Home About us Editorial board Search Browse articles Submit article Instructions Contacts Login 
Users Online: 279
Home Print this page Email this page

 



 
Previous article Browse articles Next article 
ORIGINAL ARTICLE
J Edu Health Promot 2019,  8:67

The presence of the child, the opportunity or a threat to marital satisfaction: A qualitative study


1 Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran; Department of Midwifery, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
4 Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran

Date of Submission27-Aug-2018
Date of Acceptance20-Nov-2018
Date of Web Publication14-Mar-2019

Correspondence Address:
Dr. Hamid Salehiniya
Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jehp.jehp_250_18

Rights and Permissions
  Abstract 

BACKGROUND: The aim of this qualitative study was to explore if the presence of a child in the family was an opportunity or threat to the marital life.
METHODS: In this common qualitative content analysis, semi-structured interviews with 20 participants were conducted. All of the interviews were recorded and then transcribed. The data were categorized, and the main themes and sub-themes were extracted.
RESULTS: Twenty transcription were analysed. The data analysis led to the development of the first theme of “feeling evolution” with the category of “flourishing the motherhood sense,” and the second theme of “strengthening the marital life” with the two categories of “the marital life stabilization” and “efforts for a common goal.”
CONCLUSIONS: The presence of the child can lead to the feeling of development and stabilizing the marital life. Furthermore, the presence of the child can facilitate or hinder marital satisfaction. Given the challenges due to a lack of preparation of parents for childbirth, consultation and support by family members or the society can help with adaptation with this life period and increasing the positive effects of the presence of the child on parents' relationships and marital satisfaction.

Keywords: Iran, marital satisfaction, opportunity, presence of child, qualitative study, threat


How to cite this article:
Tavakol Z, Nasrabadi AN, Moghadam ZB, Salehiniya H. The presence of the child, the opportunity or a threat to marital satisfaction: A qualitative study. J Edu Health Promot 2019;8:67

How to cite this URL:
Tavakol Z, Nasrabadi AN, Moghadam ZB, Salehiniya H. The presence of the child, the opportunity or a threat to marital satisfaction: A qualitative study. J Edu Health Promot [serial online] 2019 [cited 2019 Mar 25];8:67. Available from: http://www.jehp.net/text.asp?2019/8/1/67/254052


  Introduction Top


One of the common concepts that show the happiness and stability of marriage is marital satisfaction.[1] Marital satisfaction is a situation where the husband and wife in most cases feel happiness and satisfaction.[2] Marital satisfaction is the husband or wife's perception of the other side needs and willingness to meet them.[3] Marital satisfaction is studied for decades and is a complex and multidimensional phenomenon.[4] It affects different aspects of life including family health, life satisfaction, job satisfaction and income, and even can affect the life expectancy of couples.[5] Studies on marital satisfaction in the course of life have shown that it follows a U-shaped path. During the early stages of marriage and marital satisfaction, marital satisfaction is increased, but it starts to decline over the next 10–20 years. After that children leave home and get married, couples find more opportunities to strengthen their relationships and intimacy.[6],[7]

Having children in some communities is a great value, and the presence of the child in the family helps with achieving the sense of satisfaction as a key element of life. In Iranian society, having children is considered a value. Therefore, married men and women naturally expect to have a child soon after marriage. Clearly, when couples are unable to have a child, not only their lives but also their marital relationship is undermined.[8] Salter believes when women assume themselves complete that brings up a child. Furthermore, women find their biological, psychological, and social achievements in relation to their ability to give birth to a child.[9] Several studies have shown that birth can affect marital satisfaction.[10] Parenting as a life's stage changes usual activities, increases vulnerability, discontent, discomfort, fear, and anxiety. It also is accompanied by losing something and gaining some other things.[11] Assuming the parenting role is an opportunity for personal growth and maturity because duties, feelings, and responsibilities related to students' parenting are imposed on parents.[12]

Studies on the arrival of the first child in the family show the fact that this step is a critical period of development and sensitive experience for parents. The results of Lee Masters' study on 46 middle-class urban couples with an average age of 35–25 years regarding the effect of childbirth on the family showed that only 17% of couples had no problem with this life stage. However, the remaining 83% had a lot of problems and difficulties including couples neglect. Increasing the number of arguments and disputes between spouses, cutting previous programs were expressed as one of the causes for fatigue and weakening in social and sexual life. In summary, mutual satisfaction is dropped suddenly after the birth of the first child.[13] Furthermore, the results of a qualitative study by Nyström and Ohrling with the aim of determining parents' experiences during the 1st year of childbirth reported the theme of “living in a new and hard world.” This indicated that both mothers and fathers experienced dramatic changes during the 1st year of childbirth.[14]

According to previous studies, there is a need for improving our understanding of this topic. On the other hand, the culture dominating the Iranian society is such that it considers the presence of the child to be part of the strengthening of marital relations and considers one of the ways to eliminate the problems of couples in adapting to each other and reducing the probability of divorce. The results of this study on the effectiveness of the presence of a child in marital relations between couples can help them to make informed decisions to complete their families and make decision to help them become children. Therefore, the aim of this qualitative study was to explore if the presence of a child in the family was an opportunity or a threat to the marital life.


  Methods Top


Design

A qualitative study using a conventional content analysis approach was used. Qualitative research aims at improving our understanding and description human experiences.[15] Furthermore, it is suitable for understanding social and psychological phenomena. The importance of qualitative research in the evaluation of psychological outcomes for marriage has been widely recognized. Content analysis is a systematic coding and categorizing approach for exploring a large amount of textual data with the aim of determining communication patterns and processes.[16]

Data collection

Participants were chosen using purposive sampling with the consideration of maximum variation in sampling in terms of the duration of the marriage, having the child, the woman's educational level and employment status.

Participants' inclusion criteria include experience of at least 3 years of marriage, resident urban community in Tehran, Muslim and Iranian origin, with the ability to understand and speak Persian, who was his first marriage and have a desire to participate in the study. Samples were selected from the university, hospital, health centers, private offices, and public spaces.

Semi-structured interviews were held with 20 married women living in an urban area of Iran who were able to speak in Farsi and willing to share their experiences. The women were interviewed in private places without the presence of their husbands. The duration of the interviews was 55 min. The focus of the interviews was as follow:

  • What are your understandings of having a child during your marital life?
  • What changes have happened from the time that you gave birth?
  • Does having a child affect marital satisfaction?


The data were collected from 2015 to 2016. The women were informed of the aim and method of the study. The interviews were performed in Farsi and translated to English for this study. The interviews were transcribed verbatim and concurrently with the data collection was analyzed.

Data analysis

According to Graneheim and Lundman, the following steps were taken to analyze data:

  • The interviews were transcribed verbatim and read several times to get the sense of whole
  • The transcriptions were classified into condensed meaning units
  • Codes were extracted from the meaning units
  • The codes were sorted based on their similarities and differences to categories and subcategories
  • Themes developed as the latent meaning of the text.[17]


Rigor

Credibility was assessed using member checking, prolonged engagement with the participants and member checking. For member checking, the transcriptions and summary of codes were given to some participants, and they were asked to provide feedbacks. Discussions were held between the team members with regard to the coding process, categorizing, and theme developments for resolving disagreements. For transferability, the details of the data collection and analysis processes were provided for future investigations.[18]

Ethical considerations

This article was one part of the first author's Ph.D. dissertation supported financially by Tehran University of Medical Sciences. Furthermore, the ethics committee affiliated with this university approved this study's ethical considerations. The participants were all informed of the study aim and process. The permission to tape-record the participants' voices was obtained. Moreover, their information was confidentially reserved for the researcher. They knew that participation in this study was voluntary and they could withdraw from the study at any time without being penalized. Therefore, this study did not have any problems about ethical considerations.


  Results Top


In general, 20 women participated in this study. The average age was 4/7 ± 5/35. The average number of children and number of years of life were 1.0 ± 5.8 and 12.8 ± 9.3, respectively. Eight of them were graduate (40%), two were bachelors (10%), seven were diplomas (35%), two were below the diplomas (10%) and one was illiterate (5%). Their job status was three students (15%), two doctors (10%), one help assistant (5%), 2 employees (10%), 10 housewives (50%), one tailor 5%) and one family counselor (5%).

The data analysis led to the development of the first theme of “feeling evolution” with the category of “flourishing the motherhood sense,” and the second theme of “strengthening the marital life” with the two categories of “the marital life stabilization” and “efforts for a common goal.”

Feeling evolution

This theme was consisted of a category as follows.

Flourishing the motherhood sense

Loving the child is a natural talent and a social value. In societies where having the child is a value, it is natural that couples find the virtues of married life and love in the child. Some participants believed that the child is the fruit of marriage and one should redirect her efforts to the development of the child. Therefore, those couples who have no children feel empty and continue to find their marital lives shaken. One of the participants said:

“Generally, when there is a child in the marital life, something may happen in life, which can be ignored for the sake of the child. Everything is done in life for the child to be developed and improved from social, mental aspects. The child has the worth more than any other thing. Therefore, the presence of the child makes everything better even the marital connection.”

Furthermore, the presence of a child in the family is so important that if the couples soon after marriage do not have a child, they feel empty and failure in life. A participant stated:

“Before the childbirth, I felt empty. Now, I feel that my life is completed and there is no vacuum in my life.”

Strengthening the marital life

The marital life stabilization

The childbirth can have a large effect on couples' relationships. As the participants stated, after childbirth, the relationships between couples was transformed from a contractual relationship to familial one, which is important for them. They have made a stronger relationship that prevents the disconnection of their relationships. Furthermore, the presence of the child improves the relationship between couples, but cannot prevent the development of an inappropriate one. A participant stated:

“The child has a great effect. If you want to create concrete, the concrete is needed. The child is similar to the cement, which connects the couples together. Some quarrel may happen between couples, but they make friendship for the sake of the child. When there is no child, couples live together, but they are divided. After childbirth, couples get closer. When my child was 2 years old, I felt so close to my husband. Before that, we felt divided, and now we feel closer.”

Another participant said:

“After getting married, conflicts between couples are increased. The presence of the child connects couples together like glue and makes them learn how to live together. If there is no child, conflicts may damage the family unity.”

The presence of the child can also be a debilitating factor on the road to marital satisfaction. In fact, the child can need special attention from both parents, which reduces the amount of attention paid to the wife or husband. Therefore, if one of the couples does not do his/her own duties or is unable to manage the relationship with the husband or wife, the marital satisfaction is endangered. For instance, one participant with two girls and after 12 years of the marital life said:

“…due to the motherhood duties, the relationship between couples is affected. For instance, my husband and I felt lonely and my husband was much lonelier. He needed me to take care of him, but I was busy. Therefore, the child has a negative effect on my personal life. If it is not understood well, it can damage the marital life and men may encounter misperceptions. It seems that my husband's attention to me has reduced, but this is not the case really.”

It seems that after the childbirth, the attention of the family is turned to the child and its needs. One woman with regard to the negative effects of the presence of the child said:

“.I feel that my whole life is the child-centered. If we work, this is for the sake of the child. Before marriage, I worked for myself, but now it is for the sake of the child. Since the child is born, couples have less time for themselves.”

Therefore, it is suggested that couples achieve the required abilities for resolving conflicts.

Efforts for a common goal

When couples observe each other's efforts for a common goal that is the child's growth and development, they get satisfied with the marital life. A participant said:

“…the child laughs, there is a common interest, and my husband and I enjoys it…a sense of pride that we both feel, which makes us closer together.”

One of the common goals between couples is the development of an appropriate relationship with the child. If this communication is constructive, it is more probable to reach this goal. Therefore, from the participants' perspectives, the intimate relationship between couples and the child affects marital relationships. A participant with three children and 25 years of marital life said:

“When I see that my children are satisfied with their father and are happy together, my husband makes a friendly communication with them and also with me, I feel satisfaction with my life.”

Couples need to resolve their marital conflicts before childbirth to make them ready for the presence of the child. The division of work between couples with justice and reaching agreements for childcare should be considered. Any disagreement between parents with regard to childcare and child development leads to quarrels between couples and reduces their marital satisfaction.

“…I have no problem with my husband. We can make it together…if any problem happens between us; it may be related to childcare or child development. For instance, if the child wants something, I am positive with it, but perhaps my husband is not happy with it. Sometimes I am stringent, but my husband is not.”

In fact, the presence of the child in the family is a turning point between couples. Growing up the child is a sacred goal for couples. Such a goal makes the connection between couples closer. Therefore, efforts by couples for growing up the child facilitate marital satisfaction.


  Discussion Top


The data analysis led to the development of the first theme of “feeling evolution” with the category of “flourishing the motherhood sense,” and the second theme of “strengthening the marital life” with the two categories of “the marital life stabilization” and “efforts for a common goal.”

This study found that the presence of the child had a dual effect on marital satisfaction. It was a turning point in the human being life and created the feelings of reviving proud, physical, and psychological satisfaction. Furthermore, the loving need to the child is met, and the marital relationship is stabilized. Researchers believe that the positive feeling of the presence of the child is due to the fulfilment of the bio-psycho-socio needs.[9] For many couples, the inability to bring a child can be considered some sort of failure.[19],[20]

Twenge et al. believe that the presence of the first child is accompanied with many issues for couples because some changes happen in the relationship between family members that may have positive and negative aspects. The positive effects of such changes, the feeling of achievement and enjoyment of bringing up the child. The negative effects can be fatigue, losing time to take care of their own needs and disagreements in childcare and family tasks.[21]

Hirchberger state that many married people experience considerable changes in their life after childbirth including changes in identity and intra-familial and extra-familial roles. It also encompasses changes in couples' relationships.[22] Tavakol et al. in their study reported that a woman, who becomes mother, has a deeper feeling in relation to her husband, and the love of child is their held in common interest, so long as reducing the distance between them, increases their love especially when they have a settlement on parenting style.[23]

Some other believe that the presence of the child reduces marital satisfaction through reducing communication opportunities between couples, parental responsibilities, depression, and excitement.[22],[24] Therefore, marital satisfaction is damaged, especially if the presence of the child adds to couples' current difficulties such as economic and living conditions.

The study by Yousefzadeh et al. reported a negative relationship between marital adaptation and the number of children, which was not statistically significant.[25] Shakerian found that demographic variables could predict marital satisfaction among students.[26] Some studies showed that increasing the number of children reduced marital satisfaction though reducing opportunities for couples' relationships.[24],[27] Gorchoff et al. believed that a lack of the presence of the child has a positive relationship with marital satisfaction. When the child gets older and leave the house, marital satisfaction is again increased.[7] However, some others believe that the presence of the first child is not the only reason for marital dissatisfaction but also passing time and erosion of relationships affect it.[28]

The findings of some studies are controversies. For instance, Onyishi there is a positive relationship between the number of children and marital satisfaction. Therefore, the cause for such a finding is culture of people in Nigeria, which is different from western countries.[29] Moreover, in some countries, the gender of the child affects marital satisfaction. For instance, in a Japanese study, the presence of a male child can affect marital satisfaction.[30]

The satisfactory marital relationship is the cornerstone of appropriate familial function that directly or indirectly influences parents and children relationships and even improves adaptation among children. When an agreement is present in marital life, the child-parent relationship is positive, which can lead to future positive collaborations. This is difficult for couples to remain noncomparative couples but become competent parents.[31] Furthermore, the marital relationship is not confined to the relationship between couples. The relationship between couples and children is an important part of marital life. The participants in this study stated that the relationship between couples and children affect marital satisfaction. Bernier said that marital satisfaction positively affects the interaction between parents and children. However, the researchers found no such a relationship between the father and female children.[32] Minnotte found that when the father and children make strong emotional relationships, marital satisfaction in increased, but if this emotional relationship becomes stronger than the relationship between couples, marital satisfaction is reduced.[33]

This study indicated the positive role of a common goal between couples for childcare, development and achievement. Mohamadi Khashoei in a study on supportive and collaborative needs of couples in the presence of the first child using a phenomenological design reported three themes including “taking the role”, participation in the role and social support for stabilizing the family' life and couples' marital life in the first experience of childbirth. They noted that to successfully pass this stage, parents should collaborate with each other and help each other to play their roles. Furthermore, they need to divide parental tasks between each other to prevent any damage to marital satisfaction.[34]


  Conclusions Top


The presence of the child can lead to the feeling of development and stabilizing the marital life. Also, the presence of the child can facilitate or hinder marital satisfaction. Given the challenges due to a lack of preparation of parents for childbirth, consultation, and support by family members or the society can help with adaptation with this life period and increasing the positive effects of the presence of the child on parents' relationships and marital satisfaction.

Acknowledgments

This paper has been extracted from Dr. Zeinab Tavakol's dissertation with registration number 9121151007, which has been supported by Tehran University of Medical Sciences. The authors would like to thank all participants in our research.

Financial support and sponsorship

The study was supported by Tehran University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Fatehizadeh M, Ahmadi A. The relationship between marital satisfaction and communication patterns of couples in Isfahan University. J Fam Res 2006;1:109-20.  Back to cited text no. 1
    
2.
Mirgain SA, Cordova JV. Emotion skills and marital health: The association between observed and self-reported emotion skills, intimacy, and marital satisfaction. J Soc Clin Psychol 2007;26:983-1009.  Back to cited text no. 2
    
3.
Peleg O. The relation between differentiation of self and marital satisfaction: What can be learned from married people over the course of life? Am J Fam Ther 2008;36:388-401.  Back to cited text no. 3
    
4.
Mósmann C, Wagner A, Féres-Carneiro T. [Marital quality: Mapping concepts]. Paidéia 2007;16:315-25.  Back to cited text no. 4
    
5.
Hassan SA, Horany A. Marital adjustment among postgraduate students at universities in Malaysia. Elixir Psychol 2011;37:3773-6.  Back to cited text no. 5
    
6.
Huber CH, Navarro RL, Womble MW, Mumme FL. Family resilience and midlife marital satisfaction. Fam J 2010;6:1-10.  Back to cited text no. 6
    
7.
Gorchoff SM, John OP, Helson R. Contextualizing change in marital satisfaction during middle age: An 18-year longitudinal study. Psychol Sci 2008;19:1194-200.  Back to cited text no. 7
    
8.
Rebar SK. Infertility, Evaluation and Treatment. Translated by Zadeh K. 1st ed. Yazd: Chehr Publications; 1996. p. 48.  Back to cited text no. 8
    
9.
Salter M. Altered Body Image. 2nd ed. London: Beqlliere Publication; 1987. p. 49-65.  Back to cited text no. 9
    
10.
Tavakol Z, Nasrabadi AN, Moghadam ZB, Salehiniya H, Rezaei E. A Review of the Factors Associated with Marital Satisfaction. GMJ.2017;6(3):197-207.  Back to cited text no. 10
    
11.
Fraser DM, Cooper MA. Myles' Textbook for Midwives. 14th ed. Edinburgh: Churchill Livingstone; 2014.  Back to cited text no. 11
    
12.
Littleton LY, Engebretson JC. Maternity Nursing Care. Canada: Thomson; 2005.  Back to cited text no. 12
    
13.
Jafarnezhad K, Asadiyonesi MR, Rastgoomoghadam M. The relationship between family communication patterns and frequency and intensity of parent-adolescent conflict. J Fam Res 2015;11:219-35.  Back to cited text no. 13
    
14.
Nyström K, Ohrling K. Parenthood experiences during the child's first year: Literature review. J Adv Nurs 2004;46:319-30.  Back to cited text no. 14
    
15.
Myers, M. Qualitative research and the generalizability question: Standing firm with Proteus. The Qualitative Report [On-line serial], 4 (3/4). Available: http://www.nova.edu/ssss/QR/QR4-1/myers.html  Back to cited text no. 15
    
16.
Grbich C. Qualitative Data Analysis: An Introduction. (2st edn). London: Sage Publications; 2012.  Back to cited text no. 16
    
17.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105-12.  Back to cited text no. 17
    
18.
Streubert-Speziale HJ, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative. Philadelphia: Lippincott Williams and Wilkins; 2007.  Back to cited text no. 18
    
19.
Marci R, Graziano A, Piva I, Lo Monte G, Soave I, Giugliano E, et al. Procreative sex in infertile couples: The decay of pleasure? Health Qual Life Outcomes 2012;10:140.  Back to cited text no. 19
    
20.
Reis S, Xavier MR, Coelho R, Montenegro N. Psychological impact of single and multiple courses of assisted reproductive treatments in couples: A comparative study. Eur J Obstet Gynecol Reprod Biol 2013;171:61-6.  Back to cited text no. 20
    
21.
Twenge J, Campbell WK, Foster CA. Parenthood and marital satisfaction: A meta-analytic review. J Marriage Fam 2003;65:574-83.  Back to cited text no. 21
    
22.
Hirschberger G, Srivastava S, Marsh P, Cowan CP, Cowan PA. Attachment, marital satisfaction, and divorce during the first fifteen years of parenthood. Pers Relatsh 2009;16:401-20.  Back to cited text no. 22
    
23.
Tavakol Z, Moghadam ZB, Nasrabadi AN, Iesazadeh N, Esmaeili M. Marital satisfaction through the lens of Iranian women: a qualitative study. Pan Afr Med J. 2016;25:208.  Back to cited text no. 23
    
24.
Jose O, Alfons V. Do demographics affect marital satisfaction? J Sex Marital Ther 2007;33:73-85.  Back to cited text no. 24
    
25.
Yousefzadeh MR, Yaghoobi A, Rashidi M. The impact of metacognition skills instruction on secondary school girl students' self-efficacy. J Sch Psychol 2012;1:118-3.  Back to cited text no. 25
    
26.
Shakerian A. Evaluation of the factors influencing marital satisfaction in the students of Islamic Azad Uiversity in Sanandaj. Sci J Kurdistan Univ Med Sci 2008;14:40-9.  Back to cited text no. 26
    
27.
Lincoln KD, Taylor RJ, Jackson JS. Romantic relationships among unmarried African Americans and Caribbean blacks: Findings from the national survey of American life. Fam Relat 2008;57:254-66.  Back to cited text no. 27
    
28.
MacDermid SM, Huston TL, McHale SM. Changes in marriage associated with the transition to parenthood: Individual differences as a function of sex-role attitudes and changes in the division of household labor. J Marriage Fam 1990;52:475-86.  Back to cited text no. 28
    
29.
Onyishi EI, Sorokowski P, Sorokowska A, Pipitonec RN. Children and marital satisfaction in a non-Western sample: Having more children increases marital satisfaction among the Igbo people of Nigeria. Evol Hum Behav 2012;33:771-4.  Back to cited text no. 29
    
30.
Guo B, Huang J. Marital and sexual satisfaction in chinese families: Exploring the moderating effects. J Sex Marital Ther 2005;31:21-9.  Back to cited text no. 30
    
31.
Cumming SM, O'Reilly WA. Fathers in Family Context: Effects of Marital Quality on Child Adjustment in the Role of the Father in Child Development. New York: Wiley and Sons; 1997.  Back to cited text no. 31
    
32.
Bernier A, Jarry-Boileau V, Lacharité C. Marital satisfaction and quality of father-child interactions: The moderating role of child gender. J Genet Psychol 2014;175:105-17.  Back to cited text no. 32
    
33.
Minnotte KL, Pedersen D, Mannon SE. The emotional terrain of parenting and marriage: Emotion work and marital satisfaction. Soc Sci J 2010;47:747-61.  Back to cited text no. 33
    
34.
Mohammadi Khashouei RA, Mohammadi Khashouei M, Ghorbani M, Khosravi S. The experiences of supportive and participative needs of couples in the first experience of child bearing: A qualitative study with phenomenology approach. J Fam Res 2016;11:455-69.  Back to cited text no. 34
    




 

Top
Previous article  Next article
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methods
Results
Discussion
Conclusions
References

 Article Access Statistics
    Viewed72    
    Printed1    
    Emailed0    
    PDF Downloaded23    
    Comments [Add]    

Recommend this journal