***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: 4 successive cohorts of low-income families were r and omly assigned either to a home-based intervention program that focused on modeling verbal interaction between mother and child around selected toys and books or to comparison treatments . Large program effects were found on maternal interaction styles in videotaped observations . Small IQ and program-specific effects were found for children in contrast to much larger IQ effects found in earlier research . IQ effects did not appear to have been mediated by changes in maternal behavior . A variation in which toys and books were supplied without home visits was as effective as the full program on IQ but not on maternal behavior . 3 years postprogram , there were no detectable effects in achievement or IQ tests or in first grade teachers ' ratings of school adjustment and performance , but IQ and achievement scores were near national norms . Reasons for discrepancies with earlier results are discussed . The results highlight the need for continued experimental evaluation of early intervention programs with safeguards to insure that sample s are educationally at risk OBJECTIVE --To see whether non-professional volunteer community mothers  could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year . DESIGN --R and omised controlled trial . SETTING --A regional health authority in Dublin . SUBJECTS--262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin ; 30 experienced mothers from the same community recruited as community mothers . INTERVENTIONS --All the first time mothers received st and ard support from the public health nurse . In addition , those in the intervention group received the services of a community mother , who was scheduled to visit monthly during the first year of the child 's life . RESULTS --232 ( 89 % ) first time mothers completed the study --127 in the intervention group , 105 controls . At the end of the study children in the intervention group were more likely to have received all of their primary immunisations , to be read to , and to be read to daily , played more cognitive games ; and were exposed to more nursery rhymes . They were less likely to begin cows ' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein , non-animal protein , wholefoods , vegetables , fruit , and milk . Mothers in the intervention group also had a better diet than controls . At the end of the study they were less likely to be tired , feel miserable , and want to stay indoors ; had more positive feelings ; and were less likely to display negative feelings . CONCLUSION --Non-professionals can deliver a health promotion programme on child development effectively . Whether they can do so as effectively as professionals requires further study OBJECTIVE To evaluate the efficacy of home intervention with drug-abusing women on parenting behavior and attitudes , and on children 's development . DESIGN A r and omized , clinical trial of 60 drug-abusing women recruited prenatally and r and omized into an intervention ( n = 31 ) or comparison ( n = 29 ) group . There were no group differences in gestational age , 1-minute Apgar scores , duration of hospital stay , or neonatal abstinence score . Intervention infants were slightly heavier ( P = .098 ) and had slightly lower 5-minute Apgar scores ( P = .089 ) . Most mothers were single , African-American , multiparous , and non-high school graduates from low income families . Approximately 40 % of the women were human immunodeficiency virus (HIV)-positive , all admitted to either cocaine and /or heroin use , and 62 % had a history of incarceration . Intervention and comparison group women did not differ on any background variables . INTERVENTIONS All  children received primary care in a multidisciplinary clinic . Biweekly home visits were provided by a nurse beginning before delivery and extending through 18 months of life . The intervention was design ed to provide maternal support and to promote parenting , child development , the utilization of informal and formal re sources , and advocacy . MEASUREMENTS Behavioral measures included self-reported ongoing drug abuse , compliance with primary care appointments , and an observation of the child-centered quality of the home ( HOME Scale ) . Parenting attitudes were measured by the Child Abuse Potential Inventory ( CAPI ) and the Parenting Stress Index . The CAPI was administered before initiating the intervention and the Parenting Stress Index was administered when the children were 3 months of age . Both scales were repeated when the children were 18 months of age . Developmental status was measured with the Bayley Scales of Infant Development administered at 6 , 12 , and 18 months . ANALYSES Repeated measures multivariate analyses of variance were used to examine changes in parenting attitudes and children 's development . Analyses of covariance were used to examine compliance with primary care appointments and the quality of the home . Logistic regression was used to examine ongoing drug abuse . Birth weight and maternal education were used as covariates in all analyses . To control for social desirability , the faking-good index of the CAPI was included as a covariate in analyses involving self-report measures . MAIN RESULTS Women in the intervention group were marginally more likely to report being drug-free ( P = .059 ) and were compliant with primary care appointments for their children ( P = .069 ) . Based on the HOME Scale , women in the intervention group were more emotionally responsive ( P = .033 ) and provided marginally more opportunities for stimulation ( P = .065 ) . At 18 months parents reported more normative attitudes regarding parenting and more child-related stress than they had initially , but the differences were not related to intervention status . At 6 months infants in the intervention group obtained marginally higher cognitive scores ( P = .099 ) ; at 12 and 18 months there were no differences . CONCLUSIONS The findings suggest a cautious optimism regarding the efficacy of early home intervention among drug-abusing women in promoting positive behaviors . Subsequent investigations of home intervention should include larger sample sizes and more intensive options 65 families with children at risk for cognitive difficulties were r and omly assigned at the time of the child 's birth to 1 of 3 groups , 2 intervention and 1 control . For the most intensive intervention group , family education was combined with a center-based educational day-care program ; the less intensive intervention group received the home-based family education program only . To assess the cognitive performance of children , The Bayley Scales of Infant Development were administered at 6 , 12 , and 18 months ; the Stanford-Binet Intelligence Test at 24 , 36 , and 48 months ; and the McCarthy Scales of Children 's Abilities at 30 , 42 , and 54 months . On each test after the 6-month assessment , scores of children in the educational day-care plus family support group were greater than those in the other 2 groups . No cognitive intervention effects were obtained for the family education group . Group effects were not obtained for measures of either the quality of the home environment or parent attention Physicians are often faced with conflicting recommendations from therapeutic studies . An evaluation form is proposed to facilitate the evaluation of the quality of therapeutic studies  and the result ing treatment or management recommendations in any area of medicine . Twelve major topics for evaluation include sample size determination , r and omization , selection of control group(s ) , " blinding , " and support for treatment recommendations . Emphasis is placed on study design and performance rather than data analysis . Thirty-four primary criteria based on accepted research st and ards are design ated as most important , and examples from the literature are provided to illustrate their use . The form provides a comprehensive set of well-accepted st and ards of research in a format that encourages detailed , consistent , and thoughtful evaluation of therapeutic studies . The evaluation form is recommended as a tool for physicians who wish to develop and exercise skill in evaluating therapeutic studies Evaluation of high-risk cases treated via a tri-agency , interdisciplinary , early-intervention program suggests that a better outcome was achieved in the treatment program than in a control group of similar high-risk families receiving st and ard care . The number of treated cases requiring child protection services decreased during treatment , and confirmed episodes of child abuse were fewer in the treated group than in the control group A r and omized trial tested the psychosocial efficacy of a home visitation model for women at risk of out-of-home placement of their newborns . After an average of ten months of exposure , the experimental group reported significantly increased social support , greater access to services , and decreased psychological distress . Implication s of the findings for interventions with at-risk families are discussed Effects of early and extended postpartum contact and paraprofessional home visits on maternal attachment , reports of child abuse and neglect , and health care utilization were determined by r and om assignment of 321 low-income women to intervention or control groups immediately after delivery . Observations of maternal attachment were made at four months and 12 months . Hospital , health and welfare agency records , and interviews were used to determine reports of child abuse and neglect and health care utilization . After establishing a control for maternal background variables , early and extended contact explained statistically significant but small amounts of variance in several of the attachment measures . There were no statistically significant effects of the home visit interventions on maternal attachment , and neither intervention was related to reports of child abuse and neglect and health care utilization . Although the study supported earlier findings that early and extended contact has a significant effect , additional interventions are needed to support mother-infant attachment To determine if a relationship exists between structured , informative inhome teaching concerning infant behavior and  primiparous mothers ' perceptions of their newborn . 30 primip-aras completed Broussard 's Neonatal Perception Inventories I and II . The sample —30 women between the ages of 18 and 30 who had had no chronic disorders and had experienced normal pregnancy , labor , delivery , and postpartal course — was deliberately selected from a 489-bed community teaching hospital ; 15 women were assigned r and omly to a  control  group and 15 to an experimental group . All participants completed NPII on their first or second postpartum day . Experimental participants received structured , informative teaching concerning infant behavior two to four days after discharge . All subjects were again visited at one month to complete NPI II . Data were analyzed by t test ; significance was set at p=.05 . No significant difference was found between the groups in NPI I perceptions . On NPI II a significantly positive change in perception was found for the experimental group , but not for the control group OBJECTIVE To examine , during the 3rd and 4th years of life , the health , development , rates of child maltreatment , and living conditions of children who had been enrolled in a r and omized trial of nurse home visitation during pregnancy and first 2 years of their lives . DESIGN Prospect i ve follow-up of families who had been r and omly assigned to nurse-visited and comparison conditions .  SETTING Study conducted in semirural community in upstate New York . Families dispersed among 14 other states during 2-year period after children 's second birthdays . PARTICIPANTS Four hundred women were recruited through a health department antepartum clinic and offices of private obstetricians and were registered before 30th week of pregnancy . All women had no previous live births and 85 % were either teenaged ( < 18 years at registration ) , unmarried , or from Hollingshead social classes IV or V. Analysis focused on whites , who comprised 89 % of sample . INTERVENTION Nurse home visitation from pregnancy through second year of the child 's life . MAIN RESULTS There were no treatment differences in the rates of child abuse and neglect or children 's intellectual functioning from 25 to 48 months of age . Nurse-visited children , nevertheless , lived in homes with fewer hazards for children ; they had 40 % fewer injuries and ingestions and 45 % fewer behavioral and parental coping problems noted in the physician record ; and they made 35 % fewer visits to the emergency department than did children in the comparison group . Nurse-visited mothers were observed to be more involved with and to punish their children to a greater extent than were mothers in the comparison group . The functional meaning of punishment differed between the nurse-visited and comparison families . CONCLUSIONS The program does have enduring effects on certain aspects of parental caregiving , safety of the home , and children 's use of the health care system , but it may be necessary to extend the length of the program for families at highest risk to produce lasting reductions in child abuse and neglect We investigated the effects of a year-long home intervention with a sample of preterm infants r and omly assigned to 1 of 3 groups : a developmental intervention , a parent-infant intervention , and a no-treatment control group . A full-term no-treatment control was also used . Both intervention approaches focused on the parent-child unit , providing training for parents to improve observational skills , emotional support , and information about community re sources . However , whereas specific tasks to facilitate the child 's development were provided in the developmental intervention group , the quality of the parent-infant interaction was the target for treatment in the other group . All infants were assessed at 4 , 8 , 12 , and 16 months of age corrected for prematurity . The results suggest that although both intervention approaches were effective in modifying some aspects of the home environment and , to a lesser degree , in improving infants ' cognitive development , the parent-infant interaction approach seemed to have the greater impact . These findings confirm previous observations regarding the cognitive development of preterm and full-term infants during the first 18 months of life and demonstrate changes in behavior and behavior styles in both pre- and full-term infants as they become older CONTEXT Interest in home-visitation services as a way of improving maternal and child outcomes has grown out of the favorable results of a trial in semirural New York . The findings have not been replicated in other population s. OBJECTIVE To test the effect of prenatal and infancy home visits by nurses on  pregnancy-induced hypertension , preterm delivery , and low birth weight ; on children 's injuries , immunizations , mental development , and behavioral problems ; and on maternal life course . DESIGN R and omized controlled trial . 
    Output:
    
Home visiting programmes were associated with an improvement in the quality of the home environment .