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: 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 Background : Whereas breastfeeding initiation rates have risen in all groups throughout the country , rates of breastfeeding duration have changed more slowly . Peer counseling has had some success in sustaining breastfeeding , but with intensive programs and variable effects . Objectives : We aim ed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally . We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention . Methods : One hundred twenty prenatal women underwent stratified r and omization based on breastfeeding attitude , measured by the Iowa Infant Feeding Attitude Scale ( IIFAS ) . The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery . Study groups were compared on breastfeeding outcomes , adjusting for IIFAS strata , and on interactions with self-efficacy . Results : One hundred three women were followed to at least 1 month . Women with positive attitudes had significantly higher rates of initiation ( 93 % vs 61 % ) and breastfeeding at 1 and 6 months ( 79 % vs 25 % and 12 % vs 0 % , respectively ) than those with negative attitudes , regardless of intervention . After adjusting for self-efficacy , women who received peer counseling had significantly higher breastfeeding rates at 1 month ( odds ratio = 3.2 ; 95 % confidence interval , 1.02 - 9.8 ) . The intervention group was marginally more likely to achieve their breastfeeding goal ( 43 % vs 22 % , P = .073 ) . Conclusion : Breastfeeding rates in all women improved during the study period . Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support . Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals The aim of this study was to investigate whether mothers with newborn children , the usage of autogenic training with advice on breastfeeding effect on : the decision and the duration of breastfeeding , increase maternal confidence and support . It was assumed that the above result in a higher percentage of mothers who exclusively breastfed baby during the first six months of child 's life . The survey was conducted in the Association " For a healthy and happy childhood"-Counseling center for mother and child , in Bjelovar in 2010 . The Counseling center was attended by 100 nursing mothers with children aged up to two months . They r and omly went to the study or control group . Mothers of both groups were advised to successful breastfeeding . Study group has practice d autogenic training until the child 's age of six months . In parallel , by using psychotherapeutic interview and specific question naires we collected data on the somatic , psychological and social situation of the mother , discovered mother 's mental changes ( anxiety , depression ) that were treated . The results at the end of the study confirm the initial expected benefits from the application of autogenic training . Mothers of the study group were significantly more emotionally balanced with a higher self-esteem .  Autogenous training with the advices for successful breastfeeding conducted in this counseling center contributed in significantly higher rate of breastfeeding children up to six months of life , improved mental and physical health of mother and child and their peculiar relationship OBJECTIVE To study the factors involved in the maintenance of exclusive breastfeeding  in healthy infants during the first 4 months of life , with emphasis on the role of pediatricians . MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba , state of Minas Gerais , Brazil . The babies were divided at r and om into three groups : G1 , receiving advice from a multiprofessional breastfeeding team ; G2 , receiving advice from a pediatrician trained in breastfeeding ; and G3 , receiving advice from a pediatrician with no breastfeeding training . Group r and omization was confirmed by analysis of variance . The factors involved in the type of feeding at 4 months were analyzed by the chi-square test , by analysis of variance and by multiple variable analysis . RESULTS At the end of follow-up , Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding . In addition , the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 ( p = 0.002 ) . The use of a pacifier was negatively correlated with exclusive breastfeeding ( p = 0.003 ) . More maternal schooling increased the chance of exclusive breastfeeding at 4 months ( p = 0.041 ) . CONCLUSIONS In this study , a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries PURPOSE To develop , implement , and examine the effect of a breastfeeding educational program on breastfeeding knowledge and practice s of Egyptian mothers of preterm infants . METHODS An experimental design was used with a convenience sample of 60 mothers and their preterm infants who were born before 37 weeks of gestation . They were r and omly assigned to intervention and control groups . Data collection instruments included breastfeeding knowledge question naire , observational checklist of mother 's breastfeeding practice s , breastfeeding diary , infant 's and mother 's profile form , and demographic information . A five-session breastfeeding educational program based on B and ura 's Social Cognitive Theory was implemented with the intervention group during the infant 's hospitalization and after discharge . Both groups were followed up to 3 months after discharge . Descriptive statistics , ANOVA , Chi-square , and regression were used to analyze the data . FINDINGS Mother 's knowledge significantly increased for the intervention group but not the control group ( p = 0.041 ) . The intervention group showed gradual improvement in breastfeeding practice s , i.e. , started breast milk expression earlier and had more breast milk expression frequency than the control group . Of the intervention group , 80 % were discharged on exclusive breastfeeding compared to 40 % among the control group , and breastfeeding problems were less among the intervention group . CONCLUSIONS The breastfeeding educational program was effective in improving breastfeeding knowledge and practice s among mothers of preterm infants 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 : To investigate the effect of antenatal breastfeeding counseling on the breastfeeding rates for women who give birth to twins . Design : Prospect i ve r and omized trial . Setting : Multiple Pregnancy Unit , Obstetrics Department , University of São Paulo , Brazil . Participants : A total of 171 mothers of twins and their 342 infants . Methods : The participants were r and omized into the prenatal counseling group ( PCG ) or control group ( CG ) . Breastfeeding data were collected through personal interviews at three times after birth : 30 to 40 days ( Time 1 ) , 90 days ( Time 2 ) , and 180 days ( Time 3 ) . The primary endpoint was a comparison of the mothers ' breastfeeding rates between PCG and CG in each analyzed period . The secondary endpoint was the comparison of the overall rates of twin infant breastfeeding between PCG and CG until 180 days after birth . Results : The final analysis included 68 women pregnant with twins in the PCG and 60 in the CG . There was no significant difference in the breastfeeding rates between PCG and CG in the analyzed periods : Time 1 ( odds ratio [ OR ] = 1.87 , 95 % confidence interval [ CI ] [ 0.71 , 4.95 ] ) , Time 2 ( OR = 1.50 , 95 % CI [ 0.72 , 3.10 ] ) , and Time 3 ( OR = 1.06 , 95 % CI [ 0.51 , 2.19 ] ) . Also , no difference existed in the overall rates of breastfeeding between PCG and CG at 180 days . Conclusion : In women pregnant with twins , antenatal breastfeeding counseling did not significantly affect the breastfeeding rates . Further research about the best moment to counsel mothers of twins is needed to improve breastfeeding rates BACKGROUND Exclusive breastfeeding is the recommended breastfeeding method for infants during the first 6 postnatal months . OBJECTIVE This study aim ed to increase breastfeeding duration and frequency using a breastfeeding motivation program ( BMP ) , which was structurally based on Pender 's Health Promotion Model ( HPM ) and administered during pregnancy and the postnatal period . The study was also design ed to determine the BMP effectiveness in supporting exclusive breastfeeding . MATERIAL S AND METHODS The sample of this r and omized controlled trial included 100 pregnant women ( 50 in the BMP , 50 in the control group ) who applied to the pregnancy preparation course in a state hospital located in Usak , western Turkey . Participants in the study were allocated into either the BMP group or control group through systematic sampling and r and omization . The BMP was structured based on the HPM and was carried out with the BMP study group four times : during the antenatal period , on the first postnatal day , between the fourth and sixth postnatal weeks , and during the fourth postnatal month . Data were analyzed using the descriptive statistical test , Pearson 's chi-square test , independent sample s t test , and ANOVA . RESULTS The mothers in the BMP group started breastfeeding earlier than the mothers in the control group ( 97.1 % ) and had fewer problems with their first breastfeeding experience . The average score of perceived self-efficacy in breastfeeding and the rate of first breastfeeding experience ( 70.6 % ) were higher in the BMP group by a statistically significant amount . CONCLUSION BMP for breastfeeding , structurally based on Pender 's HPM , can 
    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: 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 Background : Whereas breastfeeding initiation rates have risen in all groups throughout the country , rates of breastfeeding duration have changed more slowly . Peer counseling has had some success in sustaining breastfeeding , but with intensive programs and variable effects . Objectives : We aim ed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally . We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention . Methods : One hundred twenty prenatal women underwent stratified r and omization based on breastfeeding attitude , measured by the Iowa Infant Feeding Attitude Scale ( IIFAS ) . The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery . Study groups were compared on breastfeeding outcomes , adjusting for IIFAS strata , and on interactions with self-efficacy . Results : One hundred three women were followed to at least 1 month . Women with positive attitudes had significantly higher rates of initiation ( 93 % vs 61 % ) and breastfeeding at 1 and 6 months ( 79 % vs 25 % and 12 % vs 0 % , respectively ) than those with negative attitudes , regardless of intervention . After adjusting for self-efficacy , women who received peer counseling had significantly higher breastfeeding rates at 1 month ( odds ratio = 3.2 ; 95 % confidence interval , 1.02 - 9.8 ) . The intervention group was marginally more likely to achieve their breastfeeding goal ( 43 % vs 22 % , P = .073 ) . Conclusion : Breastfeeding rates in all women improved during the study period . Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support . Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals The aim of this study was to investigate whether mothers with newborn children , the usage of autogenic training with advice on breastfeeding effect on : the decision and the duration of breastfeeding , increase maternal confidence and support . It was assumed that the above result in a higher percentage of mothers who exclusively breastfed baby during the first six months of child 's life . The survey was conducted in the Association " For a healthy and happy childhood"-Counseling center for mother and child , in Bjelovar in 2010 . The Counseling center was attended by 100 nursing mothers with children aged up to two months . They r and omly went to the study or control group . Mothers of both groups were advised to successful breastfeeding . Study group has practice d autogenic training until the child 's age of six months . In parallel , by using psychotherapeutic interview and specific question naires we collected data on the somatic , psychological and social situation of the mother , discovered mother 's mental changes ( anxiety , depression ) that were treated . The results at the end of the study confirm the initial expected benefits from the application of autogenic training . Mothers of the study group were significantly more emotionally balanced with a higher self-esteem .  Autogenous training with the advices for successful breastfeeding conducted in this counseling center contributed in significantly higher rate of breastfeeding children up to six months of life , improved mental and physical health of mother and child and their peculiar relationship OBJECTIVE To study the factors involved in the maintenance of exclusive breastfeeding  in healthy infants during the first 4 months of life , with emphasis on the role of pediatricians . MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba , state of Minas Gerais , Brazil . The babies were divided at r and om into three groups : G1 , receiving advice from a multiprofessional breastfeeding team ; G2 , receiving advice from a pediatrician trained in breastfeeding ; and G3 , receiving advice from a pediatrician with no breastfeeding training . Group r and omization was confirmed by analysis of variance . The factors involved in the type of feeding at 4 months were analyzed by the chi-square test , by analysis of variance and by multiple variable analysis . RESULTS At the end of follow-up , Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding . In addition , the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 ( p = 0.002 ) . The use of a pacifier was negatively correlated with exclusive breastfeeding ( p = 0.003 ) . More maternal schooling increased the chance of exclusive breastfeeding at 4 months ( p = 0.041 ) . CONCLUSIONS In this study , a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries PURPOSE To develop , implement , and examine the effect of a breastfeeding educational program on breastfeeding knowledge and practice s of Egyptian mothers of preterm infants . METHODS An experimental design was used with a convenience sample of 60 mothers and their preterm infants who were born before 37 weeks of gestation . They were r and omly assigned to intervention and control groups . Data collection instruments included breastfeeding knowledge question naire , observational checklist of mother 's breastfeeding practice s , breastfeeding diary , infant 's and mother 's profile form , and demographic information . A five-session breastfeeding educational program based on B and ura 's Social Cognitive Theory was implemented with the intervention group during the infant 's hospitalization and after discharge . Both groups were followed up to 3 months after discharge . Descriptive statistics , ANOVA , Chi-square , and regression were used to analyze the data . FINDINGS Mother 's knowledge significantly increased for the intervention group but not the control group ( p = 0.041 ) . The intervention group showed gradual improvement in breastfeeding practice s , i.e. , started breast milk expression earlier and had more breast milk expression frequency than the control group . Of the intervention group , 80 % were discharged on exclusive breastfeeding compared to 40 % among the control group , and breastfeeding problems were less among the intervention group . CONCLUSIONS The breastfeeding educational program was effective in improving breastfeeding knowledge and practice s among mothers of preterm infants 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 : To investigate the effect of antenatal breastfeeding counseling on the breastfeeding rates for women who give birth to twins . Design : Prospect i ve r and omized trial . Setting : Multiple Pregnancy Unit , Obstetrics Department , University of São Paulo , Brazil . Participants : A total of 171 mothers of twins and their 342 infants . Methods : The participants were r and omized into the prenatal counseling group ( PCG ) or control group ( CG ) . Breastfeeding data were collected through personal interviews at three times after birth : 30 to 40 days ( Time 1 ) , 90 days ( Time 2 ) , and 180 days ( Time 3 ) . The primary endpoint was a comparison of the mothers ' breastfeeding rates between PCG and CG in each analyzed period . The secondary endpoint was the comparison of the overall rates of twin infant breastfeeding between PCG and CG until 180 days after birth . Results : The final analysis included 68 women pregnant with twins in the PCG and 60 in the CG . There was no significant difference in the breastfeeding rates between PCG and CG in the analyzed periods : Time 1 ( odds ratio [ OR ] = 1.87 , 95 % confidence interval [ CI ] [ 0.71 , 4.95 ] ) , Time 2 ( OR = 1.50 , 95 % CI [ 0.72 , 3.10 ] ) , and Time 3 ( OR = 1.06 , 95 % CI [ 0.51 , 2.19 ] ) . Also , no difference existed in the overall rates of breastfeeding between PCG and CG at 180 days . Conclusion : In women pregnant with twins , antenatal breastfeeding counseling did not significantly affect the breastfeeding rates . Further research about the best moment to counsel mothers of twins is needed to improve breastfeeding rates BACKGROUND Exclusive breastfeeding is the recommended breastfeeding method for infants during the first 6 postnatal months . OBJECTIVE This study aim ed to increase breastfeeding duration and frequency using a breastfeeding motivation program ( BMP ) , which was structurally based on Pender 's Health Promotion Model ( HPM ) and administered during pregnancy and the postnatal period . The study was also design ed to determine the BMP effectiveness in supporting exclusive breastfeeding . MATERIAL S AND METHODS The sample of this r and omized controlled trial included 100 pregnant women ( 50 in the BMP , 50 in the control group ) who applied to the pregnancy preparation course in a state hospital located in Usak , western Turkey . Participants in the study were allocated into either the BMP group or control group through systematic sampling and r and omization . The BMP was structured based on the HPM and was carried out with the BMP study group four times : during the antenatal period , on the first postnatal day , between the fourth and sixth postnatal weeks , and during the fourth postnatal month . Data were analyzed using the descriptive statistical test , Pearson 's chi-square test , independent sample s t test , and ANOVA . RESULTS The mothers in the BMP group started breastfeeding earlier than the mothers in the control group ( 97.1 % ) and had fewer problems with their first breastfeeding experience . The average score of perceived self-efficacy in breastfeeding and the rate of first breastfeeding experience ( 70.6 % ) were higher in the BMP group by a statistically significant amount . CONCLUSION BMP for breastfeeding , structurally based on Pender 's HPM , can 
    Output:
    