Transition to Motherhood: Adverse Childhood Experiences, and Support from Partner, Family and Friends.

BACKGROUND: The complex identity changes women have to go through to become mothers makes it a challenging transitional period. Especially, mothers who have experienced childhood adversity (ACEs) may be vulnerable to poor adjustment to motherhood. However, support from a partner, family and friends can act as a buffer to cope with this challenging transitional period. Therefore, the aim was to study whether ACEs and experienced social support (partners, family, and friends) were related to the adjustment to motherhood or 'motherhood constellation' of women after the birth of their first child. METHOD: Data were collected via an online questionnaire among first-time mothers from June-September 2020. Motherhood constellation was measured with four items based on the descriptions by (Stern, 1995) about the motherhood constellation, i.e. worries about Life/Growth, Emotional Engagement, Support Systems, Identity Organisation. Multiple regression analyses with pairwise deletion were conducted. RESULTS: ACEs were related to all four themes of motherhood constellation, indicating that the more frequent these adverse experiences occurred in the past the more concerns, both about the child and herself, the mother had. Moreover, after controlling for ACEs and other forms of support, only support from friends was related to the use of support systems and identity organisation. Finally, statistically significant interactions were found between ACES and support from friends with life/growth and between ACES and support from family with identity organisation. These interactions indicated that contrary to the expectation the positive association between mother's ACEs and worries was stronger for mothers who experienced more support. CONCLUSION: The consequences of ACEs seemed to show up in the transition to motherhood, indicating that interventions targeting first-time mothers should address the motherhood constellation that may arise from earlier adverse life experiences. Moreover, especially support from friends seemed to be associated with less worries among mothers. Social support has no buffering effect for the negative consequences of ACEs on the themes of motherhood constellation. Further research is clearly needed to get more insight into these themes and to understand the meaning of different types of social support during the transition to motherhood.

[Diabetic night clinic. Advantages for insured patients and insurance carriers]. / Diabetes-Nachtklinik. Vorteile für Versicherte und Kostenträger.

The night clinic for diabetics is a new, partially inpatient supplement of the present medical treatment. It represents a modern cooperative model which provides treatment in the time period that is not taken care of by either out-patient or normal in-patient service. The effectivity in the education and metabolic adjustment of the patients is as good as in a normal clinic. The night clinic permits the insured patient to have equal opportunities at work and a better quality of life. It thus fulfills the social and medical demands in the St.-Vincent declaration. The diabetic can no longer be discriminated against due to missing work in order to be instructed. By remaining employed the patients can be more realistically adapted through cooperation with the company doctor. The social and medical subsequent costs can thus be clearly reduced for the payer. By this cost reduction and by lower operating costs while simultaneously being a more efficient way of treatment, the night clinic conception fulfills modern medical, economic and legal standards.

[Prospective study of the incidence and prevalence of ulcerative colitis in a large urban population in Germany (western Ruhr area)]. / Prospektive Untersuchung von Inzidenz und Prävalenz der Colitis ulcerosa in einer Grossstadtbevölkerung in Deutschland (Westliches Ruhrgebiet).

A prospective epidemiological study of the incidence and prevalence of ulcerative colitis was conducted from 1980 to the end of 1984. The population at risk comprised 1.6 million inhabitants in the four industrial cities Essen, Duisburg, Mülheim and Oberhausen of the western Ruhr-area. All 35 hospitals of the area with 79 departments of internal medicine, surgery and pediatrics with in- and outpatients took part in the study. 225 patients with substantial ulcerative colitis (excluded proctitis) were newly diagnosed during the study period (129 men, 96 women); patients suffering only from ulcerative proctitis were not included. The mean incidence was 2.9 new cases per 100,000 inhabitants and year ranging from 2.3 to 3.7 without significant difference between these 5 years. Incidence figures were somewhat higher for men (3.5) than for women (2.4) and this difference was significant (p < 0.05). The age- and sex-adjusted incidence was found to have a broad range for both sexes between 20 and 65 years of age without a high incidence-peak in young adults or a second peak later in life. Additionally all formerly diagnosed cases of ulcerative colitis were registered during this time period and the hospital archives were looked backward for prevalent cases til 1975 retrospectively. From all these cases the prevalence of ulcerative colitis at December 31, 1984 was calculated for 27.3 patients per 100,000 inhabitants (n = 417) similarly with a significant preponderance of men against women (31.1 vs. 22.1 per 100,000 inhabitants, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Successful treatment of flecainide (Tambocor) poisoning--effect of hemodialysis/hemoperfusion?]. / Erfolgreiche Therapie einer Flecainid-(Tambocor-)Intoxikation--Effekt einer Hämodialyse/Hämoperfusion?

After suicidal ingestion of 3 g flecainide a 34-year-old woman showed somnolence, cerebral convulsion, disturbances of atrioventricular and intraventricular conduction and ventricular asystole. The maximum flecainide plasma level was 4900 ng/ml; this level is extremely high and exceeds the maximum therapeutic level by five times. After initial cardiopulmonary resuscitation and stabilization by intensive care treatment we performed a combined hemodialysis/hemoperfusion therapy (with activated charcoal). This procedure led to a rapid decrease of flecainide plasma levels and simultaneous improvement of ECG-alterations. The initial decrease in flecainide plasma levels during extracorporeal elimination occurred much quicker (4.5-8.5 h plasma halflife) than the spontaneous decrease rate of flecainide in humans (12-20 h plasma half-life). We conclude that, perhaps, hemodialysis/hemoperfusion therapy is an efficient method for decreasing toxic plasma levels of flecainide and for improvement of the clinical course of this intoxication.

Clinical relapse of Crohn's disease under standardized conservative treatment and after excisional surgery.

The course of 205 patients with Crohn's disease at one gastroenterological center was studied in patients with conservative drug treatment or with operative management of their disease. The decision for one or the other treatment regimen was made by an interdisciplinary team of gastroenterologists and surgeons. Using life-table analysis the 205 patients showed a clinical relapse rate of 27% after two years and 38% after four years. Clinical relapse was defined by a Crohn's disease activity index (CDAI) over 150. We used a standardized drug regimen of salazosulfapyridin and prednisone; the indication for excisional surgery was limited strictly to life-threatening situations, absolute nonresponse to drug treatment, and severe intervisceral fistulae. The operated patients (N = 93) had a lower relapse rate than the patients treated conservatively (N = 112), 20% and 51%, respectively, after four years. There were considerably fewer relapses in Crohn's colitis patients who were operated upon than in conservatively treated patients (18% versus 67% after four years); the same was found for ileocolitis (20% vs 49% after four years), but there was no difference between the treatment groups in ileitis (25-30% relapses for both after four years). In addition the patients with Crohn's disease of the colon had a more favorable course after resection with respect to symptoms, clinical and laboratory findings, and CDAI in remission. This paper gives data only for surgery in severe clinical situations and does not give a rationale for earlier surgery. This problem should now be studied in a randomized trial.

[The achievement of surgery in the overall therapy plan in Crohn disease]. / Die Leistung der Chirurgie im Gesamttherapieplan des M. Crohn.

The analysis of 205 prospectively investigated patients with Crohn's disease under conservative (112) and operative (93) treatment with essentially comparable distribution of age and duration of the disease resulted in a significantly better outcome of the operated patients judging by the time free of recurrencies and the frequency of recurrencies for the localisation of ileocolitis and colitis. In ileitis, however, the results are nearly equal for both groups. The results warrant a more liberal indication for operation especially in those patients with involved colon.