Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 3 Issue: 6

Validating the Mother-to-Infant Relation and Feelings� Scale by First-Time Mothers� Descriptions Three Months after Birth

Thorstensson Stina1*, Claesson, Amanda2, Packalen, Anna3, Hertfelt-Wahn, Elisabeth1 and Ekström Anette1
1School of Health and Education, University of Skövde, Sweden
2Mölndal labour ward, Sahlgrenska University Hospital, Göteborg, Sweden
3Kvinnokliniken, Skaraborgs Sjukhus Skövde, Sweden
Corresponding author : Stina Thorstensson
Post School of Health and Education, University of Skövde, Post box 408, S 541 28 Skövde
Tel: +46500-448455
E-mail: [email protected]
Received: August 23, 2014 Accepted: October 27, 2014 Published: November 03, 2014
Citation: Thorstensson S, Claesson A, Packalen A, Hertfelt-Wahn E, Ekström A (2014) Validating the Mother-to-Infant Relation and Feelings’ Scale by First-Time Mothers’ Descriptions Three Months after Birth. J Womens Health, Issues Care 3:6. doi:10.4172/2325-9795.1000173


Validating the Mother-to-Infant Relation and Feelings’ Scale by First-Time Mothers’ Descriptions Three Months after Birth

Becoming a mother is life-changing requiring development of knowledge and sensitivity toward the needs of the baby. When offering support professionals need knowledge about mother-infant interaction and the becoming-a-mother process.

Keywords: Mother-infant-interaction; Professional support; Becoming a mother; Feelings for and relation to the baby; Interviews; Think-aloud method


Mother-infant-interaction; Professional support; Becoming a mother; Feelings for and relation to the baby; Interviews; Think-aloud method


Becoming a mother for the first time is life-changing [1-3], affecting a woman’s personality and bringing a new perspective to her life [4]. Being pregnant means both physical and psychological change [5,6], and developing a relationship with the baby is a key factor in the psychological process of adaptation [7]. From the start of pregnancy, a woman’s relation to her baby varies from a vague sense of relation to an experience of closeness [8]. The relation between mother and baby affects the process of attachment, which is important for the baby’s development [9,10]. Attachment is a vital, instinctive process occurring irrespective of whether or not the caregiver is sensitive to the baby’s needs and signals [11]. However, a mother’s sensitivity to her baby’s signals is important for giving the baby a sense of security [12,13]. Professional support is important in facilitating both a mother’s sensitivity to her baby´s signals and needs and an appropriate caring response [14], and to consolidate the mother’s new role [15] and her well-being [12]. In order to give professionals useful tools to support mothers in their relations to and feelings for their baby, it is important to develop easy-to-use measurement scales for visualizing the mother-baby interaction, both for research and for clinical practice [2,16,17]. Becoming a mother has been described as a process [1] hence it seems important to interview first-time mothers also at three months after birth since their experience then could differ from the experience described directly after birth [2]. The aim of this study was to describe first time mothers’ experiences of relation to and feelings for their baby three months after birth as a step in the validation of the “Mother-to-Infant-Relation-and-Feelings” (MIRF) scale.

Materials and Methods

Inspired by the “think aloud” method [18], a qualitative design using both inductive and deductive approaches was selected [19]; validity testing of a scale is an ongoing process, and a variety of methodological approaches should be used in order to understand what inferences can be drawn from the scale [20]. Individual interviews were used to capture directly the voices of mothers, an important factor when aiming to measure abstract phenomena [20,21]. Interviews were performed using open questions followed by questions based on the MIRF-scale items, as described in the MIRF Scale section below. This data collection method aimed to elucidate participants’ perceptions [18] of their relation to and feelings for their baby in their own words before introducing them to the MIRF scale. Data were analyzed using both inductive and deductive qualitative content analysis [22].
Participants and data collection procedure
A purposive sampling strategy [23] was adopted, aiming for variation in age, education level, type of delivery and gender of the baby. Inclusion criteria were first-time mothers with healthy babies around three months of age. Exclusion criteria were mothers who did not speak or understand Swedish enough to be able to answer the interview questions and/or to understand the MIRF scale.
First-time mothers with babies around 3 months old were approached by a Child Health nurse at the post-natal healthcare center following the purposive sampling strategy. This nurse offered written information, and when mothers agreed to participate, they were contacted by author (AC). The eight participating first-time mothers varied in age between 23 to 31 years; three were educated to secondary level and five to university level. Their birth experiences varied from normal vaginal birth to vacuum extraction birth. Three of their babies were girls and five were boys. The mothers all had experience of breast-feeding and they were all co-habiting with the baby’s father.
Interviews were conducted in 2010 at a location chosen by the individual mother. Each interview started with two open questions: Describe your relation with your baby and Describe your feelings for your baby. During the interviews, participants were encouraged to reflect on their experience. The mothers then completed the MIRF scale and described their thoughts about each item, and why they answered as they did. Interviews lasted between 23 and 46 minutes, and were recorded and then transcribed verbatim.
The MIRF scale
The MIRF scale is a 7th point scale constructed from theory [5,24,25] in which some items are occasionally reversed to avoid routine responses [23]. The MIRF scale comprises two parts: the mother’s perceived relationship to (part 1) and feelings for (part 2) the baby. Part 1 opens with a question about how the mother perceives her relation to the baby, followed by these seven opposing binary statements: “I talk a lot with my baby / I do not talk at all with my baby”; “I enjoy resting when my baby is with me / I enjoy resting when my baby is with someone else”; “I enjoy breastfeeding / I do not enjoy breastfeeding”; “I feel that my baby is my own / I do not feel that my baby is my own”; “I know what my baby wants / I do not know what my baby wants”; “My baby is more beautiful than other babies / My baby is not as beautiful as other babies”; “My maternal feelings are very strong / My maternal feelings are not very strong”. Part 2 opens with a question about how the mother perceive her contact with the baby, followed by seven opposing word pairs: “Warm / Cold”; “Secure / Insecure”; “Close / Distant”; “Confident / Unconfident”; “Stable / Unstable”; “Easy / Difficult”; and “Pleasant / Unpleasant.”
Data analysis
For the open questions, an inductive qualitative content analysis [22] was used to explore the mother’s direct experience. Transcripts of the interviews were read through several times and discussed, compared and validated by all authors. Words and sentences relevant to the research questions were identified as meaning units, which were then condensed and coded, grouped under subcategories and then organized into categories (Table 1). In the final step, data were analyzed by reading across the categories, searching for new associations and meanings and in this process the theme was identified.
Table 1: Example of analytic process.
For the MIRF scale items, a deductive qualitative content analysis was used [22]. The mother’s answers were read through and analyzed for each item, and the perceived meaning of each item was identified. When answers to MIRF scale items were lower or higher then their individual description of these MIRF scale items was analyzed. Finally findings from the inductive and deductive analysis were compared to identify similarities and differences. This procedure allowed for comparison in order to understand what inference could be drawn from the MIRF scale in relation to first-time mothers 3 months after birth [20].
Ethical considerations
Ethical approval was obtained from the Ethical Review Board of Gothenburg [26] before any data collection began. The head of the maternity ward was informed and granted permission to undertake this study. The participating first-time mothers were given written and verbal information, confirming that participation was voluntary and that they could withdraw at any time without providing a reason, and without their care being affected.
Findings (1): open questions
Relation to and feelings for the baby in the first-time mother’s own words was described using the theme “First-time mothers’ relation and feeling for the baby was felt as a growing bond and a balance between love, protection and the challenge in adapting to a new role”, addressing two main categories: “A growing bond and mixed feelings” and “Balancing in a new relation”, elaborated as subcategories in Table 2. The main categories and sub-categories are first described ending with the description of the theme.
Table 2: Overview of the theme, main categories and sub-categories.
A growing bond and mixed feelings
A growing bond and mixed feeling involves unconditional love that these mothers have not experienced before. The mothers described a growing bond which was strengthened through interaction with the baby and trying to understand the babies’ needs. At the same time the mothers experienced unexpected feelings of wanting to protect while also worrying for the baby.
Unconditional love
Participants described the love they felt for their baby as something they have never felt for anyone else. They felt that love had gained a new dimension, and were surprised to find themselves so quickly and closely attached to someone they did not really know. They described these feelings for their baby as growing deeper every day and as overwhelming, an unconditional love with no demands in return.
It is so difficult to explain but you love your baby more than… more than anything else that you have ever loved ever… it is not possible to compare these feelings to the feelings I have for instance for her father, these are completely different feelings because these are mother feelings.
Before birth, mothers believed it was easy to imagine loving their baby, but they realized after giving birth that this was something entirely new. The mothers described feeling fantastic when they were with their baby, and that they sometimes did not know what to do with all these feelings. This love for the baby had dispelled all their preconceived ideas about motherly feelings and love. They felt they would do anything for their baby, regardless of what the baby might do now or in the future, and that their entire life and world had changed.
Presence and closeness strengthens a growing bond
The mothers described a growing bond with their baby. The point at which they could sense this bond for the first time depended on their wellbeing during pregnancy. None of these mothers had complicated pregnancies, but experiencing discomfort during pregnancy affected their attention, which was directed toward their own lack of wellbeing rather than, toward the baby they expected. Even so, they described the bond as growing stronger automatically and without their conscious attention. After birth, the ability to separate the cries of their own baby from those of other babies was seen as part of this bond. They described how their ability to comfort their baby better than anyone else strengthened this bond. They felt that this bond was everlasting, for the rest of their lives:
… that the bond will grow stronger and stronger and stronger from a small thread to a strong rope at the end…
This growing bond could be sensed during pregnancy, and learning to distinguish and understand the movements of the baby was described as important. After birth, mothers could recognize and identify their baby from movements and patterns during pregnancy. Bonding after birth was also strengthened through close bodily contact and attention to the baby’s signals, and when mother and baby spent most of the day together:
It is created through much closeness and above all from me being attentive and sensitive and well … present the whole time… // … that one learns and is there in the best way for one’s baby.
At three months of age, the baby was more interactive and responsive, further strengthening the mother-baby bond and leading to a more varied relationship. The babies were described as more awake, alert and happy. Being awake together at night, waking up together in the morning or when the baby was on the changing Table were identified as moments when they were close to each other in trusting interaction. These moments were described as strengthening their bond, and the mothers did not want anything to disturb them.
Again, to strengthen the growing bond it was considered important to interact with the baby and to understand and meet his/her needs. As time seemed to pass quickly, it proved difficult for the mothers to keep up with their baby’s development. They were astonished by the changes that came so early, but also felt it was wonderful to watch the child develop and change. They felt a responsibility to understand their baby, and they sometimes doubted their ability in this regard. They said this was more difficult up to three months of age, after which time the baby began to express needs more clearly through sounds and body language. They felt that their attention was constantly focused on the baby because it was necessary to be sensitive to the baby’s needs. An ability to understand the wishes of the baby before the baby expressed them—a kind of intuition— was also described. Being present and able to interact was considered important when the baby was with someone else: the baby indicated this by seeking contact with the mother through smiling, which was described as the main way of seeking such contact. The mothers described interacting through words, singing and body language. They talked to the baby constantly, feeling that their voice made him/ her feel secure.
When not interacting with their baby, perhaps when meeting friends, or if the baby had slept, mothers reported missing the baby intensely. To make up for this lost interaction, the mothers allocated special time to the baby. They reported that after three months they had established a bond, and that their baby responded to them as mothers.
Unexpected feelings of worry and protection
Participants reported unexpected feelings such as worry and needing to protect the baby. This idea of protection included ability to comfort the baby and feelings of insufficiency and powerlessness when they failed to do so. Worry about the baby was ever-present, and they had not imagined that they could worry over such small things. Worry created “security” thinking in the mothers as their biggest fear was that of losing the baby:
What is frightening is this worry all the time that something might happen.. //… This is what makes it so frightening because one has these strong feelings and if something would happen what would one do then.
To keep worry at bay, they tried to focus on what was going well, so that they could not focus on anything else until the baby was at ease. Their protective feelings were strongest when the baby was with someone else and was discontented. They pictured this phenomenon in terms of being a lioness or a mother hen:
One becomes a lioness protecting her cub… sort of when she (the baby) is with someone else and she is not content then one strongly want to go there and take care of one’s baby.
This feeling of protection and worry was reported as sometimes being so strong that they did not want anyone else to touch or even look at their baby. Their confidence in other family members failed, and they felt an urge to control everything that everybody else did in relation to the baby.
Balancing in a new relation
Balancing in a new relation describe the challenge of adapting to a new role at the same time as adapting to the rhythm of the baby and setting own needs aside. This balance was inevitably linked to mothers’ feelings and relation to the baby and included anticipation of their own ability as mothers.
Adapting to a new role
Anticipations of motherhood were characterized by anxiety about not being a good enough mother, and participants described their uncertainty about being able to understand their baby. During pregnancy, their curiosity grew about the expected baby, and they had fantasies about this person they would become a mother to. After birth, understanding of the baby was delayed by the need to heal, and in this process support from professionals was crucial. During this time, feelings of happiness were not as prominent as they subsequently became, as they struggled to understand what it meant to become a mother.
To begin with I did not understand that it was my baby and that she would follow me home...well I understood that she would follow us home but I could not picture myself as mother to this baby”
The understanding of what motherhood means developed gradually, but three months after birth they still found it to some extent unreal. Motherhood was described as two-sided: they felt proud of their baby, and it was meaningful to be a mother, but they also found it demanding and distressing that the baby required their constant attention. Encouraging words about the baby from healthcare professionals were important in consolidating their new role and helping them to realize that the baby was theirs.
Adapting to the rhythm of the baby
The baby was seen to dictate the rhythm of the family, and life adapted to this. Patterns became apparent three months after birth, and participants found a working routine that shaped everyday life, giving them a sense of safety and security in their role as mothers. During these months, life focused on the baby’s needs for nourishment and growth, and breastfeeding was described as a big part of relating to the baby. The mothers wanted to breastfeed for the sake of the baby but were faced with difficult decisions when breastfeeding sometimes did not work. The mothers also described pain during breastfeeding sore nipples or insufficient milk supply. Breastfeeding was seen as a moment for the baby to feel close and secure and to get comfort: the mothers described experiencing the wellbeing of the baby, which helped to motivate them when problems arose. The baby might be quick in feeding, but afterwards was a time for being cozy and close:
He hugs with his hands when he is feeding and he wants to grab something and he pulls my sweater and it is so wonderful to see that he is enjoying himself…”
Breastfeeding also brought about feelings of sacrifice and of being tied down. Opinion from other people about the decision to breastfeed or not was described as guilt-provoking: the mothers were concerned that whatever they decided, they would be queried. Breastfeeding was described as inseparable from the role of being a mother.
Putting one’s own needs aside
Participants understood their new role as mothers to mean putting their own needs aside and devoting their full attention to the baby. This responsibility demanded all their energy, but the moments of love made it easier to persevere. However this attention towards the baby needed balancing toward mother’s need of time for themselves and the relief of sometimes being able to leave the responsibility to someone else:
I could feel it is nice, if I am allowed to say, to get away and only be with myself for a while and not being a mother to go up to town and walk around in shops as I used to do before I became a mum”
It proved impossible for mothers to relax unless they were out of the home and their baby was elsewhere; but while time for themselves was considered important, this need also aroused feelings of shame, and mothers found it difficult to express their needs because this made them feel selfish and as not good enough mothers.
First-time mothers’ relation and feeling for the baby was felt as a growing bond and a balance between love, protection and the challenge in adapting to a new role
First-time mothers feelings for and relation to their baby three months after birth was a balancing act. Mothers need to balance strong, happy but mixed feelings for the baby and at the same time handle overwhelming feelings of entering their new role as mothers. The need to be sensitive toward the baby’s signals and to protect the baby could interfere with the mothers own needs to be able to relax. It was difficult for the mothers to distinguish between relation and feelings for the baby and their own transformation toward motherhood.
Findings (2): MIRF scale items
Participants described thoughts about each item of the MIRF scale, and these are summarized below, along with a range and mean of their answers. The MIRF scale being 7 point meant a high answer was closer to 7 and a low answer was closer to 1.
Item: I talk a lot to my baby / I do not talk at all to my baby (range 6–7, mean 6.63)
Mothers talked a lot to their baby, and, although the baby was only three months old, it was described as company to have someone to talk to. They reported ways of interacting included talking, singing and making other sounds to express their feelings.
Item: I know what my baby wants / I do not know what my baby wants (range 5-7, mean 6.0)
Being first-time mothers also meant being new to all situations involving the baby. During these first three months, confidence in understanding the needs of their baby developed and strengthened, but there were some contradictions in the answers given. Despite answering positively (higher) here, the mothers still expressed doubts about understanding the needs of their baby. One notable finding was that mothers who answered more negatively (lower) had had difficulties in breastfeeding and a mo re complicated delivery. In general, mothers concluded that it was impossible to know for certain whether they had correctly interpreted the baby’s needs.
Item: I rest better when the baby is with me / I rest better when the baby is with someone else (range 2–7, mean 4.5)
There was hesitation in acknowledging being better able to relax if someone else took care of the baby, even if they answered in this way (lower). However, resting with the baby encouraged relaxation in both mother and baby (answering higher). Overall, this item was found difficult to respond to.
Item: My baby is more beautiful than other babies / My baby is not as beautiful as other babies (range 4 – 7 mean 6,63)
Despite some variation in their answers, the mothers described their baby as most beautiful even if their descriptions differed in nuance. This item was found easy to answer.
Item: I have strong maternal feelings / I do not have strong maternal feelings (range 5-7, mean 6.5)
Having to value their maternal feelings was described by participants as a way of reflecting on all their new feelings. Answering lower (more negatively) indicated strong feelings relating to caring for the baby rather than to their sense of being mothers. Answering higher (more positively) on this item indicated having strong maternal feelings.
Item: I feel that the baby is my own / I do not feel that the baby is my own (All answered 7)
At three months after birth, mothers felt that the baby was their own, and they had no doubts. However, had this question been posed earlier their answers might have been different.
Item: I enjoy breastfeeding / I do not enjoy breastfeeding (range 2–7, mean 4.6)
Mothers wished to breastfeed because they had been informed this was optimal for the baby. Experiences and enjoyment of breastfeeding varied: breastfeeding was described as difficult and being tied up, and mothers answering lower (more negatively) described difficulties with pain and insufficient milk supply.
Mothers’ answers to opposing words
Overall, the opposing word pairs attracted ratings that were high or positive. Close contact was described in terms of “Close–Distant” (range 6–7, mean 6.88), and this close contact was considered important for understanding their baby. “Warm–Cold” (range 6–7, mean 6.88) was considered similar to”Close–Distant”, and answers were also quite similar. Answering low to “Confident–Unconfident” (range 5–7, mean 6.4), indicated uncertainty in understanding the needs of the baby when he/she cried for no obvious reason “Easy– Difficult” (range 5–7, mean 6.5) was found to be similar “Confident – Unconfident”. The mothers answered high to ”Secure–Insecure” (range 6–7, mean 6.75), describing security in their contact. On “Pleasant–Unpleasant” (range 6–7, mean 6.63), contact with the baby was considered unpleasant when the baby cried and could not be soothed, but overall contact was considered pleasant. “Stable– Fragile” was found to be similar to “Pleasant–Unpleasant”, but the mean response was slightly higher (6.88).
Mothers’ overall experience of the MIRF scale
It was considered important to have the opportunity to reflect on the scale items, as confirmation of themselves as mothers. Some scale items, such as “I rest better when the baby is with me / I rest better when the baby is with someone else” were more difficult to answer, and the mothers valued that the scale had 7 points.
Comparing inductive and deductive findings
First-time mothers’ descriptions of feelings and relation to their baby in their own word (inductive findings) and their description to the MIRF –scale item (deductive findings) were overall coherent even if the inductive findings were more nuanced.


Responses to the open questions show that, at three months after birth, first-time mothers’ relation and feeling for the baby was felt as a growing bond and a balance between love, protection and the challenge in adapting to a new role. It proves difficult to separate becoming a mother from feelings for and relation to their baby, which start during pregnancy. Being sensitive toward the baby’s needs and interacting with the baby is described as an important, even vital, part of this process, but is also seen to demand constant attention to the baby. This is experienced as tiring, and the mothers describe balancing putting own needs aside while longing for a chance to take a break from this huge and overwhelming responsibility—a struggle that is also evident in mothers’ answers to the MIRF scale.
Participants describe being unprepared for the strong feelings they have for their baby. Loving someone you do not really know is for them a new dimension of love, which, according to Mercer [1], is part of accepting the role of mother. The mothers also describe unexpected feelings of worry and wanting to protect their baby. Research suggests that worrying and wishing to protect the baby are fundamental to sensitive parenthood. Although these feelings are strong and overwhelming, they are also natural in relation to the process of becoming a mother [1,5], and new mothers need professional as well social support to understand and handle these feelings [2].
Mothers vary in terms of when they begin to sense a growing bond with their baby, and discomfort during pregnancy was described as one source of hindrance in this regard. It therefore seems important that support for new mothers should start during pregnancy [27-29]. Neglecting possible discomfort during pregnancy, may delay the process of becoming-a-mother [1]. In line with earlier research [27], the present findings also indicate that women worry about their ability as mothers. Professionals could support the process by talking about the baby, and by promoting skin-to-skin-contact, breastfeeding and trying not to separate mother and baby at birth [30-32]. It is important that professionals act with sensitivity to individual needs, as well as seeking to enhance mothers’ competence and sensitivity toward the baby.
Participants describe that spending time and interacting with their baby strengthens their growing bond. They also doubt their ability to understand their baby’s signals, and note the importance of being sensitive to those signals. Research shows that professionals can strengthen women in their role as mothers by informing them about infants’ early signals [15]. This may help to increase understanding of these signals, which is important for the baby’s physical and psychological development [9,10] and for the development of secure attachment [12]. Mothers also describe that relation to and understanding of the baby develops through intuition, in directing their full and constant attention to the baby. This may be one reason for the difficulties they describe in relaxing when the baby is with them. Healthcare professionals should offer support in discussing these aspects of parenthood while at the same time being sensitive to women’s physical, psychological, spiritual and emotional needs [33].
Our findings illuminate the complexity of the process of becoming a mother—the need to pay full attention to the baby while on the other hand acknowledging that this means putting personal needs aside. Research confirms the importance of being able to adjust to the baby’s needs [13], and of parents’ perceptions of their relation to their baby [5,34]. In the present study, answers to the item about relaxing when the baby is with me or with someone else illustrate this complexity, as mothers hesitate to say that they relax better when someone else has responsibility for the baby. Crucially, the mothers answering lower or negatively to this item also describe having complicated births, and research indicates that prolonged labor [35] and caesarean birth have negative impacts on mother-infant interaction [36-38]. Improved professional support during pregnancy may strengthen mothers and compensate for the negative impact of caesarean birth in relation to mother-infant interaction [39].
Participants found that the MIRF items helped them to reflect on the needs and signals of their baby. Again, research suggests that professionals could support the process of becoming a mother by increasing mothers’ knowledge in this regard [15]. The MIRF items could be used to initiate such a dialogue with mothers [2].
Comparing inductive with deductive findings suggest that the MIRF scale could be improved by adding items about the growing mother-baby bond and about the mother’s worries and anxieties. These items reflect mothers’ ability to know what their baby wants, and their maternal feelings, already addressed in earlier research [2,5,13,34]. Adding more items to the scale must therefore be balanced against diluting the inferences that can be drawn [20].
One limitation of this study is that it was based on eight first-time mothers in one area of Sweden. However, these mothers varied in age, education level and childbirth experience, which arguably strengthens our findings [23]. Both inductive and deductive analyses were used to capture mothers’ voices directly, while their reflection on MIRF scale items proved important for assessing these complex human experiences [21,40]. The answers to the MIRF scale in this study seem less varied, especially in part 2. However, when the MIRF scale has been used in studies with more participants [39,41] a variation can be detected implying the usefulness of the scale. Throughout the study, steps were taken to ensure its trustworthiness [23], such as discussing categories and theme during analysis among all authors


The MIRF scale seems to be a valid means of assessing mothers’ feelings for and relation to their baby, which is promising for future research. The findings here also contribute to a deeper understanding of the complex process of becoming a mother. First-time mothers need to talk and reflect on their new role as well as developing their ability to interact with and understand their baby. The MIRF scale items seem to provide a useful means of initiating a dialogue about the needs and signals of babies, both during pregnancy and after birth as participating mothers describe their experience as a process from pregnancy to present.

Clinical Implications

If professionals focus their attention only on the baby, they neglect mothers’ need to reflect and talk about their new role. However, as a basis for dialogue, the MIRF scale could help to increase knowledge and understanding of individual mothers and improve professionals’ ability to offer support during this process of becoming a mother.

Clinical Implications

No conflict of interest has been declared by the authors.


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