***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 Determine whether Multisystemic Therapy-Health Care ( MST-HC ) improved asthma knowledge and controller device use skills among African-American youth with poorly controlled asthma and whether any improvements mediated changes in illness management . METHODS A r and omized controlled trial was conducted with 170 adolescents with moderate to severe asthma . Families were r and omized to MST-HC or attention control . Data were collected at baseline and 6 and 12 months after intervention completion . RESULTS In linear mixed models , adolescents in the MST-HC group had increases in asthma knowledge ; asthma knowledge was unchanged for attention control . Controller device use skills increased for adolescents in the MST-HC group , while skills declined for attention control . Both knowledge and skills mediated the relationship between intervention condition and changes in illness management . CONCLUSIONS Tailored , home-based interventions that include knowledge and skills building components are one means by which illness management in African-American youth with poorly controlled asthma can be improved ABSTRACT Objective : To assess the feasibility of a mobile health , inhaled corticosteroid ( ICS ) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma . Methods : Children aged 2–13 with persistent asthma were enrolled in this pilot r and omized controlled trial during an asthma emergency department ( ED ) visit or hospitalization . Intervention arm participants received daily text message reminders for 30 days , and both arms received electronic sensors to measure ICS use .  Primary outcomes were feasibility of sensor use and text message acceptability . Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories . Group-based trajectory modeling was used to examine adherence trajectories . Results : Forty-one participants ( mean age 5.9 ) were r and omized to intervention ( n = 21 ) or control ( n = 20 ) . Overall , 85 % were Black , 88 % had public insurance , and 51 % of the caregivers had a high school education or less . Thirty-two participant families ( 78 % ) transmitted medication adherence data ; of caregivers who completed the acceptability survey , 25 ( 96 % ) chose to receive daily reminders beyond that study interval . Secondary outcome analyses demonstrated similar average daily adherence between groups ( intervention = 36 % ; control = 32 % , P = 0.73 ) . Three adherence trajectories were identified with none ever exceeding 80 % adherence . Conclusions : Within a high-risk pediatric cohort , electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants , but there was no signal of effect . Adherence trajectories following severe exacerbation were suboptimal , demonstrating an important opportunity for asthma care improvement Real-time medication monitoring ( RTMM ) is a promising tool for improving adherence to inhaled corticosteroids ( ICS ) , but has not been sufficiently tested in children with asthma . We aim ed to study the effects of RTMM with short message service ( SMS ) reminders on adherence to ICS , asthma control , asthma-specific quality of life and asthma exacerbation rate ; and to study the associated cost-effectiveness . In a multicentre , r and omised controlled trial , children ( aged 4–11 years ) using ICS were recruited from five outpatient clinics and were given an RTMM device for 12 months . The intervention group also received tailored SMS reminders , sent only when a dose was at risk of omission . Outcome measures were adherence to ICS ( RTMM data ) , asthma control ( childhood asthma control test question naire ) , quality of life ( paediatric asthma quality of life question naire ) and asthma exacerbations . Costs were calculated from a healthcare and societal perspective . We included 209 children .  Mean adherence was higher in the intervention group : 69.3 % versus 57.3 % ( difference 12.0 % , 95 % CI 6.7%–17.7 % ) . No differences were found for asthma control , quality of life or asthma exacerbations . Costs were higher in the intervention group , but this difference was not statistically significant . RTMM with tailored SMS reminders improved adherence to ICS , but not asthma control , quality of life or exacerbations in children using ICS for asthma . e-Monitoring with tailored SMS reminders improves adherence to ICS , but not clinical outcomes in children with asthma BACKGROUND Suboptimum adherence to preventive asthma treatment is associated with substantial morbidity and mortality , yet adherence often remains poor . We aim ed to investigate whether use of an inhaler with audiovisual reminders leads to improved adherence and asthma outcomes in school-aged children who presented to the emergency department with an asthma exacerbation . METHODS We did a r and omised controlled trial in patients aged 6 - 15 years who attended the regional emergency department in Auckl and , New Zeal and with an asthma exacerbation and were on regular inhaled corticosteroids .  Using a simple , unrestricted block r and omisation with block sizes of 200 , we r and omly assigned patients to receive an electronic monitoring device for use with their preventer inhaler with the audiovisual reminder functions either enabled to support adherence to inhaled corticosteroids ( intervention group ) or disabled ( control group ) . Participants were followed up every 2 months for 6 months . The primary outcomes were adherence to preventive inhaled corticosteroids and number of days absent from school for any reason . Asthma control was assessed as a secondary outcome . All analyses were done in the intention-to-treat population . This trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12613001353785 . FINDINGS The study took place between May 10 , 2010 , and Feb 26 , 2012 . We r and omly assigned 220 patients , 110 to the intervention group and 110 to the control group .  Median percentage adherence was 84 % ( 10th percentile 54 % , 90th percentile 96 % ) in the intervention group , compared with 30 % ( 8 % , 68 % ) in the control group ( p<0·0001 ) . The proportion of days absent from school for any reason was 1·9 % ( 10th percentile 0·0 % , 90th percentile 7·9 % ) in the intervention group and 1·7 % ( 0·0 % , 8·6 % ) in the control group . The change in asthma morbidity score from baseline to 6 months was significantly greater in the intervention group than in the control group ( p=0·008 ) , with a reduction of 2·0 points from a mean baseline score of 9·3 ( SD 2·2 ) to 7·3 ( 2·1 ) in the intervention group , compared with a reduction of 1·2 points from a baseline of 9·2 ( 2·5 ) to 8·0 ( 2·2 ) in the control group . INTERPRETATION Use of an electronic monitoring device with an audiovisual reminder led to significant improvements in adherence to inhaled corticosteroids in school-aged children with asthma . This intervention could be beneficial for the improvement of asthma control in patients for whom poor asthma control is related to poor adherence . FUNDING Health Research Council of New Zeal and and Cure Kids International guidelines recommend that severe asthma can only be diagnosed after contributory factors , including adherence , have been addressed . Accurate assessment of adherence is difficult in clinical practice . We hypothesised that electronic monitoring in children would identify nonadherence , thus delineating the small number with true severe asthma . Asthmatic children already prescribed inhaled corticosteroids were prospect ively recruited and persistence of adherence assessed using electronic monitoring devices .  Spirometry , airway inflammation and asthma control were measured at the start and end of the monitoring period . 93 children ( 62 male ; median age 12.4 years ) were monitored for a median of 92 days . Median ( range ) monitored adherence was 74 % ( 21–99 % ) . We identified four groups : 1 ) good adherence during monitoring with improved control , 24 % ( likely previous poor adherence ) ; 2 ) good adherence with poor control , 18 % ( severe therapy-resistant asthma ) ; 3 ) poor adherence with good control , 26 % ( likely overtreated ) ; and 4 ) poor adherence with poor control , 32 % . No clinical parameter prior to monitoring distinguished these groups . Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated . Different approaches are needed in those who are controlled when adherent or who are nonadherent . Electronic monitoring is essential in a paediatric severe asthma clinic . Children with true , severe therapy-resistant asthma can not be identified without electronic adherence monitoring OBJECTIVE To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma . METHODS We used a r and omized clinical trial with 48 youth ( aged 9 - 15 years ) assigned to 1 of 3 groups : Teamwork Intervention ( TI ) , Asthma Education ( AE ) , or St and ard Care ( SC ) . Treatment occurred across 2 months , with a 3-month follow-up assessment . Adherence to inhaled corticosteroids was assessed via the MDILog-II . Parent-adolescent conflict , asthma functional severity , and spirometry assessment s were obtained pre-treatment , post-treatment , and on follow-up . Mixed linear model analysis was used to evaluate group and time effects for outcome measures . RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions , and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group . CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management BACKGROUND Poor adherence to inhaled corticosteroids ( ICS ) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents . OBJECTIVE This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS . METHODS Low-income African American and /or Hispanic adolescents , ages 11 - 16 years old , with persistent asthma , and poor ( ≤ 48 % ) adherence to prescription ICS during the 3-week run-in were r and omized to intervention or attention control groups ( ATG ) for the 10-week treatment . During treatment , the intervention arm subjects participated in weekly coping peer group support sessions and received mp3 peer-recorded asthma messages that promoted adherence . The ATG participated in weekly meetings with a research assistant and received an equivalent number of mp3 physician-recorded asthma messages . Adherence was measured by using self-report and the Doser CT , an electronic dose counter . The primary outcome was the difference in adherence at 10 weeks between the 2 arms . RESULTS Thirty-four subjects were r and omized to each arm . At 10 weeks , no statistical difference in objective ly measured adherence could be detected between the 2 arms when adjusting for baseline adherence ( P = .929 ) . Adherence declined in both groups over the course of the active treatment period . In both study arms , self-reported adherence by participants was significantly higher than their objective ly measured adherence at week 10 ( P < .0001 ) . CONCLUSION Improving medication adherence in longitudinal studies is challenging . Peer support and mp3-delivered peer asthma messages may not be of sufficient dose to improve outcomes Purpose To investigate the association of ethnicity with objective ly , electronically measured adherence to inhaled corticosteroids ( ICS ) in a multicultural population of children with asthma in the city of Amsterdam . Methods The study was design ed as a prospect i ve , observational multicenter study in which adherence to ICS and potential risk factors for adherence to ICS were measured in a cohort of Moroccan and native Dutch children with asthma .  Electronic adherence measurements  were performed for 3 months per patient using a Real Time Medication Monitoring ( RTMM ) system . Ethnicity and other potential risk factors , such as socio-economic status , asthma control and parental medication beliefs , were extracted from medical records or parent interviews . The association between adherence and ethnicity was analysed using multivariate linear regression analysis . Results A total of 90 children ( aged 1–11 years ) were included in the study and data of 87 children were used for analysis .  Average adherence to ICS  was 49.3 % . Native Dutch children showed higher adherence to ICS  than Moroccan children ( 55.9 vs. 42.5 % , respectively ; p = 0.044 , univariate analysis ) . After correction for confounders ( > 3 annual visits to the paediatric outpatient clinic , regular use of a spacer during inhalation ) , the final regression model showed that ethnicity was independently associated with adherence ( p = 0.028 ) . Conclusions In our Western European population of inner city children with asthma , poor adherence to ICS  was a serious problem , and even somewhat more so in ethnic minorities . Paediatricians involved in asthma treatment should be aware of these cultural differences in medication-taking behaviour , but further studies are needed to eluci date the causal mechanism OBJECTIVE To 
    Output:
    
Conclusion : Adherence rate in children with severe asthma is not satisfactory but it can be improved after proper interventions .