***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 This project aim ed to evaluate the impact of a home visiting programme that targeted families where the child , for environmental reasons , was at great risk of poor health and developmental outcomes . METHODOLOGY Women in the immediate postpartum period were recruited to a r and omized double-blind controlled trial on the basis of self-reported vulnerability factors and were r and omly assigned to receive either a structured programme of nurse home visiting , supported by a social worker and paediatrician ( n = 90 ) , or assigned to a comparison group receiving st and ard community child health services ( n = 91 ) . Parenting stress and maternal depression were measured at enrollment and at 6 weeks . Preventive health behaviour , service satisfaction and home environment outcomes were tested at 6 weeks , as were child health outcomes . RESULTS At six weeks , women receiving the home-based programme had significant reductions in postnatal depression screening scores as well as improvements in their experience of the parental role and improvement in the ability to maintain their own identity . Maternal-infant interactions were more likely to be positive , with significantly higher ( better ) scores in aspects of the home environment related to optimal development in children , particularly maternal-infant secure attachment . Intervention group mothers were significantly more satisfied with the community child health service . CONCLUSIONS This form of intervention for families is effective in promoting secure maternal-infant attachment , preventing maternal mood disorder and is welcomed by the families receiving it . These findings may predict long-term benefits for the healthy development of children otherwise at risk of a range of poor health and development outcomes OBJECTIVE : To estimate the efficacy of a psycho-behavioral intervention in reducing intimate partner violence recurrence during pregnancy and postpartum and in improving birth outcomes in African-American women . METHODS : We conducted a r and omized controlled trial for which 1,044 women were recruited . Women were r and omly assigned to receive either intervention ( n=521 ) or usual care ( n=523 ) . Individually tailored counseling sessions were adapted from evidence -based interventions for intimate partner violence and other risks . Logistic regression was used to model intimate partner violence victimization recurrence and to predict minor , severe , physical , and sexual intimate partner violence . RESULTS : Women r and omly assigned to the intervention group were less likely to have recurrent episodes of intimate partner violence victimization ( odds ratio [ OR ] 0.48 , 95 % confidence interval [ CI ] 0.29–0.80 ) . Women with minor intimate partner violence were significantly less likely to experience further episodes during pregnancy ( OR 0.48 , 95 % CI 0.26–0.86 , OR 0.53 , 95 % CI 0.28–0.99 ) and postpartum ( OR 0.56 , 95 % CI 0.34–0.93 ) . Numbers needed to treat were 17 , 12 , and 22 , respectively , as compared with the usual care group . Women with severe intimate partner violence showed significantly reduced episodes postpartum ( OR 0.39 , 95 % CI 0.18–0.82 ) ; the number needed to treat was 27 . Women who experienced physical intimate partner violence showed significant reduction at the first follow-up ( OR 0.49 , 95 % CI 0.27–0.91 ) and postpartum ( OR 0.47 , 95 % CI 0.27–0.82 ) ; the numbers needed to treat were 18 and 20 , respectively . Women in the intervention group had significantly fewer very preterm neonates ( 1.5 % intervention group , 6.6 % usual care group ; P=.03 ) and an increased mean gestational age ( 38.2±3.3 intervention group , 36.9±5.9 usual care group ; P=.016 ) . CONCLUSION : A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes . Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00381823 . LEVEL OF EVIDENCE : OBJECTIVES : Intimate partner violence ( IPV ) during pregnancy affects 0.9 % to 17 % of women and affects maternal health significantly . The impact of IPV extends to the health of children , including an increased risk of complications during pregnancy and the neonatal period , mental health problems , and cognitive delays . Despite substantial sequelae , there is limited research substantiating best practice s for engaging and retaining high-risk families in perinatal home visiting ( HV ) programs , which have been shown to improve infant development and reduce maltreatment . METHODS : The Domestic Violence Enhanced Home Visitation Program ( DOVE ) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs . The DOVE intervention , based on an empowerment model , combined 2 evidence -based interventions : a 10-minute brochure-based IPV intervention and nurse home visitation . RESULTS : Across all sites , 689 referrals were received from participating health departments . A total of 339 abused pregnant women were eligible for r and omization ; 42 women refused , and 239 women were r and omly assigned ( 124 DOVE ; 115 usual care ) , result ing in a 71 % recruitment rate .  Retention rates from baseline included 93 % at delivery , 80 % at 3 months , 76 % at 6 months , and 72 % at 12 months . CONCLUSIONS : Challenges for HV programs include identifying and retaining abused pregnant women in their programs . DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs ’ federal government m and ates for the appropriate identification and intervention of women and children exposed to IPV Background Intimate partner violence ( IPV ) can result in significant harm to women and families and is especially prevalent when women are pregnant or recent mothers . Maternal and child health nurses ( MCHN ) in Victoria , Australia are community-based nurse/midwives who see over 95 % of all mothers with newborns . MCHN are in an ideal position to identify and support women experiencing IPV , or refer them to specialist family violence services . Evidence for IPV screening in primary health care is inconclusive to date . The Victorian government recently required nurses to screen all mothers when babies are four weeks old , offering an opportunity to examine the effectiveness of MCHN IPV screening practice s. This protocol describes the development and design of MOVE , a study to examine IPV screening effectiveness and the sustainability of screening practice . Methods / design MOVE is a cluster r and omised trial of a good practice model of MCHN IPV screening involving eight maternal and child health nurse teams in Melbourne , Victoria . Normalisation Process Theory ( NPT ) was incorporated into the design , implementation and evaluation of the MOVE trial to enhance and evaluate sustainability . Using NPT , the development stage combined participatory action research with intervention nurse teams and a systematic review of nurse IPV studies to develop an intervention model incorporating consensus guidelines , clinical pathway and strategies for individual nurses , their teams and family violence services . Following twelve months ’ implementation , primary outcomes assessed include IPV inquiry , IPV disclosure by women and referral using data from MCHN routine data collection and a survey to all women giving birth in the previous eight months . IPV will be measured using the Composite Abuse Scale . Process and impact evaluation data ( online surveys and key stakeholders interviews ) will highlight NPT concepts to enhance sustainability of IPV identification and referral . Data will be collected again in two years . Discussion MOVE will be the first r and omised trial to determine IPV screening effectiveness in a community based nurse setting and the first to examine sustainability of an IPV screening intervention . It will further inform the debate about the effectiveness of IPV screening and describe IPV prevalence in a community based post-partum and early infant population .Trial registration BACKGROUND Intimate partner violence ( IPV ) during pregnancy poses a significant health risk to the mother and developing fetus . Practice guidelines recommend that prenatal providers screen for and counsel their patients about IPV , yet many physicians express reluctance or discomfort regarding such discussion s. The Health in Pregnancy ( HIP ) computer program was design ed to improve prenatal providers ' counseling about behavioral risks . METHODS English-speaking women 18 years or older , less than 26-weeks pregnant , and receiving prenatal care at one of the five participating clinics in the San Francisco area , were r and omized in parallel groups in a controlled trial ( June 2006-present ; data analyzed June 2007 ) . Participants reporting one or more risks were r and omized to intervention or control in stratified blocks . Providers received summary " cueing sheets " alerting them to their patient 's risk(s ) and suggesting counseling statements . RESULTS Thirteen percent ( 37/286 ) of the sample reported current IPV . Provider cueing result ed in 85 % of the IPV-intervention group reporting discussion s with their provider , compared to 23.5 % of the control group ( p<0.001 ) . CONCLUSIONS IPV discussion s were influenced strongly by cueing providers . Provider cueing is an effective and appropriate adjunct to routine risk counseling in prenatal care This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks ( smoking , environmental tobacco smoke exposure ( ETSE ) , depression , and intimate partner violence ( IPV ) ) in African-Americans is associated with improved pregnancy outcomes . A r and omized controlled trial targeting risks during pregnancy was conducted in the District of Columbia . African-American women were recruited if reporting at least one of the risks mentioned above . R and omization to intervention or usual care was site and risk specific . Sociodemographic , health risk and pregnancy outcome data were collected . Data on 819 women , and their singleton live born infants were analyzed using an intent-to-treat approach . Bivariate analyses preceded a reduced logistical model approach to eluci date the effect of the intervention on the reduction of prematurity and low birth weight . The incidence of low birthweight ( LBW ) was 12 % and very low birthweight ( VLBW ) was 1.6 % . Multivariate logistic regression results showed that depression was associated with LBW ( OR = 1.71 , 95 % CI = 1.12–2.62 ) . IPV was associated with preterm birth ( PTB ) and very preterm birth ( VPTB ) ( OR 1.64 , 95 % CI = 1.07–2.51 , OR = 2.94 , 95 % CI = 1.40–6.16 , respectively ) . The occurrence of VPTB was significantly reduced in the intervention compared to the usual care group ( OR = 0.42 , 95 % CI = 0.19 - 0.93 ) . Our study confirms the significant associations between multiple psycho-behavioral risks and poor pregnancy outcomes , including LBW and PTB . Our behavioral intervention with demonstrated efficacy in addressing multiple risk factors simultaneously reduced VPTB within an urban minority population OBJECTIVES To estimate whether home visitation beginning after childbirth was associated with changes in average rates of mothers ' intimate partner violence ( IPV ) victimization and perpetration as well as rates of specific IPV types ( physical assault , verbal abuse , sexual assault , and injury ) during the 3 years of program implementation and during 3 years of long-term follow-up . DESIGN R and omized controlled trial . SETTING Oahu , Hawaii . PARTICIPANTS Six hundred forty-three families with an infant at high risk for child maltreatment born between November 1994 and December 1995 . Intervention Home visitors provided direct services and linked families to community re sources . Home visits were to initially occur weekly and to continue for at least 3 years . MAIN OUTCOME MEASURES Women 's self-reports of past-year IPV victimization and perpetration using the Conflict Tactics Scale . Blinded research staff conducted maternal interviews following the child 's birth and annually when children were aged 1 to 3 years and then 7 to 9 years . RESULTS During program implementation ,  intervention mothers as compared with control mothers reported lower rates of IPV victimization ( incidence rate ratio [ IRR ] , 0.86 ; 95 % confidence interval [ CI ] , 0.73 - 1.01 ) and significantly lower rates of perpetration ( IRR , 0.83 ; 95 % CI , 0.72 - 0.96 ) . Considering specific IPV types , intervention women reported significantly lower rates of physical assault victimization ( IRR , 0.85 ; 95 % CI , 0.71 - 1.00 ) and perpetration ( IRR , 0.82 ; 95 % CI , 0.70 - 0.96 ) . During long-term follow-up , rates of overall IPV victimization and perpetration decreased , with nonsignificant between-group differences . Verbal abuse victimization rates ( IRR , 1.14 , 95 % CI , 0.97 - 1.34 ) may have increased among intervention mothers . CONCLUSION Early-childhood home visitation may be a promising strategy for reducing IPV Background : A pregnant woman 's psychological health is a significant predictor of postpartum outcomes . The Antenatal Psychosocial Health Assessment ( ALPHA ) form incorporates 15 risk factors associated with poor postpartum outcomes of woman abuse , child abuse , postpartum depression and couple dysfunction . We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among 
    Output:
    
Finally , the risk for low birthweight ( < 2500 g ) did not differ between groups ( RR 0.74 , 95 % CI 0.41 to 1.32 , 306 infants , low quality ) .There were few statistically significant differences between intervention and control groups for depression during pregnancy and the postnatal period .
AUTHORS ' CONCLUSIONS There is insufficient evidence to assess the effectiveness of interventions for domestic violence on pregnancy outcomes .
There is a need for high- quality , RCTs with adequate statistical power to determine whether intervention programs prevent or reduce domestic violence episodes during pregnancy , or have any effect on maternal and neonatal mortality and morbidity outcomes