***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: Traumatic stress due to conflict and war causes major mental health problems in many re source -poor countries . The objective of this study was to examine whether trained lay counselors can carry out effective treatment of  posttraumatic stress disorder ( PTSD )  in a refugee settlement . In a r and omized controlled dissemination trial in Ug and a with 277 Rw and an and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors . Strictly manualized narrative exposure therapy ( NET ) was compared with more flexible trauma counseling ( TC ) and a no-treatment monitoring group ( MG ) . Fewer participants ( 4 % ) dropped out of NET treatment than TC ( 21 % ) . Both active treatment groups were statistically and clinical ly superior to MG on PTSD symptoms and physical health but did not differ from each other . At follow-up , a PTSD diagnosis could not be established anymore in 70 % of NET and 65 % TC participants , whereas only 37 % in MG did not meet PTSD criteria anymore . Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement Undernutrition in early childhood is associated with poor mental development and affects 45 % of children in Bangladesh . Although limited evidence shows that psychosocial stimulation can reduce the deficits , no such interventions have been reported from Bangladesh . The Bangladesh Integrated Nutrition Program ( BINP ) has provided nutrition supplementation to undernourished children through community nutrition centers ( CNCs ) . We added psychosocial stimulation to the treatment of undernourished children in a r and omized controlled trial to assess the effects on children 's development and growth and mothers ' knowledge . Twenty CNCs were r and omly assigned to intervention or control groups with 107 children in each group . We also studied 107 nonintervened better-nourished children from the same villages . Pre- and postintervention measurements included children 's height , weight , development assessed on Bayley Scales , behavior ratings during the test , and a question naire on mothers ' knowledge of childrearing . The intervention comprised home visits and group meetings with mothers and children for 12 mo . Intervention benefited children 's mental development ( 4.6 + /- 2.0 , P = 0.02 ) , vocalization ( 0.48 + /- 0.23 , P = 0.04 ) , cooperation ( 0.45 + /- 0.16 , P = 0.005 ) , response-to-examiner ( 0.50 + /- 0.15 , P = 0.001 ) , emotional tone ( 0.33 + /- 0.15 , P = 0.03 ) , and mothers ' knowledge ( 3.5 + /- 0.49 , P < 0.001 ) . At the end , undernourished controls had poorer mental ( -4.6 + /- 2.0 , P = 0.02 ) and motor ( -6.6 + /- 2.2 , P = 0.003 ) development , were more inhibited ( -0.35 + /- 0.16 , P = 0.03 ) , fussier ( -0.57 + /- 0.16 , P < 0.001 ) , less cooperative ( -0.48 + /- 0.17 , P = 0.005 ) , and less vocal ( -0.76 + /- 0.23 , P = 0.001 ) than better-nourished children . Intervened children scored lower only in motor development ( -4.4 + /- 2.3 , P = 0.049 ) . Neither group of undernourished children improved in nutritional status , indicating that treatment had no effect . In conclusion , adding child development activities to the BINP improved children 's development and behavior and their mothers ' knowledge ; however , the lack of improvement in growth needs to be examined further It is not known whether nutritional supplementation in early childhood has long-term benefits on  stunted children 's mental development . We followed up 127 7 - 8-y old children who had been stunted in early childhood and received supplementation , stimulation , or both .  At 9 - 24 mo of age , the children had been r and omly assigned to four treatment groups : nutritional supplementation , stimulation , both treatments , and control . After 2 y , supplementation and stimulation had independent benefits on the children 's development and the effects were additive . The group receiving both treatments caught up to a matched group of 32 nonstunted children . Four years after the end of the 2-y intervention 97 % of the children were given a battery of cognitive function , school achievement , and fine motor tests .  An additional 52 nonstunted children were included . Factor analyses of the test scores produced three factors : general cognitive , perceptual-motor , and memory . One , the perceptual-motor factor , showed a significant benefit from stimulation , and supplementation benefited only those children whose mothers had higher verbal intelligence quotients . However , each intervention group had higher scores than the control subjects on more tests than would be expected by chance ( supplemented and both groups on 14 of 15 tests , P = 0.002 ; stimulated group in 13 of 15 tests , P = 0.01 ) , suggesting a very small global benefit . There was no longer an additive effect of combined treatments at the end of the intervention . The stunted control group had significantly lower scores than the nonstunted children on most tests . Stunted children 's heights and head circumferences on enrollment significantly predicted intelligence quotient at follow-up Objective To assess the efficacy of an intervention design ed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances . Design R and omised controlled trial . Setting Khayelitsha , a peri-urban settlement in South Africa . Participants 449 pregnant women . Interventions The intervention was delivered from late pregnancy and for six months postpartum . Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting . The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother . Women in the control group received no therapeutic input from the research team . Main outcome measures Primary outcomes : quality of mother-infant interactions at six and 12 months postpartum ; infant attachment security at 18 months . Secondary outcome : maternal depression at six and 12 months . Results The intervention was associated with significant benefit to the mother-infant relationship . At both six and 12 months , compared with control mothers , mothers in the intervention group were significantly more sensitive ( 6 months : mean difference=0.77 ( SD 0.37 ) , t=2.10 , P<0.05 , d=0.24 ; 12 months : mean difference=0.42 ( 0.18 ) , t=−2.04 , P<0.05 , d=0.26 ) and less intrusive ( 6 months : mean difference=0.68 ( 0.36 ) , t=2.28 , P<0.05 , d=0.26 ; 12 months : mean difference=−1.76 ( 0.86 ) , t=2.28 , P<0.05 , d=0.24 ) in their interactions with their infants . The intervention was also associated with a higher rate of secure infant attachments at 18 months ( 116/156 ( 74 % ) v 102/162 ( 63 % ) ; Wald=4.74 , odds ratio=1.70 , P<0.05 ) . Although the prevalence of maternal depressive disorder was not significantly reduced , the intervention had a benefit in terms of maternal depressed mood at six months ( z=2.05 , P=0.04 ) on the Edinburgh postnatal depression scale ) . Conclusions The intervention , delivered by local lay women , had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment , factors known to predict favourable child development . If these effects persist , and if they are replicated , this intervention holds considerable promise for use in the developing world . Trial registration Current Controlled Trials IS RCT N25664149 Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Dementia Rating scale ) and their caregivers were included in the trial . Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist , focusing on supporting the caregiver through information on dementia , guidance on behaviour management , a single psychiatric assessment and psychotropic medication if needed . We measured caregiver mental health ( General Health Question naire ) , caregiver burden ( Zarit Burden Score ) , distress due to behavioural disturbances ( NPI-D ) , behavioural problems in the subject ( NPI-S ) and activities of daily living in the elder with dementia ( EASI ) . Outcome evaluations were masked to the allocation status . We analysed each outcome with a mixed effects model . 81 families enrolled in the trial ; 41 were r and omly allocated to the intervention . 59 completed the trial and 18 died during the trial . The intervention led to a significant reduction of GHQ ( −1.12 , 95 % CI −2.07 to −0.17 ) and NPI-D scores ( −1.96 , 95%CI −3.51 to −0.41 ) and non-significant reductions in the ZBS , EASI and NPI-S scores . We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm ( OR 0.34 , 95 % CI 0.01 to 1.03 ) . Conclusion Home based support for caregivers of persons with dementia , which emphasizes the use of locally available , low-cost human re sources , is feasible , acceptable and leads to significant improvements in caregiver mental health and burden of caring . Clinical Trials.gov This paper summarizes a 25-year program of research that has attempted to improve the early health and development of low-income mothers and children and their future life trajectories with prenatal and infancy home visiting by nurses .  The program has been tested in two separate large-scale r and omized controlled trials with different population s living in different context s. The program has been successful in improving parental care of the child as reflected in fewer injuries and ingestions that may be associated with child abuse and neglect ; and maternal life-course , reflected in fewer subsequent pregnancies , greater work force participation , and reduced use of public assistance and food stamps . In the first trial , the program also produced long-term effects on the number of arrests , convictions , emergent substance use , and promiscuous sexual activity of 15-year-old children whose nurse-visited mothers were low-income and unmarried when they registered in the study during pregnancy . Since 1996 , the program has been offered for public investment outside of research context s. Careful attention has been given to ensuring that the program is replicated with fidelity to the model tested in the scientifically controlled studies by working with community leaders to ensure that organization and community context s are favorable for the program ; by providing the nurses with excellent training and technical assistance and detailed visit-by-visit guidelines ; and by providing organizations with a web-based clinical information system that creates a basis for monitoring program performance and continuous quality improvement BACKGROUND Community mobilisation through participatory women 's groups might improve birth outcomes in poor rural communities . We therefore assessed this approach in a largely tribal and rural population in three districts in eastern India . METHODS From 36 clusters in Jharkh and and Orissa , with an estimated population of 228 186 , we assigned 18 clusters to intervention or control using stratified r and omisation . Women were eligible to participate if they were aged 15 - 49 years , residing in the project area , and had given birth during the study . In intervention clusters , a facilitator convened 13 groups every month to support participatory action and learning for women , and facilitated the development and implementation of strategies to address maternal and newborn health problems . The primary outcomes were reductions in neonatal mortality rate ( NMR ) and maternal depression scores . Analysis was by intention to treat . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N21817853 . FINDINGS After baseline surveillance of 4692 births , we monitored outcomes for 19 030 births during 3 years ( 2005 - 08 ) . NMRs per 1000 were 55.6 , 37.1 , and 36.3 during the first , second , and third years , respectively , in intervention clusters , and 53.4 , 59.6 , and 64.3 , respectively , in control clusters . NMR was 32 % lower in intervention clusters adjusted for clustering , stratification , and baseline differences ( odds ratio 0.68 , 95 % CI 0.59 - 0.78 ) during the 3 years , and 45 % lower in years 2 and 3 ( 0.55 , 0.46 - 0.66 ) . Although we did not note a significant effect on maternal depression overall , reduction in moderate depression was 5 
    Output:
    
Conclusions LHWs have the potential to provide psychosocial and psychological interventions as part of primary and secondary prevention of MNS disorders in LMICs , but there is currently insufficient robust evidence of effectiveness of LHW led preventive strategies in this setting .