Childhood experiences, adult attachment styles and maternal outcomes

Research has shown that adverse childhood experiences (ACEs) can have devastating impacts across a person's life span, including poor health choices, disease and early death. Positive childhood experiences (PACEs) have been shown to buffer some of the effects of ACEs. This study examined how ACEs and PACEs impact attachment beginning in early childhood, and its impacts on parenting practices, substance use, and intimate partner violence. Specifically, this study examined parental reflective functioning (PRF). PRF refers to a parent's ability to see into the child's inner world and understand behaviors and emotions of the child. Parental PRF can impact child outcomes, including developmental, social, and emotional health. The first three models of this study examined the associations between ACEs, PACEs, adult attachment styles, and parental reflective functioning. The last two models of this study examined how childhood neglect and PACEs are associated with substance use and intimate partner violence and whether there are mediation effects with adult attachment styles.Results of the analyses showed that dismissive adult attachment mediated the association between two subtypes of PRF - PRF certainty of mental states and PRF pre - non mentalizing modes. Both of these subtypes of PRF have been shown to be associated with poor parenting practices and poor childhood outcomes. This study found that dismissive adult attachment style was positively associated with age. Dismissive adult attachment style - while thought to be characterized by detachment from intimate relationships - may indeed be characterized by autonomy and increased levels of maturity.Results did not demonstrate that adult attachment style mediated the association between ACEs, PACEs, and substance use or intimate partner violence. However, there were trends of significant findings between ACEs, PACEs and adult attachment styles. For example, ACEs was significantly associated with ambivalent attachment style and negatively associated with secure adult attachment style, while PACE's was negatively associated with ambivalent adult attachment and positively associated with secure adult attachment

Maternal Adverse and Protective Childhood Experiences and Prenatal Smoking

Prenatal smoking is associated with adverse pregnancy and birth outcomes as well as health problems in early childhood. Recent research determined that maternal adverse childhood experiences (ACEs) increase the odds of smoking during pregnancy. We consider the role of protective and compensatory childhood experiences (PACEs) in an effort to examine the extent to which positive childhood experiences are protective factors for maternal smoking behaviors. Between 2015-2018, 309 pregnant women in Oklahoma recruited from high-risk prenatal clinics, childbirth education classes, and social media were surveyed about their childhood experiences and smoking behaviors during pregnancy. Ordinal regression analysis was used to examine the association between ACEs, PACEs, and prenatal smoking frequency. Similar to prior studies, we found women with more ACEs reported smoking more frequently during pregnancy. Women with more PACEs reported significantly less frequent prenatal smoking. With both ACEs and PACEs in the model, however, ACEs was no longer a significant predictor of maternal prenatal smoking. Our findings suggest that protective and compensatory childhood experiences may be more salient for prenatal smoking behaviors than adverse childhood experiences. Identifying protective factors for pregnancy health risk behaviors such as smoking can offer a target for intervention and prevention

PD11-10 A 10-ITEM CHECKLIST CHECKLIST IMPROVES REPORTING OF CRITICAL PROCEDURAL ELEMENTS DURING TRANSURETHRAL RESECTION OF BLADDER TUMOR

Previous studies have demonstrated significant variation in recurrence rates after transurethral resection of bladder tumor, likely due to differences in surgical quality. We sought to create a framework to define, measure and improve the quality of transurethral resection of bladder tumor using a surgical checklist. We formed a multi-institutional group of urologists with expertise with bladder cancer and identified 10 critical items that should be performed during every high quality transurethral bladder tumor resection. We prospectively implemented a 10-item checklist into practice and reviewed the operative reports of such resections performed before and after implementation. Results at all institutions were combined in a meta-analysis to estimate the overall change in the mean number of items documented. The operative notes for 325 transurethral bladder tumor resections during checklist use were compared to those for 428 performed before checklist implementation. Checklist use increased the mean number of items reported from 4.8 to 8.0 per resection, resulting in a mean increase of 3.3 items (95% CI 1.9–4.7) on meta-analysis. With the checklist the percentage of reports that included all 10 items increased from 0.5% to 27% (p <0.0001). Surgeons who reported more checklist items tended to have a slightly higher proportion of biopsies containing muscle, although not at conventional significance (p = 0.062). The use of a 10-item checklist during transurethral resection of bladder tumor improved the reporting of critical procedural elements. Although there was no clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement