***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 There has been little rigorous economic analysis of the relationship between asthma and improved housing . AIM To evaluate the cost-effectiveness of installing ventilation systems , and central heating if necessary , in homes of children with ' moderate ' or ' severe ' asthma . DESIGN AND SETTING An incremental cost-effectiveness analysis alongside a pragmatic r and omised controlled trial of a tailored package of housing modifications design ed to improve ventilation and household heating in homes within Wrexham County Borough , Wales , UK . METHOD A total of 177 children aged between 5 and 14 years , identified from general practice registers , were studied . Parents reported on the quality of life of their children over a 12-month period . General practice s reported on health-service re sources used by those children , and their asthma-related prescriptions , over the same period . RESULTS The tailored package shifted 17 % of children in the intervention group from ' severe ' to ' moderate ' asthma , compared with a 3 % shift in the control group . The mean cost of these modifications was £ 1718 per child treated or £ 12300 per child shifted from ' severe ' to ' moderate ' . Healthcare costs over 12 months following r and omisation did not differ significantly between intervention and control groups . Bootstrapping gave an incremental cost-effectiveness ratio ( ICER ) of £ 234 per point improvement on the 100-point PedsQL ™ asthma-specific scale , with 95 % confidence interval ( CI ) = £ 140 to £ 590 . The ICER fell to £ 165 ( 95 % CI = £ 84 to £ 424 ) for children with ' severe ' asthma . CONCLUSION This novel and pragmatic trial , with integrated economic evaluation , reported that tailored improvement of the housing of children with moderate to severe asthma is likely to be a cost-effective use of public re sources . This is a rare example of evidence for collaboration between local government and the NHS Background Improvements in health are an important expected outcome of many housing infrastructure programs . The authors aim ed to determine if improvement in the notoriously poor housing infrastructure in Australian Indigenous communities results in reduction in common childhood illness and to identify important mediating factors in this relationship . Methods The authors conducted a prospect i ve cohort study of 418 children aged 7 years or younger in 10 Australian Indigenous communities , which benefited most substantially from government-funded housing programs over 2004–2005 . Data on functional and hygienic state of houses , reports of common childhood illness and on socio-economic conditions were collected through inspection of household infrastructure and interviews with children 's carers and householders . Results After adjustment for a range of potential confounding variables , the analysis showed no consistent reduction in carers ' reporting of common childhood illnesses in association with improvements in household infrastructure , either for specific illnesses or for these illnesses in general . While there was strong association between improvement in household infrastructure and improvement of hygienic condition of the house , there were only marginal improvements in crowding . Conclusions High levels of household crowding and poor social , economic and environmental conditions in many Australian Indigenous communities appear to place major constraints on the potential for building programs to impact on the occurrence of common childhood illness . These findings reinforce the need for building programs to be supported by a range of social , behavioural and community-wide environmental interventions in order for the potential health gains of improved housing to be more fully realised BACKGROUND Few robust studies have tested whether enhancing housing also improves health . AIM To evaluate the effectiveness of installing ventilation systems , and central heating where necessary , in the homes of children with moderate or severe asthma . DESIGN AND SETTING Pragmatic r and omised controlled trial ( RCT ) in homes within Wrexham County Borough , Wales , UK . METHOD A pragmatic RCT was carried out , of a tailored package of housing improvements providing adequate ventilation and temperature , following inspection by a housing officer . One hundred and ninety-two children with asthma aged 5 to 14 years , identified from general practice registers , were r and omised to receive this package , either immediately or a year after recruitment . At baseline , and after 4 and 12 months , parents reported their child 's asthma-specific and generic quality of life , and days off school . RESULTS The package improved parent-reported asthma-specific quality of life significantly at both 4 and 12 months . At 12 months , this showed an adjusted mean difference between groups of 7.1 points ( 95 % confidence interval [ CI ] = 2.8 to 11.4 , P= 0.001 ) : a moderate st and ardised effect size of 0.42 . The generic quality -of-life scale showed reported physical problems were significantly reduced at 4 months , but not quite at 12 months , when the mean difference was 4.5 ( 95 % CI = -0.2 to 9.1 , P= 0.061 ) . The improvement in psychosocial quality of life at 12 months was not significant , with a mean difference of 2.2 ( 95 % CI = -1.9 to 6.4 , P= 0.292 ) . Parent-reported school attendance improved , but not significantly . CONCLUSION This novel and pragmatic trial , with integrated economic evaluation , found that tailored improvement of the housing of children with moderate to severe asthma significantly increases parent-reported asthma-related quality of life and reduces physical problems .  Collaborative housing initiatives have potential to improve health Background : It is not clear whether associations between respiratory symptoms and indoor mould are causal . A r and omised controlled trial was conducted to see whether asthma improves when indoor mould is removed . Methods : Houses of patients with asthma were r and omly allocated into two groups . In one group , indoor mould was removed , fungicide was applied and a fan was installed in the loft . In the control group , intervention was delayed for 12 months . Question naires were administered and peak expiratory flow rate was measured at baseline , 6 months and 12 months . Results : Eighty-one houses were allocated to the intervention group and 83 to the control group ; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information . Peak expiratory flow rate variability declined in both groups , with no significant differences between them . At 6 months , significantly more of the intervention group showed a net improvement in wheeze affecting activities ( difference between groups 25 % , 95 % CI 3 % to 47 % ; p = 0.028 ) , perceived improvement of breathing ( 52 % , 95 % CI 30 % to 74 % ; p<0.0001 ) and perceived reduction in medication ( 59 % , 95 % CI 35 % to 81 % ; p<0.0001 ) . By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use , and more improvement in rhinitis ( 24 % , 95 % CI 9 % to 39 % ; p = 0.001 ) and rhinoconjunctivitis ( 20 % , 95 % CI 5 % to 36 % ; p = 0.009 ) . Conclusions : Although there was no objective evidence of benefit , symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould . It is unlikely that this was entirely a placebo effect In a field study carried out in three rural communities in Paraguay in a zone endemic for Chagas disease , we implemented three different vector control interventions --spraying , housing improvement , and a combination of spraying plus housing improvement -- which effectively reduced the triatomine infestation . The reduction of triatomine infestation was 100 % ( 47/47 ) in the combined intervention community , whereas in the community where housing improvement was carried out it was 96.4 % ( 53/55 ) . In the community where fumigation alone was used , the impact was 97.6 % ( 40/41 ) in terms of domiciliary infestation . In all the houses where an intervention was made , an 18-month follow-up showed reinfestation rates of less than 10 % . A serological survey of the population in the pre- and post-intervention periods revealed a shift in positive cases towards older age groups , but no significant differences were observed . The rate of seroconversion was 1.3 % ( three new cases ) in the community with housing improvement only , but none of these cases could have result ed from vector transmission . The most cost-effective intervention was insecticide spraying , which during a 21-month follow-up period had a high impact on triatomine infestation and cost US$ 29 per house as opposed to US$ 700 per house for housing improvement An outst and ing feature of marginalized Roma communities is their severely subst and ard living conditions , which contribute to their worse health status compared to the majority . However , health consequences of international and local-level housing initiatives in most cases fail to be assessed prospect ively or evaluated after implementation . This paper summarizes the result of a retrospective health impact assessment of a  Roma housing project in Hungary in comparison with the outcome evaluation of the same project . Positive impacts on education , in- and outdoor conditions were noted , but negative impacts on social networks , housing expenses and maintenance , neighbourhood satisfaction and no sustained change in health status or employment were identified . Recommendations are made to improve efficiency and sustainability of housing development initiatives among disadvantaged population Background New Zeal and homes are underheated by international st and ards , with average indoor temperatures below the WHO recommended minimum of 18 ° C . Research has highlighted the connection between low indoor temperatures and adverse health outcomes , including social functioning and psychological well-being . Both health effects and social effects can impact on school absence rates . The aim of this study was to determine whether more effective home heating affects school absence for children with asthma . Methods A single-blinded r and omised controlled trial of heating intervention in 409 households containing an asthmatic child aged 6–12 years , where the previous heating was an open fire , plug-in electric heater or unflued gas heater .  The intervention was the installation of a more effective heater of at least 6 kW before the winter of 2006 in half the houses . Demographic and health information was collected both before and after the intervention . Each child 's school was contacted directly and term-by-term absence information for that child obtained for 2006 and previous years where available . Results Complete absence data were obtained for 269 out of 409 children . Compared with the control group , children in households receiving the intervention experienced on average 21 % ( p=0.02 ) fewer days of absence after allowing for the effects of other factors . Conclusion More effective , non-indoor polluting heating  reduces school absence for asthmatic children RATIONALE Particulate air pollution is associated with cardiovascular morbidity . One hypothesized mechanism involves oxidative stress , systemic inflammation , and endothelial dysfunction . OBJECTIVES To assess an intervention 's impact on particle exposures and endothelial function among healthy adults in a woodsmoke-impacted community . We also investigated the underlying role of oxidative stress and inflammation in relation to exposure reductions . METHODS Portable air filters were used in a r and omized crossover intervention study of 45 healthy adults exposed to consecutive 7-day periods of filtered and nonfiltered air .  MEASUREMENTS AND MAIN RESULTS Reactive hyperemia index was measured as an indicator of endothelial function via peripheral artery tonometry , and markers of inflammation ( C-reactive protein , interleukin-6 , and b and cells ) and lipid peroxidation ( malondialdehyde and 8-iso-prostagl and in F(2α ) ) were quantified . Air filters reduced indoor fine particle concentrations by 60 % . Filtration was associated with a 9.4 % ( 95 % confidence interval , 0.9 - 18 % ) increase in reactive hyperemia index and a 32.6 % ( 4.4 - 60.9 % ) decrease in C-reactive protein . Decreases in particulate matter and the woodsmoke tracer levoglucosan were associated with reduced b and cell counts . There was limited evidence of more pronounced effects on endothelial function and level of systemic inflammation among males , overweight participants , younger participants , and residents of wood-burning homes . No associations were noted for oxidative stress markers . CONCLUSIONS Air filtration was associated with improved endothelial function and decreased concentrations of inflammatory biomarkers but not markers of oxidative stress . Our results support the hypothesis that systemic inflammation and impaired endothelial function , both predictors of cardiovascular morbidity , can be favorably influenced by reducing indoor particle concentrations UNLABELLED Inuit infants have high rates of reported hospitalization for respiratory infection , associated with overcrowding and reduced ventilation . We performed a r and omized , double-blind , placebo controlled trial to determine whether home heat recovery ventilators ( HRV ) would improve ventilation and reduce the risk of respiratory illnesses in young Inuit children . Inuit children under 6 years of age living in several communities in Nunavut , Canada were r and omized to receive an active or placebo HRV . We monitored respiratory symptoms , health center encounters , and indoor air quality for 6 months . HRVs were placed in 68 homes , and 51 houses could be analyzed . Subjects had a mean age of 26.8 months . Active HRVs brought indoor carbon dioxide concentrations to within recommended concentrations . Relative humidity was also reduced . Use of HRV , compared with placebo , was associated with a progressive fall in the odds ratio for reported wheeze of 12.3 % per week ( 95%CI 1.9 - 21.6 % , P = 0.022 ) . Rates of reported rhinitis were significantly lower in the HRV group than the placebo group in month 1 ( odds ratio 0.20 , 95%CI 0.058 -  
    Output:
    
Data from studies of warmth and energy efficiency interventions suggested that improvements in general health , respiratory health , and mental health are possible .
Studies which targeted those with inadequate warmth and existing chronic respiratory disease were most likely to report health improvement .
Impacts following housing-led neighbourhood renewal were less clear ; these interventions targeted areas rather than individual households in most need .
There were few reports of adverse health impacts following housing improvement .
Warmth improvements were associated with increased usable space , increased privacy , and improved social relationships ; absences from work or school due to illness were also reduced .
Housing investment which improves thermal comfort in the home can lead to health improvements , especially where the improvements are targeted at those with inadequate warmth and those with chronic respiratory disease .
The health impacts of programmes which deliver improvements across areas and do not target according to levels of individual need were less clear , but reported impacts at an area level may conceal health improvements for those with the greatest potential to benefit .
Best available evidence indicates that housing which is an appropriate size for the householders and is affordable to heat is linked to improved health and may promote improved social relationships within and beyond the household .
In addition , there is some suggestion that provision of adequate , affordable warmth may reduce absences from school or work .