***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: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed Breastfeeding rates among low-income women in the east-south- central United States are among the lowest in the country . This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee . A postpartum survey and chart review were conducted with WIC clients at nine health departments . Response rate was 99 % ( 291/293 ) .  Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group ( n= 156 ) compared with women in the no-peer counselor group ( n= 135 ) ( 53 % vs. 33%,p<0.001 , and 26 % vs. 13%,p=0.006 , respectively ) . Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding ( OR=2.43 , 95 % CI=1.23 - 4.67 ) and to be breastfeeding at 6 weeks ( OR=2.78 , 95 % CI=2.08 - 9.5 1 ) , than those in the no-peer counselor group We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service Background Exclusive Breastfeeding ( EBF ) refers to the practice of feeding breast milk only , ( including expressed breast milk ) to infants ; and excluding water , other liquids , breast milk substitutes , and solid foods . Inadequately breastfed infants are likely to be undernourished and have childhood infections . EBF knowledge and infant feeding practice s have not been studied sufficiently in Sokoto State , Nigeria . We describe the results of a r and omized community trial to promote Exclusive Breastfeeding ( EBF ) in two local government areas Kware and Bodinga selected as intervention and control groups respectively . Methods During advocacy meetings with community leaders , a Committee was formed . Members of the Committee were consulted for informed consent and selection of ten female volunteers who would educate mothers about breastfeeding during home visits . Participants comprised mothers of infants who were breastfeeding at the time of the study . A total of 179 mothers were recruited through systematic r and om sampling from each community . Volunteers conducted in-person interviews using a structured question naire and counseled mothers in the intervention group only . Results At baseline , intervention and control groups differed significantly regarding maternal occupation ( P=0.07 ) , and age of the index child ( P=0.07 ) . 42 % of infants in the intervention group were up to 6 months old and about 30 % of them were exclusively breastfed . Intention to EBF was significantly associated with maternal age ( P=0.01 ) , education ( P=0.00 ) and women who were exclusively breastfeeding ( P=0.00 ) . After counseling , all infants up to 6 months of age were exclusively breastfed . The proportion of mothers with intention to EBF increased significantly with maternal age ( P=0.00 ) , occupation ( P=0.00 ) and women who were exclusively breastfeeding ( P=0.01 ) . Post-intervention surveys showed that source of information and late initiation of breastfeeding was not significantly associated with intention to EBF . Mothers who reported practicing EBF for 6 months , were older ( P=0.00 ) multi-parous ( P=0.05 ) and more educated ( P=0.00 ) compared to those who did not practice EBF . Among them , significantly increased proportion of women agreed that EBF should be continued during the night ( P=0.03 ) , infant should be fed on dem and ( P=0.05 ) , sick child could be given medication ( P=0.02 ) , EBF offered protection against childhood diarrhea ( P=0.01 ) , and helped mothers with birth spacing ( P=0.00 ) . Conclusion This study shows that there is a need for reaching women with reliable information about infant nutrition in Sokoto State . The results show decreased EBF practice among working mothers , young women , mothers with poor education and fewer than five children . Counseling is a useful strategy for promoting the duration of EBF for six months and for developing support systems for nursing mothers . Working mothers may need additional re sources in this setting to enable them to practice EBF A r and omized controlled trial is used to determine whether assigning mixed feeders to a breastfeeding clinic within 1 week postpartum will increase exclusive breastfeeding at 1 month among Hispanic immigrants . Subjects are eligible for the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) , and 85 % are monolingual Hispanic . Mothers ( n = 522 ) of infants at low risk for hyperbilirubinemia are approached at bedside 20 to 48 hours after delivery and r and omly assigned to treatment or control groups . Intent-to-treat analysis of feeding behavior at 4 weeks postpartum indicates that the intervention group is more likely to be exclusively breastfeeding ( 16.4 % vs 10 % in the control group , P = .03 ; adjusted odds ratio 1.87 ; 95 % confidence interval , 1.07 - 3.26 ) ; that the incidence of formula supplementation does not differ between groups ; and that the intervention group is less likely to supplement with water and tea  ( P < .002 ) . J Hum Lact . 25(3):287 - 296 OBJECTIVE To determine whether peer counselors impacted breastfeeding duration among premature infants in an urban population . DESIGN This was a r and omized controlled clinical trial . SETTING The trial was conducted in the Newborn Intensive Care Unit at Boston Medical Center , an inner-city teaching hospital with approximately 2000 births per year . PARTICIPANTS One hundred eight mother-infant pairs were enrolled between 2001 and 2004 . Pairs were eligible if the mother intended and was eligible to breastfeed per the 1997 guidelines from the American Academy of Pediatrics and if the infant was 26 to 37 weeks ' gestational age and otherwise healthy . INTERVENTION Subjects were r and omized to either a peer counselor who saw the mother weekly for 6 weeks or to st and ard of care . MAIN OUTCOME MEASURE The main outcome measure was any breast-milk feeding at 12 weeks postpartum . RESULTS Intervention and control groups were similar on all measured sociodemographic factors . The average  gestational age of infants was 32 weeks ( range , 26.3 - 37 weeks ) with a mean birth weight of 1875 g ( range , 682 - 3005 g ) . At 12 weeks postpartum , women with a peer counselor had odds of providing any amount of breast milk 181 % greater than women without a peer counselor ( odds ratio , 2.81 [ 95 % confidence interval , 1.11 - 7.14 ] ; P = .01 ) . CONCLUSIONS Peer counselors increased breastfeeding duration  among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit .  Peer counseling programs can help to increase breastfeeding in this vulnerable population OBJECTIVE Recent studies have raised the issue of lower breastfeeding rates for mothers enrolled in the Special Supplemental Nutrition Program for Women , Infants and Children ( WIC ) . We wanted to explore this association of WIC and lower breastfeeding in Nurse Family Partnership Program ( NFP ) , a national representative group of mother-baby pairs on which extensive background data are available . Our aim was to compare breastfeeding rates at 6 and 12 months in NFP high-risk mothers who were enrolled in WIC to those who were not enrolled in WIC . METHODS We conducted a retrospective secondary analysis in mothers and infants from this cohort for 2000 - 2005 ( n = 3,570 ) . RESULTS We found that at 6 months of age , 87.8 % of mothers who were not breastfeeding were enrolled in WIC as compared to 82.6 % of mothers who were breastfeeding ( p < 0.001 ) . However , in the multivariate analysis , WIC was no longer a significant predictor of breastfeeding . CONCLUSIONS Prospect i ve evaluation of this issue is warranted particularly with the implementation of changes in the WIC Food Package and Breastfeeding Promotion In northern Nigeria , interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practice s. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled design s. We conducted a cluster-r and omized controlled trial in Bauchi State , Nigeria , with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients . The intervention had 3 components . Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo . Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients ( 5 - 7 women ) . The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings . The control arm continued with the regular microcredit program . R and omization occurred at the level of the monthly meeting groups . Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo . Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors . Among the clients who completed the final survey ( n = 390 ) , the odds of exclusive breastfeeding to 6 mo ( OR : 2.4 ; 95 % CI : 1.4 , 4.0 ) and timely breastfeeding initiation ( OR : 2.6 ; 95 % CI : 1.6 , 4.1 ) were increased in the intervention vs. control arm . Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention . In conclusion , a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended 
    Output:
    
RESULTS Intervention delivery in combination of setting s seemed to have higher improvements in breastfeeding rates .
Greatest improvements in early initiation of breastfeeding , exclusive breastfeeding and continued breastfeeding rates , were seen when counselling or education were provided concurrently in home and community , health systems and community , health systems and home setting s , respectively .
Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding .