Attachment theory refers to the immense body of knowledge developed over the past 30 years about the importance of close relationships in early life and the impact of these on the individual's emotional and social development. Attachment behaviours are activated in the young child when he or she feels frightened or upset, and are aimed at getting close proximity with the primary caregiver in order to regain a state of security. However, the ways in which the caregiver responds to these emotional needs will in turn influence the way in which the child approaches the attachment figure in order to gain some sense of security. Attachment theory proposes that it is in the context of close relationships that the capacity for emotional regulation is developed, and where the child can begin to build up a sense of self, a sense of other and of what can be expected of relationships. But what happens when primary caregivers do not respond to their children's need for security? What is the impact of abuse and neglect over the child's cognitive, emotional and social development? Are these children still 'attached' to their caregivers, and if so, in what way?This book by Howe and colleagues aims at providing social workers with the basic concepts to understand dysfunctional families and individuals from the point of view of attachment theory. The authors make a good case for considering this perspective whilst thinking about foster care and family support. In this sense, the book focuses on the role of practitioners in trying to prevent further trans-generational transmission of insecure attachment styles and abuse.The first half of the book gives an excellent overview of attachment theory, including the basic concepts and attachment patterns across the lifespan, with special emphasis on high-risk psychosocial environments. In this section, the authors carefully bring together important findings from research and rich clinical descriptions, in a very interesting and accessible manner. It is a shame, however, that the work of Daniel Stern on infants' psychosocial development is missing. The second half of the book is dedicated to the possible application of attachment theory to practice. The authors propose that social workers should use key aspects of research instruments such as the 'Strange Situation' and the 'Adult Attachment Interview' (AAI) to assess attachment patterns and family dysfunctions, and on this basis plan their interventions.Although the reader may find this approach very appealing, it is not without great controversy. On the one hand, attachment researchers would argue that these instruments are designed to be used in highly controlled situations and Book reviews 71

Leptin expression in third trimester placenta (p) and leptin concentrations in umbilical cord blood (cb) were investigated in normal pregnancies [n = 10 (p), 31 (cb)] and abnormal pregnancies complicated with (i) maternal insulin-dependent diabetes [IDDM: n = 3 (p), 13 (cb)], (ii) gestational diabetes [GD: n = 2 (p), 10 (cb)] and (iii) fetal growth retardation [FGR: n = 5 (p), 5 (cb)]. By in-situ hybridization and immunohistochemistry, placental leptin mRNA and protein were co-localized to the syncytiotrophoblast and villous vascular endothelial cells. Leptin receptor was immunolocalized to the syncytiotrophoblast. Relative to controls, the FGR group was characterized by low concentrations of placental and cord blood leptin. In a twin pregnancy, the normal-sized infant exhibited more placental and cord blood leptin than its growth-retarded twin. In contrast, both diabetic groups exhibited high concentrations of placental leptin mRNA and protein. The IDDM group exhibited the highest concentrations of leptin in cord blood. No change was observed in the expression of the leptin receptor in either the growth-retarded or diabetic pregnancies. In conclusion, the localization of placental leptin suggests that it may be released into both maternal and fetal blood. Furthermore, in fetal growth-retarded and diabetic pregnancies, the changes in leptin expression in the placenta and in leptin concentrations in umbilical cord blood appear to be related.

Although caregiver factors are generally considered the more potent in determining children's attachment organization, a number of child factors have also been considered. Among these have been temperament and disabilities. The present paper examines the effect of various types of children's disability on parent–child interactions, including how disabilities affect parental sensitivity and communications. A brief outline of attachment theory and patterns of organization is followed by a review of the research evidence that has looked at children with disabilities and insecure attachments. A complex picture emerges in which it is not a child's disability per se that is associated with insecure attachments but rather an interaction between children with disabilities and the caregiver's state of mind with respect to attachment. Transactions between both child and caregiver vulnerability factors affect sensitivity, communications and security of attachment. Practice implications for prevention, advice and support are considered.

Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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