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 if a series of 4 15-minute , theory-driven ( Social Cognitive Theory ) cooking programs aim ed at college students living off campus improved cooking self-efficacy , knowledge , attitudes , and behaviors regarding fruit and vegetable intake . DESIGN A r and omized controlled trial with pre- , post- and follow-up tests . SETTING University campus . PARTICIPANTS Students ( n = 101 ) from upper-level nonhealth courses ( n = 37 male and n = 94 living off campus ) . INTERVENTION The intervention group ( n = 50 ) watched 4 weekly episodes of the cooking show , Good Grubbin ' . The control group ( n = 51 ) watched 4 weekly episodes on sleep disorders . MAIN OUTCOME MEASURES Demographic information ; knowledge , self-efficacy , motivations , barriers of eating fruits and vegetables ; self-efficacy , motivations , barriers and behaviors of cooking ; fruit and vegetable intake food frequency question naire . ANALYSIS Repeated-measure analysis of variance and chi-square analyses were used to compare outcome variables . RESULTS There were significant improvements in knowledge of fruit and vegetable recommendations in the intervention group compared to the control group postintervention and at 4-month follow-up ( P < .05 ) . There were no significant changes in fruit and vegetable motivators , barriers , self-efficacy or intake . CONCLUSIONS AND IMPLICATION S A television show on nutrition and cooking may be influential in changing students ' knowledge , but it seems to have little impact on dietary behaviors . With a recent increase in popularity of cooking shows , future research should investigate the impact an extended cooking and nutrition show series might have on young adult viewers OBJECTIVE To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aim ed at altering cooking confidence , food preparation methods and dietary choices . DESIGN A st and ardised skills programme was implemented in community-based setting s. Pre- ( T1 ) and post-intervention ( T2 ) and 6-month follow-up ( T3 ) measures ( 7-day diaries and self-administered question naires ) were undertaken in intervention and comparison groups . SETTING Eight urban communities in Scotl and . SUBJECTS One hundred and thirteen adults living in areas of social deprivation . RESULTS It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic . Sixty-three subjects completed the final ( T3 ) assessment s. The response to each component varied due to inability to attend sessions , illness , study requirements , employment , moving out of the area , change in circumstances , loss of interest and loss of postal question naires . At baseline , reported consumption of fruit and vegetables was low ( mean frequency 8.1 + /- 4.78 times per week ) . Fruit intake increased significantly ( P < 0.05 ) between T1 and T2 in the intervention group ( 1.7 + /- 2.36 to 2.7 + /- 3.28 times per week ) only . Between T1 and T3 , there was a significant increase ( P < 0.05 ) in intervention subjects who reported confidence in following a recipe ( 67 - 90 % , ) . CONCLUSIONS This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation . A full-scale r and omised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention , and presents challenges for trial design OBJECTIVE To determine the degree of dietary adherence or change in eating patterns , and demographic , psychosocial and study characteristics associated with adherence , in the Comparing Healthy Options in Cooking and Eating ( CHOICE ) Study . DESIGN R and omized controlled trial where women were r and omized to one of three eating patterns : ( i ) Whole Foods , plant-based , macrobiotic-style ( n 22 ) ; and Moderate Fat with ( ii ) , and without ( iii ) , 10 g of ground flaxseed added daily , which were combined ( n 49 ) . SETTING A year-long intervention based on social cognitive theory , consisting of twenty-four class sessions involving h and s-on cooking classes and behavioural sessions . Monthly 24 h food recalls were obtained and a psychosocial question naire was administered at baseline , 6 and 12 months . SUBJECTS Healthy , free-living , postmenopausal women . RESULTS A non-adherence score measuring all food servings out-of-compliance with eating pattern recommendations was specifically design ed for the present study . Non-adherence scores decreased significantly ( P < 0·05 ) in both groups to about 65 % during the adoption phase ( first 4 months ) and remained so during the 8-month maintenance period . Class attendance of the Moderate Fat group showed a trend towards significance as a predictor of adherence ( P = 0·063 ) . None of the other predictors ( e.g. demographic and psychosocial factors ) in a longitudinal regression model were significant . CONCLUSIONS Postmenopausal women were able to adopt and maintain significant changes in their eating patterns , including those on a dem and ing , near-vegetarian eating plan , suggesting that behavioural interventions with a healthy free-living population can be effective . The non-adherence score developed for the study provides an example of a means for evaluating eating pattern adherence to a dietary intervention Overweight and obesity are common health risks , but it can be difficult to effect weight change . This r and omized controlled trial examined the effects of a novel Cookery skills intervention on body mass index ( BMI ) in overweight and obese patients with cardiovascular disease , who had previously attended a cardiac rehabilitation programme . Patients with BMI > 27 kg/m(2 ) were r and omized to either a 5-week cookery skills course with written educational material s , or to written material s only . Question naires on lifestyle risk factors and food frequencies were administered at baseline , 6 and 24 months . The primary outcome in an intention-to-treat analysis was a change in BMI at 6 months . Secondary outcome was a change in BMI at 24 months . Changes in macronutrient consumption were examined in both analysis of covariance and repeated measures ANOVA models . Of the 172 patients , 116 ( 67.4 % ) patients consented to participate in the study . The intervention was found to be well accepted and attended by the patients ( 70.5 % of patients in the intervention group attended the sessions ) . Whilst both intervention and control groups were noted to have a small reduction in BMI , there was no significant difference between the groups . There was no significant group effect noted for any change in macronutrient consumption at 6- or 24-month follow-up . This pilot study of a novel cookery skills project was well accepted amongst this population . Although the majority of participants had a net loss in BMI , the cookery skills intervention was not associated with any change in BMI beyond that achieved by written information alone Background Modest reductions in weight and small increases in step- related activity ( e.g. , walking ) can improve glycemic and blood pressure control in type 2 diabetes mellitus ( DM2 ) . We examined changes in these parameters following training in time- efficient preparation of balanced , low- energy meals combined with pedometer- based step count monitoring . Methods Seventy- two adults with DM2 were enrolled in a 24- week program ( i.e. , 15 three- hour group sessions ) . They prepared meals under a chef ’s supervision , and discussed eating behaviours/nutrition with a registered dietitian . They maintained a record of pedometer- assessed step counts . We evaluated changes from baseline to 24 weeks in terms of weight , step counts , hemoglobin A1c ( HbA1c , glycemic control ) , blood pressure , and eating control ability ( Weight Efficacy Lifestyle WEL Question naire ) . 53 participants ( 73.6 % ) completed assessment s. Results There were improvements in eating control ( 11.2 point WEL score change , 95 % CI 4.7 to 17.8 ) , step counts ( mean change 869 steps/day , 95 % CI 198 to 1,540 ) , weight ( mean change −2.2 % ; 95 % CI −3.6 to −0.8 ) , and HbA1c ( mean change −0.3 % HbA1c , 95 % CI −0.6 to −0.1 ) , as well as suggestion of systolic blood pressure reduction ( mean change −3.5 mm Hg , 95 % CI −7.8 to 0.9 ) . Findings were not attributable to medication changes . In linear regression models ( adjusted for age , sex , ethnicity , insulin use , season ) , a −2.5 % weight change was associated with a −0.3 % HbA1c change ( 95 % CI −0.4 to −0.2 ) and a −3.5 % systolic blood pressure change ( 95 % CI −5.5 to −1.4 ) . Conclusions In this ‘ proof of concept ’ study , persistence with the program led to improvements in eating and physical activity habits , glycemia reductions , and suggestion of blood pressure lowering effects . The strategy thus merits further study and development to exp and the range of options for vascular risk reduction in DM2 We design ed , implemented and evaluated an educational intervention to increase fruit and vegetable consumption among urban African-American women . Women aged 20 - 50 years ( n=212 ) from 11 public housing communities participated in seven 90-min classes with a professional nutritionist . Our prospect i ve pre- and post-test design , with 4-month follow-up , assessed the relationship between attendance and dietary change , using three 24-hour recalls per time point . Mean change in average daily dietary values for fruits and vegetables , calories and percent calories from fat ( post-test versus pre-test , follow-up versus pre-test ) was compared by class attendance , to evaluate the impact of class attendance on dietary change . Attendance varied from zero ( 35 % ) to five to seven classes ( 42 % ) . Baseline dietary recalls showed average daily consumption of 3.05 servings of fruits and vegetables , 2416 calories and 35.8 % calories from fat . No improvements in fruit and vegetable consumption , but statistically significant decreases in total calories and percent calories from fat , were seen at both endpoints . Women attending five to seven classes had the greatest dietary improvements , averaging , at post-test and follow-up , respectively , 246.2 and 324.5 fewer calories and 3.08 and 2.97 % fewer calories from fat . Results suggest that , for some residents of low-re source communities , small group interventions are popular , effective vehicles for nutrition education Background Type 2 diabetes can seriously affect patients '  health-related quality of life and their self-rated health . Most often , evaluation of diabetes interventions assess effects on glycemic control with little consideration of quality of life . The aim of the current study was to study the effectiveness of group-based rehabilitation versus individual counselling on health-related quality of life ( HRQOL ) and self-rated health in type 2 diabetes patients . Methods We r and omised 143 type 2 diabetes patients to either a six-month multidisciplinary group-based rehabilitation programme including patient education , supervised exercise and a cooking-course or a six-month individual counselling programme .  HRQOL was measured by Medical Outcomes Study Short Form 36-item Health Survey ( SF-36 ) and self-rated health was measured by Diabetes Symptom Checklist - Revised ( DCS-R ) . Results In both groups , the lowest estimated mean scores of the SF36 question naire at baseline were " vitality " and " general health " . There were no significant differences in the change of any item between the two groups after the six-month intervention period . However , vitality-score increased 5.2 points ( p = 0.12 ) within the rehabilitation group and 5.6 points ( p = 0.03 ) points among individual counselling participants .In both groups , the highest estimated mean scores of the DSC-R question naire at baseline were " Fatigue " and " Hyperglycaemia " . Hyperglycaemic and hypoglycaemic distress decreased significantly after individual counselling than after group-based rehabilitation ( difference -0.3 points , p = 0.04 ) . No between-group differences occurred for any other items . However , fatigue distress decreased 0.40 points within the rehabilitation group ( p = 0.01 ) and 0.34 points within the individual counselling group ( p < 0.01 ) . In the rehabilitation group cardiovascular distress decreased 0.25 points ( p = 0.01 ) . Conclusions A group-based rehabilitation programme did not improve health-related quality of life and self-rated health more than an individual counselling programme . In fact , the individual group experienced a significant relief in hyper- and hypoglycaemic distress compared with the rehabilitation group . However , the positive findings of several items in both groups indicate that lifestyle intervention is an important part of the management of type 2 diabetes patients OBJECTIVES The purpose of this study was to examine whether a 12-week combined physical exercise training and nutritional intervention improves physical performance and enhances health-related quality of life ( HRQOL ) among prefrail elderly women living in the community . DESIGN This was a r and omized controlled trial in which participants were recruited and r and omly assigned to the exercise and nutrition group ( EN , n = 30 ) , exercise only group ( E , n = 28 ) , and control group ( C , n = 31 ) . SETTING Group training classes were held at a research center in Itabashi Ward , Tokyo , Japan . PARTICIPANTS Eighty-nine prefrail women aged 70 years or older . INTERVENTION The EN 
    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: OBJECTIVE To determine if a series of 4 15-minute , theory-driven ( Social Cognitive Theory ) cooking programs aim ed at college students living off campus improved cooking self-efficacy , knowledge , attitudes , and behaviors regarding fruit and vegetable intake . DESIGN A r and omized controlled trial with pre- , post- and follow-up tests . SETTING University campus . PARTICIPANTS Students ( n = 101 ) from upper-level nonhealth courses ( n = 37 male and n = 94 living off campus ) . INTERVENTION The intervention group ( n = 50 ) watched 4 weekly episodes of the cooking show , Good Grubbin ' . The control group ( n = 51 ) watched 4 weekly episodes on sleep disorders . MAIN OUTCOME MEASURES Demographic information ; knowledge , self-efficacy , motivations , barriers of eating fruits and vegetables ; self-efficacy , motivations , barriers and behaviors of cooking ; fruit and vegetable intake food frequency question naire . ANALYSIS Repeated-measure analysis of variance and chi-square analyses were used to compare outcome variables . RESULTS There were significant improvements in knowledge of fruit and vegetable recommendations in the intervention group compared to the control group postintervention and at 4-month follow-up ( P < .05 ) . There were no significant changes in fruit and vegetable motivators , barriers , self-efficacy or intake . CONCLUSIONS AND IMPLICATION S A television show on nutrition and cooking may be influential in changing students ' knowledge , but it seems to have little impact on dietary behaviors . With a recent increase in popularity of cooking shows , future research should investigate the impact an extended cooking and nutrition show series might have on young adult viewers OBJECTIVE To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aim ed at altering cooking confidence , food preparation methods and dietary choices . DESIGN A st and ardised skills programme was implemented in community-based setting s. Pre- ( T1 ) and post-intervention ( T2 ) and 6-month follow-up ( T3 ) measures ( 7-day diaries and self-administered question naires ) were undertaken in intervention and comparison groups . SETTING Eight urban communities in Scotl and . SUBJECTS One hundred and thirteen adults living in areas of social deprivation . RESULTS It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic . Sixty-three subjects completed the final ( T3 ) assessment s. The response to each component varied due to inability to attend sessions , illness , study requirements , employment , moving out of the area , change in circumstances , loss of interest and loss of postal question naires . At baseline , reported consumption of fruit and vegetables was low ( mean frequency 8.1 + /- 4.78 times per week ) . Fruit intake increased significantly ( P < 0.05 ) between T1 and T2 in the intervention group ( 1.7 + /- 2.36 to 2.7 + /- 3.28 times per week ) only . Between T1 and T3 , there was a significant increase ( P < 0.05 ) in intervention subjects who reported confidence in following a recipe ( 67 - 90 % , ) . CONCLUSIONS This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation . A full-scale r and omised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention , and presents challenges for trial design OBJECTIVE To determine the degree of dietary adherence or change in eating patterns , and demographic , psychosocial and study characteristics associated with adherence , in the Comparing Healthy Options in Cooking and Eating ( CHOICE ) Study . DESIGN R and omized controlled trial where women were r and omized to one of three eating patterns : ( i ) Whole Foods , plant-based , macrobiotic-style ( n 22 ) ; and Moderate Fat with ( ii ) , and without ( iii ) , 10 g of ground flaxseed added daily , which were combined ( n 49 ) . SETTING A year-long intervention based on social cognitive theory , consisting of twenty-four class sessions involving h and s-on cooking classes and behavioural sessions . Monthly 24 h food recalls were obtained and a psychosocial question naire was administered at baseline , 6 and 12 months . SUBJECTS Healthy , free-living , postmenopausal women . RESULTS A non-adherence score measuring all food servings out-of-compliance with eating pattern recommendations was specifically design ed for the present study . Non-adherence scores decreased significantly ( P < 0·05 ) in both groups to about 65 % during the adoption phase ( first 4 months ) and remained so during the 8-month maintenance period . Class attendance of the Moderate Fat group showed a trend towards significance as a predictor of adherence ( P = 0·063 ) . None of the other predictors ( e.g. demographic and psychosocial factors ) in a longitudinal regression model were significant . CONCLUSIONS Postmenopausal women were able to adopt and maintain significant changes in their eating patterns , including those on a dem and ing , near-vegetarian eating plan , suggesting that behavioural interventions with a healthy free-living population can be effective . The non-adherence score developed for the study provides an example of a means for evaluating eating pattern adherence to a dietary intervention Overweight and obesity are common health risks , but it can be difficult to effect weight change . This r and omized controlled trial examined the effects of a novel Cookery skills intervention on body mass index ( BMI ) in overweight and obese patients with cardiovascular disease , who had previously attended a cardiac rehabilitation programme . Patients with BMI > 27 kg/m(2 ) were r and omized to either a 5-week cookery skills course with written educational material s , or to written material s only . Question naires on lifestyle risk factors and food frequencies were administered at baseline , 6 and 24 months . The primary outcome in an intention-to-treat analysis was a change in BMI at 6 months . Secondary outcome was a change in BMI at 24 months . Changes in macronutrient consumption were examined in both analysis of covariance and repeated measures ANOVA models . Of the 172 patients , 116 ( 67.4 % ) patients consented to participate in the study . The intervention was found to be well accepted and attended by the patients ( 70.5 % of patients in the intervention group attended the sessions ) . Whilst both intervention and control groups were noted to have a small reduction in BMI , there was no significant difference between the groups . There was no significant group effect noted for any change in macronutrient consumption at 6- or 24-month follow-up . This pilot study of a novel cookery skills project was well accepted amongst this population . Although the majority of participants had a net loss in BMI , the cookery skills intervention was not associated with any change in BMI beyond that achieved by written information alone Background Modest reductions in weight and small increases in step- related activity ( e.g. , walking ) can improve glycemic and blood pressure control in type 2 diabetes mellitus ( DM2 ) . We examined changes in these parameters following training in time- efficient preparation of balanced , low- energy meals combined with pedometer- based step count monitoring . Methods Seventy- two adults with DM2 were enrolled in a 24- week program ( i.e. , 15 three- hour group sessions ) . They prepared meals under a chef ’s supervision , and discussed eating behaviours/nutrition with a registered dietitian . They maintained a record of pedometer- assessed step counts . We evaluated changes from baseline to 24 weeks in terms of weight , step counts , hemoglobin A1c ( HbA1c , glycemic control ) , blood pressure , and eating control ability ( Weight Efficacy Lifestyle WEL Question naire ) . 53 participants ( 73.6 % ) completed assessment s. Results There were improvements in eating control ( 11.2 point WEL score change , 95 % CI 4.7 to 17.8 ) , step counts ( mean change 869 steps/day , 95 % CI 198 to 1,540 ) , weight ( mean change −2.2 % ; 95 % CI −3.6 to −0.8 ) , and HbA1c ( mean change −0.3 % HbA1c , 95 % CI −0.6 to −0.1 ) , as well as suggestion of systolic blood pressure reduction ( mean change −3.5 mm Hg , 95 % CI −7.8 to 0.9 ) . Findings were not attributable to medication changes . In linear regression models ( adjusted for age , sex , ethnicity , insulin use , season ) , a −2.5 % weight change was associated with a −0.3 % HbA1c change ( 95 % CI −0.4 to −0.2 ) and a −3.5 % systolic blood pressure change ( 95 % CI −5.5 to −1.4 ) . Conclusions In this ‘ proof of concept ’ study , persistence with the program led to improvements in eating and physical activity habits , glycemia reductions , and suggestion of blood pressure lowering effects . The strategy thus merits further study and development to exp and the range of options for vascular risk reduction in DM2 We design ed , implemented and evaluated an educational intervention to increase fruit and vegetable consumption among urban African-American women . Women aged 20 - 50 years ( n=212 ) from 11 public housing communities participated in seven 90-min classes with a professional nutritionist . Our prospect i ve pre- and post-test design , with 4-month follow-up , assessed the relationship between attendance and dietary change , using three 24-hour recalls per time point . Mean change in average daily dietary values for fruits and vegetables , calories and percent calories from fat ( post-test versus pre-test , follow-up versus pre-test ) was compared by class attendance , to evaluate the impact of class attendance on dietary change . Attendance varied from zero ( 35 % ) to five to seven classes ( 42 % ) . Baseline dietary recalls showed average daily consumption of 3.05 servings of fruits and vegetables , 2416 calories and 35.8 % calories from fat . No improvements in fruit and vegetable consumption , but statistically significant decreases in total calories and percent calories from fat , were seen at both endpoints . Women attending five to seven classes had the greatest dietary improvements , averaging , at post-test and follow-up , respectively , 246.2 and 324.5 fewer calories and 3.08 and 2.97 % fewer calories from fat . Results suggest that , for some residents of low-re source communities , small group interventions are popular , effective vehicles for nutrition education Background Type 2 diabetes can seriously affect patients '  health-related quality of life and their self-rated health . Most often , evaluation of diabetes interventions assess effects on glycemic control with little consideration of quality of life . The aim of the current study was to study the effectiveness of group-based rehabilitation versus individual counselling on health-related quality of life ( HRQOL ) and self-rated health in type 2 diabetes patients . Methods We r and omised 143 type 2 diabetes patients to either a six-month multidisciplinary group-based rehabilitation programme including patient education , supervised exercise and a cooking-course or a six-month individual counselling programme .  HRQOL was measured by Medical Outcomes Study Short Form 36-item Health Survey ( SF-36 ) and self-rated health was measured by Diabetes Symptom Checklist - Revised ( DCS-R ) . Results In both groups , the lowest estimated mean scores of the SF36 question naire at baseline were " vitality " and " general health " . There were no significant differences in the change of any item between the two groups after the six-month intervention period . However , vitality-score increased 5.2 points ( p = 0.12 ) within the rehabilitation group and 5.6 points ( p = 0.03 ) points among individual counselling participants .In both groups , the highest estimated mean scores of the DSC-R question naire at baseline were " Fatigue " and " Hyperglycaemia " . Hyperglycaemic and hypoglycaemic distress decreased significantly after individual counselling than after group-based rehabilitation ( difference -0.3 points , p = 0.04 ) . No between-group differences occurred for any other items . However , fatigue distress decreased 0.40 points within the rehabilitation group ( p = 0.01 ) and 0.34 points within the individual counselling group ( p < 0.01 ) . In the rehabilitation group cardiovascular distress decreased 0.25 points ( p = 0.01 ) . Conclusions A group-based rehabilitation programme did not improve health-related quality of life and self-rated health more than an individual counselling programme . In fact , the individual group experienced a significant relief in hyper- and hypoglycaemic distress compared with the rehabilitation group . However , the positive findings of several items in both groups indicate that lifestyle intervention is an important part of the management of type 2 diabetes patients OBJECTIVES The purpose of this study was to examine whether a 12-week combined physical exercise training and nutritional intervention improves physical performance and enhances health-related quality of life ( HRQOL ) among prefrail elderly women living in the community . DESIGN This was a r and omized controlled trial in which participants were recruited and r and omly assigned to the exercise and nutrition group ( EN , n = 30 ) , exercise only group ( E , n = 28 ) , and control group ( C , n = 31 ) . SETTING Group training classes were held at a research center in Itabashi Ward , Tokyo , Japan . PARTICIPANTS Eighty-nine prefrail women aged 70 years or older . INTERVENTION The EN 
    Output:
    