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: Aims : There is ongoing debate over the effectiveness of preventive home visits ( PHVs ) for the elderly . A municipality in the north of Sweden carried out a controlled trial of such visits . Healthy seniors aged 75 years and over received two PHVs per year over 2 years . The aim of this study was to do a cost utility analysis of the intervention . Methods : The intervention group ( n=196 ) was compared with a control group ( n=346 ) , and a  cost utility analysis was performed . The analysis was carried out with three different time perspectives . Data were source d from official documents and medical and social records . Results : From a societal perspective , using a time period of 4 years , the analysis of PHVs to healthy seniors showed net savings . When including estimated future costs for health and elderly care during gained life years , the result changed from a net saving to a cost of Euro 200,000 . A lifetime perspective also result ed in net savings if the costs of future health and elderly care were not included in the analysis . In this case , the total costs rose to approximately Euro 900,000 . The cost could also be expressed as Euro 14,200 per quality -adjusted life year gained if future costs for elderly care and healthcare were included . Conclusions : PHVs represent a cost-effective intervention in this setting . The costs are justified by the outcomes Background : multifactorial falls prevention programmes for older people have been proved to reduce falls . However , evidence of their cost-effectiveness is mixed . Design : economic evaluation alongside pragmatic r and omised controlled trial . Intervention : r and omised trial of 364 people aged ≥70 , living in the community , recruited via GP and identified as high risk of falling . Both arms received a falls prevention information leaflet . The intervention arm were also offered a ( day hospital ) multidisciplinary falls prevention programme , including physiotherapy , occupational therapy , nurse , medical review and referral to other specialists . Measurements : self-reported falls , as collected in 12 monthly diaries . Levels of health re source use associated with the falls prevention programme , screening ( both attributed to intervention arm only ) and other health-care contacts were monitored . Mean NHS costs and falls per person per year were estimated for both arms , along with the incremental cost-effectiveness ratio ( ICER ) and cost effectiveness acceptability curve . Results : in the base-case analysis , the mean falls programme cost was £ 349 per person . This , coupled with higher screening and other health-care costs , result ed in a mean incremental cost of £ 578 for the intervention arm . The mean falls rate was lower in the intervention arm ( 2.07 per person/year ) , compared with the control arm ( 2.24 ) . The estimated ICER was £ 3,320 per fall averted . Conclusions : the estimated ICER was £ 3,320 per fall averted . Future research should focus on adherence to the intervention and an assessment of impact on quality of life OBJECTIVE To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women . DESIGN An economic evaluation carried out within a r and omised controlled trial with two years of follow up . Participants were individually prescribed an exercise programme ( exercise group , n=116 ) or received usual care and social visits ( control group , n=117 ) . SETTING 17 general practice s in Dunedin , New Zeal and . PARTICIPANTS Women aged 80 years and older living in the community and invited by their general practitioner to take part . MAIN OUTCOME MEASURES Number of falls and injuries related to falls , costs of implementing the intervention , healthcare service costs result ing from falls and total healthcare service costs during the trial . Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented . MAIN RESULTS 27 % of total hospital costs during the trial were related to falls . However , there were no significant differences in health service costs between the two groups . Implementing the exercise programme for one and two years respectively cost $ 314 and $ 265 ( 1995 New Zeal and dollars ) per fall prevented , and $ 457 and $ 426 per fall result ing in a moderate or serious injury prevented . CONCLUSIONS The costs result ing from falls make up a substantial proportion of the hospital costs for older people . Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs . However , the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies Summary We estimated the incremental cost-effectiveness of a once-weekly or twice-weekly resistance training intervention compared with balance and tone classes in terms of falls prevented and quality -adjusted life years ( QALYs ) gained . Both resistance training interventions were more likely to save health care re source money and offer better health outcomes for falls prevention than balance and tone classes . Introduction This study aims to estimate the incremental cost-effectiveness and cost-utility of a once-weekly or twice-weekly resistance training intervention compared with twice-weekly balance and tone classes in terms of falls prevented and QALYs gained . Methods Economic evaluation was conducted concurrently with a three-arm r and omized controlled trial including 155 community-dwelling women aged 65 to 75 years , Mini Mental State Examination ≥24 , and visual acuity 20/40 or better . Participants received the once-weekly resistance training ( n = 54 ) , the twice-weekly resistance training ( n = 51 ) or the twice-weekly balance and tone ( the comparator ) classes ( n = 50 ) for 1 year . Measurements included the number of falls for each participant , healthcare re source utilization , and associated costs over 9 months ; health status was assessed using the EQ-5D and SF-6D to calculate QALYs . Results Based on the point estimates from our base case analysis , we found that both once- and twice-weekly resistance training groups were less costly ( p < 0.05 ) and more effective than twice-weekly balance and tone classes . The incremental QALYs assessed using the SF-6D were 0.003 for both the once- and twice-weekly resistance training groups , compared with the twice-weekly balance and tone classes . The incremental QALYs assessed using the EQ-5D were 0.084 for the once-weekly and 0.179 for the twice-weekly resistance training groups , respectively , compared with the twice-weekly balance and tone classes . Conclusions An individually tailored resistance training intervention delivered once or twice weekly provided better value for money for falls prevention than balance and tone classes OBJECTIVE This longitudinal study was design ed to assess the effect of an educational training package for primary health care teams in accident prevention for older people , with reference to the incidence of accidents and their associated economic consequence . METHODS Nineteen general practice s in the West Midl and s serving a population of 138 397 were allocated r and omly at the practice level either to receive  training  or continue normal practice . Study data was collated from the initial telephone call , reporting an accident , to the surgery , advice/treatment given at the practice and /or the community , casualty , inpatient care , written correspondence to the patient 's GP and any subsequent follow-up visits for accidents to people aged 65 years or older . RESULTS One thous and , six hundred and sixty-six ( 8.2 % ) patients aged 65 years or older registered with the participating practice s experienced one accident or more , costing the NHS pound 1.4 million . Extrapolated nationally , annual costs to the NHS for accidents to older people amount to pound 568 million . The educational package had no significant impact on the incidence of accidents . A paucity of general safety advice was given [ 48 ( 1.8 % ) occasions ] . CONCLUSIONS Budgets are being eroded and patients are suffering unnecessarily due to lack of accident prevention advice . This should be considered a priority within the primary health care team . Educational packages alone do not appear to be a cost-effective approach to accident prevention in primary care OBJECTIVES This cluster-r and omised controlled trial assessed whether oral health care education ( OHCE ) for nursing home caregivers would achieve improvements in clients ' oral health . METHODS Twenty-two nursing homes were r and omly allocated to intervention or control group . Clients were examined at baseline and at follow-up visits 1- and 6-months after caregivers received OHCE . Main outcome measures were denture plaque , denture-induced stomatitis , dental plaque and gingivitis . Differences in group means/medians were compared with adjustment for cluster r and omisation . RESULTS Clients ' baseline oral health was poor . After OHCE , the intervention group 's oral health scores improved significantly . Reductions in denture plaque scores ( 0 - 4 scale ) exceeded those of the control group by 1.15 ( 95%CI=0.83 , 1.47 ) at 1 month and by 1.47 ( 95%CI=1.13 , 1.80 ) at 6 months . Denture-induced stomatitis prevalence reduced significantly over 6 months compared to the control group ( P<0.0001 ) . Group differences in favour of the intervention group were 0.41 ( 95%CI=0.18 , 0.65 ) at 1 month and 0.34 ( 95%CI=0.14 , 0.53 ) at 6 months for dental plaque ( 0 - 3 scale ) , and 0.17 ( 95%CI= -0.01 , 0.35 ) at 1 month and 0.28 ( 95%CI 0.15 , 0.42 ) at 6 months for gingivitis ( 0 - 2 scale ) . Key differences remained significant after adjustment for clustering effects . The provider 's costs would currently be approximately pounds 6700 per year to deliver the intervention to a Health Authority with 100 homes . CONCLUSIONS Although final levels of residents ' oral health were still short of ideal , this study clearly shows that , for a modest cost , OHCE can improve caregivers '  knowledge , attitudes and oral health care performance for elderly , functionally dependent clients OBJECTIVES To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults . DESIGN Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature . SETTING Model represents population level interventions . PARTICIPANTS No human subjects were involved in the study . MEASUREMENS : The last Cochrane data base review and meta-analyses of r and omized controlled trials categorized effective fall-prevention interventions into seven groups : medical management ( withdrawal ) of psychotropics , group tai chi , vitamin D supplementation , muscle and balance exercises , home modifications , multifactorial individualized programs for all elderly people , and multifactorial individualized treatments for high-risk frail elderly people . Fall-related hip fracture incidence was obtained from the literature . Salary figures for health professionals were based on Bureau of Labor Statistics data . Using an integrated healthcare system perspective , healthcare costs were estimated based on practice and studies on falls in older adults . Base case incremental cost utility ratios were calculated , and probabilistic sensitivity analyses were conducted . RESULTS Medical management of psychotropics and group tai chi were the least-costly , most-effective options , but they were also the least studied . Excluding these interventions , the least-expensive , most-effective options are  vitamin D supplementation and home modifications . Vitamin D supplementation costs less than home modifications , but home modifications cost only $ 14,794/ quality -adjusted life year ( QALY ) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi , home modification is most likely to have the highest economic benefit when QALYs are valued at $ 50,000 or $ 100,000 . CONCLUSION Of single interventions studied , management of psychotropics and tai chi reduces costs the most . Of more-studied interventions , home modifications provide the best value . These results must be interpreted in the context of the multifactorial nature of falls Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more  exercise sessions  . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement We examined the costs of a  physical activity ( PA ) and an educational comparison intervention .  424 older adults at risk for mobility disability were r and 
    Output:
    
agent
In this area , there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention .
***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: Aims : There is ongoing debate over the effectiveness of preventive home visits ( PHVs ) for the elderly . A municipality in the north of Sweden carried out a controlled trial of such visits . Healthy seniors aged 75 years and over received two PHVs per year over 2 years . The aim of this study was to do a cost utility analysis of the intervention . Methods : The intervention group ( n=196 ) was compared with a control group ( n=346 ) , and a  cost utility analysis was performed . The analysis was carried out with three different time perspectives . Data were source d from official documents and medical and social records . Results : From a societal perspective , using a time period of 4 years , the analysis of PHVs to healthy seniors showed net savings . When including estimated future costs for health and elderly care during gained life years , the result changed from a net saving to a cost of Euro 200,000 . A lifetime perspective also result ed in net savings if the costs of future health and elderly care were not included in the analysis . In this case , the total costs rose to approximately Euro 900,000 . The cost could also be expressed as Euro 14,200 per quality -adjusted life year gained if future costs for elderly care and healthcare were included . Conclusions : PHVs represent a cost-effective intervention in this setting . The costs are justified by the outcomes Background : multifactorial falls prevention programmes for older people have been proved to reduce falls . However , evidence of their cost-effectiveness is mixed . Design : economic evaluation alongside pragmatic r and omised controlled trial . Intervention : r and omised trial of 364 people aged ≥70 , living in the community , recruited via GP and identified as high risk of falling . Both arms received a falls prevention information leaflet . The intervention arm were also offered a ( day hospital ) multidisciplinary falls prevention programme , including physiotherapy , occupational therapy , nurse , medical review and referral to other specialists . Measurements : self-reported falls , as collected in 12 monthly diaries . Levels of health re source use associated with the falls prevention programme , screening ( both attributed to intervention arm only ) and other health-care contacts were monitored . Mean NHS costs and falls per person per year were estimated for both arms , along with the incremental cost-effectiveness ratio ( ICER ) and cost effectiveness acceptability curve . Results : in the base-case analysis , the mean falls programme cost was £ 349 per person . This , coupled with higher screening and other health-care costs , result ed in a mean incremental cost of £ 578 for the intervention arm . The mean falls rate was lower in the intervention arm ( 2.07 per person/year ) , compared with the control arm ( 2.24 ) . The estimated ICER was £ 3,320 per fall averted . Conclusions : the estimated ICER was £ 3,320 per fall averted . Future research should focus on adherence to the intervention and an assessment of impact on quality of life OBJECTIVE To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women . DESIGN An economic evaluation carried out within a r and omised controlled trial with two years of follow up . Participants were individually prescribed an exercise programme ( exercise group , n=116 ) or received usual care and social visits ( control group , n=117 ) . SETTING 17 general practice s in Dunedin , New Zeal and . PARTICIPANTS Women aged 80 years and older living in the community and invited by their general practitioner to take part . MAIN OUTCOME MEASURES Number of falls and injuries related to falls , costs of implementing the intervention , healthcare service costs result ing from falls and total healthcare service costs during the trial . Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented . MAIN RESULTS 27 % of total hospital costs during the trial were related to falls . However , there were no significant differences in health service costs between the two groups . Implementing the exercise programme for one and two years respectively cost $ 314 and $ 265 ( 1995 New Zeal and dollars ) per fall prevented , and $ 457 and $ 426 per fall result ing in a moderate or serious injury prevented . CONCLUSIONS The costs result ing from falls make up a substantial proportion of the hospital costs for older people . Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs . However , the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies Summary We estimated the incremental cost-effectiveness of a once-weekly or twice-weekly resistance training intervention compared with balance and tone classes in terms of falls prevented and quality -adjusted life years ( QALYs ) gained . Both resistance training interventions were more likely to save health care re source money and offer better health outcomes for falls prevention than balance and tone classes . Introduction This study aims to estimate the incremental cost-effectiveness and cost-utility of a once-weekly or twice-weekly resistance training intervention compared with twice-weekly balance and tone classes in terms of falls prevented and QALYs gained . Methods Economic evaluation was conducted concurrently with a three-arm r and omized controlled trial including 155 community-dwelling women aged 65 to 75 years , Mini Mental State Examination ≥24 , and visual acuity 20/40 or better . Participants received the once-weekly resistance training ( n = 54 ) , the twice-weekly resistance training ( n = 51 ) or the twice-weekly balance and tone ( the comparator ) classes ( n = 50 ) for 1 year . Measurements included the number of falls for each participant , healthcare re source utilization , and associated costs over 9 months ; health status was assessed using the EQ-5D and SF-6D to calculate QALYs . Results Based on the point estimates from our base case analysis , we found that both once- and twice-weekly resistance training groups were less costly ( p < 0.05 ) and more effective than twice-weekly balance and tone classes . The incremental QALYs assessed using the SF-6D were 0.003 for both the once- and twice-weekly resistance training groups , compared with the twice-weekly balance and tone classes . The incremental QALYs assessed using the EQ-5D were 0.084 for the once-weekly and 0.179 for the twice-weekly resistance training groups , respectively , compared with the twice-weekly balance and tone classes . Conclusions An individually tailored resistance training intervention delivered once or twice weekly provided better value for money for falls prevention than balance and tone classes OBJECTIVE This longitudinal study was design ed to assess the effect of an educational training package for primary health care teams in accident prevention for older people , with reference to the incidence of accidents and their associated economic consequence . METHODS Nineteen general practice s in the West Midl and s serving a population of 138 397 were allocated r and omly at the practice level either to receive  training  or continue normal practice . Study data was collated from the initial telephone call , reporting an accident , to the surgery , advice/treatment given at the practice and /or the community , casualty , inpatient care , written correspondence to the patient 's GP and any subsequent follow-up visits for accidents to people aged 65 years or older . RESULTS One thous and , six hundred and sixty-six ( 8.2 % ) patients aged 65 years or older registered with the participating practice s experienced one accident or more , costing the NHS pound 1.4 million . Extrapolated nationally , annual costs to the NHS for accidents to older people amount to pound 568 million . The educational package had no significant impact on the incidence of accidents . A paucity of general safety advice was given [ 48 ( 1.8 % ) occasions ] . CONCLUSIONS Budgets are being eroded and patients are suffering unnecessarily due to lack of accident prevention advice . This should be considered a priority within the primary health care team . Educational packages alone do not appear to be a cost-effective approach to accident prevention in primary care OBJECTIVES This cluster-r and omised controlled trial assessed whether oral health care education ( OHCE ) for nursing home caregivers would achieve improvements in clients ' oral health . METHODS Twenty-two nursing homes were r and omly allocated to intervention or control group . Clients were examined at baseline and at follow-up visits 1- and 6-months after caregivers received OHCE . Main outcome measures were denture plaque , denture-induced stomatitis , dental plaque and gingivitis . Differences in group means/medians were compared with adjustment for cluster r and omisation . RESULTS Clients ' baseline oral health was poor . After OHCE , the intervention group 's oral health scores improved significantly . Reductions in denture plaque scores ( 0 - 4 scale ) exceeded those of the control group by 1.15 ( 95%CI=0.83 , 1.47 ) at 1 month and by 1.47 ( 95%CI=1.13 , 1.80 ) at 6 months . Denture-induced stomatitis prevalence reduced significantly over 6 months compared to the control group ( P<0.0001 ) . Group differences in favour of the intervention group were 0.41 ( 95%CI=0.18 , 0.65 ) at 1 month and 0.34 ( 95%CI=0.14 , 0.53 ) at 6 months for dental plaque ( 0 - 3 scale ) , and 0.17 ( 95%CI= -0.01 , 0.35 ) at 1 month and 0.28 ( 95%CI 0.15 , 0.42 ) at 6 months for gingivitis ( 0 - 2 scale ) . Key differences remained significant after adjustment for clustering effects . The provider 's costs would currently be approximately pounds 6700 per year to deliver the intervention to a Health Authority with 100 homes . CONCLUSIONS Although final levels of residents ' oral health were still short of ideal , this study clearly shows that , for a modest cost , OHCE can improve caregivers '  knowledge , attitudes and oral health care performance for elderly , functionally dependent clients OBJECTIVES To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults . DESIGN Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature . SETTING Model represents population level interventions . PARTICIPANTS No human subjects were involved in the study . MEASUREMENS : The last Cochrane data base review and meta-analyses of r and omized controlled trials categorized effective fall-prevention interventions into seven groups : medical management ( withdrawal ) of psychotropics , group tai chi , vitamin D supplementation , muscle and balance exercises , home modifications , multifactorial individualized programs for all elderly people , and multifactorial individualized treatments for high-risk frail elderly people . Fall-related hip fracture incidence was obtained from the literature . Salary figures for health professionals were based on Bureau of Labor Statistics data . Using an integrated healthcare system perspective , healthcare costs were estimated based on practice and studies on falls in older adults . Base case incremental cost utility ratios were calculated , and probabilistic sensitivity analyses were conducted . RESULTS Medical management of psychotropics and group tai chi were the least-costly , most-effective options , but they were also the least studied . Excluding these interventions , the least-expensive , most-effective options are  vitamin D supplementation and home modifications . Vitamin D supplementation costs less than home modifications , but home modifications cost only $ 14,794/ quality -adjusted life year ( QALY ) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi , home modification is most likely to have the highest economic benefit when QALYs are valued at $ 50,000 or $ 100,000 . CONCLUSION Of single interventions studied , management of psychotropics and tai chi reduces costs the most . Of more-studied interventions , home modifications provide the best value . These results must be interpreted in the context of the multifactorial nature of falls Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more  exercise sessions  . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement We examined the costs of a  physical activity ( PA ) and an educational comparison intervention .  424 older adults at risk for mobility disability were r and 
    Output:
    