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 Data collected on more than 12,000 women in 15 r and omized controlled trials provide robust evidence of the beneficial effects of doula support on medical outcomes to childbirth . The objective of this paper was to examine the association between doula support and maternal perceptions of the infant , self , and support from others at 6 to 8 weeks postpartum . The doula was a minimally trained close female relative or friend . METHODS Six hundred low-risk , nulliparous women were enrolled in the original clinical trial and r and omized to doula support ( n = 300 ) or st and ard care ( n = 300 ) . The mother-to-be and her doula attended two 2-hour classes about providing nonmedical , continuous support to laboring women . For the secondary study , presented here , research participants ( N = 494 ) were interviewed by telephone using a 42-item question naire . RESULTS Overall , when doula-supported mothers ( n = 229 ) were compared with mothers who received st and ard care ( n = 265 ) , they were more likely to report positive prenatal expectations about childbirth and positive perceptions of their infants , support from others , and self-worth . Doula-supported mothers were also most likely to have breastfed and to have been very satisfied with the care they received at the hospital . CONCLUSIONS Labor support by a minimally trained female friend or relative , selected by the mother-to-be , enhances the postpartum well-being of nulliparous mothers and their infants , and is a low-cost alternative to professional doulas Objective . To investigate whether supporting fathers to recognize the relevance of their role in the success of breastfeeding and teaching them how to prevent and to manage the most common lactation problems would result in more women breastfeeding . Methods . A controlled trial , in which the participating fathers were allocated in 2-month blocks to a child care training session , was conducted of 280 mothers considering breastfeeding and their 280 partners at a university obstetric department in Naples , Italy .  Support and advice about breastfeeding was provided to all of the mothers . Among the fathers of the intervention group , the training session included the management of breastfeeding ; among those of the control group , it did not . Primary outcome was the prevalence of full breastfeeding at 6 months . Secondary outcomes were the proportion of women who perceived their milk to be insufficient , who stopped breastfeeding because of problems , and who reported to have received help in breastfeeding management by their partners . Results The prevalence of full breastfeeding at 6 months was 25 % ( 35 of 140 ) in the intervention group and 15 % ( 21 of 140 ) in the control group and that of any breastfeeding at 12 months was 19 % ( 27 ) and 11 % ( 16 ) , respectively . Perceived milk insufficiency was significantly more frequent among the mothers of the control group ( 38 [ 27 % ] of 140 vs 12 [ 8.6 % ] of 140 ) , as well as breastfeeding interruption because of problems with lactation ( 25 [ 18 % ] of 140 vs 6 [ 4 % ] of 140 ) . Moreover , significantly more women in the intervention group reported receiving support and relevant help with infant feeding management from their partners ( 128 [ 91 % ] of 140 vs 48 [ 34 % ] of 140 ) . Among the women who had reported difficulties with lactation in the intervention and control groups ( 96 [ 69 % ] and 89 [ 64 % ] , respectively ) , the prevalence of full breastfeeding at 6 months was 24 % and 4.5 % , respectively . Conclusions Teaching fathers how to prevent and to manage the most common lactation difficulties is associated with higher rates of full breastfeeding at 6 months BACKGROUND Breastfeeding can ameliorate some of the complex health issues faced by low-income families . Women who breastfeed and their infants have lower health care costs compared with those who formula feed . Increasing the duration of breastfeeding is recognized as a national priority , particularly for low-income women . This community-based r and omized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits , and telephone support by a community health nurse/peer counselor team for 6 months after delivery . METHODS Forty-one women were recruited after delivery of a full-term singleton infant and r and omly assigned to intervention or usual care groups . RESULTS Women receiving the community health intervention  breastfed longer than the women receiving usual care . The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group . The intervention cost ( $ 301/mother ) was partially offset by cost savings on formula and health care . CONCLUSIONS Community health nurse and peer counselor support can increase breastfeeding duration in low-income women , and has the potential to reduce total costs including the cost of support BACKGROUND The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow . METHODS The study was design ed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme . The intervention comprised peer counselling of pregnant women , support of breastfeeding mothers and local awareness-raising activities .  The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area . Data were collected by means of four self-completion question naires , two administered antenatally and two post-natally . The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time . RESULTS Of the 995 women enrolled in the study , data were available for analysis on 919 ( 92 per cent ) to 6 weeks postnatally . At booking , 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed . At delivery , the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls , and by 6 weeks post-natally , the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group . Using multivariate analysis to adjust for factors ( such as socio-economic status ) known to influence breastfeeding , the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [ odds ratio ( OR ) 2.0 ; 95 per cent confidence interval ( CI ) 1.2 - 3.1 , p = 0.006 ] . By 6 weeks post-natally the difference between the two groups was not statistically significant ( OR 1.8 ; 95 per cent CI 1.0 - 3.4 , p=0.07 ) . CONCLUSIONS As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally , it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities Abstract Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding .  Design R and omised controlled trial . Setting 32 general practice s in London and south Essex . Participants 720 women considering breast feeding . Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks . Secondary outcomes were the proportion of women giving any breast feeds , or bottle feeds at four months , duration of any breast feeding , time to introduction of bottle feeds , and satisfaction with breast feeding . Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks ( 65 % ( 218/336 ) in the intervention group and 63 % ( 213/336 ) in the control group ; relative risk 1.02 , 95 % confidence interval 0.84 to 1.24 ) . Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups . Not all women in the intervention group contacted counsellors postnatally , but 73 % ( 123/179 ) of those who did rated them as very helpful . More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources . Conclusions Women valued the support of a counsellor in breast feeding , but the intervention did not significantly increase breastfeeding rates , perhaps because some women did not ask for help OBJECTIVE To assess the efficacy of peer counseling to promote exclusive breastfeeding ( EBF ) among low-income inner-city women in Hartford , Conn. DESIGN Participants recruited prenatally were r and omly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support ( peer counseling group [ PC ] ) or only conventional breastfeeding support ( control group [ CG ] ) and followed through 3 months post partum . SETTING Low-income predominantly Latina community . PARTICIPANTS Expectant mothers , less than 32 weeks gestation and considering breastfeeding ( N = 162 ) . Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits , daily perinatal visits , 9 postpartum home visits , and telephone counseling as needed . MAIN OUTCOME MEASURES Exclusive breastfeeding rates at hospital discharge , 1 , 2 , and 3 months post partum ( n = 135 ) . RESULTS At hospital discharge , 24 % in the CG compared with 9 % in the PC had not initiated breastfeeding , with 56 % and 41 % , respectively , nonexclusively breastfeeding . At 3 months , 97 % in the CG and 73 % in the PC had not exclusively breastfed ( relative risk [ RR ] = 1.33 ; 95 % CI , 1.14 - 1.56 ) during the previous 24 hours . The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC ( 99 % vs 79 % ; RR = 1.24 ; 95 % CI , 1.09 - 1.41 ) . Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months ( 33 % vs 52 % ; RR = 0.64 ; 95 % CI , 0.43 - 0.95 ) . The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC ( 18 % vs 38 % ; RR = 2.15 ; 95 % CI , 1.16 - 3.97 ) . CONCLUSION Well-structured , intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income , inner-city women in the United States BACKGROUND Breastfeeding peer counseling has improved breastfeeding rates in developing countries ; however , its impact in this country has not been adequately evaluated . OBJECTIVE To evaluate the effectiveness of an existing , breastfeeding peer counseling program within the United States . DESIGN R and omized , prospect i ve , controlled trial in which participants were recruited prenatally and r and omly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling . SETTING An urban hospital serving a large population of low-income Latinas . PARTICIPANTS Pregnant women ( < or = 26 weeks ' gestation ) were recruited from the hospital 's prenatal clinic . Inclusion criteria specified that participants be low income , be considering breastfeeding , have delivered a healthy , full-term singleton , and have access to a telephone . Intervention Breastfeeding peer counseling services included 1 prenatal home visit , daily perinatal visits , 3 postpartum home visits , and telephone contact as needed . MAIN OUTCOME MEASURES Breastfeeding rates at birth and 1 , 3 , and 6 months postpartum . RESULTS The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls ( 8/90 [ 9 % ] vs 17/75 [ 23 % ] ; relative risk , 0.39 ; 95 % confidence interval , 0.18 - 0.86 ) . The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month ( 36 % vs 49 % ; relative risk , 0.72 ; 95 % confidence interval , 0.50 - 1.05 ) and 3 months ( 56 % vs 71 % ; relative risk , 0.78 ; 95 % confidence interval , 0.61 - 1.00 ) . CONCLUSION These findings demonstrate that , in the United States , peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum BACKGROUND Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes , but no study has assessed women 's and peer volunteers ' views on , or the nature and intensity of , the supportive intervention . The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial . METHODS A r and omized controlled trial was conducted to evaluate the effect of telephone-based peer ( mother-to-mother ) support on breastfeeding duration .  Two hundred and fifty-six primiparous breastfeeding women were r and omly allocated to receive either conventional care or conventional care plus peer support . Three primary outcome measures were peer volunteer activity logs , maternal perceptions of peer support , and evaluations of the peer volunteer experience . RESULTS Question naires were completed by 98.5 percent ( n=130 ) of the mothers in the peer support group . Mothers 
    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 Data collected on more than 12,000 women in 15 r and omized controlled trials provide robust evidence of the beneficial effects of doula support on medical outcomes to childbirth . The objective of this paper was to examine the association between doula support and maternal perceptions of the infant , self , and support from others at 6 to 8 weeks postpartum . The doula was a minimally trained close female relative or friend . METHODS Six hundred low-risk , nulliparous women were enrolled in the original clinical trial and r and omized to doula support ( n = 300 ) or st and ard care ( n = 300 ) . The mother-to-be and her doula attended two 2-hour classes about providing nonmedical , continuous support to laboring women . For the secondary study , presented here , research participants ( N = 494 ) were interviewed by telephone using a 42-item question naire . RESULTS Overall , when doula-supported mothers ( n = 229 ) were compared with mothers who received st and ard care ( n = 265 ) , they were more likely to report positive prenatal expectations about childbirth and positive perceptions of their infants , support from others , and self-worth . Doula-supported mothers were also most likely to have breastfed and to have been very satisfied with the care they received at the hospital . CONCLUSIONS Labor support by a minimally trained female friend or relative , selected by the mother-to-be , enhances the postpartum well-being of nulliparous mothers and their infants , and is a low-cost alternative to professional doulas Objective . To investigate whether supporting fathers to recognize the relevance of their role in the success of breastfeeding and teaching them how to prevent and to manage the most common lactation problems would result in more women breastfeeding . Methods . A controlled trial , in which the participating fathers were allocated in 2-month blocks to a child care training session , was conducted of 280 mothers considering breastfeeding and their 280 partners at a university obstetric department in Naples , Italy .  Support and advice about breastfeeding was provided to all of the mothers . Among the fathers of the intervention group , the training session included the management of breastfeeding ; among those of the control group , it did not . Primary outcome was the prevalence of full breastfeeding at 6 months . Secondary outcomes were the proportion of women who perceived their milk to be insufficient , who stopped breastfeeding because of problems , and who reported to have received help in breastfeeding management by their partners . Results The prevalence of full breastfeeding at 6 months was 25 % ( 35 of 140 ) in the intervention group and 15 % ( 21 of 140 ) in the control group and that of any breastfeeding at 12 months was 19 % ( 27 ) and 11 % ( 16 ) , respectively . Perceived milk insufficiency was significantly more frequent among the mothers of the control group ( 38 [ 27 % ] of 140 vs 12 [ 8.6 % ] of 140 ) , as well as breastfeeding interruption because of problems with lactation ( 25 [ 18 % ] of 140 vs 6 [ 4 % ] of 140 ) . Moreover , significantly more women in the intervention group reported receiving support and relevant help with infant feeding management from their partners ( 128 [ 91 % ] of 140 vs 48 [ 34 % ] of 140 ) . Among the women who had reported difficulties with lactation in the intervention and control groups ( 96 [ 69 % ] and 89 [ 64 % ] , respectively ) , the prevalence of full breastfeeding at 6 months was 24 % and 4.5 % , respectively . Conclusions Teaching fathers how to prevent and to manage the most common lactation difficulties is associated with higher rates of full breastfeeding at 6 months BACKGROUND Breastfeeding can ameliorate some of the complex health issues faced by low-income families . Women who breastfeed and their infants have lower health care costs compared with those who formula feed . Increasing the duration of breastfeeding is recognized as a national priority , particularly for low-income women . This community-based r and omized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits , and telephone support by a community health nurse/peer counselor team for 6 months after delivery . METHODS Forty-one women were recruited after delivery of a full-term singleton infant and r and omly assigned to intervention or usual care groups . RESULTS Women receiving the community health intervention  breastfed longer than the women receiving usual care . The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group . The intervention cost ( $ 301/mother ) was partially offset by cost savings on formula and health care . CONCLUSIONS Community health nurse and peer counselor support can increase breastfeeding duration in low-income women , and has the potential to reduce total costs including the cost of support BACKGROUND The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow . METHODS The study was design ed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme . The intervention comprised peer counselling of pregnant women , support of breastfeeding mothers and local awareness-raising activities .  The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area . Data were collected by means of four self-completion question naires , two administered antenatally and two post-natally . The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time . RESULTS Of the 995 women enrolled in the study , data were available for analysis on 919 ( 92 per cent ) to 6 weeks postnatally . At booking , 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed . At delivery , the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls , and by 6 weeks post-natally , the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group . Using multivariate analysis to adjust for factors ( such as socio-economic status ) known to influence breastfeeding , the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [ odds ratio ( OR ) 2.0 ; 95 per cent confidence interval ( CI ) 1.2 - 3.1 , p = 0.006 ] . By 6 weeks post-natally the difference between the two groups was not statistically significant ( OR 1.8 ; 95 per cent CI 1.0 - 3.4 , p=0.07 ) . CONCLUSIONS As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally , it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities Abstract Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding .  Design R and omised controlled trial . Setting 32 general practice s in London and south Essex . Participants 720 women considering breast feeding . Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks . Secondary outcomes were the proportion of women giving any breast feeds , or bottle feeds at four months , duration of any breast feeding , time to introduction of bottle feeds , and satisfaction with breast feeding . Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks ( 65 % ( 218/336 ) in the intervention group and 63 % ( 213/336 ) in the control group ; relative risk 1.02 , 95 % confidence interval 0.84 to 1.24 ) . Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups . Not all women in the intervention group contacted counsellors postnatally , but 73 % ( 123/179 ) of those who did rated them as very helpful . More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources . Conclusions Women valued the support of a counsellor in breast feeding , but the intervention did not significantly increase breastfeeding rates , perhaps because some women did not ask for help OBJECTIVE To assess the efficacy of peer counseling to promote exclusive breastfeeding ( EBF ) among low-income inner-city women in Hartford , Conn. DESIGN Participants recruited prenatally were r and omly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support ( peer counseling group [ PC ] ) or only conventional breastfeeding support ( control group [ CG ] ) and followed through 3 months post partum . SETTING Low-income predominantly Latina community . PARTICIPANTS Expectant mothers , less than 32 weeks gestation and considering breastfeeding ( N = 162 ) . Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits , daily perinatal visits , 9 postpartum home visits , and telephone counseling as needed . MAIN OUTCOME MEASURES Exclusive breastfeeding rates at hospital discharge , 1 , 2 , and 3 months post partum ( n = 135 ) . RESULTS At hospital discharge , 24 % in the CG compared with 9 % in the PC had not initiated breastfeeding , with 56 % and 41 % , respectively , nonexclusively breastfeeding . At 3 months , 97 % in the CG and 73 % in the PC had not exclusively breastfed ( relative risk [ RR ] = 1.33 ; 95 % CI , 1.14 - 1.56 ) during the previous 24 hours . The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC ( 99 % vs 79 % ; RR = 1.24 ; 95 % CI , 1.09 - 1.41 ) . Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months ( 33 % vs 52 % ; RR = 0.64 ; 95 % CI , 0.43 - 0.95 ) . The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC ( 18 % vs 38 % ; RR = 2.15 ; 95 % CI , 1.16 - 3.97 ) . CONCLUSION Well-structured , intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income , inner-city women in the United States BACKGROUND Breastfeeding peer counseling has improved breastfeeding rates in developing countries ; however , its impact in this country has not been adequately evaluated . OBJECTIVE To evaluate the effectiveness of an existing , breastfeeding peer counseling program within the United States . DESIGN R and omized , prospect i ve , controlled trial in which participants were recruited prenatally and r and omly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling . SETTING An urban hospital serving a large population of low-income Latinas . PARTICIPANTS Pregnant women ( < or = 26 weeks ' gestation ) were recruited from the hospital 's prenatal clinic . Inclusion criteria specified that participants be low income , be considering breastfeeding , have delivered a healthy , full-term singleton , and have access to a telephone . Intervention Breastfeeding peer counseling services included 1 prenatal home visit , daily perinatal visits , 3 postpartum home visits , and telephone contact as needed . MAIN OUTCOME MEASURES Breastfeeding rates at birth and 1 , 3 , and 6 months postpartum . RESULTS The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls ( 8/90 [ 9 % ] vs 17/75 [ 23 % ] ; relative risk , 0.39 ; 95 % confidence interval , 0.18 - 0.86 ) . The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month ( 36 % vs 49 % ; relative risk , 0.72 ; 95 % confidence interval , 0.50 - 1.05 ) and 3 months ( 56 % vs 71 % ; relative risk , 0.78 ; 95 % confidence interval , 0.61 - 1.00 ) . CONCLUSION These findings demonstrate that , in the United States , peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum BACKGROUND Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes , but no study has assessed women 's and peer volunteers ' views on , or the nature and intensity of , the supportive intervention . The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial . METHODS A r and omized controlled trial was conducted to evaluate the effect of telephone-based peer ( mother-to-mother ) support on breastfeeding duration .  Two hundred and fifty-six primiparous breastfeeding women were r and omly allocated to receive either conventional care or conventional care plus peer support . Three primary outcome measures were peer volunteer activity logs , maternal perceptions of peer support , and evaluations of the peer volunteer experience . RESULTS Question naires were completed by 98.5 percent ( n=130 ) of the mothers in the peer support group . Mothers 
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