Although establishing an affective tie with a child during perinatality is considered one of the most important maternal tasks, little is still known about the mediators of the association between maternal antenatal and postnatal bonding with the infant. This prospective study addresses this gap by evaluating a community sample of 110 Italian women to assess whether maternal pre- and postnatal bonds with the infant are mediated by parental reflective functioning (PRF), as assessed at the third trimester of pregnancy and three months postpartum. Controlling for confounding variables, the hierarchical regression analyses show the maternal prenatal quality of attachment to the fetus as the main predictor of maternal postnatal attachment to the child (β = 0.315; t = 0.2.86; p = 0.005). The mediation analyses show that mothers’ PRF (b = 0.245; SE = 0.119; 95% CI = 0.071, 0.531) explains 39% of the relationship between maternal pre- and postnatal bonding with the child. The findings of this study contribute to research on the association between prenatal and mother-to-infant bonding by additionally investigating the importance of taking into account maternal PRF as a mediating variable. This provides support for the clinical utility of interventions focused on maternal PRF.

Background: There is concern that recommendations on prophylactic antiseizure drugs (PASDs) for patients with spontaneous intracerebral hemorrhage (sICH) are biased by studies using older drugs and no electrographic monitoring. Aims: We performed a systematic review and meta-analysis to determine whether PASDs in patients with sICH reduced seizure occurrence and improved functional outcomes. We included analyses of newer trials, newer antiseizure drugs, and effectiveness in patients with consistent electrographic monitoring. Methods: Medline, Embase, and Cochrane were searched from inception until August 12th, 2022, to identify studies with patients with sICH treated with PASDs, regardless of study design. The studied outcomes were functional status and occurrence of seizures. Results: 14 studies were included, including 6742 patients. Risk of bias was low overall. There was no effect of PASD on seizure occurrence overall (OR 0.73, 95% CI 0.47-1.15) but they were associated with reduced occurrence in studies with electrographic monitoring (OR 0.36, 95% CI 0.18-0.70). There was no effect of PASDs on functional outcomes (OR 1.15; 95% CI 0.91-1.47) or mortality (OR 0.85, 95% CI 0.65-1.11). Conclusions: Prophylactic antiseizure medications after spontaneous intracerebral hemorrhage reduce seizures in studies with EEG monitoring in high-risk patients. However, this benefit did not reflect in improvement of functional outcomes, even in studies with newer, less toxic, antiseizure drugs.

Background Several randomized clinical trials (RCTs) have shown that dual orexin receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. However, the superiority of one particular DORA over the others remains unclear. Objective To perform a network meta-analysis to evaluate the efficacy of different DORAs in patients with chronic insomnia. Methods The Medline, Embase, and Cochrane Central databases were searched for RCTs that compared DORA with placebo in patients ≥ 18 years of age with a diagnosis of insomnia disorder. We pooled outcomes for wake time after sleep onset (WASO), latency to persistent sleep (LPS), total sleep time (TST), and adverse events (AEs). Results We included 10 RCTs with 7,806 patients, 4,849 of whom received DORAs as the intervention. Overall, we found that DORAs were associated with the improvement of all analyzed efficacy outcomes. Concerning TST, an apparent dose-dependent pattern was noticed, with higher doses relating to a longer TST. Lemborexant 10mg provided the largest reduction in WASO (at month 1) in minutes (standardized mean difference [SMD] = -25.40; 95% confidence interval [95%CI] = -40.02–-10.78), followed by suvorexant 20/15mg (SMD = -25.29; 95%CI = -36.42–-14.15), which also appeared to provide the largest decrease in long-term WASO (SMD = -23.70; 95%CI = -35.89–-11.51). The most frequent AEs were somnolence, nasopharyngitis, and headache, with rates of up to 14.8%. Conclusion Our results suggest that DORAs are associated with greater efficacy when compared with placebo in the treatment of insomnia, a complex 24-hour sleep disorder. Additionally, dosing might play an important role in the management of chronic insomnia.

Objetivo: Analisar os índices de mortalidade por malformações congênitas em aparelho circulatório em crianças menores de 1 ano na região Sudeste do Brasil entre os anos de 2014 e 2019. Métodos: Trata-se de um estudo ecológico de série temporal realizado através da análise quantitativa e qualitativa da amostra composta pelos óbitos de crianças menores de 1 ano, em decorrência de malformações congênitas em aparelho circulatório, na região Sudeste brasileira no período decorrido entre 2014 e 2019. Os dados foram coletados do Sistema de Informações sobre Mortalidade (SIM), disponibilizados por meio do Departamento de Informática do Sistema Único de Saúde (DATASUS). Foram incluídas todas as notificações realizadas durante o intervalo de seis anos estudado e excluídas as informações não computadas pelo SIM. A análise dos aspectos epidemiológicos partiu das seguintes variáveis: ano de óbito, Unidade da Federação (UF), local de ocorrência, cor/raça e sexo. Resultados: Foi computado o total de 9.884 óbitos, distribuídos de maneira pouco variável entre os anos observados. Destes, 51,82% ocorreu no estado de São Paulo; 94,55% em ambiente hospitalar; 62,09% em crianças de cor/raça branca e 53,3% em crianças do sexo masculino. Conclusão: O presente estudo elucidou e relacionou os aspectos epidemiológicos dos óbitos por malformações congênitas em aparelho circulatório em crianças menores de 1 ano entre 2014 e 2019, contribuindo, assim, para o reconhecimento do impacto destas condições sobre a vida da criança e da importância de medidas diagnósticas precoces na redução da mortalidade.

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