***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: The aim of the present study was to investigate cause-specific mortality in people with intellectual disability ( ID ) . It was based on a 35-year follow-up study of a nation-wide population of 2369 subjects aged between 2 and 97 years . The 1095 deceased people had accumulated 64 539 person-years . The research took the form of a prospect i ve cohort study with mortality follow-up . Observed and expected deaths were calculated as st and ardized mortality ratios using the Finnish general population as the reference . Cause-specific mortality ratios were calculated by the level of ID , sex and age . The three most common causes of death were cardiovascular diseases , respiratory diseases and neoplasms . Disease mortality was high up to 40 years of age , but did not increase thereafter . The difference between sexes in cause-specific mortality was smaller than in the general population . Cause-specific mortality differed significantly from the general population , with reduced mortality from neoplasms and external causes , but ageing individuals with mild ID had similar mortality patterns to the general population . The disparities in the cause-specific mortality between younger people with ID and the general population fade with advancing age , producing similar health risks . In preventative work , special attention should focus on common diseases and accidents in the community The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherl and s. A prospect i ve cohort study was done with four data collection s , each with an interval of one year . Data were collected by means of question naires which were completed by each person 's physician . Striking results included the reported high prevalence and incidence of visual and hearing impairment , which was even more pronounced in people with Down 's syndrome than in people with intellectual disability result ing from other causes . Gastrointestinal problems also appeared to have high incidence rates . Dementia was frequently reported in people with Down 's syndrome aged 40 years and older . The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability The authors conducted a r and omized controlled trial of functional disability screening in a hospital-based internal medicine group practice . They assigned 60 physicians and 497 of their patients to either an experimental or a control group . Every four months the patients in both groups completed a self-administered question naire measuring physical , psychological , and social function . The experimental group physicians received reports summarizing their patients ’ responses ; the control group physicians received no report . At the end of one year the authors found no significant difference between the patients of the experimental and control group physicians on any measure of functional status . Functional disability screening alone does not improve patient function International research has demonstrated significant shortcomings in the health of adults with intellectual disability ( ID ) . Because general practitioners ( GPs ) are the main providers of primary healthcare for this population , strategies to improve general practice care are an important aspect of rectifying these shortcomings . The present pilot study aim ed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs , with a view to informing larger scale studies . The GPs were recruited through an earlier question naire-based postal survey . The GPs identified all their adult patients with ID , then obtained consent for participation from three patients r and omly selected by the investigators . The GPs completed two self-evaluation forms and case note audits  12 months apart , read a synopsis of the relevant literature provided by the research ers , and completed a  comprehensive health assessment ( CHA ) of their three patients . Forty-five GPs agreed to participate in the CHA programme ( CHAP )  , and 15 completed the project . Thirty-eight patients completed the project . The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time . The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice . The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise . The CHAP appeared to provide a superior review process compared to the other interventions used in the present study . The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable . The CHAP served as a communication tool and an educative instrument , providing a basis for future studies and strategies to improve the general practice care of adults with ID BACKGROUND Assertive community treatment ( ACT ) has been applied to a number of disorders in the adult population , such as schizophrenia , with some degree of success ; its use in the treatment of people with intellectual disability ( ID ) and mental illness has received little attention . Despite the high costs of ID in health and social care , there has been very little evidence -based practice for people with ID and mental illness , and it remains a neglected area of research . Aims The aims of this study were an exploratory comparison of the effectiveness of an ACT model for the treatment of mental illness in people with ID ( ACT-ID ) with a st and ard community treatment ( SCT-ID ) approach . METHOD A R and omized controlled trial design was adopted and allocation was made by stratified r and omization by an independent statistician . The prognostic factors used in the r and omization were gender and psychiatric diagnosis ( psychosis vs. affective ) . Service users were r and omly allocated to either ACT-ID or SCT-ID . RESULTS There were no statistically significant differences between ACT-ID and SCT-ID in terms of the level of unmet needs , carer burden , functioning and quality of life , but borderline evidence of a difference between treatment groups in quality of life in favour of SCT-ID . Both SCT-ID and ACT-ID groups decreased level of unmet needs and carer burden , and increased functioning .  SCT-ID also led to a small increase in quality of life BACKGROUND The health status of people with intellectual disability ( ID ) is poor , yet very little research has been done on their health needs . There are several barriers to performing this research . The aim of our research was to examine the significant barriers encountered in recruiting adults with ID to participate in research . METHODS Our project was a r and omized controlled trial aim ing to improve health advocacy of people with ID . We approached many organizations to recruit participants and kept records of our results . Recruitment was very low for the first 4 months . Then we adopted two new recruitment strategies -- in-service telephone recruitment and meetings with prospect i ve participants . We then monitored the subsequent recruitment rates . We also question ed participants about the difficulties they encountered when considering recruitment . RESULTS Initial recruitment of participants yielded less than one-third of the expected number . Additional strategies implemented were partially successful . Significant barriers to recruitment included several sectoral issues and the challenges arising from the research process . CONCLUSIONS While this population is a difficult one to reach for research , attempts to do so should not be ab and oned , because the potential health benefits for this underserved group far outweigh the recruitment barriers experienced BACKGROUND Little research has been carried out on the benefits of intensive case management ( ICM ) for people with borderline IQ and severe mental illness . AIMS To compare outcome and costs of care of patients with severe psychotic illness with borderline IQ to patients of normal IQ and to assess whether ICM is more beneficial for the former than for the latter . METHOD The study utilises data from the UK700 multi-centre r and omised controlled trial of case management . The main outcome measure was the number of days spent in hospital for psychiatric reasons . Secondary outcomes were costs of care and clinical outcome . RESULTS ICM was significantly more beneficial for borderline-IQ patients than those of normal IQ in terms of reductions in days spent in hospital , hospital admissions , total costs and needs and increased satisfaction . CONCLUSIONS ICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits BACKGROUND Congestive heart failure is the most common indication for admission to the hospital among older adults . Behavioral factors , such as poor compliance with treatment , frequently contribute to exacerbations of heart failure , a fact suggesting that many admissions could be prevented . METHODS We conducted a prospect i ve , r and omized trial of the effect of a nurse-directed , multidisciplinary intervention on rates of readmission within 90 days of hospital discharge , quality of life , and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure . The intervention consisted of comprehensive education of the patient and family , a prescribed diet , social-service consultation and planning for an early discharge , a review of medications , and intensive follow-up . RESULTS Survival for 90 days without readmission , the primary outcome measure , was achieved in 91 of the 142 patients in the treatment group , as compared with 75 of the 140 patients in the control group , who received conventional care ( P = 0.09 ) . There were 94 readmissions in the control group and 53 in the treatment group ( risk ratio , 0.56 ; P = 0.02 ) . The number of readmissions for heart failure was reduced by 56.2 percent in the treatment group ( 54 vs. 24 , P = 0.04 ) , whereas the number of readmissions for other causes was reduced by 28.5 percent ( 40 vs. 29 , P not significant ) . In the control group , 23 patients ( 16.4 percent ) had more than one readmission , as compared with 9 patients ( 6.3 percent ) in the treatment group ( risk ratio , 0.39 ; P = 0.01 ) . In a subgroup of 126 patients , quality -of-life scores at 90 days improved more from base line for patients in the treatment group ( P = 0.001 ) . Because of the reduction in hospital admissions , the overall cost of care was $ 460 less per patient in the treatment group . CONCLUSIONS A nurse-directed , multidisciplinary intervention can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure BACKGROUND Bereaved adults with intellectual disabilities are known to experience prolonged and atypical grief which is often unrecognized . The aim of this project was to find an effective way to improve mental health and behavioural outcomes . METHODS Subjects were r and omized to two different therapeutic interventions : traditional counselling by volunteer bereavement counsellors , and an integrated intervention delivered by carers which offered bereavement specific support . Qualitative and quantitative methods were used to determine their effectiveness and efficacy . RESULTS The counselling intervention result ed in measurable gains both clinical ly and in terms of quality of life ; the second intervention proved impracticable in most setting s and no improvement in mental health or behaviour result ed . CONCLUSIONS Despite small numbers , the quantitative findings were highly significant , were supported by the qualitative data , and were of practical relevance to primary care practitioners and specialist mental health and intellectual disability staff This paper describes the  community mental health services in Shanghai , analyses the effectiveness of these services , and discusses their culture-specific characteristics . It reports on a prospect i ve , matched-control study of the three most important types of service : a community follow-up programme in psychiatric out-patient clinics at primary -level general hospitals , ' guardianship networks ' operated by non-professional volunteers , and work therapy stations . In total 308 pairs of subjects completed the study . Using Chinese versions of the Disability Assessment Schedule to assess impairment in psychosocial functioning and the Present State Examination to assess the levels of positive and negative symptoms , ten blind evaluators who had excellent inter-rater reliability assessed the functioning of subjects at enrollment and every six months for the next two years . Over the two years , symptoms and social functioning improved in the treatment groups and deteriorated in the control groups . Thus these community psychiatric services have the dual benefit of promoting rehabilitation and preventing psychosocial deterioration M eeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice . Usual care is not doing the job ; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy , have poor disease con- trol , and are unhappy with their care ( 1 ) . Results of r and omized trials also show that effective disease management programs can achieve substantially better outcomes than usual care , the control intervention . These trials , along with the ideas and efforts for improvement discussed in this issue , show that we can improve care and outcomes . As the articles suggest , these improvements will not come easily . If we are to improve care for most patients with chronic illness , the evidence strongly suggests that we reshape our ambulatory care systems for this purpose . Pri- mary care practice was largely design ed to provide ready access and care to patients with acute , varied problems , with an emphasis on triage and patient flow ; short appointments ; diagnosis and treatment of symptoms and signs ; reliance on laborato- ry investigations and prescriptions ; brief , didactic patient education ; and patient- initiated follow-up . Patients and families struggling with chronic illness have differ- ent needs , and these needs are unlikely to be met by an acute care organization and culture . They require planned , regular interactions with their caregivers , with a focus on function and prevention of exacerbations and complications . This interac- tion includes systematic assessment s , attention to treatment guidelines , and behav- iorally sophisticated support for the patient 's role as self-manager . These interactions must be linked through time by clinical ly relevant information systems and continu- ing follow-up initiated by the medical practice . Comprehensive System The aim of this study was to investigate the effectiveness of specialized hospital treatment vs. outreach treatment of patients with mental retardation and serious mental illness . A total of 50 patients were r and omly assigned to either the hospital treatment ( n=25 ) or the outreach treatment group ( n=25 ) . The outcome measures included psychiatric symptoms , family burden , costs and hospital admissions . At most observation points ( up to 28 weeks ) and at all endpoints the two groups were equivalent with regard to psychiatric symptoms . The burden on carers did not increase significantly during the outreach treatment . Treatment costs were lower for the outreach treatment . Of the 25 patients who 
    Output:
    
There are currently no well design ed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems .