Childhood sexual abuse (CSA) is associated with negative outcomes in adulthood, including difficulty in relationships. Research has posited CSA may lead to insecure attachment in survivors, which may be the vehicle by which dysfunctional parent-child relationships develop. The purpose of the proposed study was to examine differences in parenting outcomes between CSA and non-CSA mothers utilizing both observational and self-report methods and to examine the unique impact of CSA on parenting attitudes. Abuse status was determined by scores on the Sexual Abuse subscale of the Childhood Trauma Questionnaire (CTQ), with the CSA group comprised of mothers scoring in the moderate to severe range. Mothers self-reported parenting attitudes on the Parent-Parental Acceptance Rejection Questionnaire/Control (P-PARQ/Control) and the Adult Adolescent Parenting Inventory-2 (AAPI-2), while parental depression was assessed with the revised Beck Depression Inventory (BDI-2). Parenting behaviors were observed by coding the Parent-Child Interaction Assessment (PCIA). Hypotheses were not supported until child gender was considered as a third variable. Results of MANCOVA analyses indicated CSA mothers, but not comparison mothers, exhibited significantly poorer limit-setting skills (h² = .21) with male children compared to female children, but did not self-report these differences. Although not statistically significant, small but potentially meaningful effect sizes were found when the self-reports of CSA mothers were compared to their observed behaviors. Specifically, CSA mothers displayed increased levels of physical nurturance (h² = .11) and role reversal (h² = .08) with male children compared to female children, but again, did not self-report these differences. Finally, CSA mothers, but not comparison mothers tended to self-report greater beliefs in corporal punishment with male children compared to females (h² = .08). Secondary findings revealed parental depression was the only unique predictor of parental nurturance, attitude toward corporal punishment, and role reversal. Findings confirm the importance of third variables, including child gender and parental depression. Theoretical and clinical implications are discussed, as well as limitations and future research directions.

Operationen mit großem Gewebetrauma können mit starken postoperativen Schmerzen und ausgeprägten perioperativen Homöostasestörungen einhergehen. Dabei werden sowohl hyperinflammatorische als auch immunparalytische Reaktionen beobachtet, die sich negativ auf den postoperativen Verlauf auswirken können. Um eine effektive und sichere Analgesie zu gewähren, werden alternativ zu der intravenösen Therapie mit Opioiden zunehmend epidurale Verfahren eingesetzt. In dieser prospektiven, randomisierten und doppelblinden Studie wurde die patientenkontrollierte epidurale Analgesie mit der patientenkontrollierten intra-venösen Schmerztherapie hinsichtlich der analgetischen Effektivität und der Beeinflussung der postoperativen Immunkompetenz verglichen. 54 Patienten erhielten bis zum Morgen des 4. postoperativen Tages entweder über einen intraoperativ gelegten epiduralen Katheter (PDK) Ropivacain und Sufentanil (PCEA-Gruppe) oder intravenös Morphin (PCIA-Gruppe). Cortisol, Leukozytenpopulationen, lymphozytäre Subpopulationen, monozytäre Oberflächenmarker und die löslichen Mediatoren TNF alpha, MCP-1, MIF, IL-8, IL-6 und IL-10 wurden perioperativ gemessen. Zudem wurde die Schmerzempfindung der Patienten in Ruhe und bei Mobilisation erhoben. Im Vergleich zur PCIA-Gruppe profitierten die Patienten der PCEA-Gruppe von einer deutlich besseren Analgesie. Cortisol wies postoperativ in beiden Studiengruppen einen ähnlich leichten Anstieg auf. Die monozytären Oberflächenmarker (HLA-DR, CD86) fielen im Verlauf deutlich ab mit einem Minimum am 1. postoperativen Tag, erholten sich bis zum 7. postoperativen Tag nahezu vollständig und zeigten keine signifikanten Gruppenunterschiede. Dagegen wurde der postoperative Abfall der CD4+ T-Lymphozyten, CD4/CD8 T-Zellratio, CD3+ Lymphozyten und CD19+ Lymphozyten bei den Patienten, die eine Epiduralanalgesie erhielten, signifikant vermindert. Hinsichtlich der löslichen Mediatoren gab es keine signifikanten Gruppenunterschiede. Somit scheint die epidurale Schmerztherapie die T-Zellkompetenz während der postoperativen Phase besser zu erhalten, während sich bei den monozytären Oberflächenmarkern und dem Stresshormon Cortisol kein Unterschied zwischen den beiden Analgesie-verfahren zeigte. / Surgeries accompanied by an extensive tissue trauma are associated with intense postsurgical pain and major perioperative homeostatic disorders. Both hyper-inflammatory and immuneparalytic reactions can be observed, what can negatively effect the postoperative course. To realise an effective and safe analgesia, epidural procedures are used to an increasing degree as an alternative method to the therapy with intravenous opioids. In this prospective, randomized, double-blinded trial we compared the patient-controlled epidural analgesia and the patient-controlled intravenous analgesia with respect to the analgesic efficiency and the influence on the postoperative immune competence. 54 patients received until the morning of the fourth postoperative day either ropivacaine plus sufentanil through an intraoperatively placed epidural catheter (PCEA-group) or intravenous morphine (PCIA-group). Cortisol, populations of leukocytes and lymphocytes, cell-surface molecules of monocytes and the soluble mediators TNF-alpha, MCP-1, MIF, IL-8, IL-6 and IL-10 were measured perioperatively. Additionally we determined the subjective pain scores of the patients in rest and with mobilisation. Patients of the PCEA-group had a better pain control compared to the patients of the PCIA-group. Cortisol showed a similar slight increase in both study-groups. The monocyte cell-surface molecules (HLA-DR, CD86) decreased in the observed period with a minimum on the first postoperative day and recovered until the seventh postoperative day without a significant difference between both groups. In contrast, the postoperative decrease in CD4+ T-lymphocytes, CD4+/CD8+ T-cell ratio, CD3+ lymphocytes and CD19+ lymphocytes was significantly reduced in patients receiving epidural analgesia. No group differences were found in soluble mediators. This implicates a better postoperative competence of T-cells induced by epidural analgesia, whereas no differences between both analgetic methods were found in cell-surface markers of monocytes and the stress hormone cortisol.