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 BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible . Preventing progression to worsening frailty may benefit individuals and lower health/social care costs . However , we know little about effective approaches to preventing frailty progression . OBJECTIVES ( 1 ) To develop an evidence - and theory-based home-based health promotion intervention for older people with mild frailty . ( 2 ) To assess feasibility , costs and acceptability of ( i ) the intervention and ( ii ) a full-scale clinical effectiveness and cost-effectiveness r and omised controlled trial ( RCT ) . DESIGN Evidence review s , qualitative studies , intervention development and a feasibility RCT with process evaluation . INTERVENTION DEVELOPMENT Two systematic review s ( including systematic search es of 14 data bases and registries , 1990 - 2016 and 1980 - 2014 ) , a state-of-the-art review ( from inception to 2015 ) and policy review identified effective components for our intervention . We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people ( aged 65 - 94 years ) ( n = 44 ) , carers ( n = 12 ) and health/social care professionals ( n = 27 ) . These data , and our evidence review s , fed into development of the ' HomeHealth ' intervention in collaboration with older people and multidisciplinary stakeholders . ' HomeHealth ' comprised 3 - 6 sessions with a support worker trained in behaviour change techniques , communication skills , exercise , nutrition and mood . Participants addressed self-directed independence and well-being goals , supported through education , skills training , enabling individuals to overcome barriers , providing feedback , maximising motivation and promoting habit formation . FEASIBILITY RCT Single-blind RCT , individually r and omised to ' HomeHealth ' or treatment as usual ( TAU ) . SETTING Community setting s in London and Hertfordshire , UK . PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty . MAIN OUTCOME MEASURES Feasibility - recruitment , retention , acceptability and intervention costs . Clinical and health economic outcome data at 6 months included functioning , frailty status , well-being , psychological distress , quality of life , capability and NHS and societal service utilisation/costs . RESULTS We successfully recruited to target , with good 6-month retention ( 94 % ) . Trial procedures were acceptable with minimal missing data . Individual r and omisation was feasible . The intervention was acceptable , with good fidelity and modest delivery costs ( £ 307 per patient ) . A total of 96 % of participants identified at least one goal , which were mostly exercise related ( 73 % ) . We found significantly better functioning ( Barthel Index + 1.68 ; p = 0.004 ) , better grip strength ( + 6.48 kg ; p = 0.02 ) , reduced psychological distress ( 12-item General Health Question naire -3.92 ; p = 0.01 ) and increased capability-adjusted life-years [ + 0.017 ; 95 % confidence interval ( CI ) 0.001 to 0.031 ] at 6 months in the intervention arm than the TAU arm , with no differences in other outcomes . NHS and carer support costs were variable but , overall , were lower in the intervention arm than the TAU arm . The main limitation was difficulty maintaining outcome assessor blinding . CONCLUSIONS Evidence is lacking to inform frailty prevention service design , with no large-scale trials of multidomain interventions . From stakeholder/public perspectives , new frailty prevention services should be personalised and encompass multiple domains , particularly socialising and mobility , and can be delivered by trained non-specialists . Our multicomponent health promotion intervention was acceptable and delivered at modest cost . Our small study shows promise for improving clinical outcomes , including functioning and independence . A full-scale individually RCT is feasible . FUTURE WORK A large , definitive RCT of the HomeHealth service is warranted . STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials IS RCT N11986672 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 73 . See the NIHR Journals Library website for further project information 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 To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans . DESIGN Secondary objective of r and omized trial that assessed the effect of exercise counseling ( relative to usual care ) on physical performance , physical activity , function , disability , and medical re source use and cost . SETTING Veterans Affairs Medical Center , Durham , North Carolina . PARTICIPANTS Male veterans aged ≥70 years ( n = 398 ) . INTERVENTION An experienced health counselor provided baseline in-person exercise counseling , followed by telephone counseling at 2 , 4 , and 6 weeks , and monthly thereafter through one year . Each participant 's primary care physician provided initial endorsement of the intervention , followed by monthly automated telephone messages tailored to the patient . Individualized progress reports were mailed quarterly . MEASUREMENTS Intervention costs were assessed . Health care re source use and costs were estimated from enrollment through one year follow-up . The incremental cost of achieving clinical ly significant changes in major trial endpoints was calculated . RESULTS The total direct cost of the intervention per participant was $ 459 , 85 % of which was counselor effort . With overhead , program cost totaled $ 696 per participant . Medical costs during follow-up reached $ 10,418 with the intervention , versus $ 12,052 with usual care ( difference = -$1,634 ( 95 % confidence interval = -$4,683 to $ 1,416 ; P = .29 ) ) . Expressed in terms of short-term clinical outcomes , the intervention cost $ 4,971 per additional patient reaching target exercise levels , or $ 4,640 per patient achieving a clinical ly significant change in rapid gait speed . CONCLUSION Improvements in physical activity and rapid gait speed  in the physical activity counseling group were obtained at a cost that represents a small fraction of patients ' annual health care costs BACKGROUND Losing the ability to walk safely and independently is a major concern for many older adults . The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity ( PA ) intervention can delay the onset of major mobility disability . Our objective is to examine the re sources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention . METHODS The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability . They were recruited at eight field centers and r and omly assigned to either PA or health education . The PA program consisted of 50-minute center-based exercise 2 × weekly , augmented with home-based activity to achieve a goal of 150 min/wk of PA . Health education consisted of weekly workshops for 26 weeks , and monthly sessions thereafter . Analyses were conducted from a health system perspective , with a 2.6-year time horizon . RESULTS The average cost per participant over 2.6 years was US$ 3,302 and US$ 1,001 for the PA and health education interventions , respectively . PA participants accrued 0.047 per person more Quality -Adjusted Life-Years ( QALYs ) than health education participants . PA interventions costs were slightly higher than other recent PA interventions . The incremental cost-effectiveness ratios were US$ 42,376/major mobility disability prevented and US$ 49,167/QAL 
    Output:
    
agent
Disregarding these method ological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and , hence , an age-based rationing of public health care
***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 BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible . Preventing progression to worsening frailty may benefit individuals and lower health/social care costs . However , we know little about effective approaches to preventing frailty progression . OBJECTIVES ( 1 ) To develop an evidence - and theory-based home-based health promotion intervention for older people with mild frailty . ( 2 ) To assess feasibility , costs and acceptability of ( i ) the intervention and ( ii ) a full-scale clinical effectiveness and cost-effectiveness r and omised controlled trial ( RCT ) . DESIGN Evidence review s , qualitative studies , intervention development and a feasibility RCT with process evaluation . INTERVENTION DEVELOPMENT Two systematic review s ( including systematic search es of 14 data bases and registries , 1990 - 2016 and 1980 - 2014 ) , a state-of-the-art review ( from inception to 2015 ) and policy review identified effective components for our intervention . We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people ( aged 65 - 94 years ) ( n = 44 ) , carers ( n = 12 ) and health/social care professionals ( n = 27 ) . These data , and our evidence review s , fed into development of the ' HomeHealth ' intervention in collaboration with older people and multidisciplinary stakeholders . ' HomeHealth ' comprised 3 - 6 sessions with a support worker trained in behaviour change techniques , communication skills , exercise , nutrition and mood . Participants addressed self-directed independence and well-being goals , supported through education , skills training , enabling individuals to overcome barriers , providing feedback , maximising motivation and promoting habit formation . FEASIBILITY RCT Single-blind RCT , individually r and omised to ' HomeHealth ' or treatment as usual ( TAU ) . SETTING Community setting s in London and Hertfordshire , UK . PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty . MAIN OUTCOME MEASURES Feasibility - recruitment , retention , acceptability and intervention costs . Clinical and health economic outcome data at 6 months included functioning , frailty status , well-being , psychological distress , quality of life , capability and NHS and societal service utilisation/costs . RESULTS We successfully recruited to target , with good 6-month retention ( 94 % ) . Trial procedures were acceptable with minimal missing data . Individual r and omisation was feasible . The intervention was acceptable , with good fidelity and modest delivery costs ( £ 307 per patient ) . A total of 96 % of participants identified at least one goal , which were mostly exercise related ( 73 % ) . We found significantly better functioning ( Barthel Index + 1.68 ; p = 0.004 ) , better grip strength ( + 6.48 kg ; p = 0.02 ) , reduced psychological distress ( 12-item General Health Question naire -3.92 ; p = 0.01 ) and increased capability-adjusted life-years [ + 0.017 ; 95 % confidence interval ( CI ) 0.001 to 0.031 ] at 6 months in the intervention arm than the TAU arm , with no differences in other outcomes . NHS and carer support costs were variable but , overall , were lower in the intervention arm than the TAU arm . The main limitation was difficulty maintaining outcome assessor blinding . CONCLUSIONS Evidence is lacking to inform frailty prevention service design , with no large-scale trials of multidomain interventions . From stakeholder/public perspectives , new frailty prevention services should be personalised and encompass multiple domains , particularly socialising and mobility , and can be delivered by trained non-specialists . Our multicomponent health promotion intervention was acceptable and delivered at modest cost . Our small study shows promise for improving clinical outcomes , including functioning and independence . A full-scale individually RCT is feasible . FUTURE WORK A large , definitive RCT of the HomeHealth service is warranted . STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials IS RCT N11986672 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 73 . See the NIHR Journals Library website for further project information 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 To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans . DESIGN Secondary objective of r and omized trial that assessed the effect of exercise counseling ( relative to usual care ) on physical performance , physical activity , function , disability , and medical re source use and cost . SETTING Veterans Affairs Medical Center , Durham , North Carolina . PARTICIPANTS Male veterans aged ≥70 years ( n = 398 ) . INTERVENTION An experienced health counselor provided baseline in-person exercise counseling , followed by telephone counseling at 2 , 4 , and 6 weeks , and monthly thereafter through one year . Each participant 's primary care physician provided initial endorsement of the intervention , followed by monthly automated telephone messages tailored to the patient . Individualized progress reports were mailed quarterly . MEASUREMENTS Intervention costs were assessed . Health care re source use and costs were estimated from enrollment through one year follow-up . The incremental cost of achieving clinical ly significant changes in major trial endpoints was calculated . RESULTS The total direct cost of the intervention per participant was $ 459 , 85 % of which was counselor effort . With overhead , program cost totaled $ 696 per participant . Medical costs during follow-up reached $ 10,418 with the intervention , versus $ 12,052 with usual care ( difference = -$1,634 ( 95 % confidence interval = -$4,683 to $ 1,416 ; P = .29 ) ) . Expressed in terms of short-term clinical outcomes , the intervention cost $ 4,971 per additional patient reaching target exercise levels , or $ 4,640 per patient achieving a clinical ly significant change in rapid gait speed . CONCLUSION Improvements in physical activity and rapid gait speed  in the physical activity counseling group were obtained at a cost that represents a small fraction of patients ' annual health care costs BACKGROUND Losing the ability to walk safely and independently is a major concern for many older adults . The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity ( PA ) intervention can delay the onset of major mobility disability . Our objective is to examine the re sources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention . METHODS The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability . They were recruited at eight field centers and r and omly assigned to either PA or health education . The PA program consisted of 50-minute center-based exercise 2 × weekly , augmented with home-based activity to achieve a goal of 150 min/wk of PA . Health education consisted of weekly workshops for 26 weeks , and monthly sessions thereafter . Analyses were conducted from a health system perspective , with a 2.6-year time horizon . RESULTS The average cost per participant over 2.6 years was US$ 3,302 and US$ 1,001 for the PA and health education interventions , respectively . PA participants accrued 0.047 per person more Quality -Adjusted Life-Years ( QALYs ) than health education participants . PA interventions costs were slightly higher than other recent PA interventions . The incremental cost-effectiveness ratios were US$ 42,376/major mobility disability prevented and US$ 49,167/QAL 
    Output:
    