***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 Aboriginal and Torres Strait Isl and er women experience higher rates of heart disease and type 2 diabetes than non-Indigenous Australian women . Increasing physical activity , improving diets and losing weight have been shown to reduce cardio metabolic risk . The primary aim was to evaluate the effectiveness of a 12-week structured exercise and nutrition program in a cohort of urban Indigenous Australian women on waist circumference , weight and biomedical markers of metabolic functioning from baseline ( T1 ) to program completion ( T2 ) . The secondary aim assessed whether these outcomes were maintained at 3-month follow-up . Methods One hundred Aboriginal and /or Torres Strait Isl and er women aged 18–64 years living in the Adelaide metropolitan area were recruited . The program included two 60-minute group cardiovascular and resistance training classes per week , and four nutrition education workshops . Participants were r and omly assigned to an ‘ active ’ group or ‘ waitlisted ’ control group .  Body weight , height , waist and hip circumference , blood pressure , fasting glucose , fasting insulin , glycated haemoglobin ( HbA1C ) , lipid profile and C-reactive protein ( CRP ) were assessed at baseline ( T1 ) , immediately after the program ( T2 ) and three months post program ( T3 ) . Results The active group showed modest reductions in weight and body mass index ( BMI ) . Compared to the waitlisted group , the active group had a statistically significantly change in weight and BMI from baseline assessment s ; at T2 , -1.65 kg and -0.66 kg/m2 and at T3 , -2.50 kg and -1.03 kg/m2 , respectively . Systolic and diastolic blood pressure also had a statistically significant difference from baseline in the active group compared to the waitlisted group at T2 , -1.24 mmHg and -2.46 mmHg and at T3 , -4.09 mmHg and -2.17 mmHg , respectively . The findings were independent of the baseline measure of the outcome variable , age , households with children and employment status . Changes in waist circumference and other clinical measures were not significant at T2 or T3 . The primary outcome measure , waist circumference , proved problematic to assess reliably . Missing data and participants lost to follow-up were significant . Conclusions This 12-week exercise program demonstrated modest reductions in weight , BMI and blood pressure at T2 , which improved further at 3-month follow-up ( T3 ) . Positive intervention effects were observed despite low attendance at exercise classes . Structured exercise programs implemented in community setting s require attention to underst and ing the barriers to participation for this high risk group . Trial registration Australian New Zeal and Clinical Trials Registry Background Aboriginal and Torres Strait Isl and er people have higher rates of chronic disease and a lower life expectancy than non-Indigenous Australians . In non-urban areas these health disparities are even larger . The aim of this qualitative study was to explore perceived barriers and enablers to attending an eight-week physical activity program in a rural and regional setting which aim ed to improve health outcomes , but had a low attendance rate . Methods Thirty-four Indigenous Australians participated in the intervention from the rural ( n = 12 ) and the regional ( n = 22 ) community .  Qualitative semi-structured individual interviews were conducted at the follow-up health assessment s with 12 participants . A thematic network analysis was undertaken to examine the barriers and enablers to participation in the program . Results Overall , there were positive attitudes to , and high levels of motivation towards , the physical activity program . Enablers to participation were the inclusion of family members , no financial cost and a good relationship with the principal investigator , which was strengthened by the community-based participatory approach to the program design . Barriers to program attendance were mostly beyond the control of the individuals , such as ‘ sorry business ’ , needing to travel away from the community and lack of community infrastructure . Conclusions More consideration is needed prior to implementation of programs to underst and how community-specific barriers and enablers will affect attendance to the program . Trial registration ACTRN12616000497404 . Registered 18 April 2016 Objective American Indian children of pre-school age have disproportionally high obesity rates and consequent risk for related diseases . Healthy Children , Strong Families was a family-based r and omized trial assessing the efficacy of an obesity prevention toolkit delivered by a mentor v. mailed delivery that was design ed and administered using community-based participatory research approaches . Design During Year 1 , twelve healthy behaviour toolkit lessons were delivered by either a community-based home mentor or monthly mailings . Primary outcomes were  child BMI percentile , child BMI Z-score and adult BMI . Secondary outcomes included fruit/vegetable consumption , sugar consumption , television watching , physical activity , adult health-related self-efficacy and perceived health status . During a maintenance year , home-mentored families had access to monthly support groups and all families received monthly newsletters . Setting Family homes in four tribal communities , Wisconsin , USA . Subjects Adult and child ( 2–5-year-olds ) dyads ( n 150 ) . Results No significant effect of the mentored v. mailed intervention delivery was found ; however , significant improvements were noted in both groups exposed to the toolkit . Obese child participants showed a reduction in BMI percentile at Year 1 that continued through Year 2 ( P<0·05 ) ; no change in adult BMI was observed . Child fruit/vegetable consumption increased ( P=0·006 ) and mean television watching decreased for children ( P=0·05 ) and adults ( P=0·002 ) . Reported adult self-efficacy for health-related behaviour changes ( P=0·006 ) and quality of life increased ( P=0·02 ) . Conclusions Although no effect of delivery method was demonstrated , toolkit exposure positively affected adult and child health . The intervention was well received by community partners ; a more comprehensive intervention is currently underway based on these findings Introduction : Type 2 diabetes mellitus ( T2DM ) is a major health issue in New Zeal and Māori . Clinical trials have demonstrated potential for the prevention of T2DM , but whether community public health programmes aim ing to prevent diabetes are effective is untested . Objective : To describe the planning and design of an intervention aim ing to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Māori community . Approach : Community concerns about the diabetes burden were heard by the local diabetes nurse , herself a tribal member , and discussed with a locally raised academic . Project planning ensued . The intervention and its evaluation were design ed using a participatory community development model . The planned intervention had three components : community-wide health promotion initiatives conveying healthy lifestyle messages , community education and monitoring for identified high-risk individuals and their extended families , and a structural strategy aim ed at adapting local environments to support lifestyle changes . The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a r and omised control trial design . Discussion : Consulting communities , validating community concerns and prioritising cultural and ethical issues were key steps . Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable , as the team were united in addressing the project planning and implementation challenges , such as funding obstacles that arose because of our ethically and culturally appropriate non-r and omised control trial evaluation design . The pre-intervention survey demonstrated high rates of diabetes ( 13 % ) , insulin resistance ( 33 % ) and risk factors , and provided evidence for positive , as opposed to negative , lifestyle intervention messages . Conclusion : Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities , but require a high level of commitment from the health sector and buy-in from the community . Adequate commitment , leadership , planning and re sources are essential Background Quality improvement collaboratives ( QIC ) have proliferated internationally , but there is little empirical evidence for their effectiveness . Method We search ed Medline , Embase , CINAHL , PsycINFO and the Cochrane Library data bases from January 1995 to December 2014 . Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care ( EPOC ) minimum study design characteristics for inclusion in a review . We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 st and ards . Results Of the 220 studies meeting QIC criteria , 64 met EPOC study design st and ards for inclusion . There were 10 cluster r and omised controlled trials , 24 controlled before-after studies and 30 interrupted time series studies . QICs encompassed a broad range of clinical setting s , topics and population s ranging from neonates to the elderly . Few reports fully described  QIC implementation and methods , intensity of activities , degree of site engagement and important context ual factors . By care setting , an improvement was reported for one or more of the study ’s primary effect measures in 83 % of the studies ( 32/39 ( 82 % ) hospital based , 17/20 ( 85 % ) ambulatory care , 3/4 nursing home and a sole ambulance QIC ) . Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative . Collaboratives reporting success generally addressed relatively straightforward aspects of care , had a strong evidence base and noted a clear evidence - practice gap in an accepted clinical pathway or guideline . Conclusions QICs have been adopted widely as an approach to shared learning and improvement in healthcare . Overall , the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes . These reports are encouraging , but most be interpreted cautiously since fewer than a third met established quality and reporting criteria , and publication bias is likely Background Culturally adapted interventions are needed to reduce diabetes-related morbidity and mortality among Native Hawaiian and Pacific People . Purpose The purpose of this study is to pilot test the effectiveness of a culturally adapted diabetes self-management intervention . Methods Participants were r and omly assigned in an unbalanced design to the Partners in Care intervention ( n = 48 ) or wait list control group ( n = 34 ) . Assessment s of hemoglobin A1c , underst and ing of diabetes self-management , performance of self-care activities , and diabetes-related distress were measured at baseline and 3 months ( post intervention ) . Analysis of covariance was used to test between-group differences . The community steering committee and focus group data informed the cultural adaptation of the intervention . Results There were significant baseline adjusted differences at 3 months between the Partners in Care and wait list control group in intent-to-treat ( p < 0.001 ) and complete case analyses ( p < 0.0001 ) for A1c , underst and ing ( p < 0.0001 ) , and performing diabetes self-management ( p < 0.0001 ) . Conclusions A culturally adapted diabetes self-management intervention of short duration was an effective approach to improving glycemic control among Native Hawaiian and Pacific Isl and ers OBJECTIVE The progression from impaired glucose tolerance (IGT)/impaired fasting glucose ( IFG ) to type 2 diabetes can be prevented or delayed through intensive lifestyle changes . How to translate this to implementation across whole communities remains unclear . We now describe the results to a pilot of a personal trainer ( Maori Community Health Worker , MCHW ) approach among Maori in New Zeal and . DESIGN , SETTING AND SUBJECTS A r and omised cluster-controlled trial of intensive lifestyle change was commenced among 5,240 non-pregnant Maori family members without diabetes from 106 rural and 106 urban geographical clusters . Baseline assessment s included lifestyle question naires , anthropometric measurements and venesection . A pilot study ( Vanguard Study ) cohort of 160 participants were weighed before and during MCHW intervention , and compared with fifty-two participants weighed immediately before intervention and with 1,143 participants from the same geographical area . Interactions between participants and the MCHW were reported using personal digital assistants with a programmed detailed structured approach to each interview . RESULTS During the Vanguard Study , participants and MCHW found the messages , toolkit and delivery approach acceptable . Those with IGT/IFG diagnosed ( n 27 ) experienced significant weight loss after screening and during the Vanguard Study ( 5.2 ( sd 6.6 ) kg , paired t test P < 0.01 ) . Significant weight loss occurred during the Vanguard Study among all participants ( -1.3 ( sd 3.6 ) kg , P < 0.001 ) . CONCLUSIONS Comparable initial weight loss was shown among those with IGT/IFG and those from existing trials . Community-wide prevention programmes are feasible among Maori and are likely to result in significant reductions in the incidence of diabetes Background The 12-month Healthy Foods North intervention program was developed to improve diet among Inuit and Inuvialuit living in A rct ic Canada and assess the impact of the intervention established for the communities . Methods A quasi-experimental study r and omly selected men and women ( ≥19 years of age ) in six remote communities in Nunavut and the Northwest Territories . Vali date d quantitative food frequency and adult impact question naires were used . Four communities received the intervention and two communities served as delayed intervention controls . Pre- and post-intervention changes in frequency of/total intake of de-promoted food groups and healthiness of cooking methods were determined . The impact of the intervention was assessed using analysis of covariance ( ANCOVA ) . Results Post-intervention data were analysed in the intervention ( n = 221 ) and control ( n = 111 ) communities , with participant retention rates of 91 % for Nunavut and 83 % for the Northwest Territories . There was a significant decrease in de-promoted foods , such 
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Conclusions The HPW Implementation Framework is a comprehensive model for potentially underst and ing implementation effectiveness in Indigenous communities .
The review suggests that the studies are reflective of high levels of community engagement and culture-centredness .
The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation .