***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: In a r and omized trial of a behavioral intervention among substance-using men who have sex with men , aim ed at reducing sexual risk behavior , Mansergh and colleagues fail to find evidence of a reduction in risk from the intervention Following a r and omized trial of case manager delivered HIV prevention intervention to persons with severe mental illness ( SMI ) , this study sought to document changes within the service environment and with case managers themselves as a result of their experience and skills training . Utilizing qualitative methods , research ers conducted focus groups and in-depth interviews with 22 case managers and 3 administrators at an urban community mental health center . Beyond confirming previously established barriers to case manager delivery of HIV prevention interventions for persons with SMI , most noteworthy was the finding that case managers were generally unskilled in conducting assessment s and tended to focus on “ spoiled identity ” and illness parts of their consumers . Experimental case managers revealed that they had been transformed by the training experience in a manner permitting them to both underst and and work from a recovery model . Implication s and directions for further study are discussed Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged Among severely mentally ill ( SMI ) substance abusers , HIV rates are elevated and HIV risk reduction interventions have been shown to be less effective . An enhanced cognitive behavioral HIV risk reduction intervention ( E-CB ) for SMI was compared to a health promotion condition ( HPC ) in 222 psychiatric out patients at 6 months postintervention . Compared to females , males in the E-CB improved on intention to practice safer sex and in condom use skills and in unprotected vaginal sex , but did not differ in HIV knowledge , perceived susceptibility , anxiety , condom attitudes , safer sex self-efficacy , unprotected vaginal sex acts , or sex partners . Across intervention groups , there were improvements in all areas except self-efficacy and number of partners . Risk reduction among SMI may be facilitated by increasing awareness of health related behaviors and HIV-targeted content . However , meaningful changes in critical risk reduction skills and intentions may require a more focused intervention and may vary by gender This paper describes a 10-session behavioral intervention introducing female-initiated methods of human immunodeficiency virus ( HIV ) prevention to reduce vulnerability to HIV infection for women with severe mental illness . In a pilot test of the intervention , 35 women were r and omly placed in the experimental intervention group or an HIV education control .  Subjective norms , intentions to use , perceived efficacy , and attitudes toward the male condom , female condom , and a microbicide  were assessed at baseline , postintervention , and 6-week follow-up . The participants in the treatment group reported a significantly more positive attitude toward the use of female condoms ( t = −2.12 , P < .05 ) at 6-week follow-up . Providing women with severe mental illness with choices o f protective methods and the knowledge and skills to ensure proper use are among the many crucial ingredients in prevention of acquired immunodeficiency syndrome OBJECTIVE Research shows that many chronic psychiatric patients are at risk for infection by the human immunodeficiency virus ( HIV ) . This study investigated the effects of a behavioral skills training program design ed to prevent HIV infection among chronic mentally ill adults living in an inner-city area . METHODS Twenty-seven men and 25 women were r and omly assigned either to a four-session AIDS prevention program emphasizing risk education , sexual assertiveness , condom use , risk-related behavioral self-management , and problem-solving skills or to a waiting-list group , who later received the same intervention . RESULTS Compared with the waiting-list control group , participants in the prevention program demonstrated significant gains in AIDS-related knowledge and intentions to change risk behaviors . The prevention program also significantly reduced rates of unprotected sexual intercourse and increased the use of condoms over a one-month follow-up period . A subset of participants who provided two-month follow-up data maintained some behavior changes . CONCLUSIONS A relatively brief , skills-focused AIDS prevention program for chronic psychiatric patients produced reductions in HIV risk behaviors . Such HIV risk reduction intervention programs may be of use in inpatient , outpatient , and community-based setting Abstract Objective To evaluate the effectiveness of a service for early psychosis . Design R and omised controlled clinical trial . Setting Community mental health teams in one London borough . Participants 144 people aged 16 - 40 years presenting to mental health services for the first or second time with non-organic , non-affective psychosis . Interventions Assertive outreach with evidence based biopsychosocial interventions ( specialised care group ) and st and ard care ( control group ) delivered by community mental health teams . Primary outcome measures Rates of relapse and readmission to hospital . Results Compared with patients in the st and ard care group , those in the specialised care group were less likely to relapse ( odds ratio 0.46 , 95 % confidence interval 0.22 to 0.97 ) , were readmitted fewer times ( β 0.39 , 0.10 to 0.68 ) , and were less likely to drop out of the study ( odds ratio 0.35 , 0.15 to 0.81 ) . When rates were adjusted for sex , previous psychotic episode , and ethnicity , the difference in relapse was no longer significant ( odds ratio 0.55 , 0.24 to 1.26 ) ; only total number of readmissions ( β 0.36 , 0.04 to 0.66 ) and dropout rates ( β 0.28 , 0.12 to 0.73 ) remained significant . Conclusions Limited evidence shows that a team delivering specialised care for patients with early psychosis is superior to st and ard care for maintaining contact with professionals and for reducing readmissions to hospital . No firm conclusions can , however , be drawn owing to the modest sample size BACKGROUND The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention ; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn . In this r and omized clinical trial , we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness . METHODS Men were recruited from a psychiatric program in a homeless shelter . Of 116 eligible men , 97 ( 83.6 % ) participated . Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder . Participants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months . The 59 participants sexually active before the trial were the main target of the intervention . Sexual risk behavior was the primary outcome . RESULTS Among the 59 sexually active men , follow-up data were obtained on 59 ( 100 % ) for the initial 6-month follow-up and on 56 ( 95 % ) for the remainder of the 18-month follow-up . The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group ( 1.0 vs 3.1 ; P=.01 ) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up . CONCLUSIONS This intervention successfully reduced sexual risk behaviors of homeless men with mental illness . The effect diminished over 18 months but did not disappear . Similar approaches may be effective in other impaired high-risk groups Background The serious mental illness Health Improvement Profile [ HIP ] is a brief pragmatic tool , which enables mental health nurses to work together with patients to screen physical health and take evidence -based action when variables are identified to be at risk . Piloting has demonstrated clinical utility and acceptability . Methods / Design A single blind parallel group cluster r and omised controlled trial with secondary economic analysis and process observation . Unit of r and omisation : mental health nurses [ MHNs ] working in adult community mental health teams across two NHS Trusts . Subjects : Patients over 18 years with a diagnosis of schizophrenia , schizoaffective or bipolar disorder on the caseload of participating MHNs . Primary objective : To determine the effects of the HIP programme on patients ' physical wellbeing assessed by the physical component score of the Medical Outcome Study ( MOS ) 36 Item Short Form Health Survey version 2 [ SF-36v2 ] . Secondary objectives : To determine the effects of the HIP programme on : cost effectiveness , mental wellbeing , cardiovascular risk , physical health care attitudes and knowledge of MHNs and to determine the acceptability of the HIP Programme  in the NHS . Consented nurses ( and patients ) will be r and omised to receive the HIP Programme or treatment as usual . Outcomes will be measured at baseline and 12 months with a process observation after 12 months to include evaluation of patients ' and professionals ' experience and observation of any effect on care plans and primary - secondary care interface communication . Outcomes will be analysed on an intention-to-treat ( ITT ) basis . Discussion The results of the trial and process observation will provide information about the effectiveness of the HIP Programme in supporting MHNs to address physical comorbidity in serious mental illness . Given the current unacceptable prevalence of physical comorbidity and mortality in the serious mental illness population , it is hoped the HIP trial will provide a timely contribution to evidence on organisation and delivery of care for patients , clinicians and policy makers . Trial Registration IS RCT N : IS RCT Research indicates that people with serious mental illnesses ( SMI ; e.g. , schizophrenia , schizoaffective disorder , bipolar disorder ) are at enhanced risk for infection with the human immunodeficiency virus ( HIV ) . To decrease this risk , we piloted a six-session HIV-risk reduction intervention for two single-gender groups ( nine women , eight men ; M age = 39.8 years ) of SMI out patients . The intervention and assessment were based on the  Information-Motivation-Behavioral Skills model of HIV-preventive behavior ( Fisher & Fisher , 1992 , Psychological Bulletin , 111 , 455 - 474 ) and employed activities design ed specifically for people with a SMI . Data were collected at pre- and post- interventions and at a one-month follow-up . Results indicated that this brief intervention result ed in enhanced HIV-related knowledge , and trends toward enhanced skill at condom use negotiation and condom use self-efficacy . Overall , a modest decrease in risk behavior among participants was observed . Thus , this pilot investigation revealed that HIV-related risk of the SMI can be reduced through traditional behavioral skills and education methods . Future research employing control groups , more intensive interventions , and baseline screening for high risk is encouraged OBJECTIVES The study evaluated the relative impact of HIV risk reduction interventions for adults with severe mental illness living in the inner city . METHODS A total of 104 chronically mentally ill men and women were interviewed to determine sexual risk behavior over the past month and to assess HIV risk-related psychological characteristics , including their knowledge about risk behavior , their belief in their ability to change their behavior , their perceptions of peer and social norms about safer sex , their expectancies about the outcomes of these changes , and their perceived barriers to condom use . Participants were then r and omly assigned to one of three conditions : a single AIDS education session , a seven-session cognitive-behavioral HIV risk reduction group intervention , or a seven-session group intervention that combined the cognitive-behavioral intervention with training to act as a risk reduction advocate to friends ( advocacy training ) . Individuals were reinter 
    Output:
    
Owing to the large between- study variability ( especially in the population s , interventions , comparators and reported outcomes ) and mixed results , there is insufficient evidence to fully support or reject the identified sexual health interventions for people with SMI .