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 effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral Objective To evaluate the effectiveness of relapse prevention ( RP ) and brief intervention ( BI ) in reducing HIV risk-taking behaviours among injecting drug users ( IDU ) enrolled in methadone programmes . The hypotheses tested were : ( 1 ) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition ( C ) ; and ( 2 ) that Bl would be more effective in reducing HIV risk-taking behaviours than C. Design Clients of methadone programmes were r and omly assigned to either RP , Bl , or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects ' group allocations . Setting Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject . Participants Ninety-five IDU enrolled in methadone programmes . Study entry criteria were : injection of any drug in the 6 months before the day of pre-intervention assessment ; literacy in English ; agreement to HIV-antibody testing for research purpose s ; and no known diagnosis of a serious mental illness . Eighty subjects were contacted successfully for a 6-month follow-up . Interventions The RP intervention was a six-session programme . Each 60–90-min session was conducted individually . The Bl was a one-session motivational interview lasting 60–90 min , accompanied by a self-help booklet . Main outcome measures All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up . At follow-up , the Highest HIV Risk-Taking Behaviour Scale , collateral reports from subjects ' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected . Results Compliance with interventions was good . Correspondence of self-reports with urinalysis and collateral reports was satisfactory . There were no significant differences between groups in risk-taking behaviours during the month before follow-up . However , there was evidence of a lower rate of needle-risk behaviour ( sharing and cleaning ) during the heaviest risk-taking month since pre-intervention assessment in the group given RP . There were no indications that Bl was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour . Conclusions The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes , but further research is required to replicate this finding Adult marijuana users ( N = 291 ) seeking treatment were r and omly assigned to an extended 14-session cognitive-behavioral group treatment ( relapse prevention support group ; RPSG ) , a brief 2-session individual treatment using motivational interviewing ( individualized assessment and intervention ; IAI ) , or a 4-month delayed treatment control ( DTC ) condition . Results indicated that marijuana use , dependence symptoms , and negative consequences were reduced significantly in relation to pretreatment levels at 1- , 4- , 7- , 13- , and 16-month follow-ups . Participants in the RPSG and IAI treatments showed significantly and substantially greater improvement than DTC participants at the 4-month follow-up . There were no significant differences between RPSG and IAI outcomes at any follow-up . The relative efficacy of brief versus extended interventions for chronic marijuana-using adults is discussed OBJECTIVE This study was design ed to conduct a r and omized controlled trial of motivational enhancement therapy ( MET ) with two control conditions : nondirective reflective listening ( NDRL ) and no further counseling ( NFC ) ; and to conduct this study in a sample of patients with a primary diagnosis of mild to moderate alcohol dependence , in a " real-life " clinical setting . METHOD Patients with mild to moderate alcohol dependence were recruited , assessed and treated at the Community Alcohol and Drug Service of Christchurch , New Zeal and . All patients received a feedback/education session before r and omization to either four sessions of MET , four sessions of NDRL , or NFC . Outcome data on 122 subjects ( 57.4 % men ) were obtained 6 months following the end of treatment , by an interviewer who was blind to the treatment condition . The primary drinking outcome was unequivocal heavy drinking , defined as drinking 10 or more st and ard drinks six or more times in the follow-up period . Global assessment scale ( GAS ) measured general personal/social functioning . RESULTS Of patients treated with MET , 42.9 % showed unequivocal heavy drinking compared with 62.5 % of the NDRL and 65.0 % of the NFC groups ( p = .04 ) . No significant differences were found for GAS score according to treatment condition . CONCLUSIONS In patients with mild to moderate alcohol dependence , MET is more effective for reducing unequivocal heavy drinking than either a feedback/education session alone or four sessions of NDRL . MET can be considered an effective " value added " counseling intervention in a real-life clinical setting . In patients with mild to moderate alcohol dependence , nondirective reflective listening provides no additional advantage over a feedback/education session alone In theory-based interventions for behavior change , there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs . These two questions are addressed in the Physically Active for Life study , a r and omized trial of physician-based exercise counseling for older adults . Three hundred fifty-five patients participated ( intervention n = 181 , control n = 174 ; mean age = 65.6 years ) . The underlying theories used were the Transtheoretical Model , Social Cognitive Theory and the constructs of decisional balance ( benefits and barriers ) , self-efficacy , and behavioral and cognitive processes of change . Motivational readiness for physical activity and related constructs were assessed at baseline , 6 weeks , and 8 months . Linear or logistic mixed effects models were used to examine intervention effects on the constructs , and logistic mixed effects models were used for mediator analyses . At 6 weeks , the intervention had significant effects on decisional balance , self-efficacy , and behavioral processes , but these effects were not maintained at 8 months . At 6 weeks , only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes . Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults BACKGROUND A r and omised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy , a brief pragmatic intervention targeting treatment adherence in psychotic disorders , based on motivational interviewing and recent cognitive approaches to psychosis . METHOD Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit , received 4 - 6 sessions of either compliance therapy or non-specific counselling , and were followed-up over 18 months . The principal outcome measures were observer-rated compliance , attitudes to treatment , insight and social functioning . RESULTS Significant advantages were found for the compliance therapy group post-treatment on measures of insight , attitudes to treatment and observer-rated compliance which were retained over the follow-up period . Global social functioning improved relatively more over time in the compliance therapy group compared with the control group . Survival in the community prior to readmission was significantly longer in the compliance therapy group . CONCLUSIONS The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode Some clients who are court-ordered to undergo substance abuse treatment are not able or willing to identify treatment-related goals . This situation can cause difficulties in the therapeutic relationship and compromise treatment . To address this problem , we offered a group-based motivational enhancement program prior to st and ard treatment . Over 2 years , 73 clients attended the motivation group while 94 did not . Compared to those who did not , those who attended the motivation group were significantly less likely to meet criteria for substance abuse dependence , they attended a higher proportion of their treatment sessions , and they were more likely to have completed treatment . After controlling for diagnosis , employment , and age , attending the motivation group was still related to higher rates of attendance and treatment completion . A motivation group may promote better participation in substance abuse treatment programs among persons who do not identify treatment goals . Additional research is needed to draw firm conclusions The purpose of this prospect i ve , r and omized controlled study was to determine the efficacy of an intensified , late pregnancy , smoking cessation intervention for resistant pregnant smokers ( n = 269 ) . Participants received 3 - 5 min of counseling plus a self-help booklet at their first prenatal visit and seven booklets mailed weekly thereafter ; at 28 weeks , all had been smoking in the past 28 days . The experimental group received a stage of change-based , personalized feedback letter and two telephone counseling calls using Motivational Interviewing ( MI ) strategies . The control group received care as usual . The 34th week cotinine data demonstrated no overall difference between groups . However , an implementation analysis suggested that 43 % of women who received the full intervention ( E2 ) were classified as not smoking compared to 34 % of the control group . At 6 weeks postpartum , 27.1 % of the E2 group reported being abstinent or light smokers vs. 14.6 % of the controls . No differences were detected at 3 and 6 months postpartum . Results lend preliminary but very modest support for this intervention with resistant pregnant smokers . Improvements in the intervention and implementation issues are discussed Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient 's readiness to change health behaviors . Recently , elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters . This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children ( DISC ) . DISC is a r and omized , multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children . In the first 3 years of follow-up covering ages 8 - 13 , intervention participants ( n = 334 ) were exposed to a family-based group intervention approach to change dietary choices . To address adherence and retention obstacles as participants moved into adolescence ( age 13 - 17 ) , an individual-level motivational intervention was implemented . The DISC motivational intervention integrates several intervention models : stages of change , motivational interviewing , brief negotiation and behavioral self-management . A preliminary test of the intervention model suggests that it was acceptable to the participants , popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model OBJECTIVE The aim of this r and omized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM . RESEARCH DESIGN AND METHODS Twenty-two older obese women ( 41 % black ) with NIDDM were r and omly assigned to 1 ) a st and ard 16-week group behavioral weight-control program that provided instruction in diet , exercise , and behavioral modification or 2 ) the same group behavioral program with three individualized motivational interviewing sessions added . RESULTS The motivational group attended significantly more 
    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 effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral Objective To evaluate the effectiveness of relapse prevention ( RP ) and brief intervention ( BI ) in reducing HIV risk-taking behaviours among injecting drug users ( IDU ) enrolled in methadone programmes . The hypotheses tested were : ( 1 ) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition ( C ) ; and ( 2 ) that Bl would be more effective in reducing HIV risk-taking behaviours than C. Design Clients of methadone programmes were r and omly assigned to either RP , Bl , or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects ' group allocations . Setting Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject . Participants Ninety-five IDU enrolled in methadone programmes . Study entry criteria were : injection of any drug in the 6 months before the day of pre-intervention assessment ; literacy in English ; agreement to HIV-antibody testing for research purpose s ; and no known diagnosis of a serious mental illness . Eighty subjects were contacted successfully for a 6-month follow-up . Interventions The RP intervention was a six-session programme . Each 60–90-min session was conducted individually . The Bl was a one-session motivational interview lasting 60–90 min , accompanied by a self-help booklet . Main outcome measures All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up . At follow-up , the Highest HIV Risk-Taking Behaviour Scale , collateral reports from subjects ' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected . Results Compliance with interventions was good . Correspondence of self-reports with urinalysis and collateral reports was satisfactory . There were no significant differences between groups in risk-taking behaviours during the month before follow-up . However , there was evidence of a lower rate of needle-risk behaviour ( sharing and cleaning ) during the heaviest risk-taking month since pre-intervention assessment in the group given RP . There were no indications that Bl was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour . Conclusions The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes , but further research is required to replicate this finding Adult marijuana users ( N = 291 ) seeking treatment were r and omly assigned to an extended 14-session cognitive-behavioral group treatment ( relapse prevention support group ; RPSG ) , a brief 2-session individual treatment using motivational interviewing ( individualized assessment and intervention ; IAI ) , or a 4-month delayed treatment control ( DTC ) condition . Results indicated that marijuana use , dependence symptoms , and negative consequences were reduced significantly in relation to pretreatment levels at 1- , 4- , 7- , 13- , and 16-month follow-ups . Participants in the RPSG and IAI treatments showed significantly and substantially greater improvement than DTC participants at the 4-month follow-up . There were no significant differences between RPSG and IAI outcomes at any follow-up . The relative efficacy of brief versus extended interventions for chronic marijuana-using adults is discussed OBJECTIVE This study was design ed to conduct a r and omized controlled trial of motivational enhancement therapy ( MET ) with two control conditions : nondirective reflective listening ( NDRL ) and no further counseling ( NFC ) ; and to conduct this study in a sample of patients with a primary diagnosis of mild to moderate alcohol dependence , in a " real-life " clinical setting . METHOD Patients with mild to moderate alcohol dependence were recruited , assessed and treated at the Community Alcohol and Drug Service of Christchurch , New Zeal and . All patients received a feedback/education session before r and omization to either four sessions of MET , four sessions of NDRL , or NFC . Outcome data on 122 subjects ( 57.4 % men ) were obtained 6 months following the end of treatment , by an interviewer who was blind to the treatment condition . The primary drinking outcome was unequivocal heavy drinking , defined as drinking 10 or more st and ard drinks six or more times in the follow-up period . Global assessment scale ( GAS ) measured general personal/social functioning . RESULTS Of patients treated with MET , 42.9 % showed unequivocal heavy drinking compared with 62.5 % of the NDRL and 65.0 % of the NFC groups ( p = .04 ) . No significant differences were found for GAS score according to treatment condition . CONCLUSIONS In patients with mild to moderate alcohol dependence , MET is more effective for reducing unequivocal heavy drinking than either a feedback/education session alone or four sessions of NDRL . MET can be considered an effective " value added " counseling intervention in a real-life clinical setting . In patients with mild to moderate alcohol dependence , nondirective reflective listening provides no additional advantage over a feedback/education session alone In theory-based interventions for behavior change , there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs . These two questions are addressed in the Physically Active for Life study , a r and omized trial of physician-based exercise counseling for older adults . Three hundred fifty-five patients participated ( intervention n = 181 , control n = 174 ; mean age = 65.6 years ) . The underlying theories used were the Transtheoretical Model , Social Cognitive Theory and the constructs of decisional balance ( benefits and barriers ) , self-efficacy , and behavioral and cognitive processes of change . Motivational readiness for physical activity and related constructs were assessed at baseline , 6 weeks , and 8 months . Linear or logistic mixed effects models were used to examine intervention effects on the constructs , and logistic mixed effects models were used for mediator analyses . At 6 weeks , the intervention had significant effects on decisional balance , self-efficacy , and behavioral processes , but these effects were not maintained at 8 months . At 6 weeks , only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes . Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults BACKGROUND A r and omised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy , a brief pragmatic intervention targeting treatment adherence in psychotic disorders , based on motivational interviewing and recent cognitive approaches to psychosis . METHOD Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit , received 4 - 6 sessions of either compliance therapy or non-specific counselling , and were followed-up over 18 months . The principal outcome measures were observer-rated compliance , attitudes to treatment , insight and social functioning . RESULTS Significant advantages were found for the compliance therapy group post-treatment on measures of insight , attitudes to treatment and observer-rated compliance which were retained over the follow-up period . Global social functioning improved relatively more over time in the compliance therapy group compared with the control group . Survival in the community prior to readmission was significantly longer in the compliance therapy group . CONCLUSIONS The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode Some clients who are court-ordered to undergo substance abuse treatment are not able or willing to identify treatment-related goals . This situation can cause difficulties in the therapeutic relationship and compromise treatment . To address this problem , we offered a group-based motivational enhancement program prior to st and ard treatment . Over 2 years , 73 clients attended the motivation group while 94 did not . Compared to those who did not , those who attended the motivation group were significantly less likely to meet criteria for substance abuse dependence , they attended a higher proportion of their treatment sessions , and they were more likely to have completed treatment . After controlling for diagnosis , employment , and age , attending the motivation group was still related to higher rates of attendance and treatment completion . A motivation group may promote better participation in substance abuse treatment programs among persons who do not identify treatment goals . Additional research is needed to draw firm conclusions The purpose of this prospect i ve , r and omized controlled study was to determine the efficacy of an intensified , late pregnancy , smoking cessation intervention for resistant pregnant smokers ( n = 269 ) . Participants received 3 - 5 min of counseling plus a self-help booklet at their first prenatal visit and seven booklets mailed weekly thereafter ; at 28 weeks , all had been smoking in the past 28 days . The experimental group received a stage of change-based , personalized feedback letter and two telephone counseling calls using Motivational Interviewing ( MI ) strategies . The control group received care as usual . The 34th week cotinine data demonstrated no overall difference between groups . However , an implementation analysis suggested that 43 % of women who received the full intervention ( E2 ) were classified as not smoking compared to 34 % of the control group . At 6 weeks postpartum , 27.1 % of the E2 group reported being abstinent or light smokers vs. 14.6 % of the controls . No differences were detected at 3 and 6 months postpartum . Results lend preliminary but very modest support for this intervention with resistant pregnant smokers . Improvements in the intervention and implementation issues are discussed Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient 's readiness to change health behaviors . Recently , elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters . This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children ( DISC ) . DISC is a r and omized , multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children . In the first 3 years of follow-up covering ages 8 - 13 , intervention participants ( n = 334 ) were exposed to a family-based group intervention approach to change dietary choices . To address adherence and retention obstacles as participants moved into adolescence ( age 13 - 17 ) , an individual-level motivational intervention was implemented . The DISC motivational intervention integrates several intervention models : stages of change , motivational interviewing , brief negotiation and behavioral self-management . A preliminary test of the intervention model suggests that it was acceptable to the participants , popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model OBJECTIVE The aim of this r and omized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM . RESEARCH DESIGN AND METHODS Twenty-two older obese women ( 41 % black ) with NIDDM were r and omly assigned to 1 ) a st and ard 16-week group behavioral weight-control program that provided instruction in diet , exercise , and behavioral modification or 2 ) the same group behavioral program with three individualized motivational interviewing sessions added . RESULTS The motivational group attended significantly more 
    Output:
    