The effect of antepartum depressive and anxiety symptoms on mother-infant interaction: The mediating role of antepartum maternal emotional stress.

Anxiety disorders, depression, and emotional stress during the antepartum period are interlinked with adverse child development. The quality of the dyadic interaction seems to play a crucial role in the transmission of these effects. In this study, we explored the mediating effect of antepartum maternal emotional stress (assessed via the Prenatal Emotional Stress Index) regarding the relationship of antepartum maternal depressive (assessed via the Edinburgh Postpartum Depression Scale), anxiety symptoms (assessed via the Stat-Trait-Anxiety-Inventory), and depressive and anxiety disorders (assessed according to the DSM-IV-TR) in the antepartum period on postpartum interactive quality in a longitudinal design. The Face-to-Face-Still-Face Paradigm (FFSF) and the Infant and Caregiver Engagement Phases (ICEP-R) coding system were used to assess the postpartum interactive qualities of the mother-infant dyads. The sample consisted of 59 women, 38 in the clinical and 21 in the control group. We found significant indirect effects of antepartum depressive symptoms and maternal diagnostic status on the mother's neutral engagement and on the latency to the first social positive interactive match during the interaction - effects that were mediated by antepartum stress. Moreover, there was an indirect effect of state anxiety on neutral engagement - mediated by antepartum stress. Therapeutic intervention studies focusing on maternal antepartum regulation of emotional stress and postpartum interactive patterns might be crucial to encounter maladaptive developmental trajectories.

The effectiveness of integrated online health-coaching on physical activity and excessive gestational weight gain: a prospective randomized-controlled trial.

PURPOSE: Low levels of physical activity during pregnancy go along with increased risks for numerous health complications. We investigated whether an integrated lifestyle intervention leads to higher levels of physical activity and reduces the rate of excessive gestational weight gain (EGWG). METHODS: We conducted a randomized-controlled trial on 97 pregnant women, randomly assigned to receive an additional telehealth lifestyle intervention (experimental group, EG; n = 49) or conventional antenatal care (control group, CG; n = 48). The core lifestyle intervention comprised regular video calls, providing integrated personal support and motivation to physical activity. The primary outcome was change in physical activity measured in steps per day. An additional exploratory outcome was the proportion of participants with EGWG. RESULTS: The mean step count during the third trimester was 6483 steps/day (EG) and 5957 steps/day (CG), respectively (p = 0.078). Repeated-measures ANOVA revealed a significant interaction effect (p = 0.045) reflecting an overall increase of 497 steps per day in the EG vs. a decrease of 300 steps per day in the CG. The proportion of participants who met the IOM recommendation for total weight gain during pregnancy was significantly higher in the EG (p = 0.048) and the ratio of women that gained excessively was higher in the CG (p = 0.026). CONCLUSIONS: We assume that the personalized online intervention supports women in increasing or at least maintaining their level of physical activity during the course of pregnancy. Additionally, it reduces the rate of excessive weight gain.

Development of a conceptual framework to detect perioperative symptom burden following abdominal surgery for cancer.

BACKGROUND: Abdominal surgery for gastrointestinal malignancies has a significant impact on patients' health-related quality of life. However, there is so far no patient-reported outcome measures (PROM) in the immediate postoperative period to detect the perioperative symptom burden and patients' needs which may precede occult and severe complications. The aim of the study was to create a conceptual framework for the development of a PROM to measure perioperative symptom burden in abdominal cancer patients. METHODS: This mixed method study was performed between March 2021, and July 2021 as part of a multiphase approach to develop a new PROM. A systematic review of the literature was performed health domains were identified. The relevance of the health domains was assessed in a two-round Delphi study with clinical experts. Qualitative interviews were performed in patients who underwent abdominal surgery for cancer. RESULTS: The systematic literature review yielded 12 different PROM with 168 items and 55 health domains. The most common health domains involved the "digestive system" and "pain". In total, 30 patients (median age 66 years, 20 men [60%]) were included for qualitative patient interviews. Of 16 health domains identified by the Delphi study, a total 15 health domains were confirmed during patients' interviews. The final conceptual framework included 20 health domains. CONCLUSION: This study provides the essential groundwork to develop and validate a new PROM for the immediate postoperative period of patients undergoing abdominal surgery for cancer.

Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment.

BACKGROUND: Knowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment. METHODS: In a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12-24 months. RESULTS: Results indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153). LIMITATIONS: Participants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported. CONCLUSIONS: PAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.

Neurocognitive Deficits in First-Episode and Chronic Psychotic Disorders: A Systematic Review from 2009 to 2022.

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.

[Follow-up Routine in Primary Care of Women after Hypertensive Disorders in Pregnancy - a Single-Center, Survey-Based Study]. / Versorgungsrealität von Frauen nach hypertensiver Schwangerschaftserkrankung ­ eine monozentrische fragebogenbasierte Analyse.

INTRODUCTION: Women with a history of a hypertensive disorders of pregnancy have a significantly higher risk of future cardiovascular diseases and are therefore recommended to participate in screening examinations and counseling on primary prevention. To understand the current routine of postpartum care, we examined how many women engage in follow-up examinations and whether counseling takes place. METHODOLOGY: Single-center, survey-based study of 113 women affected by hypertensive disorders of pregnancy between 2014 and 2019. Descriptive analysis was used to analyze the responses. RESULTS: A total of 54% of the women engaged in follow-up. Of the participants, 47% were informed about their diagnosis in a personal conversation and possible consequences were pointed out. Of the 67 women with a BMI≥25 kg/m2, 23% received a recommendation to increase physical activity, and 13% of these women were advised to reduce their weight. Significantly more women with a higher burden of disease (BMI, p=0.027; arterial hypertension, p=0.016) and a severe form of hypertensive pregnancy disorder (eclampsia, intensive care treatment, each p=0.016) engaged in follow-up care. CONCLUSIONS: The present results suggest that the strategies to prevent cardiovascular diseases and detect cardiovascular risk factors have not been consistently pursued. After a hypertensive disorder of pregnancy, every woman should receive a recommendation to engage in follow-up examinations.

Neurocognitive deficits in depression: a systematic review of cognitive impairment in the acute and remitted state.

Previous research suggests a broad range of deficits in major depressive disorder. Our goal was to update the current assumptions and investigate the extent of cognitive impairment in depression in the acute and remitted state. A systematic review of the existing literature between 2009 and 2019 assessing the risk of bias within the included studies was performed. Of the 42 articles reviewed, an unclear risk of bias was shown overall. The risk of bias mainly concerned the sample selection, inadequate remedial measures, as well as the lack of blinding the assessors. In the acute phase, we found strong support for impairment in processing speed, learning, and memory. Follow-up studies and direct comparisons revealed less pronounced deficits in remission, however, deficits were still present in attention, learning and memory, and working memory. A positive correlation between the number of episodes and cognitive deficits as well as depression severity and cognitive deficits was reported. The results also demonstrate a resemblance between the cognitive profiles in bipolar disorder and depression. Comparisons of depression with schizophrenia led to unclear results, at times suggesting an overlap in cognitive performance. The main findings support the global deficit hypothesis and align with results from prior meta-analyses and reviews. Recommendations for future research are also presented.

The COVID-19 pandemic as a traumatic event and the associated psychological impact on families - A systematic review.

BACKGROUND: The COVID-19 pandemic and its accompanying containment measures can be conceptualized as traumatic events. This review systematically investigates trauma-related symptoms in the course of the COVID-19 pandemic and the association of the pandemic and its containment measures with trauma-related disorders or symptoms. METHODS: The EBSCO (MEDLINE, PsycINFO, PsycARTICLES, PSYNDEX), Cochrane Library, and Web of Science databases were searched in June 2021. The Quality Assessment Tool for Quantitative Studies (EPHPP-QAT; Thomas et al., 2004) was applied. Studies conceptualizing the COVID-19 pandemic as a traumatic event and assessing typically developing children and adolescents (under 18 years), and/or caregivers (at least 18 years) were included. RESULTS AND LIMITATIONS: 22 primary studies including 27,322 participants were evaluated. Only three primary studies executed a statistical comparison with pre-pandemic or retrospective data, showing a negative impact of the COVID-19 pandemic and its associated measures on children's and caregiver's internalizing symptoms and hyperactivity. In the majority of the remaining studies, prevalence rates of various trauma sequelae in children, adolescents, and caregivers were reported to be descriptively higher in the context of the COVID-19 pandemic when compared to other pre-pandemic studies. However, due to numerous methodological differences between these studies the statement that the pandemic is associated with higher prevalence rates of trauma-associated symptoms cannot be validly answered at this point. CONCLUSION: Due to some methodological shortcomings of the primary studies, our results might be cautiously interpreted as a first indicator of an association between the COVID-19 pandemic and trauma sequelae.

[Intensive Care ventilation-New norm establishes a uniform nomenclature for ventilation modes]. / Intensivbeatmung ­ neue Norm legt einheitliche Nomenklatur für Beatmungsmodi fest.

BACKGROUND: The current naming of ventilation modes in anesthesiology and critical care is characterized by manufacturer-specific inconsistent acronyms. This is confusing for users and potentially life-threatening for patients. The standard, published in August 2021 in its German version as DIN EN ISO 19223:2021, aims to introduce a uniform classification with corresponding nomenclature. AIM OF THE WORK: To present the new standard and its consequences for the user. MATERIAL AND METHOD: Review and summary of DIN EN ISO 19223:2021 with a critical appraisal of its strengths and weaknesses. RESULTS: A simplified scheme shows the group classification of ventilation modes based on similar characteristics. These are further specified by additional variables. A reference table contrasts the new nomenclature of ventilation modes with those currently in use. Accordingly, the new classification scheme appears inconsistent and the variables are difficult to distinguish. CONCLUSION: Standardized terminology and semantics in respiratory care are necessary and desirable for error reduction. However, the recently presented standard fulfils these expectations only to some extent and in its current form will probably lead to further ambiguities and problems in the clinical routine. Accordingly, it is imperative that this first version of DIN EN ISO 19223:2021 be understood as the starting point for a discussion of its content, even outside the standards committees, so that its obvious weaknesses can be eradicated and the nomenclature made suitable for everyday use.

Study protocol of the COMPARE-Interaction study: the impact of maternal comorbid depression and anxiety disorders in the peripartum period on child development.

INTRODUCTION: To date, there are only few studies that compare the consequences of peripartum maternal depressive disorders (PD) versus depressive with comorbid anxiety disorders (PDCA) for infant and child development. As comorbidity is associated with greater impairment and symptom severity related to the primary diagnosis, comorbidity in mothers might raise their offspring's risk of developing internalising or externalising disorders even more than has been noted in conjunction with PD alone. METHODS AND ANALYSIS: This study aims to analyse the impact of parental psychopathology, particularly peripartum depression in mothers with and without comorbid anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on child cognitive and socioemotional development. Maternal/paternal psychopathology, mother-infant/father-infant interaction and child development are assessed at four measurement points over the first 2 years (T1: 3-4 months postpartum, T2: 12 months postpartum, T3: 18 months postpartum and T4: 24 months postpartum). The mediating role of mother-infant/father-infant interaction and infant stress reactivity in the relationship between PD/PDCA and infant cognitive and socioemotional development will be analysed. In the ongoing study, 174 families (n=58 mothers with PD, n=58 mothers with PDCA and n=58 healthy controls) will be recruited in inpatient and outpatient centres as well as maternity hospitals in Munich and Heidelberg. ETHICS AND DISSEMINATION: This study is implemented in accordance with the current guidelines of the World Medical Association (revised Declaration of Helsinki) and the General Data Protection Regulation of the European Union. The study procedures were approved by the independent ethics committees of the Department of Psychology, Ludwig-Maximilians-University Munich (74_Reck_b) and of the Medical Faculty, University Heidelberg (S-446/2017). Participation is voluntary. A signed written informed consent form must be obtained from each study subject prior to any study-specific procedure. Participants can withdraw from the study at any point in time without giving a reason or being subjected to any future disadvantages. In case of withdrawal from the study, the subject's data and material will be kept unless the participant asks for data removal. Results will be published and disseminated to further the discussion on the effects of maternal PD and PDCA on parent-infant interaction, infant stress reactivity and child development. Furthermore, study results will be presented at international congresses and expert conferences.

From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study.

Parental mental disorders increase the risk for insecure attachment in children. However, the quality of caregiver-infant interaction plays a key role in the development of infant attachment. Dyadic interaction is frequently investigated via global scales which are too rough to uncover micro-temporal mechanisms. Prior research found that the latency to reparation of uncoordinated dyadic states is associated with infant behavioral and neuroendocrine regulation. We investigated the hypothesis that this interactive mechanism is critical in predicting secure vs. insecure attachment quality in infancy. We also assessed the predictive quality of infant attachment regarding neuroendocrine reactivity later in childhood. A subsample of N = 58 dyads (n = 22 mothers with anxiety disorders, n = 36 controls) from a larger study were analyzed. At 3-8 months postpartum, maternal anxiety disorders were diagnosed via a structured clinical interview as well as dyadic interaction during the Face-to-Face-Still-Face (FFSF) was observed and coded on a micro-temporal scale. Infant attachment quality was assessed with the strange situation paradigm at 12-24 months of age. In an overlapping subsample of N = 39 (n = 13 mothers with anxiety disorder; n = 26 controls), we assessed child cortisol reactivity at 5 to 6 years of age. Generalized linear modeling revealed that longer latencies to interactive reparation during the reunion episode of the FFSF as well as maternal diagnosis at 3-8 months of age predict insecure attachment in children aged 12-24 months. Cox regressions demonstrated that dyads with infants who developed insecure attachment at 12-24 months of age were 48% less likely to achieve an interactive reparation at 3-8 months of age. Mixed models revealed that compared to securely attached children, children who had developed an insecure attachment at 12-24 months of age had an increased cortisol reactivity at 5 to 6 years of age during free play. The results confirm the hypothesis that the development of attachment is affected by experienced micro-temporal interactive patterns besides diagnostic categories. They also showed that infants of mothers with postpartum anxiety disorders have a more than fivefold increased risk of developing an insecure attachment than the infants of the control group. Moreover, results imply that these patterns may influence neurohormonal regulation even in preschool aged children.