***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 Human re source limitations are a challenge to the delivery of antiretroviral therapy ( ART ) in low-re source setting s. We conducted a cluster r and omized trial to assess the effect of community-based peer health workers ( PHW ) on AIDS care of adults in Rakai , Ug and a. Methodology /Principal Findings 15 AIDS clinics were r and omized 2∶1 to receive the PHW intervention ( n = 10 ) or control ( n = 5 ) . PHW tasks included clinic and home-based provision of counseling , clinical , adherence to ART , and social support . Primary outcomes were adherence and cumulative risk of virologic failure ( > 400 copies/mL ) . Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART . Analysis was by intention to treat . From May 2006 to July 2008 , 1336 patients were followed . 444 ( 33 % ) of these patients were already on ART at the start of the study . No significant differences were found in lack of adherence ( < 95 % pill count adherence risk ratio [ RR ] 0.55 , 95 % confidence interval [ CI ] 0.23–1.35 ; < 100 % adherence RR 1.10 , 95 % CI 0.94–1.30 ) , cumulative risk of virologic failure ( RR 0.81 , 95 % CI 0.61–1.08 ) or in shorter-term virologic outcomes ( 24 week virologic failure RR 0.93 , 95 % CI 0.65–1.32 ; 48 week , RR 0.83 , 95 % CI 0.47–1.48 ; 72 week , RR 0.81 , 95 % CI 0.44–1.49 ) . However , virologic failure rates ≥96 weeks into ART were significantly decreased in the intervention arm compared to the control arm ( 96 week failure RR 0.50 , 95 % CI 0.31–0.81 ; 120 week , RR 0.59 , 95 % CI 0.22–1.60 ; 144 week , RR 0.39 , 95 % CI 0.16–0.95 ; 168 week , RR 0.30 , 95 % CI 0.097–0.92 ; 192 week , RR 0.067 , 95 % CI 0.0065–0.71 ) . Conclusions / Significance A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART , but did not affect cumulative risk of virologic failure , adherence measures , or shorter-term virologic outcomes . PHWs may be an effective intervention to sustain long-term ART in low-re source setting s. Trial Registration Clinical Trials.gov OBJECTIVES Marijuana was involved in 209,563 emergency department ( ED ) visits in 2006 , according to the Drug Abuse Warning Network . Although screening and brief intervention ( SBI ) has been effective in changing drinking among ED patients in a number of studies , tests of marijuana SBI in a pediatric emergency department ( PED ) have not yet been reported . The aim of this pilot study was to test whether SBI is effective in reducing marijuana consumption among youth and young adults presenting to a PED with a diverse range of clinical entities . METHODS A three-group r and omized controlled preliminary trial was structured to test 1 ) differences between Intervention ( Int ) and st and ard Assessed Control ( AC ) groups in marijuana consumption , from baseline to 12 months , and 2 ) the feasibility of adding a Nonassessed Control ( NAC ) group to evaluate regression to the mean and assessment reactivity . Patients aged 14 - 21 years in an urban , academic PED were screened during 2006 - 2007 , using st and ardized risk factor questions . Subjects were eligible if they used marijuana three or more times in the past 30 days , but were excluded for co-occurring high-risk alcohol use . Consented enrollees were r and omized to NAC , AC , and Int groups in a two-stage process that permitted blinding to status during assessment and follow-up . NACs received a re source h and out , written advice about marijuana use risks , and a 12-month follow-up appointment . ACs were assessed using st and ardized instruments and received re sources , written advice , and 3- and 12-month follow-up appointments . The Int group received assessment , re sources , written advice , 3- and 12-month appointments , a 20-minute structured conversation conducted by older peers , and a 10-day booster telephone call . A peer educator utilized a motivational style interview protocol adapted for adolescents to elicit daily life context and future goals , provide feedback , review pros and cons of marijuana use , assess readiness to change , evaluate strengths and assets , negotiate a contract for change , and make referrals to treatment and /or other re sources . Measurements included demographic information ; 30-day self-report of marijuana use ; attempts to quit , cut back , or change conditions of use ; and risk factor questions repeated at follow-up . RESULTS Among 7,804 PED patients screened , 325 were eligible ; 210 consented and enrolled ( Int , n = 68 ; AC , n = 71 ; NAC , n = 71 ) , with a 12-month follow-up rate of 71 % . For the primary objective , we compared Int to AC . At 12 months , Int participants were more likely to be abstinent for the past 30 days than ACs ( odds ratio [ OR ] for reported abstinence = 2.89 , 95 % confidence interval [ CI ] = 1.22 to 6.84 , p < 0.014 ) . The Int group had greater reduction in days used , baseline to 12 months , controlling for baseline ( Int = -7.1 vs. AC = -1.8 ) , were less likely to have been high among those who smoked ( OR = 0.39 , 95 % CI = 0.17 to 0.89 , p < 0.05 ) , and were more likely to receive referrals . In a linear regression model controlling for baseline use , NACs  smoked 4 fewer days per month than ACs , but consumption was not significantly different , suggesting no assessment reactivity effect . CONCLUSIONS A preliminary trial of SBI promoted marijuana abstinence and reduced consumption among PED patients aged 14 - 21 years . A no-contact condition for the NAC group over the year after enrollment was insufficient to capture enrollees for follow-up across a range of baseline acuity Background Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders . However , it is still unclear which participants might or might not profit from this particular kind of treatment delivery . Objective The study aim ed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment ( TIMT ) offered to patients after inpatient psychotherapy for mental disorders in routine care . Methods Using data from a r and omized controlled trial ( N=400 ) design ed to test the effectiveness of TIMT , we performed secondary analyses to identify factors moderating the effects of TIMT ( intervention ) when compared with those of a treatment-as-usual control condition . TIMT involved an online self-management module , asynchronous patient – therapist communication , a peer support group , and online-based progress monitoring . Participants in the control condition had unstructured access to outpatient psychotherapy , st and ardized outpatient face-to-face continuation treatment , and psychotropic management . Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment ( T1 ) , at discharge from inpatient treatment/start of TIMT ( T2 ) , and at 3-month ( T3 ) and 12-month follow-up ( T4 ) . Results Education level , positive outcome expectations , and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3 . Only education level moderated change differences between T2 and T4 . The effectiveness of the intervention ( vs control ) was more pronounced among participants with a low ( vs high ) education level ( T2-T3 : B=–0.32 , SE 0.16 , P=.049 ; T2-T4 : B=–0.42 , SE 0.21 , P=.049 ) , participants with high ( vs low ) positive outcome expectations ( T2-T3 : B=–0.12 , SE 0.05 , P=.02 ) and participants with anxiety disorder ( vs mood disorder ) ( T2-T3 : B=–0.43 , SE 0.21 , P=.04 ) . Simple slope analyses revealed that despite some subgroups benefiting less from the intervention than others , all subgroups still benefited significantly . Conclusions This transdiagnostic Internet-based maintenance treatment might be suitable for a wide range of participants differing in various clinical , motivational , and demographic characteristics . The treatment is especially effective for participants with low education levels . These findings may generalize to other Internet-based maintenance treatments . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 28632626 ; http://www.controlled-trials.com/is rct n/pf/28632626 ( Archived by WebCite at http://www.webcitation.org/6IqZjTLrx ) Objective To evaluate the effectiveness of telephone based peer support in the prevention of postnatal depression . Design Multisite r and omised controlled trial . Setting Seven health regions across Ontario , Canada . Participants 701 women in the first two weeks postpartum identified as high risk for postnatal depression with the Edinburgh postnatal depression scale and r and omised with an internet based r and omisation service . Intervention Proactive individualised telephone based peer ( mother to mother ) support , initiated within 48 - 72 hours of r and omisation , provided by a volunteer recruited from the community who had previously experienced and recovered from self reported postnatal depression and attended a four hour training session . Main outcome measures Edinburgh postnatal depression scale , structured clinical interview-depression , state-trait anxiety inventory , UCLA loneliness scale , and use of health services . Results After web based screening of 21 470 women , 701 ( 72 % ) eligible mothers were recruited . A blinded research nurse followed up more than 85 % by telephone , including 613 at 12 weeks and 600 at 24 weeks postpartum . At 12 weeks , 14 % ( 40/297 ) of women in the intervention group and 25 % ( 78/315 ) in the control group had an Edinburgh postnatal depression scale score > 12 ( χ2=12.5 , P<0.001 ; number need to treat 8.8 , 95 % confidence interval 5.9 to 19.6 ; relative risk reduction 0.46 , 95 % confidence interval 0.24 to 0.62 ) . There was a positive trend in favour of the intervention group for maternal anxiety but not loneliness or use of health services . For ethical reasons , participants identified with clinical depression at 12 weeks were referred for treatment , result ing in no differences between groups at 24 weeks . Of the 221 women in the intervention group who received and evaluated their experience of peer support , over 80 % were satisfied and would recommend this support to a friend . Conclusion Telephone based peer support  can be effective in preventing postnatal depression among women at high risk . Trial registration IS RCT N 68337727 The increasing prevalence of diabetes and obesity , growing health disparities , and shortage of bilingual and culturally trained health care professionals underscore the role of trained community health workers ( CHWs ) to provide economically sustainable and culturally relevant services . This prospect i ve r and omized design evaluated the relative effectiveness of a CHW intervention among Hispanic persons with newly diagnosed type 2 diabetes , as compared with usual clinic practice in three inner-city health centers . In sum , 189 Hispanic patients newly diagnosed with type 2 diabetes were r and omly assigned to one of three 6-month diabetes management approaches — CHW , case management , and st and ard provider care— and assessed for diabetes-related health measures and clinical indicators at baseline and postintervention . Participants in the CHW group achieved greater improvements than did the controls in program measures : health status , emergency department utilization , dietary habits , physical activity , and medication adherence . They also had 2.9 times greater odds of decreasing body mass index OBJECTIVE Demonstrate the effective use of community-based evidence for health promotion by Lady Health Workers ( LHWs ) in Sindh , Pakistan . METHODS A baseline study on mothers and children provided local evidence for risk communication tools design ed and tested by LHWs . The communities were r and omized to intervention and control . LHWs visited  women before and after childbirth  to discuss safe practice s in pregnancy , in the intervention group LHW using the new tools and in the control group using their st and ard procedures . A household survey and focus groups permitted assessment of the impact of the intervention . RESULTS Women in the intervention communities were more likely to attend prenatal checkups , to stop routine heavy work during pregnancy , to give colostrum to newborn babies , and to maintain exclusive breastfeeding for four months . Community focus groups confirmed a positive reaction to the tools . CONCLUSION Discussion by lay health workers of local evidence underlying safe motherhood messages improved uptake of protective health practice s. PRA 
    Output:
    
Peer support is a broad and robust strategy for reaching groups that health services too often fail to engage .