scholarly journals Oestrogen levels in serum and urine of premenopausal women eating low and high amounts of meat

2013 ◽  
Vol 17 (9) ◽  
pp. 2087-2093 ◽  
Author(s):  
Brook E Harmon ◽  
Yukiko Morimoto ◽  
Fanchon Beckford ◽  
Adrian A Franke ◽  
Frank Z Stanczyk ◽  
...  
Keyword(s):  
Mixed Models ◽  
Repeated Measures ◽  
Premenopausal Women ◽  
Least Square ◽  
Serum Samples ◽  
Meat Eating ◽  
Three Samples ◽  
Blood And Urine Samples ◽  
The Mean ◽  
Serum And Urine

AbstractObjectiveBased on the hypothesis that high-meat diets may increase breast cancer risk through hormonal pathways, the present analysis compared oestrogens in serum and urine by meat-eating status.DesignIntervention with repeated measures.SettingTwo randomized soya trials (BEAN1 and BEAN2) among premenopausal healthy women.SubjectsBEAN1 participants completed seven unannounced 24 h dietary recalls and donated five blood and urine samples over 2 years. BEAN2 women provided seven recalls and three samples over 13 months. Serum samples were analysed for oestrone (E1) and oestradiol (E2) using RIA. Nine oestrogen metabolites were measured in urine by LC–MS. Semi-vegetarians included women who reported consuming <30 g of red meat, poultry and fish daily, and pescatarians those who reported consuming <20 g of meat/poultry but >10 g of fish daily. All other women were classified as non-vegetarians. We applied mixed models to compute least-square means by vegetarian status adjusted for potential confounders.ResultsThe mean age of the 272 participants was 41·9 (sd 4·5) years. Serum E1 (85 v. 100 pg/ml, P = 0·04) and E2 (140 v. 154 pg/ml, P = 0·04) levels were lower in the thirty-seven semi-vegetarians than in the 235 non-vegetarians. The sum of the nine urinary oestrogen metabolites (183 v. 200 pmol/mg creatinine, P = 0·27) and the proportions of individual oestrogens and pathways did not differ by meat-eating status. Restricting the models to the samples collected during the luteal phase strengthened the associations.ConclusionsGiven the limitations of the study, the lower levels of serum oestrogens in semi-vegetarians than non-vegetarians need confirmation in larger populations.

Changes in multiple sclerosis symptoms are associated with changes in work productivity of people living with multiple sclerosis

2021 ◽  
pp. 135245852199455
Author(s):  
Barnabas Bessing ◽  
Mohammad A Hussain ◽  
Suzi B Claflin ◽  
Jing Chen ◽  
Leigh Blizzard ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mixed Models ◽  
Repeated Measures ◽  
Work Productivity ◽  
Annual Change ◽  
Individual Variations ◽  
Unit Increase ◽  
The Mean ◽  
Employment Rates ◽  
Study Participants

Background: While employment rates have increased in people with multiple sclerosis (PwMS), little is known about the longitudinal trends of work productivity. Objective: To describe the longitudinal patterns of work productivity and examine the factors associated with annual change of work productivity of PwMS. Methods: Study participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures ( n = 2121). We used linear mixed models to examine if the within-individual variations in MS symptoms are associated with changes in work productivity. Results: The mean annual change in work productivity between 2015 and 2019 was −0.23% ( SD = 18.68%). Not the actual severity of symptoms but rather the changes in severity of symptoms that are associated with change in work productivity in the same year. In a multivariable model, every unit increase in mean annual change in ‘pain and sensory symptoms’, ‘feelings of anxiety and depression’, and ‘fatigue and cognitive symptoms’ were independently associated with 2.43%, 1.55% and 1.01% annual reductions in work productivity, respectively. Conclusion: Individual changes in work productivity are largely driven by the changes in symptom severity rather than the absolute severity. Stabilising/improving MS symptoms might improve work productivity.

scholarly journals A Brief Exposure to Moderate Passive Smoke Increases Metabolism and Thyroid Hormone Secretion

2007 ◽  
Vol 92 (1) ◽  
pp. 208-211 ◽  
Author(s):  
Giorgos S. Metsios ◽  
Andreas D. Flouris ◽  
Athanasios Z. Jamurtas ◽  
Andres E. Carrillo ◽  
Demetrios Kouretas ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Passive Smoking ◽  
Repeated Measures ◽  
Hormone Secretion ◽  
Free T4 ◽  
Hormone Levels ◽  
Urine Cotinine ◽  
The Mean ◽  
Thyroid Hormone Levels ◽  
Serum And Urine

Abstract Context: Active smoking influences normal metabolic status and thyroid function. Objective: The objective was to assess experimentally the effects of 1 h of moderate passive smoking in a controlled simulated bar/restaurant environment on the metabolism and thyroid hormone levels in healthy nonsmokers. Participants: Eighteen (nine females, nine males) healthy individuals (mean ± sd: age, 25.3 ± 3.1 yr; height, 174.0 ± 10.1 cm; weight, 65.2 ± 13.7 kg) participated in the study. Design: In repeated-measures randomized blocks, participants visited the laboratory on 2 consecutive days. In the experimental condition, they were exposed to 1 h of moderate passive smoking at a carbon monoxide concentration of 23 ± 1 ppm in an environmental chamber, whereas in the control condition participants remained in the same chamber for 1 h breathing normal atmospheric air. Main Outcome Measures: In both conditions, cotinine serum and urine levels, resting energy expenditure (REE), as well as concentration of T3, free T4, and TSH were assessed before participants entered the chamber and immediately after their exit. Heart rate and blood pressure were tested in 10-min intervals during all REE assessments. Results: The mean ± sd difference of serum and urine cotinine levels (−0.27 ± 3.94 vs. 14.01 ± 6.54 and 0.05 ± 2.07 vs. 7.23 ± 3.75, respectively), REE (6.73 ± 98.06 vs. 80.58 ± 120.91) as well as T3 and free T4 (0.05 ± 0.11 vs. 0.13 ± 0.12 and 0.02 ± 0.15 vs. 0.22 ± 0.20) were increased in the experimental compared with the control condition at baseline and follow-up (P &lt; 0.05). No statistically significant variation was observed in the mean difference of the remaining parameters (P &gt; 0.05). Serum and urine cotinine values were linearly associated with REE (P &lt; 0.05). Conclusion: One hour of passive smoking at bar/restaurant levels is accompanied by significant increases in metabolism and thyroid hormone levels.

scholarly journals Provincial and Temporal Variation in Macrolide and Lincosamide Antimicrobial Use by Outpatients in Canada, 1995 to 2010

2014 ◽  
Vol 25 (2) ◽  
pp. 103-106 ◽  
Author(s):  
Shiona K Glass-Kaastra ◽  
Rita Finley ◽  
Jim Hutchinson ◽  
David M Patrick ◽  
Karl Weiss ◽  
...  
Keyword(s):  
Mixed Models ◽  
Repeated Measures ◽  
Secular Trend ◽  
Time Frame ◽  
Antimicrobial Use ◽  
Patterns Of Use ◽  
Defined Daily Doses ◽  
The Mean ◽  
Canadian Provinces ◽  
Over Time

INTRODUCTION: Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is very important.OBJECTIVE: To assess the use of macrolide and lincosamide (ML) antimicrobials within Canadian provinces over time, and to compare use rates with those reported by European countries.METHODS: Antimicrobial prescribing data were used to develop two yearly metrics: prescriptions per 1000 inhabitant-days (PrIDs) and the mean defined daily doses (DDDs) per prescription, which were then used to build linear mixed models to assess differences among provinces over time.RESULTS: After accounting for repeated measures over time, prescribing rates (PrIDs) varied significantly according to province and year (P<0.001). However, little change occurred within each province over the time frame studied; from 1995 to 2010, each province had a PrID change <0.01. Quebec and British Columbia had significantly lower prescribing rates than all other provinces. No overall secular trend was apparent. In contrast, the DDDs per prescription did not vary significantly according to province, but showed a significant year-to-year increase.DISCUSSION: ML prescribing varied among provinces in Canada between 1995 and 2010, but remained relatively stable within each province. The average DDDs per ML prescription did not vary according to province, but increased linearly over time. These increases are likely to indicate that fewer prescriptions are being written for children over time, a practice supported by good antimicrobial stewardship principles.

scholarly journals Urinary and blood procalcitonin concentration in healthy persons

2019 ◽  
Vol 36 (5) ◽  
pp. 35-43
Author(s):  
Dmitriy Yu. Sosnin ◽  
Ol'ga Yu. Nenasheva ◽  
Nadezhda A. Zubareva ◽  
Andrey V. Renzhin ◽  
Konstantin R. Gal'kovich
Keyword(s):  
Blood Serum ◽  
Middle Age ◽  
Solid Phase ◽  
Case Control ◽  
Test System ◽  
Serum Samples ◽  
Positive Dependence ◽  
The Mean ◽  
Healthy Persons ◽  
Serum And Urine

Aim. Blood serum and urinary procalcitonin (PCT) concentration in healthy persons was studied. Materials and methods. A single-stage observational study of case-control type was performed. The study included 32 men and 37 women of middle age (53.4 16.4 years) with normal renal function. PTC concentration was determined with the method of solid-phase enzyme immunoassay using test-system (Procalcitonin IFA-BEST, Russia). Results. Blood serum PCT concentration in the examined persons was 0.029 0.016 ng/ml (M SD). The number of blood serum samples with PTC level 0.05 ng/ml was 5.8 % (4 from 69). The mean urinary PTC concentration by 72.59 times exceeded the mean blood serum PTC content and was 2.12 1.832 ng/ml (р 0.000001). Coefficient of variation of results for the urine by 1.57 times exceeded the analogous index for the blood serum. When comparing the results of blood serum and urine analyses, no statistically significant differences between men and women were revealed. When estimating the coefficients of linear correlation between PTC content in the blood serum and urine, a weak positive dependence was established (R = 0.302782). Conclusions. High PTC concentration in the urine permits to suppose that one of the ways of procalcitonin removal from the blood plasma is its elimination by kidneys in unchanged type by means of glomerular filtration.

Prevalence and temporal patterns of persistence of symptoms in 165 rectal cancer patients receiving preoperative chemoradiation therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19580-19580
Author(s):  
S. Krishnan ◽  
T. Mendoza ◽  
Y. Zhang ◽  
X. S. Wang ◽  
P. Das ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Mixed Models ◽  
Repeated Measures ◽  
Symptom Burden ◽  
Preoperative Chemoradiation ◽  
Chemoradiation Therapy ◽  
Time Points ◽  
Preoperative Chemoradiation Therapy ◽  
Data Points ◽  
The Mean

19580 Background: The symptom burden during preoperative chemoradiation therapy for rectal cancer (CRT) has not been objectively characterized previously. The severity and temporal patterns of patient self-reported symptoms during CRT were assessed using the MD Anderson Symptom Inventory (MDASI). Methods: 165 consecutive patients with T3/T4/N+ rectal cancer received 45–55 Gy in 25–30 fractions concurrently with capecitabine chemotherapy. No additional intervention beyond standard supportive care was triggered by the MDASI score severity. The mean symptom scores were grouped into three time points; weeks 0–1 (“baseline”), 2–3 (“early treatment”), and 4–6 (“late treatment”) of CRT. Lowess curves were used to demonstrate the severity and pattern of individual symptoms. Linear mixed models were used to assess changes in symptom severity. Repeated measures analyses compared the mean severity of the reported symptoms at the three time points. Results: The median number of data points per patient was 3.0 (range, 1–6), for a total of 533 data points. Lowess curves demonstrated increasing symptom severity during CRT, which was confirmed by the linear mixed models analysis for each symptom (p<0.05). Using repeated measures with the three time points, these symptoms, except fatigue, showed statistically significant differences in mean severity ( Table 1 ). High baseline fatigue levels blunted statistical power to detect differences during CRT. Despite normal hemoglobin levels, fatigue remained the most severe symptom. Placed in context, the mean symptom levels remained mild throughout CRT. Conclusions: CRT was associated with a high prevalence of and progressive increase in symptom burden during therapy although the functional impact was limited. All symptoms followed clinically recognized patterns. The linear mixed model, a more sensitive measure of these trends, is recommended for prospective studies of interventions for symptom control [Table: see text] No significant financial relationships to disclose.

scholarly journals PERBANDINGAN KADAR KREATININ DAN ASAM URAT PADA SERUM DAN URIN PENDERITA HIPERTENSI DAN NORMOTENSI

Jurnal BIOMA ◽  
2015 ◽  
Vol 11 (2) ◽  
pp. 164
Author(s):  
Putri Octviani
Keyword(s):  
Blood Pressure ◽  
Uric Acid ◽  
Clinical Chemistry ◽  
Mean Value ◽  
Cross Sectional ◽  
Ex Post ◽  
Ex Post Facto ◽  
Blood And Urine Samples ◽  
The Mean ◽  
Serum And Urine

ABSTRACT Hypertension is an increase  of  blood  pressure  over  140/90  mmHg.  Hypertensionin along  period of timecaninterfere withkidney function. Impaired kidney functioncan be caused byhigh levelsof uricacidin the bloodthatis directly associatedwithperipheralvascular resistanceandrenalvascular. Measurement ofrenal functioncan be measuredbycreatininetest, becauseconcentrations in serumandurineexcretionin24 hoursis relativelyconstant. The aim of this research was to measure and compare creatinine and uric acid on serum and urine in hypertensive and normotensive. The parameters were measured by Mindray BS-300 clinical chemistry analyzer. Ex Post Facto used as method and Cross- sectional used as design. A total of 36 blood and urine samples collected from Hypertensive (N1=18) and normotensive (N2=18) from February to March 2014. SPSS 16.0 was used to analyze the datas, t-test was used to compare value of creatinine urine and uric acid serum while U Mann-Whitney test was used to compare value of creatinine serum. The result of this research showed that the mean value of creatinine serum was 0.80 mg/dL in hypertensive and 0.86 mg/dL in normotensive (p=0.14). The mean value of creatinine urin was 87.28 mg/dL in hypertensive and 74.47 mg/dL in normotensive (p=0.35). The mean value of uric acid serum was 4.06 mg/dL in hypertensive and 4.5 mg/dL in normotensive (p=0.41). The resultsofthe urineuricacidwere foundnegativeofthe presence ofuricacid crystals.In conclusion, there was no different of creatinine and uric acid on serum and urine in hypertensive and normotensive.   Keywords: hypertension, normotensive, creatinine, uric acid

Measurement of a more stable region of osteocalcin in serum by ELISA with two monoclonal antibodies

1995 ◽  
Vol 41 (10) ◽  
pp. 1439-1445 ◽  
Author(s):  
C Rosenquist ◽  
P Qvist ◽  
N Bjarnason ◽  
C Christiansen
Keyword(s):  
Monoclonal Antibodies ◽  
Hormone Replacement ◽  
Premenopausal Women ◽  
Stable Region ◽  
Serum Samples ◽  
Early Postmenopausal Women ◽  
Intact Molecule ◽  
Capture Antibody ◽  
The Mean ◽  
Human Osteocalcin

Abstract Intact human osteocalcin purified from femoral bones as well as tryptic fragments of the intact molecule [amino acids (aa) 1-19, 20-43, and 45-49] were used to raise and screen monoclonal antibodies (MAbs). A two-site ELISA for measurement of human osteocalcin in serum was developed with use of these MAbs. A MAb recognizing midregion human osteocalcin (aa20-43) was used as capture antibody, and an NH2 terminus (aa7-19)-specific peroxidase-conjugated MAb was used for detection. Human osteocalcin obtained from bone was used for calibration, and parallelism was observed for osteocalcin from serum samples, NH2-terminal midfragments (aa1-43), and synthetic human osteocalcin. Both inter- and intraassay variations were &lt; 7%. Serum osteocalcin in healthy premenopausal women (n = 49) was 18.3 +/- 4.2 micrograms/L (mean +/- SD) and 28.6 +/- 9.7 micrograms/L in early postmenopausal women (n = 114). The mean serum concentration (n = 10) decreased by 10% after 7 days of storage at 4 degrees C, whereas the concentration of intact human osteocalcin was reduced 63%. The N-MID ELISA and an IRMA measuring intact human osteocalcin were used to monitor the effect of hormone replacement therapy in a retrospective study. A significant decrease to the premenopausal concentration was detected only in the N-MID ELISA.

Immunologic Assessment of Patients Treated with Bovine Fibrin as a Hemostatic Agent

1996 ◽  
Vol 76 (06) ◽  
pp. 0925-0931 ◽  
Author(s):  
John F Carroll ◽  
Keith A Moskowitz ◽  
Niloo M Edwards ◽  
Thomas J Hickey ◽  
Eric A Rose ◽  
...  
Keyword(s):  
Coagulation Factors ◽  
Allergic Reactions ◽  
Factor V ◽  
Normal Range ◽  
Serum Samples ◽  
Human Fibrinogen ◽  
Bovine Thrombin ◽  
Thrombotic Complications ◽  
The Mean ◽  
Clinically Significant

SummaryTwenty-one cardiothoracic surgical patients have been treated with fibrin as a topical hemostatic/sealing agent, prepared from bovine fibrinogen clotted with bovine thrombin. Serum samples have been collected before treatment with fibrin and postoperatively between 1 and 9 days, 3 and 12 weeks, and 6 and 8 months. The titers of anti-bovine fibrinogen antibodies, measured by ELISA specific for immunoglobulins IgG or IgM, increased to maximal values after about 8 or 6 weeks, respectively. After 8 months, IgG titers were on average 20-fold lower than the mean maximal value, while IgM titers returned to the normal range. IgG was the predominant anti-bovine fibrinogen immunoglobulin as documented by ELISA, affinity chromatography and electrophoresis. Anti-bovine fibrinogen antibodies present in patients reacted readily with bovine fibrinogen, but did not cross-react with human fibrinogen as measured by ELISA or by immunoelectrophoresis. A significant amount of antibodies against bovine thrombin and factor V has been found, many cross-reacting with the human counterparts. No hemorrhagic or thrombotic complications, or clinically significant allergic reactions, occurred in any patient, in spite of antibody presence against some bovine and human coagulation factors. The treatment of patients with bovine fibrin, without induction of immunologic response against human fibrinogen, appeared to be an effective topical hemostatic/sealing measure.

Autoantibodies to Thrombomodulin: Development of an Enzyme Immunoassay and a Survey of their Frequency in Patients with the Lupus Anticoagulant

1992 ◽  
Vol 67 (05) ◽  
pp. 507-509 ◽  
Author(s):  
John Gibson ◽  
Margaret Nelson ◽  
Ross Brown ◽  
Hatem Salem ◽  
Harry Kronenberg
Keyword(s):  
Enzyme Immunoassay ◽  
Lupus Anticoagulant ◽  
Specific Binding ◽  
Technical Problem ◽  
Serum Samples ◽  
Citrate Buffer ◽  
The Mean ◽  
Sample Dilution ◽  
Negative Population ◽  
Serum Components

SummaryIn order to investigate the possibility that autoantibodies to thrombomodulin (TM) may exist in patients with the lupus anticoagulant (LA) and perhaps be implicated in the pathogenesis of recurrent thrombosis seen in such patients, we developed an enzyme-immunoassay to screen serum samples for anti-human TM activity. The major technical problem encountered in developing this assay was to reduce the non-specific binding of serum components from both the LA positive and the negative population. Considerable reduction of non-specific binding was achieved by use of a phosphate/citrate buffer at pH 8.0 and the use of an optimal sample dilution of 1/40. In addition, samples were always tested in parallel in blank wells and results are expressed as an OD ratio. Samples from 113 patients with the LA were assayed and compared to 78 patients referred for LA testing but found to be negative. The mean OD values for the LA positive patients (± SD) was 1.36 (0.44) with a range of 0.78-2.57. This was virtually identical to the values for the LA negative population (1.38 ± 0.40, range 0.76-2.77). The results of this study indicate that there is no evidence for the presence of a significant autoantibody activity to TM in patients with the LA when compared to LA negative patients. If such autoantibodies do exist their frequency must be quite low.

Efektivitas Comprehensive Breastfeeding Education terhadap Keberhasilan Pemberian Air Susu Ibu Postpartum

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Irma Nurbaeti ◽  
Kustati Budi Lestari
Keyword(s):  
Repeated Measures ◽  
Breastfeeding Support ◽  
Breastfeeding Practices ◽  
Breastfeeding Education ◽  
Repeated Measures Analysis ◽  
Post Test ◽  
Quasi Experimental ◽  
The Mean ◽  
Convenience Sampling ◽  
Postpartum Mothers

Pemberian Air Susu Ibu (ASI) masih merupakan masalah bagi pemenuhan kebutuhan nutrisi bayi baru lahir. Dukungan agar ibu menyusui bayi merupakan hal penting dalam menginisiasi dan mempertahankan pemberian ASI. Strategi dibutuhkan untuk mendukung keberhasilan menyusui. Tujuan penelitian adalah menganalisis efektivitas comprehensive breastfeeding education terhadap keberhasilan pemberian (ASI) pada periode postpartum. Jenis penelitian ini menggunakan kuasi eksperimen one group pre post test repeated measured design. Jumlah sampel sebanyak 22 ibu dengan menggunakan teknik accidental sampling. Pengumpulan data dilaksanakan pada bulan September–Oktober 2013 di Puskesmas wilayah Kota Tangerang Selatan. Intervensi dilakukan selama 30 menit. Pengumpulan data dilakukan sebelum intervensi, 3 hari setelah intervensi (post1), dan 10 hari setelah intervensi (post 2). Pengumpulan data menggunakan kuesioner dan observasi. Keberhasilan pemberian ASI berdasar pada parameter pengetahuan, langkah menyusui, perlekatan bayi, dan kecukupan ASI. Analisis data menggunakan general linear model repeated measureANOVA. Hasil penelitian menunjukkan adanya signifikansi comprehensive breastfeeding education (p=0.001). Rata-rata keberhasilan pemberian ASI sebelum dan setelah intervensi meningkat. Sebesar 93,9% intervensi memengaruhi tingkat keberhasilan. Rata-rata sebelum intervensi 56,74 (SD 5,92), post 1 sebesar 60,83 (SD 6,38) dan post2 sebesar 74,55 (SD 5,32). Subvariabel yang memiliki efek secara signifikan setelah intervensi adalah pengetahuan (p=0.001) dan langkah menyusui (p=0.001), sedangkan subvariabel perlekatan bayi (p=0.061) dan kecukupan ASI (p=0.162) tidak secara signifikan berbeda antara sebelum dan setelah intervensi. Pelaksanaanbreastfeeding education disarankan pada ibu agar dapat melakukan posisi perlekatan bayi yang benar sehingga dapat mengurangi masalah-masalah berkaitan dengan perlekatan yang tidak sesuai seperti puting perih, lecet atau berdarah, dan bayi kurang puas dalam menyusu yang bisa mengakibatkan gagalnya program ASI ekslusif.Kata kunci:Menyusui, pendidikan, perlekatan, postpartum AbstractBreastfeeding have still been problem for adequate newborn nutrition. Adequate breastfeeding support is essential for mothers to initiate and maintain optimal breastfeeding practices. A strategic needed to support successful breastfeeding. The purpose of research is to analyze the effectiveness comprehensive breastfeeding education on successful breastfeeding at postpartum periods. A quasi-experimental one group pretest, post test, repeated mesaured was used. This study was conducted at public health in Tangerang Selatan municipality in September–October 2013 among 22 postpartum mothers, convenience sampling methods. Intervention was done 30 minute. Data were collected before intervention (pretest), third day after intervention (post 1) and tenth day after intervention (repeated/post 2) using four parameter, that are knowledge, breastfeeding steps, proper lacth-on and adequate breastmilk. Using repeated measures analysis of variance there was a significant increase (p=0.001) in the overall Successful breastfeeding mean. Around 93,9% the effectiveness of intervention influence on successful. The mean before intervention is 56,74 (SD 5,92), increased at post 1:60,83 (SD 6,38) and post 2:74,55 (SD 5,32). Subvariable which has effect significantly after intervention is knowledge (p=0.001) and breastfeeding steps (p=0.001), in contrary, proper latch-on (p=0,061) and adequate breastmilk (p=0.162) have no significant effect after intervention. Suggestion to support breastfeeding education and counselling proper latch-on adequately that can decrease the problem such as painful, creaks or bloody putting.Key words: Breastfeeding, education, latch-on, postpartum

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