***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 : To test the effectiveness of a brief intervention in the reduction of prenatal alcohol consumption  by women when a partner is included . METHODS : R and omized trial of a single session brief intervention given by the study nurse or principal investigator for 304 pregnant women and their partners . The women had positive T-ACE ( Tolerance , Annoyed , Cut down , Eye-opener , an alcohol screening test ) results and were at risk for alcohol consumption while pregnant . All completed initial diagnostic and postpartum interviews . RESULTS : Fewer than 20 % of participants ( median 11.5 weeks of gestation ) were abstinent at study enrollment , averaging more than 1.5 drinks per episode . Nearly 30 % had 2 or more drinks at a time while pregnant . Prenatal alcohol use declined in both the treatment and control groups after study enrollment , based on a 95 % follow-up rate . Factors associated with increased prenatal alcohol use after r and omization included more years of education , extent of previous alcohol consumption , and temptation to drink in social situations . Brief interventions for prenatal alcohol reduced subsequent consumption most significantly for the women with the highest consumption initially ( regression coefficient , b = −0.163 , st and ard error ( b ) = 0.063 , P < .01 ) . Moreover , the effects of the brief intervention were significantly enhanced when a partner participated ( b = −0.932 , st and ard error ( b ) = 0.468 ) , P < .05 ) . CONCLUSION : Pregnant women with the highest levels of alcohol use reduced their drinking most after a brief intervention that included their partners . Recommendations include consistent screening for prenatal alcohol use followed by diagnostic assessment when indicated , and if confirmed by other studies , a patient-partner brief intervention for the heaviest drinkers . LEVEL OF EVIDENCE : OBJECTIVE To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women . METHOD A r and omized longitudinal cohort study . One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life , defined by mother 's inability to provide care . Data analyzed included neonatal characteristics , urine toxicology at delivery , maternal history of drug use , maternal depression , social support , and social and health history . RESULTS Sixty-six infants ( 43.4 % ) had disruption in their primary care during the first 18 months of their life , 86 infants ( 56.6 % ) remained in the care of their mothers . Women who were younger , were heroin users , had two or more children , had other children in foster care , and reported depressive symptoms were least likely to provide ongoing primary care for their infant . CONCLUSIONS Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving , maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving . Identifying these families can enable health care providers to monitor them more closely and , when appropriate , encourage support from the extended family OBJECTIVE To examine the effectiveness of home visiting by paraprofessionals and by nurses as separate means of improving maternal and child health when both types of visitors are trained in a program model that has demonstrated effectiveness when delivered by nurses . METHODS A r and omized , controlled trial was conducted in public- and private-care setting s in Denver , Colorado . One thous and one hundred seventy-eight consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance were invited to participate . Seven hundred thirty-five women were r and omized to control , paraprofessional , or nurse conditions . Nurses completed an average of 6.5 home visits during pregnancy and 21 visits from birth to the children 's second birthdays . Paraprofessionals completed an average of 6.3 home visits during pregnancy and 16 visits from birth to the children 's second birthdays . The main outcomes consisted of changes in women 's urine cotinine over the course of pregnancy ; women 's use of ancillary services during pregnancy ; subsequent pregnancies and births , educational achievement , workforce participation , and use of welfare ; mother-infant responsive interaction ; families ' home environments ; infants ' emotional vulnerability in response to fear stimuli and low emotional vitality in response to joy and anger stimuli ; and children 's language and mental development , temperament , and behavioral problems . RESULTS Paraprofessional-visited mother-child pairs in which the mother had low psychological re sources interacted with one another more responsively than their control-group counterparts ( 99.45 vs 97.54 st and ard score points ) . There were no other statistically significant paraprofessional effects . In contrast to their control-group counterparts , nurse-visited smokers had greater reductions in cotinine levels from intake to the end of pregnancy ( 259.0 vs 12.32 ng/mL ) ; by the study child 's second birthday , women visited by nurses had fewer subsequent pregnancies ( 29 % vs 41 % ) and births ( 12 % vs 19 % ) ; they delayed subsequent pregnancies for longer intervals ; and during the second year after the birth of their first child , they worked more than women in the control group ( 6.83 vs 5.65 months ) . Nurse-visited mother-child pairs interacted with one another more responsively than those in the control group ( 100.31 vs 98.99 st and ard score points ) . At 6 months of age , nurse-visited infants , in contrast to their control-group counterparts , were less likely to exhibit emotional vulnerability in response to fear stimuli ( 16 % vs 25 % ) and nurse-visited infants born to women with low psychological re sources were less likely to exhibit low emotional vitality in response to joy and anger stimuli ( 24 % vs 40 % and 13 % vs 33 % ) . At 21 months , nurse-visited children born to women with low psychological re sources were less likely to exhibit language delays ( 7 % vs 18 % ) ; and at 24 months , they exhibited superior mental development ( 90.18 vs 86.20 Mental Development Index scores ) than their control-group counterparts . There were no statistically significant program effects for the nurses on  women 's  use of ancillary prenatal services , educational achievement , use of welfare , or their children 's temperament or behavior problems . For most outcomes on which either visitor produced significant effects , the paraprofessionals typically had effects that were about half the size of those produced by nurses . CONCLUSIONS When trained in a model program of prenatal and infancy home visiting , paraprofessionals produced small effects that rarely achieved statistical or clinical significance ; the absence of statistical significance for some outcomes is probably attributable to limited statistical power to detect small effects . Nurses produced significant effects on a wide range of maternal and child outcomes CONTEXT Maternal use of cocaine during pregnancy remains a significant public health problem , particularly in urban areas of the United States and among women of low socioeconomic status . Few longitudinal studies have examined cocaine-exposed infants , however , and findings are contradictory because of method ologic limitations . OBJECTIVE To assess the effects of prenatal cocaine exposure on child developmental outcomes . DESIGN Longitudinal , prospect i ve , masked , comparison birth cohort study with recruitment in 1994 - 1996 . SETTING Obstetric unit of a large US urban teaching hospital . PARTICIPANTS Four hundred fifteen consecutively enrolled infants ( 218 cocaine-exposed and 197 unexposed ) identified from a high-risk , low-socioeconomic status , primarily black ( 80 % ) population screened through clinical interview and urine and meconium sample s for drug use .  The retention rate was 94 % at 2 years of age . MAIN OUTCOME MEASURES The Bayley Mental and Motor Scales of Infant Development , assessed at 6.5 , 12 , and 24 months of corrected age . RESULTS Controlled for confounding variables , cocaine exposure had significant effects on cognitive development , accounting for a 6-point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years , with cocaine-exposed children twice as likely to have significant delay ( mental development index < 80 ) ( odds ratio , 1.98 ; 95 % confidence interval , 1.21 - 3.24 ; P = .006 ) . For motor outcomes , there were no significant cocaine effects . CONCLUSIONS Cocaine-exposed children had significant cognitive deficits and a doubling of the rate of developmental delay during the first 2 years of life . Because 2-year outcomes are predictive of later cognitive outcomes , it is possible that these children will continue to have learning difficulties at school age BACKGROUND Studies suggest that 14 % of women age 18 to 40 drink alcohol above recommended limits . Of special concern is the increasing use of alcohol by women during pregnancy . This article reports 48 month follow-up data from a sub analysis of a trial for early alcohol treatment ( Project TrEAT ) focused on women of childbearing age . METHODS Project TrEAT was conducted in the offices of 64 primary care , community-based physicians from 10 Wisconsin counties . Of 5979 female patients ages 18 to 40 who were screened for problem drinking , 205 were r and omized into an experimental group ( n = 103 ) or control group ( n = 102 ) . The intervention consisted of two 15 min , physician-delivered counseling visits that included advice , education , and contracting by using a scripted workbook . A total of 174 subjects ( 85 % ) completed the 48 month follow-up procedures . RESULTS No significant differences were found between the experimental and control groups at baseline for alcohol use , age , socioeconomic status , smoking , depression or anxiety , conduct disorder , lifetime drug use , or health care utilization . The trial found a significant treatment effect in reducing both 7 day alcohol use ( p = 0.0039 ) and binge drinking episodes ( p = 0.0021 ) over the 48 month follow-up period . Women in the experimental group who became pregnant during the follow-up period had the most dramatic decreases in alcohol use . A logistic regression model based on a 20 % or greater reduction in drinking found an odds ratio of 1.93 ( confidence interval 1.07 - 3.46 ) in the sample exposed to physician intervention . Age , smoking , depression , conduct disorder , antisocial personality disorder , and illicit drug use did not reduce drinking significantly . No significant differences were found in health care utilization and health status between groups . CONCLUSIONS This trial provides the first direct evidence that brief intervention is associated with sustained reductions in alcohol consumption by women of childbearing age . The results have enormous implication s for the U.S. health care system This study was conducted to determine whether health education material s were more effective when written at a lower rather than a higher reading level . Women ( n = 252 ) who visited public health maternity clinics selected either English- or Spanish- language health design ed to discourage alcohol use , depending on whether the women preferred to read English or Spanish . The material s were written on the third and the 10th- grade reading levels . The women were r and omly assigned to receive material s written on one of the two levels . Then participants completed the pre-test , read the health education material and were post-tested immediately . Among English-speaking participants , the material written at the lower reading level was shown to be more effective . Whereas among Spanish-speaking participants , test scores were unchanged after reading either health education material . Overall , we recommend that health care providers design or purchase material s that are easy-to-read and provide face-to-face counseling about abstaining from alcohol . Providers should not rely on written material s to communicate important messages when working with pregnant women AIMS To assess the impact of a brief intervention on  antepartum alcohol consumption .  DESIGN A r and omized clinical trial . SETTING The obstetrics practice s of the Brigham and Women 's Hospital in Boston , MA , USA . PARTICIPANTS Two hundred and fifty eligible women initiating prenatal care . INTERVENTION A comprehensive assessment of alcohol use ( assessment only , AO ) or the same comprehensive assessment with a brief intervention ( BI ) . MEASUREMENT Demographic background and obstetric history of subjects , current and lifetime use of alcohol and substances , composite Addiction Severity Index scores , and antepartum alcohol use . FINDINGS Of the 250 , 247 ( 99 % ) subjects provided information on their antepartum drinking . Both the AO and BI groups had reductions in antepartum alcohol consumption , but differences in reductions by group were not statistically significant ( p > 0.05 ) . Risk of antepartum drinking after either the AO or BI was increased nearly threefold if the subject had any prenatal alcohol consumption before assessment ( p = 0.0001 ) . For the 143 subjects who were abstinent pre- assessment , however , those who received the BI maintained higher rates of abstinence ( 86 % versus 72 % , p = 0.04 ) . CONCLUSIONS After a comprehensive assessment of alcohol use , subjects in both the AO and BI groups reduced their antepartum alcohol consumption . The importance of screening for prenatal alcohol use is underscored by the findings that any prenatal alcohol consumption increases the risk of continued antepartum drinking The fact that women of childbearing age make up a large proportion of the alcohol and other drug using population has gained national attention . Since treatment for addicted pregnant women and women with children has become a federal priority , treatment 
    Output:
    
There is a need for high quality r and omised controlled trials to determine the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs