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: This retrospective study assessed the effects of pre- and post-training programme for  healthcare professionals  about breastfeeding . The study included 3,114 mothers who had children aged 1–72 month(s ) . Their knowledge and behaviours relating to breastfeeding were evaluated . The mothers were r and omly divided into two groups : the ‘ before ’  group included 2,000 women who were not informed about breastfeeding  , and the ‘ after  ’  group comprised 1,114 women who had been informed about breastfeeding .  56.2 % and 66.1 % of the mothers started  breastfeeding  within 30 minutes after delivery , respectively , in the before and the after group ( x2=29.31 , p<0.001 ) . 16.7 % and 36.5 % gave exclusive breastfeeding for six months ( x2=72.85 , p<0.001 ) , and 28.5 % and 23.7 % stopped breastfeeding within the first five months ( x2=17.20 , p=0.002 ) . Ninety-four percent delivered in a hospital or in a primary healthcare centre . Therefore , prenatal and postnatal breastfeeding education and support courses may improve a woman 's chance of starting and continuing to breastfeed her baby . In terms of the number of antenatal check-ups , since the differences between the two groups were significant ( x2=390.67 , p=0.000 ) , the importance of the training programme about breastfeeding was highlighted . Follow-up interventions after training are suggested 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 Exclusive breast-feeding ( EBF ) rates remain low despite numerous health benefits associated with this behavior . We conducted a r and omized trial on the effect of lactation counseling on EBF , which controlled for the Hawthorne effect while also varying the timing of the intervention . Pregnant women attending prenatal clinics in Tema were r and omly assigned to 1 of 2 intervention groups ( IG ) or to a control group ( C ) , as follows : 1 ) EBF support given pre- , peri- , and postnatally ( IG1 ; n = 43 ) ; 2 ) EBF support given only peri- and postnatally ( IG2 ; n = 44 ) ; or 3 ) nonbreast-feeding health educational support ( C ; n = 49 ) that had an equal amount of contact with lactation counselors . Two educational sessions were provided prenatally , and 9 home follow-up visits were provided in the 6-mo postpartum period . Infant feeding data were collected monthly at the participant 's home . The 3 groups did not differ in sociodemographic characteristics . At 6 mo postpartum , 90.0 % in IG1 and 74.4 % in IG2 had exclusively breast-fed during the previous month . By contrast , only 47.7 % in C were doing so ( P = 0.008 ) . Similarly , the percentage of EBF during the 6 mo was significantly higher ( P = 0.02 ) among IG1 and IG2 ( 39.5 % ) than among C ( 19.6 % ) . The 100 % increase in EBF rates can be attributed to the lactation counseling provided . Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth 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 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 certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support . The control group ( n=178 ) received the current conventional care of postnatal breastfeeding support . Definitions of breastfeeding practice s were according to World Health Organization ( WHO ) definitions . Participants answered a self-administered question naire during recruitment and were later followed up at one , four and 6-month intervals during the postpartum period via a telephone-based question naire . RESULTS At 1 month , a higher percentage of mothers in the intervention group practice d exclusive breastfeeding , compared to the control group ( 84.3 % vs. 74.7 % , OR 1.825 95 % , p=0.042 , CI=1.054 , 3.157 ) . At 4 and 6 months postpartum , similar percentages of mothers from the two groups practice d exclusive breastfeeding ( 41.98 % vs. 38.99 % ; 12.50 % vs. 12.02 % , no significant differences , both p>0.05 ) . Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1 , 4 and 6 month marks , compared to the intervention group ( 7.4 % vs. 5.4 % ; 12.6 % vs. 9.9 % ; 13.9 % vs. 9.4 % ; all p>0.05 ) . The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply , while returning to work was the main reason for stopping breastfeeding later in the postpartum period . CONCLUSIONS Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals OBJECTIVE : To test the effectiveness of cognitive-behavioral counseling on the rate and duration of exclusive breastfeeding ( EBF )  during the first 6 months of an infant ’s life compared with routine counseling . METHODS : A single blind cluster-r and omized controlled trial was undertaken in 40 Union Councils of a rural district in the northwest province of Pakistan between May 2009 and April 2010 . By simple unmatched r and omization , 20 Union Councils were each allocated to intervention and control arms . Two hundred twenty-four third trimester pregnant women in the intervention and 228 third trimester pregnant women in the control arm were enrolled and followed-up biweekly until 6 months postpartum . Analyses were by intention to treat . Mothers in the intervention group received 7 sessions of cognitive-behavioral counseling from antenatal to 6 months postpartum , whereas the control group received an equal number of routine sessions . Proportion of mothers exclusively breastfeeding at 6 months postpartum and duration of EBF through these 6 months was assessed . RESULTS : At 6 months postpartum , 59.6 % of mothers in the intervention arm and 28.6 % in the control arm were exclusively breastfeeding . This translates into a 60 % reduced risk of stopping exclusively breastfeeding during the first 6 months ( adjusted hazard ratio , 0.40 [ 95 % confidence interval : 0.27–0.60 ] , P < .001 ) . Mothers in the intervention group were half as likely to use prelacteal feeds with their infants ( adjusted relative risk , 0.51 [ 95 % confidence interval : 0.34–0.78 ] ) . CONCLUSIONS : Compared with routine counseling , cognitive-behavioral counseling significantly prolonged the duration of EBF , doubling the rates of EBF at 6 months postpartum OBJECTIVE to assess the effectiveness of a peer support worker ( PSW ) service on breast-feeding continuation . DESIGN cluster r and omised controlled trial ( IS RCT N16126175 ) . SETTING Primary Care Trust , UK serving a multi-ethnic , socio-economically disadvantaged population . PARTICIPANTS 2,724 women 
    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: This retrospective study assessed the effects of pre- and post-training programme for  healthcare professionals  about breastfeeding . The study included 3,114 mothers who had children aged 1–72 month(s ) . Their knowledge and behaviours relating to breastfeeding were evaluated . The mothers were r and omly divided into two groups : the ‘ before ’  group included 2,000 women who were not informed about breastfeeding  , and the ‘ after  ’  group comprised 1,114 women who had been informed about breastfeeding .  56.2 % and 66.1 % of the mothers started  breastfeeding  within 30 minutes after delivery , respectively , in the before and the after group ( x2=29.31 , p<0.001 ) . 16.7 % and 36.5 % gave exclusive breastfeeding for six months ( x2=72.85 , p<0.001 ) , and 28.5 % and 23.7 % stopped breastfeeding within the first five months ( x2=17.20 , p=0.002 ) . Ninety-four percent delivered in a hospital or in a primary healthcare centre . Therefore , prenatal and postnatal breastfeeding education and support courses may improve a woman 's chance of starting and continuing to breastfeed her baby . In terms of the number of antenatal check-ups , since the differences between the two groups were significant ( x2=390.67 , p=0.000 ) , the importance of the training programme about breastfeeding was highlighted . Follow-up interventions after training are suggested 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 Exclusive breast-feeding ( EBF ) rates remain low despite numerous health benefits associated with this behavior . We conducted a r and omized trial on the effect of lactation counseling on EBF , which controlled for the Hawthorne effect while also varying the timing of the intervention . Pregnant women attending prenatal clinics in Tema were r and omly assigned to 1 of 2 intervention groups ( IG ) or to a control group ( C ) , as follows : 1 ) EBF support given pre- , peri- , and postnatally ( IG1 ; n = 43 ) ; 2 ) EBF support given only peri- and postnatally ( IG2 ; n = 44 ) ; or 3 ) nonbreast-feeding health educational support ( C ; n = 49 ) that had an equal amount of contact with lactation counselors . Two educational sessions were provided prenatally , and 9 home follow-up visits were provided in the 6-mo postpartum period . Infant feeding data were collected monthly at the participant 's home . The 3 groups did not differ in sociodemographic characteristics . At 6 mo postpartum , 90.0 % in IG1 and 74.4 % in IG2 had exclusively breast-fed during the previous month . By contrast , only 47.7 % in C were doing so ( P = 0.008 ) . Similarly , the percentage of EBF during the 6 mo was significantly higher ( P = 0.02 ) among IG1 and IG2 ( 39.5 % ) than among C ( 19.6 % ) . The 100 % increase in EBF rates can be attributed to the lactation counseling provided . Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth 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 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 certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support . The control group ( n=178 ) received the current conventional care of postnatal breastfeeding support . Definitions of breastfeeding practice s were according to World Health Organization ( WHO ) definitions . Participants answered a self-administered question naire during recruitment and were later followed up at one , four and 6-month intervals during the postpartum period via a telephone-based question naire . RESULTS At 1 month , a higher percentage of mothers in the intervention group practice d exclusive breastfeeding , compared to the control group ( 84.3 % vs. 74.7 % , OR 1.825 95 % , p=0.042 , CI=1.054 , 3.157 ) . At 4 and 6 months postpartum , similar percentages of mothers from the two groups practice d exclusive breastfeeding ( 41.98 % vs. 38.99 % ; 12.50 % vs. 12.02 % , no significant differences , both p>0.05 ) . Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1 , 4 and 6 month marks , compared to the intervention group ( 7.4 % vs. 5.4 % ; 12.6 % vs. 9.9 % ; 13.9 % vs. 9.4 % ; all p>0.05 ) . The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply , while returning to work was the main reason for stopping breastfeeding later in the postpartum period . CONCLUSIONS Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals OBJECTIVE : To test the effectiveness of cognitive-behavioral counseling on the rate and duration of exclusive breastfeeding ( EBF )  during the first 6 months of an infant ’s life compared with routine counseling . METHODS : A single blind cluster-r and omized controlled trial was undertaken in 40 Union Councils of a rural district in the northwest province of Pakistan between May 2009 and April 2010 . By simple unmatched r and omization , 20 Union Councils were each allocated to intervention and control arms . Two hundred twenty-four third trimester pregnant women in the intervention and 228 third trimester pregnant women in the control arm were enrolled and followed-up biweekly until 6 months postpartum . Analyses were by intention to treat . Mothers in the intervention group received 7 sessions of cognitive-behavioral counseling from antenatal to 6 months postpartum , whereas the control group received an equal number of routine sessions . Proportion of mothers exclusively breastfeeding at 6 months postpartum and duration of EBF through these 6 months was assessed . RESULTS : At 6 months postpartum , 59.6 % of mothers in the intervention arm and 28.6 % in the control arm were exclusively breastfeeding . This translates into a 60 % reduced risk of stopping exclusively breastfeeding during the first 6 months ( adjusted hazard ratio , 0.40 [ 95 % confidence interval : 0.27–0.60 ] , P < .001 ) . Mothers in the intervention group were half as likely to use prelacteal feeds with their infants ( adjusted relative risk , 0.51 [ 95 % confidence interval : 0.34–0.78 ] ) . CONCLUSIONS : Compared with routine counseling , cognitive-behavioral counseling significantly prolonged the duration of EBF , doubling the rates of EBF at 6 months postpartum OBJECTIVE to assess the effectiveness of a peer support worker ( PSW ) service on breast-feeding continuation . DESIGN cluster r and omised controlled trial ( IS RCT N16126175 ) . SETTING Primary Care Trust , UK serving a multi-ethnic , socio-economically disadvantaged population . PARTICIPANTS 2,724 women 
    Output:
    