***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT BACKGROUND Food insecurity— lack of dependable access to adequate food — may play a role in poor diabetes control . OBJECTIVE We aim ed to determine the relationship between food security status and depression , diabetes distress , medication adherence and glycemic control . DESIGN Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes , a r and omized controlled trial that enrolled patients from November 2011 to October 2013 . PARTICIPANTS Participants had poorly controlled type 2 diabetes ( A1c ≥ 8.0 % on eligibility screen ) , household income < 250 % of the federal poverty level , were 30–70 years old , and were recruited from a large public hospital , a VA medical center and a community-health center in King County , Washington . MAIN MEASURES We measured food insecurity determined by the Department of Agriculture ’s 6-Item Food Security Module . Depression , diabetes distress and medication adherence measured by PHQ-8 , Diabetes Distress Scale and Morisky Medication Adherence Scale , respectively . Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool . Incidence of hypoglycemic episodes was by patient report . Glycemic control was assessed with glycosylated hemoglobin ( A1c ) values from fingerstick blood sample .KEY RESULTS The prevalence of food insecurity was 47.4 % . Chi-square tests revealed participants with food insecurity were more likely to be depressed ( 40.7 % vs. 15.4 % , p < 0.001 ) , report diabetes distress ( 55.2 % vs. 33.8 % , p < 0.001 ) and have low medication adherence ( 52.9 % vs. 37.2 % , p = 0.02 ) . Based on linear regression modeling , those with food insecurity had significantly higher mean A1c levels ( β = 0.51 ; p = 0.02 ) after adjusting for sex , age , race/ethnicity , language , education , marital status , BMI , insulin use , depression , diabetes distress and low medication adherence . CONCLUSIONS Almost half of participants had food insecurity . Food insecurity was associated with depression , diabetes distress , low medication adherence and worse glycemic control . Even with adjustment , people with food insecurity had higher mean A1c levels than their food-secure counterparts , suggesting there may be other mediating factors , such as diet , that explain the relationship between food security status and diabetes control This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer The prevalence of household food security , which reflects adequacy and stability of the food supply , has been measured periodically in the United States and occasionally in high-risk groups or specific regions . Despite a plausible biological mechanism to suggest negative health outcomes of food insecurity , this relation has not been adequately evaluated . This study was conducted in the Lower Mississippi Delta region to examine the association between household food insecurity and self-reported health status in adults . A two-stage stratified cluster sample representative of the population in 36 counties in the Delta region of Arkansas , Louisiana , and Mississippi was selected using list-assisted r and om digit dialing telephone methodology . After households were selected and screened , a r and omly selected adult was interviewed within each sample d household . Data were collected to measure food security status and self-reported mental , physical , and general health status , using the U.S. Food Security Survey Module and the Short Form 12-item Health Survey ( SF-12 ) . Data were reported on a sample of 1488 households . Adults in food-insecure households were significantly more likely to rate their health as poor/fair and scored significantly lower on the physical and mental health scales of the SF-12 . In regression models controlling for income , gender , and ethnicity , the interaction between food insecurity status and race was a significant predictor of fair/poor health and lower scores on physical and mental health . Household food insecurity is associated with poorer self-reported health status of adults in this rural , high-risk sample in the Lower Mississippi Delta Household food insecurity has been associated with several negative health outcomes , yet little is known about the prevalence and correlates of household food insecurity during pregnancy . This study was conducted as part of the Pregnancy , Infection , and Nutrition prospect i ve cohort study to identify risk factors of preterm birth . The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes < or= 400 % of poverty . Descriptive statistics and logistic regression were used to identify socioeconomic , demographic , and psychosocial predictors of household food insecurity . Among 606 pregnant women , 75 % were from fully food-secure , 15 % from marginally food-secure , and 10 % from food-insecure households . Women from marginally food-secure and food-insecure households had significantly less income , less education , and were older than women from fully food-secure households . In bivariate analysis , all psychosocial factors were significantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity . Socioeconomic and demographic predictors for household food insecurity were income , black race , and age . After controlling for socioeconomic and demographic variables , psychosocial indicators of perceived stress , trait anxiety , and depressive symptoms , and a locus of control attributed to chance were positively associated with any household food insecurity . Conversely , self-esteem and mastery were inversely associated with any household food insecurity . Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women ; however , the direction of causation between psychosocial indicators and food insecurity can not be determined in these data We assessed the role of  promotoras — briefly trained community health workers — in depression care at community health centers . The intervention focused on four context ual sources of depression in underserved , low-income communities : underemployment , inadequate housing , food insecurity , and violence . A multi- method design included quantitative and ethnographic techniques to study predictors of depression and the intervention ’s impact . After a structured training program , primary care practitioners ( PCPs ) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and /or arranged consultations by mental health professionals and promotoras addressed the context ual sources of depression . Based on an intake interview with 464 r and omly recruited patients , 120 patients with depression were r and omized to  enhanced care plus the promotora context ual intervention , or to enhanced care alone . All four context ual problems emerged as strong predictors of depression ( chi square , p < .05 ) ; logistic regression revealed housing and food insecurity as the most important predictors ( odds ratios both 2.40 , p < .05 ) . Unexpected challenges arose in the intervention ’s implementation , involving infrastructure at the health centers , boundaries of the promotoras ’ roles , and “ turf ” issues with medical assistants . In the quantitative assessment , the intervention did not lead to statistically significant improvements in depression ( odds ratio 4.33 , confidence interval overlapping 1 ) . Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders , including patients , promotoras , PCPs , non-professional staff workers , administrators , and community advisory board members . Due to continuing unmet mental health needs , we favor further assessment of innovative roles for community health workers SUMMARY Poor women with children are disproportionately represented among the food insufficient . Recent research has linked food insufficiency with dietary deficiencies , but further research linking this problem to health and mental health problems is needed to inform health and social policy . We analyzed the relationship between food insufficiency and physical and mental health in a r and om sample of 724 single women who were welfare recipients in February , 1997 . Food insufficiency was significantly associated with poor or fair self-rated health and physical limitations , and with respondents ' meeting DSM-III-R criteria for recent major depression . Although the cross-sectional design of this study precludes causal inference , these findings add to a growing body of evidence that food insufficiency is associated with serious adverse physical and mental health consequences Background Observational studies have linked work – family issues with cigarette consumption . This study examined the 6-month effects on cigarette consumption of a work – family supportive organisational intervention among nursing home workers . Methods Group r and omised controlled trial where 30 nursing homes across New Engl and states were r and omly assigned to either usual practice or to a 4-month intervention aim ed at reducing work – family conflict via increased schedule control and family supportive supervisory behaviours ( FSSB ) . Cigarette consumption was based on self-reported number of cigarettes per week , measured at the individual level . Results A total of 1524 direct-care workers were enrolled in the trial .  Cigarette consumption was prevalent in 30 % of the sample , consuming an average of 77 cigarettes/week . Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes , while no reduction was observed among smokers at usual practice sites ( b=−7.12 , 95 % CI −13.83 to −0.40 , p<0.05 ) ( d=−0.15 ) . The majority of smokers were US-born White nursing assistants , and among this subgroup , the reduction in cigarette consumption was stronger ( b=−12.77 , 95 % CI −22.31 to −3.22 , p<0.05 ) ( d=−0.27 ) . Although the intervention prevented a decline in FSSB ( d=0.08 ) , effects on cigarette consumption were not mediated by FSSB . Conclusions Cigarette consumption was reduced among smokers at organisations where a work – family supportive intervention was implemented . This effect , however , was not explained by specific targets of the intervention , but other psychosocial pathways related to the work – family interface . Trial registration number NCT02050204 ; results PURPOSE Food insecurity is defined as being uncertain of having enough food due to insufficient money or other re sources . The purpose of this study was to examine the construct and correlates of food insecurity in a sample of cancer patients in Kentucky . PATIENTS AND METHODS Data were collected in the waiting rooms of the chemotherapy , hematology/oncology , and gynecology/oncology clinics of a university cancer center , and included 115 cancer patients actively receiving treatment ( mean age , 55.85 years ; range , 23 to 88 years ) who completed a series of st and ardized measures to assess food insecurity status and psychological and nutritional well-being  . Descriptive statistics and independent sample s t tests were used to assess the prevalence of food insecurity in the sample , and to identify differences between the persons who were food insecure and food secure . RESULTS The prevalence rates of food insecurity and food insecurity with hunger in the sample were 17.4 % and 7.8 % , respectively , which are higher than in the general population . Food-insecure patients had statistically significant higher levels of nutritional risk , depression , and financial strain , and lower quality of life compared with food secure patients . Fifty-five percent of food insecure patients reported not taking a prescribed medication because they could not afford it , versus 12.8 % of food-secure patients ( P = .002 ) . CONCLUSION Food insecurity may be an important consideration for clinical oncology practice , especially when caring for individuals of lower socioeconomic status . Further study is warranted , including prospect i ve studies of cancer patients to identify causal relationships among food insecurity , cancer incidence , cancer treatments , and patient outcomes and well-being BACKGROUND AND OBJECTIVE Publication bias and other sample size effects are issues for meta-analyses of test accuracy , as for r and omized trials . We investigate limitations of st and ard funnel plots and tests when applied to meta-analyses of test accuracy and look for improved methods . METHODS Type I and type II error rates for existing and alternative tests of sample size effects were estimated and compared in simulated meta-analyses of test accuracy . RESULTS Type I error rates for the Begg , Egger , and Macaskill tests are inflated for typical diagnostic odds ratios ( DOR ) , when disease prevalence differs from 50 % and when thresholds favor sensitivity over specificity or vice versa . Regression and correlation tests based on functions of effective sample size are valid , if occasionally conservative , tests for sample size effects . Empirical evidence suggests that they have adequate power to be useful tests . When DORs are heterogeneous , however , all tests of funnel plot asymmetry have low power . CONCLUSION Existing tests that use st and ard errors of odds ratios are likely to be seriously misleading if applied to meta-analyses of test accuracy . The effective sample size funnel plot and associated regression test of asymmetry should be used to detect publication bias and other sample size related effects Introduction : Approximately , 15 % of HIV-infected individuals have comorbid diabetes . Studies suggest that HIV and di 
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The highest risks were found for depression and anxiety which had statistically similar values .
The results were robust to covariates and population groups .