***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 AND OBJECTIVE : Impoverished urban children suffer disproportionately from asthma and underuse preventive asthma medications . The objective of this study was to examine cost-effectiveness ( CE ) of the School-Based Asthma Therapy ( SBAT ) program compared with usual care ( UC ) . METHODS : The analysis was based on the SBAT trial , including 525 children aged 3 to 10 years attending urban preschool or elementary school who were r and omized to either UC or administration of 1 dose of preventive asthma medication at school by the school nurse each school day . The primary outcome was the mean number of symptom-free days ( SFDs ) . The impact of the intervention on medical costs was estimated by using parent-reported child health services utilization data and average national reimbursement rates . We estimated the cost of running the program using wages for program staff . Productivity costs were estimated by using value of parent lost time due to child illness . CE of the SBAT program compared with UC was evaluated based on the incremental CE ratio . RESULTS : The health benefit of the intervention was equal to ∼158 SFD gained per each 30-day period ( P < .05 ) per 100 children . The programmatic expenses summed to an extra $ 4822 per 100 children per month . The net saving due to the intervention ( reduction in medical costs and parental productivity , and improvement in school attendance ) was $ 3240 , result ing in the incremental cost-savings difference of $ 1583 and CE of $ 10 per 1 extra SFD gained . CONCLUSIONS : The SBAT was effective and cost-effective in reducing symptoms in urban children with asthma compared with other existing programs UNLABELLED Teachers and support staff are often called upon to manage asthma at school but may have little knowledge and underst and ing of the condition . The objectives of this study were to develop educational package ( pamphlets ) about asthma , and assess its effectiveness as an educational tool for schools ' staff through evaluation of its impact on the staff 's asthma-related knowledge , attitudes and management practice s on their pupils . A pre-post experimental research design was used in Riyadh city with distribution of self-administered question naires and asthma package to 4 r and omly selected girls schools compounds . Participants were school staff ( n = 297 ) of primary , intermediate and secondary schools . Results showed that only 5.7 % of the staff had received previous training in asthma education . Lack of knowledge and misconceptions about asthma medication were evident among a considerable proportion of the staff specifically for use of antibiotics , steroids , side effect of ventolin , and addicting effect of inhalers . At pretest , only 35 % and 40.1 % of the staff had good level of knowledge and management practice s. At posttest , the corresponding percentages increased significantly to be 83.9 % and 68.6 % respectively . The mean total score of staff 's asthma related-attitudes became more favorable towards asthma education after intervention , it increased significantly from 53.5 to be 55.0 . Total posttest knowledge score was the only predictor of both staff attitudes and management practice s constituting 9.1 % and 10.2 % of their variance . The great majority cited lack of training ( 92 % ) , unavailability school policy ( 86.8 % ) , and shortage of educational re sources ( 88.3 % ) as barriers against asthma education and management in their schools . CONCLUSIONS Most of school staff had poor to fair level of asthma knowledge and management practice s. Such simple educational intervention using pamphlets and demonstration of inhaler use and peaked flow meter was significantly successful in enhancing staff 's asthma-related knowledge , attitudes and management practice s among their pupils . It is very important that training is directed to all staff as pre-service and in-service programs This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city , largely African-American school system . All 54 elementary schools ( combined enrollment 13,247 students ) from a single urban school system participated in this study . Schools were r and omly divided between immediate and delayed intervention programs . The intervention consisted of 3 separate educational programs ( for school faculty/staff , students with asthma , and peers without asthma ) and medical management for the children with asthma ( including an Individual Asthma Action Plan , medications , and peakflow meters ) .  Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study . No significant differences were observed in school absences , grade point average , emergency room visits , or hospitalizations between the immediate and delayed intervention groups . Significant increases in knowledge were observed in the immediate intervention group . This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes . Our experience leads us to believe that such measures are difficult to impact and are not always reliable . Future research ers should be aware of the problems associated with using such measures . In addition , connecting children with a regular source of health care in this population was difficult . More intensive methods of medical management , such as school-based health centers or supervised asthma therapy , might prove more effective in inner-city schools BACKGROUND In Ohio , 14.5 % of 5- to 9-year-olds and 17.3 % of 10- to 17-year-olds have asthma  . Moreover , there is concern that these numbers may underestimate the true disease burden . We sought to evaluate variability in asthma rates and respiratory symptoms among central Ohio fourth grade rs as a means to assess potential undiagnosed and undertreated asthma and its determinants . METHODS We recruited 13 central Ohio elementary schools representing a broad range of nonurban setting s and surveyed fourth grade rs to estimate school-level physician-diagnosed asthma ( PDA ) , respiratory morbidity , and home exposures to smoking and pets . We used generalized linear mixed models with r and om intercept for school to examine relationships among exposures , respiratory symptoms , and PDA . RESULTS Across the 13 schools , 94 % of students participated in the survey , and the estimated asthma prevalence rate was 10.2 % ( N = 101 of 987 ) . An additional 41 % reported not having PDA but then went on to report symptoms consistent with asthma potentially suggestive of undiagnosed asthma . Of students with PDA , 21 % reported symptoms suggestive of poorly controlled asthma . High levels of secondh and smoke ( SHS ) exposure were associated both with PDA ( p = .05 ) and with respiratory symptoms ( p < .0001 ) . Students who owned a cat or a bird were more likely to report respiratory symptoms ( p = .02 and p = .04 , respectively ) . CONCLUSIONS We provide evidence that the already high childhood asthma public health burden in central Ohio may be underreported . Schools may be an ideal location to conduct screenings and implement environmental interventions oriented toward SHS and household pets that will yield respiratory morbidity benefits 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 Objectives . Because children spend a significant proportion of their day in school , pediatric emergencies such as the exacerbation of medical conditions , behavioral crises , and accidental/intentional injuries are likely to occur . Recently , both the American Academy of Pediatrics and the American Heart Association have published guidelines stressing the need for school leaders to establish emergency-response plans to deal with life-threatening medical emergencies in children . The goals include developing an efficient and effective campus-wide communication system for each school with local emergency medical services ( EMS ) ; establishing and practicing a medical emergency-response plan ( MERP ) involving school nurses , physicians , athletic trainers , and the EMS system ; identifying students at risk for life-threatening emergencies and ensuring the presence of individual emergency care plans ; training staff and students in first aid and cardiopulmonary resuscitation ( CPR ) ; equipping the school for potential life-threatening emergencies ; and implementing lay rescuer automated external defibrillator ( AED ) programs . The objective of this study was to use published guidelines by the American Academy of Pediatrics and the American Heart Association to examine the preparedness of schools to respond to pediatric emergencies , including those involving children with special care needs , and potential mass disasters . Methods . A 2-part question naire was mailed to 1000 r and omly selected members of the National Association of School Nurses . The first part included 20 questions focusing on : ( 1 ) the clinical background of the school nurse ( highest level of education , years practicing as a school health provider , CPR training ) ; ( 2 ) demographic features of the school ( student attendance , grade s represented , inner-city or rural/suburban setting , private or public funding , presence of children with special needs ) ; ( 3 ) self-reported frequency of medical and psychiatric emergencies ( most common reported school emergencies encountered over the past school year , weekly number of visits to school nurses , annual number of “ life-threatening ” emergencies requiring activation of EMS ) ; and ( 4 ) the preparedness of schools to manage life-threatening emergencies ( presence of an MERP , presence of emergency care plans for asthmatics , diabetics , and children with special needs , presence of a school nurse during all school hours , CPR training of staff and students , availability of athletic trainers during all athletic events , presence of an MERP for potential mass disasters ) . The second part included 10 clinical scenarios measuring the availability of emergency equipment and the confidence level of the school nurse to manage potential life-threatening emergencies . Results . Of the 675 question naires returned , 573 were eligible for analysis . A majority of responses were from registered nurses who have been practicing for > 5 years in a rural or suburban setting . The most common reported school emergencies were extremity sprains and shortness of breath . Sixty-eight percent ( 391 of 573 [ 95 % confidence interval ( CI ) : 64–72 % ] ) of school nurses have managed a life-threatening emergency requiring EMS activation during the past school year . Eighty-six percent ( 95 % CI : 84–90 % ) of schools have an MERP , although 35 % ( 95 % CI : 31–39 % ) of schools do not practice the plan . Thirteen percent ( 95 % CI : 10–16 % ) of schools do not identify authorized personnel to make emergency medical decisions . When stratified by mean student attendance , school setting , and funding classification , schools with and without an MERP did not differ significantly . Of the 205 schools that do not have a school nurse present on campus during all school hours , 17 % ( 95 % CI : 12–23 % ) do not have an MERP , 17 % ( 95 % CI : 12–23 % ) do not identify an authorized person to make medical decisions when faced with a life-threatening emergency , and 72 % ( 95 % CI : 65–78 % ) do not have an effective campus-wide communication system . CPR training is offered to 76 % ( 95 % CI : 70–81 % ) of the teachers , 68 % ( 95 % CI : 61–74 % ) of the administrative staff , and 28 % ( 95 % CI : 22–35 % ) of the students . School nurses reported the availability of a bronchodilator meter-dosed inhaler ( 78 % [ 95 % CI : 74–81 % ] ) , AED ( 32 % [ 95 % CI : 28–36 % ] ) , and epinephrine autoinjector ( 76 % [ 95 % CI : 68–79 % ] ) in their school . When stratified by inner-city and rural/suburban school setting , the availability of emergency equipment did not differ significantly except for the availability of an oxygen source , which was higher in rural/suburban schools ( 15 % vs 5 % ) . School-nurse responders self-reported more confidence in managing respiratory distress , airway obstruction , profuse bleeding/extremity fracture , anaphylaxis , and shock in a diabetic child and comparatively less confidence in managing cardiac arrest , overdose , seizure , heat illness , and head injury . When analyzing schools with at least 1 child with special care needs , 90 % ( 95 % CI : 86–93 % ) have an MERP , 64 % ( 95 % CI : 58–69 % ) have a nurse available during all school hours , and 32 % ( 
    Output:
    
Data for symptom days , night-time awakenings , restricted activities of daily living and school absences were skewed or could not be analysed ; some mean scores were better in the trained group , but most differences between groups were small and did not persist to 24 months .
Schools that received asthma education were more adherent to asthma policies , and staff were better prepared ; more schools that had received  staff asthma training  had written asthma policies compared with control schools , more intervention schools showed improvement in measures taken to prevent or manage exercise-induced asthma attacks and more staff at intervention schools reported that they felt able to administer salbutamol via a spacer .
Asthma education for school staff increases asthma knowledge and preparedness , but studies vary and all available evidence is of low quality .
Studies have not yet captured whether this improvement in knowledge has led to appreciable benefits over the short term or the longer term for the safety and health of children with asthma in school .
R and omised evidence does not contribute to our knowledge of content or attributes of interventions that lead to the best outcomes , or of re sources required for successful implementation .
This applies to both r and omised and non-r and omised studies , although the latter may be better placed to observe important clinical outcomes such as exacerbations and mortality in the longer term