ABSTRACTAimTo investigate whether webcam access for parents of infants in neonatal intensive care units influences parental postpartum depression and stress experiences.MethodsParents whose infants had a birth weight below 1500 g and who were admitted to one of the four participating tertiary care hospitals were eligible to participate in the study. The study followed the structure of a multi‐centre cross‐over pragmatic randomised controlled trial. Depending on their assigned study group, participants gained access to a webcam either in Weeks 1–4 of the observation period and abstained from webcam use in Weeks 5–8 (First‐Half Access Group) or vice versa (Second‐Half Access Group). Outcomes were measured at four time points utilising the Edinburgh Postnatal Depression Scale and the Parental Stressor Scale: Neonatal Intensive Care Unit. Effects were estimated using linear mixed‐effects regression modelling.ResultsData from 229 mothers and 211 fathers/partners were analysed; neither group's webcam access had a significant effect on the level of symptoms related to postpartum depression or stress experienced.ConclusionBased on the present results, webcam access has neither negative nor positive effects on parental psychological strain. Further research is needed to understand how individual preferences and physical presence influence the impact of webcams.

Objectives: During the COVID-19 pandemic, dental appointments were cancelled or postponed by both patients and dentists. This study investigated the associations between German dentists' concerns on cross infection and their emotional burden due to personal economic impact on dentist -initiated appointment cancellations. Methods: Data were collected using an anonymous cross-sectional online survey of outpatient physicians in Germany from March through April 2020. Dental treatments were divided into 3 treatment categories (plannable treatments, acute treatments without COVID-19 -like symptoms, and acute treatments with COVID-19 -like symptoms). Descriptive analyses and multivariate logistic regression models were performed. Results: A sample of 269 self-employed dentists was considered. Cancellations of prophylaxis appointments were reported by 82% of dentists, whilst 49% reported cancellations of appointments for acute complaints with simultaneous patient -side COVID-19 -like symptoms. Further, 58% of respondents stated high or very high concerns about COVID-19 selfinfection; 81% stated to be emotionally burdened by the personal economic impact. Dentists' concern of infecting themselves significantly decreased the likelihood of maintaining appointments, with odds ratios of 0.635 (95% confidence interval [CI], 0.426 to 0.932) for plannable treatments and 0.587 (95% CI, 0.367 to 0.916) for treatments of patients with acute complaints and simultaneous COVID-19 -like symptoms. In addition, there was a significant negative association between dentists who reported emotional distress due to personal economic impact and the likelihood to maintain appointments, with odds ratios of 0.291 (95% CI, 0.123 to 0.695) for plannable treatments and 0.231 (95% CI, 0.053; 0.706) for treatments of patients without acute complaints and simultaneous COVID-19 -like symptoms. Conclusion: Dentists' fear of infecting themselves with COVID-19 played a role in terms of practice -related appointment cancellations. Dentists differentiated their appointment cancellations according to different treatment categories and patient needs. If dental care is to be maintained in pandemic times, physicians' personal factors such as concerns about infection and perceived pandemic -related personal economic impact need to be considered. (c) 2023 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

BACKGROUND:The challenging transition to parenthood affects both mothers and fathers; yet, the strain intensifies with a premature birth in the neonatal intensive care unit (NICU), underscoring the importance of acknowledging and addressing potential differences in parental roles. PURPOSE:This paper aimed to investigate how parental role conflicts among mothers and fathers of preterm-born infants hospitalized in German NICUs manifest and investigated potential parental resources. METHODS:Twenty-four participants, 17 mothers, and seven fathers of very low birth-weight infants were interviewed. A thematic content analysis was performed at a semantic level. RESULTS:Fathers feel pressured to fulfill the role expectations, often leading to the suppression of paternal feelings and needs. For mothers, deviating from societal expectations regarding their expressive roles can be distressing, as they worry that such deviation might hinder their infants from having a successful start in life. Consulting with healthcare professionals shows to ease challenges for both parental roles. IMPLICATIONS FOR PRACTICE AND RESEARCH:Maternal and paternal challenges are often rooted in expectations placed on their societal roles. Highlighting these challenges can be essential for increasing awareness and effectively addressing them. Tailored nursing practices may have the potential to facilitate individuals' navigation of uncertainties and fulfillment of caregiving roles.

Background:The challenging transition to parenthood affects both mothers and fathers; yet, the strain intensifies with a premature birth in the neonatal intensive care unit (NICU), underscoring the importance of acknowledging and addressing potential differences in parental roles.Purpose:This paper aimed to investigate how parental role conflicts among mothers and fathers of preterm-born infants hospitalized in German NICUs manifest and investigated potential parental resources.Methods:Twenty-four participants, 17 mothers, and seven fathers of very low birth-weight infants were interviewed. A thematic content analysis was performed at a semantic level.Results:Fathers feel pressured to fulfill the role expectations, often leading to the suppression of paternal feelings and needs. For mothers, deviating from societal expectations regarding their expressive roles can be distressing, as they worry that such deviation might hinder their infants from having a successful start in life. Consulting with healthcare professionals shows to ease challenges for both parental roles.Implications for Practice and Research:Maternal and paternal challenges are often rooted in expectations placed on their societal roles. Highlighting these challenges can be essential for increasing awareness and effectively addressing them. Tailored nursing practices may have the potential to facilitate individuals' navigation of uncertainties and fulfillment of caregiving roles.

AIM:Strain on couple relationships is associated with a lower well-being. As premature birth is known to pose stress to parents, this study explores whether interparental relationship strain comes to pass within mothers and fathers during their infant's stay in a neonatal intensive care unit. METHODS:A retrospective cross-sectional survey was conducted with parents who experienced a preterm birth (September to December 2020). Linear regression was used to analyse associations between stress and relationship strain. RESULTS:The study included 437 mothers and 301 fathers. Fathers experienced lower relationship strain (M = 2.49, SD = 1.00) than mothers (M = 3.37, SD = 1.04). Overall, a significant association between relationship strain and stress due to the infant's behaviour and appearance was found for mothers (β = 0.16, p = 0.02) and fathers, with a significantly higher association for fathers (β = 0.27, p ≤ 0.002). With regard to parental role alterations, only mothers showed a significant association (β = 0.21, p ≤ 0.001). CONCLUSION:Although mothers showed higher levels of stress and relationship strain, stress may also have an impact on fathers. Therefore, research should focus on stress prevention measures to meet both maternal and paternal needs.

Hintergrund In Zeiten eines landesweiten Mangels an Ärzt*innen und Pflegekräften [1], speziell im Bereich der pädiatrischen und neonatologischen Intensivmedizin [2] [3] ist es für die zukünftige Ausrichtung des Fachgebiets entscheidend, mehr über die erlebte Arbeitszufriedenheit zu erfahren und zukünftigen Herausforderungen somit gezielt frühzeitig zu begegnen.

Hintergrund Die Nutzung von Webcams auf neonatologischen Intensivstationen soll kein Ersatz für persönliche Besuche der Eltern auf der Station sein. Trotzdem ruft sie häufig die Sorge vor einer Abnahme der elterlichen Anwesenheit beim Kind auf der Station hervor [1]. Die Studie Neo-CamCare evaluiert den Einsatz von Webcams auf neonatologischen Intensivstationen u. a. im Hinblick auf die elterlichen Besuchszeiten und die Webcamnutzung.

Background: COVID-19 vaccination is recognized as a key component in addressing the COVID-19 pan-demic. Physicians' attitudes toward vaccination are known to play a defining role in the management and dissemination of medical advice to patients. In Germany, outpatient practitioners are predominantly responsible for the dissemination of vaccines.Method: Using a cross-sectional online survey, 932 outpatient general practitioners, gynecologists, and pediatricians in Germany were asked in fall, 2021, about their attitude toward COVID-19 vaccination and - among others - their communication in vaccine discussions, their assessment of vaccine safety, and reporting of suspected adverse events. Physicians were divided into two groups along their attitudes toward COVID-19 vaccination. In addition, multivariate linear regression models were constructed to assess differences in communication strategies.Results: 92 % of physicians had a positive or very positive attitude toward COVID-19 vaccination. Own vaccination status, practice-based vaccination delivery, and estimated vaccination coverage among patients were significantly associated with the attitude toward vaccination. Confidence in vaccine safety was significantly lower among physicians with negative attitudes. There were no differences between the two groups in self-assessment of the ability to detect suspected adverse events, but there were differ-ences in the observing and reporting of adverse events. For the linear regression models, we found that a more negative attitude toward COVID-19 vaccination was significantly associated with increased accep-tance of patient refusal of COVID-19 vaccination and empathic behavior for patient concerns. In contrast, willingness to engage in a detailed persuasion consultation was significantly lower. Pediatricians showed significantly higher empathy for patient-side concerns compared to general practitioners, whereas gyne-cologists showed less empathy than general practitioners.Discussion: The physician's attitude toward COVID-19 vaccination influences the physician's practices as a vaccine provider. However, when providing medical advice and healthcare, the physician should focus on the actual needs of the patient.(c) 2022 Elsevier Ltd. All rights reserved.

The measures taken to contain the COVID-19 pandemic had a major impact on society, affecting medical care as well as the utilization of medical services. We aimed to identify pandemic-related changes in gynaecologic/obstetric care through the personal experience of practitioners in the outpatient sector in Germany. Three consecutive anonymous online surveys of practising gynaecologists were conducted during the pandemic (07–09/2020, 11–12/2020 and 09–11/2021). Appointment management, medical supply and patients’ demand as well as concomitant circumstances were queried. Data from 860 (393, 262 and 205 from the first, second and third surveys, respectively) respondents were analysed. At the peak of the first COVID-19 wave, more than 50% of the gynaecologists surveyed had cancelled cancer screening appointments. There was a significant association between fear of self-infection and cancellation of cancer screening appointments (p = 0.006). An increase in domestic violence was reported by 13%, an increase in obesity by 67% and more advanced tumours due to delayed screening by 24% of respondents. Primary gynaecological oncological prevention was reduced in supply and demand during the COVID-19 pandemic, and this shortfall should be addressed in future similar situations. Prenatal care has been offered continuously since the start of the pandemic in Germany.

Hintergrund Die Milch der eigenen Mutter ist die beste Ernährung für frühgeborene Kinder. Als kritischer Schwellenwert gilt dabei eine abgepumpte Muttermilchmenge von 500 ml/24h am Tag 14 post partum (p.p.) [1]. Für die erfolgreiche Initiierung der Laktation essentiell ist regelmäßiges Abpumpen, wobei mindesten 8 Abpumpvorgänge pro Tag durchgeführt werden sollten [2]. Empfohlen wird vor dem Kind abzupumpen, oder wenn dies nicht möglich ist ein Bild oder ein Video des Kindes beim Abpumpen anzusehen, um die Produktion von Oxytocin anzuregen. Fragestellung: Untersucht wurde anhand von Real-Life Daten das Abpumpverhalten, wie auch die Milchmenge in Abhängigkeit der Rahmenbedingungen des Abpumpens (vor dem Kind, mit Foto und vor einem Live-Stream des Kindes, ohne).

Abstract Background An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. Methods Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. Results Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993–0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915–0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126–0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09–0.648, low vs. high OR = 0.251; 95% CI = 0.077–0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. Conclusion Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.

Background: Job satisfaction and the well-being of medical and nursing staff are relevant for staff bonding but also for maintaining high quality patient care. Due to the shortage of staff in neonatology, it is important to learn more about the current state of job satisfaction, work-life balance and intentions to change jobs.Methods: A total of 389 physicians and nurses were surveyed for this purpose.Results: Overall, 74% of physicians work full-time (>= 38 h per week) (male physicians 80%, female physicians 69%), although this is desired by only 49% of the physicians surveyed (male physicians 57%, female physicians 41%). For 56% of physicians with a clinically conspicuous WHO 5 well-being index, there is also a need for action here. Approximately 44% of the physicians under 60 years of age surveyed plan to change their employer in the next 5 years. This is significantly related to burnout and work-life balance conflicts.Discussion: Overall, there are major challenges in the balance of work and family and, as a result, the increased desire for part-time work.

Zusammenfassung Hintergrund Die Arbeitszufriedenheit wie auch das Wohlbefinden der ärztlichen und pflegerischen Mitarbeiter*innen sind zum einen relevant zur Mitarbeiter*innenbindung, aber auch zur Aufrechterhaltung einer qualitativ hochwertigen Patient*innenversorgung. Aufgrund des Personalmangels in der Neonatologie ist es wichtig, mehr über den aktuellen Stand der Arbeitsplatzzufriedenheit, der Work-Life Balance wie auch der Wechselabsichten zu erfahren. Methode Hierzu sind insgesamt 389 Ärzt*innen und Pflegekräfte befragt worden. Ergebnisse Insgesamt arbeiten 74 % der Ärzt*innen in Vollzeit (≥ 38 h/Woche) (Ärzte: 80 %, Ärztinnen: 69 %), wobei dies jedoch nur von 49 % der befragten Ärzt*innen (Ärzte: 57 %, Ärztinnen: 41 %) gewünscht ist. Mit 56 % an Ärzt*innen mit einem klinisch auffälligen WHO-5-Wohlbefindens Index zeigt sich auch hier Handlungsbedarf. Circa 44 % der befragten Ärzt*innen unter 60 Jahren planen, in den nächsten 5 Jahren ihren Arbeitgeber zu wechseln. Dies steht im signifikanten Zusammenhang zu Burn-out und Work-Life-Balance-Konflikten. Diskussion Insgesamt zeigen sich große Herausforderungen in der Vereinbarkeit von Arbeit und Familie und hierdurch der vermehrte Wunsch nach Teilzeit.

Hintergrund Webcams werden bereits auf einzelnen neonatologischen Intensivstationen (NICUs) in Deutschland und international eingesetzt. Die Webcams ermöglichen es Eltern von Frühgeborenen, ihr Kind auch dann sehen zu können, wenn sie selbst nicht im Krankenhaus sein können. Die Neo-CamCare Studie evaluierte über einen Zeitraum von drei Jahren multiperspektivisch den Einsatz von Webcams auf NICUs. Ein Ziel der Studie war es, herauszufinden, wie sich die Nutzung der Webcams auf das Wohlbefinden der Eltern auswirkt.

Background: In Germany, general practitioners (GPs) provide basic and primary care in the ambulatory sector and refer patients to other specialists when necessary. Often, GPs present the first point of contact for patients in the German healthcare system. During the COVID-19 pandemic, GPs and other medical specialists in the ambulatory setting suddenly were confronted with unprecedented challenges. Objective: To answer the following research questions: How did COVID-19-related challenges affect the work climate? Do physicians with deteriorated work climate simultaneously report a worsened provision of patient care? Which challenges were the most burdening? Methods: In the course of the project COVID-GAMS more than 18 000 physicians of various specialties had been invited to a quantitative cross-sectional online survey (in Summer 2020). Analyses were conducted separately for the groups of GPs and other medical specialists. Group differences were analysed statistically and burdening factors were identified. Results: 1703 participants were included in the analysis. 22.2% of GPs (other medical specialists: 19.9%) stated, their work climate had deteriorated. Physicians with a deteriorated work climate showed a tendency towards poorer personal provision of patient care (M = 3.75, SD = 0.98 versus M = 3.93, SD = 0.99) compared to unchanged or improved work climate. The lack of protective material in March/April 2020, changes in practice management and possible economic impacts on the practice were the most burdening factors reported by GPs. Conclusion: GPs who reported a negative impact on the work climate in the course of the first pandemic lockdown also tend to see own deficits in the provision of patient care.

Abstract Background The use of webcam technology in neonatal intensive care units (NICUs) enables parents to see their child when the parents cannot be present at the NICU. The webcam’s use has been gaining increasing attention. Lead physicians and lead nursing staff play a key role in the decision of whether to implement webcams. This study investigates factors that are associated with the readiness for the implementation of a webcam system among lead NICU staff. Methods A postal survey was conducted among all lead physicians and lead nursing staff in all German NICUs between December 2020 and April 2021 (total N = 416, one lead physician and one lead nursing staff per NICU, N = 208). On the basis of normalization process theory, personal (technology acceptance) and organizational (innovation climate) attributes were chosen to determine their association with the readiness for the implementation of a webcam system. The association of these factors was determined using multiple linear regression models for both lead physicians and lead nurses. Results Overall, a response rate of 66.59% (n = 277) was achieved. Technology acceptance proved to be a significant factor associated with the readiness for the implementation of a webcam system among lead physicians. Furthermore, staff already working with webcams in their NICUs indicated a significantly higher level of technology acceptance than staff without webcam experience and without any desire to use a webcam in the future. No significant association was found between innovation climate and the readiness for the implementation of a webcam system. Conclusions Technology acceptance was identified as a factor associated with the readiness for the implementation of a webcam system. The insights from this study can be used to manage potential barriers regarding the readiness for implementation of webcams in NICUs. Trial registration The Neo-CamCare study is registered at the German Clinical Trials Register. DRKS-ID: DRKS00017755. Date of Registration in DRKS: 25-09-2019.

BACKGROUND:In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany.METHODS:The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians.RESULTS:The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients.CONCLUSION:The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.

Background Some neonatal intensive care units offer parents webcam systems for times when they cannot be in the ward. Leaving an infant in the ward can be challenging for parents, and trust in the neonatal healthcare professionals mitigates parents’ worries of not knowing how their infant is doing while they are away. If parents lack trust in the neonatal healthcare professionals, they may attempt to compensate by using webcams. In this work, we examine whether an association exists between the parental preference to use a webcam and low trust in physicians and nursing staff. Methods In a nationwide, retrospective cross-sectional study, parents of infants with a birth weight below 1500 g were surveyed six to 18 months after their infant’s birth. Parents who were not offered a webcam system in the ward were asked whether they would have opted for it. Trust was measured by the Trust in Physician and Trust in Nursing Staff scales. Results Of the parents who were not offered a webcam, 69% would have chosen to use a webcam if they had been granted the opportunity. The decision for or against a webcam was not significantly associated with either trust in physicians (OR = 0.654, 95% CI = 0.456, 0.937, p = .124) or trust in nursing staff (OR = 1.064, 95% CI = 0.783, 1.446, p = .932). Conclusions While the majority of parents surveyed would opt for webcam usage, this preference should not be interpreted as an indicator of lacking trust in neonatal healthcare professionals.

Acta PaediatricaEarly View READER’S FORUM Response to the letter concerning our publication on parental trust and stress experience Laura Mause, Corresponding Author Laura Mause laura.mause@uk-koeln.de orcid.org/0000-0002-7124-7882 Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany Correspondence Laura Mause, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany. Email: laura.mause@uk-koeln.deSearch for more papers by this authorJan Hoffmann, Jan Hoffmann Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, GermanySearch for more papers by this authorAlinda Reimer, Alinda Reimer Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, GermanySearch for more papers by this authorTill Dresbach, Till Dresbach Department of Pediatrics, University Hospital Bonn, Bonn, GermanySearch for more papers by this authorDirk Horenkamp-Sonntag, Dirk Horenkamp-Sonntag Techniker Krankenkasse, Healthcare Management, Hamburg, GermanySearch for more papers by this authorMelanie Klein, Melanie Klein DAK Gesundheit, Hamburg, GermanySearch for more papers by this authorNadine Scholten, Nadine Scholten orcid.org/0000-0002-7793-7745 Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, GermanySearch for more papers by this author Laura Mause, Corresponding Author Laura Mause laura.mause@uk-koeln.de orcid.org/0000-0002-7124-7882 Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany Correspondence Laura Mause, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany. Email: laura.mause@uk-koeln.deSearch for more papers by this authorJan Hoffmann, Jan Hoffmann Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, GermanySearch for more papers by this authorAlinda Reimer, Alinda Reimer Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, GermanySearch for more papers by this authorTill Dresbach, Till Dresbach Department of Pediatrics, University Hospital Bonn, Bonn, GermanySearch for more papers by this authorDirk Horenkamp-Sonntag, Dirk Horenkamp-Sonntag Techniker Krankenkasse, Healthcare Management, Hamburg, GermanySearch for more papers by this authorMelanie Klein, Melanie Klein DAK Gesundheit, Hamburg, GermanySearch for more papers by this authorNadine Scholten, Nadine Scholten orcid.org/0000-0002-7793-7745 Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, GermanySearch for more papers by this author First published: 10 February 2022 https://doi.org/10.1111/apa.16286Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Abstract Background Relationship satisfaction is an important predictor of well-being. Few studies address the effects of stress on interparental relationships of parents with preterm infants. However, the experience of a preterm birth represents an extreme, stressful event and therefore may place a strain on a relationship. Our aim is to examine the impact of postnatal stress on maternal and paternal perceptions of relationship strain. Methods As part of the Neo-CamCare project, a retrospective cross-sectional study was conducted targeting parents with infants with a birth weight below 1,500 g. Linear regression was used to analyse the influence of stress on relationship strain. Results 437 mothers and 301 fathers participated. Data indicate that interparental relationship strain experienced by fathers (M = 2.61, SD = 1.46) is lower than strain experienced by mothers (M = 3.43, SD = 1.7). The stress level due to the infant's behaviour and appearance is lower in fathers (M = 2.53, SD = 0.95) than in mothers (M = 2.98, SD = 1.05). Stress due to parental role change is higher in mothers (M = 3.37, p = 1.04) than in fathers (M = 2.49, SD = 0.99). Regression analyses show that stress due to behaviour and appearance, as well as parental role change, can be associated with relationship strain in mothers. For fathers, only stress experienced due to the behaviour and appearance can be associated with relationship strain, whereas parental role change is not significant. Conclusions Our data illustrate that relationship strain can result from stress in mothers and fathers, indicating the need for stress prevention measures for both. Only mothers show relationship strain due to stress in their parental role. Although it is unclear what mechanisms underlie these findings, we assume that the maternal role is still primarily associated with child care. One way to relieve maternal stress could be to increase psychological support and the promotion paternal involvement in the postnatal period. Key messages