***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: Background Delayed diagnosis and treatment of tuberculosis ( TB ) results in severe disease and a higher mortality . It also leads to an increased period of infectivity in the community . The objective of this study was to determine the length of delays , and analyze the factors affecting the delay from onset of symptoms of pulmonary tuberculosis ( PTB ) until the commencement of treatment . Methods In r and omly selected TB management units ( TBMUs ) , i.e. government health institutions which have diagnosing and treatment facilities for TB in Amhara Region , we conducted a cross sectional study from September 1-December 31/2003 . Delay was analyzed from two perspectives , 1 . Period between onset of TB symptoms to first visit to any health provider ( health seeking period ) , and from the first health provider visit to initiation of treatment ( health providers ' delay ) , and 2 . Period between onset of TB symptoms to first visit to a medical provider ( patients ' delay ) , and from this visit to commencement of anti-TB treatment ( health systems ' delay ) . Patients were interviewed on the same date of diagnosis using a semi-structured question naire . Logistics regression analysis was applied to analyze the risk factors of delays . Results A total of 384 new smear positive PTB patients participated in the study . The median total delay was 80 days . The median health-seeking period and health providers ' delays were 15 and 61 days , respectively . Conversely , the median patients ' and health systems ' delays were 30 and 21 days , respectively . Taking medical providers as a reference point , we found that forty eight percent of the subjects delayed for more than one month . Patients ' delays were strongly associated with first visit to non-formal health providers and self treatment ( P < 0.0001 ) . Prior attendance to a health post/clinic was associated with increased health systems ' delay ( p < 0.0001 ) . Conclusion Delay in the diagnosis and treatment of PTB is unacceptably high in Amhara region . Health providers ' and health systems ' delays represent the major portion of the total delay . Accessing a simple and rapid diagnostic test for TB at the lowest level of health care facility and encouraging a dialogue among all health providers are imperative interventions Background One of the main strategies to control tuberculosis ( TB ) is to find and treat people with active disease . Unfortunately , the case detection rates remain low in many countries . Thus , we need interventions to find and treat sufficient number of patients to control TB . We investigated whether involving health extension workers ( HEWs : trained community health workers ) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia . Methodology /Principal Finding We carried out a community-r and omized trial in southern Ethiopia from September 2006 to April 2008 . Fifty-one kebeles ( with a total population of 296 , 811 ) were r and omly allocated to intervention and control groups . We trained HEWs in the intervention kebeles on how to identify suspects , collect sputum , and provide directly observed treatment . The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts . Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles . The mean case detection rate was higher in the intervention than in the control kebeles ( 122.2 % vs 69.4 % , p<0.001 ) . In addition , more females patients were identified in the intervention kebeles ( 149.0 vs 91.6 , p<0.001 ) . The mean treatment success rate was higher in the intervention than in the control kebeles ( 89.3 % vs 83.1 % , p = 0.012 ) and more for females patients ( 89.8 % vs 81.3 % , p = 0.05 ) . Conclusions / Significance The involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate , possibly because of an improved service access . This could be applied in setting s with low health service coverage and a shortage of health workers . Trial Registration Clinical Trials.gov Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement A cross-sectional study was made of 500 patients and 500 health care workers r and omly selected from 250 primary health care centres throughout Iraq to evaluate knowledge , attitudes and practice s towards tuberculosis ( TB ) . Using structured question naire interviews , the study showed 64.4 % of patients had good knowledge , while 54.8 % had negative attitudes and practice s towards TB . The 2 most important sources of patient information about TB were physicians and television . Of health care workers , 95.5 % had good knowledge about TB and this was significantly associated with age and job duration . By contrast , health care workers ' practice was poor : only 38.2 % h and led suspected TB cases correctly . The national TB programme in Iraq has had a good impact on knowledge of TB patients and health care workers OBJECTIVE To assess an active case-finding strategy for the identification of  smear-positive pulmonary tuberculosis ( TB ) in a rural district of Amhara Region , Ethiopia . METHODS Study kebeles ( smallest administrative units ) were r and omly selected in a cross-sectional study . House-to-house visits involving individuals aged > or=15 years in all households of the kebeles were conducted . The heads of households were asked to identify subjects with TB symptoms . Identified suspects were asked to provide three sputum sample s for smear microscopy . RESULTS Among the 47,478 individuals living in households that were screened , 1006 TB suspects and 38 cases were detected . This result ed in 38 cases of smear-positive TB , i.e. , 80 per 100,000 population , using cluster sampling . The ratio of active vs. passive case detection was 2.5:1 , indicating 2.5 undetected TB cases in the community for every smear-positive TB case receiving treatment during the survey period . A higher proportion of female patients was detected by the survey . CONCLUSION The study revealed a very high proportion of undiagnosed TB . This indicates that the potential for a large infectious pool and significant transmission of TB in the community is high . The expansion of diagnostic facilities and the active involvement of health extension workers is necessary to expedite early detection , timely referral and treatment of TB Background Optimally , exp and ed HIV testing programs should reduce barriers to testing while attracting new and high-risk testers . We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing ( MVCT ) campaigns in four rural villages in the Kilimanjaro Region of Tanzania . Methods Between December 2007 and April 2008 , 878 MVCT participants and 506 r and omly selected community residents who did not access MVCT were surveyed . Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics , HIV exposure risk , testing histories , HIV related stigma , and attitudes toward testing between  MVCT participants and community residents who did not access MVCT . Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics , HIV exposure risk , testing histories , HIV related stigma , and attitudes toward testing , between the two groups . Results MVCT clients reported greater HIV exposure risk ( OR 1.20 [ 1.04 to 1.38 ] for males ; OR 1.11 [ 1.03 to 1.19 ] for females ) . Female MVCT clients were more likely to report low household expenditures ( OR 1.47 [ 1.04 to 2.05 ] ) , male clients reported higher rates of unstable income sources ( OR 1.99 [ 1.22 to 3.24 ] ) . First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested ( OR 2.17 [ 1.05 to 4.48 ] for males ; OR 5.95 [ 2.85 to 12.45 ] for females ) . HIV-related stigma , fears of testing or test disclosure , and not being able to leave work were strongly associated with non-participation in MVCT ( ORs from 0.11 to 0.84 ) . Conclusions MVCT attracted clients with increased exposure risk and fewer economic re sources ; HIV related stigma and testing-related fears remained barriers to testing . MVCT did not disproportionately attract either first-time or frequent repeat testers . Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk population Background The CONSORT statement is intended to improve reporting of r and omised controlled trials and focuses on minimising the risk of bias ( internal validity ) . The applicability of a trial ’s results ( generalisability or external validity ) is also important , particularly for pragmatic trials . A pragmatic trial ( a term first used in 1967 by Schwartz and Lellouch ) can be broadly defined as a r and omised controlled trial whose purpose is to inform decisions about practice . This extension of the CONSORT statement is intended to improve the reporting of such trials and focuses on applicability . Methods At two , two-day meetings held in Toronto in 2005 and 2008 , we review ed the CONSORT statement and its extensions , the literature on pragmatic trials and applicability , and our experiences in conducting pragmatic trials . Recommendations We recommend extending eight CONSORT checklist items for reporting of pragmatic trials : the background , participants , interventions , outcomes , sample size , blinding , participant flow , and generalisability of the findings . These extensions are presented , along with illustrative examples of reporting , and an explanation of each extension . Adherence to these reporting criteria will make it easier for decision makers to judge how applicable the results of r and omised controlled trials are to their own conditions . Empirical studies are needed to ascertain the usefulness and comprehensiveness of these CONSORT checklist item extensions . In the meantime we recommend that those who support , conduct , and report pragmatic trials should use this extension of the CONSORT statement to facilitate the use of trial results in decisions about health care . Pragmatic trials are design ed to inform decisions about practice , but poor reporting can reduce their usefulness . The CONSORT and Practihc groups describe modifications to the CONSORT guidelines to help readers assess the applicability of the SETTING Bangladesh national tuberculosis control programme districts supported by the Damien Foundation ( population 18 million ) . OBJECTIVE To determine whether the observed gender difference is epidemiologically true or whether it is due to accessibility barriers for women . DESIGN Two-stage r and om sampling population survey . People were interviewed by teams composed of one male and one female volunteer about the presence of symptoms suggestive of tuberculosis . One early morning sputum specimen of all thus identified tuberculosis suspects was examined by Ziehl-Neelsen technique .  RESULTS A total of 266189 people were surveyed , among whom 223 936 ( 84.1 % ) could be interviewed . This led to the identification of 7001 tuberculosis suspects ( 2406 females and 4595 males ) and 64 confirmed TB cases ( 16 females and 48 males ) . The female/male ratio ( 0.33:1 ) of cases found during the survey was not higher than that observed through routine diagnosis ( 0.42:1 ) . The routine case-notification rate of sputum-positive cases during 2000 was about twice the rate observed during the survey ( 44.3 vs. 24.0 per 100 000 population ) . CONCLUSIONS The gender difference observed in routine tuberculosis diagnosis is real , and is not due to lesser accessibility of women to the health services . The routine notification rate compares favourably with the detection of previously unknown cases found during the survey Background Tuberculosis ( TB ) is a global health concern . Inadequate case finding and case holding has been cited as major barrier to the control of TB . The TB literature is written almost entirely from a biomedical perspective , while recent studies show that it is imperative to underst and lay perception to determine why people seek treatment and may stop taking treatment . The Eastern Cape is known as a province with high TB incidence , prevalence and with one of the worst cure rates of South Africa . Its inhabitants can be considered lay experts when it comes to TB . Therefore , we investigated knowledge , perceptions of ( access to ) TB treatment and adherence to treatment  among an Eastern Cape population . Methods 
    Output:
    
Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services .
When differences were identified , women experienced greater barriers and longer delays than men