***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 Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss OBJECTIVE To determine if lifestyle improved at a short term through an intervention to involve patients in cardiovascular risk management by the practice nurse . METHODS The IMPALA study ( 2006 , the Netherl and s ) was a cluster-r and omised controlled trial involving 25 general practice s and 615 patients who were eligible for cardiovascular risk management . The intervention consisted of ( 1 ) individual 10-year cardiovascular risk assessment , ( 2 ) risk communication , ( 3 ) use of a decision aid and ( 4 ) adapted motivational interviewing , applied by practice nurses in two consultations . Outcomes were smoking , alcohol , diet , physical activity and the secondary outcomes risk perception , anxiety , confidence about the decision and satisfaction with the communication , measured at baseline and after 12 weeks . RESULTS Patients of both groups improved their lifestyle , but no relevant significant differences between the groups were found . Intervention group patients improved in terms of the appropriateness of risk perception , although not significantly . Intervention group patients improved significantly in terms of appropriateness of anxiety and were more satisfied with the communication compared to control group patients . CONCLUSION The intervention seems to have improved the patients ' risk perception , anxiety and satisfaction with the communication , which are important conditions for shared decision making . However , we found no additional effect of the intervention on lifestyle OBJECTIVE To investigate the virtual importance of identified barriers to preventive interventions and to explore the association between physicians ' characteristics and their attitudes towards prevention . METHODS We conducted a cross-sectional survey of 182 r and omly selected family and general physicians ( 164/182=90 % response rate ) from total of 385 general physicians from 5 health sectors of Riyadh , Kingdom of Saudi Arabia in 2005 . A pre-tested question naire asking physicians to rate the general importance of 8 preventive health strategies was used . RESULTS The ranking of different preventive intervention varies from 124 ( 75.6 % ) for colorectal cancer screening to 155 ( 94.5 % ) for blood pressure control . Lack of time was rated an important barrier by 100 ( 61 % ) physicians , and lack of patient interest by 125 ( 76.2 % ) of physicians . There were 4 characteristics of physicians , which predicted negative attitudes toward prevention , sedentary lifestyle ( odds ratio [ OR ] = 3.4 , 95 % confidence interval [ CI ] , 1.1 - 11.1 ) , lack of awareness of their own blood pressure ( OR = 2.0 , 95 % CI , 1.0 - 3.9 ) , lack of training ( OR=2.2 , 95 % CI , 1.5 - 2.9 ) , and lack of evidence of benefits ( OR=1.98 , 95 % CI , 1.7 - 3.9 ) . CONCLUSION The influence of physicians ' own health behaviors and the importance of preventive intervention barriers , indicates a need for development of an approach to reduce the dominance of risky behavior INTRODUCTION The long-term effects on diet of dietary advice to eat fruit and vegetables or fatty fish are not well described . MATERIAL S AND METHODS From 1990 to 1996 3114 men aged 37 - 70 with treated angina were recruited from general practice s in South Wales . A dietitian r and omly allocated the eligible men to receive advice to eat more fruit and vegetables , or advice to eat more fatty fish , or both these types of advice or neither . In 2000 , a brief self-completion question naire was sent to a sample of 1191 of the men known to be alive at the end of March 1999 . RESULTS The question naire was returned by 944 of the 1036 men alive at the time the question naire was sent . Those given fish advice were consuming more fatty fish but the difference was modest 21.9 g day(-1 ) vs. 14.0 g day(-1 ) ( P < 0.01 ) . The differences in fruit and vegetables intake between those given fruit advice and those not given fruit advice were small 373.2 g day(-1 ) vs. 351.7 g day(-1 ) ( P = 0.05 ) . DISCUSSION Men of this age group may be particularly resistant to fruit and vegetables advice ; population -based interventions or interventions targeted at women might be more effective OBJECTIVE To examine stage-matched nutrition counseling by family physicians and its effect on dietary intake , anthropometry , and serum lipid levels in patients at elevated risk for cardiovascular disease . METHODS In this controlled trial , patients r and omized to intervention practice s received nutrition information following the Stages-of-Change Model , and patients r and omized to control practice s received usual care .  RESULTS At both 6 and 12 months after baseline , total fat intake and saturated fat intake declined significantly more in the intervention group than in the control group : -5.7 % and -2.6 % of energy , respectively , at 6 months , and -3.6 % and -1.7 % of energy , respectively , at 12 months . For energy intake , body weight , and BMI , there were significant differences between groups only at 6 months : -0.8 megajoules ( MJ ) , -0.7 kg , and -0.3 kg/m(2 ) , respectively . None of the serum lipid values changed significantly between groups at 12 months . CONCLUSIONS Nutritional counseling based on stages of change led to reductions in dietary fat intake and weight loss in the short term . However , we found no corresponding changes in serum lipid concentrations Our aim was to investigate the response of participants in different Stage of Change ( SOC ) groups to an intervention to increase fruit and vegetable consumption .  Participants recruited from a primary -care health centre were entered into a trial investigating an intervention to increase  fruit and vegetable consumption .  A total of 729 men and women were r and omized into intervention and control groups . Participants attended two appointments 6 months apart and completed postal question naires before each appointment . The question naire included SOC questions which were used to classify participants into ' pre-contemplation ' , ' contemplation ' and ' action ' groups at baseline and at follow-up . All intervention participants received a st and ard intervention to increase consumption of fruit and vegetables to at least five portions per day . After 6 months at the end of the trial control participants received the same intervention . The main outcome measures were the changes in plasma concentrations of antioxidant vitamins . Changes in self-reported fruit and vegetable intake were a secondary outcome measure . At baseline , 38 % ( 113/297 ) of the intervention participants were described as being in the ' pre-contemplation ' stage , 35 % in ' contemplation ' and 27 % in ' action ' groups . For control participants , 36 % ( 112/310 ) were in ' pre-contemplation ' , 34 % in ' contemplation ' and 30 % in ' action ' groups . In the intervention groups , 50 % ( 57/113 ) of ' pre-contemplators ' moved to the ' action ' stage and 37 % ( 42/113 ) moved to ' contemplation ' . There was little movement in the control ' SOC ' groups between baseline and follow-up , other than a small drift to ' contemplation ' . Overall , the intervention group reported a greater increase in fruit and vegetable consumption than the controls ( mean difference in change of 1.4 daily portions ; 95 % confidence interval 1.2 , 1.6 ; after adjustment for baseline intake and gender ) and significantly greater changes were reported in all three intervention ' SOC ' groups compared to the corresponding ' control ' groups ( P < 0.001 in each case ) . These results suggest that peoples ' SOC may have little bearing on their success in increasing fruit and vegetable consumption Background The prevalence of type 2 diabetes is rising worldwide , as has been the global mean fasting plasma glucose level . This study aim ed to evaluate the effectiveness of a structured individual-based lifestyle education ( SILE ) program to reduce the hemoglobin A1c ( HbA1c ) level in type 2 diabetes patients delivered by registered dietitians in primary care clinical setting s. Methods This was a 6-month prospect i ve cluster r and omized controlled trial in a primary care setting with r and omization at the practice level . Twenty general practitioners in 20 clinics in Kanagawa prefecture , Japan , were involved . 193 adults ( 51 % men , mean age 61.3 years ) with type 2 diabetes and HbA1c ≥6.5 % who received treatment in medical clinics were the participants .  A SILE program was implemented through 4 sessions with trained registered dietitians during the 6-month study period . Results were compared with those of a control group who received usual care . The primary endpoint was the change in HbA1c levels at 6 months from baseline . Secondary endpoints were the changes at 6 months from baseline in fasting plasma glucose , lipid profile , blood pressure , BMI , energy , and nutrient intakes ( whole day and each meal ) . Intention-to-treat analysis was conducted . Mixed-effects linear models were used to examine the effects of the treatment . Results The mean change at 6 months from baseline in HbA1c was a 0.7 % decrease in the intervention group ( n = 100 ) and a 0.2 % decrease in the control group ( n = 93 ) ( difference −0.5 % , 95%CI : -0.2 % to −0.8 % , p = 0.004 ) . After adjusting for baseline values and other factors , the difference was still significant ( p = 0.003 ~ 0.011 ) . The intervention group had a significantly greater decrease in mean energy intake at dinner compared with the control group and a greater increase in mean vegetable intake for the whole day , breakfast , and lunch as shown in crude and adjusted models . A tendency toward improvement was observed in the other secondary endpoints but the improvement was not statistically significant . These results were confirmed by several sensitivity analyses . Conclusions The SILE program that was provided in primary care setting s for patients with type 2 diabetes result ed in greater improvement in HbA1c levels than usual diabetes care and education . Trial registration Background Postpartum weight retention may contribute to the development of obesity . We studied whether individual counselling on diet and physical activity from 2 to 10 months postpartum has positive effects on diet and leisure time physical activity and increases the proportion of primiparas returning to their pre-pregnancy weight . Methods A controlled trial including ninety-two postpartum primiparas was conducted in three intervention and three control child health clinics in primary health care in Finl and . The intervention included individual counselling on diet and physical activity during five routine visits to a public health nurse ; the controls received the usual care . Results In total , 50 % of the intervention group and 30 % of the control group returned to their pre-pregnancy weight ( weight retention ≤ 0 kg ) by 10 months postpartum ( p = 0.06 ) . The confounder-adjusted odds ratio for returning to pre-pregnancy weight was 3.89 ( 95 % CI 1.16–13.04 , p = 0.028 ) for the intervention group compared with the controls . The mean proportion of high-fibre bread ( of total weekly amount of bread ) increased by 16.1 % ( 95 % CI 4.3–27.9 ) by 10 months postpartum in the intervention group compared with the controls when adjusted for confounders ( p = 0.008 ) . No significant differences were observed in changes in leisure time physical activity between the groups . Conclusion The intervention increased the proportion of  primiparas returning to pre-pregnancy weight  and the proportion of high-fibre bread in their diet . Larger r and omized controlled trials are needed to show whether counselling can improve dietary and leisure time physical activity habits in postpartum women and also to confirm the results concerning the effect on reducing postpartum weight retention . Trial registration Current Controlled Trials IS RCT Abstract Objective : To measure the effect of brief behavioural counselling in general practice on patients ' consumption of fruit and vegetables  in adults from a low income population . Design : Parallel group r and omised controlled trial . Setting : Primary health centre in a deprived , ethnically mixed inner city area . Participants : 271 patients aged 18 - 70 years without serious illness . Intervention : Brief individual behavioural counselling based on the stage of change model ; time matched nut 
    Output:
    
CONCLUSION Interventions involving nutrition care provided by primary health professionals have the potential to improve patients ' dietary behaviours .