***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: Abstract Background Neonatal mortality  remains high in rural Nepal . Previous work suggests that local women 's groups can effect significant improvement through community mobilisation . The possibility of identification and management of newborn infections by community-based workers has also arisen . Methods / Design The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers .  MIRA Dhanusha community groups : a participatory intervention with women 's groups . MIRA Dhanusha sepsis management : training of community volunteers in the recognition and management of neonatal sepsis . The study design is a cluster r and omized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design . MIRA Dhanusha community groups : Female Community Health Volunteers ( FCHVs ) are supported in convening monthly women 's groups . Nine groups per cluster ( 270 in total ) work through two action research cycles in which they ( i ) identify local issues around maternity , newborn health and nutrition , ( ii ) prioritise key problems , ( iii ) develop strategies to address them , ( iv ) implement the strategies , and ( v ) evaluate their success . Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practice s. MIRA Dhanusha sepsis management : FCHVs are trained to care for vulnerable newborn infants . They ( i ) identify local births , ( ii ) identify low birth weight infants , ( iii ) identify possible newborn infection , ( iv ) manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin , and ( v ) follow up infants and support families . Primary outcome : neonatal mortality rates . Secondary outcomes : MIRA Dhanusha community group : stillbirth , infant and under-two mortality rates , care practice s and health care seeking behaviour , maternal diet , breastfeeding and complementary feeding practice s , maternal and under-2 anthropometric status . MIRA Dhanusha sepsis management : identification and treatment of neonatal sepsis by community health volunteers , infection-specific neonatal mortality . Trial Registration noIS RCT N : IS RCT Background Publicly reported performance on quality measures is intended to enable patients to make more informed choices . Despite the growing availability of these reports , patients ’ use remains limited and disparities exist . Low health literacy and numeracy are two barriers that may contribute to these disparities . Patient navigators have helped patients overcome barriers such as these in other areas , such as cancer care and may prove useful for overcoming barriers to using publicly reported quality data . Methods / Design The goals of this study are : to determine the efficacy of a patient navigator intervention to assist low-income pregnant women in the use of publicly available information about quality of care when choosing a pediatrician ; to evaluate the relative importance of factors influencing women ’s choice of pediatric practice s ; to evaluate the effect of the intervention on patient engagement in management of their own and their child ’s health care ; and to assess variation in efficacy of the intervention for sub-groups based on parity , age , and race/ethnicity . English speaking women ages 16 to 50 attending a prenatal clinic at a large urban medical center will be r and omized to receive an in-person navigator intervention or an informational pamphlet control between 20 to 34 weeks of gestation . The intervention will include in-person guided use of the Massachusetts Health Quality Partners website , which reports pediatric practice s ’ performance on quality measures and patient experience . The primary study outcomes will be the mean scores on a ) clinical quality and b ) patient experience measures . Discussion Successful completion of the study aims will yield important new knowledge about the value of guided website navigation as a strategy to increase the impact of publicly reported quality data and to reduce disparities in use of these data .Trial registration Clinical Trials.gov # CONTEXT Latinos experience significant health disparities at the end of life compared with non-Latinos . OBJECTIVES To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness . METHODS This was a pilot r and omized controlled trial that included 64 Latino adults with life-limiting illness r and omized to an intervention or a control group . All participants received a packet of linguistically matched material s on palliative care . In addition , intervention participants received up to five home visits from the bilingual , bicultural patient navigator . Visits focused on addressing barriers to palliative care through education , activation , and culturally tailored messaging . Outcomes included feasibility and advance care planning rates , documentation of pain management discussion s in the medical record , and hospice utilization . RESULTS Of the 32 patients r and omized to the intervention arm , 81 % had at least one home visit ( range 1 - 5 ) with the patient navigator . Overall , advance care planning was higher in the intervention group ( 47 % [ n = 15 ] vs. 25 % [ n = 8 ] , P = 0.06 ) , and 79 % of intervention participants had a discussion about pain management documented in their medical record vs. 54 % of control patients ( P = 0.05 ) . Hospice enrollment between the two groups ( n = 18 decedents ) was similar ( n = 7 intervention vs. n = 6 control ) ; length of stay in the intervention group was 36.4 ± 51.6 vs. 19.7 ± 33.6 days for control patients ( P = 0.39 ) . CONCLUSION A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness , justifying a fully powered r and omized controlled trial Past efforts to promote  family planning in Pakistan have been disappointing , but between 1990 - 91 and 2000 - 01 contraceptive use has more than doubled . This rise has coincided with a concerted effort on the part of the Pakistani government to increase access to contraceptive services , particularly in rural areas . The Lady Health Worker Programme ( LHWP ) , initiated under the Ministry of Health in the early 1990s , aim ed at integrating family planning into the doorstep provision of primary health care . This paper presents findings from the first national evaluation of this Programme . Data are analyzed from a r and om sample survey of 4277 women living in households served by the LHWP and those living in control areas .  Logistic regression analysis was performed to determine the effect of the Programme on the uptake of modern reversible contraceptive methods  , controlling for other independent variables . The data provide strong evidence that the LHWP has succeeded in increasing modern contraceptive use among rural women . Women served by Lady Health Workers are significantly more likely to use a modern reversible method  than women in communities not served by the Programme ( OR=1.50 , 95 % CI=1.04 - 2.16 , p=0.031 ) , even after controlling for various household and individual characteristics . The model of providing doorstep services through community-based female workers should remain central to achieving universal access to safe family planning methods  by the end of the decade -- the long-term objective of Pakistan 's most recent population policy adopted in 2002 Background One of the major challenges for management of visceral leishmaniasis ( VL ) is early diagnosis of cases to improve treatment outcome and reduce transmission . We have therefore investigated active case detection of VL with the help of accredited social health activists ( ASHA ) .  ASHAs are women who live in the community and receive performance-based incentives for overseeing maternal and other health-related issues in their village . Methods and Principal Finding Through conducting interviews with 400 r and omly selected ASHAs from four primary health care centers ( PHCs ) , it was observed that their level of knowledge about visceral leishmaniasis ( VL ) regarding transmission , diagnosis , and treatment was limited . The baseline data indicated that less than 10 % of VL cases seeking treatment at the PHCs were referred by ASHAs . To increase the knowledge and the referral rate of VL cases by ASHAs , training sessions were carried out during the monthly ASHA meetings at their respective PHCs . Following a single training session , the referral rate increased from less than 10 % to over 27 % and the overall knowledge about VL substantially improved . It was not possible , however , to demonstrate that ASHA training reduced the time that individuals had fever before treatment at the PHC . Conclusions Training ASHAs to identify VL cases in villages for early diagnosis and treatment at the local PHC is feasible and should be undertaken routinely to improve knowledge about VL The elimination of cancer disparities is critically important for lessening the burden of breast cancer ( BC ) . Patient navigator programs ( PNPs ) have been shown to improve rates of BC screening in underserved communities , but there is a dearth of evidence regarding their benefits after the actual diagnosis of BC . We retrospectively examined sociodemographic characteristics , disease characteristics , and concordance to quality measures ( QMs ) of BC care among women participating in a PNP that services disadvantaged minority communities in the greater Boston area . Of the 186 PNP patients diagnosed with BC in 2001 - 2011 in three neighborhood community health centers , treatment data was available for 158 ( 85 % ) and race and disease stage information was available for 149 ( 80 % ) . Regarding stage , 25 % were diagnosed with in situ cancer , 32 % had stage 1 , 25 % had stage 2 , 13 % had stage 3 , and 5 % had stage 4 BC . Guideline -indicated care was received by 70 of 74 patients ( 95 % ) for the hormonal therapy QM , 15 of 17 ( 88 % ) patients for the chemotherapy QM , and 65 of 71 ( 92 % ) patients for the radiation QM , all similar to published concordance rates at elite National Comprehensive Cancer Network institutions . These findings suggest that PNPs may facilitate evidence -based quality care for vulnerable population s. Future research should prospect ively analyze quality metrics to assess measures to improve the process and outcomes of patient navigation in diverse underserved setting s , compared with control non-navigated population Colorectal cancer screening has clear benefits in terms of mortality reduction ; however , it is still underutilized and especially among medically underserved population s , including African Americans , who also suffer a disproportionate colorectal cancer burden . This study consisted of a theory-driven ( health belief model ) spiritually based intervention aim ed at increasing screening  among African Americans through a community health advisor-led educational series  in 16 churches . Using a r and omized design , churches were assigned to receive either the spiritually based intervention or a nonspiritual comparison , which was the same in every way except that it did not contain spiritual/religious content and themes . Trained and certified peer community health advisors in each church led a series of two group educational sessions on colorectal cancer and screening . Study enrollees completed a baseline , 1-month , and 12-month follow-up survey at their churches . The interventions had significant pre – post impact on awareness of all four screening modalities , and self-report receipt of fecal occult blood test , flexible sigmoidoscopy , and colonoscopy . There were no significant study group differences in study outcomes , with the exception of fecal occult blood test utilization , whereas those in the nonspiritual intervention reported significantly greater pre – post change . Both of these community-engaged , theory-driven , culturally relevant approaches to increasing colorectal cancer awareness and screening appeared to have an impact on study outcomes . Although adding spiritual/religious themes to the intervention was appealing to the audience , it may not result in increased intervention efficacy OBJECTIVE To determine whether community-based health workers in a rural region of Ethiopia can provide  injectable contraceptives  to women with similar levels of safety , effectiveness and acceptability as health extension workers ( HEWs ) . METHODS This was a prospect i ve non-r and omized community intervention trial design ed to test the provision of injectable contraceptives by community-based reproductive health agents ( CBRHAs ) . Effectiveness , safety , acceptability and continuation rates were the outcomes of interest . The outcomes observed when injectable contraceptives were administered by HEWs in health posts and when they were administered by CBRHAs were compared by means of χ(2 ) tests for association among categorical variables and t-tests for independent sample s to determine differences between group means . FINDINGS A total of 1062 women participated in the study . Compared with health post clients , the clients of CBRHAs were , on average , slightly older , less likely to be married and less educated , and they had significantly more living children . Women seeking services from CBRHAs were also significantly more likely to be using injectable contraceptives for the first time ; health post clients were more likely to have used them in the past . In addition , clients of CBRHAs were less likely to discontinue using injectable contraceptives over three injection cycles than health post clients . CONCLUSION Receiving injectable contraceptives from CBRHAs proved as safe and acceptable to this sample of Ethiopian women as receiving them in health posts from HEWs . These findings add to the growing body of evidence supporting the development , introduction and scale up of programmes to train community-based health workers such as CBRHAs to safely administer injectable contraceptives Background Results of previous studies attest to the greater illness burden of common mental disorders ( anxiety and depression ) in older Latinos and the need for developing preventive interventions that are effective , acceptable , and scalable .  Happy Older Latinos are Active ( HOLA ) is a newly developed intervention that uses a community health worker ( CHW ) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos . This pilot study tests the feasibility and acceptability of delivering HOLA to older , at-risk Latinos . Methods / Design HOLA is a multi-component , health promotion intervention funded by the National Institute of Mental Health ( NIMH ) . This prevention approach will be tested against a fotonovela , an enhanced psychoeducation control condition , in a sample of Latino elderly with minor or subthreshold depression or anxiety 
    Output:
    
The review shows CHWs as paraprofessionals or lay individuals with an in-depth underst and ing of the community culture and language , have received st and ardised job-related training of a shorter duration than health professionals , and their primary goal is to provide culturally appropriate health services to the community .
Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried .