Effectiveness of attachment based STEEP™ intervention in a German high-risk sample.

STEEP(TM) was one of the first attachment-based early intervention programs. The program applied findings from the Minnesota Longitudinal Study on Risk and Adaptation to the development of a supportive program for young high-risk mothers and their infants. STEEP's effectiveness was evaluated first in a randomized controlled study launched in 1987. The study showed effects of the one-year intervention on important individual and parenting variables, but not on quality of mother-infant attachment. In the current German study with young mothers at risk for abuse and neglect, a two-year adaptation of STEEP was evaluated within a quasi-experimental design. STEEP mother-infant pairs (N = 78) were compared with pairs who received standard services of the German Child Welfare System (GCWS, N = 29). Compared with GCWS pairs, significantly more mother-infant pairs in the intervention group showed secure attachment patterns in Ainsworth´s Strange Situation when the infants were 12 months of age. At the end of the intervention (infant age = 24 month), attachment security scores derived from Waters' Attachment Q-Sort were in the predicted direction and showed a medium effect size, but did not reach criteria of statistical significance. At both time points, the STEEP group showed significantly fewer signs of attachment disorganization than the comparison group.

[Preliminary results concerning the effectiveness of early intervention from the STEEP practice research project "WiEge"]. / Erste Ergebnisse zur Wirksamkeit Früher Hilfen aus dem STEEP-Praxisforschungsprojekt "WiEge".

Preliminary results of the attachment-based STEEP(TM) (Steps toward effective and enjoyable parenting) research practice project "WiEge" are presented. Within a multisite, longitudinal intervention study, young high-risk mothers enrolled in the 2-year STEEP(TM) program have developed significantly more secure attachment relationships with their 1-year old children compared to mothers of the control group, who received the standard support as usual in the German welfare system. Age of mothers at birth of their children, educational level, single motherhood status, and mental health diagnoses indicate that both groups are comparable. A global measure of risk status indicates that mothers of the STEEP(TM) group confront even more risks than control group mothers. Additional data on depression (Edinburgh postnatal depression scale, EPDS), parenting stress (PSI), or risky parental attitudes (Adult-Adolescent Parenting Interview®, AAPI) are being presented and discussed with regard to the differences found being an effect of the STEEP(TM) program. Since the focus of the STEEP(TM) program is on empirically validated mechanisms in attachment development, it is also important that the results are in line with attachment theory. At the same time, we did not find significant group differences with regard to attachment disorganization. Supporting mothers in being more sensitive and to improve on reflective functioning--as being done in STEEP(TM)--does not seem to be sufficient to prevent attachment disorganization, as others studies have also shown. Although based on small sample sizes, the results are informative for improving intervention strategies, which need to focus more on the developmental process underlying attachment disorganization, i.e., unusual parental behavior.

[Arterial-adaptive dilatation and Doppler velocimetry in normal fetuses with a single umbilical artery]. / Resistance-Indices und Arterienflächen bei normalen Feten mit singulärer Nabelschnurarterie.

PURPOSE: In this study we examined the arterial-adaptive dilatation and Doppler velocimetry, especially RI values, in normal fetuses with a single umbilical artery (SUA). MATERIALS AND METHODS: We studied 195 fetuses from 18 to 39 weeks of gestational age with a prenatally identified SUA retrospectively. They were enrolled in this study if the following information applied: > 18 weeks of gestational age, no structural or chromosomal abnormalities, and histopathological confirmation of SUA. Sonographic examination included evaluation of the umbilical artery resistance and the cross-sectional area of the umbilical cord, and its vessels were measured in all cases. Small for gestational age (SGA) was diagnosed when the birth weight was below the 10th percentile for gestational age. Fetuses with intrauterine growth restriction were defined as those with biometric data below the 5th percentile. RESULTS: There were 119 cases of prenatally identified SUA which met the inclusion criteria. RI values were below the 10th percentile in 33/119 (27.33) and below the 50th percentile in 73/119 (61.33). RI values below the 10th percentile were significantly more likely to be in the normal collective than in the growth restricted collective [31/87 (35.63%) vs. 2/32 (6.25%); p = 0.001]. Even more significant differences became apparent when comparing the RI values below the 50th percentile of both groups. An umbilical artery diameter over the 90th percentile was found in 49 (41.9%) of cases and was significantly more likely to be present in normal growing fetuses than in the growth restricted group. CONCLUSION: Normal fetuses with SUA are at higher risk to be born as SGA. With our study results we can confirm the hypothesis that Doppler flow measurements and arterial diameter in SUA are different from those found in normal fetal umbilical arteries. RI values over the 50th percentile or a cross-sectional area of the artery below 95th percentile after 26th week of gestation significantly increases the risk of SGA.

[Strengthening the capacity of reference in response to violence in society and within the family]. / Stärkung der Beziehungsfähigkeit als Antwort auf Gewalt in der Gesellschaft und in der Familie. Plädoyer für frühe Hilfen zur Förderung der Eltern-Kind-Bindung.

Results of longitudinal studies in developmental psychology have shown the importance of protective factors especially within high risk samples for adaptive development as they serve as puffers against many risks. An outstanding protective factor is a secure parent-child attachment relationship. This article outlines the different ways how attachment relationships can serve as protective mechanisms and especially how disorganized attachment relationships are leading to maladaptation and hostile attitudes and behaviors. In doing so it underscores the special importance of attachment experiences in early infancy. The concept of attachment relationship is described as opposed to the bonding concept with regard to its implications for practice. One of the first is to intervene early. In the final part the evidence based early intervention program "STEEP" is described as an application of attachment research on a poverty sample and as a response to violence.

Indoor factors and their association to respiratory symptoms suggestive of asthma in Austrian children aged 6-9 years.

The ISAAC (International Study of Asthma and Allergy in Childhood) was founded in 1990 in order to maximise the value of epidemiological research into asthma and allergic diseases, to describe the prevalence of asthma and allergic disease in children living in different locations, to make comparisons within and between countries, to provide a framework for further etiological research and to find prevention strategies. We analysed a sub-sample of a population-based study (1995 to 1997) in Upper Austria. The aim of our study was to investigate the influence of indoor risk factors on wheezing in children 6-9 years old. Our calculations were based on the results of a questionnaire answered by parents about their children's indoor environment at home. Smoking of the mother during pregnancy and/or during breastfeeding (OR 1.28; 95% CI 1.08-1.48), smoking of the mother at the present time (OR 1.25; 95% CI 1.12-1.41), a bird (OR 1.40; 95% CI 1.06-1.85) or rabbit (OR 1.37; 95% CI 1.03-1.82) as a domestic pet, synthetic bedding (OR 1.33; 95% CI 1.18-1.49) and dampness or mould at home (OR 1.43; 95% CI 1.24-1.65) are associated with a significantly increased risk of childhood wheezing in the last 12 months. Other variables such as "smoking of the father", "cooking with gas", "gas central heating" and other "pets" do not achieve statistical significance.

[Psychological expert assessment as an intervention in child custody conflicts during divorce]. / Das psychologische Sachverständigengutachten als Intervention bei Sorgerechtskonflikten während der Scheidung.

How to deal appropriately with families affected by divorce has also been discussed among psychological experts for years. In this article the psychological expert opinion in a divorce is described as a possibility of intervention in a current separation conflict. Based upon a process oriented and systemic point of view the corresponding main principles and approaches are described which are essential for the task of forming an expert opinion in such a conflict.

[Treatment of divorce families--considerations from the viewpoint of object relations theory and contextual therapy]. / Arbeit mit Scheidungsfamilien--Uberlegungen aus der Sicht der Bindungstheorie und kontextuellen Therapie.

A child's relationship to both parents in divorcing families is discussed on the background of attachment research. Empirical data emphasize the effects of quality of attachment to both parents on child development, which arises out of the absence or the provision of a secure base. As a consequence the child develops internal working models of attachment figures and self, which is increasingly individually organized during the preschool years and shows considerable continuity throughout early and middle childhood. Adverse effects on attachment and its internal representations are expected to the degree to which through divorce the provision of a secure base is impaired. In psychological practice, parents have to be helped not only in balancing their adult conflicts but in providing a secure base for their children, without missusing them as alies or exposing them to pathological form of parentificaiton. All those are important issues of contextual therapy, which usefullness is especially discussed with respect to its key concept "multidirected partiality".

Squamous-cell carcinoma of the floor of the mouth.

This study was based on the analysis of 100 cases of squamous-cell carcinoma of the floor of the mouth. The male/female ratio was 4.25:1. The peak incidence in women was in the 50 to 59 year age group; in men there was equal frequency in each age group above 50. The five-year survival rate decreased from 86 per cent to 0 as the stage of disease progressed from I to IV. The five-year survival for all stages of disease was 52.7 per cent. Thirty-three per cent developed new primary malignancies; 22 per cent were of the upper alimentary and respiratory tracts. Distant metastases were present in 21 per cent. Fifty per cent were heavy smokers, 33 per cent were heavy drinkers, 28 per cent were both heavy smokers and heavy drinkers, and 21 per cent were nonsmokers and nondrinkers.