Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception

STUDY QUESTION Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)? SUMMARY ANSWER Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner. WHAT IS KNOWN ALREADY Most studies have not found differences between ART and NC singletons in parent-adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships. STUDY DESIGN, SIZE, DURATION This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers and fathers gave background information for this study during pregnancy, and during the child's first year and early school age (7-8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships-Relationship Structures) at 17-19 years of age. MAIN RESULTS AND THE ROLE OF CHANCE Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055. LIMITATIONS, REASONS FOR CAUTION The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons. WIDER IMPLICATIONS OF THE FINDINGS The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother-child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father-adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest.Peer reviewe

Ikäihmisten verkostomallinen kuntoutus : Laitos- ja avopainotteisen kuntoutusmallin arviointi

Ikäihmisille järjestetyssä eri toimintatahojen (kunta, kuntoutuslaitos, Kela) verkostoitumiseen perustuvassa kehittämishankkeessa arvioitiin laitoskuntoutukseen ja avokuntoutukseen perustuvia kuntoutusmalleja. Kuntoutujiksi valittiin henkilöitä, joiden toimintakyky oli alentunut ja kotona selviytyminen oli vaikeutunut. Kuntoutuksen aloitti 543 henkilöä (466 naista ja 77 miestä; keski-ikä 76 vuotta, vaihteluväli 64?92 vuotta). Heistä 70 % osallistui laitos- ja 30 % avokuntoutukseen, ja 46 naisen ja 10 miehen kuntoutus keskeytyi. Hankkeen tavoitteena oli löytää ikäihmisten kuntoutukseen soveltuva, eri toimijatahojen yhteistoimin-taan perustuva moniammatillinen yhteistyö- ja kuntoutusmalli. Kuntoutujakeskeiset tavoitteet olivat kuntoutujan toimintakyvyn edistäminen ja hänen omatoimisuutensa tukeminen. Kuntoutusverkostoja koskevat tiedot kerättiin teemahaastatteluilla ja kyselyillä. Kuntoutuslaitokset keräsivät tietoa kuntoutujien sairauksista, toimintakyvystä, mielialasta, palveluista ja heidän käytössään olevista apuvälineistä kuntoutuksen alkaessa ja sen lopussa. Kuntoutujien mielipiteitä kuntoutuksesta kartoitettiin puoli vuotta kuntoutuksen loppumisesta lomakekyselyllä, johon vastasi 76 % kuntoutujista. Ikäihmisten monialaista ja monitoimijaista kuntoutusyhteistyötä tukee eri toimijatahojen sitoutuminen ja innostuneisuus. Toiminnan esteitä olivat kuntien taloudellisten resurssien ja kunnan toimijoiden aikaresurssien vähäisyys. Ikäihmisten kuntoutuksesta saama hyöty näkyi mielialan kohenemisena ja kivun lie-vittymisenä, selvemmin laitoskuntoutukseen osallistuneilla. Avokuntoutuksessa pystyttiin ottamaan laitoskuntoutusta paremmin huomioon kuntoutujan kotiolot, ja heille suositeltiin useammin apuvälineitä ja tehtiin asunnonmuutostöitä.5,55 euro

A Little Bit Pregnant: Modeling How the Accurate Detection of Pregnancy Can Improve HIV Prevention Trials

The prevalence of unplanned pregnancies contributes to the methodological challenges of human immunodeficiency virus (HIV) prevention trials. In this paper, the authors discuss the incidence of pregnancy, including chemical pregnancy, and how the different methods of pregnancy diagnosis could affect the statistical power and calculated outcomes of HIV prevention trials. Study sample size inflation factors are estimated to aid in the design of clinical trials.The authors used published data of women attempting pregnancy as well as data from HPTN 055 (www.HPTN.org/research_studies/hptn055.asp) to estimate the percentage of early study discontinuation that would be associated with 3 diagnostic methods for pregnancy in a hypothetical clinical trial. They classified chemical pregnancies as false-positive pregnancy tests and showed the sample size adjustment that would be necessary in clinical trial design because of the early discontinuations associated with pregnancy. There is a greater than 3-fold difference in the number of falsely positive pregnancy tests that will be detected, depending upon the diagnostic method used. The number of incident pregnancies may render HIV prevention trial sample sizes inadequate by as much as 50%. Pregnancy prevention and precise pregnancy diagnosis are critical to the statistical power and integrity of HIV prevention trials