Maternal sensitivity is a modifiable determinant of infant attachment security and a precursor to optimal child development. Contextual stressors undermine sensitivity, but research was yet to be synthesized. We aimed to identify i) types of stress associations analyzed in studies of maternal sensitivity and ii) the strength of effects of various stress factors. A systematic search identified all studies that used the Maternal Behavior Q-Sort (MBQS) to code sensitivity in dyadic observations and that reported a coefficient for MBQS associations with contextual stress. Identified stressors cohered around three spheres: sociodemography (maternal education, family income, composite SES, maternal age and cohabitation status); parenting stress (perceived maternal stress related to parenting); and mental health (specifically maternal internalizing symptoms). Seven meta-analyses (combined ns range 223-1239) of a subset of 30 effects from 20 articles, and a multi-level meta-analysis (N=1324) assessed aggregated correlations with sensitivity. Significant mean effects emerged in expected directions, whereby all stress indicators were negatively associated with sensitivity. Small effects were found for associations with parenting stress (r=-0.13) and mental health indicators (r=-0.12). Generally moderate effects were found for associations with socio-demographic indicators (range r=-0.12 to r=0.32). Emerging findings support the proposition that in various contexts of stress, maternal sensitivity to infant needs can be undermined. Implications and research directions are discussed.

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We conclude that further studies are needed for direct comparison of supplemental and dietary calcium to fully establish if one is superior to the other with regard to improving bone density. We also propose further studies on the cardiovascular risk of long-term increased calcium intake and on physician estimates of patients' daily calcium intake to better pinpoint those patients who require calcium supplementation.

Purpose Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed. Methods We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress. Results We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety (r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress (r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety (r = .16 [95% CI 0.10, 0.22]), and stress (r = .15 [95% CI − 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r = − 0.17 [95% CI − 0.22, − 0.11]). Conclusion Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.

This study examined the impact of computers on rheumatologist-patient communication. Fifteen rheumatologist-patient consultations were videotaped and analysed qualitatively. Patients routinely ceased their reporting on a particular topic when the rheumatologist's body and gaze were reoriented toward the computer. Rheumatologists employed the computer to direct the consultation, whilst patients took advantage of spaces in the consultation created by the physician's use of the computer to continue talking, often involving extended pain reporting. These findings are discussed in relation to the potential impact of the computer in the consultation.