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: OBJECTIVES To evaluate the cost-effectiveness of a 9-month preventive occupational therapy ( OT ) program in the Well-Elderly Study : a r and omized trial in independent-living older adults that found significant health , function , and quality of life benefits attributable to preventive OT . DESIGN A r and omized trial . SETTING Two government-subsidized apartment complexes . PARTICIPANTS One hundred sixty-three culturally diverse volunteers aged 60 and older . INTERVENTION An OT group , a social activity group ( active control ) , and a nontreatment group ( passive control ) . MEASUREMENTS Use of healthcare services was determined by telephone interview during and after the treatment phase . A conversion algorithm was applied to the R AND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index , quality -adjusted life years ( QALYs ) , and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group . RESULTS Costs for the 9-month OT program averaged $ 548 per subject . Postintervention healthcare costs were lower for the OT group ( $ 967 ) than for the active control group ( $ 1,726 ) , the passive control group ( $ 3,334 ) , or a combination of the control groups ( $ 2,593 ) . The quality of life index showed a 4.5 % QALY differential ( OT vs combined control ) , P < .001 . The cost per QALY estimates for the OT group was $ 10,666 ( 95 % confidence interval = $ 6,747-$25,430 ) . For the passive and active control groups , the corresponding costs per QALY were $ 13,784 and $ 7,820 , respectively . CONCLUSION In this study , preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures Background Workplace mental health promotion ( WMHP ) aims to prevent and effectively manage the social and economic costs of common mental illnesses such as depression . The mental health of managers and employees within small-medium enterprises ( SMEs ) is a neglected sector in occupational health research and practice , despite the fact that this sector is the most common work setting in most economies . The availability and propensity of SME staff to attend face-to-face training/therapy or workshop style interventions often seen in corporate or public sector work setting s is a widely recognised problem . The ' Business in Mind ' program employs a DVD mode of delivery that is convenient for SME managers , particularly those operating in regional and remote areas where internet delivery may not be optimal . The objective of the intervention program is to improve the mental health of SME managers , and examine whether employees of managers ' whose mental health improves , report positive change in their psychosocial work environment . The mechanisms via which we aim to improve managers ' mental health are through the development of their psychological capital ( a higher order construct comprised of hope , self efficacy , resilience and optimism ) and their skills and capacities for coping with work stress . Methods / Design The effectiveness of two versions of the program ( self administered and telephone facilitated ) will be assessed using a r and omised trial with an active control condition ( psychoeducation only ) . We aim to recruit a minimum of 249 managers and a sample of their employees . This design allows for 83 managers per group , as power analyses showed that this number would allow for attrition of 20 % and still enable detection of an effect size of 0.5 . The intervention will be implemented over a three month period and postal surveys will assess managers and employees in each group at baseline , intervention completion , and at 6 month follow up . The intervention groups ( managers only ) will also be assessed at 12 and 24 month follow-up to examine maintenance of effects . Primary outcomes are managers ' levels of psychological capital ( hope , resilience , self-efficacy and optimism ) , coping strategies , anxiety and depression symptoms , self-reported health , job satisfaction and job tension . Secondary outcomes are participating managers subordinates ' perceptions of manager support , relational justice , emotional climate and job tension . In order to provide an economic evaluation of the intervention , both employees and manager rates of absenteeism and presenteeism will also be assessed . Discussion The intervention being trialled is expected to improve both primary and secondary outcomes . If proven efficacious , the intervention could be disseminated to reach a much larger proportion of the business community . Trial registration Current controlled trials IS RCT N Background  Depression in older adults is a serious health problem with a poor prognosis . There is a need for indicated preventive psychological interventions for older adults , that show to be promising in preventing depressive disorders . Methods / design This manuscript describes the design of a study evaluating ' Looking for Meaning ' , a newly developed prevention course for older adults with depressive symptoms , based on life- review . Both clinical and economic effectiveness are evaluated in a pragmatic r and omized controlled trial . The control condition of this 12-session preventive intervention is a 20-minute video movie . The primary outcome is symptoms of depression at post-treatment and follow-up ( 6 months after post-treatment ) . Secondary outcomes are symptoms of anxiety , satisfaction with life , mastery , reminiscence styles , quality of life , and health care costs . An additional result of this study is the insight into the working elements of the course , provided by the qualitative study . The qualitative data , mainly based on 20 open-ended interviews with participants , are to be analyzed with an emphasis on newly emerging insight . Discussion This study will add to the existing scientific knowledge in several ways , especially by also including an economic evaluation and a qualitative study to gain insight into the working mechanisms of the course , both rather new in the field of life review . Positive results of this study will make an evidence -based intervention to improve public health among older people available . Trial registration Current Controlled Trials Ltd , IS RCT OBJECTIVES : To evaluate the effectiveness of a home visiting program on health-related measures in a population of older people with poor health status . DESIGN : R and omized , clinical trial . SETTING : Community-dwelling citizens in the Netherl and s. PARTICIPANTS : Three hundred thirty people aged 70 to 84 r and omly assigned to an intervention group ( n=160 ) or a control group ( n=170 ) . INTERVENTION : Eight home visits , lasting 1 hour or more , with telephone follow-up , over an 18-month period , conducted by experienced home nurses under supervision of a public health nurse ; key elements of the ( systematic ) visits were assessment of health problems and risks , advice , and referral to professional and community services . MEASUREMENTS : Self-rated health , functional status , quality of life , and changes in self-reported problems . RESULTS : No differences were found between the intervention and control group in these and other outcome measures at the end of the intervention Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service Study objective : To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on  maternal and child health outcomes . Design : R and omised controlled trial with economic and process evaluations and follow up at 12 and 18 months . The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor ( SHV ) , or a year of support from community groups providing drop in sessions , home visiting and /or telephone support ( CGS ) . Each was compared with a control group that received st and ard health visitor services . Setting : Two disadvantaged boroughs of London , United Kingdom . Participants : 731 women from culturally diverse background s with infants . Main results : At 12 and 18 months , there was little impact for either intervention on the main outcomes : child injury ( SHV : relative risk 0.99 ; 95 % confidence intervals 0.68 to 1.45 , CGS : 0.91 ; 0.61 to1.36 ) , maternal smoking ( SHV : 0.86 ; 0.62 to 1.19 , CGS : 0.97 ; 0.72 to 1.33 ) or maternal depression ( SHV : 0.86 ; 0.62 to1.19 , CGS : 0.93 ; 0.69 to 1.27 ) . SHV women had different patterns of health service use ( with fewer taking their children to the GP ) and had less anxious experiences of motherhood than control women . User satisfaction with the SHV intervention was high . Uptake of the CGS intervention was low : 19 % , compared with 94 % for the SHV intervention . Conclusions : There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population . The SHV intervention was associated with improvement in some of the secondary outcomes Background : The impact of depression on the workplace has been widely observed in studies examining absenteeism and reduced productivity during days at work . However , there is little scientific evidence about whether depression interventions are cost-beneficial to employers . Objective : We construct a cost – benefit analysis of depression treatment under different workplace assumptions better reflecting the nature of employment . Research Design : Data from a r and omized controlled trial in which employed primary care patients with depression were treated in practice s r and omly assigned to an enhanced treatment intervention or usual care were used to construct a cost – benefit model from an employer perspective under different assumptions regarding employment . Subjects : A national sample of 198 workers employed in a range of positions by companies was studied . Measures : Benefits included self-reported productivity and absenteeism ; costs included intervention and treatment costs . Net benefit was calculated under different scenarios and return on investment ( ROI ) is derived . Results : Enhanced depression treatment result ed in an average net benefit to the employer of $ 30 per participating worker in Year 1 of the intervention and $ 257 per participating worker in Year 2 , for an estimated ROI during the 2-year period of 302 % . ROI increased in firms that rely on team production , hire more costly substitute labor , or realize penalties for output shortfalls . ROI decreased in firms that have a large fraction of employees with dependent coverage and experience high turnover rates . Results also are sensitive to how subjectively reported productivity is valued . Conclusion : Many employers will receive a potentially significant ROI from depression treatment models that improve absenteeism and productivity at work Childhood psychological conditions including depression and substance abuse are a growing concern among American children , but their long-term economic costs are unknown . This paper uses unique data from the US Panel Study of Income Dynamics ( PSID ) following groups of siblings and their parents for up to 40 years prospect ively collecting information on education , income , work  , and marriage . Following siblings offers an opportunity to control for unobserved family and neighborhood effects . A retrospective child health history design ed by the author was placed into the 2007 PSID wave measuring whether respondents had any of 14 childhood physical illnesses or suffered from depression , substance abuse , or other psychological conditions . Large effects are found on the ability of affected children to work and earn as adults . Educational accomplishments are diminished , and adult family incomes are reduced by 20 % or $ 10,400 per year with $ 18,000 less family household assets . Lost income is partly a consequence of seven fewer weeks worked per year . There is also an 11 % point lower probability of being married . Controlling for physical childhood diseases shows that these effects are not due to the co-existence of psychological and physical diseases , and estimates controlling for within-sibling differences demonstrate that these effects are not due to unobserved common family differences . The long-term economic damages of childhood psychological problems are large-a lifetime cost in lost family income of approximately $ 300,000 , and total lifetime economic cost for all those affected of 2.1 trillion dollars Objective To investigate the cost effectiveness of a parenting programme . Design An incremental cost effectiveness analysis alongside a pragmatic r and omised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community . Setting Sure Start areas in north and mid Wales . Participants Parents of 116 children aged 36 - 59 months ( 87 % of the clinical sample ) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory ) . Children were identified by health visitors and recruited by the research team . Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control . Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory . Results The bootstrapped incremental cost effectiveness ratio point estimate was � 73 ( € 10 
    Output:
    
agent
Caution must therefore be exercised in interpreting results , but the case for investment in parenting and health visitor-related programmes appears most strong , especially when impacts beyond the health sector are taken into account .
In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects ( largely in the USA ) was reported , while group-based exercise and psychosocial interventions are of potential benefit to older people .
***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: OBJECTIVES To evaluate the cost-effectiveness of a 9-month preventive occupational therapy ( OT ) program in the Well-Elderly Study : a r and omized trial in independent-living older adults that found significant health , function , and quality of life benefits attributable to preventive OT . DESIGN A r and omized trial . SETTING Two government-subsidized apartment complexes . PARTICIPANTS One hundred sixty-three culturally diverse volunteers aged 60 and older . INTERVENTION An OT group , a social activity group ( active control ) , and a nontreatment group ( passive control ) . MEASUREMENTS Use of healthcare services was determined by telephone interview during and after the treatment phase . A conversion algorithm was applied to the R AND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index , quality -adjusted life years ( QALYs ) , and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group . RESULTS Costs for the 9-month OT program averaged $ 548 per subject . Postintervention healthcare costs were lower for the OT group ( $ 967 ) than for the active control group ( $ 1,726 ) , the passive control group ( $ 3,334 ) , or a combination of the control groups ( $ 2,593 ) . The quality of life index showed a 4.5 % QALY differential ( OT vs combined control ) , P < .001 . The cost per QALY estimates for the OT group was $ 10,666 ( 95 % confidence interval = $ 6,747-$25,430 ) . For the passive and active control groups , the corresponding costs per QALY were $ 13,784 and $ 7,820 , respectively . CONCLUSION In this study , preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures Background Workplace mental health promotion ( WMHP ) aims to prevent and effectively manage the social and economic costs of common mental illnesses such as depression . The mental health of managers and employees within small-medium enterprises ( SMEs ) is a neglected sector in occupational health research and practice , despite the fact that this sector is the most common work setting in most economies . The availability and propensity of SME staff to attend face-to-face training/therapy or workshop style interventions often seen in corporate or public sector work setting s is a widely recognised problem . The ' Business in Mind ' program employs a DVD mode of delivery that is convenient for SME managers , particularly those operating in regional and remote areas where internet delivery may not be optimal . The objective of the intervention program is to improve the mental health of SME managers , and examine whether employees of managers ' whose mental health improves , report positive change in their psychosocial work environment . The mechanisms via which we aim to improve managers ' mental health are through the development of their psychological capital ( a higher order construct comprised of hope , self efficacy , resilience and optimism ) and their skills and capacities for coping with work stress . Methods / Design The effectiveness of two versions of the program ( self administered and telephone facilitated ) will be assessed using a r and omised trial with an active control condition ( psychoeducation only ) . We aim to recruit a minimum of 249 managers and a sample of their employees . This design allows for 83 managers per group , as power analyses showed that this number would allow for attrition of 20 % and still enable detection of an effect size of 0.5 . The intervention will be implemented over a three month period and postal surveys will assess managers and employees in each group at baseline , intervention completion , and at 6 month follow up . The intervention groups ( managers only ) will also be assessed at 12 and 24 month follow-up to examine maintenance of effects . Primary outcomes are managers ' levels of psychological capital ( hope , resilience , self-efficacy and optimism ) , coping strategies , anxiety and depression symptoms , self-reported health , job satisfaction and job tension . Secondary outcomes are participating managers subordinates ' perceptions of manager support , relational justice , emotional climate and job tension . In order to provide an economic evaluation of the intervention , both employees and manager rates of absenteeism and presenteeism will also be assessed . Discussion The intervention being trialled is expected to improve both primary and secondary outcomes . If proven efficacious , the intervention could be disseminated to reach a much larger proportion of the business community . Trial registration Current controlled trials IS RCT N Background  Depression in older adults is a serious health problem with a poor prognosis . There is a need for indicated preventive psychological interventions for older adults , that show to be promising in preventing depressive disorders . Methods / design This manuscript describes the design of a study evaluating ' Looking for Meaning ' , a newly developed prevention course for older adults with depressive symptoms , based on life- review . Both clinical and economic effectiveness are evaluated in a pragmatic r and omized controlled trial . The control condition of this 12-session preventive intervention is a 20-minute video movie . The primary outcome is symptoms of depression at post-treatment and follow-up ( 6 months after post-treatment ) . Secondary outcomes are symptoms of anxiety , satisfaction with life , mastery , reminiscence styles , quality of life , and health care costs . An additional result of this study is the insight into the working elements of the course , provided by the qualitative study . The qualitative data , mainly based on 20 open-ended interviews with participants , are to be analyzed with an emphasis on newly emerging insight . Discussion This study will add to the existing scientific knowledge in several ways , especially by also including an economic evaluation and a qualitative study to gain insight into the working mechanisms of the course , both rather new in the field of life review . Positive results of this study will make an evidence -based intervention to improve public health among older people available . Trial registration Current Controlled Trials Ltd , IS RCT OBJECTIVES : To evaluate the effectiveness of a home visiting program on health-related measures in a population of older people with poor health status . DESIGN : R and omized , clinical trial . SETTING : Community-dwelling citizens in the Netherl and s. PARTICIPANTS : Three hundred thirty people aged 70 to 84 r and omly assigned to an intervention group ( n=160 ) or a control group ( n=170 ) . INTERVENTION : Eight home visits , lasting 1 hour or more , with telephone follow-up , over an 18-month period , conducted by experienced home nurses under supervision of a public health nurse ; key elements of the ( systematic ) visits were assessment of health problems and risks , advice , and referral to professional and community services . MEASUREMENTS : Self-rated health , functional status , quality of life , and changes in self-reported problems . RESULTS : No differences were found between the intervention and control group in these and other outcome measures at the end of the intervention Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service Study objective : To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on  maternal and child health outcomes . Design : R and omised controlled trial with economic and process evaluations and follow up at 12 and 18 months . The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor ( SHV ) , or a year of support from community groups providing drop in sessions , home visiting and /or telephone support ( CGS ) . Each was compared with a control group that received st and ard health visitor services . Setting : Two disadvantaged boroughs of London , United Kingdom . Participants : 731 women from culturally diverse background s with infants . Main results : At 12 and 18 months , there was little impact for either intervention on the main outcomes : child injury ( SHV : relative risk 0.99 ; 95 % confidence intervals 0.68 to 1.45 , CGS : 0.91 ; 0.61 to1.36 ) , maternal smoking ( SHV : 0.86 ; 0.62 to 1.19 , CGS : 0.97 ; 0.72 to 1.33 ) or maternal depression ( SHV : 0.86 ; 0.62 to1.19 , CGS : 0.93 ; 0.69 to 1.27 ) . SHV women had different patterns of health service use ( with fewer taking their children to the GP ) and had less anxious experiences of motherhood than control women . User satisfaction with the SHV intervention was high . Uptake of the CGS intervention was low : 19 % , compared with 94 % for the SHV intervention . Conclusions : There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population . The SHV intervention was associated with improvement in some of the secondary outcomes Background : The impact of depression on the workplace has been widely observed in studies examining absenteeism and reduced productivity during days at work . However , there is little scientific evidence about whether depression interventions are cost-beneficial to employers . Objective : We construct a cost – benefit analysis of depression treatment under different workplace assumptions better reflecting the nature of employment . Research Design : Data from a r and omized controlled trial in which employed primary care patients with depression were treated in practice s r and omly assigned to an enhanced treatment intervention or usual care were used to construct a cost – benefit model from an employer perspective under different assumptions regarding employment . Subjects : A national sample of 198 workers employed in a range of positions by companies was studied . Measures : Benefits included self-reported productivity and absenteeism ; costs included intervention and treatment costs . Net benefit was calculated under different scenarios and return on investment ( ROI ) is derived . Results : Enhanced depression treatment result ed in an average net benefit to the employer of $ 30 per participating worker in Year 1 of the intervention and $ 257 per participating worker in Year 2 , for an estimated ROI during the 2-year period of 302 % . ROI increased in firms that rely on team production , hire more costly substitute labor , or realize penalties for output shortfalls . ROI decreased in firms that have a large fraction of employees with dependent coverage and experience high turnover rates . Results also are sensitive to how subjectively reported productivity is valued . Conclusion : Many employers will receive a potentially significant ROI from depression treatment models that improve absenteeism and productivity at work Childhood psychological conditions including depression and substance abuse are a growing concern among American children , but their long-term economic costs are unknown . This paper uses unique data from the US Panel Study of Income Dynamics ( PSID ) following groups of siblings and their parents for up to 40 years prospect ively collecting information on education , income , work  , and marriage . Following siblings offers an opportunity to control for unobserved family and neighborhood effects . A retrospective child health history design ed by the author was placed into the 2007 PSID wave measuring whether respondents had any of 14 childhood physical illnesses or suffered from depression , substance abuse , or other psychological conditions . Large effects are found on the ability of affected children to work and earn as adults . Educational accomplishments are diminished , and adult family incomes are reduced by 20 % or $ 10,400 per year with $ 18,000 less family household assets . Lost income is partly a consequence of seven fewer weeks worked per year . There is also an 11 % point lower probability of being married . Controlling for physical childhood diseases shows that these effects are not due to the co-existence of psychological and physical diseases , and estimates controlling for within-sibling differences demonstrate that these effects are not due to unobserved common family differences . The long-term economic damages of childhood psychological problems are large-a lifetime cost in lost family income of approximately $ 300,000 , and total lifetime economic cost for all those affected of 2.1 trillion dollars Objective To investigate the cost effectiveness of a parenting programme . Design An incremental cost effectiveness analysis alongside a pragmatic r and omised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community . Setting Sure Start areas in north and mid Wales . Participants Parents of 116 children aged 36 - 59 months ( 87 % of the clinical sample ) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory ) . Children were identified by health visitors and recruited by the research team . Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control . Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory . Results The bootstrapped incremental cost effectiveness ratio point estimate was � 73 ( € 10 
    Output:
    