***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 
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    Input: BACKGROUND Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes . Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma . The objective of this study was to determine whether an environmental intervention tailored to each child 's allergic sensitization and environmental risk factors could improve asthma-related outcomes . METHODS We enrolled 937 children with atopic asthma ( age , 5 to 11 years ) in seven major U.S. cities in a r and omized , controlled trial of an environmental intervention that lasted one year ( intervention year ) and included education and remediation for exposure to both allergens and environmental tobacco smoke . Home environmental exposures were assessed every six months , and asthma-related complications were assessed every two months during the intervention and for one year after the intervention . RESULTS For every 2-week period , the intervention group had fewer days with symptoms than did the control group both during the intervention year ( 3.39 vs. 4.20 days , P<0.001 ) and the year afterward ( 2.62 vs. 3.21 days , P<0.001 ) , as well as greater declines in the levels of allergens at home , such as Dermatophagoides farinae ( Der f1 ) allergen in the bed ( P<0.001 ) and on the bedroom floor ( P=0.004 ) , D. pteronyssinus in the bed ( P=0.007 ) , and cockroach allergen on the bedroom floor ( P<0.001 ) . Reductions in the levels of cockroach allergen and dust-mite allergen ( Der f1 ) on the bedroom floor were significantly correlated with reduced complications of asthma ( P<0.001 ) . CONCLUSIONS Among inner-city children with atopic asthma , an individualized , home-based , comprehensive environmental intervention decreases exposure to indoor allergens , including cockroach and dust-mite allergens , result ing in reduced asthma-associated morbidity Aims : Because logistical and financial obstacles impede using large prospect i ve cohort studies , surveillance decisions in occupational setting s must often be made without evidence of relative benefits and costs . Using the example of isocyanate induced asthma , the most commonly reported immune mediated occupational asthma , the authors developed a model based approach to evaluate the costs and benefits of surveillance from both an employer and a societal perspective . Methods : The authors used a mathematical simulation model of isocyanate asthma to compare annual surveillance to passive case finding . Outcome measures included symptom free days ( SFD ) , quality adjusted life years ( QALY ) , direct costs , productivity losses , and incremental cost effectiveness ratio ( CER ) , measured from the employer and the societal perspectives . Input data were obtained from a variety of published sources . Results : For 100 000 exposed workers , surveillance result ed in 683 fewer cases of disability over 10 years . Surveillance conferred benefits at an incremental cost of $ 24,000/QALY ( employer perspective ; $ 13.33/SFD ) and was cost saving from the societal perspective . Results were sensitive to assumptions about sensitisation rate , removal rates , and time to diagnosis , but not to assumptions about therapy costs and disability rates . Conclusions : Baseline results placed the CER for surveillance for isocyanate asthma within the acceptable range . Costs from the societal and employer perspective differed substantially with a more attractive CER from the societal perspective , suggesting opportunities for employer/societal cost sharing . The analysis demonstrates the value of a model based approach to evaluate the cost effectiveness of surveillance programmes for isocyanate asthma , and to inform shared decision making among clinicians , patients , employers , and society . Such a modeling approach may be applicable to surveillance programmes for other work related conditions BACKGROUND Isl and and mainl and Puerto Rican children have the highest rates of asthma and asthma morbidity of any ethnic group in the United States . OBJECTIVE We evaluated the effectiveness of a culturally adapted family asthma management intervention called CALMA ( an acronym of the Spanish for " Take Control , Empower Yourself and Achieve Management of Asthma " ) in reducing asthma morbidity in poor Puerto Rican children with asthma . METHODS Low-income children with persistent asthma were selected from a national health plan insurance cl aims data base by using a computerized algorithm . After baseline , families were r and omly assigned to either the intervention or a control group . RESULTS No significant differences between control and intervention group were found for the primary outcome of symptom-free days . However , children in the CALMA intervention group had 6.5 % more symptom-free nights , were 3 times more likely to have their asthma under control , and were less likely to visit the emergency department and be hospitalized as compared to the control group . Caregivers receiving CALMA were significantly less likely to feel helpless , frustrated , or upset because of their child 's asthma and more likely to feel confident to manage their child 's asthma . CONCLUSION A home-based asthma intervention program tailored to the cultural needs of low income Puerto Rican families is a promising intervention for reducing asthma morbidity Objective Home dampness and the presence of mold and allergens have been associated with  asthma morbidity . We examined changes in  asthma morbidity in children as a result of home remediation aim ed at moisture sources . Design In this prospect i ve , r and omized controlled trial , symptomatic , asthmatic children ( n = 62 ) , 2–17 years of age , living in a home with indoor mold , received an asthma intervention including an action plan , education , and individualized problem solving . The remediation group also received household repairs , including reduction of water infiltration , removal of water-damaged building material s , and heating/ventilation/air-conditioning alterations . The control group received only home cleaning information . We measured children ’s total and allergen-specific serum immuno-globulin E , peripheral blood eosinophil counts , and urinary cotinine . Environmental dust sample s were analyzed for dust mite , cockroach , rodent urinary protein , endotoxin , and fungi . The follow-up period was 1 year . Results Children in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study . The remediation group had a significant decrease in symptom days ( p = 0.003 , as r and omized ; p = 0.004 , intent to treat ) after remodeling , whereas these parameters in the control group did not significantly change . In the postremediation period , the remediation group had a lower rate of exacerbations compared with control asthmatics ( as treated : 1 of 29 vs. 11 of 33 , respectively , p = 0 . 003 ; intent to treat : 28.1 % and 10.0 % , respectively , p = 0.11 ) . Conclusion Construction remediation aim ed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem Care of asthmatic children is often episodic and more therapeutic than preventive . A 2-year r and omized , controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures . Interventions for the study group during the first year included 3-month clinic visits , education , and home visits by a specially trained research nurse . Control subjects continued to receive regular care from a family physician or pediatrician .  Eight-nine subjects ( 93 % ) completed the study . Study subjects had less school absenteeism than control subjects ( 10.7 vs. 16.0 days , P = .04 ) and showed significantly better small airway function after 1 year . Asthma severity improved in 13 study subjects and worsened in 5 . The reverse was true for control subjects . Study subjects exhibited better metered aerosol technique than control subjects ( P = .0005 ) . Fewer days were spent in hospital by the study subjects admitted compared with control subjects ( 3.67 vs 11.2 days , P = .02 ) . After 1 year , more study than control families ( 72.1 % vs 33.1 % , P = .006 ) reported that their asthmatic child took responsibility for the asthma management . The intervention failed to reduce exposure to secondh and smoke or to household pets . There were no significant differences in medical visits , theophylline levels , or records of asthma symptoms . One year after discontinuing the intervention , a marked " washout " effect was observed . Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained OBJECTIVE To present an interim analysis of the effect of a home-based intervention with low-income caregivers of wheezing infants at risk for childhood asthma on mediating variables . METHOD Infants aged 9 to 24 months with 3 or more physician-documented wheezing episodes were r and omly assigned to environmental support intervention ( ES ) ( n = 90 ) or control ( n = 91 ) groups . Nurse home visitors intervened for 1 year to decrease allergen and environmental tobacco smoke exposure and improve symptom perception and management . Assessment s at baseline and 12 months included allergens in house dust , infant urinary cotinine levels , caregivers ' symptom reports , quality of life , illness management , and quality of caregiving . Medical records were coded for hospitalizations , emergency department visits , and corticosteroid bursts . RESULTS Within the ES group , cockroach allergen levels were significantly reduced and there was a trend toward reduction in dog d and er levels . Among infants with detectable urinary cotinine , levels were significantly reduced in the ES group . Caregiver psychological re sources modified the impact , and low-re source ES caregivers were the most strongly affected . Asthma knowledge and provider collaboration improved significantly in the ES group . Neither reports of infant symptoms nor emergency department visits or hospitalizations showed positive intervention effects . Number of corticosteroid bursts for infants was significantly higher for the ES group . CONCLUSIONS The Childhood Asthma Prevention Study intervention was effective in reducing several environmental exposures and improving illness management . However , even with an intensive home-based intervention , we failed to reduce respiratory symptoms or medical use in the ES group relative to the control group , illustrating the difficulty of changing the course of early asthma development among low-income infants The effectiveness of community health workers ( CHWs ) assisting families in reducing exposure to indoor asthma triggers has not been studied . In all , 274 low-income asthmatic children were r and omly assigned to high- or low-intensity groups . CHWs visited all homes to assess exposures , develop action plans and provide bedding encasements . The higher-intensity group also received cleaning equipment and five to nine visits over a year focusing on asthma trigger reduction . The asthma trigger composite score decreased from 1.56 to 1.19 ( Δ=−0.37 , 95 % CI 0.13 , 0.61 ) in the higher-intensity group and from 1.63 to 1.43 in the low-intensity group ( Δ=−0.20 , 95 % CI 0.004 , 0.4 ) . The difference in this measure due to the intervention was significant at the P=0.096 level . The higher-intensity group also showed improvement during the intervention year in measurements of condensation , roaches , moisture , cleaning behavior , dust weight , dust mite antigen , and total antigens above a cut point , effects not demonstrated in the low-intensity group . CHWs are effective in reducing asthma trigger exposure in low-income children . Further research is needed to determine the effectiveness of specific interventions and structural improvements on asthma trigger exposure and health Background : Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes . A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes . Methods : A pragmatic r and omised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics . All had previous hospital admissions and /or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management . Patients were visited in their homes for assessment and , where appropriate , intervention . The main outcomes measured were symptom control , asthma specific quality of life , and generic health status . Results : At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control , physical functioning , or mental health scores ( differences ( with 95 % CI ) −0.35 ( −1.83 to 1.13 ) , 3.10 ( −11.42 to 17.63 ) , 0.42 ( −10.22 to 11.07 ) , respectively ) . Small effects on asthma specific quality of life up to 12 months ( e.g. adjusted difference at 12 months 0.13 ( 95 % CI 0.02 to 0.25 ) ) and short term effects on generic health status , which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention , were apparent only from fully adjusted analyses . Conclusions : A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes STUDY OBJECTIVES To 
    Output:
    
Home-based , multi-trigger , multicomponent interventions with an environmental focus are effective in improving overall quality of life and productivity in children and adolescents with asthma .