[Impact of early life maltreatment of women on the mother-child relationship : Data from mother-child dyads from Heidelberg and Berlin]

Early life maltreatment can have severe and long-lasting consequences for the directly affected individual as well as for the next generation. Data from our research including mother-child dyads from Heidelberg and Berlin show that early life maltreatment is associated with behavioral and neural changes including personality traits and attachment style of the affected mothers that negatively affect their relationship with their child. The children of these mothers affected by early life maltreatment have an elevated risk to be maltreated and to develop mental disorders. They also show a heightened cortisol concentration and a reduced inhibition control. It seems to be of importance whether the mother has experienced early life maltreatment but is resilient, meaning that she has not developed a mental disorder (up to the time of examination) or whether in addition to the early life maltreatment she has developed a mental disorder later in life. Children of mothers with early life maltreatment and a lifetime mental disorder seem to be especially exposed to stress and show the greatest impairments and risks. Based on the existing data from our research practical and clinical implications are discussed and one possible intervention in the form of a training of mentalization competencies for parents is presented.

Assessment of the Heineke-Mikulicz anoplasty for skin level postoperative anal strictures and congenital anal stenosis

INTRODUCTION

Acquired skin-level strictures following posterior sagittal anorectoplasty (PSARP) and some rare cases of congenital anal stenosis can be managed using a Heineke-Mikulicz like anoplasty (HMA). We hypothesized that this procedure was an effective, safe, and durable outpatient procedure in select patients.

METHODS

We retrospectively reviewed all patients who underwent HMA for skin level strictures following PSARP or for certain congenital anal stenoses from 2014 to 2017.

RESULTS

Twenty-eight patients (19 males, 9 females) with a mean age of 5.8 years (range 0.5-24.4) underwent HMA. Twenty-six had a prior PSARP, of which 18 were redo, and 8 were primary procedures. Two patients had congenital skin level anal stenosis. The mean follow up was 1.0 years (range 0.4-2.9). The average preprocedure anal size was Hegar 8, which after HMA increased 8 Hegar sizes to 16 (95% CI 7-9, p < 0.001). There were no operative complications. One patient restenosed and required a secondary procedure.

CONCLUSION

HMA is a safe procedure for skin-level anal strictures following PSARP (primary and redo) and can also be used in some rare cases of congenital anal stenosis. Long-term follow up to determine the restricture rate is ongoing. A plan to do an HMA if a stricture develops may offer an alternative to routine anal dilations, particularly after a redo PSARP in an older child.

TYPE OF STUDY

Case series.

LEVEL OF EVIDENCE

Level IV.

Surgical management of functional constipation: An intermediate report of a new approach using a laparoscopic sigmoid resection combined with malone appendicostomy

INTRODUCTION

We previously reported our surgical technique for functional constipation for patients who have failed medical management using a novel collaborative approach with gastroenterology input, pre-operative contrast enema, colonic manometry, and laxative protocol combined with a laparoscopic colonic resection with Malone appendicostomy. Now we report our intermediate outcomes.

METHODS

Patients who failed bowel management program for functional constipation were reviewed from 3/2014-2/2017. Patients with Hirschsprung disease, anorectal malformation, tethered cord, spina bifida, Trisomy 21, cerebral palsy, mitochondrial disease, or prior colon resection were excluded.

RESULTS

Of 31 patients (14 females; median age 12years, follow-up 10.3months) with functional constipation and failed medical management, 26 (84%) had preoperative colonic manometry which, in addition to the contrast enema, guided laparoscopic colon resection. Ten patients (32.3%) are clean with no flushes (1 takes no laxatives, 8 are on low dose laxatives only, and 1 patient was clean on laxatives but chose to switch back to flushes). Of the 21 patients that remain on antegrade flushes, 20 (95.2%) are clean, and one patient (4.8%) continues to soil. We define clean as no soiling and no abnormal stool burden on x-ray. Laxative trials are planned for all patients on an antegrade flush regimen.

CONCLUSION

Our intermediate results show that laparoscopic colon resection with Malone appendicostomy allows the majority of patients to be clean on antegrade flushes, and some to be on no or minimal laxatives.

TYPE OF STUDY

Retrospective review.

LEVEL OF EVIDENCE

3.

Maternal avoidance, anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period

BACKGROUND

Few studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy.

AIMS

This longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development.

STUDY DESIGN

Subjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age.

SUBJECTS

n = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant.

OUTCOME MEASURES

Infant performance on Bayley-III language and cognitive scales.

RESULTS

Infants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of "maternal avoidance accompanied" in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance.

CONCLUSIONS

Results underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.

Surgical Management of Functional Constipation: Preliminary Report of a New Approach Using a Laparoscopic Sigmoid Resection Combined with a Malone Appendicostomy

Introduction Functional constipation is a common problem in children. It usually can be managed with laxatives but a small subset of patients develop intolerable cramps and need to be temporarily treated with enemas. The senior author has previously reported: 1) open sigmoid resection as a surgical option, but this did not sufficiently reduce the laxative need, then 2) a transanal approach (with resection of rectosigmoid), but this led to a high rate of soiling due to extensive stretching of the anal canal and loss of the rectal reservoir. The understanding of these procedures' results has led us to use a laparoscopic sigmoid ± left colonic resection with a Malone appendicostomy for these patients, to decrease the laxative requirements, temporarily treat with antegrade flushes, and to reduce postoperative soiling. Methods A single-institution retrospective review (3/2014-9/2015) included patients who failed our laxative protocol, and therefore were considered surgical candidates. Patients with anorectal malformation (ARM), Hirschsprung disease, spina bifida, tethered cord, trisomy 21, cerebral palsy, mitochondrial disease, prior colon resection at other facilities, or those that did not participate in our laxative program were excluded. Demographics, duration of symptoms, prior treatments, postoperative complications, and postoperative bowel regimens were evaluated. Results A total of 6 patients (3 males; median age of 12.5 years) presented with soiling related to constipation and intolerance to laxatives. Four patients failed preoperative cecostomy (done prior to referral to us). An average of 4.7 medication treatments were previously tried. In all, 4 patients had required in-patient disimpactions. Duration of symptoms was 7.5 years (median). The median senna dose was 30 mg (range, 15-150 mg), and all patients had intolerable symptoms or failed to empty their colon, which we considered a failed laxative trial. All had contrast enemas that demonstrated a dilated and/or redundant sigmoid colon, and colonic manometry was abnormal in 4. All patients underwent laparoscopic sigmoid and left colon resection, or only sigmoid resection (a low anterior resection). Two patients had postoperative colitis treated with oral antibiotics. The median follow-up was 52 days (range, 8-304 days). Five patients are on antegrade enemas with plans to convert to laxatives at 6 months, 1 is taking laxatives alone at a 33% lower dosage. Five of six are completely clean, 1 soils occasionally and their daily flush is being adjusted. Conclusion Only a minority of patients with functional constipation are medically unmanageable. This preliminary report shows that laparoscopic colon resection combined with antegrade flushes is an effective surgical technique to treat that group. A laparoscopic approach, guided by contrast enema and colonic manometry, allows for a defined resection of the abnormal segment of colon with the advantages of minimally invasive surgery including allowing for an extensive rectal resection (an improvement over open sigmoid resection) and avoidance of overstretching of the anal canal and removal of the rectal reservoir (an improvement over the transanal approach). Having antegrade access is useful to manage soiling and avoiding cramping from laxatives in the early postoperative period. Although our series is small, we believe that long-term most patients can avoid antegrade flushes and be on no, or a dramatically reduced, laxative dose.

A standardized approach for the assessment and treatment of internationally adopted children with a previously repaired anorectal malformation (ARM)

INTRODUCTION

A significant number of internationally adopted children have congenital birth defects. As a specialist center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population.

METHODS

The results of investigations, indications, and rate of reoperation were assessed for adopted children with an ARM evaluated between 2014 and 2016.

RESULTS

56 patients (28 males) were identified. 76.8% required reoperative surgery. Mislocation of the anus outside the sphincter complex was seen in 50% of males and 39.3% of females. Anal stricture, rectal prolapse, retained vaginal septum, and a strictured vaginal introitus were also common.

CONCLUSION

The reoperative surgery rate in the internationally adopted child with an ARM is high. Complete, systematic evaluation of these children is required to identify complications following initial repair. Development of mechanisms to improve the primary surgical care these children receive is needed.

Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding

Research investigating maternal bonding and parenting stress in the course of postpartum depression is lacking. Aim of the study was to investigate the development and potential mediation of both constructs in the course of postpartum depression. n = 31 mothers with postpartum depression according to DSM-IV and n = 32 healthy controls completed the German version of the Postpartum Bonding Questionnaire and the Parenting Stress Index at two measuring times: acute depression (T1) and remission (T2). At T1, the clinical group reported lower bonding and higher parenting stress. Bonding was found to partially mediate the link between maternal diagnosis and parenting stress. Furthermore, the clinical group reported lower bonding and higher parenting stress averaged over both measurement times. However, at T2, the clinical group still differed from the controls even though they improved in bonding and reported less parenting stress. A significant increase of bonding was also observed in the control group. Maternal bonding seems to buffer the negative impact of postpartum depression on parenting stress. The results emphasize the need for interventions focusing on maternal bonding and mother-infant interaction in order to prevent impairment of the mother-child relationship.

Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour

Hardly any research has examined the link between postpartum anxiety disorder and maternal bonding. This study examined if postpartum anxiety disorder and maternal bonding are related in the postpartum period. Thereby, subclinical depressive symptoms and specific aspects of an anxious symptomatology were also taken into consideration. The German sample of N = 78 mother-infant dyads is composed of n = 30 mothers with postpartum anxiety disorders but without major or minor depression according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and n = 48 healthy mothers. Subjects were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months. Moreover, mothers filled out the Postpartum Bonding Questionnaire-16. The Anxiety Cognitions Questionnaire, the Body Sensations Questionnaire and the Mobility Inventory were chosen to assess different aspects of anxious symptomatology. To control for concurrent subclinical depressive symptoms, we used the German Edinburgh-Postnatal-Depression Scale. Mothers with postpartum anxiety disorder reported significantly lower bonding than healthy mothers. However, in a linear regression analysis, concurrent subclinical depressive symptoms and avoidance of anxiety-related situations in company explained 27 % of the overall variance in maternal bonding. The perceived lower bonding of mothers with anxiety disorder could be due to aspects of a concurrent subclinical depressive symptomatology. This notion emphasizes the need to target even mild depressive symptoms in the treatment of postpartum anxiety disorders. The outcomes also underline that the severity of anxious symptomatology, reflected by avoidance behaviour in company, puts the mother-infant bond at risk.

Interleukin-8 predicts 60-day mortality in premature infants with necrotizing enterocolitis

OBJECTIVE

The purpose of this study was to evaluate the predictiveness of circulating interleukin (IL)-8 for 60-day mortality in premature infants with necrotizing enterocolitis (NEC).

BACKGROUND

NEC affects up to 5% of premature infants and remains a leading cause of mortality among neonates.

METHODS

A total of 113 infants with surgically (n=50) or medically (n=63) treated NEC were retrospectively analyzed. Laboratory parameters including serum IL-8 were assessed at the diagnosis of NEC and during the preoperative workup.

RESULTS

The 60-day mortality was 19% (22/113), 10% (6/63) in medical and 33% (16/50) in surgical NEC. IL-8 levels significantly correlated with 60-day mortality (odds ratio: 1.38; CI 1.14-1.67; p=0.001). Median IL-8 levels at diagnosis were significantly higher in neonates who were later treated surgically (median=2625 pg/ml; range: 27-7500) compared with those treated medically (median=156 pg/ml; range: 5-7500; p<0.001). The AUC to discriminate between medical and surgical NEC was 0.82 (CI, 0.74-0.90), and an exploratory IL-8 cutoff point could be established at 1783 pg/ml (sensitivity of 90.5%; specificity of 59.2%).

CONCLUSIONS

Our findings that serum IL-8 (i) correlates directly with 60-day mortality and (ii) differs significantly between medically and surgically treated infants may change the process of therapeutic decision making in NEC.

The influence of general anxiety and childbirth-specific anxiety on birth outcome

In the present study, we examined a German sample to determine whether anxiety symptoms during pregnancy had an impact on the duration and method of childbirth. Data of N = 88 women recruited at the Heidelberg University Hospital were used in the analyses. Prepartum anxiety symptoms were assessed with the State-Trait Anxiety Inventory (STAI, general anxiety) and the Pregnancy Related Anxiety Questionnaire (PRAQ-R, pregnancy-specific anxiety). Obstetric outcome was taken from birth records and operationalized by two parameters: the total duration of birth (dilation and fetal expulsion) and the incidence of pregnancy or birth-related interventions (ventouse, planned, and unplanned Cesarean section). The data show that childbirth-specific anxiety assessed by the PRAQ-R is an important predictor of total birth duration. In contrast, general anxiety measured by the STAI had no effect. The incidence of birth intervention was explained by parity. Anxiety, however, had no predictive value. In addition to medical factors, childbirth-specific anxiety during pregnancy plays an important role in the process of childbirth. The findings of the present study point to the need of implementing psychological interventions to reduce childbirth-specific anxiety and thereby positively influencing birth outcome.

Subclinical depressive symptoms during pregnancy and birth outcome--a pilot study in a healthy German sample

There is a high prevalence of depression in Germany and all over the world. Maternal depressive symptoms during pregnancy have been shown in some studies to be associated with an increased risk of preterm birth and low birth weight. The influence of maternal depressive symptoms during pregnancy on preterm delivery and fetal birth weight was investigated in a prospective single-centre study. A sample of 273 healthy pregnant women was assessed for symptoms of antepartum depression. Symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ). Symptoms of anxiety were assessed using the State/Trait Anxiety Inventory. Patients who scored above the cutoff were contacted by phone for a Structured Clinical Diagnostic interview. Neonatal measurements were obtained from the birth registry of the Department of Obstetrics. Baseline data were assessed with a self-styled data sheet. Prevalence of elevated depressive symptoms was 13.2% when measured with the EPDS and 8.4% with the PHQ. According to DSM-IV criteria, only four (EPDS) respective two (PHQ-D) of these patients could be diagnosed with a depressive disorder and ten (EPDS) respective seven (PHQ) with an anxiety disorder. There was no significant influence on preterm birth or birth weight. Maternal depressive symptoms are self-reported. Elevated subclinical symptoms of depression and anxiety during pregnancy are common. However, this study showed no evidence that these symptoms are associated with adverse pregnancy outcome.

Comprehensive evaluation of 11 cytokines in premature infants with surgical necrotizing enterocolitis

OBJECTIVE

A prospective study to investigate the pattern of pro- and anti-inflammatory cytokine responses in neonates with surgical necrotizing enterocolitis (NEC) and identify those cytokines being the most promising for future research.

METHODS

A panel of 11 different cytokines were measured in 9 infants with proven NEC and compared with 18 age-matched healthy neonates.

RESULTS

The serum concentrations of the interleukins (IL)-6, IL-8, and IL-10 were significantly (32-fold to 56-fold) higher in NEC infants compared with controls. In contrast, IL-5, IFN gamma, IL-4 and IL-2 showed slightly (1.4-fold to 5.9-fold) lower levels in the NEC samples. However, these cytokines showed a very low absolute concentration in infants with NEC and in controls. The sum of the serum concentrations of IL-6, IL-8 and IL-10 was able to clearly separate infants with NEC from control samples. IL-1 beta and TNF-alpha showed no statistically different levels. The serum levels of TNF-beta and IL-12p70 were below the detection limit in more than 50% of all samples per group.

CONCLUSION

In spite of strong local inflammation only three out of eleven cytokines (IL-6, IL-8, and IL-10) showed strongly increased serum levels indicating an important role of them in the pathogenesis of NEC. At least two of these three cytokines were elevated in every single NEC patient. Thus, longitudinal monitoring of combined IL-8, IL-6, and IL-10 levels could reveal their potency in being clinical relevant markers in NEC.

Modulation of local field potential power of the subthalamic nucleus during isometric force generation in patients with Parkinson's disease

Investigations of local field potentials of the subthalamic nucleus of patients with Parkinson's disease have provided evidence for pathologically exaggerated oscillatory beta-band activity (13-30 Hz) which is amenable to physiological modulation by, e.g., voluntary movement. Previous functional magnetic resonance imaging studies in healthy controls have provided evidence for an increase of subthalamic nucleus blood-oxygenation-level-dependant signal in incremental force generation tasks. However, the modulation of neuronal activity by force generation and its relationship to peripheral feedback remain to be elucidated. We hypothesised that beta-band activity in the subthalamic nucleus is modulated by incremental force generation. Subthalamic nucleus local field potentials were recorded intraoperatively in 13 patients with Parkinson's disease (37 recording sites) during rest and five incremental isometric force generation conditions of the arm with applied loads of 0-400 g (in 100-g increments). Repeated measures analysis of variance (ANOVA) revealed a modulation of local field potential (LFP) power in the upper beta-band (in 24-30 Hz; F(₃.₀₄₂)=4.693, p=0.036) and the gamma-band (in 70-76 Hz; F(₄)=4.116, p=0.036). Granger-causality was computed with the squared partial directed coherence and showed no significant modulation during incremental isometric force generation. Our findings indicate that the upper beta- and gamma-band power of subthalamic nucleus local field potentials are modulated by the physiological task of force generation in patients with Parkinson's disease. This modulation seems to be not an effect of a modulation of peripheral feedback.

MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance

PURPOSE

Conventionally, radiography studies revealed prolonged glenoidal drill hole visibilities with an unclear influence to the clinical outcome after arthroscopic Bankart repair using Poly-Laevo-Lactic-Acid (PLLA) anchors. The primary aim of the present study was the separated assessment of drill hole consolidation (DHC) and the concomitant osseous reaction (OR) of the glenoidal bio-degradation process in new specific magnetic resonance grading systems. In accordance with the specific DHC and the OR graduation, the clinical relevance was the secondary focus.

METHODS

Twenty-eight patients with arthroscopic Bankart repair using knotless PLLA anchors were prospectively followed and analyzed using a clinical scoring system (3, 6, 15 and 32 months). The T2-weighted OR and T1-weighted DHC were assessed using specific magnetic resonance imaging grading protocols (15 and 32 months).

RESULTS

Longitudinal assessments revealed successive clinical status improvements over time (32 months: Rowe 95.7 ± 3.8; Walch-Duplay 93.8 ± 6.6; Constant 93.9 ± 4.5; ASES 93.8 ± 6.9; DASH 28.6 ± 7.2; NAS(pain) 1.1 ± 1.3; NAS(function) 1.3 ± 1.4). The initial OR level regressed over the 15-32 month period while the DHC showed significant drill hole reductions (P < 0.05). The inferior glenoid revealed a significantly increased bio-degradation capacity (P < 0.05) with drill hole enlargements in 14.3%. Neither the OR nor the drill hole enlargements influenced the clinical status. In no case were clinical or radiologic signs for a foreign body reaction.

CONCLUSION

Knotless bio-anchors provide secure glenoidal fixation for Bankart repair without any specific clinical or MR evidence of an inflammatory response. The clinical status remained unaffected by the bio-degradation process.

LEVEL OF EVIDENCE

IV.

Interleukin 8 correlates with intestinal involvement in surgically treated infants with necrotizing enterocolitis

PURPOSE

The aim of this study was to test the predictive value of interleukin (IL) 8 in the assessment of intestinal involvement in necrotizing enterocolitis (NEC).

METHODS

Forty infants with surgically treated NEC were classified into 3 groups based on intestinal involvement during laparotomy: focal (n = 11), multifocal (n = 16), and panintestinal (n = 13). Preoperatively obtained serum levels of IL-8, C-reactive protein, white blood cell count, and platelet count were correlated with intestinal involvement using logistic regression models.

RESULTS

Interleukin 8 correlated significantly with intestinal involvement in infants with surgically treated NEC (odds ratio, 1.74; confidence interval, 1.27-2.39; P < .001). An exploratory IL-8 cutoff value of 449 pg/mL provided a specificity of 81.8% and sensitivity of 82.8% to discriminate focal from multifocal and panintestinal disease. An IL-8 cutoff value of 1388 pg/mL provided a specificity of 77.8% and a sensitivity of 76.9% to discriminate panintestinal disease from focal and multifocal disease.

CONCLUSIONS

To our knowledge, this is the first study to demonstrate a significant correlation of IL-8 with intestinal involvement in advanced NEC in a large patient population. Our results indicate that IL-8 may be a promising biomarker for assessing intestinal involvement in infants with advanced NEC.

Perceived parental rearing in subjects with obsessive-compulsive disorder and their siblings

OBJECTIVE

Perceived parenting in patients suffering from obsessive-compulsive disorder (OCD) is examined. We attempted to overcome some methodological limitations of prior studies by taking age of onset, parental OCD and comorbid depression into consideration. In addition, we included data from unaffected siblings to corroborate information on parental rearing.

METHOD

One hundred and twenty-two cases with OCD and 41 of their siblings as well as 59 healthy controls and 45 of their siblings completed the German short-version of the EMBU (FEE).

RESULTS

Obsessive-compulsive disorder cases reported less parental warmth and more parental rejection and control. Further analyses indicated that parenting is also associated with OCD in cases with late onset and cases without parents affected by OCD. OCD cases with comorbid depression described their parents particularly negatively. Data from siblings indicated good validity of perceived parenting in OCD.

CONCLUSION

This study provides further evidence for dysfunctional child rearing being relevant to the development of OCD and depression.

Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders

OBJECTIVE

The study presents data on the 3-month prevalences of postpartum anxiety disorders (PAD) and postpartum depressive disorders (PDD) and their comorbidity in a German community sample. Associations with sociodemographic variables and previous history of psychopathology were analysed.

METHOD

Data were gathered in a longitudinal study over the first 3 months postpartum. In a two-stage screening procedure, a population-based representative sample of 1024 postpartum women was assessed for symptoms of anxiety and depression using DSM-IV-based screening instruments.

RESULTS

The estimated rates of DSM-IV disorders were 11.1% for PAD and 6.1% for PDD. Comorbidity was found in 2.1%. The rate for PAD with postpartum onset was 2.2% and for PDD 4.6%. Young mothers and mothers with a low education level had a heightened risk of developing depression following delivery.

CONCLUSION

Because of the clinical relevance of PAD, controlled studies and specialized programmes for prevention and treatment are urgently required.

FENOTIPIA E CONCENTRAÇÃO INIBITÓRIA MÍNIMA (CIM) EM LINHAGENS DE ESCHERICHIA COLI ISOLADAS DE LEITÕES COM DIARRÉIA NAS FASES DE MATERNIDADE, CRECHE, CRESCIMENTO E TERMINAÇÃO

RESUMO Escherichia coli é reconhecida como causa freqüente de diarréia em suínos em todo o mundo. O objetivo do presente estudo foi caracterizar fenotipicamente os tipos fimbriais de 349 linhagens de E. coli isoladas de suínos com diarréia, em diferentes faixas etárias, utilizando os testes de microhemaglutinação e soroaglutinação, bem como determinar o perfil de suscetibilidade frente aos principais antimicrobianos utilizados em granjas de suínos. Do total de 159 linhagens de E. coli que não aglutinaram eritrócitos no teste de hemaglutinação manose-resistente (HAMR), 57 (35%) foram positivas para a expressão do antígeno fimbrial F6 no teste de soroaglutinação rápida em placa. Considerando a faixa etária e o fenótipo fimbrial, os sorotipos de E. coli, potencialmente patogênicos mais prevalentes até a terceira semana de idade, foram F5 (K99), F6 (987P), F42 e F41 em, respectivamente, 29%, 23%, 11% e 10% das linhagens. Em leitões com mais de 25 dias, predominaram fimbrias F4 (K88) em 44,6% (58) das linhagens. Os animais foram suscetíveis às cepas contendo F4, durante todas as faixas etárias, mas com maior predominância em idades mais avançadas, acima de 76 dias. Os maiores índices de resistência das linhagens foram observados para oxitetraciclina (84,0%), gentamicina (76,0 %) e amoxicilina (72,0%). Os menores valores de Concentração Inibitória Mínima (CIM) 50 e 90 foram observados para o ceftiofur.

Complications during pregnancy, peri- and postnatal period in a sample of women with a history of child abuse

BACKGROUND

As a proposed risk factor for infant and child development, maternal history of abuse has been a frequent target of investigation. However, there have been no controlled studies about the impact of maternal history of abuse on the medical course of pregnancy, the peri- and postnatal period.

METHOD

All women with a newborn child were contacted by mail and presented with the Childhood Trauma Questionnaire (CTQ). The index group (n = 58) was formed by women who scored above the cutoff for moderate or severe abuse and compared to a control group (n = 60) with regard to pre,- peri-, and postnatal complications as documented in the patient charts.

RESULTS

The results show that women with a history of abuse have significantly more prenatal medical complications and infant medical complications in the post- but not perinatal period.

CONCLUSIONS

Maternal history of abuse significantly impacts the medical course of delivery and the puerperium. Given the prevalence of abusive experiences, this finding is highly relevant from a preventive point of view.

Childhood behavioral inhibition and maternal symptoms of depression

BACKGROUND

The significance of behavioral inhibition in the second year of life for the development of social phobia in later childhood was the incentive to explore whether maternal postnatal psychopathology is a predictor for behavioral inhibition in the offspring.

METHOD

101 mother-infant pairs were recruited from local obstetric units and examined for maternal psychopathology by the Symptom Checklist and the Edinburgh Postnatal Depression Scale several times during the first postnatal year. Child behavioral inhibition was assessed at 14 months in a laboratory procedure.

RESULTS

Postpartum depression at 4 months measured by the Edinburgh Postnatal Depression Scale was found to be strongly associated with toddlers' fear score/behavioral inhibition at 14 months. Maternal depressive symptoms assessed by the revised 90-item Symptom Checklist at 6 weeks , 4 and 14 months were found to be related to child inhibition as well.

CONCLUSIONS

Even maternal depression not reaching the level of clinical diagnosis and treatment has an impact on child behavioral development. These data should give rise to further studies on the origins of this relationship, which might be primarily genetic or interactional.

Impulsiveness in obsessive-compulsive disorder: results from a family study

OBJECTIVE

Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families.

METHOD

Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms.

RESULTS

OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found.

CONCLUSION

OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.

Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding

BACKGROUND

Postnatal Depression has demonstrated long-term consequences on child cognitive and emotional development, however, the link between maternal and child pathology has not been clearly identified.

OBJECTIVE

This study examined whether maternal bonding to the infant and young child is impaired by maternal depressive symptoms.

METHODS

101 mothers of newborn infants were recruited from local obstetric units and examined for psychopathology using Symptom Checklist, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire at two weeks, six weeks, four months and fourteen months postpartum.

RESULTS

Maternal depressive symptoms at 2 weeks, 6 weeks and four months postnatally but not at fourteen months of infant's age were found to be strongly associated with lower quality of maternal bonding to the infant and child from two weeks until fourteen months of postnatal age. Even mild and unrecognized maternal depressive symptoms had a significant impact on maternal bonding, if they occurred during the first four months of life.

CONCLUSIONS

This gives reason for increased concern for mother-infant dyads in the first few months after birth that could be regarded as a highly sensitive period for the development of the mother-child relationship. The findings warrant further studies and inspire the development of preventive programs focussing on infant and early childhood mental health by emphasizing protection and support during the first critical months.

The German version of the Postpartum Bonding Instrument: psychometric properties and association with postpartum depression

BACKGROUND

To date there has been no study investigating mother-infant bonding impairment and its link to pospartum depressive symptoms in a representative German population sample. The present study therefore aimed to carry out initial analyses of the psychometric properties of the German version of the Postpartum Bonding Questionnaire (PBQ).

METHODS

Eight hundred and sixty two mothers provided the data for a principal component analysis of the original 25 item PBQ. This analysis was used to assess the validity of the four scale structure of the questionnaire. Correlations between postpartum depression, sociodemographic variables and bonding impairment were additionally calculated.

FINDINGS

On the basis of our data, the original 4 factor structure of the PBQ scale was not confirmed. Nine items did not meaningfully load onto the single factor accounting for the most variance. Mother-infant bonding impairment and postpartum depression were shown to be significantly positively correlated. According to the factor solution of Brockington we found a 7.1% rate of mothers with bonding impairment two weeks postpartum (with 95% confidence ranging from 5.5 to 9%).

INTERPRETATION

An abridged 16 item German version of the PBQ can be implemented as a reliable screening instrument for bonding impairment.

Mutter-Kind-Behandlung bei postpartalen Störungen im internationalen Vergleich

Postnatal depression is among the most frequent mental disorders in young women (incidence 10-15 %). Besides depressive illness, however anxiety disorder, stress disorder and psychosis play an important role as well. These disorders have not only negative impact on women's mental health, but may also adversely affect the child's development as well as the mother-child relationship. Inpatient mother-child care as established e. g. at the Heidelberg University Hospital offers adequate treatment without the need for the mother to separate from her child. In a retrospective study a profile of the women treated at the Psychiatric Department of the University Hospital Heidelberg was developed which reflects the psychological and social stress in their life situations. In order to gain an overview on the specific treatment options the data were then compared with those of other national and international centres. Analysis of demand shows that this mother-child psychiatric care is well accepted by the population and that there is a considerable need for adequate in- and outpatient care of postnatal mental disorders.