Associations between depressive symptoms and breastfeeding are well documented. However, evidence is lacking for subdivisions of feeding styles, namely exclusive breastfeeding, exclusive formula feeding and a mixed feeding style (breastfeeding and formula feeding). In addition, studies examining associations between mother-child-bonding and breastfeeding have yielded mixed results. The aim of this study is to provide a more profound understanding of the different feeding styles and their associations with maternal mental health and mother-child-bonding. Data from 307 women were collected longitudinally in person (prenatally) and by telephone (3 months postnatally) using validated self-report measures, and analyzed using correlational analyses, unpaired group comparisons and regression analyses. Our results from a multinomial regression analysis revealed that impaired mother-child-bonding was positively associated with mixed feeding style (p = .003) and depressive symptoms prenatal were positively associated with exclusive formula feeding (p = .013). Further studies could investigate whether information about the underlying reasons we found for mixed feeding, such as insufficient weight gain of the child or the feeling that the child is unsatiated, could help prevent impaired mother-child-bonding. Overall, the results of this study have promising new implications for research and practice, regarding at-risk populations and implications for preventive measures regarding postpartum depression and an impaired mother-child-bonding.

Background: The treatment of children and adolescents with disabilities (CA-Dis) and psycho-emotional disorders (CA-Psy) places special demands on dentists. Aim: To explore German dentists’ (with key expertise in paediatric dentistry) perception of their competence and comfort levels in dealing with these patients, and implications for access to care. Methods: Online questionnaire surveying demographic information and self-assessment of training, knowledge, and comfort in dealing with CA-Dis and CA-Psy among 1725 members of the German Society of Paediatric Dentistry (DGKiZ). Results: Ninety-two participants (11 male, 81 female) completed the questionnaire: 17.4% (n = 16) treated CA-Dis once or more a day; CA-Psy were rarely treated on a daily basis (7.6%; n = 7). In regard to CA-Dis, 62% (n = 57) rated their level of expertise as “good” or “very good”; for CA-Psy this was 40.2% (n = 37). Overall, 76.1% (n = 70), respectively, 88.0% (n = 81) of the respondents felt they had been inadequately prepared to treat CA-Dis or CA-Psy. Although the physical burden of treating CA-Psy was rated as “not at all stressful” or only “slightly stressful” by 45.7% of the participants, 31.5% rated the psychological distress as “very stressful” or “extremely stressful”. The better their self-assessed expertise in treating CA-Dis was, the lower their own psychological distress was rated (r = −0.34). Training on this topic seems to have an impact on the perceived burden of treating such patients. Conclusions: A core curriculum in special care dentistry needs to be embedded in the German dental curriculum. The results permit the development of health programs for workplace health management in dentistry.

This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it‘s feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one’s own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R² = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.

Background/Objectives: More children and adolescents are adopting vegetarian diets. A balanced diet is particularly important for growth and bone development in children. It is important to clarify whether a vegetarian diet affects these processes. A systematic literature review was conducted to identify studies investigating differences in anthropometric data, nutrient intake, and biomarkers between vegetarian and omnivorous children. Methods: PUBMED, MEDLINE, and Web of Science Core Collections were searched between the end of 2014 and 2023. We included peer-reviewed randomized controlled trials, intervention, or observational studies that were published in English or German and investigated the differences between healthy children and adolescents from high-income countries who consumed either a vegetarian or an omnivorous diet. The review was conducted in accordance with the PRISMA guidelines. If at least five values with the same unit were available from different studies, a cumulative analysis of selected parameters was conducted. Due to the participants’ varying ages across the studies, limited cumulative analyses were conducted additionally by age category. Results: A total of 1681 studies were screened, of which 20 met the inclusion criteria. Significant differences were found in fiber and energy intake from carbohydrates and proteins. The results were strengthened by the restricted cumulative analysis of the 2–10 age category, which also revealed significant differences when comparing VG and OM. Conclusions: A higher intake of fiber, more energy from carbohydrates, and sufficient energy from proteins and less from fat can be regarded as the benefits of a vegetarian diet, according to this review. There are also the first indications of enhanced vitamin C and E, iron, folate, and magnesium intake. These characteristics can be regarded as potential benefits of a vegetarian diet. A lower vitamin B12 and vitamin D intake has been identified as a potential risk factor. Further longitudinal, prospective, observational studies are needed. Prospero registration date and number: 6 March 2023, CRD42023402301.

Background: Most German hospitals do not offer a trial of labour after two caesarean sections (TOLA2C). TOLA2C is claimed to be associated with too many complications, above all the high risk of uterine rupture. The objective of this study is to review our experience with TOLA2C, with special attention paid to the risk and probability of uterine ruptures. Secondary outcomes include comparing neonatal and maternal outcomes in the group of TOLA2C with the group of elective repeat caesarean section (ERCS) and to assess the success rate for vaginal birth after two caesarean sections (VBAC-2). Methods: The retrospective cohort study was conducted in a community hospital in North Rhine-Westphalia. Inclusion criteria were all pregnant women with two caesarean sections in their medical history, with a current vertex singleton pregnancy and the absence of morphological abnormalities of the foetus, who gave birth in our facility between January 2015 and June 2021. Descriptive statistics were calculated and Kolmogorov-Smirnov tests, Mann-Whitney U tests, Fishers exact tests, Chi² –tests and t-tests for independent samples were performed. Results: A total of 91 cases were included in the TOLA2C-group. These were compared to 99 cases that, within the same time frame, had an elective repeat caesarean section (ERCS-group). There was no statistically significant difference found in the neonatal outcome between the two groups (except for the neonatal pH-value: p 0.024). The hospital stay was significantly shorter in the TOLA2C-group, while maternal complication rates were almost similar (13.2% in the TOLA2C-Group, vs. 16.2% in the ERCS-Group). The success rate for TOLA2C was 55%. No complete uterine rupture was found, but in three cases an incomplete rupture (3.3% rate for incomplete uterine ruptures) occurred, but had no influence on the neonatal outcome. Conclusion: TOLA2C is not associated with a worse maternal or neonatal outcome compared to ERCS, and especially the risk of complete uterine ruptures seems to be low. TOLA2C should be more widely offered to suitable patients who are motivated for it.

Hintergrund Verschiedene Studien berichten über das Stresserleben von Krankenhausmitarbeitern während der COVID-19-Pandemie, aber auch vor der Pandemie fühlten sich viele ärztliche Klinikmitarbeiter durch ein hohes Arbeitspensum oder unklare Vorgaben emotional erschöpft. Methoden Kognitive Bewertungen und das Stresserleben von ärztlichem Krankenhauspersonal aus 6 Kliniken im zeitlichen Verlauf der COVID-19-Pandemie wurden ausgewertet. Neben der deutschsprachigen Version des „Stress Appraisal Measure“ (SAM) wurden die COVID-19-Patientenbelegungen und die relative Bettenbelegung erfragt; Korrelationen im Quer- und Längsschnitt wurden berechnet. Ergebnisse Teilnehmer t1: 170, t2: 55, t3: 47 Ärzte. Obwohl keine Erfahrung mit einer solchen Pandemie vorhanden war, waren die SAM-Mittelwerte nicht auffallend unterschiedlich im Zeitverlauf. Höhere lokale Neuinfektionen gingen nicht einher mit einer erhöhten Bewertung, die Situation als bedrohlich oder stressend zu erleben. Hohe positive Korrelationen der gleichen SAM-Unterskalen im Längsschnitt könnten ein Hinweis sein für ein zeitstabiles Persönlichkeitsmerkmal, welches die kognitiven Bewertungen beeinflusst. Schlussfolgerung Die Ergebnisse geben erste Hinweise, dass das ärztliche Personal eine gute Strategie zur Bewältigung des pandemiebedingten Stresserlebens hatte. Eine differenziertere Analyse des Stresserlebens von medizinischem Personal im Allgemeinen, und nicht nur zu besonderen Zeiten der Pandemie, könnte zukünftig vorgenommen werden. Background Several studies report on the stress experiences by hospital employees during the COVID-19 pandemic, but also before the pandemic many medical hospital employees felt emotionally exhausted due to a high workload or unclear guidelines. Methods Cognitive appraisal and stress experiences of physicians from six hospitals during COVID-19 pandemic were assessed. Additionally, to the German-language version of the “Stress Appraisal Measure” (SAM), COVID-19 patient occupancy and relative bed occupancy were queried. Correlations in cross-sectional and longitudinal design were calculated. Results Participants t1: 170, t2: 55, t3: 47 physicians. Although there was no experience of such a pandemic, SAM averages were not noticeably different over time. Higher local new infections were not accompanied by an increased rating of the situation as threatening or stressful. High positive correlations of the same SAM sub-scales in the longitudinal design could be an indication of a time stable personality trait, which influences cognitive appraisal. Conclusion The results provide initial indications that medical staff had a good coping strategy with the stressful experiences caused by the pandemic. A more differentiated analysis of the stress experiences by medical staff in general, and not only at particular times of the pandemic, could be carried out in the future. Publication Date: 09 February 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany