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: Abstract Objective : To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease . Design : R and omised controlled trial of clinics over one year with assessment by self completed postal question naires and audit of medical records at the start and end of the trial . Setting : R and om sample of 19 general practice s in northeast Scotl and . Subjects : 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound . Intervention : Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures : Health status measured by the SF-36 question naire , chest pain by the angina type specification , and anxiety and depression by the hospital anxiety and depression scale . Use of health services before and during the study . Results : There were significant improvements in six of eight health status domains ( all functioning scales , pain , and general health ) among patients attending the clinic . Role limitations attributed to physical problems improved most ( adjusted difference 8.52 , 95 % confidence interval 4.16 to 12.9 ) . Fewer patients reported worsening chest pain ( odds ratio 0.59 , 95 % confidence interval 0.37 to 0.94 ) . There were no significant effects on anxiety or depression . Fewer intervention group patients required hospital admissions ( 0.64 , 0.48 to 0.86 ) , but general practitioner consultation rates did not alter . Conclusions : Within their first year secondary prevention clinics improved patients ' health and reduced hospital admissions . Key messages Nurse led clinics in general practice were used to promote secondary prevention to patients with coronary heart disease Within the first year the health of patients invited to the clinics improved Most benefit was in functional status , but chest pain improved too There was no effects on anxiety or depression There were significant reductions in hospital admissions in the first OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone AIM This paper reports a study to determine the factors affecting community-dwelling older Chinese people 's  health-promoting behaviour in the domains of physical activity , healthy dietary practice s and stress management , and to identify any barriers to these behaviours . BACKGROUND Previous studies have identified factors affecting different types of health-promoting behaviours , including perceived self-efficacy , perceived benefits and five individual characteristics ( age , sex , marital status , education and perceived health ) of older non-Chinese people . However , few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people 's health-promoting behaviour . METHOD Individual face-to-face interviews were completed in 2002 - 2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 ( years mean 76 ) . Participants had no apparent communication and cognition impairments . A structured interview schedule was used to collect the data . RESULTS Multiple regression analysis showed that perceived self-efficacy , perceived benefits and sex together explained 38.4 % of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong . Fatigue during and after physical activity , enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour . CONCLUSION When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers , community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour . Future studies should include more critical factors based on theories , empirical evidence and knowledge of culture with sample s that are r and om and from more diverse community setting Few studies have evaluated the efficacy of cholesterol-lowering interventions in a community setting and have included a control or comparison group . As part of a preventive health demonstration project in rural Pennsylvania , Medicare beneficiaries underwent cholesterol screening to identify high-risk individuals with serum cholesterol levels > or = 240 mg/dL. These high-risk individuals were r and omized to a  cholesterol-lowering intervention  through either local hospitals or physicians ' offices or to a control group . Baseline and follow-up serum cholesterol levels collected two to three years later were compared according to service location ( hospital versus physician 's office ) , intervention attendance , degree of participation , baseline heart disease history , and cholesterol-lowering medication use at follow-up . Serum cholesterol levels decreased between 5.7 % and 6.6 % in the hospital-based and physician-based groups , as well as in a control group not offered the intervention .  Participation rates did not differ between treatment groups , nor did participation affect serum cholesterol levels . Attendance level and heart disease history were not associated with a greater decrease in serum cholesterol levels . Individuals reporting cholesterol-lowering drug use at follow-up had significantly higher baseline serum cholesterol levels and a significantly greater decrease in total serum cholesterol ( P < .0001 ) than those not on medication . Both nonpharmacological ( diet ) and pharmacological ( drug ) interventions will reduce serum cholesterol levels and heart attack risk . The study results suggest that , at least for older individuals , the impact of nonpharmacological interventions on the community is minimal . We conclude that only very aggressive treatment will significantly loser serum cholesterol levels in older individuals at risk for heart attack Medicare beneficiaries enrolled in a health maintenance organization ( HMO ) were r and omized to a preventive services benefit package for 2 years or to usual care . At 24- and 48-month followups , the treatment group had completed more advance directives , participated in more exercise , and consumed less dietary fat than the control group . Unexpectedly , more deaths occurred in the treatment group . Surviving treatment-group enrollees reported higher satisfaction with health , less decline in self-rated health status , and fewer depressive symptoms than surviving control participants . Despite these changes , the intervention did not yield lower cost per quality -adjusted life year in this historically prevention-oriented HMO Background Lifestyle risk factors , in particular smoking , nutrition , alcohol consumption and physical inactivity ( SNAP ) are the main behavioural risk factors for chronic disease . Primary health care ( PHC ) has been shown to be an effective setting to address lifestyle risk factors at the individual level . However much of the focus of research to date has been in general practice . Relatively little attention has been paid to the role of nurses working in the PHC setting . Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time , providing the opportunity to offer intervention and enhance motivation through repeated contacts . The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients ' SNAP risk factors . Methods / Design The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia . Services have been r and omly allocated to an ' early intervention ' group or ' late intervention ' ( comparison ) group . ' Early intervention ' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations . ' Late intervention site ' provide usual care and will be offered the study intervention following the final data collection point . A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites . Data collection consists of 1 ) telephone surveys with clients at baseline , three months and six months to examine change in SNAP risk factors and readiness to change 2 ) nurse survey at baseline , six and 12 months to examine changes in nurse confidence , attitudes and practice s in the assessment and management of SNAP risk factors 3 ) semi-structured interviews/focus with nurses , managers and clients in ' early intervention ' sites to explore the feasibility , acceptability and sustainability of the intervention . Discussion The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice . This will inform future community nursing practice and PHC policy . Trial Registration BACKGROUND many heart failure disease management programs are primarily conducted in the male population . An approach incorporating disciplines such as physiotherapy , occupational therapy , social work , dietary and pharmacy in a st and ardized clinical pathway merits further investigation in older women with HF . METHODS in this r and omized controlled trial , female patients in the intervention group received the multidisciplinary clinical pathway consisting of a series of 12 visits over a 6-week period in an outpatient clinic . RESULTS ninety-one community dwelling female patients aged 63 to 89 were r and omized . Comparison of change between the two groups from baseline in the Minnesota Living with Heart Failure Question naire score did not show a difference ( P<0.470 ) . There was also no difference between the two groups in functional outcome as measured by change from baseline by the Physical Self-Maintenance Scale ( P<0.321 ) . The treatment group had significantly more hospitalizations , and cardiologist visits during the study period ( P < 0.0001 ) . CONCLUSION It is feasible to conduct a r and omized study in a frail community-based older female population and to test a complex multidisciplinary pathway . Future studies should provide insight into the optimal intensity and duration of heart failure management programs with optimal targeting BACKGROUND Generalizable research on high-risk older persons requires sample s that are both large enough for adequate statistical power and similar enough to community population s that its results can be generalized to them . We tested the effectiveness and efficiency of mixed-mode ( mail-telephone ) solicitation of a defined population as a method for recruiting a large , representative sample for a r and omized trial of outpatient geriatric evaluation and management ( GEM ) . METHODS Fee-for-service , community-dwelling older Medicare beneficiaries were mailed a short self-administered screening question naire . Eligible respondents were called to assess eligibility and willingness to give consent ; consenters were called again for baseline data . Information about nonrespondents , ineligibles , and refusers was obtained from the Health Care Financing Administration . RESULTS The response rate to the screening question naire was 61.1 % . Of the respondents , 13.2 % were eligible for the study and , of those , 34.4 % agreed to participate . Response rates appeared to be influenced by small financial incentives and by subjects ' age , race , sex , location of residence , and use of hospitals in the previous year . Consent rates were influenced by age and sex . The final sample ( N = 522 ) was representative of community high-risk respondents in racial composition , previous use of hospitals , and probability of repeated admission ( Pre ) in the future , but it was slightly younger and contained a higher percentage of men .  Recruitment costs averaged $ 286.92 per consenting person . CONCLUSIONS Mixed-mode solicitation of defined population s can produce , at reasonable cost , large sample s whose representativeness of community high-risk population s can be determined . Procedures that may enhance the success of this approach include : advance communication with members of the target population and their families and physicians ; provision of medical and small financial incentives ; continuous monitoring of recruitment results ; and attention to subjects ' needs for convenience , time , transportation , and reassurance OBJECTIVE The Diabetes Prevention Program ( DPP ) showed that intensive lifestyle intervention reduced the risk of diabetes by 58 % . This paper examines demographic , psychosocial 
    Output:
    
agent
***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: Abstract Objective : To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease . Design : R and omised controlled trial of clinics over one year with assessment by self completed postal question naires and audit of medical records at the start and end of the trial . Setting : R and om sample of 19 general practice s in northeast Scotl and . Subjects : 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound . Intervention : Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures : Health status measured by the SF-36 question naire , chest pain by the angina type specification , and anxiety and depression by the hospital anxiety and depression scale . Use of health services before and during the study . Results : There were significant improvements in six of eight health status domains ( all functioning scales , pain , and general health ) among patients attending the clinic . Role limitations attributed to physical problems improved most ( adjusted difference 8.52 , 95 % confidence interval 4.16 to 12.9 ) . Fewer patients reported worsening chest pain ( odds ratio 0.59 , 95 % confidence interval 0.37 to 0.94 ) . There were no significant effects on anxiety or depression . Fewer intervention group patients required hospital admissions ( 0.64 , 0.48 to 0.86 ) , but general practitioner consultation rates did not alter . Conclusions : Within their first year secondary prevention clinics improved patients ' health and reduced hospital admissions . Key messages Nurse led clinics in general practice were used to promote secondary prevention to patients with coronary heart disease Within the first year the health of patients invited to the clinics improved Most benefit was in functional status , but chest pain improved too There was no effects on anxiety or depression There were significant reductions in hospital admissions in the first OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone AIM This paper reports a study to determine the factors affecting community-dwelling older Chinese people 's  health-promoting behaviour in the domains of physical activity , healthy dietary practice s and stress management , and to identify any barriers to these behaviours . BACKGROUND Previous studies have identified factors affecting different types of health-promoting behaviours , including perceived self-efficacy , perceived benefits and five individual characteristics ( age , sex , marital status , education and perceived health ) of older non-Chinese people . However , few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people 's health-promoting behaviour . METHOD Individual face-to-face interviews were completed in 2002 - 2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 ( years mean 76 ) . Participants had no apparent communication and cognition impairments . A structured interview schedule was used to collect the data . RESULTS Multiple regression analysis showed that perceived self-efficacy , perceived benefits and sex together explained 38.4 % of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong . Fatigue during and after physical activity , enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour . CONCLUSION When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers , community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour . Future studies should include more critical factors based on theories , empirical evidence and knowledge of culture with sample s that are r and om and from more diverse community setting Few studies have evaluated the efficacy of cholesterol-lowering interventions in a community setting and have included a control or comparison group . As part of a preventive health demonstration project in rural Pennsylvania , Medicare beneficiaries underwent cholesterol screening to identify high-risk individuals with serum cholesterol levels > or = 240 mg/dL. These high-risk individuals were r and omized to a  cholesterol-lowering intervention  through either local hospitals or physicians ' offices or to a control group . Baseline and follow-up serum cholesterol levels collected two to three years later were compared according to service location ( hospital versus physician 's office ) , intervention attendance , degree of participation , baseline heart disease history , and cholesterol-lowering medication use at follow-up . Serum cholesterol levels decreased between 5.7 % and 6.6 % in the hospital-based and physician-based groups , as well as in a control group not offered the intervention .  Participation rates did not differ between treatment groups , nor did participation affect serum cholesterol levels . Attendance level and heart disease history were not associated with a greater decrease in serum cholesterol levels . Individuals reporting cholesterol-lowering drug use at follow-up had significantly higher baseline serum cholesterol levels and a significantly greater decrease in total serum cholesterol ( P < .0001 ) than those not on medication . Both nonpharmacological ( diet ) and pharmacological ( drug ) interventions will reduce serum cholesterol levels and heart attack risk . The study results suggest that , at least for older individuals , the impact of nonpharmacological interventions on the community is minimal . We conclude that only very aggressive treatment will significantly loser serum cholesterol levels in older individuals at risk for heart attack Medicare beneficiaries enrolled in a health maintenance organization ( HMO ) were r and omized to a preventive services benefit package for 2 years or to usual care . At 24- and 48-month followups , the treatment group had completed more advance directives , participated in more exercise , and consumed less dietary fat than the control group . Unexpectedly , more deaths occurred in the treatment group . Surviving treatment-group enrollees reported higher satisfaction with health , less decline in self-rated health status , and fewer depressive symptoms than surviving control participants . Despite these changes , the intervention did not yield lower cost per quality -adjusted life year in this historically prevention-oriented HMO Background Lifestyle risk factors , in particular smoking , nutrition , alcohol consumption and physical inactivity ( SNAP ) are the main behavioural risk factors for chronic disease . Primary health care ( PHC ) has been shown to be an effective setting to address lifestyle risk factors at the individual level . However much of the focus of research to date has been in general practice . Relatively little attention has been paid to the role of nurses working in the PHC setting . Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time , providing the opportunity to offer intervention and enhance motivation through repeated contacts . The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients ' SNAP risk factors . Methods / Design The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia . Services have been r and omly allocated to an ' early intervention ' group or ' late intervention ' ( comparison ) group . ' Early intervention ' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations . ' Late intervention site ' provide usual care and will be offered the study intervention following the final data collection point . A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites . Data collection consists of 1 ) telephone surveys with clients at baseline , three months and six months to examine change in SNAP risk factors and readiness to change 2 ) nurse survey at baseline , six and 12 months to examine changes in nurse confidence , attitudes and practice s in the assessment and management of SNAP risk factors 3 ) semi-structured interviews/focus with nurses , managers and clients in ' early intervention ' sites to explore the feasibility , acceptability and sustainability of the intervention . Discussion The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice . This will inform future community nursing practice and PHC policy . Trial Registration BACKGROUND many heart failure disease management programs are primarily conducted in the male population . An approach incorporating disciplines such as physiotherapy , occupational therapy , social work , dietary and pharmacy in a st and ardized clinical pathway merits further investigation in older women with HF . METHODS in this r and omized controlled trial , female patients in the intervention group received the multidisciplinary clinical pathway consisting of a series of 12 visits over a 6-week period in an outpatient clinic . RESULTS ninety-one community dwelling female patients aged 63 to 89 were r and omized . Comparison of change between the two groups from baseline in the Minnesota Living with Heart Failure Question naire score did not show a difference ( P<0.470 ) . There was also no difference between the two groups in functional outcome as measured by change from baseline by the Physical Self-Maintenance Scale ( P<0.321 ) . The treatment group had significantly more hospitalizations , and cardiologist visits during the study period ( P < 0.0001 ) . CONCLUSION It is feasible to conduct a r and omized study in a frail community-based older female population and to test a complex multidisciplinary pathway . Future studies should provide insight into the optimal intensity and duration of heart failure management programs with optimal targeting BACKGROUND Generalizable research on high-risk older persons requires sample s that are both large enough for adequate statistical power and similar enough to community population s that its results can be generalized to them . We tested the effectiveness and efficiency of mixed-mode ( mail-telephone ) solicitation of a defined population as a method for recruiting a large , representative sample for a r and omized trial of outpatient geriatric evaluation and management ( GEM ) . METHODS Fee-for-service , community-dwelling older Medicare beneficiaries were mailed a short self-administered screening question naire . Eligible respondents were called to assess eligibility and willingness to give consent ; consenters were called again for baseline data . Information about nonrespondents , ineligibles , and refusers was obtained from the Health Care Financing Administration . RESULTS The response rate to the screening question naire was 61.1 % . Of the respondents , 13.2 % were eligible for the study and , of those , 34.4 % agreed to participate . Response rates appeared to be influenced by small financial incentives and by subjects ' age , race , sex , location of residence , and use of hospitals in the previous year . Consent rates were influenced by age and sex . The final sample ( N = 522 ) was representative of community high-risk respondents in racial composition , previous use of hospitals , and probability of repeated admission ( Pre ) in the future , but it was slightly younger and contained a higher percentage of men .  Recruitment costs averaged $ 286.92 per consenting person . CONCLUSIONS Mixed-mode solicitation of defined population s can produce , at reasonable cost , large sample s whose representativeness of community high-risk population s can be determined . Procedures that may enhance the success of this approach include : advance communication with members of the target population and their families and physicians ; provision of medical and small financial incentives ; continuous monitoring of recruitment results ; and attention to subjects ' needs for convenience , time , transportation , and reassurance OBJECTIVE The Diabetes Prevention Program ( DPP ) showed that intensive lifestyle intervention reduced the risk of diabetes by 58 % . This paper examines demographic , psychosocial 
    Output:
    