***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: BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed This study examined the effects of dietary weight loss and exercise on the health-related quality of life ( HRQL ) of overweight and obese , older adults with knee osteoarthritis . A total of 316 older men and women with documented evidence of knee osteoarthritis were r and omly assigned to 1 of 4 18-month interventions : dietary weight loss , exercise , dietary weight loss and exercise , or healthy lifestyle control . Measures included the SF-36 Health Survey and satisfaction with body function and appearance . Results revealed that the combined diet and exercise intervention had the most consistent , positive effect on HRQL compared with the control group ; however , findings were restricted to measures of physical health or psychological outcomes that are related to the physical self Sedentary adults ( N = 379 ) were r and omly assigned in a 2 x 2 design to walk 30 min per day at a frequency of either 3 - 4 or 5 - 7 days per week , at an intensity of either 45%-55 % or 65%-75 % of maximum heart rate reserve . Analyses of exercise accumulated over 6 months showed greater amounts completed in the higher frequency ( p = .0001 ) and moderate intensity ( p = .021 ) conditions . Analyses of percentage of prescribed exercise completed showed greater adherence in the moderate intensity(p = .02 ) condition . Prescribing a higher frequency increased the accumulation of exercise without a decline in adherence , whereas prescribing a higher intensity decreased adherence and result ed in the completion of less exercise CONTEXT Rapid increases in access to the Internet have made it a viable mode for public health intervention . No controlled studies have evaluated this re source for weight loss . OBJECTIVE To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site . DESIGN R and omized , controlled trial conducted from April to December 1999 . SETTING AND PARTICIPANTS Ninety-one healthy , overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2 ) . Analyses were performed for the 65 who had complete follow-up data . INTERVENTIONS Participants were r and omly assigned to a 6-month weight loss program of either Internet education ( education ; n = 32 with complete data ) or Internet behavior therapy ( behavior therapy ; n = 33 with complete data ) . All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss re sources . Participants in the behavior therapy group received additional behavioral procedures , including a sequence of 24 weekly behavioral lessons via e-mail , weekly online su bmi ssion of self-monitoring diaries with individualized therapist feedback via e-mail , and an online bulletin board . MAIN OUTCOME MEASURES Body weight and waist circumference , measured at 0 , 3 , and 6 months , compared the 2 intervention groups . RESULTS Repeated- measures analyses showed that the behavior therapy group lost more weight than the education group ( P = .005 ) . The behavior therapy group lost a mean ( SD ) of 4.0 ( 2.8 ) kg by 3 months and 4.1 ( 4.5 ) kg by 6 months . Weight loss in the education group was 1.7 ( 2.7 ) kg at 3 months and 1.6 ( 3.3 ) kg by 6 months . More participants in the behavior therapy than education group achieved the 5 % weight loss goal ( 45 % vs 22 % ; P = .05 ) by 6 months . Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months ( P = .001 ) and 6 months ( P = .005 ) . CONCLUSIONS Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites . Thus , the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs CONTEXT Although the use of electron beam tomography ( EBT ) as a motivational tool to change behavior is practice d , its efficacy has not been studied . OBJECTIVE To assess the effects of incorporating EBT as a motivational factor into a cardiovascular screening program in the context of either intensive case management ( ICM ) or usual care by assessing its impact over 1 year on a composite measure of projected risk . DESIGN R and omized controlled trial with a 2 x 2 factorial design and 1 year of follow-up . SETTING AND PARTICIPANTS A consecutive sample of 450 asymptomatic active-duty US Army personnel aged 39 to 45 years stationed within the Washington , DC , area and scheduled to undergo a periodic Army-m and ated physical examination were enrolled between January 1999 and March 2001 ( mean age , 42 years ; 79 % male ; 66 [ 15 % ] had coronary calcification ; mean [ SD ] predicted 10-year coronary risk , 5.85 % [ 3.85 % ] ) . INTERVENTIONS Patients were r and omly assigned to 1 of 4 intervention arms : EBT results provided in the setting of either ICM ( n = 111 ) or usual care ( n = 119 ) or EBT results withheld in the setting of either ICM ( n = 124 ) or usual care ( n = 96 ) . MAIN OUTCOME MEASURE The primary outcome measure was change in a composite measure of risk , the 10-year Framingham Risk Score ( FRS ) . RESULTS Comparing the groups who received EBT results with those who did not , the mean absolute risk change in 10-year FRS was + 0.30 vs + 0.36 ( P = .81 ) . Comparing the groups who received ICM with those who received usual care , the mean absolute risk change in 10-year FRS was -0.06 vs + 0.74 ( P = .003 ) . Improvement or stabilization of cardiovascular risk was noted in 157 patients ( 40.2 % ) . In multivariable analyses predicting change in FRS , after controlling for knowledge of coronary calcification , motivation for change , and multiple psychological variables , only the number of risk factors ( odds ratio , 1.42 ; 95 % confidence interval , 1.16 - 1.75 for each additional risk factor ) and receipt of ICM ( odds ratio , 1.62 ; 95 % confidence interval , 1.04 - 2.52 ) were associated with improved or stabilized projected risk . CONCLUSIONS Using coronary calcification screening to motivate patients to make evidence -based changes in risk factors was not associated with improvement in modifiable cardiovascular risk at 1 year . Case management was superior to usual care in the management of risk factors BACKGROUND We tested the hypothesis that dietary intervention can inhibit the development of recurrent colorectal adenomas , which are precursors of most large-bowel cancers . METHODS We r and omly assigned 2079 men and women who were 35 years of age or older and who had had one or more histologically confirmed colorectal adenomas removed within six months before r and omization to one of two groups : an intervention group given intensive counseling and assigned to follow a diet that was low in fat ( 20 percent of total calories ) and high in fiber ( 18 g of dietary fiber per 1000 kcal ) and fruits and vegetables ( 3.5 servings per 1000 kcal ) , and a control group given a st and ard brochure on healthy eating and assigned to follow their usual diet . Subjects entered the study after undergoing complete colonoscopy and removal of adenomatous polyps ; they remained in the study for approximately four years , undergoing colonoscopy one and four years after r and omization . RESULTS A total of 1905 of the r and omized subjects ( 91.6 percent ) completed the study . Of the 958 subjects in the intervention group and the 947 in the control group who completed the study , 39.7 percent and 39.5 percent , respectively , had at least one recurrent adenoma ; the unadjusted risk ratio was 1.00 ( 95 percent confidence interval , 0.90 to 1.12 ) . Among subjects with recurrent adenomas , the mean ( + /-SE ) number of such lesions was 1.85+/-0.08 in the intervention group and 1.84+/-0.07 in the control group . The rate of recurrence of large adenomas ( with a maximal diameter of at least 1 cm ) and advanced adenomas ( defined as lesions that had a maximal diameter of at least 1 cm or at least 25 percent villous elements or evidence of high- grade dysplasia , including carcinoma ) did not differ significantly between the two groups . CONCLUSIONS Adopting a diet that is low in fat and high in fiber , fruits , and vegetables does not influence the risk of recurrence of colorectal adenomas Infertile women express higher levels of distress than fertile women , with distress peaking between the 2nd and 3rd year . The purpose of this study was to determine whether group psychological interventions could prevent this surge . One hundred eighty-four women who had been trying to conceive between 1 and 2 years were r and omized into either a cognitive-behavioral group , a support group , or a control group . All experimental participants attended a 10-session group program . Participants completed psychological question naires at intake and again at 6 and 12 months . Substantial attrition occurred , particularly in the control group . The cognitive-behavioral and support participants experienced significant psychological improvement at 6 and 12 months compared with the control participants , with the cognitive-behavioral participants experiencing the greatest positive change This study compared the effectiveness of 4 videotaped educational programs design ed to motivate HIV testing among low-income , ethnic minority women . Four hundred eighty women were assigned r and omly to watch one of 2 gain-framed or 2 loss-framed videos . Consistent with prospect theory , participants ' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure . Among participants who reported being certain of the test 's outcome , those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message . Among women who perceived the outcome of HIV testing as relatively uncertain , gain- and loss-framed videos led to similar rates of self-reported testing , with some advantage for the loss-framed message CONTEXT Depression and low perceived social support ( LPSS ) after myocardial infa rct ion ( MI ) are associated with higher morbidity and mortality , but little is known about whether this excess risk can be reduced through treatment . OBJECTIVE To determine whether mortality and recurrent infa rct ion are reduced by treatment of depression and LPSS with cognitive behavior therapy ( CBT ) , supplemented with a selective serotonin reuptake inhibitor ( SSRI ) antidepressant when indicated , in patients enrolled within 28 days after MI . DESIGN , SETTING , AND PATIENTS R and omized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients ( 1084 women , 1397 men ) enrolled from 8 clinical centers . Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression ( H 
    Output:
    
Findings revealed areas of weakness in analytic aspects of the behavioral health RCTs reported in both sets of journals .
Weaknesses were more pronounced in behavioral journals .