***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: The purpose of the research was to develop , implement , and evaluate a new adult asthma self-management program with a multidisciplinary perspective . Small groups of adults met for 2 hr for 7 consecutive weekly meetings . Participants were asked to practice asthma specific behaviors ( including peak expiratory flow monitoring , avoidance/removal of asthma triggers , and controller medication adherence ) and general lifestyle behaviors ( including drinking water , practicing relaxation , washing h and s , and exercising ) . Learner-centered teaching techniques such as interactive communication and social support were utilized to help participants practice self-management behaviors including problem-solving and goal - setting . Paired sample t-tests included statistically significant improvements in asthma knowledge , asthma specific quality of life ( QOL ) , asthma specific behaviors such as peak flow monitoring and general life style behaviors such as frequency of daily exercise . These results provide evidence that this new adult asthma self-management program can lead to both knowledge acquisition and behavioral changes OBJECTIVE To describe challenges in disseminating the Health Enhancement Program ( HEP ) , a community-based disability prevention program for community dwelling elders , and to examine program effectiveness in geographically dispersed sites . METHODS Within-group , pre-test-post-test comparisons of disability risk factors , health and functional status , and hospitalizations for 115 participants completing one year in HEP  , and primary care provider awareness and perceptions of the program . RESULTS Most ( 77 % ) participants were women , with an average age of 73 years and an average of 3.5 chronic conditions . At one-year follow-up , compared with enrollment , fewer participants were depressed ( 8.8 % vs 15.9 % ) , physically inactive ( 15.8 % vs 38.6 % ) , at high nutritional risk ( 24.3 % vs 44.1 % ) , or experiencing restricted activity days ( 35 % vs 48 % ) . Severity scores on most measures also improved significantly . The proportion hospitalized was unchanged from the year prior to HEP , although risk factors predicted an increase in hospitalizations as for the control group in the r and omized trial . CONCLUSIONS HEP reduced participants '  disability risk factors . Sites varied on numbers enrolled and time to implement the program , likely due to differing referral bases , degree of physician awareness of HEP , and site readiness . However , the benefits of HEP participation were comparable with those reported previously In the 1970s Archie Cochrane noted that many healthcare procedures and forms of organisation lacked evidence of effectiveness and efficiency , and argued for improved methods of evaluation , moving from clinical opinion and observation to r and omised controlled trials ( RCTs ) . His arguments gradually became accepted in medicine , but there has been considerable resistance among policymakers and research ers to their application to social and public health interventions . This essay argues that opposition to RCTs in public health is often based on a false distinction between healthcare and community setting s , and sometimes on a misunderst and ing of the principles of RCTs in health care . It suggests that just as in medicine , good intentions and received wisdom are not a sufficient basis for making public policy and allocating public funds for social or health improvement OBJECTIVE The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors ( balance , lower extremity strength , and mobility )  in community-living older adults . METHODS Four hundred fifty-three sedentary adults ( 65 years old or older ) were r and omized to either a multifaceted intervention ( 3 times a week group exercise , 6 hours of fall prevention education , comprehensive falls risk assessment results sent to primary health care provider ) or control group ( written material s on falls prevention ) . Primary outcome was fall incidence rates calculated from self-reported falls reported monthly for 12 months . Secondary outcomes were tests of leg strength , balance , and mobility prior to and following the 12-month intervention . RESULTS Twelve-month follow-up was completed on 95 % of participants . Intent-to-treat analysis found that the incidence rate of falls was 25 % lower among those in the intervention group compared with control group ( 1.33 vs 1.77 falls/person-year , rate ratio 0.75 , 95 % confidence interval [ CI ] , 0.52 - 1.09 ) . This difference was not statistically significant . The risk ratio for any fall was 0.96 ( 95 % CI , 0.82 - 1.13 ) . Small but significant improvements were found on the Berg Balance Test ( adjusted mean difference + 1.5 points , 95 % CI , 0.8 - 2.3 ) , the Chair St and Test ( adjusted mean difference + 1.2 , 95 % 0.6 - 1.9 ) , and the Timed Up and Go Test ( adjusted mean difference -0.7 , 95 % CI , -1.2 to -0.2 ) . CONCLUSIONS A community-based multifaceted intervention was effective in improving balance , mobility , and leg strength , all known fall risk factors . Although the incidence of falls was lower , the confidence interval included the possibility of no intervention effect on falls OBJECTIVE To compare an educational group intervention with individual care to improve clinical and management variables among patients with cardiovascular risk ( CVR ) in community health care ( PC ) . METHODS A r and omised controlled experimental study was developed in 7 PC centres of Barcelona ( Spain ) . A total of 2,127 patients included in the chronic diseases protocol of the centres were selected . The intervention group ( IG ) attended four educative workshops led by their nurses during one year .  Clinical and management variables ( number of visits , pharmaceutical expenditure , nurse time consumption ) were measured at baseline and 3 months after the intervention in the IG and in the control group ( CG ) . Pre-post-intervention and IG vs. CG differences were analysed . RESULTS Among the 672 patients belonging to the IG , 144 were lost due to failing to attend the workshops . CG ( n=824 ) had no withdrawals . At the end of follow-up there were no significant differences between their clinical variables . The number of visits and pharmaceutical expenditure increased in the IG . However , the annual dedication of nurses per patient per year was 39.59 minutes in the IG and 60 minutes in the CG . CONCLUSIONS Nurse group control of patients with CVR in PC saves nurse-time compared with the usual individual visits . However , further studies are needed to better define what type of patient that is more susceptible to follow cardiovascular control through group workshops and whether this time-saving is related to the use of other health re sources Objective The objective of the Cardiovascular Health Awareness Program ( CHAP ) is to improve the processes of care related to the cardiovascular health of older adults . Participants Two Ontario communities including family physicians ( FP ) , pharmacists , public health units and nurses , volunteer peer health educators , older adult patients and community organizations . Setting Community pharmacies and family physician offices . InterventionCHAP is design ed to close a process of care loop around cardiovascular health awareness that originates from , and returns to , the FP . Older patients are invited by their FP to attend pharmacy CHAP sessions .  At these sessions , trained volunteer peer health educators ( PHEs ) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile . This information is relayed to their respective FP via an automated computerized data base . Pharmacists and patients receive copies of the results . Based on these cumulative risk profiles , patients are advised to follow-up with their FP . Outcomes Of the FPs and pharmacists asked , 47 % and 79 % , respectively , agreed to participate in the project . 39 % of older adult patients invited by their FPs attended the CHAP community pharmacy sessions . Of these , 100 % agreed to having their risk profile , including their blood pressure readings , forwarded to their FP . Positive feedback about CHAP was expressed by the volunteer PHEs , the FPs and the pharmacists . Conclusion The community-based pharmacy CHAP sessions are a feasible way of improving patient , physician , and pharmacist access to reliable blood pressure measurements and to cardiovascular health information . A r and omized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure . RésuméObjectifL’objectif du programme communautaire de sensibilisation à l’hypertension CHAP ( Cardiovascular Health Awareness Program ) est d’améliorer les soins apportés aux personnes âgées en matière de santé cardiovasculaire . Participants Deux localités de l’Ontario , des médecins de famille , des pharmaciens , des infirmières de santé publique , des bénévoles-éducateurs en santé des pairs , des personnes âgées , des bureaux de santé publique et des organismes communautaires . MilieuPharmacies communautaires et cabinets de médecins de famille . InterventionCHAP est un programme conçu pour boucler la boucle des soins en matière de sensibilisation à la santé cardiovasculaire qui débute et se termine avec le médecin de famille . Des personnes âgées reçoivent une invitation de leur médecin de famille de participer au programme CHAP . Au cours de ces séances , des éducateurs-bénévoles en santé des pairs ayant reçu une formation aident les patients à mesurer leur tension artérielle à l’aide d’un appareil calibré et automatisé , ainsi qu’à remplir un profil de risques cardiovasculaires . Ces renseignements sont ensuite transmis à leurs médecins de famille à l’aide d’une banque de données informatisée ; les pharmaciens et patients reçoivent aussi des copies des résultats . Selon leur profil cumulé de risques , on conseille aux patients de consulter leur médecin . RésultatsParmi les médecins et pharmaciens approchés , 47 % et 79 % respectivement ont accepté de participer au projet . Chez les aînés , 39 % des personnes ayant reçu une invitation de leur médecin de famille ont participé aux séances d’évaluation de la tension artérielle . De ce groupe , 100 % ont consenti à ce que leur profil de risques et leurs chiffres tensionnels soient transmis au médecin de famille . Les bénévoles-éducateurs , médecins de famille et pharmaciens ont exprimé des commentaires positifs au sujet du CHAP . Conclusion Ces séances en pharmacies communautaires sont une façon viable d’améliorer l’accès des patients , des médecins et des pharmaciens à des mesures précises de la tension artérielle et à des renseignements sur la santé cardiovasculaire Objective To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years . Design Three year follow-up of a multicentre cluster r and omised controlled trial in primary care , with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 731 of the 824 participants included in the original trial were eligible for follow-up . Biomedical data were collected on 604 ( 82.6 % ) and question naire data on 513 ( 70.1 % ) participants . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) levels . The secondary outcomes were blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , emotional impact of diabetes , and drug use at three years . Results HbA1c levels at three years had decreased in both groups . After adjusting for baseline and cluster the difference was not significant ( difference −0.02 , 95 % confidence interval −0.22 to 0.17 ) . The groups did not differ for the other biomedical and lifestyle outcomes and drug use . The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years ( P<0.01 ) . Depression scores and quality of life did not differ at three years . Conclusion A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs . Trial registration Current Controlled Trials IS RCT N17844016 OBJECTIVES To compare the effectiveness of Cooperative Health Care Clinic ( ( CHCC ) group outpatient model for chronically ill , older health maintenance organization ( HMO ) patients ) with usual care .  DESIGN Two-year , r and omized , controlled trial conducted with recruitment from February 1995 through July of 1996 . SETTING Nonprofit group model HMO . PARTICIPANTS Two hundred ninety-four adults ( 145 intervention and 149 usual care ) , aged 60 and older ( mean age 74.1 ) with 11 or more outpatient visits in the prior 18 months , one or more self-reported chronic conditions , and expressed interest in participating in a group clinic . INTERVENTION Monthly group meetings held by patients ' primary care physicians . MEASUREMENT Differences in clinic visits , inpatient admissions , emergency room visits , hospital outpatient services , professional services , home health , and skilled nursing facility admissions ; measures of patient satisfaction , quality of life , self-efficacy , and activities of daily living ( ADLs ) . RESULTS Outpatient , pharmacy services , home health , and skilled nursing facility use did not differ between groups , but CHCC patients had fewer hospital admissions ( P=.012 ) , emergency visits ( P=.008 ) , and professional services ( P=.005 ) . CHCC patients ' costs were $ 41.80 per member per month 
    Output:
    
There is evidence on the effectiveness of  community interventions  in reducing cardiovascular risk factors , encouraging physical exercise , preventing falls and improving self-care among chronic patients  compared with usual individual care .
The effectiveness of some interventions increases when the community is involved in their development .
The community approach may be more effective than the individual in usual preventive interventions in primary care .