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 study the factors involved in the maintenance of exclusive breastfeeding  in healthy infants during the first 4 months of life , with emphasis on the role of pediatricians . MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba , state of Minas Gerais , Brazil . The babies were divided at r and om into three groups : G1 , receiving advice from a multiprofessional breastfeeding team ; G2 , receiving advice from a pediatrician trained in breastfeeding ; and G3 , receiving advice from a pediatrician with no breastfeeding training . Group r and omization was confirmed by analysis of variance . The factors involved in the type of feeding at 4 months were analyzed by the chi-square test , by analysis of variance and by multiple variable analysis . RESULTS At the end of follow-up , Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding . In addition , the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 ( p = 0.002 ) . The use of a pacifier was negatively correlated with exclusive breastfeeding ( p = 0.003 ) . More maternal schooling increased the chance of exclusive breastfeeding at 4 months ( p = 0.041 ) . CONCLUSIONS In this study , a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months OBJECTIVE To enhance breastfeeding practice s , the World Health Organization discourages pacifiers and bottle-feeding . However , the effect of artificial nipples on breastfeeding duration is poorly defined . The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated : 1 ) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2 ) early ( 2 - 5 days ) versus late ( > 4 weeks ) pacifier introduction . METHODS A total of 700 breastfed newborns ( 36 - 42 weeks , birth weight > or=2200 g ) were r and omly assigned to 1 of 4 intervention groups : bottle/early pacifier ( n = 169 ) , bottle/late pacifier ( n = 167 ) , cup/early pacifier ( n = 185 ) , or cup/late pacifier ( n = 179 ) . The cup/bottle intervention was invoked for infants who received supplemental feedings : cup ( n = 251 ) , bottle ( n = 230 ) . Data were collected at delivery and at 2 , 5 , 10 , 16 , 24 , 38 , and 52 weeks ' postpartum . Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses . RESULTS Supplemental feedings , regardless of method ( cup or bottle ) , had a detrimental effect on breastfeeding duration . There were no differences in cup versus bottle groups for breastfeeding duration . Effects were modified by the number of supplements ; exclusive and full breastfeeding duration were prolonged in cup-fed infants given > 2 supplements . Among infants delivered by cesarean , cupfeeding significantly prolonged exclusive , full , and overall breastfeeding duration . Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers ( early pacifier group ; odds ratio : 1.5 ; 95 % confidence interval : 1.0 - 2.0 ) . Early , as compared with late , pacifier use shortened overall duration ( adjusted hazard ratio : 1.22 ; 95 % confidence interval : 1.03 - 1.44 ) but did not affect exclusive or full duration . CONCLUSIONS There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants , but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean . Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding . These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period A cohort study tracks two or more groups forward from exposure to outcome . This type of study can be done by going ahead in time from the present ( prospect i ve cohort study ) or , alternatively , by going back in time to comprise the cohorts and following them up to the present ( retrospective cohort study ) . A cohort study is the best way to identify incidence and natural history of a disease , and can be used to examine multiple outcomes after a single exposure . However , this type of study is less useful for examination of rare events or those that take a long time to develop . A cohort study should provide specific definitions of exposures and outcomes : determination of both should be as objective as possible . The control group ( unexposed ) should be similar in all important respects to the exposed , with the exception of not having the exposure . Observational studies , however , rarely achieve such a degree of similarity , so investigators need to measure and control for confounding factors . Reduction of loss to follow-up over time is a challenge , since differential losses to follow-up introduce bias . Variations on the cohort theme include the before-after study and nested case-control study ( within a cohort study ) . Strengths of a cohort study include the ability to calculate incidence rates , relative risks , and 95 % CIs . This format is the preferred way of presenting study results , rather that with p values Objectives . To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants , on the duration of exclusive breastfeeding , and on the total breastfeeding duration . Study Design . Descriptive , longitudinal , prospect i ve study . Setting . The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital , Uppsala , Sweden between May 1989 and December 1992 . Study Population . 506 mother – infant pairs . Methods . Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study . Fortnightly home visits with structured interviews by a research assistant . Results . Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours , shorter duration of exclusive breastfeeding , and shorter total breastfeeding duration compared with no pacifier use . These associations were not found for thumb sucking . The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use . Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration . Conclusions . More frequent use of a pacifier was associated with shorter breastfeeding duration , even among a group of mothers who were highly motivated to breastfeed . breastfeeding duration , breastfeeding pattern , exclusive breastfeeding , pacifier use , thumb sucking OBJECTIVE To evaluate the effects of pacifier use and the timing of pacifier introduction on  breastfeeding duration , problems , and frequency . METHODS A cohort of 265 breastfeeding mother-infant dyads was followed prospect ively . Maternal interviews were conducted at delivery , 2 , 6 , 12 , and 24 weeks , and thereafter every 90 days until breastfeeding ended . Information was obtained regarding pacifier use , infant feeding , use of supplemental foods and breastfeeding frequency , duration , and problems . The effect of pacifier introduction by 6 weeks of age on breastfeeding duration was evaluated with Kaplan-Meier and Cox proportional hazards models . The effect of the timing of pacifier introduction ( < /=2 weeks and < /=6 weeks ) on breastfeeding duration at 2 and 3 months was evaluated using logistic regression modeling . RESULTS A total of 181 mothers ( 68 % ) introduced a pacifier before 6 weeks . In adjusted analyses , pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full ( hazard ratio , 1.53 ; 95 % confidence interval : 1.15 , 2.05 ) and overall ( hazard ratio , 1.61 ; 95 % confidence interval : 1.19,2.19 ) breastfeeding . Women who introduced pacifiers tended to breastfeed their infants fewer times per day , with significant differences noted at 2 ( 8.1 + /- 2.6 vs 9.0 + /- 2.3 ) and 12 weeks ' ( 6.3 + /- 2.0 vs 7.4 + /- 1.6 ) postpartum . At 12 weeks postpartum , women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies . Pacifier use begun either before 2 weeks or before 6 weeks ' postpartum was not significantly associated with breastfeeding duration at 2 and 3 months . CONCLUSIONS Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding . Breastfeeding duration in the first 3 months ' postpartum , however , was unaffected by pacifier use . Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding . Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants OBJECTIVE To assess the effectiveness of home visits for advising mothers about breastfeeding and weaning on pacifier use in the first year of life . METHOD A r and omized field trial was conducted on mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo ( intervention group = 200 ; controls = 300 ) . The intervention group received the advice 10 days after the child 's birth , monthly up to 6 months , at 8 , 10 , and 12 months , based on the ' Ten Steps for Healthy Feeding ' , a Brazilian national health policy for primary care , which follows WHO guidelines . Relative risk ( RR ) was used to estimate the effects of the intervention on the risk of using a pacifier . RESULTS 55.4 % of the children in the intervention group and 66.1 % of the controls used a pacifier  in the first year of life . The risk of using a pacifier  was 16 % lower for the intervention group ( RR = 0.84 ; 95 % CI , 0.71 - 0.99 ) . A multivariable Poisson regression model showed higher adjusted risk of using a pacifier  for children who had breastfeeding interrupted in the first month of life ( RR = 1.43 ; 95 % CI , 1.21 - 1.69 ) and whose mothers presented higher level of depression ( RR = 1.40 ; 95 % CI , 1.17 - 1.66 ) . CONCLUSIONS  Pacifier use is highly prevalent in the population studied . The home visits for dietary advice appear to help in reducing  pacifier use in infants . These findings suggest the need for public health strategies that address early advice on pacifier use to promote child oral and general health OBJECTIVE To determine the prevalence of exclusive breastfeeding during the first 3 months of life and its determinant factors in a city in the South region of Brazil . METHODS Prospect i ve study of a cohort of babies born between September 2002 and May 2003 in the city of Pelotas , RS . Data were obtained in interviews , at maternity units and during home visits , with mothers of babies aged between 1 and 3 months . Factors related to the cessation of breastfeeding were subjected to univariate , bivariate and multivariate analysis . RESULTS Nine hundred and forty mothers of children aged 3 months or less were interviewed , 39 % of whom were still exclusively breastfeeding and around 1/3 of whom no longer breastfed . Multivariate analysis by logistic regression demonstrated a significant association between interruption of exclusive breastfeeding before 3 months and maternal employment , use of a pacifier , low family income ( between one and three times the minimum wage ) , and less than 5 years ' paternal education . CONCLUSIONS Exclusive breastfeeding throughout the first 3 months of life is an uncommon practice among the population of Pelotas , RS , in particular when the mother works away from home , the father has little education and the child is given a pacifier , which reinforces the need to continue stimulating exclusive breastfeeding during the first months of life Objectives . In Switzerl and , the Baby-Friendly Hospital Initiative ( BFHI ) proposed by the United Nations Children 's Fund ( UNICEF ) was introduced in 1993 to promote breastfeeding nationwide . This study reports results of a national study of the prevalence and duration of breastfeeding in 2003 throughout Switzerl and and analyzes the influence of compliance with UNICEF guidelines of the hospital where delivery took place on breastfeeding duration . Methods . Between April and September 2003 , a r and om sample of mothers who had given birth in the past 9 months in Switzerl and received a question naire on breastfeeding and complementary feeding . Seventy-four percent of the contacted mothers ( n = 3032 ) participated ; they completed a 24-hour dietary recall question naire and reported the age at first introduction of various foods and drinks . After excluding question naires with missing information relevant for the analyses , we analyzed data for 2861 infants 0 to 11 months of age , born in 145 different health facilities . Because it was known whether each child was born in a design ated baby-friendly hospital ( 45 hospitals ) or in a health facility in the process of being evaluated for BFHI inclusion ( 31 facilities ) , we were able to assess a possible influence of the BFHI on breastfeeding success . For this purpose , we merged individual data with hospital data on compliance with the UNICEF guidelines , from a data source collected on an annual basis for quality monitoring of design ated baby-friendly hospitals and health facilities in the evaluation process . Information on actual compliance with the guidelines allowed us to investigate the relationship between breastfeeding outcomes and compliance with UNICEF guidelines . We were also able to compare the breastfeeding results with 
    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 study the factors involved in the maintenance of exclusive breastfeeding  in healthy infants during the first 4 months of life , with emphasis on the role of pediatricians . MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba , state of Minas Gerais , Brazil . The babies were divided at r and om into three groups : G1 , receiving advice from a multiprofessional breastfeeding team ; G2 , receiving advice from a pediatrician trained in breastfeeding ; and G3 , receiving advice from a pediatrician with no breastfeeding training . Group r and omization was confirmed by analysis of variance . The factors involved in the type of feeding at 4 months were analyzed by the chi-square test , by analysis of variance and by multiple variable analysis . RESULTS At the end of follow-up , Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding . In addition , the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 ( p = 0.002 ) . The use of a pacifier was negatively correlated with exclusive breastfeeding ( p = 0.003 ) . More maternal schooling increased the chance of exclusive breastfeeding at 4 months ( p = 0.041 ) . CONCLUSIONS In this study , a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months OBJECTIVE To enhance breastfeeding practice s , the World Health Organization discourages pacifiers and bottle-feeding . However , the effect of artificial nipples on breastfeeding duration is poorly defined . The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated : 1 ) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2 ) early ( 2 - 5 days ) versus late ( > 4 weeks ) pacifier introduction . METHODS A total of 700 breastfed newborns ( 36 - 42 weeks , birth weight > or=2200 g ) were r and omly assigned to 1 of 4 intervention groups : bottle/early pacifier ( n = 169 ) , bottle/late pacifier ( n = 167 ) , cup/early pacifier ( n = 185 ) , or cup/late pacifier ( n = 179 ) . The cup/bottle intervention was invoked for infants who received supplemental feedings : cup ( n = 251 ) , bottle ( n = 230 ) . Data were collected at delivery and at 2 , 5 , 10 , 16 , 24 , 38 , and 52 weeks ' postpartum . Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses . RESULTS Supplemental feedings , regardless of method ( cup or bottle ) , had a detrimental effect on breastfeeding duration . There were no differences in cup versus bottle groups for breastfeeding duration . Effects were modified by the number of supplements ; exclusive and full breastfeeding duration were prolonged in cup-fed infants given > 2 supplements . Among infants delivered by cesarean , cupfeeding significantly prolonged exclusive , full , and overall breastfeeding duration . Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers ( early pacifier group ; odds ratio : 1.5 ; 95 % confidence interval : 1.0 - 2.0 ) . Early , as compared with late , pacifier use shortened overall duration ( adjusted hazard ratio : 1.22 ; 95 % confidence interval : 1.03 - 1.44 ) but did not affect exclusive or full duration . CONCLUSIONS There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants , but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean . Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding . These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period A cohort study tracks two or more groups forward from exposure to outcome . This type of study can be done by going ahead in time from the present ( prospect i ve cohort study ) or , alternatively , by going back in time to comprise the cohorts and following them up to the present ( retrospective cohort study ) . A cohort study is the best way to identify incidence and natural history of a disease , and can be used to examine multiple outcomes after a single exposure . However , this type of study is less useful for examination of rare events or those that take a long time to develop . A cohort study should provide specific definitions of exposures and outcomes : determination of both should be as objective as possible . The control group ( unexposed ) should be similar in all important respects to the exposed , with the exception of not having the exposure . Observational studies , however , rarely achieve such a degree of similarity , so investigators need to measure and control for confounding factors . Reduction of loss to follow-up over time is a challenge , since differential losses to follow-up introduce bias . Variations on the cohort theme include the before-after study and nested case-control study ( within a cohort study ) . Strengths of a cohort study include the ability to calculate incidence rates , relative risks , and 95 % CIs . This format is the preferred way of presenting study results , rather that with p values Objectives . To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants , on the duration of exclusive breastfeeding , and on the total breastfeeding duration . Study Design . Descriptive , longitudinal , prospect i ve study . Setting . The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital , Uppsala , Sweden between May 1989 and December 1992 . Study Population . 506 mother – infant pairs . Methods . Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study . Fortnightly home visits with structured interviews by a research assistant . Results . Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours , shorter duration of exclusive breastfeeding , and shorter total breastfeeding duration compared with no pacifier use . These associations were not found for thumb sucking . The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use . Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration . Conclusions . More frequent use of a pacifier was associated with shorter breastfeeding duration , even among a group of mothers who were highly motivated to breastfeed . breastfeeding duration , breastfeeding pattern , exclusive breastfeeding , pacifier use , thumb sucking OBJECTIVE To evaluate the effects of pacifier use and the timing of pacifier introduction on  breastfeeding duration , problems , and frequency . METHODS A cohort of 265 breastfeeding mother-infant dyads was followed prospect ively . Maternal interviews were conducted at delivery , 2 , 6 , 12 , and 24 weeks , and thereafter every 90 days until breastfeeding ended . Information was obtained regarding pacifier use , infant feeding , use of supplemental foods and breastfeeding frequency , duration , and problems . The effect of pacifier introduction by 6 weeks of age on breastfeeding duration was evaluated with Kaplan-Meier and Cox proportional hazards models . The effect of the timing of pacifier introduction ( < /=2 weeks and < /=6 weeks ) on breastfeeding duration at 2 and 3 months was evaluated using logistic regression modeling . RESULTS A total of 181 mothers ( 68 % ) introduced a pacifier before 6 weeks . In adjusted analyses , pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full ( hazard ratio , 1.53 ; 95 % confidence interval : 1.15 , 2.05 ) and overall ( hazard ratio , 1.61 ; 95 % confidence interval : 1.19,2.19 ) breastfeeding . Women who introduced pacifiers tended to breastfeed their infants fewer times per day , with significant differences noted at 2 ( 8.1 + /- 2.6 vs 9.0 + /- 2.3 ) and 12 weeks ' ( 6.3 + /- 2.0 vs 7.4 + /- 1.6 ) postpartum . At 12 weeks postpartum , women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies . Pacifier use begun either before 2 weeks or before 6 weeks ' postpartum was not significantly associated with breastfeeding duration at 2 and 3 months . CONCLUSIONS Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding . Breastfeeding duration in the first 3 months ' postpartum , however , was unaffected by pacifier use . Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding . Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants OBJECTIVE To assess the effectiveness of home visits for advising mothers about breastfeeding and weaning on pacifier use in the first year of life . METHOD A r and omized field trial was conducted on mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo ( intervention group = 200 ; controls = 300 ) . The intervention group received the advice 10 days after the child 's birth , monthly up to 6 months , at 8 , 10 , and 12 months , based on the ' Ten Steps for Healthy Feeding ' , a Brazilian national health policy for primary care , which follows WHO guidelines . Relative risk ( RR ) was used to estimate the effects of the intervention on the risk of using a pacifier . RESULTS 55.4 % of the children in the intervention group and 66.1 % of the controls used a pacifier  in the first year of life . The risk of using a pacifier  was 16 % lower for the intervention group ( RR = 0.84 ; 95 % CI , 0.71 - 0.99 ) . A multivariable Poisson regression model showed higher adjusted risk of using a pacifier  for children who had breastfeeding interrupted in the first month of life ( RR = 1.43 ; 95 % CI , 1.21 - 1.69 ) and whose mothers presented higher level of depression ( RR = 1.40 ; 95 % CI , 1.17 - 1.66 ) . CONCLUSIONS  Pacifier use is highly prevalent in the population studied . The home visits for dietary advice appear to help in reducing  pacifier use in infants . These findings suggest the need for public health strategies that address early advice on pacifier use to promote child oral and general health OBJECTIVE To determine the prevalence of exclusive breastfeeding during the first 3 months of life and its determinant factors in a city in the South region of Brazil . METHODS Prospect i ve study of a cohort of babies born between September 2002 and May 2003 in the city of Pelotas , RS . Data were obtained in interviews , at maternity units and during home visits , with mothers of babies aged between 1 and 3 months . Factors related to the cessation of breastfeeding were subjected to univariate , bivariate and multivariate analysis . RESULTS Nine hundred and forty mothers of children aged 3 months or less were interviewed , 39 % of whom were still exclusively breastfeeding and around 1/3 of whom no longer breastfed . Multivariate analysis by logistic regression demonstrated a significant association between interruption of exclusive breastfeeding before 3 months and maternal employment , use of a pacifier , low family income ( between one and three times the minimum wage ) , and less than 5 years ' paternal education . CONCLUSIONS Exclusive breastfeeding throughout the first 3 months of life is an uncommon practice among the population of Pelotas , RS , in particular when the mother works away from home , the father has little education and the child is given a pacifier , which reinforces the need to continue stimulating exclusive breastfeeding during the first months of life Objectives . In Switzerl and , the Baby-Friendly Hospital Initiative ( BFHI ) proposed by the United Nations Children 's Fund ( UNICEF ) was introduced in 1993 to promote breastfeeding nationwide . This study reports results of a national study of the prevalence and duration of breastfeeding in 2003 throughout Switzerl and and analyzes the influence of compliance with UNICEF guidelines of the hospital where delivery took place on breastfeeding duration . Methods . Between April and September 2003 , a r and om sample of mothers who had given birth in the past 9 months in Switzerl and received a question naire on breastfeeding and complementary feeding . Seventy-four percent of the contacted mothers ( n = 3032 ) participated ; they completed a 24-hour dietary recall question naire and reported the age at first introduction of various foods and drinks . After excluding question naires with missing information relevant for the analyses , we analyzed data for 2861 infants 0 to 11 months of age , born in 145 different health facilities . Because it was known whether each child was born in a design ated baby-friendly hospital ( 45 hospitals ) or in a health facility in the process of being evaluated for BFHI inclusion ( 31 facilities ) , we were able to assess a possible influence of the BFHI on breastfeeding success . For this purpose , we merged individual data with hospital data on compliance with the UNICEF guidelines , from a data source collected on an annual basis for quality monitoring of design ated baby-friendly hospitals and health facilities in the evaluation process . Information on actual compliance with the guidelines allowed us to investigate the relationship between breastfeeding outcomes and compliance with UNICEF guidelines . We were also able to compare the breastfeeding results with 
    Output:
    