***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 Women who have suffered one episode of postpartum-onset major depression ( PPMD ) comprise a high-risk group for subsequent episodes . We conducted a double-blind , r and omized clinical trial to test the efficacy of nortriptyline in the prevention of recurrent PPMD . METHOD Nondepressed women who had at least one past episode of PPMD ( Research Diagnostic Criteria ) were recruited during pregnancy . Subjects were r and omly assigned to nortriptyline or placebo . Treatment began immediately postpartum . Each subject was assessed for 20 sequential weeks with the Hamilton Rating Scale for Depression and Research Diagnostic Criteria for recurrence of major depression . RESULTS No difference was found in the rate of recurrence in women treated with nortriptyline compared with those treated with placebo . Of 26 subjects who took nortriptyline preventively , 6 ( 0.23 , 95 % exact confidence interval [ CI ] = 0.09 to 0.44 ) suffered recurrences . Of 25 subjects who took placebo  , 6 ( 0.24 , 95 % exact CI = 0.09 to 0.45 ) suffered recurrence ( Fisher exact p = 1.00 ) . CONCLUSION Nortriptyline did not confer additional preventive efficacy beyond that of placebo . The rate of recurrence of PPMD ( one fourth of women ) was unacceptably high OBJECTIVE Rates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics . This study compared smoking outcomes for pregnant women ( n=105 ) who were r and omized to receive either usual care ( st and ard cessation advice from the health care provider ) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor . METHODS Subjects were 105 low income , predominantly Hispanic , pregnant patients in an urban prenatal clinic .  Smoking outcomes were assessed at end of pregnancy and 6 months post-partum . RESULTS At follow-up , 28.3 % and 9.4 % of participants in the experimental intervention and 9.6 % and 3.8 % of patients in usual care were abstinent at end of pregnancy ( p=.015 ) and 6 months post-partum , respectively ( p=.251 ) . Cost of the intervention was $ 56 per patient and cost to produce a non-smoker at end of pregnancy was $ 299 . CONCLUSIONS This model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy . PRACTICAL IMPLICATION S If these findings are replicated , prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session This pilot study evaluated the effectiveness of a nurse-delivered home-visiting program during the postpartum period that included a low-intensity smoking relapse-prevention intervention . A prospect i ve two-group design was used . Participants were women who had quit smoking during their pregnancy . They were invited to participate during postpartum hospitalization on a university hospital postpartum ward . A brief intervention during postpartum hospitalization , a home visit , and two follow-up phone calls over a 1- to 2-month period were compared with a routine home visit without any prescribed focus on tobacco use . The main outcome was biochemically verified smoking abstinence at 3 and 6 months postenrollment . Abstinence was defined as a salivary cotinine level of 14 ng/ml or less . At 3 months postenrollment , 26.4 % of the intervention group were classified as abstinent , compared with 12.4 % of the comparison group ( OR = 2.4 , 95 % CI = 1.16 - 4.98 ) . At 6 months , the proportion of the intervention group categorized as abstinent was 21.5 % , compared with 10.2 % of comparison group participants ( OR = 2.5 , 95 % CI = 1.13 - 5.71 ) . Greater than three times as many in the intervention group remained abstinent at both times ( 18.2 % ) , compared with the comparison group ( 5.2 % ; OR = 2.4 , 95 % CI = 1.16 - 4.93 ) . The effectiveness of this brief , low-cost , and potentially replicable intervention in improving the rate of persistent postpartum smoke-free status for women who quit smoking during pregnancy is encouraging . A r and omized trial of the approach is warranted BACKGROUND Mirena is a levonorgestrel-releasing intrauterine system ( LNG-IUS ) that provides highly effective and long-acting progestogen-only contraception . OBJECTIVE The objective of this study was to analyze the possible effects of using LNG-20 microg IUS on breast-feeding performance , infant growth and infant development during the first postpartum year as compared with the Copper T380A intrauterine device ( Cu T380A IUD ) . DESIGN This study is a prospect i ve , controlled and r and omized trial . SETTING The study was conducted at the Department of Obstetrics and Gynecology , Assiut University Hospital , Egypt . METHODS Three hundred twenty lactating women asking for initiation of contraception during the early postpartum stage were assigned r and omly into two groups , the LNG-20 microg IUS group ( n=163 ) and the Cu T380A group ( n=157 ) . The insertions were done 6 - 8 weeks postpartum . Each participant was followed up at three monthly intervals after insertion and until the first birthday of her baby . During these visits , the breast-feeding pattern was assessed , certain infant physical growth parameters were measured and a set of infant development tests was performed . RESULTS No pregnancy occurred in both groups . There were no significant differences in the net continuation rates between the two groups ( 89.3 for LNG-IUS vs. 90.9 for Cu T380A ) . The LNG-20 microg IUS group had comparable rates of breast-feeding continuation , complete weaning , full breast-feeding and partial breast-feeding , with the Cu-IUD group . No statistically significant differences were found between groups with regard to all infant physical growth parameters and various infant development tests . CONCLUSION The findings of the current study confirm that the use of LNG-20 microg IUS during the first postpartum year in lactating women provides highly effective and acceptable contraception and does not negatively influence breast-feeding or the growth and development of breast-fed infants BACKGROUND Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants . Research is needed to evaluate the efficacy of psychotherapy for postpartum depression . METHODS A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and r and omly assigned to 12 weeks of interpersonal psychotherapy ( IPT ) or to a  waiting list condition ( WLC ) control group .  Subjects completed interview and self-report assessment s of depressive symptoms and social adjustment every 4 weeks . RESULTS Ninety-nine of the 120 patients completed the protocol .  Hamilton Rating Scale for Depression ( HRSD ) scores of women receiving IPT declined from 19.4 to 8.3 , a significantly greater decrease than occurred in the WLC group ( 19.8 to 16.8 ) . The Beck Depression Inventory ( BDI ) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks , a significantly greater decrease than occurred in the WLC group ( 23.0 to 19.2 ) . A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower ( 37 . 5 % ) and BDI scores of 9 or lower ( 43.8 % ) compared with women in the WLC group ( 13.7 % and 13.7 % , respectively ) . Women receiving IPT also had significant improvement on the Postpartum Adjustment Question naire and the Social Adjustment Scale-Self-Report relative to women in the WLC group . CONCLUSIONS These findings suggest that IPT is an efficacious treatment for postpartum depression . Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment , and represents an alternative to pharmacotherapy , particularly for women who are breastfeeding This three-group r and omized controlled trial assessed the effectiveness of a postpartum public health nurse telephone visit on infant-care behaviours of primiparous women in Ottawa-Carleton . The impact of a clerk call on recruiting mothers to parent-baby groups was also described . Low risk primiparas were r and omized into telephone visit , clerk call and control groups . At three months postpartum , there were no significant differences in infant-care behaviour scores among the study groups . Women who received the telephone visit had the highest parent-baby group attendance rates and among attenders , the highest rates of smoking during pregnancy , the least education , and lowest incomes . Analysis of variance revealed a significant interaction term between attendance at parent-baby groups and assigned study group . This effect disappeared after adjusting for age and education . The telephone visit was no more effective in producing the desired infant-care behaviour changes than a mailed out information package with or without a clerk phone call . However , the intervention did increase the utilization of parent-baby support groups by women who were more socioeconomically disadvantaged A prospect i ve cohort study was undertaken to evaluate the impact of pregnancy and the first delivery on the defecatory symptoms and to identify associated factors . Included were 487 nulliparous pregnant women who completed four question naires .  Flatus and fecal incontinence , constipation , and painful defecation are already present in early pregnancy and are significantly predictive for reporting symptoms after delivery , except for fecal incontinence . A third or fourth degree sphincter tear was significantly associated with fecal incontinence 12 months postpartum and with de novo fecal incontinence , while other factors associated with de novo onset of symptoms were of borderline significance . Defecation symptoms already present in early pregnancy are highly predictive for reported symptoms at 12 months postpartum except for fecal incontinence that is mainly related to anal sphincter lesion . Therefore , investigating the effects of childbirth in general on the anorectal function is not justified without knowledge of this function during pregnancy PURPOSE : Third-degree tears are generally managed by primary anal sphincter repair . Postoperatively , some physicians recommend laxative use , whereas others favor bowel confinement after anorectal reconstructive surgery . This r and omized trial was design ed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair . METHODS : A total of 105 females were r and omized after primary repair of a third-degree tear to receive lactulose ( laxative group ) or codeine phosphate ( constipated group ) for three days postoperatively . Patients were review ed at three days and at three months postpartum . Recorded outcome measures were symptomatic and functional outcome and early postoperative morbidity . RESULTS : Forty-nine patients were r and omly assigned to the constipated group and 56 patients to the laxative group . The first postoperative bowel motion occurred at a median of four ( mean , 4.5 ( range , 1–9 ) ) days in the constipated group and at two ( mean , 2.5 ( range , 1–7 ) ) days in the laxative group ( P < 0.001 ) . Patients in the constipated group had a significantly more painful first evacuation compared with the laxative group ( P < 0.001 ) . The mean duration of hospital stay was 3.7 ( range , 2–6 ) days in the constipated group and 3.05 days in the laxative group ( range , 2–5 ; P = 0.001 ) . Nine patients in the constipated group complained of troublesome postoperative constipation compared with three in the laxative group ( P = 0.033 ) . Continence scores , anal manometry , and endoanal ultrasound findings were similar in the two groups at three months postpartum . CONCLUSIONS : Patients in the laxative group had a significantly earlier and less painful bowel motion and earlier postnatal discharge . There was no difference in the symptomatic or functional outcome of repair between the two regimens OBJECTIVE --To determine whether counselling by health visitors  is helpful in managing postnatal depression .  DESIGN --Controlled , r and om order trial . SETTING --Health centres in Edinburgh and Livingston . PATIENTS --Sixty women identified as depressed by screening at six weeks post partum and by psychiatric interview at about 13 weeks post partum . Five women did not wish to participate , and a further five did not complete the trial . Age , social and obstetric factors , and diagnosis were similar in women who completed the trial and those who withdrew . INTERVENTION -- Eight weekly counselling visits by health visitors who had been given a short training in counselling for postnatal depression . END POINT -- Reduction of depression . MEASUREMENTS and main results --St and ardised psychiatric interviews and a 10 point self report scale were used to identify depression before and after intervention . The psychiatrist was not told to which group women were allocated . After three months 18 ( 69 % ) of the 26 women in the treatment group had fully recovered compared with nine ( 38 % ) of the 24 in the control group . The difference between the groups was thus 32 % ( 95 % confidence interval 5 to 58 ) . CONCLUSIONS --Counselling by health visitors 
    Output:
    
RECENT FINDINGS Mental health outcomes are improved with postpartum support in at-risk women .
There has yet to be an effective , postpartum , smoking-cessation program developed , although intensive motivational counseling shows some promising early results .
Bladder dysfunction continues to be a significant problem for women even at 10 years postpartum .
Pelvic floor muscle exercises can help prevent and treat incontinence at 12 months , but longer-term follow-up studies are needed .
Prevalence studies suggest that bowel dysfunction is common in the postpartum period , but r and omized , controlled trials are limited to treatment in women with third-degree perineal damage .