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Child maltreatment has been linked to insecure adult attachment. However, it is not yet clear how different child maltreatment types are associated with attachment-related anxiety and avoidance in adulthood; and whether resilience against these insecure attachment styles is dependent on risk-specific resources. Therefore, this study explored differential pathways from child maltreatment types to attachment-related anxiety and avoidance in adulthood and examined whether psychological resources (self-esteem) and social resources (perceived social support) show risk-specific effects. An online survey retrospectively assessed experiences of child maltreatment, the level of attachment-related anxiety and avoidance in adulthood, self-esteem, and perceived social support in N = 604 former members of fundamentalist Christian faith communities (mean age = 41.27 years, SD = 12.50; 65.90% female). Cross-sectional data was analyzed using Bayesian network analysis. Only emotional child maltreatment showed direct relationships to insecure adult attachment. Specifically, emotional abuse and emotional neglect were associated with anxious and avoidant adult attachment, respectively. The effects of other child abuse types on adult attachment were mediated through emotional abuse, which indicated patterns of complex traumatization. Self-esteem mediated the effect of emotional abuse on anxious attachment, while perceived social support mediated the effect of emotional neglect on avoidant attachment. Social support was also linked to self-esteem and was therefore also important for individuals with experiences of emotional abuse. This study showed that child maltreatment types and their interactions are meaningfully linked to attachment-related anxiety and avoidance in adulthood. Interventions for survivors of child maltreatment should focus on risk-specific resources to support their resilience.

Although childhood adversity can have lasting effects into later life, positive adaptations have also been observed, including an increased tendency toward prosocial behavior. However, little is known about the link between childhood adversity and later life prosocial behavior, with a particular scarcity of research on intrafamilial childhood adversity. Therefore, this study aimed to examine older adult's experiences of childhood adversity and identify mechanisms linked to prosocial behavior. Two adversity contexts (intrafamilial and extrafamilial) were compared to explore individual, as well as broader cultural and contextual mechanisms linking childhood adversity and later life prosocial behavior.Semi-structured interviews (60-120 min) were conducted withFive themes were identified on prosocial mechanisms, with three themes in both survivor groups (enhanced empathy, self-identity, amelioration), and two group-specific themes (compassion fatigue in intrafamilial survivors; denouncing detrimental social values in institutional survivors).Results identified motivational processes and volitional factors linked to later life prosocial behavior. Connections to caring roles, (lack of) support, and social norms in childhood, as well as the need for a sense of purpose and meaning from the adversities in adulthood, highlight potential targets for psychotherapeutic intervention to promote prosocial responding and positive adaptation for childhood adversity survivors.

The heterogeneity in the operationalisation of successful ageing (SA) hinders a straightforward examination of SA associations and correlates, and in turn, the identification of potentially modifiable predictors of SA. It is unclear which SA associations and correlates influence all facets of the SA construct, and whether psychosocial reserve models developed in neuropathological ageing research can also be linked to SA. It was therefore the aim of this study to disentangle the effect of various previously identified SA associations and correlates on (1) a general SA factor, which represents the shared underpinnings of three SA facets, and (2) more confined, specific factors, using bifactor modelling. The associations and correlates of three recently validated SA operationalisations were compared in 2478 participants from the German AgeCoDe study, aged 75 years and above. Based on participants’ main occupation, cognitive reserve (CR) and motivational reserve (MR) models were built. Younger age, male gender, more education, higher socio-economic status, being married or widowed, as well as more physical exercise and cognitive activities in old age were found to correlate positively with the general SA factor, indicating a simultaneous effect on all aspects of SA. Smoking and ApoE-ε4 were related only to the physiological facet of SA. CR models were significantly related to the general SA factor. Among all SA associations and correlates, proxy indicators of lifelong cognitive activity and physical exercise showed the strongest effects on SA. Future intervention studies should assess the influence of the preservation of active lifestyle across the life span on SA. Electronic supplementary material The online version of this article (10.1007/s10433-020-00593-4) contains supplementary material, which is available to authorised users.

The aim of the present study was to establish whether the size (diameter and area) of bullet entrance holes in skin varies between distant shots to the anterior and posterior trunk, respectively, when using the same ammunition (in concreto pistol cartridges 9 mm Luger). For that purpose, specimens of porcine skin from the belly region and the back were taken (10 samples each) and shot at from a distance of 1.6 m. The entrance holes were photo-documented under standardised conditions. After image processing for contrast enhancement, the maximum diameter and the area of each skin defect were measured automatically by means of an image analysis system. Both size parameters differed significantly depending on the body region affected. On the back with its comparatively thick dermis, the skin defects were considerably smaller than those on the ventral trunk where the corium is less thick. This difference can be explained by the fact that the elastic properties of skin are strongly determined by the connective tissue which is especially rich in fibres. The study results were consistent with the authors’ casework experience and support the assumption that the entrance site of gunshot wounds has a major influence on the size of the bullet hole in skin.

Complex trauma exposure in childhood and/or adolescence is common and has repeatedly been linked to mental ill-health across the lifespan. While the correlates of complex trauma and mental health are well-studied in individuals up to middle adulthood, correlates in older adulthood, as well as potential mediators of this relationship, such as stress coping, are insufficiently studied. Therefore, this study aimed to (a) examine the mental health of Swiss older adults affected by complex trauma exposure in childhood and/or adolescence, in comparison to non-affected individuals; and (b) to examine the potential mediating role of coping strategies and coping self-perception. Data from N = 257 participants (complex trauma [CT] group: n = 161; Mage = 69.66 years, 48.4% female; non-complex trauma [nCT] group: n = 96; Mage = 72.49 years, 42.7% female) were assessed using self-report questionnaires and a clinical interview. The CT group presented with significantly more current and lifetime mental health disorders, more disadvantageous coping strategies, and significantly lower coping self-perception, compared to the nCT group. Mediation analyses revealed that maladaptive coping and coping self-perception were relevant mediators of the relationship between complex trauma exposure and psychopathology. Results suggest that complex trauma exposure in childhood and/or adolescence can have a lasting impact on mental health in later life and can be negatively associated with stress coping. Findings emphasize the relevance of a lifespan perspective in research and clinical practice for addressing consequences of complex trauma exposure.

Individuals with complex trauma exposure (CTE) in early life (i.e., childhood/adolescence) are at heightened risk for developing problems in various domains of functioning. As such, CTE has repeatedly been linked to internalizing mental health disorders, such as depression and anxiety, as well as emotion dysregulation across the lifespan. While these correlates of CTE are comparatively well studied up to middle adulthood, they are insufficiently studied in older adulthood. Therefore, this study aimed to (a) compare Swiss older adults with and without a CTE history regarding current and lifetime internalizing mental health disorders and emotion regulation strategies; and (b) to examine the potential mediating role of emotion regulation in the mental health disparities between these groups. A total of

Brain reserve (i.e., the ability of the brain to tolerate age- and disease-related changes in a way that cognitive function is still maintained) is assumed to be based on the lifelong training of various abilities. Motivational reserve (MR) is a form of brain reserve and can be defined as a set of motivational abilities that provide the individual with resilience to neuropathological damage. The first part of the chapter explains the term motivational processes and the model of MR and describes the measurement concept. The second part summarizes the results of several studies on the model of MR. For example, motivational abilities have been shown to be associated with a reduced risk of mild cognitive impairment and Alzheimer disease (AD) in apolipoprotein E ɛ4 carriers, but not in noncarriers. Revealing the mechanisms underlying the association of motivational abilities and cognitive decline may lead to novel strategies for delaying the onset of AD symptoms.

Objective: This study set out to empirically identify joint health trajectories in individuals of advanced age. Predictors of subgroup allocation were investigated to identify the impact of psychol...

Humankind is confronted with progressing climate change, pollution, environmental degradation, and/or destruction of the air, soil, water, and ecosystems. The climate and environmental crisis is probably one of the greatest challenges in the history of humankind. It not only poses a serious current and continuing threat to physical health, but is also an existing and growing hazard to the mental health of millions of people worldwide. This synergy of literature provides a current summary of the adverse mental health impacts of the climate and environmental crisis from the perspective of Clinical Psychology. Furthermore, it presents potential underlying processes, including biological, emotional, cognitive, behavioral, and social pathways. The existing data suggest that the climate and environmental crisis not only acts as a direct stressor, but can also exert a detrimental impact on the various pathways, with the potential to amplify an individual's biopsychosocial vulnerability to develop mental ill-health. This is a call for an increased investigation into this emerging research field of Clinical Ecopsychology by clinical psychologists and other researchers.

Background With widespread deprivation in the education of minors affected by child welfare practices (CWP) in the last century, affected individuals often continued a life dominated by socio-economic disadvantage. According to life course theories, the impact of socio-economic disadvantage can accumulate across the life span, leading to worse health in later life. However, the scientific examination of health correlates of CWP in later life and the mediating role of socio-economic factors (SEF) has previously been neglected. Objective This study examined whether Swiss survivors of CWP, including former Verdingkinder, have poorer health in later life compared to controls, and whether this association is mediated by socio-economic factors: education, income, satisfaction with financial situation, socio-economic status. Participants and setting Two face-to-face interviews were conducted with N = 257 participants (risk group, RG, n = 132, MAGE = 70.83 years, 58 % male; control group, CG, n = 125, MAGE = 70.6 years, 49 % male). Methods A broad set of physical health outcomes, stress, well-being, and SEF were assessed with psychometric instruments. Results The RG reported more physical illnesses, vascular risk factors, health symptoms, stress, and lower well-being, compared to the CG. Mediation analyses revealed that SEF were relevant mediators for the significant health and stress disparities between groups. Conclusions Results suggest that SEF can play a crucial role in mitigating the negative effects and health impairments in individuals formerly affected by CWP. Public health services and policies that target these SEF could improve current welfare practices by providing opportunities to overcome early-life disadvantage and facilitating healthier life trajectories.

BackgroundEmerging systemic approaches on resilience propose that a person’s or group’s adaptability to significant stress relies on a network of interdependent resources. However, little knowledge exists on systemic resilience in older survivors of early-life adversity (ELA) and how ELA affects their resource network in later life.ObjectiveThis study investigated how ELA may be linked to the interplay of resources and stress-related risk factors in later life.Research Design and MethodsData from N = 235 older adults (Mage = 70.43 years; 46.40% female) were assessed. Half the participants were affected by ELA through compulsory social measures and placements in childhood, and/or adolescence (“risk group”). The other half were age-matched, non-affected participants (“control group”). Using psychometric instruments, a set of resilience-supporting resources in later life and current stress indices were assessed. Regularized partial correlation networks examined the interplay of resources in both groups, whilst also considering the impact of stress.ResultsBoth groups demonstrated only positive resource interrelations. Although the control group showed more possible resource connections, the groups did not significantly differ in the overall strength of connections. While group-specific resource interrelations were identified, self-esteem was observed to be the most important resource for the network interconnectedness of both groups. The risk group network showed a higher vulnerability to current stress.Discussion and ImplicationsNetwork analysis is a useful approach in the examination of the complex interrelationships between resilience resources and stress-related risk factors in older adulthood.

Experiences of child maltreatment are associated with a host of adverse mental and physical health outcomes in adulthood. Altered reactivity to psychosocial stress exposure may partially explain known associations between early experiences of maltreatment and later life health. The present study focuses on examining whether experiences of child maltreatment are associated with physiological reactions to initial and repeated psychosocial stress in adulthood. To this end, 44 healthy adults (52% male, aged 18–65) completed the Childhood Trauma Questionnaire to provide information about exposure to child maltreatment and completed the Trier Social Stress Test (TSST) on 2 consecutive days. Peripheral blood was collected prior to as well as 30 and 120 min following the TSST on each day. Plasma Interleukin-6 (IL-6) and gene expression of IL-6, IL-1β, nuclear factor-kB (NF-kB), and inhibitor of kB (IkB) were measured from each blood sample. Total CTQ scores were unrelated to plasma IL-6 and gene expression (ps > .10) but a history of childhood physical neglect was associated with increased interleukin-1β (β =.35; p =.02; R2 =.19) and nuclear factor-kB (β =.30; p =.046; R2 =.13) expression following initial stress. Following repeated exposure to the TSST, childhood physical neglect was associated with increased plasma IL-6 reactivity (β =.34; p =.02; R2 =.16) and increased expression of nuclear factor-kB (β =.31; p =.04; R2 =.08). Finally, childhood physical neglect was associated with decreased habituation following repeated exposure to the TSST. Other CTQ subscales were not related to plasma IL-6 and gene expression when considered individually. Results from this study are suggestive of a unique effect of childhood physical neglect on the physiological stress response following initial and repeated exposure to a common psychosocial stressor. This provides important directions for future research because the effect of childhood physical neglect on long-term neglect are not well understood and in need of further investigation.

Die psychotherapeutischen Behandlungsansatze der posttraumatischen Belastungsstorung („posttraumatic stress disorder“, PTSD) wurden in den letzten 20 Jahren bestandig weiterentwickelt und uberpruft. Ihre positiven Effekte sind mittlerweile weitgehend gut und ubereinstimmend belegt. Der Nutzen pharmakologischer Behandlungsmoglichkeiten ist weniger gut evaluiert, und die Datenlage ist widerspruchlicher. Der vorliegende Beitrag prasentiert einen Uberblick uber den gegenwartigen Forschungsstand der storungsorientierten psychotherapeutischen und pharmakologischen Ansatze der PTSD und deren Effektivitat. Zunachst erfolgt ein Uberblick uber die Metaanalysen der letzten 10 Jahre zur Effektivitat der Psychotherapie und der Pharmakotherapie der PTSD. Im Weiteren wird die aktuelle Datenlage aus Vergleichsstudien zu Pharmako- und Psychotherapie vorgestellt. Die prasentierten Studien zeigen durchgangig relativ geringe Effektstarken bei Pharmakotherapie als Monotherapie (zumeist placebokontrolliert) und relativ geringe Effektstarkengewinne in Verbindung mit Psychotherapie gegenuber Psychotherapie allein. Beim Vergleich Psychotherapie vs. Pharmakotherapie bestatigt die aktuelle Studienlage keine Aquivalenz bezuglich der Effekte. Auf der Basis der aktuellen Studienlage erscheint es angezeigt, dass Fachgesellschaften eventuell noch fortbestehende Empfehlungen der Pharmakotherapie als Behandlung erster Wahl einer Revision unterziehen und generell pharmakotherapeutische Optionen mit groserer Zuruckhaltung vertreten.

Abstract. Research has predominantly focused on the negative effects of adversity on health and well-being. However, the salutogenic perspective suggests that adversity may not always be detrimental ( Antonovsky, 1996 ). In fact, under certain circumstances, adversity may have the potential for positive outcomes, such as increased resilience and thriving ( Carver, 1998 ; Rutter, 1987 ). The “steeling effect” suggests that past experiences of adversity may increase resistance to later adversities. It proposes that moderate adversity may facilitate more adaptive functioning than no adversity or high levels of adversity ( Rutter, 2006 , 2012 ). The relationship between adversity and health may be optimally assessed using curvilinear models, yet the majority of previous studies have examined linear associations ( Masten & Cicchetti, 2016 ). It is therefore the aim of this review to determine whether moderate adversity is associated with more adaptive functioning when compared to no and high levels of adversity. Practical implications and future research are also discussed.

Introduction Inflammation is drawing attention as pathway between psychosocial stress and health, and basal HPA axis activity has been suggested to exert a consistent regulatory influence on peripheral inflammation. Here we studied the relationship between basal HPA axis activity and inflammatory and HPA axis acute stress reactivity. Methods We recruited 48 healthy individuals and collected saliva for diurnal cortisol sampling at 6 points. Participants were previously exposed to the Trier Social Stress Test (TSST) on two consecutive days. Plasma interleukin-6 (IL-6) and salivary cortisol reactivity to acute stress were measured, and their relationships with basal HPA axis activity were analyzed. Results Steeper cortisol awakening response (CAR) linear increase was related with stronger cortisol stress reactivity (γ = 0.015; p = 0.042) and marginally significantly with greater habituation (γ = 0.01; p = 0.066). Greater curvilinearity of CAR was related with stronger cortisol reactivity (γ = −0.014; p = 0.021) and greater cortisol habituation (γ = −0.011; p = 0.006). Steeper daily linear decline was related with significant or marginally significantly stronger cortisol and IL-6 reactivity (cortisol: γ = −0.0004; p = 0.06; IL-6: γ = −0.028; p = 0.031) and greater habituation (cortisol: γ = −0.002; p = 0.009, IL-6: γ = −0.015; p = 0.033). Greater curvilinearity of daily decline was related with stronger IL-6 reactivity (γ = 0.002; p = 0.024) and also greater cortisol and IL-6 habituation (cortisol: γ = 0.00009; p = 0.03, IL-6: γ = 0.001; p = 0.024). Conclusions Patterns of basal HPA axis activity that are related with healthier outcomes were found to be related with stronger initial cortisol and IL-6 reactivity and greater habituation. This is an important step in understanding the long-term health implications of acute stress responsiveness, and future studies should employ longitudinal designs to identify the direction of these relationships.

Effective adjustment of the stress systems to repeated stress is regarded as an adaptive response of the organism facing environmental threats. Given the intertwined relationship between the stress systems and the inflammatory system, it could be expected that inflammatory processes should adapt to repeated stress as well. However, only little is known about adaptational processes of the different components of the immune system in response to repeated stress, and how these might be related to adaptational processes of the hypothalamus-pituitary-adrenal (HPA) axis. We here examined N=22 healthy participants (mean age 23years, 50% female) and exposed them to a standardized laboratory stressor twice, 24h apart. Plasma interleukin 6 (IL-6), salivary cortisol and psychometric parameters were assessed repeatedly up to 120min post stress. Results revealed a significant day by time interaction for cortisol (F=5.06; p=0.013) and IL-6 (F=4.42; p=0.041), indicating habituation of HPA axis and sensitization of inflammatory stress responses. Cortisol habituation and inflammatory sensitization were inversely related when controlling for sex (r=-0.44; p=0.044). Explorative analyses revealed significant associations between the IL-6 response on the second exposure with perceived stress (r=0.58; p=0.004), vital exhaustion (r=0.57; p=0.009), depression (r=0.47; p=0.026) and purpose in life (r=-0.50; p=0.04). These findings may help to increase understanding of the still only rudimentary understood interplay of adaptational processes of endocrine and immune responses to repeated stress and might indicate a link between inflammatory disinhibition and psychological indicators of well-being.

Several international cohorts of older adults share past experiences of welfare-related adversity. In Ireland, reports of childhood maltreatment, neglect, and abuse within institutional welfare settings included a harsh regime, childhood labour, and physical and sexual assault. Preliminary research with these Irish survivors revealed a high prevalence of psychological disorders in adulthood. A pathological perspective of aging is often applied to such older adults, due to the long-term health consequences associated with childhood trauma. However, little is known about later life resilience or resilience mechanisms in this population. Therefore, using conceptual models of resilience, this qualitative study aimed to investigate factors associated with resilience in older adult survivors of childhood institutional abuse. Participants were 17 Irish older adults, 50-77 years of age, with experiences of childhood abuse in institutional care settings. Semi-structured interviews were conducted, lasting 60-120 minutes. Transcribed interviews were analysed using the Framework Analysis method. Nine themes were derived from the data, including core, internal, and external resilience factors: Individual characteristics, personality characteristics, support systems, goal attainment, adaptive belief systems, processing, influential events and experiences, recognition and collective identity, and access to services. Results suggest that resilience can be understood not only as an inherent trait, but also as a learnable set of behaviours, thoughts, and attitudes, which can be supported by external resources in an older adults’ environment. The identification of personal and contextual factors underpinning resilience in older adults with trauma experiences may help foster a more positive, strengths-based approach to aging in psychological research and practice.

Health and well-being in later life are heavily influenced by behaviors across the life course, which in turn are influenced by a variety of wider contextual, social, economic, and organizational factors. There is considerable potential for inequalities in health-promoting behaviors and health outcomes, arising from poverty, social, and environmental factors. This suggests that individuals from disadvantaged backgrounds and circumstances may have more exposure to (chronic) stressors, coupled with reduced access to resources, and increased susceptibility to risk factors for ill-health and mental disorders in later life. This drastically decreases the likelihood for successful aging in individuals from less advantaged backgrounds. Nevertheless, despite these adverse circumstances, some high-risk, disadvantaged individuals have been shown to achieve and maintain good health and well-being into later life. This scientific update provides an overview of recently published research with samples that, against expectations, demonstrate successful aging. Favorable personality traits, cognitive strategies, and a high-level of intrinsic motivation, paired with a supportive social environment, have been found to build a prosperous basis for successful aging and positive health outcomes in later life for individuals living in aversive environmental circumstances. For clinical psychologists, the movement towards the investigation of underlying mechanisms of successful aging from a psychological perspective, particularly in disadvantaged individuals, may be a critical step towards understanding the vast heterogeneity in aging. Successful aging is possible in disadvantaged individuals. Psychological and social resilience resources may compensate for the impact of disadvantage. The application of multi-level resilience models can aid future research on successful aging. Successful aging is possible in disadvantaged individuals. Psychological and social resilience resources may compensate for the impact of disadvantage. The application of multi-level resilience models can aid future research on successful aging.

The steeling effect suggests that “optimal” stress positively affects well-being by enhancing resilience. However, there is lack of longitudinal investigations in diverse age groups. The aim was to explore steeling in later life and potential predictors. The sample consisted of N = 195 participants. A 1-year longitudinal survey study was conducted. Sociodemographics, experienced stress, resilience resources, and satisfaction with life were assessed. Latent profile analysis was used to identify profiles that differ in the change of resilience resources over time and to examine differences between the profiles across the other study variables. Three profiles emerged: decreased resources ( Decrease), stability of resources ( Maintenance), and increased resources ( Increase). “Decrease” was characterized by low, Maintenance by moderate, and Increase by high stress. Age influenced profile membership. While the results failed to support the classic steeling effect, with high stress associated with increased resilience resources, optimal stress was associated with the maintenance of resilience resources.

Childhood adversity and maltreatment can have lasting negative effects into later life. However, emerging research suggests that certain factors may facilitate resilience in adults with experiences of childhood adversity and maltreatment.Using conceptual models of resilience, this qualitative study investigated factors associated with resilience in older adult survivors of childhood institutional adversity and maltreatment.Participants consisted of 17 adults, 10 females and 7 males, aged between 50-77 years (mean age = 60 years). All participants had experienced childhood adversity and maltreatment within institutional care settings during childhood and/or adolescence.In-depth, semi-structured interviews were conducted, lasting between 60-120 min. Transcribed interviews were analysed using the Framework Analysis method.Nine themes were derived from the data, including core, internal, and external resilience factors: Individual characteristics, personality characteristics, support systems, goal attainment, adaptive belief systems, processing, influential events and experiences, recognition and collective identity, and access to services.Results support a dynamic concept of resilience that can be understood not only as an inherent trait, but also as a learnable set of behaviours, thoughts, and attitudes, which can be supported by external resources in an older adults' environment. These findings add a novel contribution to the literature in the identification of a distinct cluster of personal and contextual factors underpinning resilience in this sample of survivors of childhood institutional adversity and maltreatment, which may inform the psychological treatment of this population and provide a focus for further research.

Background and Objectives We examined the validity of 5 successful aging (SA) operationalizations that assessed different facets of the SA construct (cognitive and physical health and disability; well-being; social engagement). Research Design and Methods A total of 2,478 participants (mean age = 82.5 years, standard deviation [SD] = 3.47) were studied. We used confirmatory factor analysis to investigate the relationships between facets and to determine the convergent validity as well as short-term (1.5 years) and long-term (4.5 years) predictive validity of the 5 SA operationalizations for measures of quality of life (QoL) and objective health outcomes. Results A general SA operationalization that included all SA facets but also allowed differences between them showed the best model fit and construct validity. A biomedical operationalization of SA that excluded either the well-being or the social engagement facet showed lower convergent and predictive validity for subjective measures (e.g., QoL) but higher associations with objective measures (e.g., health). A purely psychosocial SA operationalization that excluded the physiological facet did not allow good prediction of objective health outcomes. Discussion and Implications Our results suggest that a well-balanced SA operationalization should include measures assessing health, disability, well-being, and social engagement.

Ante el descubrimiento de una masa anexial, conviene ante todo descartar una urgencia quirurgica que pueda comprometer la funcion ovarica. Estas urgencias estan dominadas por las torsiones anexiales. En ausencia de urgencia terapeutica, un estudio completo (clinico, pruebas de imagen y biologico) debe permitir estimar el riesgo de malignidad y discutir la indicacion operatoria, asi como la via de abordaje quirurgica. Otros elementos pueden entrar en juego en la indicacion terapeutica: la existencia de infertilidad, en particular en caso de endometriosis, y el riesgo de torsion, sobre todo en caso de quistes de gran tamano. Este articulo revisa de manera practica los principales problemas que se plantean ante el descubrimiento de un tumor ovarico supuestamente benigno.

Das klassische Konzept der „sozialen Unterstutzung“ wird im Zusammenhang mit traumatisierten Patientengruppen und hier aktuell den traumatisierten Fluchtlingen und Migranten wieder besonders aktuell. Der Beitrag soll wichtige Ergebnisse der Soziale-Unterstutzungs-Forschung illustrieren, z. B. die Arten ihrer positiven Wirkung, Kontexte, Geschlechts- und kulturelle Aspekte. Alle diese Aspekte werden anhand vorhandener Untersuchungen dargestellt, die aus der angewandten Gesundheitsforschung stammen und die eine grose Bandbreite gesundheitlicher Wirkungen beschreiben: neben erhohtem Wohlbefinden und verringerter Depressivitat, verbesserte funktionelle Fahigkeiten, verbesserter Immunstatus und langere Uberlebenszeiten. Zwei neue traumaspezifische Differenzierungen des Konzepts werden eingefuhrt: Wertschatzung als Traumauberlebende und Offenlegung traumatischer Erfahrungen. Fur die Arbeit mit und die Versorgung von Fluchtlingen ergeben sich viele Anknupfungspunkte: Die Forderung von Selbstwirksamkeit und posttraumatischer Reifung sowie die Therapie psychischer Storungen profitieren entscheidend von der (Mit-)Orientierung auf soziale Unterstutzung. Zum Schluss wird auf die Moglichkeiten der digitalen Kommunikation als soziale Unterstutzung hingewiesen, die in diesem Kontext ebenfalls relevant sind.

Childhood adversity is highly prevalent and linked to lasting psychological and physiological consequences. A potential mechanism for negative health outcomes is altered stress reactivity. While previous research has addressed associations of childhood adversity with stress system reactivity, sympathetic nervous system (SNS) stress reactivity is understudied. We therefore set out here to examining salivary alpha-amylase (sAA) reactivity in relation with childhood adversity. Forty-one healthy adult subjects (n = 24 male; n = 17 female) aged 18-34 years underwent the Trier Social Stress Test (TSST) and completed the Childhood Trauma Questionnaire (CTQ). Saliva for measurement of sAA was collected at three time points; before the TSST, immediately after, and 10 min post-TSST. We found that those with childhood trauma had a higher overall sAA response to the TSST, as seen in a repeated measures ANOVA (CTQ by time interaction: F(1.8,71.5) = 6.46, p = .01) and an independent samples t-test indicating higher sAA baseline to peak response (t = 3.22, p = .003). There was also a positive correlation between sAA reactivity and the CTQ subscales of childhood physical abuse (r = .46, p = .005) and emotional abuse (r = .37, p = .024). Healthy adults with low-to-moderate childhood adversity had a heightened sAA response immediately following the stressor. Higher SNS reactivity could be a link to negative health outcomes in adults with early adversity. Future research should address whether altered sAA reactivity is predictive of negative health outcomes in those with childhood adversity.

Background: Anxiety disorders and major depressive disorder (MDD) have been associated with increased and blunted HPA axis reactivity to social stress. However, research focusing on associations between HPA axis responses to stress and symptoms of anxiety and depression among individuals without a diagnosis remains an understudied area of research. Methods: One hundred forty-three adults (52% female) completed the Trier Social Stress Test (TSST). Symptoms of depression and anxiety were assessed prior to the TSST using the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS). HPA axis responses were assessed by measuring salivary cortisol at baseline and following the TSST. Reactivity to and recovery from stress were assessed using multilevel growth modeling controlling for age, BMI, and sex among the full sample and a subset of cortisol responders (n = 72). Results: Anxiety symptoms were positively associated with flatter recovery slopes among the full sample (t(122.3) = 2.082, p = .039). Among cortisol responders, depression symptoms were associated with steeper reactivity (t(63.32) = 2.53, p = .026) and recovery (t(58.75)=−2.20, p = .03). Anxiety symptoms were associated with marginally flatter reactivity (t(64.00)=−1.97, p = .053) and significantly flatter recovery (t(59.22) = 2.29, p = .025). Conclusion: Symptoms of anxiety and depression among individuals without a psychiatric diagnosis are associated with blunted and exaggerated cortisol responses to and recovery from stress. Such patterns could indicate increased risk for unhealthy HPA axis dysregulation, allostatic load, and disease.

Social self-preservation theory posits that stress is experienced when an aspect of an individual's identity has the potential to be negatively evaluated. Appearance is a central part of identity; however, little research has examined whether perceived appearance judgements are a source of social-evaluative stress. In addition, stress may be an explanatory link in the association between appearance perceptions and depressive symptoms. This study examined whether perceived appearance judgements were associated with increased stress and greater depressive symptoms among adults. Study 1 examined the associations between self-reported appearance judgements and cortisol stress responses in response to a laboratory stressor (Trier Social Stress Test) among 71 individuals aged 18-65. Study 2 assessed self-reported appearance judgements and depressive symptoms among 498 adults ages 18-65 via an online survey data collection. Appearance judgement was associated with a stronger cortisol response, higher self-reported stress, and greater depressive symptoms. Stress mediated all associations between appearance judgements and depressive symptoms and neither age nor gender moderated these associations. The findings suggest that appearance judgements contribute to psychological and biological stress processes and demonstrated that stress mediated the association between appearance judgements and depressive symptoms.

Background: Trauma, stress, and adversity are well-known for having lasting negative effects on health. Yet, not all individuals go on to develop psychopathology or impaired health. However, little is known about the underlying mechanisms which influence the development of stress-related resilience. Sense of coherence-revised (SOC-R) may play a role in this process, as it is formed through overcoming stress or adversity. It may also influence the steeling effect, which suggests that previous exposure to moderate adversity increases resilience to later adversities.Objectives: This study aimed to examine the mediating and moderating roles of SOC-R in the relationship between stress or adversity, and psychological health and well-being. It further aimed to investigate the role of SOC-R in steeling processes.Methods: The study used a longitudinal design, with data collection at baseline and one-year follow-up. Participants included (N = 238) Swiss older adults (Mage = 68.3 years). Standardized questionnaires assessed early-life adversity, recent chronic stress, SOC-R, and current health and well-being. Mediation and moderation analyses examined the mechanisms underpinning stress-related resilience and curvilinear associations assessed steeling.Results: Results showed that the Manageability subscale of SOC-R significantly moderated the relationship between chronic stress and general mental health (b = 0.04, 95% CI [0.007, 0.082], t = 2.32, p < 0.05). Furthermore, SOC-R significantly mediated the relationship for general mental health (GMH) and satisfaction with life (SWL) with childhood emotional neglect (GMH: b = −0.056, 95% BCa CI [−0.126, −0.002]; SWL: b = −0.043, 95% BCa CI [−0.088, −0.004]), childhood physical neglect (GMH: b = −0.100, 95% BCa CI [−0.232, −0.002]; SWL: b = −0.081, 95% BCa CI [−0.181, −0.002]), and chronic stress (GMH: b = −0.052, 95% BCa CI [−0.100, −0.001]; SWL: b = −0.055, 95% BCa CI [−0.097, −0.020]). No curvilinear associations were observed between stress or adversity and SOC-R.Conclusions: This study expands on the limited research on stress-related resilience by examining the role of SOC-R in the interactions between adversity, stress, and health. Future research should examine SOC-R in samples with a greater range and different types of adversity. Overall, findings suggest that SOC-R is an important mechanism underpinning the development of stress-related resilience.

Acute stress induces increases in plasma inflammatory mediators, which do not habituate to repeated stress. Inflammation is a risk factor for age-related illnesses, highlighting the need to understand factors controlling inflammation. No studies have examined changes in pro- and anti-inflammatory gene expression in response to repeated acute stress in humans.RNA was isolated from peripheral blood before, 30 and 120min after exposure of n=32 healthy human participants to the Trier Social Stress Test (TSST) on two days. Gene expression of interleukin (IL)-6, IL-1β, nuclear factor (NF)-κB and IκB was measured repeatedly on both days. We further assessed leukocyte numbers, plasma IL-6, and salivary cortisol.Stress induced IL-6 (F=44.7; p0.001) and cortisol responses (F=18.6; p0.001). Cortisol responses habituated (F=5.1, p=0.003), but IL-6 responses did not (n.s.). All genes increased in response to initial stress (IL-6: F=3.8; p=0.029; IL-1β: F=7.1; p=0.008; NF-κB: F=5.1; p=0.009; IκB: F=4.7; p=0.013) and showed habituation to repeated stress (IL-6: t=2.3; p=0.03; IL-1β: t=3.9; p=0.001; NF-κB: t=2.1; p=0.041; IκB: t=3.1; p=0.005). Day 1 responses of IL-1β and IκB were not explained by changes in leukocyte populations, but IL-6 and NF-κB, as well as most day 2 changes were not independent of leukocyte populations.Stress response and habituation of pro- and anti-inflammatory gene expression as found here might indicate that even on an intracellular level, inflammatory responses to acute stress are adaptive in that they respond to initial, but habituate to repeated, similar stress. Future studies will need to test whether non-habituation is predictive of disease.

The steeling effect suggests that early-life adversity can have a beneficial impact later in life. However, little is known about its underlying mechanisms and long-term outcomes . The study aimed to examine the role of early-life adversity (ELA) on successful aging, and whether this relationship can be explained by mental and physical health.Socio-demographics, early-life adversity (ELA), individual quality of life (iQoL), and mental and physical health of 270 individuals (MSignificant inverse U-shaped associations were found between ELA and iQoL (β = -.59, p = .005) and between ELA and mental health (β = -.64, p = .002), but not between ELA and physical health. Furthermore, mental health significantly mediated the relationship between ELA and iQoL (b = -.84, BCa CI [-1.66, -.27]).Highest level of individual quality of life (i.e. successful aging) was related to a moderate amount of ELA. Additionally, mental health significantly mediated this relationship. These findings suggest that some amount of ELA could be beneficial for successful aging. Resource-focused interventions are needed to improve health and promote successful aging for an underdetected, at-risk subgroup with low early-life adversity.

Background and objectivesTo evaluate the Revised Sense of Coherence (SOC-R) scale in a large representative German sample.DesignA nationwide household survey involving a total of 2510 face-to-face interviews.MethodsIn addition to the SOC-R, childhood trauma and maltreatment (CTM), lifetime traumatic events (Childhood Trauma Questionnaire, CTQ, and the Life Events Checklist for DSM-5, LEC-5), and mental health (Patient Health Questionnaire, PHQ-4) were assessed.ResultsThe final sample consisted of N = 2373 participants (52.3% females; M = 48.24 years). Confirmatory factor analyses confirmed a three-factor structure for the SOC-R ('manageability', 'balance', 'reflection') with acceptable indices (RMSEA .066; 90% CI [.062, .071]). Reliability analyses revealed good internal consistency (α = .87). Construct validity was supported by significant but low correlations with psychopathology. Gender marginally influenced SOC-R (t = 1.99, p = .05). Moderation analyses revealed that SOC-R exerted a protective impact on depression in the context of CTQ (t = 2.29, p < .05) and lifetime traumatic events (t = -2.37, p < .05).ConclusionsThis study supports the psychometric properties of the SOC-R and emphasizes the importance of considering salutogenic effects to better understand interindividual differences in the effect of adversity.

Objective The study of life-long consequences of severe childhood adversities or trauma has recently received much attention. However, little is known about the subjective coping success and development of positively-evaluated resources, which may originate within these adverse experiences, and which may be conceptualized as thriving. This study set out to examine the relationship between thriving in response to early adversity and successful aging with a sample of former indentured child laborers in Switzerland ( Verdingkinder) . Method Participants were screened according to subjective and objective health-related attributes and those who were evaluated to be ‘successful agers' were included. Semi-structured interviews were conducted with twelve former Verdingkinder, mean age: 71 years, that lasted 60 – 120 minutes. The interviews were analyzed using the paradigm model of the Grounded Theory. Results In the interviews, a variety of adverse experiences and negative consequences were reported. However, where thriving was triggered in response to these experiences, the factors identified as ‘lightheartedness', ‘social purpose', and ‘self-enhancement' were associated with successful aging. Factors including motivation, reflection, personality traits, social support, individual coping strategies, turning points, and processing were reported as central to thriving. Conclusion The identified factors show similarities with established predictors of health and well-being. Thus, we conclude that under certain circumstances early and prolonged adverse experiences can also provide the opportunity to develop positive resources for successful aging.

Childhood adversity, such as neglect, or physical, emotional, or sexual abuse, is prevalent in the U.S. and worldwide, and connected to an elevated incidence of disease in adulthood. A pathway in this relationship might be altered hypothalamic-pituitary-adrenal (HPA) axis functioning, as a result of differential hippocampal development in early life. A blunted diurnal cortisol slope is a precursor for many disorders. While studies have focused on HPA reactivity in relation to childhood adversity, there has been markedly less research on basal HPA functioning in those with low-to-moderate adversity. Based on previous research, we hypothesized that adults with low-to-moderate childhood adversity would have altered HPA axis functioning, as evidenced by a blunted diurnal cortisol slope and altered cortisol awakening response (CAR). Healthy adults aged 18–65 (n = 61 adults; 31 males and 30 females) completed the Childhood Trauma Questionnaire. Participants provided at-home saliva samples on two consecutive days at wake-up, and 30 min, 1, 4, 9, and 13 h later; samples were averaged over the 2 days. We found that low-to-moderate childhood adversity predicted lower morning cortisol (β = -0.34, p = 0.007, R2 = 0.21), as well as a blunted cortisol slope (β = 2.97, p = 0.004, R2 = 0.22), but found no association with CAR (β = 0.19, p = 0.14, R2 = 0.12). Overall, we found that in healthy participants, low-to-moderate adversity in childhood is associated with altered basal HPA activity in adulthood. Our findings indicate that even low levels of childhood adversity may predispose individuals to disease associated with HPA dysregulation in later life.

The present study evaluated the revised Sense of Coherence (SOC-R) scale in a sample of older adults, using an extended range of psychological concepts. It further examined the psychometric properties of the revised scale and tested the theoretical assumptions underpinning the SOC-R concept.The SOC-R scale was evaluated in 268 Swiss older adults (mean age = 66.9 years), including n = 15 heavily traumatized former indentured child labourers. Standardised questionnaires collected information on positive and negative life experiences, resources, current health, and well-being. Results: Confirmatory Factor Analysis indicated good model fit for a second-order three-factor model of SOC-R with the factors manageability, balance, and reflection. Satisfactory convergent and discriminant correlations were shown with related psychological concepts, including neuroticism (r = -.32, p .01), optimism (r = .31, p .01), and general self-efficacy (r = .49, p .01). SOC-R was not observed to differ by age group. Moderation analyses indicated that SOC-R moderated the relationship between certain early-life adversities and mental health.The study provides support for the psychometric properties and theoretical assumptions of SOC-R and suggests that SOC-R is a valid and reliable measure suitable for use with older adults. Future studies should employ longitudinal designs to examine the stability of SOC-R.

The lack of consensus on what constitutes successful aging (SA) has triggered over 100 different operational definitions. This heterogeneity hinders the straightforward identification of modifiable predictors of SA. It remains to be clarified whether predictors of SA differ as a function of varying constitutes of SA and whether reserve models from dementia research can be used to predict SA. It was therefore the aim of the current study to replicate and validate existing SA constructs and compare their predictors in a German subsample of a prospective longitudinal multicenter study.

Overweight and obese individuals, who comprise approximately two-thirds of the U.S. population, are at increased risk for developing a range of diseases. This increased risk may be due in part to maladaptive stress responses within this group, including heightened low-grade inflammation and HPA axis non-habituation. In this study we tested the relationship between adiposity, plasma interleukin-6 (IL-6) and HPA axis responses to repeated stress.Sixty-seven healthy participants were exposed to the Trier Social Stress Test (TSST) on two consecutive days. We collected saliva for cortisol measurements at baseline and at 1, 10, 30, 60 and 120min post-TSST, and blood for plasma IL-6 measurements at baseline and 30 and 120min post-TSST.Stress exposure induced significant increases of cortisol and IL-6 on both days (cortisol: F=38, p0.001; IL-6: F=90.8; p0.001), and repeated exposure was related with cortisol habituation (F=8.2; p0.001) and IL-6 sensitization (F=5.2; p=0.022). BMI and body fat were related with higher cortisol responses to repeated stress (BMI: beta=0.34; p=0.014; body fat: beta=0.29; p=0.045), and with higher IL-6 responses to repeated stress (BMI: beta=0.27, p=0.044; body fat: beta=0.37; p=0.006).Taken together, individuals with higher measures of adiposity showed less efficient HPA axis habituation as well as sensitization of IL-6 responses to repeated acute stress. These findings point to maladaptive stress response patterns in overweight humans, which, through exposure to higher levels of inflammatory mediators, might partially explain diseases related with overweight and/or obesity.

Waiting for a medical procedure can exert significant feelings of state anxiety in patients. Music listening has been shown to be effective in decreasing anxiety levels. No study so far examined the potential anxiety and stress-reducing effect of a music intervention on pre-treatment anxiety and stress in patients waiting for dental hygiene treatment. Knowing whether the anxiety-reducing effect of music would also be detectible in the context of preventive routine medical procedures in healthy individuals would widen the area of application of music from the hospital or clinical environment to medical offices in general. Waiting for a medical treatment can induce anxiety and may lead to the experience of stress. We set out to examine the effect of music on pre-treatment anxiety in a healthy patient sample waiting for a dental treatment. In a randomized controlled clinical trial, 92 consecutive volunteer patients (mean age, 57 years) waiting for their scheduled dental hygiene treatment were randomly allocated to either an experimental (n = 46, listening to music for 10 min) or a control group (n = 46, waiting in silence). State and habitual anxiety, subjective stress, and mood measures were assessed before and after music listening or silence, respectively. State anxiety levels in the music group decreased significantly after intervention as compared to the control group (F(1/90) = 8.06; p = 0.006). Participants’ trait anxiety and dental anxiety were not found to moderate this effect. Listening to music prior to dental hygiene treatment decreases anxiety levels to a greater extent than waiting in silence.

The first aim of this study was the empirical identification of clustered health trajectories in older individuals, including an expected, more favorable or successful aging (SA) trajectory. The second aim was the identification and analysis of determinants useful for subgroup membership prediction. Particular focus was on early-life and chronic stress, as well as on a broad set of psychological characteristics, such as resilience, personality traits and general affect. A longitudinal survey study with two assessments one year apart has been conducted with older adults (N=224; mean age = 68 years; 72% women). The clustered health trajectories were identified using a longitudinal variant of k-means. For the prediction of subgroup allocation, random forests with conditional interferences were used. The applied machine learning-based approach revealed two latent clustered health trajectories: a ‘constant high health’ (66% of the sample) and a ‘maintaining low health’ trajectory (34%). Chronic stress and positive affect were found to be the most important predictors. Further predictors and their interactions were found to be important for predicting subgroup belonging, including resilience, self-esteem, social support, optimism, as well as negative affect and pessimism. Also, childhood adversities have to be included to predict subgroup belonging. With this study, we were able to show that individuals can be empirically allocated to two separate joint health trajectories in later life over the observation period of one year. In order to understand the current heterogeneity in health in older age, previous and current stress exposure and psychological characteristics have to be taken into account.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 1 - p. 19-25

Der spezielle Umgang mit einem erlebten Trauma und dessen psychopathologischen Folgen im Alter machen das Erkennen und Behandeln der posttraumatischen Belastungsstörung (PTBS) bei älteren Menschen zu einer Herausforderung. Dabei spielen auch Sozialisierungsmerkmale der heutigen älteren Generation eine wichtige Rolle. Nicht ohne Grund wird noch heute die PTBS im Alter als »stummes Problem« bezeichnet. Weiterhin sind unterschiedliche Formen der PTBS, namentlich die aktuelle, verzögerte und chronische PTBS, und damit verbundene Ursachen spezifisch im Alter zu beachten. Auch die wachsendeWahrscheinlichkeit einer multiplen Traumatisierung mit zunehmendem Alter ist zu berücksichtigen. Daher wird als Ergänzung zu gängigen, altersunspezifischen Therapieverfahren ein biografisch informierter Ansatz empfohlen. Dieser findet in der Lebensrückblickstherapie explizit Verwendung. Weiterhin zeigen sich auch PTBSStandardinterventionen im Alter als effektiv. Mehr Forschung bezüglich PTBS im Alter und deren Therapie ist notwendig, um höhere Remissionsraten zu erreichen.

The classical concept of social support has recently become of relevance again, particularly in the context of traumatized patient groups, which include refugees and migrants. This article summarizes the evidence from social support research, e. g. different types of positive effects as well as context, gender and cultural aspects. These aspects are highlighted by means of studies stemming from applied healthcare research and thus describe a wide range of health effects, e.g. increased well-being and reduced depressive symptoms, improved functional abilities, better immune status and longevity. Two new trauma-specific differentiations of the social support concept are introduced: societal acknowledgement as a trauma survivor and disclosure of traumatic experiences. Against this background several implications for working with refugees arise: promotion of self-efficacy and posttraumatic maturation as well as the treatment of mental disorders show considerable benefits from focusing on social support. Finally, possibilities emerging from digital communication media are discussed, which are particularly relevant in this context.

Music is a stimulus capable of triggering an array of basic and complex emotions. We investigated whether and how individuals employ music to induce specific emotional states in everyday situations for the purpose of emotion regulation. Furthermore, we wanted to examine whether specific emotion-regulation styles influence music selection in specific situations. Participants indicated how likely it would be that they would want to listen to various pieces of music (which are known to elicit specific emotions) in various emotional situations. Data analyses by means of non-metric multidimensional scaling revealed a clear preference for pieces of music that were emotionally congruent with an emotional situation. In addition, we found that specific emotion-regulation styles might influence the selection of pieces of music characterised by specific emotions. Our findings demonstrate emotion-congruent music selection and highlight the important role of specific emotion-regulation styles in the selection of music in everyday situations.

Music listening has been suggested to have short-term beneficial effects. The aim of this study was to investigate the association and potential mediating mechanisms between various aspects of habitual music-listening behaviour and physiological and psychological functioning. An internet-based survey was conducted in university students, measuring habitual music-listening behaviour, emotion regulation, stress reactivity, as well as physiological and psychological functioning. A total of 1230 individuals (mean = 24.89 ± 5.34 years, 55.3% women) completed the questionnaire. Quantitative aspects of habitual music-listening behaviour, i.e. average duration of music listening and subjective relevance of music, were not associated with physiological and psychological functioning. In contrast, qualitative aspects, i.e. reasons for listening (especially 'reducing loneliness and aggression', and 'arousing or intensifying specific emotions') were significantly related to physiological and psychological functioning (all p = 0.001). These direct effects were mediated by distress-augmenting emotion regulation and individual stress reactivity. The habitual music-listening behaviour appears to be a multifaceted behaviour that is further influenced by dispositions that are usually not related to music listening. Consequently, habitual music-listening behaviour is not obviously linked to physiological and psychological functioning.

The purpose of this retrospective study was to evaluate the accuracy of MRI using pelvic-phased-array and endocavitary coils in detecting intestinal wall invasion by an endometriotic nodule.Forty-seven patients (32.1 +/- 4.2 years) who were planned for a surgical cure of deep endometriosis underwent MRI with conventional sequences using both coils. A thin bright layer on T(2)-w with enhancement on post-Gd T(1)-w defined our MR pattern for muscular layer involvement. MR results were correlated with surgical and pathological findings of the removed nodule.MR results for Group 1 (both coils) achieved a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100-63%, 96-92%, 90-70%, 100-85%, and 97-83% for endovaginal coil and phased-array coil, respectively. Group 2 (phased-array coil) had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 73%, 93%, 84%, 88%, and 87% for this coil, respectively.Combined pelvic-phased-array and endovaginal coils are better than phased array alone in the detection of intestinal wall invasion. Easy to perform, it has to be considered as a preoperative staging for deep posterior endometriosis to orientate the surgical management.

Today, hysterectomy is, after caesarean section, the most frequent surgical intervention performed in fertile women. Introduced in 1989, laparoscopic hysterectomy remains poorly diffused: today, less than 5% of all hysterectomies remain done by laparoscopy. Nevertheless after a correct learning curve, laparoscopic hysterectomy finds perfect indications in benign and even some malignant indications. In these conditions, the complication rate is similar to those of the other surgical routes. Currently the limitations of this technique are the very bulky uterus, contraindicated uterine morcellation, the lengthening of the operative time potentially generated by this technique, and the lack of experienced instructors.

A uterovaginal fistula was reported after an uneventful laparoscopic excision of a left uterosacral endometriotic nodule in a young woman. Indirect thermal injury to the left ureter by the bipolar grasping forceps was the main cause of the injury. Contributing factors are analyzed and preventive measures pertinent to this case are discussed.

En la actualidad, la histerectomia es la intervencion quirurgica que mas se practica en las mujeres de edad fertil, despues de la cesarea. Aunque comenzo a efectuarse en 1989, la histerectomia por via laparoscopica tuvo dificultades para imponerse y hoy en dia menos del 5% de las histerectomias se llevan a cabo por esta via. Sin embargo, despues de un periodo de entrenamiento adecuado, la practica de la laparoscopia presta utilidad en las histerectomias efectuadas por afecciones benignas o malignas, con un indice de complicaciones comparable al de las demas vias de acceso. Los limites actuales de la tecnica son uteros muy voluminosos, contraindicacion de la fragmentacion uterina, prolongacion del tiempo quirurgico y la carencia de instructores con experiencia.

Background Recent research suggests that childhood adversity exerts a lasting impact not only on the affected individuals but also on their offspring. Little is known about the role of parental rearing behavior in the transgenerational conveyance of parental childhood adversity and filial psychological health. Objective Hence, it was the aim of the current study to investigate the relationship between parental rearing behavior of former Swiss indentured child laborers (“Verdingkinder”) and psychological health of their adult offspring. Methods We applied a two-generation control-group design with two parental samples (n=16, former “Verdingkinder,” Mage=76.13, SD=6.81 and n=19, parental controls, Mage=72.63, SD=5.96) and their offspring (n=21, former “Verdingkinder” offspring, Mage=52.91, SD=5.90, and n=29 offspring controls, Mage=44.55, SD=7.71). Parental rearing behavior, childhood trauma, and psychological health were assessed with questionnaires. Data were analyzed using Bayesian analyses, where Bayes factors (BF) of 3 or higher were considered as substantial evidence for the tested hypotheses. Results We found that “Verdingkinder” offspring reported more physical abuse (BF10=5.197) and higher total childhood trauma exposure (BF10=2.476). They described both their fathers (BF10=14.246) and mothers (BF10=24.153) as less emotional and their mothers as more punitive (BF10=18.725). An increased sense of reflection, for instance, one's ability to take different perspectives, was found in the offspring controls (BF10=5.245). Furthermore, exploratory analyses revealed that lower perceived familial emotionality was associated with higher psychopathology (all BF10=10.471) and higher pessimism (all BF10=5.396). Discussion Our data provide cross-sectional evidence of a meaningful transgenerational relationship between parental childhood adversity, dysfunctional rearing behavior, and psychological health of offspring. Prospective studies are needed to investigate these findings in a longitudinal setting. Highlights of the article The study showed elevated levels of aversive childhood events in the adult offspring of former indentured childhood laborers.The offspring of former indentured childhood laborers did not exhibit increased general psychopathology (as assessed by the Symptom-Checklist: SCL).However, the recalled childhood rearing behavior was more problematic (higher punishment, less emotional warmth) in the offspring of former indentured childhood laborers as compared to a 2nd generation control group.Second generation group differences for world view variables (optimism, pessimism) were not substantial or in favor of the control participants (reflection facet of sense of coherence-revised).