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: OBJECTIVE To determine geographical variation in the prevalence of rheumatoid arthritis ( RA ) and spondyloarthropathies ( SpA ) in France . METHODS The survey sample was drawn from 7 areas of France . Households were r and omly selected using the national telephone directory , and an individual within each household was r and omly chosen by the next-birthday method . All cases of suspected RA and SpA were confirmed by the patient 's rheumatologist or by clinical examination . St and ardized estimates of prevalence were compared between regions and groups of regions . RESULTS In total 15,219 anonymous telephone numbers were selected . An average response rate of 64 % led to a total of 9395 respondents included in the study . The highest regional rates of RA were observed in the south ( range 0.59 - 0.66 % ) , and the lowest in the north ( range 0.14 - 0.24 % ) , with a national rate of 0.31 % ( 95 % CI 0.18 - 0.48 % ) . Regional heterogeneity was observed for SpA , with the highest rates in Bretagne ( 0.47 % ) and the Sud-Est ( 0.53 % ) and a national rate of 0.30 % ( 95 % CI 0.17 - 0.46 % ) . CONCLUSION This study is the largest of its kind conducted in France . It shows inter-regional variations , mainly in RA , with a higher prevalence in the south of the country . The many potential reasons for the heterogeneity observed , including genetic and environmental factors , warrant further research BACKGROUND It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis ( RA ) for the UK were published . Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA , especially in women . OBJECTIVES To estimate the age- and sex-specific point prevalence of RA ( defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment ) . The estimate was made in the primary care setting in Norfolk , UK . METHODS A stratified r and om sample was drawn from seven age and gender b and s. The 7050 individuals selected were mailed a screening question naire . Positive responders were invited to attend for a clinical examination . The sample was matched against the names in the Norfolk Arthritis Register ( NOAR ) , a register of incident cases of inflammatory polyarthritis which has been in existence since 1990 . RESULTS The overall response rate was 82 % . Sixty-six cases of RA were identified . Extrapolated to the population of the UK , the overall minimum prevalence of RA is 1.16 % in women and 0.44 % in men . A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission . In addition , some cases who failed to attend for examination had significant disability . These prevalence figures are therefore an underestimate . CONCLUSIONS The prevalence of RA in women , but not in men , in the UK may have fallen since the 1950s Background —Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease . We compared the incidence rates of myocardial infa rct ion and stroke in subjects with and without rheumatoid arthritis . Methods and Results —A prospect i ve cohort study was conducted among the 114 342 women participating in the Nurses ’ Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976 . All self-reported cases of rheumatoid arthritis were confirmed by medical record review . Fatal and nonfatal myocardial infa rct ions and strokes were similarly confirmed . Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors . Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infa rct ions and strokes  were confirmed during 2.4 million person-years of follow-up . The adjusted relative risk of myocardial infa rct ion in women with rheumatoid arthritis compared with those without was 2.0 ( 95 % confidence interval [ CI ] , 1.23 to 3.29 ) . For stroke , the adjusted relative risk was 1.48 ( 95 % CI , 0.70 to 3.12 ) . Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infa rct ion of 3.10 ( 95 % CI , 1.64 to 5.87 ) . Conclusion —In this large prospect i ve cohort of women , participants with rheumatoid arthritis had a significantly increased risk of myocardial infa rct ion but not stroke compared with those without rheumatoid arthritis . If these data are confirmed , aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions OBJECTIVE To evaluate the impact of a 2-year program of strength training on muscle strength , bone mineral density ( BMD ) , physical function , joint damage , and disease activity in patients with recent-onset ( < 2 years ) rheumatoid arthritis ( RA ) . METHODS In this prospect i ve trial , 70 RA patients were r and omly assigned to perform either strength training ( all major muscle groups of the lower and upper extremities and trunk , with loads of 50 - 70 % of repetition maximum ) or range of motion exercises ( without resistance ) twice a week ; all were encouraged to engage in recreational activities 2 - 3 times a week . All patients completed training diaries  ( evaluated bi-monthly ) and were examined at 6-month intervals . All were treated with medications to achieve disease remission . Maximum strength of the knee extensors , trunk flexors and extensors , and grip strength was measured with dynamometers . BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry . Disease activity was determined by the Disease Activity Score , the extent of joint damage by the Larsen score , and functional capacity by the Health Assessment Question naire ( HAQ ) ; walking speed was also measured . RESULTS Sixty-two patients ( 31 per group ) completed the study .  Strength training  compliance averaged 1.4 - 1.5 times/week . The maximum strength of all muscle groups examined increased significantly ( 19 - 59 % ) in the strength-training group , with statistically significant improvements in clinical disease activity parameters , HAQ scores , and walking speed . While muscle strength , disease activity parameters , and physical function also improved significantly in the control group , the changes were not as great as those in the strength-training group . BMD in the femoral neck and spine increased by a mean + /- SD of 0.51 + /- 1.64 % and by 1.17 + /- 5.34 % , respectively , in the strength-training group , but decreased by 0.70 + /- 2.25 % and 0.91 + /- 4.07 % in the controls . Femoral neck BMD in the 17 patients with high initial disease activity ( and subsequent use of oral glucocorticoids ) remained constantly at a statistically significantly lower level than that in the other 45 patients . CONCLUSION Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function , but not BMD , in patients with early RA , without detrimental effects on disease activity OBJECTIVES Cardiovascular disease ( CVD ) is responsible for 50 % of the excess mortality for patients with RA . This study aim ed to evaluate a novel 8-week cognitive behavioural patient education intervention design ed to effect behavioural change with regard to modifiable CVD risk factors in people with RA . METHODS This was a non-blinded r and omized controlled trial with a delayed intervention arm . Participants were r and omly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1 . The primary outcome measure was patient 's knowledge of CVD in RA ; secondary measures were psychological measures relating to effecting behaviour change , actual behaviour changes and clinical risk factors . Data were collected at baseline , 2 and 6 months . RESULTS A total of 110 participants consented ( 52 in the intervention group and 58 in the control group ) to participate in the study . At 6 months , those in the intervention group had significantly higher knowledge scores ( P < 0.001 ) ; improved behavioural intentions to increase exercise ( P < 0.001 ) , eat a low-fat diet ( P = 0.01 ) and lose weight ( P = 0.06 ) ; and lower mean diastolic blood pressure by 3.7 mmHg , whereas the control group 's mean diastolic blood pressure increased by 0.8 mmHg . There was no difference between the groups on actual behaviours . CONCLUSIONS Patient education has a significant role to play in CVD risk factor modification for patients with RA , and the detailed development of this programme probably contributed to its successful results . It is disappointing that behaviours , as we measured them , did not change . The challenge , as always , is how to translate behavioural intentions into action . Larger studies , powered specifically to look at behavioural changes , are required . Trial registration . National Institute for Health Research , UKCRN 4566 The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status OBJECTIVE To examine the reliability , validity , and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis ( RA ) . METHODS Forty-one patients with RA , participating in a r and omized controlled trial examining the effect of an intensive exercise program  , were assessed by means of the  Dynaport ADL ( activities of daily living ) monitor ( AM ) .  The time spent on activities ( locomotion , st and ing , and active sitting ) during 24 hours and the intensity of trunk movement during these activities were recorded . To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment . Construct validity of the AM was determined by comparing the AM results with physical fitness measures ( muscle strength , endurance , joint mobility ) , disease activity , and functional status . As well , 37 patients were assessed 18 months after the first assessment to determine responsiveness . RESULTS All AM measurements showed satisfactory test-retest reliability ( ICC 0.63 - 0.76 ) . AM measures were significantly associated with physical fitness , functional status , and disease activity , indicating construct validity of the 
    Output:
    
agent
There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA .
***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 To determine geographical variation in the prevalence of rheumatoid arthritis ( RA ) and spondyloarthropathies ( SpA ) in France . METHODS The survey sample was drawn from 7 areas of France . Households were r and omly selected using the national telephone directory , and an individual within each household was r and omly chosen by the next-birthday method . All cases of suspected RA and SpA were confirmed by the patient 's rheumatologist or by clinical examination . St and ardized estimates of prevalence were compared between regions and groups of regions . RESULTS In total 15,219 anonymous telephone numbers were selected . An average response rate of 64 % led to a total of 9395 respondents included in the study . The highest regional rates of RA were observed in the south ( range 0.59 - 0.66 % ) , and the lowest in the north ( range 0.14 - 0.24 % ) , with a national rate of 0.31 % ( 95 % CI 0.18 - 0.48 % ) . Regional heterogeneity was observed for SpA , with the highest rates in Bretagne ( 0.47 % ) and the Sud-Est ( 0.53 % ) and a national rate of 0.30 % ( 95 % CI 0.17 - 0.46 % ) . CONCLUSION This study is the largest of its kind conducted in France . It shows inter-regional variations , mainly in RA , with a higher prevalence in the south of the country . The many potential reasons for the heterogeneity observed , including genetic and environmental factors , warrant further research BACKGROUND It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis ( RA ) for the UK were published . Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA , especially in women . OBJECTIVES To estimate the age- and sex-specific point prevalence of RA ( defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment ) . The estimate was made in the primary care setting in Norfolk , UK . METHODS A stratified r and om sample was drawn from seven age and gender b and s. The 7050 individuals selected were mailed a screening question naire . Positive responders were invited to attend for a clinical examination . The sample was matched against the names in the Norfolk Arthritis Register ( NOAR ) , a register of incident cases of inflammatory polyarthritis which has been in existence since 1990 . RESULTS The overall response rate was 82 % . Sixty-six cases of RA were identified . Extrapolated to the population of the UK , the overall minimum prevalence of RA is 1.16 % in women and 0.44 % in men . A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission . In addition , some cases who failed to attend for examination had significant disability . These prevalence figures are therefore an underestimate . CONCLUSIONS The prevalence of RA in women , but not in men , in the UK may have fallen since the 1950s Background —Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease . We compared the incidence rates of myocardial infa rct ion and stroke in subjects with and without rheumatoid arthritis . Methods and Results —A prospect i ve cohort study was conducted among the 114 342 women participating in the Nurses ’ Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976 . All self-reported cases of rheumatoid arthritis were confirmed by medical record review . Fatal and nonfatal myocardial infa rct ions and strokes were similarly confirmed . Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors . Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infa rct ions and strokes  were confirmed during 2.4 million person-years of follow-up . The adjusted relative risk of myocardial infa rct ion in women with rheumatoid arthritis compared with those without was 2.0 ( 95 % confidence interval [ CI ] , 1.23 to 3.29 ) . For stroke , the adjusted relative risk was 1.48 ( 95 % CI , 0.70 to 3.12 ) . Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infa rct ion of 3.10 ( 95 % CI , 1.64 to 5.87 ) . Conclusion —In this large prospect i ve cohort of women , participants with rheumatoid arthritis had a significantly increased risk of myocardial infa rct ion but not stroke compared with those without rheumatoid arthritis . If these data are confirmed , aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions OBJECTIVE To evaluate the impact of a 2-year program of strength training on muscle strength , bone mineral density ( BMD ) , physical function , joint damage , and disease activity in patients with recent-onset ( < 2 years ) rheumatoid arthritis ( RA ) . METHODS In this prospect i ve trial , 70 RA patients were r and omly assigned to perform either strength training ( all major muscle groups of the lower and upper extremities and trunk , with loads of 50 - 70 % of repetition maximum ) or range of motion exercises ( without resistance ) twice a week ; all were encouraged to engage in recreational activities 2 - 3 times a week . All patients completed training diaries  ( evaluated bi-monthly ) and were examined at 6-month intervals . All were treated with medications to achieve disease remission . Maximum strength of the knee extensors , trunk flexors and extensors , and grip strength was measured with dynamometers . BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry . Disease activity was determined by the Disease Activity Score , the extent of joint damage by the Larsen score , and functional capacity by the Health Assessment Question naire ( HAQ ) ; walking speed was also measured . RESULTS Sixty-two patients ( 31 per group ) completed the study .  Strength training  compliance averaged 1.4 - 1.5 times/week . The maximum strength of all muscle groups examined increased significantly ( 19 - 59 % ) in the strength-training group , with statistically significant improvements in clinical disease activity parameters , HAQ scores , and walking speed . While muscle strength , disease activity parameters , and physical function also improved significantly in the control group , the changes were not as great as those in the strength-training group . BMD in the femoral neck and spine increased by a mean + /- SD of 0.51 + /- 1.64 % and by 1.17 + /- 5.34 % , respectively , in the strength-training group , but decreased by 0.70 + /- 2.25 % and 0.91 + /- 4.07 % in the controls . Femoral neck BMD in the 17 patients with high initial disease activity ( and subsequent use of oral glucocorticoids ) remained constantly at a statistically significantly lower level than that in the other 45 patients . CONCLUSION Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function , but not BMD , in patients with early RA , without detrimental effects on disease activity OBJECTIVES Cardiovascular disease ( CVD ) is responsible for 50 % of the excess mortality for patients with RA . This study aim ed to evaluate a novel 8-week cognitive behavioural patient education intervention design ed to effect behavioural change with regard to modifiable CVD risk factors in people with RA . METHODS This was a non-blinded r and omized controlled trial with a delayed intervention arm . Participants were r and omly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1 . The primary outcome measure was patient 's knowledge of CVD in RA ; secondary measures were psychological measures relating to effecting behaviour change , actual behaviour changes and clinical risk factors . Data were collected at baseline , 2 and 6 months . RESULTS A total of 110 participants consented ( 52 in the intervention group and 58 in the control group ) to participate in the study . At 6 months , those in the intervention group had significantly higher knowledge scores ( P < 0.001 ) ; improved behavioural intentions to increase exercise ( P < 0.001 ) , eat a low-fat diet ( P = 0.01 ) and lose weight ( P = 0.06 ) ; and lower mean diastolic blood pressure by 3.7 mmHg , whereas the control group 's mean diastolic blood pressure increased by 0.8 mmHg . There was no difference between the groups on actual behaviours . CONCLUSIONS Patient education has a significant role to play in CVD risk factor modification for patients with RA , and the detailed development of this programme probably contributed to its successful results . It is disappointing that behaviours , as we measured them , did not change . The challenge , as always , is how to translate behavioural intentions into action . Larger studies , powered specifically to look at behavioural changes , are required . Trial registration . National Institute for Health Research , UKCRN 4566 The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status OBJECTIVE To examine the reliability , validity , and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis ( RA ) . METHODS Forty-one patients with RA , participating in a r and omized controlled trial examining the effect of an intensive exercise program  , were assessed by means of the  Dynaport ADL ( activities of daily living ) monitor ( AM ) .  The time spent on activities ( locomotion , st and ing , and active sitting ) during 24 hours and the intensity of trunk movement during these activities were recorded . To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment . Construct validity of the AM was determined by comparing the AM results with physical fitness measures ( muscle strength , endurance , joint mobility ) , disease activity , and functional status . As well , 37 patients were assessed 18 months after the first assessment to determine responsiveness . RESULTS All AM measurements showed satisfactory test-retest reliability ( ICC 0.63 - 0.76 ) . AM measures were significantly associated with physical fitness , functional status , and disease activity , indicating construct validity of the 
    Output:
    