human
***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 whether community mobilization adds effectiveness to conventional dengue control . Design Pragmatic open label parallel group cluster r and omized controlled trial . Those assessing the outcomes and analyzing the data were blinded to group assignment . Central ized computerized r and omization after the baseline study allocated half the sites to intervention , stratified by country , evidence of recent dengue virus infection in children aged 3 - 9 , and vector indices . Setting R and om sample of communities in Managua , capital of Nicaragua , and three coastal regions in Guerrero State in the south of Mexico . Participants Residents in a r and om sample of census enumeration areas across both countries : 75 intervention and 75 control clusters ( about 140 households each ) were r and omized and analyzed ( 60 clusters in Nicaragua and 90 in Mexico ) , including 85 182 residents in 18 838 households . Interventions A community mobilization protocol began with community discussion of baseline results . Each intervention cluster adapted the basic intervention — chemical-free prevention of mosquito reproduction — to its own circumstances . All clusters continued the government run dengue control program . Main outcome measures Primary outcomes per protocol were self reported cases of dengue , serological evidence of recent dengue virus infection , and conventional entomological indices ( house index : households with larvae or pupae/households examined ; container index : containers with larvae or pupae/containers examined ; Breteau index : containers with larvae or pupae/households examined ; and pupae per person : pupae found/number of residents ) . Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use . Results With cluster as the unit of analysis , serological evidence from intervention sites showed a lower risk of infection with dengue virus in children ( relative risk reduction 29.5 % , 95 % confidence interval 3.8 % to 55.3 % ) , fewer reports of dengue illness ( 24.7 % , 1.8 % to 51.2 % ) , fewer houses with larvae or pupae among houses visited ( house index ) ( 44.1 % , 13.6 % to 74.7 % ) , fewer containers with larvae or pupae among containers examined ( container index ) ( 36.7 % , 24.5 % to 44.8 % ) , fewer containers with larvae or pupae among houses visited ( Breteau index ) ( 35.1 % , 16.7 % to 55.5 % ) , and fewer pupae per person ( 51.7 % , 36.2 % to 76.1 % ) . The numbers needed to treat were 30 ( 95 % confidence interval 20 to 59 ) for a lower risk of infection in children , 71 ( 48 to 143 ) for fewer reports of dengue illness , 17 ( 14 to 20 ) for the house index , 37 ( 35 to 67 ) for the container index , 10 ( 6 to 29 ) for the Breteau index , and 12 ( 7 to 31 ) for fewer pupae per person . Secondary per protocol analysis showed no serological evidence of a protective effect of temephos . Conclusions Evidence based community mobilization can add effectiveness to dengue vector control . Each site implementing the intervention in its own way has the advantage of local customization and strong community engagement . Trial registration IS RCT Background Dengue is a serious public health problem with an important economic impact . This study used data from a cluster r and omised controlled trial of community mobilisation for dengue prevention to estimate the household costs of treatment of dengue illness . It examined the economic impact of the trial intervention in the three coastal regions of Mexico ’s Guerrero State . Methods The 2010 baseline survey covered households in a r and om sample of 90 clusters in the coastal regions ; the clusters were r and omly allocated to intervention or control and re-surveyed in 2012 . The surveys asked about dengue cases in the last 12 months , expenditures on their treatment , and work or school days lost by patients and care givers . We did not assign monetary value to days lost , since a lost day to a person of low earning power is of equal or higher value to that person than to one who earns more . Results The 12,312 households in 2010 reported 1020 dengue cases in the last 12 months ( 1.9 % of the sample population ) . Most ( 78 % ) were ambulatory cases , with a mean cost of USD 51 and 10.8 work/school days , rising to USD 96 and 11.4 work/school days if treated by a private physician . Hospitalised cases cost USD 28–94 in government institutions and USD 392 in private hospitals ( excluding additional inpatient charges ) , as well as 9.6–17.3 work/school days . Dengue cases cost households an estimated 412,825 work/school days throughout the three coastal regions . In the follow up survey , 6.1 % ( 326/5349 ) of households in intervention clusters and 7.9 % ( 405/5139 ) in control clusters reported at least one dengue case . The mean of days lost per case was similar in intervention and control clusters , but the number of days lost from dengue and all elements of costs for dengue cases per 1000 population were lower in intervention clusters . If the total population of the three coastal regions had received the intervention , some 149,401 work or school days lost per year could have been prevented . Conclusion The economic effect of dengue on households , including lost work days , is substantial . The Camino Verde trial intervention reduced household costs for treatment of dengue cases . Trial registration The trial was registered as IS RCT N:27,581,154 Camino Verde ( the Green Way ) is an evidence -based  community  mobilisation tool for prevention of dengue and other mosquito-borne viral diseases . Its effectiveness was demonstrated in a cluster-r and omised controlled trial conducted in 2010–2013 in Nicaragua and Mexico . The common approach that brought functional consistency to the Camino Verde intervention in both Mexico and Nicaragua is Socialisation of Evidence for Participatory Action (SEPA).In this article , we explain the SEPA concept and its theoretical origins , giving examples of its previous application in different countries and context s. We describe how the approach was used in the Camino Verde intervention , with details that show commonalities and differences in the application of the approach in Mexico and Nicaragua . We discuss issues of cost , replicability and sustainability , and comment on which components of the intervention were most important to its success . In complex interventions , multiple components act in synergy to produce change . Among key factors in the success of Camino Verde were the use of community volunteers called brigadistas , the house-to-house visits they conducted , the use of evidence derived from the communities themselves , and community ownership of the undertaking . Communities received the intervention by r and om assignment ; dengue was not necessarily their greatest concern . The very nature of the dengue threat dictated many of the actions that needed to be taken at household and neighbourhood levels to control it . But within these parameters , communities exercised a large degree of control over the intervention and displayed considerable ingenuity in the process . Trial registration IS RCT N27581154 Background Underst and ing the breeding patterns of Aedes aegypti in households and the factors associated with infestation are important for implementing vector control . The baseline survey of a cluster r and omised controlled trial of community mobilisation for dengue prevention in Mexico and Nicaragua collected information about the containers that are the main breeding sites , identified possible actions to reduce breeding , and examined factors associated with household infestation . This paper describes findings from the Mexican arm of the baseline survey . Methods In 2010 field teams conducted household surveys and entomological inspections in 11,995 households from 90 representative communities in the three coastal regions of Guerrero State , Mexico . We characterized Ae . aegypti breeding sites and examined the effect of two preventive measures : temephos application in water containers , and keeping the containers covered . We examined associations with household infestation , using bivariate and multivariate analysis adjusted for clustering effects . Results We conducted entomological inspections in 11,995 households . Among 45,353 water containers examined , 6.5 % ( 2958/45,353 ) were positive for larvae and /or pupae . Concrete tanks ( pilas ) and barrels ( tambos ) together accounted for 74 % of pupal productivity . Both covering water containers and inserting temephos were independently associated with a lower risk of presence of larvae or pupae , with the effect of covering ( OR 0.22 ; 95 % CIca 0.15–0.27 ) stronger than that of temephos ( OR 0.66 ; 95 % CIca 0.53–0.84 ) . Having more than four water containers was associated with household infestation in both rural areas ( OR 1.42 ; 95 % CIca 1.17–1.72 ) and urban areas ( 1.81 ; 1.47–2.25 ) , as was low education of the household head  ( rural : 1.27 ; 1.11–1.46 , and urban : 1.39 ; 1.17–1.66 ) . Additional factors in rural areas were : household head without paid work ( 1.31 ; 1.08–1.59 ) ; being in the Acapulco region ( 1.91 ; 1.06–3.44 ) ; and using anti-mosquito products  ( 1.27 ; 1.09–1.47 ) . In urban areas only , presence of temephos was associated with a lower risk of household infestation ( 0.44 ; 0.32–0.60 ) . Conclusion Concrete tanks and barrels accounted for the majority of pupal productivity .  Covering water containers could be an effective means of Ae . aegypti vector control , with a bigger effect than using temephos . These findings were useful in planning and implementing the Camino Verde trial intervention in Mexico Camino Verde ( the Green Way ) is an evidence -based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases . Its effectiveness was demonstrated in a cluster-r and omised controlled trial conducted in 2010–2013 in Nicaragua and Mexico . The Nicaraguan arm of the trial was preceded , from 2004 to 2008 , by a feasibility study that provided valuable lessons and trained facilitators for the trial itself . Here , guided by the Template for Intervention Description and Replication ( TIDieR ) , we describe the  Camino Verde intervention in Nicaragua , presenting its rationale , its time and location , activities , material s used , the main actors , modes of delivery , how it was tailored to encourage community engagement , modifications made from the feasibility study to the trial itself , and how fidelity to the process originally design ed was maintained . We also present information on costs and discuss the place of this study within the literature on implementation science . Trial registration IS RCT N27581154 Background Dengue is a serious public health issue that affects households in endemic areas in terms of health and also economically , imposing costs for prevention and treatment of cases . The Camino Verde cluster-r and omised controlled trial in Mexico and Nicaragua assessed the impact of evidence -based community engagement in dengue prevention .  The Mexican arm of the trial was conducted in 90 r and omly selected communities in three coastal regions of Guerrero State . This study reports an analysis of a secondary outcome of the trial : household use of and expenditure on anti-mosquito products .  We examined whether the education and mobilisation activities of the trial motivated people to spend less on anti-mosquito products . Methods We carried out a household question naire survey in the trial communities in 2010 ( 12,312 households ) and 2012 ( 5349 households in intervention clusters , 5142 households in control clusters ) , including questions about socio-economic status , self-reported dengue illness , and purchase of and expenditure on insecticide anti-mosquito products in the previous month . We examined expenditures on anti-mosquito products  at baseline in relation to social vulnerability and we compared use of and expenditures on these products between intervention and control clusters in 2012 . Results In 2010 , 44.2 % of 12,312 households reported using anti-mosquito products , with a mean expenditure of USD4.61 per month among those who used them . Socially vulnerable households spent less on the products . In 2012 , after the intervention , the proportion of households who purchased anti-mosquito products in the last month was significantly lower in intervention clusters ( 47.8 % ; 2503/5293 ) than in control clusters ( 53.3 % ; 2707/5079 ) ( difference − 0.05 , 95 % CIca −0.100 to −0.010 ) . The mean expenditure on the products , among those households who bought them , was USD6.43 ; 30.4 % in the intervention clusters and 36.7 % in the control clusters spent more than this ( difference − 0.06 , 95 % CIca −0.12 to −0.01 ) . These expenditures on anti-mosquito products represent 3.3 % and 3.8 % respectively of monthly household income for the poorest 10 % of the population in 2012 . Conclusions The Camino Verde community mobilisation intervention , as well as being effective in reducing dengue infections , was effective in reducing household use of and expenditure on insecticide anti-mosquito products . Trial registration ( IS RCT N27581154 ) Background A modified theory of planned behaviour ( acronym CASCADA ) proposes that Conscious knowledge precedes a change in Attitude , which in turn precedes positive deviations from negative Subjective norms , intention to Change , perception of Agency to change , 
    Output:
    
agent
The Camino Verde trial of community mobilisation for control of dengue reported a significant impact on entomological indices of the Aedes aegypti vector , and on serological dengue virus infection and self-reported dengue cases .
***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 whether community mobilization adds effectiveness to conventional dengue control . Design Pragmatic open label parallel group cluster r and omized controlled trial . Those assessing the outcomes and analyzing the data were blinded to group assignment . Central ized computerized r and omization after the baseline study allocated half the sites to intervention , stratified by country , evidence of recent dengue virus infection in children aged 3 - 9 , and vector indices . Setting R and om sample of communities in Managua , capital of Nicaragua , and three coastal regions in Guerrero State in the south of Mexico . Participants Residents in a r and om sample of census enumeration areas across both countries : 75 intervention and 75 control clusters ( about 140 households each ) were r and omized and analyzed ( 60 clusters in Nicaragua and 90 in Mexico ) , including 85 182 residents in 18 838 households . Interventions A community mobilization protocol began with community discussion of baseline results . Each intervention cluster adapted the basic intervention — chemical-free prevention of mosquito reproduction — to its own circumstances . All clusters continued the government run dengue control program . Main outcome measures Primary outcomes per protocol were self reported cases of dengue , serological evidence of recent dengue virus infection , and conventional entomological indices ( house index : households with larvae or pupae/households examined ; container index : containers with larvae or pupae/containers examined ; Breteau index : containers with larvae or pupae/households examined ; and pupae per person : pupae found/number of residents ) . Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use . Results With cluster as the unit of analysis , serological evidence from intervention sites showed a lower risk of infection with dengue virus in children ( relative risk reduction 29.5 % , 95 % confidence interval 3.8 % to 55.3 % ) , fewer reports of dengue illness ( 24.7 % , 1.8 % to 51.2 % ) , fewer houses with larvae or pupae among houses visited ( house index ) ( 44.1 % , 13.6 % to 74.7 % ) , fewer containers with larvae or pupae among containers examined ( container index ) ( 36.7 % , 24.5 % to 44.8 % ) , fewer containers with larvae or pupae among houses visited ( Breteau index ) ( 35.1 % , 16.7 % to 55.5 % ) , and fewer pupae per person ( 51.7 % , 36.2 % to 76.1 % ) . The numbers needed to treat were 30 ( 95 % confidence interval 20 to 59 ) for a lower risk of infection in children , 71 ( 48 to 143 ) for fewer reports of dengue illness , 17 ( 14 to 20 ) for the house index , 37 ( 35 to 67 ) for the container index , 10 ( 6 to 29 ) for the Breteau index , and 12 ( 7 to 31 ) for fewer pupae per person . Secondary per protocol analysis showed no serological evidence of a protective effect of temephos . Conclusions Evidence based community mobilization can add effectiveness to dengue vector control . Each site implementing the intervention in its own way has the advantage of local customization and strong community engagement . Trial registration IS RCT Background Dengue is a serious public health problem with an important economic impact . This study used data from a cluster r and omised controlled trial of community mobilisation for dengue prevention to estimate the household costs of treatment of dengue illness . It examined the economic impact of the trial intervention in the three coastal regions of Mexico ’s Guerrero State . Methods The 2010 baseline survey covered households in a r and om sample of 90 clusters in the coastal regions ; the clusters were r and omly allocated to intervention or control and re-surveyed in 2012 . The surveys asked about dengue cases in the last 12 months , expenditures on their treatment , and work or school days lost by patients and care givers . We did not assign monetary value to days lost , since a lost day to a person of low earning power is of equal or higher value to that person than to one who earns more . Results The 12,312 households in 2010 reported 1020 dengue cases in the last 12 months ( 1.9 % of the sample population ) . Most ( 78 % ) were ambulatory cases , with a mean cost of USD 51 and 10.8 work/school days , rising to USD 96 and 11.4 work/school days if treated by a private physician . Hospitalised cases cost USD 28–94 in government institutions and USD 392 in private hospitals ( excluding additional inpatient charges ) , as well as 9.6–17.3 work/school days . Dengue cases cost households an estimated 412,825 work/school days throughout the three coastal regions . In the follow up survey , 6.1 % ( 326/5349 ) of households in intervention clusters and 7.9 % ( 405/5139 ) in control clusters reported at least one dengue case . The mean of days lost per case was similar in intervention and control clusters , but the number of days lost from dengue and all elements of costs for dengue cases per 1000 population were lower in intervention clusters . If the total population of the three coastal regions had received the intervention , some 149,401 work or school days lost per year could have been prevented . Conclusion The economic effect of dengue on households , including lost work days , is substantial . The Camino Verde trial intervention reduced household costs for treatment of dengue cases . Trial registration The trial was registered as IS RCT N:27,581,154 Camino Verde ( the Green Way ) is an evidence -based  community  mobilisation tool for prevention of dengue and other mosquito-borne viral diseases . Its effectiveness was demonstrated in a cluster-r and omised controlled trial conducted in 2010–2013 in Nicaragua and Mexico . The common approach that brought functional consistency to the Camino Verde intervention in both Mexico and Nicaragua is Socialisation of Evidence for Participatory Action (SEPA).In this article , we explain the SEPA concept and its theoretical origins , giving examples of its previous application in different countries and context s. We describe how the approach was used in the Camino Verde intervention , with details that show commonalities and differences in the application of the approach in Mexico and Nicaragua . We discuss issues of cost , replicability and sustainability , and comment on which components of the intervention were most important to its success . In complex interventions , multiple components act in synergy to produce change . Among key factors in the success of Camino Verde were the use of community volunteers called brigadistas , the house-to-house visits they conducted , the use of evidence derived from the communities themselves , and community ownership of the undertaking . Communities received the intervention by r and om assignment ; dengue was not necessarily their greatest concern . The very nature of the dengue threat dictated many of the actions that needed to be taken at household and neighbourhood levels to control it . But within these parameters , communities exercised a large degree of control over the intervention and displayed considerable ingenuity in the process . Trial registration IS RCT N27581154 Background Underst and ing the breeding patterns of Aedes aegypti in households and the factors associated with infestation are important for implementing vector control . The baseline survey of a cluster r and omised controlled trial of community mobilisation for dengue prevention in Mexico and Nicaragua collected information about the containers that are the main breeding sites , identified possible actions to reduce breeding , and examined factors associated with household infestation . This paper describes findings from the Mexican arm of the baseline survey . Methods In 2010 field teams conducted household surveys and entomological inspections in 11,995 households from 90 representative communities in the three coastal regions of Guerrero State , Mexico . We characterized Ae . aegypti breeding sites and examined the effect of two preventive measures : temephos application in water containers , and keeping the containers covered . We examined associations with household infestation , using bivariate and multivariate analysis adjusted for clustering effects . Results We conducted entomological inspections in 11,995 households . Among 45,353 water containers examined , 6.5 % ( 2958/45,353 ) were positive for larvae and /or pupae . Concrete tanks ( pilas ) and barrels ( tambos ) together accounted for 74 % of pupal productivity . Both covering water containers and inserting temephos were independently associated with a lower risk of presence of larvae or pupae , with the effect of covering ( OR 0.22 ; 95 % CIca 0.15–0.27 ) stronger than that of temephos ( OR 0.66 ; 95 % CIca 0.53–0.84 ) . Having more than four water containers was associated with household infestation in both rural areas ( OR 1.42 ; 95 % CIca 1.17–1.72 ) and urban areas ( 1.81 ; 1.47–2.25 ) , as was low education of the household head  ( rural : 1.27 ; 1.11–1.46 , and urban : 1.39 ; 1.17–1.66 ) . Additional factors in rural areas were : household head without paid work ( 1.31 ; 1.08–1.59 ) ; being in the Acapulco region ( 1.91 ; 1.06–3.44 ) ; and using anti-mosquito products  ( 1.27 ; 1.09–1.47 ) . In urban areas only , presence of temephos was associated with a lower risk of household infestation ( 0.44 ; 0.32–0.60 ) . Conclusion Concrete tanks and barrels accounted for the majority of pupal productivity .  Covering water containers could be an effective means of Ae . aegypti vector control , with a bigger effect than using temephos . These findings were useful in planning and implementing the Camino Verde trial intervention in Mexico Camino Verde ( the Green Way ) is an evidence -based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases . Its effectiveness was demonstrated in a cluster-r and omised controlled trial conducted in 2010–2013 in Nicaragua and Mexico . The Nicaraguan arm of the trial was preceded , from 2004 to 2008 , by a feasibility study that provided valuable lessons and trained facilitators for the trial itself . Here , guided by the Template for Intervention Description and Replication ( TIDieR ) , we describe the  Camino Verde intervention in Nicaragua , presenting its rationale , its time and location , activities , material s used , the main actors , modes of delivery , how it was tailored to encourage community engagement , modifications made from the feasibility study to the trial itself , and how fidelity to the process originally design ed was maintained . We also present information on costs and discuss the place of this study within the literature on implementation science . Trial registration IS RCT N27581154 Background Dengue is a serious public health issue that affects households in endemic areas in terms of health and also economically , imposing costs for prevention and treatment of cases . The Camino Verde cluster-r and omised controlled trial in Mexico and Nicaragua assessed the impact of evidence -based community engagement in dengue prevention .  The Mexican arm of the trial was conducted in 90 r and omly selected communities in three coastal regions of Guerrero State . This study reports an analysis of a secondary outcome of the trial : household use of and expenditure on anti-mosquito products .  We examined whether the education and mobilisation activities of the trial motivated people to spend less on anti-mosquito products . Methods We carried out a household question naire survey in the trial communities in 2010 ( 12,312 households ) and 2012 ( 5349 households in intervention clusters , 5142 households in control clusters ) , including questions about socio-economic status , self-reported dengue illness , and purchase of and expenditure on insecticide anti-mosquito products in the previous month . We examined expenditures on anti-mosquito products  at baseline in relation to social vulnerability and we compared use of and expenditures on these products between intervention and control clusters in 2012 . Results In 2010 , 44.2 % of 12,312 households reported using anti-mosquito products , with a mean expenditure of USD4.61 per month among those who used them . Socially vulnerable households spent less on the products . In 2012 , after the intervention , the proportion of households who purchased anti-mosquito products in the last month was significantly lower in intervention clusters ( 47.8 % ; 2503/5293 ) than in control clusters ( 53.3 % ; 2707/5079 ) ( difference − 0.05 , 95 % CIca −0.100 to −0.010 ) . The mean expenditure on the products , among those households who bought them , was USD6.43 ; 30.4 % in the intervention clusters and 36.7 % in the control clusters spent more than this ( difference − 0.06 , 95 % CIca −0.12 to −0.01 ) . These expenditures on anti-mosquito products represent 3.3 % and 3.8 % respectively of monthly household income for the poorest 10 % of the population in 2012 . Conclusions The Camino Verde community mobilisation intervention , as well as being effective in reducing dengue infections , was effective in reducing household use of and expenditure on insecticide anti-mosquito products . Trial registration ( IS RCT N27581154 ) Background A modified theory of planned behaviour ( acronym CASCADA ) proposes that Conscious knowledge precedes a change in Attitude , which in turn precedes positive deviations from negative Subjective norms , intention to Change , perception of Agency to change , 
    Output:
    