***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: Background We examined the effectiveness of a structured collaboration in general practice between a practice nurse , a peer health educator , the general practitioner ( GP ) and a GP assistant in providing intensified preventive care for patients at high risk of developing cardiovascular diseases . Design A r and omized controlled trial in three healthcare centres ( 18 GPs ) in deprived neighbourhoods of two major Dutch cities . Methods Two hundred seventy-five high-risk patients ( 30 - 70 years ) from various ethnic groups were r and omized to intervention ( n = 137 ) or usual care group ( n = 138 ) . We determined group differences in outcomes [ 10-year absolute risk ( Framingham risk equation ) , blood pressure , lipids and body mass index ] at 12-month follow-up . Results The 10-year absolute risk was reduced by 1.76 % ( st and ard error : 0.81 ) in intervention and by 2.27 % ( st and ard error : 0.69 ) in usual care group ; the difference in mean change was 0.88 % [ 95 % confidence interval : −1.16 to 2.93 ] . In both groups significant reductions were observed in the following individual risk factors : total cholesterol , total cholesterol/high-density lipoprotein cholesterol , and low-density lipoprotein cholesterol , with no relevance between group differences . Conclusion The cardiovascular risk profile of intervention and control patients improved after 1-year follow-up . However , no extra effect of the structured preventive care on the risk for cardiovascular diseases was achieved . Eur J Cardiovasc Prev Rehabil 15:488 - 493 © 2008 The European Society of Background Blood pressure ( BP ) control remains elusive for many Americans . Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control , hypertension ( HTN ) management has not been a high priority in post-acute care . Objective To examine the effects of two home-based interventions design ed to improve BP outcomes among high-risk African-American patients . Design Cluster r and omized controlled trial . Participants A total of 845 newly admitted patients with uncontrolled HTN ( JNC7 stages 1 or 2 ) . Interventions The “ basic ” intervention delivered key HTN information to clinicians and patients , and a home BP monitor to patients , while the patients received usual post-acute care . The “ augmented ” intervention provided more intensive and extensive HTN information , monitoring and feedback for 3 months beyond the index home care admission . Measures Primary : BP control . Secondary : reductions in mmHG SBP and DBP , improvements in proportions improving JNC7 stage or achieving clinical ly meaningful reductions in SBP and DBP . Methods Multivariate regression models . Key Results The basic intervention produced no significant BP improvements ; the augmented intervention significantly improved stage 2 patients ’ outcomes . Among stage 2 patients , the augmented intervention increased BP control by 8.7 percentage points relative to usual care ( 8.9 % vs. 17.6 % ; p = 0.01 ) , yielded an 8.3 mmHG relative reduction in SBP ( p = 0.01 ) , and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points ( p = 0.01 ) . Conclusion Among stage 2 patients , a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control , plus improvements in secondary BP outcomes OBJECTIVES This study evaluated the impact of a breathing awareness meditation ( BAM ) program on ambulatory blood pressure and sodium h and ling in African American adolescents with high-normal systolic blood pressure ( SBP ) levels . DESIGN AND METHODS Following three consecutive days of SBP screenings , 66 eligible ninth grade rs were r and omly assigned by school to either BAM ( n = 20 ) or health education control ( n = 46 ) groups . The BAM group engaged in 10-minute BAM sessions at school and at home each day for three months . Teachers conducted sessions at school during health classes . Before and after the intervention , overnight urine sample s were collected , and ambulatory SBP , diastolic blood pressure , and heart rate were recorded periodically for 24 hours . RESULTS Significant changes before and after the intervention were observed between BAM and control groups for SBP during school hours ( -4.7 vs .9 mm Hg , P < .05 ) , SBP at night ( -4.8 vs -.6 mm Hg , P < .01 ) , and heart rate during school hours ( -6.7 vs -2.3 bpm , P < .02 ) , adjusted for their respective preintervention levels . The overnight urinary sodium excretion rate decreased in the BAM group but increased in the control group ( -.3 + /- 4.9 vs 1.1 + /- 4.0 mEq/hour , P < .03 ) . CONCLUSIONS These findings demonstrate the potential beneficial impact of BAM taught by school health teachers on blood pressure control in the natural environment in African American youth at risk for development of hypertension Purpose The purpose of this pilot study was to determine the feasibility of offering the authors ' Diabetes Coaching Program ( DCP ) , adapted for African Americans , in a sample of African American adults with type 2 diabetes . Methods The study used a 1-group , pretest-posttest design to test the acceptance and potential effectiveness of the DCP .  Subjects were a convenience sample of 16 African Americans ( 8 women , 8 men ) with type 2 diabetes ; 12 subjects ( 6 women , 6 men ) completed the program . The DCP included 4 weekly class sessions devoted to resilience education and diabetes self-management , followed by 8 biweekly support group meetings .  Psychosocial process variables ( resilience , coping strategies , diabetes empowerment ) and proximal ( perceived stress , depressive symptoms , diabetes self-management ) and distal outcomes ( body mass index [ BMI ] , fasting blood glucose , HbA1C , lipidemia , blood pressure ) were assessed at baseline and at 6 months after study entry . Qualitative data were collected at 8 months via a focus group conducted to examine the acceptability of the DCP . Results Preliminary paired t tests indicated statistically significant improvements in diabetes empowerment , diabetes self-management , BMI , HbA1c , total cholesterol , low-density lipoprotein cholesterol , and systolic and diastolic blood pressure . Medium to large effect sizes were reported . Resilience , perceived stress , fasting blood glucose , and high-density lipoprotein cholesterol improved , but changes were not statistically significant . Focus group data confirmed that participants held positive opinions regarding the DCP and follow-up support group sessions , although they suggested an increase in program length from 4 to 8 weeks . Conclusions The pilot study documented the feasibility and potential effectiveness of the DCP to enhance diabetes empowerment , diabetes self-management , and reductions in the progression of obesity , type 2 diabetes , and cardiovascular disease in the African American community . R and omized experimental design s are needed to confirm these findings To study the role of nutrition in the association of birth size and childhood growth with development of cardiovascular disease , the authors in 2002 - 2004 surveyed 665 men and 790 women aged 25 - 42 years who had been exposed as children to a community-r and omized nutrition supplementation intervention in four villages in eastern Guatemala . Exposure was associated with a lower fasting glucose level ( 7.0 mg/dl , 95 % confidence interval ( CI ) : 0.5 , 13.5 ) for exposure at ages 36 - 72 months ; lower systolic blood pressure ( 3.0 mmHg , 95 % CI : 0.4 , 5.6 ) for exposure at ages 24 - 60 months ; and a lower triglyceride level ( sex-adjusted ; 22.2 mg/dl , 95 % CI : 0.4 , 44.1 ) and higher high density lipoprotein cholesterol level ( males only ; 4.7 mg/dl , 95 % CI : 1.5 , 7.9 ) for exposure prior to age 36 months . Improved nutrition at any age prior to 7 years was not associated with diastolic blood pressure , total or low density lipoprotein cholesterol level , or prevalence of the metabolic syndrome .  Interventions design ed to address nutrient deficiencies and ameliorate stunting that are targeted at pregnant women and young children are unlikely to increase cardiovascular disease risk later in life and may instead lower the risk Barbershops constitute potential sites for community health promotion programs targeting hypertension ( HTN ) in black men , but such programs have not been evaluated previously . Here we conducted 2 nonr and omized feasibility studies to determine whether an enhanced intervention program of continuous blood pressure ( BP ) monitoring and peer-based health messaging in a barbershop lowers BP more than st and ard screening and health education ( study 1 ) and can be implemented by barbers rather than research personnel ( study 2 ) . In study 1 , we measured changes in HTN treatment and BP in regular barbershop customers with poorly controlled HTN assigned for 8 months to either an enhanced intervention group ( n=36 ) or a contemporaneous comparison group ( n=27 ) . Groups were similar at baseline . BP fell by 16±3/9±2 mm Hg in the enhanced intervention group but was unchanged in the comparison group ( P<0.0001 , adjusted for age and body mass index ) . HTN treatment and control increased from 47 % to 92 % ( P<0.001 ) and 19 % to 58 % ( P<0.001 ) , respectively , in the enhanced intervention group , whereas both remained unchanged in the comparison group . In study 2 , barbers were trained to administer the enhanced intervention continuously for 14 months to the entire adult black male clientele ( n=321 ) in 1 shop . Six barbers recorded 8953 BP checks during 11 066 haircuts , thus demonstrating a high degree of intervention fidelity . Furthermore , among 107 regular customers with HTN , treatment and control increased progressively with increasing intervention exposure ( P<0.01 ) . Taken together , these data suggest that black-owned barbershops can be transformed into effective HTN detection , referral , and follow-up centers . Further research is warranted Background —The risk of cardiovascular mortality is higher among black women than white women , and the reasons for this disparity are largely unexplored . We sought to evaluate differences in medical care and clinical outcomes among black and white women with established coronary artery disease . Methods and Results —Among the 2699 women enrolled in the Heart and Estrogen/progestin Replacement Study ( HERS )  , we used Cox proportional hazards models to determine the association of race with risk of coronary heart disease ( CHD ) events independent of major cardiovascular risk factors or medical therapies . During an average of 4.1 years of follow-up , CHD events were twice as likely in black compared with white women ( 6.4 versus 3.1 per 100 person-years , hazard ratio , 2.1 ; 95 % confidence interval , 1.5 to 2.8 ; P < 0.001 ) . Black women had higher rates of hypertension , diabetes , and hypercholesterolemia , yet were less likely to receive  aspirin or statins .  Black women less often had optimal blood pressure ( 56 % versus 63 % ; P = 0.01 ) and LDL cholesterol ( 30 % versus 38 % ; P = 0.04 ) control at baseline and during follow-up . After adjusting for these and other differences , black women still had > 50 % higher CHD event risk ( hazard ratio , 1.52 ; 95 % confidence interval , 1.1 to 2.1 ; P = 0.03 ) . Conclusions —In a large cohort of women with heart disease , black women less often received appropriate preventive therapy and adequate risk factor control despite a greater CHD event risk . Interventions to improve appropriate therapy and risk factor control in all women , and especially black women , are needed Mainstream preventive interventions often fail to reach poor population s with a high risk of cardiovascular diseases ( CVDs ) in Pakistan . A community-based CVD primary prevention project aim ed at developing approaches to reduce risk factors in such population s was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran . The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01 - 03/04 . These were targeted in 4 key setting s : community health education , mass media interventions , training of health professionals and health education through Lady Health Workers . The project received support from the Department for International Development , UK . At the community level , a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention . Pre and post-intervention ( training ) evaluations were conducted involving all health care providers in r and omly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level . In order to assess practice s of physician and non-physician health care providers patient interviews , with control comparisons were conducted at each health care facility . Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet , beneficial level of physical activity , the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health . Significant changes in behaviors at a practice level were not shown in 
    Output:
    
Interventions aim ed at decreasing blood pressure were the most promising , whereas behavior change interventions were the most challenging .