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 Biomass fuel is used as a primary cooking source by more than half of the world ’s population , contributing to a high burden of disease . Although cleaner fuels are available , some households continue using solid fuels because of financial constraints and absence of infrastructure , especially in non-notified slums . The present study documents a r and omised controlled study investigating the efficacy of improved cookstove on the personal exposure to air pollution and the respiratory health of women and children in an Indian slum . The improved cookstove was based on co-creation of a low-smoke chulha with local communities in order to support adaption and sustained uptake . Methods The study will be conducted in a non-notified slum called Ashrayanagar in Bangalore , India . The study design will be a 1:1 r and omised controlled intervention trial , including 250 households . The intervention group will receive an improved cookstove ( low-smoke chulha ) and the control group will continue using either the traditional cookstove ( chulha ) or a combination of the traditional stove and the kerosene/diesel stove . Follow-up time is 1 year . Outcomes include change in lung function ( FEV1/FVC ) , incidence of pneumonia , change in personal PM2.5 and CO exposure , incidence of respiratory symptoms ( cough , phlegm , wheeze and shortness of breath ) , prevalence of other related symptoms ( headache and burning eyes ) , change in behaviour and adoption of the stove . Ethical clearance was obtained from the Institutional Ethics Committee of the Indian Institute of Public Health Hyderabad- Bengaluru Campus . Discussion The findings from this study aim to provide insight into the effects of improved cookstoves in urban slums . Results can give evidence for the decrease of indoor air pollution and the improvement of respiratory health for children and women . Trial registration The trial was registered with clinical trials.gov on 21 June 2016 with the identifier NCT02821650 ; A Study to Test the Impact of an Improved Chulha on the Respiratory Health of Women and Children in Indian Slums Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries . We conducted a 5-month household r and omised controlled trial among 566 households in rural Rw and a to assess uptake , compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free . Compliance was measured monthly by self-report and spot-check observations . Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a r and om sub sample of 121 households to assess household air pollution  , while sample s of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms . Adoption was generally high , with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove . However , some householders continued to drink untreated water and most continued to cook on traditional stoves . The intervention was associated with a 97.5 % reduction in mean faecal indicator bacteria ( Williams means 0.5 vs. 20.2 TTC/100 mL , p<0.001 ) and a median reduction of 48 % of 24-h PM2.5 concentrations in the cooking area ( p = 0.005 ) . Further studies to increase compliance should be undertaken to better inform large-scale interventions . Trial registration : Clinical trials.gov ; NCT01882777 ; http:// clinical trials.gov/ct2/ results ? term = NCT01882777 & Search = Abstract Background : Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality , which can be prevented by simple low-cost interventions . Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously . Methods : We conducted a community-r and omized – controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package , consisting of improved solid-fuel stoves , kitchen sinks , solar disinfection of drinking water and hygiene promotion , reduces lower respiratory infections , diarrhoeal disease and improves growth in children younger than 36 months . The attention control group received an early child stimulation programme . Results : We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up  . Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm . This corresponds to a relative rate of 0.78 [ 95 % confidence interval ( CI ) : 0.58–1.05 ] for diarrhoea incidence and an odds ratio of 0.71 ( 95 % CI : 0.47–1.06 ) for diarrhoea prevalence . No effects on acute lower respiratory infections or children ’s growth rates were observed . Conclusions : Combined home-based environmental interventions slightly reduced  childhood diarrhoea , but the confidence interval included unity . Effects on growth and respiratory outcomes were not observed , despite high user compliance of the interventions . The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions Background and Objective RESPIRE , a r and omized trial of an improved cookstove , was conducted in Guatemala to assess health effects of long-term reductions in wood smoke exposure . Given the evidence that ambient particles increase blood pressure , we hypothesized that the intervention would lower blood pressure . Methods Two study design s were used : a ) between-group comparisons based on r and omized stove assignment , and b ) before- and -after comparisons within subjects before and after they received improved stoves . From 2003 to 2005 , we measured personal fine particle ( particulate matter with aerodynamic diameter < 2.5 μm ; PM2.5 ) exposures and systolic ( SBP ) and diastolic blood pressure ( DBP ) among women > 38 years of age from the chimney woodstove intervention group ( 49 subjects ) and traditional open wood fire control group ( 71 subjects ) . Measures were repeated up to three occasions . Results Daily average PM2.5 exposures were 264 and 102 μg/m3 in the control and intervention groups , respectively . After adjusting for age , body mass index , an asset index , smoking , secondh and tobacco smoke , apparent temperature , season , day of week , time of day , and a r and om subject intercept , the improved stove intervention was associated with 3.7 mm Hg lower SBP [ 95 % confidence interval ( CI ) , −8.1 to 0.6 ] and 3.0 mm Hg lower DBP ( 95 % CI , −5.7 to −0.4 ) compared with controls . In the second study design , among 55 control subjects measured both before and after receiving chimney stoves , similar associations were observed . Conclusion The between-group comparisons provide evidence , particularly for DBP , that the chimney stove reduces blood pressure , and the before- and -after comparisons are consistent with this evidence During the first r and omized intervention trial ( RESPIRE : R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) in air pollution epidemiology , we pioneered application of passive carbon monoxide ( CO ) diffusion tubes to measure long-term personal exposures to woodsmoke . Here we report on the protocol s and validations of the method , trends in personal exposure for mothers and their young children , and the efficacy of the introduced improved chimney stove in reducing personal exposures and kitchen concentrations . Passive diffusion tubes originally developed for industrial hygiene applications were deployed on a quarterly basis to measure 48-hour integrated personal carbon monoxide exposures among 515 children 0 - 18 months of age and 532 mothers aged 15 - 55 years and area sample s in a sub sample of 77 kitchens , in households r and omized into control and intervention groups . Instrument comparisons among types of passive diffusion tubes and against a continuous electrochemical CO monitor indicated that tubes responded nonlinearly to CO , and regression calibration was used to reduce this bias . Before stove introduction , the baseline arithmetic ( geometric ) mean 48-h child ( n=270 ) , mother ( n=529 ) and kitchen ( n=65 ) levels were , respectively , 3.4 ( 2.8 ) , 3.4 ( 2.8 ) and 10.2 ( 8.4 ) p.p.m . The between-group analysis of the 3355 post-baseline measurements found CO levels to be significantly lower among the intervention group during the trial period : kitchen levels : −90 % ; mothers : −61 % ; and children : −52 % in geometric means . No significant deterioration in stove effect was observed over the 18 months of surveillance . The reliability of these findings is strengthened by the large sample size made feasible by these unobtrusive and inexpensive tubes , measurement error reduction through instrument calibration , and a r and omized , longitudinal study design . These results from the first r and omized trial of improved household energy technology in a developing country and demonstrate that a simple chimney stove can substantially reduce chronic exposures to harmful indoor air pollutants among women and infants Efforts to introduce more efficient stoves increasingly leverage carbon-finance to scale up dissemination of interventions . We conducted a r and omized intervention study to evaluate a Clean Development Mechanism approved stove replacement impact on fuelwood usage , and climate and health-relevant air pollutants . We r and omly assigned 187 households to either receive the intervention or to continue using traditional stoves .  Measurements of fine particulate matter ( PM2.5 ) and absorbance were conducted in cooking areas , village center and at upwind background site . There were minor and overlapping seasonal differences ( post- minus preintervention change ) between control and intervention groups for median ( 95 % CI ) fuel use ( -0.60 ( -1.02 , -0.22 ) vs -0.52 ( -1.07 , 0.00 ) kg day(-1 ) ) , and 24 h absorbance ( 35 ( 18 , 60 ) vs 36 ( 22 , 50 ) × 10(-6 ) m(-1 ) ) ; for 24 h PM2.5 , there was a higher ( 139 ( 61,229 ) vs 73(-6 , 156 ) μg m(-3 ) ) ) increase in control compared to intervention homes between the two seasons . Forty percent of the intervention homes continued using traditional stoves . For intervention homes , absorbance-to-mass ratios suggest a higher proportion of black carbon in PM2.5 emitted from intervention compared with traditional stoves . Absent of field-based evaluation , stove interventions may be pursued that fail to realize expected carbon reductions or anticipated health and climate co benefits Background : Cooking with biomass fuels on open fires results in exposure to health-damaging pollutants such as carbon monoxide ( CO ) , polycyclic aromatic hydrocarbons ( PAHs ) , and particulate matter . Objective : We compared CO exposures and urinary PAH biomarkers pre- and postintervention with an improved biomass stove , the Patsari stove . Methods : In a sub sample of 63 women participating in a r and omized controlled trial in central Mexico , we measured personal CO exposure for 8 hr during the day using continuous monitors and passive sample rs . In addition , first-morning urine sample s obtained the next day were analyzed for monohydroxylated PAH metabolites by gas chromatography/isotope dilution/high-resolution mass spectrometry . Exposure data were collected during the use of an open fire ( preintervention ) and after installation of the improved stove ( postintervention ) for 47 women , enabling paired comparisons . Results : Median pre- and postintervention values were 4 and 1 ppm for continuous personal CO and 3 and 1 ppm for passive sample r CO , respectively . Postintervention measurements indicated an average reduction of 42 % for hydroxylated metabolites of naphthalene , fluorene , phenanthrene , and pyrene on a whole-weight concentration basis ( micrograms per liter of urine ) , and a 34 % reduction on a creatinine-adjusted basis ( micrograms per gram of creatinine ) . Pre- and postintervention geometric mean values for 1-hydroxypyrene were 3.2 and 2.0 μg/g creatinine , respectively . Conclusion : Use of the Patsari stove significantly reduced CO and  PAH exposures in women . However , levels of many PAH biomarkers remained higher than those reported among smokers Background : A growing body of evidence indicates a relationship between household indoor air pollution from cooking fires and adverse neonatal outcomes , such as  low birth weight ( LBW )  , in re source -poor countries . Objective : We examined the effect of reduced wood smoke exposure in pregnancy on LBW  of Guatemalan infants in RESPIRE ( R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) . Methods : Pregnant women ( n = 266 ) either received a chimney stove ( intervention ) or continued to cook over an open fire ( control ) . Between October 2002 and December 2004 we weighed 174 eligible infants ( 69 to mothers who used a chimney stove and 105 to mothers who used an open fire during pregnancy ) within 48 hr of birth . Multivariate linear regression and adjusted odds ratios ( ORs ) were used to estimate differences in birth weight and LBW ( < 2,500 g ) associated with chimney-stove versus open-fire use during pregnancy . Results : Pregnant women using chimney stoves had a 39 % reduction in mean exposure to carbon monoxide compared with those using 
    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 Biomass fuel is used as a primary cooking source by more than half of the world ’s population , contributing to a high burden of disease . Although cleaner fuels are available , some households continue using solid fuels because of financial constraints and absence of infrastructure , especially in non-notified slums . The present study documents a r and omised controlled study investigating the efficacy of improved cookstove on the personal exposure to air pollution and the respiratory health of women and children in an Indian slum . The improved cookstove was based on co-creation of a low-smoke chulha with local communities in order to support adaption and sustained uptake . Methods The study will be conducted in a non-notified slum called Ashrayanagar in Bangalore , India . The study design will be a 1:1 r and omised controlled intervention trial , including 250 households . The intervention group will receive an improved cookstove ( low-smoke chulha ) and the control group will continue using either the traditional cookstove ( chulha ) or a combination of the traditional stove and the kerosene/diesel stove . Follow-up time is 1 year . Outcomes include change in lung function ( FEV1/FVC ) , incidence of pneumonia , change in personal PM2.5 and CO exposure , incidence of respiratory symptoms ( cough , phlegm , wheeze and shortness of breath ) , prevalence of other related symptoms ( headache and burning eyes ) , change in behaviour and adoption of the stove . Ethical clearance was obtained from the Institutional Ethics Committee of the Indian Institute of Public Health Hyderabad- Bengaluru Campus . Discussion The findings from this study aim to provide insight into the effects of improved cookstoves in urban slums . Results can give evidence for the decrease of indoor air pollution and the improvement of respiratory health for children and women . Trial registration The trial was registered with clinical trials.gov on 21 June 2016 with the identifier NCT02821650 ; A Study to Test the Impact of an Improved Chulha on the Respiratory Health of Women and Children in Indian Slums Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries . We conducted a 5-month household r and omised controlled trial among 566 households in rural Rw and a to assess uptake , compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free . Compliance was measured monthly by self-report and spot-check observations . Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a r and om sub sample of 121 households to assess household air pollution  , while sample s of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms . Adoption was generally high , with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove . However , some householders continued to drink untreated water and most continued to cook on traditional stoves . The intervention was associated with a 97.5 % reduction in mean faecal indicator bacteria ( Williams means 0.5 vs. 20.2 TTC/100 mL , p<0.001 ) and a median reduction of 48 % of 24-h PM2.5 concentrations in the cooking area ( p = 0.005 ) . Further studies to increase compliance should be undertaken to better inform large-scale interventions . Trial registration : Clinical trials.gov ; NCT01882777 ; http:// clinical trials.gov/ct2/ results ? term = NCT01882777 & Search = Abstract Background : Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality , which can be prevented by simple low-cost interventions . Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously . Methods : We conducted a community-r and omized – controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package , consisting of improved solid-fuel stoves , kitchen sinks , solar disinfection of drinking water and hygiene promotion , reduces lower respiratory infections , diarrhoeal disease and improves growth in children younger than 36 months . The attention control group received an early child stimulation programme . Results : We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up  . Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm . This corresponds to a relative rate of 0.78 [ 95 % confidence interval ( CI ) : 0.58–1.05 ] for diarrhoea incidence and an odds ratio of 0.71 ( 95 % CI : 0.47–1.06 ) for diarrhoea prevalence . No effects on acute lower respiratory infections or children ’s growth rates were observed . Conclusions : Combined home-based environmental interventions slightly reduced  childhood diarrhoea , but the confidence interval included unity . Effects on growth and respiratory outcomes were not observed , despite high user compliance of the interventions . The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions Background and Objective RESPIRE , a r and omized trial of an improved cookstove , was conducted in Guatemala to assess health effects of long-term reductions in wood smoke exposure . Given the evidence that ambient particles increase blood pressure , we hypothesized that the intervention would lower blood pressure . Methods Two study design s were used : a ) between-group comparisons based on r and omized stove assignment , and b ) before- and -after comparisons within subjects before and after they received improved stoves . From 2003 to 2005 , we measured personal fine particle ( particulate matter with aerodynamic diameter < 2.5 μm ; PM2.5 ) exposures and systolic ( SBP ) and diastolic blood pressure ( DBP ) among women > 38 years of age from the chimney woodstove intervention group ( 49 subjects ) and traditional open wood fire control group ( 71 subjects ) . Measures were repeated up to three occasions . Results Daily average PM2.5 exposures were 264 and 102 μg/m3 in the control and intervention groups , respectively . After adjusting for age , body mass index , an asset index , smoking , secondh and tobacco smoke , apparent temperature , season , day of week , time of day , and a r and om subject intercept , the improved stove intervention was associated with 3.7 mm Hg lower SBP [ 95 % confidence interval ( CI ) , −8.1 to 0.6 ] and 3.0 mm Hg lower DBP ( 95 % CI , −5.7 to −0.4 ) compared with controls . In the second study design , among 55 control subjects measured both before and after receiving chimney stoves , similar associations were observed . Conclusion The between-group comparisons provide evidence , particularly for DBP , that the chimney stove reduces blood pressure , and the before- and -after comparisons are consistent with this evidence During the first r and omized intervention trial ( RESPIRE : R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) in air pollution epidemiology , we pioneered application of passive carbon monoxide ( CO ) diffusion tubes to measure long-term personal exposures to woodsmoke . Here we report on the protocol s and validations of the method , trends in personal exposure for mothers and their young children , and the efficacy of the introduced improved chimney stove in reducing personal exposures and kitchen concentrations . Passive diffusion tubes originally developed for industrial hygiene applications were deployed on a quarterly basis to measure 48-hour integrated personal carbon monoxide exposures among 515 children 0 - 18 months of age and 532 mothers aged 15 - 55 years and area sample s in a sub sample of 77 kitchens , in households r and omized into control and intervention groups . Instrument comparisons among types of passive diffusion tubes and against a continuous electrochemical CO monitor indicated that tubes responded nonlinearly to CO , and regression calibration was used to reduce this bias . Before stove introduction , the baseline arithmetic ( geometric ) mean 48-h child ( n=270 ) , mother ( n=529 ) and kitchen ( n=65 ) levels were , respectively , 3.4 ( 2.8 ) , 3.4 ( 2.8 ) and 10.2 ( 8.4 ) p.p.m . The between-group analysis of the 3355 post-baseline measurements found CO levels to be significantly lower among the intervention group during the trial period : kitchen levels : −90 % ; mothers : −61 % ; and children : −52 % in geometric means . No significant deterioration in stove effect was observed over the 18 months of surveillance . The reliability of these findings is strengthened by the large sample size made feasible by these unobtrusive and inexpensive tubes , measurement error reduction through instrument calibration , and a r and omized , longitudinal study design . These results from the first r and omized trial of improved household energy technology in a developing country and demonstrate that a simple chimney stove can substantially reduce chronic exposures to harmful indoor air pollutants among women and infants Efforts to introduce more efficient stoves increasingly leverage carbon-finance to scale up dissemination of interventions . We conducted a r and omized intervention study to evaluate a Clean Development Mechanism approved stove replacement impact on fuelwood usage , and climate and health-relevant air pollutants . We r and omly assigned 187 households to either receive the intervention or to continue using traditional stoves .  Measurements of fine particulate matter ( PM2.5 ) and absorbance were conducted in cooking areas , village center and at upwind background site . There were minor and overlapping seasonal differences ( post- minus preintervention change ) between control and intervention groups for median ( 95 % CI ) fuel use ( -0.60 ( -1.02 , -0.22 ) vs -0.52 ( -1.07 , 0.00 ) kg day(-1 ) ) , and 24 h absorbance ( 35 ( 18 , 60 ) vs 36 ( 22 , 50 ) × 10(-6 ) m(-1 ) ) ; for 24 h PM2.5 , there was a higher ( 139 ( 61,229 ) vs 73(-6 , 156 ) μg m(-3 ) ) ) increase in control compared to intervention homes between the two seasons . Forty percent of the intervention homes continued using traditional stoves . For intervention homes , absorbance-to-mass ratios suggest a higher proportion of black carbon in PM2.5 emitted from intervention compared with traditional stoves . Absent of field-based evaluation , stove interventions may be pursued that fail to realize expected carbon reductions or anticipated health and climate co benefits Background : Cooking with biomass fuels on open fires results in exposure to health-damaging pollutants such as carbon monoxide ( CO ) , polycyclic aromatic hydrocarbons ( PAHs ) , and particulate matter . Objective : We compared CO exposures and urinary PAH biomarkers pre- and postintervention with an improved biomass stove , the Patsari stove . Methods : In a sub sample of 63 women participating in a r and omized controlled trial in central Mexico , we measured personal CO exposure for 8 hr during the day using continuous monitors and passive sample rs . In addition , first-morning urine sample s obtained the next day were analyzed for monohydroxylated PAH metabolites by gas chromatography/isotope dilution/high-resolution mass spectrometry . Exposure data were collected during the use of an open fire ( preintervention ) and after installation of the improved stove ( postintervention ) for 47 women , enabling paired comparisons . Results : Median pre- and postintervention values were 4 and 1 ppm for continuous personal CO and 3 and 1 ppm for passive sample r CO , respectively . Postintervention measurements indicated an average reduction of 42 % for hydroxylated metabolites of naphthalene , fluorene , phenanthrene , and pyrene on a whole-weight concentration basis ( micrograms per liter of urine ) , and a 34 % reduction on a creatinine-adjusted basis ( micrograms per gram of creatinine ) . Pre- and postintervention geometric mean values for 1-hydroxypyrene were 3.2 and 2.0 μg/g creatinine , respectively . Conclusion : Use of the Patsari stove significantly reduced CO and  PAH exposures in women . However , levels of many PAH biomarkers remained higher than those reported among smokers Background : A growing body of evidence indicates a relationship between household indoor air pollution from cooking fires and adverse neonatal outcomes , such as  low birth weight ( LBW )  , in re source -poor countries . Objective : We examined the effect of reduced wood smoke exposure in pregnancy on LBW  of Guatemalan infants in RESPIRE ( R and omized Exposure Study of Pollution Indoors and Respiratory Effects ) . Methods : Pregnant women ( n = 266 ) either received a chimney stove ( intervention ) or continued to cook over an open fire ( control ) . Between October 2002 and December 2004 we weighed 174 eligible infants ( 69 to mothers who used a chimney stove and 105 to mothers who used an open fire during pregnancy ) within 48 hr of birth . Multivariate linear regression and adjusted odds ratios ( ORs ) were used to estimate differences in birth weight and LBW ( < 2,500 g ) associated with chimney-stove versus open-fire use during pregnancy . Results : Pregnant women using chimney stoves had a 39 % reduction in mean exposure to carbon monoxide compared with those using 
    Output:
    