A randomized control trial was performed on 75 dyads in Stockholm, Sweden, with infants under 1½ years. It recruited mothers who worried about the babies, themselves as mothers, and/or the mother-baby relationship. Two groups of mother-infant dyads were compared. One received only Child Health Centre care (the "CHCC" group) while the other received mother-infant psychoanalytic treatment plus CHCC (the "MIP" group). Significant treatment effects were found on mother-reported depression, interviewer-rated dyadic relationship qualities and externally rated maternal sensitivity, and near-significant effects on mother-reported stress, all in favor of MIP. The objective of this study is to investigate the predictive and moderating influences on outcomes by qualitatively assessed maternal and infant characteristics. The qualitative factors covered maternal suitability for psychoanalysis, and "ideal types" of mother and child, respectively. Outcome measures from two interviews with a 6-month interval were depression (Edinburgh Postnatal Depression Scale (J. Cox, J. Holden, & R. Sagovsky, 1987), stress (Swedish Parental Stress Questionnaire (M. Östberg, B. Hagekull, & S. Wettergren, 1997), distress (Swedish Symptom Checklist-90 (SCL-90; L.R. Derogatis, 1994; M. Fridell, Z. Cesarec, M. Johansson, & S. Malling Thorsen, 2002) and infant social and emotional functioning (Ages and Stages Questionnaire: Social-Emotional (J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002), relationship qualities (Parent-Infant Global Assessment Scale (PIR-GAS; ZERO TO THREE, 2005), and videotaped interactions (Emotional Availability Scales, Z. Biringen, J.L. Robinson, & R.N. Emde, 1998). Suitability for psychoanalysis predicted outcome only on the PIR-GAS. Two overarching maternal ideal types were created, reflecting their attitude to the psychoanalytic process: "Participators" and "Abandoned." The Participators benefited more from MIP than they did from CHCC on maternal interactive sensitivity. A contrasting, but nonsignificant, pattern was found among the Abandoned mothers. Two ideal types of babies emerged: those "Affected" and "Unaffected" by the disturbance, respectively. Among Affected babies, dyadic relationships and sensitivity among their mothers improved significantly more from MIP than they did from CHCC. The superior effects of MIP applied especially to Participator mothers and Affected infants. For Abandoned mothers and Unaffected infants, CHCC seemed to be of equal value.

Mother-infant relationship disturbances occur in three domains: maternal distress, infant functional problems, and relationship difficulties. They constitute common clinical problems. In Sweden, they are usually handled by nurses as part of public Child Health Centre care. Severe cases are referred to child psychiatry services. This randomized controlled trial compared two groups of mother-infant dyads in a Stockholm sample. One received only Child Health Centre care (the "CHCC" group) while the other received mother-infant psychoanalytic treatment plus CHCC (the "MIP" group). Eighty dyads of mothers and infants under 1½ years of age where the mothers had serious concerns about themselves in their role as mothers, their infants' well-being, or the mother-baby relationship were randomly selected for either the MIP or the CHCC group. The primary outcomes were mother-reported depression, mother-reported infant functional problems, and interviewer-based relationship assessments, all at 6 months after joining the project. Secondary outcomes were mother-reported stress and general psychic distress, externally rated video-recorded interactions, and the consumption of healthcare at the CHC, again all after 6 months. Intent-to-treat analyses of Treatment × Time effects significantly favored MIP treatment for maternal depression, mother-infant relationships, and maternal sensitivity. Effects were nearly significant on maternal stress, but nonsignificant on mother-reported infant functional problems, general psychic distress, maternal interactive structuring and nonintrusiveness, infant responsiveness and involvement, and healthcare consumption. MIP treatment improved mother-infant relationships and maternal sensitivity and depression, all of which are known to influence child development. If effects persist and are reproduced, MIP treatment holds promise for more widespread use.

No abstract

Mother-report questionnaires of infant socioemotional functioning are increasingly used to screen for clinical referral to infant mental health services. The validity of the Ages & Stages Questionnaire: Social Emotional (ASQ:SE; J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002) was investigated in a sample of help-seeking mothers with young infants. It was compared with independent observer-rated dyadic interactions, and the quality of dyadic relationships was rated by expert clinicians. The ASQ:SE ratings also were compared with questionnaires on maternal psychological stress and distress. The ASQ:SE did not correlate significantly with either external ratings of dyadic interaction or clinically assessed relationship qualities, though the latter two were strongly associated with each other. In contrast, ASQ:SE scores were associated with questionnaires relating to maternal psychological distress. This was especially true for mothers classified as depressed. Furthermore, reports on the ASQ:SE were strongly predicted by maternal stress. The study points to some problems with the concurrent validity of the ASQ:SE in clinical samples. It also demonstrates a close link between mothers' psychological distress and their ratings of infant social and emotional functioning. Further research should investigate the extent to which the ASQ:SE specifically measures infant functioning or maternal distress, and how it functions in clinical versus nonclinical samples.

A randomized controlled trial (RCT) compared two groups of mother-infant dyads in a Stockholm sample. One had received mother-infant psychoanalytic treatment (MIP group) and the other Child Health Center care (CHCC group). Effects were found on mother-reported depression and expert-rated mother-infant relationship qualities and maternal sensitivity. When the children were 4½ years old, they were followed up with assessments of attachment representations, socioemotional development, and global functioning. They also were divided into two types according to individual characteristics and psychological well-being: the "OK" and the "Troubled" children. Of 80 dyads in the mother-infant RCT, data were gathered from 66 cases approximately 3½ years after treatment. The children in the MIP group had better results on global functioning. There were more OK children in the MIP group and more Troubled children in the CHCC group. No other between-group differences were found. A relatively brief mother-infant psychotherapy seemed to help the children function better and be less troubled 3½ years after therapy.

Background and purposeFor more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus.Patients and methodsThis study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013.ResultsThere were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9–2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6–5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0–3.8) compared to older patients.InterpretationRevision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection.

Children with attention-deficit/hyperactivity disorder (ADHD) and disorder of attention, motility control, and perception (DAMP) are often sensitive to the analyst's interventions. This is not always due to the literal import of the intervention. The children sometimes react as if the words were dangerous concrete objects, which they must physically fend off. The author traces this phenomenon to the child's unstable internal situation. A bad, un-containing internal object is easily awakened and threatens to expel the analyst's words independently of their content. This results in violent clinical situations. Infant research and psychoanalytic work with infants and mothers evince how a complex semiotic process develops between mother and baby. The prerequisite for this process to get started and maintained is a secure external object, which gradually is internalized. Findings from developmental research and clinical infant work are used to illuminate analytic work with children with ADHD and DAMP. Vignettes demonstrate how important it is for the analyst to phrase interpretations after having gauged the state of the analysand's internal object as well as his/her own countertransference. If this is overlooked, the psychoanalytic dialogue easily capsizes. The author provides some technical recommendations on the psychoanalysis of these children. As part of the theoretical discussion he raises the general question of how the representations, which the baby forms in interaction with the mother, and the analysand forms in interaction with the analyst, should be classified. Rather than dividing them into bipartite thing- or word-presentations (Freud), the author suggests C. S. Peirce's tripartite semiotic classification in that the baby forms representations of icons, indices, and symbols.

Infants suffer to a considerable degree from disturbances in nursing, sleep, mood, and attachment. Psychotherapeutic methods are increasingly used to help them. According to case reports, psychoanalytic work with infants and mothers has shown deep-reaching and often surprisingly rapid results, both in symptom reduction and in improved relations between mother and child. The clinical urgency of the method makes it important to study its results and theoretical underpinnings. Among the theoretical issues often raised in discussions on this modified form of psychoanalysis, those addressing the nature of communication between analyst, baby, and the mother are the most frequent. For example, how and what does an infant understand when the analyst interprets to her? What does the analyst understand of the infant's communication? These issues are addressed by investigating the infant's tools for understanding linguistic and emotional communication, and by providing a semiotic framework for describing the communication between the three participants in the analytic setting. The paper also investigates problems with the traditional ways of using the concept of symbolization within psychoanalytic theory. The theoretical investigation is illustrated by two brief vignettes from psychoanalytic work with an 8 month-old girl and her mother.