***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: OBJECTIVE This project aim ed to evaluate the impact of a home visiting programme that targeted families where the child , for environmental reasons , was at great risk of poor health and developmental outcomes . METHODOLOGY Women in the immediate postpartum period were recruited to a r and omized double-blind controlled trial on the basis of self-reported vulnerability factors and were r and omly assigned to receive either a structured programme of nurse home visiting , supported by a social worker and paediatrician ( n = 90 ) , or assigned to a comparison group receiving st and ard community child health services ( n = 91 ) . Parenting stress and maternal depression were measured at enrollment and at 6 weeks . Preventive health behaviour , service satisfaction and home environment outcomes were tested at 6 weeks , as were child health outcomes . RESULTS At six weeks , women receiving the home-based programme had significant reductions in postnatal depression screening scores as well as improvements in their experience of the parental role and improvement in the ability to maintain their own identity . Maternal-infant interactions were more likely to be positive , with significantly higher ( better ) scores in aspects of the home environment related to optimal development in children , particularly maternal-infant secure attachment . Intervention group mothers were significantly more satisfied with the community child health service . CONCLUSIONS This form of intervention for families is effective in promoting secure maternal-infant attachment , preventing maternal mood disorder and is welcomed by the families receiving it . These findings may predict long-term benefits for the healthy development of children otherwise at risk of a range of poor health and development outcomes In order to change current practice concerning hospital stays , a project was initiated in which shortening hospital stay was combined with shifting care to primary health care . Research was aim ed at assessing quality of care of shortened hospital stays with home care by the community nurse and /or the general practitioner ( GP ) . A r and omized clinical trial was conducted with three subgroups : 1 . traditional hospital stay ; 2 . hospital admission on the day of surgery , discharge the day after ; two consultations at the outpatient department ; one visit by the community nurse before surgery , two visits after ; 3 . mostly as for 2 . with two GP visits replacing the two consultations at the outpatient department . The selected surgical procedures were : laparoscopic cholecystectomy , varicose veins , removal of osteo synthesis material , hernia surgery and other minor surgery ( normal hospital stay 4 - 6 days ) . Every motivated patient meeting the inclusion criteria entered the study . During one year 120 patients were thus selected . Only minor differences were found between the three subgroups in the result ing quality of care . It is concluded that late admission and early discharge even without after discharge care is feasible in most cases for healthy patients Ranking ninth in the world for its contribution to the global burden of tuberculosis ( TB ) , South Africa continues to battle the disease . Within the framework of the World Health Organisation 's Directly Observed Treatment Short Course ( DOTS ) strategy , attempts have been made to utilize lay health workers  ( LHWs ) as TB treatment supporters . Previous research has highlighted the benefits and difficulties associated with such an approach , but little attention has been paid to the perceptions of LHWs themselves . A r and omised control trial of a LHW intervention in TB treatment in the farming areas of the Western Cape , South Africa has shown a 19 % improvement in TB treatment outcomes . This paper describes the experiences of those LHWs drawing on data collected through focus groups with incumbents . The data has shown that once trained , respondents were engaged in a wide range of activities , well beyond simple health care . In the majority LHWs were women . Becoming LHWs opened up their worlds , creating opportunities they would otherwise not have had . But while doing so , it also added extra responsibilities and stresses , which were not easy to manage . Respondents sustained themselves through support from each other , the intervention team , their employers and contact with the public health system . The question this study raises is given the obvious need for LHWs , how can they be motivated to participate in primary health care in such a way that maximises their access to re sources while minimising their experience of the role as burdensome BACKGROUND The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk , low-income black women attending a prenatal clinic in Clevel and . METHODS Based on previous research , risk was defined by clinic registration between the 17th and 28th weeks of gestation , low family functioning score , and experience of at least one stressful life event prior to registration . Optional factors included being a smoker , a low maternal weight-height ratio , being age 27 or older , and a previous premature birth . A 21-item family function screen previously vali date d in a similar population was the primary determinant of psychosocial risk . Low birth weight was defined as weight less than 2,500 g regardless of gestational age . RESULTS There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking , drug and nutrition education , support , and links with community services , compared to women who received no visits . The number of prenatal visits was significantly higher in the intervention group , but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight . Despite previous research , the family function screen was not an effective predictor of low birth weight in our study . A revised equation involving a history of previous premature birth , smoking , and a low maternal weight-height ratio did predict low birth weight . CONCLUSIONS These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic population s. The family function screen was not cross vali date d. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research BACKGROUND The continued high mortality and morbidity rates for unintentional childhood injuries remain a public health concern . This article reports on the influence of a home visitation programme ( HVP ) on household hazards associated with unintentional childhood injuries in a South African low-income setting . METHODS A r and omised controlled trial ( n=211 households ) was conducted in a South African informal settlement . Community members were recruited and trained as paraprofessional visitors . Four intervention visits were conducted over 3 months , focusing on child development , and the prevention of burn , poison , and fall injuries . The HVP , a multi-component intervention , included educational inputs , provision of safety devices , and an implicit enforcement strategy . The intervention effect ( IE ) was measured with a st and ardised risk assessment index that compared post-intervention scores for intervention and control households . RESULTS A significant reduction was observed in the hazards associated with electrical and paraffin appliances , as well as in hazards related to poisoning . Non-significant changes were observed for burn safety household practice s and fall injury hazards . CONCLUSIONS This study confirmed that a multi-component HVP effectively reduced household hazards associated with electrical and paraffin appliances and poisoning among children in a low-income South African setting Breastfeeding rates among low-income women in the east-south- central United States are among the lowest in the country . This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee . A postpartum survey and chart review were conducted with WIC clients at nine health departments . Response rate was 99 % ( 291/293 ) .  Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group ( n= 156 ) compared with women in the no-peer counselor group ( n= 135 ) ( 53 % vs. 33%,p<0.001 , and 26 % vs. 13%,p=0.006 , respectively ) . Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding ( OR=2.43 , 95 % CI=1.23 - 4.67 ) and to be breastfeeding at 6 weeks ( OR=2.78 , 95 % CI=2.08 - 9.5 1 ) , than those in the no-peer counselor group We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum OBJECTIVE . The purpose of this work was to evaluate whether education about zinc supplements and provision of zinc supplements to caregivers is effective in the treatment of  acute diarrhea  and whether this strategy adversely affects the use of oral rehydration salts . PATIENTS AND METHODS . Six clusters of 30 000 people each in Haryana , India , were r and omly assigned to intervention and control sites . Government and private providers and village health workers were trained to prescribe zinc and oral rehydration salts for use in diarrheal episodes in 1-month-old to 5-year-old children in intervention communities ; in the control sites , oral rehydration salts alone was promoted . In 2 cross-sectional surveys commencing 3 months ( survey 2 ) and 6 months ( survey 3 ) after the start of the intervention , care-seeking behavior , drug therapy , and oral rehydration salts use during diarrhea , diarrheal and respiratory morbidity , and hospitalization rates were measured . RESULTS . In the 2 surveys , zinc was used in 36.5 % ( n = 1571 ) and 59.8 % ( n = 1649 ) and oral rehydration salts in 34.8 % ( n = 1571 ) and 59.2 % ( n = 1649 ) of diarrheal episodes occurring in the 4 weeks preceding interviews in the intervention areas . In control areas , oral rehydration salts were used in 7.8 % ( n = 2209 ) and 9.8 % ( n = 2609 ) of episodes . In the intervention communities , care seeking for diarrhea reduced by 34 % ( survey 3 ) , as did the prescription of drugs of unknown identity ( survey 3 ) and antibiotics ( survey 3 ) for diarrhea . The 24-hour prevalences of diarrhea and acute lower respiratory infections were lower in the intervention communities ( survey 3 ) . All-cause , diarrhea , and pneumonia hospitalizations in the preceding 3 months were reduced in the intervention compared with control areas ( survey 3 ) . CONCLUSIONS . Diarrhea is more effectively treated when caregivers receive education on zinc supplementation and have ready access to supplies of oral rehydration salts and zinc , and this approach does not adversely affect the use of oral rehydration salts ; in fact , it greatly increases use of the same BACKGROUND Maternal depression can be detrimental to infant development .  Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer . The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies , but there is no evidence of its impact from trials . The support is not structured and both the frequency and content of visits may vary . METHODS A cluster r and omized study allocated Home-Start local schemes to intervention or control conditions . Mothers in all areas were screened at routine health checks in late pregnancy . In intervention areas names of those scoring 9 + on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer . Not all those offered the support accepted the offer . In control areas no support was offered . Research assessment s were conducted at 2 and 12 months . The outcomes were major or minor depression occurring between 2 and 12 months ( Structured Clinical Interview for Diagnostic and Statistical Manual - Third Edition - Revised ) and depression symptoms at 12 months ( Edinburgh Postnatal Depression Scale ) . Three groups were compared : supported , case-matched controls and those offered but not receiving support . RESULTS Almost one-third experienced depression during the time period . Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months . The major predictor of both was depression identified at 2 months . CONCLUSIONS It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants An experimental treatment program was design ed to reduce institutionalization of severely and profoundly retarded children under 6 years of age . Subjects were r and omly assigned to experimental and control groups . Results showed that counseling with the mother alone tends to result in increased marital conflict as well as a decision to keep the child at home , particularly for parents who are uncertain about their plans and hopes for the child . Since this conflict could defeat the real purpose of fostering the welfare of the child , family counseling should be used and consensus within the family should be sought . Instructing the mother in child-training procedures tends to reduce the number of instances of objectionable child behavior , as well as to induce a decision to keep the child at home , particularly for parents who are uncertain about their hopes and plans for the child Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . 
    Output:
    
For other health issues , the evidence is insufficient to draw conclusions regarding effectiveness , or to enable the identification of specific LHW training or intervention strategies likely to be most effective .
LHWs provide promising benefits in promoting immunisation uptake and breastfeeding , improving TB treatment outcomes , and reducing child morbidity and mortality when compared to usual care .
For other health issues , evidence is insufficient to draw conclusions about the effects of LHWs