***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: This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks ( smoking , environmental tobacco smoke exposure ( ETSE ) , depression , and intimate partner violence ( IPV ) ) in African-Americans is associated with improved pregnancy outcomes . A r and omized controlled trial targeting risks during pregnancy was conducted in the District of Columbia . African-American women were recruited if reporting at least one of the risks mentioned above . R and omization to intervention or usual care was site and risk specific . Sociodemographic , health risk and pregnancy outcome data were collected . Data on 819 women , and their singleton live born infants were analyzed using an intent-to-treat approach . Bivariate analyses preceded a reduced logistical model approach to eluci date the effect of the intervention on the reduction of prematurity and low birth weight . The incidence of low birthweight ( LBW ) was 12 % and very low birthweight ( VLBW ) was 1.6 % . Multivariate logistic regression results showed that depression was associated with LBW ( OR = 1.71 , 95 % CI = 1.12–2.62 ) . IPV was associated with preterm birth ( PTB ) and very preterm birth ( VPTB ) ( OR 1.64 , 95 % CI = 1.07–2.51 , OR = 2.94 , 95 % CI = 1.40–6.16 , respectively ) . The occurrence of VPTB was significantly reduced in the intervention compared to the usual care group ( OR = 0.42 , 95 % CI = 0.19 - 0.93 ) . Our study confirms the significant associations between multiple psycho-behavioral risks and poor pregnancy outcomes , including LBW and PTB . Our behavioral intervention with demonstrated efficacy in addressing multiple risk factors simultaneously reduced VPTB within an urban minority population Summary Stress and negative mood during pregnancy increase risk for poor childbirth outcomes and postnatal mood problems and may interfere with mother – infant attachment and child development . However , relatively little research has focused on the efficacy of psychosocial interventions to reduce stress and negative mood during pregnancy . In this study , we developed and pilot tested an eight-week mindfulness-based intervention directed toward reducing stress and improving mood in pregnancy and early postpartum . We then conducted a small r and omized trial ( n = 31 ) comparing women who received the intervention during the last half of their pregnancy to a wait-list control group .  Measures of perceived stress , positive and negative affect , depressed and anxious mood , and affect regulation were collected prior to , immediately following , and three months after the intervention ( postpartum ) . Mothers who received the intervention showed significantly reduced anxiety ( effect size , 0.89 ; p < 0.05 ) and negative affect ( effect size , 0.83 ; p < 0.05 ) during the third trimester in comparison to those who did not receive the intervention . The brief and nonpharmaceutical nature of this intervention makes it a promising c and i date for use during pregnancy BACKGROUND Health communication and interpersonal skills are increasingly emphasized in the measurement of health care quality , yet there is limited research on the association of interpersonal care with health outcomes . As approximately 50 % of pregnancies in the United States are unintended , whether interpersonal communication influences contraceptive use is of public health importance . OBJECTIVE The aim of this study was to determine whether the quality of interpersonal care during contraceptive counseling is associated with contraceptive use over time . STUDY DESIGN The Patient-Provider Communication about Contraception study is a prospect i ve cohort study of 348 English-speaking women seen for contraceptive care , conducted between 2009 and 2012 in the San Francisco Bay Area .  Quality of communication was assessed using a patient-reported interpersonal quality  in family planning care measure based on the dimensions of patient-centered care . In addition , the clinical visit was audio recorded and its content coded according to the vali date d Four Habits Coding Scheme to assess interpersonal communication behaviors of clinicians . The outcome measures were 6-month continuation of the selected contraceptive method and use of a highly or moderately effective method at 6 months . Results were analyzed using mixed effect logistic regression models controlling for patient demographics , the clinic and the provider at which the visit occurred , and the method selected . RESULTS Patient participants had a mean age of 26.8 years ( SD 6.9 years ) ; 46 % were white , 26 % Latina , and 28 % black . Almost two-thirds of participants had an income of < 200 % of the Federal Poverty Level . Most of the women ( 73 % ) were making visits to a provider whom they had not seen before . Of the patient participants , 41 % were still using their chosen contraceptive method at 6-month follow-up . Patients who reported high interpersonal quality of family planning care were more likely to maintain use of their chosen contraceptive method ( adjusted odds ratio [ aOR ] , 1.8 ; 95 % CI , 1.1 - 3.0 ) and to be using a highly or moderately effective method at 6 months ( aOR , 2.0 ; 95 % CI , 1.2 - 3.5 ) . In addition , 2 of the Four Habits were associated with contraceptive continuation ; " invests in the beginning " ( aOR , 2.3 ; 95 % CI , 1.2 - 4.3 ) and " elicits the patient 's perspective " ( aOR , 1.8 ; 95 % CI , 1.0 - 3.2 ) . CONCLUSION Our study provides evidence that the quality of interpersonal care , measured using both patient report and observation of provider behaviors , influences contraceptive use . These results provide support for ongoing attention to interpersonal communication as an important aspect of health care quality . The associations of establishing rapport and eliciting the patient perspective with contraceptive continuation are suggestive of areas of focus for provider communication skills training for contraceptive care OBJECTIVES to compare the effects of partnership caseload midwifery care , with conventional team midwifery care . Comparisons of labour interventions and birth outcomes were made between the two models of care . DESIGN a prospect i ve , non-r and omised clinical trial . SETTING Women 's Hospital at Leicester Royal Infirmary , Leicester , UK in 1998 . PARTICIPANTS 303 women from the experimental group and 308 from the control group ( 611 in total ) matched for age , ethnicity , marital status , parity , gravida and height who gave birth between April 1997 and August 1998 . INTERVENTION the control group received conventional team midwifery care during pregnancy , labour and birth , and the experimental group received care from midwives working in partnerships that provided continuity of care during pregnancy , labour and birth . KEY FINDINGS 21 % of women in the experimental group had an epidural compared with 32 % of the controls ( OR 0.56 95 % , CI 0.39 - 0.81 , P=0.002 ) . The normal vaginal birth rate ( 74 % v 66 % , OR 1.45 , 95 % CI 1.02 - 2.05 , P=0.038 ) , upright birth posture rate ( 60 % v 14 % , OR 9.64 , 95 % CI 5.96 - 15.61 , P= or < 0.001 ) , intact perineum rate ( 40 % v 30 % , OR 1.57 , 95 % CI 1.05 - 2.35 , P=0.027 ) , and physiological third stage rate ( 37 % v 1.5 % , OR 38.69 , 95 % CI 11.98 - 124.89 , P= or < 0.001 ) were significantly higher in the experimental group . The induction of labour rate ( 16 % v 23 % , OR 0.66 , 95 % CI 0.44 - 0.98 , P=0.042 ) was significantly lower in the experimental group . Women in the experimental group had more home births ( 17 % v 1.3 % , OR 15.38 . 95 % CI 5.48 - 43.14 , P= or < 0.001 ) ; used the midwife-led birthing suite more often ( 28 % v 12 % , OR 2.77 , 95 % CI 1.82 - 4.22 , P= or < 0.001 ) ; were more likely to take an early discharge ( two to six hours ) from hospital following birth ( 25 % v 3 % , OR 11.32 . 95 % CI 5.55 - 23.06 , P= or < 0.001 ) ; and were attended in birth more often by either their named midwife ( 67 % v 5 % , OR 39.65 , 95 % CI 22.38 - 70.25 , P= or < 0.001 ) or her partner ( known midwife ) ( 84 % v 14 % , OR 32.74 , CI 20.96 - 51.14 , P= or < 0.001 ) . IMPLICATION S FOR PRACTICE partnership caseload midwifery care result ed in less interventionist labour and more normal birth than conventional team midwifery care . Women in the experimental group had more home births , birth in a midwife-led suite and opted for early discharge home postnatally more often than the controls . They also experienced much higher levels of continuity , particularly of a known midwife during labour and birth . The study findings should encourage other maternity units in the UK to pilot and evaluate the model to see if these benefits are transferable Objective To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth r and omised to either psychoeducation or conventional surveillance during pregnancy Background To study maternal anxiety and perinatal outcomes in pregnant women su bmi tted to a Multidisciplinary Program for Childbirth and Motherhood Preparation ( MPCM ) . Methods This is a not r and omized controlled trial on 67 nulliparous pregnant women divided into two groups according to participation ( MPCM Group ; n = 38 ) or not ( Control Group ; n = 29 ) in MPCM .  The program consisted of 10 meetings ( between the 18th and the 38th gestational week ) during which educational , physiotherapeutic and interaction activities were developed . Anxiety was quantified at the beginning and at the end of the gestational period by the  Trace-State Anxiety Inventory  ( STAI ) . Results Initial maternal anxiety was equivalent between the groups . At the end of the gestational period , it was observed that anxiety levels increased in the Control Group and were maintained in the MPCM Group . A higher occurrence of vaginal deliveries ( 83.8 % ) and hospital discharge of three-day-older newborns ( 81.6 % ) as a result of MPCM was also significant . Levels of state-anxiety at the end of pregnancy showed a negative correlation with vaginal delivery , gestational age , birth weight and Apgar index at the first minute and positive correlation with the hospital period remaining of the newborns . Conclusion In the study conditions , MPCM was associated with lower levels of maternal anxiety , a larger number of vaginal deliveries and shorter hospitalization time of newborns . It was not related to adverse perinatal outcomes OBJECTIVES To evaluate the impact of a community-based , collaborative , shared antenatal care intervention ( the Mums and Babies program ) for Indigenous women in Townsville . DESIGN AND PARTICIPANTS Prospect i ve cohort study of women attending Townsville Aboriginal and Isl and er Health Service ( TAIHS ) for shared antenatal care with a singleton Indigenous birth between 1 January 2000 and 31 December 2003 ( 456 women ; the MB group ) , compared with a historical control group of 84 women who attended TAIHS for antenatal care before the intervention between 1 January 1998 and 30 June1999 , and a contemporary control group of 540 women who had a singleton birth at Townsville Hospital between 1 January 2000 and 30 June 2003 , but did not attend TAIHS for antenatal care .  INTERVENTION Integration of previously autonomous service providers delivering shared antenatal care from TAIHS . MAIN OUTCOME MEASURES Patterns of antenatal visits , proportion of women undertaking key antenatal screening , and perinatal outcomes . RESULTS The number of  Indigenous women who entered the MB program and gave birth at Townsville Hospital rose from 23.8 % in 2000 to 61.2 % in 2003 . The number of antenatal care visits per pregnancy increased from three ( interquartile [ IQ ] range , 2 - 6 ) in the historical control group to seven ( IQ range , 4 - 10 ) in the MB group ( P < 0.001 ) . 88 % of women in the MB group had at least one ultrasound . About 90 % of all women attending for antenatal care were screened for sexually transmitted infections . In the MB group , there was a significant reduction in preterm births compared with the contemporary control group ( 8.7 % v 14.3 % , P < 0.01 ) . There was no significant reduction in the prevalence of low birthweight births or perinatal mortality . CONCLUSION A community-based collaborative approach to shared antenatal care services increased access to antenatal care and was associated with fewer preterm births  among Indigenous women in Townsville . The model may be adaptable in other urban centres with multiple antenatal care providers and significant numbers of Indigenous people across Australia Observ 
    Output:
    
An intervention ’s primary and secondary PCC objectives frequently did not align with the measured person-centered outcomes .
Generally , PCC interventions either improved or made no difference to person-centered outcomes .
There was no clear relationship between PCC objectives and clinical outcomes .