***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 By 2025 , it is estimated that approximately 1.8 million Australian adults ( approximately 8.4 % of the adult population ) will have diabetes , with the majority having type 2 diabetes . Weight management via improved physical activity and diet is the cornerstone of type 2 diabetes management . However , the majority of weight loss trials in diabetes have evaluated short-term , intensive clinic-based interventions that , while producing short-term outcomes , have failed to address issues of maintenance and broad population reach . Telephone-delivered interventions have the potential to address these gaps . Methods / Design Using a two-arm r and omised controlled design , this study will evaluate an 18-month , telephone-delivered , behavioural weight loss intervention focussing on physical activity , diet and behavioural therapy , versus usual care , with follow-up at 24 months . Three-hundred adult participants , aged 20 - 75 years , with type 2 diabetes , will be recruited from 10 general practice s via electronic medical records search . The Social-Cognitive Theory driven intervention involves a six-month intensive phase ( 4 weekly calls and 11 fortnightly calls ) and a 12-month maintenance phase ( one call per month ) . Primary outcomes , assessed at 6 , 18 and 24 months , are : weight loss , physical activity , and glycaemic control ( HbA1c ) , with weight loss and physical activity also measured at 12 months . Incremental cost-effectiveness will also be examined . Study recruitment began in February 2009 , with final data collection expected by February 2013 . Discussion This is the first study to evaluate the telephone as the primary method of delivering a behavioural weight loss intervention in type 2 diabetes . The evaluation of maintenance outcomes ( 6 months following the end of intervention ) , the use of accelerometers to objective ly measure physical activity , and the inclusion of a cost-effectiveness analysis will advance the science of broad reach approaches to weight control and health behaviour change , and will build the evidence base needed to advocate for the translation of this work into population health practice .Trial Registration Background Patients with depression use more health services than patients without depression . However , when depression symptoms respond to treatment , use of health services declines . Most depression quality improvement studies increase total cost in the short run , which if unevenly distributed across stakeholders , could compromise buy-in and sustainability . The objective of this budget impact analysis was to examine patterns of utilization and cost associated with telemedicine-based collaborative care , an intervention that targets patients treated in small rural primary care clinics . Methods Patients with depression were recruited from VA Community-based Outpatient Clinics , and 395 patients were enrolled and r and omized to telemedicine-based collaborative care or usual care . Dependent variables representing utilization and cost were collected from administrative data . Independent variables representing clinical casemix were collected from self-report at baseline . Results There were no significant group differences in the total number or cost of primary care encounters . However , as intended , patients in the intervention group had significantly greater depression-related primary care encounters ( marginal effect=0.34 , P=0.004 ) and cost ( marginal effect=$61.4 , P=0.013 ) to adjust antidepressant therapy for nonresponders . There were no significant group differences in total mental health encounters or cost . However , as intended , the intervention group had significantly higher depression-related mental health costs ( marginal effect=$107.55 , P=0.03 ) due to referrals of treatment-resistant patients . Unexpectedly , patients in the intervention group had significantly greater specialty physical health encounters ( marginal effect = 0.42 , P=0.001 ) and cost ( marginal effect = $ 490.6 , P=0.003 ) , but not depression-related encounters or cost . Overall , intervention patients had a significantly greater total outpatient cost compared with usual care ( marginal effect=$599.28 , P=0.012 ) . Conclusions Results suggest that telemedicine-based collaborative care does not increase total workload for primary care or mental health providers . Thus , there is no disincentive for mental health providers to offer telemedicine-based collaborative care or for primary care providers to refer patients to telemedicine-based collaborative care Background Intensive lifestyle intervention trials in type 2 diabetes contribute evidence on what can be achieved under optimal conditions , but are less informative for translation in applied setting s. Purpose Living Well with Diabetes is a telephone-delivered weight loss intervention design ed for real-world delivery . Methods This study is a r and omized controlled trial of telephone counseling  ( n = 151 ) versus  usual care ( n = 151 ) ; 6-month primary outcomes of weight , physical activity , HbA1c ; secondary diet outcomes ; analysis was by adjusted generalized linear models . Results Relative to usual care , telephone counseling participants had small but significantly better weight loss [ −1.12 % of initial body weight ; 95 % confidence interval ( CI ) −1.92 , −0.33 % ] ; physical activity [ relative rate ( RR ) = 1.30 ; 95 % CI , 1.08 , 1.57 ] ; energy intake reduction ( −0.63 MJ/day ; 95 % CI , −1.01 , −0.25 ) ; and diet quality ( 3.72 points ; 95 % CI , 1.77 , 5.68 ) , with no intervention effect for HbA1c ( RR = 0.99 ; 95 % CI , 0.96 , 1.01 ) . Conclusions Results are discussed in light of challenges to intervention delivery Background Until a few years ago , Web-based computer-tailored interventions were almost exclusively delivered via computer ( eHealth ) . However , nowadays , interventions delivered via mobile phones ( mHealth ) are an interesting alternative for health promotion , as they may more easily reach people 24/7 . Objective The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group . The second aim was to assess potential differences in use and appreciation between the 2 versions . Methods We collected data among 373 Dutch adults at 5 points in time ( baseline , after 1 week , after 2 weeks , after 3 weeks , and after 6 months ) . We recruited participants from a Dutch online research panel and r and omly assigned them to 1 of 3 conditions : eHealth ( n=138 ) , mHealth ( n=108 ) , or control condition ( n=127 ) . All participants were asked to complete question naires at the 5 points in time . Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity . Furthermore , they received personal feedback aim ed at increasing their amount of physical activity when needed . We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy , use , and appreciation . Results Participants receiving feedback messages ( eHealth and mHealth together ) were significantly more physically active after 6 months than participants in the control group ( B=8.48 , df=2 , P=.03 , Cohen d=0.27 ) . We found a small effect size favoring the eHealth condition over the control group ( B=6.13 , df=2 , P=.09 , Cohen d=0.21 ) . The eHealth condition had lower dropout rates ( 117/138 , 84.8 % ) than the mHealth condition ( 81/108 , 75.0 % ) and the control group ( 91/127 , 71.7 % ) . Furthermore , in terms of usability and appreciation , the eHealth condition outperformed the mHealth condition with regard to participants receiving ( t182=3.07 , P=.002 ) and reading the feedback messages ( t181=2.34 , P=.02 ) , as well as the clarity of the messages ( t181=1.99 , P=.049 ) . Conclusions We tested 2 Web-based computer-tailored physical activity intervention versions ( mHealth and eHealth ) against a control condition with regard to efficacy , use , usability , and appreciation . The overall effect was mainly caused by the more effective eHealth intervention . The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation . More research is needed to assess how both methods can complement each other . Trial Registration Netherl and s Trial Register : NTR4503 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=4503 ( Archived by WebCite at http://www.webcitation.org/6lEi1x40s OBJECTIVE The authors examined racial differences in response rates to an intervention involving collaborative care and usual care among 360 veterans treated for depression at Department of Veterans Affairs community-based primary care clinics . METHODS Individuals who screened positive for depression were assigned r and omly to usual care ( N=200 ) or to  a collaborative care intervention ( N=160 ) that provided phone contact when necessary with a registered nurse and clinical pharmacist to address issues related to compliance with medication and side effect management as well as supervision by a psychiatrist through video chats with the collaborative care team . Data about patients ' characteristics , treatment history , and response to treatment were collected by telephone at baseline and after six months . RESULTS Seventy-five percent ( N=272 ) of the veterans were Caucasian , and 25 % ( N=88 ) belonged to a minority group , including 18 % ( N=64 ) who were African American , 3 % ( N=11 ) who were Native American , and 3.6 % ( N=13 ) who were of other minority groups . There were no significant differences between response rates between the Caucasian and minority group to usual care ( 18 % and 8 % , respectively ) , but the minority group had a higher response rate ( 42 % ) than Caucasians ( 19 % ) to the intervention ( χ²=8.2 , df=1 , p=.004 ) . Regression analysis indicated that the interaction of minority group status by intervention significantly predicted response ( odds ratio [OR]=6.2 , 95 % confidence interval [CI]=1.6 - 24.5 , p=.009 ) , even after adjustment for other factors associated with minority status ( OR=6.0 , 95 % CI=1.5 - 24.3 , p=.01 ) . CONCLUSIONS Racial disparities in depression care may be ameliorated through collaborative care programs The objective of this study was to determine the effectiveness of a telephone-facilitated depression care protocol in older , medically ill adults compared to routine care . A 12-week double blind r and omized controlled trial was conducted in recently discharged primary care patients ( N = 124 ) . Depression was assessed with the Patient Health Question naire-9 . Primary care providers were notified of the level of depression severity and indications for treatment , but neither they nor the patients were contacted by a psychiatrist or other mental health professional . The primary outcome was initiation of treatment . Secondary outcomes were symptoms reduction and depression remission rates . There were no significant outcome differences between the facilitated and routine care groups . This study showed that older , medically ill adults may require a level of depression care that goes beyond a telephone-facilitated protocol BACKGROUND The feasibility and acceptability of telepsychiatry for low-income Hispanic patients with major depression were assessed . SUBJECTS AND METHODS In total , 167 adult Hispanic patients with major depression recruited from a community health center ( CHC ) were r and omly assigned to receive psychiatry services through a video Webcam ( WEB ) ( n=80 ) or to treatment as usual ( TAU ) ( n=87 ) . The WEB condition consisted of monthly telepsychiatry sessions at the CHC for 6 months provided by one of two Hispanic psychiatrists using an online virtual meeting program . TAU patients received their care from their providers . Acceptability was assessed by comparing appointment keeping for primary care versus telepsychiatry , patients ' perceived working alliance with their provider , visit satisfaction , and antidepressant use . Feasibility was assessed using depression outcomes , functional days ( unproductive or days lost ) , and whether WEB and TAU patients differed in their appointment keeping . RESULTS WEB patients did not differ in the proportion of completed primary care versus telepsychiatry appointments and rated their working alliance with the psychiatrist and their visit satisfaction significantly higher than the TAU patients with their provider . Significantly more WEB than TAU patients used antidepressants . Although depression severity decreased faster among WEB than TAU patients , no differences were found in the overall depression score . WEB and TAU patients did not differ in the number of days that were lost or unproductive due to depression . Although WEB and TAU patients reported being willing to pay for mental health services provided by the CHC , almost proportionately twice as many WEB patients were willing to pay for telepsychiatry . CONCLUSIONS Results show that for low-income depressed Hispanic patients , telepsychiatry service for depression is acceptable , although its feasibility is question able . The benefits of telemedicine were discussed in terms of improving patient care in ways other than directly providing services to the patients OBJECTIVE This pilot study tested the effectiveness of culturally tailored , telephone-based cognitive-behavioral therapy ( CBT ) for improving depression outcomes among Latino primary care patients living in rural setting s. METHODS A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were r and omly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community . Blinded study assistants assessed depression symptom severity , using the Hopkins Symptom Checklist ( SCL ) depression items and the Patient Health Question naire-9 , and patient satisfaction after six weeks , 
    Output:
    
The data provided limited insight into the mechanisms underpinning these interventions , most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring , education and support and goal setting .
Patients were relatively passive in the interaction , and the level of patient response attributed to their intrinsic level of motivation .
Apart from intrinsic motivation , health literacy may also influence the reaction of vulnerable groups to technology .
Social persuasion was the main way interventions sought to achieve better self-management .
Efforts to engage patients by healthcare providers were lower than expected .