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: Background In the UK public concern about the safety of the combined measles , mumps and rubella [ MMR ] vaccine continues to impact on MMR coverage . Whilst the sharp decline in uptake has begun to level out , first and second dose uptake rates remain short of that required for population immunity . Furthermore , international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children . Together , this work suggests that effective interventions are required to support parents to make informed decisions about MMR.This trial assessed the impact of a parent-centred , multi-component intervention ( balanced information , group discussion , coaching exercise ) on informed parental decision-making for MMR . Methods This was a two arm , cluster r and omised trial . One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organisations . The intervention arm received an MMR information leaflet and participated in the intervention ( parent meeting ) . The control arm received the leaflet only . The primary outcome was decisional conflict . Secondary outcomes were actual and intended MMR choice , knowledge , attitude , concern and necessity beliefs about MMR and anxiety . Results Decisional conflict decreased for both arms to a level where an ' effective ' MMR decision could be made one-week ( effect estimate = -0.54 , p < 0.001 ) and three-months ( effect estimate = -0.60 , p < 0.001 ) post-intervention . There was no significant difference between arms ( effect estimate = 0.07 , p = 0.215 ) . Heightened decisional conflict was evident for parents making the MMR decision for their first child ( effect estimate = -0.25 , p = 0.003 ) , who were concerned ( effect estimate = 0.07 , p < 0.001 ) , had less positive attitudes ( effect estimate = -0.20 , p < 0.001 ) yet stronger intentions ( effect estimate = 0.09 , p = 0.006 ) . Significantly more parents in the intervention arm reported vaccinating their child ( 93 % versus 73 % , p = 0.04 ) . Conclusions Whilst both the leaflet and the parent meeting reduced parents ' decisional conflict , the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake Uptake of the measles , mumps , and rubella vaccine in the United Kingdom has declined to levels that will allow outbreaks of these preventable diseases to occur . A leaflet sent with a personalized reminder did not increase vaccine uptake in children who had not been immunised at 21 months of age BACKGROUND While the Advisory Committee on Immunization Practice s recommends a st and ing order as the most effective mechanism to increase pneumococcal and influenza vaccination rates , Georgia 's Medical Practice Act does not authorize nurses to screen , order , and administer adult vaccines in inpatient setting s. METHODS The setting was a 1000-bed public teaching hospital in metropolitan Atlanta . A 1-month intervention ( INT1 ) included four wards r and omized to intervention or control . A 5-month hospital-wide intervention ( INT2 ) followed INT1 . The intervention used was provider reminder with in-service training .  Chart review was the measure used . The main outcome was pneumococcal vaccination prior to discharge . RESULTS During INT1 , 534 patients ( 296 intervention and 238 control ) were discharged . Of the 534 patients , 475 ( 89.0 % ) were African American , 188 ( 35.2 % ) were uninsured , and the median age was 48 ( range 19 to 96 ) . Of the 205 intervention patients with vaccine indications and no contraindications , 78 of 205 ( 38 % ) were vaccinated compared to 7 of 143 ( 4.9 % ) of the control patients ( p<0.001 ) . During INT2 , 879 patient charts were review ed . Patient demographics were similar to INT1 . However , of 554 eligible patients , 16 % were vaccinated , significantly higher than control floors during INT1 ( p<0.001 ) . Although nurses initiated the form almost 70 % of the time , physicians assessed fewer than 35 % of patients with indications . CONCLUSIONS Significantly higher proportions of high-risk patients were vaccinated through the use of a preprinted nurse screening and physician order form . However , a significant percentage of patients did not receive the vaccine owing to the physician 's failure to order it . In these cases , use of st and ing orders would have further increased vaccination rates while also promoting a more sustainable program Background Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality . However , childhood vaccination coverage remains sub-optimal in many setting s. While communication is a key feature of vaccination programmes , we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage . Developing a classification system ( taxonomy ) organised into conceptually similar categories will aid in : underst and ing the relationships between different types of communication interventions ; facilitating conceptual mapping of these interventions ; clarifying the key purpose s and features of interventions to aid implementation and evaluation ; and identifying areas where evidence is strong and where there are gaps . This paper reports on the development of the ‘ Communicate to vaccinate ’ taxonomy . Methods The taxonomy was developed in two stages . Stage 1 included : 1 ) forming an advisory group ; 2 ) search ing for descriptions of interventions in trials ( CENTRAL data base ) and general health literature ( Medline ) ; 3 ) developing a sampling strategy ; 4 ) screening the search results ; 5 ) developing a data extraction form ; and 6 ) extracting intervention data . Stage 2 included : 1 ) grouping the interventions according to purpose ; 2 ) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback ; 3 ) conducting a targeted search of grey literature to supplement the taxonomy ; 4 ) finalising the taxonomy based on the input provided . Results The taxonomy includes seven main categories of communication interventions : inform or educate , remind or recall , teach skills , provide support , facilitate decision making , enable communication and enhance community ownership . These categories are broken down into 43 intervention types across three target groups : parents or soon-to-be-parents ; communities , community members or volunteers ; and health care providers . Conclusions Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake . We have utilised a variety of data sources , capturing information from rigorous evaluations such as r and omised trials as well as experiences and knowledge of practitioners and vaccination stakeholders . The taxonomy reflects current public health practice and can guide the future development of vaccination programmes Background Household decision-makers decide about service use based largely on the costs and perceived benefits of health interventions . Very often this leads to different decisions than those imagined by health planners , result ing in under-utilisation of public services like immunisation . In the case of Lasbela district in the south of Pakistan , only one in every ten children is immunised despite free immunisation offers by government health services . Methods / design In 32 communities representative of Lasbela district , 3344 households participated in a baseline survey on early child health . In the 18 r and omly selected intervention communities , we will stimulate discussion s on the household cost-benefit equation , as measured in the baseline . The reference ( control ) communities will also participate in the three annual follow-up surveys , feedback of the general survey results and the usual health promotion activities relating to immunisation , but without focussed discussion on the household cost-benefit equations . Discussion This project proposes knowledge translation as a two-way communication that can be augmented by local and international evidence . We will document cultural and context ual barriers to immunisation in the context of household cost-benefit equations . The project makes this information accessible to health managers , and reciprocally , makes information on immunisation effects and side effects available to communities . We will measure the impact of this two-way knowledge translation on immunisation uptake Background Maternal , perinatal and neonatal mortality remains high in low-income countries . We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi . Methods We evaluated a rural participatory women ’s group community intervention ( CI ) and a quality improvement intervention at health centres ( FI ) via a two-by-two factorial cluster r and omized controlled trial . Consenting pregnant women were followed-up to 2 months after birth using key informants . Primary outcomes were maternal , perinatal and neonatal mortality . Clusters were health centre catchment areas assigned using stratified computer-generated r and omization . Following exclusions , including non-birthing facilities , 61 clusters were analysed : control ( 17 clusters , 4912 births ) , FI ( 15 , 5335 ) , CI ( 15 , 5080 ) and FI + CI ( 14 , 5249 ) . This trial was registered as International St and ard R and omised Controlled Trial [ IS RCT N18073903 ] . Outcomes for 14 576 and 20 576 births were recorded during baseline ( June 2007–September 2008 ) and intervention ( October 2008–December 2010 ) periods . Results For control , FI , CI and FI + CI clusters neonatal mortality rates were 34.0 , 28.3 , 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2 , 55.1 , 48.0 and 48.4 per 1000 births , during the intervention period . Adjusting for clustering and stratification , the neonatal mortality rate was 22 % lower in FI + CI than control clusters ( OR = 0.78 , 95 % CI 0.60–1.01 ) , and the perinatal mortality rate was 16 % lower in CI clusters ( OR = 0.84 , 95 % CI 0.72–0.97 ) . We did not observe any intervention effects on maternal mortality . Conclusions Despite implementation problems , a combined community and facility approach using participatory women ’s groups and quality improvement at health centres reduced newborn mortality in rural Malawi BACKGROUND Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years . 90 % of deliveries in the poorest quintile of households happen at home . We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates . METHODS We pair-matched 42 geopolitical clusters in Makwanpur district , Nepal , selected 12 pairs r and omly , and r and omly assigned one of each pair to intervention or control . In each intervention cluster ( average population 7000 ) , a female facilitator convened nine women 's group meetings every month . The facilitator supported groups through an action-learning cycle in which they identified local perinatal problems and formulated strategies to address them . We monitored birth outcomes in a cohort of 28?931 women , of whom 8 % joined the groups . The primary outcome was neonatal mortality rate . Other outcomes included stillbirths and maternal deaths , uptake of antenatal and delivery services , home care practice s , infant morbidity , and health-care seeking . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N31137309 . FINDINGS From 2001 to 2003 , the neonatal mortality rate was 26.2 per 1000 ( 76 deaths per 2899 livebirths ) in intervention clusters compared with 36.9 per 1000 ( 119 deaths per 3226 livebirths ) in controls ( adjusted odds ratio 0.70 [ 95 % CI 0.53 - 0.94 ] ) . Stillbirth rates were similar in both groups . The maternal mortality ratio was 69 per 100000 ( two deaths per 2899 livebirths ) in intervention clusters compared with 341 per 100000 ( 11 deaths per 3226 livebirths ) in control clusters ( 0.22 [ 0.05 - 0.90 ] ) . Women in intervention clusters were more likely to have antenatal care , institutional delivery , trained birth attendance , and hygienic care than were controls . INTERPRETATION Birth outcomes in a poor rural population improved greatly through a low cost , potentially sustainable and scalable , participatory intervention with women 's groups The widespread decline in uptake of the measles , mumps and rubella ( MMR ) vaccine started when an association between vaccination and Crohn ’s disease was suggested by research ers at the Royal Free Hospital and elsewhere in a series of papers published between 1993 and 1996 . It accelerated after February 1998 when the same workers hypothesized an association with autism through a putative mechanism of enterocolitis and toxin absorption . The widespread media coverage that the papers received result ed in a substantial minority of parents being misled into believing that there was a large body of medical opinion suspicious of MMR .  Uptake of MMR vaccine  began to decline rapidly and the incidence of measles and mumps infections increased . Novel methods of improving uptake of MMR vaccine  have been explored , but the authors ’ approach – to issue teddy bears wearing T-shirts displaying a website address and telephone number that provided information about MMR – has not been described previously . A pragmatic r and omized controlled trial was design ed with prospect i ve selection of subjects . 
    Output:
    
agent
***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: Background In the UK public concern about the safety of the combined measles , mumps and rubella [ MMR ] vaccine continues to impact on MMR coverage . Whilst the sharp decline in uptake has begun to level out , first and second dose uptake rates remain short of that required for population immunity . Furthermore , international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children . Together , this work suggests that effective interventions are required to support parents to make informed decisions about MMR.This trial assessed the impact of a parent-centred , multi-component intervention ( balanced information , group discussion , coaching exercise ) on informed parental decision-making for MMR . Methods This was a two arm , cluster r and omised trial . One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organisations . The intervention arm received an MMR information leaflet and participated in the intervention ( parent meeting ) . The control arm received the leaflet only . The primary outcome was decisional conflict . Secondary outcomes were actual and intended MMR choice , knowledge , attitude , concern and necessity beliefs about MMR and anxiety . Results Decisional conflict decreased for both arms to a level where an ' effective ' MMR decision could be made one-week ( effect estimate = -0.54 , p < 0.001 ) and three-months ( effect estimate = -0.60 , p < 0.001 ) post-intervention . There was no significant difference between arms ( effect estimate = 0.07 , p = 0.215 ) . Heightened decisional conflict was evident for parents making the MMR decision for their first child ( effect estimate = -0.25 , p = 0.003 ) , who were concerned ( effect estimate = 0.07 , p < 0.001 ) , had less positive attitudes ( effect estimate = -0.20 , p < 0.001 ) yet stronger intentions ( effect estimate = 0.09 , p = 0.006 ) . Significantly more parents in the intervention arm reported vaccinating their child ( 93 % versus 73 % , p = 0.04 ) . Conclusions Whilst both the leaflet and the parent meeting reduced parents ' decisional conflict , the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake Uptake of the measles , mumps , and rubella vaccine in the United Kingdom has declined to levels that will allow outbreaks of these preventable diseases to occur . A leaflet sent with a personalized reminder did not increase vaccine uptake in children who had not been immunised at 21 months of age BACKGROUND While the Advisory Committee on Immunization Practice s recommends a st and ing order as the most effective mechanism to increase pneumococcal and influenza vaccination rates , Georgia 's Medical Practice Act does not authorize nurses to screen , order , and administer adult vaccines in inpatient setting s. METHODS The setting was a 1000-bed public teaching hospital in metropolitan Atlanta . A 1-month intervention ( INT1 ) included four wards r and omized to intervention or control . A 5-month hospital-wide intervention ( INT2 ) followed INT1 . The intervention used was provider reminder with in-service training .  Chart review was the measure used . The main outcome was pneumococcal vaccination prior to discharge . RESULTS During INT1 , 534 patients ( 296 intervention and 238 control ) were discharged . Of the 534 patients , 475 ( 89.0 % ) were African American , 188 ( 35.2 % ) were uninsured , and the median age was 48 ( range 19 to 96 ) . Of the 205 intervention patients with vaccine indications and no contraindications , 78 of 205 ( 38 % ) were vaccinated compared to 7 of 143 ( 4.9 % ) of the control patients ( p<0.001 ) . During INT2 , 879 patient charts were review ed . Patient demographics were similar to INT1 . However , of 554 eligible patients , 16 % were vaccinated , significantly higher than control floors during INT1 ( p<0.001 ) . Although nurses initiated the form almost 70 % of the time , physicians assessed fewer than 35 % of patients with indications . CONCLUSIONS Significantly higher proportions of high-risk patients were vaccinated through the use of a preprinted nurse screening and physician order form . However , a significant percentage of patients did not receive the vaccine owing to the physician 's failure to order it . In these cases , use of st and ing orders would have further increased vaccination rates while also promoting a more sustainable program Background Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality . However , childhood vaccination coverage remains sub-optimal in many setting s. While communication is a key feature of vaccination programmes , we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage . Developing a classification system ( taxonomy ) organised into conceptually similar categories will aid in : underst and ing the relationships between different types of communication interventions ; facilitating conceptual mapping of these interventions ; clarifying the key purpose s and features of interventions to aid implementation and evaluation ; and identifying areas where evidence is strong and where there are gaps . This paper reports on the development of the ‘ Communicate to vaccinate ’ taxonomy . Methods The taxonomy was developed in two stages . Stage 1 included : 1 ) forming an advisory group ; 2 ) search ing for descriptions of interventions in trials ( CENTRAL data base ) and general health literature ( Medline ) ; 3 ) developing a sampling strategy ; 4 ) screening the search results ; 5 ) developing a data extraction form ; and 6 ) extracting intervention data . Stage 2 included : 1 ) grouping the interventions according to purpose ; 2 ) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback ; 3 ) conducting a targeted search of grey literature to supplement the taxonomy ; 4 ) finalising the taxonomy based on the input provided . Results The taxonomy includes seven main categories of communication interventions : inform or educate , remind or recall , teach skills , provide support , facilitate decision making , enable communication and enhance community ownership . These categories are broken down into 43 intervention types across three target groups : parents or soon-to-be-parents ; communities , community members or volunteers ; and health care providers . Conclusions Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake . We have utilised a variety of data sources , capturing information from rigorous evaluations such as r and omised trials as well as experiences and knowledge of practitioners and vaccination stakeholders . The taxonomy reflects current public health practice and can guide the future development of vaccination programmes Background Household decision-makers decide about service use based largely on the costs and perceived benefits of health interventions . Very often this leads to different decisions than those imagined by health planners , result ing in under-utilisation of public services like immunisation . In the case of Lasbela district in the south of Pakistan , only one in every ten children is immunised despite free immunisation offers by government health services . Methods / design In 32 communities representative of Lasbela district , 3344 households participated in a baseline survey on early child health . In the 18 r and omly selected intervention communities , we will stimulate discussion s on the household cost-benefit equation , as measured in the baseline . The reference ( control ) communities will also participate in the three annual follow-up surveys , feedback of the general survey results and the usual health promotion activities relating to immunisation , but without focussed discussion on the household cost-benefit equations . Discussion This project proposes knowledge translation as a two-way communication that can be augmented by local and international evidence . We will document cultural and context ual barriers to immunisation in the context of household cost-benefit equations . The project makes this information accessible to health managers , and reciprocally , makes information on immunisation effects and side effects available to communities . We will measure the impact of this two-way knowledge translation on immunisation uptake Background Maternal , perinatal and neonatal mortality remains high in low-income countries . We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi . Methods We evaluated a rural participatory women ’s group community intervention ( CI ) and a quality improvement intervention at health centres ( FI ) via a two-by-two factorial cluster r and omized controlled trial . Consenting pregnant women were followed-up to 2 months after birth using key informants . Primary outcomes were maternal , perinatal and neonatal mortality . Clusters were health centre catchment areas assigned using stratified computer-generated r and omization . Following exclusions , including non-birthing facilities , 61 clusters were analysed : control ( 17 clusters , 4912 births ) , FI ( 15 , 5335 ) , CI ( 15 , 5080 ) and FI + CI ( 14 , 5249 ) . This trial was registered as International St and ard R and omised Controlled Trial [ IS RCT N18073903 ] . Outcomes for 14 576 and 20 576 births were recorded during baseline ( June 2007–September 2008 ) and intervention ( October 2008–December 2010 ) periods . Results For control , FI , CI and FI + CI clusters neonatal mortality rates were 34.0 , 28.3 , 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2 , 55.1 , 48.0 and 48.4 per 1000 births , during the intervention period . Adjusting for clustering and stratification , the neonatal mortality rate was 22 % lower in FI + CI than control clusters ( OR = 0.78 , 95 % CI 0.60–1.01 ) , and the perinatal mortality rate was 16 % lower in CI clusters ( OR = 0.84 , 95 % CI 0.72–0.97 ) . We did not observe any intervention effects on maternal mortality . Conclusions Despite implementation problems , a combined community and facility approach using participatory women ’s groups and quality improvement at health centres reduced newborn mortality in rural Malawi BACKGROUND Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years . 90 % of deliveries in the poorest quintile of households happen at home . We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates . METHODS We pair-matched 42 geopolitical clusters in Makwanpur district , Nepal , selected 12 pairs r and omly , and r and omly assigned one of each pair to intervention or control . In each intervention cluster ( average population 7000 ) , a female facilitator convened nine women 's group meetings every month . The facilitator supported groups through an action-learning cycle in which they identified local perinatal problems and formulated strategies to address them . We monitored birth outcomes in a cohort of 28?931 women , of whom 8 % joined the groups . The primary outcome was neonatal mortality rate . Other outcomes included stillbirths and maternal deaths , uptake of antenatal and delivery services , home care practice s , infant morbidity , and health-care seeking . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N31137309 . FINDINGS From 2001 to 2003 , the neonatal mortality rate was 26.2 per 1000 ( 76 deaths per 2899 livebirths ) in intervention clusters compared with 36.9 per 1000 ( 119 deaths per 3226 livebirths ) in controls ( adjusted odds ratio 0.70 [ 95 % CI 0.53 - 0.94 ] ) . Stillbirth rates were similar in both groups . The maternal mortality ratio was 69 per 100000 ( two deaths per 2899 livebirths ) in intervention clusters compared with 341 per 100000 ( 11 deaths per 3226 livebirths ) in control clusters ( 0.22 [ 0.05 - 0.90 ] ) . Women in intervention clusters were more likely to have antenatal care , institutional delivery , trained birth attendance , and hygienic care than were controls . INTERPRETATION Birth outcomes in a poor rural population improved greatly through a low cost , potentially sustainable and scalable , participatory intervention with women 's groups The widespread decline in uptake of the measles , mumps and rubella ( MMR ) vaccine started when an association between vaccination and Crohn ’s disease was suggested by research ers at the Royal Free Hospital and elsewhere in a series of papers published between 1993 and 1996 . It accelerated after February 1998 when the same workers hypothesized an association with autism through a putative mechanism of enterocolitis and toxin absorption . The widespread media coverage that the papers received result ed in a substantial minority of parents being misled into believing that there was a large body of medical opinion suspicious of MMR .  Uptake of MMR vaccine  began to decline rapidly and the incidence of measles and mumps infections increased . Novel methods of improving uptake of MMR vaccine  have been explored , but the authors ’ approach – to issue teddy bears wearing T-shirts displaying a website address and telephone number that provided information about MMR – has not been described previously . A pragmatic r and omized controlled trial was design ed with prospect i ve selection of subjects . 
    Output:
    