***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: A controlled , prospect i ve comparison of the use of the infant seat versus prone , head-elevated positioning in a harness was undertaken in 15 infants with gastroesophageal reflux .  pH monitoring of the distal esophagus demonstrated less reflux in the harness than in the seat ( P less than 0.001 ) during 19 pairs of two-hour postpr and ial trials . This difference was the result of both fewer episodes ( P less than 0.001 ) and briefer episodes ( P less than 0.05 ) . Prone-elevated positioning in the harness described is superior to positioning in an infant seat in the treatment of gastroesophageal reflux in infants younger than 6 months To assess the association between  infant sleeping position and risk of sudden infant death syndrome ( SIDS ) in an ethnically diverse US population , the authors conducted a population -based case-control study in 11 counties in California from May 1997 through April 2000 . The authors conducted in-person interviews with the mothers of 185 SIDS cases and 312 r and omly selected race/ethnicity- and age-matched controls to collect information on sleeping positions . Infants who had last been put down to sleep in the prone or side position were at greater risk of SIDS than were infants who had last been put down on their backs ( adjusted odds ratio ( AOR ) = 2.6 ( 95 % confidence interval ( CI ) : 1.5 , 4.5 ) and AOR = 2.0 ( 95 % CI : 1.2 , 3.4 ) for the prone and side positions , respectively ) . The risk of SIDS was especially high for an unstable side position in which an infant was placed on its side and found prone ( AOR = 8.7 , 95 % CI : 3.3 , 22.7 ) . Infants who were usually placed on their backs to sleep but had last been put down in the prone or side position ( an unaccustomed position ) had a significantly high risk of SIDS ( AOR = 8.2 ( 95 % CI : 2.6 , 26.0 ) and AOR = 6.9 ( 95 % CI : 2.3 , 20.6 ) for the prone and side positions , respectively ) . Infants placed in an unaccustomed prone or side sleeping position had a higher risk of SIDS than infants who were always placed prone or on the side The AAP has alerted pediatricians to the importance of safe sleep environment for infants . The elements of a safe sleep environment include supine sleep position , safe crib , and avoidance of smoke exposure , soft bedding , and overheating . With the Back to Sleep campaign , prone sleeping among all U.S. infants has decreased to less than 20 % , and the incidence of SIDS has decreased 40 % . However , the decline in SIDS and prone sleeping has leveled off in recent years . Further declines may be possible with decreasing other modifiable risk factors , such as prenatal and postnatal exposure to cigarette smoking . Prior studies have demonstrated that health care professional advice is influential in determining infant care practice s. It is important that physicians caring for infants be aware of the importance of a safe sleep environment and underst and other modifiable risk factors for SIDS . We surveyed a r and om sample of 3,717 physicians in North Carolina and the metropolitan Washington , DC , area to determine knowledge , beliefs , and practice s regarding SIDS and SIDS risk reduction among physicians caring for pregnant women and infants . Twenty-three percent ( 835 ) responded . Most physicians are aware of prone sleeping and cigarette smoke exposure as risk factors for SIDS . Almost all physicians agree that there are measures that can be taken to reduce the risk of SIDS , and they consider it important to discuss SIDS and SIDS risk reduction strategies with parents of young infants . In spite of this belief , only 56 % of family/general practitioners , 18 % of obstetrician-gynecologists , and 79 % of pediatricians discuss SIDS routinely . Only 35 % of pediatricians , 15 % of family/general practitioners , and 16 % of obstetrician-gynecologists provide written information . In addition , only 38 % of physicians recommend supine , while 50 % recommend side or back , 6 % side , and 7 % prone . Only two thirds of pediatricians and one third of family/general practitioners are aware that the AAP recommends supine as the preferred sleep position for infants . Pediatricians are more likely to be aware of the AAP recommendation ( p < O.OOOJ ) and to discuss SIDS risk reduction strategies with parents ( p=0.03 ) . We conclude that many physicians who care for infants are unaware of the AAP 's most current recommendation for sleep position and are incorrectly recommending the side position . Physicians may also be unaware of other sleep environment hazards . Further educational efforts must continue for physicians who provide care to pregnant women and children to ensure a continued decline in the incidence of SIDS OBJECTIVES To identify the risk factors for sudden infant death syndrome ( SIDS )  following a national campaign to prevent SIDS . METHODS For 2 years ( October 1 , 1991 through September 30 , 1993 ) data were collected by community child health nurses on all infants born in New Zeal and at initial contact and at 2 months . RESULTS There were 232 SIDS cases in the postneonatal age group ( 2.0/1000 live births ) and these were compared with 1200 r and omly selected control subjects . Information was available for 127 cases ( 54.7 % ) and 922 ( 76.8 % ) of controls . The previously identified modifiable risk factors were examined . The prevalence of prone sleeping position of the infant was very low ( 0.7 % at initial contact and 3 . 0 % at 2 months ) , but was still associated with an increased risk of SIDS . In addition , the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position ( at 2 months : adjusted odds ratio ( OR ) = 6.57 ; 95 % confidence interval ( CI ) = 1.71 , 25.23 ) . Maternal smoking was found to be the major risk factor for SIDS . Bed sharing was also associated with an increased risk of SIDS . There was an interaction between maternal smoking and bed sharing on the risk of SIDS . Compared with infants not exposed to either bed sharing or maternal smoking , the adjusted OR for infants of mothers who smoked was 5.01 ( 95 % CI = 2.01 , 12.46 ) for bed sharing at the initial contact and 5.02 ( 95 % CI = 1.05 , 24 . 05 ) for bed sharing at 2 months . In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS . The other risk factors for SIDS identified were : unmarried mother , leaving school at a younger age , young mother , greater number of previous pregnancies , late attendance for antenatal care , smoking in pregnancy , male infant , Maori ethnicity , low birth weight , and shorter gestation . CONCLUSIONS After adjustment for potential confounders , prone and side sleeping positions , maternal smoking , and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS . A change from the side to the supine sleeping position could result in a substantial reduction in SIDS .  Maternal smoking is common in New Zeal and and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country . However , smoking behavior has been difficult to change . Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke . Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third . Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders , but as breastfeeding rates are comparatively good in New Zeal and , this result should be interpreted with caution as the power of this study to detect a benefit is small Background : Although advice from healthcare professionals may influence parental infant placement choice to reduce sudden infant death syndrome risk , literature on nursery staff infant placement behaviors and the degree to which they influence maternal infant sleep positioning is limited . Objective : To assess newborn placement practice s of the mother and nursery staff and their interrelationship in the hospital setting . Methods : A cross-sectional survey-based study was conducted among hospital newborn nursery staff ( n = 96 ) and mothers of newborns ( n = 579 ) at eight perinatal hospitals in Orange County , California . Results : Although a majority of sample d nursery staff ( 72 % ) identified the supine position as the placement that most lowers sudden infant death syndrome risk , only 30 % reported most often placing infants to sleep in that position , with most staff ( 91 % ) citing fear of aspiration as the motivation for supine position avoidance . Only 34 % of staff reported advising exclusive supine infant positioning to mothers . Approximately 36 % of mothers reported using  supine infant placement  exclusively . Maternal infant placement choice varied by both the advice ( p < .01 ) and the placement modeling ( p < .01 ) provided by staff , with the highest proportion of usual supine infant placement found among mothers who reported receiving both . A mother ’s race/ethnicity also affected the reception of exclusive supine placement recommendations ( p < .01 ) . Conclusions : Exclusive supine infant placement appears to be underused by both nursery staff and mothers of newborn infants . Culturally grounded educational intervention with nursery staff regarding infant positioning and placement in the hospital setting is indicated & NA ; There is a direct relationship between nonsupine sleeping and sudden infant death syndrome ( SIDS ) . Premature infants are at greater risk for SIDS and are often cared for in nonsupine positions during the course of hospitalization . Healthy premature infants should be placed supine for sleep before discharge from the neonatal intensive care unit ( NICU ) , and parents receive specific instruction about infant sleep position and other risk factors for SIDS . Most published literature addressing nursing practice s for SIDS reduction reflects practice s with the healthy newborn population . PURPOSE : To examine and describe NICU nurses ' knowledge of SIDS risk-reduction measures , modeling of safe infant sleep interventions prior to discharge , and inclusion of SIDS risk reduction in parent education . SUBJECTS : Convenience sample of nurses practicing in level II and III NICUs located in 2 Middle Atlantic States . DESIGN AND METHODS : A prospect i ve survey design was used for the study . The 14-item question naire was developed by a team of neonatal clinical experts and distributed via site coordinators to nurses in 19 NICUs . PRINCIPAL RESULTS : A total of 1080 surveys were distributed and 430 ( 40 % ) NICU nurses completed the survey . The majority of nurses ( 85 % ) identified the American Academy of Pediatrics SIDS risk-reduction strategies for safe sleep . The investigators found that age , years of nursing and neonatal nursing experience , and educational preparation did not significantly contribute to the practice of “ supine-only ” position for sleep for infants in NICUs . The study revealed that nurses frequently position healthy preterm infants supine for sleep when weaned to an open crib ( 50 % ) . Others wait one to a few days before discharge ( 15 % ) and some never position supine for sleep ( 6 % ) . Stuffed toys are removed from cribs 90.5 % of the time . For term infants without major medical complications , 45.5 % of surveyed nurses continued to use positioning aids/rolls in infants ' cribs . The most common reasons nurses cited to position preterm infants side-lying or prone in a crib were fear of aspiration ( 29 % ) , infant comfort ( 28 % ) , and infant safety ( 20 % ) . NICU nurses educated parents about SIDS and reduction strategies , using various media . At discharge , 73 % of the nurses verbally communicated with parents , 53 % provided printed literature , and 14 % used audiovisual aids with parents . CONCLUSIONS : NICU nurses are in influential positions to educate parents and model SIDS risk-reduction strategies . This study supports other published research that points to inconsistencies in nursing practice regarding implementation of methods to reduce the risk of SIDS 
    Output:
    
The effectiveness of the BTS campaigns in publicising the benefits of the supine position is confirmed by this paper .
However , the decrease in the knowledge about non-prone positions suggests that the campaigns may not have focused enough on the dangers of the prone position