***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 AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review IMPORTANCE Few weight loss treatments produce clinical ly meaningful weight loss outcomes among black women , particularly in the primary care setting . New weight management strategies are necessary for this population . Weight gain prevention might be an effective treatment option , with particular benefits for overweight and class 1 obese black women . OBJECTIVE To compare changes in weight and cardiometabolic risk during a 12-month period among black women r and omized to a primary care-based behavioral weight gain prevention intervention , relative to usual care . DESIGN , SETTING , AND PARTICIPANTS Two-arm r and omized clinical trial ( the Shape Program ) . We recruited patients from a 6-site community health center system . We r and omized 194 overweight and class 1 obese ( body mass index [ calculated as weight in kilograms divided by height in meters squared ] , 25 - 34.9 ) premenopausal black women aged 25 to 44 years . Enrollment began on December 7 , 2009 ; 12- and 18-month assessment s were completed in February and October 2 , 2012 . INTERVENTIONS The medium-intensity intervention included tailored behavior change goals , weekly self-monitoring via interactive voice response , monthly counseling calls , tailored skills training material s , and a gym membership . MAIN OUTCOMES AND MEASURES Twelve-month change in weight and body mass index and maintenance of change at 18 months . RESULTS Participants had a mean age of 35.4 years , a mean weight of 81.1 kg , and a mean body mass index of 30.2 at baseline . Most were socioeconomically disadvantaged ( 79.7 % with educational level less than a college degree ; 74.3 % reporting annual income < $ 30,000 ) . The 12-month weight change was larger among intervention participants ( mean [ SD ] , -1.0 [ 0.5 ] kg ) , relative to usual care ( 0.5 [ 0.5 ] kg ; mean difference , -1.4 kg [ 95 % CI , -2.8 to -0.1 kg ] ; P = .04 ) . At month 12 , 62 % of intervention participants were at or below their baseline weights compared with 45 % of usual-care participants ( P = .03 ) . By 18 months , intervention participants maintained significantly larger changes in weight ( mean difference , -1.7 kg ; 95 % CI , -3.3 to -0.2 kg ) . CONCLUSIONS AND RELEVANCE A medium-intensity primary care-based behavioral intervention demonstrated efficacy for weight gain prevention among socioeconomically disadvantaged black women . A " maintain , do n't gain " approach might be a useful alternative treatment for reducing obesity-associated disease risk among some premenopausal black women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00938535 Background Poor mental health has large social and economic consequences both for the individual and society . In Sweden , the prevalence of mental health symptoms has increased since the beginning of the 1990s . There is a need for a better underst and ing of the area for planning preventive activities and health care . Methods The study is based on a postal survey question naire sent to a r and om sample of men and women aged 18–84 years in 2004 . The overall response rate was 64 % . The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden . The study population includes 42,448 respondents .  Mental health was measured with self-reported symptoms of anxiety/depression ( EQ-5D , 5th question ) . The association between socio-economic conditions , lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models . Results About 40 % of women and 30 % of men reported that they were moderately or extremely anxious or depressed . Younger subjects reported poorer mental health than older subjects , the best mental health was found at ages 65–74 years . Factors that were strongly and independently related to mental health symptoms were poor social support , experiences of being belittled , employment status ( receiving a disability pension and unemployment ) , economic hardship , critical life events , and functional disability . A strong association was also found between how burdensome domestic work was experienced and anxiety/depression . This was true for both men and women . Educational level was not associated with mental health symptoms . Of lifestyle factors , physical inactivity , underweight and risk consumption of alcohol were independently associated with mental health symptoms . Conclusion Our results support the notion that a ground for good mental health includes balance in social relations , in domestic work and in employment as well as in personal economy both among men and women . In addition , physical inactivity , underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors BACKGROUND This r and omized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders . METHODS A total of 120 individuals enrolled in a Veterans Affairs ( VA ) mental health clinic were r and omized to receive primary medical care through an integrated care initiative located in the mental health clinic ( n = 59 ) or through the VA general medicine clinic ( n = 61 ) . Veterans who obtained care in the  integrated care clinic received on-site primary care and case management that emphasized preventive medical care , patient education , and close collaboration with mental health providers to improve access to and continuity of care . Analyses compared health process ( use of medical services , quality of care , and satisfaction ) and outcomes ( health and mental health status and costs ) between the groups in the year after r and omization . RESULTS Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care visits than those in the usual care group . They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines . Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic ( 4.7 points vs -0.3 points , P<.001 ) . There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs . CONCLUSION On-site , integrated primary care was associated with improved quality and outcomes of medical care This r and omized controlled trial examined benefits of adding active health promotion to basic primary care ( BPC ) services for SMI adults . It compared BPC with BPC plus wellness training ( WT ) , a 12 months intervention promoting individual skills in self-management .  Three hundred nine participants enrolled during short-term residential treatment completed baseline assessment s and were assigned to treatment groups , before discharge . Outcomes of perceived health status ( SF-36 ) , global assessment of function , and ratings of self-efficacy were assessed at follow-up interviews at 6 , 12 , and 18 months . The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time , controlling for health related covariates . The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales . Findings affirm ability of SMI adults to benefit from active health promotion BACKGROUND People with schizophrenia make poor dietary choices . AIMS To measure the impact of giving free fruit and vegetables for 6 months on eating habits in schizophrenia . METHOD We r and omly allocated 102 people with schizophrenia in two areas of Scotl and to receive free fruit and vegetables for 6 months , supported by instruction in meal planning and food preparation ; free fruit and vegetables alone ; or to continue as before .  Diet was assessed using the Scottish Health Survey question naire . Blood sample s to measure micronutrients were taken and mental state , body mass index , level of physical activity and future risk of coronary heart disease ( CHD ) were assessed . RESULTS After the intervention , those who received free fruit and vegetables , or free fruit and vegetables and associated instruction , were consuming significantly more fruit and vegetables than those in the treatment as usual group . Consumption fell to pre-intervention levels 12 months after the intervention stopped . There was no between-group difference at any time in blood micronutrients , body mass index , physical activity or risk of CHD . CONCLUSIONS The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was given free fruit and vegetables but this was not sustained after withdrawal of the intervention . A support programme added no benefit Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder BACKGROUND The main objective was to assess the efficacy of a weight management program design ed for out patients taking olanzapine for schizophrenia or schizoaffective disorder and to compare these patients with a r and omized control group . The effects of the weight management program were also assessed with regard to safety and quality of life . METHOD Forty-eight patients were enrolled in a 12-week , r and omized , multicenter weight management study . Thirty-three patients were r and omly allocated to an intervention group in which they received olanzapine within a weight management program .  Fifteen patients were allocated to a control group in which they were given olanzapine treatment as usual out patients . Weight , body mass index ( BMI ) , and measurements of safety and quality of life were evaluated . The study was conducted from January 7 , 2003 , to September 16 , 2003 . RESULTS Thirty-six patients ( 75 % ) completed this study . We found significant differences in weight ( -3.94 + /- 3.63 kg vs. -1.48 + /- 1.88 kg , p = .006 ) and BMI ( -1.50 + /- 1.34 vs. -0.59 + /- 0.73 , p = .007 ) change from baseline to endpoint between the intervention and control groups , respectively . Significant differences in weight reduction were initially observed at week 8 ( p = .040 ) . No significant differences were found with regard to the safety outcomes . When the ratio of low-density lipoproteins to high-density lipoproteins was calculated , change from baseline was greater in the intervention group than the control group ( -0.19 vs. -0.04 ) , but the difference was not statistically significant ( p = .556 ) . After the completion of the weight management program , there was a trend toward statistical difference in the physical health score changes between the weight management and control groups ( 1.12 in the intervention group vs. -0.93 in the control group , p = .067 ) . CONCLUSION The weight management program was effective in terms of weight reduction in patients with schizophrenia or schizoaffective disorder taking olanzapine and was also found to be safe in terms of psychiatric symptoms , vital signs , and laboratory data . In addition , such 
    Output:
    
Conclusions This review was unable to demonstrate effectiveness of educational interventions in primary care .