***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 Asthma is a serious problem for low-income preteens living in disadvantaged communities . Among the chronic diseases of childhood and adolescence , asthma has the highest prevalence and related health care use . School-based asthma interventions have proven successful for older and younger students , but results have not been demonstrated for those in middle school . METHODS This r and omized controlled study screened students 10 - 13 years of age in 19 middle schools in low-income communities in Detroit , Michigan . Of the 6,872 students who were screened , 1,292 students were identified with asthma . Schools were matched and r and omly assigned to Program 1 or 2 or control . Baseline , 12 , and 24 months data were collected by telephone ( parents ) , at school ( students ) and from school system records . Measures were the students ' asthma symptoms , quality of life , academic performance , self-regulation , and asthma management practice s. Data were analyzed using multiple imputation with sequential regression analysis . Mixed models and Poisson regressions were used to develop final models . RESULTS Neither program produced significant change in asthma symptoms or quality of life . One produced improved school grade s ( p = .02 ) . The other enhanced self-regulation ( p = .01 ) at 24 months . Both slowed the decline in self-regulation in undiagnosed preteens at 12 months and increased self-regulation at 24 months ( p = .04 ; p = .003 ) . CONCLUSION Programs had effects on academic performance and self-regulation capacities of students . More developmentally focused interventions may be needed for students at this transitional stage . Disruptive factors in the schools may have reduced both program impact and the potential for outcome assessment Pediatric asthma rates are reaching epidemic proportions , adversely affecting children 's quality of life , educational potential , and health care costs , especially those in the inner city . This study evaluated the effectiveness of a school-based asthma case management ( CM ) approach with medically underserved inner-city children attending Memphis City schools . Fourteen elementary schools with high rates of asthma-related hospital utilization were grouped according to school size , percentage of children with asthma enrolled , and percentage of children eligible for free or reduced-price lunch . Schools were r and omized to either a nurse CM intervention or a usual care ( UC ) condition . The CM group included 115 students ; 128 students were in the UC group . A longitudinal design was used to follow students ' progress . Students were primarily African-American children diagnosed with asthma . In CM schools , nurse case managers conducted weekly group sessions incorporating the Open Airways curriculum , followed up on students ' school absences , and coordinated students ' asthma care with families , school personnel , and medical providers . In UC schools , students received routine school nursing services . CM students had fewer school absences than their counterparts in UC schools ( mean 4.38 vs 8.18 days , respectively ) and experienced significantly fewer emergency department visits ( p < .0001 ) and fewer hospital days ( p < .05 ) than UC students . No such differences existed before program initiation . Replication and follow-up in year 2 showed continued significant improvements . School-based nurse CM can achieve significant improvements in school attendance and medical utilization OBJECTIVE To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma . DESIGN R and omized trial , with children stratified by smoke exposure in the home and r and omized to a school-based care group or a usual care control group . SETTING Rochester , New York . PARTICIPANTS Children aged 3 to 10 years with persistent asthma . INTERVENTIONS Directly observed administration of daily preventive asthma medications by school nurses ( with dose adjustments according to National Heart , Lung , and Blood Institute Expert Panel guidelines ) and a home-based environmental tobacco smoke reduction program for smoke-exposed children , using motivational interviewing . MAIN OUTCOME MEASURE Mean number of symptom-free days per 2 weeks during the peak winter season ( November-February ) , assessed by blinded interviews . RESULTS We enrolled 530 children ( 74 % participation rate ) . During the peak winter season , children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group ( adjusted difference = 0.92 days per 2 weeks ; 95 % confidence interval , 0.50 - 1.33 ) and also had fewer nighttime symptoms , less rescue medication use , and fewer days with limited activity ( all P < .01 ) . Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone ( 12 % vs 18 % , respectively ; relative risk = 0.64 ; 95 % confidence interval , 0.41 - 1.00 ) . Stratified analyses showed positive intervention effects even for children with smoke exposure ( n = 285 ; mean symptom-free days per 2 weeks : 11.6 for children in the treatment group vs 10.9 for those in the control group ; difference = 0.96 days per 2 weeks ; 95 % confidence interval , 0.39 - 1.52 ) . CONCLUSIONS The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma . This program could serve as a model for improved asthma care in urban communities OBJECTIVE To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology ( SB-PACT ) program , which includes directly observed therapy of preventive asthma medications in school facilitated by Web-based technology for systematic symptom screening , electronic report generation , and medication authorization from providers . STUDY DESIGN We conducted a pilot r and omized trial of SB-PACT versus usual care with 100 children ( aged 3 - 10 years ) from 19 inner-city schools in Rochester , New York . Outcomes were assessed longitudinally by blinded interviewers . Analyses included bivariate statistics and linear regression models , adjusting for baseline symptoms . RESULTS There were data for 99 subjects for analysis . We screened all children using the Web-based system  , and 44 of 49 treatment group children received directly observed therapy as authorized by their providers . Treatment group children received preventive medications 98 % of the time they were in school . Over the school year , children in the treatment group experienced nearly 1 additional symptom-free day over 2 weeks versus the usual care group ( 11.33 vs 10.40 , P = .13 ) . Treatment children also experienced fewer nights with symptoms ( 1.68 vs 2.20 , P = .02 ) , days requiring rescue medications ( 1.66 vs 2.44 , P = .01 ) , and days absent from school due to asthma ( 0.37 vs 0.85 , P = .03 ) compared with usual care . Further , treatment children had a greater decrease in exhaled nitric oxide ( -9.62 vs -0.39 , P = .03 ) , suggesting reduction in airway inflammation . CONCLUSION The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study . Future work will focus on further integration of preventive care delivery across community and primary care systems This study examines healthcare utilization over time in Bronx , New York schoolchildren with asthma who were previously identified via parent surveys in six elementary schools . Four of the schools have on-site school-based health centers ( SBHCs ) , and two do not have on-site health services ( control schools ) . At baseline , we reported an asthma prevalence of 20 % , and high rates of emergency department ( ED ) use ( 46 % ) in the previous year . To determine if asthma morbidity ( specifically , ED use , community provider use , and hospitalizations for asthma ) could be reduced by incorporating an aggressive intervention at two schools with SBHCs  , we prospect ively followed children for up to 3 years . Parents were scheduled for interviews every 6 months , and were queried about their children 's use of health services for asthma in the prior 6 months . In multivariate models , children in the two intervention SBHC schools were less likely to have visited a community provider for asthma ( relative rate ratio , 0.52 ; 95 % confidence interval ( CI ) , 0.30 - 0.88 ) or an emergency department for asthma ( odds ratio , 0.44 ; 95 % CI , 0.14 - 1.38 ; P = 0.059 ) in the prior 6 months compared to children attending control schools . There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools . However , school type did not affect asthma hospitalization rates , which declined in all groups . Our findings support the effectiveness of aggressive school-based asthma services provided by SBHCs to reduce asthma morbidity and complement community health services Abstract Objective : To present outcomes of an asthma self-management educational intervention delivered to children ( grade s 2–5 ) at school and to parents in a home visit . Methods : The intervention effectiveness was tested in a 12-month longitudinal study with r and omization by elementary schools into treatment and attention-control  groups with 183 children who had a diagnosis of asthma . Data were collected at four time points . Change over time was examined with linear mixed models . Results : Quality of life ( QOL ) , hospitalizations , and emergency department visits improved significantly for all the children . African American and Mexican American children had worse asthma-related QOL than did White children . Asthma management behaviors , asthma self-efficacy , and coping likewise improved with girls improving significantly more than the boys . Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group . Treatment group parents showed significant improvements in home asthma management and self-efficacy . Conclusions : The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting . The reduction in the treatment group ’s asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved . The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles . The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction INTRODUCTION Asthma is the most prevalent chronic illness , affecting more than 7 million children younger than 17 years . Asthma has become a leading public health concern because of the dramatic rise in the incidence of this disease during the past 15 years , particularly in minority population s. This study tested a two-part intervention on selected psychosocial and health outcomes of 8- to 13-year-old inner city minority students with asthma . METHOD The intervention consisted of participation in an asthma education program ( Open Airways ) followed by 5 monthly visits with a nurse practitioner . The total sample of 52 children was composed of 28 children in the treatment group who received the intervention and 24 children who served as a control group .  RESULTS Students in the treatment group scored significantly higher than the control group over time on measures of asthma knowledge , asthma self-efficacy , general self-care practice s , and asthma self-care practice s. No significant differences were found between the two groups on health outcomes . DISCUSSION A school-based intervention program can improve psychosocial outcomes for inner-city minority children with asthma . Recommendations for future research and clinical practice are discussed STUDY OBJECTIVE This study assessed the impact of a comprehensive school-based asthma program on symptoms , grade s , and school absences in children , and parents ' asthma management practice s. DESIGN R and omized controlled trial . SETTING Fourteen elementary schools in low-income neighborhoods in Detroit , MI . PARTICIPANTS Eight hundred thirty-five children with asthma in grade s 2 through 5 and their parents . INTERVENTION The intervention entailed six components for children , their parents , classmates , and school personnel to encourage and enable disease management . MEASUREMENTS AND RESULTS Parents completed telephone interviews and the schools provided data at baseline and 24 months after intervention . At follow-up , treatment children with persistent disease had significant declines in both daytime ( 14 % fewer , p < 0.0001 ) and nighttime ( 14 % fewer , p < 0.0001 ) symptoms . Among children with both mild intermittent and persistent disease , those in the treatment group had 17 % fewer daytime symptoms ( p < 0.0001 ) but 40 % more nighttime symptoms . Treatment children had higher grade s for science ( p < 0.02 ) but not reading , mathematics , or physical education . No differences in school absences for all causes between groups were noted in school records . However , parents of treatment group children reported fewer absences attributable to asthma in the previous 3 months ( 34 % fewer , p < 0.0001 ) and 12 months ( 8 % fewer , p < 0.05 ) . Parents of treatment children had higher scores ( 2.19 greater , p = 0.02 ) on an asthma management index . The program may have stimulated attention to symptoms at night by parents of children with mild intermittent disease . Overall , the intervention provided significant benefits , particularly for children with persistent asthma School-based asthma interventions delivered by nonschool staff have been successful but are limited in their reach because of the cost and effort of bringing in outside educators and their inability to establish improved communication about asthma between schools , families , and primary care providers ( PCPs ) . To address these problems , Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a r and omized controlled trial to test the efficacy of a comprehensive school-based asthma program 
    Output:
    
Direct access to school nursing and other health services , as well as disease-specific education , improved health and academic outcomes among students with CHCs .