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 The physiological and psychological signalling between mother and infant during lactation is one of the prominent mother-infant factors that may influence breastfeeding outcomes . The infant can ‘ signal ’ his needs through vocalisation , and the mother can respond by allowing or restricting nipple access , which might alter the breast milk composition or volume . This may lead to parent-offspring conflict during the lactation period . Challenging infant behaviour has also been associated with maternal psychological distress , which might affect breastfeeding performance . Most attempts to improve breastfeeding rates focus on providing additional support , yet many aspects of the breastfeeding process are poorly understood . Thus , our objective is to investigate mother-infant signalling during breastfeeding by manipulating maternal psychological state using a relaxation therapy intervention . The study will test the hypothesis that mothers who listen to the therapy will be more relaxed/less stressed and this will favourably alter breast milk composition and /or affect milk volume and hence influence infant outcomes . Methods A r and omised controlled trial will be conducted in first-time breastfeeding mothers and their new-born infants . Pregnant mothers will be recruited at antenatal clinics in Selangor , Malaysia , and four home visits will be carried out at 2 , 6 , 12 and 14 weeks postnatally . Participants will be r and omised into a control and an intervention group in the early post-partum period . Mothers from the intervention group will be asked to listen daily to an audio recording with relaxation therapy during breastfeeding .  Maternal psychological state , breastfeeding practice s and infant behaviour will be assessed using vali date d question naires . Milk volume will be measured using stable isotopes . Breast milk sample s will be collected to measure macronutrient content and hormone levels . Anthropometric measurements ( weight , length and head circumference ) will be performed during all home visits , including body composition at week 14 . Discussion The main outcomes will be the effect of the intervention on maternal psychological state , milk production , cortisol levels , and infant behaviour and growth . Secondary outcomes will be associations between breast milk composition and infant appetite and growth . This study aims to provide a greater underst and ing of maternal-infant factors which influence breastfeeding outcomes and which may be useful targets for future interventions .Trial registration Clinical Trials.gov identifier : NCT01971216 Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy , yet its effects in mothers during the early parenting period are unknown . The purpose of the present pilot study was to examine the effectiveness of a  mindfulness-based intervention in breast-feeding mothers . We developed and tested an 8-week mindfulness-based intervention aim ed at improving maternal self-efficacy , mindfulness , self-compassion , satisfaction with life , and subjective happiness , and at reducing psychological distress . A r and omized controlled , between-groups design was used with treatment and control groups ( n = 26 ) and pretest and posttest measures . ANCOVA results indicated that , compared to the control group , mothers in the treatment group scored significantly higher on maternal self-efficacy , some dimensions of mindfulness ( observing , acting with awareness , non-judging , and non-reactivity ) , and self-compassion ( self-kindness , mindfulness , over- identification , and total self-compassion ) . In addition , mothers who received the treatment exhibited significantly less anxiety , stress , and psychological distress . The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period . Additional research is needed to vali date our findings in non-breast-feeding mothers and to examine the intervention ’s indirect benefits in terms of family relationships and child development OBJECTIVE Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations . The current , national breastfeeding continuation rate of 29 % at 6 months lags behind the Healthy People 2010 goal of 50 % . The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support , maternal physical and mental health status , workplace issues , and other factors amenable to intervention . METHODS A prospect i ve cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a r and omized , controlled trial of home visits . Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks . Logistic regression modeling was performed to assess the independent effects of the predictors of interest , adjusting for sociodemographic and other confounding variables . RESULTS Of the 1163 mother-newborn pairs in the cohort , 1007 ( 87 % ) initiated breastfeeding , 872 ( 75 % ) were breastfeeding at the 2-week interview , and 646 ( 55 % ) were breastfeeding at the 12-week interview . In the final multivariate models , breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview ( odds ratio [ OR ] : 2.8 ; 95 % confidence interval [ CI ] : 1.02 - 7.6 ) , early breastfeeding problems ( OR : 1.5 ; 95 % CI : 1.1 - 1.97 ) , Asian race/ethnicity ( OR : 2.6 ; 95 % CI : 1.1 - 5.7 ) , and lower maternal education ( OR : 1.5 ; 95 % CI : 1.2 - 1.9 ) . Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported ( during the 12-week interview ) having received encouragement from their clinician to breastfeed ( OR : 0.6 ; 95 % CI : 0.4 - 0.8 ) . Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms ( OR : 1.18 ; 95 % CI : 1.01 - 1.37 ) and returning to work or school by 12 weeks postpartum ( OR : 2.4 ; 95 % CI : 1.8 - 3.3 ) . CONCLUSIONS Our results indicate that support from clinicians and maternal depressive symptoms are associated with breastfeeding duration . Attention to these issues may help to promote breastfeeding continuation among mothers who initiate . Policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may also be important , given the elevated risk of discontinuation associated with return to work or school Objective : To investigate the influence of psychological stress on suckling-induced oxytocin release . Methods : The pulsatile release of suckling-induced oxytocin  was measured in 22 puerperal women . The blood sample s for oxytocin assay were collected at 2-minute intervals in a manner that minimized degradation by plasma oxytocin assay were used for radioimmunoassay after extraction . Results : The release of suckling-induced oxytocin during nursing is pulsatile , with discrete , short pulses . The frequency of pulsatile release of oxytocin was significantly lower in the two groups in which stress was imposed by mental calculation or noise than in the control group without stress ( mental calculation group , 1.28 ± 0.76 pulses/20- minute suckling period ; noise group , 1.14 ± 0.38 ; control group , 2.25 ± 0.71 ) . However , there were no differences among the three groups in the increase of prolactin during nursing or in the milk yield . Conclusion : The release of suckling-induced oxytocin is pulsatile , and psychological stress reduces the pulsatile oxytocin release . Our data suggest that suckling-induced oxytocin release may be modulated by the central nervous system and that psychological relaxation is necessary for an adequate let-down response PURPOSE : Maternal breast milk is considered the nutritional “ gold st and ard ” for all infants , especially premature infants . However , preterm mothers are at risk of not producing adequate milk . Multiple factors affect the production of milk , including stress , fatigue , and the separation of the breastfeeding dyad — for example , when mother or infant is hospitalized . The purpose of this study was to examine the effects of listening and visual interventions on the quantity and quality of breast milk produced by mothers using a double electric breast pump . SUBJECTS : Mothers of 162 preterm infants were r and omly assigned to 1 of 4 groups . METHODS : The control group received st and ard nursing care , whereas mothers in the 3 experimental groups additionally listened to a recording of 1 of 3 music-based listening interventions while using the pump . RESULTS : Mothers in the experimental groups produced significantly more milk ( P < .0012 ) . Mothers in these groups also produced milk with significantly higher fat content during the first 6 days of the study INTRODUCTION The promotion of breastfeeding is a simple and efficient strategy in reducing morbidity and mortality in neonates worldwide . Milk from the mother of a Preterm New Born ( PTNB ) infant contains a higher concentration of nutrients and energy than that produced by mothers of a full-term infant . Studies have shown that music therapy can reduce maternal anxiety , helping mothers cope with the hospitalization of their newborns in Neonatal Intensive Care Unit ( NICU ) . OBJECTIVE To evaluate the impact of music therapy on amount of breast milk secretion among mothers of premature newborns by reducing maternal stress . MATERIAL S AND METHODS Mothers of premature babies who were admitted to NICU at a tertiary health care centre were included as subjects . Mothers of premature infants were enrolled in the study once they came to NICU to express breast milk from Dec 2012 to May 2013 . Each subject was assessed for 4 sessions on MT ( Music Therapy ) and 4 sessions on NMT ( No Music Therapy ) over 4 days . Breast milk was expressed using breast milk pump and quantity was measured for two sessions each day once at 11.00am and other at 4.00pm . Raga malkauns and yaman by flute was used for music therapy . MT was administered for 4 sessions in a r and omized manner during the study period of 30mins ( 15mins prior to and 15mins during Breast milk amount ) . To assess the psychological stress , PSS question naire was administered on day 1 and day 4 of MT . Mother 's saliva was collected to estimate salivary cortisol level on the last day of study during the sessions with MT and NMT . RESULTS Music therapy was associated with a significant reduction in stress level as shown by improved PSS score and reduced salivary cortisol . Subjects who received music therapy had significant increase ( p-value- 0.033 ) in breast milk expression when compared to mothers who did n't . CONCLUSION Music therapy can be easily used in the breast milk expression room as a method to increase breast milk secretion in mothers who are stressed because of their neonates being admitted in NICU OBJECTIVE To evaluate the hypothesis that breast-feeding women who participate in relaxation training  will have increased secretory IgA ( sIgA ) levels in their breast milk compared with women not receiving training . DESIGN Nonr and omized control trial of a convenience sample . SETTING Women were recruited from the postpartum floor of a university teaching hospital . The intervention took place in the women 's homes . PARTICIPANTS Women in the first 48 hours after delivery who were planning to breast-feed their healthy newborn infants for at least 8 weeks were approached for enrollment . Women were excluded if they had previous experience with relaxation training .  At 4 to 6 weeks postpartum , we enrolled 38 women still breast-feeding their infants . INTERVENTIONS Women were allocated into 3 groups . Women in group 1 were taught relaxation and had breast milk sample s collected before and after the teaching . Women in group 2 had conversation with similar breast milk sample collection , and women in group 3 had 1 breast milk sample collected . Women in group 1 were encouraged to practice the relaxation once or twice a day for 2 weeks , and a second visit was made to all mothers with repeated breast milk collection s. Women who were still breast-feeding at 6 to 8 weeks after study end had a final breast milk sample collected . Breast milk was analyzed for secretory IgA levels . Stress was assayed using the Symptom Checklist-90-R and open-ended questions . RESULTS There was no difference in sIgA levels among the 3 groups at any time . Women who reported stress present between visit 1 and visit 2 increased their sIgA levels at the final sample collection ( + 0.16 g/L ) compared with women who reported no stress ( -0.09 g/L ; P= .03 ) . The ratings of success in relaxation in women in group 1 were related to the following sIgA levels in sample 4 : poor relaxation , 0.67 g/L ; fair relaxation , 0.41 g/L ; good relaxation , 0.35 g/L ; and very good , 0.30 g/L ( P= .006 ) . CONCLUSIONS Self-reported stress appears to increase breast milk sIgA levels . Success at relaxation was inversely related to sIgA levels in the group learning relaxation Many women whose premature infants are hospitalized in a newborn intensive care unit choose to express breast milk for their babies . Yet anxiety , fatigue , and emotional stress are powerful inhibitors of lactation . To facilitate the breast-feeding experience , intervention mothers were given a 20-minute audio cassette tape based on relaxation and visual imagery techniques . At a single follow-up expression of milk at the hospital approximately 1 week after enrollment , they expressed 63 % more breast milk than a r and omized group of control mothers . The fat content of the breast milk in the two groups was not significantly different . Among a small group of mothers whose infants were receiving 
    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 The physiological and psychological signalling between mother and infant during lactation is one of the prominent mother-infant factors that may influence breastfeeding outcomes . The infant can ‘ signal ’ his needs through vocalisation , and the mother can respond by allowing or restricting nipple access , which might alter the breast milk composition or volume . This may lead to parent-offspring conflict during the lactation period . Challenging infant behaviour has also been associated with maternal psychological distress , which might affect breastfeeding performance . Most attempts to improve breastfeeding rates focus on providing additional support , yet many aspects of the breastfeeding process are poorly understood . Thus , our objective is to investigate mother-infant signalling during breastfeeding by manipulating maternal psychological state using a relaxation therapy intervention . The study will test the hypothesis that mothers who listen to the therapy will be more relaxed/less stressed and this will favourably alter breast milk composition and /or affect milk volume and hence influence infant outcomes . Methods A r and omised controlled trial will be conducted in first-time breastfeeding mothers and their new-born infants . Pregnant mothers will be recruited at antenatal clinics in Selangor , Malaysia , and four home visits will be carried out at 2 , 6 , 12 and 14 weeks postnatally . Participants will be r and omised into a control and an intervention group in the early post-partum period . Mothers from the intervention group will be asked to listen daily to an audio recording with relaxation therapy during breastfeeding .  Maternal psychological state , breastfeeding practice s and infant behaviour will be assessed using vali date d question naires . Milk volume will be measured using stable isotopes . Breast milk sample s will be collected to measure macronutrient content and hormone levels . Anthropometric measurements ( weight , length and head circumference ) will be performed during all home visits , including body composition at week 14 . Discussion The main outcomes will be the effect of the intervention on maternal psychological state , milk production , cortisol levels , and infant behaviour and growth . Secondary outcomes will be associations between breast milk composition and infant appetite and growth . This study aims to provide a greater underst and ing of maternal-infant factors which influence breastfeeding outcomes and which may be useful targets for future interventions .Trial registration Clinical Trials.gov identifier : NCT01971216 Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy , yet its effects in mothers during the early parenting period are unknown . The purpose of the present pilot study was to examine the effectiveness of a  mindfulness-based intervention in breast-feeding mothers . We developed and tested an 8-week mindfulness-based intervention aim ed at improving maternal self-efficacy , mindfulness , self-compassion , satisfaction with life , and subjective happiness , and at reducing psychological distress . A r and omized controlled , between-groups design was used with treatment and control groups ( n = 26 ) and pretest and posttest measures . ANCOVA results indicated that , compared to the control group , mothers in the treatment group scored significantly higher on maternal self-efficacy , some dimensions of mindfulness ( observing , acting with awareness , non-judging , and non-reactivity ) , and self-compassion ( self-kindness , mindfulness , over- identification , and total self-compassion ) . In addition , mothers who received the treatment exhibited significantly less anxiety , stress , and psychological distress . The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period . Additional research is needed to vali date our findings in non-breast-feeding mothers and to examine the intervention ’s indirect benefits in terms of family relationships and child development OBJECTIVE Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations . The current , national breastfeeding continuation rate of 29 % at 6 months lags behind the Healthy People 2010 goal of 50 % . The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support , maternal physical and mental health status , workplace issues , and other factors amenable to intervention . METHODS A prospect i ve cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a r and omized , controlled trial of home visits . Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks . Logistic regression modeling was performed to assess the independent effects of the predictors of interest , adjusting for sociodemographic and other confounding variables . RESULTS Of the 1163 mother-newborn pairs in the cohort , 1007 ( 87 % ) initiated breastfeeding , 872 ( 75 % ) were breastfeeding at the 2-week interview , and 646 ( 55 % ) were breastfeeding at the 12-week interview . In the final multivariate models , breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview ( odds ratio [ OR ] : 2.8 ; 95 % confidence interval [ CI ] : 1.02 - 7.6 ) , early breastfeeding problems ( OR : 1.5 ; 95 % CI : 1.1 - 1.97 ) , Asian race/ethnicity ( OR : 2.6 ; 95 % CI : 1.1 - 5.7 ) , and lower maternal education ( OR : 1.5 ; 95 % CI : 1.2 - 1.9 ) . Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported ( during the 12-week interview ) having received encouragement from their clinician to breastfeed ( OR : 0.6 ; 95 % CI : 0.4 - 0.8 ) . Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms ( OR : 1.18 ; 95 % CI : 1.01 - 1.37 ) and returning to work or school by 12 weeks postpartum ( OR : 2.4 ; 95 % CI : 1.8 - 3.3 ) . CONCLUSIONS Our results indicate that support from clinicians and maternal depressive symptoms are associated with breastfeeding duration . Attention to these issues may help to promote breastfeeding continuation among mothers who initiate . Policies to enhance scheduling flexibility and privacy for breastfeeding mothers at work or school may also be important , given the elevated risk of discontinuation associated with return to work or school Objective : To investigate the influence of psychological stress on suckling-induced oxytocin release . Methods : The pulsatile release of suckling-induced oxytocin  was measured in 22 puerperal women . The blood sample s for oxytocin assay were collected at 2-minute intervals in a manner that minimized degradation by plasma oxytocin assay were used for radioimmunoassay after extraction . Results : The release of suckling-induced oxytocin during nursing is pulsatile , with discrete , short pulses . The frequency of pulsatile release of oxytocin was significantly lower in the two groups in which stress was imposed by mental calculation or noise than in the control group without stress ( mental calculation group , 1.28 ± 0.76 pulses/20- minute suckling period ; noise group , 1.14 ± 0.38 ; control group , 2.25 ± 0.71 ) . However , there were no differences among the three groups in the increase of prolactin during nursing or in the milk yield . Conclusion : The release of suckling-induced oxytocin is pulsatile , and psychological stress reduces the pulsatile oxytocin release . Our data suggest that suckling-induced oxytocin release may be modulated by the central nervous system and that psychological relaxation is necessary for an adequate let-down response PURPOSE : Maternal breast milk is considered the nutritional “ gold st and ard ” for all infants , especially premature infants . However , preterm mothers are at risk of not producing adequate milk . Multiple factors affect the production of milk , including stress , fatigue , and the separation of the breastfeeding dyad — for example , when mother or infant is hospitalized . The purpose of this study was to examine the effects of listening and visual interventions on the quantity and quality of breast milk produced by mothers using a double electric breast pump . SUBJECTS : Mothers of 162 preterm infants were r and omly assigned to 1 of 4 groups . METHODS : The control group received st and ard nursing care , whereas mothers in the 3 experimental groups additionally listened to a recording of 1 of 3 music-based listening interventions while using the pump . RESULTS : Mothers in the experimental groups produced significantly more milk ( P < .0012 ) . Mothers in these groups also produced milk with significantly higher fat content during the first 6 days of the study INTRODUCTION The promotion of breastfeeding is a simple and efficient strategy in reducing morbidity and mortality in neonates worldwide . Milk from the mother of a Preterm New Born ( PTNB ) infant contains a higher concentration of nutrients and energy than that produced by mothers of a full-term infant . Studies have shown that music therapy can reduce maternal anxiety , helping mothers cope with the hospitalization of their newborns in Neonatal Intensive Care Unit ( NICU ) . OBJECTIVE To evaluate the impact of music therapy on amount of breast milk secretion among mothers of premature newborns by reducing maternal stress . MATERIAL S AND METHODS Mothers of premature babies who were admitted to NICU at a tertiary health care centre were included as subjects . Mothers of premature infants were enrolled in the study once they came to NICU to express breast milk from Dec 2012 to May 2013 . Each subject was assessed for 4 sessions on MT ( Music Therapy ) and 4 sessions on NMT ( No Music Therapy ) over 4 days . Breast milk was expressed using breast milk pump and quantity was measured for two sessions each day once at 11.00am and other at 4.00pm . Raga malkauns and yaman by flute was used for music therapy . MT was administered for 4 sessions in a r and omized manner during the study period of 30mins ( 15mins prior to and 15mins during Breast milk amount ) . To assess the psychological stress , PSS question naire was administered on day 1 and day 4 of MT . Mother 's saliva was collected to estimate salivary cortisol level on the last day of study during the sessions with MT and NMT . RESULTS Music therapy was associated with a significant reduction in stress level as shown by improved PSS score and reduced salivary cortisol . Subjects who received music therapy had significant increase ( p-value- 0.033 ) in breast milk expression when compared to mothers who did n't . CONCLUSION Music therapy can be easily used in the breast milk expression room as a method to increase breast milk secretion in mothers who are stressed because of their neonates being admitted in NICU OBJECTIVE To evaluate the hypothesis that breast-feeding women who participate in relaxation training  will have increased secretory IgA ( sIgA ) levels in their breast milk compared with women not receiving training . DESIGN Nonr and omized control trial of a convenience sample . SETTING Women were recruited from the postpartum floor of a university teaching hospital . The intervention took place in the women 's homes . PARTICIPANTS Women in the first 48 hours after delivery who were planning to breast-feed their healthy newborn infants for at least 8 weeks were approached for enrollment . Women were excluded if they had previous experience with relaxation training .  At 4 to 6 weeks postpartum , we enrolled 38 women still breast-feeding their infants . INTERVENTIONS Women were allocated into 3 groups . Women in group 1 were taught relaxation and had breast milk sample s collected before and after the teaching . Women in group 2 had conversation with similar breast milk sample collection , and women in group 3 had 1 breast milk sample collected . Women in group 1 were encouraged to practice the relaxation once or twice a day for 2 weeks , and a second visit was made to all mothers with repeated breast milk collection s. Women who were still breast-feeding at 6 to 8 weeks after study end had a final breast milk sample collected . Breast milk was analyzed for secretory IgA levels . Stress was assayed using the Symptom Checklist-90-R and open-ended questions . RESULTS There was no difference in sIgA levels among the 3 groups at any time . Women who reported stress present between visit 1 and visit 2 increased their sIgA levels at the final sample collection ( + 0.16 g/L ) compared with women who reported no stress ( -0.09 g/L ; P= .03 ) . The ratings of success in relaxation in women in group 1 were related to the following sIgA levels in sample 4 : poor relaxation , 0.67 g/L ; fair relaxation , 0.41 g/L ; good relaxation , 0.35 g/L ; and very good , 0.30 g/L ( P= .006 ) . CONCLUSIONS Self-reported stress appears to increase breast milk sIgA levels . Success at relaxation was inversely related to sIgA levels in the group learning relaxation Many women whose premature infants are hospitalized in a newborn intensive care unit choose to express breast milk for their babies . Yet anxiety , fatigue , and emotional stress are powerful inhibitors of lactation . To facilitate the breast-feeding experience , intervention mothers were given a 20-minute audio cassette tape based on relaxation and visual imagery techniques . At a single follow-up expression of milk at the hospital approximately 1 week after enrollment , they expressed 63 % more breast milk than a r and omized group of control mothers . The fat content of the breast milk in the two groups was not significantly different . Among a small group of mothers whose infants were receiving 
    Output:
    