***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 There has been little rigorous economic analysis of the relationship between asthma and improved housing . AIM To evaluate the cost-effectiveness of installing ventilation systems , and central heating if necessary , in homes of children with ' moderate ' or ' severe ' asthma . DESIGN AND SETTING An incremental cost-effectiveness analysis alongside a pragmatic r and omised controlled trial of a tailored package of housing modifications design ed to improve ventilation and household heating in homes within Wrexham County Borough , Wales , UK . METHOD A total of 177 children aged between 5 and 14 years , identified from general practice registers , were studied . Parents reported on the quality of life of their children over a 12-month period . General practice s reported on health-service re sources used by those children , and their asthma-related prescriptions , over the same period . RESULTS The tailored package shifted 17 % of children in the intervention group from ' severe ' to ' moderate ' asthma , compared with a 3 % shift in the control group . The mean cost of these modifications was £ 1718 per child treated or £ 12300 per child shifted from ' severe ' to ' moderate ' . Healthcare costs over 12 months following r and omisation did not differ significantly between intervention and control groups . Bootstrapping gave an incremental cost-effectiveness ratio ( ICER ) of £ 234 per point improvement on the 100-point PedsQL ™ asthma-specific scale , with 95 % confidence interval ( CI ) = £ 140 to £ 590 . The ICER fell to £ 165 ( 95 % CI = £ 84 to £ 424 ) for children with ' severe ' asthma . CONCLUSION This novel and pragmatic trial , with integrated economic evaluation , reported that tailored improvement of the housing of children with moderate to severe asthma is likely to be a cost-effective use of public re sources . This is a rare example of evidence for collaboration between local government and the NHS Background : Housing is an important environmental influence on population health , and there is growing evidence of health effects from indoor environment characteristics such as low indoor temperatures . However , there is relatively little research , and thus little firm guidance , on the cost-effectiveness of public policies to retrospectively improve the st and ards of houses . The purpose of this study was to value the health , energy and environmental benefits of retrofitting insulation , through assessing a number of forms of possible benefit : a reduced number of visits to GPs , hospitalisations , days off school , days off work , energy savings and CO2 savings . Methods : All these metrics are used in a cluster r and omised trial — the “ Housing , Insulation and Health Study ” —of retrofitting insulation in 1350 houses , in which at least one person had symptoms of respiratory disease , in predominantly low-income communities in New Zeal and . Results : Valuing the health gains , and energy and CO2 emissions savings , suggests that total benefits in “ present value ” ( discounted ) terms are one and a half to two times the magnitude of the cost of retrofitting insulation . Conclusion : This study points to the need to consider as wide a range of benefits as possible , including health and environmental benefits , when assessing the value for money of an intervention to improve housing quality . From an environmental , energy and health perspective , the value for money of improving housing quality by retrofitting insulation is compelling This paper describes the purpose and methods of a single-blinded , clustered and r and omised trial of the health impacts of insulating existing houses . The key research question was whether this intervention increased the indoor temperature and lowered the relative humidity , energy consumption and mould growth in the houses , as well as improved the health and well-being of the occupants and thereby lowered their utilisation of health care . Households in which at least one person had symptoms of respiratory disease were recruited from seven predominantly low-income communities in New Zeal and . These households were then r and omised within communities to receive retrofitted insulation either during or after the study . Measures at baseline ( 2001 ) and follow-up ( 2002 ) included subjective measures of health , comfort and well-being and objective measures of house condition , temperature , relative humidity , mould ( speciation and mass ) , endotoxin , beta glucans , house dust mite allergens , general practitioner and hospital visits , and energy or fuel usage . All measurements referred to the three coldest winter months , June , July and August . From the 1352 households that were initially recruited , baseline information was obtained from 1310 households and 4413 people . At follow-up , 3312 people and 1110 households remained , an 84 % household retention rate and a 75 % individual retention rate . Final outcome results will be reported in a subsequent paper . The study showed that large trials of complex environmental interventions can be conducted in a robust manner with high participation rates . Critical success factors are effective community involvement and an intervention that is valued by the participants Objective To determine whether insulating existing houses increases indoor temperatures and improves occupants ' health and wellbeing . Design Community based , cluster , single blinded r and omised study . Setting Seven low income communities in New Zeal and . Participants 1350 households containing 4407 participants . Intervention Installation of a st and ard retrofit insulation package . Main outcome measures Indoor temperature and relative humidity , energy consumption , self reported health , wheezing , days off school and work , visits to general practitioners , and admissions to hospital . Results Insulation was associated with a small increase in bedroom temperatures during the winter ( 0.5 � C ) and decreased relative humidity ( −2.3 % ) , despite energy consumption in insulated houses being 81 % of that in uninsulated houses . Bedroom temperatures were below 10 � C for 1.7 fewer hours each day in insulated homes than in uninsulated ones . These changes were associated with reduced odds in the insulated homes of fair or poor self rated health ( adjusted odds ratio 0.50 , 95 % confidence interval 0.38 to 0.68 ) , self reports of wheezing in the past three months ( 0.57 , 0.47 to 0.70 ) , self reports of children taking a day off school ( 0.49 , 0.31 to 0.80 ) , and self reports of adults taking a day off work ( 0.62 , 0.46 to 0.83 ) . Visits to general practitioners were less often reported by occupants of insulated homes ( 0.73 , 0.62 to 0.87 ) . Hospital admissions for respiratory conditions were also reduced ( 0.53 , 0.22 to 1.29 ) , but this reduction was not statistically significant ( P=0.16 ) . Conclusion Insulating existing houses led to a significantly warmer , drier indoor environment and result ed in improved self rated health , self reported wheezing , days off school and work , and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions Objective To assess whether non-polluting , more effective home heating ( heat pump , wood pellet burner , flued gas ) has a positive effect on the health of children with asthma . Design R and omised controlled trial . Setting Households in five communities in New Zeal and . Participants 409 children aged 6 - 12 years with doctor diagnosed asthma . Interventions Installation of a non-polluting , more effective home heater before winter . The control group received a replacement heater at the end of the trial . Main outcome measures The primary outcome was change in lung function ( peak expiratory flow rate and forced expiratory volume in one second , FEV1 ) . Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs . At the end of winter 2005 ( baseline ) and winter 2006 ( follow-up ) parents reported their child ’s general health , use of health services , overall respiratory health , and housing conditions . Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child ’s bedroom were recorded hourly . Results Improvements in lung function were not significant ( difference in mean FEV1 130.7 ml , 95 % confidence interval −20.3 to 281.7 ) . Compared with children in the control group , however , children in the intervention group had 1.80 fewer days off school ( 95 % confidence interval 0.11 to 3.13 ) , 0.40 fewer visits to a doctor for asthma ( 0.11 to 0.62 ) , and 0.25 fewer visits to a pharmacist for asthma ( 0.09 to 0.32 ) . Children in the intervention group also had fewer reports of poor health ( adjusted odds ratio 0.48 , 95 % confidence interval 0.31 to 0.74 ) , less sleep disturbed by wheezing ( 0.55 , 0.35 to 0.85 ) , less dry cough at night ( 0.52 , 0.32 to 0.83 ) , and reduced scores for lower respiratory tract symptoms ( 0.77 , 0.73 to 0.81 ) than children in the control group . The intervention was associated with a mean temperature rise in the living room of 1.10 ° C ( 95 % confidence interval 0.54 ° C to 1.64 ° C ) and in the child ’s bedroom of 0.57 ° C ( 0.05 ° C to 1.08 ° C ) . Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households ( geometric mean 8.5 μg/m3 v 15.7 μg/m3 , P<0.001 ) . A similar effect was found in the children ’s bedrooms ( 7.3 μg/m3 v 10.9 μg/m3 , P<0.001 ) . Conclusion Installing non-polluting , more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma , days off school , healthcare utilisation , and visits to a pharmacist . Trial registration Clinical Trials NCT00489762 Study objective : To evaluate self-reported changes in housing quality and health associated with housing-led area regeneration . Design : A prospect i ve study over 1 year using structured interviews with 50 households who moved to new housing and with 50 matched controls who did not move .  Setting and participants : Residents of two social rented housing schemes in the West of Scotl and . Results : Small but not statistically significant increases in levels of “ excellent ” or “ good ” self-reported health status were found in both groups . Both intervention and control groups experienced reductions in problems related to warmth , but no significant change in how they felt about their house . Conclusions : It is feasible to conduct prospect i ve controlled studies to evaluate the health effects of housing improvement using matched control groups . The absence of marked improvement in health after moving to new housing might be due to the small sample size or to the limited potential to improve health through this intervention alone Objective : To assess the short term health effects of improving housing . Design : R and omised to waiting list . Setting : 119 council owned houses in south Devon , UK . Participants : About 480 residents of these houses . Intervention : Upgrading houses ( including central heating , ventilation , rewiring , insulation , and re-roofing ) in two phases a year apart . Main outcome measures : All residents completed an annual health question  naire  : SF36 and GHQ12  ( adults ) . Residents reporting respiratory illness or arthritis were interviewed using condition-specific question naires , the former also completing peak flow and symptom diaries ( children ) or spirometry ( adults ) . Data on health service use and time lost from school were collected . Results : Interventions improved energy efficiency . For those living in intervention houses , non-asthma-related chest problems ( Mann – Whitney test , p = 0.005 ) and the combined asthma symptom score for adults ( Mann – Whitney test , z = 2.7 , p = 0.007 ) diminished significantly compared with control houses . No difference between intervention and control houses was seen for SF36 or GHQ12 . Conclusions : Rigorous study design s for the evaluation of complex public health and community based interventions are possible . Quantitatively measured health benefits are small , but as health benefits were measured over a short time scale , there may have been insufficient time for measurable improvements in general and disease-specific health to become apparent BACKGROUND A r and omized study of the effect on people 's  health of improving their housing is underway in Torbay . The link between poor health , particularly respiratory health , and poor housing conditions has been recognized for a long time , but there have been few intervention studies to demonstrate that improving housing can improve health . In 1994 , South and West Devon Health Authority set up a community development project in a deprived area of Torbay , in response to the concerns of local primary health-care workers . A community development worker helped local residents survey their homes for dampness and record their respiratory symptoms . The survey reported high levels of condensation/dampness and respiratory illness and the Council agreed to direct the majority of their housing improvement funds to the estate over the next 3 years . The Health Authority , University of Plymouth and Torbay Council were successful in obtaining funding to evaluate the housing improvements from the NHS R & D programme . PARTICIPANTS AND METHODS Of 119 houses eligible for the study , 50 were chosen at r and om and improved in the first year . The rest were improved the following year . Question naires screening for health problems were sent to all 580 residents and baseline surveys of the indoor environment were also carried out . More detailed health surveys were completed by community nurses visiting residents in their homes . All adults were asked to complete SF-36 and GHQ 12 question naires , as well as disease-specific question naires if appropriate . PROGRESS All houses in the study have now been improved , including insulation , double-glazing , re-roofing , heating , ventilation and electrical re 
    Output:
    
When undertaken appropriately , economic evaluation provides the potential to make significant contributions to housing policy