human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss Background :  Physical activity ( PA )  is important for management of diabetes , yet practical interventions that achieve sustained behavior change are rare . Purpose : The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection . Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months . Methods : Three hundred thirty-five participants were recruited from 42 primary care physicians and then r and omized to either a computer-assisted , tailored self-management intervention ( N = 174 ) or health risk appraisal with feedback control ( N = 161 ) . Primary outcome measures included the Community Healthy Activities Model Program for Seniors Question naire , diet , and psychosocial assessment s at baseline and 2 months . Results : For 301 participants who completed the 2-month follow-up , the intervention significantly improved all PA ( p < .01 ) and moderate PA ( metabolic equivalents > 3.0 , p < .01 ) relative to controls . Baseline cluster analyses grouped participant activity patterns into three categories . At 2 months , cluster assignment differentially predicted change in calories expended in moderate , rote , sport , and lifestyle PA . Conclusions : A computer-assisted , multifaceted approach to PA demonstrated improvement after 2 months . The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Purpose The purpose of this study was to determine the frequency and effectiveness of behavioral goal choices in the self-management of diabetes and to test goal - setting theory hypotheses that self- selection and behavioral specificity of goals are key to enhancing persistence . Methods Participants with type 2 diabetes in a r and omized controlled trial ( n = 422 ) completed baseline behavioral assessment  s using a clinic-based , interactive , self-management CD-ROM that allowed them to select a behavioral goal and receive mail and telephone support for the initial 6 months of the trial followed by additional behavioral assessment s. Frequency of behavioral goal selection and 6-month behavioral data were collected . Results Approximately 49 % , 27 % , and 24 % of the participants , respectively , set goals to increase physical activity ( PA ) , reduce fat intake , or increase fruits and vegetables ( F&V ) consumed . At baseline , participants who selected PA , reduced fat consumption , or F&V were significantly , and respectively , less active , consumed more dietary fat , and ate fewer F&V regardless of demographic characteristics . Participants who selected a reduced-fat goal showed a significantly larger decrease than did those that selected PA or F&V goals . Participants who selected an F&V goal showed significant changes in F&V consumption . Participants who selected a PA goal demonstrated significant changes in days of moderate and vigorous physical activity . Conclusions When participants are provided with information on health behavior status and an option of behavioral goals for managing type 2 diabetes , they will select personally appropriate goals , result ing in significant behavioral changes over a 6-month period Background Psychoeducational programs are increasingly being delivered over the Internet . We created an Internet-based , cognitive therapy , self-help program to be used as a st and -alone intervention for mild-to-moderate depression , or as an adjunct to traditional services for more severe depression . Objective To evaluate the effectiveness of a web-based intervention program to reduce depression in a r and omized , controlled trial Methods In a private , nonprofit health maintenance organization , we mailed recruitment brochures to two population s : depressed adults ( n = 6994 ) who received traditional medical services for depression , and an age/gender matched sample of nondepressed adults ( n = 6996 ) . Participants consenting to the study were r and omized to either the experimental Web site ( n = 144 ) , or a no-access control group ( n = 155 ) . Participants in both groups were free to obtain nonexperimental , usual care services for their depression . All participants completed an on-line version of the Center for Epidemiological Studies Depression Scale ( CES-D ) at enrollment and at 4- , 8- , 16- and 32-weeks after enrollment . Mean intake scores were in the severely depressed range . 74 % of participants completed at least one follow-up assessment . Unfortunately , most intervention participants accessed the Internet site infrequently . Results We failed to find an effect for the Internet program across the entire sample . However , post-hoc , exploratory analyses revealed a modest effect among persons reporting low levels of depression at intake . Conclusions The negative results might have result ed from infrequent patient use of the Internet site , or a more seriously depressed sample than the intervention was intended to help . Future studies should focus on recruiting persons with mild to moderate levels of depression , and on increasing participant use of the Internet site Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated . Subjects aged 6 - 17 were recruited from four pediatric practice s and r and omly assigned to the computer intervention condition or to the usual-care comparison .  The main character in the game could match the subject on gender and ethnicity . Characteristics of the protagonist 's asthma were tailored to be like those of the subject . Subjects played the computer game as part of regular asthma visits . Time between pre- and post-test varied from 4 to 15.6 months ( mean , 7.6 months ) . Analysis of covariance , with pre-test scores , age , and asthma severity as covariates , found that the intervention was associated with fewer hospitalizations , better symptom scores , increased functional status , greater knowledge of asthma management , and better child self-management behavior for those in the intervention condition . Interactions with covariates were found and discussed in terms of variable efficacy of the intervention Background To date , there has been very little work investigating behaviour changes induced by interventions that are design ed to increase help seeking . The present paper examines the effects of two Internet depression websites on help seeking . Methods 414 individuals with elevated scores on a depression assessment scale were r and omly allocated to a depression information website , a cognitive-behavioural skills training website ( CBT ) or an attention control condition . Reports of help seeking for specific treatments , from specific sources and for categories of treatments were assessed . Results Relative to the control , the depression information site was associated with decreases in seeking support from friends and family , the use of music and of everyday treatments and no increase in seeking evidence based interventions . The CBT site was associated with the report of help seeking for CBT , massage and exercise . Conclusion Methods to encourage the use of evidence -based treatments need further research to determine whether the assistance sought is evidence based and whether there are unintended effects BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs 
    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: BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss Background :  Physical activity ( PA )  is important for management of diabetes , yet practical interventions that achieve sustained behavior change are rare . Purpose : The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection . Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months . Methods : Three hundred thirty-five participants were recruited from 42 primary care physicians and then r and omized to either a computer-assisted , tailored self-management intervention ( N = 174 ) or health risk appraisal with feedback control ( N = 161 ) . Primary outcome measures included the Community Healthy Activities Model Program for Seniors Question naire , diet , and psychosocial assessment s at baseline and 2 months . Results : For 301 participants who completed the 2-month follow-up , the intervention significantly improved all PA ( p < .01 ) and moderate PA ( metabolic equivalents > 3.0 , p < .01 ) relative to controls . Baseline cluster analyses grouped participant activity patterns into three categories . At 2 months , cluster assignment differentially predicted change in calories expended in moderate , rote , sport , and lifestyle PA . Conclusions : A computer-assisted , multifaceted approach to PA demonstrated improvement after 2 months . The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Purpose The purpose of this study was to determine the frequency and effectiveness of behavioral goal choices in the self-management of diabetes and to test goal - setting theory hypotheses that self- selection and behavioral specificity of goals are key to enhancing persistence . Methods Participants with type 2 diabetes in a r and omized controlled trial ( n = 422 ) completed baseline behavioral assessment  s using a clinic-based , interactive , self-management CD-ROM that allowed them to select a behavioral goal and receive mail and telephone support for the initial 6 months of the trial followed by additional behavioral assessment s. Frequency of behavioral goal selection and 6-month behavioral data were collected . Results Approximately 49 % , 27 % , and 24 % of the participants , respectively , set goals to increase physical activity ( PA ) , reduce fat intake , or increase fruits and vegetables ( F&V ) consumed . At baseline , participants who selected PA , reduced fat consumption , or F&V were significantly , and respectively , less active , consumed more dietary fat , and ate fewer F&V regardless of demographic characteristics . Participants who selected a reduced-fat goal showed a significantly larger decrease than did those that selected PA or F&V goals . Participants who selected an F&V goal showed significant changes in F&V consumption . Participants who selected a PA goal demonstrated significant changes in days of moderate and vigorous physical activity . Conclusions When participants are provided with information on health behavior status and an option of behavioral goals for managing type 2 diabetes , they will select personally appropriate goals , result ing in significant behavioral changes over a 6-month period Background Psychoeducational programs are increasingly being delivered over the Internet . We created an Internet-based , cognitive therapy , self-help program to be used as a st and -alone intervention for mild-to-moderate depression , or as an adjunct to traditional services for more severe depression . Objective To evaluate the effectiveness of a web-based intervention program to reduce depression in a r and omized , controlled trial Methods In a private , nonprofit health maintenance organization , we mailed recruitment brochures to two population s : depressed adults ( n = 6994 ) who received traditional medical services for depression , and an age/gender matched sample of nondepressed adults ( n = 6996 ) . Participants consenting to the study were r and omized to either the experimental Web site ( n = 144 ) , or a no-access control group ( n = 155 ) . Participants in both groups were free to obtain nonexperimental , usual care services for their depression . All participants completed an on-line version of the Center for Epidemiological Studies Depression Scale ( CES-D ) at enrollment and at 4- , 8- , 16- and 32-weeks after enrollment . Mean intake scores were in the severely depressed range . 74 % of participants completed at least one follow-up assessment . Unfortunately , most intervention participants accessed the Internet site infrequently . Results We failed to find an effect for the Internet program across the entire sample . However , post-hoc , exploratory analyses revealed a modest effect among persons reporting low levels of depression at intake . Conclusions The negative results might have result ed from infrequent patient use of the Internet site , or a more seriously depressed sample than the intervention was intended to help . Future studies should focus on recruiting persons with mild to moderate levels of depression , and on increasing participant use of the Internet site Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated . Subjects aged 6 - 17 were recruited from four pediatric practice s and r and omly assigned to the computer intervention condition or to the usual-care comparison .  The main character in the game could match the subject on gender and ethnicity . Characteristics of the protagonist 's asthma were tailored to be like those of the subject . Subjects played the computer game as part of regular asthma visits . Time between pre- and post-test varied from 4 to 15.6 months ( mean , 7.6 months ) . Analysis of covariance , with pre-test scores , age , and asthma severity as covariates , found that the intervention was associated with fewer hospitalizations , better symptom scores , increased functional status , greater knowledge of asthma management , and better child self-management behavior for those in the intervention condition . Interactions with covariates were found and discussed in terms of variable efficacy of the intervention Background To date , there has been very little work investigating behaviour changes induced by interventions that are design ed to increase help seeking . The present paper examines the effects of two Internet depression websites on help seeking . Methods 414 individuals with elevated scores on a depression assessment scale were r and omly allocated to a depression information website , a cognitive-behavioural skills training website ( CBT ) or an attention control condition . Reports of help seeking for specific treatments , from specific sources and for categories of treatments were assessed . Results Relative to the control , the depression information site was associated with decreases in seeking support from friends and family , the use of music and of everyday treatments and no increase in seeking evidence based interventions . The CBT site was associated with the report of help seeking for CBT , massage and exercise . Conclusion Methods to encourage the use of evidence -based treatments need further research to determine whether the assistance sought is evidence based and whether there are unintended effects BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs 
    Output:
    