***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: Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service CONTEXT Home-visitation services have been promoted as a means of improving maternal and child health and functioning . However , long-term effects have not been examined . OBJECTIVE To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women 's life course and child abuse and neglect . DESIGN R and omized trial . SETTING Semirural community in New York . PARTICIPANTS Of 400 consecutive pregnant women with no previous live births enrolled , 324 participated in a follow-up study when their children were 15 years old . INTERVENTION Families received a mean of 9 home visits during pregnancy and 23 home visits from the child 's birth through the second birthday . DATA SOURCES AND MEASURES : Women 's use of welfare and number of subsequent children were based on self-report ; their arrests and convictions were based on self-report and archived data from New York State . Verified reports of child abuse and neglect were abstract ed from state records . MAIN RESULTS During the 15-year period after the birth of their first child , in contrast to women in the comparison group , women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports ( P<.001 ) . Among women who were unmarried and from households of low socioeconomic status at initial enrollment , in contrast to those in the comparison group , nurse-visited women had 1.3 vs 1.6 subsequent births ( P=.02 ) , 65 vs 37 months between the birth of the first and a second child ( P=.001 ) , 60 vs 90 months ' receiving Aid to Families With Dependent Children ( P=.005 ) , 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs ( P=.03 ) , 0.18 vs 0.58 arrests by self-report ( P<.001 ) , and 0.16 vs 0.90 arrests disclosed by New York State records ( P<.001 ) . CONCLUSIONS This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies , the use of welfare , child abuse and neglect , and criminal behavior on the part of low-income , unmarried mothers for up to 15 years after the birth of the first child STUDY OBJECTIVES : The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies , during a period of 42 days after delivery . Another aim was to compare the mothers ' , the midwife 's , and the doctor 's findings of prevalence of health problems at the end of the puerperium period . DESIGN : A r and omised controlled trial was carried out . One group of mothers and their infants were r and omly allocated to a home visiting group ( Group A ) ; the other group ( Group B ) was only visited at day 42 . SETTING : The study was carried out at the University Teaching Hospital ( UTH ) in Lusaka , the capital city of Zambia . PARTICIPANTS : A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant , as assessed by the attending midwife , were r and omised to two groups . Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3 , 7 , 28 , and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42 . MAIN RESULTS : At day 42 an equal proportion ( 30 % ) of mothers in both groups perceived that they had health problems . The prevalence of infant health problems in Group B was significantly higher ( p < 0.01 ) as perceived by mothers . There were more mothers in Group B ( p < 0.01 ) perceiving insufficient milk production and giving supplementary feeding . At day 42 , mothers in Group A ( 56 % ) took more actions than mothers in Group B ( 41 % ) to solve infant health problems ( p < 0.03 ) . In both groups the mothers ' perceived own health problems , were significantly higher ( p < 0.01 ) than those observed by the obstetrician and those observed by the midwife . The midwife found more infant health problems in Group B ( p < 0.01 ) than in Group A and more infants with health problems in both groups compared with the paediatrician 's findings ( p < 0.01 ) . CONCLUSIONS : There was a significant difference between the mothers ' reported health problems and the health problems identified by the midwife and the doctors . The study shows that a midwife home visit and individual health education to mothers , reduce the prevalence of infant health problems , and enables the mother to more often take action when an infant health problem is identified . There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care OBJECTIVES This study examined differences between  nurses and paraprofessionals  in implementation of a home visiting program for low-income , first-time parents during pregnancy and the first 2 years of the child 's life . METHODS Mothers were r and omly assigned to either a nurse-visited ( n = 236 ) or a paraprofessional-visited ( n = 244 ) condition .  Nurse- and paraprofessional-visited families were compared on number and length of visits , topics covered , number of program dropouts , and relationship with home visitor . RESULTS On average , nurses completed more visits than paraprofessionals ( 28 vs 23 ; P < .001 ) and spent a greater proportion of time on physical health issues during pregnancy ( 38 % vs 27 % ; P < .001 ) and on parenting issues during infancy ( 46 % vs 32 % ; P < .001 ) . Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues ( 15 % vs 7 % pregnancy ; 15 % vs 8 % infancy ; P < .001 ) . While home visitors were viewed equally positively by mothers , nurses had fewer dropouts than did paraprofessionals ( 38 % vs 48 % ; P = .04 ) . More paraprofessional-visited families than nurse-visited families experienced staff turnover . CONCLUSIONS Nurses and paraprofessionals , even when using the same model , provide home visiting services in different ways Background In the year after birth one in six women has a depressive illness , and 30 % are still depressed , or depressed again , when their child is 2 years old , 94 % experience at least one major health problem ( e.g. back pain , perineal pain , mastitis , urinary or faecal incontinence ) , 26 % experience sexual problems and almost 20 % have relationship problems with partners . Women with depression report less practical and emotional support from partners , less social support overall , more negative life events , and poorer physical health . Their perceptions of factors contributing to depression are lack of support , isolation , exhaustion and physical health problems . Fewer than one in three affected women seek help in primary care despite frequent contacts . Methods / Design PRISM aims to reduce depression and physical health problems of recent mothers through primary care strategies to increase practitioners ' response to these issues , and through community-based strategies to develop broader family and community supports for recent mothers . Eligible local governments will be recruited and r and omised to intervention or comparison arms , after stratification ( urban/rural , size , birth numbers , extent of community activity ) , avoiding contiguous boundaries . Maternal depression and physical health will be measured six months after birth , in a one year cohort of mothers , in intervention and comparison communities . The sample size to detect a 20 % relative reduction in depression , adjusting for cluster sampling , and estimating a population response fraction of 67 % is 5740 × 2 . Analysis of the physical and mental health outcomes , by intention to treat , will adjust for the correlated structure of the data OBJECTIVE To examine the effectiveness of home visiting by paraprofessionals and by nurses as separate means of improving maternal and child health when both types of visitors are trained in a program model that has demonstrated effectiveness when delivered by nurses . METHODS A r and omized , controlled trial was conducted in public- and private-care setting s in Denver , Colorado . One thous and one hundred seventy-eight consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance were invited to participate . Seven hundred thirty-five women were r and omized to control , paraprofessional , or nurse conditions . Nurses completed an average of 6.5 home visits during pregnancy and 21 visits from birth to the children 's second birthdays . Paraprofessionals completed an average of 6.3 home visits during pregnancy and 16 visits from birth to the children 's second birthdays . The main outcomes consisted of changes in women 's urine cotinine over the course of pregnancy ; women 's use of ancillary services during pregnancy ; subsequent pregnancies and births , educational achievement , workforce participation , and use of welfare ; mother-infant responsive interaction ; families ' home environments ; infants ' emotional vulnerability in response to fear stimuli and low emotional vitality in response to joy and anger stimuli ; and children 's language and mental development , temperament , and behavioral problems . RESULTS Paraprofessional-visited mother-child pairs in which the mother had low psychological re sources interacted with one another more responsively than their control-group counterparts ( 99.45 vs 97.54 st and ard score points ) . There were no other statistically significant paraprofessional effects . In contrast to their control-group counterparts , nurse-visited smokers had greater reductions in cotinine levels from intake to the end of pregnancy ( 259.0 vs 12.32 ng/mL ) ; by the study child 's second birthday , women visited by nurses had fewer subsequent pregnancies ( 29 % vs 41 % ) and births ( 12 % vs 19 % ) ; they delayed subsequent pregnancies for longer intervals ; and during the second year after the birth of their first child , they worked more than women in the control group ( 6.83 vs 5.65 months ) . Nurse-visited mother-child pairs interacted with one another more responsively than those in the control group ( 100.31 vs 98.99 st and ard score points ) . At 6 months of age , nurse-visited infants , in contrast to their control-group counterparts , were less likely to exhibit emotional vulnerability in response to fear stimuli ( 16 % vs 25 % ) and nurse-visited infants born to women with low psychological re sources were less likely to exhibit low emotional vitality in response to joy and anger stimuli ( 24 % vs 40 % and 13 % vs 33 % ) . At 21 months , nurse-visited children born to women with low psychological re sources were less likely to exhibit language delays ( 7 % vs 18 % ) ; and at 24 months , they exhibited superior mental development ( 90.18 vs 86.20 Mental Development Index scores ) than their control-group counterparts . There were no statistically significant program effects for the nurses on  women 's  use of ancillary prenatal services , educational achievement , use of welfare , or their children 's temperament or behavior problems . For most outcomes on which either visitor produced significant effects , the paraprofessionals typically had effects that were about half the size of those produced by nurses . CONCLUSIONS When trained in a model program of prenatal and infancy home visiting , paraprofessionals produced small effects that rarely achieved statistical or clinical significance ; the absence of statistical significance for some outcomes is probably attributable to limited statistical power to detect small effects . Nurses produced significant effects on a wide range of maternal and child outcomes OBJECTIVE To compare office-based care ( OBC ) with a care model using a home nursing visit ( HNV ) as the initial postdischarge encounter for " well " breastfeeding newborns and mothers . DESIGN R and omized controlled trial . SETTING A single academic hospital . PARTICIPANTS A total of 1154 postpartum mothers intending to 
    Output:
    
The trials were carried out in countries across the world , and in both high- and low-re source setting s. In low-re source setting s women receiving usual care may have received no additional postnatal care after early hospital discharge .
There was no evidence that home visits were associated with improvements in maternal and neonatal mortality , and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health .
There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth , and that more home visits may encourage more women to exclusively breastfeed their babies .
There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care .
Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women , although overall findings in different studies were not consistent .