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: With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy OBJECTIVE To compare short-term and long-term effectiveness of the Arthritis Self-Help Course ( ASHC ) and the Chronic Disease Self-Management Program ( CDSMP ) for persons with arthritis concerning health care use , health-related quality of life , health behaviors , and arthritis self-efficacy . METHODS Forty-eight workshops were r and omized to the  ASHC ( n = 26 ) or CDSMP ( n = 22 ) . A total of 416 individuals , including 365 African Americans , participated . The mean age for each group was 64 years , mean years of education was 11.7 , mean number of chronic conditions was 4 , and 75 - 80 % of participants in each group were female . Multivariate statistical tests were used to assess effectiveness within and between programs for all workshop participants and African Americans . RESULTS At 4 months all ASHC participants including African Americans , had significant improvements ( P < or= 0.05 ) in self-efficacy , stretching and strengthening exercises , aerobic exercises , and general health . All CDSMP participants had statistically significant improvements in self-efficacy , disability , pain , and general health . African American CDSMP participants showed statistically significant improvements in general health . Trends toward improvement ( P = 0.051 - 0.100 ) were shown in 5 variables among African American CDSMP participants and in 4 variables among all CDSMP participants . Statistically significant differences between the 2 programs at 4 months were seen in pain and disability in both groups . The CDSMP produced stronger results . Significant results at 1 year within and between programs were minimal for both groups . CONCLUSION When population s with arthritis and multiple comorbid conditions are targeted , the CDSMP may be most cost effective Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . A1C and body mass index were measured at baseline , 6 months , and 12 months . All other data were collected by self-administered question naires . Results At 6 months , DSMP participants did not demonstrate improvements in A1C as compared with controls . Baseline A1C was much lower than in similar trials . Participants did have significant improvements in depression , symptoms of hypoglycemia , communication with physicians , healthy eating , and reading food labels ( P < .01 ) . They also had significant improvements in patient activation and self-efficacy . At 12 months , DSMP intervention participants continued to demonstrate improvements in depression , communication with physicians , healthy eating , patient activation , and self-efficacy ( P < .01 ) . There were no significant changes in utilization measures . Conclusions These findings suggest that people with diabetes without elevated A1C can benefit from a community-based , peer-led diabetes program . Given the large number of people with diabetes and lack of low-cost diabetes education , the DSMP deserves consideration for implementation Background This study aim ed to explore if group-based peer support as an additional component to a disease management programme ( DMP ) in type 2 diabetes can reduce the number of prescribed drugs ; hospital admissions ; and length of hospital stay and therefore be a cost-effective model . Methods Controlled study based on a secondary data analysis of a cluster r and omized trial . Our study population was general practitioners and patients in the province of Salzburg . The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters . The groups exercised together , discussed diabetes related topics , and received support by professionals . Data was anonymously collected on clusters through the statutory health insurance . Results Data were available of 118 ( 82.5%,17 clusters of the patients in the original r and omized trial ) participants in the intervention and 143 ( 77.3%,19 clusters ) in the control groups .  The length of hospital stay was shorter in the intervention groups compared with controls . The mean difference during the 24-month study period was -40.13 days ( 95 % CI - 78.54 to - 1.71 , P = 0.041 ) in favour of the intervention groups . No differences were seen in the number of prescribed drugs and hospital admission . Estimated yearly savings by reducing the length of hospital stay was € 1660.60 per patient . Conclusion A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care . Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy . Limitations of most studies , however , include use of multiple outcome measures without pre design ated primary outcomes and lack of r and omized follow-up beyond 6 months . We conducted a 1-year r and omized controlled trial of Homing in on Health ( HIOH ) , a Chronic Disease Self-Management Program variant , addressing these limitations . METHODS We r and omized out patients ( N = 415 ) aged 40 years and older and who had 1 or more of 6 common chronic illnesses , plus functional impairment , to HIOH delivered in homes or by telephone for 6 weeks or to usual care . Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey‘s physical component ( PCS-36 ) and mental component ( MCS-36 ) summary scores . Secondary outcomes included the EuroQol EQ-5D and visual analog scale ( EQ VAS ) , hospitalizations , and health care expenditures . RESULTS Compared with usual care , HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks ( effect size = 0.27 ; 95 % CI , 0.10–0.43 ) and at 6 months ( 0.17 ; 95 % CI , 0.01–0.33 ) , but not at 1 year . In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome , the EQ VAS ( 1-year effect size = 0.40 ; CI , 0.14–0.66 ) . HIOH delivered by telephone had no significant effects on any outcomes . CONCLUSIONS Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies , in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization . These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program ( CDSMP ) . METHODS A r and omized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment ( waiting-list controls )  in five urban communities in Shanghai , China . Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately ; those in the control group received the same education and book six months later . FINDINGS In total , 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension , heart disease , chronic lung disease , arthritis , stroke , or diabetes who lived in communities were assigned r and omly to treatment ( n = 526 ) and control ( n = 428 ) groups . Overall , 430 ( 81.7 % ) and 349 ( 81.5 % ) patients in the treatment and control groups completed the six-month study . Patients who received treatment had significant improvements in weekly minutes of aerobic exercise , practice of cognitive symptom management , self-efficacy to manage own symptoms , and self-efficacy to manage own disease in general compared with controls . They also had significant improvements in eight indices of health status and , on average , fewer hospitalizations . CONCLUSION When implemented in Shanghai , the CDSMP was acceptable culturally to Chinese patients . The programme improved participants ' health behaviour , self-efficacy , and health status and reduced the number of hospitalizations six months after the course . The locally based delivery model was integrated into the routine of community government organizations and community health services . Chinese lay leaders taught the CDSMP courses as successfully as professionals Objective To assess the cost effectiveness of a self management programme plus education booklet for arthritis in primary care . Design Cost effectiveness and cost utility analysis from health and social care and societal perspectives alongside a r and omised controlled trial . Setting 74 general practice s in the United Kingdom . Participants 812 patients aged 50 or more with osteoarthritis of the hips or knees , or both , and pain or disability , or both . Interventions R and omisation to either six sessions of an arthritis self management programme plus an education booklet ( intervention group ) or the education booklet alone ( st and ard care control group ) . Main outcome measures Total health and social care costs and total societal costs at 12 months ; cost effectiveness ( incremental cost effectiveness ratios and cost effectiveness acceptability curves ) on basis of quality of life ( SF-36 , primary outcome measure ) , EuroQol visual analogue scale , and quality adjusted life years ( QALYs ) . Results At 12 months health and social care costs in the intervention group were £ 101 higher ( 95 % confidence interval £ 3 to £ 176 ) than those in the control group because the additional costs of the arthritis self management programme did not seem to be fully offset by savings elsewhere . There were no significant differences in societal costs ( which were up to 13 times the size of health and social care costs ) or any of the outcomes . From the health and social care perspective the intervention was dominated by the control on the basis of QALYs ( which were non-significantly lower in the intervention group ) and had incremental cost effectiveness ratios between £ 279 and £ 13 473 for the other outcomes . From the societal perspective the intervention seemed superior to the control owing to non- 
    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: With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy OBJECTIVE To compare short-term and long-term effectiveness of the Arthritis Self-Help Course ( ASHC ) and the Chronic Disease Self-Management Program ( CDSMP ) for persons with arthritis concerning health care use , health-related quality of life , health behaviors , and arthritis self-efficacy . METHODS Forty-eight workshops were r and omized to the  ASHC ( n = 26 ) or CDSMP ( n = 22 ) . A total of 416 individuals , including 365 African Americans , participated . The mean age for each group was 64 years , mean years of education was 11.7 , mean number of chronic conditions was 4 , and 75 - 80 % of participants in each group were female . Multivariate statistical tests were used to assess effectiveness within and between programs for all workshop participants and African Americans . RESULTS At 4 months all ASHC participants including African Americans , had significant improvements ( P < or= 0.05 ) in self-efficacy , stretching and strengthening exercises , aerobic exercises , and general health . All CDSMP participants had statistically significant improvements in self-efficacy , disability , pain , and general health . African American CDSMP participants showed statistically significant improvements in general health . Trends toward improvement ( P = 0.051 - 0.100 ) were shown in 5 variables among African American CDSMP participants and in 4 variables among all CDSMP participants . Statistically significant differences between the 2 programs at 4 months were seen in pain and disability in both groups . The CDSMP produced stronger results . Significant results at 1 year within and between programs were minimal for both groups . CONCLUSION When population s with arthritis and multiple comorbid conditions are targeted , the CDSMP may be most cost effective Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . A1C and body mass index were measured at baseline , 6 months , and 12 months . All other data were collected by self-administered question naires . Results At 6 months , DSMP participants did not demonstrate improvements in A1C as compared with controls . Baseline A1C was much lower than in similar trials . Participants did have significant improvements in depression , symptoms of hypoglycemia , communication with physicians , healthy eating , and reading food labels ( P < .01 ) . They also had significant improvements in patient activation and self-efficacy . At 12 months , DSMP intervention participants continued to demonstrate improvements in depression , communication with physicians , healthy eating , patient activation , and self-efficacy ( P < .01 ) . There were no significant changes in utilization measures . Conclusions These findings suggest that people with diabetes without elevated A1C can benefit from a community-based , peer-led diabetes program . Given the large number of people with diabetes and lack of low-cost diabetes education , the DSMP deserves consideration for implementation Background This study aim ed to explore if group-based peer support as an additional component to a disease management programme ( DMP ) in type 2 diabetes can reduce the number of prescribed drugs ; hospital admissions ; and length of hospital stay and therefore be a cost-effective model . Methods Controlled study based on a secondary data analysis of a cluster r and omized trial . Our study population was general practitioners and patients in the province of Salzburg . The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters . The groups exercised together , discussed diabetes related topics , and received support by professionals . Data was anonymously collected on clusters through the statutory health insurance . Results Data were available of 118 ( 82.5%,17 clusters of the patients in the original r and omized trial ) participants in the intervention and 143 ( 77.3%,19 clusters ) in the control groups .  The length of hospital stay was shorter in the intervention groups compared with controls . The mean difference during the 24-month study period was -40.13 days ( 95 % CI - 78.54 to - 1.71 , P = 0.041 ) in favour of the intervention groups . No differences were seen in the number of prescribed drugs and hospital admission . Estimated yearly savings by reducing the length of hospital stay was € 1660.60 per patient . Conclusion A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care . Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy . Limitations of most studies , however , include use of multiple outcome measures without pre design ated primary outcomes and lack of r and omized follow-up beyond 6 months . We conducted a 1-year r and omized controlled trial of Homing in on Health ( HIOH ) , a Chronic Disease Self-Management Program variant , addressing these limitations . METHODS We r and omized out patients ( N = 415 ) aged 40 years and older and who had 1 or more of 6 common chronic illnesses , plus functional impairment , to HIOH delivered in homes or by telephone for 6 weeks or to usual care . Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey‘s physical component ( PCS-36 ) and mental component ( MCS-36 ) summary scores . Secondary outcomes included the EuroQol EQ-5D and visual analog scale ( EQ VAS ) , hospitalizations , and health care expenditures . RESULTS Compared with usual care , HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks ( effect size = 0.27 ; 95 % CI , 0.10–0.43 ) and at 6 months ( 0.17 ; 95 % CI , 0.01–0.33 ) , but not at 1 year . In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome , the EQ VAS ( 1-year effect size = 0.40 ; CI , 0.14–0.66 ) . HIOH delivered by telephone had no significant effects on any outcomes . CONCLUSIONS Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies , in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization . These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program ( CDSMP ) . METHODS A r and omized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment ( waiting-list controls )  in five urban communities in Shanghai , China . Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately ; those in the control group received the same education and book six months later . FINDINGS In total , 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension , heart disease , chronic lung disease , arthritis , stroke , or diabetes who lived in communities were assigned r and omly to treatment ( n = 526 ) and control ( n = 428 ) groups . Overall , 430 ( 81.7 % ) and 349 ( 81.5 % ) patients in the treatment and control groups completed the six-month study . Patients who received treatment had significant improvements in weekly minutes of aerobic exercise , practice of cognitive symptom management , self-efficacy to manage own symptoms , and self-efficacy to manage own disease in general compared with controls . They also had significant improvements in eight indices of health status and , on average , fewer hospitalizations . CONCLUSION When implemented in Shanghai , the CDSMP was acceptable culturally to Chinese patients . The programme improved participants ' health behaviour , self-efficacy , and health status and reduced the number of hospitalizations six months after the course . The locally based delivery model was integrated into the routine of community government organizations and community health services . Chinese lay leaders taught the CDSMP courses as successfully as professionals Objective To assess the cost effectiveness of a self management programme plus education booklet for arthritis in primary care . Design Cost effectiveness and cost utility analysis from health and social care and societal perspectives alongside a r and omised controlled trial . Setting 74 general practice s in the United Kingdom . Participants 812 patients aged 50 or more with osteoarthritis of the hips or knees , or both , and pain or disability , or both . Interventions R and omisation to either six sessions of an arthritis self management programme plus an education booklet ( intervention group ) or the education booklet alone ( st and ard care control group ) . Main outcome measures Total health and social care costs and total societal costs at 12 months ; cost effectiveness ( incremental cost effectiveness ratios and cost effectiveness acceptability curves ) on basis of quality of life ( SF-36 , primary outcome measure ) , EuroQol visual analogue scale , and quality adjusted life years ( QALYs ) . Results At 12 months health and social care costs in the intervention group were £ 101 higher ( 95 % confidence interval £ 3 to £ 176 ) than those in the control group because the additional costs of the arthritis self management programme did not seem to be fully offset by savings elsewhere . There were no significant differences in societal costs ( which were up to 13 times the size of health and social care costs ) or any of the outcomes . From the health and social care perspective the intervention was dominated by the control on the basis of QALYs ( which were non-significantly lower in the intervention group ) and had incremental cost effectiveness ratios between £ 279 and £ 13 473 for the other outcomes . From the societal perspective the intervention seemed superior to the control owing to non- 
    Output:
    