***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 pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed OBJECTIVE There is increasing evidence about the importance of factors that impact health beyond health care and individual behavior , yet there is little public and policy discourse about these things in the United States . We surveyed Wisconsin adults to see what they think are the most important factors that affect health . We also examined which interventions they believe would improve health , and whether government should prioritize such interventions . METHODS A phone survey of a r and om sample of 1459 Wisconsin adults was conducted between September 2006 and February 2007 . RESULTS The Wisconsin public believes that health practice s , access to health care , and health insurance are the most important factors affecting health , and that health insurance is a high government priority . Other broader social and economic determinants of health , such as employment , social support , income , housing , and neighborhood factors are seen as less important to health . Although respondents believe that health practice s are important to health , they are less likely to suggest that government prioritize improving individual health practice s. Although the public believes the government should prioritize access to health care and health insurance , they are not as likely to support government implementing social or economic policies in order to improve health . CONCLUSION In light of research demonstrating the importance of social and economic determinants of health , and of ongoing public forums meant to raise awareness of these determinants of health , it will be important to track whether public opinion of Wisconsin adults changes over time to increase attention to the social and economic determinants of health and related policy initiatives Background Women with gestational diabetes ( GDM ) are at high risk of developing diabetes later in life . After a GDM diagnosis , women receive prenatal care to control their blood glucose levels via diet , physical activity and medications . Continuing such lifestyle skills into early motherhood may reduce the risk of diabetes in this high risk population . In the Gestational Diabetes ’ Effects on Moms ( GEM ) study , we are evaluating the comparative effectiveness of diabetes prevention strategies for weight management design ed for pregnant/postpartum women with GDM and delivered at the health system level . Methods / Design The GEM study is a pragmatic cluster r and omized clinical trial of 44 medical facilities at Kaiser Permanente Northern California r and omly assigned to either the intervention or usual care conditions , that includes 2,320 women with a GDM diagnosis between March 27 , 2011 and March 30 , 2012 . A Diabetes Prevention Program-derived print/telephone lifestyle intervention of 13 telephonic sessions tailored to pregnant/postpartum women was developed . The effectiveness of this intervention added to usual care is to be compared to usual care practice s alone , which includes two pages of printed lifestyle recommendations sent to postpartum women via mail . Primary outcomes include the proportion of women who reach a postpartum weight goal and total weight change . Secondary outcomes include postpartum glycemia , blood pressure , depression , percent of calories from fat , total caloric intake and physical activity levels . Data were collected through electronic medical records and surveys at baseline ( soon after GDM diagnosis ) , 6 weeks ( range 2 to 11 weeks ) , 6 months ( range 12 to 34 weeks ) and 12 months postpartum ( range 35 to 64 weeks ) . Discussion There is a need for evidence regarding the effectiveness of lifestyle modification for the prevention of diabetes in women with GDM , as well as confirmation that a diabetes prevention program delivered at the health system level is able to successfully reach this population . Given the use of a telephonic case management model , our Diabetes Prevention Program-derived print/telephone intervention has the potential to be adopted in other setting s and to inform policies to promote the prevention of diabetes among women with GDM.Trial registration Clinical Trials.gov number , NCT01344278 Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results AIMS To report the weight loss findings after the first year of a lifestyle intervention trial among women with gestational diabetes mellitus ( GDM ) . METHODS A total of 1180 women with GDM were r and omly assigned ( 1:1 ) to receive a 4-year lifestyle intervention ( intervention group , n = 586 ) or st and ard care ( control group , n = 594 ) between August 2009 and July 2011 . Major elements of the intervention included 6 face-to-face sessions with study dieticians and two telephone calls in the first year , and two individual sessions and two telephone calls in each subsequent year . RESULTS Among 79 % of participants who completed the year 1 trial  , mean weight loss was 0.82 kg ( 1.12 % of initial weight ) in the intervention group and 0.09 kg ( 0.03 % of initial weight ) in the control group ( P = .001 ) . In a prespecified subgroup analysis of people who completed the trial , weight loss was more pronounced in women who were overweight ( body mass index ≥24 kg/m2 ) at baseline : mean weight loss 2.01 kg ( 2.87 % of initial weight ) in the intervention group and 0.44 kg ( 0.52 % of initial weight ) in the control group ( P < .001 ) . Compared with those in the control group , women in the intervention group had a greater decrease in waist circumference ( 1.76 cm vs 0.73 cm ; P = .003 ) and body fat ( 0.50 % vs 0.05 % increase ; P = .001 ) . CONCLUSION The 1-year lifestyle intervention led to significant weight losses after delivery in women who had GDM , and the effect was more pronounced in women who were overweight at baseline The YMCA ’s Diabetes Prevention Program gives you the skills you need and the support you deserve to make lasting healthy lifestyle changes . WHAT IS PREDIABETES ? Prediabetes occurs when blood sugar levels are higher than normal but not high enough for a type 2 diabetes diagnosis . Risk for developing type 2 diabetes may be reduced or eliminated by weight loss , healthier eating and increased physical activity AIMS To explore factors influencing post-natal health behaviours following the experience of gestational diabetes , and to elicit women 's views about the feasibility of lifestyle intervention to prevent diabetes during the first 2 years after childbirth . METHODS Qualitative study using semi-structured interviews with women who had gestational diabetes . In phase 1 ( 31 women ) , interviews explored the experience of gestational diabetes , ideas about future risk of diabetes and factors influencing post-natal health-related behaviours . Statements were developed summarizing women 's views of lifestyle change to prevent diabetes . In phase 2 ( 14 women ) , interviews explored how the passage of time had contributed to changes in health behaviour , and the statements were used to develop views about diabetes interventions . RESULTS Women were aware of their risk of developing diabetes , but did not always act on such knowledge . Pregnancy motivated behaviour changes to benefit the unborn child , but after delivery these changes were often not maintained . Tiredness , maternal attachment and childcare dem and s were prominent barriers in the early post-natal months . Later , work , family and child development became more significant barriers . Many women became more receptive to healthy eating messages around the time of weaning . Women were positive about long-term support for self-management to reduce their diabetes risk . CONCLUSIONS There is potential to reduce the risk of Type 2 diabetes post-natally among women with gestational diabetes . Interventions need to be developed that take into account context ual factors and competing dem and s , are flexible and respond to women 's individual circumstances . R and omized trials of such interventions are warranted OBJECTIVE In this study , we examined patterns of postpartum physical activity among women with recent gestational diabetes mellitus ( GDM ) and psychosocial factors related to this behavior that could be addressed in diabetes prevention interventions . RESEARCH DESIGN AND METHODS A r and om sample of women who had attended diabetes clinics in Sydney , Australia , in the past 6 - 24 months for treatment of GDM were surveyed by telephone . Variables measured included physical activity behaviors , self-efficacy , social support , and barriers to participation . RESULTS Of 226 women who completed the survey ( mean age 33.4 years ) , 26.5 % were classified as sedentary , and only 33.6 % reported sufficient physical activity as recommended by health authorities . Walking was the most popular physical activity , and most women reported no other moderate- or vigorous-intensity activity . Lack of assistance with child care ( 49.1 % ) and insufficient time ( 37.6 % ) were the most common barriers to physical activity . The type of social support most often reported was verbal encouragement ( 39.1 % ) , with more than half of the women never receiving assistance with housework or others exercising with them . Self-efficacy for physical activity was lowest when women were under time pressure or tired . Multivariate analyses showed that sufficient physical activity was associated with high social support ( odds ratio 2.5 [ 95 % CI 1.21 - 3.79 ] ) and high self-efficacy ( 2.09 [ 1.06 - 3.20 ] ) . CONCLUSIONS The prevalence of sufficient physical activity was found to be low and strongly related to social support and self-efficacy . This is an important group to whom diabetes prevention strategies can be targeted Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined . We report a pilot study of a convenient , home based exercise program with telephone support , suited to the early post-partum period . Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week r and omised controlled trial of Usual Care ( n = 13 ) versus Supported Care ( individualised exercise program with regular telephone support ; n = 15 ) . Baseline characteristics ( Mean ± SD ) were : Age 33 ± 4 years ; Weight 80 ± 20 kg and Body Mass Index ( BMI ) 30.0 ± 9.7 kg/m2 . The primary outcome , planned physical activity { Median ( Range ) } , increased by 60 ( 0 
    Output:
    
Interventions that incorporated these factors were associated with effectiveness .
Education about how to reduce future risk of Type 2 diabetes and using pedometers in interventions were not associated with intervention effectiveness .
Other factors that future interventions should address consist of ' putting others before yourself ' ; ' putting off lifestyle change ' ; ' lack of support from healthcare professionals ' and ' being a healthy role model for families ' .
Conclusion Combining the results of qualitative and quantitative studies can provide a nuanced underst and ing of the effectiveness of physical activity and lifestyle interventions