and reliability were established before program evaluation . STATISTICAL ANALYSES PERFORMED Factor analysis identified underlying factor structures . Analysis of covariance with pretest score as covariate was used to compare groups at posttest . Paired t tests compared results within groups . RESULTS Two factors were identified for outcome expectations ( positive and negative ) and for self-efficacy ( promoters of and barriers to diabetes management ) . The experimental group had greater improvement in total knowledge scores ( mean + /- st and ard error of the mean : 7.8+/-0.7 ) than the control group ( 0.2+/-0.7 ) ( P < .0001 ) , positive outcome expectations ( 0.59+/-0.15 vs 0.06+/-0.15 , P = .01 ) , promoters of diabetes management ( 0.83+/-0.12 vs -0.09+/-0.18 , P < or = .001 ) and decision-making skills ( 5.1+/-0.5 vs 0.3+/-0.5 , P < .0001 ) and greater reduction in barriers to diabetes management ( 1.1+/-0.16 vs 0.34+/-0.16 , P < .01 ) . No significant difference in negative outcome expectations occurred between groups at posttest . APPLICATIONS/ CONCLUSIONS Older adults with diabetes can benefit from nutrition education design ed to improve knowledge and skills necessary for diabetes management Purpose . Examine the effects of three iterative tailored feedback letters addressing smoking ; physical activity ; and fruit , vegetable , and fat intake , and test the additional effects of providing feedback on action plans . Design . A tailored , print-based intervention was developed and tested in a r and omized control trial with a posttest after 9 months . Setting . A total of 2827 respondents agreed to participate . They were recruited from a r and om sample of 35,000 addresses obtained through the Dutch national telephone company . Subjects . The mean age was 49 years , and 55 % were female . Intervention . The experimental group received three printed tailored letters , and the control group received three printed generic letters . Respondents from the experimental group r and omly received either a third letter with tailored information or tailored information and action-planning feedback . Measures . The question naire assessed physical activity ; smoking ; consumption of fruit , vegetables and fat ; motivational determinants ; action plans ; and demographics . Results . Tailored information result ed in more improvement over time than generic information for the intake of fruit , vegetables , and fat and for physical activity . No differences between the conditions were found for smoking because of high cessation rates in all conditions . Action-planning feedback did not increase the effects . Conclusions . Tailored lifestyle information can be effective for adults in changing nutrition behavior and physical activity Background Although experts cl aim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change , few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet . Purpose To evaluate the short-term ( 1 month ) efficacy of an Internet-delivered , computer-tailored lifestyle intervention targeting saturated fat intake , physical activity ( PA ) , and smoking cessation , and to evaluate exposure to the intervention . Methods A pretest – posttest r and omized controlled trial with an  intervention group and a no intervention waiting list control group was conducted . Self-reported behavior and determinants were assessed at baseline and 1 month follow-up . Exposure to the intervention was monitored through server registration s. The data were analyzed using multiple linear and logistic regression analysis . Results The intervention result ed in a significantly lower self-reported saturated fat intake ( b = −0.76 , p < 0.01 ) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline ( OR = 1.34 , 95%CI = 1.001–1.80 ) . No significant intervention effects were found for self-reported smoking status . Of the participants , 81 % actually visited the website . Conclusions The Internet-delivered , computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study Purpose The purpose of this study was to evaluate the community-based Chronic Disease Self-management Program ( CDSMP ) and the Spanish- language version ( Tom and o Control de Su Salud ) programs as delivered in setting s along the Texas/New Mexico/Mexico border . The programs had proven effective in r and omized trials , and the authors wished to determine if they would be as effective when administered by others to different population s. Methods The El Paso Diabetes Association administered the CDSMP and Tom and o to 445 persons with chronic illness ( two thirds with diabetes ) in Texas , New Mexico , and Mexico . Four-month and 1-year outcomes were compared to baseline using t tests of change scores . Regression models were used to test whether baseline demographics and self-efficacy were associated with positive outcomes of the programs . Results Participants showed improvements in health behaviors , health status , and self-efficacy at both 4 month and 1 year . Baseline self-efficacy and 4-month change in self-efficacy were significantly associated with improved 1- year outcomes . Conclusions The CDSMP and Tom and o are effective when used in setting s other than that of the original study for population s other than those for which they were initially developed This study compared the efficacy of two low-cost interventions for physical activity adoption . Sedentary ( N=194 ) adults recruited through newspaper advertisements were r and omized to receive either a motivationally-matched , individually-tailored intervention ( IT ) or a st and ard self-help intervention ( ST ) . Assessment s and interventions were delivered by repeated mailings at baseline , one , three , and six months . Participants were assessed regarding current physical activity behavior , motivational readiness to adopt regular physical activity , and psychological constructs associated with physical activity participation ( e.g. self-efficacy , decisional balance ) . Repeated measures analyses of variance ( ANOVAs ) revealed significant increases in physical activity participation between baseline and six months for both groups with a significantly greater increase among IT participants . The IT group outperformed the ST group on all primary outcome measures : ( a ) minutes of physical activity per week , ( b ) reaching Centers for Disease Control and American College of Sports Medicine ( CDC/ACSM ) recommended minimum physical activity criteria , and ( c ) achieving the Action stage of motivational readiness for physical activity adoption . Both groups showed significant improvement between baseline and six months on the psychological constructs associated with physical activity adoption ( e.g. self-efficacy ) , with no significant differences observed between the treatment groups . Utilizing computer expert systems and self-help manuals to provide individually-tailored , motivationally-matched interventions appears to be an effective , low-cost approach for enhancing physical activity participation in the community BACKGROUND Rates of physical inactivity and poor nutrition , which are 2 of the most important modifiable risk factors for cardiovascular disease in women , are substantial . Even so , studies of interventions design ed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas . OBJECTIVE To evaluate the effect of Choose to Move on increasing women 's physical activity , improving their knowledge of heart disease and stroke , and improving their nutrition . PARTICIPANTS AND METHODS A prospect i ve , nonr and omized , 12-week educational intervention design ed by the American Heart Association for women across the United States . Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change . Women ( N = 23 171 ) aged 25 years or older were recruited by direct mail , the media , health care providers , and other means . Follow-up evaluations were returned from 6389 women at 2 weeks , 5338 at 4 weeks , 4209 at 8 weeks , 3916 at 10 weeks , and 3775 at 12 weeks . Participants self-reported their physical activity , diet , and knowledge about heart disease , stroke , and related symptoms . RESULTS Ninety percent of the participants were white and 56 % were aged between 35 and 54 years . Among the participants who completed the week 12 follow-up evaluation , the percentage who reported being active ( at least moderate exercise > or = 5 times per week or > 2(1/2 ) hours per week for the past 1 to 6 months ) increased from 32 % at baseline to 67 % at the program 's end ( P = .001 ) . Participants currently limiting excess calories or fat increased from 72 % to 91 % at week 10 follow-up evaluation ( P = .001 ) . The proportion correctly identifying heart disease as the leading cause of death increased from 84 % to 91 % at week 10 follow-up evaluation ( P<.001 ) . CONCLUSIONS Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity , reduced their consumption of high-fat foods , and increased their knowledge and awareness of cardiovascular disease risk and its symptoms . This program provides an important model for public health , voluntary , and other health organizations of population -based , targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity , nutrition , and cardiovascular health Chronic obstructive pulmonary disease ( COPD ) is disabling , with symptoms such as chronic cough , phlegm , wheezing , shortness of breath and increased infections of the respiratory passage . The aim was to examine the effects of a structured educational intervention programme at a nurse-led primary health care clinic ( PHCC ) on quality of life ( QoL ) , knowledge about COPD and smoking cessation in patients with COPD . This study had an experimental design in which 52 patients with COPD from a Swedish primary care setting were r and omized into two groups ( intervention or control ) . Both groups received st and ard care but patients in the intervention group were also offered two visits to a nurse specialized in COPD care . The purpose of the visits was to increase the patients ' self-care ability and their knowledge about COPD . The study was approved by the local Research Ethics Committee . Data were collected using two question naires , one pertaining to knowledge about COPD and smoking habits and St. George 's Respiratory Question naire , addressing how QoL was affected by the patients ' respiratory symptoms . The intervention and control groups answered both question naires on their first and last visits to the PHCC . A statistically significant increase was noted in the intervention group on QoL , the number of patients who stopped smoking and patients ' knowledge about COPD at the follow-up , 3 - 5 months after intervention . However , a confounding factor may have been that one of the research ers ( Eva Osterlund Efr aims son ) , as a nurse in the PHCC , performed the intervention . This implies that patients were in a dependent relationship which may have affected the responses in a favourable direction . Our findings show that conventional care alone did not have an effect on patients ' QoL and smoking habits . Instead , the evidence suggests that a structured programme with self-care education is needed to motivate patients for life-style changes BACKGROUND We evaluated a multifaceted preventive nutrition intervention to improve dietary habits among adult primary care patients . METHODS We r and omized six group practice s in a managed care organization . Participants completed baseline and 3-month follow-up surveys . The intervention comprised ( 1 ) mailed personalized dietary recommendations and educational booklets focusing on fruits and vegetables , red meat , and dairy foods , tailored to patients ' baseline intake and stage of readiness to change eating behaviors ; ( 2 ) verbal endorsement by the primary care provider of the benefits of these recommendations ; and ( 3 ) two motivational counseling sessions with telephone counselors to set dietary goals . RESULTS Among the 230 subjects in the intervention group and 274 in the control group , mean age was 54 years , 70 % were female , and 91 % were white and 7 % African American . Eighty-nine percent of the participants completed the follow-up survey . We measured change in intake of foods using results from the baseline and follow-up food frequency question naires . Using an intention-to-treat analysis and adjusting for age , sex , race , and baseline intake , the change in fruit and vegetable intake in the intervention group was 0.6 ( 95 % confidence interval 0.3 , 0.8 ) servings/day higher than in the control group . There was no intervention effect on red meat and dairy products . CONCLUSIONS Tailored clinical nutrition interventions that combine brief physician endorsement with practice supports may be effective in changing patients ' eating behavior BACKGROUND Increasing regular physical activity in adults at elevated risk of cardiovascular disease is an important target for preventive medicine . This study evaluated demographic , social and cognitive predictors of self-reported changes in physical activity after 4 and 12 months in a r and omized trial of behavioral counseling in primary 
    Output:
    
More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions .
Conclusion Group and individual interventions of varying intensity in primary health  care  and community setting s are useful in supporting sustained change in health literacy for change in behavioral risk factors .
Certain aspects of risk behavior may be better h and led in clinical setting s while others more effectively in the community .