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: Objectives Within a r and omised trial of neonatal vitamin A supplementation ( VAS ) in Guinea-Bissau , neonatal VAS did not affect overall  infant mortality . We conducted a post-hoc analysis to test the hypothesis that neonatal VAS primes the response to subsequent vitamin A. Methods All trial children were offered VAS after follow-up ended at 1 year of age ( FU-VAS ) . We compared mortality between 1 and 3 years of age according to initial r and omization to neonatal VAS or placebo in Cox-regression models ; we expected that children r and omized to neonatal VAS compared with those r and omized to placebo would have lower mortality after reception of FU-VAS . Results Of 4345 infants enrolled in the original trial , 3646 lived in the study area at 1 year of age and 2958 received FU-VAS .  Between 1 and 3 years of age , 112 children died . After FU-VAS , neonatal VAS was associated with lower mortality than placebo : Mortality Rate Ratio ( MRR ) = 0.54 ( 95%CI : 0.31–0.94 ) . The effect was more pronounced in girls ( MRR = 0.37 ( 0.16–0.89 ) ) than boys ( MRR = 0.73 ( 0.35–1.51 ) ) . The beneficial effect of neonatal VAS may have been particularly strong for girls who received both VAS in a campaign and FU-VAS ( MRR = 0.15 ( 0.03–0.67 ) ) . Among children who had not received FU-VAS , mortality in the second and third year of life did not differ according to reception of neonatal VAS or placebo . Hence , in the second and third year of life the effect of neonatal VAS versus placebo was different in girls who had or had not received FU-VAS ( p for homogeneity = 0.01 ) . Conclusions The present results suggest that neonatal VAS primes the response in girls such that they get a beneficial effect after a subsequent dose of VAS . Trial Registration Clinical trials.gov A r and omized , double-masked trial was carried out in rural Nepal to investigate the incidence and severity of acute side-effects among neonates ( < 1 month of age ) and infants aged 1 - 6 months who received a large , oral dose of vitamin A ( 15,000 retinol equivalents ( RE ) ( 50,000 IU ) and 30,000 RE ( 100,000 IU ) , respectively ) or placebo ( 75 RE ( 250 IU ) and 150 RE ( 500 IU ) , respectively ) in oil . Infants ( vitamin A group , n = 1461 ; controls , n = 1379 ) were assessed for vomiting , loose stools , fever , and irritability during the 24 hours before and after dosing . Fontanelles were palpated 24 hours after dosing . Neonates exhibited no excess risk of adverse side-effects after receiving 15,000 RE . Compared with controls the older infants who ingested 30,000 RE had a 1.6 % excess rate of vomiting ( 95 % confidence interval ( CI ) : 0.2 - 3.0 % ) and a 0.5 % excess rate ( 95 % CI : -0.1 to 1.1 % ) in the occurrence of bulging fontanelles . There were no other significant differences in the older infants . The controlled , periodic distribution of a single 15,000 RE dose of vitamin A therefore confers no apparent acute risk to young infants ; a 30,000 RE dose is associated with a minimum risk of transient , acute side-effects A placebo-controlled trial was carried out among 2067 Indonesian neonates to assess the safety of administering one oral 52-mumol ( 50,000 IU ) dose of vitamin A.  Infants were assessed for potential acute side-effects before and throughout 48 hours after the dose . The first 965 infants were examined by cranial ultrasound before and at 24 hours after dosing to rule out intracranial haemorrhage and determine the resistive index ( RI ) of the anterior cerebral artery using duplex Doppler . Groups were comparable at the baseline . A bulging fontanelle occurred in the control and vitamin A groups , respectively , among 2.7 % and 4.6 % of the infants at 24 hours , and 2.4 % and 4.5 % of the infants at 48 hours . The groups did not differ in any other sign or symptom assessed . No infant developed intracranial haemorrhage . Mean RI values were normal and not different between groups at baseline or at 24 hours . Mean RI fell during the 24 hours , as normally occurs ; the mean decrease was nearly identical in the two groups . A bulging fontanelle was not associated with increased rates of any sign or symptom or with an increase in RI . The 52-mumol dose of oral vitamin A may cause a small increase in intracranial volume in a small proportion of infants , but no increase in intracranial pressure . Acute side-effects following this intervention were rare and mild OBJECTIVES --To determine whether a single high dose of vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and to assess whether periodic community wide supplementation could be readily incorporated into an ongoing primary health programme . DESIGN --Opportunistic controlled trial . SETTING --Jumla district , Nepal . SUBJECTS -- All children aged under 5 years ; 3786 in eight subdistricts given single dose of vitamin A and 3411 in remaining eight subdistricts given no supplementation .  MAIN OUTCOME MEASURES --Mortality and cause of death in the five months after supplementation . RESULTS --Risk of death for children aged 1 - 59 months in supplemented communities was 26 % lower ( relative risk 0.74 , 95 % confidence interval 0.55 to 0.99 ) than in unsupplemented communities . The reduction in mortality was greatest among children aged 6 - 11 months : death rate ( deaths/1000 child years at risk ) was 133.8 in supplemented children and 260.8 in unsupplemented children ( relative risk 0.51 , 0.30 to 0.89 ) . The death rate from diarrhoea was also reduced ( 63.5 supplemented v 97.5 unsupplemented ; relative risk 0.65 , 0.44 to 0.95 ) . The extra cost per death averted was about $ 11 . CONCLUSION --The results support a role for Vitamin A in increasing child survival . The supplementation programme was readily integrated with the ongoing community health programme at little extra cost Objective To investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality . Design R and omised placebo controlled trial . Setting B and i m Health Project ’s demographic surveillance system in Guinea-Bissau , covering approximately 90 000 inhabitants . Participants 4345 infants due to receive BCG . Intervention Infants were r and omised to 50 000 IU vitamin A or placebo and followed until age 12 months . Main outcome measure Mortality rate ratios . Results 174 children  died during follow-up ( mortality=47/1000 person-years ) . Vitamin A supplementation was not significantly associated with mortality ; the mortality rate ratio was 1.07 ( 95 % confidence interval 0.79 to 1.44 ) . The effect was 1.00 ( 0.65 to 1.56 ) during the first four months and 1.13 ( 0.75 to 1.68 ) from 4 to 12 months of age . The mortality rate ratio in boys was 0.84 ( 0.55 to 1.27 ) compared with 1.39 ( 0.90 to 2.14 ) in girls ( P for interaction=0.10 ) . An explorative analysis revealed a strong interaction between vitamin A and season of administration . Conclusions Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African setting . Although little doubt exists that vitamin A supplementation reduces mortality in older children , a global recommendation of supplementation for all newborn infants may not contribute to better survival . Trial registration Clinical trials NCT00168597 Vitamin A deficiency is associated with increased morbidity and mortality from diarrheal disease , measles , and malaria . It has been proposed that vitamin A supplementation could be linked with childhood immunization programs to improve child health . We conducted a r and omized , double‐blind , placebo‐controlled clinical trial to evaluate the impact of linking vitamin A supplementation with the Exp and ed Programme on Immunization on morbidity and child growth .  In West Java , Indonesia , 467 six‐week‐old infants were r and omized to receive 7.5 mg retinol equivalent ( RE ) , 15 mg RE , or placebo with childhood immunization contacts at 6 , 10 , and 14 wks and 9 mo of age . Child growth was assessed through anthropometry , and morbidity histories were obtained . Vitamin A supplementation had no apparent impact upon linear or ponderal growth or infectious disease morbidity in the first 15 mo of age when integrated with the Exp and ed Programme on Immunization Background Vitamins A and E are two potent antioxidant nutrients that play a significant role in immune function . In contrast to the numerous studies of vitamin A and E status in children , adolescents , and adults , information on term infants , particularly breast-fed infants , is scarce . The goals of the present investigation were to examine the vitamins A and E nutritional status of term breast-fed infants at birth and to assess retinol and tocopherol plasma levels during a 3-month supplementation trial . Methods The study was a prospect i ve , blinded comparison of a supplementation protocol with a placebo in a group of consecutively recruited term newborns . The supplemented group received 3000 IU vitamin A and 5 IU vitamin E orally . The placebo group received a solution of similar viscosity and organoleptic characteristics . Vitamin A and E were separated by reverse-phase high-performance liquid chromatography on a C18 Spectrasyl column and quantified by ultraviolet spectrophotometry . Results Vitamin A and E levels steadily increased with age in both groups of infants . However , levels at 3 months were higher in the supplemented than in the control group . Conclusion The data show that supplementation with 3000 IU vitamin A and 5 IU vitamin E for 3 months increases circulating vitamin levels in newborn term babies compared with those in nonsupplemented infants The effect of supplementing 11,918 infants < 1 mo and 1 - 5 mo of age with vitamin A ( 15,000 and 30,000 micrograms retinol equivalents or 50,000 and 100,000 IU , respectively ) or a placebo on subsequent 4-mo mortality was assessed in a r and omized , double-masked community trial in the rural plains of Nepal . There were 130 deaths ( 51.6/1000 child-y ) in the control group and 150 deaths ( 57.1/1000 child-y ) in the vitamin A group , yielding a relative risk of 1.11 ( 95 % CI : 0.86 , 1.42 ) , which is indicative of no overall effect on early infant mortality . There was a tendency for the relative risk of mortality among vitamin A recipients to rise with improved nutritional status . These results suggest that distribution of a large oral dose of vitamin A to infants < 5 - 6 mo of age may not benefit short-term survival . This is in contrast with the results of trials in which older infants and children in this same population were supplemented The effects of maternal postpartum vitamin A or beta-carotene supplementation  on  maternal and infant serum retinol concentrations , modified relative dose-response ( MRDR ) ratios and breast milk vitamin A concentrations were assessed during a community-based trial in Matlab , Bangladesh . At 1 - 3 wk postpartum , women were r and omly assigned to receive either ( 1 ) a single dose of 200,000 international units [ 60,000 retinol equivalents ( RE ) ] vitamin A followed by daily placebos ( n = 74 ) , ( 2 ) daily doses of beta-carotene [ 7.8 mg ( 1300 RE ) ] ( n = 73 ) or ( 3 ) daily placebos ( n = 73 ) until 9 mo postpartum . Compared to placebos , vitamin A supplementation result ed in lower maternal MRDR ratios ( i.e. , increased liver stores ) and higher milk vitamin A concentrations at 3 mo , but these improvements were not sustained . The beta-carotene supplementation acted more slowly , result ing in milk vitamin A concentrations higher than the placebo group only at 9 mo . Irrespective of treatment group , over 50 % of women produced milk with low vitamin A concentrations ( < /=1.05 micromol/L or < /=0.28 micromol/g fat ) throughout the study . Overall , mean maternal serum retinol concentrations were not affected by supplementation . Compared to the placebo group , the mean MRDR ratio of 6-mo-old infants was higher in the vitamin A group . Infants ( 33 % ) had serum retinol concentrations < 0.70 micromol/L and 8 
    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: Objectives Within a r and omised trial of neonatal vitamin A supplementation ( VAS ) in Guinea-Bissau , neonatal VAS did not affect overall  infant mortality . We conducted a post-hoc analysis to test the hypothesis that neonatal VAS primes the response to subsequent vitamin A. Methods All trial children were offered VAS after follow-up ended at 1 year of age ( FU-VAS ) . We compared mortality between 1 and 3 years of age according to initial r and omization to neonatal VAS or placebo in Cox-regression models ; we expected that children r and omized to neonatal VAS compared with those r and omized to placebo would have lower mortality after reception of FU-VAS . Results Of 4345 infants enrolled in the original trial , 3646 lived in the study area at 1 year of age and 2958 received FU-VAS .  Between 1 and 3 years of age , 112 children died . After FU-VAS , neonatal VAS was associated with lower mortality than placebo : Mortality Rate Ratio ( MRR ) = 0.54 ( 95%CI : 0.31–0.94 ) . The effect was more pronounced in girls ( MRR = 0.37 ( 0.16–0.89 ) ) than boys ( MRR = 0.73 ( 0.35–1.51 ) ) . The beneficial effect of neonatal VAS may have been particularly strong for girls who received both VAS in a campaign and FU-VAS ( MRR = 0.15 ( 0.03–0.67 ) ) . Among children who had not received FU-VAS , mortality in the second and third year of life did not differ according to reception of neonatal VAS or placebo . Hence , in the second and third year of life the effect of neonatal VAS versus placebo was different in girls who had or had not received FU-VAS ( p for homogeneity = 0.01 ) . Conclusions The present results suggest that neonatal VAS primes the response in girls such that they get a beneficial effect after a subsequent dose of VAS . Trial Registration Clinical trials.gov A r and omized , double-masked trial was carried out in rural Nepal to investigate the incidence and severity of acute side-effects among neonates ( < 1 month of age ) and infants aged 1 - 6 months who received a large , oral dose of vitamin A ( 15,000 retinol equivalents ( RE ) ( 50,000 IU ) and 30,000 RE ( 100,000 IU ) , respectively ) or placebo ( 75 RE ( 250 IU ) and 150 RE ( 500 IU ) , respectively ) in oil . Infants ( vitamin A group , n = 1461 ; controls , n = 1379 ) were assessed for vomiting , loose stools , fever , and irritability during the 24 hours before and after dosing . Fontanelles were palpated 24 hours after dosing . Neonates exhibited no excess risk of adverse side-effects after receiving 15,000 RE . Compared with controls the older infants who ingested 30,000 RE had a 1.6 % excess rate of vomiting ( 95 % confidence interval ( CI ) : 0.2 - 3.0 % ) and a 0.5 % excess rate ( 95 % CI : -0.1 to 1.1 % ) in the occurrence of bulging fontanelles . There were no other significant differences in the older infants . The controlled , periodic distribution of a single 15,000 RE dose of vitamin A therefore confers no apparent acute risk to young infants ; a 30,000 RE dose is associated with a minimum risk of transient , acute side-effects A placebo-controlled trial was carried out among 2067 Indonesian neonates to assess the safety of administering one oral 52-mumol ( 50,000 IU ) dose of vitamin A.  Infants were assessed for potential acute side-effects before and throughout 48 hours after the dose . The first 965 infants were examined by cranial ultrasound before and at 24 hours after dosing to rule out intracranial haemorrhage and determine the resistive index ( RI ) of the anterior cerebral artery using duplex Doppler . Groups were comparable at the baseline . A bulging fontanelle occurred in the control and vitamin A groups , respectively , among 2.7 % and 4.6 % of the infants at 24 hours , and 2.4 % and 4.5 % of the infants at 48 hours . The groups did not differ in any other sign or symptom assessed . No infant developed intracranial haemorrhage . Mean RI values were normal and not different between groups at baseline or at 24 hours . Mean RI fell during the 24 hours , as normally occurs ; the mean decrease was nearly identical in the two groups . A bulging fontanelle was not associated with increased rates of any sign or symptom or with an increase in RI . The 52-mumol dose of oral vitamin A may cause a small increase in intracranial volume in a small proportion of infants , but no increase in intracranial pressure . Acute side-effects following this intervention were rare and mild OBJECTIVES --To determine whether a single high dose of vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and to assess whether periodic community wide supplementation could be readily incorporated into an ongoing primary health programme . DESIGN --Opportunistic controlled trial . SETTING --Jumla district , Nepal . SUBJECTS -- All children aged under 5 years ; 3786 in eight subdistricts given single dose of vitamin A and 3411 in remaining eight subdistricts given no supplementation .  MAIN OUTCOME MEASURES --Mortality and cause of death in the five months after supplementation . RESULTS --Risk of death for children aged 1 - 59 months in supplemented communities was 26 % lower ( relative risk 0.74 , 95 % confidence interval 0.55 to 0.99 ) than in unsupplemented communities . The reduction in mortality was greatest among children aged 6 - 11 months : death rate ( deaths/1000 child years at risk ) was 133.8 in supplemented children and 260.8 in unsupplemented children ( relative risk 0.51 , 0.30 to 0.89 ) . The death rate from diarrhoea was also reduced ( 63.5 supplemented v 97.5 unsupplemented ; relative risk 0.65 , 0.44 to 0.95 ) . The extra cost per death averted was about $ 11 . CONCLUSION --The results support a role for Vitamin A in increasing child survival . The supplementation programme was readily integrated with the ongoing community health programme at little extra cost Objective To investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality . Design R and omised placebo controlled trial . Setting B and i m Health Project ’s demographic surveillance system in Guinea-Bissau , covering approximately 90 000 inhabitants . Participants 4345 infants due to receive BCG . Intervention Infants were r and omised to 50 000 IU vitamin A or placebo and followed until age 12 months . Main outcome measure Mortality rate ratios . Results 174 children  died during follow-up ( mortality=47/1000 person-years ) . Vitamin A supplementation was not significantly associated with mortality ; the mortality rate ratio was 1.07 ( 95 % confidence interval 0.79 to 1.44 ) . The effect was 1.00 ( 0.65 to 1.56 ) during the first four months and 1.13 ( 0.75 to 1.68 ) from 4 to 12 months of age . The mortality rate ratio in boys was 0.84 ( 0.55 to 1.27 ) compared with 1.39 ( 0.90 to 2.14 ) in girls ( P for interaction=0.10 ) . An explorative analysis revealed a strong interaction between vitamin A and season of administration . Conclusions Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African setting . Although little doubt exists that vitamin A supplementation reduces mortality in older children , a global recommendation of supplementation for all newborn infants may not contribute to better survival . Trial registration Clinical trials NCT00168597 Vitamin A deficiency is associated with increased morbidity and mortality from diarrheal disease , measles , and malaria . It has been proposed that vitamin A supplementation could be linked with childhood immunization programs to improve child health . We conducted a r and omized , double‐blind , placebo‐controlled clinical trial to evaluate the impact of linking vitamin A supplementation with the Exp and ed Programme on Immunization on morbidity and child growth .  In West Java , Indonesia , 467 six‐week‐old infants were r and omized to receive 7.5 mg retinol equivalent ( RE ) , 15 mg RE , or placebo with childhood immunization contacts at 6 , 10 , and 14 wks and 9 mo of age . Child growth was assessed through anthropometry , and morbidity histories were obtained . Vitamin A supplementation had no apparent impact upon linear or ponderal growth or infectious disease morbidity in the first 15 mo of age when integrated with the Exp and ed Programme on Immunization Background Vitamins A and E are two potent antioxidant nutrients that play a significant role in immune function . In contrast to the numerous studies of vitamin A and E status in children , adolescents , and adults , information on term infants , particularly breast-fed infants , is scarce . The goals of the present investigation were to examine the vitamins A and E nutritional status of term breast-fed infants at birth and to assess retinol and tocopherol plasma levels during a 3-month supplementation trial . Methods The study was a prospect i ve , blinded comparison of a supplementation protocol with a placebo in a group of consecutively recruited term newborns . The supplemented group received 3000 IU vitamin A and 5 IU vitamin E orally . The placebo group received a solution of similar viscosity and organoleptic characteristics . Vitamin A and E were separated by reverse-phase high-performance liquid chromatography on a C18 Spectrasyl column and quantified by ultraviolet spectrophotometry . Results Vitamin A and E levels steadily increased with age in both groups of infants . However , levels at 3 months were higher in the supplemented than in the control group . Conclusion The data show that supplementation with 3000 IU vitamin A and 5 IU vitamin E for 3 months increases circulating vitamin levels in newborn term babies compared with those in nonsupplemented infants The effect of supplementing 11,918 infants < 1 mo and 1 - 5 mo of age with vitamin A ( 15,000 and 30,000 micrograms retinol equivalents or 50,000 and 100,000 IU , respectively ) or a placebo on subsequent 4-mo mortality was assessed in a r and omized , double-masked community trial in the rural plains of Nepal . There were 130 deaths ( 51.6/1000 child-y ) in the control group and 150 deaths ( 57.1/1000 child-y ) in the vitamin A group , yielding a relative risk of 1.11 ( 95 % CI : 0.86 , 1.42 ) , which is indicative of no overall effect on early infant mortality . There was a tendency for the relative risk of mortality among vitamin A recipients to rise with improved nutritional status . These results suggest that distribution of a large oral dose of vitamin A to infants < 5 - 6 mo of age may not benefit short-term survival . This is in contrast with the results of trials in which older infants and children in this same population were supplemented The effects of maternal postpartum vitamin A or beta-carotene supplementation  on  maternal and infant serum retinol concentrations , modified relative dose-response ( MRDR ) ratios and breast milk vitamin A concentrations were assessed during a community-based trial in Matlab , Bangladesh . At 1 - 3 wk postpartum , women were r and omly assigned to receive either ( 1 ) a single dose of 200,000 international units [ 60,000 retinol equivalents ( RE ) ] vitamin A followed by daily placebos ( n = 74 ) , ( 2 ) daily doses of beta-carotene [ 7.8 mg ( 1300 RE ) ] ( n = 73 ) or ( 3 ) daily placebos ( n = 73 ) until 9 mo postpartum . Compared to placebos , vitamin A supplementation result ed in lower maternal MRDR ratios ( i.e. , increased liver stores ) and higher milk vitamin A concentrations at 3 mo , but these improvements were not sustained . The beta-carotene supplementation acted more slowly , result ing in milk vitamin A concentrations higher than the placebo group only at 9 mo . Irrespective of treatment group , over 50 % of women produced milk with low vitamin A concentrations ( < /=1.05 micromol/L or < /=0.28 micromol/g fat ) throughout the study . Overall , mean maternal serum retinol concentrations were not affected by supplementation . Compared to the placebo group , the mean MRDR ratio of 6-mo-old infants was higher in the vitamin A group . Infants ( 33 % ) had serum retinol concentrations < 0.70 micromol/L and 8 
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