***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 Regular review and support for asthma self-management is promoted in guidelines . A r and omised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses . Methods Following the RCT , a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the result ing impact on unscheduled healthcare ( measure of effectiveness ) in this trial . Results One year data ( n = 418 ) showed that 29 % ( 61/205 ) of the nurse group required unscheduled healthcare ( 177 events ) compared with 30.5 % ( 65/213 ) for lay-trainers ( 178 events).The training costs for the lay-trainers were greater than nurses ( £ 36 versus £ 18 respectively per patient , p<0.001 ) , however , the consultation cost for lay-trainers were lower than nurses ( £ 6 per patient versus £ 24 , p<0.001 ) . If the cost of unscheduled healthcare are accounted for then the costs of nurses is £ 161 , and £ 135 for lay-trainers ( mean difference £ 25 , [ 95 % CI = −£97 , £ 149 , p = 0.681 ] ) . The total costs ( delivery and unscheduled healthcare ) were £ 202 per patient for nurses versus £ 178 for lay-trainers , ( mean difference £ 24 , [ 95%CI = −£100 , £ 147 , p = 0.707 ] ) . Conclusions There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers , and no significant difference in the cost of unscheduled health care use 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 determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma . METHODS We used a r and omized clinical trial with 48 youth ( aged 9 - 15 years ) assigned to 1 of 3 groups : Teamwork Intervention ( TI ) , Asthma Education ( AE ) , or St and ard Care ( SC ) . Treatment occurred across 2 months , with a 3-month follow-up assessment . Adherence to inhaled corticosteroids was assessed via the MDILog-II . Parent-adolescent conflict , asthma functional severity , and spirometry assessment s were obtained pre-treatment , post-treatment , and on follow-up . Mixed linear model analysis was used to evaluate group and time effects for outcome measures . RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions , and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group . CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management BACKGROUND Poor adherence to inhaled corticosteroids ( ICS ) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents . OBJECTIVE This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS . METHODS Low-income African American and /or Hispanic adolescents , ages 11 - 16 years old , with persistent asthma , and poor ( ≤ 48 % ) adherence to prescription ICS during the 3-week run-in were r and omized to intervention or attention control groups ( ATG ) for the 10-week treatment . During treatment , the intervention arm subjects participated in weekly coping peer group support sessions and received mp3 peer-recorded asthma messages that promoted adherence . The ATG participated in weekly meetings with a research assistant and received an equivalent number of mp3 physician-recorded asthma messages . Adherence was measured by using self-report and the Doser CT , an electronic dose counter . The primary outcome was the difference in adherence at 10 weeks between the 2 arms . RESULTS Thirty-four subjects were r and omized to each arm . At 10 weeks , no statistical difference in objective ly measured adherence could be detected between the 2 arms when adjusting for baseline adherence ( P = .929 ) . Adherence declined in both groups over the course of the active treatment period . In both study arms , self-reported adherence by participants was significantly higher than their objective ly measured adherence at week 10 ( P < .0001 ) . CONCLUSION Improving medication adherence in longitudinal studies is challenging . Peer support and mp3-delivered peer asthma messages may not be of sufficient dose to improve outcomes One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals Background Estimates of asthma incidence and its possible determinants in adolescent population s have rarely been obtained using prospect i ve design s. We sought to identify socio-demographic and other patterns in the incidence of asthma among Canadian adolescents and to examine possible behavioural and environmental determinants of asthma incidence using longitudinal analyses . Methods We used  data from the National Population Health Survey ( NPHS ) , a nationally representative longitudinal survey of Canadians . All persons aged 12–18 years without asthma at baseline were followed up to a maximum of 12 years . The outcome was a reported diagnosis of asthma during the follow-up period . Analyses were weighted to the population and bootstrapping procedures were used to estimate variances . Results Participants ( n = 956 ) represented 2,038,890 adolescents of whom 293,450 ( 14.4 % ) developed asthma over the 21,274,890 person-years of follow-up . Overall , the incidence of asthma was 10.2 per 1000 person-years . In adjusted Cox regression analysis , being female ( HR = 2.13 , 95 % CI = 1.26 - 3.62 , p = 0.005 ) and being exposed to passive smoking ( HR = 2.06 , 95 % CI = 1.27 - 3.34 , p = 0.003 ) were associated with the development of asthma while no statistically significant associations were identified for rural residence , being overweight , and other health behaviours . There was also an apparent cohort effect among girls where girls who were older at baseline reported being diagnosed with asthma more over the follow-up than their younger counterparts . This was not observed among males . Conclusions Asthma prevention initiatives for adolescents should target girls and focus on smoking exposures . The role that differential diagnostic patterns play in these observations should be investigated to more accurately assess the incidence of asthma 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 OBJECTIVES We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma . METHODS Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were r and omly assigned into 2 groups ( immediate and delayed intervention ) in a crossover study . Each group participated in the active phase ( intervention ) and the inactive phase . Outcomes included asthma symptoms , albuterol use , emergency department visits , hospitalizations , and trigger reduction . RESULTS A total of 264 primarily Black ( 94 % ) children were enrolled . The mean number of emergency visits decreased by 30 % and inpatient visits decreased by 53 % ( P < .001 ) after the intervention . Reductions were seen in pests , presence of carpets in bedrooms , and dust . Nighttime wheezing was significantly reduced after the intervention in both groups ( P < .001 ) . CONCLUSIONS Lay health educators effectively reduced asthma triggers and increased caregiver asthma knowledge , which result ed in reduced emergency department visits , hospitalizations , and asthma symptoms . The relationships formed between the caregivers and the lay health educators appeared to positively impact asthma outcomes in this disadvantaged population Abstract Objective : To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma . Design : Cluster r and omised controlled trial . Setting : Six high schools in rural Australia . Participants : 272 students with recent wheeze , recruited from a cohort of 1515 students from two school years ( mean age 12.5 and 15.5 years ) ; 251 ( 92.3 % ) completed the study . Intervention : A structured education programme for peers comprising three steps ( the “ Triple A Program ” ) . Main outcome measures : Quality of life , school absenteeism , asthma attacks , and lung function . Results : When adjusted for year and sex , mean total quality of life scores showed significant improvement in the intervention than control group . Clinical ly important improvement in quality of life ( > 0.5 units ) occurred in 25 % of students with asthma in the intervention group compared with 12 % in the control group ( P=0.01 ) . The number needed to treat was 8 ( 95 % confidence interval 4.5 to 35.7 ) . 
    Output:
    
Effects on asthma control favoured the intervention but findings were not statistically significant .
Results from two studies with high levels of baseline smoking showed some promise for self-efficacy to stop smoking , but overall nicotine dependence and smoking-related knowledge were not significantly better in the intervention group .
Investigators did not report adverse events .
Although weak evidence suggests that lay-led and peer support interventions could lead to a small improvement in asthma-related quality of life for adolescents , benefits for asthma control , exacerbations and medication adherence remain unproven .
Current evidence is insufficient to reveal whether routine use of lay-led or peer support programmes is beneficial for adolescents receiving asthma care .