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 examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries Abstract Objectives : To investigate the association between the duration of exclusive breast feeding and the development of  asthma related outcomes in children at age 6 years . Design : Prospect i ve cohort study . Setting : Western Australia . Subjects : 2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years . Main outcome measures : Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age , allowing for several important confounders : sex , gestational age , smoking in the household , and early childcare . Results : After adjustment for confounders , the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years : asthma diagnosed by a doctor ( odds ratio 1.25 , 95 % confidence interval 1.02 to 1.52 ) ; wheeze three or more times since 1 year of age ( 1.41 , 1.14 to 1.76 ) ; wheeze in the past year ( 1.31 , 1.05 to 1.64 ) ; sleep disturbance due to wheeze within the past year ( 1.42 , 1.07 to 1.89 ) ; age when doctor diagnosed asthma ( hazard ratio 1.22 , 1.03 to 1.43 ) ; age at first wheeze ( 1.36 , 1.17 to 1.59 ) ; and positive skin prick test reaction to at least one common aeroallergen ( 1.30 , 1.04 to 1.61 ) . Conclusion : A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth . These findings are important for our underst and ing of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits . Key messages Asthma is the leading cause of admission to hospital in Australian children and its prevalence is increasing Whether breast feeding protects against asthma or atopy , or both , is controversial Asthma is a complex disease , and the relative risks between breast feeding and asthma or atopy are unlikely to be large ; this suggests the need for investigation in a large prospect i ve birth cohort with timely assessment of atopic outcomes and all relevant exposures Exclusive breast feeding for at least 4 months is associated with a significant reduction in the risk of asthma and atopy at age 6 years and with a significant delay in the age at onset of wheezing and asthma being diagnosed by a doctor Public health interventions to promote an increased duration of exclusive breast feeding may help to reduce the morbidity and prevalence of childhood asthma  and BACKGROUND Breast-feeding clearly protects against early wheezing , but recent data suggest that it might increase later risk of atopic disease and asthma . OBJECTIVE We sought to examine the relationship between breast-feeding and later asthma and allergy outcomes by using data from the Avon Longitudinal Study of Parents and Children , a large birth cohort in the United Kingdom . METHODS We used adjusted logistic regression models to evaluate the association between breast-feeding and atopy at age 7 years , bronchial responsiveness to methacholine at age 8 years , and wheeze at ages 3 and 7 1/2 years . Bayesian methods were used to assess the possibility of bias caused by an influence of early wheezing on the duration of breast-feeding , as well as selection bias . RESULTS Breast-feeding was protective for wheeze in the first 3 years of life ( odds ratio [ OR ] of 0.80 [ 95 % CI , 0.70 - 0.90 ] for > or = 6 months relative to never ) but not wheeze ( OR , 0.98 ; 95 % CI , 0.79 - 1.22 ) , atopy ( OR , 1.12 ; 95 % CI , 0.92 - 1.35 ) , or bronchial hyperresponsiveness ( OR , 1.07 ; 95 % CI , 0.82 - 1.40 ) at ages 7 to 8 years . Bayesian models adjusting for the longer duration of breast-feeding among children with wheezing in early infancy produced virtually identical results . CONCLUSIONS We did not find consistent evidence for either a deleterious effect or a protective effect of breast-feeding on later risk of allergic disease in a large prospect i ve birth cohort of children with objective outcome measures and extensive data on potential confounders and effect modifiers . Neither reverse causation nor loss to follow-up appears to have material ly biased our results BACKGROUND Little is known about factors that determine prescribing of  asthma therapy in infancy . OBJECTIVE To describe factors related to the initiation and refill of asthma therapy in infancy . METHODS This study included 1202 infants who participated in a prospect i ve birth cohort study : the ' Wheezing Illnesses Study Leidsche Rijn ( WHISTLER ) ' . Outcomes ,  asthma therapy initiation and refill , were assessed using prescription data . Logistic regression analysis was used to study determinants of therapy initiation in two groups : total population and infants with a respiratory system symptom diagnosis . In addition , determinants of refilling prescriptions were studied in infants who started therapy in their first year of life . RESULTS Fifteen per cent of all infants started asthma therapy in their first year of life . Respiratory symptoms were an important driver of both initiation and refill of prescriptions . In the total population , therapy initiation was associated with male gender [ odds ratio ( OR ) : 1.6 , 95 % confidence interval ( CI ) : 1.1 - 2.6 ] , day-care attendance ( OR : 1.6 , 95 % CI : 1.0 - 2.5 ) and breastfeeding ( OR : 0.6 , 95 % CI : 0.3 - 1.0 ) . For infants with a respiratory system symptom diagnosis , day-care attendance was associated with an increased chance of therapy initiation ( OR : 5.3 , 95 % CI : 1.8 - 16.2 ) and breastfeeding was associated with a lower chance of starting therapy ( OR : 0.4 , 95 % CI : 0.1 - 1.1 ) . Dutch children had a higher chance of refilling prescriptions in infancy ( OR : 5.3 , 95 % CI : 1.1 - 26.8 ) . CONCLUSIONS Apart from other factors involved , the principal reason for initiation and refill of asthma therapy in infancy was the presence of respiratory symptoms . This appeared the only reason to prescribe medication and physicians are not distracted by other factors OBJECTIVE To estimate the prevalence of  wheezing in the chest among adults , and to explore the effect of some variables on the prevalence of this condition . METHODS This was a prospect i ve cohort study on individuals born in the city of Pelotas ( Southern Brazil ) in 1982 . A total of 4,297 subjects was traced in 2004 - 5 , representing 77.4 % of the original cohort . Data were collected by means of interviews using the ISAAC ( International Study of Asthma and Allergies in Childhood Steering Committee ) question naire . Associations between the outcome ' occurrence of wheezing in the chest within the 12 months prior to the interview ' and the variables of socioeconomic , demographic and birth characteristics were tested by means of multivariable analyses , using Poisson regression . RESULTS The prevalence of wheezing over the preceding year was 24.9 % . Among the individuals reporting wheezing , 54.6 % reported difficulty in sleeping , and 12.9 % reported difficulty in speaking due to wheezing . The prevalence of wheezing in the chest was significantly higher among women . This association was maintained in analyses adjusted for non-white skin color , family history of asthma and low socioeconomic level . Among men , there was no significant association in the analyses adjusted for skin color and family income at birth . Family histories of asthma and poverty throughout life presented significant associations with wheezing in the chest . For both sexes , there were no associations with the variables of birth weight and breastfeeding duration . CONCLUSIONS The prevalence of wheezing in the chest was high , and subjects with low family income at birth were more likely to have had wheezing in the chest over the preceding year OBJECTIVES To investigate the relationship of infant feeding to  recurrent wheezing at age 6 years and to assess whether this relationship is altered by a history of wheezing lower respiratory tract illnesses . DESIGN Prospect i ve , longitudinal study of healthy infants followed up from birth to 6 years of age . SETTING Nonselected health maintenance organization population in Tucson , Arizona . PARTICIPANTS There were 1246 healthy infants enrolled at birth , 988 of whom had data on both infant feeding and wheezing at age 6 years . INTERVENTIONS None . MAIN OUTCOME MEASURES Recurrent wheeze ( four or more episodes in the past year ) was assessed by a question naire that was completed by parents when the children were 6 years old . Children were classified by atopic status on the basis of skin prick tests . RESULTS Breast-feeding information was collected prospect ively , and lower respiratory tract illnesses in the first 3 years of life were diagnosed by the pediatrician . Being breast-fed was associated with lower rates of recurrent wheeze at age 6 years ( 3.1 % vs 9.7 % , P < .01 ) for nonatopic children ; this relationship was not significant for atopic children . The relationship of breast-feeding with recurrent wheeze was apparent among nonatopic children both with and without a wheezing lower respiratory tract illness in the first 6 months of life . When potential confounders , including early wheezing lower respiratory tract illness , were included in a multivariate model , nonatopic children who had not been breast-fed had three times the odds of wheezing recurrently ( odds ratio , 3.03 ; confidence interval , 1.06 to 8.69 ) . Eleven percent of recurrent wheeze among nonatopic children could be attributed to not breast-feeding . CONCLUSIONS Recurrent wheeze at age 6 years is less common among nonatopic children who were breast-fed as infants . This effect is independent of whether the child wheezed with a lower respiratory tract illness in the first 6 months of life The relationship between  breastfeeding , respiratory and other allergic disorders has been controversial . Our aim was to investigate the relationships between  breastfeeding  , respiratory outcomes , eczema and atopy at 15 months of age in a prospect i ve birth cohort in New Zeal and . A total of 1105 children were enrolled at birth , and 1011 ( 91.2 % ) were followed up at 15 months .  Logistic regression was used to model associations between  breastfeeding  duration and respiratory outcomes , eczema and atopy after adjusting for relevant confounding variables : ethnicity , socio-economic status , parity , body mass index , smoking in pregnancy , gender and respiratory infections in the first 3 months of life . Breastfeeding was associated with a significant reduction in the risk of adverse respiratory outcomes at 15 months . After adjustment for confounders , each month of exclusive breastfeeding reduced the risk of doctor-diagnosed asthma by 20 % ( odds ratio 0.80 , 95 % confidence interval 0.71 to 0.90 ) , wheezing by 12 % ( 0.88 , 0.82 to 0.94 ) 
    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 examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries Abstract Objectives : To investigate the association between the duration of exclusive breast feeding and the development of  asthma related outcomes in children at age 6 years . Design : Prospect i ve cohort study . Setting : Western Australia . Subjects : 2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years . Main outcome measures : Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age , allowing for several important confounders : sex , gestational age , smoking in the household , and early childcare . Results : After adjustment for confounders , the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years : asthma diagnosed by a doctor ( odds ratio 1.25 , 95 % confidence interval 1.02 to 1.52 ) ; wheeze three or more times since 1 year of age ( 1.41 , 1.14 to 1.76 ) ; wheeze in the past year ( 1.31 , 1.05 to 1.64 ) ; sleep disturbance due to wheeze within the past year ( 1.42 , 1.07 to 1.89 ) ; age when doctor diagnosed asthma ( hazard ratio 1.22 , 1.03 to 1.43 ) ; age at first wheeze ( 1.36 , 1.17 to 1.59 ) ; and positive skin prick test reaction to at least one common aeroallergen ( 1.30 , 1.04 to 1.61 ) . Conclusion : A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth . These findings are important for our underst and ing of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits . Key messages Asthma is the leading cause of admission to hospital in Australian children and its prevalence is increasing Whether breast feeding protects against asthma or atopy , or both , is controversial Asthma is a complex disease , and the relative risks between breast feeding and asthma or atopy are unlikely to be large ; this suggests the need for investigation in a large prospect i ve birth cohort with timely assessment of atopic outcomes and all relevant exposures Exclusive breast feeding for at least 4 months is associated with a significant reduction in the risk of asthma and atopy at age 6 years and with a significant delay in the age at onset of wheezing and asthma being diagnosed by a doctor Public health interventions to promote an increased duration of exclusive breast feeding may help to reduce the morbidity and prevalence of childhood asthma  and BACKGROUND Breast-feeding clearly protects against early wheezing , but recent data suggest that it might increase later risk of atopic disease and asthma . OBJECTIVE We sought to examine the relationship between breast-feeding and later asthma and allergy outcomes by using data from the Avon Longitudinal Study of Parents and Children , a large birth cohort in the United Kingdom . METHODS We used adjusted logistic regression models to evaluate the association between breast-feeding and atopy at age 7 years , bronchial responsiveness to methacholine at age 8 years , and wheeze at ages 3 and 7 1/2 years . Bayesian methods were used to assess the possibility of bias caused by an influence of early wheezing on the duration of breast-feeding , as well as selection bias . RESULTS Breast-feeding was protective for wheeze in the first 3 years of life ( odds ratio [ OR ] of 0.80 [ 95 % CI , 0.70 - 0.90 ] for > or = 6 months relative to never ) but not wheeze ( OR , 0.98 ; 95 % CI , 0.79 - 1.22 ) , atopy ( OR , 1.12 ; 95 % CI , 0.92 - 1.35 ) , or bronchial hyperresponsiveness ( OR , 1.07 ; 95 % CI , 0.82 - 1.40 ) at ages 7 to 8 years . Bayesian models adjusting for the longer duration of breast-feeding among children with wheezing in early infancy produced virtually identical results . CONCLUSIONS We did not find consistent evidence for either a deleterious effect or a protective effect of breast-feeding on later risk of allergic disease in a large prospect i ve birth cohort of children with objective outcome measures and extensive data on potential confounders and effect modifiers . Neither reverse causation nor loss to follow-up appears to have material ly biased our results BACKGROUND Little is known about factors that determine prescribing of  asthma therapy in infancy . OBJECTIVE To describe factors related to the initiation and refill of asthma therapy in infancy . METHODS This study included 1202 infants who participated in a prospect i ve birth cohort study : the ' Wheezing Illnesses Study Leidsche Rijn ( WHISTLER ) ' . Outcomes ,  asthma therapy initiation and refill , were assessed using prescription data . Logistic regression analysis was used to study determinants of therapy initiation in two groups : total population and infants with a respiratory system symptom diagnosis . In addition , determinants of refilling prescriptions were studied in infants who started therapy in their first year of life . RESULTS Fifteen per cent of all infants started asthma therapy in their first year of life . Respiratory symptoms were an important driver of both initiation and refill of prescriptions . In the total population , therapy initiation was associated with male gender [ odds ratio ( OR ) : 1.6 , 95 % confidence interval ( CI ) : 1.1 - 2.6 ] , day-care attendance ( OR : 1.6 , 95 % CI : 1.0 - 2.5 ) and breastfeeding ( OR : 0.6 , 95 % CI : 0.3 - 1.0 ) . For infants with a respiratory system symptom diagnosis , day-care attendance was associated with an increased chance of therapy initiation ( OR : 5.3 , 95 % CI : 1.8 - 16.2 ) and breastfeeding was associated with a lower chance of starting therapy ( OR : 0.4 , 95 % CI : 0.1 - 1.1 ) . Dutch children had a higher chance of refilling prescriptions in infancy ( OR : 5.3 , 95 % CI : 1.1 - 26.8 ) . CONCLUSIONS Apart from other factors involved , the principal reason for initiation and refill of asthma therapy in infancy was the presence of respiratory symptoms . This appeared the only reason to prescribe medication and physicians are not distracted by other factors OBJECTIVE To estimate the prevalence of  wheezing in the chest among adults , and to explore the effect of some variables on the prevalence of this condition . METHODS This was a prospect i ve cohort study on individuals born in the city of Pelotas ( Southern Brazil ) in 1982 . A total of 4,297 subjects was traced in 2004 - 5 , representing 77.4 % of the original cohort . Data were collected by means of interviews using the ISAAC ( International Study of Asthma and Allergies in Childhood Steering Committee ) question naire . Associations between the outcome ' occurrence of wheezing in the chest within the 12 months prior to the interview ' and the variables of socioeconomic , demographic and birth characteristics were tested by means of multivariable analyses , using Poisson regression . RESULTS The prevalence of wheezing over the preceding year was 24.9 % . Among the individuals reporting wheezing , 54.6 % reported difficulty in sleeping , and 12.9 % reported difficulty in speaking due to wheezing . The prevalence of wheezing in the chest was significantly higher among women . This association was maintained in analyses adjusted for non-white skin color , family history of asthma and low socioeconomic level . Among men , there was no significant association in the analyses adjusted for skin color and family income at birth . Family histories of asthma and poverty throughout life presented significant associations with wheezing in the chest . For both sexes , there were no associations with the variables of birth weight and breastfeeding duration . CONCLUSIONS The prevalence of wheezing in the chest was high , and subjects with low family income at birth were more likely to have had wheezing in the chest over the preceding year OBJECTIVES To investigate the relationship of infant feeding to  recurrent wheezing at age 6 years and to assess whether this relationship is altered by a history of wheezing lower respiratory tract illnesses . DESIGN Prospect i ve , longitudinal study of healthy infants followed up from birth to 6 years of age . SETTING Nonselected health maintenance organization population in Tucson , Arizona . PARTICIPANTS There were 1246 healthy infants enrolled at birth , 988 of whom had data on both infant feeding and wheezing at age 6 years . INTERVENTIONS None . MAIN OUTCOME MEASURES Recurrent wheeze ( four or more episodes in the past year ) was assessed by a question naire that was completed by parents when the children were 6 years old . Children were classified by atopic status on the basis of skin prick tests . RESULTS Breast-feeding information was collected prospect ively , and lower respiratory tract illnesses in the first 3 years of life were diagnosed by the pediatrician . Being breast-fed was associated with lower rates of recurrent wheeze at age 6 years ( 3.1 % vs 9.7 % , P < .01 ) for nonatopic children ; this relationship was not significant for atopic children . The relationship of breast-feeding with recurrent wheeze was apparent among nonatopic children both with and without a wheezing lower respiratory tract illness in the first 6 months of life . When potential confounders , including early wheezing lower respiratory tract illness , were included in a multivariate model , nonatopic children who had not been breast-fed had three times the odds of wheezing recurrently ( odds ratio , 3.03 ; confidence interval , 1.06 to 8.69 ) . Eleven percent of recurrent wheeze among nonatopic children could be attributed to not breast-feeding . CONCLUSIONS Recurrent wheeze at age 6 years is less common among nonatopic children who were breast-fed as infants . This effect is independent of whether the child wheezed with a lower respiratory tract illness in the first 6 months of life The relationship between  breastfeeding , respiratory and other allergic disorders has been controversial . Our aim was to investigate the relationships between  breastfeeding  , respiratory outcomes , eczema and atopy at 15 months of age in a prospect i ve birth cohort in New Zeal and . A total of 1105 children were enrolled at birth , and 1011 ( 91.2 % ) were followed up at 15 months .  Logistic regression was used to model associations between  breastfeeding  duration and respiratory outcomes , eczema and atopy after adjusting for relevant confounding variables : ethnicity , socio-economic status , parity , body mass index , smoking in pregnancy , gender and respiratory infections in the first 3 months of life . Breastfeeding was associated with a significant reduction in the risk of adverse respiratory outcomes at 15 months . After adjustment for confounders , each month of exclusive breastfeeding reduced the risk of doctor-diagnosed asthma by 20 % ( odds ratio 0.80 , 95 % confidence interval 0.71 to 0.90 ) , wheezing by 12 % ( 0.88 , 0.82 to 0.94 ) 
    Output:
    