***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 There are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory . The present study investigated the effect of  different maternity home practice s in St. Petersburg , Russia , as well as of physiological breast engorgement and maternal mood , on milk production in primi- and multiparous women on day four . The amount of milk was studied in relation to the duration of " nearly exclusive " breastfeeding . Methods 176 mother-infant pairs were r and omised into four groups according to an experimental two-factor design taking into account infant location and apparel . Data were recorded in the delivery ward at 25–120 minutes postpartum and later in the maternity ward . Group I infants ( n = 37 ) were placed skin-to-skin in the delivery ward while Group II infants ( n = 40 ) were dressed and placed in their mother 's arms . Both groups later roomed-in in the maternity ward . These infants had the possibility of early suckling during two hours postpartum . Group III infants ( n = 38 ) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in . Group IV infants ( n = 38 ) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward . Equal numbers per group were either swaddled or clothed . Episodes of early suckling were noted . Number of breastfeeds , amount of milk ingested ( recorded on day 4 postpartum ) and duration of " nearly exclusive " breastfeeding were recorded . Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being " low/blue " . Results On day four , multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule ( 7 times a day ; Group III ) . In contrast , there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on dem and ( Groups I , II and IV ) , although multiparas had higher numbers of feedings than primiparas . In addition during the first three days postpartum , multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling " low/blue " than primiparous mothers . Early suckling was shown to positively affect milk production irrespective of parity . Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not ( 284 and 184 ml respectively , SE = 14 and 27 ml , p = 0.0006).Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling , intensity of breast engorgement and number of breastfeeds on day 3 were most important . Intensity of feeling " low/blue " was negatively related to amount of milk ingested . The significant factor for multiparous women was early suckling . Similar results were obtained in Groups III and IV ; however , in primiparous mothers , engorgement was the most important factor and in multiparous women it was rooming-in . Amount of milk produced on day 4 was strongly correlated to a duration of " nearly exclusive " breastfeeding ( p < 0.0001 ) . Conclusion The present data show that ward routines influence milk production . As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors , further research is needed Background A small , non-blinded , RCT ( r and omised controlled trial ) had reported that oral antibiotics reduced the incidence of mastitis in lactating women with Staphylococcus aureus ( S. aureus)- colonized cracked nipples . We aim ed to replicate the study with a more rigorous design and adequate sample size . Methods Our intention was to conduct a double-blind placebo-controlled trial to determine if an antibiotic ( flucloxacillin ) could prevent mastitis in lactating women with S. aureus-colonized cracked nipples . We planned to recruit two groups of 133 women with S. aureus-colonized cracked nipples . Results We spent over twelve months su bmi tting applications to five hospital ethics committees and seven funding bodies , before commencing the trial . Recruitment to the trial was very slow and only ten women were r and omized to the trial after twelve months , and therefore the trial was stopped early . Conclusions In retrospect we should have conducted a feasibility study , which would have revealed the low number of women in these Melbourne hospitals ( maternity wards and breastfeeding clinics ) with damaged nipples . The appropriate use of antibiotics for breastfeeding women with cracked nipples still needs to be tested Objective : The purpose s of this study were to compare the efficacy of amoxicillin and cephradine for the treatment of sporadic acute puerperal mastitis ( SAPM ) and to evaluate the microbiology and clinical parameters of this infection . Methods : We conducted a prospect i ve , r and omized , single-blinded study comparing amoxicillin , 500 mg orally q 8 h for 7 days , and cephradine , 500 mg orally q 6 h for 7 days . The diagnostic criteria for SAPM included a temperature of ≥37.56 ℃ ( ≥99.6 ℉ ) and erythema and tenderness of the breast(s ) . Results : Twenty-seven consecutive out patients with SAPM were evaluated for admission to the study , and 25 of these were enrolled . The mean temperature at enrollment was 38.17 ℃ ( 100.7 ℉ ) , with a mean WBC count of 11,440/μl . The most frequent bacterial isolates from expressed milk were Staphylococcus aureus ( 7 ) , staphylococcal species ( coagulase negative ) ( 8) , and α-hemolytic streptococci ( 4 ) . There were no significant differences between the 2 antibiotic regimens in cure rate , mean days to resolution of symptoms , or recurrence within 30 days . Both of the treatment failures and 1 of the 3 recurrences within 30 days were amoxicillin-treated patients whose cultures grew S. aureus . Conclusions : Oral amoxicillin and cephradine appear equally effective in the treatment of SAPM . Staphylococci were the most frequent isolates from the milk of women with mastitis OBJECTIVE to study the effect of birth centre care on the duration of breast feeding , breast feeding complications , and women 's experiences of breast feeding .  DESIGN r and omised controlled trial . SETTING in-hospital birth centre at South Hospital , Stockholm , and st and ard obstetric care in the Greater Stockholm area . SUBJECTS 1230 women with expected date of birth between October 1989 and February 1992 , interested in participating in a birth centre trial , and meeting medical low-risk criteria . 617 women were allocated to the experimental group offered birth centre care ( EG ) , and 613 to the  control group offered  st and ard obstetric care ( CG ) . MAIN OUTCOME MEASURES duration of breast feeding , breast feeding complications such as sore nipples , engorgement , milk stasis , and mastitis , and women 's experiences of breast feeding . FINDINGS no difference was found between EG and CG in the duration of breast feeding . Ninety-three per cent in both groups were breast feeding exclusively two months post partum . The average number of months of breast feeding , exclusively or partly , when investigated one year after the birth was 8.6 in EG and 8.5 in CG . No difference was observed in women 's experiences of breast feeding , but rather more women in EG than in CG reported sore nipples , 36 % and 30 % respectively ( p = 0.03 ) , and milk stasis , 26 % and 19 % respectively ( p = 0.002 ) . CONCLUSIONS birth centre care had no effect on the duration of breast feeding , or on women 's experiences of breast feeding . Prenatal attitudes were probably more significant predictors of these outcomes than differences in the two modes of maternity care in this population of highly breast feeding-motivated women . The larger proportion of sore nipples and milk stasis in the EG might have been due to earlier discharge , or to midwives less skilled in assisting with breast feeding at the birth centre than in the postpartum wards Background It has proven difficult to reach World Health Organization ( WHO ) recommendations that infants be exclusively breastfed from birth to six months of age [ 1 , 2 ] , yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration . Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding . This study aims to determine whether mid-pregnancy breastfeeding education  , with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding , has an effect on rates of breastfeeding initiation and duration . Secondary aims of the study are to : explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives . Methods / Design A r and omised controlled trial ( RCT ) design will be used . Women having their first baby , and planning to give birth as public patients at the Royal Women 's Hospital ( RWH ) , Melbourne , will be approached at 18–20 weeks of pregnancy and invited to participate in the study . Participants will be r and omly allocated to a control group or one of two group interventions : a previously design ed and trialled tool to teach practical aspects of breastfeeding or an exploration of family attitudes to breastfeeding . The latter was developed and piloted by the investigators in conjunction with the group facilitators , prior to trial commencement . The interventions are planned to take place at 20–25 weeks . Data will be collected by question naire at recruitment , at interview in hospital after the birth and by telephone interview six months later . Medical/obstetric outcomes will be obtained from the medical record . The sample size ( 972 ) was calculated to identify an increase in breastfeeding initiation from 75 to 85 % and an increase from 40 to 50 % in breastfeeding at six months The research undertaken in this study utilized a case-control group nested within a prospect i ve cohort which was followed for the first 3 months postpartum . Mothers with mastitis and their controls were requested to complete a self-report question naire design ed to investigate the association between the potential risk factors , identified from the literature , and lactation mastitis . Logistic regression analyses of the possible risk factors were performed separately for mothers who had not breastfed Obviously and those mothers who had breastfed at least one infant prior to this lactation/nalysis showed blocked duct(s ) and increased levels of stress were the significant pre icors for mastitis in mothers who had breastfed a previous infant and blocked duct(s ) , restriction from a tight bra , attachment difficulties , and nipple pain during a feed were the significant predictors for mastitis in first time breastfeeding mothers Recommendations for the care of the nipple postpartum are numerous and variable . Cracks and fissures in the nipple must be prevented to prevent mastitis . A r and omized prospect i ve study shows that it does not matter whether powder or ointments or nothing is placed on the nipples after nursing . The incidence of cracked nipples is not significantly changed by theses measures . For the prevention of mastitis the general measures for the prevention of hospital acquired infections are necessary and more important than modifications of the nipple care OBJECTIVES to further compare acupuncture treatment and care interventions for the relief of inflammatory symptoms of the breast during lactation and to investigate the relationship between bacteria in the breast milk and clinical signs and symptoms . DESIGN r and omised , non-blinded , controlled trial of acupuncture and care interventions . SETTING a midwife-led breast feeding clinic in Sweden . PARTICIPANTS 205 mothers with 210 cases of inflammatory symptoms of the breast during lactation agreed to participate . The mothers were r and omly assigned to one of three treatment groups , two of which included acupuncture among the care interventions and one without acupuncture . All groups were given essential care . Protocol s , which included scales for erythema , breast tension and pain , were maintained for each day of contact with the breast feeding clinic . A Severity Index ( SI ) for each mother and each day was created by adding together the scores on the erythema , breast tension and pain scales . The range of the SI was 0 ( least severe ) to 19 ( most severe ) . FINDINGS no significant difference was found in numbers of mothers in the treatment groups , with the lowest possible score for severity of symptoms on contact days 3 , 4 or 5 . No statistically significant differences were found between the treatment groups for number of contact days needed until the mother felt well enough to discontinue contact with the breast feeding clinic or for number of mothers prescribed antibiotics . Significant differences were found in the mean SI scores on contact days 3 and 4 between the non-acupuncture group and the two acupuncture groups . Mothers with less favourable outcomes ( 6 contact days , n=61 ) were , at first contact with the midwife , more often given advice on correction of the baby 's attachment to the breast . An obstetrician was called to examine 20 % of the mothers , and antibiotic treatment was prescribed for 15 % of the study population . The presence of Group B streptococci in the breast milk was related to less favourable outcomes . KEY CONCLUSIONS AND IMPLICATION S FOR PRACTICE if acupuncture treatment is acceptable to the mother , this , together with care interventions such as correction of breast feeding position and babies ' attachment to the breast , might be a more expedient and less invasive choice of treatment than the use of oxytocin nasal spray . Midwives , nurses or medical 
    Output:
    
We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care ( one trial ) ; anti-secretory factor cereal ( one trial ) ; and mupirocin , fusidic acid ointment or breastfeeding advice ( one trial).Generally we found no differences in any of the trials for breastfeeding initiation or duration ; or symptoms of mastitis .
AUTHORS ' CONCLUSIONS There was insufficient evidence to show effectiveness of any of the interventions , including breastfeeding education , pharmacological treatments and alternative therapies , regarding the occurrence of mastitis or breastfeeding exclusivity and duration .
An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions