***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 Violence during pregnancy is a global problem , associated with serious health risks for both the mother and baby . Evaluation of interventions targeted for reducing or controlling domestic violence ( DV ) is still in its infancy , and the majority of findings are primarily from high-income countries ( HICs ) . Therefore , there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries ( LMICs ) . Methods Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines will be employed to structure the review . A comprehensive search will be carried out via electronic data bases including MEDLINE , CINAHL , Scopus , Embase , Web of Science , PsycINFO , and The Cochrane library . Gray literature will also be scrutinized for potential articles . An optimal search strategy has been developed following consultations with subject-matter experts and librarians . This search strategy will be adapted to the different data bases . Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review . The review will only include literature written in English . Two review ers will independently screen and assess studies for inclusion in the review . A third author will resolve any discrepancies between the review ers . Risk of bias will be assessed based on the Cochrane risk of bias assessment tool , and overall quality of the evidence will be judged using Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) criteria . Findings will be presented with the narrative synthesis , and if applicable , they will be further quantified using r and om-effects meta- analysis . Effect size , risk ratio for dichotomous variables , and st and ardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3 . Discussion Systematic review s to evaluate the efficacy of interventions to address DV within the perinatal context have been limited . Hence , no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences . The evidence generated from this systematic review will inform research ers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area . This in turn will contribute towards violence prevention in LMICs . Systematic review registration PROSPERO OBJECTIVE : To estimate the efficacy of a psycho-behavioral intervention in reducing intimate partner violence recurrence during pregnancy and postpartum and in improving birth outcomes in African-American women . METHODS : We conducted a r and omized controlled trial for which 1,044 women were recruited . Women were r and omly assigned to receive either intervention ( n=521 ) or usual care ( n=523 ) . Individually tailored counseling sessions were adapted from evidence -based interventions for intimate partner violence and other risks . Logistic regression was used to model intimate partner violence victimization recurrence and to predict minor , severe , physical , and sexual intimate partner violence . RESULTS : Women r and omly assigned to the intervention group were less likely to have recurrent episodes of intimate partner violence victimization ( odds ratio [ OR ] 0.48 , 95 % confidence interval [ CI ] 0.29–0.80 ) . Women with minor intimate partner violence were significantly less likely to experience further episodes during pregnancy ( OR 0.48 , 95 % CI 0.26–0.86 , OR 0.53 , 95 % CI 0.28–0.99 ) and postpartum ( OR 0.56 , 95 % CI 0.34–0.93 ) . Numbers needed to treat were 17 , 12 , and 22 , respectively , as compared with the usual care group . Women with severe intimate partner violence showed significantly reduced episodes postpartum ( OR 0.39 , 95 % CI 0.18–0.82 ) ; the number needed to treat was 27 . Women who experienced physical intimate partner violence showed significant reduction at the first follow-up ( OR 0.49 , 95 % CI 0.27–0.91 ) and postpartum ( OR 0.47 , 95 % CI 0.27–0.82 ) ; the numbers needed to treat were 18 and 20 , respectively . Women in the intervention group had significantly fewer very preterm neonates ( 1.5 % intervention group , 6.6 % usual care group ; P=.03 ) and an increased mean gestational age ( 38.2±3.3 intervention group , 36.9±5.9 usual care group ; P=.016 ) . CONCLUSION : A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes . Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00381823 . LEVEL OF EVIDENCE : Summary Background Although structured psychological treatments are recommended as first-line interventions for depression , only a small fraction of people globally receive these treatments because of poor access in routine primary care . We assessed the effectiveness and cost-effectiveness of a brief psychological treatment ( Healthy Activity Program [ HAP ] ) for delivery by lay counsellors to patients with moderately severe to severe depression in primary health-care setting s. Methods In this r and omised controlled trial , we recruited participants aged 18–65 years scoring more than 14 on the Patient Health Question naire 9 ( PHQ-9 ) indicating moderately severe to severe depression from ten primary health centres in Goa , India . Pregnant women or patients who needed urgent medical attention or were unable to communicate clearly were not eligible . Participants were r and omly allocated ( 1:1 ) to enhanced usual care ( EUC ) alone or EUC combined with HAP in r and omly sized blocks ( block size four to six [ two to four for men ] ) , stratified by primary health centre and sex , and allocation was concealed with use of sequential numbered opaque envelopes . Physicians providing EUC were masked . Primary outcomes were depression symptom severity on the Beck Depression Inventory version II and remission from depression ( PHQ-9 score of < 10 ) at 3 months in the intention-to-treat population , assessed by masked field research ers . Secondary outcomes were disability , days unable to work , behavioural activation , suicidal thoughts or attempts , intimate partner violence , and re source use and costs of illness . We assessed serious adverse events in the per- protocol population . This trial is registered with the IS RCT N registry , number IS RCT N95149997 . Findings Between Oct 28 , 2013 , and July 29 , 2015 , we enrolled and r and omly allocated 495 participants ( 247 [ 50 % ] to the  EUC plus HAP  group [ two of whom were subsequently excluded because of protocol violations ] and 248 [ 50 % ] to the EUC alone group ) , of whom 466 ( 95 % ) completed the 3 month primary outcome assessment ( 230 [ 49 % ] in the EUC plus HAP group and 236 [ 51 % ] in the EUC alone group ) . Participants in the EUC plus HAP group had significantly lower symptom severity ( Beck Depression Inventory version II in EUC plus HAP group 19·99 [ SD 15·70 ] vs 27·52 [ 13·26 ] in EUC alone group ; adjusted mean difference −7·57 [ 95 % CI −10·27 to −4·86 ] ; p<0·0001 ) and higher remission ( 147 [ 64 % ] of 230 had a PHQ-9 score of < 10 in the HAP plus EUC group vs 91 [ 39 % ] of 236 in the EUC alone group ; adjusted prevalence ratio 1·61 [ 1·34–1·93 ] ) than did those in the EUC alone group . EUC plus HAP showed better results than did EUC alone  for the secondary outcomes of disability ( adjusted mean difference −2·73 [ –4·39 to −1·06 ] ; p=0·001 ) , days out of work ( −2·29 [ –3·84 to −0·73 ] ; p=0·004 ) , intimate partner physical violence in women ( 0·53 [ 0·29–0·96 ] ; p=0·04 ) , behavioural activation ( 2·17 [ 1·34–3·00 ] ; p<0·0001 ) , and suicidal thoughts or attempts ( 0·61 [ 0·45–0·83 ] ; p=0·001 ) . The incremental cost per quality -adjusted life-year gained was $ 9333 ( 95 % CI 3862–28 169 ; 2015 international dollars ) , with an 87 % chance of being cost-effective in the study setting . Serious adverse events were infrequent and similar between groups ( nine [ 4 % ] in the EUC plus HAP group vs ten [ 4 % ] in the EUC alone group ; p=1·00 ) . Interpretation HAP delivered by lay counsellors plus EUC was better than EUC alone was for patients with moderately severe to severe depression in routine primary care in Goa , India . HAP was readily accepted by this previously untreated population and was cost-effective in this setting . HAP could be a key strategy to reduce the treatment gap for depressive disorders , the leading mental health disorder worldwide . Funding Wellcome Trust Background Rigorous evaluations of health sector interventions addressing intimate partner violence ( IPV ) in low- and middle-income countries are lacking . We aim ed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors , use of community re sources , reproductive coercion , and mental quality of life . Methods We r and omized 42 public health clinics in Mexico City to treatment or control arms . In treatment clinics , women received the nurse-delivered session ( IPV screening , supportive referrals , health/safety risk assessment s ) at baseline ( T1 ) , and a booster counselling session after 3 months ( T2 ) . In control clinics , women received screening and a referral card from nurses . Surveys were conducted at T1 , T2 , and T3 ( 15 months from baseline ) . Our main outcome was past-year physical and sexual IPV . Intent-to-treat analyses were conducted via three-level r and om intercepts models to evaluate the interaction term for treatment status by time . Results Between April and October 2013 , 950 women ( 480 in control clinics , 470 in treatment clinics ) with recent IPV experiences enrolled in the study . While reductions in IPV were observed for both women enrolled in treatment ( OR , 0.40 ; 95 % CI , 0.28–0.55 ; P < 0.01 ) and control ( OR , 0.51 ; 95 % CI , 0.36–0.72 ; P < 0.01 ) clinics at T3 ( July to December 2014 ) , no significant treatment effects were observed ( OR , 0.78 ; 95 % CI , 0.49–1.24 ; P = 0.30 ) . At T2 ( July to December 2013 ) , women in treatment clinics reported significant improvements , compared to women in control clinics , in mental quality of life ( β , 1.45 ; 95 % CI , 0.14–2.75 ; P = 0.03 ) and safety planning behaviors ( β , 0.41 ; 95 % CI , 0.02–0.79 ; P = 0.04 ) . Conclusion While reductions in IPV levels were seen among women in both treatment and control clinics , the enhanced nurse intervention was no more effective in reducing IPV . The enhanced nursing intervention may offer short-term improvements in addressing safety planning and mental quality of life . Nurses can play a supportive role in assisting women with IPV experiences . Trial Registration Clinical trials.gov ( NCT01661504 ) . Registration Date : August 2 , Background Intimate partner violence ( IPV ) during or before pregnancy is associated with many adverse health outcomes . Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress , both of which impact maternal health and fetal growth and development . Antenatal care can be a key entry point within the health system for many women , particularly in low-re source setting s. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences . Methods Following a formative research phase , a r and omized controlled trial will be conducted to test a nurse-led empowerment counselling intervention , originally developed for high-income setting s and adapted for urban South Africa . The primary outcome is reduction of partner violence , and secondary outcomes include improvement in women ’s mental health , safety and self-efficacy . The study aims to recruit 504 pregnant women from three antenatal clinics in Johannesburg who will be r and omized to the nurse-led empowerment arm  ( two 30-min counselling sessions ) or enhanced control condition ( a referral list ) to determine whether participants in the intervention arm have better outcomes as compared to the those in the control arm . Discussion This research will provide much needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low re source setting s that have high prevalence of IPV and HIV.Trial registration The study was registered in the South African Clinical Trials Registry ( DOH-27 - 0414 - 4720 ) on 11 August 2014 and in the IS RCT N Registry ( IS RCT N3 
    Output:
    
The interventions consisting of supportive counselling demonstrated a reduction in DV and an improvement in use of safety behaviours .
The development of a ToC was critical in underst and ing how certain activities led to the desired outcomes .