1
|
Baltacı N, Doğan Yüksekol Ö, Koç E, Ulucan M. The effects of listening to lullabies and self-selected music at home on prenatal stress and anxiety in nulliparous pregnant women: A randomized-controlled study. Health Care Women Int 2023; 45:562-578. [PMID: 37010820 DOI: 10.1080/07399332.2023.2196510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/25/2023] [Indexed: 04/04/2023]
Abstract
To compare the effects of nulliparous pregnant women listening to lullabies and self-selected music on reducing the anxiety and antenatal stress. This was a randomized controlled study. Lullaby group (LG) (n = 40) listened to the lullaby chosen by the researcher, mixed music group (MG) (n = 40) listened to self-selected music and control group (CG) (n = 40) received general care. Post-test anxiety and stress levels was lower in two intervention groups versus CG (p < 0.01). Post-test anxiety was lower in the MG versus LG (p < 0.01), however post-test stress levels were similar. Pregnant women listening to self-selected music at home is more effective in reducing anxiety.
Collapse
Affiliation(s)
- Nazlı Baltacı
- Department of Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Özlem Doğan Yüksekol
- Department of Midwifery, Faculty of Health Sciences, Munzur University, Tunceli, Turkey
| | - Emine Koç
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Mihriban Ulucan
- Department of Midwifery, Faculty of Health Sciences, Munzur University, Tunceli, Turkey
| |
Collapse
|
2
|
O'Reilly G, Cheung PS, McCaffrey T. A Pilot Study of Maternal Songwriting to Support Bonding During Pregnancy: "I Could Feel Her Rise and Fall With My Breath While Singing". J Midwifery Womens Health 2023; 68:205-209. [PMID: 36683203 DOI: 10.1111/jmwh.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Attachment is a lasting psychological and emotional bond that impacts a child's social, emotional, and cognitive development. Maternal-fetal attachment is a precursor to this bond that is regarded as a predictor for mother-infant relating postbirth. Although previous studies have investigated use of music interventions to support maternal-fetal attachment, no study to date has investigated the use of maternal songwriting to support this bond during pregnancy. METHODS Four pregnant women were recruited to this pilot study. Each woman participated in 2 songwriting workshops with the aim of writing an original song to their fetus. Following the workshops, experiences of using songwriting for the purposes of supporting bonding were investigated through individual semistructured interviews and analyzed using thematic content analysis. RESULTS Analysis of semistructured interviews with pregnant women revealed 3 main themes: song singing promotes physical connection with the fetus; songwriting encourages open communication with the fetus; and songwriting can create a musical legacy within families. DISCUSSION To the best of our knowledge, this study is the first of its kind that investigated maternal songwriting to support bonding during pregnancy. Findings indicated that songwriting has the potential to support such attachment due to its capacity to enhance physical connection and open communication with the fetus, while also creating a musical legacy that can be used and passed on among other family members. Overall, songwriting may support pregnant women to draw on their inner resources to create such a bespoke musical gift to their unborn child. Further research around this topic is warranted.
Collapse
Affiliation(s)
- Gemma O'Reilly
- Irish World Academy of Music and Dance, University of Limerick, Limerick, Ireland
| | - Pui Sze Cheung
- Irish World Academy of Music and Dance, University of Limerick, Limerick, Ireland
| | - Tríona McCaffrey
- Irish World Academy of Music and Dance, University of Limerick, Limerick, Ireland
| |
Collapse
|
3
|
Ng A, Wei B, Jain J, Ward EA, Tandon SD, Moskowitz JT, Krogh-Jespersen S, Wakschlag LS, Alshurafa N. Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation. JMIR Mhealth Uhealth 2022; 10:e33850. [PMID: 35917157 PMCID: PMC9382551 DOI: 10.2196/33850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cognitive behavioral therapy–based interventions are effective in reducing prenatal stress, which can have severe adverse health effects on mothers and newborns if unaddressed. Predicting next-day physiological or perceived stress can help to inform and enable pre-emptive interventions for a likely physiologically and perceptibly stressful day. Machine learning models are useful tools that can be developed to predict next-day physiological and perceived stress by using data collected from the previous day. Such models can improve our understanding of the specific factors that predict physiological and perceived stress and allow researchers to develop systems that collect selected features for assessment in clinical trials to minimize the burden of data collection. Objective The aim of this study was to build and evaluate a machine-learned model that predicts next-day physiological and perceived stress by using sensor-based, ecological momentary assessment (EMA)–based, and intervention-based features and to explain the prediction results. Methods We enrolled pregnant women into a prospective proof-of-concept study and collected electrocardiography, EMA, and cognitive behavioral therapy intervention data over 12 weeks. We used the data to train and evaluate 6 machine learning models to predict next-day physiological and perceived stress. After selecting the best performing model, Shapley Additive Explanations were used to identify the feature importance and explainability of each feature. Results A total of 16 pregnant women enrolled in the study. Overall, 4157.18 hours of data were collected, and participants answered 2838 EMAs. After applying feature selection, 8 and 10 features were found to positively predict next-day physiological and perceived stress, respectively. A random forest classifier performed the best in predicting next-day physiological stress (F1 score of 0.84) and next-day perceived stress (F1 score of 0.74) by using all features. Although any subset of sensor-based, EMA-based, or intervention-based features could reliably predict next-day physiological stress, EMA-based features were necessary to predict next-day perceived stress. The analysis of explainability metrics showed that the prolonged duration of physiological stress was highly predictive of next-day physiological stress and that physiological stress and perceived stress were temporally divergent. Conclusions In this study, we were able to build interpretable machine learning models to predict next-day physiological and perceived stress, and we identified unique features that were highly predictive of next-day stress that can help to reduce the burden of data collection.
Collapse
Affiliation(s)
- Ada Ng
- McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Boyang Wei
- McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jayalakshmi Jain
- McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Erin A Ward
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Judith T Moskowitz
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Lauren S Wakschlag
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nabil Alshurafa
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
4
|
Carvalho ME, Ricon R, Gameiro M, Rodrigues H. Creating a prenatal song for an unborn infant during a music therapy program: A longitudinal and microanalytic case study from before birth to three months of age. NORDIC JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1080/08098131.2021.2004612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Eduarda Carvalho
- Center for Sociology and Musical Aesthetics Studies, Faculty of Social and Human Sciences of New University of Lisbon, CESEM-NOVA-FCSH, Lisbon, Portugal
| | - Raul Ricon
- Center for Sociology and Musical Aesthetics Studies, Faculty of Social and Human Sciences of New University of Lisbon, CESEM-NOVA-FCSH, Lisbon, Portugal
| | - Mariana Gameiro
- Center for Sociology and Musical Aesthetics Studies, Faculty of Social and Human Sciences of New University of Lisbon, CESEM-NOVA-FCSH, Lisbon, Portugal
| | - Helene Rodrigues
- Center for Sociology and Musical Aesthetics Studies, Faculty of Social and Human Sciences of New University of Lisbon, CESEM-NOVA-FCSH, Lisbon, Portugal
| |
Collapse
|
5
|
Baltacı N, Başer M. The Effect of Lullaby Intervention on Anxiety and Prenatal Attachment in Women with High-Risk Pregnancy: A Randomized Controlled Study. Complement Med Res 2021; 29:127-135. [PMID: 34818646 DOI: 10.1159/000520139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with high-risk pregnancy experience anxiety and low mother-fetal attachment when faced with signs of danger and health problems. This study aimed to investigate the effects of lullaby intervention on anxiety and prenatal attachment in women with high-risk pregnancy. MATERIALS AND METHODS This randomized controlled trial was conducted in the perinatology clinic of a state maternity hospital in Turkey. Seventy-six women with high-risk pregnancy were included. The intervention group listened to lullabies for 20 min once a day, and accompanied by lullabies touched their abdomen and thought about their babies, but the control group did not. Data were collected using the Pregnant Information Form, the State Anxiety Inventory, and the Prenatal Attachment Inventory. RESULTS Baseline anxiety did not differ in the intervention versus control group (47.83 ± 10.74 vs. 44.10 ± 8.08, mean difference 3.73 [95% Cl -1.18 to 8.64], p = 0.13), but after the 2nd day lullaby intervention anxiety was lower in the intervention group versus control group (33.66 ± 9.32 vs. 43.06 ± 8.10, mean difference -9.40 [95% Cl -13.91 to -4.88], p < 0.01). Baseline prenatal attachment did not differ in the intervention versus control group (56.03 ± 10.71 vs. 53.86 ± 9.98, mean difference 2.16 [95% Cl -3.18 to 7.51], p = 0.42), but after the 2nd day lullaby intervention prenatal attachment was higher in the intervention group versus control group (66.70 ± 7.60 vs. 54.36 ± 9.52, mean difference 12.33 [95% Cl 7.87 to 16.78], p < 0.01). In the within-group analysis the intervention group had lower anxiety and better prenatal attachment (p < 0.01), but not in the control group (p > 0.05). CONCLUSION Lullaby intervention can play an effective role in reducing anxiety and improving prenatal attachment. The use of this integrative, noninvasive, non-pharmacologic, time-efficient, and natural intervention is suggested in the care of pregnant women.
Collapse
Affiliation(s)
- Nazlı Baltacı
- Department of Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Mürüvvet Başer
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| |
Collapse
|
6
|
Shimada BMO, Santos MDSOMD, Cabral MA, Silva VO, Vagetti GC. Interventions among Pregnant Women in the Field of Music Therapy: A Systematic Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:403-413. [PMID: 34182584 PMCID: PMC10304802 DOI: 10.1055/s-0041-1731924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To investigate in the literature the studies on the benefits of music therapy interventions among pregnant women in the prenatal, delivery and postpartum periods. DATA SOURCES The search for articles was carried out in the following electronic databases: VHL, LILACS, SciELO, Portal CAPES, PsycINFO, ERIC, PubMed/Medline, and journals specialized in this field: Revista Brasileira de Musicoterapia ("Brazilian Journal of Music Therapy") and Voices. STUDY SELECTION Descriptors in Portuguese (musicoterapia, gravidez, gestantes, revisão), English (music therapy, pregnancy, pregnant women, review) and Spanish (musicoterapia, embarazo, mujeres embarazadas, revisión) were used. The search was delimited between January 2009 and June 2019. The process of selection and evaluation of the articles was performed through peer review. DATA COLLECTION The following data were extracted: article title, year of publication, journal, author(s), database, country and date of collection, purpose of the study, sample size, type of care, intervention, instruments used, results, and conclusion. The data were organized in chronological order based on the year of publication of the study. SUMMARY OF THE DATA In total, 146 articles were identified, and only 23 studies were included in this systematic review. The articles found indicate among their results relaxation, decreased levels of anxiety, psychosocial stress and depression, decreased pain, increase in the maternal bond, improvement in the quality of sleep, control of the fetal heart rate and maternal blood pressure, and decreased intake of drugs in the postoperative period. CONCLUSION Music therapy during the prenatal, delivery and postpartum periods can provide benefits to pregnant women and newborns, thus justifying its importance in this field.
Collapse
|
7
|
Perkins R, Mason-Bertrand A, Fancourt D, Baxter L, Williamon A. How Participatory Music Engagement Supports Mental Well-being: A Meta-Ethnography. QUALITATIVE HEALTH RESEARCH 2020; 30:1924-1940. [PMID: 32755294 PMCID: PMC7502980 DOI: 10.1177/1049732320944142] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Participatory music engagement has the capacity to support well-being. Yet, there is little research that has scrutinized the processes through which music has an effect. In this meta-ethnography [PROSPERO CRD42019130164], we conducted a systematic search of 19 electronic databases and a critical appraisal to identify 46 qualitative studies reporting on participants' subjective views of how participatory music engagement supports their mental well-being. Synthesis of first-order and second-order interpretations using thematic coding resulted in four third-order pathways that account for how participatory music engagement supports mental well-being: managing and expressing emotions, facilitating self-development, providing respite, and facilitating connections. Our interpretation suggests that people benefit from participatory music engagement by engaging with specific and multiple processes that meet their individual needs and circumstances. These findings inform research directions within the field of music and well-being, as well as guiding the development and delivery of future music interventions.
Collapse
Affiliation(s)
- Rosie Perkins
- Imperial College London, London, United Kingdom
- Royal College of Music, London, United Kingdom
| | | | | | | | - Aaron Williamon
- Imperial College London, London, United Kingdom
- Royal College of Music, London, United Kingdom
| |
Collapse
|
8
|
The effects of a music and singing intervention during pregnancy on maternal well-being and mother-infant bonding: a randomised, controlled study. Arch Gynecol Obstet 2020; 303:69-83. [PMID: 32776296 PMCID: PMC7854426 DOI: 10.1007/s00404-020-05727-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
Purpose Stress and impaired mother–infant bonding during pregnancy can lead to adverse effects for the expectant mother and the unborn child. The present study investigates whether a prenatal music and singing intervention can improve maternal well-being as well as mother–infant bonding. Methods A total of 172 pregnant women took part in this prospective, randomised, three-armed (music, singing or control group) study. Depressive symptoms, self-efficacy, maternal well-being and mother–infant bonding were assessed with visual analogue scales and questionnaires before the intervention phase (30th week of gestation) and afterwards (36th week of gestation). Additionally, immediate changes regarding experienced stress and mood from before until after the music and singing interventions were explored with questionnaires as well as saliva samples (for cortisol, alpha-amylase and oxytocin determination). Results Regarding immediate effects, both interventions showed positive effects on the emotional state, stress (cortisol) and bonding (oxytocin). Additionally, the singing group showed a larger reduction in cortisol and a larger improvement in valence than the music group. Looking at more prolonged effects, significant effects on general self-efficacy and perceived closeness to the unborn child (measured with a visual analogue scale) were found. No significant effects were revealed for the mother–infant bonding questionnaire and for depressive symptoms. Conclusion In the present study, promising effects of music and in particular singing on maternal well-being and perceived closeness during pregnancy appeared. Prenatal music and singing interventions could be an easy to implement and effective addition to improve mood and well-being of the expectant mother and support mother-infant bonding. Trial registration number DRKS00012822, date of registration: 17.10.2017 Electronic supplementary material The online version of this article (10.1007/s00404-020-05727-8) contains supplementary material, which is available to authorized users.
Collapse
|
9
|
Perinatal mental health in Ireland: A scoping review. Midwifery 2020; 89:102763. [PMID: 32570092 DOI: 10.1016/j.midw.2020.102763] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The international literature clearly indicates that perinatal mental health issues affect many women, and can have profound negative consequences for both the mother, infant and family, and that the causes of perinatal mental health issues are multifaceted and complex. AIM This scoping review explores the existing research on perinatal mental health in Ireland to provide a baseline and to guide further research as well as inform the implementation of the recent policy strategies. DESIGN Scoping Review METHODS: We conducted a structured literature search on Science Direct, Web of Science, PubMed, PsychInfo and Scopus, using key words to search for publications up to December 2018. All publications based on empirical studies on perinatal mental health in Ireland (regardless of research design, sample size, and methods used) were included. Exclusion criteria were: study location not the Republic of Ireland; not relating to the perinatal period (pregnancy up to the first 12 months after birth); not relating to mental health; and not relating to maternal mental health, not relating to human subjects; not an empirical study; international study with generalised results. Data were mapped onto a charting form, allowing us to a) conduct a basic numerical analysis of prevalent research questions and designs, and b) to identify key themes within the data, utilising Braun and Clarke's (2006) thematic analysis. RESULTS The search resulted in 623 unique references. 29 publications were included in this review. Our analysis resulted in three main findings. (1) A significant number of women in Ireland are affected by perinatal mental health problems, but prevalence rates vary significantly between studies. (2) A history of mental health problems and lack of social support were identified as key risk factors. (3) The existing perinatal mental health services in Ireland are generally inadequate. We further noted a focus on quantitative approaches and a medicalisation of perinatal mental health, resulting in an absence of women's voices and their lived experiences, particularly those of women of colour, migrant women and ethnic minorities. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We conclude that in order to further the vision of woman-centred maternity care, we need to conduct woman-centred research that puts women's subjective experiences of perinatal mental health and well-being at the centre, including those of marginalised women in an increasingly diverse Irish society.
Collapse
|
10
|
Teckenberg-Jansson P, Turunen S, Pölkki T, Lauri-Haikala MJ, Lipsanen J, Henelius A, Aitokallio-Tallberg A, Pakarinen S, Leinikka M, Huotilainen M. Effects of live music therapy on heart rate variability and self-reported stress and anxiety among hospitalized pregnant women: A randomized controlled trial. NORDIC JOURNAL OF MUSIC THERAPY 2019. [DOI: 10.1080/08098131.2018.1546223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Siiri Turunen
- CICERO Learning Network, Faculty of Educational Sciences and Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tarja Pölkki
- Department of Children and Women, Oulu University Hospital, Oulu, Finland
| | - Minna-Johanna Lauri-Haikala
- CICERO Learning Network, Faculty of Educational Sciences and Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- CICERO Learning Network, Faculty of Educational Sciences and Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Andreas Henelius
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Ansa Aitokallio-Tallberg
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Satu Pakarinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Minna Huotilainen
- CICERO Learning Network, Faculty of Educational Sciences and Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
11
|
Investigating the Effect of Fordyce Happiness Cognitive-Behavioral Training on Perceived Stress and Happiness in Pregnant Females: Applying the Self-Efficacy Theory. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.59284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, Harvey R, Bessey A, Cantrell A, Dennis CL, Ren S, Ragonesi M, Barkham M, Churchill D, Henshaw C, Newstead J, Slade P, Spiby H, Stewart-Brown S. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 2018; 20:1-414. [PMID: 27184772 DOI: 10.3310/hta20370] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) is a major depressive disorder in the year following childbirth, which impacts on women, their infants and their families. A range of interventions has been developed to prevent PND. OBJECTIVES To (1) evaluate the clinical effectiveness, cost-effectiveness, acceptability and safety of antenatal and postnatal interventions for pregnant and postnatal women to prevent PND; (2) apply rigorous methods of systematic reviewing of quantitative and qualitative studies, evidence synthesis and decision-analytic modelling to evaluate the preventive impact on women, their infants and their families; and (3) estimate cost-effectiveness. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases (from inception to July 2013) in December 2012, and we were updated by electronic alerts until July 2013. REVIEW METHODS Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment. All universal, selective and indicated preventive interventions for pregnant women and women in the first 6 postnatal weeks were included. All outcomes were included, focusing on the Edinburgh Postnatal Depression Scale (EPDS), diagnostic instruments and infant outcomes. The quantitative evidence was synthesised using network meta-analyses (NMAs). A mathematical model was constructed to explore the cost-effectiveness of interventions contained within the NMA for EPDS values. RESULTS From 3072 records identified, 122 papers (86 trials) were included in the quantitative review. From 2152 records, 56 papers (44 studies) were included in the qualitative review. The results were inconclusive. The most beneficial interventions appeared to be midwifery redesigned postnatal care [as shown by the mean 12-month EPDS score difference of -1.43 (95% credible interval -4.00 to 1.36)], person-centred approach (PCA)-based and cognitive-behavioural therapy (CBT)-based intervention (universal), interpersonal psychotherapy (IPT)-based intervention and education on preparing for parenting (selective), promoting parent-infant interaction, peer support, IPT-based intervention and PCA-based and CBT-based intervention (indicated). Women valued seeing the same health worker, the involvement of partners and access to several visits from a midwife or health visitor trained in person-centred or cognitive-behavioural approaches. The most cost-effective interventions were estimated to be midwifery redesigned postnatal care (universal), PCA-based intervention (indicated) and IPT-based intervention in the sensitivity analysis (indicated), although there was considerable uncertainty. Expected value of partial perfect information (EVPPI) for efficacy data was in excess of £150M for each population. Given the EVPPI values, future trials assessing the relative efficacies of promising interventions appears to represent value for money. LIMITATIONS In the NMAs, some trials were omitted because they could not be connected to the main network of evidence or did not provide EPDS scores. This may have introduced reporting or selection bias. No adjustment was made for the lack of quality of some trials. Although we appraised a very large number of studies, much of the evidence was inconclusive. CONCLUSIONS Interventions warrant replication within randomised controlled trials (RCTs). Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. FUTURE WORK RECOMMENDATIONS Several interventions appear to be cost-effective relative to usual care, but this is subject to considerable uncertainty. Future research conducting RCTs to establish which interventions are most clinically effective and cost-effective should be considered. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003273. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- C Jane Morrell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Harvey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margherita Ragonesi
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Dick Churchill
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Henshaw
- Division of Psychiatry, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Jo Newstead
- Nottingham Experts Patients Group, Clinical Reference Group for Perinatal Mental Health, Nottingham, UK
| | - Pauline Slade
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
13
|
Wulff V, Hepp P, Fehm T, Schaal NK. Music in Obstetrics: An Intervention Option to Reduce Tension, Pain and Stress. Geburtshilfe Frauenheilkd 2017; 77:967-975. [PMID: 28959060 DOI: 10.1055/s-0043-118414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/15/2017] [Accepted: 08/15/2017] [Indexed: 01/18/2023] Open
Abstract
In recent years, the effect of music interventions and music therapy has experienced increased attention in the literature. It has been shown that music has positive effects on cognitive and physical performance, such as concentration and endurance, as well as on psychological parameters, such as anxiety and relaxation. Studies within the context of medicine in particular are increasingly indicating that music may be used as an intervention for relief against anxiety, stress and pain. Music is therefore seen in actual practice as a supplement to conventional pharmacological and non-pharmacological forms of treatment - and the trend is rising. Studies involving music interventions in the field of obstetrics have shown, amongst other things, that music improves the ability to relax during pregnancy and can reduce anxiety. It was also discovered that during childbirth music interventions resulted in a reduction of pain and stress. Music also has the effect of reducing stress, pain and anxiety in expectant mothers during deliveries by caesarean section. This review intends to provide an overview of the literature on music interventions in the field of obstetrics and to give a resume on the current state of research around the topic of music in relation to pregnancy, spontaneous deliveries and caesarean sections. Furthermore, the relevance of music for everyday obstetrics will be illustrated.
Collapse
Affiliation(s)
- Verena Wulff
- Institut für Experimentelle Psychologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Philip Hepp
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Nora K Schaal
- Institut für Experimentelle Psychologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
14
|
Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study. Altern Ther Health Med 2017; 17:256. [PMID: 28482901 PMCID: PMC5423008 DOI: 10.1186/s12906-017-1759-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prenatal anxiety and depression are distressing for the expectant mother and can have adverse effects on her fetus and subsequently, her child. This study aimed to determine whether listening to specially composed songs would be an effective intervention for reducing symptoms of prenatal anxiety and depression. METHODS Pregnant women were recruited online and randomly assigned to one of two groups: the music group (daily listening to specially composed songs) or control group (daily relaxation) for 12 weeks each. Self-report questionnaires were used to assess symptoms of State and Trait anxiety (Spielberger) and depression (Edinburgh Postnatal Depression Scale (EPDS)). Trait anxiety was measured as the primary outcome, while State anxiety and depression were the secondary outcomes. 111 participants were randomised to each group. 20 participants in the intervention group and 16 participants in the active control group completed the study. RESULTS The music group demonstrated lower Trait Anxiety (p = .0001) (effect size 0.80), State Anxiety (p = .02) (effect size 0.64), and EPDS (p = .002) (effect size 0.92) scores at week 12 compared to baseline, by paired t test. There were no such changes in the control group. CONCLUSIONS Though this pilot study had high levels of attrition, the results do suggest that regular listening to relaxing music should be explored further as an effective non-pharmacological means for reducing prenatal anxiety and depression. TRIAL REGISTRATION ClinicalTrials.gov NCT02776293 LV-001. Registered 17 May 2016. Retrospectively registered.
Collapse
|
15
|
Scope A, Booth A, Morrell CJ, Sutcliffe P, Cantrell A. Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis. J Affect Disord 2017; 210:100-110. [PMID: 28024220 DOI: 10.1016/j.jad.2016.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/28/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND More women experience depressive symptoms antenatally than postnatally. Supporting women through the antenatal period is recognised as important in mitigating negative outcomes and in preventing postnatal depression (PND). A systematic review was conducted which aimed to provide a detailed service user and service provider perspective on the uptake, acceptability, and perception of harms of antenatal interventions and postnatal interventions for preventing PND. METHODS A comprehensive literature search was conducted in 12 major bibliographic databases in November 2012 and updated in December 2014. Studies were included if they contained qualitative evidence on the perspectives and attitudes of pregnant women and postnatal women who had taken part in, or healthcare professionals (HCPs) involved in delivering, preventive interventions for PND. RESULTS Twenty-two studies were included. Support and empowerment through education were identified as particularly helpful to women as intervention components, across all intervention types. Implications for accessing the service, understanding the remit of the service and women's preferences for group and individual care also emerged. LIMITATIONS The majority of the included studies were of moderate or low quality, which may result in a lack of rich data consistently across all studies, limiting to some degree interpretations that can be made. CONCLUSION The synthesis demonstrated important considerations for devising new interventions or adapting existing interventions. Specifically, it is important that individual or group interventions are carefully tailored to women's needs or preferences and women are aware of the remit of the HCPs role to ensure they feel able to access the support required.
Collapse
Affiliation(s)
- Alison Scope
- The University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK.
| | - Andrew Booth
- The University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK.
| | - C Jane Morrell
- University of Nottingham, School of Health Sciences, Nottingham, UK
| | - Paul Sutcliffe
- University of Warwick, Warwick Medical School, Warwick, UK
| | - Anna Cantrell
- The University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, UK
| |
Collapse
|
16
|
Persico G, Antolini L, Vergani P, Costantini W, Nardi MT, Bellotti L. Maternal singing of lullabies during pregnancy and after birth: Effects on mother-infant bonding and on newborns' behaviour. Concurrent Cohort Study. Women Birth 2017; 30:e214-e220. [PMID: 28169158 DOI: 10.1016/j.wombi.2017.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/12/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mother-infant bonding is of great importance for the development and the well-being of the baby. The aim of this Concurrent Cohort Study was to investigate the effects of mothers singing lullabies on bonding, newborns' behaviour and maternal stress. METHODS Eighty-three (singing cohort) and 85 (concurrent cohort) women were recruited at antenatal classes at 24 weeks g.a. and followed up to 3 months after birth. The Prenatal Attachment Inventory (PAI) and the Mother-to-Infant Bonding Scale (MIBS) were used to assess maternal-foetal attachment and postnatal bonding. FINDINGS No significant influence was found on Prenatal Attachment; by contrast, Postnatal Bonding was significantly greater (i.e. lower MIBS) in the singing group 3 months after birth (mean 1.28 vs 1.96; p=0.001). In the same singing group, the incidence of neonatal crying episodes in the first month was significantly lower (18.5% vs 28.2; p<0.0001) as were the infantile colic (64.7% vs 38.3%; p=0.003) and perceived maternal stress (29.6% vs 36.5%; p<0.05). Infantile colic was reduced in the singing group, even in the second month after birth (22.8% vs 36.5; p=0.002). At the same time, a reduction was observed in the neonatal nightly awakening (1.5% vs 4.7; p<0.0001). CONCLUSIONS Mothers singing lullabies could improve maternal-infant bonding. It could also have positive effects on neonatal behaviour and maternal stress.
Collapse
Affiliation(s)
| | - Laura Antolini
- Department of Health Sciences, Center of Biostatistics for Clinical Epidemiology, University of Milano Bicocca, Italy
| | - Patrizia Vergani
- School of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Walter Costantini
- Department of Clinical and Community Sciences, University of Milan, Italy
| | - Maria Teresa Nardi
- Musicologist and Music Therapist, Via Vittorio Emanuele II 24, 20842 Besana Brianza (MB), Italy
| | - Lidia Bellotti
- Maternal Neonatal Ward of San Gerardo Hospital, Monza, Italy
| |
Collapse
|
17
|
Rieger KL, Heaman MI. Factors Associated With High Levels of Perceived Prenatal Stress Among Inner-City Women. J Obstet Gynecol Neonatal Nurs 2016; 45:180-95. [PMID: 26807819 DOI: 10.1016/j.jogn.2015.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To explore the factors associated with high rates of perceived prenatal stress among inner-city women. DESIGN Observational cross-sectional study. SETTING/PARTICIPANTS We conducted a secondary analysis of data from 603 inner-city women. In our study, 330 participants (54.7%) self-identified as First Nations, Metis, or First Nations/Metis. METHODS Prenatal stress was measured with Cohen's Perceived Stress Scale. A social ecological model provided the theoretical framework for the study, and variables representing all levels of the model were selected for study. Data analyses included t tests to compare women with high stress and low/moderate stress, univariable logistic regression analysis to determine the association of selected factors with maternal stress, and multivariable logistic regression analysis to provide adjusted odds ratios and 95% confidence intervals for the factors. RESULTS Of the 603 participants, 17.2% (104) reported high levels of perceived stress, and 82.8% (499) reported low/moderate levels. The high-stress group included a significantly greater proportion of First Nations, Metis, or First Nations/Metis women (76.0%) than the low/moderate-stress group (50.3%). Low rates of self-esteem and social support, residential mobility, abuse before/during pregnancy, and experiencing discrimination were significantly associated with high levels of perceived prenatal stress. CONCLUSION Our findings demonstrated that factors that influence prenatal stress occur at all levels of the social ecological model. The identified factors are amenable to change, and implications for practice include the need for psychosocial risk assessment, alternative forms of prenatal care, relational care, and advocacy initiatives. A greater understanding of the complex factors associated with high rates of perceived prenatal stress can inform the development of effective interventions for inner-city women.
Collapse
|
18
|
Mastnak W. Perinatal Music Therapy and Antenatal Music Classes: Principles, Mechanisms, and Benefits. J Perinat Educ 2016; 25:184-192. [PMID: 30538415 DOI: 10.1891/1058-1243.25.3.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Antenatal music activities are in the ascendant. Regarding evidence-based research, the article advocates 5 main aims: music therapeutic control of pre- and perinatal stress, anxiety, and depression; music-related mental and physical birth preparation comprising cognitive adjustment, emotional regulation, physical activity, relaxation and pain management, and social inclusion; music-associated bonding and self-efficacy; prenatal sound stimulation to trigger learning processes, pedagogical priming and brain maturation; music activities to facilitate the child's acculturation and adaptive self-regulation. Underlying mechanisms such as neuroplasticity help to understand the multifaceted effects of music in pre- and perinatal care. Individual conditions and features of the mother and her child have to be taken into account and music interventions to be harmonized with complementary perinatal programs.
Collapse
|
19
|
Chang HC, Yu CH, Chen SY, Chen CH. The effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy. Complement Ther Med 2015; 23:509-15. [PMID: 26275644 DOI: 10.1016/j.ctim.2015.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 05/13/2015] [Accepted: 05/24/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE While music listening has been studied as an intervention to help reduce anxiety in pregnant women, few studies have explored the effect of music listening on pregnancy-specific stress relief. This study examines the effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy. DESIGN A randomized controlled trial was implemented. A valid sample of 296 pregnant women in their second or third trimester was randomly distributed into an experimental group (n=145) and a control group (n=151). INTERVENTIONS The experimental group received routine prenatal care and music listening. The control group received routine prenatal care only. MAIN OUTCOME MEASURES Data were collected using a demographic form, Pregnancy Stress Rating Scale (PSRS), Perceived Stress Scale (PSS), and Maternal-Fetal Attachment Scale (MFAS). RESULTS The post-test results identified a significantly lower level of psychosocial stress in the experimental group than in the control group, particularly in terms of the stresses related to baby care and changing family relationships and to maternal role identification. However, no statistically significant differences in terms of perceived stress and maternal-fetal attachment were found between the post-test results of the two groups. CONCLUSION This study provides evidence in support of using of music in interventions designed to relieve psychosocial stress in prenatal women. IRB approval number: ER98223.
Collapse
Affiliation(s)
- Hsing-Chi Chang
- Institute of Allied Health Science, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan.
| | - Chen-Hsiang Yu
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical Center, No. 138, Sheng Li Road, Tainan 701, Taiwan.
| | - Shu-Yueh Chen
- Department of Nursing, HungKuang University, No. 1018, Sec. 6, Taiwan Boulevard, Shalu District, Taichung 403, Taiwan.
| | - Chung-Hey Chen
- Institute of Allied Health Science, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan.
| |
Collapse
|
20
|
Morrison J, Pikhart H, Ruiz M, Goldblatt P. Systematic review of parenting interventions in European countries aiming to reduce social inequalities in children's health and development. BMC Public Health 2014; 14:1040. [PMID: 25287010 PMCID: PMC4203958 DOI: 10.1186/1471-2458-14-1040] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/09/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early child development influences many aspects of wellbeing, health, competence in literacy and numeracy, criminality, and social and economic participation throughout the life course. Children from disadvantaged groups have less possibilities of achieving full development. By providing a positive start for all children across the social gradient, improved developmental outcomes will be seen during later childhood and throughout their lives. The objective of this systematic review was to identify interventions during early childhood in countries from the World Health Organisation European Region in 1999-2013 which reduced inequalities in children's health and development. METHODS A systematic review was carried out adhering to the PRISMA guidelines. The review examined universal, targeted and proportionate universalism interventions, programs and services using an electronic search strategy in PubMed and the International Bibliography of the Social Sciences [IBSS] databases. A further search was performed in the grey literature. Interventions were included only if they were aimed at children or their parents and had been evaluated. RESULTS We identified 23 interventions in total: 6 in the PubMed data base, 5 in IBSS and 12 in grey literature. All but 1 intervention-delivered in Sweden-were carried out in the United Kingdom and the Republic of Ireland. These aimed to improve parenting abilities, however, some had additional components such as: day-care provision, improving housing conditions and speech or psychological therapies. Programmes offering intensive support, information and home visits using a psycho-educational approach and aimed at developing parent's and children's skills showed more favourable outcomes. These were parenting behaviours, overall children's health and higher level of fine motor skills and cognitive functioning. Child injuries and abuse were also reduced. Two interventions were universally proportionate and all others were aimed at a specific target population. CONCLUSIONS Interventions with better outcomes and a higher level of evidence combined workshops and educational programmes for both parents and children beginning during early pregnancy and included home visits by specialised staff. Further evaluation and publication of early years interventions should be carried out also within a wider range of countries than just the UK and Ireland.
Collapse
Affiliation(s)
- Joana Morrison
- />Department of Epidemiology and Public Health, University College London, London, UK
| | - Hynek Pikhart
- />Department of Epidemiology and Public Health, University College London, London, UK
| | - Milagros Ruiz
- />Department of Epidemiology and Public Health, University College London, London, UK
| | - Peter Goldblatt
- />Institute of Health Equity, Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
21
|
Chan KP. Prenatal meditation influences infant behaviors. Infant Behav Dev 2014; 37:556-61. [PMID: 25063985 DOI: 10.1016/j.infbeh.2014.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/04/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
Abstract
Meditation is important in facilitating health. Pregnancy health has been shown to have significant consequences for infant behaviors. In view of limited studies on meditation and infant temperament, this study aims to explore the effects of prenatal meditation on these aspects. The conceptual framework was based on the postulation of positive relationships between prenatal meditation and infant health. A randomized control quantitative study was carried out at Obstetric Unit, Queen Elizabeth Hospital in Hong Kong. 64 pregnant Chinese women were recruited for intervention and 59 were for control. Outcome measures were cord blood cortisol, infant salivary cortisol, and Carey Infant Temperament Questionnaire. Cord blood cortisol level of babies was higher in the intervention group (p<0.01) indicates positive health status of the newborns verifies that prenatal meditation can influence fetal health. Carey Infant Temperament Questionnaire showed that the infants of intervention group have better temperament (p<0.05) at fifth month reflects the importance of prenatal meditation in relation to child health. Present study concludes the positive effects of prenatal meditation on infant behaviors and recommends that pregnancy care providers should provide prenatal meditation to pregnant women.
Collapse
Affiliation(s)
- Ka Po Chan
- The Buddhist Institute of Enlightenment (Hk) Ltd., 270 Sha Tsui Road 2/F, Tsuen Wan, Hong Kong.
| |
Collapse
|
22
|
Poth M, Carolan M. Pregnant women's knowledge about the prevention of gestational diabetes mellitus: A qualitative study. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjom.2013.21.10.692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Experiences of pregnant women attending a lullaby programme in Limerick, Ireland: A qualitative study. Midwifery 2012; 28:321-8. [DOI: 10.1016/j.midw.2011.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 04/17/2011] [Accepted: 04/22/2011] [Indexed: 11/21/2022]
|