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 : There are increasing opportunities for MI patients to attend lay-led , community based generic self-management programmes via self-referral . Aims : To determine the effectiveness of the Expert Patient Programme ( EPP ) for MI patients who had completed CR using a r and omised controlled , wait-list design , with a nested qualitative study . Methods : The Intervention Group attends the EPP immediately after completing the baseline assessment ; The Control Group had the opportunity to attend the EPP after completion of the 4-month follow-up .  192 MI patients ( 72 % men ) completed baseline assessment ; 162 responded at follow-up . Telephone interviews were conducted with 10 male and 9 female Intervention group participants . Results : Intention-to-treat analysis revealed no statistically significant differences between the groups although a pattern of small improvements among the Intervention Group was observed over time . Interviews revealed that Intervention Group participants viewed CR as being more about instruction whereas the EPP was viewed as being more about discussion , mutual support , and goal setting . A gender difference emerged whereby male participants valued information exchange whereas female participants expressed a preference for emotional support and social interaction within the EPP context . Conclusion : The EPP appears to hold few benefits for MI patients who have attended CR 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 Background The prevalence of obesity in men in the UK is amongst the highest in Europe but men are less likely than women to use existing weight loss programmes . Developing weight management programmes which are appealing and acceptable to men is a public health priority . Football Fans in Training ( FFIT ) , a men-only weight management programme delivered to groups of men at top professional football clubs , encourages men to lose weight by working with , not against , cultural ideals of masculinity . To inform further development of interventions in football club setting s , the current study explored who is attracted to FFIT and why overweight/obese men choose to take part . Methods A mixed- methods study analysing baseline data on 747 men aged 35–65 years with BMI ≥ 28 kg/m2 who were participants in a r and omised controlled trial of FFIT , and data from 13 focus group discussion s with 63 men who had attended the programme . Results Objective ly-measured mean body mass index was 35.3 kg/m2 ( sd 4.9 ) . Overall over 90 % of participants were at very high or extremely high risk of future ill-health . Around three-quarters of participants in all age groups were at ‘ very high ’ risk of type 2 diabetes , hypertension and cardiovascular disease ( 72 % , 73 % and 80 % of men aged 35–44 , 45–54 and 55–64 years respectively ) . A further 21 % , 16 % and 13 % were at ‘ extremely high ’ risk . Qualitative data revealed that the powerful ‘ draw ’ of the football club attracted men otherwise reluctant to attend existing weight management programmes . The location and style of delivery of early FFIT sessions fostered team spirit ; men appreciated being with others ‘ like them ’ and the opportunity to undertake weight management in circumstances that enhanced physical and symbolic proximity to something they valued highly , the football club . Conclusions The delivery of a weight management intervention via professional football clubs attracted men at high risk of ill-health . The setting enabled men to join a weight management programme in circumstances that felt ‘ right ’ rather than threatening to themselves as men . FFIT is an example of how to facilitate health promotion activities in a way that is consistent with , rather than challenging to , common ideals of masculinity BACKGROUND The prevalence of male obesity is increasing but few men take part in weight loss programmes . We assessed the effect of a weight loss and healthy living programme on weight loss in football ( soccer ) fans . METHODS We did a two-group , pragmatic , r and omised controlled trial of 747 male football fans aged 35 - 65 years with a body-mass index ( BMI ) of 28 kg/m(2 ) or higher from 13 Scottish professional football clubs . Participants were r and omly assigned with SAS ( version 9·2 , block size 2 - 9 ) in a 1:1 ratio , stratified by club , to a weight loss programme delivered by community coaching staff in 12 sessions held every week . The intervention group started a weight loss programme within 3 weeks , and the comparison group were put on a 12 month waiting list . All participants received a weight management booklet . Primary outcome was mean difference in weight loss between groups at 12 months , expressed as absolute weight and a percentage of their baseline weight . Primary outcome assessment was masked . Analyses were based on intention to treat . The trial is registered with Current Controlled Trials , number IS RCT N32677491 . FINDINGS 374 men were allocated to the intervention group and 374 to the comparison group . 333 ( 89 % ) of the intervention group and 355 ( 95 % ) of the comparison group completed 12 month assessment s. At 12 months the mean difference in weight loss between groups , adjusted for baseline weight and club , was 4·94 kg ( 95 % CI 3·95 - 5·94 ) and percentage weight loss , similarly adjusted , was 4·36 % ( 3·64 - 5·08 ) , both in favour of the intervention ( p<0·0001 ) . Eight serious adverse events were reported , five in the intervention group ( lost consciousness due to drugs for pre-existing angina , gallbladder removal , hospital admission with suspected heart attack , ruptured gut , and ruptured Achilles tendon ) and three in the comparison group ( transient ischaemic attack , and two deaths ) . Of these , two adverse events were reported as related to participation in the programme ( gallbladder removal and ruptured Achilles tendon ) . INTERPRETATION The FFIT programme can help a large proportion of men to lose a clinical ly important amount of weight ; it offers one effective strategy to challenge male obesity . FUNDING Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust . The National Institute for Health Research Public Health Research Programme funded the assessment ( 09/3010/06 ) Background The severe iatrogenic hypogonadal state induced by medical castration used for treatment of prostate cancer is associated with adverse effects including fatigue , increased fracture risk , and a decrease in skeletal muscle function , which negatively impact quality of life . We have previously reported beneficial changes in healthy lifestyle behaviors , physical function and fatigue as a result of a novel combined exercise and dietary advice intervention ( a lifestyle intervention ) in men with prostate cancer on and rogen suppression therapy ( AST ) . The aim of this research was to conduct a qualitative evaluation of the lifestyle intervention in these men with advanced prostate cancer receiving and rogen suppression therapy ( AST ) . Methods Twelve men with prostate cancer on AST took part in three focus groups in a UK higher education institution following the 12 week intervention . Sessions lasted between 45 and 60 minutes in duration . All discussion s were audio-taped and transcribed . A framework analysis approach was applied to the focus group data . An initial coding framework was developed from a priori issues listed in the topic guide and extended and refined following initial familiarization with the focus group transcripts . Line by line indexing of the transcripts was undertaken iteratively to allow for the incorporation of new codes . Coded sections of text were grouped together ( charted ) into themes and subthemes prior to a further process of comparison and interpretation . Results None of the participants involved in the trial were provided with information on how lifestyle changes might be beneficial to men with prostate cancer during the course of their st and ard medical treatment . We present novel findings that this intervention was considered beneficial for reducing anxiety around treatment and fear of disease progression . Men were supportive of the benefits of the intervention over conventional cancer survival discussion group arrangements as it facilitated peer support in addition to physical rehabilitation . Conclusions The benefits of lifestyle changes in men with prostate cancer are not well appreciated by care providers despite a range of benefits becoming apparent . Strategies to implement exercise and dietary interventions in st and ard care should be further evaluated . Trial registration Current Controlled Trials IS RCT Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation Objective : Supporting patients ’ self care could have a major effect on the management of long-term conditions , which has led to worldwide interest in effective self care interventions . In Engl and , self care support is being developed through the “ Expert Patients Programme ” , which provides lay-led generic courses to improve patients ’ self care skills . However , the clinical and cost effectiveness of such courses remains unclear . Methods : Two-arm pragmatic r and omised controlled trial design with waiting list control in community setting s in Engl and . 629 patients with a wide range of self-defined long-term conditions were studied . The lay-led self care support group involved 6-weekly sessions to teach self care skills . Primary outcomes were self-efficacy , reported energy and routine health services utilisation at 6 months . A cost-effectiveness analysis was also conducted . Results : Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up , but reported no statistically significant reductions in routine health services utilisation over the same time period . The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life , and a small reduction in costs . If a quality adjusted life year was valued at £ 20 000 ( $ 39 191 ; € 30 282 ) , there was a 70 % probability that the intervention was cost effective . Conclusions : Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions , and are likely to be cost effective over 6 months at conventional values of a decision-maker ’s willingness to pay . They may be a useful addition to current services in the management of long-term conditions Objective To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care . Design Pragmatic , two arm , cluster r and omised controlled trial . Setting General practice s , serving a population in northwest Engl and with high levels of deprivation . Participants 5599 patients with a diagnosis of diabetes ( n=2546 ) , chronic obstructive pulmonary disease ( n=1634 ) , and irritable bowel syndrome ( n=1419 ) from 43 practice s ( 19 intervention and 22 control practice s ) . Intervention Practice level training in a whole systems approach to self management support . Practice s were trained to use a range of re sources : a tool to assess the support needs of patients , guidebooks on self management , and a web based directory of local self management re sources . Training facilitators were employed by the health management organisation . Main outcome measures Primary outcomes were shared decision making , self efficacy , and generic health related quality of life measured at 12 months . Secondary outcomes were general health , social or role limitations , energy and vitality , psychological wellbeing , self care activity , and enablement . Results We r and omised 44 practice s and recruited 5599 patients , representing 43 % of the eligible population on the practice 
    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 : There are increasing opportunities for MI patients to attend lay-led , community based generic self-management programmes via self-referral . Aims : To determine the effectiveness of the Expert Patient Programme ( EPP ) for MI patients who had completed CR using a r and omised controlled , wait-list design , with a nested qualitative study . Methods : The Intervention Group attends the EPP immediately after completing the baseline assessment ; The Control Group had the opportunity to attend the EPP after completion of the 4-month follow-up .  192 MI patients ( 72 % men ) completed baseline assessment ; 162 responded at follow-up . Telephone interviews were conducted with 10 male and 9 female Intervention group participants . Results : Intention-to-treat analysis revealed no statistically significant differences between the groups although a pattern of small improvements among the Intervention Group was observed over time . Interviews revealed that Intervention Group participants viewed CR as being more about instruction whereas the EPP was viewed as being more about discussion , mutual support , and goal setting . A gender difference emerged whereby male participants valued information exchange whereas female participants expressed a preference for emotional support and social interaction within the EPP context . Conclusion : The EPP appears to hold few benefits for MI patients who have attended CR 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 Background The prevalence of obesity in men in the UK is amongst the highest in Europe but men are less likely than women to use existing weight loss programmes . Developing weight management programmes which are appealing and acceptable to men is a public health priority . Football Fans in Training ( FFIT ) , a men-only weight management programme delivered to groups of men at top professional football clubs , encourages men to lose weight by working with , not against , cultural ideals of masculinity . To inform further development of interventions in football club setting s , the current study explored who is attracted to FFIT and why overweight/obese men choose to take part . Methods A mixed- methods study analysing baseline data on 747 men aged 35–65 years with BMI ≥ 28 kg/m2 who were participants in a r and omised controlled trial of FFIT , and data from 13 focus group discussion s with 63 men who had attended the programme . Results Objective ly-measured mean body mass index was 35.3 kg/m2 ( sd 4.9 ) . Overall over 90 % of participants were at very high or extremely high risk of future ill-health . Around three-quarters of participants in all age groups were at ‘ very high ’ risk of type 2 diabetes , hypertension and cardiovascular disease ( 72 % , 73 % and 80 % of men aged 35–44 , 45–54 and 55–64 years respectively ) . A further 21 % , 16 % and 13 % were at ‘ extremely high ’ risk . Qualitative data revealed that the powerful ‘ draw ’ of the football club attracted men otherwise reluctant to attend existing weight management programmes . The location and style of delivery of early FFIT sessions fostered team spirit ; men appreciated being with others ‘ like them ’ and the opportunity to undertake weight management in circumstances that enhanced physical and symbolic proximity to something they valued highly , the football club . Conclusions The delivery of a weight management intervention via professional football clubs attracted men at high risk of ill-health . The setting enabled men to join a weight management programme in circumstances that felt ‘ right ’ rather than threatening to themselves as men . FFIT is an example of how to facilitate health promotion activities in a way that is consistent with , rather than challenging to , common ideals of masculinity BACKGROUND The prevalence of male obesity is increasing but few men take part in weight loss programmes . We assessed the effect of a weight loss and healthy living programme on weight loss in football ( soccer ) fans . METHODS We did a two-group , pragmatic , r and omised controlled trial of 747 male football fans aged 35 - 65 years with a body-mass index ( BMI ) of 28 kg/m(2 ) or higher from 13 Scottish professional football clubs . Participants were r and omly assigned with SAS ( version 9·2 , block size 2 - 9 ) in a 1:1 ratio , stratified by club , to a weight loss programme delivered by community coaching staff in 12 sessions held every week . The intervention group started a weight loss programme within 3 weeks , and the comparison group were put on a 12 month waiting list . All participants received a weight management booklet . Primary outcome was mean difference in weight loss between groups at 12 months , expressed as absolute weight and a percentage of their baseline weight . Primary outcome assessment was masked . Analyses were based on intention to treat . The trial is registered with Current Controlled Trials , number IS RCT N32677491 . FINDINGS 374 men were allocated to the intervention group and 374 to the comparison group . 333 ( 89 % ) of the intervention group and 355 ( 95 % ) of the comparison group completed 12 month assessment s. At 12 months the mean difference in weight loss between groups , adjusted for baseline weight and club , was 4·94 kg ( 95 % CI 3·95 - 5·94 ) and percentage weight loss , similarly adjusted , was 4·36 % ( 3·64 - 5·08 ) , both in favour of the intervention ( p<0·0001 ) . Eight serious adverse events were reported , five in the intervention group ( lost consciousness due to drugs for pre-existing angina , gallbladder removal , hospital admission with suspected heart attack , ruptured gut , and ruptured Achilles tendon ) and three in the comparison group ( transient ischaemic attack , and two deaths ) . Of these , two adverse events were reported as related to participation in the programme ( gallbladder removal and ruptured Achilles tendon ) . INTERPRETATION The FFIT programme can help a large proportion of men to lose a clinical ly important amount of weight ; it offers one effective strategy to challenge male obesity . FUNDING Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust . The National Institute for Health Research Public Health Research Programme funded the assessment ( 09/3010/06 ) Background The severe iatrogenic hypogonadal state induced by medical castration used for treatment of prostate cancer is associated with adverse effects including fatigue , increased fracture risk , and a decrease in skeletal muscle function , which negatively impact quality of life . We have previously reported beneficial changes in healthy lifestyle behaviors , physical function and fatigue as a result of a novel combined exercise and dietary advice intervention ( a lifestyle intervention ) in men with prostate cancer on and rogen suppression therapy ( AST ) . The aim of this research was to conduct a qualitative evaluation of the lifestyle intervention in these men with advanced prostate cancer receiving and rogen suppression therapy ( AST ) . Methods Twelve men with prostate cancer on AST took part in three focus groups in a UK higher education institution following the 12 week intervention . Sessions lasted between 45 and 60 minutes in duration . All discussion s were audio-taped and transcribed . A framework analysis approach was applied to the focus group data . An initial coding framework was developed from a priori issues listed in the topic guide and extended and refined following initial familiarization with the focus group transcripts . Line by line indexing of the transcripts was undertaken iteratively to allow for the incorporation of new codes . Coded sections of text were grouped together ( charted ) into themes and subthemes prior to a further process of comparison and interpretation . Results None of the participants involved in the trial were provided with information on how lifestyle changes might be beneficial to men with prostate cancer during the course of their st and ard medical treatment . We present novel findings that this intervention was considered beneficial for reducing anxiety around treatment and fear of disease progression . Men were supportive of the benefits of the intervention over conventional cancer survival discussion group arrangements as it facilitated peer support in addition to physical rehabilitation . Conclusions The benefits of lifestyle changes in men with prostate cancer are not well appreciated by care providers despite a range of benefits becoming apparent . Strategies to implement exercise and dietary interventions in st and ard care should be further evaluated . Trial registration Current Controlled Trials IS RCT Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation Objective : Supporting patients ’ self care could have a major effect on the management of long-term conditions , which has led to worldwide interest in effective self care interventions . In Engl and , self care support is being developed through the “ Expert Patients Programme ” , which provides lay-led generic courses to improve patients ’ self care skills . However , the clinical and cost effectiveness of such courses remains unclear . Methods : Two-arm pragmatic r and omised controlled trial design with waiting list control in community setting s in Engl and . 629 patients with a wide range of self-defined long-term conditions were studied . The lay-led self care support group involved 6-weekly sessions to teach self care skills . Primary outcomes were self-efficacy , reported energy and routine health services utilisation at 6 months . A cost-effectiveness analysis was also conducted . Results : Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up , but reported no statistically significant reductions in routine health services utilisation over the same time period . The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life , and a small reduction in costs . If a quality adjusted life year was valued at £ 20 000 ( $ 39 191 ; € 30 282 ) , there was a 70 % probability that the intervention was cost effective . Conclusions : Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions , and are likely to be cost effective over 6 months at conventional values of a decision-maker ’s willingness to pay . They may be a useful addition to current services in the management of long-term conditions Objective To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care . Design Pragmatic , two arm , cluster r and omised controlled trial . Setting General practice s , serving a population in northwest Engl and with high levels of deprivation . Participants 5599 patients with a diagnosis of diabetes ( n=2546 ) , chronic obstructive pulmonary disease ( n=1634 ) , and irritable bowel syndrome ( n=1419 ) from 43 practice s ( 19 intervention and 22 control practice s ) . Intervention Practice level training in a whole systems approach to self management support . Practice s were trained to use a range of re sources : a tool to assess the support needs of patients , guidebooks on self management , and a web based directory of local self management re sources . Training facilitators were employed by the health management organisation . Main outcome measures Primary outcomes were shared decision making , self efficacy , and generic health related quality of life measured at 12 months . Secondary outcomes were general health , social or role limitations , energy and vitality , psychological wellbeing , self care activity , and enablement . Results We r and omised 44 practice s and recruited 5599 patients , representing 43 % of the eligible population on the practice 
    Output:
    