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: Current influenza vaccination recommendations focus on immunizing high-risk people ; however , influenza mortality and morbidity remain elevated . U.S. policymakers are considering expansion of flu vaccination recommendations to include school-age children ( ages 5 - 18 ) . Children are at risk for flu and propagate epidemic spread . Immunizing children at school offers an efficient approach to covering this population . This study examines the cost consequences of a large multistate , school-based influenza immunization program .  The results show that immunization reduces disease among children and adults and is cost-saving to society . An epidemiologically based influenza immunization policy might be an important supplement to the existing risk-based policy 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 CONTEXT An overarching national health goal of Healthy People 2010 is to eliminate disparities in leading health care indicators including immunizations . Disparities in US childhood immunization rates persist , with inner-city , black , and Hispanic children having lower rates . Although practice or clinic-based interventions , such as patient reminder/recall systems , have been found to improve immunization rates in specific setting s , there is little evidence that those site-based interventions can reduce disparities in immunization rates at the community level . OBJECTIVE To assess the effect of a community-wide reminder , recall , and outreach ( RRO ) system for childhood immunizations on known disparities in immunization rates between inner-city versus suburban population s and among white , black , and Hispanic children within an entire county . SETTING Monroe County , New York ( birth cohort : 10 000 , total population : 750 000 ) , which includes the city of Rochester . Three geographic regions within the county were compared : the inner city of Rochester , which contains the greatest concentration of poverty ( among 2-year-old children , 64 % have Medicaid ) ; the rest of the city of Rochester ( 38 % have Medicaid ) ; and the suburbs of the county ( 8 % have Medicaid ) . INTERVENTIONS An RRO system was implemented in 8 city practice s in 1995 ( covering 64 % of inner-city children ) and was exp and ed to 10 city practice s by 1999 ( covering 74 % of inner-city children , 61 % of rest-of-city children , and 9 % of suburban children ) . The RRO intervention involved lay community-based outreach workers who were assigned to city practice s to track immunization rates of all 0- to 2-year-olds , and to provide a staged intervention with increasing intensity depending on the degree to which children were behind in immunizations ( tracking for all children , mail , or telephone reminders for most children , assistance with transportation or scheduling for some children , and home visits for 5 % of children who were most behind in immunizations and who faced complex barriers ) . STUDY PARTICIPANTS Three separate cohorts of 0- to 2-year-old children were assessed-those residing in the county in 1993 , 1996 , and 1999 . STUDY DESIGN Immunization rates were measured for each geographic region in Monroe County at 3 time periods : before the implementation of a systematic RRO system ( 1993 ) , during early phases of implementation of the RRO system ( 1996 ) , and after implementation of the RRO system in 10 city practice s ( 1999 ) . Immunization rates were compared for children living in the 3 geographic regions , and for white , black , and Hispanic children . Immunization rates were measured by the same methodology in each of the 3 time periods . A denominator of children was obtained by merging patient lists from the practice files of most pediatric and family medicine practice s in the county ( covering 85 % to 89 % of county children ) . A r and om sample of children ( > 500 from the suburbs and > 1200 from the city for each sampling period ) was then selected for medical chart review at practice s to determine demographic characteristics ( including race and ethnicity ) and immunization rates . City children were over sample d to allow detection of effects by geographic region and race . Rates for the 3 geographic regions and for the entire county were determined using Stata to adjust for the clustered sampling . MAIN OUTCOME MEASURES Immunization rates at 12 and 24 months for recommended vaccines ( 4 diphtheria-tetanus-pertussis:3 polio:1 measles-mumps-rubella : > or = 1 Haemophilus influenzae type b on or after 12 months of age ) . RESULTS DISPARITIES BY GEOGRAPHIC REGION : Baseline immunization rates ( 1993 ) for 24-month-olds were as follows : inner city ( 55 % ) , rest of city ( 64 % ) , and suburbs ( 73 % ) , with an 18 % difference in rates between the inner city and suburbs . By 1996 , immunization rates rose faster in the inner city ( + 21 % points ) than in the suburbs ( + 14 % points ) so that the difference in rates between the inner city and suburbs had narrowed to 11 % . In 1999 , rates were similar across geographic regions : inner city ( 84 % ) , rest of city ( 81 % ) , and suburbs ( 88 % ) , with a 4 % difference between the inner city and suburbs . DISPARITIES BY RACE AND ETHNICITY : Immunization rates were available in 1996 and 1999 by race and ethnicity . Twenty-four-month immunization rates in 1996 showed disparities : white ( 89 % ) , black ( 76 % ) , and Hispanic ( 74 % ) , with a 13 % difference between rates for white and black children and a 15 % difference between white and Hispanic children . In 1999 , rates were similar across the groups : white ( 88 % ) , black ( 81 % ) , and Hispanic ( 87 % ) , with a 7 % difference between rates for white and black children , and a 1 % difference between white and Hispanic children . CONCLUSIONS A community-wide intervention of patient RRO  raised childhood immunization rates in the inner city of Rochester and was associated with marked reductions in disparities in immunization rates between inner-city and suburban children and among racial and ethnic minority population s. By targeting a relatively manageable number of primary care practice s that serve city children and using an effective strategy to increase immunization rates in each practice , it is possible to eliminate disparities in immunizations for vulnerable children OBJECTIVE To determine if a community-based intervention program focusing on parenting education will have an impact on preventive health care utilization behaviors among low-income , minority mothers in Washington , DC . DESIGN The experimental design was a r and omized , controlled study in which 286 mother-infant dyads were assigned to either the st and ard social services ( control ) group or to the intervention group .  Women and their newborn infants were recruited during the immediate postpartum period in 4 Washington , DC , hospital sites from April 1995 to April 1997 . The year-long multicomponent intervention included home visits and hospital-based group sessions in addition to the st and ard social services available at the hospital sites . A total of 286 postpartum women with inadequate prenatal care were assigned r and omly to the control or the intervention group . Women and their infants were followed for 1 full year . Outcome measures included usage of preventive health care services including well care infant visits and adherence to immunization schedules during the first year of the infant 's life . RESULTS Infants in the intervention group initiated well care at an earlier age than controls ( by 6 weeks , 62.5 % vs 50 % had received their first well infant visit ) . Infants in the intervention group had more frequent well visits ( by 12 months of age , 3.5 vs 2.7 visits ) . Multivariate analyses showed infants in the intervention group to be more likely to complete their scheduled immunizations ( by 9 months , odds ratio = 2.2 , 95 % confidence interval : 1.09 - 4.53 ) . Those in the intervention group with more frequent contacts ( 30 + visits ) with study personnel were most likely to have followed age-appropriate immunization schedules when compared with controls ( at 9 months odds ratio = 3.63 , 95 % confidence interval : 1.58 - 8.33 ) . CONCLUSIONS It is possible to influence health care usage patterns of high-risk minority population s through public health interventions that are global in their perspective . Focusing on parental knowledge and beliefs regarding health-related issues and life skills in a self-efficacy model is associated with improved usage of infant health care re sources BACKGROUND Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60 % and 70 % . Almost all influenza immunisation in the UK is done within general practice . Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies . AIM To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practice s. DESIGN OF STUDY R and omised controlled trial . SETTING Three research general practice s within the East London and Essex network of research ers ( ELENoR ) . METHOD Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice . The intervention , during October 2000 , was a telephone call from the practice receptionist to intervention group households , offering an appointment for influenza immunisation at a nurse-run . clinic Main outcome measures were the numbers of individuals in each group receiving immunisation , and practice costs of a telephone-appointing programme . RESULTS intention to treat analysis showed an immunisation rate in the control group of 44 % , compared with 50 % in the intervention group ( odds ratio = 1.29 , 95 % confidence interval = 1.03 to 1.63 ) . Of the patients making a telephone appointment  , 88 % recieved immunisation , while 22 % of those not wanting an appointment went on to be immunised . In the controlgroup , income generated was 11.35 pounds per immunisation , for each additional immunisation in the intervention group the income was 5.20 pounds . The ' number needed to telephone ' was 17 . CONCLUSION Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6 % using a simple intervention by receptionists . Immunisation rates in this low-risk group fell well short of the 60 % government target . Improving immunisation rates will require a sustained public health campaign . Retaining the item-of-service payments to practice s should support costs of practice -based interventions CONTEXT Immunization rates in the inner city remain lower than in the general US population , but efforts to raise immunization levels in inner-city areas have been largely untested . OBJECTIVE To assess the effectiveness of case management in raising immunization levels among infants of inner-city , African American families . DESIGN R and omized controlled trial with follow-up through 1 year of life . SETTING Low-income areas of inner-city Los Angeles , Calif. PATIENTS A representative sample of 419 African American infants and their families . INTERVENTIONS In-depth assessment by case managers before infants were 6 weeks of age , with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed . MAIN OUTCOME MEASURES Percentage of children with up-to- date immunizations at age 1 year , characteristics associated with improved immunization rates , and cost-effectiveness of case management intervention .  RESULTS A 
    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: Current influenza vaccination recommendations focus on immunizing high-risk people ; however , influenza mortality and morbidity remain elevated . U.S. policymakers are considering expansion of flu vaccination recommendations to include school-age children ( ages 5 - 18 ) . Children are at risk for flu and propagate epidemic spread . Immunizing children at school offers an efficient approach to covering this population . This study examines the cost consequences of a large multistate , school-based influenza immunization program .  The results show that immunization reduces disease among children and adults and is cost-saving to society . An epidemiologically based influenza immunization policy might be an important supplement to the existing risk-based policy 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 CONTEXT An overarching national health goal of Healthy People 2010 is to eliminate disparities in leading health care indicators including immunizations . Disparities in US childhood immunization rates persist , with inner-city , black , and Hispanic children having lower rates . Although practice or clinic-based interventions , such as patient reminder/recall systems , have been found to improve immunization rates in specific setting s , there is little evidence that those site-based interventions can reduce disparities in immunization rates at the community level . OBJECTIVE To assess the effect of a community-wide reminder , recall , and outreach ( RRO ) system for childhood immunizations on known disparities in immunization rates between inner-city versus suburban population s and among white , black , and Hispanic children within an entire county . SETTING Monroe County , New York ( birth cohort : 10 000 , total population : 750 000 ) , which includes the city of Rochester . Three geographic regions within the county were compared : the inner city of Rochester , which contains the greatest concentration of poverty ( among 2-year-old children , 64 % have Medicaid ) ; the rest of the city of Rochester ( 38 % have Medicaid ) ; and the suburbs of the county ( 8 % have Medicaid ) . INTERVENTIONS An RRO system was implemented in 8 city practice s in 1995 ( covering 64 % of inner-city children ) and was exp and ed to 10 city practice s by 1999 ( covering 74 % of inner-city children , 61 % of rest-of-city children , and 9 % of suburban children ) . The RRO intervention involved lay community-based outreach workers who were assigned to city practice s to track immunization rates of all 0- to 2-year-olds , and to provide a staged intervention with increasing intensity depending on the degree to which children were behind in immunizations ( tracking for all children , mail , or telephone reminders for most children , assistance with transportation or scheduling for some children , and home visits for 5 % of children who were most behind in immunizations and who faced complex barriers ) . STUDY PARTICIPANTS Three separate cohorts of 0- to 2-year-old children were assessed-those residing in the county in 1993 , 1996 , and 1999 . STUDY DESIGN Immunization rates were measured for each geographic region in Monroe County at 3 time periods : before the implementation of a systematic RRO system ( 1993 ) , during early phases of implementation of the RRO system ( 1996 ) , and after implementation of the RRO system in 10 city practice s ( 1999 ) . Immunization rates were compared for children living in the 3 geographic regions , and for white , black , and Hispanic children . Immunization rates were measured by the same methodology in each of the 3 time periods . A denominator of children was obtained by merging patient lists from the practice files of most pediatric and family medicine practice s in the county ( covering 85 % to 89 % of county children ) . A r and om sample of children ( > 500 from the suburbs and > 1200 from the city for each sampling period ) was then selected for medical chart review at practice s to determine demographic characteristics ( including race and ethnicity ) and immunization rates . City children were over sample d to allow detection of effects by geographic region and race . Rates for the 3 geographic regions and for the entire county were determined using Stata to adjust for the clustered sampling . MAIN OUTCOME MEASURES Immunization rates at 12 and 24 months for recommended vaccines ( 4 diphtheria-tetanus-pertussis:3 polio:1 measles-mumps-rubella : > or = 1 Haemophilus influenzae type b on or after 12 months of age ) . RESULTS DISPARITIES BY GEOGRAPHIC REGION : Baseline immunization rates ( 1993 ) for 24-month-olds were as follows : inner city ( 55 % ) , rest of city ( 64 % ) , and suburbs ( 73 % ) , with an 18 % difference in rates between the inner city and suburbs . By 1996 , immunization rates rose faster in the inner city ( + 21 % points ) than in the suburbs ( + 14 % points ) so that the difference in rates between the inner city and suburbs had narrowed to 11 % . In 1999 , rates were similar across geographic regions : inner city ( 84 % ) , rest of city ( 81 % ) , and suburbs ( 88 % ) , with a 4 % difference between the inner city and suburbs . DISPARITIES BY RACE AND ETHNICITY : Immunization rates were available in 1996 and 1999 by race and ethnicity . Twenty-four-month immunization rates in 1996 showed disparities : white ( 89 % ) , black ( 76 % ) , and Hispanic ( 74 % ) , with a 13 % difference between rates for white and black children and a 15 % difference between white and Hispanic children . In 1999 , rates were similar across the groups : white ( 88 % ) , black ( 81 % ) , and Hispanic ( 87 % ) , with a 7 % difference between rates for white and black children , and a 1 % difference between white and Hispanic children . CONCLUSIONS A community-wide intervention of patient RRO  raised childhood immunization rates in the inner city of Rochester and was associated with marked reductions in disparities in immunization rates between inner-city and suburban children and among racial and ethnic minority population s. By targeting a relatively manageable number of primary care practice s that serve city children and using an effective strategy to increase immunization rates in each practice , it is possible to eliminate disparities in immunizations for vulnerable children OBJECTIVE To determine if a community-based intervention program focusing on parenting education will have an impact on preventive health care utilization behaviors among low-income , minority mothers in Washington , DC . DESIGN The experimental design was a r and omized , controlled study in which 286 mother-infant dyads were assigned to either the st and ard social services ( control ) group or to the intervention group .  Women and their newborn infants were recruited during the immediate postpartum period in 4 Washington , DC , hospital sites from April 1995 to April 1997 . The year-long multicomponent intervention included home visits and hospital-based group sessions in addition to the st and ard social services available at the hospital sites . A total of 286 postpartum women with inadequate prenatal care were assigned r and omly to the control or the intervention group . Women and their infants were followed for 1 full year . Outcome measures included usage of preventive health care services including well care infant visits and adherence to immunization schedules during the first year of the infant 's life . RESULTS Infants in the intervention group initiated well care at an earlier age than controls ( by 6 weeks , 62.5 % vs 50 % had received their first well infant visit ) . Infants in the intervention group had more frequent well visits ( by 12 months of age , 3.5 vs 2.7 visits ) . Multivariate analyses showed infants in the intervention group to be more likely to complete their scheduled immunizations ( by 9 months , odds ratio = 2.2 , 95 % confidence interval : 1.09 - 4.53 ) . Those in the intervention group with more frequent contacts ( 30 + visits ) with study personnel were most likely to have followed age-appropriate immunization schedules when compared with controls ( at 9 months odds ratio = 3.63 , 95 % confidence interval : 1.58 - 8.33 ) . CONCLUSIONS It is possible to influence health care usage patterns of high-risk minority population s through public health interventions that are global in their perspective . Focusing on parental knowledge and beliefs regarding health-related issues and life skills in a self-efficacy model is associated with improved usage of infant health care re sources BACKGROUND Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60 % and 70 % . Almost all influenza immunisation in the UK is done within general practice . Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies . AIM To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practice s. DESIGN OF STUDY R and omised controlled trial . SETTING Three research general practice s within the East London and Essex network of research ers ( ELENoR ) . METHOD Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice . The intervention , during October 2000 , was a telephone call from the practice receptionist to intervention group households , offering an appointment for influenza immunisation at a nurse-run . clinic Main outcome measures were the numbers of individuals in each group receiving immunisation , and practice costs of a telephone-appointing programme . RESULTS intention to treat analysis showed an immunisation rate in the control group of 44 % , compared with 50 % in the intervention group ( odds ratio = 1.29 , 95 % confidence interval = 1.03 to 1.63 ) . Of the patients making a telephone appointment  , 88 % recieved immunisation , while 22 % of those not wanting an appointment went on to be immunised . In the controlgroup , income generated was 11.35 pounds per immunisation , for each additional immunisation in the intervention group the income was 5.20 pounds . The ' number needed to telephone ' was 17 . CONCLUSION Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6 % using a simple intervention by receptionists . Immunisation rates in this low-risk group fell well short of the 60 % government target . Improving immunisation rates will require a sustained public health campaign . Retaining the item-of-service payments to practice s should support costs of practice -based interventions CONTEXT Immunization rates in the inner city remain lower than in the general US population , but efforts to raise immunization levels in inner-city areas have been largely untested . OBJECTIVE To assess the effectiveness of case management in raising immunization levels among infants of inner-city , African American families . DESIGN R and omized controlled trial with follow-up through 1 year of life . SETTING Low-income areas of inner-city Los Angeles , Calif. PATIENTS A representative sample of 419 African American infants and their families . INTERVENTIONS In-depth assessment by case managers before infants were 6 weeks of age , with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed . MAIN OUTCOME MEASURES Percentage of children with up-to- date immunizations at age 1 year , characteristics associated with improved immunization rates , and cost-effectiveness of case management intervention .  RESULTS A 
    Output:
    