***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 Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation . This study reports clinical outcomes and quality of life from a community based project investigating white European ( W/E ) and Indian subcontinent ( ISC ) ethnic groups with asthma living in deprived inner city areas of Birmingham , UK . METHODS Six hundred and eighty nine asthmatic subjects ( 345 W/E , 344 ISC ) of mean ( SD ) age 34.5 ( 15 ) years ( range 11–59 ) and mean forced expiratory volume in one second ( FEV1 ) of 80 % predicted were interviewed in English , Punjabi , Hindi , or Urdu . Subjects r and omised to the active limb of a prospect i ve , open , r and omised , controlled , parallel group , 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up ( active intervention ) . Control groups were seen only at the beginning and end of the study . Urgent or emergency interactions with primary and secondary health care ( clinical outcomes ) and both cross sectional and longitudinal data from an Asthma Quality of Life Question naire ( AQLQ ) were analysed . RESULTS Clinical outcomes were available for 593 subjects . Fewer of the active intervention group consulted their GP ( 41.8 % versus 57.8 % , odds ratio ( OR ) 0.52 ( 95 % CI 0.37 to 0.74 ) ) or were prescribed antibiotics ( 34.9 % versus 51.2 % , OR 0.51 ( 95 % CI 0.36 to 0.72 ) ) , but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits . Active intervention reduced the number of hospital admissions ( 10 versus 30 ) , GP consultations ( 341 versus 476 ) , prescriptions of rescue oral steroids ( 92 versus 177 ) , and antibiotics ( 220 versus 340 ) , but again significant improvements by ethnicity only occurred in the active W/E group . AQLQ scores were negatively skewed to the higher values ; regression analysis showed that lower values were associated with ISC ethnicity . Longitudinal changes ( for 522 subjects ) in the mean AQLQ scores were small but statistically significant for both ethnic groups , with scores improving in the active and worsening in the control groups . CONCLUSIONS Active intervention only improved clinical outcomes in the W/E group . AQLQ scores , although lower in the ISC group , were improved by active intervention in both ethnic groups Background . Asthma , a leading chronic disease of children , currently affects about 6.2 million ( 8.5 % ) children in the United States . Despite advances in asthma research and availability of increasingly effective therapy , many children do not receive appropriate medications to control the disease , have overreliance on reliever medication , and lack systematic follow-up care . The situation is even worse for poor inner-city and minority children who have significantly worse asthma rates , severity , and outcomes . National Asthma Education and Prevention Program Guidelines recommend a multimodal , chronic care approach . Objective . The authors assessed the effectiveness of practice re design and computerized provider feedback in improving both practitioner adherence to National Asthma Education and Prevention Program Guidelines ( NAEPP ) , and patient outcomes in 295 poor minority children across four Federally Qualified Health Centers ( FQHC ) . Methods . In a nonr and omized , two-group ( intervention versus comparison ) , two-phase trial , all sites were provided re design support to provide quarterly well-asthma visits using structured visit forms , community health workers for outreach and follow-up , a Web-based disease registry for tracking and scheduling , and a provider education package . Intervention sites were given an additional Web-based , computerized patient-specific provider feedback system that produced a guideline -driven medication assessment prompt . Results . Logistic regression results showed that providers at intervention sites were more than twice as likely on average to prescribe guideline -appropriate medications after exposure to our feedback system during the Phase I enrollment period than providers at comparison sites ( exp(B ) = 2.351 , confidence interval [ CI ] = 1.315–4.204 ) . In Phase II ( the postenrollment visit period ) , hierarchical linear models ( HLMs ) and latent growth curves were used to show that asthma control improved significantly by .19 ( SE = .05 ) on average for each of the remaining four visits ( about 11 % of a st and ard deviation ) , and improved even more for patients at intervention sites . These results show that implementation of practice re design support guided by a pediatric chronic care model can improve provider adherence to treatment guidelines as well as patients ’ asthma control . Conclusions . The addition of patient-specific feedback for providers results in quicker adoption of guideline recommendations and potentially greater improvements in asthma control compared to the basic practice re design support alone OBJECTIVE To assess the outcomes of an education intervention for childhood asthma conducted by Australian Indigenous health care workers ( IHCWs ) . DESIGN AND SETTING R and omised controlled trial in a primary health care setting on Thursday Isl and and Horn Isl and , and in Bamaga , Torres Strait region of northern Australia , April 2005 to March 2007 . PARTICIPANTS 88 children , aged 1 - 17 years , with asthma diagnosed by a respiratory physician ( intervention group , 35 ; control group , 53 ; 98 % Indigenous children ) . INTERVENTIONS Children were r and omly allocated to : ( i ) three additional asthma education sessions with a trained IHCW , or ( ii ) no additional asthma education . Both groups were re-assessed at 12 months . MAIN OUTCOME MEASURES Primary endpoint : number of unscheduled visits to hospital or a doctor caused by asthma exacerbation . SECONDARY OUTCOMES measures of quality of life ( QoL ) and functional severity index ; asthma knowledge and underst and ing of asthma action plans ( AAPs ) ; and school days missed because of wheezing . RESULTS The groups were comparable at baseline ( except for asthma severity , which was adjusted for in the analysis ) . There were no significant differences in the primary outcome ( number of unscheduled medical visits for asthma ) . School children in the intervention group missed fewer school days because of wheezing ( 100 % < 7 days v 21 % of those in the control group missed 7 - 14 days ) . Significantly more carers in the intervention group could answer questions about asthma medication , knew where their AAP was kept ( 84 % v 56 % ) , and were able to describe the plan ( 67 % v 40 % ) . In both the intervention and control groups ( before- and -after comparison ) , there was a significantly reduced frequency of asthma exacerbations , as well as an improved QoL score and functional severity index , with no significant differences between the groups . CONCLUSIONS A community-based asthma education program conducted by trained IHCWs improves some important asthma outcomes in Indigenous children with asthma . TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN012605000718640 OBJECTIVE To describe the management of  asthma in children in a remote indigenous community and the delivery of subspecialist service through the indigenous health-care model . METHODOLOGY Children referred by indigenous health-care workers were evaluated prospect ively by paediatric respiratory physicians , based on a st and ardized protocol , at a primary health care setting at Thursday Isl and , Queensl and . RESULTS Forty of the 54 children referred with a provisional diagnosis of asthma did have asthma , with 30 % having persistent asthma . Only 59 % of parents knew the dose of the medication prescribed and 80 % had minimal knowledge of the medications . In 88 % of children , the management of asthma was improved by introduction of an appropriate spacer device and changing the dose and type of medications . CONCLUSIONS The management of children with asthma in the Torres region can be improved substantially by the use of age appropriate delivery devices and medications , and improving knowledge of asthma . Specialist delivery service to remote indigenous communities can be effectively delivered in partnership with the indigenous health service . The high proportion of persistent asthma in the Torres Straits community in comparison to urbanised Australia raises issues of inequity of appropriate medical service delivery to remote indigenous communities OBJECTIVE : Because asthma disproportionately affects minorities , we evaluated the effects of parent mentors ( PMs ) on asthma outcomes in minority children . METHODS : This r and omized , controlled trial allocated minority asthmatic children to the PM intervention or traditional asthma care . Intervention families were assigned PMs ( experienced parents of asthmatic children who received specialized training )  . PMs met monthly with children and families at community sites , phoned parents monthly , and made home visits . Ten asthma outcomes and costs were monitored for 1 year . Outcomes were examined by using both intention-to-treat analyses and stratified analyses for high participants ( attending ≥25 % of community meetings and completing ≥50 % of PM phone interactions ) . RESULTS : Patients were r and omly assigned to PMs ( n = 112 ) or the control group ( n = 108 ) . In intention-to-treat analyses , intervention but not control children experienced significantly reduced rapid-breathing episodes , asthma exacerbations , and emergency department ( ED ) visits . High participants ( but not controls or low participants ) experienced significantly reduced wheezing , asthma exacerbations , and ED visits and improved parental efficacy in knowing when breathing problems are controllable at home . Mean reductions in missed parental work days were greater for high participants than controls . The average monthly cost per patient for the PM program was $ 60.42 , and net savings of $ 46.16 for high participants . CONCLUSIONS : For asthmatic minority children  , PMs can reduce wheezing , asthma exacerbations , ED visits , and missed parental work days while improving parental self-efficacy . These outcomes are achieved at a reasonable cost and with net cost savings for high participants . PMs may be a promising , cost-effective means for reducing childhood asthma disparities BACKGROUND Despite significant medical advances , many ethnic and racial minority children who live in inner cities continue to experience disproportionately high levels of asthma morbidity and mortality compared with white children . As a result , a growing number of psychosocial asthma management interventions are being developed to address their needs ; however , only a few of these interventions have incorporated cultural variables into their treatments and have had their efficacy evaluated . OBJECTIVE To examine the efficacy of the Multifamily Asthma Group Treatment ( MFAGT ) , design ed to enhance asthma management and reduce emergency department ( ED ) visits among African American and Hispanic families . METHODS Twenty-four African American and Hispanic families who have children with asthma were r and omly assigned to either the MFAGT or the St and ard Psychoeducational Asthma Intervention . Differences in the number of ED visits and the level of asthma management in both groups were compared 1 year before and 1 year after the intervention . In addition , these groups were contrasted to a control group that did not receive any psychoeducational intervention . RESULTS The MFAGT was significantly ( P = .04 ) more effective than the St and ard Psychoeducational Asthma Intervention and the control in decreasing ED visits and increasing parental asthma knowledge . CONCLUSIONS These preliminary results suggest that the MFAGT is efficacious in enhancing asthma management and in reducing ED visits in inner-city African American and Hispanic children from a lower socioeconomic background Although asthma self-management plans are widely recommended as essential in the long-term treatment of adult asthma , there have been few studies examining their use . Our objective was to assess the effect of a " credit card " adult asthma self-management plan in a community experiencing major health problems from asthma , by means of a before and after intervention trial of the efficacy of the " credit card " plan , when introduced through community-based asthma clinics . The participants were 69 Maori people with asthma . The " credit card " plan consisted of written guidelines for the self-management of asthma , based on self- assessment of asthma severity , printed on a plastic card . On one side , management guidelines were based on the interpretation of peak expiratory flow rate ( PEFR ) recordings , whilst the reverse side was based on symptoms . The outcome measures used were before and after comparison of markers of asthma morbidity and requirement for acute medical treatment ; and a structured question naire assessing the acceptability and use of the credit card plan . Following the introduction of the plan , the mean PEFR increased from 347 to 389 l.min-1 , the percentage of nights woken fell from 30.4 to 16.9 % , and the number of days " out of action " fell from 3.8 to 1.7 % . The requirements for acute medical treatment also fell during the intervention period . Most participants commented favourably on the content and usefulness of the plan . In the situation of worsening asthma , 28 % of subjects found the peak flow side of the card most helpful , 7 % the symptoms side , and 48 % found both sides equally helpful . ( ABSTRACT TRUNCATED AT 250 WORDS The aim of this study was to evaluate the effectiveness of an asthma education programme in moderate and severe asthma patients in a longitudinal , prospect i ve and r and omized study with a control group . Fifty-three asthmatic patients were studied , 26 of whom were 
    Output:
    
The involvement of IHW in asthma programs targeted for their own ethnic group in 2 small trials was beneficial in improving most , but not all asthma outcomes in children with asthma .
It is very likely that involvement of an IHW is beneficial .