Leben mit dem Ungeborenen : die Beziehung werdender Mütter zu ihrem ungeborenen Kind

Einleitung: Forschungsgegenstand dieser qualitativen Arbeit ist die Beziehung werdender Mütter zu ihrem Ungeborenen. Die Mutter-Kind-Beziehung entwickelt sich bereits in der Schwangerschaft und geht einher mit Emotionen, Wünschen und Ängsten, die Einfluss haben auf die spätere Bindungsentwicklung zwischen der Mutter und ihrem Kind. Der Arbeit, für die in theoretischer Hinsicht ein psychoanalytisch orientiertes Rahmenkonzept gewählt wurde, liegen folgende Fragen zugrunde: Wie beschreiben und erleben werdende Mütter die Beziehung zu ihrem Ungeborenen? Welche Bedeutung haben subjektive Erfahrungen für die sich entwickelnde Mutter-Kind-Beziehung? Ziel der Arbeit: Das Erkenntnisinteresse dieser Arbeit richtet sich auf die Erfahrungs- und Erlebenswelt werdender Mütter. Eine genaue Analyse des konkreten Einzelfalls soll einen Beitrag leisten zu einem grösseren Verständnis von Erfahrungen werdender Mütter. Methode: Grundlage der empirischen Arbeit sind vier narrative Interviews mit werdenden Müttern im 2. oder 3. Trimenon der Schwangerschaft, die mittels Inhaltsanalyse nach Kuckartz qualitativ ausgewertet wurden. Ergebnisse: Die inhaltsanalytischen Befunde zeigen, wie verschieden werdende Mütter die Beziehung zu ihrem Ungeborenen erleben und welchen Einflussfaktoren die Begegnung zwischen Mutter und Ungeborenem unterliegt. Diskussion: Ein wichtiges Ergebnis ist die Wirkung des Erzählens auf die sich entwickelnde Mutter-Kind-Beziehung. Erzählend kann es den Frauen gelingen, die Beziehung zu ihrem Ungeborenen aufleben zu lassen, sich des eigenen Erlebens bewusst zu werden und dieses in ein neues Verhältnis mit der Wirklichkeit zu setzen. Schlussfolgerung: Psychoanalytische Entwicklungstheorien bilden eine wertvolle Grundlage für das theoretische Verständnis der Mutter-Kind-Beziehung. Eine daran anknüpfende Gesprächshaltung gibt dem subjektiven Empfinden Raum und eröffnet die Möglichkeit, Erlebtes zu verarbeiten. Das Angebot eines Erzählraums kann werdende Mütter wesentlich unterstützen im Beziehungsaufbau zu ihrem Kind

Machen telefonische Nachgespräche die Hebammen zufriedener?

Von Hebammen initiierte und selbstständig geleitete Projekte können die Berufszufriedenheit positiv beeinflussen. In einer Studie der Zürcher Hochschule für Angewandte Wissenschaften mit dem Hebammenteam am UniversitätsSpital Zürich wurde die Berufszufriedenheit vor und nach Einführung des hebammengeleiteten Projekts «Telefonischen Nachgespräche mit Wöchnerinnen» erhoben. Erste Ergebnisse zeigen keine kurzfristige Verbesserung der Berufszufriedenheit

Patients with diffuse idiopathic skeletal hyperostosis do not have increased peripheral bone mineral density and geometry

Objectives. Recent studies have suggested that areal BMD (aBMD) measured by DXA is elevated in patients with DISH. We used peripheral QCT (pQCT) to assess volumetric BMD (vBMD) and bone geometry of the radius, tibia and the third metacarpal bone. Methods. Patients with established DISH and a control group of healthy individuals were recruited. pQCT measurements were performed at the distal epiphyses and mid-shafts of the radius, the tibia and the third metacarpal bone. At the epiphyses cross-sectional area (CSA), total BMD and trabecular BMD were measured. At the shafts, total bone CSA, cortical CSA, cortical wall thickness and cortical BMD were determined. In addition, muscle and fat CSA of the forearm and lower leg were assessed. Bone parameters were compared between the two groups using independent t-tests. Results. Thirty DISH patients and 30 controls comparable with regard to age and height were included in this study. None of the measured bone parameters differed between groups. Conclusions. In contrast to suggestions based on DXA, pQCT revealed that DISH patients do not have increased vBMD and bone geometry in the appendicular skeleton. Ossification at tendon or ligament insertion sites may lead to overestimation of aBMD if assessed by DX

High-resolution ultrasound confirms reduced synovial hyperplasia following rituximab treatment in rheumatoid arthritis

Objective. To assess the response of RA patients to rituximab (RTX) treatment using a sensitive imaging technique for synovitis. Methods. Twenty-three RA patients were treated with two 1000-mg infusions of the B-cell depleting antibody, RTX, in an observational protocol. Clinical response was assessed by the European League Against Rheumatism (EULAR) response criteria. High-resolution grey-scale and colour-coded power Doppler (PD) ultrasonography was performed at baseline and 6 months after RTX. The second to fifth MCP and PIP joints were bilaterally examined with joints in a neutral 0 position from a palmar view and scored from 0 to 3. Results. Median disease activity score (DAS28) improved from 5.03 to 3.56 (P = 0.001), which corresponded to a EULAR moderate response in 11 of 23 patients and a EULAR good response in another 6 patients. Improved control of disease activity by RTX was also indicated by tapering of median daily corticosteroid doses from 10 to 5 mg, without flare ups. Mean grey-scale scores correlated with the swollen joint count at baseline (r = 0.484, P = 0.022) and month 6 (r = 0.519, P = 0.011). Mean grey-scale scores improved upon RTX from a 0.90 median (range 0.13-1.87) to 0.75 (range 0.19-1.50, P = 0.023). Frequency of PD positive joints was low (6.1%) at baseline and did not significantly change following RTX treatment. Conclusions. High-resolution grey-scale ultrasonography (US) examination confirmed reduced synovial hyperplasia, but the applied PD method displayed no significant changes. Therefore, only grey-scale US is recommended in follow-up examinations after RTX treatmen

A composite score combining waist circumference and body mass index more accurately predicts body fat percentage in 6- to 13-year-old children

Purpose: Body mass index (BMI) and waist circumference (WC) are widely used to predict % body fat (BF) and classify degrees of pediatric adiposity. However, both measures have limitations. The aim of this study was to evaluate whether a combination of WC and BMI would more accurately predict %BF than either alone. Methods: In a nationally representative sample of 2,303 6- to 13-year-old Swiss children, weight, height, and WC were measured, and %BF was determined from multiple skinfold thicknesses. Regression and receiver operating characteristic (ROC) curves were used to evaluate the combination of WC and BMI in predicting %BF against WC or BMI alone. An optimized composite score (CS) was generated. Results: A quadratic polynomial combination of WC and BMI led to a better prediction of %BF (r 2=0.68) compared with the two measures alone (r 2=0.58-0.62). The areas under the ROC curve for the CS [0.6*WC-SDS+0.4*BMI-SDS] ranged from 0.962±0.0053 (overweight girls) to 0.982±0.0046 (obese boys) and were somewhat greater than the AUCs for either BMI or WC alone. At a given specificity, the sensitivity of the prediction of overweight and obesity based on the CS was higher than that based on either WC or BMI alone, although the improvement was small. Conclusion: Both BMI and WC are good predictors of %BF in primary school children. However, a composite score incorporating both measures increased sensitivity at a constant specificity as compared to the individual measures. It may therefore be a useful tool for clinical and epidemiological studies of pediatric adiposit

Decrease in the prevalence of paediatric adiposity in Switzerland from 2002 to 2007

Abstract Objective A national study in Switzerland in 2002 suggested nearly one in five schoolchildren was overweight. Since then, many programmes have been introduced in an attempt to control the problem. The aim of the present study was to determine the prevalence of childhood overweight in Switzerland five years later. Design In both studies a cross-sectional, three-stage, probability-proportional-to-size cluster sampling of schools throughout Switzerland was used to obtain a representative sample of approximately 2500 children aged 6-13 years. Height and weight were measured and BMI calculated. The BMI references from the Centers for Disease Control and Prevention were used to determine the prevalences of underweight (100 000 compared with smaller communities (P < 0·05). Conclusions In summary, over the past 5 years, the prevalence of adiposity has decreased in Swiss children. These findings suggest that increased awareness combined with mainly school-based programmes aimed at physical activity and healthy nutrition may have helped to control this public health problem. Future monitoring in Switzerland will determine if these findings are sustaine