***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 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 : OBJECTIVE To compare the behaviors of black , white , and Hispanic children who were 18 months to 18 years of age and exposed to intimate partner violence with an age- and ethnically similar sample of children who were not exposed to violence and to compare both exposed and nonexposed children to normative sample s. METHODS As part of a study on treatments for abused women in primary care public health clinics and Women , Infants and Children clinics in a large urban area , 258 abused mothers completed the  Child Behavior Checklist ( CBCL ) on 1 of their r and omly selected children between the ages of 18 months and 18 years . An ethnically similar sample of 72 nonabused mothers also completed the CBCL . The CBCL is a st and ardized instrument that provides a parental report of the extent of a child 's behavioral problems and social competencies . The CBCL consists of a form for children 18 months to 5 years and a version for ages 6 to 18 years . The CBCL is orally administered to a parent , who rates the presence and frequency of certain behaviors on a 3-point scale ( 0 = not true , 1 = somewhat or sometimes true , and 2 = very true or often true ) . The time period is the last 6 months for the child 6 to 18 years of age and 2 months for the child 18 months to 5 years of age . Examples of behaviors for the child age 6 to 18 years include " gets in many fights , " " truancy , skips school . " Examples of behaviors for the child 18 months to 5 years of age include " cruel to animals , " " physically attacks people , " and " does n't want to sleep alone . " Both forms of the CBCL consist of 2 broadb and factors of behavioral problems : internalizing and externalizing with mean scale scores for national normative sample s as well as clinical ly referred and nonreferred sample s of children . Internalizing behaviors include anxiety/depression , withdrawal , and somatic complaints . Externalizing behaviors include attention problems , aggressive behavior , and rule-breaking actions . Behavior scales yield a score of total behavioral problems . Scores are summed and then converted to normalized T scores . T scores > or=60 are within the borderline/ clinical referral range-higher scores represent more deviant behavior . Multivariate analyses of variance ( MANOVAs ) were used to determine whether children from abused mothers differed significantly in their internalizing behaviors , externalizing behaviors , and total behavior problems from children of nonabused mothers . One sample t tests were used to compare children from abused and nonabused mothers to the matched clinical ly referred and nonreferred normative sample . Four pair-wise comparisons were considered : 1 ) children from abused women to referred norm , 2 ) children from abused women to nonreferred norm , 3 ) children from nonabused women to referred norm , and 4 ) children from nonabused to nonreferred norm . The internal , external , and total behavior problem T scores were dichotomized into a referral status : nonreferred = T score < 60 , referred = T score > or= 60 . Frequencies and percentages were used to describe the distribution of referral status among the children from the abused and nonabused women , and chi(2 ) tests of independence were used to determine whether the groups were significantly different . RESULTS No significant differences in demographic characteristics between children from the abused women and nonabused women were observed . The sample consisted of a large number of Hispanic children ( 68.9 % ) and slightly more girls ( 53.6 % ) , and nearly half ( 45.2 % ) had annual household incomes < 10,000 dollars . Means , st and ard deviations , and results from the MANOVAs performed on internal , external , and total behavior problem scores between children from abused and nonabused women revealed no significant differences ( F[3,139 ] = 1.21 ) for children ages 18 months through 5 years . Results from the MANOVA performed for ages 6 through 18 years revealed a significant group difference ( F[3,183 ] = 3.13 ) . Univariate tests revealed significant group differences for internalizing behavior ( F[1,185 ] = 6.81 ) , externalizing behav = 6.81 ) , externalizing behavior ( F[1,185 ] = 7.84 ) , and total behavior problems ( F[1,185 ] = 9.45 ) . Overall , children of abused mothers had significantly higher internalizing ( 58.5 + /- 12.1 ) , externalizing ( 55.5 + /- 12.4 ) , and total behavior problems ( 57.6 + /- 12.3 ) scores than the internalizing ( 52.9 + /- 13.7 ) , externalizing ( 49.7 + /- 10.6 ) , and total behavior problems ( 51.0 + /- 13.0 ) scores exhibited for children of nonabused mothers . Most comparisons of children from the abused women to the referred and nonreferred norms are significant . The mean internal , external , and total behavior problem scores from children of abused women were significantly higher than the nonreferred norms and significantly lower than the referred norms . In contrast , all comparisons for children from nonabused women were not significantly different from the nonreferred norms . CONCLUSIONS Children , ages 6 to 18 years , of abused mothers exhibit significantly more internalizing , externalizing , and total behavior problems than children for the same age and sex of nonabused mothers . In addition , the mean internalizing behavior score for boys 6 to 11 years of age as well as girls and boys 12 to 18 years of age of abused mothers were not significantly different from the clinical referral norms . Internalizing behaviors of anxiety , withdrawal , and depression are consistent with suicidal risk . The association of a child 's exposure to intimate partner violence and subsequent attempted and /or completed suicide dem and s research . Our data demonstrate that children of abused mothers have significantly more behavioral problems than the non clinical ly referred norm children but also , for most children , display significantly fewer problems than the clinical ly referred children . These children of abused mothers are clearly suspended above normal and below deviant , with children ages 6 to 18 being at the greatest risk . If abused mothers can be identified and treated , then perhaps behavior problems of their children can be arrested and behavioral scores improved . The American Academy of Pediatrics Committee on Child Abuse and Neglect recommends routine screening of all women for abuse at the time of the well-child visit and implementation of a protocol that includes a safety plan for the entire family . Clinicians can use this research information to assess for intimate partner violence during child health visits and inform abused mothers of the potential effects on their children 's behavior . Early detection and treatment for intimate partner violence against women has the potential to interrupt and prevent behavioral problems for their children CONTEXT Home visitation to families with young children has been promoted as an effective way to prevent child maltreatment , but few studies have examined the conditions under which such programs meet this goal . OBJECTIVE To investigate whether the presence of domestic violence limits the effects of nurse home visitation interventions in reducing substantiated reports of child abuse and neglect . DESIGN Fifteen-year follow-up study of a r and omized trial . SETTING Semirural community in upstate New York . PARTICIPANTS Of 400 socially disadvantaged pregnant women with no previous live births enrolled consecutively between April 1978 and September 1980 , 324 mothers and their children participated in the follow-up study . INTERVENTIONS Families were r and omly assigned to receive routine perinatal care ( control group ; n = 184 participated in follow-up ) , routine care plus nurse home visits during pregnancy only ( n = 100 ) , or routine care plus nurse home visits during pregnancy and through the child 's second birthday ( n = 116 ) . MAIN OUTCOME MEASURES Number of substantiated reports over the entire 15-year period involving the study child as subject regardless of the identity of the perpetrator or involving the mother as perpetrator regardless of the identity of the child abstract ed from state records and analyzed by treatment group and level of domestic violence in the home as measured by the Conflict Tactics Scale . RESULTS Families receiving home visitation during pregnancy and infancy had significantly fewer child maltreatment reports involving the mother as perpetrator ( P = . 01 ) or the study child as subject ( P = .04 ) than families not receiving home visitation . The number of maltreatment reports for mothers who received home visitation during pregnancy only was not different from the control group . For mothers who received visits through the child 's second birthday , the treatment effect decreased as the level of domestic violence increased . Of women who reported 28 or fewer incidents of domestic violence ( 79 % of sample ) , home-visited mothers had significantly fewer child maltreatment reports during the 15-year period than mothers not receiving the longer-term intervention ( P = .01 ) . However , this intervention did not significantly reduce child maltreatment among mothers reporting more than 28 incidents of domestic violence ( 21 % of sample ) . CONCLUSIONS The presence of domestic violence may limit the effectiveness of interventions to reduce incidence of child abuse and neglect . JAMA . 2000;284:1385 - 1391 OBJECTIVE . Our goal was to test the effect of prenatal and infancy home visits by nurses on  mothers ' fertility and children 's functioning 7 years after the program ended at child age 2 . METHODS . We conducted a r and omized , controlled trial in a public system of obstetric and pediatric care . A total of 743 primarily black women < 29 weeks ' gestation , with previous live births and at least 2 sociodemographic risk characteristics ( unmarried , < 12 years of education , unemployed ) , were r and omly assigned to receive nurse home visits or comparison services . Primary outcomes consisted of intervals between births of first and second children and number of children born per year ; mothers ' stability of relationships with partners and relationships with the biological father of the child ; mothers ' use of welfare , food stamps , and Medicaid ; mothers ' use of substances ; mothers ' arrests and incarcerations ; and children 's academic achievement , school conduct , and mental disorders . Secondary outcomes were the sequelae of subsequent pregnancies , women 's employment , experience of domestic violence , and children 's mortality . RESULTS . Nurse-visited women had longer intervals between births of first and second children , fewer cumulative subsequent births per year , and longer relationships with current partners . From birth through child age 9 , nurse-visited women used welfare and food stamps for fewer months . Nurse-visited children born to mothers with low psychological re sources , compared with control-group counterparts , had better grade -point averages and achievement test scores in math and reading in grade s 1 through 3 . Nurse-visited children , as a trend , were less likely to die from birth through age 9 , an effect accounted for by deaths that were attributable to potentially preventable causes . CONCLUSIONS . By child age 9 , the program reduced women 's rates of subsequent births , increased the intervals between the births of first and second children , increased the stability of their relationships with partners , facilitated children 's academic adjustment to elementary school , and seems to have reduced childhood mortality from preventable causes This study examines 
    Output:
    
Risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children .
Early childhood home visitation also reduced abuse and neglect , but results were inconsistent .