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 . Topical lidocaine-prilocaine ( EMLA ) effectively decreases the pain associated with minor procedures including immunization , although the effect on the antibody response to diphtheria-tetanus-acellular pertussis-inactivated poliovirus -Haemophilus influenzae type b conjugate ( DTaP-IPV-Hib ) and hepatitis B vaccines has not been assessed . Objective . To measure the antibody response to DTaP-IPV-Hib and hepatitis B vaccines ; to measure pain reduction associated with the use of the lidocaine-prilocaine ( EMLA ) patch ; and to assess safety by comparing adverse reactions . Participants and setting . One hundred nine healthy 6-month-old infants ( Part A of study ) and 56 healthy infants birth to 2 months of age ( Part B of study ) undergoing primary immunization with DTaP-IPV-Hib and hepatitis B vaccines in an ambulatory setting . Design and interventions . Two center , r and omized , double blind , controlled trial of EMLA patch or placebo before DTaP-IPV-Hib and hepatitis B immunization . Antibody titers measured at 0 to 2 , 6 and 7 months . Outcome measures . The primary outcome measure was the antibody response to diphtheria , tetanus , pertussis antigens , Haemophilus influenzae type b and hepatitis B by enzyme immunoassay ; and poliovirus 1 , 2 and 3 by neutralization . The secondary outcomes were pain scores by the Modified Behavioral Pain Scale and drug- and vaccine-associated adverse events collected with a parent diary and structured question naire . Results . There was no difference in the antibody response between the EMLA- and placebo-treated groups as assessed by geometric mean antibody titers , rates of seroconversion or the proportion of participants achieving protective or positive antibody titers postimmunization . At the 6-month visit , EMLA recipients had less pain after immunization ( total pain score , 6.75 vs. 7.35;P = 0.005 ; pain score increase , 3.99 vs. 4.74;P = 0.004 ) than did placebo recipients . Skin pallor and erythema at the patch application site were more frequently reported after EMLA use . Rates of vaccine-associated adverse events were similar in the two groups . Conclusions . The EMLA patch has no adverse effect on the antibody response to the vaccine antigens , is effective in reducing pain associated with DTaP-IPV-Hib and hepatitis B immunizations and does not result in any significant or unexpected adverse reactions Background The aim of this study was to examine the effect of breastfeeding on pain relief in full-term neonates during injection of hepatitis B vaccine . Methods This was a r and omized clinical trial . A sample of full-term neonates was r and omly allocated into two groups : the experimental group and the control group . Neonates in the experimental group were breastfed two minutes before , during , and after the hepatitis B immunization and the control group were held in mothers ’ arms but not fed .  Pain was assessed using the Douleur Aiguë du Nouveau-né ( DAN ) scale measuring facial expressions , limb movements and vocal expressions . The assessment s were carried out after hepatitis B immunization . Results One hundred thirty healthy full-term neonates were studied ( 65 in the experimental group and 65 in the control group ) . Gestational age , birth weight , Apgar score and gender did not differ between the two groups . The mean total pain score as measured by the DAN scale was 3.52 ( SD = 1.37 ) for the experimental group and it was 6.78 ( SD = 1.69 ) for the controls indicating a significant lower pain score for the experimental group ( P<0.001 ) . Also , there were significant differences for the three measures of DAN scale that are facial expressions , limb movements and vocal expression , between the two study groups ( P<0.001 ) . Conclusion The findings confirm that breastfeeding reduces pain and is effective way for pain relief during hepatitis B vaccine injection . Trial registration I RCT Objective : Pain from vaccine injections remains undertreated , despite the availability of numerous pain-relieving strategies . Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management . The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection . Patients and Methods : Prospect i ve naturalistic study in 8 urban outpatient primary care clinics ( 4 pediatric and 4 family practice ) in Toronto . For 48 to 59 consecutive childhood vaccination appointments at each site , child waiting time from clinic arrival until first vaccine injection was tracked . Results : Altogether , 405 vaccine appointments were included . The median age of the child undergoing vaccination was 12 months . The mean ( SD ) time from clinic arrival until first vaccine injection was 41.6 minutes ( 20.9 ) , with a range of 7 to 132 minutes . Linear regression identified a significant ( P<0.05 ) difference according to clinic [ ranging from 19.4 min ( 6.5 ) to 57.5 min ( 20.2 ) ] and number of family members in the appointment [ ranging from 40.6 min ( 21.0 ) for an appointment in the index child only to 50 min ( 14.3 ) for an appointment in the index child and 2 other family members ] . Conclusions : Contrary to healthcare provider perceptions , the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions . Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence -based strategies This experiment had three goals : 1 . To identify the basis of sucking-induced analgesia in healthy , term , newborn humans undergoing the painful , routine , procedure of heel lance and blood collection . 2 . To evaluate how taste-induced and sucking-induced analgesias combine to combat pain . 3 . To determine whether facial grimacing was an accurate index of diminished pain , or whether it was linked to tissue trauma . We report that : 1 . Sucking an unflavored pacifier was analgesic when and only when suck rate exceeded 30 sucks/min . 2 . The combination of sucrose and nonnutritive sucking was remarkably analgesic ; we saw no behavioral indication in nine of the ten infants that the heel lance had even occurred . 3 . Grimacing was reduced to almost naught by procedures that essentially eliminated crying and markedly reduced heart rate during the blood harvesting procedure OBJECTIVE To determine whether milk and its components reduce  crying  in newborns during and after blood collection for phenylketonuria evaluation . METHODOLOGY Seventy-two normal newborns ingested 2 mL of milk ( Similac ) , Ross Special Formula , fat , protein , lactose , sucrose , or water for the 2 minutes preceding blood collection via heel lance . Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance . RESULTS Sucrose and Similac each reduced crying during the blood collection procedure . Sucrose , fat , protein , and Ross Special Formula were effective during the 3-minute recovery period . Neither water nor lactose were effective during or after blood collection . CONCLUSION Milk and some of its components are antinociceptive in human newborns . Based on previous studies , reduced crying during and after painful stimulation may be mediated through endogenous opioids . These findings are of potential clinical significance : natural protective mechanisms , normally engaged during suckling , may safely and noninvasively be activated to reduce  newborn crying to painful stimulation OBJECTIVE To evaluate the effects of acetaminophen on the incidence of adverse effects to , and the immunogenicity of , whole-virus influenza vaccine in health care workers . DESIGN Prospect i ve , r and omized , double-blind placebo-controlled trial . SETTING Health Sciences Centre , an acute care teaching hospital in Winnipeg . PARTICIPANTS Of 474 hospital personnel who agreed to undergo influenza vaccination during the 1990 - 91 season 262 volunteered to participate in the study . INTERVENTIONS A dose of 0.5 mL of inactivated trivalent whole-virus influenza vaccine was injected into the deltoid muscle . Volunteers were r and omly assigned to ingest two capsules of acetaminophen in a half dose ( 162.5 mg per capsule ) or a full dose ( 325 mg per capsule ) or two identical placebo capsules . Capsules were to be taken at vaccination and at 4 , 8 and 12 hours afterward . Subjects were asked to answer questions regarding six symptoms in a diary for the 3 days after vaccination and to record their ingestion of the study medication . MAIN OUTCOME MEASURES Incidence of local ( sore arm ) and systemic ( headache , fever , muscle ache , nausea and diarrhea ) side effects as well as serum titres of hemagglutination inhibition ( HAI ) antibody to vaccine antigens before vaccination and 2 weeks and 6 months afterward . RESULTS A total of 87 , 87 and 88 subjects received the half dose , full dose and placebo respectively ; 96 % returned the diaries , 83 % ingested all four doses of medication , and 87 % volunteered all blood sample s. Compared with the placebo group the incidence of sore arm was 25 % to 28 % lower in the half-dose and full-dose groups respectively at 24 hours after vaccination , and the rate of nausea was 90 % lower in the full-dose group . The HAI titres were similar among the groups at the three test times . CONCLUSIONS The full dose of acetaminophen significantly reduced the incidence of sore arm and nausea without affecting the antibody response . Acetaminophen use may increase the acceptance of influenza vaccine by health care workers in whom concern about side effects is an impediment to vaccination OBJECTIVE To investigate interventions that affect pain reduction during vaccination in infants and children attending a well-child unit . STUDY DESIGN A consecutive sample of 243 children between age 0 and 48 months receiving their routine vaccinations was r and omly assigned to 1 of the study groups . A total of 158 infants under age 6 months were r and omly assigned to breast-feeding or no breast-feeding during immunization , and 85 children age 6 to 48 months were r and omly assigned to receive 12 % sucrose solution , lidocaine-prilocaine cream , or no intervention . All children were evaluated for crying time and pain score by a pediatrician using the Neonatal Infant Pain Scale ( NIPS ) for those under age 12 months and the Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) for those over age 12 months . RESULTS Breast-feeding in infants under age 6 months and use of sucrose or lidocaine-prilocaine in children age 6 to 48 months significantly reduced crying time and pain scores compared with controls . No difference in outcome was seen between the sucrose and lidocaine-prilocaine treatment groups . CONCLUSIONS Here we exp and on previous findings by demonstrating that breast-feeding may have an analgesic effect up to age 6 months and that in older children , both sucrose and lidocaine-prilocaine reduce vaccination pain Worldwide , paracetamol is administered as a remedy for complaints that occur after vaccination . Recently published results indicate that paracetamol inhibits the vaccination response in infants when given prior to vaccination . The goal of this study was to establish whether paracetamol exerts similar effects in young adults . In addition , the effect of timing of paracetamol intake was investigated . In two r and omized , controlled , open-label studies 496 healthy young adults were r and omly assigned to three groups . The study groups received paracetamol for 24 hours starting at the time of ( prophylactic use ) - or 6 hours after ( therapeutic use ) the primary ( 0 month ) and first booster ( 1 month ) hepatitis B vaccination . The control group received no paracetamol . None of the participants used paracetamol around the second booster ( 6 months ) vaccination . Anti-HBs levels were measured prior to and one month after the second booster vaccination on ADVIA Centaur XP . One month after the second booster vaccination , the anti-HBs level in the prophylactic paracetamol group was significantly lower ( p = 0.048 ) than the level in the control group ( 4257 mIU/mL vs. 5768 mIU/mL ) . The anti-HBs level in the therapeutic paracetamol group ( 4958 mIU/mL ) was not different ( p = 0.34 ) from the level in the control group . Only prophylactic paracetamol treatment , and not therapeutic treatment , during vaccination has a negative influence on the antibody concentration after hepatitis B vaccination in adults . These findings prompt to consider therapeutic instead of prophylactic treatment to ensure maximal vaccination efficacy and retain the possibility to treat pain and fever after vaccination . Trial Registration Controlled-Trials.com IS RCT Objective To compare analgesic effect of direct breast feeding , 25 % dextrose solution and placebo as we give 1st intramuscular whole cell DPT injection to 6week — 3month old infants . Design R and omized 
    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 . Topical lidocaine-prilocaine ( EMLA ) effectively decreases the pain associated with minor procedures including immunization , although the effect on the antibody response to diphtheria-tetanus-acellular pertussis-inactivated poliovirus -Haemophilus influenzae type b conjugate ( DTaP-IPV-Hib ) and hepatitis B vaccines has not been assessed . Objective . To measure the antibody response to DTaP-IPV-Hib and hepatitis B vaccines ; to measure pain reduction associated with the use of the lidocaine-prilocaine ( EMLA ) patch ; and to assess safety by comparing adverse reactions . Participants and setting . One hundred nine healthy 6-month-old infants ( Part A of study ) and 56 healthy infants birth to 2 months of age ( Part B of study ) undergoing primary immunization with DTaP-IPV-Hib and hepatitis B vaccines in an ambulatory setting . Design and interventions . Two center , r and omized , double blind , controlled trial of EMLA patch or placebo before DTaP-IPV-Hib and hepatitis B immunization . Antibody titers measured at 0 to 2 , 6 and 7 months . Outcome measures . The primary outcome measure was the antibody response to diphtheria , tetanus , pertussis antigens , Haemophilus influenzae type b and hepatitis B by enzyme immunoassay ; and poliovirus 1 , 2 and 3 by neutralization . The secondary outcomes were pain scores by the Modified Behavioral Pain Scale and drug- and vaccine-associated adverse events collected with a parent diary and structured question naire . Results . There was no difference in the antibody response between the EMLA- and placebo-treated groups as assessed by geometric mean antibody titers , rates of seroconversion or the proportion of participants achieving protective or positive antibody titers postimmunization . At the 6-month visit , EMLA recipients had less pain after immunization ( total pain score , 6.75 vs. 7.35;P = 0.005 ; pain score increase , 3.99 vs. 4.74;P = 0.004 ) than did placebo recipients . Skin pallor and erythema at the patch application site were more frequently reported after EMLA use . Rates of vaccine-associated adverse events were similar in the two groups . Conclusions . The EMLA patch has no adverse effect on the antibody response to the vaccine antigens , is effective in reducing pain associated with DTaP-IPV-Hib and hepatitis B immunizations and does not result in any significant or unexpected adverse reactions Background The aim of this study was to examine the effect of breastfeeding on pain relief in full-term neonates during injection of hepatitis B vaccine . Methods This was a r and omized clinical trial . A sample of full-term neonates was r and omly allocated into two groups : the experimental group and the control group . Neonates in the experimental group were breastfed two minutes before , during , and after the hepatitis B immunization and the control group were held in mothers ’ arms but not fed .  Pain was assessed using the Douleur Aiguë du Nouveau-né ( DAN ) scale measuring facial expressions , limb movements and vocal expressions . The assessment s were carried out after hepatitis B immunization . Results One hundred thirty healthy full-term neonates were studied ( 65 in the experimental group and 65 in the control group ) . Gestational age , birth weight , Apgar score and gender did not differ between the two groups . The mean total pain score as measured by the DAN scale was 3.52 ( SD = 1.37 ) for the experimental group and it was 6.78 ( SD = 1.69 ) for the controls indicating a significant lower pain score for the experimental group ( P<0.001 ) . Also , there were significant differences for the three measures of DAN scale that are facial expressions , limb movements and vocal expression , between the two study groups ( P<0.001 ) . Conclusion The findings confirm that breastfeeding reduces pain and is effective way for pain relief during hepatitis B vaccine injection . Trial registration I RCT Objective : Pain from vaccine injections remains undertreated , despite the availability of numerous pain-relieving strategies . Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management . The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection . Patients and Methods : Prospect i ve naturalistic study in 8 urban outpatient primary care clinics ( 4 pediatric and 4 family practice ) in Toronto . For 48 to 59 consecutive childhood vaccination appointments at each site , child waiting time from clinic arrival until first vaccine injection was tracked . Results : Altogether , 405 vaccine appointments were included . The median age of the child undergoing vaccination was 12 months . The mean ( SD ) time from clinic arrival until first vaccine injection was 41.6 minutes ( 20.9 ) , with a range of 7 to 132 minutes . Linear regression identified a significant ( P<0.05 ) difference according to clinic [ ranging from 19.4 min ( 6.5 ) to 57.5 min ( 20.2 ) ] and number of family members in the appointment [ ranging from 40.6 min ( 21.0 ) for an appointment in the index child only to 50 min ( 14.3 ) for an appointment in the index child and 2 other family members ] . Conclusions : Contrary to healthcare provider perceptions , the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions . Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence -based strategies This experiment had three goals : 1 . To identify the basis of sucking-induced analgesia in healthy , term , newborn humans undergoing the painful , routine , procedure of heel lance and blood collection . 2 . To evaluate how taste-induced and sucking-induced analgesias combine to combat pain . 3 . To determine whether facial grimacing was an accurate index of diminished pain , or whether it was linked to tissue trauma . We report that : 1 . Sucking an unflavored pacifier was analgesic when and only when suck rate exceeded 30 sucks/min . 2 . The combination of sucrose and nonnutritive sucking was remarkably analgesic ; we saw no behavioral indication in nine of the ten infants that the heel lance had even occurred . 3 . Grimacing was reduced to almost naught by procedures that essentially eliminated crying and markedly reduced heart rate during the blood harvesting procedure OBJECTIVE To determine whether milk and its components reduce  crying  in newborns during and after blood collection for phenylketonuria evaluation . METHODOLOGY Seventy-two normal newborns ingested 2 mL of milk ( Similac ) , Ross Special Formula , fat , protein , lactose , sucrose , or water for the 2 minutes preceding blood collection via heel lance . Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance . RESULTS Sucrose and Similac each reduced crying during the blood collection procedure . Sucrose , fat , protein , and Ross Special Formula were effective during the 3-minute recovery period . Neither water nor lactose were effective during or after blood collection . CONCLUSION Milk and some of its components are antinociceptive in human newborns . Based on previous studies , reduced crying during and after painful stimulation may be mediated through endogenous opioids . These findings are of potential clinical significance : natural protective mechanisms , normally engaged during suckling , may safely and noninvasively be activated to reduce  newborn crying to painful stimulation OBJECTIVE To evaluate the effects of acetaminophen on the incidence of adverse effects to , and the immunogenicity of , whole-virus influenza vaccine in health care workers . DESIGN Prospect i ve , r and omized , double-blind placebo-controlled trial . SETTING Health Sciences Centre , an acute care teaching hospital in Winnipeg . PARTICIPANTS Of 474 hospital personnel who agreed to undergo influenza vaccination during the 1990 - 91 season 262 volunteered to participate in the study . INTERVENTIONS A dose of 0.5 mL of inactivated trivalent whole-virus influenza vaccine was injected into the deltoid muscle . Volunteers were r and omly assigned to ingest two capsules of acetaminophen in a half dose ( 162.5 mg per capsule ) or a full dose ( 325 mg per capsule ) or two identical placebo capsules . Capsules were to be taken at vaccination and at 4 , 8 and 12 hours afterward . Subjects were asked to answer questions regarding six symptoms in a diary for the 3 days after vaccination and to record their ingestion of the study medication . MAIN OUTCOME MEASURES Incidence of local ( sore arm ) and systemic ( headache , fever , muscle ache , nausea and diarrhea ) side effects as well as serum titres of hemagglutination inhibition ( HAI ) antibody to vaccine antigens before vaccination and 2 weeks and 6 months afterward . RESULTS A total of 87 , 87 and 88 subjects received the half dose , full dose and placebo respectively ; 96 % returned the diaries , 83 % ingested all four doses of medication , and 87 % volunteered all blood sample s. Compared with the placebo group the incidence of sore arm was 25 % to 28 % lower in the half-dose and full-dose groups respectively at 24 hours after vaccination , and the rate of nausea was 90 % lower in the full-dose group . The HAI titres were similar among the groups at the three test times . CONCLUSIONS The full dose of acetaminophen significantly reduced the incidence of sore arm and nausea without affecting the antibody response . Acetaminophen use may increase the acceptance of influenza vaccine by health care workers in whom concern about side effects is an impediment to vaccination OBJECTIVE To investigate interventions that affect pain reduction during vaccination in infants and children attending a well-child unit . STUDY DESIGN A consecutive sample of 243 children between age 0 and 48 months receiving their routine vaccinations was r and omly assigned to 1 of the study groups . A total of 158 infants under age 6 months were r and omly assigned to breast-feeding or no breast-feeding during immunization , and 85 children age 6 to 48 months were r and omly assigned to receive 12 % sucrose solution , lidocaine-prilocaine cream , or no intervention . All children were evaluated for crying time and pain score by a pediatrician using the Neonatal Infant Pain Scale ( NIPS ) for those under age 12 months and the Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) for those over age 12 months . RESULTS Breast-feeding in infants under age 6 months and use of sucrose or lidocaine-prilocaine in children age 6 to 48 months significantly reduced crying time and pain scores compared with controls . No difference in outcome was seen between the sucrose and lidocaine-prilocaine treatment groups . CONCLUSIONS Here we exp and on previous findings by demonstrating that breast-feeding may have an analgesic effect up to age 6 months and that in older children , both sucrose and lidocaine-prilocaine reduce vaccination pain Worldwide , paracetamol is administered as a remedy for complaints that occur after vaccination . Recently published results indicate that paracetamol inhibits the vaccination response in infants when given prior to vaccination . The goal of this study was to establish whether paracetamol exerts similar effects in young adults . In addition , the effect of timing of paracetamol intake was investigated . In two r and omized , controlled , open-label studies 496 healthy young adults were r and omly assigned to three groups . The study groups received paracetamol for 24 hours starting at the time of ( prophylactic use ) - or 6 hours after ( therapeutic use ) the primary ( 0 month ) and first booster ( 1 month ) hepatitis B vaccination . The control group received no paracetamol . None of the participants used paracetamol around the second booster ( 6 months ) vaccination . Anti-HBs levels were measured prior to and one month after the second booster vaccination on ADVIA Centaur XP . One month after the second booster vaccination , the anti-HBs level in the prophylactic paracetamol group was significantly lower ( p = 0.048 ) than the level in the control group ( 4257 mIU/mL vs. 5768 mIU/mL ) . The anti-HBs level in the therapeutic paracetamol group ( 4958 mIU/mL ) was not different ( p = 0.34 ) from the level in the control group . Only prophylactic paracetamol treatment , and not therapeutic treatment , during vaccination has a negative influence on the antibody concentration after hepatitis B vaccination in adults . These findings prompt to consider therapeutic instead of prophylactic treatment to ensure maximal vaccination efficacy and retain the possibility to treat pain and fever after vaccination . Trial Registration Controlled-Trials.com IS RCT Objective To compare analgesic effect of direct breast feeding , 25 % dextrose solution and placebo as we give 1st intramuscular whole cell DPT injection to 6week — 3month old infants . Design R and omized 
    Output:
    