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.

Ressuscitação cardiopulmonar na gravidez / Cardiopulmonary resuscitation in pregnancy

A parada cardíaca durante a gravidez apresenta altos índices de mortalidade maternae fetal que variam conforme a etiologia. Felizmente, sua ocorrência é pouco comum,sendo o número de casos estimados de um para 30.000 gestações. Segundo estudosepidemiológicos em mortalidade materna, as maiores causas de morte devido a paradacardiorrespiratória (PCR) são: tromboembolismo venoso, síndromes hipertensivasda gravidez, sepse, embolismo pelo fluido amniótico, hemorragia, trauma, causasiatrogênicas e doenças cardíacas congênitas ou adquiridas. Independentemente dacausa, uma intervenção deve ser adotada precocemente para otimizar as chances desobrevivência da mãe e/ou do feto. Dentre essas intervenções, destacam-se o suportebásico e avançado de vida, a cesariana perimortem e a cesariana postmortem, queserão abordadas neste artigo.

Cardiac arrest during pregnancy has high rates of maternal and fetal mortality, whichvary according to the etiology. Fortunately, its occurrence is uncommon, and the estimatednumber of cases is 1 for each 30,000 pregnancies5. According to epidemiologicalstudies on maternal mortality, the major causes of death due to cardiopulmonary arrestare: venous thromboembolism, hypertensive disorders of pregnancy, sepsis, pulmonaryembolism by amniotic fluid, hemorrhage, trauma, iatrogenic causes and congenital or acquiredheart conditions. Whatever the cause is, intervention must be done early, in orderto maximize the chances of survival of the mother and/or fetus. Among these interventions,the basic and advanced life support, and the perimortem and postmortem cesareansection modalities will be discussed in this review.

Abdômen agudo secundário a hímen imperfurado: relato de caso / Acute abdomen secondary to imperforate hymen: a case report

O hímen imperfurado (HI) é a causa congênita mais comum de obstrução do fluxo genital no sexo feminino. Embora seja detectável em todas as faixas etárias pela inspeção da genitália externa, o HI é um diagnóstico que muitas vezes passa despercebido. Relatamos o caso de uma adolescente virgem, com desenvolvimento normal de caracteres sexuais secundários, ausência de menarca, que apresentou um quadro clínico de abdome agudo secundário à hematocolpo por hímen imperfurado.

Imperforate hymen is the most common congenital cause of genital flow obstruction in females. Although it is noticeable in all ages by the inspection of external genitalia, imperforate hymen is commonly misdiagnosed. We present a case in which a virgo intacta adolescent, with normal secondary sexual characters, without menarche, that evolved to acute abdomen and hematocolpus due to imperforate hymen.