Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children's health at scale.

BACKGROUND: Children's exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents' capacity for insight into their child's and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents' RF in the domains of attachment, parenting quality, immune function, and children's cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. METHODS: The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire - 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. DISCUSSION: The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. TRIAL REGISTRATION: Name of registry: https://clinicaltrials.gov/. REGISTRATION NUMBER: NCT04853888 . Date of registration: April 22, 2021.

Pre-implantation genetic testing for aneuploidy: motivations, concerns, and perceptions in a UK population.

PURPOSE: Pre-implantation genetic testing for aneuploidies (PGT-A) is a technique used as part of in vitro fertilisation to improve outcomes. Despite the upward trend in women utilising PGT-A, data on women's motivations and concerns toward using the technology, and perceptions having undergone the process, remain scarce. METHODS: This cross-sectional survey, based at a fertility clinic in the UK, utilised an electronic questionnaire to assess the motivations of women who undergo PGT-A and their perceptions and attitudes toward PGT-A after using it. RESULTS: One hundred sixty-one women responded. The most significant motivating factors to undergo PGT-A were to improve the probability of having a baby per cycle (9.0 ± 2.1) and enhance the chance of implantation (8.8 ± 2.5). The least important motivations were reducing the number of embryos transferred per cycle (2.7 ± 3.3) and saving money by reducing the number of procedures required (4.6 ± 3.4). The most significant concerning factors identified included not having embryos to transfer (5.7 ± 3.4) and the potential for embryo damage (5.2 ± 3.3). The least concerning factors included religious (0.6 ± 1.7) or moral (1 ± 2.2) concerns. The majority of women were satisfied/very satisfied following treatment (n = 109; 68%). The proportion of those who were satisfied/very satisfied increased to 94.2% (n = 81) following a successful outcome, and reduced to 43.5% (n = 27) in those who had an unsuccessful outcome or had not undergone embryo transfer (p < 0.001). CONCLUSION: This study highlights that perceptions amongst women who use PGT-A are mostly positive. We also demonstrate a significant association between satisfaction and reproductive outcomes, with those who achieve a live birth reporting more positive perceptions toward PGT-A.

Perceptions, outcomes, and regret following social egg freezing in the UK; a cross-sectional survey.

INTRODUCTION: Social egg freezing enhances reproductive autonomy by empowering women with the capacity to delay their childbearing years, while preserving the opportunity to maintain biological relation with subsequent offspring. However, age-related obstetric complications, economic implications and the risk of unsuccessful future treatment make it a controversial option. Despite the upward trend in women electively cryopreserving their eggs, there is limited data about the women's perceptions, having undergone the process. The aim of this study was to investigate the motivations of women who have undergone social egg freezing, identify their perceptions following treatment, and assess potential feelings of regret. MATERIAL AND METHODS: This cross-sectional survey, based at a fertility clinic in the UK, used an electronic questionnaire to assess the motivations and perceptions of women who underwent social egg freezing between 1 January 2008 and 31 December 2018. RESULTS: One hundred questionnaires were distributed, and 85 women responded (85% response rate). The most frequent reason for freezing oocytes was not having a partner with 56 (70%) women saying it "definitely" influenced their decision. The majority of women (83%; n = 68) knew there was a chance of treatment failure in the future and that a live birth could not be guaranteed. More than half (n = 39; 51%) disagreed or strongly disagreed that the 10-year UK storage limit is fair. One-third of respondents (n = 17; 33%) felt the storage time should be indefinite and 29% (n = 15) believed it should be up to the age of 50. Twenty percent (n = 15) of the women who underwent social egg freezing have successfully had a baby or are currently pregnant, half (n = 8; 53%) of whom conceived spontaneously and a quarter (n = 4; 26%) used their stored oocytes. In all, 91% (n = 73) had no regrets over their decision to undergo social egg freezing. CONCLUSIONS: We demonstrate herein important and novel insights into the motivations and perceptions of women from a UK population who have undergone social egg freezing. Despite potential physical, psychological, and financial burdens, only a small minority of women experience regret after social egg freezing. We also highlight clear discontent with the Human Fertilisation & Embryology Authority storage limit among social egg freezers in the UK.

Asthma-associated comorbidities in children with and without secondhand smoke exposure.

BACKGROUND: Secondhand smoke (SHS) exposure is known to trigger asthma, but asthma disease severity and comorbidities in children exposed to SHS are not very well quantified. OBJECTIVE: To identify comorbidities and understand health care usage in children with asthma exposed to SHS (cases) compared with children with asthma but without SHS exposure (controls). METHODS: A retrospective nested matched case-and-control study was conducted with children 5 to 18 years old who were enrolled in the Pediatric Asthma Management Program. Pulmonary function testing (spirometry, methacholine challenges, and exhaled nitric oxide) and body mass index were reviewed. Influenza vaccination rates, oral steroid usage, emergency department visits, and hospitalizations were assessed. Network analysis of the 2 groups also was conducted to evaluate for any associations between the variables. RESULTS: Cases had significantly higher body mass index percentiles (>75%, odds ratio [OR] 1.64, 95% confidence interval [CI] 1.22-2.2, P = .001). Cases were less likely to have had a methacholine challenge (OR 0.49, 95% CI 0.36-0.68, P < .001) and an exhaled nitric oxide (OR 0.6, 95% CI 0.37-0.97, P = .04) performed than controls. The ratio of forced expiration volume in 1 second to forced vital capacity and forced expiration volume in 1 second were lower in cases than in controls (P < .05). Cases were less likely to have received an influenza vaccination (OR 0.61, 95% CI 0.45-0.82, P = .001) than controls. Unsupervised multivariable network analysis suggested a lack of discrete and unique subgroups between cases and controls. CONCLUSION: Children with asthma exposed to SHS are more likely to have comorbid conditions such as obesity, more severe asthma, and less health care usage than those not exposed to SHS. Smoking cessation interventions and addressing health disparities could be crucial in this vulnerable population.

LGBTQ+ Sociopolitical Engagement: Examining the Role of House Ball Community Involvement and LGBTQ+ Community Connection.

Recent events such as the Black Lives Matter movement, COVID-19, and political elections have highlighted the power of a socially and politically engaged society. One under-researched cultural pillar at the core of sociopolitical resistance for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color (POC) has been the House Ball Community, a dynamic subculture made up of intricate social networks. This study uses data collected for the Social Justice Sexuality Project (N = 246) to examine LGBTQ+ community connection and House Ball Community involvement as predictors of LGBTQ+ and intersectional LGBTQ+ sociopolitical engagement. Two continuous variables, community connection and sociopolitical engagement (consisting of separate scales about LGBTQ+ individuals and LGBTQ+ POC), were included in the analysis. Multivariate linear regression analyses were performed to examine the relationships between these variables. While community connection was significantly associated with both scales of sociopolitical engagement, House Ball involvement was only associated with intersectional LGBTQ+ sociopolitical engagement. Relative to community connection, House Ball involvement was more strongly associated with intersectional LGBTQ+ sociopolitical engagement. Findings suggest that House Ball involvement may influence behavior for LGBTQ+ POC. Authors discuss implications for intersectionality in social movements and culturally responsive direct, community, and systems-level social work practice within the current U.S. sociopolitical landscape.

The novel use of fertility quality of life (FertiQoL) treatment subscale to assess treatment acceptability in social egg freezing.

This is the first study to assess the impact of social egg freezing (SEF) on quality of life. This cross-sectional survey utilised the FertiQoL treatment module in women who underwent SEF between January 2008 and October 2019 (n = 94). The mean treatment score was 65.5, whereas the tolerability and environment scores were 62.4 and 68 respectively. Being married or in a relationship was associated with higher, albeit not statistically significant, scores (69.2) when compared to single women (66.3; p = 0.49). However, being separated or divorced was associated with significantly worse scores compared to married women, women in a relationship and single women (43.3 vs. 67.0; p = 0.001). There were no significant differences in scores between younger and older women, low and high number of oocytes stored, duration of stimulation cycles, or in those who had single or multiple cycles. These data suggest SEF is largely tolerable, with favourable FertiQoL scores compared to infertile women undergoing IVF. However, whilst such women are physiologically fertile, their situation renders them socially infertile. As such, women undergoing SEF should be identified as a population that requires additional support, who should be offered extensive counselling, active monitoring throughout the process and additional support if required.

Is oocyte maturity influenced by ovulation trigger type in oocyte donation cycles?

The aim of this study was to compare clinical and laboratory outcomes between GnRHa, dual and HCG triggers in altruistic oocyte donation cycles. Normal or high responders were given either gonadotropin releasing hormone agonist (GnRHa) or a dual trigger of GnRHa and a low dose of human chorionic gonadotropin (HCG). Low responders were given HCG trigger. In 333 cycles, 232 (69.7%) received GnRHa trigger, 59 (17.7%) received dual trigger and 42 (12.6%) had HCG trigger. The total number of mature oocytes retrieved and cryopreserved were significantly higher in the GnRHa and dual trigger groups, compared to the HCG group (p < 0.001). However, the ovarian hyperstimulation syndrome (OHSS) rate was significantly higher in the dual trigger group (n = 5 (8.5%)), compared to the GnRH agonist (n = 1 (0.4%)) and HCG groups (n = 0 (0%)) (p = 0.001). GnRHa trigger maximises mature oocyte yields in oocyte donors suspected of normal and high response but offers a significant reduction in OHSS risk compared to dual trigger. As such, dual trigger should not be used in oocyte donation. HCG trigger can also be used with a very low risk of OHSS at low risk of OHSS in carefully selected donors where GnRHa is unlikely to be effective.

Are Pediatricians Complicit in Vitamin K Deficiency Bleeding?

The American Academy of Pediatrics recommends that all newborns receive a single dose of intramuscular vitamin K to prevent vitamin K deficiency bleeding. How should the clinician respond when parents decline vitamin K? Although vitamin K deficiency bleeding can have devastating sequelae, they are uncommon; therefore, parents are generally allowed to decline vitamin K after counseling is provided. When parents ask for a vitamin K preparation of unproven effectiveness, should the clinician honor that request? To address these questions, we present a case of a healthy newborn whose parents declined intramuscular vitamin K and requested an oral preparation. Two general pediatricians discuss the medical and ethical issues these situations pose, and the parents describe their experience.

Six related nucleoside/nucleobase transporters from Trypanosoma brucei exhibit distinct biochemical functions.

Purine nucleoside and nucleobase transporters are of fundamental importance for Trypanosoma brucei and related kinetoplastid parasites because these protozoa are not able to synthesize purines de novo and must salvage the compounds from their hosts. In the studies reported here, we have identified a family of six clustered genes in T. brucei that encode nucleoside/nucleobase transporters. These genes, TbNT2/927, TbNT3, TbNT4, TbNT5, TbNT6, and TbNT7, have predicted amino acid sequences that show high identity to each other and to TbNT2, a P1 type nucleoside transporter recently identified in our laboratory. Expression in Xenopus laevis oocytes revealed that TbNT2/927, TbNT5, TbNT6, and TbNT7 are high affinity adenosine/inosine transporters with K(m) values of <5 microm. In addition, TbNT5, and to a limited degree TbNT6 and TbNT7, also mediate the uptake of the nucleobase hypoxanthine. Ribonuclease protection assays showed that mRNA from all of the six members of this gene family are expressed in the bloodstream stage of the T. brucei life cycle but that TbNT2/927 and TbNT5 mRNAs are also expressed in the insect stage of the life cycle. These results demonstrate that T. brucei expresses multiple purine transporters with distinct substrate specificities and different patterns of expression during the parasite life cycle.