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 Research on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population and may increase the risk of developing a subsequent major depression . This study was aim ed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms . Methods A r and omized controlled study design with a one-year follow-up was used . Fifty patients with mild to moderate depressive symptoms ( 74 % female , aged 57 ± 9 yrs , diabetes duration of 10 ± 8 yrs , BMI 31 ± 6 kg/m2 , HbA1C 7.7 % ± 1.4 , 53 % insulin treated ) were r and omly assigned to either an intervention or a control group . The intervention group underwent four psycho-educational sessions aim ed at enabling self-management of depressive symptoms . The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual . Both groups were contacted by phone in 2–3-month intervals , and re-assessed for depression after 6 and 12 months . Changes in depressive symptoms and glycaemic control were considered primary outcomes . Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups . Results Both the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale ( Friedman ANOVA χ2 = 10.8 p = .004 and χ2 = 7.3 p = 0.03 , respectively ) . The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups ( χ2 = 11.6 p = 0.003 and χ2 = 17.1 p = 0.0002 , respectively ) . Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up ( all p > 0.05 ) . Conclusion Psycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms  , but its effects are comparable with the non-specific support given to the subjects in the control group . Trial registration Current Controlled Trials IS RCT 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 Purpose To explore the relationship between the symptoms of schizophrenia experienced by older persons diagnosed with schizophrenia and type 2 diabetes mellitus and their response to a health promoting intervention . Methods Secondary data analysis of data obtained from a lifestyle intervention program that recruited participants over age 40 with schizophrenia or schizoaffective disorder and type 2 diabetes mellitus from board- and -care facilities and day treatment programs . Participants had been r and omly assigned to a 24-week diabetes awareness and rehabilitation training ( DART ; n = 32 ) or a usual care plus information ( UCI ; n = 32 ) comparison group . Baseline and 6-month ( intervention completion ) assessment s included a diabetes knowledge test ( DKT ) , diabetes self-efficacy measured by the diabetes empowerment scale ( DES ) , and symptomatology defined by the Positive and Negative Syndrome Scale ( PANSS ) . Simple linear regression models in 3 steps were used to analyze the data . Results A significant condition by symptom interaction was found for DKT . The difference between change in knowledge for DART and UCI groups depended on the prevalence and severity of the total , negative , and general symptoms . There was no significant condition by positive symptom interaction for DKT . A significant main effect was found between total , negative , positive , and general symptoms in the total sample for improvement in DES scores . Higher prevalence and severity of symptoms was negatively associated with improvement in DES scores . Conclusion Research ers need to consider the impact of schizophrenia symptoms in response to health promoting interventions Objectives : In a trial completed in 2010 , US patients with diabetes and depression were r and omized to usual care or telephone cognitive behavioural therapy that emphasized physical activity . Twelve-month intervention effects were observed for blood pressure , depression , and pedometer-measured step-counts . This study examined variation in intervention effects across patient subgroups defined by a measure of clinical complexity . Methods : Three groups of patients were identified at baseline using the Vector Model of Complexity that recognizes socioeconomic , biological , behavioural , and other determinants of treatment response . Complexity-by-intervention interactions were examined using regression models . Results : Intervention effects for blood pressure , depression , and step-counts differed across complexity levels ( each p < 0.01 ) . Effects on Beck Depression Inventory scores were greater in the low-complexity group ( −8.8 ) than in the medium- ( −3.2 ) or high-complexity groups ( −2.7 ) . Physical activity effects also were greatest in the low-complexity group ( increase of 1498 steps per day ) . In contrast , systolic blood pressure effects were greater among intervention patients with high complexity ( −8.5 mmHg ) . Conclusions : This intervention had varying impacts on physical and mental health depending on patients ' clinical complexity . Physical activity and depressive symptom gains may be more likely among less complex patients , although more complex patients may achieve cardiovascular benefits through decreased blood pressures Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care .  Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the  Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background : Patients with psychiatric illness have increased somatic morbidity and increased mortality . Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required . The aims of this study were to investigate whether an intervention programme to improve physical health is effective . Methods : An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions ( HELPS ) project further developed as a 12-month controlled cluster-r and omized intervention study in the Danish centre . Waist circumference was a proxy of unhealthy body fat in view of the increased risk of cardiovascular diseases and type 2 diabetes . Results :  Waist circumference was 108 cm for men and 108 cm for women . Controlled for cluster r and omization , sex , age , and body fat , the intervention group showed a small , but not significant , reduction in waist circumference , while participants in the control group showed a significant increase in waist circumference . Conclusions : The intervention had a positive effect on the physical health of the patients measured by a reduction in the increase of waist circumference OBJECTIVE Comorbid depression is common in patients with type 1 and type 2 diabetes , adversely affecting quality of life , diabetes outcomes , and mortality . Depression can be effectively treated with cognitive behavior therapy ( CBT ) . The Internet is a new and attractive method for delivering CBT intervention on a large scale at relatively low costs . This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes , with minimal guidance . RESEARCH DESIGN AND METHODS A r and omized controlled trial was conducted in the Netherl and s in 255 adult diabetic patients with elevated depressive symptoms . Primary outcomes were depressive symptoms . Secondary outcomes were diabetes-specific emotional distress and glycemic control . Assessment s were at baseline , after treatment , and at the 1-month follow-up . RESULTS The Web-based CBT was effective in reducing depressive symptoms by intention-to-treat analyses ( P = 0.04 , d = 0.29 ; clinical improvement 41 % vs. 24 % P < 0.001 ) and by per- protocol analyses ( P < 0.001 , d = 0.70 ; clinical improvement , 56 % vs. 24 % P < 0.001 ) . The intervention reduced diabetes-specific emotional distress ( P = 0.03 ) but had no beneficial effect on glycemic control ( P > 0.05 ) . CONCLUSIONS Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes . In addition , the intervention reduces diabetes-specific emotional distress in depressed patients Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT 
    Output:
    
agent
Research ers noted small improvements in body mass index immediately after the intervention was provided and at six months , along with improved weight post intervention .
Diabetes knowledge and self efficacy improved immediately following receipt of the intervention , and knowledge also at six months .
The intervention did not improve blood pressure .
Evidence is insufficient to show whether type 2 diabetes self management interventions for people with severe mental illness are effective in improving outcomes .
***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 Research on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population and may increase the risk of developing a subsequent major depression . This study was aim ed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms . Methods A r and omized controlled study design with a one-year follow-up was used . Fifty patients with mild to moderate depressive symptoms ( 74 % female , aged 57 ± 9 yrs , diabetes duration of 10 ± 8 yrs , BMI 31 ± 6 kg/m2 , HbA1C 7.7 % ± 1.4 , 53 % insulin treated ) were r and omly assigned to either an intervention or a control group . The intervention group underwent four psycho-educational sessions aim ed at enabling self-management of depressive symptoms . The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual . Both groups were contacted by phone in 2–3-month intervals , and re-assessed for depression after 6 and 12 months . Changes in depressive symptoms and glycaemic control were considered primary outcomes . Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups . Results Both the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale ( Friedman ANOVA χ2 = 10.8 p = .004 and χ2 = 7.3 p = 0.03 , respectively ) . The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups ( χ2 = 11.6 p = 0.003 and χ2 = 17.1 p = 0.0002 , respectively ) . Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up ( all p > 0.05 ) . Conclusion Psycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms  , but its effects are comparable with the non-specific support given to the subjects in the control group . Trial registration Current Controlled Trials IS RCT 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 Purpose To explore the relationship between the symptoms of schizophrenia experienced by older persons diagnosed with schizophrenia and type 2 diabetes mellitus and their response to a health promoting intervention . Methods Secondary data analysis of data obtained from a lifestyle intervention program that recruited participants over age 40 with schizophrenia or schizoaffective disorder and type 2 diabetes mellitus from board- and -care facilities and day treatment programs . Participants had been r and omly assigned to a 24-week diabetes awareness and rehabilitation training ( DART ; n = 32 ) or a usual care plus information ( UCI ; n = 32 ) comparison group . Baseline and 6-month ( intervention completion ) assessment s included a diabetes knowledge test ( DKT ) , diabetes self-efficacy measured by the diabetes empowerment scale ( DES ) , and symptomatology defined by the Positive and Negative Syndrome Scale ( PANSS ) . Simple linear regression models in 3 steps were used to analyze the data . Results A significant condition by symptom interaction was found for DKT . The difference between change in knowledge for DART and UCI groups depended on the prevalence and severity of the total , negative , and general symptoms . There was no significant condition by positive symptom interaction for DKT . A significant main effect was found between total , negative , positive , and general symptoms in the total sample for improvement in DES scores . Higher prevalence and severity of symptoms was negatively associated with improvement in DES scores . Conclusion Research ers need to consider the impact of schizophrenia symptoms in response to health promoting interventions Objectives : In a trial completed in 2010 , US patients with diabetes and depression were r and omized to usual care or telephone cognitive behavioural therapy that emphasized physical activity . Twelve-month intervention effects were observed for blood pressure , depression , and pedometer-measured step-counts . This study examined variation in intervention effects across patient subgroups defined by a measure of clinical complexity . Methods : Three groups of patients were identified at baseline using the Vector Model of Complexity that recognizes socioeconomic , biological , behavioural , and other determinants of treatment response . Complexity-by-intervention interactions were examined using regression models . Results : Intervention effects for blood pressure , depression , and step-counts differed across complexity levels ( each p < 0.01 ) . Effects on Beck Depression Inventory scores were greater in the low-complexity group ( −8.8 ) than in the medium- ( −3.2 ) or high-complexity groups ( −2.7 ) . Physical activity effects also were greatest in the low-complexity group ( increase of 1498 steps per day ) . In contrast , systolic blood pressure effects were greater among intervention patients with high complexity ( −8.5 mmHg ) . Conclusions : This intervention had varying impacts on physical and mental health depending on patients ' clinical complexity . Physical activity and depressive symptom gains may be more likely among less complex patients , although more complex patients may achieve cardiovascular benefits through decreased blood pressures Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care .  Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the  Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background : Patients with psychiatric illness have increased somatic morbidity and increased mortality . Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required . The aims of this study were to investigate whether an intervention programme to improve physical health is effective . Methods : An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions ( HELPS ) project further developed as a 12-month controlled cluster-r and omized intervention study in the Danish centre . Waist circumference was a proxy of unhealthy body fat in view of the increased risk of cardiovascular diseases and type 2 diabetes . Results :  Waist circumference was 108 cm for men and 108 cm for women . Controlled for cluster r and omization , sex , age , and body fat , the intervention group showed a small , but not significant , reduction in waist circumference , while participants in the control group showed a significant increase in waist circumference . Conclusions : The intervention had a positive effect on the physical health of the patients measured by a reduction in the increase of waist circumference OBJECTIVE Comorbid depression is common in patients with type 1 and type 2 diabetes , adversely affecting quality of life , diabetes outcomes , and mortality . Depression can be effectively treated with cognitive behavior therapy ( CBT ) . The Internet is a new and attractive method for delivering CBT intervention on a large scale at relatively low costs . This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes , with minimal guidance . RESEARCH DESIGN AND METHODS A r and omized controlled trial was conducted in the Netherl and s in 255 adult diabetic patients with elevated depressive symptoms . Primary outcomes were depressive symptoms . Secondary outcomes were diabetes-specific emotional distress and glycemic control . Assessment s were at baseline , after treatment , and at the 1-month follow-up . RESULTS The Web-based CBT was effective in reducing depressive symptoms by intention-to-treat analyses ( P = 0.04 , d = 0.29 ; clinical improvement 41 % vs. 24 % P < 0.001 ) and by per- protocol analyses ( P < 0.001 , d = 0.70 ; clinical improvement , 56 % vs. 24 % P < 0.001 ) . The intervention reduced diabetes-specific emotional distress ( P = 0.03 ) but had no beneficial effect on glycemic control ( P > 0.05 ) . CONCLUSIONS Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes . In addition , the intervention reduces diabetes-specific emotional distress in depressed patients Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT 
    Output:
    