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I
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Vo
l.
15
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20
26
,
p
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428
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ma
therapy
on l
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ctation
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Ra
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y:
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Dec
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R
ev
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r
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ime
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ter
m
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e
ffe
c
ti
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ss
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o
m
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o
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y
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in
m
a
ss
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g
e
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n
d
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lary
sa
g
e
a
ro
m
a
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tatio
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a
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teri
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wo
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A
q
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e
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p
e
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n
tal
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s
c
o
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d
u
c
ted
a
m
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n
g
3
0
p
a
rti
c
i
p
a
n
ts
(
1
5
c
o
n
tro
ls;
1
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i
n
terv
e
n
ti
o
n
)
.
In
th
e
c
o
n
tr
o
l
g
r
o
u
p
,
m
e
a
n
b
re
a
st
m
il
k
v
o
lu
m
e
in
c
re
a
se
d
fro
m
3
2
.
0
0
±
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4
.
7
4
m
L
to
1
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.
3
3
±
1
8
.
0
7
m
L
(Δ
=
7
3
.
3
3
±
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7
.
2
9
;
p
<
0
.
0
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.
I
n
t
h
e
i
n
terv
e
n
ti
o
n
g
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o
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p
,
i
t
i
n
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re
a
se
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o
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,
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h
n
o
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n
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c
a
n
t
in
terg
r
o
u
p
d
iffere
n
c
e
(p
=
0
.
2
6
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).
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we
v
e
r,
u
terin
e
in
v
o
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u
ti
o
n
d
iffere
d
sig
n
ifi
c
a
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ly
b
e
twe
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=
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=
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.
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e
c
o
m
b
in
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d
in
ter
v
e
n
ti
o
n
m
a
y
se
rv
e
a
s
a
c
o
m
p
lem
e
n
tar
y
stra
teg
y
to
e
n
h
a
n
c
e
u
teri
n
e
re
c
o
v
e
ry
,
a
lt
h
o
u
g
h
i
ts
e
ffe
c
t
o
n
b
re
a
st
m
il
k
p
ro
d
u
c
ti
o
n
wa
s n
o
t
sta
ti
stica
ll
y
su
p
e
ri
o
r
t
o
st
a
n
d
a
rd
c
a
re
.
K
ey
w
o
r
d
s
:
Ar
o
m
ath
er
ap
y
clar
y
s
ag
e
B
r
ea
s
t m
ilk
p
r
o
d
u
ctio
n
Ox
y
to
cin
m
ass
ag
e
Po
s
tp
ar
tu
m
Uter
in
e
r
ec
o
v
er
y
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
R
ah
m
ad
in
i Far
ich
a
Hak
im
Dep
ar
tm
en
t o
f
Mid
wif
er
y
,
Fac
u
lty
o
f
Me
d
ici
n
e,
Un
iv
er
s
itas
An
d
alas
Pad
an
g
,
I
n
d
o
n
esia
E
m
ail:
f
ar
ich
a.
f
ik
a@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
p
o
s
tp
ar
tu
m
p
er
io
d
e
x
ten
d
s
f
r
o
m
c
h
ild
b
ir
th
u
n
til
6
wee
k
s
(
4
2
d
a
y
s
)
af
te
r
d
eliv
er
y
.
T
h
is
p
h
ase
r
ep
r
esen
ts
a
cr
itical
p
er
io
d
m
a
r
k
ed
b
y
s
ig
n
if
ican
t p
h
y
s
ical,
em
o
tio
n
al
,
an
d
s
o
cial
ch
a
n
g
es f
o
llo
win
g
ch
ild
b
ir
t
h
[
1
]
.
Du
r
in
g
th
is
tim
e,
th
e
m
ate
r
n
al
b
o
d
y
u
n
d
er
g
o
es p
h
y
s
io
lo
g
ical
r
ec
o
v
er
y
p
r
o
ce
s
s
es,
ch
ar
ac
ter
ized
b
y
u
ter
in
e
co
n
tr
ac
tio
n
s
,
lo
c
h
ia
d
is
ch
ar
g
e
,
an
d
h
o
r
m
o
n
al
ad
ju
s
tm
en
ts
.
I
n
p
o
s
tn
atal
m
i
d
wif
er
y
ca
r
e,
p
r
im
ar
y
atten
tio
n
is
d
ir
ec
ted
to
war
d
o
p
tim
izin
g
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
an
d
p
r
o
m
o
tin
g
u
ter
i
n
e
in
v
o
lu
tio
n
,
a
s
b
o
th
ar
e
ess
en
tia
l
in
d
icato
r
s
o
f
m
ate
r
n
al
r
ec
o
v
er
y
[
2
]
.
T
h
e
r
esu
lts
o
f
th
e
s
tu
d
y
s
h
o
w
th
at
6
0
-
8
0
%
o
f
m
o
th
er
s
e
x
p
er
ien
ce
p
r
o
b
lem
s
in
th
e
b
r
ea
s
tf
ee
d
in
g
p
r
o
ce
s
s
an
d
d
if
f
icu
lties
in
r
ec
o
v
er
in
g
r
ep
r
o
d
u
cti
v
e
o
r
g
an
s
[
3
]
.
R
esear
ch
in
Ug
a
n
d
a
s
h
o
ws
th
at
as
m
an
y
as
6
7
.
6
%
o
f
m
o
th
er
s
ex
p
er
ie
n
c
e
p
o
s
tp
ar
tu
m
h
em
o
r
r
h
ag
e
[
4
]
.
I
n
I
n
d
o
n
esia,
o
n
ly
4
8
.
6
%
o
f
in
f
an
ts
i
n
itiate
b
r
ea
s
tf
ee
d
in
g
with
in
th
e
f
ir
s
t
h
o
u
r
af
ter
b
ir
th
[
5
]
.
Me
a
n
wh
ile,
o
b
s
tetr
ic
h
em
o
r
r
h
a
g
e
ca
s
es
ar
e
th
e
lar
g
est
co
n
tr
ib
u
to
r
to
p
o
s
tp
ar
tu
m
m
a
ter
n
al
m
o
r
tality
[
6
]
.
H
o
wev
er
,
alth
o
u
g
h
v
ar
io
u
s
p
o
s
t
-
p
r
eg
n
an
cy
in
ter
v
en
tio
n
s
ar
e
av
ailab
le,
m
an
y
m
o
th
er
s
s
till
f
ac
e
ch
allen
g
es
in
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
a
n
d
u
ter
in
e
r
ec
o
v
er
y
,
s
o
f
u
r
th
e
r
s
tu
d
ies ar
e
n
ee
d
ed
to
f
in
d
ef
f
e
ctiv
e
an
d
s
af
e
in
ter
v
en
tio
n
s
.
Pro
b
lem
s
th
at
ar
is
e
d
u
r
in
g
th
e
p
o
s
tp
ar
tu
m
p
er
io
d
a
r
e
lar
g
e
ly
in
f
lu
en
ce
d
b
y
t
h
e
h
o
r
m
o
n
e
s
p
r
o
lactin
an
d
o
x
y
to
cin
.
T
h
ese
two
h
o
r
m
o
n
es
ca
n
b
e
in
f
lu
en
ce
d
b
y
m
ater
n
al
f
ac
to
r
s
s
u
c
h
as
n
u
tr
itio
n
,
s
tr
ess
,
p
h
y
s
ical
co
n
d
itio
n
,
an
d
b
ab
y
f
ac
to
r
s
,
wh
ich
ar
e
ass
ess
ed
f
r
o
m
t
h
e
b
ab
y
'
s
ab
ilit
y
to
s
u
ck
[
7
]
.
Ox
y
to
cin
p
lay
s
a
c
en
tr
al
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Oxy
to
cin
ma
s
s
a
g
e
a
n
d
cla
r
y
s
a
g
e
a
r
o
ma
th
era
p
y
o
n
la
cta
tio
n
a
n
d
u
teri
n
e
…
(
R
a
h
ma
d
in
i F
a
r
ich
a
Ha
kim
)
429
r
o
le
in
v
ar
io
u
s
p
h
y
s
io
lo
g
ica
l
an
d
p
s
y
ch
o
s
o
cial
p
r
o
ce
s
s
es
in
th
e
p
er
in
atal
p
er
io
d
,
in
clu
d
in
g
ch
ild
b
ir
th
,
lacta
tio
n
,
b
o
n
d
in
g
b
etwe
en
m
o
th
er
an
d
b
ab
y
,
an
d
r
e
g
u
latio
n
o
f
m
ater
n
al
em
o
tio
n
al
r
esp
o
n
s
es
af
ter
ch
ild
b
ir
th
.
Ph
y
s
io
lo
g
ically
,
o
x
y
to
ci
n
tr
ig
g
er
s
u
ter
in
e
co
n
tr
ac
tio
n
s
d
u
r
i
n
g
lab
o
r
an
d
co
n
tr
ib
u
tes
to
th
e
r
eg
u
latio
n
o
f
t
h
e
m
ilk
ejec
tio
n
r
ef
lex
in
th
e
b
r
ea
s
tf
ee
d
in
g
p
r
o
ce
s
s
,
th
u
s
s
u
p
p
o
r
tin
g
th
e
s
u
cc
ess
o
f
lacta
tio
n
[
8
]
.
Fro
m
th
e
p
s
y
ch
o
s
o
cial
asp
ec
t,
in
cr
ea
s
e
d
o
x
y
t
o
cin
lev
els
ar
e
ass
o
ciate
d
with
s
tr
en
g
th
en
in
g
m
ater
n
al
-
in
f
an
t
b
o
n
d
i
n
g
th
r
o
u
g
h
n
e
u
r
o
h
o
r
m
o
n
al
m
ec
h
an
is
m
s
,
in
cr
ea
s
e
d
m
ater
n
al
attac
h
m
en
t,
an
d
m
o
d
u
latio
n
o
f
s
tr
ess
an
d
an
x
iety
r
esp
o
n
s
es
in
p
o
s
tp
ar
tu
m
m
o
th
er
s
.
Op
tim
al
o
x
y
to
cin
ac
tiv
ity
p
lay
s
a
r
o
le
in
im
p
r
o
v
in
g
m
at
er
n
al
p
s
y
ch
o
l
o
g
ical
well
-
b
ein
g
an
d
lo
wer
in
g
th
e
r
is
k
o
f
p
o
s
tp
ar
tu
m
m
o
o
d
d
is
o
r
d
er
s
,
in
clu
d
in
g
p
o
s
tp
ar
t
u
m
d
ep
r
ess
io
n
[
9
]
.
L
ik
ewise,
th
e
h
o
r
m
o
n
e
p
r
o
lactin
,
wh
ich
is
ess
en
tial
f
o
r
t
h
e
p
r
o
ce
s
s
o
f
lacto
g
en
esis
,
tr
ig
g
er
s
th
e
g
r
o
wth
an
d
d
if
f
er
en
tiatio
n
o
f
d
u
ctu
s
a
n
d
alv
eo
li
tis
s
u
es
o
f
th
e
m
am
m
a
r
y
g
lan
d
as
well
as
th
e
p
r
o
lif
er
atio
n
o
f
s
ec
r
eto
r
y
ep
ith
elial
ce
lls
r
esp
o
n
s
ib
le
f
o
r
th
e
s
y
n
th
esis
o
f
b
r
ea
s
t
m
ilk
[
1
0
]
.
Ox
y
to
cin
an
d
p
r
o
lactin
w
o
r
k
s
y
n
er
g
is
tically
in
s
u
p
p
o
r
tin
g
th
e
lacta
tio
n
p
r
o
ce
s
s
,
wh
er
e
th
e
s
y
n
t
h
esis
an
d
p
r
o
d
u
ctio
n
o
f
b
r
ea
s
t
m
ilk
ar
e
d
o
m
i
n
ated
b
y
p
r
o
lactin
,
wh
ile
o
x
y
t
o
cin
co
n
tr
ib
u
tes
to
th
e
m
ilk
ejec
tio
n
r
ef
lex
as
well
as
to
th
e
p
s
y
c
h
o
s
o
cial
asp
ec
ts
o
f
b
r
ea
s
tf
ee
d
in
g
.
T
h
e
co
o
r
d
in
ate
d
ac
tiv
ity
o
f
th
ese
h
o
r
m
o
n
es
s
u
p
p
o
r
ts
o
p
tim
al
lacta
tio
n
o
u
tc
o
m
es
an
d
en
h
an
ce
s
th
e
p
h
y
s
io
lo
g
ical
an
d
p
s
y
ch
o
l
o
g
ical
well
-
b
ein
g
o
f
th
e
m
o
th
e
r
in
th
e
p
o
s
tp
ar
tu
m
p
er
io
d
.
No
n
-
p
h
a
r
m
ac
o
lo
g
ical
ap
p
r
o
ac
h
es
ar
e
co
n
s
id
er
ed
s
af
er
alter
n
ativ
es
to
p
h
ar
m
ac
o
lo
g
ical
m
eth
o
d
s
f
o
r
in
cr
ea
s
in
g
b
r
ea
s
t
m
ilk
p
r
o
d
u
c
tio
n
,
as
th
ey
d
o
n
o
t
ca
u
s
e
h
ar
m
f
u
l
s
id
e
ef
f
ec
ts
f
o
r
th
e
m
o
th
er
o
r
in
f
a
n
t.
T
h
ese
m
eth
o
d
s
in
clu
d
e
th
e
u
s
e
o
f
h
er
b
s
,
ac
u
p
u
n
ctu
r
e
,
an
d
o
x
y
to
cin
m
ass
ag
e
[
1
1
]
,
[
1
2
]
.
Pre
v
i
o
u
s
s
tu
d
ies
in
d
icate
th
at
o
x
y
to
cin
m
ass
ag
e
in
cr
ea
s
es
cir
cu
latin
g
an
d
p
r
o
lactin
co
n
ce
n
tr
atio
n
,
co
n
tr
ib
u
tin
g
to
im
p
r
o
v
e
d
lacta
tio
n
in
p
o
s
tp
ar
tu
m
wo
m
e
n
[
1
3
]
,
[
1
4
]
.
Ox
y
to
cin
lev
els
in
cr
ea
s
ed
s
ig
n
if
ican
tly
am
o
n
g
p
ar
ticip
an
ts
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
[
1
4
]
.
I
n
a
d
d
itio
n
to
o
x
y
to
cin
m
ass
ag
e,
ar
o
m
at
h
er
a
p
y
h
as
also
b
ee
n
r
ep
o
r
ted
to
s
tim
u
late
o
x
y
to
cin
s
ec
r
etio
n
,
in
clu
d
in
g
lav
en
d
e
r
,
jasmin
e,
an
d
clar
y
s
ag
e
[
1
5
]
.
C
lar
y
s
ag
e
(
S
a
lvia
s
cla
r
ea
)
is
co
n
s
id
er
ed
s
af
e
f
o
r
b
o
th
m
o
th
er
a
n
d
in
f
an
t
an
d
h
as
b
ee
n
r
ep
o
r
t
ed
to
p
r
o
m
o
te
r
elax
atio
n
,
r
ed
u
ce
an
x
iety
,
an
d
s
tim
u
late
o
x
y
to
cin
r
elea
s
e
[
1
6
]
.
A
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
in
th
e
in
v
o
l
u
tio
n
p
r
o
ce
s
s
was
o
b
s
er
v
ed
c
o
m
p
ar
e
d
t
o
th
e
co
n
tr
o
l
g
r
o
u
p
(
p
=
0
.
0
0
2
)
,
in
d
icatin
g
s
tatis
tically
s
ig
n
if
ican
t
[
1
7
]
.
Po
s
tp
ar
tu
m
m
o
th
er
s
wh
o
r
ec
e
iv
ed
clar
y
s
ag
e
ar
o
m
ath
er
a
p
y
d
em
o
n
s
tr
ated
im
p
r
o
v
ed
m
o
o
d
an
d
h
ig
h
er
s
aliv
ar
y
o
x
y
to
cin
lev
els
co
m
p
ar
e
d
to
th
o
s
e
wh
o
d
id
n
o
t
r
ec
eiv
e
t
h
e
in
ter
v
en
tio
n
.
T
h
is
e
f
f
ec
t
m
a
y
b
e
attr
ib
u
te
d
to
th
e
a
ctiv
e
co
m
p
o
u
n
d
s
in
clar
y
s
ag
e,
s
u
ch
a
s
lin
alo
o
l
an
d
lin
aly
l
ac
etate
,
w
h
ich
ac
t o
n
t
h
e
lim
b
i
c
s
y
s
tem
an
d
h
y
p
o
th
alam
u
s
in
v
o
lv
ed
i
n
h
o
r
m
o
n
al
r
eg
u
latio
n
[
1
5
]
.
Ov
er
all,
s
cien
tific
ev
id
e
n
ce
s
u
g
g
ests
th
at
o
x
y
to
cin
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
ath
er
ap
y
ea
ch
h
a
v
e
b
en
ef
its
in
s
u
p
p
o
r
tin
g
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
an
d
u
ter
in
e
r
ec
o
v
er
y
.
Ho
wev
e
r
,
m
o
s
t
ex
is
tin
g
s
tu
d
ies
s
till
ev
alu
ate
th
e
two
i
n
ter
v
en
tio
n
s
s
ep
ar
ately
.
T
o
d
ate,
th
er
e
h
av
e
b
ee
n
n
o
s
tu
d
ies
th
at
h
av
e
s
y
s
tem
atica
lly
ex
am
in
ed
th
e
e
f
f
ec
ts
o
f
th
e
o
x
y
to
cin
m
ass
ag
e
co
m
b
in
atio
n
with
clar
y
s
ag
e
a
r
o
m
ath
er
a
p
y
o
n
lacta
tio
n
an
d
u
ter
in
e
r
ec
o
v
er
y
.
R
ec
o
g
n
izin
g
th
e
s
ig
n
if
ica
n
ce
o
f
im
p
r
o
v
in
g
m
ater
n
al
a
n
d
n
eo
n
atal
well
-
b
ein
g
in
th
e
p
o
s
tp
ar
tu
m
p
er
io
d
,
ef
f
o
r
ts
ar
e
n
ee
d
ed
to
s
tim
u
late
lacta
tio
n
an
d
ac
ce
ler
ate
u
ter
in
e
r
ec
o
v
e
r
y
d
u
r
in
g
th
is
p
er
io
d
;
th
e
r
ef
o
r
e
,
th
is
r
esear
ch
is
im
p
o
r
tan
t
to
c
o
n
d
u
ct
.
T
h
e
p
r
esen
t
s
tu
d
y
in
v
esti
g
ates
m
o
r
e
d
ee
p
ly
th
e
b
e
n
ef
its
o
f
clar
y
s
ag
e
ar
o
m
ath
er
a
p
y
as
an
ad
ju
n
ct
t
h
er
ap
y
to
o
x
y
to
cin
m
ass
ag
e
in
en
h
a
n
cin
g
lacta
tio
n
an
d
a
cc
eler
atin
g
u
te
r
in
e
in
v
o
lu
tio
n
,
wh
ich
is
m
ea
s
u
r
e
d
th
r
o
u
g
h
b
r
ea
s
t
m
ilk
p
r
o
d
u
c
tio
n
,
h
eig
h
t
o
f
th
e
f
u
n
d
u
s
u
ter
i,
an
d
d
u
r
atio
n
o
f
p
o
s
tp
ar
tu
m
b
leed
in
g
.
T
h
is
s
tu
d
y
c
o
n
tr
ib
u
tes
to
e
n
r
ich
in
g
th
e
s
cien
tific
ev
id
e
n
ce
b
y
ev
alu
atin
g
th
e
s
y
n
er
g
is
tic
p
o
ten
tial
o
f
t
h
e
co
m
b
in
atio
n
o
f
two
n
o
n
p
h
ar
m
ac
o
l
o
g
ical
i
n
ter
v
en
tio
n
s
,
n
am
ely
o
x
y
to
ci
n
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
ath
e
r
ap
y
,
in
p
o
s
tp
a
r
tu
m
o
b
s
tetr
ic
ca
r
e,
p
ar
ticu
la
r
ly
r
elate
d
to
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
a
n
d
u
ter
in
e
r
ec
o
v
er
y
.
B
y
em
p
h
asizin
g
s
af
e,
ea
s
y
-
to
-
im
p
lem
e
n
t
,
an
d
l
o
w
-
co
s
t
in
ter
v
en
tio
n
s
,
th
e
r
ese
ar
ch
is
ex
p
ec
ted
to
s
tr
en
g
th
en
in
itiativ
es
to
im
p
r
o
v
e
m
ater
n
al
an
d
in
f
an
t
h
ea
lth
,
p
ar
ticu
l
ar
ly
in
lo
wer
in
g
m
ater
n
al
m
o
r
tality
r
ates
an
d
im
p
r
o
v
in
g
th
e
s
tan
d
ar
d
o
f
m
ater
n
al
an
d
n
eo
n
atal
h
ea
lth
s
er
v
ices.
2
.
M
E
T
H
O
D
A
to
tal
o
f
3
0
p
a
r
ticip
an
ts
in
th
is
s
tu
d
y
wer
e
allo
ca
ted
in
t
o
a
co
n
tr
o
l g
r
o
u
p
an
d
an
in
ter
v
e
n
tio
n
g
r
o
u
p
.
A
p
o
wer
an
aly
s
is
was
co
n
d
u
ct
ed
to
d
eter
m
in
e
th
e
r
eq
u
i
r
ed
s
am
p
le
s
ize,
with
a
s
ig
n
if
ican
ce
lev
el
(
)
o
f
0
.
0
5
,
s
tatis
t
ical
p
o
wer
o
f
8
0
%,
an
d
an
esti
m
ate
o
f
th
e
m
ag
n
itu
d
e
o
f
th
e
m
ed
iu
m
ef
f
ec
t
(
C
o
h
e
n
'
s
d
=
0
.
5
)
,
wh
ich
in
d
icate
d
th
at
a
m
in
im
u
m
o
f
2
7
p
ar
ticip
an
ts
was
r
eq
u
ir
ed
.
T
o
an
ticip
ate
th
e
p
o
s
s
ib
ilit
y
o
f
lo
s
in
g
s
u
b
jects,
th
e
f
in
al
s
am
p
le
co
m
p
r
is
ed
3
0
p
ar
ticip
an
ts
.
I
n
itial
d
ata
co
llectio
n
was
ca
r
r
ied
o
u
t
b
y
m
ea
s
u
r
in
g
b
r
ea
s
t
m
il
k
v
o
lu
m
e
o
n
p
o
s
tp
ar
t
u
m
d
ay
tw
o
.
Po
s
t
-
in
ter
v
e
n
tio
n
d
ata
co
lle
ctio
n
was
co
n
d
u
cted
o
n
d
a
y
1
0
.
Af
ter
th
e
m
o
t
h
e
r
r
ec
eiv
ed
o
x
y
to
cin
m
ass
ag
e
f
o
r
1
0
c
o
n
s
ec
u
tiv
e
d
a
y
s
,
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
,
d
ata
wer
e
co
llected
af
ter
th
e
m
o
th
er
r
ec
eiv
ed
an
in
ter
v
e
n
tio
n
.
I
B
M
SP
SS
Stati
s
tics
v
er
s
io
n
2
7
was
u
s
ed
to
co
n
d
u
ct
s
tatis
t
ical
an
aly
s
is
.
B
r
ea
s
t
m
ilk
(
m
l)
an
d
h
eig
h
t
o
f
th
e
f
u
n
d
u
s
u
ter
i
(
cm
)
wer
e
a
n
aly
ze
d
u
s
in
g
a
p
air
e
d
t
-
test
o
r
W
ilco
x
o
n
Sig
n
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R
an
k
T
est
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ch
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n
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o
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ased
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p
o
s
t
-
p
r
e
-
d
if
f
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e
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ce
s
.
T
h
e
o
r
d
in
al
v
a
r
iab
le,
n
am
el
y
lo
ch
ia,
was a
n
aly
ze
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u
s
in
g
th
e
W
ilco
x
o
n
Sig
n
ed
-
R
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k
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ch
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o
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o
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p
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d
th
e
Ma
n
n
-
W
h
itn
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T
est
f
o
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
2
8
-
4
3
6
430
co
m
p
ar
is
o
n
b
etwe
en
g
r
o
u
p
s
.
Uter
in
e
r
ec
o
v
er
y
was
m
ea
s
u
r
ed
o
n
ly
o
n
ce
,
n
am
ely
,
a
c
o
m
p
ar
is
o
n
b
etwe
en
g
r
o
u
p
s
u
s
in
g
th
e
Ma
n
n
-
W
h
itn
ey
U
T
est.
T
h
e
r
esu
lts
a
r
e
p
r
es
en
ted
as
m
ea
n
±
SD
f
o
r
q
u
an
titativ
e
d
ata
o
r
m
ed
ian
f
o
r
o
r
d
in
al
d
ata,
with
p
<
0
.
0
5
as th
e
s
ig
n
if
ican
ce
b
o
u
n
d
ar
y
.
3
.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Cha
ra
c
t
er
is
t
ics o
f
pa
rt
i
cipa
nts
T
wo
d
if
f
er
e
n
t
n
o
n
-
p
h
a
r
m
ac
o
l
o
g
ical
m
eth
o
d
s
ar
e
u
s
ed
in
t
h
is
s
tu
d
y
:
clar
y
s
ag
e
ar
o
m
at
h
er
ap
y
an
d
o
x
y
to
cin
m
ass
ag
e.
T
h
ese
m
eth
o
d
s
ar
e
u
s
ed
to
s
tim
u
late
lacta
tio
n
an
d
ac
ce
ler
at
e
u
ter
in
e
r
ec
o
v
er
y
.
T
h
e
in
ter
v
en
tio
n
g
r
o
u
p
r
ec
eiv
ed
b
o
th
o
x
y
to
cin
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
ath
er
ap
y
v
ia
a
d
if
f
u
s
er
,
wh
ile
th
e
co
n
tr
o
l
g
r
o
u
p
r
ec
ei
v
ed
o
n
ly
o
x
y
t
o
cin
m
ass
ag
e.
T
h
e
p
ar
ticip
an
ts
’
ch
ar
ac
ter
is
tics
in
th
is
s
tu
d
y
ar
e
p
r
esen
ted
i
n
T
ab
le
1
.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
p
ar
ticip
an
ts
No
Q
u
e
st
i
o
n
i
t
e
ms
C
o
n
t
r
o
l
(n
=
1
5
)
I
n
t
e
r
v
e
n
t
i
o
n
(n
=
1
5
)
F
%
F
%
1.
M
o
t
h
e
r
's
a
g
e
20
-
3
5
y
e
a
r
s
o
l
d
13
8
6
.
7
15
1
0
0
>
3
5
y
e
a
r
s o
l
d
2
1
3
.
3
0
0
2.
P
a
r
i
t
a
s
P
r
i
mi
p
a
r
a
6
4
0
.
0
4
2
6
.
7
M
u
l
t
i
p
a
r
a
9
6
0
.
0
11
7
3
.
3
3.
M
o
t
h
e
r
's w
o
r
k
N
o
t
w
o
r
k
i
n
g
10
6
6
.
7
12
80
W
o
r
k
5
3
3
.
3
3
20
4.
Ed
u
c
a
t
i
o
n
El
e
m
e
n
t
a
r
y
s
c
h
o
o
l
2
1
3
.
3
0
0
Ju
n
i
o
r
h
i
g
h
sc
h
o
o
l
1
6
.
7
0
0
S
e
n
i
o
r
h
i
g
h
s
c
h
o
o
l
7
4
6
.
7
11
7
3
.
3
C
o
l
l
e
g
e
5
3
3
.
3
4
2
6
.
7
B
ased
o
n
p
ar
ticip
an
ts
’
ch
ar
a
cter
is
tics
d
ata,
m
o
s
t
m
o
th
er
s
ar
e
in
th
e
ag
e
g
r
o
u
p
o
f
2
0
–
3
5
y
ea
r
s
(
8
6
.
7
%),
wh
ile
all
p
ar
ticip
an
ts
in
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
wer
e
with
in
th
e
s
am
e
ag
e
r
a
n
g
e
(
1
0
0
%).
I
n
ter
m
s
o
f
p
ar
ity
,
th
e
co
n
tr
o
l
g
r
o
u
p
was
p
r
ed
o
m
in
an
tly
m
u
ltip
ar
o
u
s
(
6
0
.
0
%),
a
n
d
th
e
i
n
ter
v
en
ti
o
n
g
r
o
u
p
was
als
o
d
o
m
in
ated
b
y
m
u
ltip
a
r
o
u
s
m
o
th
er
s
(
7
3
.
3
%).
R
eg
ar
d
in
g
o
c
cu
p
atio
n
,
m
o
s
t
m
o
th
er
s
in
b
o
th
g
r
o
u
p
s
wer
e
n
o
t
wo
r
k
in
g
.
B
ased
o
n
ed
u
ca
tio
n
l
ev
el,
b
o
th
g
r
o
u
p
s
wer
e
d
o
m
in
ated
b
y
h
ig
h
s
ch
o
o
l e
d
u
ca
tio
n
lev
el,
4
6
.
7
% o
f
th
e
co
n
tr
o
l
g
r
o
u
p
,
7
3
.
3
%
o
f
th
e
in
ter
v
en
tio
n
g
r
o
u
p
,
f
o
llo
wed
b
y
co
lleg
e
-
le
v
el
ed
u
ca
tio
n
in
th
e
co
n
tr
o
l
g
r
o
u
p
(
3
3
.
3
%)
a
n
d
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
(
2
6
.
7
%).
3
.
2
.
B
re
a
s
t
m
ilk
pro
du
ct
io
n
in po
s
t
pa
rt
um
m
o
t
hers
B
ased
o
n
T
ab
le
2
,
b
r
ea
s
t
m
il
k
p
r
o
d
u
ctio
n
in
cr
ea
s
ed
in
b
o
t
h
g
r
o
u
p
s
af
ter
t
h
e
in
ter
v
e
n
tio
n
,
with
a
m
ea
n
ch
an
g
e
(
Δ
)
o
f
7
3
.
3
3
±
1
7
.
2
9
m
l
in
th
e
c
o
n
tr
o
l
g
r
o
u
p
an
d
6
1
.
3
3
±
3
6
.
6
2
m
l
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
.
W
ith
in
ea
ch
g
r
o
u
p
,
th
e
p
air
ed
t
-
test
in
d
icate
s
a
s
tat
is
tic
ally
s
ig
n
if
ican
t
in
cr
ea
s
e
(
p
<
0
.
0
0
1
)
.
T
h
e
m
ea
n
ch
an
g
es
b
etwe
en
g
r
o
u
p
s
wer
e
co
m
p
ar
ed
u
s
in
g
a
n
in
d
ep
en
d
en
t
t
-
test
.
T
h
er
e
was
n
o
s
tat
is
tically
s
ig
n
if
i
ca
n
t
d
if
f
er
en
ce
in
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
b
etwe
e
n
th
e
co
n
tr
o
l
an
d
in
ter
v
e
n
tio
n
g
r
o
u
p
(
p
=
0
.
2
6
5
)
.
Alth
o
u
g
h
b
o
th
g
r
o
u
p
s
ex
p
e
r
ien
ce
d
s
ig
n
if
ic
an
t
in
tr
ag
r
o
u
p
im
p
r
o
v
em
en
t
s
,
th
e
m
a
g
n
itu
d
e
o
f
in
c
r
ea
s
e
d
id
n
o
t
d
if
f
er
s
ig
n
if
ican
tly
b
etwe
en
g
r
o
u
p
s
.
T
h
ese
f
in
d
in
g
s
s
u
g
g
est
th
at
o
x
y
to
cin
m
ass
ag
e
co
m
b
in
e
d
with
clar
y
s
ag
e
ar
o
m
ath
er
a
p
y
d
i
d
n
o
t
p
r
o
d
u
ce
a
g
r
ea
ter
ef
f
ec
t th
an
th
e
in
ter
v
en
tio
n
ad
m
i
n
is
ter
ed
in
th
e
c
o
n
tr
o
l g
r
o
u
p
.
Ox
y
to
cin
m
ass
ag
e
h
as
b
ee
n
s
h
o
wn
to
p
r
o
m
o
te
o
x
y
to
cin
r
ele
ase,
h
en
ce
en
h
an
cin
g
m
ilk
p
r
o
d
u
ctio
n
i
n
b
r
e
astfe
ed
in
g
m
o
th
er
s
.
I
n
t
h
e
p
r
esen
t
s
tu
d
y
,
b
r
ea
s
t
m
ilk
v
o
lu
m
e
in
c
r
ea
s
es
s
ig
n
if
ican
tly
af
ter
th
e
ad
m
in
is
tr
atio
n
o
f
o
x
y
to
cin
m
a
s
s
ag
e
co
m
p
ar
ed
to
b
aselin
e.
T
h
ese
f
in
d
in
g
s
ar
e
i
n
lin
e
with
ea
r
lier
r
esear
ch
th
at
th
e
co
m
b
in
atio
n
o
f
o
x
y
to
cin
m
ass
ag
e
an
d
b
r
ea
s
t
ca
r
e
s
ig
n
if
ican
tly
im
p
r
o
v
es
b
r
ea
s
t
m
il
k
p
r
o
d
u
ctio
n
.
T
h
e
im
p
r
o
v
em
e
n
t
was
r
ef
lecte
d
i
n
in
cr
ea
s
ed
b
r
ea
s
tf
ee
d
i
n
g
f
r
e
q
u
en
cy
a
n
d
lo
n
g
er
b
r
ea
s
tf
ee
d
in
g
d
u
r
atio
n
,
with
s
tatis
t
ically
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
(
p
<
0
.
0
5
)
.
T
h
e
r
esu
lts
r
ein
f
o
r
ce
th
e
e
v
id
en
ce
t
h
at
n
o
n
-
p
h
ar
m
a
co
lo
g
ical
in
ter
v
en
tio
n
s
,
p
a
r
ticu
lar
ly
o
x
y
to
cin
m
ass
ag
e
co
m
b
in
e
d
with
b
r
ea
s
t
ca
r
e,
co
n
tr
i
b
u
ted
p
o
s
itiv
ely
to
lacta
tio
n
th
r
o
u
g
h
th
e
p
h
y
s
io
lo
g
ical
m
ec
h
an
is
m
o
f
o
x
y
to
ci
n
r
elea
s
e
[
1
8
]
.
Pre
v
io
u
s
r
esear
ch
r
ep
o
r
ted
th
at
o
x
y
to
ci
n
m
ass
ag
e
s
ig
n
if
ica
n
tly
in
cr
ea
s
ed
b
r
e
ast
m
ilk
p
r
o
d
u
ctio
n
,
as
ass
es
s
ed
b
y
in
f
an
t
weig
h
t,
b
r
ea
s
tf
ee
d
in
g
f
r
eq
u
e
n
cy
,
an
d
d
u
r
atio
n
.
Po
s
t
-
in
ter
v
en
tio
n
r
es
u
lts
s
h
o
wed
th
at
1
8
m
o
th
er
s
wh
o
r
ec
eiv
ed
o
x
y
to
c
in
m
ass
ag
e
ex
p
er
ien
ce
d
im
p
r
o
v
em
en
t
in
m
ilk
p
r
o
d
u
ctio
n
f
r
o
m
in
s
u
f
f
icien
t
to
ad
eq
u
ate
lev
els,
with
a
s
tatis
tically
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
(
p
=
0
.
0
1
6
)
[
1
9
]
.
Ph
y
s
io
lo
g
ica
lly
,
lacta
tio
n
o
cc
u
r
s
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Oxy
to
cin
ma
s
s
a
g
e
a
n
d
cla
r
y
s
a
g
e
a
r
o
ma
th
era
p
y
o
n
la
cta
tio
n
a
n
d
u
teri
n
e
…
(
R
a
h
ma
d
in
i F
a
r
ich
a
Ha
kim
)
431
th
r
o
u
g
h
two
m
ain
s
tag
es:
m
il
k
p
r
o
d
u
ctio
n
a
n
d
m
ilk
ejec
tio
n
.
Pro
lactin
p
lay
s
a
ce
n
t
r
al
r
o
l
e
in
m
ilk
s
y
n
th
esis
,
wh
er
ea
s
o
x
y
to
cin
is
r
esp
o
n
s
ib
le
f
o
r
th
e
m
ilk
ejec
tio
n
r
ef
lex
[
1
9
]
.
Ox
y
t
o
cin
r
elea
s
e
ca
n
b
e
s
tim
u
lated
th
r
o
u
g
h
n
ip
p
le
s
tim
u
latio
n
d
u
r
in
g
b
r
e
astfe
ed
in
g
o
r
th
r
o
u
g
h
b
ac
k
m
ass
ag
e.
T
h
ese
f
in
d
in
g
s
s
u
p
p
o
r
t
th
e
th
e
o
r
y
th
at
o
x
y
to
cin
m
ass
ag
e
p
r
o
m
o
tes
m
ater
n
al
r
ela
x
atio
n
,
r
ed
u
ce
s
an
x
iety
,
an
d
e
n
h
an
ce
s
m
o
t
h
er
-
in
f
a
n
t
b
o
n
d
i
n
g
,
th
er
eb
y
f
ac
ilit
atin
g
o
x
y
to
cin
r
elea
s
e
an
d
im
p
r
o
v
in
g
m
ilk
ejec
tio
n
.
I
n
th
is
s
tu
d
y
,
o
x
y
t
o
cin
m
ass
ag
e
was
s
h
o
wn
to
h
av
e
a
p
o
s
itiv
e
im
p
ac
t o
n
b
r
ea
s
tf
ee
d
in
g
o
u
tco
m
es
[2
0
].
Ho
wev
er
,
th
e
f
in
d
in
g
s
o
f
t
h
e
p
r
esen
t
s
tu
d
y
d
if
f
e
r
f
r
o
m
p
r
e
v
io
u
s
r
esear
c
h
,
wh
ic
h
r
ep
o
r
ted
a
s
tatis
t
ically
s
ig
n
if
ican
t
ef
f
ec
t
o
f
co
m
b
in
ed
o
x
y
to
c
in
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
ath
er
ap
y
o
n
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
.
I
n
s
ev
er
al
r
a
n
d
o
m
ized
co
n
t
r
o
lled
tr
ials
(
R
C
T
s
)
,
p
h
y
s
ical
in
ter
v
en
tio
n
s
s
u
c
h
as
m
ass
ag
e
wer
e
ex
clu
d
ed
f
r
o
m
th
e
m
ain
an
aly
s
is
d
u
e
to
s
tr
ict
d
esig
n
cr
iter
ia,
lim
itin
g
th
e
av
ailab
ilit
y
o
f
h
i
g
h
-
q
u
ality
ev
id
e
n
ce
d
ir
ec
tly
ev
alu
atin
g
th
e
ef
f
ec
tiv
en
ess
o
f
o
x
y
to
ci
n
m
ass
ag
e.
Alth
o
u
g
h
o
x
y
to
cin
m
ass
ag
e
th
eo
r
etica
lly
f
ac
ilit
ates
o
x
y
to
cin
r
elea
s
e
th
r
o
u
g
h
p
a
r
asy
m
p
ath
etic
s
tim
u
latio
n
a
n
d
r
elax
atio
n
m
ec
h
a
n
is
m
s
,
r
o
b
u
s
t
R
C
T
-
b
ased
em
p
ir
ical
ev
id
en
ce
s
u
p
p
o
r
tin
g
it
s
d
ir
ec
t
ef
f
ec
t
o
n
m
ilk
p
r
o
d
u
ctio
n
r
em
ain
s
lim
ited
.
T
h
er
ef
o
r
e,
th
e
a
b
s
en
ce
o
f
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
o
b
s
er
v
ed
in
th
is
s
tu
d
y
m
ay
n
o
t
s
o
lely
r
ef
lect
a
lack
o
f
ef
f
ec
tiv
en
ess
o
f
th
e
in
ter
v
en
tio
n
b
u
t
m
a
y
also
in
d
icate
m
eth
o
d
o
lo
g
ical
g
ap
s
in
p
r
ev
io
u
s
r
esear
c
h
,
in
clu
d
in
g
v
ar
iatio
n
s
in
s
tu
d
y
d
esig
n
,
s
m
all
s
am
p
le
s
izes,
an
d
lim
itatio
n
s
in
o
b
jectiv
e
m
ea
s
u
r
em
en
t
o
f
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
[
2
1
]
.
C
o
m
p
ar
ab
le
r
esu
lts
h
av
e
b
ee
n
d
o
c
u
m
en
ted
i
n
p
r
e
v
io
u
s
s
tu
d
ies,
in
d
icatin
g
n
o
s
ig
n
if
ican
t
d
if
f
er
en
c
e
in
m
ilk
p
r
o
d
u
ctio
n
b
etwe
en
t
h
e
two
g
r
o
u
p
s
r
ec
eiv
in
g
a
co
m
b
in
atio
n
o
f
o
x
y
to
cin
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
ath
er
a
p
y
.
Sev
er
al
f
ac
to
r
s
m
ay
ex
p
lain
th
ese
r
esu
lts
.
T
h
e
in
h
alatio
n
p
r
o
ce
s
s
o
f
ar
o
m
a
th
er
ap
y
is
d
if
f
ic
u
lt
to
s
tan
d
ar
d
ize
an
d
f
u
lly
co
n
tr
o
l
d
u
r
in
g
in
ter
v
en
tio
n
.
I
n
ad
d
itio
n
,
b
r
ea
s
t
m
ilk
v
o
l
u
m
e
in
th
is
s
tu
d
y
was
m
ea
s
u
r
ed
in
a
s
in
g
le
s
ess
io
n
,
wh
ich
m
ay
n
o
t
ad
eq
u
ately
r
ef
l
ec
t
p
h
y
s
io
lo
g
ical
f
lu
ctu
atio
n
s
in
m
ilk
p
r
o
d
u
ctio
n
.
Fu
r
th
er
m
o
r
e
,
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
was
ass
es
s
ed
s
o
lely
b
ased
o
n
ex
p
r
ess
ed
m
ilk
v
o
l
u
m
e
u
s
in
g
a
b
r
ea
s
t
p
u
m
p
an
d
m
ea
s
u
r
in
g
cu
p
.
A
m
o
r
e
co
m
p
r
e
h
en
s
iv
e
ass
ess
m
en
t
s
h
o
u
ld
in
co
r
p
o
r
ate
a
d
d
itio
n
al
in
d
icato
r
s
,
s
u
c
h
as
b
r
ea
s
tf
ee
d
in
g
f
r
e
q
u
en
c
y
,
i
n
f
an
t
u
r
i
n
atio
n
f
r
e
q
u
en
cy
,
an
d
in
f
an
t
weig
h
t
g
ain
.
Ma
ter
n
al
f
ac
to
r
s
,
in
clu
d
in
g
f
atig
u
e
an
d
p
s
y
ch
o
lo
g
ical
s
tr
ess
d
u
r
in
g
th
e
p
o
s
tp
ar
tu
m
p
e
r
io
d
,
m
ay
also
in
f
lu
en
ce
lact
atio
n
o
u
tco
m
es
an
d
p
o
ten
tially
r
ed
u
ce
th
e
m
ea
s
u
r
a
b
le
ef
f
ec
t o
f
clar
y
s
ag
e
a
r
o
m
at
h
er
ap
y
i
n
th
e
in
ter
v
en
tio
n
g
r
o
u
p
.
C
lar
y
s
ag
e
(
S
a
lvia
s
cla
r
ea
)
h
as
an
x
io
ly
tic
an
d
an
tis
p
asm
o
d
ic
p
r
o
p
e
r
ties
th
at
h
av
e
th
e
p
o
ten
tial
to
af
f
ec
t
th
e
b
alan
ce
o
f
th
e
au
t
o
n
o
m
ic
n
er
v
o
u
s
s
y
s
tem
as
wel
l
as
h
o
r
m
o
n
al
r
e
g
u
latio
n
,
in
cl
u
d
in
g
o
x
y
to
cin
an
d
p
r
o
lactin
.
Ho
wev
er
,
em
p
ir
ica
l
ev
id
en
ce
r
eg
ar
d
in
g
th
e
e
f
f
i
ca
cy
o
f
clar
y
s
ag
e
ar
o
m
ath
e
r
ap
y
in
in
cr
ea
s
in
g
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
an
d
u
t
er
in
e
r
ec
o
v
er
y
r
em
ain
s
in
co
n
s
is
ten
t.
Sev
er
al
s
tu
d
ies
r
ep
o
r
t
s
ig
n
if
ican
t
b
en
ef
its
o
n
r
elax
atio
n
an
d
p
h
y
s
ical
an
d
p
s
y
c
h
o
lo
g
ical
co
m
f
o
r
t
o
f
p
o
s
tp
ar
tu
m
m
o
t
h
er
s
,
b
u
t
s
p
ec
if
ic
r
esear
ch
o
n
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
o
r
u
ter
in
e
in
v
o
lu
tio
n
is
s
till
m
in
im
al
an
d
in
c
o
n
clu
s
iv
e
[2
2
].
Ar
o
m
ath
er
ap
y
ca
n
s
u
p
p
o
r
t
th
e
p
h
y
s
ical
an
d
p
s
y
ch
o
lo
g
ical
co
m
f
o
r
t
o
f
p
o
s
tp
ar
tu
m
m
o
th
e
r
s
,
s
u
ch
as
an
x
iety
,
m
o
o
d
,
a
n
d
s
tr
ess
d
is
o
r
d
er
s
[
2
3
]
.
I
n
clin
ical
p
r
ac
tice
in
J
ap
an
,
f
o
o
t
b
ath
s
as
a
m
eth
o
d
o
f
lab
o
r
s
tim
u
latio
n
ar
e
ap
p
lied
u
s
in
g
clar
y
s
ag
e
an
d
lav
e
n
d
er
o
ils
.
T
h
e
u
s
e
o
f
a
c
o
m
b
in
atio
n
o
f
clar
y
s
ag
e
an
d
lav
en
d
er
o
ils
is
th
o
u
g
h
t
to
s
u
p
p
o
r
t
in
cr
ea
s
ed
o
x
y
to
cin
lev
els
th
r
o
u
g
h
a
m
ec
h
an
is
m
o
f
d
ec
r
ea
s
in
g
th
e
o
x
y
to
cin
r
elea
s
e
b
ar
r
ier
d
u
e
to
s
tr
ess
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
r
ese
ar
ch
,
wh
ic
h
s
h
o
wed
th
at
in
h
a
latio
n
o
f
clar
y
s
ag
e
o
il
ca
n
r
ed
u
ce
an
x
iety
a
n
d
s
tr
e
s
s
th
r
o
u
g
h
m
o
d
u
latio
n
o
f
th
e
au
to
n
o
m
ic
n
e
r
v
o
u
s
s
y
s
tem
,
b
u
t
th
e
ef
f
ec
ts
o
n
lacta
tio
n
h
o
r
m
o
n
es
an
d
th
e
ac
ce
ler
atio
n
o
f
u
ter
in
e
in
v
o
lu
tio
n
u
s
in
g
clar
y
s
ag
e
in
p
o
s
tp
ar
tu
m
m
o
th
er
s
ar
e
s
till
in
ad
eq
u
ate
an
d
r
eq
u
ir
e
f
u
r
th
er
r
esear
ch
[
2
4
].
T
ab
le
2
.
E
f
f
ec
t o
f
t
h
e
co
m
b
in
a
tio
n
o
f
o
x
y
to
ci
n
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
at
h
er
ap
y
o
n
b
r
ea
s
t m
ilk
p
r
o
d
u
ctio
n
in
p
o
s
tp
ar
tu
m
m
o
t
h
er
s
V
a
r
i
a
b
e
l
G
r
o
u
p
s
Pre
-
t
e
st
(
M
e
a
n
±
S
D
)
P
o
st
-
t
e
st
(
M
e
a
n
±
S
D
)
Δ (
P
re
-
p
o
st
)
(
M
e
a
n
±
S
D
)
p
-
v
a
l
u
e
(
In
a
g
r
o
u
p
)
p
-
v
a
l
u
e
(
i
n
t
e
r
g
r
o
u
p
)
B
r
e
a
s
t
m
i
l
k
(
m
l
)
C
o
n
t
r
o
l
3
2
.
0
0
±
1
4
.
7
4
1
0
5
.
3
3
±
1
8
.
0
7
7
3
.
3
3
±
1
7
.
2
9
<
0
.
0
0
1
0
.
2
6
5
I
n
t
e
r
v
e
n
t
i
o
n
3
7
.
0
0
±
2
4
.
0
4
9
8
.
3
3
±
4
0
.
3
9
6
1
.
3
3
±
3
6
.
6
2
<
0
.
0
0
1
3
.
3
.
H
eig
ht
o
f
t
he
ute
rine
f
un
du
s
o
f
t
he
po
s
t
pa
rt
um
m
o
t
hers
B
ased
o
n
T
ab
le
3
,
f
o
r
th
e
h
eig
h
t
o
f
th
e
u
ter
in
e
f
u
n
d
u
s
,
t
h
e
m
ea
n
d
ec
r
ea
s
ed
f
r
o
m
1
2
.
9
3
±
2
.
2
5
cm
to
0
.
0
0
±
0
.
0
0
c
m
in
th
e
co
n
tr
o
l
g
r
o
u
p
a
n
d
f
r
o
m
1
5
.
0
7
±
1
.
6
7
cm
to
0
.
0
0
±
0
.
0
0
cm
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
,
with
Δ
ea
ch
s
ig
n
if
ican
t
ac
co
r
d
in
g
to
W
ilco
x
o
n
(
p
<
0
.
0
0
1
)
.
T
h
e
Ma
n
n
-
W
h
itn
ey
U
test
r
e
v
ea
led
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
in
th
e
r
ed
u
ctio
n
o
f
u
ter
in
e
f
u
n
d
al
h
ei
g
h
t
b
etwe
en
th
e
g
r
o
u
p
s
(
p
=
0
.
0
0
3
)
,
in
d
icatin
g
th
at
th
e
in
ter
v
en
tio
n
g
r
o
u
p
e
x
p
er
ien
ce
d
u
ter
in
e
in
v
o
lu
tio
n
f
aster
th
a
n
th
e
co
n
tr
o
l g
r
o
u
p
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
r
esear
ch
th
at
in
m
o
th
er
s
wh
o
wer
e
g
iv
en
o
x
y
to
cin
m
ass
ag
e,
th
er
e
was a
v
er
y
r
ap
id
an
d
n
o
r
m
al
d
ec
r
ea
s
e
in
u
ter
in
e
f
u
n
d
u
s
h
eig
h
t
[
25
].
Acc
o
r
d
in
g
to
th
e
th
eo
r
y
,
th
e
p
r
o
ce
s
s
o
f
u
ter
i
n
e
in
v
o
lu
tio
n
,
o
r
th
e
r
et
u
r
n
o
f
th
e
s
ize
o
f
t
h
e
u
ter
u
s
to
its
o
r
ig
in
al
s
ize,
o
cc
u
r
s
in
th
e
r
ep
r
o
d
u
ctiv
e
s
y
s
tem
o
f
th
e
p
o
s
t
-
ca
lcin
ed
m
o
th
e
r
with
a
weig
h
t
o
f
ab
o
u
t
6
0
g
r
am
s
.
H
o
wev
er
,
o
f
ten
th
is
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
2
8
-
4
3
6
432
p
r
o
ce
s
s
d
o
es
n
o
t
r
u
n
o
p
tim
all
y
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
s
u
p
p
o
r
t
th
e
th
eo
r
y
th
at
o
n
th
e
7
th
d
ay
,
th
e
h
eig
h
t
o
f
th
e
u
ter
in
e
f
u
n
d
u
s
is
u
s
u
ally
5
cm
f
r
o
m
t
h
e
u
p
p
er
ed
g
e
o
f
th
e
s
y
m
p
h
y
s
is
o
r
th
e
m
id
d
le
o
f
th
e
s
y
m
p
h
y
s
is
ce
n
ter
,
an
d
o
n
th
e
1
4
th
d
ay
,
t
h
e
h
eig
h
t o
f
th
e
u
ter
in
e
f
u
n
d
u
s
is
d
if
f
icu
lt
to
p
al
p
ate
[
26
].
T
h
e
ac
ce
ler
atio
n
o
f
th
e
d
ec
r
ea
s
e
in
th
e
s
ize
o
f
th
e
u
ter
in
e
f
u
n
d
u
s
o
cc
u
r
s
d
u
e
to
th
e
r
esp
o
n
s
e
o
f
o
x
y
t
o
cin
m
ass
ag
e
g
iv
en
to
th
e
m
o
t
h
er
.
T
h
e
p
ar
t
o
f
t
h
e
h
y
p
o
th
alam
u
s
,
n
am
ely
th
e
an
ter
i
o
r
a
n
d
p
o
s
ter
io
r
p
itu
itar
y
,
s
tim
u
lates
th
e
p
r
o
d
u
ctio
n
o
f
t
h
e
h
o
r
m
o
n
e
o
x
y
to
cin
t
h
r
o
u
g
h
t
h
e
ad
m
in
is
tr
atio
n
o
f
o
x
y
t
o
cin
m
ass
ag
e
s
o
th
at
th
e
h
o
r
m
o
n
e
o
x
y
to
cin
will
tr
ig
g
er
th
e
co
n
tr
ac
tio
n
o
f
s
m
o
o
th
m
u
s
cles in
th
e
u
ter
u
s
,
wh
ich
is
k
n
o
wn
as th
e
u
ter
in
e
in
v
o
l
u
tio
n
p
r
o
ce
s
s
[
25
]
,
[
27
].
T
ab
le
3
.
E
f
f
ec
t o
f
t
h
e
co
m
b
in
a
tio
n
o
f
o
x
y
to
ci
n
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
at
h
er
ap
y
o
n
th
e
h
eig
h
t o
f
th
e
u
ter
in
e
f
u
n
d
u
s
o
f
th
e
p
o
s
tp
ar
tu
m
m
o
th
er
s
V
a
r
i
a
b
e
l
G
r
o
u
p
s
Pre
-
t
e
st
(
M
e
a
n
±
S
D
)
P
o
st
-
t
e
st
(
M
e
a
n
±
S
D
)
Δ (
P
re
-
p
o
st
)
(
M
e
a
n
±
S
D
)
p
-
v
a
l
u
e
(
In
a
g
r
o
u
p
)
p
-
v
a
l
u
e
(
i
n
t
e
r
g
r
o
u
p
)
H
e
i
g
h
t
o
f
t
h
e
u
t
e
r
i
n
e
f
u
n
d
u
s (cm)
C
o
n
t
r
o
l
1
2
.
9
3
±
2
.
2
5
0
.
0
0
±
0
.
0
0
1
2
.
9
3
±
2
.
2
5
<
0
.
0
0
1
0
.
0
0
3
I
n
t
e
r
v
e
n
t
i
o
n
1
5
.
0
7
±
1
.
6
7
0
.
0
0
±
0
.
0
0
1
5
.
0
7
±
1
.
6
7
<
0
.
0
0
1
3
.
4
.
L
o
chia
in po
s
t
pa
rt
um
m
o
t
hers
B
ased
o
n
T
ab
le
4
,
l
o
ch
ia
in
b
o
th
g
r
o
u
p
s
im
p
r
o
v
ed
a
f
ter
th
e
in
ter
v
en
tio
n
,
with
an
a
v
er
ag
e
o
f
0
.
4
0
±
0
.
5
1
to
2
.
0
7
±
0
.
2
6
in
th
e
c
o
n
tr
o
l
g
r
o
u
p
an
d
0
.
2
7
±
0
.
4
6
to
2
.
4
0
±
0
.
5
1
in
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
.
T
h
e
r
esu
lts
o
f
th
e
W
ilco
x
o
n
test
s
h
o
wed
s
ig
n
if
ican
t
im
p
r
o
v
e
m
en
t
in
ea
ch
g
r
o
u
p
(
p
<
0
.
0
0
1
in
th
e
c
o
n
tr
o
l;
p
=
0
.
0
0
1
in
th
e
in
ter
v
en
ti
o
n
)
.
T
h
er
e
was
a
ch
an
g
e
i
n
lo
ch
ia
af
ter
1
0
d
ay
s
o
f
m
o
n
ito
r
in
g
,
wh
er
e
th
e
r
esu
lts
s
h
o
wed
th
at
th
e
m
o
th
er
ex
p
er
ien
ce
d
a
ch
a
n
g
e
i
n
lo
ch
ia,
wh
ich
was
in
itially
r
u
b
r
a,
b
ec
am
e
s
er
o
u
s
,
a
n
d
th
e
n
alb
a.
L
o
ch
ia
is
th
e
f
lu
id
th
at
th
e
u
ter
u
s
ex
cr
ete
s
d
u
r
in
g
th
e
p
o
s
tp
ar
t
u
m
p
er
io
d
.
I
t
co
n
tain
s
b
lo
o
d
an
d
t
h
e
n
ec
r
o
tic
r
est
o
f
d
esiccate
d
tis
s
u
e
f
r
o
m
th
e
u
ter
u
s
.
T
h
e
p
r
o
ce
s
s
o
f
u
ter
in
e
in
v
o
lu
tio
n
ca
u
s
es c
h
an
g
es in
th
e
l
o
ch
ia.
Acc
o
r
d
in
g
to
p
h
y
s
io
lo
g
ical
t
h
eo
r
y
,
lo
c
h
ia
s
er
o
s
a
is
ty
p
ically
d
is
ch
ar
g
ed
b
etwe
en
th
e
3
rd
an
d
1
0
th
p
o
s
tp
ar
tu
m
d
a
y
s
,
ch
ar
ac
ter
iz
ed
b
y
a
b
r
o
wn
is
h
-
r
e
d
f
lu
id
.
Af
ter
ap
p
r
o
x
im
ately
th
e
1
0
th
d
ay
,
lo
ch
ia
alb
a
ap
p
ea
r
s
,
p
r
esen
tin
g
as
a
wh
i
tis
h
d
is
ch
ar
g
e.
I
n
th
is
s
tu
d
y
,
m
o
s
t
r
esp
o
n
d
e
n
ts
o
n
th
e
10
th
p
o
s
tp
ar
tu
m
d
ay
ex
h
ib
ited
l
o
ch
ia
al
b
a,
in
d
icatin
g
a
n
o
r
m
al
p
r
o
g
r
ess
io
n
o
f
u
ter
in
e
in
v
o
lu
tio
n
.
T
h
ese
f
in
d
i
n
g
s
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
s
tu
d
ies
ev
alu
ati
n
g
ch
an
g
es
in
lo
ch
ia
am
o
n
g
m
o
th
er
s
wh
o
r
ec
eiv
e
d
o
x
y
to
cin
m
ass
ag
e.
Ox
y
to
cin
m
ass
ag
e
p
r
o
m
o
tes
th
e
s
e
cr
etio
n
o
f
o
x
y
to
cin
,
wh
ich
en
h
a
n
ce
s
u
ter
in
e
co
n
tr
ac
tio
n
s
.
Ad
eq
u
ate
an
d
s
tr
o
n
g
u
ter
in
e
co
n
tr
ac
tio
n
s
ac
ce
ler
at
e
th
e
in
v
o
lu
tio
n
p
r
o
ce
s
s
an
d
f
ac
ilit
ate
th
e
ex
p
u
ls
io
n
o
f
lo
ch
ia.
Sm
o
o
th
an
d
r
eg
u
lar
lo
ch
ia
d
is
ch
ar
g
e
d
r
ef
lect
ef
f
ec
tiv
e
u
ter
in
e
co
n
t
r
ac
tili
ty
.
T
h
e
r
esu
lts
s
u
p
p
o
r
t
th
e
th
eo
r
y
t
h
at
th
e
o
x
y
to
cin
m
ass
ag
e
co
n
tr
ib
u
te
s
to
f
aster
r
ec
o
v
er
y
o
f
p
o
s
t
p
ar
tu
m
r
ep
r
o
d
u
ctiv
e
o
r
g
an
s
,
as
in
d
icate
d
b
y
a
r
ed
u
ctio
n
i
n
f
u
n
d
al
h
eig
h
t
an
d
n
o
r
m
al,
ac
ce
ler
ated
c
h
an
g
es
in
lo
ch
ia
[
26
]
,
[
28
]
.
Fu
r
th
e
r
m
o
r
e,
b
ac
k
m
ass
ag
e
co
m
b
in
ed
with
clar
y
s
ag
e
ess
en
tial
o
il
was
ass
o
ciate
d
with
ac
ce
ler
ated
u
ter
in
e
in
v
o
l
u
tio
n
co
m
p
a
r
ed
to
th
e
co
n
tr
o
l
g
r
o
u
p
.
Ph
y
s
io
lo
g
icall
y
,
f
aster
u
ter
in
e
in
v
o
lu
tio
n
i
s
r
elate
d
to
a
m
o
r
e
r
eg
u
lar
l
o
ch
ia
p
atter
n
af
ter
ch
ild
b
ir
th
[
2
9
]
.
Ho
wev
e
r
,
co
m
p
ar
is
o
n
o
f
lo
c
h
ia
b
etwe
en
g
r
o
u
p
s
u
s
in
g
th
e
Ma
n
n
-
W
h
itn
ey
U
test
s
h
o
wed
n
o
s
tatis
t
ically
s
ig
n
if
ican
t
d
if
f
e
r
e
n
ce
(
p
=
0
.
0
9
0
)
,
in
d
icatin
g
th
at
lo
ch
ia
r
ec
o
v
e
r
y
was
r
elativ
ely
s
im
ilar
in
b
o
th
g
r
o
u
p
s
.
T
h
is
f
in
d
in
g
m
ay
b
e
e
x
p
lain
ed
b
y
t
h
e
s
u
b
jectiv
e
ass
ess
m
en
t
o
f
lo
ch
ia,
wh
ich
m
ay
b
e
less
s
en
s
itiv
e
in
d
etec
tin
g
m
in
o
r
ch
an
g
es.
T
ab
le
4
.
E
f
f
ec
t o
f
t
h
e
co
m
b
in
a
tio
n
o
f
o
x
y
to
ci
n
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
at
h
er
ap
y
o
n
lo
ch
ea
in
p
o
s
tp
ar
tu
m
m
o
th
er
s
V
a
r
i
a
b
e
l
G
r
o
u
p
s
Pre
-
t
e
st
(
M
e
a
n
±
S
D
)
P
o
st
-
t
e
st
(
M
e
a
n
±
S
D
)
p
-
v
a
l
u
e
(
In
a
g
r
o
u
p
)
p
-
v
a
l
u
e
(
i
n
t
e
r
g
r
o
u
p
)
Lo
c
h
e
a
C
o
n
t
r
o
l
0
.
4
0
±
0
.
5
1
2
.
0
7
±
0
.
2
6
<
0
.
0
0
1
0
.
0
9
0
I
n
t
e
r
v
e
n
t
i
o
n
0
.
2
7
±
0
.
4
6
2
.
4
0
±
0
.
5
1
0
.
0
0
1
3
.
5
.
Ut
er
ine r
ec
o
v
er
y
in po
s
t
pa
rt
um
mo
t
hers
B
ased
o
n
T
ab
le
5
,
u
ter
in
e
r
ec
o
v
er
y
h
ad
a
m
e
d
ian
s
co
r
e
o
f
1
6
.
0
0
in
b
o
th
g
r
o
u
p
s
,
in
d
icatin
g
th
at
m
o
s
t
m
o
th
er
s
wer
e
in
t
h
e
f
ast
r
ec
o
v
er
y
ca
teg
o
r
y
.
B
ased
o
n
th
e
r
esu
lts
o
f
th
e
Ma
n
n
-
W
h
itn
ey
test
,
a
v
alu
e
o
f
U
=
4
3
,
0
0
0
with
p
=
0
.
0
0
3
(
p
<
0
.
0
5
)
was
o
b
tain
e
d
,
s
o
it
ca
n
b
e
co
n
clu
d
e
d
th
at
th
e
r
e
was
a
s
ig
n
if
ican
t
d
if
f
er
en
ce
b
etwe
en
th
e
c
o
n
tr
o
l
g
r
o
u
p
a
n
d
th
e
in
ter
v
en
tio
n
in
t
h
e
r
ep
r
o
d
u
ctiv
e
o
r
g
a
n
r
ec
o
v
er
y
s
co
r
e.
T
h
e
in
te
r
v
en
tio
n
g
r
o
u
p
s
h
o
wed
b
etter
r
ec
o
v
er
y
v
alu
es th
an
th
e
c
o
n
tr
o
l
g
r
o
u
p
.
T
h
e
r
esu
lts
o
f
th
e
s
tu
d
y
s
h
o
wed
th
at
o
x
y
to
cin
m
ass
ag
e
also
in
f
lu
en
ce
d
th
e
u
te
r
in
e
r
ec
o
v
er
y
.
T
h
e
u
ter
in
e
r
ec
o
v
e
r
y
was
ass
e
s
s
ed
b
ased
o
n
th
e
h
eig
h
t
o
f
th
e
u
t
er
in
e
f
u
n
d
u
s
an
d
ch
an
g
es
in
th
e
ty
p
e
o
f
m
ater
n
al
lo
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ia.
T
h
is
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tu
d
y
s
h
o
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a
t
af
ter
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ter
v
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tio
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iv
en
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u
ter
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e
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ec
o
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er
y
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ec
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es
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o
r
m
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ast,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
lth
Sci
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SS
N:
2252
-
8
8
0
6
Oxy
to
cin
ma
s
s
a
g
e
a
n
d
cla
r
y
s
a
g
e
a
r
o
ma
th
era
p
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n
la
cta
tio
n
a
n
d
u
teri
n
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…
(
R
a
h
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i F
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ich
a
Ha
kim
)
433
with
o
u
t
ex
p
er
ien
cin
g
co
m
p
lic
atio
n
s
s
u
ch
as
in
f
ec
tio
n
an
d
b
leed
in
g
.
T
h
e
s
tu
d
y
’
s
f
in
d
i
n
g
s
s
h
o
wed
a
d
if
f
er
en
ce
b
etwe
en
b
ef
o
r
e
an
d
af
ter
th
e
in
ter
v
en
tio
n
o
f
o
x
y
t
o
cin
m
ass
ag
e
co
m
b
i
n
ed
with
clar
y
s
ag
e
a
r
o
m
ath
er
a
p
y
.
A
to
tal
o
f
1
5
r
esp
o
n
d
e
n
ts
in
th
e
s
am
e
g
r
o
u
p
ex
p
e
r
ien
ce
d
a
s
ig
n
if
ican
t in
cr
ea
s
e
in
b
r
ea
s
t m
ilk
v
o
lu
m
e
an
d
a
d
ec
r
ea
s
e
i
n
th
e
h
eig
h
t
o
f
th
e
u
ter
in
e
f
u
n
d
u
s
an
d
f
aster
lo
ch
ia
ch
a
n
g
es.
T
h
is
is
in
f
lu
en
ce
d
b
y
th
e
ad
m
in
is
tr
atio
n
o
f
o
x
y
to
cin
m
a
s
s
ag
e,
wh
ich
is
ca
r
r
ied
o
u
t
in
co
n
ju
n
ctio
n
with
th
e
ad
m
in
is
tr
atio
n
o
f
clar
y
s
ag
e
ar
o
m
ath
er
a
p
y
.
Ar
o
m
ath
er
ap
y
is
a
m
eth
o
d
o
f
u
s
in
g
ar
o
m
atic
o
ils
th
at
ar
e
tar
g
eted
to
im
p
r
o
v
e
h
ea
lth
,
a
n
d
ca
n
b
e
ap
p
lied
th
r
o
u
g
h
m
ass
ag
e,
in
h
alatio
n
,
a
n
d
as
a
b
ath
wate
r
wh
en
b
ath
in
g
.
W
h
en
c
o
m
p
a
r
e
d
to
o
t
h
er
m
eth
o
d
s
,
s
u
ch
as
u
s
in
g
h
er
b
al
m
ed
ici
n
es,
ar
o
m
ath
er
ap
y
is
m
o
r
e
p
r
ac
tical
an
d
h
as
less
r
i
s
k
[
30
]
.
Ar
o
m
ath
er
a
p
y
is
in
clu
d
ed
i
n
th
e
r
elax
atio
n
t
h
er
ap
y
th
at
wo
r
k
s
in
in
d
u
ci
n
g
a
r
elax
atio
n
r
esp
o
n
s
e
b
y
s
ta
b
ilizin
g
h
ea
r
t
r
ate,
r
esp
ir
ato
r
y
r
ate,
an
d
b
lo
o
d
p
r
ess
u
r
e.
T
h
is
th
er
ap
y
was
id
en
tifie
d
b
y
a
C
o
ch
r
an
e
r
ev
ie
w
as
a
p
r
o
m
is
in
g
tech
n
iq
u
e
f
o
r
im
p
r
o
v
i
n
g
lact
at
io
n
o
u
tc
o
m
es
[
31
].
Ar
o
m
ath
er
ap
y
clar
y
s
ag
e
is
o
n
e
o
f
th
e
im
p
o
r
tan
t
s
o
u
r
ce
s
o
f
ess
en
tial
o
ils
f
r
o
m
S
a
lvia
s
cl
a
r
ea
p
lan
t,
wh
ich
is
s
af
e
to
u
s
e
as
ar
o
m
ath
er
ap
y
f
o
r
g
y
n
ec
o
lo
g
ic
al
p
r
o
b
lem
s
.
C
lar
y
s
ag
e
o
il
co
n
tain
s
th
e
m
ain
co
m
p
o
n
en
ts
lin
aly
l
ac
etate
(
6
8
.
6
%),
β
-
b
o
u
r
b
o
n
e
n
e
(
1
0
.
3
%)
,
an
d
g
e
r
m
ac
r
en
e
D
(
6
.
9
%)
[
3
2
]
.
C
lar
y
s
ag
e
is
co
n
s
id
er
ed
g
o
o
d
b
ec
au
s
e
it
is
h
ig
h
in
an
tib
ac
ter
ial,
an
tifu
n
g
al,
an
d
an
tio
x
id
an
t
p
r
o
p
er
tie
s
an
d
f
u
n
ctio
n
s
in
im
p
r
o
v
in
g
th
e
f
u
n
ctio
n
in
g
o
f
th
e
n
er
v
o
u
s
s
y
s
tem
[
33
]
.
Acc
o
r
d
in
g
to
Ma
h
b
o
u
b
i
[
3
2
]
r
e
s
ea
r
ch
,
as
m
an
y
as
7
0
%
o
f
m
ater
n
ity
m
o
th
er
s
d
o
n
o
t
n
ee
d
ad
d
itio
n
al
o
x
y
to
cin
i
n
ch
ild
b
ir
t
h
,
a
n
d
8
6
%
o
f
m
o
t
h
er
s
co
n
s
id
er
clar
y
s
ag
e
ef
f
ec
tiv
e
in
ac
ce
ler
atin
g
t
h
e
s
lo
w
d
eliv
er
y
p
r
o
ce
s
s
.
Acc
o
r
d
in
g
t
o
r
esear
ch
,
th
e
u
s
e
o
f
ar
o
m
ath
er
ap
y
clar
y
s
ag
e
h
as
a
ca
lm
in
g
ef
f
ec
t,
i
n
cr
ea
s
es
r
elax
atio
n
,
an
ti
-
in
f
lam
m
ato
r
y
,
im
p
r
o
v
es
m
o
o
d
,
ac
ts
as
an
an
ti
o
x
id
an
t
,
an
d
e
n
h
an
ce
s
t
h
e
b
o
d
y
'
s
n
atu
r
al
h
ea
lin
g
p
r
o
ce
s
s
[
34
]
,
[
35
]
.
I
n
R
u
s
s
ia,
clar
y
s
ag
e
o
il
is
u
s
ed
in
ch
ild
b
ir
th
b
ec
au
s
e
it
is
a
n
o
n
-
to
x
ic
ag
e
n
t,
d
o
es
n
o
t
ca
u
s
e
s
en
s
itizati
o
n
,
d
o
es
n
o
t
ir
r
itate
,
an
d
ca
n
in
cr
ea
s
e
u
ter
in
e
c
o
n
t
r
ac
tio
n
s
to
s
p
ee
d
u
p
lab
o
r
.
As
an
a
n
tis
p
asm
o
d
ic
ag
en
t,
clar
y
s
ag
e
o
il
is
r
ec
o
g
n
ized
to
b
e
a
s
u
cc
ess
f
u
l
t
r
ea
tm
en
t
f
o
r
p
o
s
tp
ar
tu
m
d
e
p
r
ess
io
n
a
n
d
h
elp
s
less
en
d
is
co
m
f
o
r
t
i
n
th
e
m
u
s
cles
an
d
d
u
r
in
g
lab
o
u
r
.
Owi
n
g
to
its
estro
g
en
-
lik
e
p
r
o
p
er
ties
,
it
h
as
b
ee
n
tr
a
d
itio
n
ally
u
s
ed
as
an
em
m
en
ag
o
g
u
e
an
d
f
o
r
th
e
m
an
ag
em
e
n
t
o
f
p
ai
n
r
elate
d
t
o
d
y
s
m
en
o
r
r
h
ea
a
n
d
am
e
n
o
r
r
h
ea
.
I
n
ad
d
itio
n
,
clar
y
s
ag
e
is
u
s
ed
in
to
b
ac
co
t
o
r
e
d
u
ce
to
b
ac
c
o
d
e
p
en
d
en
ce
.
An
o
th
e
r
b
en
ef
it
is
t
h
at
cla
r
y
s
ag
e
o
il
as
a
to
n
ic
is
u
s
ed
t
o
r
e
g
u
late
m
en
s
tr
u
al
cy
cles,
m
u
s
cle
cr
am
p
s
,
an
d
r
elate
d
p
r
o
b
lem
s
in
t
h
e
u
ter
u
s
[
32
]
,
[
36
]
.
T
h
e
r
esu
lts
o
f
th
e
s
tu
d
y
s
u
p
p
o
r
t
t
h
e
th
eo
r
y
th
at
clar
y
s
ag
e
o
il
ca
n
in
cr
ea
s
e
u
ter
in
e
c
o
n
tr
ac
ti
o
n
s
s
o
th
at
u
ter
in
e
r
ec
o
v
er
y
ca
n
r
u
n
o
p
tim
ally
.
T
ab
le
5
.
E
f
f
ec
t o
f
t
h
e
co
m
b
in
a
tio
n
o
f
o
x
y
to
ci
n
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
at
h
er
ap
y
o
n
u
t
er
in
e
r
ec
o
v
er
y
V
a
r
i
a
b
e
l
M
e
d
i
a
n
M
a
n
n
-
W
h
i
t
n
e
y
U
Z
p
-
v
a
l
u
e
U
t
e
r
i
n
e
r
e
c
o
v
e
r
y
1
6
.
0
0
4
3
.
0
0
0
–
2
.
9
3
2
0
.
0
0
3
4
.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
co
n
clu
d
ed
th
at
th
e
co
m
b
in
atio
n
o
f
o
x
y
t
o
cin
m
ass
ag
e
an
d
clar
y
s
ag
e
ar
o
m
ath
er
a
p
y
d
id
n
o
t
h
av
e
a
s
ig
n
if
ican
t e
f
f
ec
t
o
n
in
cr
ea
s
in
g
th
e
v
o
lu
m
e
o
f
b
r
ea
s
t m
ilk
p
r
o
d
u
ctio
n
b
u
t h
ad
a
s
ig
n
if
ican
t in
f
lu
en
ce
o
n
u
ter
in
e
r
ec
o
v
e
r
y
in
p
o
s
tp
ar
tu
m
m
o
th
er
s
,
esp
ec
ially
in
th
e
p
r
o
ce
s
s
o
f
u
ter
in
e
in
v
o
lu
tio
n
.
T
h
ese
f
in
d
in
g
s
in
d
icate
th
at
th
e
ad
m
in
is
tr
atio
n
o
f
o
x
y
to
cin
m
ass
ag
e
ac
co
m
p
an
ied
b
y
clar
y
s
ag
e
a
r
o
m
ath
e
r
ap
y
p
la
y
s
a
g
r
ea
ter
r
o
le
in
ac
ce
le
r
atin
g
t
h
e
p
h
y
s
io
lo
g
ical
u
ter
in
e
r
ec
o
v
er
y
th
an
in
in
cr
ea
s
in
g
m
ilk
p
r
o
d
u
ctio
n
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
ca
n
b
e
ap
p
lie
d
as
a
n
o
n
-
p
h
ar
m
ac
o
lo
g
ical
co
m
p
le
m
en
tar
y
ap
p
r
o
ac
h
i
n
p
o
s
tp
ar
tu
m
o
b
s
tetr
ic
ca
r
e,
esp
ec
ially
in
s
u
p
p
o
r
tin
g
th
e
u
ter
in
e
in
v
o
lu
tio
n
p
r
o
ce
s
s
.
Fu
r
th
er
r
esear
ch
is
r
ec
o
m
m
e
n
d
ed
to
u
s
e
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
b
r
ea
s
t
m
ilk
p
r
o
d
u
ctio
n
ass
ess
m
en
t
in
d
icato
r
s
,
s
u
ch
as
a
c
o
m
b
in
atio
n
o
f
m
ea
s
u
r
in
g
th
e
v
o
l
u
m
e
o
f
b
r
ea
s
t
m
ilk
,
i
n
cr
ea
s
ed
in
f
a
n
t
weig
h
t
,
an
d
f
r
e
q
u
en
c
y
o
f
in
f
an
t
u
r
in
atio
n
,
a
n
d
in
v
o
lv
in
g
a
lar
g
er
n
u
m
b
e
r
o
f
s
am
p
les to
o
b
tain
m
o
r
e
o
p
tim
al
r
esu
lts
.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
wo
u
ld
lik
e
to
ex
p
r
ess
o
u
r
g
r
atitu
d
e
t
o
th
e
Facu
lty
o
f
Me
d
icin
e,
An
d
alas
Un
iv
er
s
it
y
an
d
t
h
e
I
n
d
o
n
esian
Mid
wiv
es
Ass
o
ciatio
n
o
f
Pad
an
g
C
ity
f
o
r
p
er
m
i
s
s
io
n
to
ca
r
r
y
o
u
t
t
h
is
r
esear
c
h
an
d
ex
p
r
ess
o
u
r
g
r
atitu
d
e
to
all
p
ar
ties
wh
o
d
ir
ec
tly
o
r
in
d
i
r
ec
tly
co
n
t
r
ib
u
ted
to
th
is
r
esear
ch
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
r
esear
ch
was f
u
n
d
e
d
b
y
t
h
e
Facu
lty
o
f
Me
d
icin
e,
An
d
alas U
n
iv
er
s
ity
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
2
8
-
4
3
6
434
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
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RE
F
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NC
E
S
[
1
]
W
H
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,
WHO
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O
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l
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]
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A
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E.
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[
4
]
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.
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.
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5
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U
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6
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7
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ss d
u
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d
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:
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e
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[
9
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A
.
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.
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1
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Evaluation Warning : The document was created with Spire.PDF for Python.
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[
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h
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ly
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t
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