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: Background Children with severe malnutrition who develop shock have a high  mortality . Contrary to contemporaneous paediatric practice , current guidelines recommend use of low dose hypotonic fluid resuscitation ( half-strength Darrows/5 % dextrose ( HSD/5D ) . We evaluated the safety and efficacy of this guideline compared to resuscitation with a st and ard isotonic solution . Methods A Phase II r and omised controlled , safety and efficacy trial in Kenyan children aged over 6 months with severe malnutrition and shock including children with severe dehydration/shock and presumptive septic shock ( non-diarrhoeal shock ) . Eligible children were r and omised to HSD/5D or Ringer 's Lactate ( RL ) . A maximum of two boluses of 15 ml/kg of HSD/5D were given over two hours ( as recommended by guidelines ) while those r and omised to RL received 10 ml/kg aliquots half hourly ( maximum 40 ml/kg ) . Primary endpoint was resolution of shock at 8 and 24 hours . Secondary outcomes included resolution of acidosis , adverse events and mortality . Results 61 children were enrolled : 41 had shock and severe dehydrating diarrhoea , 20 had presumptive septic shock ; 69 % had decompensated shock . By 8 hours response to volume resuscitation was poor with shock persisting in most children:-HSD/5D 15/22 ( 68 % ) and RL14/25 ( 52 % ) , p = 0.39 . Oliguria was more prevalent at 8 hours in the HSD/5D group , 9/22 ( 41 % ) , compared to RL-3/25 ( 12 % ) , p = 0.02 . Mortality was high , HSD/5D-15/26(58 % ) and RL 13/29(45 % ) ; p = 0.42 . Most deaths occurred within 48 hours of admission . Neither pulmonary oedema nor cardiogenic failure was detected . Conclusions Outcome was universally poor characterised by persistence of shock , oliguria and high case fatality . Isotonic fluid was associated with modest improvement in shock and survival when compared to HSD/5D but inconclusive due to the limitations of design and effectiveness of either resuscitation strategy . Although isotonic fluid resuscitation did not result in cardiogenic heart failure , as previously feared , we conclude that the modest volumes used and rate of infusion were insufficient to promptly correct shock . The adverse performance of the recommended fluid resuscitation guideline for severe malnutrition should prompt clinical investigation of isotonic fluids for resuscitation of compensated shock , defining rate and volumes required to inform future guidelines .Trial Registration The trial is registered as ISCRTN : This paper explores a number of socioeconomic factors thought to explain the wide prevalence of undernutrition among rural Bangladeshi women . The 1992 baseline survey data of the BRAC-ICDDR , B Joint Research Project at Matlab were used . Anthropometry was performed on a r and om sub- sample of 1462 currently married , non-pregnant women between 15 and 49 years of age . Women 's nutritional status was defined in terms of Body Mass Index ( BMI = wt in kg/ht in m2 ) . Compared with women from better-off households , the mean weight ( 41.2 vs 43.0 kg ; p < 0.0001 ) , mid-upper arm circumference ( MUAC ) ( 22.1 vs 22.7 ; p < 0.0001 ) , and BMI ( 18.5 vs 19.1 ; p < 0.0001 ) of poor women were consistently lower . However , no significant difference in mean height was found between the two groups . The results showed that women aged more than 35 years are twice as likely to have a BMI < 18.5 compared with younger women . Both years of schooling received and socioeconomic status are found to be important predictors of women 's BMI . Women who have received one or more years of formal education are nearly half as likely to suffer chronic energy deficiency ( BMI < 18.5 ) than women with no schooling . Again , better-off women are found to be 0.77 times less likely to have chronic energy deficiency than women from poor households . The implication s of these findings in improving the nutritional status of rural Bangladeshi women are discussed Background : Intestinal damage and malabsorption caused by chronic environmental enteropathy are associated with growth faltering seen in infants in less-developed countries . Evidence has suggested that supplementary omega-3 ( n−3 ) long-chain PUFAs ( LC-PUFAs ) might ameliorate this damage by reducing gastrointestinal inflammation . LC-PUFA supplementation may also benefit cognitive development . Objective : We tested whether early n−3 LC-PUFA supplementation improves  infant intestinal integrity , growth , and cognitive function . Design : A r and omized , double-blind , controlled trial [ 200 mg DHA and 300 mg EPA or 2 mL olive oil/d for 6 mo ] was conducted in a population of 172 rural Gambian infants aged 3–9 mo . The primary endpoints were anthropometric measures and gut integrity [ assessed by using urinary lactulose : mannitol ratios ( LMRs ) ] . Plasma fatty acid status , intestinal mucosal inflammation ( fecal calprotectin ) , daily morbidity , and cognitive development ( 2-step means-end test and an attention assessment ) were secondary endpoints . Results : PUFA supplementation result ed in a significant increase in plasma n−3 LC-PUFA concentrations ( P < 0.001 for both DHA and EPA ) and midupper arm circumference ( MUAC ) ( effect size : 0.31 z scores ; 95 % CI : 0.06 , 0.56 ; P = 0.017 ) at 9 mo of age . At 12 mo , MUAC remained greater in the intervention group , and we observed significant increases in skinfold thicknesses ( P ≤ 0.022 for all ) . No other significant differences between treatment groups were detected for growth or LMRs at 9 mo or for secondary outcomes . Conclusions : Fish-oil supplementation successfully increased plasma n−3 fatty acid status . However , in young , breastfed Gambian infants , the intervention failed to improve linear growth , intestinal integrity , morbidity , or selected measures of cognitive development . The trial was registered at www.is rct n.org as IS RCT N66645725 Objective : Early supplementation of breastfed infants may have consequences both for the mother and the child . We hypothesised that it would result in decreased maternal weight loss and in shorter duration s of breastfeeding and birth intervals . Design : Controlled r and omised population -based trial . Setting : Six villages in the Sine area of Senegal , West Africa . Subjects : Healthy breastfed infants and their mothers , 68 controls and 66 supplemented infants at r and omization . Intervention : Supplementation with high-energy , nutrient dense food from 4 to 7 months of age , twice daily under supervision of field workers . Both controls and supplemented infants were free to eat other complementary foods .  Maternal weight was measured monthly . Date s of breastfeeding cessation and of subsequent births were collected prospect ively through weekly demographic surveillance , and were analysed using Cox 's regression models and ‘ intent-to-supplement ’ approach . Results : Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group ( + 0.25 kg/months , 95 % confidence interval ( CI ) : −0.07 , + 0.57 ) . Supplemented infants were breastfed for significantly longer duration s than controls ( medians : 24.9 and 23.7 months , respectively , P : 0.034 ) . Their adjusted hazard ratio ( HR ) for breastfeeding cessation was 0.59 ( 95 % CI : 0.40 , 0.89 ) . Their mothers had a lower risk of a new birth than mothers of controls ( adjusted HR : 0.57 , 95 % CI : 0.36 , 0.92 ) . Conclusions : Early short-term infant supplementation tended to decrease maternal postpartum weight loss , but it increased , rather than shortened , the duration of breastfeeding and birth interval . Sponsorship : This study was supported by a grant from the French Ministry of Research ( Grant 92L0623 ) BACKGROUND Strong associations between delayed initiation of breastfeeding and increased  neonatal mortality  ( 2 - 28 d ) were recently reported in rural Ghana . Investigation into the biological plausibility of this relation and potential causal pathways is needed . OBJECTIVE The objective was to assess the effect of early infant feeding practice s ( delayed initiation , prelacteal feeding , established neonatal breastfeeding ) on infection-specific neonatal mortality in breastfed neonates aged 2 - 28 d. DESIGN This prospect i ve observational cohort study was based on 10 942 breastfed singleton neonates born between 1 July 2003 and 30 June 2004 , who survived to day 2 , and whose mothers were visited in the neonatal period . Verbal autopsies were used to ascertain the cause of death . RESULTS One hundred forty neonates  died from day 2 to day 28 ; 93 died of infection and 47 of noninfectious causes . The risk of death as a result of infection increased with increasing delay in initiation of breastfeeding from 1 h to day 7 ; overall late initiation ( after day 1 ) was associated with a 2.6-fold risk [ adjusted odds ratio ( adj OR ) : 2.61 ; 95 % CI : 1.68 , 4.04 ] . Partial breastfeeding was associated with a 5.7-fold adjusted risk of death as a result of infectious disease ( adj OR : 5.73 ; 95 % CI : 2.75 , 11.91 ) . No obvious associations were observed between these feeding practice s and noninfection-specific mortality . Prelacteal feeding was not associated with infection ( adj OR : 1.11 ; 95 % CI : 0.66 , 1.86 ) or noninfection-specific ( adj OR : 1.33 ; 95 % CI : 0.55 , 3.22 ) mortality . CONCLUSIONS This study provides the first epidemiologic evidence of a causal association between early breastfeeding and reduced infection-specific neonatal mortality in young human infants BACKGROUND Vitamin A deficiency is an important public health problem in many developing countries . Women of childbearing age and children are documented as the most affected groups . OBJECTIVE The objective was to determine the length of time mothers are protected postpartum against vitamin A depletion after receiving either 400,000 IU vitamin A in 2 divided doses or 200,000 IU as a single dose plus a placebo 24 h apart . DESIGN Mothers ( n = 168 ) were recruited by trained fieldworkers 7 - 10 d after delivery .  Modified-relative-dose-response ( MRDR ) tests  were performed at baseline in 167 women , and vitamin A was administered within 6 wk after delivery . The women were r and omly assigned to 2 main treatment groups , and each treatment group was divided into 3 follow-up subgroups . Each subgroup was invited back once at month 1 , 3 , or 5 for a second MRDR test . RESULTS The serum retinol concentration and the MRDR value were 1.4 + /- 0.5 micromol/L and 0.048 + /- 0.037 , respectively , at baseline . A significant improvement in vitamin A status occurred after vitamin A treatment as assessed by the MRDR test ( P < 0.0001 ) . Serum retinol concentrations were not different after vitamin A treatment ( P = 0.87 ) . CONCLUSIONS The mothers had marginally depleted liver reserves of vitamin A at baseline on the basis of MRDR test results . Liver reserves of vitamin A significantly improved in both treatment groups , and the improvement was maintained for > or= 5 mo OBJECTIVE To determine the association of different feeding patterns for infants ( exclusive breastfeeding , predominant breastfeeding , partial breastfeeding and no breastfeeding ) with  mortality and hospital admissions  during the first half of infancy . METHODS This paper is based on a secondary analysis of data from a multicentre r and omized controlled trial on immunization-linked vitamin A supplementation . Altogether , 9424 infants and their mothers ( 2919 in Ghana , 4000 in India and 2505 in Peru ) were enrolled when infants were 18 - 42 days old in two urban slums in New Delhi , India , a periurban shanty town in Lima , Peru , and 37 villages in the Kintampo district of Ghana . Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru . At each visit , mothers were queried about what they had offered their infant to eat or drink during the past week . Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months . The main outcome measures were all-cause mortality , diarrhoea-specific mortality , mortality caused by acute lower respiratory infections , and hospital admissions . FINDINGS There was no significant difference in the risk of 
    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: Background Children with severe malnutrition who develop shock have a high  mortality . Contrary to contemporaneous paediatric practice , current guidelines recommend use of low dose hypotonic fluid resuscitation ( half-strength Darrows/5 % dextrose ( HSD/5D ) . We evaluated the safety and efficacy of this guideline compared to resuscitation with a st and ard isotonic solution . Methods A Phase II r and omised controlled , safety and efficacy trial in Kenyan children aged over 6 months with severe malnutrition and shock including children with severe dehydration/shock and presumptive septic shock ( non-diarrhoeal shock ) . Eligible children were r and omised to HSD/5D or Ringer 's Lactate ( RL ) . A maximum of two boluses of 15 ml/kg of HSD/5D were given over two hours ( as recommended by guidelines ) while those r and omised to RL received 10 ml/kg aliquots half hourly ( maximum 40 ml/kg ) . Primary endpoint was resolution of shock at 8 and 24 hours . Secondary outcomes included resolution of acidosis , adverse events and mortality . Results 61 children were enrolled : 41 had shock and severe dehydrating diarrhoea , 20 had presumptive septic shock ; 69 % had decompensated shock . By 8 hours response to volume resuscitation was poor with shock persisting in most children:-HSD/5D 15/22 ( 68 % ) and RL14/25 ( 52 % ) , p = 0.39 . Oliguria was more prevalent at 8 hours in the HSD/5D group , 9/22 ( 41 % ) , compared to RL-3/25 ( 12 % ) , p = 0.02 . Mortality was high , HSD/5D-15/26(58 % ) and RL 13/29(45 % ) ; p = 0.42 . Most deaths occurred within 48 hours of admission . Neither pulmonary oedema nor cardiogenic failure was detected . Conclusions Outcome was universally poor characterised by persistence of shock , oliguria and high case fatality . Isotonic fluid was associated with modest improvement in shock and survival when compared to HSD/5D but inconclusive due to the limitations of design and effectiveness of either resuscitation strategy . Although isotonic fluid resuscitation did not result in cardiogenic heart failure , as previously feared , we conclude that the modest volumes used and rate of infusion were insufficient to promptly correct shock . The adverse performance of the recommended fluid resuscitation guideline for severe malnutrition should prompt clinical investigation of isotonic fluids for resuscitation of compensated shock , defining rate and volumes required to inform future guidelines .Trial Registration The trial is registered as ISCRTN : This paper explores a number of socioeconomic factors thought to explain the wide prevalence of undernutrition among rural Bangladeshi women . The 1992 baseline survey data of the BRAC-ICDDR , B Joint Research Project at Matlab were used . Anthropometry was performed on a r and om sub- sample of 1462 currently married , non-pregnant women between 15 and 49 years of age . Women 's nutritional status was defined in terms of Body Mass Index ( BMI = wt in kg/ht in m2 ) . Compared with women from better-off households , the mean weight ( 41.2 vs 43.0 kg ; p < 0.0001 ) , mid-upper arm circumference ( MUAC ) ( 22.1 vs 22.7 ; p < 0.0001 ) , and BMI ( 18.5 vs 19.1 ; p < 0.0001 ) of poor women were consistently lower . However , no significant difference in mean height was found between the two groups . The results showed that women aged more than 35 years are twice as likely to have a BMI < 18.5 compared with younger women . Both years of schooling received and socioeconomic status are found to be important predictors of women 's BMI . Women who have received one or more years of formal education are nearly half as likely to suffer chronic energy deficiency ( BMI < 18.5 ) than women with no schooling . Again , better-off women are found to be 0.77 times less likely to have chronic energy deficiency than women from poor households . The implication s of these findings in improving the nutritional status of rural Bangladeshi women are discussed Background : Intestinal damage and malabsorption caused by chronic environmental enteropathy are associated with growth faltering seen in infants in less-developed countries . Evidence has suggested that supplementary omega-3 ( n−3 ) long-chain PUFAs ( LC-PUFAs ) might ameliorate this damage by reducing gastrointestinal inflammation . LC-PUFA supplementation may also benefit cognitive development . Objective : We tested whether early n−3 LC-PUFA supplementation improves  infant intestinal integrity , growth , and cognitive function . Design : A r and omized , double-blind , controlled trial [ 200 mg DHA and 300 mg EPA or 2 mL olive oil/d for 6 mo ] was conducted in a population of 172 rural Gambian infants aged 3–9 mo . The primary endpoints were anthropometric measures and gut integrity [ assessed by using urinary lactulose : mannitol ratios ( LMRs ) ] . Plasma fatty acid status , intestinal mucosal inflammation ( fecal calprotectin ) , daily morbidity , and cognitive development ( 2-step means-end test and an attention assessment ) were secondary endpoints . Results : PUFA supplementation result ed in a significant increase in plasma n−3 LC-PUFA concentrations ( P < 0.001 for both DHA and EPA ) and midupper arm circumference ( MUAC ) ( effect size : 0.31 z scores ; 95 % CI : 0.06 , 0.56 ; P = 0.017 ) at 9 mo of age . At 12 mo , MUAC remained greater in the intervention group , and we observed significant increases in skinfold thicknesses ( P ≤ 0.022 for all ) . No other significant differences between treatment groups were detected for growth or LMRs at 9 mo or for secondary outcomes . Conclusions : Fish-oil supplementation successfully increased plasma n−3 fatty acid status . However , in young , breastfed Gambian infants , the intervention failed to improve linear growth , intestinal integrity , morbidity , or selected measures of cognitive development . The trial was registered at www.is rct n.org as IS RCT N66645725 Objective : Early supplementation of breastfed infants may have consequences both for the mother and the child . We hypothesised that it would result in decreased maternal weight loss and in shorter duration s of breastfeeding and birth intervals . Design : Controlled r and omised population -based trial . Setting : Six villages in the Sine area of Senegal , West Africa . Subjects : Healthy breastfed infants and their mothers , 68 controls and 66 supplemented infants at r and omization . Intervention : Supplementation with high-energy , nutrient dense food from 4 to 7 months of age , twice daily under supervision of field workers . Both controls and supplemented infants were free to eat other complementary foods .  Maternal weight was measured monthly . Date s of breastfeeding cessation and of subsequent births were collected prospect ively through weekly demographic surveillance , and were analysed using Cox 's regression models and ‘ intent-to-supplement ’ approach . Results : Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group ( + 0.25 kg/months , 95 % confidence interval ( CI ) : −0.07 , + 0.57 ) . Supplemented infants were breastfed for significantly longer duration s than controls ( medians : 24.9 and 23.7 months , respectively , P : 0.034 ) . Their adjusted hazard ratio ( HR ) for breastfeeding cessation was 0.59 ( 95 % CI : 0.40 , 0.89 ) . Their mothers had a lower risk of a new birth than mothers of controls ( adjusted HR : 0.57 , 95 % CI : 0.36 , 0.92 ) . Conclusions : Early short-term infant supplementation tended to decrease maternal postpartum weight loss , but it increased , rather than shortened , the duration of breastfeeding and birth interval . Sponsorship : This study was supported by a grant from the French Ministry of Research ( Grant 92L0623 ) BACKGROUND Strong associations between delayed initiation of breastfeeding and increased  neonatal mortality  ( 2 - 28 d ) were recently reported in rural Ghana . Investigation into the biological plausibility of this relation and potential causal pathways is needed . OBJECTIVE The objective was to assess the effect of early infant feeding practice s ( delayed initiation , prelacteal feeding , established neonatal breastfeeding ) on infection-specific neonatal mortality in breastfed neonates aged 2 - 28 d. DESIGN This prospect i ve observational cohort study was based on 10 942 breastfed singleton neonates born between 1 July 2003 and 30 June 2004 , who survived to day 2 , and whose mothers were visited in the neonatal period . Verbal autopsies were used to ascertain the cause of death . RESULTS One hundred forty neonates  died from day 2 to day 28 ; 93 died of infection and 47 of noninfectious causes . The risk of death as a result of infection increased with increasing delay in initiation of breastfeeding from 1 h to day 7 ; overall late initiation ( after day 1 ) was associated with a 2.6-fold risk [ adjusted odds ratio ( adj OR ) : 2.61 ; 95 % CI : 1.68 , 4.04 ] . Partial breastfeeding was associated with a 5.7-fold adjusted risk of death as a result of infectious disease ( adj OR : 5.73 ; 95 % CI : 2.75 , 11.91 ) . No obvious associations were observed between these feeding practice s and noninfection-specific mortality . Prelacteal feeding was not associated with infection ( adj OR : 1.11 ; 95 % CI : 0.66 , 1.86 ) or noninfection-specific ( adj OR : 1.33 ; 95 % CI : 0.55 , 3.22 ) mortality . CONCLUSIONS This study provides the first epidemiologic evidence of a causal association between early breastfeeding and reduced infection-specific neonatal mortality in young human infants BACKGROUND Vitamin A deficiency is an important public health problem in many developing countries . Women of childbearing age and children are documented as the most affected groups . OBJECTIVE The objective was to determine the length of time mothers are protected postpartum against vitamin A depletion after receiving either 400,000 IU vitamin A in 2 divided doses or 200,000 IU as a single dose plus a placebo 24 h apart . DESIGN Mothers ( n = 168 ) were recruited by trained fieldworkers 7 - 10 d after delivery .  Modified-relative-dose-response ( MRDR ) tests  were performed at baseline in 167 women , and vitamin A was administered within 6 wk after delivery . The women were r and omly assigned to 2 main treatment groups , and each treatment group was divided into 3 follow-up subgroups . Each subgroup was invited back once at month 1 , 3 , or 5 for a second MRDR test . RESULTS The serum retinol concentration and the MRDR value were 1.4 + /- 0.5 micromol/L and 0.048 + /- 0.037 , respectively , at baseline . A significant improvement in vitamin A status occurred after vitamin A treatment as assessed by the MRDR test ( P < 0.0001 ) . Serum retinol concentrations were not different after vitamin A treatment ( P = 0.87 ) . CONCLUSIONS The mothers had marginally depleted liver reserves of vitamin A at baseline on the basis of MRDR test results . Liver reserves of vitamin A significantly improved in both treatment groups , and the improvement was maintained for > or= 5 mo OBJECTIVE To determine the association of different feeding patterns for infants ( exclusive breastfeeding , predominant breastfeeding , partial breastfeeding and no breastfeeding ) with  mortality and hospital admissions  during the first half of infancy . METHODS This paper is based on a secondary analysis of data from a multicentre r and omized controlled trial on immunization-linked vitamin A supplementation . Altogether , 9424 infants and their mothers ( 2919 in Ghana , 4000 in India and 2505 in Peru ) were enrolled when infants were 18 - 42 days old in two urban slums in New Delhi , India , a periurban shanty town in Lima , Peru , and 37 villages in the Kintampo district of Ghana . Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru . At each visit , mothers were queried about what they had offered their infant to eat or drink during the past week . Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months . The main outcome measures were all-cause mortality , diarrhoea-specific mortality , mortality caused by acute lower respiratory infections , and hospital admissions . FINDINGS There was no significant difference in the risk of 
    Output:
    