***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: PURPOSE This study evaluated 24-month outcomes of a school-based intensive lifestyle weight management program targeting overweight Mexican-American adolescents . METHODS We recruited a total of 71 adolescents ( 32 males ; 45.1 % ) between the ages of 10 and 14 years , at or above the 85th percentile for body mass index ( BMI ) . Participants were r and omized to a 6-month instructor-led intervention ( ILI ) or a self-help ( SH ) program . Both interventions were aim ed at modifying eating and physical activity behaviors using behavior modification strategies . We assessed changes in participants ' st and ardized BMI and BMI percentile at baseline , 1 , and 2 years . RESULTS Repeated- measures analyses showed that ILI participants showed significantly greater decreases in st and ardized BMI at 1 and 2 years ( F = 8.58 , p < .01 ; and F = 9.27 , p < .01 , respectively ) compared with SH controls . Similar results were found for changes in BMI and BMI percentile . At 2 years , the ILI condition decreased their average BMI percentile by 3.9 percentile points , compared to an increase of 1.6 percentile points in the SH condition . CONCLUSIONS A school-based intervention result ed in improved weight outcomes in overweight Mexican-American adolescents and results were maintained over 2 years OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Models are needed for implementing weight management interventions for adolescents through readily accessible venues . This study evaluated the feasibility and efficacy of a school nurse-delivered intervention in improving diet and activity and reducing body mass index ( BMI )  among overweight and obese adolescents . METHODS Six high schools were r and omized to either a 6-session school nurse-delivered counseling intervention utilizing cognitive-behavioral techniques or nurse contact with provision of information .  Eighty-four overweight or obese adolescents in grade s 9 through 11 completed  behavioral and physiological assessment  s at baseline and 2- and 6-month follow-ups . RESULTS At 2 months , intervention participants ate breakfast on more days/week ( difference = 1.01 days ; 95 % CI : 0.11 , 1.92 ) , and had a lower intake of total sugar ( difference = -45.79 g ; 95 % CI : -88.34 , -3.24 ) and added sugar ( difference = -51.35 g ; 95 % CI : -92.45 , -10.26 ) compared to control participants . At 6 months , they were more likely to drink soda ≤ one time/day ( OR 4.10 ; 95 % CI : 1.19 , 16.93 ) and eat at fast food restaurants ≤ one time/week ( OR 4.62 ; 95 % CI : 1.10 , 23.76 ) compared to control participants . There were no significant differences in BMI , activity , or caloric intake . CONCLUSION A brief school nurse-delivered intervention  was feasible , acceptable , and improved selected obesogenic behaviors , but not BMI After-school programs can be implemented by school nurses to facilitate healthy lifestyle choices in children with the goal of decreasing obesity .  Kids Living Fit ™ (KLF ) , an after-school program design ed by community hospital nurses , was implemented in elementary schools and focused on best lifestyle choices regarding foods consumed and activities chosen for children in grade s 2 through 5 . Study measures included comparison of body mass index ( BMI ) percentiles for age and gender and waist circumference between two self-selected groups composing a total sample size of 185 participants : the KLF intervention group ( n = 80 ) and the no-intervention/ contrast group ( n = 105 ) . The 12-week intervention included a weekly fitness program and monthly dietitian presentations . Participants  completed food and activity diaries and wore pedometers . In pairwise comparisons , the KLF group had a significant decrease in BMI percentile between baseline and follow-up ( −2.3 % ) compared with the contrast group . The KLF group also demonstrated a smaller increase in waist circumference than the contrast group BACKGROUND This study evaluated a school-based obesity intervention for elementary school children ( N = 835 ) where health professionals assisted teachers with the integration of healthy messages into the school curriculum . METHODS Schools were r and omized into a professional-facilitated intervention ( PFI ; N = 4 ) or a self-help ( SH ; N = 3 ) condition . Changes in weight-based outcomes were assessed in students enrolled in the second grade from all 7 schools ( overall : N = 835 students ; PFI : N = 509 students , SH : N = 326 students ) . Students were between ages 7 and 9 and from diverse ethnic background s ( Asian = 25.3 % , Black = 23.3 % , Hispanic = 23.1 % , White = 28.3 % ) . The sample included 321 overweight/obese ( BMI ≥ 85th percentile ) , 477 normal-weight ( BMI ≥ 5th percentile and < 85th percentile ) , and 37 underweight ( BMI < 5th percentile ) students . RESULTS After 2 years , children who were overweight/obese in the PFI condition significantly reduced their st and ardized BMI ( z BMI ) compared to children in the SH condition ( Wald χ(2 ) = 28.7 , p < .001 ) . End-of-year grade s decreased for overweight/obese students in both conditions ; however , students in the PFI exhibited a smaller decrease in grade s compared to the SH condition ( Wald χ(2 ) = 80.3 , p < .001 ) . CONCLUSION The results indicate that an obesity prevention program where health professionals assist teachers by integrating healthy messages into existing curriculum was effective in reducing z BMI compared to the SH condition BACKGROUND Underserved children , particularly girls and those in urban communities , do not meet the recommended physical activity guidelines ( > 60min of daily physical activity ) , and this behavior can lead to obesity . The school years are known to be a critical period in the life course for shaping attitudes and behaviors . Children look to schools for much of their access to physical activity . Thus , through the provision of appropriate physical activity programs , schools have the power to influence apt physical activity choices , especially for underserved children where disparities in obesity-related outcomes exist . OBJECTIVES To evaluate the impact of a nurse directed , coordinated , culturally sensitive , school-based , family-centered lifestyle program on activity behaviors and body mass index . DESIGN , SETTING S AND PARTICIPANTS This was a parallel group , r and omized controlled trial utilizing a community-based participatory research approach , through a partnership with a University and 5 community schools . Participants included 251 children ages 8 - 12 from elementary schools in urban , low-income neighborhoods in Los Angeles , USA . METHODS The intervention included Kids N Fitness ( © ) , a 6-week program which met weekly to provide 45min of structured physical activity and a 45min nutrition education class for parents and children . Intervention sites also participated in school-wide wellness activities , including health and counseling services , staff professional development in health promotion , parental education newsletters , and wellness policies for the provision of healthy foods at the school . The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Question naire measured physical activity behavior , including : daily physical activity , participation in team sports , attending physical education class , and TV viewing/computer game playing . Anthropometric measures included height , weight , body mass index , resting blood pressure , and waist circumference . Measures were collected at baseline , completion of the intervention phase ( 4 months ) , and 12 months post-intervention . RESULTS Significant results for students in the intervention , included for boys decreases in TV viewing ; and girls increases in daily physical activity , physical education class attendance , and decreases in body mass index z-scores from baseline to the 12 month follow-up . CONCLUSIONS Our study shows the value of utilizing nurses to implement a culturally sensitive , coordinated , intervention to decrease disparities in activity and TV viewing among underserved girls and boys BACKGROUND Given the increasing prevalence of obesity among youth over the past decade , prevention has become an international public health priority . PURPOSE To evaluate the 2-year effectiveness of three strategies aim ed at preventing overweight and obesity among adolescents in a high school setting . DESIGN PRomotion de l'ALIMentation et de l'Activité Physique ( PRALIMAP ) is a school-based RCT . Each study high school was assigned to receive or not , over a 2-year period ( Grade s 10 and 11 ) , each of three prevention strategies according to a 2 × 2 × 2 factorial school r and omization . Data were collected in 2006 - 2009 and analyzed in 2009 - 2011 . SETTING / PARTICIPANTS A total of 3538 adolescents ( aged 15.6±0.7 years at baseline ) in 24 public high schools in Lorraine ( northeastern France ) completed the PRALIMAP trial . INTERVENTIONS The prevention strategies were education ( development of nutritional knowledge and skills ) ; environment ( creation of a favorable environment by improving availability of " healthy " dietary items and physical activity ) ; and screening and care ( detection of overweight/obesity and , if necessary , adapted care management ) . MAIN OUTCOMES MEASURES The main outcome of interest was BMI ; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes . RESULTS Adolescents who completed the PRALIMAP trial were younger , less often suspected of having eating  disorders and depression , and came from a higher socioeconomic class than those who did not . The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones : a 0.11 lower increase in BMI ( p=0.0303 ) ; a 0.04 greater decrease in BMI z-score ( p=0.0173 ) ; and a 1.71 % greater decrease in overweight/obesity prevalence ( p=0.0386 ) . Education and environment strategies were not more effective than no strategy intervention . CONCLUSIONS Although the screening and care strategy is an effective way to prevent , at 2 years , overweight and obesity among adolescents in a high school setting , its effects over and above no strategy intervention were small . TRIAL REGISTRATION This study is registered at www . clinical trials.govNCT00814554 
    Output:
    
These findings are similar to those of other meta-analyses of school-based interventions and suggest that school nurses can play a key role in implementing sustainable , effective school-based obesity interventions