human
***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 Treatment goals for cardiovascular risk management are generally not achieved . Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid . The aim of this study was to compare st and ard treatment supported by self-monitoring with st and ard treatment without self-monitoring , both conducted by practice nurses , on cardiovascular risk and separate risk factors . Methods Men aged 50–75 years and women aged 55–75 years without a history of cardiovascular disease or diabetes , but with a SCORE 10-year risk of cardiovascular mortality ≥5 % and at least one treatable risk factor ( smoking , hypertension , lack of physical activity or overweight ) , were r and omized into two groups . The control group received st and ard treatment according to guidelines , the intervention group additionally received pro-active counseling and self-monitoring ( pedometer , weighing scale and / or blood pressure device ) . After one year treatment effect on 179 participants was analyzed . Results SCORE risk assessment decreased 1.6 % ( 95 % CI 1.0–2.2 ) for the control group and 1.8 % ( 1.2–2.4 ) for the intervention group , difference between groups was .2 % ( −.6–1.1 ) . Most risk factors tended to improve in both groups . The number of visits was higher and visits took more time in the intervention group ( 4.9 ( SD2.2 ) vs. 2.6 ( SD1.5 ) visits p < .001 and 27 ( P25 –P75:20–33 ) vs. 23 ( P25 –P75:19–30 ) minutes/visit p = .048 ) . Conclusions In both groups cardiovascular risk decreased significantly after one year of treatment by practice nurses . No additional effect of basing the pro-active counseling on self-monitoring was found , despite the extra time investment . Trial registration trialregister.nl Abstract The drop-out problem was studied in a r and omly selected population sample of men invited to a primary preventive trial against coronary heart disease among middle-aged men . Participants and non- participants in the intervention group were compared with regard to mortality , causes of death , autopsy findings , morbidity and sobriety . The non-participation group was characterized by a somewhat higher prevalence of chronic diseases and alcoholic problems . These features were more pronounced in subjects who died during the follow-up compared to still living subjects . Mortality , total as well as cause-specific , was considerably higher among non- participants . The death rate was higher in the non-participation group irrespective of duration of sick leave . The amount of coronary atherosclerosis , evaluated post-mortem , was essentially the same in those who died in the participation and non-participation groups . The difference in characteristics between participants and non- participants affects the possibilities of generalization to the total population under study . Similar differences between participants and non- participants are certainly present in other studies too AIM The aim of this paper is to describe the prevalence of cardiovascular risk factors in families screened systematic ally by nurses in British general practice , and in subgroups with reported hypertension , hypercholesterolaemia , diabetes and coronary heart disease . METHOD Twenty six general practice s ( 13 intervention and 13 control practice s ) in 13 towns in Engl and , Wales and Scotl and were involved in a r and omized control trial . R and omly ordered invitations were sent for a family health check to 4158 households ( men aged 40 - 59 years and their partners ) registered with the 13 intervention practice s. RESULTS One or more adult members from 2373 households ( 57 % ) were screened ; in 1477 visits the selected man and his female partner attended of whom 98 % were married . In all , 3850 individuals were screened ( 2246 men and 1604 women ) ; 15 % of men and women were in the predefined top quintile of the British family heart study risk score . Twenty four per cent of men and 22 % of women smoked cigarettes and 62 % of men and 44 % of women were overweight ( body mass index 25 + ) . One third of men and one sixth of women with no known history of high blood pressure had a diastolic blood pressure of 90 + mmHg . Among the 491 individuals with previously reported high blood pressure 64 % were not adequately controlled , having a diastolic blood pressure of 90 + mmHg , while 26 % had diastolic blood pressure of 100 + mmHg . Eighteen per cent of men and women with no known history of a high cholesterol level had a r and om cholesterol level of 6.5 + mmol l-1 . In the 173 people with a previously reported high cholesterol level  and who had their level measured over half had a cholesterol level of 6.5 + mmol l-1 and in 7 % this level was 8.0 + mmol l-1 . One per cent of men and 0.3 % of women were newly identified as diabetic ( r and om glucose level of 10.0 + mmol l-1 ) . In the 52 with previously diagnosed diabetes unsatisfactory control was found in 52 % ( r and om level of 10.0 + mmol l-1 ) . A total of 3034 men and women overall ( 79 % ) qualified for follow up for one or more risk factor ; 1909 men ( 85 % ) and 1125 women ( 70 % ) . Among the 139 with pre-existing coronary heart disease 119 ( 86 % ) had modifiable risk factors : 27 % were cigarette smokers , 68 % had a body mass index of 25 + , 40 % had diastolic hypertension , 29 % had hypercholesterolaemia and 19 % had hyperglycaemia . Five per cent of men and women were taking antihypertensive drugs , 0.3 % cholesterol lowering drugs and 0.7 % drugs for diabetes . CONCLUSION There is considerable scope for primary and secondary prevention among families registered with general practice s , but whether nursing and medical intervention can reduce the risk factors related to cardiovascular disease in this setting remains unknown OBJECTIVES To investigate the impact of general health screenings and discussion s with general practitioners on the cardiovascular risk profile of a r and om population of patients . STUDY DESIGN A population -based , r and omized , controlled , 5-year follow-up trial conducted in a primary care setting . POPULATION The study group consisted of 2000 patients , r and omly selected middle-aged men and women aged 30 to 50 years from family practice s in the district of Ebeltoft , Denmark . Of these patients , 1507 ( 75.4 % ) agreed to participate . Patients were r and omized into ( 1 ) a control group who did not receive health screenings , ( 2 ) an intervention group that received 2 health screenings , ( 3 ) an intervention group that received both the 2 screenings and a 45-minute follow-up consultation annually with their general practitioner . OUTCOMES MEASURED Cardiovascular risk score ( CRS ) , body mass index ( BMI ) , blood pressure , serum cholesterol , carbon monoxide in expiratory air , and tobacco use . RESULTS After 5 years , the CRS , BMI , and serum cholesterol levels were lower in the intervention groups compared with the control group . The improved outcome was greater in the baseline risk groups . The number of patients with elevated CRS in the intervention groups was approximately half the number of patients with elevated CRS in the control group . The difference was not a result of medication use . There was no difference between the group that received consultations after the screenings and the group that had health screenings alone . CONCLUSIONS Health screenings reduced the CRS in the intervention groups . After 5 years of follow-up , the number of persons at elevated cardiovascular risk was about half that expected , based on the prevalence/proportion in a population not receiving the health checks ( the control group ) . The impact of intervention was higher among at-risk individuals . Consultations about health did not appear to improve the cardiovascular profile of the study population The objectives of this study were to : ( 1 ) study if an opportunistic screening of coronary heart disease ( CHD ) risk factors among male attenders in general practice ( GP ) influenced the overall subjective satisfaction with life of persons labelled ‘ high risk ’ compared to other screened persons ; ( 2 ) compare psychological well-being and patient satisfaction in a patient centred and self-directive ( PCSD ) intervention with conventional care ( CC ) ; and ( 3 ) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study . Effects of ‘ labelling ’ were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population . The 22 participating GP centres were r and omly allocated to follow either a PCSD intervention or a CC approach . An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Question naire ( 20 item version ) . Satisfaction measures on health care aspects were also included . No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening . No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention . Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group ( p=0.02 ) . Satisfaction with own efforts for improving health was , however , more pronounced in the PCSD group ( p=0.01 ) . A substantial number ( n=61 ) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health . Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected , clinicians should be aware that encouraging patients to change life style may lead to patients ' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts . Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts , but reduce satisfaction with medical care Aims There is continuing uncertainty regarding the overall net benefits of population -based screening for Type 2 diabetes . We compared clinical measures , prescribed medication , cardiovascular morbidity and self-rated health in individuals without diabetes in a screened vs. an unscreened population . Methods A parallel-group , cohort study of people aged 40–65 years , free of known diabetes , identified from the population register of a general practice in Ely , Cambridgeshire ( n = 4936 ) . In 1990–1992 , one third ( n = 1705 ) , selected r and omly , received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals ( screened population ) . From the remainder of the sampling frame , 1705 r and omly selected individuals were invited to diabetes screening 10 years later ( unscreened population ) . Patients without known diabetes from both population s were invited for a health assessment . Results Of 3390 eligible individuals without diabetes , 1442 ( 43 % ) attended for health assessment , with no significant difference in attendance between groups . Thirteen years after the commencement of screening , self-rated functional health status and health utility were identical between the screened and unscreened population s. Clinical measures , self-reported medication and cardiovascular morbidity were similar between the two groups . Conclusions Screening for diabetes is not associated with long-term harms at the population level . However , screening has limited long-term impact on those testing negative ; benefits may largely be restricted to those whose diabetes is detected early through screening Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease ( CHD ) risk could lower patients ' predicted Framingham CHD risk vs. usual care . Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospect i ve , controlled , cluster-r and omised trial in nine European countries , among patients at moderate cardiovascular risk . Following baseline assessment s , physicians in the intervention group calculated patients ' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme . Usual care physicians did not calculate patients ' risk and provided usual care only . The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care . Results Of 1103 patients across 100 sites , 524 patients receiving intervention , and 461 receiving usual care , were analysed for efficacy . After 6 months , mean predicted risks were 12.5 % with intervention , and 13.7 % with usual care [ odds ratio = 0.896 ; p = 0.001 , adjusted for risk at baseline ( 17.2 % intervention ; 16.9 % usual care ) and other covariates ] . The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention ( 25.4 % ) than usual care ( 14.1 % ; p < 0.001 ) , and 29.3 % of smokers in the intervention group quit smoking vs. 21.4 % of those receiving usual care ( p = 0.04 ) . Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients ' modifiable risk factor profile , and lowered predicted CHD risk compared with usual care . By combining this strategy with more intensive treatment to reduce residual modifiable risk , we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice Objective To determine the effectiveness of intensive structured care to optimise blood pressure control based on individual absolute risk targets in primary care . Design Pragmatic multicentre r and om 
    Output:
    
agent
General practice -based health checks are associated with statistically significant , albeit clinical ly small , improvements in surrogate outcome control , especially among high-risk patients .
***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 Treatment goals for cardiovascular risk management are generally not achieved . Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid . The aim of this study was to compare st and ard treatment supported by self-monitoring with st and ard treatment without self-monitoring , both conducted by practice nurses , on cardiovascular risk and separate risk factors . Methods Men aged 50–75 years and women aged 55–75 years without a history of cardiovascular disease or diabetes , but with a SCORE 10-year risk of cardiovascular mortality ≥5 % and at least one treatable risk factor ( smoking , hypertension , lack of physical activity or overweight ) , were r and omized into two groups . The control group received st and ard treatment according to guidelines , the intervention group additionally received pro-active counseling and self-monitoring ( pedometer , weighing scale and / or blood pressure device ) . After one year treatment effect on 179 participants was analyzed . Results SCORE risk assessment decreased 1.6 % ( 95 % CI 1.0–2.2 ) for the control group and 1.8 % ( 1.2–2.4 ) for the intervention group , difference between groups was .2 % ( −.6–1.1 ) . Most risk factors tended to improve in both groups . The number of visits was higher and visits took more time in the intervention group ( 4.9 ( SD2.2 ) vs. 2.6 ( SD1.5 ) visits p < .001 and 27 ( P25 –P75:20–33 ) vs. 23 ( P25 –P75:19–30 ) minutes/visit p = .048 ) . Conclusions In both groups cardiovascular risk decreased significantly after one year of treatment by practice nurses . No additional effect of basing the pro-active counseling on self-monitoring was found , despite the extra time investment . Trial registration trialregister.nl Abstract The drop-out problem was studied in a r and omly selected population sample of men invited to a primary preventive trial against coronary heart disease among middle-aged men . Participants and non- participants in the intervention group were compared with regard to mortality , causes of death , autopsy findings , morbidity and sobriety . The non-participation group was characterized by a somewhat higher prevalence of chronic diseases and alcoholic problems . These features were more pronounced in subjects who died during the follow-up compared to still living subjects . Mortality , total as well as cause-specific , was considerably higher among non- participants . The death rate was higher in the non-participation group irrespective of duration of sick leave . The amount of coronary atherosclerosis , evaluated post-mortem , was essentially the same in those who died in the participation and non-participation groups . The difference in characteristics between participants and non- participants affects the possibilities of generalization to the total population under study . Similar differences between participants and non- participants are certainly present in other studies too AIM The aim of this paper is to describe the prevalence of cardiovascular risk factors in families screened systematic ally by nurses in British general practice , and in subgroups with reported hypertension , hypercholesterolaemia , diabetes and coronary heart disease . METHOD Twenty six general practice s ( 13 intervention and 13 control practice s ) in 13 towns in Engl and , Wales and Scotl and were involved in a r and omized control trial . R and omly ordered invitations were sent for a family health check to 4158 households ( men aged 40 - 59 years and their partners ) registered with the 13 intervention practice s. RESULTS One or more adult members from 2373 households ( 57 % ) were screened ; in 1477 visits the selected man and his female partner attended of whom 98 % were married . In all , 3850 individuals were screened ( 2246 men and 1604 women ) ; 15 % of men and women were in the predefined top quintile of the British family heart study risk score . Twenty four per cent of men and 22 % of women smoked cigarettes and 62 % of men and 44 % of women were overweight ( body mass index 25 + ) . One third of men and one sixth of women with no known history of high blood pressure had a diastolic blood pressure of 90 + mmHg . Among the 491 individuals with previously reported high blood pressure 64 % were not adequately controlled , having a diastolic blood pressure of 90 + mmHg , while 26 % had diastolic blood pressure of 100 + mmHg . Eighteen per cent of men and women with no known history of a high cholesterol level had a r and om cholesterol level of 6.5 + mmol l-1 . In the 173 people with a previously reported high cholesterol level  and who had their level measured over half had a cholesterol level of 6.5 + mmol l-1 and in 7 % this level was 8.0 + mmol l-1 . One per cent of men and 0.3 % of women were newly identified as diabetic ( r and om glucose level of 10.0 + mmol l-1 ) . In the 52 with previously diagnosed diabetes unsatisfactory control was found in 52 % ( r and om level of 10.0 + mmol l-1 ) . A total of 3034 men and women overall ( 79 % ) qualified for follow up for one or more risk factor ; 1909 men ( 85 % ) and 1125 women ( 70 % ) . Among the 139 with pre-existing coronary heart disease 119 ( 86 % ) had modifiable risk factors : 27 % were cigarette smokers , 68 % had a body mass index of 25 + , 40 % had diastolic hypertension , 29 % had hypercholesterolaemia and 19 % had hyperglycaemia . Five per cent of men and women were taking antihypertensive drugs , 0.3 % cholesterol lowering drugs and 0.7 % drugs for diabetes . CONCLUSION There is considerable scope for primary and secondary prevention among families registered with general practice s , but whether nursing and medical intervention can reduce the risk factors related to cardiovascular disease in this setting remains unknown OBJECTIVES To investigate the impact of general health screenings and discussion s with general practitioners on the cardiovascular risk profile of a r and om population of patients . STUDY DESIGN A population -based , r and omized , controlled , 5-year follow-up trial conducted in a primary care setting . POPULATION The study group consisted of 2000 patients , r and omly selected middle-aged men and women aged 30 to 50 years from family practice s in the district of Ebeltoft , Denmark . Of these patients , 1507 ( 75.4 % ) agreed to participate . Patients were r and omized into ( 1 ) a control group who did not receive health screenings , ( 2 ) an intervention group that received 2 health screenings , ( 3 ) an intervention group that received both the 2 screenings and a 45-minute follow-up consultation annually with their general practitioner . OUTCOMES MEASURED Cardiovascular risk score ( CRS ) , body mass index ( BMI ) , blood pressure , serum cholesterol , carbon monoxide in expiratory air , and tobacco use . RESULTS After 5 years , the CRS , BMI , and serum cholesterol levels were lower in the intervention groups compared with the control group . The improved outcome was greater in the baseline risk groups . The number of patients with elevated CRS in the intervention groups was approximately half the number of patients with elevated CRS in the control group . The difference was not a result of medication use . There was no difference between the group that received consultations after the screenings and the group that had health screenings alone . CONCLUSIONS Health screenings reduced the CRS in the intervention groups . After 5 years of follow-up , the number of persons at elevated cardiovascular risk was about half that expected , based on the prevalence/proportion in a population not receiving the health checks ( the control group ) . The impact of intervention was higher among at-risk individuals . Consultations about health did not appear to improve the cardiovascular profile of the study population The objectives of this study were to : ( 1 ) study if an opportunistic screening of coronary heart disease ( CHD ) risk factors among male attenders in general practice ( GP ) influenced the overall subjective satisfaction with life of persons labelled ‘ high risk ’ compared to other screened persons ; ( 2 ) compare psychological well-being and patient satisfaction in a patient centred and self-directive ( PCSD ) intervention with conventional care ( CC ) ; and ( 3 ) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study . Effects of ‘ labelling ’ were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population . The 22 participating GP centres were r and omly allocated to follow either a PCSD intervention or a CC approach . An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Question naire ( 20 item version ) . Satisfaction measures on health care aspects were also included . No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening . No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention . Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group ( p=0.02 ) . Satisfaction with own efforts for improving health was , however , more pronounced in the PCSD group ( p=0.01 ) . A substantial number ( n=61 ) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health . Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected , clinicians should be aware that encouraging patients to change life style may lead to patients ' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts . Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts , but reduce satisfaction with medical care Aims There is continuing uncertainty regarding the overall net benefits of population -based screening for Type 2 diabetes . We compared clinical measures , prescribed medication , cardiovascular morbidity and self-rated health in individuals without diabetes in a screened vs. an unscreened population . Methods A parallel-group , cohort study of people aged 40–65 years , free of known diabetes , identified from the population register of a general practice in Ely , Cambridgeshire ( n = 4936 ) . In 1990–1992 , one third ( n = 1705 ) , selected r and omly , received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals ( screened population ) . From the remainder of the sampling frame , 1705 r and omly selected individuals were invited to diabetes screening 10 years later ( unscreened population ) . Patients without known diabetes from both population s were invited for a health assessment . Results Of 3390 eligible individuals without diabetes , 1442 ( 43 % ) attended for health assessment , with no significant difference in attendance between groups . Thirteen years after the commencement of screening , self-rated functional health status and health utility were identical between the screened and unscreened population s. Clinical measures , self-reported medication and cardiovascular morbidity were similar between the two groups . Conclusions Screening for diabetes is not associated with long-term harms at the population level . However , screening has limited long-term impact on those testing negative ; benefits may largely be restricted to those whose diabetes is detected early through screening Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease ( CHD ) risk could lower patients ' predicted Framingham CHD risk vs. usual care . Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospect i ve , controlled , cluster-r and omised trial in nine European countries , among patients at moderate cardiovascular risk . Following baseline assessment s , physicians in the intervention group calculated patients ' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme . Usual care physicians did not calculate patients ' risk and provided usual care only . The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care . Results Of 1103 patients across 100 sites , 524 patients receiving intervention , and 461 receiving usual care , were analysed for efficacy . After 6 months , mean predicted risks were 12.5 % with intervention , and 13.7 % with usual care [ odds ratio = 0.896 ; p = 0.001 , adjusted for risk at baseline ( 17.2 % intervention ; 16.9 % usual care ) and other covariates ] . The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention ( 25.4 % ) than usual care ( 14.1 % ; p < 0.001 ) , and 29.3 % of smokers in the intervention group quit smoking vs. 21.4 % of those receiving usual care ( p = 0.04 ) . Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients ' modifiable risk factor profile , and lowered predicted CHD risk compared with usual care . By combining this strategy with more intensive treatment to reduce residual modifiable risk , we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice Objective To determine the effectiveness of intensive structured care to optimise blood pressure control based on individual absolute risk targets in primary care . Design Pragmatic multicentre r and om 
    Output:
    