***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 Adolescence represents a critical period for the development of overweight that tracks into adulthood . This risk is significantly heightened for adolescents that become pregnant , many of whom experience postpartum weight retention . The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy ( BALANCE ) , a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program . Methods A group r and omized , nested cohort design was used with 1325 adolescents , 694 intervention and 490 control , ( mean age = 17.8 years , 52 % underrepresented minorities ) located across 30 states .  Participatory methods were used to integrate lifestyle behavior change strategies within st and ard parent education practice . Content targeted replacement of high-risk obesogenic patterns ( e.g. sweetened drink and high fat snack consumption , sedentary activity ) with positive behaviors ( e.g. water intake , fruit and vegetables , increased walking ) . Parent educators delivered BALANCE through home visits , school based classroom-group meetings , and website activities . Control adolescents received st and ard child development information . Phase I included baseline to posttest ( 12 months ) ; Phase II included baseline to follow-up ( 24 months ) . Results When compared to the control group , BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely ( p = 0.02 ) to maintain a normal BMI or improve an overweight/obese BMI by 12 months ; this change was not sustained at 24 months . When compared to the control group , BALANCE adolescents significantly improved fruit and vegetable intake ( p = .03 ) . In stratified analyses , water intake improved among younger BALANCE teens ( p = .001 ) and overweight/obese BALANCE teens ( p = .05 ) when compared to control counterparts . There were no significant differences between groups in sweetened drink and snack consumption or walking . Conclusion Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity , which contributes to the intergenerational transmission of obesity to her offspring . Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity . Trial registration Clinical Trails.gov NCT01617486 Objective : To access an underserved , mobile segment of a monolingual Spanish speaking population and to improve maternal self efficacy for home safety behaviors using a culturally appropriate intervention . Design : A pre- and post-test experimental design tested differences in maternal childhood injury health beliefs ( MCIHB ) and controllable safety hazards ( CHS ) . Participants were r and omly assigned to experimental and control groups . Baseline data assessed demographic and study variables comparability . The intervention included counseling , assessment of maternal safety practice s , and provision of safety items . Setting : A non-urban area in Texas where low income , largely migrant Hispanics represent the majority of residents . Participants : Eighty two mothers of 1–4 year old children . Results : The 95 % retention rate of an itinerant , hard to reach population suggests that minority participants may be receptive to culturally appropriate home visits . The intervention group demonstrated improved self efficacy for home safety behaviors ( F ( 2 , 77 ) = 7.50 , p = 0.01 ) . Mothers with stronger self efficacy and fewer perceived barriers had fewer accessible in-home hazards . Observed home hazard predictors were : ( a ) never being married ; ( b ) poor home repair , ( c ) lower self efficacy for safety behaviors ; and ( d ) control group status . Conclusions : Safety items coupled with a home visit tailored to child age and maternal culture was an effective intervention in a hard to reach population . This study contributes to design ing research for a monolingual population with limited local language proficiency and community residency . Injuries represent a major source of health disparities in these neglected population OBJECTIVES We conducted a trial to evaluate the effectiveness of a cervical cancer control intervention for Vietnamese American women that used lay health workers . METHODS The study group included 234 women who had not received a Papanicolaou ( Pap ) test in the last 3 years . Experimental group participants received a lay health worker home visit . Our trial endpoint was Pap test receipt within 6 months of r and omization . Pap testing completion was ascertained through women 's self-reports and medical record review s. We examined intervention effects among women who had ever received a Pap test ( prior to r and omization ) and women who had never received a Pap test . RESULTS Three quarters of the women in the experimental group completed a home visit . Ever-screened experimental group women were significantly more likely to report Pap testing ( P < .02 ) and to have records verifying Pap testing ( P < .04 ) than were ever-screened control group women . There were no significant differences between the trial arms for women who had never been screened . CONCLUSIONS Our findings indicate that lay health worker-based interventions for Vietnamese American women are feasible to implement and can increase levels of Pap testing use among ever-screened women but not among never-screened women Background R and omized controlled trials that test the effectiveness of mobile health-based weight loss programs are attractive to participants , funders , and research ers because of the low implementation cost , minimal participant burden , and the ability to recruit participants from longer distances . Collecting weight data from geographically dispersed participants is a challenge . Relying on participant self-report is one approach to data collection , but epidemiologic studies indicate that self-reported anthropometric data may be inaccurate . Methods We provided women enrolled in a r and omized controlled trial ( RCT ) of postpartum weight loss after gestational diabetes with a digital scale and training to collect and report weight via a web-based survey . To vali date self-reported weights and heights , we visited  30 r and omly selected women in their homes  , with a reference scale and stadiometer , a mean of 34 days after the self-report . We ran linear regression models to identify characteristics that were associated with underreporting or overreporting of anthropometric measures . Results Of the 30 women we visited , 11 women ( 37 % ) were assigned to the weight loss intervention group and 19 women ( 63 % ) were in the control group . Mean age was 38.5 years ( SD 4.5 ) . The overall mean difference between participants ’ self-reported weights and the weights obtained at their home visit was 0.70 kg ( + 1.92 ) . Women assigned to the intervention group underreported their weight in comparison with the control group by 1.29 kg ( 95 % CI −2.52 , −0.06 ) . The overall difference in collected to self-reported height was −0.56 cm ( ±1.91 ) . No characteristics were associated with underreporting or overreporting of height . Conclusions Our research suggests that by providing a digital scale and developing a weight collection protocol , research ers can train women to collect and record their own study weights with reasonable validity . To achieve the level of validity required for clinical trials , research ers should consider additional strategies to assure the validity of the data .Trial registration NCT01923350 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 OBJECTIVES Depression is prevalent in mothers receiving home visiting .  Little is known about the impact of treatment on associated features of maternal depression in this population . The purpose of this study was to examine the impact of a novel , adapted treatment for depressed mothers in home visiting on psychological distress and social functioning . METHODS In-Home Cognitive Behavioral Therapy ( IH-CBT ) was developed to treat depressed mothers in home visiting . A r and omized clinical trial design was used in which subjects were 93 new mothers in a home visiting program . Mothers with major depressive disorder identified at 3 months postpartum were r and omized into IH-CBT and ongoing home visiting ( n = 47 ) or st and ard home visiting ( SHV ; n = 46 ) in which they received home visitation alone and could obtain treatment in the community .  Measures of psychological distress , social support , and social network were measured at pre-treatment , post-treatment , and three-month follow-up . Clinical features of depression and home visiting parameters were examined as potential moderators . RESULTS Subjects receiving IH-CBT reported decreased psychological distress at post-treatment ( ES = 0.77 ) and follow-up ( ES = 0.73 ) . Examination of types of psychological distress indicated broad improvements at both time points . Those receiving IH-CBT reported increased social support over time relative to those in the SHV condition . Effect sizes were modest at post-treatment ( ES = 0.38 ) but increased at follow-up ( ES = 0.65 ) . Improvements were seen in affiliative and belonginess aspects of social support , in contrast to tangible support which was statistically non-significant . Findings were not moderated by clinical features of depression or home visiting parameters . No group differences were found in size of and involvement with social networks . CONCLUSIONS IH-CBT is effective in reducing psychological distress and improving perceived social support in depressed mothers receiving home visiting . To the extent that mothers are better adjusted and feel socially supported , they are more available to their children and more amenable to home visiting services . IH-CBT is a feasible , readily adopted treatment that is compatible with multiple home visiting models . As a result it is a promising approach to help depressed mothers in home visiting . Additional interventions may be needed to support depressed mothers in building sizable and stable social networks BACKGROUND : Although observational studies have consistently reported an association between media use and  child sleep problems  , it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children . METHODS : We conducted a r and omized controlled trial of a healthy media use intervention in families of children aged 3 to 5 years . The intervention encouraged families to replace violent or age-inappropriate media content with quality educational and prosocial content , through an initial home visit and follow-up telephone calls over 6 months . Sleep measures were derived from the Child Sleep Habits Question naire and were collected at 6 , 12 , and 18 months after baseline ; repeated- measures regression analyses were used . RESULTS : Among the 565 children analyzed , the most common sleep problem was delayed sleep-onset latency ( 38 % ) . Children in the intervention group had significantly lower odds of “ any sleep problem ” at follow-up in the repeated- measures analysis ( odds ratio = 0.36 ; 95 % confidence interval : 0.16 to 0.83 ) , with a trend toward a decrease in intervention effect over time ( P = .07 ) . Although there was no significant effect modification detected by baseline sleep or behavior problems , gender , or low-income status , there was a trend ( P = .096 ) toward an increased effect among those with high levels of violence exposure at baseline . CONCLUSIONS : The significant effects of a healthy media use intervention on  child sleep problems  in the context of a r and omized controlled trial suggest that the previously reported relationship between media use and  child sleep problems is indeed causal in nature To determine whether a Nurse-Community Health Worker ( CHW ) home visiting team , in the context of a Medicaid enhanced prenatal/postnatal services ( EPS ) , would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial re sources ( mastery , self-esteem , social support ) when compared with usual Community Care ( CC ) that includes Medicaid EPS delivered by professionals . Greatest program benefits were expected for women who reported low psychosocial re sources , high stress , or both at the time of enrollment . Medicaid eligible pregnant women ( N = 613 ) were r and omly assigned to either usual CC or the Nurse-CHW team . Mixed effects regression was used to analyze up to five prenatal and postnatal psychosocial assessment s. Compared to usual CC , assignment to the Nurse-CHW team result ed in significantly fewer depressive symptoms , and as 
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CONCLUSIONS Community and home visitation interventions by nurses can provide an effective means for mitigating social determinants of health by empowering people at risk for health disparities to avoid injury , maintain health , and prevent and manage existing disease