***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 Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate This r and omized controlled trial examined benefits of adding active health promotion to basic primary care ( BPC ) services for SMI adults . It compared BPC with BPC plus wellness training ( WT ) , a 12 months intervention promoting individual skills in self-management .  Three hundred nine participants enrolled during short-term residential treatment completed baseline assessment s and were assigned to treatment groups , before discharge . Outcomes of perceived health status ( SF-36 ) , global assessment of function , and ratings of self-efficacy were assessed at follow-up interviews at 6 , 12 , and 18 months . The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time , controlling for health related covariates . The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales . Findings affirm ability of SMI adults to benefit from active health promotion A recent meta- analysis of prospect i ve cohort studies suggests that high dietary intakes of flavonols are associated with a significantly lower risk of coronary heart disease mortality.1 The major dietary sources of flavonols such as quercetin , kaempferol , and isorhamnetin are tomatoes , onions , kale , broccoli , celery , apples , and cherries , while catechins are concentrated in tea and red wine.2,3 No clinical trials have examined the effect of interventions to increase habitual fruit and vegetable intake on plasma flavonol concentrations in free living population s. As the principal dietary sources of flavonols are restricted to a few specific food types , it is uncertain whether general dietary advice to increase fruit and vegetable consumption will increase plasma flavonol concentrations . We conducted a r and omised controlled trial to investigate the effect over six months of an intervention to increase fruit and vegetable intake  in a free living population and investigated what impact this intervention had on plasma concentrations of flavonols.4 The methods are outlined in more detail elsewhere.4 In brief , we undertook a r and omised six month parallel group controlled trial using a brief negotiation model to encourage increased consumption of fruit and vegetables to at least five portions per BACKGROUND People with schizophrenia make poor dietary choices . AIMS To measure the impact of giving free fruit and vegetables for 6 months on eating habits in schizophrenia . METHOD We r and omly allocated 102 people with schizophrenia in two areas of Scotl and to receive free fruit and vegetables for 6 months , supported by instruction in meal planning and food preparation ; free fruit and vegetables alone ; or to continue as before .  Diet was assessed using the Scottish Health Survey question naire . Blood sample s to measure micronutrients were taken and mental state , body mass index , level of physical activity and future risk of coronary heart disease ( CHD ) were assessed . RESULTS After the intervention , those who received free fruit and vegetables , or free fruit and vegetables and associated instruction , were consuming significantly more fruit and vegetables than those in the treatment as usual group . Consumption fell to pre-intervention levels 12 months after the intervention stopped . There was no between-group difference at any time in blood micronutrients , body mass index , physical activity or risk of CHD . CONCLUSIONS The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was given free fruit and vegetables but this was not sustained after withdrawal of the intervention . A support programme added no benefit Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas Objective : To assess the long-term effect of dietary advice on diet and mortality after a r and omised trial of men with a recent history of myocardial infa rct ion . Design : Question naire survey and mortality follow-up after a trial of dietary advice . Setting : Twenty-one hospitals in south Wales and south-west Engl and .Subjects : Former participants in the Diet and Reinfa rct ion Trial . Main outcome measures : Current fish intake and cereal fibre intake . All-cause mortality , stroke mortality and coronary mortality . Results : By February 2000 , after 21147 person years of follow-up , 1083 ( 53 % ) of the men had died . Completed question naires were obtained from 879 ( 85 % ) of the 1030 men alive at the beginning of 1999 . Relative increases in fish and fibre intake were still present at 10 y but were much smaller . The early reduction in all-cause mortality observed in those given fish advice ( unadjusted hazard 0.70 ( 95 % CI 0.54 , 0.92 ) ) was followed by an increased risk over the next 3 y ( unadjusted hazard 1.31 ( 95 % CI 1.01 , 1.70 ) . Fat and fibre advice had no clear effect on coronary or all-cause mortality . The risk of stroke death was increased in the fat advice group – the overall unadjusted hazard was 2.03 ( 95 % CI 1.14 , 3.63 ) . Conclusions : In this follow-up of a trial of intensive dietary advice following myocardial infa rct ion we did not observe any substantial long-term survival benefit . Further trials of fish and fibre advice are feasible and necessary to clarify the role of these foods in coronary disease In several studies , many nutrients in fruits and vegetables , such as dietary fiber , potassium , and antioxidants , have been associated with reduced risk for cardiovascular disease ( 1 - 5 ) . However , as review ed elsewhere ( 6 ) , most prospect i ve studies that have specifically examined intake of fruits and vegetables in relation to risk for cardiovascular disease have been small , and their results have been inconsistent . Dietary assessment s were often crude and available only at baseline , and few studies have examined the effects of specific types of vegetables or fruits . In a recent report ( 7 ) , we evaluated the association between fruit and vegetable intake and risk for ischemic stroke . We found that persons in the highest quintile of fruit and vegetable intake had a relative risk of 0.69 ( 95 % CI , 0.52 to 0.92 ) compared with the lowest quintile of intake ; moreover , a 1-serving/d increase in fruit or vegetable intake was associated with a 6 % lower risk for ischemic stroke , after controlling for st and ard cardiovascular risk factors . In the current study , we sought to evaluate the association between intake of overall and specific fruits and vegetables and incidence of coronary heart disease . Methods Study Sample The sample s for this analysis consisted of participants in the Nurses ' Health Study ( 8) and Health Professionals ' Follow-Up Study ( 1 ) . The two studies have similar design s ; in both , participants complete mailed question naires about medical history , health behaviors , and occurrence of cardiovascular and other outcomes every 2 years . The Nurses ' Health Study began in 1976 , when 121 700 female registered nurses 30 to 55 years of age were recruited ; diet was first assessed in 1980 . Health Professionals ' Follow-up Study participants were recruited in 1986 and comprise 51 529 male health professionals , including dentists , veterinarians , pharmacists , optometrists , osteopaths , and podiatrists , 40 to 75 years of age . Sample for Analysis We excluded participants with incomplete dietary assessment s or with previously diagnosed cancer , diabetes or cardiovascular disease that was reported before the first dietary assessment . We followed 84 251 eligible women during 14 years of follow-up and 42 148 eligible men during 8 years follow-up for incidence of coronary heart disease . The rate of follow-up for nonfatal events was 97 % of the total potential person-years of follow-up in both cohorts . Assessment of Coronary Heart Disease End Points Our primary end point was nonfatal myocardial infa rct ion or fatal coronary disease occurring after return of the 1980 question naire but before 1 June 1994 in women and after return of the 1986 question naire but before 1 January 1994 in men . We sought to review medical records for all such reports . Records were review ed by physicians who were blinded to the participants ' risk factor status . Myocardial infa rct ion was confirmed by using World Health Organization criteria : symptoms plus either diagnostic electrocardiographic changes or elevated levels of cardiac enzymes ( 9 ) . Infa rct ions that required hospital admission and for which confirmatory information was obtained by interview or letter , but for which no medical records were available , were design ated as probable . We included all confirmed and probable cases in our analyses because results were the same after probable cases were excluded . Deaths were identified by using state vital records and the National Death Index or were reported by next of kin and the U.S. postal system . Follow-up for deaths was more than 98 % complete [ 10 ] . Death certificates along with medical records were used to ascertain cause of death . Fatal coronary disease was categorized as definite if 1 ) it was confirmed by hospital 
    Output:
    
Dietary advice has been shown to improve the dietary intake of the general population .
Research is needed to determine whether dietary advice can have a similar benefit in people with serious mental illness