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: OBJECTIVE : To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries The study provides a proof-of-concept that monthly financial incentives contingent on observed breastfeeding increased breastfeeding rates through 6-month postpartum among low-income Puerto Rican mothers . BACKGROUND AND OBJECTIVE : Despite maternal and child health benefits , breastfeeding rates are relatively low among low-income Puerto Rican mothers . This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) services only among Puerto Rican mothers . METHODS : A r and omized , 2-arm parallel-group design , from February 2015 through February 2016 . Half of the r and omized participants received monthly financial incentives contingent on observed breastfeeding for 6 months ( Incentive ) , and the other half received usual WIC services only ( Control ) . Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled .  Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $ 20 to $ 70 for a total possible of $ 270 . RESULTS : The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group ( 89 % vs 44 % , P = .01 at 1 month ; 89 % vs 17 % , P < .001 at 3 months ; 72 % vs 0 % , P < .001 at 6 months ) . No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes ( ie , weight , emergency department visits ) . CONCLUSIONS : Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers ; however , no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes . Larger-scale studies are warranted to examine efficacy , implementation potential , and cost-effectiveness Background The theory of planned behavior ( TPB ) has been used to explain breastfeeding behaviors in Western cultures . Theoretically-based investigations in other groups are sparse . Objective To evaluate cross-cultural application of TPB-based models for breastfeeding duration among new mothers in Hong Kong . Method First-time breastfeeding mothers ( N = 209 ) with healthy newborns provided self-reports of TPB predictor variables during postpartum hospitalization and information about breastfeeding experiences at 1 , 3 , 6 , 9 , and 12 months postdelivery or until they weaned . Three predictive models were proposed : ( a ) a strict interpretation of the TPB with two added proximal predictors of breastfeeding duration ; ( b ) a replication with modification of the TPB-based model for more fully employed breastfeeding mothers from a previous study ( Duckett et al. , 1998 ) ; and ( c ) a model that posited perceived control ( PC ) as a mediating factor linking TPB motivational variables for breastfeeding with breastfeeding intentions and behavior . LISREL was used for the structural equation modeling analyses . Results Explained variance in PC and duration was high in all models . Overall fit of the strict TPB model was poor ( GOFI = 0.85 ) . The  TPB  for breastfeeding employed women and the PC-mediated models fit equally well ( GOFI = 0.94 ; 0.95 ) and residuals were small ( RMSR = 0.07 ) . All hypothesized paths in the PC-mediated model were significant ( p < .05 ) ; explained variance was 0.40 for perceived control and 0.36 for breastfeeding duration . Discussion Models were interpreted in light of the TPB , previous findings , the social context for breastfeeding in Hong Kong , and statistical model-building . Cross-cultural measurement issues and the need for prospect i ve design s are continuing challenges in breastfeeding research OBJECTIVE : To evaluate the effectiveness of a coparenting intervention on exclusive breastfeeding  among primiparous mothers and fathers . METHODS : A r and omized controlled trial was conducted in a large teaching hospital in Toronto , Canada . Couples were r and omized to receive either  usual care ( n = 107 ) or a coparenting breastfeeding support intervention ( n = 107 ) . Follow-up of exclusive breastfeeding and diverse secondary outcomes was conducted at 6 and 12 weeks postpartum . RESULTS : Significantly more mothers in the intervention group than in the control group continued to breastfeed at 12 weeks postpartum ( 96.2 % vs 87.6 % , P = .02 ) . Although proportionately more mothers in the intervention group were exclusively breastfeeding at 6 and 12 weeks , these differences were not significant . Fathers in the intervention group had a significantly greater increase in breastfeeding self-efficacy scores from baseline to 6 weeks postpartum compared with fathers in the control group ( P = .03 ) . In addition , significantly more mothers in the intervention group than in the control group reported that their partners provided them with breastfeeding help in the first 6 weeks ( 71 % vs 52 % , P = .02 ) and that they were satisfied with their partners ’ involvement with breastfeeding ( 89 % vs 78.1 % , P = .04 ) . Mothers in the intervention group were also more satisfied with the breastfeeding information they received ( 81 % vs 62.5 % , P < .001 ) . CONCLUSIONS : The significant improvements in breastfeeding duration , paternal breastfeeding self-efficacy , and maternal perceptions of paternal involvement and assistance with breastfeeding suggest that a coparenting intervention involving fathers warrants additional investigation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background . Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health , the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal . The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks . Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed , problems with the infant latching or suckling , and lack of individualized encouragement from their clinicians in the early postdischarge period . Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practice s during routine preventive visits . However , robust scientific evidence based on r and omized , controlled trials is currently lacking . Objective . The purpose of this study was to determine whether attending an early , routine , preventive , outpatient visit delivered in a primary care physician ’s office would improve breastfeeding outcomes . Design . The study was a prospect i ve , r and omized , parallel-group , open trial . Setting . Participants were recruited at a level 3 maternity facility , with an average of 2000 births per year , in France . Participants . A total of 231 mothers who had delivered a healthy singleton infant ( gestational age : ≥37 completed weeks ) and were breastfeeding on the day of discharge were recruited and r and omized ( 116 were assigned to the intervention group and 115 to the  control group ) between October 1 , 2001 , and May 31 , 2002 ; 226 mother-infant pairs ( 112 in the intervention group and 114 in the control group ) contributed data on outcomes . Intervention . Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members , a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge , provision of the telephone number of a peer support group , m and atory routine , preventive , outpatient visits at 1 , 2 , 3 , 4 , 5 , and 6 months of infant age , and 10 weeks of paid maternity leave ( extended to 18 weeks after the birth of the third child ) . In addition to the usual predischarge and postdischarge support , the mothers in the intervention group were invited to attend an individual , routine , preventive , outpatient visit in the office of 1 of the 17 participating primary care physicians ( pediatricians or family physicians ) within 2 weeks after the birth . The participating physicians received a 5-hour training program on breastfeeding , delivered in 2 parts in 1 month , before the beginning of the study . Outcome Measures . The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks ( defined as giving maternal milk as the only food source , with no other foods or liquids , other than vitamins or medications , being given ) . The secondary outcomes included any breastfeeding reported at 4 weeks , breastfeeding duration , breastfeeding difficulties , and satisfaction with breastfeeding experiences . Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall . Results . Ninety-two mothers ( 79.3 % ) assigned to the intervention group and 8 mothers ( 7.0 % ) assigned to the control group reported that they had attended the routine , preventive , outpatient visit in the office of 1 of the 17 primary care physicians participating in the study . Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks ( 83.9 % vs 71.9 % ; hazard ratio : 1.17 ; 95 % confidence interval [ CI ] : 1.01–1.34 ) and longer breastfeeding duration ( median : 18 weeks vs 13 weeks ; hazard ratio : 1.40 ; 95 % CI : 1.03–1.92 ) . They were less likely to report any breastfeeding difficulties ( 55.3 % vs 72.8 % ; hazard ratio : 0.76 ; 95 % CI : 0.62–0.93 ) . There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks ( 89.3 % vs 81.6 % ; hazard ratio : 1.09 ; 95 % CI : 0.98–1.22 ) and the rate of mothers fairly or very satisfied with their breastfeeding experiences ( 91.1 % vs 87.7 % ; hazard ratio : 1.04 ; 95 % CI : 0.95–1.14 ) . Conclusions . Although we can not exclude the possibility that findings might differ in other health care systems , this study provides preliminary evidence of the efficacy of breastfeeding support through an early , routine , preventive visit in the offices of trained primary care physicians . Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes . Multifaceted interventions aim ing to support breastfeeding should involve primary care physicians BACKGROUND Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative ( BFHI ) policy in government hospitals . It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates . OBJECTIVE To study the effectiveness of telephone lactation counselling on breastfeeding practice s. DESIGN Single blinded , r and omised controlled trial ( RCT ) . SETTING Maternity wards in a public hospital in Kuala Lumpur , Malaysia . PARTICIPANTS 357 mothers , each of whom had delivered a full term , healthy infant via spontaneous vaginal delivery . METHODS Mothers were followed up for 6 months . The intervention group ( n=179 ) received lactation counselling via telephone twice monthly by 
    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: OBJECTIVE : To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries The study provides a proof-of-concept that monthly financial incentives contingent on observed breastfeeding increased breastfeeding rates through 6-month postpartum among low-income Puerto Rican mothers . BACKGROUND AND OBJECTIVE : Despite maternal and child health benefits , breastfeeding rates are relatively low among low-income Puerto Rican mothers . This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) services only among Puerto Rican mothers . METHODS : A r and omized , 2-arm parallel-group design , from February 2015 through February 2016 . Half of the r and omized participants received monthly financial incentives contingent on observed breastfeeding for 6 months ( Incentive ) , and the other half received usual WIC services only ( Control ) . Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled .  Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $ 20 to $ 70 for a total possible of $ 270 . RESULTS : The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group ( 89 % vs 44 % , P = .01 at 1 month ; 89 % vs 17 % , P < .001 at 3 months ; 72 % vs 0 % , P < .001 at 6 months ) . No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes ( ie , weight , emergency department visits ) . CONCLUSIONS : Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers ; however , no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes . Larger-scale studies are warranted to examine efficacy , implementation potential , and cost-effectiveness Background The theory of planned behavior ( TPB ) has been used to explain breastfeeding behaviors in Western cultures . Theoretically-based investigations in other groups are sparse . Objective To evaluate cross-cultural application of TPB-based models for breastfeeding duration among new mothers in Hong Kong . Method First-time breastfeeding mothers ( N = 209 ) with healthy newborns provided self-reports of TPB predictor variables during postpartum hospitalization and information about breastfeeding experiences at 1 , 3 , 6 , 9 , and 12 months postdelivery or until they weaned . Three predictive models were proposed : ( a ) a strict interpretation of the TPB with two added proximal predictors of breastfeeding duration ; ( b ) a replication with modification of the TPB-based model for more fully employed breastfeeding mothers from a previous study ( Duckett et al. , 1998 ) ; and ( c ) a model that posited perceived control ( PC ) as a mediating factor linking TPB motivational variables for breastfeeding with breastfeeding intentions and behavior . LISREL was used for the structural equation modeling analyses . Results Explained variance in PC and duration was high in all models . Overall fit of the strict TPB model was poor ( GOFI = 0.85 ) . The  TPB  for breastfeeding employed women and the PC-mediated models fit equally well ( GOFI = 0.94 ; 0.95 ) and residuals were small ( RMSR = 0.07 ) . All hypothesized paths in the PC-mediated model were significant ( p < .05 ) ; explained variance was 0.40 for perceived control and 0.36 for breastfeeding duration . Discussion Models were interpreted in light of the TPB , previous findings , the social context for breastfeeding in Hong Kong , and statistical model-building . Cross-cultural measurement issues and the need for prospect i ve design s are continuing challenges in breastfeeding research OBJECTIVE : To evaluate the effectiveness of a coparenting intervention on exclusive breastfeeding  among primiparous mothers and fathers . METHODS : A r and omized controlled trial was conducted in a large teaching hospital in Toronto , Canada . Couples were r and omized to receive either  usual care ( n = 107 ) or a coparenting breastfeeding support intervention ( n = 107 ) . Follow-up of exclusive breastfeeding and diverse secondary outcomes was conducted at 6 and 12 weeks postpartum . RESULTS : Significantly more mothers in the intervention group than in the control group continued to breastfeed at 12 weeks postpartum ( 96.2 % vs 87.6 % , P = .02 ) . Although proportionately more mothers in the intervention group were exclusively breastfeeding at 6 and 12 weeks , these differences were not significant . Fathers in the intervention group had a significantly greater increase in breastfeeding self-efficacy scores from baseline to 6 weeks postpartum compared with fathers in the control group ( P = .03 ) . In addition , significantly more mothers in the intervention group than in the control group reported that their partners provided them with breastfeeding help in the first 6 weeks ( 71 % vs 52 % , P = .02 ) and that they were satisfied with their partners ’ involvement with breastfeeding ( 89 % vs 78.1 % , P = .04 ) . Mothers in the intervention group were also more satisfied with the breastfeeding information they received ( 81 % vs 62.5 % , P < .001 ) . CONCLUSIONS : The significant improvements in breastfeeding duration , paternal breastfeeding self-efficacy , and maternal perceptions of paternal involvement and assistance with breastfeeding suggest that a coparenting intervention involving fathers warrants additional investigation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background . Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health , the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal . The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks . Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed , problems with the infant latching or suckling , and lack of individualized encouragement from their clinicians in the early postdischarge period . Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practice s during routine preventive visits . However , robust scientific evidence based on r and omized , controlled trials is currently lacking . Objective . The purpose of this study was to determine whether attending an early , routine , preventive , outpatient visit delivered in a primary care physician ’s office would improve breastfeeding outcomes . Design . The study was a prospect i ve , r and omized , parallel-group , open trial . Setting . Participants were recruited at a level 3 maternity facility , with an average of 2000 births per year , in France . Participants . A total of 231 mothers who had delivered a healthy singleton infant ( gestational age : ≥37 completed weeks ) and were breastfeeding on the day of discharge were recruited and r and omized ( 116 were assigned to the intervention group and 115 to the  control group ) between October 1 , 2001 , and May 31 , 2002 ; 226 mother-infant pairs ( 112 in the intervention group and 114 in the control group ) contributed data on outcomes . Intervention . Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members , a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge , provision of the telephone number of a peer support group , m and atory routine , preventive , outpatient visits at 1 , 2 , 3 , 4 , 5 , and 6 months of infant age , and 10 weeks of paid maternity leave ( extended to 18 weeks after the birth of the third child ) . In addition to the usual predischarge and postdischarge support , the mothers in the intervention group were invited to attend an individual , routine , preventive , outpatient visit in the office of 1 of the 17 participating primary care physicians ( pediatricians or family physicians ) within 2 weeks after the birth . The participating physicians received a 5-hour training program on breastfeeding , delivered in 2 parts in 1 month , before the beginning of the study . Outcome Measures . The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks ( defined as giving maternal milk as the only food source , with no other foods or liquids , other than vitamins or medications , being given ) . The secondary outcomes included any breastfeeding reported at 4 weeks , breastfeeding duration , breastfeeding difficulties , and satisfaction with breastfeeding experiences . Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall . Results . Ninety-two mothers ( 79.3 % ) assigned to the intervention group and 8 mothers ( 7.0 % ) assigned to the control group reported that they had attended the routine , preventive , outpatient visit in the office of 1 of the 17 primary care physicians participating in the study . Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks ( 83.9 % vs 71.9 % ; hazard ratio : 1.17 ; 95 % confidence interval [ CI ] : 1.01–1.34 ) and longer breastfeeding duration ( median : 18 weeks vs 13 weeks ; hazard ratio : 1.40 ; 95 % CI : 1.03–1.92 ) . They were less likely to report any breastfeeding difficulties ( 55.3 % vs 72.8 % ; hazard ratio : 0.76 ; 95 % CI : 0.62–0.93 ) . There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks ( 89.3 % vs 81.6 % ; hazard ratio : 1.09 ; 95 % CI : 0.98–1.22 ) and the rate of mothers fairly or very satisfied with their breastfeeding experiences ( 91.1 % vs 87.7 % ; hazard ratio : 1.04 ; 95 % CI : 0.95–1.14 ) . Conclusions . Although we can not exclude the possibility that findings might differ in other health care systems , this study provides preliminary evidence of the efficacy of breastfeeding support through an early , routine , preventive visit in the offices of trained primary care physicians . Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes . Multifaceted interventions aim ing to support breastfeeding should involve primary care physicians BACKGROUND Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative ( BFHI ) policy in government hospitals . It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates . OBJECTIVE To study the effectiveness of telephone lactation counselling on breastfeeding practice s. DESIGN Single blinded , r and omised controlled trial ( RCT ) . SETTING Maternity wards in a public hospital in Kuala Lumpur , Malaysia . PARTICIPANTS 357 mothers , each of whom had delivered a full term , healthy infant via spontaneous vaginal delivery . METHODS Mothers were followed up for 6 months . The intervention group ( n=179 ) received lactation counselling via telephone twice monthly by 
    Output:
    