***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: PURPOSE Though case management has been recommended to improve the outcomes of patients with costly or morbid conditions , it has seldom been studied in controlled trials . We performed a r and omized , controlled clinical trial of an intensive , multidisciplinary case management program for patients with chronic renal insufficiency and followed patients for 5 years . PATIENTS AND METHODS We enrolled 437 primary -care patients ( 73 % of those eligible ) with chronic renal insufficiency ( estimated creatinine clearance consistently < 50 mL/min with the last serum creatinine level > 1.4 mg/dL ) who were attending an urban academic general internal medicine practice . The intensive case management , administered during the first 2 years after enrollment , consisted of m and atory repeated consultations in a nephrology case management clinic staffed by two nephrologists , a renal nurse , a renal dietitian , and a social worker . Control patients received usual care . Primary outcome measurements included serum creatinine level , estimated creatinine clearance , health services use , and mortality in the 5 years after enrollment . Secondary measures included use of renal sparing and potentially nephrotoxic drugs . RESULTS There were no differences in renal function , health services use , or mortality in the first , second , or third through fifth years after enrollment . There were significantly more outpatient visits among intervention patients , mainly because of the added visits to the nephrology case management clinic . There were also no significant differences in the use of renal sparing or selected potentially nephrotoxic drugs . The annual direct costs of the intervention were $ 89,355 ( $ 484 per intervention patient ) . CONCLUSION This intensive , multidisciplinary case-management intervention had no effect on the outcomes of care among primary -care patients with established chronic renal insufficiency . Such expensive and intrusive interventions , despite representing state-of-the-art care , should be tested prospect ively before being widely introduced into practice BACKGROUND Few robust studies have tested whether enhancing housing also improves health . AIM To evaluate the effectiveness of installing ventilation systems , and central heating where necessary , in the homes of children with moderate or severe asthma . DESIGN AND SETTING Pragmatic r and omised controlled trial ( RCT ) in homes within Wrexham County Borough , Wales , UK . METHOD A pragmatic RCT was carried out , of a tailored package of housing improvements providing adequate ventilation and temperature , following inspection by a housing officer . One hundred and ninety-two children with asthma aged 5 to 14 years , identified from general practice registers , were r and omised to receive this package , either immediately or a year after recruitment . At baseline , and after 4 and 12 months , parents reported their child 's asthma-specific and generic quality of life , and days off school . RESULTS The package improved parent-reported asthma-specific quality of life significantly at both 4 and 12 months . At 12 months , this showed an adjusted mean difference between groups of 7.1 points ( 95 % confidence interval [ CI ] = 2.8 to 11.4 , P= 0.001 ) : a moderate st and ardised effect size of 0.42 . The generic quality -of-life scale showed reported physical problems were significantly reduced at 4 months , but not quite at 12 months , when the mean difference was 4.5 ( 95 % CI = -0.2 to 9.1 , P= 0.061 ) . The improvement in psychosocial quality of life at 12 months was not significant , with a mean difference of 2.2 ( 95 % CI = -1.9 to 6.4 , P= 0.292 ) . Parent-reported school attendance improved , but not significantly . CONCLUSION This novel and pragmatic trial , with integrated economic evaluation , found that tailored improvement of the housing of children with moderate to severe asthma significantly increases parent-reported asthma-related quality of life and reduces physical problems .  Collaborative housing initiatives have potential to improve health Background Psychosocial problems in socioeconomically deprived communities are not always amenable to traditional medical approaches . Mothers living in these areas are a particularly vulnerable group . The objective of this study was to evaluate the effectiveness of a lengthened multi-disciplinary team consultation in primary care in reducing  anxiety and depression in mothers . Methods This was a prospect i ve r and omised controlled trial of a multidisciplinary team consultation against normal care .  94 mothers were recruited from three general practice s from an area of extreme socio-economic deprivation . Mothers r and omised into the intervention group attended a multidisciplinary consultation with up to four case-specific health care professionals . Consultations addressed medical , psychological and social problems and lasted up to one hour . Conventional primary care continued to be available to the intervention families . Control group families received normal primary care services . The outcomes measured were anxiety and depression as using the Hospital Anxiety and Depression Scale ( HADS ) , health status using SF36v2 , and quality of life using the abbreviated Schedule for the Evaluation of Individual Quality of Life ( SEIQoL-DW ) at baseline , 6 months and 12 months . Results Ordered logistic regression was used to analyse the data . There was no significant difference found between intervention and control groups after 6 months and 12 months in all of the measured outcomes . Conclusions The new lengthened multi-disciplinary team consultation did not have any impact on the mental health , general health , and quality of life of mothers after 6 and 12 months . Other methods of primary health care delivery in socio-economically deprived communities need to be evaluated Aim : The aim of the present study was to evaluate the effect of assertive community treatment ( ACT ) in the Tønder Region , South Jutl and , where the first Danish ACT team was established to treat patients with severe and persistent mental illness ( SMI ) . Methods : The study compares outcome over a 2-year period between recipients of ACT and st and ard community mental healthcare .  Results : The study included 86 cases and 88 controls . At the time of recruitment , the cases and the controls did not differ significantly in demographic details and eligibility criteria . At the 2-year follow-up , the ACT patients showed a significant reduction in admissions , bed days and day hospital days , and a significant increase in the number of consultations compared with the controls . Adherence to outpatient services was higher in the ACT group . No significant improvements in psychopathology were found after 2 years , but a significant improvement in met needs and fewer unmet needs , indicating better functioning , occurred . Clients ’ satisfaction with care ( Client Satisfaction Question naire , CSQ ) was significantly higher among ACT patients than among controls . Conclusion : The treatment of these patients in this ACT service has yielded promising results , suggesting that ACT treatment may be a useful intervention for SMI patients . However , large , rigorous , r and omized control trials with ACT are needed in Europe as the existing evidence mainly comes from American studies BACKGROUND The ability of specific behaviour-change interventions to reduce HIV infection in young people remains question able . Since January 1999 , an adolescent sexual and reproductive health ( SRH ) intervention has been implemented in ten r and omly chosen intervention communities in rural Tanzania , within a community r and omised trial ( see below ; NCT00248469 ) . The intervention consisted of teacher-led , peer-assisted in-school education , youth-friendly health services , community activities , and youth condom promotion and distribution . Process evaluation in 1999 - 2002 showed high intervention quality and coverage . A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 ( HSV-2 ) seroprevalence but found substantial improvements in SRH knowledge , reported attitudes , and some reported sexual behaviours . It was postulated that the impact on " upstream " knowledge , attitude , and reported behaviour outcomes seen at the 3-year follow-up would , in the longer term , lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes . A further impact evaluation survey in 2007/8 ( approximately 9 years post-intervention ) tested this hypothesis . METHODS AND FINDINGS This is a cross-sectional survey ( June 2007 through July 2008 ) of 13,814 young people aged 15 - 30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial ( 1999 - 2002 ) . Prevalences of the primary outcomes HIV and HSV-2 were 1.8 % and 25.9 % in males and 4.0 % and 41.4 % in females , respectively . The intervention did not significantly reduce risk of HIV ( males adjusted prevalence ratio [ aPR ] 0.91 , 95%CI 0.50 - 1.65 ; females aPR 1.07 , 95%CI 0.68 - 1.67 ) or HSV-2 ( males aPR 0.94 , 95%CI 0.77 - 1.15 ; females aPR 0.96 , 95%CI 0.87 - 1.06 ) . The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime ( aPR 0.87 , 95%CI 0.78 - 0.97 ) and an increase in reported condom use at last sex with a non-regular partner among females ( aPR 1.34 , 95%CI 1.07 - 1.69 ) . There was a clear and consistent beneficial impact on knowledge , but no significant impact on reported attitudes to sexual risk , reported pregnancies , or other reported sexual behaviours . The study population was likely to have been , on average , at lower risk of HIV and other sexually transmitted infections compared to other rural population s , as only youth who had reached year five of primary school were eligible . CONCLUSIONS SRH knowledge can be improved and retained long-term , but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence .  Youth interventions integrated within intensive , community-wide risk reduction programmes may be more successful and should be evaluated . TRIAL REGISTRATION Clinical Trials.gov BACKGROUND Patients with first-episode psychosis comprise a high-risk group in terms of suicide . AIMS To identify predictive factors for suicidal behaviour and to examine the effect of integrated treatment on suicidal behaviour and hopelessness . METHOD A total of 341 patients with a first-episode schizophrenia-spectrum disorder were r and omised to integrated treatment or treatment as usual . RESULTS During the 1-year follow-up period , 11 % attempted suicide . This was associated with female gender , hopelessness , hallucinations and suicide attempt reported at baseline , with the two latter variables being the only significant ones in the final multivariate model . The integrated treatment  reduced hopelessness . CONCLUSIONS Hallucinations and suicide attempt before inclusion in the study were the most significant predictors of suicide attempt in the follow-up period OBJECTIVE To determine whether a multicomponent health promotion intervention for Dutch adolescents ( defined as persons between 12 and 14 years of age ) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 1108 adolescents ( mean age , 12.7 years ) . Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options . MAIN OUTCOME MEASURES Body height and weight , waist circumference , 4 skinfold thickness measurements , and dietary and physical activity behavior data . RESULTS Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls ( biceps skinfold and sum of 4 skinfolds ) and boys ( triceps , biceps , and subscapular skinfolds ) . Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention ( boys : -287 mL/d ; 95 % confidence interval [ CI ] , -527 to -47 ; girls : -249 ; -400 to -98 ) and at 12-month follow-up ( boys : -233 ; -371 to -95 ; girls : -271 ; -390 to -153 ) . For boys , screen-viewing behavior was significantly lower in the intervention group after 20 months ( -25 min/d ; 95 % CI , -50 to -0.3 ) . No significant intervention effects on consumption of snacks or active commuting to school were found . CONCLUSION The Dutch Obesity Intervention in Teenagers program result ed in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms Background This paper examines the association between use of protective devices , frequency of acute health problems and health-protection information received by participants engaged in the Prestige oil spill clean-up in Asturias and Cantabria , Spain . Methods We studied 133 seamen , 135 bird cleaners , 266 volunteers and 265 paid workers selected by r and om sampling , stratified by type of worker and number of working days . Information was collected by telephone interview conducted in June 2003 . The association of interest was summarized , using odds ratios ( OR ) obtained from logistic regression . Results Health-protection briefing was associated with use of protective devices and clothing . Uninformed subjects registered a significant excess risk of itchy eyes ( OR:2.89 ; 95%CI:1.21–6.90 ) , nausea/vomiting/dizziness ( OR:2.25 ; 
    Output:
    
Collaboration between local health and local government is commonly considered best practice .
However , the review did not identify any reliable evidence that interagency collaboration , compared to st and ard services , necessarily leads to health improvement .
A few studies identified component benefits but these were not reflected in overall outcome scores and could have result ed from the use of significant additional re sources .
If these weaknesses are addressed in future studies ( for example by providing greater detail on the implementation of programmes ; using more robust design s , integrated process evaluations to show how well the partners of the collaboration worked together , and measurement of health outcomes ) it could provide a better underst and ing of what might work and why .
It is possible that local collaborative partnerships delivering environmental Interventions may result in health gain but the evidence base for this is very limited .