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: CONTEXT Lactation is associated with improved glucose and insulin homeostasis , independent of weight change . OBJECTIVE To evaluate the association between lactation history and incidence of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational cohort study of 83,585 parous women in the Nurses ' Health Study ( NHS ) and retrospective observational cohort study of 73,418 parous women in the Nurses ' Health Study II ( NHS II ) . MAIN OUTCOME MEASURE Incident cases of type 2 diabetes mellitus . RESULTS In the NHS , 5145 cases of type 2 diabetes were diagnosed during 1,239,709 person-years of follow-up between 1986 and 2002 , and in the NHS II , 1132 cases were diagnosed during 778,876 person-years of follow-up between 1989 and 2001 . Among parous women , increasing duration of lactation was associated with a reduced risk of type 2 diabetes . For each additional year of lactation , women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15 % ( 95 % confidence interval , 1%-27 % ) among NHS participants and of 14 % ( 95 % confidence interval , 7%-21 % ) among NHS II participants , controlling for current body mass index and other relevant risk factors for type 2 diabetes . CONCLUSIONS Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women . Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis OBJECTIVE To test the integrity of a protocol for a r and omised controlled trial ( RCT ) to examine the effectiveness of skin-to-skin care compared to routine care on the initiation and duration of breast feeding and to provide data to be used in the power calculation for a proposed trial . DESIGN R and omised pilot study . SETTING Warrington Hospital , Cheshire , UK . PARTICIPANTS Women at 36 weeks ' gestation with healthy singleton pregnancies , who intended to breast feed , who had ' booked ' for care at Warrington Hospital and had given informed consent to participate . Twenty-eight women were r and omised in the pilot study . METHOD Women were r and omly allocated to receive either routine or skin-to-skin care following birth . The first breast feed was assessed using the Breast-feeding Assessment Tool ( BAT ) .  Mothers were followed up at discharge from hospital and again at four months to provide details of duration of breast feeding . FINDINGS 66 women were approached to participate in the trial and 44 consented ( 67 % consent rate ) . Twenty-eight women were r and omised in the study and 26 breast feeds were observed ( 93 % ) . The pilot study identified procedural changes that were required in the design of the main study , provided an estimate of recruitment rates and confirmed the previously calculated sample size . CONCLUSION The pilot study demonstrated that a large RCT of skin-to-skin versus routine care was feasible . This is an example of how a pilot study has the ability to identify unforeseen challenges in the conduct of the trial as well as allowing necessary changes to be made to the design that will increase the quality of the subsequent research Objective . In the third quarter of 2001 , the National Immunization Survey ( NIS ) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding . Using the data from the 2002 NIS , this study estimates breastfeeding rates in the United States by characteristics of the child , mother , or family . Methods . The NIS uses r and om-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations  and then vali date s the information through a mail survey of the health care providers who gave the vaccinations . In 2002 , ∼3500 households from the NIS were r and omized to 1 of the 3 rotating topical modules that covered breastfeeding . Results . More than two thirds ( 71.4 % ) of the children had ever been breastfed . At 3 months , 42.5 % of infants were exclusively breastfed , and 51.5 % were breastfed to some extent . At 6 months , these rates dropped to 13.3 % and 35.1 % , respectively . At 1 year , 16.1 % of infants were receiving some breast milk . Non-Hispanic black children had the lowest breastfeeding rates . Breastfeeding rates also varied by participation in day care or the Women , Infants , and Children program , socioeconomic status , and geographic area of residence . Conclusions . Although the rate of breastfeeding initiation in the United States is near the national goal of 75 % , at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50 % and 25 % , respectively . In addition , rates of exclusive breastfeeding are low . Strenuous public health efforts are needed to improve breastfeeding behaviors , particularly among non-Hispanic black women and socioeconomically disadvantaged groups Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement OBJECTIVE To enhance breastfeeding practice s , the World Health Organization discourages pacifiers and bottle-feeding . However , the effect of artificial nipples on breastfeeding duration is poorly defined . The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated : 1 ) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2 ) early ( 2 - 5 days ) versus late ( > 4 weeks ) pacifier introduction . METHODS A total of 700 breastfed newborns ( 36 - 42 weeks , birth weight > or=2200 g ) were r and omly assigned to 1 of 4 intervention groups : bottle/early pacifier ( n = 169 ) , bottle/late pacifier ( n = 167 ) , cup/early pacifier ( n = 185 ) , or cup/late pacifier ( n = 179 ) . The cup/bottle intervention was invoked for infants who received supplemental feedings : cup ( n = 251 ) , bottle ( n = 230 ) . Data were collected at delivery and at 2 , 5 , 10 , 16 , 24 , 38 , and 52 weeks ' postpartum . Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses . RESULTS Supplemental feedings , regardless of method ( cup or bottle ) , had a detrimental effect on breastfeeding duration . There were no differences in cup versus bottle groups for breastfeeding duration . Effects were modified by the number of supplements ; exclusive and full breastfeeding duration were prolonged in cup-fed infants given > 2 supplements . Among infants delivered by cesarean , cupfeeding significantly prolonged exclusive , full , and overall breastfeeding duration . Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers ( early pacifier group ; odds ratio : 1.5 ; 95 % confidence interval : 1.0 - 2.0 ) . Early , as compared with late , pacifier use shortened overall duration ( adjusted hazard ratio : 1.22 ; 95 % confidence interval : 1.03 - 1.44 ) but did not affect exclusive or full duration . CONCLUSIONS There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants , but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean . Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding . These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period The aim of this study was to examine prospect ively the relation between duration of breast feeding and cognitive outcomes . A cohort study of 2860 children enrolled before birth provided data from 2393 term infants of English-speaking mothers . Of these , complete infant feeding data in the first year of life and verbal cognitive IQ ( Peabody Picture Vocabulary Test - PPVT-R ) were available for 1450 children at 6 years , and a performance subtest ( Perceptual organisation WISC - Block Design ) for 1375 children at 8 years . Full breast feeding was categorised as none , > 0 to < 4 months , 4 - 6 months and > 6 months . Associations between breast-feeding duration and PPVT-R at 6 years and Block Design at 8 years were estimated before and after adjustment for gender , gestational age , maternal age , maternal education , parental smoking and the presence of older siblings . The early cessation of full breast feeding was associated with reduced verbal IQ and the performance subtest . In unadjusted analysis , mean st and ardised PPVT-R scores were 6.44 points greater ( P < 0.0001 ) in children fully breast fed for > 6 months compared with those never breast fed . After adjustment , mean PPVT-R scores were 3.56 points higher in children fully breast fed for > 6 months compared with those children never breast fed ( P = 0.003 ) . Similarly , Block Design scores were higher in those fully breast fed for > 6 months compared with those never breast fed in unadjusted ( P = 0.001 ) but not adjusted analyses ( P = 0.223 ) . Interactions between maternal education ( four levels ) and breast feeding demonstrated a positive association of maternal education on verbal IQ ( F = 2.64 ; P = 0.005 ) in children breast fed for longer but not on performance ( F = 0.74 ; P = 0.67 ) . The early introduction of milk other than breast milk was associated with reduced verbal IQ after adjustment for social and perinatal confounders . Although these effects were interacting with maternal education , they may act through undefined mechanisms in human milk This study was done to evaluate effects of maternal-infant skin-to-skin contact during the first 2 hours postbirth compared to st and ard care ( holding the infant swaddled in blankets ) on breastfeeding outcomes through 1 month follow-up . Healthy primiparous mother-infant dyads were r and omly assigned by computerized minimization to skin-to-skin contact ( n = 10 ) or st and ard care ( n = 10 ) . The Infant Breastfeeding Assessment Tool  was used to measure success of first breastfeeding and time to effective breastfeeding ( time of the first of three consecutive scores of 10 - 12 ) . Intervention dyads experienced a mean of 1.66 hours of skin-to-skin contact . These infants , compared to swaddled infants , had higher mean sucking competency during the first breastfeeding ( 8.7 + /- 2.1 vs 6.3 + /- 2.6 ; P < .02 ) and achieved effective breastfeeding sooner ( 935 + /- 721 minutes vs 1737 + /- 1001 ; P < .04 ) . No significant differences were found in number of breastfeeding problems encountered during follow-up ( 30.9 + /- 5.51 vs 32.7 + /- 5.84 ; P < .25 ) or in breastfeeding exclusivity ( 1.50 + /- 1.1 vs 2.10 + /- 2.2 ; P < .45 ) . Sucking competency was also related to maternal nipple protractility ( r = .48 ; P < .03 ) . Very early skin-to-skin contact enhanced breastfeeding success during the early postpartum period . No significant differences were found at 1 month OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at pren 
    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: CONTEXT Lactation is associated with improved glucose and insulin homeostasis , independent of weight change . OBJECTIVE To evaluate the association between lactation history and incidence of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational cohort study of 83,585 parous women in the Nurses ' Health Study ( NHS ) and retrospective observational cohort study of 73,418 parous women in the Nurses ' Health Study II ( NHS II ) . MAIN OUTCOME MEASURE Incident cases of type 2 diabetes mellitus . RESULTS In the NHS , 5145 cases of type 2 diabetes were diagnosed during 1,239,709 person-years of follow-up between 1986 and 2002 , and in the NHS II , 1132 cases were diagnosed during 778,876 person-years of follow-up between 1989 and 2001 . Among parous women , increasing duration of lactation was associated with a reduced risk of type 2 diabetes . For each additional year of lactation , women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15 % ( 95 % confidence interval , 1%-27 % ) among NHS participants and of 14 % ( 95 % confidence interval , 7%-21 % ) among NHS II participants , controlling for current body mass index and other relevant risk factors for type 2 diabetes . CONCLUSIONS Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women . Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis OBJECTIVE To test the integrity of a protocol for a r and omised controlled trial ( RCT ) to examine the effectiveness of skin-to-skin care compared to routine care on the initiation and duration of breast feeding and to provide data to be used in the power calculation for a proposed trial . DESIGN R and omised pilot study . SETTING Warrington Hospital , Cheshire , UK . PARTICIPANTS Women at 36 weeks ' gestation with healthy singleton pregnancies , who intended to breast feed , who had ' booked ' for care at Warrington Hospital and had given informed consent to participate . Twenty-eight women were r and omised in the pilot study . METHOD Women were r and omly allocated to receive either routine or skin-to-skin care following birth . The first breast feed was assessed using the Breast-feeding Assessment Tool ( BAT ) .  Mothers were followed up at discharge from hospital and again at four months to provide details of duration of breast feeding . FINDINGS 66 women were approached to participate in the trial and 44 consented ( 67 % consent rate ) . Twenty-eight women were r and omised in the study and 26 breast feeds were observed ( 93 % ) . The pilot study identified procedural changes that were required in the design of the main study , provided an estimate of recruitment rates and confirmed the previously calculated sample size . CONCLUSION The pilot study demonstrated that a large RCT of skin-to-skin versus routine care was feasible . This is an example of how a pilot study has the ability to identify unforeseen challenges in the conduct of the trial as well as allowing necessary changes to be made to the design that will increase the quality of the subsequent research Objective . In the third quarter of 2001 , the National Immunization Survey ( NIS ) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding . Using the data from the 2002 NIS , this study estimates breastfeeding rates in the United States by characteristics of the child , mother , or family . Methods . The NIS uses r and om-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations  and then vali date s the information through a mail survey of the health care providers who gave the vaccinations . In 2002 , ∼3500 households from the NIS were r and omized to 1 of the 3 rotating topical modules that covered breastfeeding . Results . More than two thirds ( 71.4 % ) of the children had ever been breastfed . At 3 months , 42.5 % of infants were exclusively breastfed , and 51.5 % were breastfed to some extent . At 6 months , these rates dropped to 13.3 % and 35.1 % , respectively . At 1 year , 16.1 % of infants were receiving some breast milk . Non-Hispanic black children had the lowest breastfeeding rates . Breastfeeding rates also varied by participation in day care or the Women , Infants , and Children program , socioeconomic status , and geographic area of residence . Conclusions . Although the rate of breastfeeding initiation in the United States is near the national goal of 75 % , at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50 % and 25 % , respectively . In addition , rates of exclusive breastfeeding are low . Strenuous public health efforts are needed to improve breastfeeding behaviors , particularly among non-Hispanic black women and socioeconomically disadvantaged groups Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement OBJECTIVE To enhance breastfeeding practice s , the World Health Organization discourages pacifiers and bottle-feeding . However , the effect of artificial nipples on breastfeeding duration is poorly defined . The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated : 1 ) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2 ) early ( 2 - 5 days ) versus late ( > 4 weeks ) pacifier introduction . METHODS A total of 700 breastfed newborns ( 36 - 42 weeks , birth weight > or=2200 g ) were r and omly assigned to 1 of 4 intervention groups : bottle/early pacifier ( n = 169 ) , bottle/late pacifier ( n = 167 ) , cup/early pacifier ( n = 185 ) , or cup/late pacifier ( n = 179 ) . The cup/bottle intervention was invoked for infants who received supplemental feedings : cup ( n = 251 ) , bottle ( n = 230 ) . Data were collected at delivery and at 2 , 5 , 10 , 16 , 24 , 38 , and 52 weeks ' postpartum . Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses . RESULTS Supplemental feedings , regardless of method ( cup or bottle ) , had a detrimental effect on breastfeeding duration . There were no differences in cup versus bottle groups for breastfeeding duration . Effects were modified by the number of supplements ; exclusive and full breastfeeding duration were prolonged in cup-fed infants given > 2 supplements . Among infants delivered by cesarean , cupfeeding significantly prolonged exclusive , full , and overall breastfeeding duration . Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers ( early pacifier group ; odds ratio : 1.5 ; 95 % confidence interval : 1.0 - 2.0 ) . Early , as compared with late , pacifier use shortened overall duration ( adjusted hazard ratio : 1.22 ; 95 % confidence interval : 1.03 - 1.44 ) but did not affect exclusive or full duration . CONCLUSIONS There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants , but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean . Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding . These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period The aim of this study was to examine prospect ively the relation between duration of breast feeding and cognitive outcomes . A cohort study of 2860 children enrolled before birth provided data from 2393 term infants of English-speaking mothers . Of these , complete infant feeding data in the first year of life and verbal cognitive IQ ( Peabody Picture Vocabulary Test - PPVT-R ) were available for 1450 children at 6 years , and a performance subtest ( Perceptual organisation WISC - Block Design ) for 1375 children at 8 years . Full breast feeding was categorised as none , > 0 to < 4 months , 4 - 6 months and > 6 months . Associations between breast-feeding duration and PPVT-R at 6 years and Block Design at 8 years were estimated before and after adjustment for gender , gestational age , maternal age , maternal education , parental smoking and the presence of older siblings . The early cessation of full breast feeding was associated with reduced verbal IQ and the performance subtest . In unadjusted analysis , mean st and ardised PPVT-R scores were 6.44 points greater ( P < 0.0001 ) in children fully breast fed for > 6 months compared with those never breast fed . After adjustment , mean PPVT-R scores were 3.56 points higher in children fully breast fed for > 6 months compared with those children never breast fed ( P = 0.003 ) . Similarly , Block Design scores were higher in those fully breast fed for > 6 months compared with those never breast fed in unadjusted ( P = 0.001 ) but not adjusted analyses ( P = 0.223 ) . Interactions between maternal education ( four levels ) and breast feeding demonstrated a positive association of maternal education on verbal IQ ( F = 2.64 ; P = 0.005 ) in children breast fed for longer but not on performance ( F = 0.74 ; P = 0.67 ) . The early introduction of milk other than breast milk was associated with reduced verbal IQ after adjustment for social and perinatal confounders . Although these effects were interacting with maternal education , they may act through undefined mechanisms in human milk This study was done to evaluate effects of maternal-infant skin-to-skin contact during the first 2 hours postbirth compared to st and ard care ( holding the infant swaddled in blankets ) on breastfeeding outcomes through 1 month follow-up . Healthy primiparous mother-infant dyads were r and omly assigned by computerized minimization to skin-to-skin contact ( n = 10 ) or st and ard care ( n = 10 ) . The Infant Breastfeeding Assessment Tool  was used to measure success of first breastfeeding and time to effective breastfeeding ( time of the first of three consecutive scores of 10 - 12 ) . Intervention dyads experienced a mean of 1.66 hours of skin-to-skin contact . These infants , compared to swaddled infants , had higher mean sucking competency during the first breastfeeding ( 8.7 + /- 2.1 vs 6.3 + /- 2.6 ; P < .02 ) and achieved effective breastfeeding sooner ( 935 + /- 721 minutes vs 1737 + /- 1001 ; P < .04 ) . No significant differences were found in number of breastfeeding problems encountered during follow-up ( 30.9 + /- 5.51 vs 32.7 + /- 5.84 ; P < .25 ) or in breastfeeding exclusivity ( 1.50 + /- 1.1 vs 2.10 + /- 2.2 ; P < .45 ) . Sucking competency was also related to maternal nipple protractility ( r = .48 ; P < .03 ) . Very early skin-to-skin contact enhanced breastfeeding success during the early postpartum period . No significant differences were found at 1 month OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at pren 
    Output:
    