***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: OBJECTIVE To determine whether an asthma coaching program can improve  parent and child asthma-related quality of life ( QOL ) and reduce urgent care events . DESIGN R and omized controlled trial of usual care vs usual care with coaching . Comparisons were made between groups using mixed models . SETTING A Midwest city . PARTICIPANTS A community-based sample of 362 families with a child aged 5 to 12 years with persistent asthma . INTERVENTION A 12-month structured telephone coaching program in which trained coaches provided education and support to parents for 4 key asthma management behaviors . MAIN OUTCOME MEASURES Parental and child QOL measured with a vali date d , interview-administered , 7-point instrument and urgent care events in a year ( unscheduled office visits , after-hours calls , emergency department visits , or hospitalizations ) determined by record audit . RESULTS Parental asthma-related QOL scores improved by an average of 0.67 units ( 95 % confidence interval [ CI ] , 0.49 to 0.84 ) in the intervention group and 0.28 units ( 95 % CI , 0.10 to 0.46 ) in the control group . The difference between study groups was statistically significant ( difference , 0.38 ; 95 % CI , 0.14 to 0.63 ) . No between-group difference was found in the change in the child 's QOL ( difference , -0.17 ; 95 % CI , -0.47 to 0.12 ) or in the mean number of urgent care events per year ( difference , 1.15 ; 95 % CI , 0.82 to 1.61 ) . The proportion of children with very poorly controlled asthma in the intervention group decreased compared with the control group ( difference , 0.34 ; 95 % CI , 0.21 to 0.48 ) . CONCLUSIONS A telephone coaching program can improve parental QOL and can be implemented without additional physician training or practice re design A r and omized , controlled trial was conducted to assess the effectiveness of Blue Angel for Asthma Kids , an Internet-based interactive asthma educational and monitoring program , used in the management of asthmatic children . One hundred sixty-four ( n = 164 ) pediatric patients with persistent asthma were enrolled and r and omized into two study groups for a 12-week controlled trial . The intervention group had 88  participants who were taught to monitor their peak expiratory flows ( PEF ) and asthma symptoms daily on the Internet . They also received an interactive response consisting of a self-management plan from the Blue Angel monitoring program . The control group had 76 participants who received a traditional asthma care plan consisting of a written asthma diary supplemented with instructions for self-management . Disease control was assessed by weekly averaged PEF values , symptom scores , and asthma control tests . Adherence measures were assessed by therapeutic and diagnostic monitoring . Outcome was assessed by examining quality of life and retention of asthma knowledge . The data were analyzed by comparing results before and after the trial . At the end of trial , the intervention group decreased nighttime ( -0.08 + /- 0.33 vs. 0.00 + /- 0.20 , p = 0.028 ) and daytime symptoms ( -0.08 + /- 0.33 vs. 0.01 + /- 0.18 , p = 0.009 ) ; improved morning ( 241.9 + /- 81.4 vs. 223.1 + /- 55.5 , p = 0.017 ) and night PEF ( 255.6 + /- 86.7 vs. 232.5 + /- 55.3 , p = 0.010 ) ; increased adherence rates ( p < 0.05 ) ; improved well-controlled rates ( 70.4 % vs. 55.3 % , p < 0.05 ) ; improved knowledge regarding self-management ( 93.2 % vs. 70.3 % , p < 0.05 ) ; and improved quality of life ( 6.5 + /- 0.5 vs. 4.3 + /- 1.2 on a 7-point scale , p < 0.05 ) when compared with conventional management . The Internet-based asthma telemonitoring program increases selfmanagement skills , improves asthma outcomes , and appears to be an effective and well-accepted technology for the care of children with asthma and their caregivers OBJECTIVE To assess the outcomes of an education intervention for childhood asthma conducted by Australian Indigenous health care workers ( IHCWs ) . DESIGN AND SETTING R and omised controlled trial in a primary health care setting on Thursday Isl and and Horn Isl and , and in Bamaga , Torres Strait region of northern Australia , April 2005 to March 2007 . PARTICIPANTS 88 children , aged 1 - 17 years , with asthma diagnosed by a respiratory physician ( intervention group , 35 ; control group , 53 ; 98 % Indigenous children ) . INTERVENTIONS Children were r and omly allocated to : ( i ) three additional asthma education sessions with a trained IHCW , or ( ii ) no additional asthma education . Both groups were re-assessed at 12 months . MAIN OUTCOME MEASURES Primary endpoint : number of unscheduled visits to hospital or a doctor caused by asthma exacerbation . SECONDARY OUTCOMES measures of quality of life ( QoL ) and functional severity index ; asthma knowledge and underst and ing of asthma action plans ( AAPs ) ; and school days missed because of wheezing . RESULTS The groups were comparable at baseline ( except for asthma severity , which was adjusted for in the analysis ) . There were no significant differences in the primary outcome ( number of unscheduled medical visits for asthma ) . School children in the intervention group missed fewer school days because of wheezing ( 100 % < 7 days v 21 % of those in the control group missed 7 - 14 days ) . Significantly more carers in the intervention group could answer questions about asthma medication , knew where their AAP was kept ( 84 % v 56 % ) , and were able to describe the plan ( 67 % v 40 % ) . In both the intervention and control groups ( before- and -after comparison ) , there was a significantly reduced frequency of asthma exacerbations , as well as an improved QoL score and functional severity index , with no significant differences between the groups . CONCLUSIONS A community-based asthma education program conducted by trained IHCWs improves some important asthma outcomes in Indigenous children with asthma . TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN012605000718640 & NA ; The issue of whether nursing instruction efforts could improve asthma knowledge and quality of life among schoolchildren was investigated using a quasi-experimental design . The key instruments were the Asthmatic Knowledge Question naire and the Childhood Asthma Question naire-Form B. Asthmatic knowledge increased among children who received instruction from nurses  ( Mean pre/post= 22.20/31.87 , p < .05 ) . These children also experienced significant improvements in their active quality of life ( Mean pre/post = 27.53/30.20 , p < .05 ) , and decreased distress ( Mean pre/post= 24.04/10.86 , p < .05 ) and asthma severity ( Mean pre/post= 13.27/8.3 , p < .05 ) . This study finds nursing instruction helpful in improving asthma knowledge . However , in terms of quality of life , elevated knowledge has a marked ( negative ) correlation only with levels of distress and severity . It shows no detectable relationship with active or passive life quality . Therefore , though nursing instruction can improve schoolchildren 's knowledge about asthma , the improvement in knowledge only relates to reducing distress and severity and thus improving quality of life . This result can provide guidance for nursing personnel in developing nursing instruction to improve active quality of life in child patients OBJECTIVE To establish the efficacy in terms of morbidity and quality of life of a group education program on asthma aim ed at children and caregivers . METHODS An open , r and omized , controlled trial was undertaken in 13 primary health care centers in Spain , Cuba , and Uruguay and involved 245 children with active asthma aged 9 to 13 years and their caregivers . The intervention consisted of 3 educational sessions lasting 45 to 60 minutes each and was performed with 3 intervention groups : children alone , caregivers alone , and both children and caregivers . The outcome measures were difference between intervention and control groups in the rate of asthma attacks and hospital admission , as well as the quality of life of children and caregivers in the 6 months following the intervention . RESULTS The rate of asthma attacks per patient-year decreased when the intervention was given only to children ( mean difference , -1.61 ; 95 % confidence interval [ CI ] , -2.87 to -0.34 ) or to both children and caregivers ( -1.60 ; 95 % CI , -2.88 to -0.31 ) . Hospital admissions per patient-year decreased in the intervention groups children alone ( -0.28 ; 95 % CI , -0.51 to -0.05 ) and both children and caregivers ( -0.25 ; 95 % CI , -0.49 to -0.02 ) . Education provided to caregivers alone was not associated with any changes in morbidity . No differences were observed in terms of quality of life between controls and any of the intervention groups . CONCLUSIONS Group education on asthma reduces morbidity but does not improve quality of life . The benefits are apparent when education is aim ed at children but no additional benefit is obtained if the intervention is also aim ed at their caregivers . Finally , group education for adult caregivers alone is not effective BACKGROUND Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma . OBJECTIVE To test an art therapy intervention in a r and omized controlled trial in children with asthma . METHODS Twenty-two children with asthma were r and omized to an active art therapy or wait-list control group . Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks . Sessions included specific art therapy tasks design ed to encourage expression , discussion , and problem-solving in response to the emotional burden of chronic illness . Measures taken at baseline , immediately after , and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment , the parent and child versions of the Pediatric Quality of Life Asthma Module , and the Beck Youth Inventories . Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions . RESULTS Score changes from baseline to completion of art therapy indicated ( 1 ) improved problem-solving and affect drawing scores ; ( 2 ) improved worry , communication , and total quality of life scores ; and ( 3 ) improved Beck anxiety and self concept scores in the active group relative to the control group . At 6 months , the active group maintained some positive changes relative to the control group including ( 1 ) drawing affect scores , ( 2 ) the worry and quality of life scores , and ( 3 ) the Beck anxiety score . Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups . CONCLUSION This was the first r and omized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life The present study investigated schools as an appropriate context for an intervention design ed to produce clinical and psychological benefits for children with asthma . A total of 193 out of 219 ( 88.1 % ) children with asthma ( aged 7–9 yrs ) from 23 out of 24 ( 95.8 % ) schools completed the study . Intervention schools received a staff asthma-training session , advice on asthma policy , an emergency β2-agonist inhaler with spacer and whole-class asthma workshops . Nonintervention schools received no asthma-related input . Intervention children required less general practitioner-prescribed preventer medication despite no differences in symptom control compared with the nonintervention asthmatic group . Increased peer knowledge of asthma may have mediated improved active quality of life in the intervention group , together with increased self-esteem in young females . Those females not receiving the intervention , but identified as being asthmatic within the classroom , and thus possibly stigmatised , reported decreased self-esteem . Lower self-esteem in young males was associated with pet ownership . No change was found in staff knowledge , the establishment of asthma policies or school absences which were low even before intervention . In conclusion , a whole-school intervention can improve the health of children with asthma  when followed with support for all children but effects are likely to be modified by sex and the home environment BACKGROUND Asthma is a serious problem for low-income preteens living in disadvantaged communities . Among the chronic diseases of childhood and adolescence , asthma has the highest prevalence and related health care use . School-based asthma interventions have proven successful for older and younger students , but results have not been demonstrated for those in middle school . METHODS This r and omized controlled study screened students 10 - 13 years of age in 19 middle schools in low-income communities in Detroit , Michigan . Of the 6,872 students who were screened , 1,292 students were identified with asthma . Schools were matched and r and omly assigned to Program 1 or 2 or control . Baseline , 12 , and 24 months data were collected by telephone ( parents ) , 
    Output:
    
Conclusions Most interventions focussed on the delivery of asthma education to children , with the purpose of improving knowledge about asthma and disease management .
There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children , adolescents , and their families .