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Mother-infant bonding is influenced by several risk and protective factors, and the literature has investigated the relationships between these factors independently. This study aimed to verify the interrelationships of some of these factors and how they influence mother-infant bonding in Brazil. In this study, 361 mothers participated, and the outcome variable of mother-infant bonding was assessed using the Postpartum Bonding Questionnaire (PBQ). Multivariate regression analysis was performed using a hierarchical model with three blocks structured according to the influence exerted on mother-infant bonding. The PBQ's factor scores were estimated and used in the subsequent analyses to decrease measurement error. The variable "violence experienced by mothers" was statistically significant for explaining the second block model but not significant for the third block. Network analysis was performed after multiple regression, showing that the violence experienced by mothers does not directly influence mother-infant bonding but rather is mediated by postpartum depression. This explains why violence is not significant in the hierarchical multiple regression when maternal depression is added to the model. This study's strengths lie in its utilization of PBQ factor scores and network analysis, enabling the estimation of conditional relationships among variables. This approach provides deeper insights into factors affecting mother-infant bonding.

Varios factores de riesgo y de protección ejercen influencia sobre la unión afectiva madre­infante; la literatura disponible ha investigado las relaciones entre estos factores de una manera independiente. Este estudio se propuso verificar las interrelaciones de algunos de estos factores y cómo ellos influyen en la unión afectiva madre­infante. Se consultó un total de 361 madres y el variable resultado de afectividad madre­infante se evaluó por medio del Cuestionario de Afectividad de Postparto (PBQ). Se llevaron a cabo análisis de regresión multivariados usando un modelo jerárquico con tres estructuras de bloques de acuerdo con la influencia ejercida sobre la unión afectiva madre­infante. Se estimaron y usaron los puntajes de factores del PBQ en los análisis subsecuentes para disminuir el error en la medida. La variable "violencia experimentada por las madres" fue estadísticamente significativa para explicar el segundo modelo de bloque, pero no significativa para el tercer bloque. Se llevó a cabo un análisis de interrelaciones después de la regresión múltiple, demostrando que la violencia experimentada por las madres no influye directamente la afectividad madre­infante, sino que la misma es mediada por la depresión posterior al parto. Esto explica por qué la violencia no es significativa en la jerárquica regresión múltiple cuando la depresión materna se le agrega al modelo. Entre los puntos fuertes de este estudio se incluye el uso de los puntajes de factores del PBQ y el análisis de interrelaciones, lo cual permitió que se estimaran las relaciones condicionales existente dentro del grupo de variables, aportando una mayor comprensión de algunos factores que interfieren en la unión afectiva madre­infante.

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Erosive Tooth Wear (ETW) is the loss of tooth structure without bacterial involvement. As the resulting loss of tooth structure is irreversible, an early evaluation of the multifactorial etiology, accurate diagnosis and regular follow-up are essential. The ETW is dynamic and its progression should be continuously monitored. A risk analysis table was developed to systematically record risk factors for ETW (Fig. 2). This allows ETW management to be integrated more efficiently into clinical practice and the progression to be documented over the years. If ETW is assumed, the risk analysis should be performed and updated at least every two years. In the assessment, risk-promoting and risk-inhibiting factors are marked, added together and compared. If the negative factors pre-dominate, measures should be taken to minimize the risk for ETW. The main purpose of the risk analysis is therefore to evaluate the individual etiology, coun-teract negative factors, promote positive factors and prevent progression.

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The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

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Loneliness in Adolescents Against the Background of the COVID-19 Pandemic: A Risk Factor Abstract. On the one hand, loneliness is the subjective experience of inadequate social integration and support. It is a normal phenomenon that can be dealt with in an emotional and action-oriented way within the framework of individual development. On the other hand, chronic loneliness goes hand in hand with considerable suffering, reduced quality of life, and an increased risk of psychological and somatic diseases. In the context of current social developments associated with the fragmentation of social networks and programmatic individualism, we discuss an increase in the problem of loneliness, especially among young people. Interventions to reduce the experience of loneliness are effective if, in addition to making social offers, they focus on the dynamics common in chronic loneliness (low self-esteem, evaluation of neutral communication as devaluing, etc.). There is no evidence that the use of virtual social networks persistently reduces feelings of loneliness in young people. In addition, the question arises on what basis of shared values and goals social integration of young people who experience loneliness will be possible in the future. According to the results of the first systematic surveys on the psychosocial consequences of the COVID-19 pandemic, we must assume that the loneliness problem of young people will continue to gain relevance because of the associated massive restrictions on real social life.

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INTRODUCTION: Intestinal helminth management in horses has both clinical and epidemiologic relevance, in additional association with anthelmintic resistance. The Swiss Army employs military owned riding horses and privately owned pack horses, which are brought together for service periods up to 12 weeks. We compared husbandry conditions and intestinal helminth management of both groups via questionnaire and analysed faecal samples of 53 riding horses and 130 pack horses using combined sedimentation/flotation, the McMaster method and larval cultures. Riding horses only had cyathostomin infections (prevalence: 60,4 %), while pack horses harboured cyathostomins (71,5 %), Parascaris sp. (6,9 %) and Strongylus vulgaris (1,5 %). Regression models combining faecal sample results with questionnaire data unveiled correlations of husbandry practices with parasite frequencies identifying risk and protective factors. Pasture management, hygiene and deworming practices were highly variable for pack horses, while for riding horses there was an overall concept. This included a selective deworming strategy with faecal egg counts (FECs) of strongyles prior to deworming, applying a threshold of 200 eggs per gram of faeces (epg). Anthelmintic treatments based on FECs, weekly faeces removal on pastures (pastures), the use of macrocyclic lactones and deworming horses regularly were identified as protective factors regarding the 200 epg threshold for strongyle eggs. Accordingly, the mean epg for strongyle eggs between the groups (111 and 539 in riding and pack horses, respectively) was significantly different (p < 0,001). Overall, intestinal helminth management in pack -horses showed room for improvement regarding pasture hygiene, the used anthelmintics and the frequency of deworming, from which all Swiss Army horses would benefit, as they share pastures during their -service, therefore entailing the risk of parasite transmission.

INTRODUCTION: La gestion des helminthes intestinaux chez les chevaux présente une importance clinique et épidémiologique, en association avec la résistance aux anthelminthiques. L'armée suisse emploie des chevaux de selle militaires et des chevaux de bât privés qui sont réunis pour des périodes de service allant jusqu'à 12 semaines. Nous avons comparé la détention animale et la gestion des helminthes intestinaux des deux groupes par le biais d'un questionnaire et analysé les échantillons fécaux de 53 chevaux de selle et 130 chevaux de bât en utilisant la sédimentation/flottation combinée, la méthode McMaster et les cultures larvaires. Les chevaux de selle ne présentaient que des infections à cyathostomes (prévalence: 60,4 %), tandis que les chevaux de bât hébergeaient des cyathostomes (71,5 %), Parascaris sp. (6,9 %) et Strongylus vulgaris (1,5 %). Des modèles de régression combinant les résultats des échantillons fécaux et les données du questionnaire ont révélé des corrélations entre les pratiques de détention animale et la fréquence des parasites, identifiant les facteurs de risque et de protection. La gestion des pâturages, l'hygiène et les pratiques en matière de vermifugation étaient très variables pour les chevaux de bât, tandis que pour les chevaux de selle, il existait un concept unitaire. Ceci comprenait stratégie de vermifugation sélective avec comptage des œufs fécaux (CEF) de strongles avant la vermifugation, en appliquant un seuil de 200 œufs par gramme de fèces (opg). Les traitements anthelminthiques basés sur les CEF, l'enlèvement hebdomadaire des crottins sur le pâturage, l'utilisation de lactones macrocycliques et la vermifugation régulière des chevaux ont été identifiés comme des facteurs de protection concernant le seuil de 200 opg pour les œufs de strongles. En conséquence, l'iog moyen pour les œufs de strongles entre les groupes (111 et 539 chez les chevaux de selle et de bât, respectivement) était significativement différent (p < 0,001). Globalement, la gestion des helminthes intestinaux chez les chevaux de bât a montré qu'il est possible d'améliorer l'hygiène des pâturages, le choix des anthelminthiques et la fréquence des vermifuges, ce dont tous les chevaux de l'armée suisse bénéficieraient, car ils partagent les pâturages pendant leur service, ce qui entraîne un risque de transmission des parasites.

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INTRODUCTION: Feline Calicivirus (FCV) is one of the most common viral pathogens in domestic cats worldwide. The first report of FCV dates back to 1957, when FCV was isolated from the gastrointestinal tract of cats in New Zealand. Subsequent reports recognised FCV as a cause of respiratory disease in cats, and at present, feline practitioners worldwide are daily confronted with cats suffering from suspected FCV. The highly mutagenic nature of FCV and its high genetic plasticity enable the virus to successfully survive in the feline population, and pose a special challenge as regards the diagnosis, treatment, and prevention of FCV-induced disease. Upper respiratory tract disease has been considered a common clinical sign of FCV infection. A study from Switzerland demonstrated that oral ulcerations, salivation and gingivitis-stomatitis were more commonly associated with FCV infection than upper respiratory tract disease, and less than half of the cats suspected to have FCV infection were found to be FCV-positive. Furthermore, a study investigating FCV isolates from Switzerland found some evidence that the genetic background of cats might influence their susceptibility to FCV infection. This review article provides a comprehensive summary of the FCV literature, and integrates the results of recent research on FCV's genetic characteristics, the cellular and humoral immunity evoked by FCV vaccination and infection, the diagnosis of FCV, FCV prevention/vaccination, the risk factors associated with FCV, and the hygienic measures necessary in FCV-contaminated areas. After each section, the key points are summarised, and relevant information is outlined to help feline practitioners in FCV diagnosis, treatment and prevention.

INTRODUCTION: Le calicivirus félin (FCV) est l'un des agents pathogènes viraux les plus courants chez les chats domestiques dans le monde. Le premier signalement de FCV remonte à 1957, lorsque le FCV a été isolé du tractus gastro-intestinal de chats en Nouvelle-Zélande. Des rapports ultérieurs ont reconnu le FCV comme une cause de maladie respiratoire chez les chats et, à l'heure actuelle, les praticiens félins du monde entier sont quotidiennement confrontés à des chats suspectés de FCV. La nature hautement mutagène du FCV et sa haute plasticité génétique permettent au virus de survivre avec succès dans la population féline et posent un défi particulier en ce qui concerne le diagnostic, le traitement et la prévention de la maladie induite par le FCV. La maladie des voies respiratoires supérieures a été considérée comme un signe clinique courant d'infection par le FCV. Une étude réalisée en Suisse a démontré que les ulcérations buccales, la salivation et la gingivite-stomatite étaient plus fréquemment associées à une infection à FCV qu'à une autre maladie des voies respiratoires supérieures et moins de la moitié des chats suspectés d'avoir une infection à FCV se sont avérés positifs pour le FCV. De plus, une étude portant sur des isolats de FCV en Suisse a trouvé des preuves que le profil génétique des chats pourrait influencer leur sensibilité à l'infection par le FCV. Cet article de synthèse fournit un résumé complet de la littérature sur le FCV et intègre les résultats de recherches récentes sur les caractéristiques génétiques du FCV, l'immunité cellulaire et humorale évoquée par la vaccination et l'infection au FCV, le diagnostic du FCV, la prévention/vaccination contre le FCV, les facteurs de risque associés avec le FCV et les mesures d'hygiène nécessaires dans les zones contaminées par le FCV. Après chaque section, les points clés sont résumés et des informations pertinentes sont décrites pour aider les praticiens félins dans le diagnostic, le traitement et la prévention du FCV.

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INTRODUCTION: A 5-year retrospective analysis of ascarid infections (Toxocara canis and Toxascaris leonina) in dogs from southern Italy was performed to update the epidemiological scenario of these parasites and to identify the risk factors which may favour these infections in animals in this study area. A total of 8,149 dogs, referred to our labs for copromicroscopic analysis using the FLOTAC technique, was considered. A sub-sample of 500 faecal samples were analysed also with the Mini-FLOTAC technique. Of the overall dog samples analysed, 9,2 % (95 % CI = 8,6-9,8) resulted positive for T. canis while 0,5 % (95 % CI = 0,4-0,7) resulted positive for T. leonina. Co-infections with T. canis and T. leonina were found in 0,1 % of dogs (95 % CI = 0,0-0,1). The results obtained by the FLOTAC and Mini-FLOTAC examinations showed a nearly perfect k agreement (k = 0,99, P < 0,001) between these two techniques. Chi-square test showed positivity to T. canis and T. leonina significantly (P < 0,001) associated with dogs housed outdoor (i.e., that lived in garden or in kennel). Moreover, the positivity for T. canis was significantly associated (P < 0,001) also with age (i.e., puppies), as shown by the logistic regression. The decreasing overall prevalence both for T. canis and T. leonina during the years of monitoring, showed that, as suggested by the European Scientific Counsel Companion Animal Parasites, the regular diagnosis could contribute to an efficient control of these parasites.

INTRODUCTION: Une analyse rétrospective sur 5 ans des infections à ascaris (Toxocara canis et Toxascaris leonina) chez les chiens du sud de l'Italie a été réalisée afin de mettre à jour le scénario épidémiologique de ces parasites et d'identifier les facteurs de risque pouvant favoriser ces infections chez les animaux de cette zone d'étude. Au total, 8149 chiens ont été analysés dans notre laboratoire avec une analyse copromicroscopique en utilisant la technique FLOTAC. De plus, un sous-échantillon de 500 échantillons fécaux a été analysé avec la technique Mini-FLOTAC. Sur l'ensemble des échantillons fécaux canins analysés, 9,2 % (IC à 95 % = 8,6 à 9,8) se sont révélés positifs pour T. canis tandis que 0,5 % (IC à 95 % = 0,4 à 0,7) ont été positifs pour T. leonina. Des co-infections avec T. canis et T. leonina ont été trouvées chez 0,1 % des chiens (IC à 95 % = 0,0­0,1). Les résultats obtenus par les examens FLOTAC et Mini-FLOTAC ont montré un coefficient Kappa presque parfait (k = 0,99, p < 0,001) entre ces deux techniques. Le test du chi carré a montré une positivité significative quant aux infections à T. canis et T. leonina (P < 0,001) associées à des chiens hébergés à l'extérieur (jardin ou chenil). De plus, la positivité pour T. canis était également significativement associée (P < 0,001) à l'âge (c'est-à-dire aux chiots), comme le montre la régression logistique. La diminution de la prévalence globale au cours de la période de surveillance a montré que le diagnostic régulier pourrait contribuer à un contrôle efficace de ces parasites à la fois pour T. canis et T. leonina, comme suggéré par le the European Scientific Counsel Companion Animal Parasites.

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Differences in epaAC© in heart failure patients with or without readmission: A retrospective case-control study Abstract. Background: Heart failure is one of the most frequent reasons for hospitalization in elderly people. In heart failure, approximately 22.8 % of hospitalised patients are rehospitalised within 30 days. The nursing assessment tool epaAC could provide information on risk factors for readmission. Aim: The aim of this study was to identify possible group differences in the items and scores of the epaAC discharge assessment with regard to the endpoint of unplanned readmissions within 30 days after discharge from index-hospitalisation. Methods: Using a retrospective case-control design, differences in the epaAC variables were investigated by descriptive and comparative statistics. Chi-square test, Wilcoxon test and t-test were performed with two-sided alpha level α < 0.05. Alpha error accumulation was accounted for by Benjamini & Hochberg correction. Results: No significant group differences were found in all items and scores of the discharge epaAC. There is only weak evidence that the presence of acute respiratory impairment at time of discharge is higher in the patient with rehospitalisation than in those without rehospitalisation. Conclusions: The items and scores of the nursing assessment instrument epaAC did not significantly differ between patients with or without 30-days readmission. Further exploration to assess the epaAC's potential to predict rehospitalisation in heart failure is needed.

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CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

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CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

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Paternal Risk and Protective Factors for Endangerment of Child Well-Being and their Consideration in the Risk Inventories Used Throughout Germany In view of the current family and role models, paternal risk and protective factors can have a significant impact on the risk of violence within a family and should therefore - in addition to the factors on the part of the mother, the child and the closer or other family systems - be taken into consideration when estimating the endangerment of child well-being. In this article we explore which empirical findings on paternal risk and protective factors for abuse, neglect and sexual abuse (sexual violence) in childhood and adolescence were published in international research literature from 1980 to 2019. Seventeen risk factors and four protective factors could be identified, which in 33 quantitative original studies showed a risk-increasing or a buffering influence on violence experiences in families on the part of the father. In addition, the risk inventories used in practice in Germany were analyzed with regard to the paternal risk and protective factors, in order to be able to illustrate the application of the empirically identified factors in early intervention, youth welfare and health care. The article used results from a benchmark survey on risk inventories from 2009. These results were compared with current findings from 2018 as part of a research update. In 2009, 67 % of the instruments "often" contained items on the father, while this was found for 12 % of the instruments in 2018. At the same time, in 2018, 53 % of the risk inventories were "often" asked about custodians, parents or main caregivers. The article thus reflects developments in research and practice in risk assessment for child well-being, in which especially the fathers, who unlike the mothers are often not explicitly addressed during screenings and interventions for families with psychosocial problems, are taken into consideration. The knowledge about the influence of the fathers can feed into the preventive interventions in early interventions and complement them meaningfully.

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INTRODUCTION: Little is known about social inequalities in outpatient long-term care of coronary heart disease (CHD) in Germany. METHODS: Regression analyses are based on the responses of women and men who participated in the national cross-sectional study "German Health update" (GEDA) 2014/2015 and had self-reported CHD (N=920). Outpatient healthcare of CHD was analysed on the basis of the self-reported administration of antihypertensive and cholesterol-lowering drugs, and the frequency of general practitioner (GP) contacts. RESULTS: On average, respondents visited their GP 7.5 times a year (mean). 46 % did not receive guideline-consistent treatment, i. e. both antihypertensive and cholesterol-lowering drugs. Respondents of lower social status consulted their GP more frequently (approx. two visits per year) than those of higher social status (AME: 1.94; 95% CI 0.56 to 3.31). Regarding treatment with antihypertensive and cholesterol-lowering drugs, there were no significant differences for either gender or social status. Nevertheless, the probability that respondents with increased levels of blood lipids or cholesterol took only one or none of the two medications recommended for long-term treatment of CHD was reduced by 54 percentage points (AME: -0,54; 95% CI -0,61 to -0,48). DISCUSSION: There are no social inequalities in the treatment of CHD patients with antihypertensive and cholesterol-lowering drugs, but inequalities exist in the frequency of visits to the GP who is more often consulted by the more socially disadvantaged patients. CONCLUSION: With about 7.5 consultations per year, CHD patients visit their general practitioner more often than average, but in about half of these patients the medication supply is less than optimal. This may indicate a deficit in the medical treatment of CHD that cannot be explained by social inequalities. A possible starting point for improving healthcare, especially for patients without other risk factors, is to focus more strongly on a guideline-based approach to prescribing medication for CHD patients.

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Unusual Cause of Acute Kidney Failure in a Patient with Metastatic Bladder Carcinoma Undergoing Palliative Chemotherapy Abstract. Tumour lysis syndrome is a potentially life-threatening complication of cancer and its treatment. It mostly occurs in highly proliferative haematological neoplasms under cytotoxic therapy but can also be seen spontaneously and in solid neoplasms, particularly with high tumour burden and/or high chemosensitivity. The present case report describes a tumour lysis syndrome in a patient with metastatic bladder cancer with an elevated lactate dehydrogenase as only potential correlate of a high tumour burden.

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Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.

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Socio-Economic Differences in the Lausanne CoLaus Cohort Abstract. The CoLaus study allowed to highlight the existence of broad social inequalities in health among the population of the city of Lausanne. In fact, participants with low socioeconomic status had a higher prevalence of cardio-metabolic risk factors, risk behaviors, sleep disturbances, and higher inflammatory markers compared to the more socio-economically advantaged participants in the study. In most cases, these inequalities are similar to those found in the neighboring cantons and countries.

Résumé. L'étude CoLaus nous a permis d'identifier de larges inégalités sociales en matière de santé au sein de la population de la ville de Lausanne. En effet, les participants avec un statut socio-économique faible avaient une prévalence plus élevée de facteurs de risque cardio-métaboliques, de comportements à risque, de troubles du sommeil, ainsi que des marqueurs inflammatoires plus élevées par rapport aux participants les plus favorisés du point de vue socio-économique. Dans la plupart des cas, ces inégalités sont similaires à celles retrouvées dans les cantons et pays voisins.

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PsyCoLaus: A Prospective Study of the Links between Mental Health and Cardiovascular Diseases Abstract. PsyCoLaus, which includes an investigation of mental disorders and cognitive functioning, aims to determine the prevalence and the course of mental disorders in the general population and to study the mechanisms underlying the association between these disorders and cardiovascular diseases. This investigation revealed a very high lifetime prevalence rate of 43.6 % for major depressive disorder in Lausanne. We have also observed that the association between major depression and cardio-metabolic risk factors is essentially attributable to the atypical subtype, characterized by an increased appetite, heaviness in limbs, hypersomnia and conserved affective reactivity. Patients who suffer from this type of depression have an increased risk to develop overweight, diabetes and the metabolic syndrome and deserve particular clinical attention on the metabolic level.

Résumé. PsyCoLaus, comportant une investigation de la santé mentale et du fonctionnement cognitif, vise à déterminer la prévalence et l'évolution des troubles mentaux et à étudier les mécanismes qui sous-tendent l'association entre ces troubles et les maladies cardiovasculaires. Cette investigation a mis en évidence un taux de prévalence vie-entière très élevé de 43,6 % pour les troubles dépressifs majeurs à Lausanne. Nous avons également observé que l'association entre la dépression et les facteurs de risque cardio-métaboliques est essentiellement attribuable au sous-type de dépression atypique, caractérisé par une augmentation de l'appétit, une lourdeur dans les membres, une hypersomnie et une réactivité affective conservée. Les patients présentant ce type de dépression ont un risque élevé de développer du surpoids, du diabète et un syndrome métabolique et méritent une attention particulière au niveau métabolique.

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Given the importance of early prevention and intervention strategies for children exposed to trauma, detection of early risk factors for exposure to traumatic events in childhood is critical. The present study examined associations between three known prenatal risk factors that characterize environmental instability in utero-prenatal substance exposure, prenatal violence victimization, and unintended pregnancy-and child exposure to interparental violence and other adverse experiences in a sample of 198 mother-child dyads (M child age = 44.48 months) referred to a hospital clinic for treatment following exposure to trauma. Prenatal substance and violence exposure were associated with child trauma exposure, and prenatal violence victimization was also associated with maternal severity ratings of traumatic exposures. Unintended pregnancy was not associated with child trauma exposure or severity. These findings expand our understanding of prenatal risk factors for trauma exposure in childhood and, specifically, highlight prenatal substance exposure and violence victimization as risk factors for subsequent exposure to trauma in early childhood. Results suggest that prenatal prevention and intervention programs should target reducing maternal substance use and in-utero exposure to violence.

Dada la importancia de las estrategias de prevención e intervención tempranas para niños expuestos al trauma, el detectar los tempranos factores de riesgo en el caso de estar expuesto a eventos traumáticos en la niñez es crítico. El presente estudio examinó las asociaciones entre tres conocidos factores de riesgo prenatales que caracterizan la inestabilidad ambiental en el útero -el haber estado expuesto a sustancias prenatalmente, la victimización de la violencia prenatal, y el embarazo no intencional -y el que el niño esté expuesto a la violencia entre progenitores (IPV) y otras experiencias adversas en un grupo muestra de 198 díadas madre-niño (edad promedio del niño = 44.48 meses) que habían sido referidas a una clínica hospital para el tratamiento que seguía al haber estado expuestos al trauma. El haber estado expuesto a sustancia y violencia prenatal se asoció con el hecho de que el niño había estado expuesto a trauma, y la victimización de la violencia prenatal también se asoció con la severidad maternal de clasificación de la exposición traumática. El embarazo no intencional no se asoció con la exposición del niño al trauma o la severidad. Estos resultados amplían nuestra comprensión de los factores de riesgo prenatales en cuanto al haber estado expuesto al trauma en la niñez y, específicamente, subrayan el haber estado expuesto a sustancias prenatalmente y la victimización de la violencia como subsecuentes factores de riesgo para estar expuesto al trauma en la temprana niñez. Los resultados sugieren que los programas de prevención e intervención prenatales deber enfocarse en reducir el uso de sustancias por parte de la madre y el estar expuesto dentro del útero a la violencia.

Vu l'importance des stratégies de prévention précoce et d'intervention pour les enfants exposés au trauma, la détection de facteurs de risque précoce pour l'exposition à des événements traumatiques s'avère critique. Cette étude a examiné les liens entre trois facteurs de risque prénatals connus qui caractérisent l'instabilité environnementale in utero - l'exposition prénatale à des substances toxiques, la victimisation liée à la violence prénatale, et la grossesse involontaire - ainsi que l'exposition à la violence conjugale et d'autres expériences adverses chez un échantillon de 198 dyades mère-enfant (moyenne d'âge de l'enfant = 44,48 mois) envoyées consulter en clinique hospitalière pour un traitement suivant une exposition à un trauma. L'exposition à la toxicomanie et l'exposition à la violence étaient liées à l'exposition de l'enfant au trauma et la victimisation liée à la violence prénatale était également liée à la sévérité des scores maternels d'expositions traumatiques. La grossesse involontaire n'était pas liée à l'exposition au trauma de l'enfant ou à la sévérité. Ces résultats élargissent notre compréhension des facteurs prénatals d'exposition au trauma dans l'enfance et mettent en lumière plus spécifiquement l'exposition à la toxicomanie prénatale et la victimisation liée à la violence en tant que facteurs de risque d'exposition ultérieure au trauma durant la petite enfance. Les résultats suggèrent que la prévention prénatale et les programmes d'intervention devraient cibler la réduction d'utilisation toxicomane maternelle et l'exposition à la violence in-utero.

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Since disturbances in the mother-child bond increase the risk of negative consequences for child development, it is important to identify risk and protective factors for bonding as well as longitudinal associations. Previous research has used different bonding instruments during pregnancy and the postnatal phase, leading to inconsistent results. In the current study, the same instrument was used during the various phases. In a large, community-based sample (N = 793), general information, feelings of pre- and postnatal bonding (Pre- and Postnatal Bonding Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and partner support (subscale Tilburg Pregnancy/Postnatal Distress Scale) were measured at both 32 weeks of pregnancy and 8 months postnatally. Partner support was found to be a protective factor for suboptimal pre- and postnatal bonding, as was the engagement with fetal movements for prenatal bonding. High maternal educational level was a risk factor for suboptimal prenatal bonding, as were depressive symptoms for suboptimal postnatal bonding. The associations between most prenatal determinants and postnatal bonding were mediated by prenatal bonding, which underlines the importance of promoting prenatal bonding. Professionals in clinical practice should be aware of partner support, engagement with fetal movements, and postnatal depressive symptoms: All these factors offer opportunities for improving the bonding processes.

Dado que las perturbaciones en la unión afectiva entre madre y niño aumentan el riesgo de consecuencias negativas para el desarrollo del niño, es importante identificar los factores de riesgo y de protección de la unión afectiva, así como también las asociaciones longitudinales. La investigación anterior ha utilizado diferentes instrumentos para la unión afectiva durante el embarazo y la fase postnatal, lo que ha llevado a resultados inconsistentes. En el presente estudio, el mismo instrumento se usó durante las diferentes fases. En un grupo muestra grande con base comunitaria (N = 793), se midieron, tanto a las 32 semanas del embarazo como a los ocho meses después del nacimiento, la información general, los sentimientos sobre la unión afectiva pre- y postnatal (Escala de Unión Afectiva Pre- y Postnatal), los síntomas depresivos (Escala de Edimburgo de la Depresión Postnatal), y el apoyo de la pareja (Sub-escala Tilburg sobre el Embarazo / Escala de la Angustia Postnatal). Se detectó el apoyo de la pareja como un factor de protección para la unión afectiva pre- y postnatal por debajo del punto óptimo, lo cual también se dio con respecto a la interacción con los movimientos fetales en la unión afectiva prenatal. El alto nivel de educación materna fue un factor de riesgo para la unión afectiva prenatal sub-óptima, así como los síntomas depresivos lo fueron para la unión afectiva postnatal sub-óptima. Las asociaciones entre la mayoría de los determinantes prenatales y la unión afectiva postnatal fueron mediadas por la unión afectiva prenatal, lo cual subraya la importancia de promover la unión afectiva prenatal. Los profesionales de la práctica clínica deben estar conscientes del apoyo de la pareja, la interacción con los movimientos fetales, y los síntomas depresivos postnatales: todos estos factores ofrecen oportunidades de mejorar los procesos de afectividad.

Etant donné que les perturbations du lien mère-enfant augmentent le risque de conséquences négatives pour le développement de l'enfant il est important d'identifier les facteurs de risque et les facteurs de protection du lien, ainsi que les associations longitudinales. Jusqu'à présent les recherches ont utilisé divers instruments de lien durant la grossesse et la phase postnatale, menant à des résultats n'étant pas uniformes. Dans cette étude, le même instrument a été utilisé durant les phases multiples. Chez un grand échantillon représentatif de la communauté (N = 793), les renseignements généraux, les sentiments de lien pré- et postnatal (Echelle Pré- et Postnatale) les symptômes dépressifs (Echelle de Dépression Postnatale d'Edinbourg) et le soutien du conjoint (sous-échelle de grossesse Tilburg/Echelle de Détresse Postnatale) ont été mesurés à la fois à 32 semaines de grossesse et à huit mois postnatalement. Le soutien du conjoint s'est avéré être une facteur de protection pour le lien sous-optimal pré- et postnatal, tout comme l'était le fait de s'engager avec les mouvements du foetus pour le lien prénatal. Un niveau élevé d'éducation chez la mère était un facteur de risque de lien prénatal sous-optimal, tout comme l'étaient des symptômes dépressifs pour le lien sous-optimal postnatal. Les associations entre la plupart des déterminants prénataux et le lien postnatal étaient toutes influencées par le lien prénatal, ce qui souligne l'important de la promotion du lien prénatal. Les professionnels en pratique clinique devraient être vigilants quant au soutien du partenaire, au fait de s'engager avec les mouvements du foetus et aux symptômes dépressifs postnataux: tous ces facteurs offrent des possibilités d'amélioration des processus de lien.

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The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.

El propósito del presente estudio fue investigar el papel de varios factores sicosociales de riesgo para predecir la sintomatología depresiva durante el embarazo en mamás y papás, respectivamente. Un total de 146 madres primerizas y 105 papás primerizos que habían reportado una condición de riesgo sicosocial fueron reclutados independientemente de los servicios de salud de maternidad e infantil, durante el segundo trimestre del embarazo. Todos los padres fueron evaluados con relación a la sintomatología depresiva, la ansiedad y el percibido apoyo social. Se llevaron a cabo dos análisis de regresión múltiple jerárquicos para determinar el papel de los factores sicosociales para predecir la sintomatología depresiva durante el embarazo, en mamás y papás. Se identificó la insatisfacción marital, la historia personal de depresión y el rasgo personal de ansiedad como factores significativos de predicción de la sintomatología depresiva durante el embarazo, tanto en mamás como en papás. Se identificó la historia familiar de abuso de sustancias, la conflictiva relación con los padres en el pasado año, así como el duelo en el pasado año como factores significativos que contribuyen a un nivel elevado de síntomas depresivos durante el embarazo en las mamás, pero no así en los papás. En este estudio, varios factores sicosociales de riesgo fueron consistentemente relacionados con un aumento en los síntomas depresivos maternos y paternos durante el embarazo: algunos de estos factores parecen estar específicamente relacionados con el estado depresivo materno.

Le but de cette étude était de rechercher le rôle de plusieurs facteurs psychosociaux dans la prédiction de symptopathologie dépressive durant la grossesse chez les mères et les pères. Un total de 146 mères primipares et de 105 pères primipares faisant état d'une condition de risque psychosocial ont été recrutés indépendamment des services de maternité et de soin de santé de l'enfant, durant le second trimestre de la grossesse. Tous les parents ont été évalués pour une symptomatologie dépressive, l'anxiété et le soutien social perçu. Deux analyses de régression multiples hiérarchiques ont été faites afin de déterminer le rôle de facteurs psychosociaux dans la prédiction de symptomatologie dépressive durant la grossesse, chez les mères et les pères. Le mécontentement conjugal, l'histoire personnelle de dépression et l'anxiété comme trait personnel ont été identifiés comme étant des prédicteurs importants de symptomatologie durant la grossesse, à la fois chez les mères et chez les pères. L'antécédent familial de toxicomanie, une relation conflictuelle avec les parents dans l'année précédente et un deuil durant l'année précédente ont tous été identifiés comme des facteurs importants contribuant à des symptômes dépressifs élevés durant la grossesse chez les mères mais pas chez les pères. Dans cette étude plusieurs facteurs de risque psychosocial étaient systématiquement liés à une augmentation des symptômes dépressifs maternels et paternels durant la grossesse : certains de ces facteurs semblaient liés plus spécifiquement à l'humeur dépressive maternelle.

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Sexual Dysfunction in Primary Health Care Abstract. In primary health care, sexual dysfunctions are usually only insufficiently recorded. At the same time, these disorders are relatively common and often remain untreated. This study investigated sexual dysfunction and how it is influenced by lifestyle in patients in a general practitioner's practice (HP). METHODS: A sample of HP patients was asked about their sexuality, psychosocial situation and lifestyle, using validated questionnaires. RESULTS: The sample consisted of 30 women and 37 men. Of these, about two thirds have never spoken to a physician about their sex life and more than four fifths have never been asked about it by a phyisican. In 75 % of the sample there was no evidence of sexual dysfunction. Men with questionnaire values indicating sexual dysfunction showed significantly higher psychological stress than those with inconspicuous values. CONCLUSION: Despite an inconspicuous anamnesis regarding risk factors of sexual dysfunction, about a quarter of the sample found evidence of sexual dysfunction. An inconspicuous anamnesis in the areas of alcohol/tobacco consumption and depression does not make a targeted questioning about sexual dysfunction superfluous. Particularly for men, acute psychological stress should be a sufficient reason to address the topic of sexuality and to deepen it if necessary.

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