The Multiple Determinants of Maternal Parenting Stress 12 Months After Birth: The Contribution of Antenatal Attachment Style, Adverse Childhood Experiences, and Infant Temperament

Parenting stress can influence caregiving behavior negatively, which in turn may harm children’s development. Identifying precursors of parenting stress, preferably beginning during pregnancy and throughout the first year of life, is therefore important. The present study aims to provide novel knowledge on this issue through a detailed examination of the association between maternal attachment style and later parenting stress. Moreover, we examine the role of several additional risk factors, specificially the mothers’ own adverse childhood experiences (ACE), as well as infants’ temperamental characteristics. Data from a community based longitudinal study of 1,036 Norwegian mothers, collected during pregnancy and 12 months after childbirth, were used. Results showed that attachment style in pregnancy predicted parenting stress 1 year after birth. In addition, it was demonstrated that the mothers’ own ACEs predicted postnatal parenting stress, and that attachment style operated as a mediator of this association. A significant association between perceived infant temperament and parenting stress was also found. The study illustrates the importance of understanding the multifactorial antecedents of parenting stress. The results may inform early intervention efforts aimed at supporting mothers and their partners in the potentially difficult transition period around childbirth

Fatty acid reference intervals in red blood cells among pregnant women in Norway–Cross sectional data from the ‘Little in Norway’ cohort

There is a growing interest in determining fatty acid reference intervals from pregnancy cohort, especially considering the lack of reference values for pregnant women in the literature and the generalized misconception of equating reference intervals for nonpregnant women as equivalent to pregnant women. Seafood and supplements are important dietary sources for the omega-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA), such as eicosapentaenoic acid (EPA, 20:5ω-3), docosapentaenoic acid (DPA, 22:55ω-3), and docosahexaenoic acid (DHA, 22:6ω-3). Sufficient intake of EPA and DHA is vital during pregnancy for the development of the fetus, as well as for maintaining adequate levels for the mother. This study describes the fatty acid status and suggests reference values and cut-offs for fatty acids in red blood cells (RBC) from pregnant women (n = 247). An electronic food frequency questionnaire (e-FFQ) mapped the dietary habits of the participants, and gas chromatography was used to determine the fatty acid levels in RBC. The association between e-FFQ variables and fatty acid concentrations was established using a principal component analysis (PCA). Twenty-nine-point-one percent (29.1%) of the participants reported eating seafood as dinner according to the Norwegian recommendations, and they added in their diet as well a high percentage (76.9%) intake of ω-3 supplements. The concentration levels of fatty acids in RBC were in agreement with those reported in similar populations from different countries. The reference interval 2.5/97.5 percentiles for EPA, DPA, DHA were 0.23/2.12, 0.56/2.80, 3.76/10.12 in relative concentration units (%), and 5.99/51.25, 11.08/61.97, 64.25/218.08 in absolute concentration units (µg/g), respectively. The number of participants and their selection from all over Norway vouch for the representativeness of the study and the validity of the proposed reference values, and therefore, the study may be a useful tool when studying associations between fatty acid status and health outcome in future studies. To the best of our knowledge, this is the first PCA study reporting a direct association between ω-3 LCPUFA and intake of seafood and ω-3 supplements in a pregnancy cohort.publishedVersio

Transporting attachment and biobehavioral catch-up to Norwegian child welfare services: A feasibility study

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Do parental cognitions during pregnancy predict bonding after birth in a low-risk sample?

Parental bonding to their infant is important for healthy parent-infant interaction and infant development. Characteristics in the parents affect how they bond to their newborn. Parental cognitions such as repetitive negative thinking, a thinking style associated with mental health issues, and cognitive dispositions, e.g., mood-congruent attentional bias or negative implicit attitudes to infants, might affect bonding. To assess the influence of cognitive factors on bonding, 350 participants (220 pregnant women and their partners) were recruited over two years by midwives at the hospital and in the communal health care services. Participants were followed throughout the pregnancy and until the infant was seven months old as a part of the Northern Babies Longitudinal Study. Both mothers and fathers took part. First, we measured demographics, repetitive negative thinking, attentional bias, and implicit attitudes to infants during pregnancy, as predictors of bonding two months postnatally. Second, we also measured infant regulatory problems, and depressive symptoms at two months postnatally as predictors of parents’ perception of infant temperament at five months. Robust regression analyses were performed to test hypotheses. Results showed that mothers and fathers differed on several variables. Parity was beneficial for bonding in mothers but not for fathers. Higher levels of mothers’ repetitive negative thinking during pregnancy predicted weaker bonding, which was a non-significant trend in fathers. For fathers, higher education predicted weaker bonding, but not for mothers. Mothers’ perception of their infant temperament at five months was significantly affected by bonding at two months, but for fathers, their depressive symptoms were the only significant predictor of perceived infant temperament. In conclusion, for mothers, their relationship with their infant is essential for how they experience their infant, while for fathers their own wellbeing might be the most important factor. Health care providers should screen parents’ thoughts and emotions already during pregnancy to help facilitate optimal bonding

Little in Norway: a prospective longitudinal community-based cohort from pregnancy to child age 18 months

The Little in Norway (LiN) project is a cross-disciplinary prospective longitudinal study starting in pregnancy. It was set up to investigate maternal and paternal mental health functioning in the transition to parenthood, detect pathways to healthy and aberrant child development and generate new knowledge about mechanisms underlying differential child mental health susceptibility.publishedVersio

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Kritikkens oppgave : en undersøkelse av kritikkbegrepet hos Walter Benjamin i verkene Der Begriff der Kunstkritik in der deutschen Romantik og Ursprung des deutschen Trauerspiels

Synopsis Det følgende er en undersøkelse av kritikkbegrepet hos den tyske tenkeren Walter Benjamin. Jeg har tatt utgangspunkt i hans avhandling om kritikkbegrepet i romantikken Der Begriff der Kunstkritik in der deutschen Romantik (1920) og sammenlignet den med hans senere verk om det tyske sørgespillet Ursprung des deutschen Trauerspiels (1928). Spørsmålet som stilles, er mer presist: Hvordan utvikler kritikkbegrepet hos Benjamin seg i skjæringspunktet mellom romantikk og modernitet? I forsøket på å besvare dette har jeg også fordypet meg i flere andre av Benjamins kortere tekster, særlig essayene «Über Sprache überhaupt und über die Sprache des Menschen» (1916) og «Die Aufgabe des Übersetzers» (1923). Jeg opererer med en antagelse om at utviklingen i synet på kritikk har sitt utgangspunkt i Benjamins egen teori om erkjennelse i forlengelsen av språkfilosofien slik den kommer til uttrykk i disse to tekstene. Benjamins språkfilosofi tar utgangspunkt i den jødiske og kristne skapelsesberetningen. Den er dermed i sin kjerne en fortelling om et fall fra enhet til splittelse. Imidlertid eksisterer det samtidig en tanke om en slags fortsettelse av denne enheten, en rest av det Benjamin kaller det Rene språk. Denne resten gir seg utslag i at det eksisterer en umiddelbarhet i språket også etter Fallet. Denne tanken har jeg knyttet til Benjamins forståelse av kritikkbegrepet i romantikken. Kritikken fremstår der som en refleksjon i utveksling mellom subjekt og objekt. Kritikkens arbeid fører slik både til en destruksjon av det opprinnelige verket og inn i en kontinuerlig og aldri avsluttet utvikling mot det absolutte Verket. Jeg har benyttet et skille mellom en «billedlighet» og en «skriftlighet» i språket for å klargjøre språkets utvikling herfra og mot fortolkningens grenser slik de fremstilles i verket om det tyske sørgespillets opprinnelse. Det billedmessige kjennetegnes her av umiddelbarhet og totalitet (fullendelse), mens skriften til sammenligning innebærer formidling og utsettelse. Benjamins romantiske språk har dermed særlig vært preget av en kombinasjon av disse, mens språkets fremste egenskap i sørgespillsteksten er det man med Benjamin kan kalle en ruinering. Umiddelbarheten er tapt, og fortolkningen fremstår som subjektiv projeksjon. Gjennom kritikken kan denne ruineringen komme til syne ved at kritikken viderefører verket som allegori. Slik innhentes på et vis subjektiviteten av allegorien, gjennom en form for billedlighet som nå kjennetegnes av bruddet. Jeg har funnet at begge de to avhandlingene til Benjamin forenes gjennom at kritikkens oppgave synes å være å lede ut av subjektiviteten

Utviklingslandenes rolle i globale miljøforhandlinger : om byttemakt o g normers relevans som påvirkningsmekanismer i forhandlingene om ozonla gsregimet og biologisk mangfold regimet

Sammendrag av hovedoppgaven med tittelen "Utviklingslandenes rolle i globale miljøforhandlinger. Om byttemakt og normers relevans som påvirkningsmekanismer i forhandlingene om ozonlagsregimet og biologisk mangfold regimet." Hovedoppgaven ser på u-landenes rolle i globale miljøforhandlinger. Utgangspunktet for oppgaven ligger i et ønske om å undersøke hvorvidt den globale økologiske gjensidige avhengigheten har bidratt til at u-landene, tross sin generelt svake posisjon i verdensøkonomien i forhold til i-landene, kan påvirke globale miljøforhandlinger. 3. Tema, problemstilling og hypoteser. A) Temaet for oppgaven. Jeg har sett på i hvilken grad u-landene har makt i miljøforhandlinger i forhold til i-landene, hva slags type makt de har, og hvordan de via eventuell makt kan få innflytelse i forhandlingsprosessen og på -utfallet. B) Problemstilling. Problemstillingen som jeg har valgt for hovedoppgaven lyder som følger; Hvorvidt, og i hvilken grad utviklingslandene har mulighet for å påvirke forhandlingsprosessen og -utfallet i globale miljøforhandlinger. Denne er utgangspunktet for to delproblemstillinger: 1) Hva er det som gir u-landene disse mulighetene/Hvorfor får de disse mulighetene?, og 2) Hvilken av de to maktformene - byttemakt eller normer - kan spille en rolle for u-landenes påvirkningsmuligheter?[6] Problemstillingen belyses med utgangspunkt i empirisk materiale fra casene jeg har sett på: Montrealprotokollen og Konvensjonen om biologisk mangfold. C) Hypoteser. Utfra problemstillingen kan man utlede følgende hypoteser; Til tross for at u-landene generelt er svake i forhold til i-landene, kan de påvirke miljøforhandlinger gjennom byttemakt. 1) U-landene kan påvirke forhandlinger ved å appellere til normer. Sammenfattende konklusjon Ved å trekke muligheten for samspill frem , viser materialet at man får en slags stereoeffekt, ettersom byttemakt og normer trekker i samme retning. Materialet viser en tendens til at i-landene ikke er villig til å ta normer innover seg, hvis ikke makt ligger i vektskålen. Normbasert innflytelse er med andre ord betinget av at u-landene har byttemakt. I-landene kan med andre ord ikke se bort fra u-landenes rimelighetsorienterte krav, fordi u-landene kontrollerer noe de har interesse av. Hvis u-landene mangler byttemakt derimot, kan i-landene velge å se bort fra hva hva som er rimelige ordninger. Har u-landene byttemakt, har i-landene ikke noe annet valg, hvis de skal kunne oppnå det u-landene kontrollerer. Dette kan også skyldes at vi har fått en såkalt samspillseffekt, hvor interesser og moral faller sammen, som gir en ekstra god grunn til å følge en bestemt linje. De to betingelsene for at u-landene skal få innflytelse - byttemakt og normer - kan i tråd med dette tolkes som utilstrekkelige betingelser hver for seg, mens de satt i sammenheng er nødvendige betingelser for at u-landene skal kunne få innflytelse. Man kan også se dette fra en litt annen synsvinkel. Materialet kan gi indikasjoner på et samspill mellom variablene hvor følelsen av å ha moralsk rett vil øke engasjementet, som indirekte kan virke inn på maktkanalen. Det å føle at en har viktige normer på sin side øker selvtilliten slik at en tør å engasjere seg sterkere, og et sterkere engasjement vil slå heldig ut særlig for svake stater, slik at man øker sannsynligheten for å få innflytelse. U-landenes mulighet for innflytelse i forhandlingene har variert i vanskelighetsgrad etter hvilken fase av forhandlingene man forholder seg til. U-landene så ut til å ha betydelig innflytelse i prosessen og på selve avtalen, mens denne avtar i den påfølgende implementeringen. Det hjelper lite å ha innflytelse på prosessen og avtalen, hvis ikke bestemmelsene som tilgodeser u-landene etterleves. [6] Begrepet "makt" og "innflytelse" vil her bety et gjennombrudd for ens interesser, generelt ved å få andre til å gjøre noe de ellers ikke ville gjort (Hernes, 1975)