Sample records for adult role transitions

  1. Clinician roles and responsibilities during care transitions of older adults.

    PubMed

    Schoenborn, Nancy L; Arbaje, Alicia I; Eubank, Kathryn J; Maynor, Kenric; Carrese, Joseph A

    2013-02-01

    To identify the perceived roles and responsibilities of clinicians during care transitions of older adults. Qualitative study involving 1-hour in-depth semistructured interviews. Audiotapes of interviews were transcribed, coded, and analyzed, and themes and subthemes were generated. An acute care hospital, a skilled nursing facility, two community-based outpatient practices, and one home healthcare agency. Forty healthcare professionals directly involved in care transitions of older adults (18 physicians, 11 home healthcare administrative and field staff, four social workers, three nurse practitioners, three physician assistants, and one hospital case manager). Perspectives of healthcare professionals regarding clinicians' roles and responsibilities during care transitions were examined and described. Content analysis revealed several themes: components of clinicians' roles during care transitions; congruence between self- and others' perceived ideal roles but incongruence between ideal and routine roles; ambiguity in accountability in the postdischarge period; factors prompting clinicians to act closer to ideal roles; and barriers to performing ideal roles. A conceptual framework was created to summarize clinicians' roles during care transitions. This study reports differences between what healthcare professionals perceive as ideal roles of clinicians during care transitions and what clinicians actually do routinely. Certain patient and clinician factors prompt clinicians to act closer to the ideal roles. Multiple barriers interfere with consistent practice of ideal roles. Future investigations could evaluate interventions targeting various components of the conceptual framework and relevant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  2. Adolescents' Changing Future Expectations Predict the Timing of Adult Role Transitions

    ERIC Educational Resources Information Center

    Beal, Sarah J.; Crockett, Lisa J.; Peugh, James

    2016-01-01

    Individual differences in the transition to adulthood are well established. This study examines the extent to which heterogeneity in pathways to adulthood that have been observed in the broader U.S. population are mirrored in adolescents' expectations regarding when they will experience key adult role transitions (e.g., marriage). Patterns of…

  3. Adolescents’ Changing Future Expectations Predict the Timing of Adult Role Transitions

    PubMed Central

    Beal, Sarah J.; Crockett, Lisa J.; Peugh, James

    2016-01-01

    Individual differences in the transition to adulthood are well established. This study examines the extent to which heterogeneity in pathways to adulthood that have been observed in the broader U.S. population are mirrored in adolescents’ expectations regarding when they will experience key adult role transitions (e.g., marriage). Patterns of change in adolescents’ expectations and the relations between their expectations and subsequent role transitions are also explored. Data from 626 youth in Grade 11 (M age = 16), Grade 12, and early adulthood (M age = 23) are analyzed using mover-stayer latent transition analysis. Results indicate three profiles of expected timing, corresponding to youth who anticipate early role entry (i.e., early starters), youth who anticipate earlier entry into employment but no other roles (i.e., employment-focused), and youth who anticipate delays in role transitions favoring increased education (i.e., education-focused). Two-thirds of youths changed their expectations from Grade 11 to 12. Grade 11 and 12 profile membership predicted role transitions in early adulthood. These findings highlight the importance of adolescents’ expectations and changes in expectations across time in shaping entry into adulthood. PMID:27548390

  4. Role transitions and substance use among Hispanic emerging adults: A longitudinal study using coarsened exact matching.

    PubMed

    Allem, Jon-Patrick; Sussman, Steve; Soto, Daniel W; Baezconde-Garbanati, Lourdes; Unger, Jennifer B

    2016-07-01

    Emerging adulthood (ages 18 to 25) is characterized by changes in relationships, education, work, and viewpoints on life. The prevalence of substance use also peaks during this period. Among emerging adults, Hispanics have a unique substance use profile, and have been described as a priority population for substance use prevention. Cross-sectional studies among Hispanics have shown that specific role transitions (e.g., starting or ending romantic relationships) were associated with substance use. Negative affect from uncertainty/stress that accompanies role transitions in emerging adulthood may lead to substance use as a maladaptive coping mechanism. Longitudinal studies are needed to gain a more complete understanding of these associations. Participants completed surveys for Project RED, a longitudinal study of substance use among Hispanics in Southern California. This study used Coarsened Exact Matching to overcome the methodological limitations of previous studies. Participants were matched on pretreatment variables including age, gender, substance use behavior in high school, and depressive symptoms. Past-month cigarette use, binge drinking, marijuana use, and hard drug use were the outcomes of interest. After matching, each outcome was regressed on each individual role transition in year one of emerging adulthood with this process repeated in year two of emerging adulthood. Role transitions in romance and work were positively associated with multiple categories of substance use. Prevention programs should teach emerging adults ways to cope with the stress from role transitions. Individual role transitions may be used to screen for subgroups of emerging adults at high risk for substance use. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. The Relationship Between the Accumulated Number of Role Transitions and Hard Drug Use Among Hispanic Emerging Adults

    PubMed Central

    Allem, Jon-Patrick; Soto, Daniel; Baezconde-Garbanati, Lourdes; Unger, Jennifer

    2014-01-01

    Emerging adults (ages 18 to 25) who experience multiple role transitions in a short period of time may engage in hard drug use as a maladaptive coping strategy to avoid negative emotions from stress. Given the collectivistic values Hispanics encounter growing up, they may experience additional role transitions due to their group oriented cultural paradigm. This study examined whether those who experience many role transitions are at greater risk for hard drug use compared to those who experience few transitions among Hispanic emerging adults. Participants completed surveys indicating their hard drug use in emerging adulthood, role transitions in the past year of emerging adulthood, age, gender, and hard drug use in high school. Simulation analyses indicated that an increase in the number of role transitions, from 0 to 13, was associated with a 14% (95% CI, 4 to 29) higher probability of hard drug use. Specific role transitions were found to be associated with hard drug use, such as starting to date or experiencing a breakup. Intervention/prevention programs may benefit from acknowledging individual reactions to transitions in emerging adulthood, as these processes may be catalysts for personal growth where identities are consolidated, and decisions regarding hard drug use are formed. PMID:25715073

  6. The Relationship Between the Accumulated Number of Role Transitions and Hard Drug Use among Hispanic Emerging Adults.

    PubMed

    Allem, Jon-Patrick; Soto, Daniel; Baezconde-Garbanati, Lourdes; Unger, Jennifer

    2015-01-01

    Emerging adults (ages 18 to 25) who experience multiple role transitions in a short period of time may engage in hard drug use as a maladaptive coping strategy to avoid negative emotions from stress. Given the collectivistic values Hispanics encounter growing up, they may experience additional role transitions due to their group-oriented cultural paradigm. This study examined whether those who experience many role transitions are at greater risk for hard drug use compared to those who experience few transitions among Hispanic emerging adults. Participants completed surveys indicating their hard drug use in emerging adulthood, role transitions in the past year of emerging adulthood, age, gender, and hard drug use in high school. Simulation analyses indicated that an increase in the number of role transitions, from 0 to 13, was associated with a 14% (95% CI, 4 to 29) higher probability of hard drug use. Specific role transitions were found to be associated with hard drug use, such as starting to date or experiencing a breakup. Intervention/prevention programs may benefit from acknowledging individual reactions to transitions in emerging adulthood, as these processes may be catalysts for personal growth where identities are consolidated and decisions regarding hard drug use are formed.

  7. The Life Course in the Making: Gender and the Development of Adolescents' Expected Timing of Adult Role Transitions

    ERIC Educational Resources Information Center

    Crockett, Lisa J.; Beal, Sarah J.

    2012-01-01

    Adolescents' expectations about the timing of adult role transitions have the potential to shape their actual transitions, setting the stage for their adult lives. Although expectations about timing emerge by early adolescence, little is known about how these expectations develop across adolescence. This longitudinal study examined developmental…

  8. From adolescents to adults with congenital heart disease: the role of transition.

    PubMed

    Moceri, Pamela; Goossens, Eva; Hascoet, Sebastien; Checler, Carine; Bonello, Béatrice; Ferrari, Emile; Acar, Philippe; Fraisse, Alain

    2015-07-01

    Improved surgical care during the last decades, together with advances in medical management, led to a remarkable increase in survival of patients with congenital heart disease (CHD). However, aging of the CHD population brings new challenges, and loss of follow-up of adolescents and adults with CHD is a major concern. It is crucial to optimize the transfer of patients with CHD from paediatric to adult health care services to prevent loss to follow-up. The transition process plays a central role in the future health and follow-up of the patient. The aim of this review is to explain and discuss the clinical impact of the transition process in adolescents with CHD. We will also discuss specific CHD adolescents' problems. Adolescence is a crucial phase for the formation of the personality. Understanding and acceptance of the responsibility for health at this stage through a transition process with a multidisciplinary team will determine the quality of future medical follow-up and probably limit psychosocial issues in their adult life. • Aging of the congenital heart disease population brings new challenges to the organisation of care. • Loss of follow-up is a major concern for patients with congenital heart disease. What is new: • The quality of a formal transition process during adolescence will determine future outcomes in patients with congenital heart disease.

  9. Becoming adults: Challenges in the transition to adult roles.

    PubMed

    Furstenberg, Frank F

    2015-09-01

    This article summarizes the reasons for the slower passage to adult status (at least measured by demographic markers) and discusses some of the important implications of what today's pattern of becoming an adult means for young people, their families, and the larger society. By no means should this article be considered a review of the growing body of evidence on the changing pattern of adult transition. Indeed, there are many reviews of the literature on this topic, including books by Richard Settersten and Barbara Ray (2010) and Jeffrey Arnett (2015). The authors intention, rather, is to provide a short overview of the topic and to identify public policies needed to make social institutions capable of adapting successfully to this later regime for entering adulthood. Indeed, entering adulthood still involves school completion, home leaving, and entering a job that is full-time. For many young adults, it also includes forming a partnership and having children, though, as discussed later, these expectations are no longer universal in American society.

  10. Preparing childhood cancer survivors for transition to adult care: The young adult perspective.

    PubMed

    Frederick, Natasha N; Bober, Sharon L; Berwick, Lexie; Tower, Mary; Kenney, Lisa B

    2017-10-01

    Childhood cancer survivors (CCSs) remain at risk for developing treatment-associated health conditions as they age; however, many do not obtain recommended follow-up, putting them at unnecessary risk for morbidity. Educational interventions targeted at providing survivors with the knowledge and skills necessary for healthcare independence might improve adherence and outcomes as they transition care to the adult medical system. To identify informational needs, educational preferences, and support that young adult CCSs perceive as beneficial for transition from pediatric to adult medical care. Sixteen young adult CCSs (ages 22-39 years) who have transitioned to adult care participated in focus groups led by a trained moderator and analyzed using a thematic analysis approach. Four major themes emerged: (1) education preferences-pediatric oncology provider as the primary source of information and guidance, enhanced by other formats, and early and ongoing engagement in education; (2) family role in transition-desire for independence and acknowledgement of need for ongoing parental support; (3) expectations for adult providers, such as close relationships, open communication, and care coordination; and (4) knowledge deficits regarding disease/treatment history, risk for long-term complications, and navigation of the adult medical system. Transition education as described by young adult CCSs should be a developmentally appropriate process beginning in early adolescents, primarily administered by pediatric oncology providers, and delivered in multiple formats. While healthcare independence is a goal for young adult CCSs, all stakeholders must recognize that families and providers continue to have an important role supporting survivors with transition logistics and medical decision-making. © 2017 Wiley Periodicals, Inc.

  11. Psychologists and the Transition From Pediatrics to Adult Health Care.

    PubMed

    Gray, Wendy N; Monaghan, Maureen C; Gilleland Marchak, Jordan; Driscoll, Kimberly A; Hilliard, Marisa E

    2015-11-01

    Guidelines for optimal transition call for multidisciplinary teams, including psychologists, to address youth and young adults' multifactorial needs. This study aimed to characterize psychologists' roles in and barriers to involvement in transition from pediatric to adult health care. Psychologists were invited via professional listservs to complete an online survey about practice settings, roles in transition programming, barriers to involvement, and funding sources. Participants also responded to open-ended questions about their experiences in transition programs. One hundred participants responded to the survey. Involvement in transition was reported at multiple levels from individual patient care to institutional transition programming, and 65% reported more than one level of involvement. Direct clinical care (88%), transition-related research (50%), and/or leadership (44%) involvement were reported, with 59% reporting more than one role. Respondents often described advocating for their involvement on transition teams. Various sources of funding were reported, yet, 23% reported no funding for their work. Barriers to work in transition were common and included health care systems issues such as poor coordination among providers or lack of a clear transition plan within the clinic/institution. Psychologists assume numerous roles in the transition of adolescents from pediatric to adult health care. With training in health care transition-related issues, psychologists are ideally positioned to partner with other health professionals to develop and implement transition programs in multidisciplinary settings, provided health care system barriers can be overcome. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  12. A Pilot Study Exploring the Role of Physical Therapists and Transition in Care of Pediatric Patients with Cystic Fibrosis to the Adult Setting

    PubMed Central

    Packel, Lora; Sood, Megha; Gormley, Michelle; Hayden, Rebecca

    2013-01-01

    Background Cystic fibrosis (CF) is a disease that requires intensive multidisciplinary care, including care by physical therapists (PTs). People with CF are now living well into adulthood, necessitating a transfer of care from the pediatric setting to an adult one. Physical therapists play a large role in the care of the person with CF; however, there is little known about the PT role in transition of care. Purpose To explore transition issues for people with CF from the perspective of PTs. Methods An 18-question online survey was sent to PTs via an electronic CF listserv. Questions were derived from an analysis of transition literature in CF and other chronic childhood conditions. Physical therapists who reported treating people with CF gave their opinions on issues impacting transition from their perspective as well as their perception of patient and parent concerns. Descriptive statistics were used for data analysis. Results A total of 26 PTs completed the survey. A majority, 61.5%, reported that there was a transition program at their facility, with 42.3% involving physical therapy. Common themes for patients and parents included feeling uncertain about: knowledge of the adult physician, acquiring pulmonary infections in the adult setting, and pace of the adult clinic. Physical therapists were concerned about adherence with airway clearance and exercise following transfer to the adult clinic. Conclusions The role of PT in transition programs is quite varied. Physical therapists should address common concerns of their patients and families to improve the transition process and possibly impact adherence to the PT plan of care. PMID:23754936

  13. Transition Readiness in Adolescents and Emerging Adults with Diabetes: The Role of Patient-Provider Communication

    PubMed Central

    Hilliard, Marisa; Sweenie, Rachel; Riekert, Kristin

    2013-01-01

    Transition from pediatric to adult care represents a high risk period for adolescents and emerging adults with diabetes. Fundamental differences between pediatric and adult care delivery models may contribute to increased risk for poor health outcomes. This review provides a brief overview of models of care in pediatric and adult settings and focuses on patient-provider communication content and quality as potential points of intervention to improve transition-related outcomes. This review also highlights disparities in transition and communication for adolescents and emerging adults from racial/ethnic minority groups and discusses recent changes in health care legislation that have significant implications for the transition process. Intervention opportunities include programs to enhance developmentally-appropriate patient-provider interactions and increased attention to promoting transition readiness skills. Improving patient-provider communication may hasten the development of vital self-advocacy skills needed in adult health care systems and, thus, help establish a lasting pattern of positive diabetes self-care. PMID:24014075

  14. Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.

    PubMed

    Maturo, Donna; Powell, Alexis; Major-Wilson, Hannah; Sanchez, Kenia; De Santis, Joseph P; Friedman, Lawrence B

    2015-01-01

    Advances in care and treatment of adolescents/young adults with HIV infection have made survival into adulthood possible, requiring transition to adult care. Researchers have documented that the transition process is challenging for adolescents/young adults. To ensure successful transition, a formal transition protocol is needed. Despite existing research, little quantitative evaluation of the transition process has been conducted. The purpose of the study was to pilot test the "Movin' Out" Transitioning Protocol, a formalized protocol developed to assist transition to adult care. A retrospective medical/nursing record review was conducted with 38 clients enrolled in the "Movin' Out" Transitioning Protocol at a university-based adolescent medicine clinic providing care to adolescents/young adults with HIV infection. Almost half of the participants were able to successfully transition to adult care. Reasons for failure to transition included relocation, attrition, lost to follow-up, and transfer to another adult service. Failure to transition to adult care was not related to adherence issues, X(2) (1, N=38)=2.49, p=.288; substance use, X(2) (1, N=38)=1.71, p=.474; mental health issues, X(2) (1, N=38)=2.23, p=.322; or pregnancy/childrearing, X(2) (1, N=38)=0.00, p=.627). Despite the small sample size, the "Movin' Out" Transitioning Protocol appears to be useful in guiding the transition process of adolescents/young adults with HIV infection to adult care. More research is needed with a larger sample to fully evaluate the "Movin' Out" Transitioning Protocol. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Causal effects of transitions to adult roles on early adult smoking and drinking: Evidence from three cohorts.

    PubMed

    Green, Michael J; Leyland, Alastair H; Sweeting, Helen; Benzeval, Michaela

    2017-08-01

    Transitions into work and family roles have become increasingly delayed as participation in tertiary education widens. Such transitions may have adverse or beneficial effects on health behaviours such as smoking and drinking (alcohol). Role socialisation effects may reduce smoking or drinking, but clustering of transitions may lead to role overload, weakening or reversing any role socialisation effects. Effects of transitions were examined in three UK cohorts: the 1958 National Child Development Study, the 1970 British Birth Cohort Study, and the West of Scotland: Twenty-07 Youth Cohort (from around Glasgow, growing up in the same time period as the 1970 cohort). Latent class analysis was employed to identify heterogeneous patterns of transition timing for leaving education, entering employment, starting cohabitation, having a first child, and leaving the parental home. Propensity weighting was then used to estimate causal effects of transition patterns (relative to tertiary education) on smoking and heavy drinking in early adulthood (ages 22-26), adjusting for background confounders (gender, parental socioeconomic position, family structure, parental and adolescent health behaviours, adolescent distress and school performance). Three groups made early (age 16) transitions from education to employment and then either delayed other transitions, made other transitions quickly, or staggered transitions with cohabitation beginning around ages 19-21; a fourth group transitioned from education to employment around ages 17-18. Compared to those in tertiary education with similar background characteristics, those in these groups generally had higher levels of smoking, especially where transitions were more clustered, but less heavy drinking (except those who delayed other transitions after moving into employment). Results partially supported role socialisation effects for drinking, and role overload effects for smoking. Wider participation in tertiary education could have

  16. The Experiences of Mothers of Young Adults with an Intellectual Disability Transitioning from Secondary School to Adult Life

    ERIC Educational Resources Information Center

    Dyke, Paula; Bourke, Jenny; Llewellyn, Gwynnyth; Leonard, Helen

    2013-01-01

    Background: The transition from school to adulthood for young adults with an intellectual disability involves movement from a generally secure and supported school environment to an emerging adult life that may be characterised by a wide variation in adoption of adult roles related to employment, independent living, friendships, and day…

  17. Tryin' to Make It during the Transition from High School: The Role of Family Obligation Attitudes and Economic Context for Latino-Emerging Adults

    ERIC Educational Resources Information Center

    Sanchez, Bernadette; Esparza, Patricia; Colon, Yari; Davis, Katrina E.

    2010-01-01

    The aim of the current study was to examine the role of familial and economic context in the decisions and behaviors of low-income, urban Latinos during the transition from high school. Thirty-two Latino emerging adults who graduated from a public high school participated in one-on-one in-depth interviews about their transition. Participants…

  18. Adult Transition Program without Walls

    ERIC Educational Resources Information Center

    Moberg, Eric

    2010-01-01

    Best practices in adult transition special education for moderate to severe students suggest student-centered planning that maximizes independence in adult life. Based on the above sources, school districts and governing boards would best serve moderate to severe transition special education students with increasing integration into the community…

  19. Dimensions of the transition service coordinator role.

    PubMed

    Betz, Cecily L; Redcay, Gay

    2005-01-01

    This article describes the development and implementation of an innovative advanced practice role, as a transition service coordinator for nurses who work with adolescents with special healthcare needs. Transition services for adolescents with special healthcare needs is an area of growing clinical need requiring that all healthcare professionals, including advanced practice nurses develop new clinical knowledge and skills to practice effectively. This emerging specialty area will require advanced practice nurses to provide direct services blending both pediatric and adult healthcare needs and to function in advanced practice roles such as case managers who can ensure the coordination of services between these two very different systems of care while promoting the youth's acquisition of goals for adulthood. This nursing role was first created to provide and coordinate transition services to youth seen in a piloted clinic titled Creating Healthy Futures. This article describes the various components of this nursing role that incorporated the advanced practice dimensions of clinical expert, consultant, change agent, leader, researcher, and educator that can be replicated in other clinical settings.

  20. Role transitions and young adult maturing out of heavy drinking: evidence for larger effects of marriage among more severe premarriage problem drinkers.

    PubMed

    Lee, Matthew R; Chassin, Laurie; MacKinnon, David P

    2015-06-01

    Research has shown a developmental process of "maturing out" of problem drinking beginning in young adulthood. Perhaps surprisingly, past studies suggest that young adult drinking reductions may be particularly pronounced among those exhibiting relatively severe forms of problem drinking earlier in emerging adulthood. This may occur because more severe problem drinkers experience stronger ameliorative effects of normative young adult role transitions like marriage. The hypothesis of stronger marriage effects among more severe problem drinkers was tested using 3 waves of data from a large ongoing study of familial alcohol disorder (N = 844; 51% children of alcoholics). Longitudinal growth models characterized (i) the curvilinear trajectory of drinking quantity from ages 17 to 40, (ii) effects of marriage on altering this age-related trajectory, and (iii) moderation of this effect by premarriage problem drinking levels (alcohol consequences and dependence symptoms). Results confirmed the hypothesis that protective marriage effects on drinking quantity trajectories would be stronger among more severe premarriage problem drinkers. Supplemental analyses showed that results were robust to alternative construct operationalizations and modeling approaches. Consistent with role incompatibility theory, findings support the view of role conflict as a key mechanism of role-driven behavior change, as greater problem drinking likely conflicts more with demands of roles like marriage. This is also consistent with the developmental psychopathology view of transitions and turning points. Role transitions among already low-severity drinkers may merely represent developmental continuity of a low-risk trajectory, whereas role transitions among higher-severity problem drinkers may represent developmentally discontinuous "turning points" that divert individuals from a higher- to a lower-risk trajectory. Practically, findings support the clinical relevance of role-related "maturing out

  1. Transitions that matter: life course differences in the employment of adults with arthritis.

    PubMed

    Jetha, Arif; Bowring, Julie; Tucker, Sean; Connelly, Catherine E; Martin Ginis, Kathleen A; Proulx, Laurie; Gignac, Monique A M

    2017-09-18

    To understand the similarities and differences in the employment participation of people living with arthritis across the life course. Focus groups and interviews were conducted with young (ages 18-34 years, n = 7), middle-aged (ages 35-54 years, n = 13) and older adults (>55 years, n = 25) with arthritis. Participants were asked about the impact of arthritis on employment, experiences with health-related changes, career progression and social role involvement. A modified grounded theory approach was used to inductively analyze the data. Young adults indicated the school-to-work transition as being influential in their employment and described the need to direct their time and energy toward finding work that accommodated health and met career aspirations. Middle-aged adults described how the transition from good health to an arthritis diagnosis disrupted involvement in diverse social roles. However, they often downplayed the impact of arthritis on employment. Older adults described the work-to-retirement transition and their decline in physical functioning as contributing to changing involvement in the labor market. Transitions related to health, career progression and social role involvement shaped employment experiences, and represent opportunities for future research and practice that is tailored to life course issues. Implications for rehabilitation Little is known about the work experiences of young- and middle-aged adults with arthritis and how they compare to their older counterparts. Life course theory offers an important framework for research and practice by providing a perspective to enhance our understanding of how employment participation differs across phases of life. Salient and diverse changes related to health, career and social role involvement were identified at each life phase and shaped employment. Rehabilitation practitioners should pay special attention to a client's age, life phase and work history as a strategy to enhance

  2. The Role of Health Advocacy in Transitions from Pediatric to Adult Care for Children with Special Health Care Needs: Bridging Families, Provider and Community Services.

    PubMed

    Okumura, Megumi J; Saunders, Mara; Rehm, Roberta S

    2015-01-01

    Youth and young adults with special healthcare needs (YASHCN) experience challenges during transition from pediatric to adult care. Prior studies have not examined how community and healthcare resources can work together to assist YASHCN in transitioning from child-focused care and services to adult-oriented providers. The aim of this study was to develop a theoretical understanding of how family, healthcare providers and community supports can assist YASHCN during the transition from pediatric to adult healthcare and services. We conducted 41 semi-structured interviews with YASHCN aged 16-25, their family members and healthcare and community providers. We focused our interviews on support mechanisms, both within the traditional healthcare system, and those available in the community. Using grounded theory methods, we performed a multi-step analysis process. The theoretical code "Transition Advocacy" was developed from the data. This theoretical perspective arose from three major categories, which were developed in the analysis: "Fighting for healthcare", "Obtaining resources", and "Getting ready to transition". Transition Advocacy consists of the presence of, or need for, a healthcare "advocate" who did or can assist the YASHCN with the healthcare transition, particularly to navigate complex health or community services. The "advocate" role was performed by family members, healthcare or agency professionals, or sometimes the YASHCN themselves. If advocates were identified, youth were more likely to obtain needed services. Parents, health providers, and community agencies are potentially well-poised to assist transitioning YASHCN. Efforts to encourage development of strong advocacy skills will facilitate better transitions for YASHCN. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Youths Transitioning as Adult Learners

    ERIC Educational Resources Information Center

    Davis, C. Amelia

    2014-01-01

    This chapter considers how transitions to adulthood have been historically represented and presents alternative ways of thinking about transitions to adulthood through the context of adult basic education programs.

  4. Parents in transition: Experiences of parents of young people with a liver transplant transferring to adult services.

    PubMed

    Wright, J; Elwell, L; McDonagh, J E; Kelly, D A; Wray, J

    2017-02-01

    Predictors of successful transition from pediatric to adult services include ability to self-manage and engage with healthcare services. Parents have a key role in healthcare management throughout childhood and adolescence including encouraging development of self-management skills in their children. Transition to adult services can be challenging for parents and young people, yet parents' views regarding transition remain largely unexplored. Nine parents of pediatric liver transplant recipients (15.2-25.1 yr) participated in semistructured interviews. Interviews were analyzed using IPA. Analysis revealed three key themes: "emotional impact of transplantation," "protection vs. independence," and "ending relationships and changing roles." Parents expressed the dichotomous nature of the desire to promote independence in their child while still maintaining control and protection, and discussed how changing roles and relationships were difficult to navigate. Parents are important facilitators of young people's development of self-management skills for successful transfer to adult services. Parents should be supported to move from a "managerial" to a "supervisory" role during transition to help young people engage independently with the healthcare team. Findings support the development of interventions for parents to emphasize their role in transition and guide the transfer of self-management skills from parent to young person. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Role Transitions and Young Adult Maturing Out of Heavy Drinking: Evidence for Larger Effects of Marriage among More Severe Pre-Marriage Problem Drinkers

    PubMed Central

    Lee, Matthew R.; Chassin, Laurie; MacKinnon, David P.

    2015-01-01

    Background Research has shown a developmental process of “maturing out” of problem drinking beginning in young adulthood. Perhaps surprisingly, past studies suggests that young adult drinking reductions may be particularly pronounced among those exhibiting relatively severe forms of problem drinking earlier in emerging adulthood. This may occur because more severe problem drinkers experience stronger ameliorative effects of normative young adult role transitions like marriage. Methods The hypothesis of stronger marriage effects among more severe problem drinkers was tested using three waves of data from a large ongoing study of familial alcohol disorder (Chassin et al., 1992; N=844; 51% children of alcoholics). Results Longitudinal growth models characterized (1) the curvilinear trajectory of drinking quantity from ages 17-40, (2) effects of marriage on altering this age-related trajectory, and moderation of this effect by pre-marriage problem drinking levels (alcohol consequences and dependence symptoms). Results confirmed the hypothesis that protective marriage effects on drinking quantity trajectories would be stronger among more severe pre-marriage problem drinkers. Supplemental analyses showed that results were robust to alternative construct operationalizations and modeling approaches. Conclusions Consistent with role incompatibility theory, findings support the view of role conflict as a key mechanism of role-driven behavior change, as greater problem drinking likely conflicts more with demands of roles like marriage. This is also consistent with the developmental psychopathology view of transitions and turning points. Role transitions among already low-severity drinkers may merely represent developmental continuity of a low-risk trajectory, whereas role transitions among higher-severity problem drinkers may represent developmentally discontinuous “turning points” that divert individuals from a higher- to a lower-risk trajectory. Practically

  6. The Role of Health Advocacy in Transitions from Pediatric to Adult Care for Children with Special Health Care Needs: Bridging Families, Provider and Community Services

    PubMed Central

    Okumura, Megumi; Saunders, Mara; Rehm, Roberta S.

    2015-01-01

    Background Youth and young adults with special healthcare needs (YASHCN) experience challenges during transition from pediatric to adult care. Prior studies have not examined how community and healthcare resources can work together to assist YASHCN in transitioning from child-focused care and services to adult-oriented providers. Objective To develop a theoretical understanding of how family, healthcare providers and community supports can assist YASHCN during the transition from pediatric to adult healthcare and services. Design/Methods We conducted 41 semi-structured interviews with YASHCN aged 16-25, their family members and healthcare and community providers. We focused our interviews on support mechanisms, both within the traditional healthcare system, and those available in the community. Using grounded theory methods, we performed a multi-step analysis process. Results The theoretical code “Transition Advocacy” was developed from the data. This theoretical perspective arose from three major categories, which were developed in the analysis: “Fighting for healthcare”, “Obtaining resources”, and “Getting ready to transition”. Transition Advocacy consists of the presence of, or need for, a healthcare ”advocate”’ who did or can assist the YASHCN with the healthcare transition, particularly to navigate complex health or community services. The ”advocate” role was performed by family members, healthcare or agency professionals, or sometimes the YASHCN themselves. If advocates were identified, youth were more likely to obtain needed services. Conclusions Parents, health providers, and community agencies are potentially well-poised to assist transitioning YASHCN. Efforts to encourage development of strong advocacy skills will facilitate better transitions for YASHCN. PMID:26228309

  7. Changes in Grandchildren's Adult Role Statuses and Their Relationships with Grandparents

    ERIC Educational Resources Information Center

    Monserud, Maria A.

    2011-01-01

    This study examines the associations between grandchildren's (N = 1,170) adult role transitions and their contact with, and closeness to, grandparents, by drawing on data from Waves 2 and 3 of the National Survey of Families and Households. Findings indicate that this relationship is frequently contingent on the nature of the adult role in…

  8. Managing Transition with Support: Experiences of Transition from Child and Adolescent Psychiatry to General Adult Psychiatry Narrated by Young Adults and Relatives

    PubMed Central

    Söderberg, Siv; Skär, Lisa

    2014-01-01

    Young adults with mental illness who need continuing care when they turn 18 are referred from child and adolescent psychiatry to general adult psychiatry. During this process, young adults are undergoing multiple transitions as they come of age while they transfer to another unit in healthcare. The aim of this study was to explore expectations and experiences of transition from child and adolescent psychiatry to general adult psychiatry as narrated by young adults and relatives. Individual interviews were conducted with three young adults and six relatives and analysed according to grounded theory. The analysis resulted in a core category: managing transition with support, and three categories: being of age but not mature, walking out of security and into uncertainty, and feeling omitted and handling concerns. The young adults' and relatives' main concerns were that they might be left out and feel uncertainty about the new situation during the transition process. To facilitate the transition process, individual care planning is needed. It is essential that young adults and relatives are participating in the process to be prepared for the changes and achieve a successful transition. Knowledge about the simultaneous processes seems to be an important issue for facilitating transition. PMID:24829900

  9. Pediatric to Adult Care Transition: Perspectives of Young Adults With Sickle Cell Disease.

    PubMed

    Porter, Jerlym S; Wesley, Kimberly M; Zhao, Mimi S; Rupff, Rebecca J; Hankins, Jane S

    2017-10-01

    The aim of this study was to explore perspectives of transition and transition readiness of young adult patients (YAs) with sickle cell disease (SCD) who have transitioned to adult health care. In all, 19 YAs with SCD (ages 18-30 years) participated in one of three focus groups and completed a brief questionnaire about transition topics. Transcripts were coded and emergent themes were examined using the social-ecological model of adolescent and young adult readiness for transition (SMART). Themes were consistent with most SMART components. Adult provider relationships and negative medical experiences emerged as salient factors. YAs ranked choosing an adult provider, seeking emergency care, understanding medications/medication adherence, knowing SCD complications, and being aware of the impact of health behaviors as the most important topics to include in transition programming. The unique perspectives of YAs can inform the development and evaluation of SCD transition programming by incorporating the identified themes. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Graduation Day: Healthcare Transition From Pediatric to Adult.

    PubMed

    Green Corkins, Kelly; Miller, Michelle A; Whitworth, John R; McGinnis, Carol

    2018-02-01

    Because more patients with pediatric-onset chronic conditions are surviving into adulthood, they are graduating from pediatric healthcare to self-management and adult healthcare. This transfer of care needs to be a process of transitioning medical and nutrition care. Despite having position statements from professional organizations and several proposed models, issues in the transition process have been well described, and gaps in transition care persist. Healthcare providers need to be aware of special needs of emerging adults related to education on chronic condition and self-management skills, emotional support before and after transition, and legal rights for both the patient and the parent if the emerging adult is not developmentally appropriate to make his or her own healthcare decisions. Both pediatric and adult providers need to be in active communication with each other and the patient to develop trusting relationships and actively support the transition of care. This review of literature describes several models for transitioning, measureable outcomes, insurance provider issues, and legal issues pertaining to healthcare transition. © 2018 American Society for Parenteral and Enteral Nutrition.

  11. Assessment of personality functioning in the transition from adolescent to adult life: preliminary findings.

    PubMed

    Naughton, M; Oppenheim, A; Hill, J

    1996-01-01

    The Adolescent to Adult Personality Functioning Assessment (ADAPFA) a modification of the Adult Personality Functioning Assessment (APFA) is described. It may be used to assess specific and general social dysfunction in the transition from childhood to adult life. Two raters independently rated 38 audiotaped interviews to test the interrater reliability of the instrument. The relationship between dysfunction in specific domains and overall psychosocial dysfunction was examined. Interrater reliabilities for the total ADAPFA score and for the majority of the domains were high. Agreement on type of dysfunction and on categorical ratings indicating the presence of personality disorder were good. The ADAPFA is a useful measure of interpersonal and social role performance in the transition between adolescent and adult life.

  12. Transitioning to Adulthood: How Do Young Adults Fare and What Characteristics Are Associated with a Lower-Risk Transition? Research Brief. Publication #2014-18

    ERIC Educational Resources Information Center

    Terzian, Mary A.; Moore, Kristin A.; Constance, Nicole

    2014-01-01

    Youth must navigate various developmental tasks as they transition to adulthood, and during this period of "emerging adulthood," young people explore roles and relationships before committing to the ones they will fill as adults. This brief seeks to identify patterns and transitions during emerging adulthood to obtain a better…

  13. Transitioning youth to adult healthcare: new tools from the Illinois Transition Care Project.

    PubMed

    Sanabria, K E; Ruch-Ross, H S; Bargeron, J L; Contri, D A; Kalichman, M A

    2015-01-01

    To improve youths' transition to adult healthcare, especially for youth with disabilities, The Illinois Transition Care Project created separate, yet complementary, curricula for pediatric and adult-oriented providers. Content from the curricula was tested by practicing physicians. The project created a library of skill worksheets with functional goals for patients. All methods included opportunities to teach life skills to patients to independently manage their conditions. The curricula used Maintenance of Certification (MOC) Part 4 credit as an incentive for physician participation. Pediatric pilot data indicate improvement across all sites and activities. Adult medicine results indicate increased perceived importance and feasibility of accepting young adult patients with childhood conditions. Patient/parent reviewers indicate the tools are understandable, interesting, and effective. Findings suggest the curricula, with MOC Part 4 credit for physicians, are effective in improving transition care. Project results provided new information on population management for transitioning youth and on the use of MOC Part 4 credit as an incentive. Findings have implications for primary care and specialty physicians, team-based care, teaching self-management skills to patients and methods for engaging adult-oriented physicians in the transition process.

  14. The Role of Higher Education in Their Life: Emerging Adults on the Crossroad

    ERIC Educational Resources Information Center

    Chiang, Shu-Chen; Hawley, Josh

    2013-01-01

    This study describes the experience of younger, so called "emerging" adults, as they transition to full-time work, focusing specifically on the role of education in this process. When leaving their family-of-origin, emerging adults re-center themselves to settle down in permanent identity and different role commitments. Our findings show…

  15. Transitioning from pediatric care to adult care for adolescents with special health care needs: dentist perspectives (part 2)

    PubMed Central

    Bayarsaikhan, Zoljargal; Cruz, Stephanie; Neff, John; Chi, Donald L.

    2015-01-01

    Purpose To understand dental care transitions for adolescents with special health care needs (ASHCN) from the dentist perspective. Methods We conducted semi-structured interviews with 13 dentists (seven pediatric dentists and six general dentists) to learn about the dental transition process for ASHCN. Results Most dentists believed transitions from child-centered to adult-centered dental care were important for ASHCN. Dentists reported two main barriers to transitions: low dental reimbursements by Medicaid and a shortage of general dentists qualified or willing to treat ASHCN. Pediatric and general dentists reported playing complimentary roles in facilitating transitions for ASHCN and their families. Conclusions Dentists acknowledged the challenges that ASHCN and their families face in transitioning to adult-centered care and believed in the importance of ASHCN maintaining a dental home. Pediatric dentists and general dentists play a key role in working together to implement dental transition plans for the ASHCN and to ensure successful dental transitions. PMID:26531088

  16. Transitioning from Pediatric to Adult Dental Care for Adolescents with Special Health Care Needs: Dentist Perspectives--Part Two.

    PubMed

    Bayarsaikhan, Zoljargal; Cruz, Stephanie; Neff, John; Chi, Donald L

    2015-01-01

    The purpose of this study was to understand dental care transitions for adolescents with special health care needs (ASHCNs) from the dentist perspective. We conducted semi-structured interviews with 13 dentists (seven pediatric dentists and six general dentists) to learn about the dental transition process for ASHCNs. Most dentists believed transitions from child-centered to adult-centered dental care were important for ASHCNs. Dentists reported two main barriers to transitions: (1) low dental reimbursements by Medicaid; and (2) a shortage of general dentists qualified or willing to treat ASHCNs. Pediatric and general dentists reported playing complimentary roles in facilitating transitions for ASHCNs and their families. Dentists acknowledged the challenges that adolescents with special health care needs and their families face in transitioning to adult-centered care and believed in the importance of ASHCNs maintaining a dental home. Pediatric dentists and general dentists play a key role in working together to implement dental transition plans for ASHCNs and to ensure successful dental transitions.

  17. Adult care providers' perspectives on the transition to adult care for emerging adults with Type 1 diabetes: a cross-sectional survey.

    PubMed

    Michaud, S; Dasgupta, K; Bell, L; Yale, J-F; Anjachak, N; Wafa, S; Nakhla, M

    2018-03-25

    To assess adult diabetes care providers' current transition practices, knowledge about transition care, and perceived barriers to implementation of best practices in transition care for emerging adults with Type 1 diabetes mellitus. We administered a 38-item web-based survey to adult diabetes care providers identified through the Québec Endocrinologist Medical Association and Diabetes Québec. Fifty-three physicians responded (35%). Fewer than half of all respondents (46%) were familiar with the American Diabetes Association's transition care position statement. Approximately one-third of respondents reported a gap of >6 months between paediatric and adult diabetes care. Most (83%) believed communication with the paediatric team was adequate; however, only 56% reported receiving a medical summary and 2% a psychosocial summary from the paediatric provider. Respondents believed that the paediatric team should improve emerging adults' preparation for transition care by developing their self-management skills and improve teaching about the differences between paediatric and adult-oriented care. Only 31% had a system for identifying emerging adults lost to follow-up in adult care. Perceived barriers included difficulty accessing psychosocial services, emerging adults' lack of motivation, and inadequate transition preparation. Most (87%) were interested in having additional resources, including a self-care management tool and a registry to track those lost to follow-up. Our findings highlight the need to better engage adult care providers into transition care practices. Despite adult physicians' interest in transition care, implementation of transition care recommendations and resources in clinical care remains limited. Enhanced efforts are needed to improve access to mental health services within the adult healthcare setting. © 2018 Diabetes UK.

  18. Transition from paediatric to adult healthcare for young people with cystic fibrosis: Parents' information needs.

    PubMed

    Coyne, Imelda; Malone, Helen; Chubb, Emma; While, Alison E

    2018-01-01

    Parents of young people with cystic fibrosis (YPWCF) play an important role during the transition from paediatric to adult health services. There is limited evidence on parental information needs and the extent to which they are met. An online survey was conducted targeting a finite population of 190 parents of YPWCF in Ireland. Fifty-nine parents responded (31% response rate). Parents reported the need for more general preparation and timing of the transfer, more information regarding the differences between adult and child health services and how their child will self-manage his/her illness in the future. Most parents received information on the timing of transfer and new healthcare providers but reported being insufficiently informed about their legal status relating to medical confidentiality for their adult child and community resources available for their child after transition to adult health services. The findings highlight the importance of information and preparation for caregivers as well as young people to promote successful transition to adult healthcare. Providing parents with clear information and anticipatory guidance are simple changes in practice that may lead to improvements in transition experiences.

  19. "Child-Adult" Transition - Adolescence: When Illness Appears….

    PubMed

    Malivoir, Sabine; Gueniche, Karinne

    2018-01-01

    Considering the patient's transition from child to adolescent to adult and its psychological aspects in endocrinology and diabetology, it is necessary to recall the child's psycho-affective development when he enters adolescence. Indeed, adolescence appears paradigmatic of the "child-adult" transition; it is a specific and decisive psychic process which allows the child to become an adult, that is to say autonomous and subject to his desire. In our paper, we study the resonance of a chronic disease in young people; type 1 diabetes is chosen. © 2018 S. Karger AG, Basel.

  20. Role transition in primary care settings.

    PubMed

    Holt, Ian G S

    2008-01-01

    This paper reports on research that explored how nurses who are engaged in advanced practice adapt and adjust to their roles in primary and community health settings. Successive government policy has highlighted how the changing roles of nurses, who are engaged in advanced practice, are crucial to delivering high-quality patient care. The paper offers a framework for role transition which is potentially generalisable to doctors, physiotherapists and other healthcare professionals. The aim of the study was to enable an understanding of role transition, from a study of nurses going through changes to their roles or moving to new roles. The intended purpose of the study was to explore what was going on within role transition, and considers by what process(es) role transition evolves or is experienced. Eleven nurses' actions, expectations, and experiences of role transition were explored, within three district nurse centres and two community NHS trusts. Data were collected from participant and non-participant observation, content analysis of job descriptions and from individual and group interviews, including semi-structured schedules and focus group techniques. Data were comparatively analysed to conceptualise and saturate core themes, which were discussed and developed with participants and healthcare managers. A theory of role transition is proposed through a model representing the 'who', 'what', 'where' and 'how' of role transition, through four concepts of centring identity(ies); focusing role(s); enacting role(s); and shaping role(s). Identity was regarded by the participants as being the role, the person, and as part of a group. Current and anticipated role foci directed enactment of role within given contexts and resources, while shaping of role involved a balance of role loss and role expansion. This article presents a theory of role transition for primary care professionals.

  1. Health system strategies supporting transition to adult care.

    PubMed

    Hepburn, Charlotte Moore; Cohen, Eyal; Bhawra, Jasmin; Weiser, Natalie; Hayeems, Robin Z; Guttmann, Astrid

    2015-06-01

    The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system 'disintegration'. (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues. An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies). Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare. Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not

  2. Adolescent to Adult HIV Health Care Transition From the Perspective of Adult Providers in the United States.

    PubMed

    Tanner, Amanda E; Philbin, Morgan M; Ma, Alice; Chambers, Brittany D; Nichols, Sharon; Lee, Sonia; Fortenberry, J Dennis

    2017-10-01

    The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives. We examined health care transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies. Overall, participants described health care transition as a "warm handoff" and a collaborative effort across adolescent and adult clinics. Emergent transition themes included adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth's first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols). Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and to improve continuum of care outcomes. Copyright © 2017 Society for Adolescent Health and Medicine. All rights reserved.

  3. Transition to adult-oriented health care: perspectives of youth and adults with complex physical disabilities.

    PubMed

    Young, Nancy L; Barden, Wendy S; Mills, Wendy A; Burke, Tricia A; Law, Mary; Boydell, Katherine

    2009-01-01

    The transition to adulthood is extremely difficult for individuals with disabilities. We sought to explore the specific issue of transition to adult-oriented health care in a Canadian context. We conducted semi-structured individual interviews with 15 youth and 15 adults with cerebral palsy, spina bifida, and acquired brain injuries of childhood, and their parents (n = 30). Respondents discussed their health care services, their experience with clinical transition, and contributing factors. We analyzed the transcripts using qualitative methods. All participants identified challenges in transition, including: lack of access to health care; lack of professionals' knowledge; lack of information and uncertainty regarding the transition process. Two solutions were identified: early provision of detailed information and more extensive support throughout the clinical transition process. The challenges of clinical transition were universal. More extensive information and support is needed during transition to ensure an efficient move to appropriate adult-oriented health care.

  4. Transition Planning Guide: From School to Adult Life.

    ERIC Educational Resources Information Center

    Thompson, Sandra Jespersen

    The guide is intended to assist disabled students, their families, and professionals working with them to become familiar with the variety of adult services available and to create a systematic plan for transition from school to adult life. The first section considers the logistics of transition planning and includes a description of the planning…

  5. Transitional Care for Older Adults with Chronic Illnesses as a Vulnerable Population: Theoretical Framework and Future Directions in Nursing.

    PubMed

    Son, Youn Jung; You, Mi Ae

    2015-12-01

    Effective transitional care is needed to improve the quality of life in older adult patients with chronic illness and avoid discontinuity of care and adverse events. The aim of this article is to provide an overview of the key features, broader implications, and the utility of Meleis' transition theory intended for the transitional care of older adults with chronic illnesses. We present the role of nurse in the context of transitional care and propose future directions to increase the quality of nursing care. The online databases Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Science Direct were searched for relevant literature published since 1970 along with textbooks regarding nursing theory. An evaluation of the usefulness of transition theory based on transitional care in older adult patients with chronic illnesses is provided. Healthy transition should be the expected standard of nursing care for older adults across all healthcare settings. Nurses need to contribute to the development of transitional care for vulnerable populations; however, transition theory needs to be enhanced through additional theoretical work and repeated evaluations of the applicability in areas of transitional care.

  6. Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community

    PubMed Central

    Burke, Robert E.; Malone, Daniel; Ridgeway, Kyle J.; McManus, Beth M.; Stevens-Lapsley, Jennifer E.

    2016-01-01

    Hospital readmissions in older adult populations are an emerging quality indicator for acute care hospitals. Recent evidence has linked functional decline during and after hospitalization with an elevated risk of hospital readmission. However, models of care that have been developed to reduce hospital readmission rates do not adequately address functional deficits. Physical therapists, as experts in optimizing physical function, have a strong opportunity to contribute meaningfully to care transition models and demonstrate the value of physical therapy interventions in reducing readmissions. Thus, the purposes of this perspective article are: (1) to describe the need for physical therapist input during care transitions for older adults and (2) to outline strategies for expanding physical therapy participation in care transitions for older adults, with an overall goal of reducing avoidable 30-day hospital readmissions. PMID:26939601

  7. Stress and coping among children of alcoholic parents through the young adult transition

    PubMed Central

    Hussong, Andrea M.; Chassin, Laurie

    2011-01-01

    The transition to young adulthood is both a time when risky health behaviors such as substance misuse peak and a time of opportunity for growth and development through the acquisition of adult roles. In this transition, coping styles include responses to the stressors and opportunities associated with the emergence of adulthood. The extent to which such coping styles are skillfully employed in part determines adjustment into adulthood. The current study used a high-risk, longitudinal design to examine the development of coping styles over adolescence, continuity in these coping styles from adolescence to adulthood, the impact of coping on adult stress and substance misuse, the ability of coping to buffer effects of stress on substance use, and differences in coping between at-risk youth (i.e., children of alcoholics [COAs]) and their peers. A sample of 340 adolescents completed four assessments over ages 11–23. We used latent trajectory models to examine interindividual and intraindividual change in coping over time. Evidence for both change and continuity in the development of coping from adolescence to adulthood was found, although adolescent coping had limited impact on stress and substance use in adulthood. Support was also found for complex stress-buffering and stress-exacerbating effects of coping on the relations between major life events and adult drug use and between stress associated with the new roles of adulthood and heavy alcohol use. Implications of these findings for development and adjustment in the transition to adulthood are discussed. PMID:15704824

  8. Immigration and Adult Transitions

    ERIC Educational Resources Information Center

    Rumbaut, Ruben G.; Komaie, Golnaz

    2010-01-01

    Almost 30 percent of the more than 68 million young adults aged eighteen to thirty-four in the United States today are either foreign born or of foreign parentage. As these newcomers make their transitions to adulthood, say Ruben Rumbaut and Golnaz Komaie, they differ significantly not only from one another but also from their native-parentage…

  9. Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community.

    PubMed

    Falvey, Jason R; Burke, Robert E; Malone, Daniel; Ridgeway, Kyle J; McManus, Beth M; Stevens-Lapsley, Jennifer E

    2016-08-01

    Hospital readmissions in older adult populations are an emerging quality indicator for acute care hospitals. Recent evidence has linked functional decline during and after hospitalization with an elevated risk of hospital readmission. However, models of care that have been developed to reduce hospital readmission rates do not adequately address functional deficits. Physical therapists, as experts in optimizing physical function, have a strong opportunity to contribute meaningfully to care transition models and demonstrate the value of physical therapy interventions in reducing readmissions. Thus, the purposes of this perspective article are: (1) to describe the need for physical therapist input during care transitions for older adults and (2) to outline strategies for expanding physical therapy participation in care transitions for older adults, with an overall goal of reducing avoidable 30-day hospital readmissions. © 2016 American Physical Therapy Association.

  10. Transformative Learning in Managerial Role Transitions

    ERIC Educational Resources Information Center

    Isopahkala-Bouret, Ulpukka

    2008-01-01

    The purpose of this study is to investigate the nature of learning in work role transitions from specialist roles to managerial roles in a context of a large international technology organisation. Prior theorisation of learning in role transitions has been based on quantitative, psychologically-oriented studies prescribing different role and…

  11. Living with transversal upper limb reduction deficiency: limitations experienced by young adults during their transition to adulthood.

    PubMed

    Lankhorst, Ilse M F; Baars, Erwin C T; Wijk, Iris van; Janssen, Wim G M; Poelma, Margriet J; van der Sluis, Corry K

    2017-08-01

    During transition to adulthood young adults with disabilities are at risk of experiencing limitations due to changing physical and social requirements. To determine whether young adults with transversal upper limb reduction deficiency (tULRD) have experienced limitations in various domains of participation during transition to adulthood and how they dealt with these limitations. Fifteen participants (mean age 21.4 years) with tULRD. A qualitative study was performed using a semi-structured interview based on the Rotterdam Transition Profile to identify the limitations experienced in participation domains. Almost all the participants reported difficulties in finding a suitable study or job. Most young adults were convinced they were suitable for almost any study or job, but their teachers and potential employers were more reserved. Few difficulties were reported on the domains leisure activities, intimate relationships/sexuality, housing/housekeeping and transportation. Participants preferred to develop their own strategies for dealing with limitations. Various aids, adaptations and prostheses were used to overcome limitations. Rehabilitation teams were infrequently consulted for advice in solving transitional problems. Young adults with tULRD experience limitations mainly in choosing and finding a suitable study or job. Rehabilitation teams may play a more extensive role in supporting individuals with transitional problems. Implications for rehabilitation Most young adults with transversal upper limb reduction deficiency (tULRD) experience limitations in study and job selection during transition to adulthood, but they do not consult the rehabilitation team. Assessment of abilities in relation to job interests and practicing job specific bimanual activities may be helpful for young adults with a tULRD. How the rehabilitation teams can meet the needs of young adults with tULRD during transitional phases, when autonomy is of growing importance, should be investigated

  12. Treatment issues for children with epilepsy transitioning to adult care.

    PubMed

    Nabbout, Rima; Camfield, Carol S; Andrade, Danielle M; Arzimanoglou, Alexis; Chiron, Catherine; Cramer, Joyce A; French, Jacqueline A; Kossoff, Eric; Mula, Marco; Camfield, Peter R

    2017-04-01

    This is the third of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper focuses on treatment issues that arise during the course of childhood epilepsy and make the process of transition to adult care more complicated. Some AEDs used during childhood, such as stiripentol, vigabatrin, and cannabidiol, are unfamiliar to adult epilepsy specialists. In addition, new drugs are being developed for treatment of specific childhood onset epilepsy syndromes and have no indication yet for adults. The ketogenic diet may be effective during childhood but is difficult to continue in adult care. Regional adult epilepsy diet clinics could be helpful. Polytherapy is common for patients transitioning to adult care. Although these complex AED regimes are difficult, they are often possible to simplify. AEDs used in childhood may need to be reconsidered in adulthood. Rescue medications to stop prolonged seizures and clusters of seizures are in wide home use in children and can be continued in adulthood. Adherence/compliance is notoriously difficult for adolescents, but there are simple clinical approaches that should be helpful. Mental health issues including depression and anxiety are not always diagnosed and treated in children and young adults even though effective treatments are available. Attention deficit hyperactivity disorder and aggressive behavior disorders may interfere with transition and successful adulthood but these can be treated. For the majority, the adult social outcome of children with epilepsy is unsatisfactory with few proven interventions. The interface between pediatric and adult care for children with epilepsy is becoming increasingly complicated with a need for more comprehensive transition programs and adult epileptologists who are knowledgeable about special treatments that benefit this group of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The gender gap in alcohol consumption during late adolescence and young adulthood: gendered attitudes and adult roles.

    PubMed

    Christie-Mizell, C André; Peralta, Robert L

    2009-12-01

    We utilize data from the National Longitudinal Survey of Youth young adult sample (N = 1,488) to investigate whether gender role attitudes and the occupation of and transition to three adult roles (i.e., employment, marriage, and parenthood) contribute to the maintenance of the gender gap in the frequency and quantity of alcohol use. Our results indicate that traditional gender role attitudes are related to less frequent drinking for both men and women, but role attitudes are not associated with the number of drinks consumed. We also find that employment and transitions to employment increase the frequency and quantity of drinking, but less so for women compared to men. Furthermore, marriage, parenthood, and transitions to parenthood are related to less frequent drinking for women only. In terms of the number of drinks consumed, only employment and transitions to employment distinguish men and women. Employment is related to increased quantity of drinking for men, but decreased drinking for women, while transitions to employment have no effect on men, but do decrease the amount of drinking for women. Marriage decreases the number of drinks consumed equally for both men and women.

  14. Transition to Adult-Oriented Health Care: Perspectives of Youth and Adults with Complex Physical Disabilities

    ERIC Educational Resources Information Center

    Young, Nancy L.; Barden, Wendy S.; Mills, Wendy A.; Burke, Tricia A.; Law, Mary; Boydell, Katherine

    2009-01-01

    Introduction: The transition to adulthood is extremely difficult for individuals with disabilities. We sought to explore the specific issue of transition to adult-oriented health care in a Canadian context. Methods: We conducted semi-structured individual interviews with 15 youth and 15 adults with cerebral palsy, spina bifida, and acquired brain…

  15. Transition to adult care for children with chronic neurological disorders.

    PubMed

    Camfield, Peter; Camfield, Carol

    2011-03-01

    Chronic neurological disorders in children have significant effects on adult medical and social function. Transition and then formal transfer of care from pediatric to adult services is a complex process, although there are virtually no objective data to inform physicians about the most effective approach. Some neurological disorders that start in children are a danger to society if poorly treated in adulthood, some disorders that were previously lethal in childhood now permit survival well into adulthood, and others are static in childhood but progressive in adulthood. Some disorders remit or are cured in childhood but continue to have serious comorbidity in adulthood, whereas others are similar and persistent in children and adults. Maturity, provision of information, and cognitive problems are confounders. We discuss several models of transition/transfer but prefer a joint pediatric/adult transition clinic. We make a series of suggestions about how to improve the transition/transfer process with the hope of better medical and social adult outcome for children with neurological disorders. Copyright © 2011 American Neurological Association.

  16. A Program Inspection on Transition of Developmentally Disabled Young Adults from School to Adult Services.

    ERIC Educational Resources Information Center

    Office of Inspector General (DHHS), Washington, DC.

    Discussions were held with 252 respondents (state and local officials, service providers, educators, parents) in 28 states concerning the problems in transition from school to adult services for developmentally disabled young adults. Transition issues were seen to include questions of where to live, what to do, and how to obtain support. The…

  17. Independent Living Transition Assistance for Young Adults Who Have Special Needs

    ERIC Educational Resources Information Center

    Russell, Rhonda L.

    2016-01-01

    This research focused on young adults who have disabilities and their transition and career planning for post-secondary life. The study sought to identify best practices in transition planning, transition planning services, and to determine the types of resources and support needed by young adults who have disabilities. For youth who have…

  18. Voices of the Forgotten Half: The Role of Social Class in the School-to-Work Transition

    ERIC Educational Resources Information Center

    Blustein, David L.; Chaves, Anna P.; Diemer, Matthew A.; Gallagher, Laura A.; Marshall, Kevin G.; Sirin, Selcuk; Bhati, Kuldhir S.

    2002-01-01

    This study examines the impact of social class on the school-to-work (STW) transitions of young adults in working-class occupations. Using an exploratory, qualitative research methodology, interviews were conducted with 10 men and 10 women to examine the role of social class in the STW transition. All participants were working in low-skilled jobs…

  19. Transitioning HIV-infected youth into adult health care.

    PubMed

    2013-07-01

    With advances in antiretroviral therapy, most HIV-infected children survive into adulthood. Optimal health care for these youth includes a formal plan for the transition of care from primary and/or subspecialty pediatric/adolescent/family medicine health care providers (medical home) to adult health care provider(s). Successful transition involves the early engagement and participation of the youth and his or her family with the pediatric medical home and adult health care teams in developing a formal plan. Referring providers should have a written policy for the transfer of HIV-infected youth to adult care, which will guide in the development of an individualized plan for each youth. The plan should be introduced to the youth in early adolescence and modified as the youth approaches transition. Assessment of developmental milestones is important to define the readiness of the youth in assuming responsibility for his or her own care before initiating the transfer. Communication among all providers is essential and should include both personal contact and a written medical summary. Progress toward the transition should be tracked and,once completed, should be documented and assessed.

  20. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services - an integrative review.

    PubMed

    Zhou, Huaqiong; Roberts, Pamela; Dhaliwal, Satvinder; Della, Phillip

    2016-11-01

    This paper aims to provide an updated comprehensive review of the research-based evidence related to the transitions of care process for adolescents and young adults with chronic illness/disabilities since 2010. Transitioning adolescent and young adults with chronic disease and/or disabilities to adult care services is a complex process, which requires coordination and continuity of health care. The quality of the transition process not only impacts on special health care needs of the patients, but also their psychosocial development. Inconsistent evidence was found regarding the process of transitioning adolescent and young adults. An integrative review was conducted using a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. A search was carried out using the EBSCOhost, Embase, MEDLINE, PsycINFO, and AustHealth, from 2010 to 31 October 2014. The key search terms were (adolescent or young adult) AND (chronic disease or long-term illness/conditions or disability) AND (transition to adult care or continuity of patient care or transfer or transition). A total of 5719 records were initially identified. After applying the inclusion criteria a final 61 studies were included. Six main categories derived from the data synthesis process are Timing of transition; Perceptions of the transition; Preparation for the transition; Patients' outcomes post-transition; Barriers to the transition; and Facilitating factors to the transition. A further 15 subcategories also surfaced. In the last five years, there has been improvement in health outcomes of adolescent and young adults post-transition by applying a structured multidisciplinary transition programme, especially for patients with cystic fibrosis and diabetes. However, overall patients' outcomes after being transited to adult health care services, if recorded, have remained poor both physically and psychosocially. An accurate tracking mechanism needs to be

  1. Policy to Performance: State ABE Transition Systems Report. Transitioning Adults to Opportunity

    ERIC Educational Resources Information Center

    Alamprese, Judith A.

    2012-01-01

    The U.S. Department of Education's Policy to Performance project was funded in 2009 to build the capacity of state adult basic education (ABE) staff to develop and implement policies and practices that would support an ABE transition system. Policy to Performance states were selected though a competitive process. State adult education directors…

  2. Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes.

    PubMed

    Weigensberg, Marc J; Vigen, Cheryl; Sequeira, Paola; Spruijt-Metz, Donna; Juarez, Magaly; Florindez, Daniella; Provisor, Joseph; Peters, Anne; Pyatak, Elizabeth A

    2018-01-01

    The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D. Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of "council" process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods. The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT. The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully

  3. The Gender Gap in Alcohol Consumption during Late Adolescence and Young Adulthood: Gendered Attitudes and Adult Roles

    ERIC Educational Resources Information Center

    Christie-Mizell, C. Andre; Peralta, Robert L.

    2009-01-01

    We utilize data from the National Longitudinal Survey of Youth young adult sample (N = 1,488) to investigate whether gender role attitudes and the occupation of and transition to three adult roles (i.e., employment, marriage, and parenthood) contribute to the maintenance of the gender gap in the frequency and quantity of alcohol use. Our results…

  4. Youth in Transition: Are They Adult Learners?

    ERIC Educational Resources Information Center

    Shaw, Lester H.; Conti, Gary J.; Shaw, Brenda S.

    2013-01-01

    Since at-risk youth are in transition to adulthood, major adult learning concepts can be applied to them. The purpose of this study was to describe the learning strategies of youth in transition to adulthood in the urban life skills program of A Pocket Full of Hope®. Both qualitative and quantitative data collecting methods were used. Assessing…

  5. Prenatal alcohol exposure, adaptive function, and entry into adult roles in a prospective study of young adults.

    PubMed

    Lynch, Mary Ellen; Kable, Julie A; Coles, Claire D

    2015-01-01

    Although many studies have demonstrated effects of prenatal alcohol exposure (PAE) on physical, cognitive, and behavioral development in children, few have focused on the long term effects on adults. In this study, data are presented on adaptive function and entry into adult roles in a community sample of young adults with PAE. The expectation was that prenatally exposed adults would show lower adaptive functioning and more difficulty with entry into adult roles than the non-exposed control group and that these effects would be related to the severity of PAE effects. The predominantly African-American, low income sample included adults with a wide range of prenatal exposure (n = 123) as well as control groups for socioeconomic (SES) (n =5 9) and disability (n = 54) status. The mothers of the alcohol-exposed and SES-control group participants were recruited before birth and offspring have been followed up periodically. The disability control group was recruited in adolescence. The adults were interviewed about adaptive function in day-to-day life and adult role entry. Collateral adults who were well-acquainted with each participant were interviewed concerning adaptive function. Results showed that adults who were dysmorphic and/or cognitively affected by PAE had difficulty with adaptive function and entry into adult roles. Males showing cognitive effects with no physical effects were the most severely affected. Results for exposed adults not showing physical or cognitive effects were similar to or more positive than those of the control group for most outcomes. PAE has long-term effects on adaptive outcomes in early adulthood. Additional research should focus on possible interventions at this transition and on factors contributing to the adjustment of the exposed, but unaffected participants. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Gender and Transition From Pediatric to Adult Health Care Among Youth With Acquired Brain Injury: Experiences in a Transition Model.

    PubMed

    Lindsay, Sally; Proulx, Meghann; Maxwell, Joanne; Hamdani, Yani; Bayley, Mark; Macarthur, Colin; Colantonio, Angela

    2016-02-01

    To explore gender and sex differences in experiences of transitioning to adult health care among young adults with acquired brain injury (ABI) who take part in a coordinated model of transitional care. Descriptive design using in-depth semistructured qualitative interviews. Interviews over the phone and in person. Participants (N=18) included 10 young adults with a diagnosis of ABI (4 women, 6 men; age range, 19-21y) and 9 parents (8 women, 1 man) from the Greater Toronto Area, Ontario, Canada. Not applicable. Semistructured interviews with participants. Our findings highlight several commonalities and differences relative to sex and gender among young adults with ABI who are transitioning from pediatric to adult care. Both young adult men and women experienced a similar transition process and similar organization, continuity, and availability of care. Sex differences were found in relational factors (eg, communication, family involvement, social support). Young adult men, and parents of the men, differed in their transition regarding relational factors (eg, communication, family involvement). Our findings show that young adult men and women with ABI who have taken part in a transition preparation program experience similarities in organization, continuity, and availability of care, but they experience differences in relational factors (eg, communication, family involvement). Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Adult social roles and alcohol use among American Indians.

    PubMed

    Greene, Kaylin M; Eitle, Tamela McNulty; Eitle, David

    2014-09-01

    American Indians are disproportionately burdened by alcohol-related problems. Yet, research exploring predictors of alcohol use among American Indians has been limited by cross-sectional designs and reservation-based samples. Guided by a life course developmental perspective, the current study used a subsample of American Indians (n=927) from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use (current drinking, usual number of drinks, and binge drinking) among this population. We examined whether adult social roles (i.e., cohabitation, marriage, parenthood, college enrollment, and full-time work) were linked to the rise and fall of alcohol use. Multi-level models demonstrated that adult social roles were linked to alcohol use at the within- and between-person levels. Becoming a parent was linked to a lower likelihood of being a current drinker, fewer alcoholic drinks, and less frequent binge drinking. Transitioning to full-time work was associated with a higher likelihood of being a current drinker and more frequent binge drinking. Results point to the importance of exploring within-group trajectories of alcohol use and highlight the protective and risky nature of adult social roles among American Indians. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Cystic fibrosis: addressing the transition from pediatric to adult-oriented health care.

    PubMed

    Kreindler, James L; Miller, Victoria A

    2013-12-11

    Survival for patients with cystic fibrosis (CF) increased to nearly 40 years in 2012 from the early childhood years in the 1940s. Therefore, patients are living long enough to require transition from pediatric CF centers to adult CF centers. The goal of transition is for the young adult to be engaged in the adult health care system in ways that optimize health, maximize potential, and increase quality of life. A successful transition promotes autonomy and responsibility with respect to one's own health. Currently, there is an information gap in the literature with respect to psychological models that can help guide informed transition processes. In this review, we establish the framework in which transition exists in CF; we review some of the published literature from the last 20 years of experience with transition in CF centers around the world; and we discuss psychological models of pediatric illness that can help to explain the current state of transition to adult-oriented care from pediatric-oriented care and help to formulate new models of ascertaining readiness for transition. Finally, we look at our current knowledge gaps and opportunities for future research endeavors.

  9. Transitioning young adults from paediatric to adult care and the HIV care continuum in Atlanta, Georgia, USA: a retrospective cohort study.

    PubMed

    Hussen, Sophia A; Chakraborty, Rana; Knezevic, Andrea; Camacho-Gonzalez, Andres; Huang, Eugene; Stephenson, Rob; Del Rio, Carlos

    2017-09-01

    The transition from paediatric to adult HIV care is a particularly high-risk time for disengagement among young adults; however, empirical data are lacking. We reviewed medical records of 72 youth seen in both the paediatric and the adult clinics of the Grady Infectious Disease Program in Atlanta, Georgia, USA, from 2004 to 2014. We abstracted clinical data on linkage, retention and virologic suppression from the last two years in the paediatric clinic through the first two years in the adult clinic. Of patients with at least one visit scheduled in adult clinic, 97% were eventually seen by an adult provider (median time between last paediatric and first adult clinic visit = 10 months, interquartile range 2-18 months). Half of the patients were enrolled in paediatric care immediately prior to transition, while the other half experienced a gap in paediatric care and re-enrolled in the clinic as adults. A total of 89% of patients were retained (at least two visits at least three months apart) in the first year and 56% in the second year after transition. Patients who were seen in adult clinic within three months of their last paediatric visit were more likely to be virologically suppressed after transition than those who took longer (Relative risk (RR): 1.76; 95% confidence interval (CI): 1.07-2.9; p  = 0.03). Patients with virologic suppression (HIV-1 RNA below the level of detection of the assay) at the last paediatric visit were also more likely to be suppressed at the most recent adult visit (RR: 2.3; 95% CI: 1.34-3.9; p  = 0.002). Retention rates once in adult care, though high initially, declined significantly by the second year after transition. Pre-transition viral suppression and shorter linkage time between paediatric and adult clinic were associated with better outcomes post-transition. Optimizing transition will require intensive transition support for patients who are not virologically controlled, as well as support for youth beyond the first year

  10. Nicotine dependence and transitional shifts in exercise behavior among young U.S. adult smokers.

    PubMed

    Loprinzi, Paul D; Walker, Jerome F; Cardinal, Bradley J

    2014-08-01

    The aim of this study is to examine the association between nicotine dependence and longitudinal exercise transitional shift patterns among young U.S. adult daily smokers. Data from the 2003-2005 National Youth Smoking Cessation Survey was used, which is a longitudinal study over a two year period. Participants included 1168 US adult daily smokers (18-24years). Nicotine dependence was assessed using the modified Fagerstrom Test for Nicotine Dependence. Four transitional shift patterns were created based on meeting current exercise guidelines; stable inactive (inactive across time), activity relapsers (starts out active and then becomes inactive), activity adopters (inactive and then becomes active), and stable active (active across time). After adjustments, for every 1-unit increase in baseline nicotine dependence, participants had 16% (OR=1.16, p=0.01) greater odds of being in the stable inactive group compared to the stable active group. Nicotine dependence appears to play an important role in shaping longitudinal exercise patterns among young U.S. adult smokers. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes

    PubMed Central

    Weigensberg, Marc J; Vigen, Cheryl; Sequeira, Paola; Spruijt-Metz, Donna; Juarez, Magaly; Florindez, Daniella; Peters, Anne; Pyatak, Elizabeth A

    2018-01-01

    Background The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D. Methods Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of “council” process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods. Results The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT. Conclusions The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention

  12. Psychological factors impacting transition from paediatric to adult care by childhood cancer survivors.

    PubMed

    Granek, Leeat; Nathan, Paul C; Rosenberg-Yunger, Zahava R S; D'Agostino, Norma; Amin, Leila; Barr, Ronald D; Greenberg, Mark L; Hodgson, David; Boydell, Katherine; Klassen, Anne F

    2012-09-01

    Childhood cancer survivors require life-long care focused on the specific late effects that may arise from their cancer and its treatment. In many centers, survivors are required to transition from follow-up care in a paediatric cancer center, to care provided in an adult care setting. The purpose of this study was to identify the psychological factors involved in this transition to adult care long-term follow-up clinics. Qualitative interviews were conducted with ten paediatric survivors still in paediatric care, as well as 28 adult survivors of whom 11 had transitioned successfully to adult care (attended three long-term follow-up (LTFU) appointments consecutively); ten who failed to transition (attended at least one LTFU appointment as an adult, but were inconsistent with subsequent attendance); and seven who had never transitioned (did not attend any LTFU care as an adult). Line-by-line coding was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories. Two overall categories and four subthemes were identified: (1) Identification with being a cancer survivor included the subthemes of 'cancer identity' and 'cancer a thing of the past' and; (2) Emotional components included the subthemes of 'fear and anxiety' and 'gratitude and gaining perspective'. The analysis revealed that the same factor could act as either a motivator or a hindrance to successful transition in different survivors (e.g., fear of recurrence of cancer might be a barrier or a facilitator depending on the survivor's life experience). Psychological factors are an important consideration when preparing cancer survivors for transition to adult long-term follow-up care. Identifying and addressing the individual psychological needs of childhood cancer survivors may improve the likelihood of their successful transition to adult care.

  13. Lessons from Life's First Teacher: The Role of the Family in Adolescent and Adult Readiness for School-to-Work Transition.

    ERIC Educational Resources Information Center

    Way, Wendy L.; Rossman, Marilyn Martin

    A study examined the nature of family contributions to adolescent and adult learners' readiness for transition from school to work and any variations between the two groups. It used data from national samples of 1,266 high school seniors and 879 adults in one- and two-year postsecondary occupational education programs. Findings, based on an…

  14. Transition to Adulthood: Validation of the Rotterdam Transition Profile for Young Adults with Cerebral Palsy and Normal Intelligence

    ERIC Educational Resources Information Center

    Donkervoort, Mireille; Wiegerink, Diana J. H. G.; van Meeteren, Jetty; Stam, Henk J.; Roebroeck, Marij E.

    2009-01-01

    The aim of this study was to investigate the validity of the Rotterdam Transition Profile (RTP) to describe the transition process from childhood to adulthood in young adults with cerebral palsy (CP). Participants were recruited from rehabilitation centres and hospital departments of rehabilitation. In total, 81 young adults (47 males, 34 females)…

  15. Transition from children's to adult services for young adults with life-limiting conditions: A realist review of the literature.

    PubMed

    Kerr, Helen; Price, Jayne; Nicholl, Honor; O'Halloran, Peter

    2017-11-01

    Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children's to adult services. This has proved a challenging process for both young adults and service providers, with complex transition interventions interacting in unpredictable ways with local contexts. To explain how intervention processes interact with contextual factors to help transition from children's to adult services for young adults with life-limiting conditions. Systematic realist review of the literature. Literature was sourced from four electronic databases: Embase, MEDLINE, Science Direct and Cochrane Library from January 1995 to April 2016. This was supplemented with a search in Google Scholar and articles sourced from reference lists of included papers. Data were extracted using an adapted standardised data extraction tool which included identifying information related to interventions, mechanisms, contextual influences and outcomes. Two reviewers assessed the relevance of papers based on the inclusion criteria. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tools. 78 articles were included in the review. Six interventions were identified related to an effective transition to adult services. Contextual factors include the need for children's service providers to collaborate with adult service providers to prepare an environment with knowledgeable staff and adequate resources. Mechanisms triggered by the interventions include a sense of empowerment and agency amongst all stakeholders. Early planning, collaboration between children's and adult service providers, and a focus on increasing the young adults' confidence in decision-making and engaging with adult services, are vital to a successful transition. Interventions should be tailored to their context and focused not only on organisational procedures but on equipping young adults, parents

  16. Residential Transitions among Adults with Intellectual Disability across 20 Years

    PubMed Central

    Woodman, Ashley C.; Mailick, Marsha R.; Anderson, Kristy A.; Esbensen, Anna J.

    2014-01-01

    The present study addresses critical gaps in the literature by examining residential transitions among 303 adults with intellectual disability over 10 years (Part 1) and 75 adults with Down syndrome over 20 years (Part 2). All adults lived at home at the start of the study, but many moved to a variety of settings. Several characteristics of the adults with intellectual disability differed across settings, most notably adaptive behavior and the number of residential transitions, while characteristics such as age, type of disability, and behavior problems were less predictive of residential placements. The number of moves over the course of the study varied widely, with critical links to earlier family dynamics, social relationships, and health and adaptive behavior. PMID:25354121

  17. Hospice support and the transition to adult services and adulthood for young people with life-limiting conditions and their families: a qualitative study.

    PubMed

    Kirk, Susan; Fraser, Claire

    2014-04-01

    Transition to adult services and adulthood is now a prospect for young people with life-limiting conditions requiring palliative care. Little is known about their transition experiences or how children's hospices can support a young adult population during/following transition. (1) To examine how young people with life-limiting conditions and their parents experience transition. (2) To identify families' and hospice staff's perceptions of family support needs during transition. (3) To identify the implications for children's hospices. Qualitative study using in-depth, semi-structured interviews. Analysis used a grounded theory approach. A total of 39 participants recruited from one children's hospice in the United Kingdom. Transition planning was absent or poorly coordinated; for most families, there were no equivalent adult health/social services. Consequently, it was a time of uncertainty and anxiety for families. Moving to a young adult unit was a positive experience for young people as the building/support model recognised their adult status. However, they had unmet needs for emotional support and accessing information/services to realise their aspirations. Parents had unmet emotional needs and were unclear of support available once their children reached adulthood. Staff identified training needs in relation to working with adults, providing emotional support and acting as an advocate/key worker. Providing an appropriate building is only one aspect of developing support for young adults. A different model of support is needed, one which promotes young people's independence and provides emotional support while continuing to support parents and siblings. Hospices could play a role in transition support and coordination.

  18. The transition from pediatric to adult care for youth with epilepsy: Basic biological, sociological, and psychological issues.

    PubMed

    Camfield, Peter; Camfield, Carol; Busiah, Kanetee; Cohen, David; Pack, Alison; Nabbout, Rima

    2017-04-01

    Transition from pediatric to adult health care for adolescents with epilepsy is challenging for the patient, family, and health care workers. This paper is the first of three that summarize the main findings from the 2nd Symposium on Transition in Epilepsies, held in Paris from June 14-25, 2016. In this paper we describe five basic themes that have an important effect on transition. First, there are important brain changes in adolescence that leave an imbalance between risk taking and pleasure seeking behaviors and frontal executive function compared with adults. Second, puberty is a major change during the transition age. The three most important but separate neuroendocrine axes involved in puberty are gonadarche (activation of the gonads), adrenarche (activation of adrenal androgen production), and activation of the growth hormone-insulin like growth factor. Third, sexual debut occurs during the transition years, and at an earlier age in adolescents with epilepsy than controls. Adult sexual performance is often unsatisfactory. Although AED-induced alterations in sexual hormones and temporal lobe epilepsy may play a role in hyposexuality, depression, anxiety, and other social factors appear most important. Fourth, psychological development is very important with an evolution from an early stage (ages 10-13years) with concrete thinking, to a middle stage (ages 14-17) with analytic and more abstract introspective thinking, and then to a late stage (ages 18-21) with at least the beginnings of adult reasoning. Epilepsy may derail this relatively orderly progression. Adolescents with autistic spectrum disorder may present with severe behavior problems that are sometimes related to undiagnosed epilepsy. Fifth, bone health in adolescence is critical to establish adequate mineralization for all of adult life. While AED interference with Vitamin D metabolism is important, there is evidence that the effects of AEDs on bone are more complex and involve changes in remodeling

  19. Transition to Adult Life for People with Disabilities. Bulletin No. 3.

    ERIC Educational Resources Information Center

    Fish, John

    This document describes and discusses aspects of the transition to adult life for people with disabilities in Great Britain and sets it in an international context. The first three sections describe the transition process, the difficulties of implementing a framework for transition, and the aims of the transition process. The aims are the…

  20. Current practice and views of neurologists on the transition from pediatric to adult care.

    PubMed

    Oskoui, Maryam; Wolfson, Christina

    2012-12-01

    To describe the current practice and views of neurologists on transitioning patients from pediatric to adult care, a cross-sectional study of all pediatric and adult neurologists in the province of Quebec, Canada, was conducted. The response rate was 73% for pediatric and 49% for adult neurologists. Most pediatric neurologists do not have a patient transition program or policy in place. Although a transfer summary is commonly provided, critical information is often lacking. Nearly half of neurologists believed that patients experience a gap in care during the transition process, and most agreed that the transition process is often poorly coordinated, highlighting patient, family, and health care factors. Current practice does not follow existing consensus statements for transition of care with respect to timing, communication, and preparation, and many pediatric neurologists experience difficulty in finding an appropriate adult health care provider for their patients. Neurologists reported many challenges in the current transition of care process.

  1. Transition to adult care in pediatric solid-organ transplant: development of a practice guideline.

    PubMed

    Gold, Anna; Martin, Kathy; Breckbill, Katie; Avitzur, Yaron; Kaufman, Miriam

    2015-06-01

    Transition to adult-centered care is becoming an increasingly important area of practice in pediatric organ transplant. Standardized, best-practice guidelines are needed to assist transplant practitioners in providing optimal transitional care for this population of patients. To describe the development and implementation of a practice guideline for the transitional care of pediatric transplant recipients. A quality improvement project was undertaken in a pediatric multiorgan transplant program setting. Strategies employed included (1) creation of an interdisciplinary working group, (2) survey of transition-related practices and learning needs of transplant practitioners, (3) review of the literature and existing transition-related materials, and (4) creation of transition guidelines. An interdisciplinary survey of transplant practitioners at our institution identified practice strengths related to transitional care and learning needs. Review of relevant literature and other materials revealed limited but emerging research related to the transition of pediatric transplant recipients from pediatric to adult care. Existing transition tools were examined and applicable items identified. A practice guideline for use with pediatric transplant recipients transitioning to adult care was developed. Strategies to educate staff about the guideline and promote ongoing guideline use were implemented. Preparing pediatric transplant recipients and their families for transition to adult-centered care is an emerging challenge for transplant teams. These guidelines provide practitioners with a developmentally sensitive overview of important transition-related domains and strategies directed toward patients and their caregivers, who may experience the process of transition differently. Dissemination of the pediatric transplant transition guideline will make transition information more widely available to transplant practitioners.

  2. Adolescent and Adult HIV Providers' Definitions of HIV-Infected Youths' Successful Transition to Adult Care in the United States.

    PubMed

    Philbin, Morgan M; Tanner, Amanda E; Ma, Alice; Chambers, Brittany D; Ware, Samuella; Kinnard, Elizabeth N; Hussen, Sophia A; Lee, Sonia; Fortenberry, J Dennis

    2017-10-01

    It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.

  3. Lack of Preparedness for Pediatric to Adult-Oriented Health Care Transition in Hospitalized Adolescents and Young Adults.

    PubMed

    Dwyer-Matzky, Keely; Blatt, Amy; Asselin, Barbara L; Wood, David L

    We examined the self-reported preparedness of hospitalized adolescents and young adults (AYA) for transition from pediatric to adult-oriented health care with regard to: 1) previous health care transition (HCT) preparation, 2) Self-Determination Theory (SDT) constructs of health self-management autonomy and competence, and 3) their perception of medical knowledge, attitudes, and concerns. From 2013 to 2015, 139 hospitalized patients aged 15 to 21 years completed a 40-item survey on HCT preparation, attitudes, concerns, and perception of knowledge adapted in part from validated questionnaires of the Department of Health and Human Services, Maternal and Child Health Bureau, and SDT Treatment Self-Regulation Study. Fewer than 40% of all respondents endorsed previous HCT preparation such as providers discussing taking responsibility for their health, transitioning to adult providers, and only 20% had discussed future health insurance needs. Of our AYA population, 84% had 1 or more special health care needs. Older patients, female patients, and those with increased HCT preparation scores had increased autonomous motivation, positive attitudes toward transition, yet also increased transition concerns. Higher autonomous motivation and perceived competence correlated with increased perception of knowledge (P = .002, < .001 respectively) and more positive attitudes toward transition planning (P < .001, .054 respectively). Multivariate regression analysis revealed those with increased HCT preparation and those with increased perceived competence had increased perception of knowledge (β = .25, P = .005 and β = .35, P < .001). Our findings suggest that hospitalized AYA received limited education and preparation regarding key elements of HCT to adult-oriented health care. Moreover, those previously exposed to transition preparation efforts were more likely to have motivation and a sense of competence in HCT skills. Copyright © 2017 Academic Pediatric Association

  4. Residential Transitions among Adults with Intellectual Disability across 20 Years

    ERIC Educational Resources Information Center

    Woodman, Ashley C.; Mailick, Marsha R.; Anderson, Kristy A.; Esbensen, Anna J.

    2014-01-01

    The present study addresses critical gaps in the literature by examining residential transitions among 303 adults with intellectual disability (ID) over 10 years (Part 1) and 75 adults with Down syndrome over 20 years (Part 2). All adults lived at home at the start of the study, but many moved to a variety of settings. Several characteristics of…

  5. Transitioning from pediatric to adult health care with familial hypercholesterolemia: Listening to young adult and parent voices.

    PubMed

    Sliwinski, Samantha K; Gooding, Holly; de Ferranti, Sarah; Mackie, Thomas I; Shah, Supriya; Saunders, Tully; Leslie, Laurel K

    Young adults with familial hypercholesterolemia (FH) are at a critical period for establishing behaviors to promote future cardiovascular health. To examine challenges transitioning to adult care for young adults with FH and parents of FH-affected young adults in the context of 2 developmental tasks, transitioning from childhood to early adulthood and assuming responsibility for self-management of a chronic disorder. Semistructured, qualitative interviews were conducted with 12 young adults with FH and 12 parents of affected young adults from a pediatric subspecialty preventive cardiology program in a northeastern academic medical center. Analyses were conducted using a modified grounded theory framework. Respondents identified 5 challenges: (1) recognizing oneself as a decision maker, (2) navigating emerging independence, (3) prioritizing treatment for a chronic disorder with limited signs and symptoms, (4) managing social implications of FH, and (5) finding credible resources for guidance. Both young adults and parents proposed similar recommendations for addressing these challenges, including the need for family and peer involvement to establish and maintain diet and exercise routines and to provide medication reminders. Systems-level recommendations included early engagement of adolescents in shared decision-making with health care team; providing credible, educational resources regarding FH; and using blood tests to track treatment efficacy. Young adults with FH transitioning to adult care may benefit from explicit interventions to address challenges to establishing healthy lifestyle behaviors and medication adherence as they move toward being responsible for their medical care. Further research should explore the efficacy of recommended interventions. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  6. HEALTH CARE TRANSITION IN YOUNG ADULTS WITH TYPE 1 DIABETES: BARRIERS TO TIMELY ESTABLISHMENT OF ADULT DIABETES CARE

    PubMed Central

    Garvey, Katharine C.; Wolpert, Howard A.; Laffel, Lori M.; Rhodes, Erinn T.; Wolfsdorf, Joseph I.; Finkelstein, Jonathan A.

    2014-01-01

    Objective To examine barriers to health care transition reported by young adults with type 1 diabetes and associations between barriers and prolonged gaps between pediatric and adult diabetes care. Methods We surveyed young adults aged 22 to 30 years with type 1 diabetes about their transition experiences, including barriers to timely establishment of adult diabetes care. We evaluated relationships between barriers and gaps in care using multivariate logistic regression. Results The response rate was 53% (258 of 484 eligible subjects). Respondents (62% female) were 26.7 ± 2.4 years old and transitioned to adult diabetes care at 19.5 ± 2.9 years. Reported barriers included lack of specific adult provider referral name (47%) or contact information (27%), competing life priorities (43%), difficulty getting an appointment (41%), feeling upset about leaving pediatrics (24%), and insurance problems (10%). In multivariate analysis, barriers most strongly associated with gaps in care >6 months were lack of adult provider name (odds ratio [OR], 6.1; 95% confidence interval [CI], 3.0–12.7) or contact information (OR, 5.3; 95% CI, 2.0–13.9), competing life priorities (OR, 5.2; 95% CI, 2.7–10.3), and insurance problems (OR, 3.5; 95% CI, 1.2–10.3). Overall, respondents reporting ≥1 moderate/major barrier (48%) had 4.7-fold greater adjusted odds of a gap in care >6 months (95% CI, 2.8–8.7). Conclusion Significant barriers to transition, such as a lack of specific adult provider referrals, may be addressed with more robust preparation by pediatric providers and care coordination. Further study is needed to evaluate strategies to improve young adult self-care in the setting of competing life priorities. PMID:23807526

  7. Performance-Shaping Factors Affecting Older Adults' Hospital-to-Home Transition Success: A Systems Approach.

    PubMed

    Werner, Nicole E; Tong, Michelle; Borkenhagen, Amy; Holden, Richard J

    2018-01-03

    Facilitating older adults' successful hospital-to-home transitions remains a persistent challenge. To address this challenge, we applied a systems lens to identify and understand the performance-shaping factors (PSFs) related older adults' hospital-to-home transition success. This study was a secondary analysis of semi-structured interviews from older adults (N = 31) recently discharged from a hospital and their informal caregivers (N = 13). We used a Human Factors Engineering approach to guide qualitative thematic analysis to develop four themes concerning the system conditions shaping hospital-to-home transition success. The four themes concerning PSFs were: (a) the hospital-to-home transition was a complex multiphase process-the process unfolded over several months and required substantial, persistent investment/effort; (b) there were unmet needs for specialized tools-information and resources provided at hospital discharge were not aligned with requirements for transition success; (c) alignment of self-care routines with transition needs-pre-hospitalization routines could be supportive/disruptive and could deteriorate/be re-established; and (d) changing levels of work demand and capacity during the transition-demand often exceeded capacity leading to work overload. Our findings highlight that the transition is not an episodic event, but rather a longitudinal process extending beyond the days just after hospital discharge. Transition interventions to improve older adults' hospital-to-home transitions need to account for this complex multiphase process. Future interventions must be developed to support older adults and informal caregivers in navigating the establishment and re-establishment of routines and managing work demands and capacity during the transition process. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Management issues of congenital adrenal hyperplasia during the transition from pediatric to adult care.

    PubMed

    Choi, Jin-Ho; Yoo, Han-Wook

    2017-02-01

    Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers. Psychosocial issues frequently affect adherence to glucocorticoid treatment. Therefore, the safe transition of adolescents to adult care requires regular follow-up of patients by a multidisciplinary team including pediatric and adult endocrinologists. The major goals for management of adults with 21-hydroxylase deficiency are to minimize the long-term complications of glucocorticoid therapy, reduce hyperandrogenism, prevent adrenal or testicular adrenal rest tumors, maintain fertility, and improve quality of life. Optimized medical or surgical treatment strategies should be developed through coordinated care, both during transition periods and throughout patients' lifetimes. This review will summarize current knowledge on the management of adults with CAH, and suggested appropriate approaches to the transition from pediatric to adult care.

  9. Development of quality indicators for transition from pediatric to adult care in sickle cell disease: A modified Delphi survey of adult providers.

    PubMed

    Sobota, Amy E; Shah, Nishita; Mack, Jennifer W

    2017-06-01

    Transition from pediatric to adult care is a vulnerable time for young adults with sickle cell disease (SCD); however, improvements in transition are limited by a lack of quality indicators. The purpose of this study was to establish quality indicators for transition in SCD and to determine the optimal timing between the final pediatric visit and the first adult provider visit. We conducted a modified Delphi survey to reach a consensus on which quality indicators are most important for a successful transition. Our expert panel consisted of members of the Sickle Cell Adult Provider Network. In the first round, the participants ranked a list of quality indicators by importance. In the second round, the participants chose their "top 5" quality indicators in terms of importance and also ranked them on feasibility. The response rates for the two rounds were 68 and 96%, respectively. Nine quality indicators were chosen as "top 5" by a majority of respondents, including communication between pediatric and adult providers, timing of first adult visit, patient self-efficacy, quality of life, and trust with their adult provider. Based on the comments from round 1, respondents were also asked for the optimal timing between leaving pediatric care and entering adult care. Most recommended a first adult visit within 2 months of the final pediatric visit. By using these quality indicators chosen by the majority of respondents, we can better develop and evaluate transition programs for young adults with SCD and improve health outcomes for these vulnerable patients. © 2016 Wiley Periodicals, Inc.

  10. Adults Role in Bullying

    ERIC Educational Resources Information Center

    Notar, Charles E.; Padgett, Sharon

    2013-01-01

    Do adults play a role in bullying? Do parents, teachers, school staff, and community adult leaders influence bullying behavior in children and teenagers? This article will focus on research regarding all adults who have almost daily contact with children and teens and their part in how bullying is identified, addressed, and prevented. This article…

  11. The transition to adulthood of young adults with IDD: Parents' joint projects.

    PubMed

    Young, Richard A; Marshall, Sheila K; Stainton, Tim; Wall, Jessie M; Curle, Deirdre; Zhu, Ma; Munro, David; Murray, John; El Bouhali, Asmae; Parada, Filomena; Zaidman-Zait, Anat

    2018-03-01

    Parents have found the transition to adulthood for their sons or daughters with intellectual and/or developmental disabilities (IDD) particularly challenging. The literature has not examined how parents work together and with others in face of this transition nor has it highlighted parental goals in this process. This study used a perspective based on joint, goal-direct action to describe the projects that Canadian parents engaged in together and with others relative to this transition. Using the qualitative action-project method, joint projects between parents and with others were identified from their conversations and followed for 6 months. Three groups of projects were described: equipping the young adult for adult life, connecting for personal support and managing day-to-day while planning for the future. Parents act together and with others relative to the transition to adulthood of their young adult children with IDD. These projects are complex and differ in goals, steps, resources and emotional regulation and motivation. © 2017 John Wiley & Sons Ltd.

  12. Cumulative Exposure to Neighborhood Context: Consequences for Health Transitions over the Adult Life Course

    PubMed Central

    Clarke, Philippa; Morenoff, Jeffrey; Debbink, Michelle; Golberstein, Ezra; Elliott, Michael R.; Lantz, Paula M.

    2012-01-01

    Over the last two decades, research has assessed the relationship between neighborhood socioeconomic factors and individual health. However, existing research is based almost exclusively on cross-sectional data, ignoring the complexity in health transitions that may be shaped by long term residential exposures. We address these limitations by specifying distinct health transitions over multiple waves of a 15 year study of American adults. We focus on transitions between a hierarchy of health states, (free from health problems, onset of health problems, and death), not just gradients in a single health indicator over time, and use a cumulative measure of exposure to neighborhoods over adulthood. We find that cumulative exposure to neighborhood disadvantage has significant effects on functional decline and mortality. Research ignoring a persons’ history of exposure to residential contexts over the life course runs the risk of underestimating the role of neighborhood disadvantage on health. PMID:24465068

  13. Integrating Social-Contextual and Intrapersonal Mechanisms of "Maturing Out": Joint Influences of Familial-Role Transitions and Personality Maturation on Problem-Drinking Reductions.

    PubMed

    Lee, Matthew R; Ellingson, Jarrod M; Sher, Kenneth J

    2015-09-01

    "Maturing out" of problem drinking is associated with both role transitions (e.g., getting married) and personality development. However, little is known concerning how these 2 mechanisms jointly influence problem-drinking desistance. This study investigated whether salutary effects of role transitions and personality occur at different points in young-adult development and whether they mediate one another's effects. Participants were initially recruited as first-year undergraduates, with family history of alcoholism overrepresented by design (N = 489). Using 4 waves of data at roughly ages 21, 25, 29, and 34, cross-lagged panel models estimated prospective relations among familial-role transitions (marriage or parenthood), personality (disinhibition, conscientiousness, and neuroticism), and problem drinking. Mixed support was found for the prediction of roles being more strongly associated with earlier maturing out of problem drinking and personality being more strongly associated with later maturing out. Regarding mediation, no evidence was found for the expectation that role effects would be mediated by personality. However, results did support mediation of personality effects by role transitions. Specifically, lower disinhibition and higher conscientiousness in emerging adulthood predicted role adoption, which, in turn, predicted later problem-drinking reductions. Family history of alcoholism also distally influenced these mediation processes. The differential timing of role and personality effects is consistent with the notion of decreasing contextual influences and increasing intrapersonal influences across development. In light of role incompatibility theory, results suggest that, over the course of development, the association of familial roles with problem drinking may increasingly reflect problem-drinking effects on role entry (i.e., role selection) and decreasingly reflect role entry effects on problem drinking (i.e., role socialization). As emerging-adult

  14. Health Care Transition in Young Adults With Type 1 Diabetes: Perspectives of Adult Endocrinologists in the U.S.

    PubMed Central

    Telo, Gabriela H.; Needleman, Joseph S.; Forbes, Peter; Finkelstein, Jonathan A.; Laffel, Lori M.

    2016-01-01

    OBJECTIVE Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. Our objective was to describe experiences, resources, and barriers reported by a national sample of adult endocrinologists receiving and caring for young adults with type 1 diabetes. RESEARCH DESIGN AND METHODS We fielded an electronic survey to adult endocrinologists with a valid e-mail address identified through the American Medical Association Physician Masterfile. RESULTS We received responses from 536 of 4,214 endocrinologists (response rate 13%); 418 surveys met the eligibility criteria. Respondents (57% male, 79% Caucasian) represented 47 states; 64% had been practicing >10 years and 42% worked at an academic center. Only 36% of respondents reported often/always reviewing pediatric records and 11% reported receiving summaries for transitioning young adults with type 1 diabetes, although >70% felt that these activities were important for patient care. While most respondents reported easy access to diabetes educators (94%) and dietitians (95%), fewer (42%) reported access to mental health professionals, especially in nonacademic settings. Controlling for practice setting and experience, endocrinologists without easy access to mental health professionals were more likely to report barriers to diabetes management for young adults with depression (odds ratio [OR] 5.3; 95% CI 3.4, 8.2), substance abuse (OR 3.5; 95% CI 2.2, 5.6), and eating disorders (OR 2.5; 95% CI 1.6, 3.8). CONCLUSIONS Our findings underscore the need for enhanced information transfer between pediatric and adult providers and increased mental health referral access for young adults with diabetes post-transition. PMID:26681724

  15. Role transition from caregiver to case manager--Part II.

    PubMed

    Schmitt, Nancy

    2006-01-01

    This two-part article explores the process of role transition as it pertains to nurses moving from roles of caregivers to roles of case managers. Part 1 of the article presented a theoretical model that demonstrated the interplay of significant factors in the process of role transition and discussed how this model could be used to examine nurses' experience of this transition. Part 2 presents findings from a qualitative study involving interview and focus group data contributed by nurses who have made the transition from caregiver to case manager. Data point to specific tensions experienced by these nurses, which are associated with time-task orientation, interactions and relationships, business culture and objectives, and self-image and professional identity. Recommendations for preparing and supporting nurses through this role are also offered.

  16. Employment outcomes of transition-aged adults with autism spectrum disorders: a state of the States report.

    PubMed

    Burgess, Sloane; Cimera, Robert E

    2014-01-01

    The primary purpose of this study was to evaluate the employment outcomes of transition-aged adults with autism spectrum disorders (ASD) served by vocational rehabilitation services (VR) over the last 10 years by state. A secondary purpose was to compare employment outcomes of individuals with ASD to those of the overall transition-aged population served by VR for the same time period. Although there was variability both within and among states, the results of this study indicate that, over time, the number of young adults with ASD seeking VR services has increased; however, employment outcomes including the percent of adults with ASD achieving employment, the number of hours worked, and wages earned have not improved for this group. The cost to provide VR services to transition-aged adults with ASD was relatively stable over time. Transition-aged adults with ASD were more likely to become successfully employed as a result of receiving VR services than the overall population of transition-aged adults served by VR. However, the employed transition-aged adults consistently worked fewer hours and earned lower wages than those in the overall population. Factors that may influence variability within and among states, and between groups, and implications for research and practice are discussed.

  17. Current Status and Issues Regarding Transitional Health Care for Adults and Young Adults with Special Health Care Needs in Japan.

    PubMed

    Ariyasu, Hiroyuki; Akamizu, Takashi

    2018-05-15

    With the progress of medical care in recent years, the prognosis of intractable diseases of childhood onset has markedly improved. Young adults with special health care needs require continuous medical support throughout their lifetimes. To provide them with optimal health care services, a smooth transition from the pediatric medical system to the adult one is essential. However, in Japan many adult health providers are not sufficiently prepared to care for these patients, due both to limited opportunities to gain up-to-date medical knowledge on transitional health care and a lack of familiarity with the medical treatment of childhood-onset chronic diseases. In this review, we discuss current issues in transitional health care in Japan from an internist's viewpoint.

  18. Transformative Vocational Education: Bridging Transitions of Underserved Urban Adult Learners

    ERIC Educational Resources Information Center

    Adkisson, Anthony C.; Monaghan, Catherine H.

    2014-01-01

    How our culture thinks about particular events as linear, normal, and expected does not always fit with the experiences of every learner, particularly underserved urban adult learners. As adult educators in this context, are there ways we might improve or change our pedagogy of instruction by developing a better understanding of transitional life…

  19. Enablers and barriers of men with Duchenne muscular dystrophy transitioning from an adult clinic within a pediatric hospital.

    PubMed

    Lindsay, Sally; McAdam, Laura; Mahendiran, Tania

    2017-01-01

    Young men with Duchenne muscular dystrophy (DMD) live into adulthood and need specialized care. However, services for adults are fragmented. We know little about young men's experiences, their parents, and clinicians who support them as they transition to adult care. To explore the enablers and barriers of clinicians, young men, and parents as they transition from an adult DMD clinic within a pediatric hospital to an adult health facility. We conducted semi-structured, in-depth interviews with 16 participants (7 clinicians, 5 parents, 4 youth). We used an open-coding, thematic approach to analyze the data. Clinicians, youth and their parents experienced several enablers and barriers in transitioning to an adult health care center. Clinicians reported that structural factors including leadership and advocacy supported the transition. Clinicians and parents found that the availability and continuity of care both enabled and hindered the transition. Parents and youth conveyed the difficulties of adjusting to the different model of adult care and also accessing resources. All participants described how relational factors (i.e., effective communication and family involvement) enabled the transition. On an individual level, clinicians, parents and youth viewed transition readiness and other life skill supports as an enabler and a barrier to transitioning. All participants reported the difficulties of maintaining mental health for youth with DMD transitioning to adult health care. Clinicians, youth, and parents experienced several enablers and barriers in transitioning to adult health care. Further work is needed to understand the complex transition needs of youth with DMD. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Transitioning to a narrow path: the impact of fear of falling in older adults.

    PubMed

    Dunlap, Pamela; Perera, Subashan; VanSwearingen, Jessie M; Wert, David; Brach, Jennifer S

    2012-01-01

    Everyday ambulation requires navigation of variable terrain, transitions from wide to narrow pathways, and avoiding obstacles. While the effect of age on the transition to a narrow path has been examined briefly, little is known about the impact of fear of falling on gait during the transition to a narrow path. The purpose was to examine the effect of age and fear of falling on gait during transition to a narrow path. In 31 young, mean age=25.3 years, and 30 older adults, mean age=79.6 years, step length, step time, step width and gait speed were examined during usual and transition to narrow pathway using an instrumented walkway. During the transition to narrow walk condition, fearful older adults compared to young had a wider step width (0.06 m vs 0.04 m) prior to the narrow path and took shorter steps (0.53 m vs 0.72 m; p<0.001). Compared to non-fearful older adults, fearful older adults walked slower and took shorter steps during narrow path walking (gait speed: 1.1m/s vs 0.82 m/s; p=0.01; step length: 0.60 m vs 0.47 m; p=0.03). In young and non-fearful older adults narrow path gait was similar to usual gait. Whereas older adults who were fearful, walked slower (0.82 m/s vs 0.91 m/s; p=0.001) and took shorter steps (0.44 m vs 0.53 m; p=0.004) during narrow path walking compared to usual walking. Changes in gait characteristics with transitioning to a narrow pathway were greater for fear of falling than for age. Copyright © 2011 Elsevier B.V. All rights reserved.

  1. Health Care Transition Preparation and Experiences in a U.S. National Sample of Young Adults With Type 1 Diabetes.

    PubMed

    Garvey, Katharine C; Foster, Nicole C; Agarwal, Shivani; DiMeglio, Linda A; Anderson, Barbara J; Corathers, Sarah D; Desimone, Marisa E; Libman, Ingrid M; Lyons, Sarah K; Peters, Anne L; Raymond, Jennifer K; Laffel, Lori M

    2017-03-01

    Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. We developed a survey to evaluate transition experiences in two groups of young adults with type 1 diabetes, before (PEDS) and after (ADULT) transition to adult care. We fielded an electronic survey to young adults (18 to <30 years) at 60 T1D Exchange Clinic Registry centers. Surveys were completed by 602 young adults, 303 in the PEDS group (60% female, age 20 ± 2 years) and 299 in the ADULT group (62% female, age 24 ± 3 years). In the PEDS group, mean anticipated transition age was 22 ± 2 years; 64% remained in pediatric care because of emotional attachment to the provider. The ADULT group transitioned at age 19 ± 2 years, mainly after pediatric provider recommendation. More than 80% of respondents reported receiving counseling on type 1 diabetes self-management and screening tests from pediatric providers, but less than half (43% PEDS and 33% ADULT) reported discussing reproductive health. In the PEDS group, half had discussed transfer with pediatric providers. Of the ADULT participants, 63% received an adult provider referral, and 66% felt mostly/completely prepared to transition. ADULT participants with fewer pretransition pediatric visits or who felt unprepared for transition had increased odds of gaps >6 months between pediatric and adult care. Receipt of transition preparation counseling was not associated with self-reported hemoglobin A 1c <7.0% in either group. These results support the need for intensive efforts to integrate transition preparation counseling and care coordination into pediatric type 1 diabetes care. © 2017 by the American Diabetes Association.

  2. Opportunities lost and found: experiences of patients with cerebral palsy and their parents transitioning from pediatric to adult healthcare.

    PubMed

    DiFazio, Rachel L; Harris, Marie; Vessey, Judith A; Glader, Laurie; Shanske, Susan

    2014-01-01

    To describe and define the experiences of adults with cerebral palsy (CP) and parents of adults with CP who have been involved in a transfer of physiatry care from pediatric to adult healthcare and to explore their experiences more generally in the transition from pediatric to adult services. A qualitative research approach was used. Semi-structured focus group interviews were conducted with adults with CP (n=5) and parents of adults with CP (n=8) to explore the health care transition (HCT) process from pediatric to adult healthcare. Four key content domains were used to facilitate the focus groups; 1) Transition Planning, 2) Accessibility of Services, 3) Experience with Adult Providers, and 4) Recommendations for Improving the Transition Process. Conventional content analysis was used to analyze the data. Four themes emerged from the focus groups; Lost in Transition, Roadmap to Care, List of None, and One Stop Shopping. Participants felt lost in the HCT process, requested a transparent transition plan, expressed concern regarding access to adult healthcare, and made recommendations for improvements. Challenges in transitioning from pediatric to adult health care were identified by all participants and several strategies were recommended for improvement.

  3. Social class and body weight among Chinese urban adults: the role of the middle classes in the nutrition transition.

    PubMed

    Bonnefond, Céline; Clément, Matthieu

    2014-07-01

    While a plethoric empirical literature addresses the relationship between socio-economic status and body weight, little is known about the influence of social class on nutritional outcomes, particularly in developing countries. The purpose of this article is to contribute to the analysis of the social determinants of adult body weight in urban China by taking into account the influence of social class. More specifically, we propose to analyse the position of the Chinese urban middle class in terms of being overweight or obese. The empirical investigations conducted as part of this research are based on a sample of 1320 households and 2841 adults from the China Health and Nutrition Survey for 2009. For the first step, we combine an economic approach and a sociological approach to identify social classes at household level. First, households with an annual per capita income between 10,000 Yuan and the 95th income percentile are considered as members of the middle class. Second, we strengthen the characterization of the middle class using information on education and employment. By applying clustering methods, we identify four groups: the elderly and inactive middle class, the old middle class, the lower middle class and the new middle class. For the second step, we implement an econometric analysis to assess the influence of social class on adult body mass index and on the probability of being overweight or obese. We use multinomial treatment regressions to deal with the endogeneity of the social class variable. Our results show that among the four subgroups of the urban middle class, the new middle class is the only one to be relatively well-protected against obesity. We suggest that this group plays a special role in adopting healthier food consumption habits and seems to be at a more advanced stage of the nutrition transition. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Transition to adult mental health services for young people with attention deficit hyperactivity disorder in Italy: Parents' and clinicians' experiences.

    PubMed

    Reale, Laura; Frassica, Simona; Gollner, Astrid; Bonati, Maurizio

    2015-01-01

    The aim of this study was to describe the experiences of parents and clinicians in relation to the transition from child and adolescent neuropsychiatric services (CANPS) to adult services for people with attention deficit hyperactivity disorder (ADHD) in Italy. Parents of people with ADHD who reached the transition boundary for CANPS were sampled from the A.I.F.A. association (Italian Association of ADHD Families). We thematically analyzed informative and qualitative questionnaires completed by parents and clinicians. Parents' (n = 24) and clinicians' (n = 27) experiences differed slightly on challenges and unmet needs, whereas clinicians agreed on the variables required for an optimal transition process. Poor transition and multiple barriers to such care were identified. Specifically, far fewer people received services, especially public health services, after reaching the age of 18, and perceived barriers included problems with user access, limited transition protocols, poor service coordination, and possible lack of ADHD-related knowledge on the part of adult practitioners. Care continuity in mental healthcare remains a need to be prioritized and better defined also for ADHD patients (and their parents). Parents' and clinicians' experiences are more likely to be positive if transition management is characterized by a gradual preparation, a period of parallel care, and commonly acknowledged, clear information on available services and how to access them. Identifying the needs and barriers of the people representing the different roles (clinicians, parents, and users) involved in the transition to adult mental health services is of particular importance in designing effective, shared transfer planning procedures.

  5. Perspectives of paediatric and adult gastroenterologists on transfer and transition care of adolescents with inflammatory bowel disease.

    PubMed

    Wright, E K; Williams, J; Andrews, J M; Day, A S; Gearry, R B; Bampton, P; Moore, D; Lemberg, D; Ravikumaran, R; Wilson, J; Lewindon, P; Radford-Smith, G; Rosenbaum, J; Catto-Smith, A; Desmond, P V; Connell, W R; Cameron, D; Alex, G; Bell, S J; De Cruz, P

    2014-05-01

    Programmes specific to inflammatory bowel disease (IBD) that facilitate transition from paediatric to adult care are currently lacking. We aimed to explore the perceived needs of adolescents with IBD among paediatric and adult gastroenterologists and to identify barriers to effective transition. A web-based survey of paediatric and adult gastroenterologists in Australia and New Zealand employed both ranked items (Likert scale; from 1 not important to 5 very important) and forced choice items regarding the importance of various factors in facilitating effective transition of adolescents from paediatric to adult care. Response rate among 178 clinicians was 41%. Only 23% of respondents felt that adolescents with IBD were adequately prepared for transition to adult care. Psychological maturity (Mean = 4.3, standard deviation (SD) = 0.70) and readiness as assessed by adult caregiver (Mean = 4, SD = 0.72) were prioritised as the most important factors in determining timing of transfer. Self-efficacy and readiness as assessed by adult caregiver were considered the two most important factors to determine timing of transition by both groups of gastroenterologists. Poor medical and surgical handover (Mean = 4.10, SD = 0.8) and patients' lack of responsibility for their own care (Mean= 4.10, SD = 0.82) were perceived as major barriers to successful transition by both paediatric and adult gastroenterologists. Deficiencies exist in current transition care of adolescents with IBD in Australia and New Zealand. Standardising transition care practices with strategies aimed at optimising communication, patient education, self-efficacy and adherence may improve outcomes. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  6. UTILITY OF PSYCHOLOGICAL SCREENING OF YOUNG ADULTS WITH TYPE 1 DIABETES TRANSITIONING TO ADULT PROVIDERS.

    PubMed

    Quinn, Sheila M; Ambrosino, Jodie M; Doyle, Elizabeth A; Weyman, K; Tamborlane, William V; Jastreboff, Ania M

    2016-09-01

    Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised. Chart review determined if clinicians noted similar symptoms during the year prior to transition. Metabolic data were also recorded. Chart review identified 5 patients with depressive symptoms and 8 patients with diabetes distress. Screening identified 2 additional patients with depressive symptoms and 1 additional patient with diabetes distress. Of those noted to have symptomatic depression or diabetes distress on chart review, several subsequently screened negative on transition. Disordered eating was not detected by chart review, but 23.5% screened positive on transition. While depression, diabetes distress, and disordered eating positively correlated with glycated hemoglobin (HbA1c) (r = 0.31, P = .05; r = 0.40, P = .009; r = 0.63, P<.001, respectively), disordered eating accounted for the majority of observed variance (df = 1; F = 18.6; P<.001). Even though HbA1c was higher in patients with versus without disordered eating (P<.001), body mass index did not differ between the 2 groups (P = .51). In young adults with T1D, formal screening provides an opportunity to detect psychological problems, which, when treated, may help optimize metabolic control during the transition process. T1D = type 1 diabetes HbA1C = hemoglobin A1c YCDP = Yale Children's Diabetes Program PHQ-8 = Patient Health Questionnaire-8 DDS = Diabetes Distress Scale DEPS

  7. Transition of adolescent and young adult patients with childhood-onset chronic kidney disease from pediatric to adult renal services: a nationwide survey in Japan.

    PubMed

    Hattori, Motoshi; Iwano, Masayuki; Sako, Mayumi; Honda, Masataka; Okada, Hirokazu; Akioka, Yuko; Ashida, Akira; Kawasaki, Yukihiko; Kiyomoto, Hideyasu; Terada, Yoshio; Hirano, Daishi; Fujieda, Mikiya; Fujimoto, Shouichi; Masaki, Takao; Maruyama, Shoichi; Mastuo, Seiich

    2016-12-01

    Transition of adolescent and young adult (AYA) patients with childhood-onset chronic kidney diseases (C-CKD) from pediatric to adult renal services has received increasing attention. However, information on transition of Japanese patients with C-CKD is limited. The Transition Medicine Working Group, in collaboration with the Japanese Society for Nephrology, the Japanese Society for Pediatric Nephrology and the Japanese Society of Pediatric Urology, conducted a retrospective cross-sectional study in 2014 on issues concerning the transition of Japanese patients with C-CKD. Few institutions in Japan had transition programs and/or transition coordinators for patients with C-CKD. Refusal to transfer by patients or their families, lack of concern about transition and inability to decide on transfer were common reasons for non-transfer of patients still followed by pediatric renal services. Around 25 % of patients who had ended or interrupted follow-up by pediatric renal services presented to adult renal services because of symptoms associated with C-CKD. Patients with various types of childhood-onset nephrourological diseases were transferred from pediatric to adult renal services. IgA nephropathy, minimal change nephrotic syndrome and congenital anomalies of the kidney and urinary tract were the most frequent primary kidney diseases in adult patients with C-CKD. These survey results indicate the need for introduction of transitional care for Japanese AYA patients with C-CKD. Consensus guidelines for the optimal clinical management of AYA patients with C-CKD are required to ensure the continuity of care from child to adult renal services.

  8. Health Care Transition in Young Adults With Type 1 Diabetes: Perspectives of Adult Endocrinologists in the U.S.

    PubMed

    Garvey, Katharine C; Telo, Gabriela H; Needleman, Joseph S; Forbes, Peter; Finkelstein, Jonathan A; Laffel, Lori M

    2016-02-01

    Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. Our objective was to describe experiences, resources, and barriers reported by a national sample of adult endocrinologists receiving and caring for young adults with type 1 diabetes. We fielded an electronic survey to adult endocrinologists with a valid e-mail address identified through the American Medical Association Physician Masterfile. We received responses from 536 of 4,214 endocrinologists (response rate 13%); 418 surveys met the eligibility criteria. Respondents (57% male, 79% Caucasian) represented 47 states; 64% had been practicing >10 years and 42% worked at an academic center. Only 36% of respondents reported often/always reviewing pediatric records and 11% reported receiving summaries for transitioning young adults with type 1 diabetes, although >70% felt that these activities were important for patient care. While most respondents reported easy access to diabetes educators (94%) and dietitians (95%), fewer (42%) reported access to mental health professionals, especially in nonacademic settings. Controlling for practice setting and experience, endocrinologists without easy access to mental health professionals were more likely to report barriers to diabetes management for young adults with depression (odds ratio [OR] 5.3; 95% CI 3.4, 8.2), substance abuse (OR 3.5; 95% CI 2.2, 5.6), and eating disorders (OR 2.5; 95% CI 1.6, 3.8). Our findings underscore the need for enhanced information transfer between pediatric and adult providers and increased mental health referral access for young adults with diabetes post-transition. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  9. Enhancing success in transition service coordinators: use of transformational leadership.

    PubMed

    Rearick, Ellen

    2007-01-01

    The lifespan of children with special healthcare needs has been extended because of improved technology and medical advances. Successful transition to the adult arena of healthcare, social services, and education by adolescents with special healthcare needs (ASHCN) is lacking. The transition service coordinator (TSC) is a multifaceted role of advanced practice nursing that provides highly specialized transition services to adolescents with special healthcare needs. The use of key concepts from the transformational leadership theory may improve healthcare outcomes. This article applies to pediatric and adult primary care and case management services that serve adolescents with special healthcare needs. Employing key concepts of transformational leadership theory will enhance the success of the TSC to improve both collaboration among stakeholders in the transitional team and young adults' transition to the world of adult services. Enhanced communication resulting in improved sharing of information, understanding of the stakeholder roles, and provision of formal linkages between pediatric and adult medical providers is a significant outcome affecting the ASHCN. Improved collaboration will produce a smooth transition for the ASHCN to the world of adult social services education, and employment. Incorporating the transformational leadership dimensions of idealized influence, inspirational motivation intellectual stimulation, and individualized consideration will enhance the ability of the TSC to improve collaboration among stakeholders in the transitional team and the quality of services for the ASHCN.

  10. Facilitating the transition of patients with special health care needs from pediatric to adult oral health care.

    PubMed

    Nowak, Arthur J; Casamassimo, Paul S; Slayton, Rebecca L

    2010-11-01

    Without guidelines or policies in dentistry for transitioning adolescents with special heath care needs from pediatric to adult oral health care, little is known about traditional support services. The authors surveyed pediatric dentists about their transition of adolescent patients with and without special health care needs (SHCNs) to adult care. In 2009, the authors e-mailed a pilot-tested survey modified from a survey used for U.S. pediatricians to 4,000 pediatric dentists. The survey included demographic questions and questions regarding services and barriers associated with the transition of patients to adult care. Responses were obtained from 1,686 (42.2 percent response) pediatric dentists who were mostly in group or solo private practices and were younger, in that most had completed their education in the preceding 15 years. More than one-half practiced in suburban settings, and most worked with both dental hygienists and dental assistants. Most assisted patients with SHCNs with their transitions to adult care, and the predominant barrier to transitioning to adult care was availability of general dentists and specialists who were willing to accept these new patients. Pediatric dentists' answers paralleled those of pediatricians for the most part in terms of services provided and barriers to transition. Most responding dentists helped adolescents with and without SHCNs make the transition into adult care, but the major barrier was the availability of general dentists and specialists. With an office protocol in place that includes trained staff members, transitioning patients (especially those with SHCNs) to adult care can be facilitated to provide the appropriate oral health and support services.

  11. The Medical Transition from Pediatric to Adult-Oriented Care: Considerations for Child and Adolescent Psychiatrists.

    PubMed

    Hart, Laura C; Maslow, Gary

    2018-01-01

    More adolescents and young adults are surviving previously fatal childhood illness and need support to transition from pediatric care to adult-oriented care. There are many barriers, but guidelines and tools assist providers with emphasis on gradually addressing transition with patients and families. Child and adolescent psychiatrists should be particularly attuned to the needs of adolescents with previously identified mental illness who are at high risk of falling out of regular care during transition. Providers are also uniquely suited to address the needs of adolescents and young adults with intellectual and developmental disabilities. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Transfers and transitions between child and adult mental health services.

    PubMed

    Paul, Moli; Ford, Tamsin; Kramer, Tami; Islam, Zoebia; Harley, Kath; Singh, Swaran P

    2013-01-01

    Transfer of care from one healthcare provider to another is often understood as a suboptimal version of the process of transition. To separate and evaluate concepts of transfer and transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). In a retrospective case-note survey of young people reaching the upper age boundary at six English CAMHS, optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer. Of 154 cases, 76 transferred to AMHS. Failure to transfer resulted mainly from non-referral by CAMHS (n = 12) and refusal by service users (n = 12) rather than refusal by AMHS (n = 7). Four cases met all criteria for optimal transition, 13 met none; continuity of care (n = 63) was met most often. Transfer was common but good transition rare. Reasons for failure to transfer differ from barriers to transition. Transfer should be investigated alongside transition in research and service development.

  13. Improving the quality of transition and transfer of care in young adults with congenital heart disease.

    PubMed

    Everitt, Ian K; Gerardin, Jennifer F; Rodriguez, Fred H; Book, Wendy M

    2017-05-01

    The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease-specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients. © 2017 Wiley Periodicals, Inc.

  14. Literacy Development and Language Expression for Adult Learners in Transition

    ERIC Educational Resources Information Center

    Larrotta, Clarena; Moon, Ji Yoon Christine

    2016-01-01

    This chapter provides examples of transitions that learners face connected to their participation in adult education and English literacy instruction. It describes their efforts to attain relevant language expression skills.

  15. Older adults' home- and community-based care service use and residential transitions: a longitudinal study.

    PubMed

    Chen, Ya-Mei; Berkowitz, Bobbie

    2012-08-10

    As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults' use of home- and community-based services and their residential transitions. The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults' residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.). Older adults' use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults' use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal

  16. Barriers and Facilitators of Transition from Pediatric to Adult Long-Term Follow-Up Care in Childhood Cancer Survivors.

    PubMed

    Rosenberg-Yunger, Zahava R S; Klassen, Anne F; Amin, Leila; Granek, Leeat; D'Agostino, Norma M; Boydell, Katherine M; Greenberg, Mark; Barr, Ronald D; Nathan, Paul C

    2013-09-01

    Despite the risk for late effects in adult survivors of cancer in childhood or adolescence, many survivors fail to transition from pediatric to adult long-term follow-up (LTFU) care. The purpose of this study was to identify the barriers and facilitators of transition from pediatric to adult LTFU care. In this qualitative study, 38 Canadian survivors of cancer in childhood or adolescence, currently aged 15-26 years, were interviewed using semi-structured, open-ended questions. Participants belonged to one of four groups: pre-transition (n=10), successful transition (n=11), failed to transition (n=7), and transitioned to an adult center but then dropped out of adult care (n=10). A constructivist grounded theory approach was used to analyze the interview data. This approach consisted of coding transcripts line by line to develop categories and using constant comparison to examine relationships within and across codes and categories. Interviewing continued until saturation was reached. Three interrelated themes were identified that affected the transition process: micro-level patient factors (e.g., due diligence, anxiety), meso-level support factors (e.g., family, friends), and macro-level system factors (e.g., appointments, communication, healthcare providers). Factors could act as facilitators to transition (e.g., family support), barriers to transition (e.g., difficulty booking appointments), or as both a barrier and a facilitator (e.g., anxiety). This study illustrates the interaction between multiple factors that facilitate and/or prevent transition from pediatric to adult LTFU cancer care. A number of recommendations are presented to address potential macro-level system barriers to successful transition.

  17. Multicentre randomized controlled trial of structured transition on diabetes care management compared to standard diabetes care in adolescents and young adults with type 1 diabetes (Transition Trial).

    PubMed

    Spaic, Tamara; Mahon, Jeff L; Hramiak, Irene; Byers, Nicole; Evans, Keira; Robinson, Tracy; Lawson, Margaret L; Malcolm, Janine; Goldbloom, Ellen B; Clarson, Cheril L

    2013-10-09

    Transition from pediatric to adult diabetes care is a high risk period during which there is an increased rate of disengagement from care. Suboptimal transition has been associated with higher risks for acute and chronic diabetes-related complications. The period of emerging adulthood challenges current systems of healthcare delivery as many young adults with type 1 diabetes (T1D) default from diabetes care and are at risk for diabetes complications which are undetected and therefore untreated. Despite the importance of minimizing loss to follow-up there are no randomized control trials evaluating models of transition from pediatric to adult diabetes care. This is a multicentre randomized controlled trial. A minimum of 188 subjects with T1D aged between 17 and 20 years will be evaluated. Eligible subjects will be recruited from three pediatric care centres and randomly assigned in a 1:1 ratio to a structured transition program that will span 18 months or to receive standard diabetes care. The structured transition program is a multidisciplinary, complex intervention aiming to provide additional support in the transition period. A Transition Coordinator will provide transition support and will provide the link between pediatric and adult diabetes care. The Transition Coordinator is central to the intervention to facilitate ongoing contact with the medical system as well as education and clinical support where appropriate. Subjects will be seen in the pediatric care setting for 6 months and will then be transferred to the adult care setting where they will be seen for one year. There will then be a one-year follow-up period for outcome assessment. The primary outcome is the proportion of subjects who fail to attend at least one outpatient adult diabetes specialist visit during the second year after transition to adult diabetes care. Secondary outcome measures include A1C frequency measurement and levels, diabetes related emergency room visits and hospital

  18. Barriers to Gender Transition-Related Healthcare: Identifying Underserved Transgender Adults in Massachusetts

    PubMed Central

    White Hughto, Jaclyn M.; Rose, Adam J.; Pachankis, John E.; Reisner, Sari L.

    2017-01-01

    Abstract Purpose: The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults. Method: In 2013, 364 transgender residents of Massachusetts completed an electronic web-based survey online (87.1%) or in person (12.9%). A multivariable logistic regression model tested whether individual, interpersonal, and structural factors were associated with access to transition-related care. Results: Overall, 23.6% reported being unable to access transition-related care in the past 12 months. In a multivariable model, younger age, low income, low educational attainment, private insurance coverage, and healthcare discrimination were significantly associated with being unable to access transition-related care (all p<0.05). Discussion: Despite state nondiscrimination policies and universal access to healthcare, many of the Massachusetts transgender residents sampled were unable to access transition-related care. Multilevel interventions are needed, including supportive policies and policy enforcement, to ensure that underserved transgender adults can access medically necessary transition-related care. PMID:29082331

  19. Integrating Social-Contextual and Intrapersonal Mechanisms of “Maturing Out”: Joint Influences of Familial-Role Transitions and Personality Maturation on Problem-Drinking Reductions

    PubMed Central

    Lee, Matthew R.; Ellingson, Jarrod M.; Sher, Kenneth J.

    2015-01-01

    Background “Maturing out” of problem drinking is associated with both role transitions (e.g., getting married) and personality development. However, little is known concerning how these two mechanisms jointly influence problem-drinking desistance. This study investigated whether salutary effects of role transitions and personality occur at different points in young-adult development and whether they mediate one another’s effects. Methods Participants were initially recruited as first-year undergraduates, with family history of alcoholism overrepresented by design (N=489; Sher et al., 1991). Using four waves of data at roughly ages 21, 25, 29, and 34, cross-lagged panel models estimated prospective relations among familial-role transitions (marriage or parenthood), personality (disinhibition, conscientiousness, and neuroticism), and problem drinking. Results Mixed support was found for the prediction of roles being more strongly associated with earlier maturing out of problem drinking and personality being more strongly associated with later maturing out. Regarding mediation, no evidence was found for the expectation that role effects would be mediated by personality. However, results did support mediation of personality effects by role transitions. Specifically, lower disinhibition and higher conscientiousness in emerging adulthood predicted role adoption, which, in turn, predicted later problem-drinking reductions. Family history of alcoholism also distally influenced these mediation processes. Conclusions The differential timing of role and personality effects is consistent with the notion of decreasing contextual influences and increasing intrapersonal influences across development. In light of role incompatibility theory, results suggest that, over the course of development, the association of familial roles with problem drinking may increasingly reflect problem-drinking effects on role entry (i.e., role selection) and decreasingly reflect role entry

  20. Short-term outcomes following implementation of a dedicated young adult congenital heart disease transition program.

    PubMed

    Vaikunth, Sumeet S; Williams, Roberta G; Uzunyan, Merujan Y; Tun, Han; Barton, Cheryl; Chang, Philip M

    2018-01-01

    Transition from pediatric to adult care is a critical time for patients with congenital heart disease. Lapses in care can lead to poor outcomes, including increased mortality. Formal transition clinics have been implemented to improve success of transferring care from pediatric to adult providers; however, data regarding outcomes remain limited. We sought to evaluate outcomes of transfer within a dedicated transition clinic for young adult patients with congenital heart disease. We performed a retrospective analysis of all 73 patients seen in a dedicated young adult congenital heart disease transition clinic from January 2012 to December 2015 within a single academic institution that delivered pediatric and adult care at separate children's and adult hospitals, respectively. Demographic characteristics including congenital heart disease severity, gender, age, presence of comorbidities, presence of cardiac implantable electronic devices, and type of insurance were correlated to success of transfer. Rate of successful transfer was evaluated, and multivariate analysis was performed to determine which demographic variables were favorably associated with transfer. Thirty-nine percent of patients successfully transferred from pediatric to adult services during the study period. Severe congenital heart disease (OR 4.44, 95% CI 1.25-15.79, P = .02) and presence of a cardiac implantable electronic device (OR 4.93, 95% CI 1.18-20.58, P = .03) correlated with transfer. Trends favoring successful transfer with presence of comorbidities and private insurance were also noted. Despite a dedicated transition clinic, successful transfer rates remained relatively low though comparable to previously published rates. Severity of disease and presence of implantable devices correlated with successful transfer. Other obstacles to transfer remain and require combined efforts from pediatric and adult care systems, insurance carriers, and policy makers to improve transfer outcomes.

  1. Adolescents' and young adults' transition experiences when transferring from paediatric to adult care: a qualitative metasynthesis.

    PubMed

    Fegran, Liv; Hall, Elisabeth O C; Uhrenfeldt, Lisbeth; Aagaard, Hanne; Ludvigsen, Mette Spliid

    2014-01-01

    The objective of this study was to synthesize qualitative studies of how adolescents and young adults with chronic diseases experience the transition from paediatric to adult hospital care. The review is designed as a qualitative metasynthesis and is following Sandelowski and Barroso's guidelines for synthesizing qualitative research. Literature searches were conducted in the databases PubMed, Ovid, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, and Nordic and German databases covering the period from 1999 to November 2010. In addition, forward citation snowball searching was conducted in the databases Ovid, CINAHL, ISI Web of Science, Scopus and Google Scholar. Of the 1143 records screened, 18 studies were included. Inclusion criteria were qualitative studies in English, German or Nordic languages on adolescents' and young adults' transition experiences when transferring from paediatric to adult care. There was no age limit, provided the focus was on the actual transfer process and participants had a chronic somatic disease. The studies were appraised as suitable for inclusion using a published appraisal tool. Data were analyzed into metasummaries and a metasynthesis according to established guidelines for synthesis of qualitative research. Four themes illustrating experiences of loss of familiar surroundings and relationships combined with insecurity and a feeling of being unprepared for what was ahead were identified: facing changes in significant relationships, moving from a familiar to an unknown ward culture, being prepared for transfer and achieving responsibility. Young adults' transition experiences seem to be comparable across diagnoses. Feelings of not belonging and of being redundant during the transfer process are striking. Health care professionals' appreciation of young adults' need to be acknowledged and valued as competent collaborators in their own transfer is crucial, and may protect them from

  2. The Chancellor's Role in a Presidential Transition

    ERIC Educational Resources Information Center

    Appleton, James R.; Dorsey, Stuart

    2009-01-01

    Successful transitions involving a formal role for the former president, such as chancellor, are rare enough that the authors think theirs is an exceptional experience and is worth sharing, especially given the bulge of presidential retirements anticipated over the next decade. The authors believe that this model of transition can be successful,…

  3. Understanding age-based transition needs: Perspectives from adolescents and adults with congenital heart disease

    USDA-ARS?s Scientific Manuscript database

    The purpose of this study was to explore the transition process in congenital heart disease (CHD) care through the perceived needs and concerns of adolescents (pretransition) and the experiential insight from adults (post-transition), in order to inform future transition initiatives and information ...

  4. Health Trajectories of Family Caregivers: Associations With Care Transitions and Adult Day Service Use

    PubMed Central

    Liu, Yin; Kim, Kyungmin; Zarit, Steven H.

    2017-01-01

    Objective The study examines family caregivers’ health changes over 1 year on four health dimensions and explores the association of differential health trajectories with adult day service (ADS) use and caregiving transitions. Method The participants were 153 primary caregivers of individuals with dementia (IWDs) who provided information on care situations and their own health at baseline, 6-month, and 12-month interviews. Results Caregivers showed increasing functional limitations and decreasing bodily pain over time, whereas role limitation and general health perception remained stable. Furthermore, caregivers’ trajectories of functional limitation were associated with their extent of ADS use at baseline and their relatives’ placement. Discussion Health is multidimensional; all dimensions of caregiver health do not change in a uniform manner. The findings underscore the importance of the association of caregiving transitions and caregiver health and the potential health benefits of ADS use for family caregivers. PMID:25348275

  5. Health trajectories of family caregivers: associations with care transitions and adult day service use.

    PubMed

    Liu, Yin; Kim, Kyungmin; Zarit, Steven H

    2015-06-01

    The study examines family caregivers' health changes over 1 year on four health dimensions and explores the association of differential health trajectories with adult day service (ADS) use and caregiving transitions. The participants were 153 primary caregivers of individuals with dementia (IWDs) who provided information on care situations and their own health at baseline, 6-month, and 12-month interviews. Caregivers showed increasing functional limitations and decreasing bodily pain over time, whereas role limitation and general health perception remained stable. Furthermore, caregivers' trajectories of functional limitation were associated with their extent of ADS use at baseline and their relatives' placement. Health is multidimensional; all dimensions of caregiver health do not change in a uniform manner. The findings underscore the importance of the association of caregiving transitions and caregiver health and the potential health benefits of ADS use for family caregivers. © The Author(s) 2014.

  6. Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force.

    PubMed

    Andrade, Danielle M; Bassett, Anne S; Bercovici, Eduard; Borlot, Felippe; Bui, Esther; Camfield, Peter; Clozza, Guida Quaglia; Cohen, Eyal; Gofine, Timothy; Graves, Lisa; Greenaway, Jon; Guttman, Beverly; Guttman-Slater, Maya; Hassan, Ayman; Henze, Megan; Kaufman, Miriam; Lawless, Bernard; Lee, Hannah; Lindzon, Lezlee; Lomax, Lysa Boissé; McAndrews, Mary Pat; Menna-Dack, Dolly; Minassian, Berge A; Mulligan, Janice; Nabbout, Rima; Nejm, Tracy; Secco, Mary; Sellers, Laurene; Shapiro, Michelle; Slegr, Marie; Smith, Rosie; Szatmari, Peter; Tao, Leeping; Vogt, Anastasia; Whiting, Sharon; Carter Snead, O

    2017-09-01

    The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system. Wiley

  7. Development and Preliminary Evaluation of the Resident Coordinated-Transitional Care (RC-TraC) Program: A Sustainable Option for Transitional Care Education

    PubMed Central

    Chapman, E.; Eastman, A.; Gilmore-Bykovskyi, A.; Vogelman, B.; Kind, A. J.

    2016-01-01

    Older adults often face poor outcomes when transitioning from hospital to home. Although physicians play a key role in overseeing transitions, there is a lack of practice-based educational programs that prepare resident physicians to manage care transitions of older adults. An educational intervention to provide residents with real-life transitional care practice was therefore developed – Resident-coordinated Transitional Care (RC-TraC). RC-TraC adapted the evidence-based Coordinated-Transitional Care (C-TraC) nurse role for residents, providing opportunities to follow patients during the peri-hospital period without additional costs to the residency program. Between July 2010 and June 2013, thirty-one Internal Medicine residents participated in RC-TraC, caring for 721 patients. RC-TraC has been a sustainable, low-cost, practice-based education experience that is recognized as transitional care education by residents and continues in operation to this day. RC-TraC is a promising option for geriatric-based transitional care education of resident physicians and could also be adapted for non-physician learners. PMID:27749162

  8. Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with Type 1 diabetes

    PubMed Central

    Pyatak, E. A.; Sequeira, P. A.; Whittemore, R.; Vigen, C. P.; Peters, A. L.; Weigensberg, M. J.

    2014-01-01

    Aim To examine challenges contributing to disruptions in care during the transition from paediatric to adult care among young adults with Type 1 diabetes who are primarily in ethnic minority groups and have low socio-economic status. Methods Participants (n = 20) were newly enrolled patients in a transition clinic for young adults with Type 1 diabetes with a history of loss to medical follow-up. Participants completed qualitative semi-structured interviews detailing their transition experiences in addition to demographic, HbA1c and psychosocial measures. Descriptive statistics were completed for quantitative data, and narrative thematic analysis of interviews was used to identify common themes. A mixed-method analysis was used to identify the associations between stressors identified in interviews and clinical and psychosocial variables. Results Three categories of challenges contributing to loss to follow-up were identified: psychosocial challenges, health provider and health system challenges and developmental challenges. Participants experienced a high degree of stressful life circumstances which were associated with higher HbA1c (r = 0.60, P = 0.005), longer duration of loss to follow-up (r = 0.51, P = 0.02), greater emergency department utilization (r = 0.45, P = 0.05), and lower life satisfaction (r = −0.62, P = 0.003). Conclusions A confluence of challenges, including stressful life circumstances, healthcare system barriers and the developmental trajectory of young adulthood, contributes to a high risk of loss to follow-up and poor health in this population of young adults with Type 1 diabetes. An integrated approach to transition addressing medical and psychosocial needs may facilitate improved follow-up and health outcomes in clinical settings. PMID:24798586

  9. [Alex, an example of a successful transition to adult psychiatry].

    PubMed

    Rochet, Thierry

    A successful transition between child psychiatry and adult psychiatry is the result of a joint project. To ensure the continuity of the adolescent's care, the two protagonists need a common and constructive clinical interpretation, and a shared understanding of the problems, without which the transition will be difficult. The story of Alex, a young teenager cared for since early childhood, illustrates the communication methods which must be put in place. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. The Transition of Adult Students to Higher Education: Legitimate Peripheral Participation in a Community of Practice?

    ERIC Educational Resources Information Center

    O'Donnell, Victoria L.; Tobbell, Jane

    2007-01-01

    This article presents empirical research exploring adult students' transition to higher education (HE) through a program designed to enable that transition. Wenger's Communities of Practice theory has been applied to informal adult learning by Merriam, Courtenay, and Baumgartner (2003), who suggested its potential for understanding formal…

  11. Barriers to using fixed-route public transit for older adults.

    DOT National Transportation Integrated Search

    2010-06-01

    For older adults, unmet transportation needs are linked to reduced well-being (Cvitkovich and Wister 2001). Current research indicates that, as a society, we are ill-prepared to provide adequate transit for the growing increasing population of older ...

  12. Predictors of substance use among young adults transitioning away from high school: a narrative review.

    PubMed

    Kirst, Maritt; Mecredy, Graham; Borland, Tracey; Chaiton, Michael

    2014-11-01

    Young adulthood has been shown to be a time of increased substance use. Yet, not enough is known about which factors contribute to initiation and progression of substance use among young adults specifically during the transition year away from high school. A narrative review was undertaken to increase understanding of the predictors of changes in use of tobacco, alcohol, cannabis, other illicit drugs, and mental health problems among young adults during the transition period after high school. A review of academic literature examining predictors of the use of tobacco, alcohol and cannabis, and co-morbidities (e.g., co-occurring substance use and/or mental health issues) among young adults transitioning from high school to post-secondary education or the workforce. Twenty six studies were included in the review. The majority of the studies (19) examined substance use during the transition from high school to post-secondary settings. Seven studies examined substance use in post-secondary settings. The studies consistently found that substance use increases among young adults as they transition away from high school. During the transition away from high school, common predictors of substance use include substance use in high school, and peer influence. Common predictors of substance use in post-secondary education include previous substance use, peer influence, psychological factors and mental health issues. Conclusions/Importance: Further research on social contextual influences on substance use, mental health issues, gender differences and availability of substances during the transition period is needed to inform the development of new preventive interventions for this age group.

  13. Transition readiness skills acquisition in adolescents and young adults with inflammatory bowel disease: findings from integrating assessment into clinical practice.

    PubMed

    Gray, Wendy N; Holbrook, Erin; Morgan, Pamela J; Saeed, Shehzad A; Denson, Lee A; Hommel, Kevin A

    2015-05-01

    Almost 80% of adult gastroenterologists report inadequacies in the preparation of patients transferred from pediatrics. To improve transition to adult care, it is important to identify the specific deficits that patients are demonstrating before transfer. We present data from a clinic-wide assessment of transition readiness skill acquisition in adolescents/young adults with IBD. A total of 195 patients (age, 16-25 yr) with IBD completed the Transition Readiness Assessment Questionnaire. Patient age, diagnosis, time since diagnosis, physician global assessment, and patient and parent disease management confidence ratings were extracted from the medical record. Transition Readiness Assessment Questionnaire scores were compared with a benchmark established by an interdisciplinary, multi-institutional Transition Task Force. Only 5.6% of older adolescents/young adults on the verge of transfer to adult care met our institutional benchmark (3.5% of adolescents, 7.3% of young adults). Patients reported mastery of 9.10 ± 4.68 out of 20 Transition Readiness Assessment Questionnaire items. Transition readiness was associated with older age (r = 0.27, P < 0.001) and female gender (F(1,192) = 13.81, P < 0.001) but not time since diagnosis, physician global assessment, or confidence ratings. Deficits in health care utilization/self-advocacy (e.g., understanding insurance, scheduling appointments/following up on referrals), and self-management (e.g., filling/reordering prescriptions) were observed. Most patients on the verge of transferring to adult care are not demonstrating transition readiness. Deficits observed represent modifiable behaviors. Using data-driven assessments to guide interventions to enhance transition readiness may minimize the retention of young adult patients in pediatrics and result in patients who are better prepared for adult care.

  14. Transitioning Students from Adult Education to Postsecondary Education through Co-Enrollment Career Pathways Model

    ERIC Educational Resources Information Center

    Maisak, Nadzeya

    2017-01-01

    As the need for educated workers in the workforce grows at the national and state level, educating low-skilled adults is one way of addressing the skills gap. Adult education programs offer low-skilled adults an opportunity to increase basic academic skills and prepare for college and career. Today, transitioning students from adult education…

  15. Collaborative Counseling: A Conceptual Framework and Approach for Counselors of Adults in Life Transitions.

    ERIC Educational Resources Information Center

    Avis, Joan P.

    1987-01-01

    Proposes collaborative counseling as a comprehensive definition of adult counseling. Presents rationale for definition based on broad implications for counselors of adult development and life transitions literature. Discusses three perspectives as a conceptual framework for defining the phenomenology of the counselor of adults. Outlines elements…

  16. The transition of young adults with lifelong urological needs from pediatric to adult services: An international children's continence society position statement.

    PubMed

    Bower, Wendy F; Christie, Deborah; DeGennaro, Mario; Latthe, Pallavi; Raes, Ann; Romao, Rodrigo L P; Taghizadeh, Arash; Wood, Dan; Woodhouse, Christopher R J; Bauer, Stuart B

    2017-03-01

    Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services. Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners. The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract-thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or

  17. Young Adult Couples Transitioning to Work: The Intersection of Career and Relationship

    ERIC Educational Resources Information Center

    Domene, Jose F.; Nee, Jessica J.; Cavanaugh, Ashley K.; McLelland, Serita; Stewart, Becky; Stephenson, Michelle; Kauffman, Bradley; Tse, Christopher K.; Young, Richard A.

    2012-01-01

    Contextual action theory was used to frame an exploratory qualitative study of young adult couples' experiences of transitioning from post-secondary education into the labor force, addressing the specific research question ''What kinds of projects for future work and life together do young adult couples jointly construct and pursue as they…

  18. Voluntary sway and rapid orthogonal transitions of voluntary sway in young adults, and low and high fall-risk older adults.

    PubMed

    Tucker, Murray G; Kavanagh, Justin J; Morrison, Steven; Barrett, Rod S

    2009-10-01

    Falls amongst older people have been linked to reduced postural stability and slowed movement responses. The objective of this study was to examine differences in postural stability and the speed of response between young adults, low fall-risk older adults, and high fall-risk older adults during voluntary postural sway movements. Twenty-five young adults (25+/-4 years), and 32 low fall-risk (74+/-5 years), and 16 high fall-risk (79+/-7 years) older adults performed voluntary sway and rapid orthogonal transitions of voluntary sway between the anterior-posterior and medial-lateral directions. Measures included reaction and movement time and the amplitudes of the centre of pressure, centre of mass, and the separation distance between the centre of pressure and centre of mass. Both fall-risk groups compared to the young had slower reaction and movement time, greater centre of pressure and/or centre of mass amplitude in the orthogonal (non-target) direction during voluntary sway, and reduced anterior-posterior and medial-lateral separation between the centre of pressure and centre of mass during voluntary sway and orthogonal transitions. High compared to low fall-risk individuals had slower reaction and movement time, increased non-target centre of mass amplitude during voluntary sway, and reduced medial-lateral centre of pressure and centre of mass separation during voluntary sway and orthogonal transitions. Age-related deterioration of postural control resulted in slower reactive responses and reduced control of the direction of body movement during voluntary sway and orthogonal transitions. Slower postural reaction and movement time and reduced medial-lateral control of the centre of mass during voluntary sway movements are associated with increased fall-risk in community-living older people.

  19. Stakeholder validation of a model of readiness for transition to adult care.

    PubMed

    Schwartz, Lisa A; Brumley, Lauren D; Tuchman, Lisa K; Barakat, Lamia P; Hobbie, Wendy L; Ginsberg, Jill P; Daniel, Lauren C; Kazak, Anne E; Bevans, Katherine; Deatrick, Janet A

    2013-10-01

    That too few youth with special health care needs make the transition to adult-oriented health care successfully may be due, in part, to lack of readiness to transfer care. There is a lack of theoretical models to guide development and implementation of evidence-based guidelines, assessments, and interventions to improve transition readiness. To further validate the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) via feedback from stakeholders (patients, parents, and providers) from a medically diverse population in need of life-long follow-up care, survivors of childhood cancer. Mixed-methods participatory research design. A large Mid-Atlantic children's hospital. Adolescent and young adult survivors of childhood cancer (n = 14), parents (n = 18), and pediatric providers (n = 10). Patients and parents participated in focus groups; providers participated in individual semi-structured interviews. Validity of SMART was assessed 3 ways: (1) ratings on importance of SMART components for transition readiness using a 5-point scale (0-4; ratings >2 support validity), (2) nominations of 3 "most important" components, and (3) directed content analysis of focus group/interview transcripts. Qualitative data supported the validity of SMART, with minor modifications to definitions of components. Quantitative ratings met criteria for validity; stakeholders endorsed all components of SMART as important for transition. No additional SMART variables were suggested by stakeholders and the "most important" components varied by stakeholders, thus supporting the comprehensiveness of SMART and need to involve multiple perspectives. SMART represents a comprehensive and empirically validated framework for transition research and program planning, supported by survivors of childhood cancer, parents, and pediatric providers. Future research should validate SMART among other populations with special health care needs.

  20. Transitions from School for Young Adults with Intellectual Disability: Parental Perspectives on "Life as an Adjustment"

    ERIC Educational Resources Information Center

    Davies, Michael D.; Beamish, Wendi

    2009-01-01

    Background: Few studies have investigated transition programs and outcomes for young adults with disabilities as viewed from the parent perspective. The current Australian study provided a voice for parents to report on the experiences of and outcomes for young adults following their recent transition from school into post-school life. Method: A…

  1. Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers

    PubMed Central

    Paine, Christine Weirich; Stollon, Natalie B.; Lucas, Matthew S.; Brumley, Lauren D.; Poole, Erika S.; Peyton, Tamara; Grant, Anne W.; Jan, Sophia; Trachtenberg, Symme; Zander, Miriam; Mamula, Petar; Bonafide, Christopher P.; Schwartz, Lisa A.

    2014-01-01

    Background For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. Methods We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. Results Participants reported evaluating transition success and failure using healthcare utilization outcomes (e.g. maintaining continuity with adult providers), health outcomes (e.g. stable symptoms), and quality of life outcomes (e.g. attending school). The patients' level of developmental maturity (i.e. ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e. helicopter parent vs. optimally-involved parent) also influenced outcomes as well as the degree of support by providers (e.g. care coordination). Conclusion IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care. PMID:25137417

  2. Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers.

    PubMed

    Paine, Christine W; Stollon, Natalie B; Lucas, Matthew S; Brumley, Lauren D; Poole, Erika S; Peyton, Tamara; Grant, Anne W; Jan, Sophia; Trachtenberg, Symme; Zander, Miriam; Mamula, Petar; Bonafide, Christopher P; Schwartz, Lisa A

    2014-11-01

    For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-Ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. Participants reported evaluating transition success and failure using health care utilization outcomes (e.g., maintaining continuity with adult providers), health outcomes (e.g., stable symptoms), and quality of life outcomes (e.g., attending school). The patients' level of developmental maturity (i.e., ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e., helicopter parent versus optimally involved parent) and the degree of support by providers (e.g., care coordination) also influenced outcomes. IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care.

  3. Perspectives on care for young adults with type 1 diabetes transitioning from pediatric to adult health systems: A national survey of pediatric endocrinologists.

    PubMed

    Agarwal, Shivani; Garvey, Katharine C; Raymond, Jennifer K; Schutta, Mark H

    2017-11-01

    Healthcare transition from pediatric to adult care for young adults (YA) with type 1 diabetes (T1D) is associated with risk of adverse outcomes. Consensus recommendations exist from US professional societies on transition care for YA with T1D, but it is not known whether they have been widely adopted. We describe experiences, barriers, and provider characteristics associated with transition care in a national sample of pediatric endocrinologists. US pediatric endocrinologists identified through the American Medical Association Physician Masterfile were sent an electronic survey. Response rate was 16% (164/1020) representing 32 states. The majority of pediatric endocrinologists (age 44 ± 10; years in practice 12 ± 11) were female (67%) and worked in academic centers (75%). Main reasons for transfer were age (49%) and glycemic control (18%). Barriers to transition included ending long-therapeutic relationships with patients (74%), lack of transition protocols (46%), and perceived deficiencies in adult care (42%). The majority of pediatric endocrinologists reported lack of transition training (68%); those who received training were less likely to have difficulty ending patient relationships [odds ratio (OR) = 0.39, P = .03], more likely to perform patient record transfer to adult systems (OR=1.27, P = .006), and less likely to report patient returns to pediatric care after transfer (OR=0.49, P = .01), independent of endocrinologist gender, years in practice, or practice type. There is wide variation in transition care for YA with T1D among US pediatric endocrinologists despite consensus recommendations. Dissemination of educational programming on transition care and provision of actionable solutions to overcome local health system and perceived barriers is needed. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. The Development and Validation of the Transition Competence Battery for Adolescents and Young Adults with Deafness.

    ERIC Educational Resources Information Center

    Reiman, John; Bullis, Michael

    1988-01-01

    The lack of appropriate assessment tools designed for deaf adolescents and young adults making the transition from educational programs to adult life is cited as one of the most glaring deficits in the field of deafness. The Transition Competence Battery (TCB) is being developed as an assessment tool that will guide individual training decisions…

  5. Family Background and Early Life Course Transitions in Kinshasa.

    ERIC Educational Resources Information Center

    Tambashe, B. Oleko; Shapiro, David

    1996-01-01

    Examines the impact of a woman's family background on transitions to sexual activity, marriage, and motherhood. Documents how parental education, parental survival status, and other factors are important in the transition to adult roles. Findings suggest that increases in educational levels should contribute to delays in these transitions and…

  6. Transition to Community College: The Journey of Adult Basic Education English Learners from Non-Credit to Credit Programs

    ERIC Educational Resources Information Center

    Csepelyi, Tunde

    2012-01-01

    This phenomenological study examined the transition of a group of adult English language learners from an Adult Basic Education program to a community college. The purpose of the study was to gain a deeper understanding of the driving forces of Adult Basic Education English language learners who had successfully transitioned from a non-credit…

  7. Resident and Staff Satisfaction of Pediatric Graduate Medical Education Training on Transition to Adult Care of Medically Complex Patients.

    PubMed

    Weeks, Matthew; Cole, Brandon; Flake, Eric; Roy, Daniel

    2018-04-11

    This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike.

  8. A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions.

    PubMed

    Schwartz, L A; Tuchman, L K; Hobbie, W L; Ginsberg, J P

    2011-11-01

    Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge. In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed. SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic. The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients. SMART consists of inter-related constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed. © 2011 Blackwell Publishing Ltd.

  9. Process of Transition for Congenital Heart Patients: Preventing Loss to Follow-up.

    PubMed

    Habibi, Hajar; Emmanuel, Yaso; Chung, Natali

    The aim of this article is to provide an overview of our nurse-led transition clinic provided to congenital heart disease patients moving from pediatric into adult care setting. Nurse-led transition clinic was analyzed at various stages of young adult care from an early stage of 12 to 14 years to entering adult setting at 16 years or older. Overview of current transition service for young adults being transferred from pediatric into adult services highlights the integral role of clinical nurse specialist as a coordinator of care. The result of the service overview indicates that nurse-led transition service enables patients to build on their knowledge. This is achieved by providing them time and the opportunities to develop an understanding of their condition and the attitudes required to engage with the adult care setting as indicated in the psychology questionnaire from transition day. A nurse-led transition clinic enhances long-term care of patients by supporting the young adults and their family/carer through the transition and transfer of the care to promote the young adult's understanding of their condition and to prevent any lost to follow-up.

  10. Volunteer Evaluations of the Transitions Program for Young Adults with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Evans, Lacey

    2018-01-01

    This study examined the effects of participation of peer volunteers in the Transitions Program for young adults with Autism Spectrum Disorder (ASD), a program that facilitates social skills and social interactions. Participants in this study were peer volunteers in the Transitions Program. Each peer volunteer completed a questionnaire, following…

  11. Transitioning childhood cancer survivors to adult-centered healthcare: insights from parents, adolescent, and young adult survivors.

    PubMed

    Casillas, Jacqueline; Kahn, Katherine L; Doose, Michelle; Landier, Wendy; Bhatia, Smita; Hernandez, Joanna; Zeltzer, Lonnie K

    2010-09-01

    To determine Latino adolescent and young adults (AYA) cancer survivors' perceived barriers or facilitators to transition from pediatric to adult-centered survivorship care and to also assess the parents' perspective of care. Partnering with a community-based organization that serves Latino survivors, we conducted a qualitative, constant comparative analytic approach exploring in-depth themes that have salience for Latino pediatric cancer survivors seeking care in the adult healthcare setting. Twenty-seven Latino AYA survivors (>or=15 years of age) completed key informant interviews and 21 Latino parents participated in focus groups. Both AYA survivors and parents identified two major facilitative factors for survivorship care: Involvement of the nuclear family in the AYA's survivorship care in the adult healthcare setting and including symptom communication in late effects discussions. Barriers to care included: perceived stigma of a cancer history and continued emotional trauma related to discussions about the childhood cancer experience. Barriers to survivorship care include cancer stigma for both patient and nuclear family, which can impact on seeking survivorship care due to constraints placed on discussions because it remains difficult to discuss 'cancer' years later. Future research can evaluate if these findings are unique to Latino childhood cancer survivors or are found in other populations of AYA cancer survivors transitioning to adult-centered healthcare. This community-based participatory research collaboration also highlights the opportunity to learn about the needs of childhood cancer survivors from the lens of community leaders serving culturally diverse populations. (c) 2010 John Wiley & Sons, Ltd.

  12. Work-role transition: from staff nurse to clinical nurse educator.

    PubMed

    Manning, Liz; Neville, Stephen

    2009-07-01

    This article presents the findings of a study describing Clinical Nurse Educators' experiences, as they recall their transition from staff nurse to the Clinical Nurse Educator role, within a New Zealand District Health Board. Nurse Educator roles influence clinical practice and professional development of nurses, and although designated as a senior role nationally, the complexities and size of the role are poorly understood. A qualitative descriptive methodology utilising transition theory as a conceptual framework underpinned the study. A sample of eight Clinical Nurse Educators from a New Zealand District Health Board were interviewed about their transition from experienced staff nurse to inexperienced senior nurse. Data were analysed using a general inductive approach. Participants found the Clinical Nurse Educator role was more complex than anticipated, with no preparation for the role and sub-optimal orientation periods being provided by the District Health Board. As a result, signs of stress were evident as the enormity of the role became apparent. Consequently, employers need to ensure that appropriate orientation programmes and mentorship are inherent in health care organisations.

  13. Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT): Baseline Findings.

    PubMed

    Grady, Kathleen L; Hof, Kathleen Van't; Andrei, Adin-Cristian; Shankel, Tamara; Chinnock, Richard; Miyamoto, Shelley; Ambardekar, Amrut V; Anderson, Allen; Addonizio, Linda; Latif, Farhana; Lefkowitz, Debra; Goldberg, Lee; Hollander, Seth A; Pham, Michael; Weissberg-Benchell, Jill; Cool, Nichole; Yancy, Clyde; Pahl, Elfriede

    2018-02-01

    Young adult solid organ transplant recipients who transfer from pediatric to adult care experience poor outcomes related to decreased adherence to the medical regimen. Our pilot trial for young adults who had heart transplant (HT) who transfer to adult care tests an intervention focused on increasing HT knowledge, self-management and self-advocacy skills, and enhancing support, as compared to usual care. We report baseline findings between groups regarding (1) patient-level outcomes and (2) components of the intervention. From 3/14 to 9/16, 88 subjects enrolled and randomized to intervention (n = 43) or usual care (n = 45) at six pediatric HT centers. Patient self-report questionnaires and medical records data were collected at baseline, and 3 and 6 months after transfer. For this report, baseline findings (at enrollment and prior to transfer to adult care) were analyzed using Chi-square and t-tests. Level of significance was p < 0.05. Baseline demographics were similar in the intervention and usual care arms: age 21.3 ± 3.2 vs 21.5 ± 3.3 years and female 44% vs 49%, respectively. At baseline, there were no differences between intervention and usual care for use of tacrolimus (70 vs 62%); tacrolimus level (mean ± SD = 6.5 ± 2.3 ng/ml vs 5.6 ± 2.3 ng/ml); average of the within patient standard deviation of the baseline mean tacrolimus levels (1.6 vs 1.3); and adherence to the medical regimen [3.6 ± 0.4 vs 3.5 ± 0.5 (1 = hardly ever to 4 = all of the time)], respectively. At baseline, both groups had a modest amount of HT knowledge, were learning self-management and self-advocacy, and perceived they were adequately supported. Baseline findings indicate that transitioning HT recipients lack essential knowledge about HT and have incomplete self-management and self-advocacy skills.

  14. Transition to Adult Care for Youth with Type 1 Diabetes

    PubMed Central

    Garvey, Katharine C.; Markowitz, Jessica T.

    2014-01-01

    Emerging adults with type 1 diabetes are at risk for poor glycemic control, gaps in medical care, and adverse health outcomes. With the increasing incidence in type 1 diabetes in the pediatric population, there will be an increase in the numbers of teens and young adults transferring their care from pediatric providers to adult diabetes services in the future. In recent years, the topic of transitioning pediatric patients with type 1 diabetes to adult diabetes care has been discussed at length in the literature and there have been many observational studies. However, there are few interventional studies and, to date, no randomized clinical trials. This paper discusses the rationale for studying this important area. We review both observational and interventional literature over the past several years, with a focus on new research. In addition, important areas for future research are outlined. PMID:22922877

  15. Enduring Ties: Older Adults' Parental Role and Responsibilities.

    ERIC Educational Resources Information Center

    Blieszner, Rosemary; Mancini, Jay A.

    1987-01-01

    Used quantitative and qualitative data from 23 independent older adults to explore these salient aspects of their parenting role: change over time; current need for the role; current expectations of adult children; and rights and responsibilities of older parents. (Author/ABB)

  16. Transition of pediatric to adult care in inflammatory bowel disease: Is it as easy as 1, 2, 3?

    PubMed

    Afzali, Anita; Wahbeh, Ghassan

    2017-05-28

    Inflammatory bowel disease (IBD) is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population, and up to 25% of IBD patients are diagnosed before 18 years of age. Adolescents with IBD tend to have more severe and extensive disease and eventually require graduation from pediatric care toadult services. The transition of patients from pediatric to adult gastroenterologists requires careful preparation and coordination, with involvement of all key players to ensure proper collaboration of care and avoid interruption in care. This can be challenging and associated with gaps in delivery of care. The pediatric and adult health paradigms have inherent differences between health care models, as well as health care priorities in IBD. The readiness of the young adult also influences this transition of care, with often times other overlaps in life events, such as school, financial independence and moving away from home. These patients are therefore at higher risk for poorer clinical disease outcomes. The aim of this paper is to review concepts pertinent to transition of care of young adults with IBD to adult care, and provides resources appropriate for an IBD pediatric to adult transition of care model.

  17. Nurse practitioner role transition: a concept analysis.

    PubMed

    MacLellan, Lorna; Levett-Jones, Tracy; Higgins, Isabel

    2015-07-01

    Transitioning from registered nurse to nurse practitioner (NP) can be challenging personally and professionally. Insight into transition experiences may help validate the experiences of new NPs and provide greater understanding of the challenges faced during their professional journey. The purpose of this article is to report a concept analysis of transition from registered nurse to NP. The article provides new knowledge, understanding, and clarity about the concept of transition. Walker and Avants' framework for concept analysis was used to identify the attributes, antecedents, and consequences of the concept. A literature review of refereed journals was undertaken. Model cases from an ethnographic study conducted in Australia provide real life examples of the attributes of transition. Transitioning to the role of NP is complex and dependent on the individual and the attitudes of healthcare colleagues. Change and adaptation are required of both the NP and members of the healthcare team. Failure to adapt by either party undermines the potential for NPs to deliver improved health care. Mentorship along with a nurturing environment may be effective strategies for increasing the NP's self-confidence and ensuring a smooth and successful transition period. ©2014 American Association of Nurse Practitioners.

  18. Parental experiences transitioning their adolescent with epilepsy and cognitive impairments to adult health care.

    PubMed

    Schultz, Rebecca J

    2013-01-01

    The objective of this study was to explicate processes that parents of adolescents with epilepsy and cognitive impairments undergo as they help their adolescents transition to adult health care. A qualitative grounded theory methodology was used in this study. Theoretical sampling techniques were used to recruit seven ethnically diverse parents of adolescents 18 years or older with epilepsy and cognitive impairments from the community in a large metropolitan area in the southern United States. Data collection and analysis occurred simultaneously using coding and constant comparison analysis. The substantive theory Journey of Advocacy was developed from interviewing the participants. The theory has five categories: crisis sparks transition, parents in turmoil, parents as advocates, web of information, and captive waiting. Parents emerged as strong advocates in the transition process. Transitioning this group of adolescents to adult health care was an unplanned, complex, multisystem process. This study affirms the need to develop a transition program that acknowledges the unique challenges of transitioning adolescents with cognitive impairments and the interrelationship between these parents and other systems. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  19. Supporting Transitions: Cultural Connections for Adults with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Greenberg, Aliza; Levinsky-Raskin, Sheri

    2017-01-01

    Museums are well-positioned to engage adults with autism and other developmental differences both as visitors and employees. This article recounts the Museum Access Consortium's process to design and implement the project Supporting Transitions: Cultural Connections for People with Autism with the goal of calling attention to a large opportunity…

  20. The Health Care Transition of Youth With Liver Disease Into the Adult Health System: Position Paper From ESPGHAN and EASL.

    PubMed

    Vajro, Pietro; Fischler, Björn; Burra, Patrizia; Debray, Dominique; Dezsofi, Antal; Guercio Nuzio, Salvatore; Hadzic, Nedim; Hierro, Loreto; Jahnel, Joerg; Lamireau, Thierry; McKiernan, Patrick; McLin, Valerie; Nobili, Valerio; Socha, Piotr; Smets, Francoise; Baumann, Ulli; Verkade, Henkjan J

    2018-06-01

    Medical advances have dramatically improved the long-term prognosis of children and adolescents with once-fatal hepatobiliary diseases. However, there is no generally accepted optimal pathway of care for the transition from paediatric care to the adult health system. The purpose of this position paper is to propose a transition process for young people with paediatric onset hepatobiliary diseases from child-centred to adult-centred healthcare services. Seventeen ESPGHAN/EASL physicians from 13 countries (Austria, Belgium, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and United Kingdom) formulated and answered questions after examining the currently published literature on transition from childhood to adulthood. PubMed and Google Scholar were systematically searched between 1980 and January 2018. Quality of evidence was assessed by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Expert opinions were used to support recommendations whenever the evidence was graded weak. All authors voted on each recommendation, using the nominal voting technique. We reviewed the literature regarding the optimal timing for the initiation of the transition process and the transfer of the patient to adult services, principal documents, transition multi-professional team components, main barriers, and goals of the general transition process. A transition plan based on available evidence was agreed focusing on the individual young people's readiness and on coordinated teamwork, with transition monitoring continuing until the first year of adult services.We further agreed on selected features of transitioning processes inherent to the most frequent paediatric-onset hepatobiliary diseases. The discussion highlights specific clinical issues that will probably present to adult gastrointestinal specialists and that should be considered, according to published evidence, in the long-term tracking of patients

  1. A Review of Interventions Aimed at Facilitating Successful Transition Planning and Transfer to Adult Care Among Youth with Chronic Illness.

    PubMed

    Weissberg-Benchell, Jill; Shapiro, Jenna B

    2017-05-01

    This article reviews studies that developed interventions aimed at facilitating the transition process and/or the transfer of youth with chronic illness to adult programs during the past decade. Three key intervention approaches have been studied. Data assessing the impact of transition coordinators suggest that the most successful outcomes occur when coordinators meet with patients prior to the transfer of care, support them as they negotiate the adult programs, and facilitate appointment keeping. Data assessing the impact of transition clinics suggest that the key to positive outcomes is helping patients develop a trusting relationship with the adult providers before fully transferring their care to the adult clinic. Similar conclusions can be drawn for transition programs, where it appears that the opportunity to discuss and plan transition with a pediatric provider over time and to meet with both the pediatric and adult providers simultaneously are beneficial for facilitating successful transfer to adult care. Although aspects of these care processes appear promising for improving transition success, this review identifies areas that need further study. We argue that studies are needed that examine individual patient and family-focused interventions as well as looking at other potential interventions in the health care system. [Pediatr Ann. 2017;46(5):e182-e187.]. Copyright 2017, SLACK Incorporated.

  2. Transition of care for patients with type 1 diabetes mellitus from pediatric to adult health care systems

    PubMed Central

    Glick, Bethany; Kamboj, Manmohan K.

    2017-01-01

    Planning for the transition from pediatric to adult healthcare is broadly understood to be beneficial to the quality of care of patients with chronic illness. Due to the level of self-care that is necessary in the maintenance of most chronic diseases, it is important that pediatric settings can offer support during a time when adolescents are beginning to take more responsibility in all areas of their lives. Lack of supportive resources for adolescents with chronic conditions often results in both decreased access to care and impaired health and function likely leading to increased medical costs later. Additionally, fundamental differences in health care delivery exist between pediatric and adult care settings. There is limited empiric data and information on best practices in transition care. In this article we address the importance of bridging pediatric and adult care settings and highlight the challenges and successes of the implementation of the young adult transition clinic program for patients with type 1 diabetes at our facility. We provide recommendations for further research and program implementation with the transition population. PMID:29184818

  3. Outcome Evidence for Structured Pediatric to Adult Health Care Transition Interventions: A Systematic Review.

    PubMed

    Gabriel, Phabinly; McManus, Margaret; Rogers, Katherine; White, Patience

    2017-09-01

    To identify statistically significant positive outcomes in pediatric-to-adult transition studies using the triple aim framework of population health, consumer experience, and utilization and costs of care. Studies published between January 1995 and April 2016 were identified using the CINAHL, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases. Included studies evaluated pre-evaluation and postevaluation data, intervention and comparison groups, and randomized clinic trials. The methodological strength of each study was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Out of a total of 3844 articles, 43 met our inclusion criteria. Statistically significant positive outcomes were found in 28 studies, most often related to population health (20 studies), followed by consumer experience (8 studies), and service utilization (9 studies). Among studies with moderate to strong quality assessment ratings, the most common positive outcomes were adherence to care and utilization of ambulatory care in adult settings. Structured transition interventions often resulted in positive outcomes. Future evaluations should consider aligning with professional transition guidance; incorporating detailed intervention descriptions about transition planning, transfer, and integration into adult care; and measuring the triple aims of population health, experience, and costs of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Resident Dyads Providing Transition Care to Adolescents and Young Adults With Chronic Illnesses and Neurodevelopmental Disabilities

    PubMed Central

    Jasien, Joan; Maslow, Gary R.

    2017-01-01

    Background Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. Objective This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration. Methods Residents from pediatrics, medicine-pediatrics, and internal medicine training programs participated in a transitions clinic for patients with chronic health conditions aged 16 to 26 years. Residents attended 1 to 4 half-day clinic sessions during 1-month ambulatory rotations. Pediatrics/adult medicine resident dyads collaboratively performed psychosocial and medical transition consultations that addressed health care navigation, self-care, and education and vocation topics. Two to 3 attending physicians supervised each clinic session (4 hours) while concurrently seeing patients. Residents completed a preclinic survey about baseline attitudes and experiences, and a postclinic survey about their transitions clinic experiences, changes in attitudes, and transition care preparedness. Results A total of 46 residents (100% of those eligible) participated in the clinic and completed the preclinic survey, and 25 (54%) completed the postclinic survey. A majority of respondents to the postclinic survey reported positive experiences. Residents in both pediatrics and internal medicine programs reported improved preparedness for providing transition care to patients with chronic health conditions and communicating effectively with colleagues in other disciplines. Conclusions A dyadic model of collaborative transition care training was positively received and yielded improvements in immediate self-assessed transition care preparedness. PMID:28439357

  5. Resident Dyads Providing Transition Care to Adolescents and Young Adults With Chronic Illnesses and Neurodevelopmental Disabilities.

    PubMed

    Chung, Richard J; Jasien, Joan; Maslow, Gary R

    2017-04-01

    Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration. Residents from pediatrics, medicine-pediatrics, and internal medicine training programs participated in a transitions clinic for patients with chronic health conditions aged 16 to 26 years. Residents attended 1 to 4 half-day clinic sessions during 1-month ambulatory rotations. Pediatrics/adult medicine resident dyads collaboratively performed psychosocial and medical transition consultations that addressed health care navigation, self-care, and education and vocation topics. Two to 3 attending physicians supervised each clinic session (4 hours) while concurrently seeing patients. Residents completed a preclinic survey about baseline attitudes and experiences, and a postclinic survey about their transitions clinic experiences, changes in attitudes, and transition care preparedness. A total of 46 residents (100% of those eligible) participated in the clinic and completed the preclinic survey, and 25 (54%) completed the postclinic survey. A majority of respondents to the postclinic survey reported positive experiences. Residents in both pediatrics and internal medicine programs reported improved preparedness for providing transition care to patients with chronic health conditions and communicating effectively with colleagues in other disciplines. A dyadic model of collaborative transition care training was positively received and yielded improvements in immediate self-assessed transition care preparedness.

  6. Transitioning an Adult-Serving University to a Blended Learning Model

    ERIC Educational Resources Information Center

    Korr, Jeremy; Derwin, Ellen Baker; Greene, Kimberly; Sokoloff, William

    2012-01-01

    While many institutions deliver some classes in blended format, Brandman University transitioned all of its face-to-face classes to blended delivery, using a model tailored to the needs of adult learners. This article provides research supporting the ways that blended learning principles align with key principles of andragogy. The article provides…

  7. Challenges of the Transition from Pediatric Care to Care of Adults: "Say Goodbye, Say Hello".

    PubMed

    Touraine, Philippe; Polak, Michel

    2018-01-01

    Transition has been defined as "the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems." We will here describe the challenges of such a process: challenges coming from the pediatrician, from the adolescent, linked to the disease itself, and those from the parents. We will outline how to overcome those fears and challenges to provide a successful transition process. A key factor to underline that process is that a relationship based on confidence should be established between the pediatrician and the physician for adults, in order for that relationship, based on trust, to be the basis for the transfer of the adolescent from the pediatric system of care to the adult one. © 2018 S. Karger AG, Basel.

  8. Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults.

    PubMed

    Mahan, Rebecca J; Bailey, Trista Askins; Bibb, Teryn J; Fenney, Megan; Williams, Tara

    2016-12-01

    Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  9. A community-based exercise intervention transitions metabolically abnormal obese adults to a metabolically healthy obese phenotype

    PubMed Central

    Dalleck, Lance C; Van Guilder, Gary P; Richardson, Tara B; Bredle, Donald L; Janot, Jeffrey M

    2014-01-01

    Background Lower habitual physical activity and poor cardiorespiratory fitness are common features of the metabolically abnormal obese (MAO) phenotype that contribute to increased cardiovascular disease risk. The aims of the present study were to determine 1) whether community-based exercise training transitions MAO adults to metabolically healthy, and 2) whether the odds of transition to metabolically healthy were larger for obese individuals who performed higher volumes of exercise and/or experienced greater increases in fitness. Methods and results Metabolic syndrome components were measured in 332 adults (190 women, 142 men) before and after a supervised 14-week community-based exercise program designed to reduce cardiometabolic risk factors. Obese (body mass index ≥30 kg · m2) adults with two to four metabolic syndrome components were classified as MAO, whereas those with no or one component were classified as metabolically healthy but obese (MHO). After community exercise, 27/68 (40%) MAO individuals (P<0.05) transitioned to metabolically healthy, increasing the total number of MHO persons by 73% (from 37 to 64). Compared with the lowest quartiles of relative energy expenditure and change in fitness, participants in the highest quartiles were 11.6 (95% confidence interval: 2.1–65.4; P<0.05) and 7.5 (95% confidence interval: 1.5–37.5; P<0.05) times more likely to transition from MAO to MHO, respectively. Conclusion Community-based exercise transitions MAO adults to metabolically healthy. MAO adults who engaged in higher volumes of exercise and experienced the greatest increase in fitness were significantly more likely to become metabolically healthy. Community exercise may be an effective model for primary prevention of cardiovascular disease. PMID:25120373

  10. Adolescents with Sickle Cell Disease: Self-Efficacy as a Factor in Readiness to Transition from Pediatric to Adult Medical Care

    ERIC Educational Resources Information Center

    Baum, Dabney

    2013-01-01

    Adolescents and young adults with sickle cell disease (SCD) must develop self-efficacy and disease-management skills to transition successfully to adult medical care. This quantitative study explored whether self-efficacy, age, and gender were predictive of transition readiness of adolescents with SCD from pediatric to adult medical care.…

  11. Management of adults with paediatric-onset chronic liver disease: strategic issues for transition care.

    PubMed

    Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello

    2014-04-01

    Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Self-management and Transition to Adult Health Care in Adolescents and Young Adults: A Team Process.

    PubMed

    Mahan, John D; Betz, Cecily L; Okumura, Megumi J; Ferris, Maria E

    2017-07-01

    As health care continues to evolve, the need for more effective health care transition (HCT) for all youth, but particularly children with chronic conditions and special health care needs, becomes even more important. With more than 90% of adolescents with chronic medical conditions now surviving into adulthood, suboptimal transition can lead to poorer quality of life and less successful adulthood.Through a series of clinical vignettes, the challenges of HCT are presented herein and accompanied by comments that underscore how these adolescents can best be helped to transition to successful adulthood. Several methods are presented to assess the readiness of adolescents and young adults (AYA) for transition. The process of transition can be divided into 3 stages: 1) setting the stage: initiation of HCT services and transition readiness assessment, 2) moving forward: ongoing provision of HCT services, and 3) reaching the goal: transfer of care and transition to adulthood.Several valuable suggestions for incorporating the HCT process into the health care system and improving HCT programs through a quality improvement (QI) approach are outlined. Future challenges in HCT include developing more precise assessments of transition status or transition readiness, better understanding the status and specific needs of AYA with chronic health care needs, continued program evaluation and QI efforts, and more reliance on patients and families to teach us about the challenges and methods in HCT that most effectively work for them. © American Academy of Pediatrics, 2017. All rights reserved.

  13. Work Role Transitions--Expert Nurses to Novice Preceptors

    ERIC Educational Resources Information Center

    Miller, Janice; Vivona, Brian; Roth, Gene

    2017-01-01

    Purpose: Several issues are reported in the literature regarding the preparation and training of nurses for the preceptor role. The purpose of this study is to explore the experiences, growth and development of nurses transitioning to the preceptor role in allied health contexts. Design/methodology/approach: A basic interpretive qualitative…

  14. Views of Young People With Chronic Conditions on Transition From Pediatric to Adult Health Services

    PubMed Central

    Hislop, Jenni; Mason, Helen; Parr, Jeremy R.; Vale, Luke; Colver, Allan

    2017-01-01

    Purpose This study sought to identify and describe the views of young people with chronic conditions about the transition from pediatric to adult services. Methods Q methodology was used to identify young people’s views on transition. A set of 39 statements about transition was developed from an existing literature review and refined in consultation with local groups of young people. Statements were printed onto cards and a purposive sample of 44 young people with chronic health conditions was recruited, 41 remaining in the study. The young people were asked to sort the statement cards onto a Q-sort grid, according to their opinions from “strongly disagree” to “strongly agree.” Factor analysis was used to identify shared points of view (patterns of similarity between individual’s Q-sorts). Results Four distinct views on transition were identified from young people: (1) “a laid-back view of transition;” (2) “anxiety about transition;” (3) “wanting independence and autonomy during transition;” and (4) “valuing social interaction with family, peers, and professionals to assist transition.” Conclusions Successful transition is likely to be influenced by how young people view the process. Discussing and understanding young people’s views and preferences about transition should help clinicians and young people develop personalized planning for transition as a whole, and more specifically the point of transfer, leading to effective and efficient engagement with adult care. PMID:27287962

  15. Views of Young People With Chronic Conditions on Transition From Pediatric to Adult Health Services.

    PubMed

    Hislop, Jenni; Mason, Helen; Parr, Jeremy R; Vale, Luke; Colver, Allan

    2016-09-01

    This study sought to identify and describe the views of young people with chronic conditions about the transition from pediatric to adult services. Q methodology was used to identify young people's views on transition. A set of 39 statements about transition was developed from an existing literature review and refined in consultation with local groups of young people. Statements were printed onto cards and a purposive sample of 44 young people with chronic health conditions was recruited, 41 remaining in the study. The young people were asked to sort the statement cards onto a Q-sort grid, according to their opinions from "strongly disagree" to "strongly agree." Factor analysis was used to identify shared points of view (patterns of similarity between individual's Q-sorts). Four distinct views on transition were identified from young people: (1) "a laid-back view of transition;" (2) "anxiety about transition;" (3) "wanting independence and autonomy during transition;" and (4) "valuing social interaction with family, peers, and professionals to assist transition." Successful transition is likely to be influenced by how young people view the process. Discussing and understanding young people's views and preferences about transition should help clinicians and young people develop personalized planning for transition as a whole, and more specifically the point of transfer, leading to effective and efficient engagement with adult care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  16. Transitioning between Work and Family Roles as a Function of Boundary Flexibility and Role Salience

    ERIC Educational Resources Information Center

    Winkel, Doan E.; Clayton, Russell W.

    2010-01-01

    This study investigates the manner in which people separate their work and family roles and how they manage the boundaries of these two important roles. Specifically, we focus on how role flexibility and salience influence transitions between roles. Results indicate that the ability and willingness to flex a role boundary and role salience are…

  17. Resident transitions to assisted living: a role for social workers.

    PubMed

    Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

    2012-08-01

    This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide, geographically representative purposive sample of Medicaid Assisted Living Waiver providers (N = 28). Findings suggest a positive relationship between the availability of a social worker and the frequency and importance of resident preadmission education in several areas. Results also suggest a gap between what AL providers believe is important for resident transitions and what is actually happening in their facilities. Social workers may play a significant role in providing preadmission education and are well positioned to address the unmet psychosocial needs of residents and family members during the transition to AL. Future studies should specifically examine the contributing role of social workers during the period of adjustment to AL and the effect of social work services on the well-being of AL residents and families in AL settings.

  18. The Role of Goals and Alcohol Behavior during the Transition out of College

    PubMed Central

    Radomski, Sharon A.; Read, Jennifer P.; Bowker, Julie C.

    2015-01-01

    Personal goals are desired outcomes that guide behavior (Palfai et al., 2011), and are typically oriented around age-appropriate developmental tasks (e.g., college graduation, employment). Goals and their pursuit take on much salience during senior year of college as individuals prepare for the transition into adult roles. This also is a time during which naturalistic changes in alcohol consumption are occurring. These changes may impact the relationship between age-related goals and their attainment, thus compromising the likelihood of a successful transition out of college. The present study examined whether and how changes in drinking over senior year moderate the association between achievement goals and related developmental task attainment as students move toward transitioning out of college. Alcohol-involved college seniors (N=437; 62.5% female) were assessed via web survey in September of their senior year and again one year later (T4). Results of multinomial logistic regression revealed that greater Achievement Goals were predictive of college graduation (versus remaining a continuing undergraduate), but only for those whose drinking decreased during senior year. Among those graduated by T4 (n=307), Achievement Goals predicted pursuing graduate education (versus being unemployed), but only for students whose drinking increased during senior year. Thus, Achievement Goals are important predictors of goal attainment as students prepare to transition out of college, and these goals can interact with drinking in complex ways during this time. Findings suggest that interventions aimed at bolstering personal goals and reducing drinking during senior year may increase the likelihood of successful transitions out of the college environment. PMID:25642583

  19. Frailty transitions and types of death in Chinese older adults: a population-based cohort study

    PubMed Central

    Jiang, Xiao-yan; Wang, Xiao-feng; Shi, Yan; Hai, Hua

    2018-01-01

    Background Little is known about the adverse effects of frailty transitions. In this study, we aimed to characterize the transitions between frailty states and examine their associations with the type of death among older adults in China, a developing country with a rapidly growing aging population. Methods We used data of 11,165 older adults (aged 65–99 years) from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Overall, 44 health deficits were used to construct frailty index (FI; range: 0–1), which was then categorized into a three-level variable: nonfrail (FI ≤0.10), prefrail (0.10< FI ≤0.21), and frail (FI >0.21). Outcome was four types of death based on bedridden days and suffering state (assessed in the 2008 wave of CLHLS). Results During the 3-year period, 3,394 (30.4%) participants had transitioned between different frailty states (nonfrail, prefrail, and frail), one-third transitioned to death, and one-third remained in previous frailty states. Transitions to greater frailty (ie, “worsening”) were more common than transitions to lesser frailty (ie, “improvement”). Among four categories of frailty transitions, “worsening” and “remaining frail” had increased risks of painful death, eg, with odds ratios of 1.92 (95% confidence interval [CI] =1.41, 2.62) and 4.75 (95% CI =3.32, 6.80), respectively, for type 4 death (ie, ≥30 bedridden days with suffering before death). Conclusion This large sample of older adults in China supports that frailty is a dynamic process, characterized by frequent types of transitions. Furthermore, those who remained frail had the highest likelihood of experiencing painful death, which raises concerns about the quality of life in frail populations. PMID:29805253

  20. The relationship between self-efficacy and transition to work or studies in young adults with disabilities.

    PubMed

    Andersén, Åsa; Larsson, Kjerstin; Pingel, Ronnie; Kristiansson, Per; Anderzén, Ingrid

    2018-03-01

    To investigate perceived self-efficacy in unemployed young adults with disabilities, and the association between self-efficacy and transition to work or studies. This prospective cohort study collected data through self-report questionnaires and registry data from a vocational rehabilitation project with young adults, aged 19-29 years. The Swedish Social Insurance Agency, the Swedish Public Employment Service and the participating municipalities identified potential participants for the study. A total of 531 participants were included in the study, of which 249 (47%) were available for analysis. Multinomial logistic regression models were carried out to estimate the associations between self-efficacy, demographic (age, country of birth, education level), health and employment status. The latter was coded as: 'no transition to work or studies', 'transition to studies', and 'transition to work'. A higher level of self-efficacy was associated with increased odds for 'transition to work' (OR = 2.37, p < 0.05). This finding remained consistent when adjusting for possible confounders. The mean value of self-efficacy was low, and participants with lower self-efficacy reported worse self-rated health ( p < 0.001) compared to participants with higher self-efficacy. The results from this study suggest that self-efficacy should be addressed in the vocational rehabilitation of young adults with disabilities in order to support their transition and integration into the labour market.

  1. Shift Work, Role Overload, and the Transition to Parenthood

    ERIC Educational Resources Information Center

    Perry-Jenkins, Maureen; Goldberg, Abbie E.; Pierce, Courtney P.; Sayer, Aline G.

    2007-01-01

    This article examines how the work hours, work schedules, and role overload of working-class couples are related to depressive symptoms and relationship conflict across the transition to parenthood. Data are from 132 dual-earner couples interviewed 5 times across the transition. Multilevel modeling analyses revealed that working evening or night…

  2. 'Mind the gap'--mapping services for young people with ADHD transitioning from child to adult mental health services.

    PubMed

    Hall, Charlotte L; Newell, Karen; Taylor, John; Sayal, Kapil; Swift, Katie D; Hollis, Chris

    2013-07-10

    Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. We report the findings of a survey of 96 healthcare professionals working in children's (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management.

  3. Measuring Transition Readiness: A Correlational Study of Perceptions of Parent and Adolescents and Young Adults with Sickle Cell Disease.

    PubMed

    Speller-Brown, Barbara; Patterson Kelly, Katherine; VanGraafeiland, Brigit; Feetham, Suzanne; Sill, Anne; Darbari, Deepika; Meier, Emily R

    2015-01-01

    Adolescents and young adults (AYAs) often transfer from pediatric to adult care without adequate preparation, resulting in increased morbidity and mortality. The purpose of this descriptive research study of parent/AYA dyads was to measure perceptions of transition readiness. Factors that were found to be associated with perceptions of increased readiness to transition included AYA age, the amount of responsibility AYAs assume for their healthcare and the degree of parent involvement. More attention should be focused on these aspects of care to improve transition from pediatric to adult care for AYAs with sickle cell disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Counseling Issues for Adult Women in Career Transition

    ERIC Educational Resources Information Center

    Ronzio, Cynthia R.

    2012-01-01

    This article addresses current psychosocial issues facing women in career transition and the implications of those issues for career counselors. Specifically, psychosocial developmental trajectories, the roles of family and relationships, the importance of underlying physical and mental health issues, and sociocultural and contextual stressors are…

  5. [Transition - how adolescents with cystic fibrosis their parents experience the change from paediatric to adult care].

    PubMed

    Becher, Christine; Regamey, Nicolas; Spichiger, Elisabeth

    2014-12-01

    Cystic Fibrosis is the most common autosomal-recessive hereditary disease among white Europeans. The average survival of CF patients has increased to above 40 years and transition from paediatric to adult care has therefore become a significant issue. With this study, experiences of adolescents with CF and their parents with the transition from the paediatric to the adult care were explored. At a Swiss university CF centre, six adolescents and their mothers were recruited. Twelve narrative interviews were conducted on how the phase of transition was experienced. The transcribed interviews were analysed according to the method of hermeneutic phenomenology. Positive and negative experiences with long term routine care in the paediatric service, general themes of adolescence and the quality of the relationship with paediatric doctors influenced the families' experience during transition significantly. For mothers, insensitive information on the CF diagnosis might have influenced the transition experience. The adolescents welcomed an individualized and age appropriate care. Continuity in care, the announcement of, and involvement in the planning of the transfer were of great importance. The families particularly appreciated the timed adaptations of the transfer to individual needs. Flexibility and a strong collaboration between paediatric and adult CF teams are most relevant in the care of families.

  6. Transitions between child and adult mental health services: service design, philosophy and meaning at uncertain times.

    PubMed

    Murcott, W J

    2014-09-01

    A young person's transition of care from child and adolescent mental health services to adult mental health services can be an uncertain and distressing event that can have serious ramifications for their recovery. Recognition of this across many countries and recent UK media interest in the dangers of mental health services failing young people has led practitioners to question the existing processes. This paper reviews the current theories and research into potential failings of services and encourages exploration for a deeper understanding of when and how care should be managed in the transition process for young people. Mental health nurses can play a vital role in this process and, by adopting the assumptions of this paradigm, look at transition from this unique perspective. By reviewing the current ideas related to age boundaries, service thresholds, service philosophy and service design, it is argued that the importance of the therapeutic relationship, the understanding of the cultural context of the young person and the placing of the young person in a position of autonomy and control should be central to any decision and process of transfer between two mental health services. © 2014 John Wiley & Sons Ltd.

  7. Binocular rivalry transitions predict inattention symptom severity in adult ADHD.

    PubMed

    Jusyte, Aiste; Zaretskaya, Natalia; Höhnle, Nina Maria; Bartels, Andreas; Schönenberg, Michael

    2018-06-01

    Attention deficit and hyperactivity disorder (ADHD) is a prevalent childhood disorder that is often maintained throughout the development and persists into adulthood. Established etiology models suggest that deficient inhibition underlies the core ADHD symptoms. While experimental evidence for impaired motor inhibition is overwhelming, little is known about the sensory inhibition processes, their changes throughout the development, and the relationship to ADHD symptoms. Here, we used the well-established binocular rivalry (BR) paradigm to investigate for the very first time the inhibitory processes related to visual perception in adults with ADHD. In BR, perception alternates between two dichoptically presented images throughout the viewing period, with shorter dominant percept durations and longer transition periods indicating poorer suppression/inhibition. Healthy controls (N = 28) and patients with ADHD (N = 32) were presented with two dissimilar images (orthogonal gratings) separately to each eye through a mirror stereoscope and asked to report their perceptual experiences. There were no differences between groups in any of the BR markers. However, an association between transition durations and symptom severity emerged in the ADHD group. Importantly, an exploratory multiple regression analysis revealed that inattention symptoms were the sole predictor for the duration of transition periods. The lack of impairments to sensory inhibition in adult, but not pediatric ADHD may reflect compensatory changes associated with development, while a correlation between inhibition and inattention symptoms may reveal an invariant core of the disorder.

  8. Specific needs of families of young adults with profound intellectual disability during and after transition to adulthood: What are we missing?

    PubMed

    Gauthier-Boudreault, Camille; Gallagher, Frances; Couture, Mélanie

    2017-07-01

    At the age of 21, the trajectory of services offered to youth with profound intellectual disability (ID) change significantly since access to specialised services is more limited. Despite the desire of parents to avoid any impact on their child, several factors can influence the course of this transition. However, there is little research on facilitators and obstacles to the transition to adulthood, and impacts on people with a profound ID. It is therefore difficult to provide solutions that meet their specific needs. The study aimed to document the needs of parents and young adults with profound ID during and after the transition to adulthood by exploring their transitioning experience and factors that influenced it. Using a descriptive qualitative design, two individual semi-structured interviews were conducted with fourteen (14) parents of young adults aged between 18 and 26 with a profound ID. At this point, many material, informative, cognitive and emotional needs of young adults and their parents are not met. Obstacles, mainly organisational, persist and result in a particularly difficult transition to adulthood experience. By knowing the specific needs of these families, it is possible to develop and implement solutions tailored to their reality. WHAT THE PAPERS ADDS?: The transition to adulthood is a critical period for families with young adults with an intellectual disability (ID), a reality observed internationally. Current literature on all levels of ID suggests some barriers to transition that lead to negative impacts on both parents and young adults with ID. However, presently, very little research exists on the reality of families of young adults with profound ID and factors influencing transition to adult life. Most of studies target people with mild to moderate ID. Considering the significant disabilities of people with profound ID, it is possible to imagine that their experience of transition will be even more difficult and they will present

  9. Characteristics of Adult Students Transitioning to a Traditional University and Perceptions of Student Services

    ERIC Educational Resources Information Center

    Rollins, Dani J.

    2012-01-01

    Limited research is devoted to the transitional process of adult students to the traditional university environment. Considering the incredible numbers of adults projected to return to higher education and/or entering a college or university program for the first time, it behooves institutions of higher learning to invest in the success of adult…

  10. Transition to adult services for young people with mental health needs: A systematic review.

    PubMed

    Paul, Moli; Street, Cathy; Wheeler, Nicola; Singh, Swaran P

    2015-07-01

    Young people's transition from child and adolescent (CAMHS) to adult mental health services (AMHS). To systematically review evidence on the effectiveness of different models of CAMHS-AMHS transitional care, service user and staff perspectives, and facilitators of/barriers to effective CAMHS-AMHS transition. A systematic search in May 2012 of Medline, PsycINFO, CINAHL, EMBASE, AMED, Health Business Elite, HMIC, Cochrane Database, Web of Science and ASSIA; ancestral searches; and consultation with experts in the field. Qualitative, quantitative and mixed-methods primary research on the CAMHS-AMHS health-care transition of young people (aged 16-21 years) with mental health problems. Two reviewers independently completed a standardised data extraction form and critically evaluated identified documents using a validated appraisal tool for empirical studies with varied methodologies. A total of 19 studies of variable quality were identified. None were randomised or case-controlled trials. Studies incorporating service user/carer perspectives highlighted the need to tackle stigma and provide accessible, age-appropriate services. Parents/carers wanted more involvement with AMHS. Transitional care provision was considered patchy and often not prioritised within mental health services. There was no clear evidence of superior effectiveness of any particular model. High-quality evidence of transitional care models is lacking. Data broadly support the development of programmes that address the broader transitional care needs of 'emerging adults' and their mental health needs but further evaluation is necessary. Developing robust transitional mental health care will require the policy-practice gap to be addressed and development of accessible, acceptable, responsive, age-appropriate provision. © The Author(s) 2014.

  11. Design and operation of the Survey of Adult Transition and Health, 2007.

    PubMed

    O'Connor, Kathleen S; Brooks, Keeshawna S; Nysse-Carris, Kari L; Skalland, Benjamin J; Sipulski, Edward T; Costanzo, Daniel M

    2011-03-01

    This report documents the survey design and operating procedures for the 2007 Survey of Adult Transition and Health (SATH). Sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration, SATH was conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics as a module of the State and Local Area Integrated Telephone Survey program. A follow-back survey design was used to attempt to locate and contact 10,933 eligible cases originally identified in the 2001 National Survey of Children with Special Health Care Needs (NS-CSHCN). These data examine the transition experience of adolescents as they switched from pediatric health care providers to those that treat adults only. Eligible persons were aged 14-17 years as of 2001, had at least one special health care need, and lived in English-speaking households. In 2007, these cases involved young adults aged 19-23. State estimates cannot be obtained from SATH. Telephone numbers sampled in 2001 were dialed to locate the 2001 NS-CSHCN respondent. This person was asked for current contact information for the eligible SATH young adult to be contacted directly. Data were collected from June 12 through August 26, 2007. Although we were unable to contact 7409 (68%) of the 2001 parent/guardian respondents, almost all of the young adults we were able to contact participated (98%). The SATH public-use microdata file contains interview data collected in 2007 from 1,865 young adults, along with variables from the 2001 NS-CSHCN public-use file. The unweighted interview completion rate was 17.5%.

  12. Transition of HIV-infected youths from paediatric to adult care, a Swedish single-centre experience.

    PubMed

    Westling, Katarina; Navér, Lars; Vesterbacka, Jan; Belfrage, Erik

    2016-01-01

    Transition of HIV-infected adolescents from paediatric care to adult care is vulnerable and entails a risk of treatment failure. Therefore, a Transitional Outpatient Clinic for HIV-infected adolescents and young adults was started in 2008. The aims were to describe the transition process and treatment results in a Swedish cohort of adolescents with HIV. A cross-sectional study of the adolescent and young adults with HIV at the clinic was performed in October 2013 and a 2-year follow-up at the end of 2015. The 34 patients in care in October 2013 were a median of 19 years, 50% were female. Thirty-one out of 34 (91%) were perinatally infected. In 2013, 88% were on antiretroviral treatment (ART), for a median duration of 9 years, 74% were on a protease inhibitor-based regimen. Twenty-nine patients were followed-up at the end of 2015. Twenty-three were transferred to the Infectious Disease Clinic and the median age for transition was 19 years. At the end of 2015, 90% were treated with ART and 61% had an integrase inhibitor-based treatment. Of those treated with ART for more than 6 months, 90% (2013) and 96% (2015) had a viral load < 50 HIV RNA copies/mL, despite resistance problems and complicating social factors. These figures were higher than reported in other studies and similar to the treatment results in the adult HIV population in Sweden. The present study showed that it is possible to achieve good treatment results in adolescents with HIV.

  13. Transportation and Aging: An Updated Research Agenda to Advance Safe Mobility among Older Adults Transitioning From Driving to Non-driving.

    PubMed

    Dickerson, Anne E; Molnar, Lisa J; Bédard, Michel; Eby, David W; Berg-Weger, Marla; Choi, Moon; Grigg, Jenai; Horowitz, Amy; Meuser, Thomas; Myers, Anita; O'Connor, Melissa; Silverstein, Nina M

    2017-07-29

    Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Targeted Transition Assessment Leading to Job Placement for Young Adults with Disabilities in Rural Areas

    ERIC Educational Resources Information Center

    Morgan, Robert L.; Openshaw, Kristi P.

    2011-01-01

    In rural areas, transition planning for young adults with disabilities presents considerable challenges, including linkage to employment upon completion of special education services. Two assessment programs, described in this article, work in concert to assist transition teachers and youth with disabilities in rural areas and include: (a)…

  15. Volunteer transitions and physical and psychological health among older adults in Taiwan.

    PubMed

    Li, Yueh-Ping; Chen, Yuh-Min; Chen, Ching-Huey

    2013-11-01

    This study examines the relationship between transitions in volunteering activity and physical and psychological health outcomes among older adults in Taiwan. We used 3 waves of a longitudinal survey from Taiwan (1999, 2003, and 2007) including 1,847 older adults aged 58-74. We categorized volunteer activity over time into 5 categories and used generalized estimating equations to examine the relationship between volunteer transition group membership and health outcomes. Approximately, 3% of older volunteers kept volunteering and 7% stopped or started their volunteering over time. Engaging in any volunteering, including continuous volunteering, discrete volunteering, active-to-inactive volunteering, and inactive-to-active volunteering, was significantly associated with better self-rated health and higher life satisfaction when compared with the nonvolunteering group. Only those in the continuous volunteer group and those who shifted from inactive-to-active volunteering showed a positive association with better physical function and less depression, compared with the nonvolunteering group. The results suggest that the positive relationship between volunteering and health may decline when older adults discontinue or withdraw from volunteering. More research is needed to explore the mechanism behind older people's desistance from, persistence in, and resumption of volunteer engagement.

  16. Transitions in Care from Pediatric to Adult Health Care Providers: Ongoing Challenges and Opportunities for Young Persons with Diabetes.

    PubMed

    Garvey, Katharine; Laffel, Lori

    2018-01-01

    Adolescence and young adulthood are times of multiple developmental changes, including physiological, social, emotional, cognitive, and behavioral transformations. The adolescent or young adult living with type 1 or type 2 diabetes must navigate the vicissitudes of these developmental stages while managing the rigors and self-care demands of these conditions. Diabetes in children is managed by adults, mainly by parents. As the child matures, diabetes management tasks transition from parents to the developing teen. This transition in care is a process that generally begins in early adolescence and culminates when the older teen successfully accepts and manages diabetes self-care tasks. Along with the transitions in diabetes management tasks, older teens and young adults must be prepared for transfer from the pediatric diabetes care team to an adult-focused health care team. Numerous publications have described the challenges associated with both the process of transition and the act of transfer. Lack of preparation during transition followed by unsuccessful transfer often results in gaps in diabetes care exceeding 6 months, deterioration in glycemic control, increase in emergency room use and hospitalization, and emergence of diabetes complications among older teens and young adults. There is need for ongoing research internationally to address these deficiencies in order to improve the short- and long-term health of young persons with diabetes. © 2018 S. Karger AG, Basel.

  17. The Role of Independent Therapy Providers in the Transition to Preschool

    ERIC Educational Resources Information Center

    Teeters-Myers, C.

    2007-01-01

    The complexity of the early intervention to preschool transition process has been highlighted in the early childhood literature; however, the role of independent therapy providers in transition planning has not been described specifically. The present study used survey research methods to gather information about the transition practices of 103…

  18. Factors Associated with Suicidal Thought and Help-Seeking Behaviour in Transition-Aged Youth versus Adults.

    PubMed

    MacKinnon, Nathalie; Colman, Ian

    2016-12-01

    Suicide is a leading cause of death for transition-aged youth (TAY), and yet few studies examine correlates of suicidal ideation specifically in this age demographic (age 18-24 years). The transition to adulthood is a unique context, marked by novel stressors (e.g., joining the workforce) and increased independence, which may influence risk factors for suicidal ideation. This study examined correlates of suicidal ideation in TAY and adults and contrasted profiles across age. We used 4 biannual cycles (2005, 2007, 2009, 2011) of the Canadian Community Health Survey, a population-based cross-sectional survey on health. We used logistic regression to assess the association between suicidal ideation and depression, distress, alcohol use, smoking, exercise, sedentary behaviour, chronic illness, restrictions to daily living, perceived physical and mental health, and perceived social support independently in both TAY ( n = 4427) and adults ( n = 14,452). We subsequently assessed possible interactions with age (18-24 v. 25-44 years) and sex and differences in help-seeking behaviour in a combined model. TAY exhibited higher rates of suicidal ideation than adults did ( P < 0.001). Numerous factors were associated with suicidal ideation in TAY. Notably, alcohol abstinence was associated with decreased suicidal ideation in TAY but not for adults. Moreover, when depressed, TAY were significantly less likely to have received professional mental health help than adults (odds ratio = 0.64, 95% CI, 0.43 to 0.94). Suicidal ideation is more prevalent in TAY than adults, and its consequences may be aggravated by poor treatment-seeking behaviour in at-risk (i.e. depressed) individuals. These different risk profiles substantiate the recent shift toward clinical interventions focusing on transition-aged youth, rather than traditional child (<18 years) and adult (>18 years) services.

  19. Implementation of an inter-agency transition model for youth with spina bifida.

    PubMed

    Lindsay, S; Cruickshank, H; McPherson, A C; Maxwell, J

    2016-03-01

    To address gaps in transfer of care and transition support, a paediatric hospital and adult community health care centre partnered to implement an inter-agency transition model for youth with spina bifida. Our objective was to understand the enablers and challenges experienced in the implementation of the model. Using a descriptive, qualitative design, we conducted semi-structured interviews, in-person or over the phone, with 12 clinicians and nine key informants involved in implementing the spina bifida transition model. We recruited all 21 participants from an urban area of Ontario, Canada. Clinicians and key informants experienced several enablers and challenges in implementing the spina bifida transition model. Enablers included dedicated leadership, advocacy, funding, inter-agency partnerships, cross-appointed staff and gaps in co-ordinated care to connect youth to adult services. Challenges included gaps in the availability of adult specialty services, limited geographical catchment of adult services, limited engagement of front-line staff, gaps in communication and role clarity. Although the transition model has realized some initial successes, there are still many challenges to overcome in transferring youth with spina bifida to adult health care and transitioning to adulthood. © 2015 John Wiley & Sons Ltd.

  20. Transitioning issues in adolescent to young adult hemophilia patients with inhibitors: an approach for a growing population.

    PubMed

    Young, Guy

    2010-09-01

    The major adverse effect of factor replacement therapy in patients with hemophilia is the development of neutralizing antibodies termed inhibitors. This complication renders standard factor replacement therapy ineffective resulting in increased morbidity and mortality. Until recently, the population of adults with inhibitors was relatively small due to the death of many of the patients from HIV that they contracted from contaminated factor in the early 1980s. With the advent of factor products with reduced risks for deadly infections in the mid-1980s to early 1990s, a cohort of inhibitor patients is now beginning to enter adulthood thus raising the issues regarding the transition of these patients into adulthood. It is, therefore, expected that adult hematologists will be seeing more inhibitor patients and that pediatric hematologists will be faced with managing this transition process, which may not necessarily include transition to an adult facility or adult hematologist. This review will discuss the various issues ranging from choice of medical provider to a discussion of psychosocial and financial issues facing this specific patient population.

  1. ‘Mind the gap’ - mapping services for young people with ADHD transitioning from child to adult mental health services

    PubMed Central

    2013-01-01

    Background Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. Method We report the findings of a survey of 96 healthcare professionals working in children’s (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Results Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. Conclusions We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management. PMID:23842080

  2. Learning to Be Illegal: Undocumented Youth and Shifting Legal Contexts in the Transition to Adulthood

    ERIC Educational Resources Information Center

    Gonzales, Roberto G.

    2011-01-01

    This article examines the transition to adulthood among 1.5-generation undocumented Latino young adults. For them, the transition to adulthood involves exiting the legally protected status of K to 12 students and entering into adult roles that require legal status as the basis for participation. This collision among contexts makes for a turbulent…

  3. Sugar is an endogenous cue for juvenile-to-adult phase transition in plants

    PubMed Central

    Yu, Sha; Cao, Li; Zhou, Chuan-Miao; Zhang, Tian-Qi; Lian, Heng; Sun, Yue; Wu, Jianqiang; Huang, Jirong; Wang, Guodong; Wang, Jia-Wei

    2013-01-01

    The transition from the juvenile to adult phase in plants is controlled by diverse exogenous and endogenous cues such as age, day length, light, nutrients, and temperature. Previous studies have shown that the gradual decline in microRNA156 (miR156) with age promotes the expression of adult traits. However, how age temporally regulates the abundance of miR156 is poorly understood. We show here that the expression of miR156 responds to sugar. Sugar represses miR156 expression at both the transcriptional level and post-transcriptional level through the degradation of miR156 primary transcripts. Defoliation and photosynthetic mutant assays further demonstrate that sugar from the pre-existing leaves acts as a mobile signal to repress miR156, and subsequently triggers the juvenile-to-adult phase transition in young leaf primordia. We propose that the gradual increase in sugar after seed germination serves as an endogenous cue for developmental timing in plants. DOI: http://dx.doi.org/10.7554/eLife.00269.001 PMID:23543845

  4. What Makes an Adult? Examining Descriptions from Adolescents of Divorce

    ERIC Educational Resources Information Center

    Kenyon, DenYelle Baete; Rankin, Lela A.; Koerner, Susan Silverberg; Dennison, Renee Peltz

    2007-01-01

    The present study examined conceptions of "what makes an adult" within a sample of adolescents (13-19 years) from divorced families. Arnett's (2003) seven criteria-of-adulthood categories (independence, interdependence, role transitions, norm compliance, biological transitions, chronological transitions, and family capacities) were used as an…

  5. Addressing cancer patient and caregiver role transitions during home hospice nursing care.

    PubMed

    Hudson, Janella; Reblin, Maija; Clayton, Margaret F; Ellington, Lee

    2018-05-15

    Many family caregivers and hospice patients experience role changes resulting from advancing illness and the need for increased caregiver responsibility. Successful navigation of conflicts that arise because of these role transitions has been linked to higher quality of patient care and improved caregiver bereavement adjustment. Nursing communication with patients and their caregivers plays an important role in facilitating these transitions. Our objective is to describe patient-caregiver-nurse communication during transitions at end of life. A secondary, qualitative analysis was conducted on transcripts. Using an iterative process of constant comparison, coders inductively categorized nurse, caregiver, and patient communication behavior into overarching themes. Participants were home hospice nurses and cancer patient/spouse caregiver dyads; participants were >45 years of age, English speaking, and cognitively able to participate. Research took place in the home during nurse visits.ResultNineteen unique home hospice visits were analyzed. Patient-caregiver conflict occurred in two major content themes (1) negotiating transitions in patient independence and (2) navigating caregiver/patient emotions (e.g., frustration, sadness). Nurse responses to transition conflict included problem-solving, mediating, or facilitating discussions about conflicts. Nurse responses to emotional conflict included validation and reassurance.Significance of resultsOur findings provide insight into the topics and processes involved in patient and caregiver transitions in home hospice and the role hospice nursing communication plays in mediating potential conflict. Nurses are often asked to take on the role of mediator, often with little conflict resolution communication education; results can be used for nursing education.

  6. Free to love? The role of intrusive parenting for young adult children's romantic relationship quality.

    PubMed

    Parise, Miriam; Manzi, Claudia; Donato, Silvia; Iafrate, Raffaella

    2017-01-01

    Intrusive parenting is a form of boundary disturbance in the parent-child relationship which has been consistently associated with children's maladjustment. The present study examines the role of intrusive parenting for young adult children's romantic relationship quality. Relying on data from a two-wave longitudinal study among young couples in transition to marriage in Italy, we investigated the link between young adults' perceived intrusive parenting and change in their romantic relationship quality from 6 months before marriage to 18 months after marriage, as well as the mediating role of change in the capacity to include the partner in the self. Data were analyzed using actor-partner interdependence modeling. Perceived intrusive parenting negatively predicted change in inclusion of the other in the self and change in romantic relationship quality for both partners. For females, change in their capacity of inclusion of the other in the self fully mediated the association between their perceived intrusive parenting and change in their own and partner's relationship quality. Limitations and implications for practice are discussed.

  7. Young adults as users of adult healthcare: experiences of young adults with complex or life-limiting conditions.

    PubMed

    Beresford, B; Stuttard, L

    2014-08-01

    Awareness is growing that young adults may have distinctive experiences of adult healthcare and that their needs may differ from those of other adult users. In addition, the role of adult health teams in supporting positive transitions from paediatrics is increasingly under discussion. This paper contributes to these debates. It reports a qualitative study of the experiences of young adults - all with complex chronic health conditions - as users of adult health services. Key findings from the study are reported, including an exploration of factors that help to explain interviewees' experiences. Study findings are discussed in the context of existing evidence from young adults in adult healthcare settings and theories of 'young adulthood'. Implications for training and practice are considered, and priorities for future research are identified. © 2014 Royal College of Physicians.

  8. Reentry of Emerging Adults: Adolescent Inmates' Transition Back into the Community

    ERIC Educational Resources Information Center

    Inderbitzin, Michelle

    2009-01-01

    This article is based on the sociological analysis of the experiences and perspectives of five young men making the transition out of one state's end-of-the-line maximum security juvenile correctional facility and attempting to reenter the community as emerging adults. As part of a larger ethnographic study of violent offenders in a cottage, these…

  9. Professional's Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting.

    PubMed

    Le Roux, Enora; Gottot, Serge; Aupiais, Camille; Girard, Thomas; Teixeira, Maria; Alberti, Corinne

    2017-01-01

    Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition. Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted. Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams' experience, a simplified categorization of these young people into four levels can be used: those "who have everything good"; those who have some deficiencies that must be addressed; those "who have everything bad"; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment. Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated structure for transition

  10. MiR-277/4989 regulate transcriptional landscape during juvenile to adult transition in the parasitic helminth Schistosoma mansoni

    PubMed Central

    van Dongen, Stijn; Collins, Julie; Quintais, Leonor; Ribeiro, Diogo M.; Sessler, Florian; Hunt, Martin; Rinaldi, Gabriel; Collins, James J.; Enright, Anton J.; Berriman, Matthew

    2017-01-01

    Schistosomes are parasitic helminths that cause schistosomiasis, a disease affecting circa 200 million people, primarily in underprivileged regions of the world. Schistosoma mansoni is the most experimentally tractable schistosome species due to its ease of propagation in the laboratory and the high quality of its genome assembly and annotation. Although there is growing interest in microRNAs (miRNAs) in trematodes, little is known about the role these molecules play in the context of developmental processes. We use the completely unaware “miRNA-blind” bioinformatics tool Sylamer to analyse the 3’-UTRs of transcripts differentially expressed between the juvenile and adult stages. We show that the miR-277/4989 family target sequence is the only one significantly enriched in the transition from juvenile to adult worms. Further, we describe a novel miRNA, sma-miR-4989 showing that its proximal genomic location to sma-miR-277 suggests that they form a miRNA cluster, and we propose hairpin folds for both miRNAs compatible with the miRNA pathway. In addition, we found that expression of sma-miR-277/4989 miRNAs are up-regulated in adults while their predicted targets are characterised by significant down-regulation in paired adult worms but remain largely undisturbed in immature “virgin” females. Finally, we show that sma-miR-4989 is expressed in tegumental cells located proximal to the oesophagus gland and also distributed throughout the male worms’ body. Our results indicate that sma-miR-277/4989 might play a dominant role in post-transcriptional regulation during development of juvenile worms and suggest an important role in the sexual development of female schistosomes. PMID:28542189

  11. Transition From Clinical to Educator Roles in Nursing: An Integrative Review.

    PubMed

    Fritz, Elizabeth

    This review identified barriers to and facilitators of nurses' transition from clinical positions into nursing professional development and other nurse educator roles. The author conducted literature searches using multiple databases. Twenty-one articles met search criteria, representing a variety of practice settings. The findings, both barriers and facilitators, were remarkably consistent across practice settings. Four practice recommendations were drawn from the literature to promote nurses' successful transition to nursing professional development roles.

  12. Bridging the gap: the role of Physiatrists in caring for adults with cerebral palsy.

    PubMed

    Cassidy, Caitlin; Campbell, Nerissa; Madady, Mona; Payne, Michael

    2016-01-01

    Individuals with cerebral palsy (CP) experience a significant gap in care as they move from interdisciplinary pediatric programs to limited or non-existent care in the adult sector. A lack of knowledgeable adult care providers has repeatedly been identified as a challenge in transitioning those with CP from pediatric to adult care. The objective of this study was to determine the extent to which Physiatrists provide care to adults with CP and to identify barriers to their engagement with this population. A survey was distributed to Physiatrists across Canada. Results were analyzed descriptively using SPSS software. Most Physiatrists provide care to very few adults with CP (10 or less), but over 80% feel that Physiatry is the most appropriate specialty to provide disability-related care to adults with CP following their pediatric discharge. Among the most frequently identified barriers to caring for this population were lack of accessible resources (i.e. social work, funded therapy, equipment) and lack of referrals. Physiatrists are willing and appropriate partners in transitioning patients with CP to adult care. Barriers to Physiatrists' engagement with this population appear to be amenable to change. A lack of knowledgeable and interested adult practitioners has repeatedly been identified as a challenge in transition planning for young adults with cerebral palsy (the vast majority of whom survive into adulthood). Physiatrists are ideally suited to manage adults with cerebral palsy, yet in this survey-based study, a majority of Canadian Physiatrists report caring for less than five adults with cerebral palsy on a regular basis. Barriers to further physiatric involvement in this population were reported to include lack of accessible resources and lack of referrals.

  13. Implications of parent-child relationships for emerging adults' subjective feelings about adulthood.

    PubMed

    Lindell, Anna K; Campione-Barr, Nicole; Killoren, Sarah E

    2017-10-01

    Little is known about the role of parents in promoting their children's successful transition to adulthood, particularly for college students who may maintain stronger ties to parents than other emerging adults. The present study therefore investigated longitudinal implications of parent-child relationship qualities during emerging adults' first year of college for their feelings about the upcoming transition to adulthood 3 years later, as well as implications of 3 types of parental control (behavioral control, psychological control, helicopter parenting) for these associations. Multilevel models indicated that emerging adults who reported less negativity in their relationships with mothers and fathers felt more like adults 3 years later compared with emerging adults with low-quality relationships, while high levels of psychological control and helicopter parenting had detrimental implications for their vocational identity development and perceived competence regarding their transition to adulthood. However, nuanced interactions between parent-child relationship quality and parental control indicated that behavioral control had positive implications for outcomes if it occurred within the context of high-quality relationships, or when utilized with sons. The present study highlights the complex role that parents may play during college students' transition to adulthood, and future work should continue to examine ways that clinicians can incorporate parents as a potential resource for promoting emerging adults' successful transition to adulthood and the workforce. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. Pediatric Provider's Perspectives on the Transition to Adult Health Care for Youth with Autism Spectrum Disorder: Current Strategies and Promising New Directions

    ERIC Educational Resources Information Center

    Kuhlthau, Karen A.; Warfield, Marji E.; Hurson, Jill; Delahaye, Jennifer; Crossman, Morgan K.

    2015-01-01

    Few youth with autism spectrum disorder (ASD) nationally report receiving services to help them transition from the pediatric health care system to the adult health care system. For example, only one-fifth (21.1%) of youth with ASD receive any transition planning services. To better understand why the transition from pediatric to adult health care…

  15. [Role transition and working adaption in new nursing graduates: a qualitative study].

    PubMed

    Ho, Hsueh-Hua; Liu, Pei-Fen; Hu, Hsiao-Chen; Huang, Su-Fei; Chen, Hsiao-Lien

    2010-12-01

    The role transition process is full of stresses and challenges for nurses. Between 35-61% nurses leave their job within the first year. Past cross-sectional quantitative studies have not provided deep descriptions of either the dynamic role transition or work adaption processes of new nurses. The purpose of this study was to understand the role transition experience of new nurses as they transitioned into clinical practice during their first three months on the job. A qualitative approach was used. Data were collected through a semi-structured interview from 50 new nurses. Data were analyzed using category-content analysis. Three stages were identified in the new nurse work adaption process over the first three-month period. These included (1) Understanding: New nurse knowledge and skills are insufficient to handle routine work, adapting to the role transition is difficult, feelings of anxiety emerge related to fears of incompetence, communication difficulties must be faced in the handover process, new nurses adopt feelings of attachment to their preceptors, they must work to adopt appropriate attitudes and approaches to nursing practice, and support is sought from family, teachers and friends; (2) Acclimation: Learning to care for patients independently, seeking role models, learning to adapt to night shifts, trying to identify with co-workers, and seeking support from colleagues, preceptors and head nurses; (3) Acceptance: Managing nursing work better in terms of time and organization, feeling gradual acceptance from co-workers, restoring personal enthusiasm for work, starting to consider other, non-work related matters, experiencing and appreciating the support of co-workers and head nurses. CONCLUSIONS/IMPLICATION: New nurses face a critical role transition process through their first three months on the job. Guidance and leadership from experienced nurses and multiple support systems can assist new nurses to acclimate to their role. Research results provide

  16. Resident Transitions to Assisted Living: A Role for Social Workers

    ERIC Educational Resources Information Center

    Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

    2012-01-01

    This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide,…

  17. Transitioning and Transfer of Adolescents and Young Adults with Pediatric Onset Chronic Disease: The Patient and Parent Perspective

    PubMed Central

    Fernandes, Susan M.; O’Sullivan-Oliveira, Joanne; Landzberg, Michael J.; Khairy, Paul; Melvin, Patrice; Sawicki, Gregory S.; Ziniel, Sonja; Kenney, Lisa B.; Garvey, Katharine C.; Sobota, Amy; O’Brien, Rebecca; Nigrovic, Peter A.; Sharma, Niraj; Fishman, Laurie N

    2017-01-01

    Purpose To determine patients’ and parents’ perceptions of transitioning education as well as their attitudes and perceived barriers to transfer to adult oriented care. Methods A self-report survey was administered to patients (16–25 years old) with various childhood onset chronic diseases. A similar survey was administered to their parents/guardians. Results A total of 155 patients and 104 parents participated in the study. The mean age of patients was 18.9±2.3 years; 57% were female. Although most patients and parents reported receiving information and training about their medical condition, significant gaps in “transitioning education” were identified. These included stated deficiencies in education regarding unprotected intercourse, health of future offspring, birth control, pregnancy, illicit drug use, and future career or vocation counseling. Commonly named barriers to transfer were emotional attachments and lack of adult medicine specialty providers; however, the majority anticipated being ready to transfer to adult oriented care by age 25 years. Conclusion Current transitioning education delivery appears to result in significant gaps in transfer of information and training, as perceived by patients and their parents. Standardization of transitioning education may help ensure that patients obtain the necessary skills for self-care in adulthood and successful transfer to adult oriented care. PMID:24919937

  18. Factors Influencing Changes in Eating Patterns Among Hong Kong Young Adults Transitioning to Tertiary Education.

    PubMed

    Kwok, Sin Tung; Capra, Sandra; Leveritt, Michael

    2016-05-01

    Transitioning to tertiary education is a significant life course event that has the potential to influence lifelong eating patterns. This study used a theoretic model developed from a life course perspective to examine factors influencing the change of food choices among 31 young adults in Hong Kong after they moved on to tertiary education. Qualitative analysis of transcripts based on the constant comparative method revealed that present life course experiences, especially increased autonomy, and social-environmental factors strongly influenced young adults' present food choices. A model was developed from life course theory and social-ecological theory to reflect the factors that led to change of food choices among participants. The model provides unique insights on food choices of the future adult population. It could also be used as a reference for the development of nutrition education interventions targeting tertiary students as they experience increased autonomy. In conclusion, food choices of young adults on transitioning to tertiary education are strongly influenced by increased autonomy and change of social and environmental factors. © 2016 APJPH.

  19. Transition from the spouse dementia caregiver role: A change for the better?

    PubMed

    Brown, Lynsey J; Bond, Malcolm J

    2016-07-01

    One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing. © The Author(s) 2014.

  20. An e-health intervention to support the transition of young people with long-term illnesses to adult healthcare services: Design and early use.

    PubMed

    Coyne, I; Prizeman, G; Sheehan, A; Malone, H; While, A E

    2016-09-01

    Co-design information and website to support adolescents and young adults with long-term illnesses in their transition to adult healthcare. A participatory iterative process involving a survey (n=207), twenty-one interviews, six participatory workshops, six video recordings, two advisory groups, and a co-design group to identify needs and preferences for e-health and information provision, was used to develop an appropriate intervention. Adolescents and young people expressed preferences for information that was trustworthy, empowering, colorful, easily downloaded online and written using non-patronizing language. They desired video testimonials of experiences from young adults who had transitioned to adult healthcare and wanted advice about becoming more independent, managing their condition, preparing for the transition, and information about medications and the differences between child and adult healthcare. They also wanted information about the location and configuration of adult healthcare, key hospital personnel, and frequently asked questions. The participatory iterative process led to the development of an online resource specifically tailored to the adolescents and young people's transition needs and information preferences. Preliminary feedback indicates that it is a valued resource. The www.SteppingUP.ie website has the potential to help prepare its target population group for the transition to adult healthcare. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Promoting School Psychologist Participation in Transition Services Using the TPIE Model

    ERIC Educational Resources Information Center

    Talapatra, Devadrita; Roach, Andrew T.; Varjas, Kris; Houchins, David E.; Crimmins, Daniel B.

    2018-01-01

    Transition services can be used to forge family, school, and community partnerships and foster a successful shift to adult life for students with intellectual disabilities (ID). School psychologists can play a valuable additive role in supporting the transition process due to their graduate training in interpersonal skills; consultation services;…

  2. Behavioral health in young adults with epilepsy: Implications for transition of care.

    PubMed

    Wagner, Janelle L; Wilson, Dulaney A; Kellermann, Tanja; Smith, Gigi; Malek, Angela M; Wannamaker, Braxton; Selassie, Anbesaw W

    2016-12-01

    Neurodevelopmental and behavioral health disorders commonly occur with epilepsy, yet risk for young adults is unknown. The aim of this study was to determine the distribution and risk characteristics of neurodevelopmental and behavior health comorbidities among young adults with epilepsy compared with those among young adults with migraine and healthy controls. A case-control study examining hospital admission, outpatient, and emergency department (ED) visits for young adults with an ICD-9-CM diagnosis of epilepsy, migraine, or lower extremity fracture (LEF) was conducted. The association of epilepsy, migraine, or LEF with comorbidities was evaluated with univariate and multivariate polytomous logistic regression. From 2000 to 2013, 29,139 young adults ages 19 to 25years were seen in hospitals and EDs for epilepsy (5666), migraine (17,507), or LEF (5966). Young adults with epilepsy had higher proportions of behavioral health comorbidities (51.8%) compared with controls with migraine (37.6%) or LEF (21.6%). In young adults with epilepsy compared with migraine, the increased risk of having any behavioral health comorbidity was 76%, and neurodevelopmental comorbidity was 297%. After adjustment, young adults with epilepsy showed significantly higher odds of each behavioral health comorbidity compared with controls with migraine and LEF. Young adults with epilepsy are particularly susceptible to behavioral health and neurodevelopmental disorders. Results are discussed within the context of transition to adult care. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Transition Strategies for Adolescents and Young Adults Who Use AAC. AAC Series

    ERIC Educational Resources Information Center

    McNaughton, David B., Ed.; Beukelman, David R., Ed.

    2010-01-01

    To make a smooth transition to a fulfilling, self-determined adult life, young people who use Augmentative-Alternative Communication (AAC) need effective services that meet their individual needs and make the most of advances in technology. Professionals will provide these critical supports with the help of this book, the first complete guide to…

  4. Role of mitochondrial permeability transition pores in mitochondrial autophagy.

    PubMed

    Rodriguez-Enriquez, Sara; He, Lihua; Lemasters, John J

    2004-12-01

    During autophagy, cells rid themselves of damaged and superfluous mitochondria, as well as other organelles. This activation of mitochondrial turnover could be the result of changes in the physiological state of mitochondria. Confocal microscopy and fluorescence techniques indicate that onset of mitochondrial permeability transition is one such change. The mitochondrial permeability transition is a reversible phenomenon whereby the mitochondrial inner membrane becomes freely permeable to solutes of less than 1500 Da. At onset of the mitochondrial permeability transition, mitochondria depolarize, uncouple, and undergo large amplitude swelling due to opening of permeability transition pores, which may form by aggregation of damaged, misfolded membrane proteins. When injurious cellular stresses occur, cells may protect themselves using autophagy to remove damaged mitochondria and mutated mitochondrial DNA. Ca(2+) overloading, reactive oxygen and nitrogen species, decreased mitochondrial membrane potential, and oxidation of pyridine nucleotides and glutathione all promote mitochondrial damage and onset of the mitochondrial permeability transition. The mitochondrial permeability transition is also associated with necrosis and apoptosis after a variety of stimuli. This review emphasizes the role of the mitochondrial permeability transition as a key event in mitochondrial autophagy.

  5. Adult-child differences in acoustic cue weighting are influenced by segmental context: Children are not always perceptually biased toward transitions

    NASA Astrophysics Data System (ADS)

    Mayo, Catherine; Turk, Alice

    2004-06-01

    It has been proposed that young children may have a perceptual preference for transitional cues [Nittrouer, S. (2002). J. Acoust. Soc. Am. 112, 711-719]. According to this proposal, this preference can manifest itself either as heavier weighting of transitional cues by children than by adults, or as heavier weighting of transitional cues than of other, more static, cues by children. This study tested this hypothesis by examining adults' and children's cue weighting for the contrasts /ess,aye,smcapi/-/sh,aye,smcapi/, /de/-/be/, /ta/-/da/, and /ti/-/di/. Children were found to weight transitions more heavily than did adults for the fricative contrast /ess,aye,smcapi/-/sh,aye,smcapi/, and were found to weight transitional cues more heavily than nontransitional cues for the voice-onset-time contrast /ta/-/da/. However, these two patterns of cue weighting were not found to hold for the contrasts /de/-/be/ and /ti/-/di/. Consistent with several studies in the literature, results suggest that children do not always show a bias towards vowel-formant transitions, but that cue weighting can differ according to segmental context, and possibly the physical distinctiveness of available acoustic cues.

  6. State Strategies to Facilitate Adult Learners' Transitions to Postsecondary Opportunities. REL 2017-223

    ERIC Educational Resources Information Center

    Hector-Mason, Anestine; Narlock, Jason; Muhisani, Helen; Bhatt, Monica P.

    2017-01-01

    Prior research has classified strategies to facilitate adult learners' transitions to postsecondary opportunities into five broad categories: advising, General Educational Development-plus (GED-plus), English as a second language, career pathways, and college preparatory (Zafft, Kallenbach, & Spohn, 2006). This two-part study relied on…

  7. A role for social workers in improving care setting transitions: a case study.

    PubMed

    Barber, Ruth D; Coulourides Kogan, Alexis; Riffenburgh, Anne; Enguidanos, Susan

    2015-01-01

    High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work-driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.

  8. Promoting Post-School Success for All: The Role of Collaboration in Person-Centered Transition Planning

    ERIC Educational Resources Information Center

    Michaels, Craig A.; Ferrara, Denise L.

    2006-01-01

    Successful collaboration and problem solving are the foundational processes on which meaningful transition plans are constructed. This article discusses the process of planning for the transition from school to adult life for students with disabilities and suggests that person-centered planning is an ideal vehicle for promoting collaboration and…

  9. Employment Outcomes of Transition-Aged Adults with Autism Spectrum Disorders: A State of the States Report

    ERIC Educational Resources Information Center

    Burgess, Sloane; Cimera, Robert E.

    2014-01-01

    The primary purpose of this study was to evaluate the employment outcomes of transition-aged adults with autism spectrum disorders (ASD) served by vocational rehabilitation services (VR) over the last 10 years by state. A secondary purpose was to compare employment outcomes of individuals with ASD to those of the overall transition-aged population…

  10. Factors influencing transitional care from adolescents to young adults with cancer in Taiwan: A population-based study.

    PubMed

    Jin, Yo-Ting; Chen, Chin-Mi; Chien, Wu-Chien

    2016-08-02

    To investigate the progress of transition from paediatric to adult health care for patients with cancer in Taiwan's medical system. The data were retrieved from the Longitudinal Health Insurance Database (LHID), which contains the original inpatient and outpatient medical claims data for 1,000,000 enrollees randomly sampled from the NHIRD between 1997 and 2010. Among the 1,411 cancer patients selected for this study, 98.09 % received adult-oriented therapy before the age of 18. In addition, only 1.91 % of the patients received paediatric-oriented therapy during adolescence. The primary factors that determine whether these patients would receive paediatric-oriented therapy or adult-oriented therapy at an early age were as follows: the age of the patient at the first visit and the performance-level of the hospital (p < 0.001). Previous studies conducted in developed countries have demonstrated that the unwillingness of patients to switch from paediatric-oriented therapy to adult-oriented therapy being the major obstacle that hinders the transition process. However, this study revealed a different result: the implementation of the National Health Insurance system in Taiwan makes healthcare affordable for the adolescent patients who may not possess adequate knowledge about paediatric health care and may not appreciate paediatric-oriented therapy, thereby hindering the transition process.

  11. Role Transition After Clinical Nurse Specialist Education.

    PubMed

    Ares, Terri L

    This study explored the transition of clinical nurse specialists into new roles after completion of their graduate education. A quantitative longitudinal survey was used to measure certification, employment, career commitment, and the imposter phenomenon. An online survey was sent to 113 participants from a previous national study that agreed to follow-up. The Student Nurse Anesthetist Experience Questionnaire and Clance Imposter Phenomenon Scale instruments were used. Each case (N = 68) was matched with data from the primary study, and 2 comparison groups were formed based on employment status as a clinical nurse specialist. The advanced practice certification rate was 66.7%, and 48.5% were employed as a clinical nurse specialist. The employed group perceived more autonomy, a more positive view of the clinical nurse specialist lifestyle, and upset life plans if not able to practice in the role when compared with the not-employed group. Self-image was significantly different based on employment, but career commitment was not particularly strong regardless of employment status. The prevalence of imposter phenomenon experiences was 74.6% in this sample. Recent graduates are struggling with their transition into practice as clinical nurse specialists.

  12. Neonatal nurse practitioner role transition: the process of reattaining expert status.

    PubMed

    Cusson, Regina M; Strange, Sally Nelson

    2008-01-01

    Neonatal nurse practitioners (NNPs) have managed care for high-risk hospitalized infants in the United States for over 30 years. The journey from being expert nurse to being novice NNP and then finally to being expert NNP is fraught with many challenges. This study used a qualitative descriptive design to describe advanced practice role transition among 70 NNPs. The data consisted of participants' written responses to open-ended questions. Four themes emerged that depicted a linear progression of the transition process from school preparation to beginning feelings in the new role and then development into a more confident practice. Theme 1: First impressions emphasized the ambivalence novice NNPs experienced regarding their preparedness for the role during a stressful and exciting adjustment period. Theme 2: The transition demonstrated the overwhelmingly similar feelings of anxiety, insecurity, exhaustion, and lack of confidence that plagued decision making. Theme 3: Making it as a real NNP indicated that the 1-year mark was a consistent, significant timeframe for feeling like a real NNP. Theme 4: The helpers and hinderers revealed the vulnerability of the novice NNPs to harsh criticism as well as the importance of support, especially from nurse colleagues. NNPs are a valuable resource; thus, enhancing transition is a worthy goal.

  13. Transitioning of special needs paediatric patients to adult special needs dental services.

    PubMed

    Borromeo, G L; Bramante, G; Betar, D; Bhikha, C; Cai, Y Y; Cajili, C

    2014-09-01

    Special needs dentistry is in its infancy compared to other dental specialties. Continuity of care through transition from paediatric to adult dental care providers is unknown. This study seeks to determine the nature of transition practices adopted by paediatric and special needs (SN) specialists practising throughout Australia. A survey was sent to all paediatric and SN specialist dentists in Australia to determine the nature of current transition practices for paediatric SN patients in Australia. Two subsequent mail-outs were sent to non-responders. Forty-nine specialist dentists registered across Australia completed the survey, of which 35 (71%) were paediatric dentists and 14 (29%) were SN dentists. Both paediatric and SN dentists treated patients over the age of 18. Of the total paediatric dentists who had transition discussions with their paediatric patients and their families, the majority (over 80%) discussed treatment options available as part of future oral care management. Paediatric dentists identified level of independence and financial situations as the most significant barrier for transition. Key factors exist that should be discussed with SN patients and their parents and/or guardians in order to enhance the prospect of sustained dental care into adulthood. © 2014 Australian Dental Association.

  14. An Overview of Transition Planning for Students Who Are Deafblind.

    PubMed

    Zatta, Mary; McGinnity, Betsy

    2016-01-01

    Children who are deafblind are one of the lowest-incidence yet most diverse groups receiving services mandated by the Individuals With Disabilities Education Improvement Act. Despite this population's diversity, the development of communication skills is critical for all children who are deafblind, and is the foundation on which good transition planning can be built. The authors describe key research findings and other professional literature on transition planning and services guided by the quality of life principle. The role of the individualized education program and case law in transition planning is discussed. Through a person-centered approach to transition planning, a coordinated set of activities designed to support the young adult in moving from school to postschool settings and activities is identified. The authors conclude that effective transition efforts will involve extensive collaboration among school and agency professionals, families, and the young adult who is deafblind.

  15. Transition from child and adolescent to adult mental health services in the Republic of Ireland: an investigation of process and operational practice.

    PubMed

    McNamara, Niamh; McNicholas, Fiona; Ford, Tamsin; Paul, Moli; Gavin, Blanaid; Coyne, Imelda; Cullen, Walter; O'Connor, Karen; Ramperti, Nicolas; Dooley, Barbara; Barry, Siobhan; Singh, Swaran P

    2014-08-01

    Ensuring a seamless transition from child to adult mental health services poses challenges for services worldwide. This is an important process in the ongoing care of young people with mental illness; therefore, it is incumbent on all countries to probe their individual structures to assess the quality of mental health service delivery to this vulnerable cohort. To date, there have been no published studies on the transition from Child to Adult Mental Health Services in the Republic of Ireland. To this end, a nationwide survey of transition policies of community mental health teams in both services was conducted in order to compare best practice guidelines for transition with current process and experience in clinical practice. Structured interviews were conducted with 57 consultant psychiatrists (representing 32 CAMHS teams and 25 AMHS teams) to obtain information on annual transition numbers, existing transition policies and operational practice from the professional perspective. Numbers of young people considered suitable for transfer to adult services (M = 7.73, SD = 9.86, n = 25) were slightly higher than numbers who actually transferred (M = 4.50, SD = 3.33, n = 20). There is a lack of standardized practice nationwide regarding the service transition boundary, an absence of written transition policies and protocols, and minimal formal interaction between child and adult services. The findings suggest that there are critical gaps between current operational practice and best practice guidelines. Future studies will investigate the impact this has on the transition experiences of young people, their carers and health-care professionals. © 2013 Wiley Publishing Asia Pty Ltd.

  16. Prefrontal Cortex: Role in Acquisition of Overlapping Associations and Transitive Inference

    ERIC Educational Resources Information Center

    DeVito, Loren M.; Lykken, Christine; Kanter, Benjamin R.; Eichenbaum, Howard

    2010-01-01

    "Transitive inference" refers to the ability to judge from memory the relationships between indirectly related items that compose a hierarchically organized series, and this capacity is considered a fundamental feature of relational memory. Here we explored the role of the prefrontal cortex in transitive inference by examining the performance of…

  17. Young adults and parental divorce: exploring important issues.

    PubMed

    Cooney, T M

    1988-01-01

    This article discusses the potential impact of parental divorce on the lives of young adult offspring. Parental divorce may upset both social and psychological aspects of the transition to adulthood process. The family roles young adults are expected to assume could be altered by the break-up, as could opportunities for particular young adult pursuits, such as advanced education. Heightened adjustment problems also are likely to result, as divorce produces additional life changes during the highly transitional period of early adulthood. Qualitative data from an exploratory study of 39 college students, ages 18-23, illustrate many of the relevant issues. Suggestions for future research are provided.

  18. Health Needs of Transition-Aged Youth: Feature Issue of IMPACT.

    ERIC Educational Resources Information Center

    Tommet, Pat, Ed.; And Others

    1994-01-01

    This feature issue explores health needs of youth with disabilities as they make the transition from child to adult roles. "School Health Services: Supporting Students with Special Health Needs" (Dee K. Bauer) describes the role of the special needs nurse on multidisciplinary teams in Multnomah County (Oregon) schools. Two articles deal with…

  19. College Students with Congenital Heart Disease: A Critical Time for Transition

    ERIC Educational Resources Information Center

    Hardy, Rose Y.; Gurvitz, Michelle; Jackson, Jamie L.; May, Susan; Miller, Paula; Daskalov, Rachel; Foster, Elyse

    2018-01-01

    As medical and surgical advances improve, more young adults with congenital heart disease (CHD) are attending college. This case study illustrates some of the issues that these young adults may face as they attend college and discusses the role that college health practitioners can play in easing that transition. Participants: A case of a male…

  20. Professional’s Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting

    PubMed Central

    Le Roux, Enora; Gottot, Serge; Aupiais, Camille; Girard, Thomas; Teixeira, Maria; Alberti, Corinne

    2017-01-01

    Background Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition. Methods Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted. Results Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams’ experience, a simplified categorization of these young people into four levels can be used: those “who have everything good”; those who have some deficiencies that must be addressed; those “who have everything bad”; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment. Conclusions Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition

  1. Gender matters in the transition to employment for young adults with physical disabilities.

    PubMed

    Lindsay, Sally; Cagliostro, Elaine; Albarico, Mikhaela; Mortaji, Neda; Srikanthan, Dilakshan

    2017-10-17

    The purpose of this study was to explore the role of gender in the transition to employment for young adults with physical disabilities. This study drew on in-depth interviews with a purposive sample of 33 participants (23 youth and 10 clinicians). The youth in our sample included 13 females (mean age 22.9) and 10 males (mean age 21.3) who had various types of physical disabilities. The person-environment-occupation (PEO) model informed our analysis. Our research showed several similarities and some differences between young males and females with physical disabilities as they transition to employment and adulthood at the person, environment, and occupational level. At the person level, issues included managing their condition, self-advocacy, and willingness to ask for help. At the environment level, themes focused on parental and social support, accommodations, stigma and discrimination, and transportation challenges. Finally, in the occupation component of the PEO model, we found that males and females with disabilities had different levels of engagement in employment. Although most clinicians commented on gender differences, many reported that they did not tailor their clinical practice accordingly. Gender sensitive vocational approaches are needed for youth with disabilities as they transition to employment. Implications for rehabilitation Clinicians, educators, and parents should encourage independence and self-advocacy skills among youth so that they are prepared to ask for accommodations that they need to succeed in a work environment. Clinicians and educators should present a variety of career and job options to youth, including science, technology, engineering, and math disciplines, an area where youth with disabilities, particularly females, are under-represented. Males may feel less able to self-advocate and seek support and may need additional assistance from clinicians, educators, and parents. Clinicians should tailor their vocational rehabilitation

  2. Bridges and barriers to successful transitioning as perceived by adolescents and young adults with Asperger syndrome.

    PubMed

    Giarelli, Ellen; Ruttenberg, Jean; Segal, Andrea

    2013-01-01

    In this thematic content analysis we examined the expectations, and perceived facilitators of (referred to as bridges) and barriers to transition to community as reported by adolescents and young adults with Asperger syndrome. Participants were adolescents/young adults, ages 18-23 years were from the East Coast of the United States. Seventy percent of adolescents hoped for employment (n = 10). Thirty percent desired to find a partner and raise a family. Perceived barriers were: self-assessed behavioral problems, self-assessed associated features, other personal factors, and institutional factors. Bridges to facilitate transition were: accommodations in the community, cognitive abilities, personal qualities/strengths, and mentor's qualities. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Gender-Role Attitudes and Behavior Across the Transition to Parenthood

    PubMed Central

    Katz-Wise, Sabra L.; Priess, Heather A.; Hyde, Janet S.

    2013-01-01

    Based on social structural theory and identity theory, the current study examined changes in gender-role attitudes and behavior across the first-time transition to parenthood, and following the birth of a second child for experienced mothers and fathers. Data were analyzed from the ongoing longitudinal Wisconsin Study of Families and Work (WSFW). Gender-role attitudes, work and family identity salience, and division of household labor were measured for 205 first-time and 198 experienced mothers and fathers across four time points from five months pregnant to 12 months postpartum. Multi-level latent growth curve analysis was used to analyze the data. In general, parents became more traditional in their gender-role attitudes and behavior following the birth of a child, women changed more than men, and first-time parents changed more than experienced parents. Findings suggest that changes in gender-role attitudes and behavior following the birth of a child may be attributed both to transitioning to parenthood for the first time, and to negotiating the demands of having a new baby in the family. PMID:20053003

  4. Transition of gastroenterological patients from paediatric to adult care: A position statement by the Italian Societies of Gastroenterology.

    PubMed

    Elli, Luca; Maieron, Roberto; Martelossi, Stefano; Guariso, Graziella; Buscarini, Elisabetta; Conte, Dario; di Giulio, Emilio; Staiano, Annamaria; Barp, Jacopo; Bassotti, Gabrio; Bianco, Maria Antonia; Buri, Luigi; Carrara, Maurizio; Ghidini, Benedetta; Giannini, Olivia; Knafelz, Daniela; Miele, Erasmo; Peralta, Sergio; Riccio, Elisabetta; Tomba, Carolina; Zilli, Maurizio; Guadagnini, Tiziana

    2015-09-01

    In 2013, four Italian Gastroenterological Societies (the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Italian Society of Hospital Gastroenterologists and Endoscopists, the Italian Society of Endoscopy, and the Italian Society of Gastroenterology) formed a joint panel of experts with the aim of preparing an official statement on transition medicine in Gastroenterology. The transition of adolescents from paediatric to adult care is a crucial moment in managing chronic diseases such as celiac disease, inflammatory bowel disease, liver disease and liver transplantation. Improved medical treatment and availability of new drugs and surgical techniques have improved the prognosis of many paediatric disorders, prolonging survival, thus making the transition to adulthood possible and necessary. An inappropriate transition or the incomplete transmission of data from the paediatrician to the adult Gastroenterologist can dramatically decrease compliance to treatment and prognosis of a young patient, particularly in the case of severe disorders. For these reasons, the Italian gastroenterological societies decided to develop an official shared transition protocol. The resulting document discusses the factors influencing the transition process and highlights the main points to accomplish to optimize compliance and prognosis of gastroenterological patients during the difficult transition from childhood to adolescence and adulthood. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  5. Transition to Employment: Role of the Family in Career Development

    ERIC Educational Resources Information Center

    Lindstrom, Lauren; Doren, Bonnie; Metheny, Jennifer; Johnson, Pam; Zane, Claire

    2007-01-01

    This study investigated the role of the family in career development and postschool employment outcomes for young adults with learning disabilities. Using a multiple-case study design, the authors examined a set of family structural and process variables. Fifty-nine in-depth interviews were conducted with young adults, parents, and school staff…

  6. The role of adult hippocampal neurogenesis in brain health and disease.

    PubMed

    Toda, Tomohisa; Parylak, Sarah L; Linker, Sara B; Gage, Fred H

    2018-04-20

    Adult neurogenesis in the dentate gyrus of the hippocampus is highly regulated by a number of environmental and cell-intrinsic factors to adapt to environmental changes. Accumulating evidence suggests that adult-born neurons may play distinct physiological roles in hippocampus-dependent functions, such as memory encoding and mood regulation. In addition, several brain diseases, such as neurological diseases and mood disorders, have deleterious effects on adult hippocampal neurogenesis, and some symptoms of those diseases can be partially explained by the dysregulation of adult hippocampal neurogenesis. Here we review a possible link between the physiological functions of adult-born neurons and their roles in pathological conditions.

  7. Examining Emerging-Adults' and Parents' Expectations about Autonomy during the Transition to College

    ERIC Educational Resources Information Center

    Kenyon, DenYelle Baete; Koerner, Susan Silverberg

    2009-01-01

    Our research goals were to document levels and examine the potential discrepancies of emerging-adults' and parents' expectations for autonomous behavior during the transition to college. Quantitative and qualitative data were collected from 204 incoming college freshmen (n = 150 females, n = 54 males) and 226 parents (n = 173 mothers, n = 53…

  8. "Are these adult doctors gonna know me?" Experiences of transition for young people with a liver transplant.

    PubMed

    Wright, J; Elwell, L; McDonagh, J E; Kelly, D A; Wray, J

    2016-11-01

    Excellent survival rates in paediatric LTx have resulted in increasing numbers of young people transferring from paediatric to adult care. Understanding the mechanisms of successful transition is imperative for ensuring good long-term outcomes and developing services for young people. Semi-structured interviews were conducted with 17 young people (10 females; age range: 15.2-25.1 years). Eight were within 1 year of transferring to adult services; nine had transferred. Interviews were analysed using IPA. Analysis revealed two major themes in both pre- and post-transfer groups: "relationships with healthcare professionals" and "continuity of care." Young people experienced difficulty ending relationships with paediatric clinicians and forming new relationships with adult clinicians. They expressed frustrations over a perceived lack of continuity of care after transfer and a fear of the unknown nature of adult services. The importance of a holistic approach to care was emphasized. Interventions are needed to support young people in transition, particularly in ending relationships in paediatric care and forming new relationships in adult care. Young people need help to develop strategies to cope with the different approaches in adult services. Interventions to provide clinicians with skills to communicate and engage with young people are imperative. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. The role of cannabinoids in adult neurogenesis

    PubMed Central

    Prenderville, Jack A; Kelly, Áine M; Downer, Eric J

    2015-01-01

    The processes underpinning post-developmental neurogenesis in the mammalian brain continue to be defined. Such processes involve the proliferation of neural stem cells and neural progenitor cells (NPCs), neuronal migration, differentiation and integration into a network of functional synapses within the brain. Both intrinsic (cell signalling cascades) and extrinsic (neurotrophins, neurotransmitters, cytokines, hormones) signalling molecules are intimately associated with adult neurogenesis and largely dictate the proliferative activity and differentiation capacity of neural cells. Cannabinoids are a unique class of chemical compounds incorporating plant-derived cannabinoids (the active components of Cannabis sativa), the endogenous cannabinoids and synthetic cannabinoid ligands, and these compounds are becoming increasingly recognized for their roles in neural developmental processes. Indeed, cannabinoids have clear modulatory roles in adult neurogenesis, probably through activation of both CB1 and CB2 receptors. In recent years, a large body of literature has deciphered the signalling networks involved in cannabinoid-mediated regulation of neurogenesis. This timely review summarizes the evidence that the cannabinoid system is intricately associated with neuronal differentiation and maturation of NPCs and highlights intrinsic/extrinsic signalling mechanisms that are cannabinoid targets. Overall, these findings identify the central role of the cannabinoid system in adult neurogenesis in the hippocampus and the lateral ventricles and hence provide insight into the processes underlying post-developmental neurogenesis in the mammalian brain. PMID:25951750

  10. Measuring change in health status of older adults at the population level: the transition probability model.

    PubMed

    Moineddin, Rahim; Nie, Jason X; Wang, Li; Tracy, C Shawn; Upshur, Ross E G

    2010-11-09

    The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization. We conducted a population-based retrospective cohort study of all Ontario residents aged 65+ eligible for public healthcare coverage from January 1998-December 2006. The main outcome measure was total number of utilization events. The total is computed by summing, on a per annum basis, the number of family physician visits, specialist visits, Emergency Department visits, drug claims, lab claims, X-rays, CT scans, MRI scans, and inpatient admissions. Three categories of utilization were created: low, moderate, and high. There is heterogeneity in health services utilization across the late lifespan. Utilization increased consistently in the 9-year study period. The probability of remaining at the high utilization category when the person was in the high category the previous year was more than 0.70 for both males and females and for all age groups. Overall healthcare utilization increases more rapidly among the high users compared to the low users. There was negligible probability for moving from high to low utilization category. Probability of death increased exponentially as age increased. Older adults in the low utilization category had the lowest probability of death. The number of male nonagenarians increased more rapidly than female nonagenarians

  11. Transition to adult services - a positive step.

    PubMed

    Kim, Samuel; Kim, Sung Hee; McDonald, Susan; Fidler, Sarah; Foster, Caroline

    2017-07-01

    Following the success of antiretroviral therapy, an expanding cohort of adolescents with perinatally acquired HIV (PaHIV) is transitioning into adult care. Dedicated multidisciplinary transitional care HIV services have been established in the UK. However, published data on patient satisfaction with such services are sparse. A single centre survey of patient satisfaction was conducted in January 2014, and results compared to a previous similar survey in 2009. Patients were asked to complete a questionnaire regarding views of their care using a 7-point Likert scale. 51/96 attended within the time period and all completed the survey, compared with 21 in 2009. Ninety-two percent were satisfied with the care provided by the clinic, compared to 100% in 2009. The proportion who felt moving to their current service had a positive effect on their health increased from 68% in 2009 to 81% in 2014. Ninety-two percent were satisfied with the overall care provided by the clinic, compared to 100% in 2009. Ninety-four percent agreed that staff knew how to talk and listen to young people, 96% agreed staff were able to explain their treatments and problems clearly in a way that they could understand. Ninety-six percent felt that a clinic specifically for young people was useful. Despite a marked increase in clinic attendees and unchanged levels of service provision, patient satisfaction remained high. Patients strongly value the provision of dedicated services for young people.

  12. Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study.

    PubMed

    Singh, Swaran P; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim; McLaren, Susan; Hovish, Kimberly; Islam, Zoebia; Belling, Ruth; White, Sarah

    2010-10-01

    Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.

  13. Occupational dream, relation to parents and depression in the early adult transition.

    PubMed

    Gooden, W; Toye, R

    1984-07-01

    Assessed the impact of difficulty forming an occupational dream and relating to parents on depression among college students in their late teens and early twenties. Becoming independent of parents and forming an occupational dream are seen as two central issues during this period of life. Results from 64 students suggest that having to give up a valued dream, viewing one's relation to mother as authority-obeyer, and doing little exploring of occupational choices are related significantly to depression (p less than .0004). The significance of these results is discussed in light of theories of depression and the possible importance of different parenting styles for young adults who are facing the early adult transition.

  14. Dimensions of Attachment and Commitment Across the Transition to Parenthood

    PubMed Central

    Ferriby, Megan; Kotila, Letitia; Dush, Claire Kamp; Schoppe-Sullivan, Sarah

    2016-01-01

    We used structural equation modeling (SEM) and Actor-Partner Interdependence Models (APIM) to test dyadic associations between adult attachment and changes in relationship commitment at the transition to parenthood in a sample of 182 dual-earner couples. Overall, more avoidant individuals experienced significant changes in commitment at the transition to parenthood; specifically higher avoidance was associated with decreases in personal confidence and dedication. More anxious fathers experienced increases in personal felt constraint while anxious mothers’ commitment remained stable. Partners of more anxious individuals experienced changes in commitment at the transition to parenthood. Higher anxiety was associated with decreases in partners’ confidence and dedication and increases in partners’ felt constraint. These results suggest that interventions focused on couple relationships at the transition to parenthood should address commitment as well as relationship skills and explore how adult attachment may influence the parents’ reactions to stress during this disruptive transition. Future research should examine whether commitment levels recover once the initial stress of the transition to parenthood decreases and family roles and routines renegotiated. PMID:26168264

  15. Adult Attitudes about School Counselor Role.

    ERIC Educational Resources Information Center

    Yockey, Karen S.

    In a time of financial difficulties for schools, few counselors use accountability practices--practices which are necessary in order to justify the expense of school counseling and guidance programs. This descriptive study examines opinions of adults about school counselors. Following a review of literature concerning the role of the counselor, a…

  16. Demonstration of the role of turbulence-driven poloidal flow generation in the L-H transition

    NASA Astrophysics Data System (ADS)

    Yu, C. X.; Xu, Y. H.; Luo, J. R.; Mao, J. S.; Liu, B. H.; Li, J. G.; Wan, B. N.; Wan, Y. X.

    2000-05-01

    This paper presents the evidence for the role of turbulence-driven poloidal flow generation in the L-H transition induced by a turbulent heating pulse on the HT-6M tokamak. It is found that the poloidal flow υθ plays a key role in developing the electric field Er and triggering the transition. The acceleration of υθ across the transition is clearly correlated with the enhancement of the Reynolds stress gradient.

  17. Current practices and experience of transition of young people on long term home parenteral nutrition (PN) to adult services - A perspective from specialist centres.

    PubMed

    Kyrana, E; Beath, S V; Gabe, S; Small, M; Hill, S

    2016-08-01

    There has been an estimated fivefold increase in the number of children receiving parenteral nutrition (PN) at home in the past 10 years with some children approaching the age when they should be referred to adult services whilst still on treatment. Models of care for moving young people onto adult providers of PN at home are not yet well developed, and transition is a potentially dangerous time for young people with complex health needs. A questionnaire to ascertain current experience and practices of transition in the context of home PN services was dispatched to 170 consultant gastroenterologists who were members of the British Association of Parenteral and Enteral Nutrition (BAPEN) and also to all 40 members of the Nutrition and IF working group of the British Society of Paediatric Gastroenterology and Nutrition (BSPGHAN). Anonymised returns were received from 12 adult and 18 paediatric centres. We estimate about 50% paediatric IF centres, and the three largest adult IF centres responded to the survey. We identified 14 young adults already transitioned and 43 currently in transition. The practices and processes of transition reported were highly variable. Time taken to achieve transition ranged from under 6 months up to 2 years. The most frequent concerns to be identified were confusion around care routines and psychological problems at the time of transition (in one third of respondents). We conclude that a transition pathway and service standards for adolescents on home PN should be developed, consideration should be given to checklists for practical aspects (e.g. pumps), key worker and psychology input to enhance emotional resilience of the young people and carers. Copyright © 2016. Published by Elsevier Ltd.

  18. Longitudinal Tobacco Use Transitions Among Adolescents and Young Adults: 2014-2016.

    PubMed

    Hair, Elizabeth C; Romberg, Alexa R; Niaura, Raymond; Abrams, David B; Bennett, Morgane A; Xiao, Haijun; Rath, Jessica M; Pitzer, Lindsay; Vallone, Donna

    2018-02-13

    Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for

  19. Transition Services for DHH Adolescents and Young Adults With Disabilities: Challenges and Theoretical Frameworks.

    PubMed

    Luft, Pamela

    2015-01-01

    Deaf and hard of hearing (DHH) adolescents and young adults with disabilities (DWD) are a highly diverse group who may also demonstrate a range of functional limitations. These present unique challenges to professional efforts to provide high-quality transition services. Despite these issues, a majority of this population has cognitive abilities within the typical range, and therefore, their transition expectations should be commensurately high in comparison to those of their DHH peers. Research-based transition practices offer a range of interventions, and although none have been validated with DHH or DWD students, several provide important foundational learning opportunities. Yet their implementation will require modifications with programming and expertise beyond what is available in most school districts. Use of a multilevel, ecological framework and person-centered planning offers systematic strategies for increasing access to transition resources and supports to address these unique needs and lead to successful adulthood.

  20. The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care.

    PubMed

    Alvarez, Renae; Ginsburg, Jacob; Grabowski, Jessica; Post, Sharon; Rosenberg, Walter

    2016-04-01

    The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components-care coordination, case management, and patient engagement-which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment's emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.

  1. Gender-role attitudes and behavior across the transition to parenthood.

    PubMed

    Katz-Wise, Sabra L; Priess, Heather A; Hyde, Janet S

    2010-01-01

    On the basis of social structural theory and identity theory, the current study examined changes in gender-role attitudes and behavior across the first-time transition to parenthood and following the birth of a second child for experienced mothers and fathers. Data were analyzed from the ongoing longitudinal Wisconsin Study of Families and Work. Gender-role attitudes, work and family identity salience, and division of household labor were measured for 205 first-time and 198 experienced mothers and fathers across 4 time points from 5 months pregnant to 12 months postpartum. Multilevel latent growth curve analysis was used to analyze the data. In general, parents became more traditional in their gender-role attitudes and behavior following the birth of a child, women changed more than men, and first-time parents changed more than experienced parents. Findings suggest that changes in gender-role attitudes and behavior following the birth of a child may be attributed to both the process of transitioning to parenthood for the first time and that of negotiating the demands of having a new baby in the family. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

  2. Transition from paediatric to adult care of adolescents living with HIV in sub-Saharan Africa: challenges, youth-friendly models, and outcomes

    PubMed Central

    Dahourou, Désiré Lucien; Gautier-Lafaye, Chloé; Teasdale, Chloe A.; Renner, Lorna; Yotebieng, Marcel; Desmonde, Sophie; Ayaya, Samuel; Davies, Mary-Ann; Leroy, Valériane

    2017-01-01

    Abstract Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition. Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with information on transition were eligible. Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older

  3. Fundamental Elements of Transition Program Design

    ERIC Educational Resources Information Center

    Karmelita, Courtney

    2017-01-01

    Adult learners require supports and services to help them successfully transition into taking on the demands and expectations of college students. Transition programs have grown in popularity as a means to aid adult learners as they transition to higher education. Unfortunately, previous research on adult learner participation in transition…

  4. Gender role attitudes across the transition to adolescent motherhood in Mexican-origin families.

    PubMed

    Toomey, Russell B; Updegraff, Kimberly A; Umaña-Taylor, Adriana J; Jahromi, Laudan B

    2015-06-01

    Using longitudinal data collected at four time points from 191 dyads of Mexican-origin adolescent first-time mothers and their mother figures, we examined changes in and socialization of traditional gender role attitudes across the transition to parenthood using latent growth curve modeling and actor-partner interdependence modeling. Longitudinal growth models indicated that, regardless of nativity status, adolescent mothers' and their foreign-born mother figures' gender role attitudes became more egalitarian across adolescents' transition to parenthood, spanning from the 3rd trimester of pregnancy to 36 months postpartum. Furthermore, actor-partner interdependence modeling suggested that adolescents' and their mother figures' gender role attitudes during adolescents' third trimester of pregnancy equally contributed to subsequent increases in one another's gender role attitudes at 10 months postpartum. Importantly, this reciprocal socialization process was not moderated by adolescent mothers' nor by their mother figures' nativity status. Findings suggest that it is important to understand the cultural and intergenerational family processes that contribute to the development of gender role attitudes during the transition to parenthood for adolescent mothers and their mother figures in Mexican-origin families. © 2015 Family Process Institute.

  5. Gender Role Attitudes Across the Transition To Adolescent Motherhood in Mexican-Origin Families

    PubMed Central

    Toomey, Russell B.; Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.; Jahromi, Laudan B.

    2015-01-01

    Using longitudinal data collected at four time points from 191 dyads of Mexican-origin adolescent first-time mothers and their mother figures, we examined changes in and socialization of traditional gender role attitudes across the transition to parenthood using latent growth curve modeling (LGC) modeling and actor-partner interdependence modeling (APIM). Person-centered analyses indicated that adolescent mothers’, regardless of nativity status, and their foreign-born mother figures’ gender role attitudes became more egalitarian across adolescents’ transition to parenthood, spanning form the 3rd trimester of pregnancy to 36 months postpartum. Further, variable-centered analyses suggested that adolescents’ and their mother figures’ gender role attitudes during adolescents’ third trimester of pregnancy equally contributed to subsequent increases in one another’s gender role attitudes at 10 months postpartum. Importantly, this reciprocal socialization process was not moderated by adolescent mothers’ nor by their mother’ figures’ nativity status. Findings suggest that it is important to understand the cultural and intergenerational family processes that contribute to the development of gender role attitudes during the transition to parenthood for adolescent mothers and their mother figures in Mexican-origin families. PMID:25615441

  6. Sexual orientation of trans adults is not linked to outcome of transition-related health care, but worth asking.

    PubMed

    Nieder, Timo O; Elaut, Els; Richards, Christina; Dekker, Arne

    2016-01-01

    Since the beginning of contemporary transition-related care at the outset of the 20th century, sexual orientation has ben considered to be closely connected with gender identity and the developmental trajectories of trans people. Specifically, health professionals have regarded the anticipated post-transitional heterosexual behaviour of trans adults as predictive of a good outcome of cross-sex hormones and gender-confirming surgeries. This article reviews the current literature according to the question of whether the sexual orientation of trans people is linked to outcome measures following transition-related interventions. A comprehensive review was undertaken using the Medline database, searching for empirical studies published between 2010 and 2015. Out of a total of 474 studies, only 10 studies reported a follow-up of trans adults and assessed sexual orientation in the study protocol at all. Sexual orientation was predominantly assessed as homosexual versus non-homosexual related to sex assigned at birth. Only one 1 of 10 follow-up studies found a significant association according to the outcome between groups differentiated by sexual orientation. Empirically there is no link between sexual orientation and outcome of transition-related health care for trans adults. In order to provide comprehensive health care, we recommend asking for sexual behaviours, attractions and identities, as well as for gender experiences and expressions; however, this knowledge should not drive, but simply inform, such comprehensive care.

  7. Role tuning between caregiver and care receiver during discharge transition: an illustration of role function mode in Roy's adaptation theory.

    PubMed

    Shyu, Y I

    2000-10-01

    The purpose of this study was to develop a conceptual framework to explain the interaction between the caregiver and the care receiver during the discharge transition. Data from face-to-face interviews with 12 care receivers and 16 caregivers were subjected to constant comparative analysis. Findings revealed that role tuning was the process used by caregivers and care receivers to achieve a harmonious pattern of caregiving and care receiving during the transition from hospital to home. This empirical finding can illustrate the concept of role function mode in the Roy adaptation theory and sensitize healthcare providers to the needs of the families during the discharge transition.

  8. Family Influences on Transition to the Adult Job Market.

    ERIC Educational Resources Information Center

    Lerman, Robert I.; Ooms, Theodora

    A study examined the interplay among the initial family context of noncollege-bound youth, their entry into the full-time adult labor force, and formation of their families. The social psychological literature suggested that parents and other family members played an important role in teaching youth about the value of work, provided them with many…

  9. The Military and the Transition to Adulthood

    ERIC Educational Resources Information Center

    Kelty, Ryan; Kleykamp, Meredith; Segal, David R.

    2010-01-01

    Ryan Kelty, Meredith Kleykamp, and David Segal examine the effect of military service on the transition to adulthood. They highlight changes since World War II in the role of the military in the lives of young adults, focusing especially on how the move from a conscription to an all-volunteer military has changed the way military service affects…

  10. Transition Services for DHH Adolescents and Young Adults with Disabilities: Challenges and Theoretical Frameworks

    ERIC Educational Resources Information Center

    Luft, Pamela

    2015-01-01

    Deaf and Hard of Hearing (DHH) adolescents and young adults with disabilities (DWD) are a highly diverse group who may also demonstrate a range of functional limitations. These present unique challenges to professional efforts to provide high-quality transition services. Despite these issues, a majority of this population has cognitive abilities…

  11. The Ticking of the Social Clock: Adults' Beliefs about the Timing of Transition Events.

    ERIC Educational Resources Information Center

    Peterson, Candida C.

    1996-01-01

    Two studies regarding beliefs about descriptive and prescriptive age norms for adults in developmental transitions were examined in a sample of 214 Australian university students ages 17 to 50. Discusses research methodology. The probable consequences for self-esteem, mental health, and life planning are discussed in the context of the research…

  12. The Effects of an Intensive Postsecondary Transition Program on College Readiness for Adult Learners

    ERIC Educational Resources Information Center

    Kallison, James M., Jr.

    2017-01-01

    Postsecondary transition programs have emerged to prepare adult learners to enter college with either limited or no remediation work needed in developmental education. This article examines the results of a pilot study, in which participants (ages 20 years and older who held GED® credentials or high school degrees) received accelerated instruction…

  13. Longitudinal Physical Activity Patterns Among Older Adults: A Latent Transition Analysis.

    PubMed

    Mooney, Stephen J; Joshi, Spruha; Cerdá, Magdalena; Kennedy, Gary J; Beard, John R; Rundle, Andrew G

    2018-05-14

    Most epidemiologic studies of physical activity measure either total energy expenditure or engagement in a single activity type, such as walking. These approaches may gloss over important nuances in activity patterns. We performed a latent transition analysis to identify patterns of activity types as well as neighborhood and individual determinants of changes in those activity patterns over two years in a cohort of 2,023 older adult residents of New York City, NY, surveyed between 2011 and 2013. We identified seven latent classes: 1) Mostly Inactive, 2) Walking, 3) Exercise, 4) Household Activities and Walking, 5) Household Activities and Exercise, 6) Gardening and Household Activities, and 7) Gardening, Household Activities, and Exercise. The majority of subjects retained the same activity patterns between waves (54% unchanged between waves 1 and 2, 66% unchanged between waves 2 and 3).Most latent class transitions were between classes distinguished only by one form of activity, and only neighborhood unemployment was consistently associated with changing between activity latent classes. Future latent transition analyses of physical activity would benefit from larger cohorts and longer follow-up periods to assess predictors of and long-term impacts of changes in activity patterns.

  14. Marriage Matters But How Much? Marital Centrality Among Young Adults.

    PubMed

    Willoughby, Brian J; Hall, Scott S; Goff, Saige

    2015-01-01

    Marriage, once a gateway to adulthood, is no longer as widely considered a requirement for achieving adult status. With declining marriage rates and delayed marital transitions, some have wondered whether current young adults have rejected the traditional notion of marriage. Utilizing a sample of 571 young adults, the present study explored how marital centrality (the expected importance to be placed on the marital role relative to other adult roles) functioned as a unique and previously unexplored marital belief among young adults. Results suggested that marriage remains an important role for many young adults. On average, young adults expected that marriage would be more important to their life than parenting, careers, or leisure activities. Marital centrality profiles were found to significantly differ based on both gender and religiosity. Marital centrality was also associated with various outcomes including binge-drinking and sexual activity. Specifically, the more central marriage was expected to be, the less young adults engaged in risk-taking or sexual behaviors.

  15. Sibling Relationships during the Transition to Adulthood

    PubMed Central

    Conger, Katherine Jewsbury; Little, Wendy M.

    2009-01-01

    Recent research has shed new light on individual development during the early adulthood years, yet few investigators have examined sibling relationships during this stage of life. These relationships undergo transformations as individuals enter adult roles and orient their lives towards friends and romantic partners and establish independence from parents and siblings. This review examines major life events and role transitions such as leaving home, completing school, obtaining employment, getting married, and having children that influence individuals and their sibling relationships. In addition, the review considers how sibling relationships may affect individuals during the transition to adulthood, and considers the context of family and culture. The article concludes with suggestions for future research on sibling relationships during early adulthood and beyond. PMID:20700389

  16. Providers' assessment of transition readiness among adolescent and young adult kidney transplant recipients.

    PubMed

    Marchak, Jordan Gilleland; Reed-Knight, Bonney; Amaral, Sandra; Mee, Laura; Blount, Ronald L

    2015-12-01

    The Readiness for Transition Questionnaire- provider version (RTQ-Provider) was developed to evaluate adolescent patients' transition readiness and healthcare behaviors from the perspective of the healthcare provider. The RTQ-Provider is a parallel version of the RTQ-Teen and RTQ-Parent completed by patients and parents. This study seeks to evaluate the psychometric properties of the RTQ-Provider and its utility as a clinical transition planning tool. Participants consisted of 49 kidney transplant recipients between the ages of 15 and 21. The RTQ-Provider was completed by the pediatric nephrologist and psychologist from the multidisciplinary healthcare team and compared to RTQ data from teens and parents. The RTQ-Provider demonstrated good-to-excellent internal consistency and interrater reliability. Construct validity was supported through significant predictive relationships between providers' perceptions of transition readiness and older patient age, increased patient healthcare responsibility, and decreased parent involvement in health care. By providing parallel teen, parent, and provider forms, the RTQ has the potential to foster open communication between patients, families, and healthcare team members regarding transition readiness. The study provides initial support for the RTQ-Provider as a clinical tool to assess providers' perceptions of transition readiness; however, future longitudinal research is needed to evaluate predictive validity following patients' transfer to adult care. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Demand for CT scans increases during transition from paediatric to adult care: an observational study from 2009 to 2015.

    PubMed

    Thurley, Pete; Crookdake, Jonathan; Norwood, Mark; Sturrock, Nigel; Fogarty, Andrew W

    2018-02-01

    Avoiding unnecessary radiation exposure is a clinical priority in children and young adults. We aimed to explore demand for CT scans in a busy general hospital with particular interest in the period of transition from paediatric to adult medical care. We used an observational epidemiological study based in a teaching hospital. Data were obtained on numbers and rates of CT scans from 2009 to 2015. The main outcome was age-stratified rates of receiving a CT scan. There were a total of 262,221 CT scans. There was a large step change in the rate of CT scans over the period of transition from paediatric to adult medical care. Individuals aged 10-15 years experienced 6.7 CT scans per 1000 clinical episodes, while those aged 19-24 years experienced 19.8 CT scans per 1000 clinical episodes (p < 0.001). This difference remained significant for all sensitivity analyses. There is almost a threefold increase in rates of CT scans in the two populations before and after the period of transition from paediatric to adult medical care. While we were unable to adjust for case mix or quantify radiation exposure, paediatricians' diagnostic strategies to minimize radiation exposure may have clinical relevance for adult physicians, and hence enable reductions in ionizing radiation to patients. Advances in knowledge: A large increase in rates of CT scans occurs during adolescence, and considering paediatricians' strategies to minimize radiation exposure may enable reductions to all patients.

  18. Establishing a School-Based Mentoring Program for Youth Who Are Transitioning from a Secure Facility

    ERIC Educational Resources Information Center

    Waller, Katherine S.; Houchins, David E.; Nomvete, Patsy Thomas

    2010-01-01

    Youth with disabilities face many obstacles when transitioning from a juvenile detention facility back to school. A school-based mentoring program provides formerly incarcerated youth with support and encouragement from a caring, responsible adult. Youth with positive role models such as a mentor are more likely to successfully transition back to…

  19. Perspective of Family Members of Transitions to Alternative Levels of Care in Anglo-Saxon Countries.

    PubMed

    Merla, C; Wickson-Griffiths, A; Kaasalainen, S; Dal Bello-Haas, V; Banfield, L; Hadjistavropoulos, T; Di Sante, E

    2018-01-01

    This scoping review explores circumstances surrounding the decision about, and eventual experience of, transitioning older adults into alternative levels of housing (ALH), such as long-term care. This topic is examined from a family member perspective, given their exposure and involvement in the care of older adult relatives during this transitional period. The scoping review methodology is based on the framework of Arksey and O'Malley and subsequent recommendations from Levac, Colquhoun, and O'Brien. Approximately 470 articles were reviewed covering the period between 2000 and November 2014; 37 articles met inclusion criteria. A temporal organization of themes was used to describe the experiences of family members in the pretransition, active transition, and posttransition periods of moving older adult relatives into ALH. This paper highlights the transitional period as a time of crisis, with a lack of planning, support, and transparent discussion. This study identifies a need for future research on the potential benefits of family support groups, interim transitional housing options, different models of ALH, changing roles in the posttransition period, and the need for a comprehensive list of housing options for older adults. Results have the potential to inform policy/practice and improve the lives of older adults and their family.

  20. The Roles and Needs of Families of Adolescents with ASD

    ERIC Educational Resources Information Center

    Smith, Leann E.; Anderson, Kristy A.

    2014-01-01

    The transition of a student out of high school and into the adult world can be a stressful time for many families of high school students. This major life transition can be particularly challenging for students with autism spectrum disorder (ASD) and their families. In this article, we first discuss the roles of families in the transition process…

  1. The Roles and Needs of Families of Adolescents with ASD

    ERIC Educational Resources Information Center

    Smith, Leanne E.; Anderson, Kristy A.

    2014-01-01

    The transition of a student out of high school and into the adult world can be a stressful time for many families of high school students. This major life transition can be particularly challenging for students with autism spectrum disorder (ASD)and their families. In this article, we first discuss the roles of families in the transition process…

  2. Transition of Youth and Young Adults with Emotional or Behavioral Difficulties: An Evidence-Supported Handbook

    ERIC Educational Resources Information Center

    Clark, Hewitt B., Ed.; Unruh, Deanne K., Ed.

    2009-01-01

    This comprehensive professional handbook will help transition specialists, general and special educators, school psychologists, and administrators support youth and young adults in setting goals and achieving positive outcomes across employment, education, and community settings. Through up-to-date research and in-depth analyses of five successful…

  3. Barriers to Transition-related Healthcare among Korean Transgender Adults: Focused on Gender Identity Disorder Diagnosis, Hormone Therapy, and Sex Reassignment Surgery.

    PubMed

    Lee, Hyemin; Park, Jooyoung; Choi, Bokyoung; Yi, Horim; Kim, Seung-Sup

    2018-02-27

    Previous literature has documented that transgender people may encounter barriers when they use transition-related healthcare services. This study aims to investigate the experiences of transition-related healthcare and the barriers to those services among transgender adults in South Korea. In 2017, we conducted a nationwide cross-sectional survey of 278 transgender adults in South Korea. We assessed the prevalence of transition-related healthcare such as Gender Identity Disorder (GID) diagnosis, hormone therapy, and sex reassignment surgery. To understand the barriers to those procedures, we asked the participants for their reason not to receive each of the three procedures. We also examined their experiences of and reasons for using non-prescribed hormone medication. We found that 91.0% have been diagnosed with GID (N=253/278), 88.0% have received hormone therapy (N=243/276), and 42.4% had any type of sex reassignment surgery (N=115/271). Cost was the most common barrier to transition-related healthcare among the Korean transgender adults. Other common barriers were identified: Negative experiences in healthcare settings, lack of healthcare professionals and facilities, and social stigma against transgender people. Among those who have taken hormone therapy, 25.1% (N=61/243) reported that they had experience of purchasing hormone medication without medical prescription. Our findings suggest that transgender people face barriers to transition-related healthcare in South Korea. These barriers may preclude transgender individuals from safely accessing to transition-related healthcare. Improving access to transition-related healthcare requires institutional interventions including expanding national health insurance coverage on those procedures and providing transition-related training programs for healthcare professionals in South Korea.

  4. The role and significance of nurses in managing transitions to palliative care: a qualitative study

    PubMed Central

    Kirby, Emma; Broom, Alex; Good, Phillip

    2014-01-01

    Objectives Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses’ accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions. Design Qualitative study using semistructured interviews. Setting Two health services with public as well as private clinical environments in a major metropolitan area of Australia. Participants Hospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care. Results Four significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses’ informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time. Conclusions The results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patient-centred timely transitions. Further research focused on the experiences of doctors, allied health

  5. The Role of Spirituality in Transition to Parenthood: Qualitative Research Using Transformative Learning Theory.

    PubMed

    Klobučar, Nataša Rijavec

    2016-08-01

    This article presents results of a qualitative study of 12 adult couples making transition to parenthood. The aim of the study was to research the meaning of transition to parenthood through the lens of transformative learning theory. Transformative learning theory explains learning through meaning-making of that life experience. In this paper, the spiritual dimension of learning is emphasized. An important part of research methodology included biographical method, using semi-structured interviews before and after the birth of the first child. The research showed that transformative learning occurs in different spheres of life during transition to parenthood. This paper discusses the spiritual dimension of learning, meaning-making and presents results of the research.

  6. A Key to Evaluation: The Transition Competence Battery for Deaf Adolescents and Young Adults

    ERIC Educational Resources Information Center

    Davis, Cheryl; Leonard, Annette

    2007-01-01

    Guiding deaf and hard of hearing students in making important decisions about their adult careers can be a difficult task. Twenty years after its inception, the TCB, as adapted for deaf and hard of hearing students, may help. The TCB is a unique assessment tool designed to measure the transition skills of deaf high school adolescents and young…

  7. Challenges of intra-institutional transfer of care from paediatric to adult congenital cardiology: the need for retention as well as transition.

    PubMed

    Bohun, Claudine M; Woods, Patricia; Winter, Christiane; Mitchell, Julie; McLarry, Joel; Weiss, Joseph; Broberg, Craig S

    2016-02-01

    Transferring patients with CHD from paediatric to adult care has been challenging, especially across institutions. Within a single institution, some issues such as provider interaction, information exchange, or administrative directives should not play a significant role, and should favour successful transfer. We studied patients who were eligible for transfer to the adult congenital heart disease service within our institution in order to identify factors associated with successful transfer to adult care providers versus failure to transfer. Patients above18 years of age with CHD who were seen by paediatric cardiologists before January, 2008 were identified through a patient-care database. Records were reviewed to determine follow-up between 2008 and 2011 and to determine whether the patient was seen in the adult congenital cardiology clinic, paediatric cardiology clinic, or had no follow-up, and statistical comparisons were made between groups. After reviewing 916 records, 229 patients were considered eligible for transition to adult congenital cardiology. Of these, 77 (34%) were transferred successfully to adult congenital cardiology, 47 (21%) continued to be seen by paediatric cardiologists, and 105 (46%) were lost to follow-up. Those who transferred successfully differed with regard to complexity of diagnosis, insurance, and whether a formal referral was made by a paediatric care provider. Only a small fraction of the patients who were lost to follow-up could be contacted. Within a single institution, with shared information systems, administrations, and care providers, successful transfer from paediatric to adult congenital cardiology was still poor. Efforts for successful retention are just as vital as those for transfer.

  8. Roles of Engineering Correlations in Hypersonic Entry Boundary Layer Transition Prediction

    NASA Technical Reports Server (NTRS)

    Campbell, Charles H.; King, Rudolph A.; Kergerise, Michael A.; Berry, Scott A.; Horvath, Thomas J.

    2010-01-01

    Efforts to design and operate hypersonic entry vehicles are constrained by many considerations that involve all aspects of an entry vehicle system. One of the more significant physical phenomenon that affect entry trajectory and thermal protection system design is the occurrence of boundary layer transition from a laminar to turbulent state. During the Space Shuttle Return To Flight activity following the loss of Columbia and her crew of seven, NASA's entry aerothermodynamics community implemented an engineering correlation based framework for the prediction of boundary layer transition on the Orbiter. The methodology for this implementation relies upon the framework of correlation techniques that have been in use for several decades. What makes the Orbiter boundary layer transition correlation implementation unique is that a statistically significant data set was acquired in multiple ground test facilities, flight data exists to assist in establishing a better correlation and the framework was founded upon state of the art chemical nonequilibrium Navier Stokes flow field simulations. The basic tenets that guided the formulation and implementation of the Orbiter Return To Flight boundary layer transition prediction capability will be reviewed as a recommended format for future empirical correlation efforts. The validity of this approach has since been demonstrated by very favorable comparison of recent entry flight testing performed with the Orbiter Discovery, which will be graphically summarized. These flight data can provide a means to validate discrete protuberance engineering correlation approaches as well as high fidelity prediction methods to higher confidence. The results of these Orbiter engineering and flight test activities only serve to reinforce the essential role that engineering correlations currently exercise in the design and operation of entry vehicles. The framework of information-related to the Orbiter empirical boundary layer transition

  9. Involving Older Adults as Co-Researchers in Social Work Education

    ERIC Educational Resources Information Center

    Gutman, Carolyn; Hantman, Shira; Ben-Oz, Miriam; Criden, Wendy; Anghel, Roxana; Ramon, Shula

    2014-01-01

    This article examines the contribution of older adults as co-researchers to the evaluation of a gerontological social work course. The evaluation was conducted at an Israeli college as part of a collaborative project with a United Kingdom university. Here, we follow the older adults who are service users through their transition to the role of…

  10. Fathers of Adults Who Have a Learning Disability: Roles, Needs and Concerns

    ERIC Educational Resources Information Center

    Davys, Deborah; Mitchell, Duncan; Martin, Rachel

    2017-01-01

    Background: There is little research that specifically relates to fathers of adults with a learning disability despite the social expectation that fathers will provide a supportive role over the lifespan. Methods: Semi-structured interviews were carried out with seven fathers of adults with a learning disability to explore their roles, needs and…

  11. Students with Reading and Writing Challenges: Using Informal Assessment to Assist in Planning for the Transition to Adult Life

    ERIC Educational Resources Information Center

    Sitlington, Patricia L.

    2008-01-01

    The transition to adult life for students with reading and writing challenges is an area that is not often addressed. The purpose of this article is to relate the informal assessment process to the broader context of high stakes assessment, high school exit exams, diploma options, and transition planning; identify the competencies needed for a…

  12. LIFE COURSE TRANSITIONS IN EARLY ADULTHOOD AND SES DISPARITIES IN TOBACCO USE

    PubMed Central

    Pampel, Fred C.; Mollborn, Stefanie; Lawrence, Elizabeth M.

    2013-01-01

    A huge literature has documented adult socioeconomic disparities in smoking but says less about how these disparities emerge over the life course. Building on findings that smoking among adolescents differs only modestly by parental SES, we utilize a life course perspective on social differentiation to help explain the widening disparities in smoking in young adulthood. Our theory suggests that achieved socioeconomic status and the nature and timing of adult role transitions affect age-based trajectories of smoking and widen disparities in adult smoking. The analyses use data from the National Longitudinal Study of Adolescent Health, which follows a representative national sample over four waves from ages 11–17 in 1994/95 to 26–34 in 2007/08. The results show divergent age trajectories in smoking by parental education and that achieved socioeconomic status and life course roles in young adulthood account in good part for differences in the age trajectories. The findings demonstrate the value of the life course perspective in understanding processes of increasing stratification in health behavior and health during the transition to adulthood. PMID:24267752

  13. The roles of users in shaping transitions to new energy systems

    NASA Astrophysics Data System (ADS)

    Schot, Johan; Kanger, Laur; Verbong, Geert

    2016-05-01

    Current government information policies and market-based instruments aimed at influencing the energy choices of consumers often ignore the fact that consumer behaviour is not fully reducible to individuals making rational conscious decisions all the time. The decisions of consumers are largely configured by shared routines embedded in socio-technical systems. To achieve a transition towards a decarbonized and energy-efficient system, an approach that goes beyond individual consumer choice and puts shared routines and system change at its centre is needed. Here, adopting a transitions perspective, we argue that consumers should be reconceptualized as users who are important stakeholders in the innovation process shaping new routines and enacting system change. We review the role of users in shifts to new decarbonized and energy-efficient systems and provide a typology of user roles.

  14. Tree Changes or Wholesale Changes: The Role of Adult Education in Transitions in Regional Life

    ERIC Educational Resources Information Center

    Townsend, Robert; Delves, Melinda

    2009-01-01

    Regional adult education and training providers have been required in recent decades to adapt to funding structures rather than engage with their local communities. This has meant providing education programs that are funded based on national or State and Territory based policy frameworks, often linked to human capital development. Adult education…

  15. Experiences and Outcomes of Transition from Pediatric to Adult Health Care Services for Young People with Congenital Heart Disease: A Systematic Review.

    PubMed

    Heery, Emily; Sheehan, Aisling M; While, Alison E; Coyne, Imelda

    2015-01-01

    This review synthesizes the empirical literature on outcomes and experiences of transfer and transition from pediatric to adult care for young people with congenital heart disease. A systematic review of papers published between January 2001 and May 2013 that examined outcomes or experiences of transfer and transition among young people with congenital heart disease was conducted. Data were extracted by two independent reviewers with the outcomes data combined using narrative synthesis and the experiences data integrated using thematic synthesis. Thirteen papers were included in the review: six reported outcomes following transfer, six reported experiences of transfer and transition, and one reported both outcomes and experiences. The review data indicate that high proportions of young people were lost to follow-up or experienced long gaps in care after leaving pediatric cardiology. Factors that protected against loss to follow-up or lapse in care included: beliefs that specialized adult care was necessary; poorer health status; attendance at pediatric appointments without parents; and pediatric referral to an adult congenital heart disease center. Data on experiences highlighted that many young people were unconcerned about transition, but lacked knowledge about their condition and were insufficiently prepared for transfer. In terms of adult services, many young people desired continuity in the quality of care, youth-oriented facilities, a personalized approach, and for their parents to remain involved in their care, but in a secondary, supportive capacity. In conclusion, the high proportions of young people lost to follow-up highlight the need for formal transition programs, which ensure a planned and coordinated transfer. Patients with congenital heart disease need education throughout adolescence about the implications of their condition, the differences between pediatric and adult services, and self-care management. © 2015 Wiley Periodicals, Inc.

  16. [Clinical benefits after soluble dietary fiber supplementation: a randomized clinical trial in adults with slow-transit constipation].

    PubMed

    Xu, Lin; Yu, Wenkui; Jiang, Jun; Li, Ning

    2014-12-30

    To explore the effect of pectin, a kind of soluble dietary fiber, on colonic transit time (CTT), clinical symptoms and gut microbiota in adults with slow-transit constipation. A total of 80 patients with slow-transit constipation were selected between June 2011 and December 2013. For this randomized controlled trial, we evaluated the efficacy of pectin on intestinal transit time and other indices of constipation in adults with slow-transit constipation. They were randomized to receive either pectin or placebo. Treatment consisted of 4-week supplementation with 24 g/d pectin (fiber group) or maltodextrin (placebo group). Before and after 4-week treatment, CTT, constipation symptoms and fecal bacterial population were compared between groups. CTT of the fiber group after treatment was lower than those of fiber group before treatment and those in the placebo group ((60.2 ± 11.2) h vs (80.3 ± 9.5), (79.4 ± 11.7) h, P < 0.01). Constipation score of the fiber group after treatment also decreased than those of fiber group before treatment and those in the placebo group (both P < 0.05). Bifidobacterium sp. and Lactobacillus sp. evidently increased (lg copies/g:8.26 ± 0.83 vs 6.42 ± 1.07 and 6.48 ± 0.82, 6.83 ± 0.77 vs 5.85 ± 0.64 and 5.91 ± 0.73; all P < 0.05) and total Clostridium sp. significantly decreased (9.07 ± 0.63 vs 9.74 ± 0.81 and 9.66 ± 0.43, P < 0.05) in the fiber group after treatment versus the placebo group. No significant adverse effects were reported. Four-week soluble dietary fiber use accelerates colon transit time and alleviates clinical symptoms in patients with slow-transit constipation. Additionally, supplementary fiber offers protective effects on gut microbiota by increasing the population of healthy microflora.

  17. Developmental change in the function of movement systems: transition of the pectoral fins between respiratory and locomotor roles in zebrafish.

    PubMed

    Hale, Melina E

    2014-07-01

    An animal may experience strikingly different functional demands on its body's systems through development. One way of meeting those demands is with temporary, stage-specific adaptations. This strategy requires the animal to develop appropriate morphological states or physiological pathways that address transient functional demands as well as processes that transition morphology, physiology, and function to that of the mature form. Recent research on ray-finned (actinopterygian) fishes is a developmental transition in function of the pectoral fin, thereby providing an opportunity to examine how an organism copes with changes in the roles of its morphology between stages of its life history. As larvae, zebrafish alternate their pectoral fins in coordination with the body axis during slow swimming. The movements of their fins do not appear to contribute to the production of thrust or to stability but instead exchange fluid near the body for cutaneous respiration. The morphology of the larval fin includes a simple stage-specific endoskeletal disc overlaid by fan-shaped adductor and abductor muscles. In contrast, the musculoskeletal system of the mature fin consists of a suite of muscles and bones. Fins are extended laterally during slow swimming of the adult, without the distinct, high-amplitude left-right fin alternation of the larval fin. The morphological and functional transition of the pectoral fin occurs through juvenile development. Early in this period, at about 3 weeks post-fertilization, the gills take over respiratory function, presumably freeing the fins for other roles. Kinematic data suggest that the loss of respiratory function does not lead to a rapid switch in patterns of fin movement but rather that both morphology and movement transition gradually through the juvenile stage of development. Studies relating structure to function often focus on stable systems that are arguably well adapted for the roles they play. Examining how animals navigate

  18. Contriving Transitive Conditioned Establishing Operations to Establish Derived Manding Skills in Adults with Severe Developmental Disabilities

    ERIC Educational Resources Information Center

    Rosales, Rocio; Rehfeldt, Ruth Anne

    2007-01-01

    The purpose of this study was to demonstrate derived manding skills in 2 adults with severe developmental disabilities and language deficits by contriving transitive conditioned establishing operations. Specifically, we evaluated whether a history of reinforced conditional discrimination learning would ultimately result in a derived mand…

  19. National Field Testing of the "Mini" Version of the Transition Competence Battery for Adolescents and Young Adults Who Are Deaf.

    ERIC Educational Resources Information Center

    Bullis, Michael; Reiman, John W.; Davis, Cheryl; Reid, Chris

    1997-01-01

    A study involving 593 students (ages 15-29) with deafness investigated the validity of a shortened version of the Transition Competence Battery for Deaf Adolescents and Young Adults (TCB). Overall results suggest that the "Mini" TCB is a viable assessment tool that can be used in transition assessment. (Author/CR)

  20. Urban adolescents with intellectual disability and challenging behaviour: costs and characteristics during transition to adult services.

    PubMed

    Barron, Diana A; Molosankwe, Iris; Romeo, Renee; Hassiotis, Angela

    2013-05-01

    Young persons with intellectual disabilities and challenging behaviour in transition usually have complex needs, which may not be served well within existing resources. In this article, we present a survey of all the young people, between 16 and 18 years of age with intellectual disabilities and challenging behaviour identified in one inner London borough. They were in transition to adult services at the time of the study (between 2006 and 2008). The objective was to examine their socio-demographic and clinical characteristics, pattern of service use and associated costs of care. An assessment toolkit was devised to measure the mental and physical health, challenging behaviour and service use of the sample. Instruments within the toolkit included the Strengths and Difficulties Questionnaire, challenging behaviour scale, Client Service Receipt Inventory (CSRI) and socio-demographic data form. Twenty-seven individuals in transition to adult services had challenging behaviour, 23 of whom had mental health diagnoses and 18 of whom had physical diagnoses. Severity of challenging behaviour did not correlate with cost of care. Informal care accounted for the highest proportion of the total cost of care (66%) with education being the second largest contributor at 22%. Evidence on transition outcomes for young people with complex needs and intellectual disabilities and associated costs is lacking. This article illustrates some of the relevant issues in this area. Further research is required to investigate these aspects and guide commissioning of appropriate services. © 2013 Blackwell Publishing Ltd.

  1. Effectiveness of Transitional and Follow-Up Programmes to Community Integration of Young Adults with Intellectual Disabilities (YAWID) in Kiambu County, Kenya

    ERIC Educational Resources Information Center

    Makanya, Margaret W.; Runo, Mary; Wawire, Violet

    2014-01-01

    The purpose of this study was to investigate how vocational education and transitional services offered in vocational institutions helped young adults with intellectual disabilities (YAWID) attain full community integration. The study objectives included investigate the effectiveness of transitional services and follow-up programs towards aiding…

  2. Development and Content Validation of the Transition Readiness Inventory Item Pool for Adolescent and Young Adult Survivors of Childhood Cancer.

    PubMed

    Schwartz, Lisa A; Hamilton, Jessica L; Brumley, Lauren D; Barakat, Lamia P; Deatrick, Janet A; Szalda, Dava E; Bevans, Katherine B; Tucker, Carole A; Daniel, Lauren C; Butler, Eliana; Kazak, Anne E; Hobbie, Wendy L; Ginsberg, Jill P; Psihogios, Alexandra M; Ver Hoeve, Elizabeth; Tuchman, Lisa K

    2017-10-01

    The development of the Transition Readiness Inventory (TRI) item pool for adolescent and young adult childhood cancer survivors is described, aiming to both advance transition research and provide an example of the application of NIH Patient Reported Outcomes Information System methods. Using rigorous measurement development methods including mixed methods, patient and parent versions of the TRI item pool were created based on the Social-ecological Model of Adolescent and young adult Readiness for Transition (SMART). Each stage informed development and refinement of the item pool. Content validity ratings and cognitive interviews resulted in 81 content valid items for the patient version and 85 items for the parent version. TRI represents the first multi-informant, rigorously developed transition readiness item pool that comprehensively measures the social-ecological components of transition readiness. Discussion includes clinical implications, the application of TRI and the methods to develop the item pool to other populations, and next steps for further validation and refinement. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care.

    PubMed

    Rutishauser, Christoph; Sawyer, Susan M; Ambresin, Anne-Emmanuelle

    2014-08-01

    The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.

  4. The Lived Experiences of Nurses Transitioning to a Preceptor Role

    ERIC Educational Resources Information Center

    Miller, Janice Ampil

    2013-01-01

    This study explores the lived experiences of nurses who have transitioned to a nurse preceptor role and provides examples of how individuals learn in the workplace. Historically, nurses who agreed to become preceptors were chosen based on their availability and experience, not necessarily their teaching and learning abilities. Nursing research has…

  5. The impact of transitional care programs on health services utilization in community-dwelling older adults: a systematic review.

    PubMed

    Weeks, Lori E; Macdonald, Marilyn; Martin-Misener, Ruth; Helwig, Melissa; Bishop, Andrea; Iduye, Damilola F; Moody, Elaine

    2018-02-01

    The objective was to identify and synthesize the best available evidence on the impact of transitional care programs on various forms of health services utilization in community-dwelling older adults. There is growing evidence that transitional care programs can help address important challenges facing health care systems and our increasing older adult population in many countries by reducing unnecessary health service utilization. There is a need for a systematic review of the research evaluating the impact of transitional care programs on hospital and other health service usage. The review included studies on community-dwelling adults age 60 and over with at least one medical diagnosis, and which evaluated the outcomes of transitional care programs on health system utilization of older adults. The outcomes for this review were hospital usage including admissions and readmissions, emergency department usage, primary care/physician usage, nursing home usage, and home health care usage. The review considered experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, and case-control studies. A three-step search was utilized to find published and unpublished studies conducted in any country but reported in English. Six electronic databases were searched from inception of the database to May, 2016. A search for unpublished studies was also conducted. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research synthesis. Quantitative data were extracted from included studies independently by the two reviewers using the standardized Joanna Briggs Institute data extraction tools. Due to the methodological heterogeneity of the included studies, a comprehensive meta-analysis for all outcomes was not possible

  6. Worries and needs of adults and parents of adults with neurofibromatosis type 1.

    PubMed

    Rietman, Andre B; van Helden, Hanneke; Both, Pauline H; Taal, Walter; Legerstee, Jeroen S; van Staa, AnneLoes; Moll, Henriette A; Oostenbrink, Rianne; van Eeghen, Agnies M

    2018-05-01

    Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder associated with lifelong tumor growth propensity and neurocognitive impairments. Although follow-up of adults with NF1 often focuses on tumor growth, follow-up of cognitive or social problems and other NF1-related comorbidity is often not a part of standardized care. In order to provide optimal care services for these patients, we explored the care needs of adults with NF1. A qualitative study was performed using semi-structured group interviews, exploring worries and care needs in medical, psychological, and socioeconomic domains, also focusing on the transition from pediatric to adult care. Four focus groups were conducted, including young adult patients, patients over age 30, and parents of young adult patients. In total, 30 patients and 12 parents participated. Data were transcribed verbatim and analyzed by computerized thematic analysis. Themes were organized using the World Health Organization International classification of functioning, disability, and health (ICF). Results indicated many and diverse worries and care needs both during the transitional period and in adulthood in medical, mental health, and socioeconomic domains. Worries could be categorized into 13 themes. Parents reported high stress levels and difficulties with their parental role. Participants expressed the need for more information, access to NF1 experts, daily living support, care for mental health and socioeconomic participation, and closer communication between health-care providers. In conclusion, worries and needs of patients and parents underline the importance of multidisciplinary follow-up and continuity of care during and after the transitional period. Additionally, parental stress requires more attention from care providers. © 2018 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.

  7. Transitive inference in adults with autism spectrum disorders

    PubMed Central

    Solomon, Marjorie; Frank, Michael J.; Smith, Anne C.; Ly, Stanford; Carter, Cameron S.

    2012-01-01

    Individuals with autism spectrum disorders (ASDs) exhibit intact rote learning with impaired generalization. A transitive inference paradigm, involving training on four sequentially presented stimulus pairs containing overlapping items, with subsequent testing on two novel pairs, was used to investigate this pattern of learning in 27 young adults with ASDs and 31 matched neurotypical individuals (TYPs). On the basis of findings about memory and neuropathology, we hypothesized that individuals with ASDs would use a relational flexibility/conjunctive strategy reliant on an intact hippocampus, versus an associative strength/value transfer strategy requiring intact interactions between the prefrontal cortex and the striatum. Hypotheses were largely confirmed. ASDs demonstrated reduced interference from intervening pairs in early training; only TYPs formed a serial position curve by test; and ASDs exhibited impairments on the novel test pair consisting of end items with intact performance on the inner test pair. However, comparable serial position curves formed for both groups by the end of the first block. PMID:21656344

  8. Parenting a child with chronic illness as they transition into adulthood: A systematic review and thematic synthesis of parents' experiences.

    PubMed

    Heath, Gemma; Farre, Albert; Shaw, Karen

    2017-01-01

    To understand how parents view and experience their role as their child with a long-term physical health condition transitions to adulthood and adult healthcare services. Five databases were systematically searched for qualitative articles examining parents' views and experiences of their child's healthcare transition. Papers were quality assessed and thematically synthesised. Thirty-two papers from six countries, spanning a 17-year period were included. Long-term conditions were diverse. Findings indicated that parents view their child's progression toward self-care as an incremental process which they seek to facilitate through up-skilling them in self-management practices. Parental perceptions of their child's readiness, wellness, competence and long-term condition impacted on the child' progression to healthcare autonomy. A lack of transitional healthcare and differences between paediatric and adult services served as barriers to effective transition. Parents were required to adjust their role, responsibilities and behaviour to support their child's growing independence. Parents can be key facilitators of their child's healthcare transition, supporting them to become experts in their own condition and care. To do so, they require clarification on their role and support from service providers. Interventions are needed which address the transitional care needs of parents as well as young people. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Transitional care in clinical networks for young people with juvenile idiopathic arthritis: current situation and challenges.

    PubMed

    Cruikshank, Mary; Foster, Helen E; Stewart, Jane; Davidson, Joyce E; Rapley, Tim

    2016-04-01

    Clinical networks for paediatric and adolescent rheumatology are evolving, and their effect and role in the transition process between paediatric and adult services are unknown. We therefore explored the experiences of those involved to try and understand this further. Health professionals, young people with juvenile idiopathic arthritis and their families were recruited via five national health service paediatric and adolescent rheumatology specialist centres and networks across the UK. Seventy participants took part in focus groups and one-to-one interviews. Data was analysed using coding, memoing and mapping techniques to identify features of transitional services across the sector. Variation and inequities in transitional care exist. Although transition services in networks are evolving, development has lagged behind other areas with network establishment focusing more on access to paediatric rheumatology multidisciplinary teams. Challenges include workforce shortfalls, differences in service priorities, standards and healthcare infrastructures, and managing the legacy of historic encounters. Providing equitable high-quality clinically effective services for transition across the UK has a long way to go. There is a call from within the sector for more protected time, staff and resources to develop transition roles and services, as well as streamlining of local referral pathways between paediatric and adult healthcare services. In addition, there is a need to support professionals in developing their understanding of transitional care in clinical networks, particularly around service design, organisational change and the interpersonal skills required for collaborative working. Key messages • Transitional care in clinical networks requires collaborative working and an effective interface with paediatric and adult rheumatology.• Professional centrism and historic encounters may affect collaborative relationships within clinical networks.• Education

  10. An exploratory study of future plans and extracurricular activities of transition-age youth and young adults.

    PubMed

    Betz, Cecily L; Redcay, Gay

    2005-01-01

    A descriptive profile of the health related concerns, school-related and extracurricular activities, employment-related activities, social relationships and future plans of 25 transition-aged youth and young adults (ages 14 to 21 years) were conducted. The findings of this exploratory study provide insight on the impact their chronic condition had upon all aspects of their lives. Sixty percent of respondents indicated they had missed school due to their condition and a third of the respondents had not completed high school. Health care professionals usually were not identified as participatory in youth transition planning. The majority of these transition-aged youth and young adults had positive feelings towards their school experience, although most of the respondents were not involved in school projects or clubs, which suggests their participation in school-related extra-curricular activities was limited. Nearly all of the respondents had some form of employment experience. Most of their work experiences were nonpaying jobs such as serving as a volunteer and participating in school-based employment training. Nearly all of the respondents expressed desires for sustainable employment and fiscal and social independence. Most of the respondents reported having social relationships with just less than half reporting seeing friends outside of school.

  11. Gender role models in fictional novels for emerging adult lesbians.

    PubMed

    Cook, Jennifer R; Rostosky, Sharon S; Riggle, Ellen D B

    2013-01-01

    Novels provide role models for young adult lesbians and thus may influence their identity development. This study focused on 16 lesbian protagonists identified in 11 young adult novels that received 2011 Lambda Literary Award nominations. Content analyses revealed six themes. Three themes defied traditional gender stereotypes: Asserting Oneself, Pursuing Intimacy with Another Woman, and Breaking Free of Constraints to Authentic Self-Expression. Three themes reinforced gender stereotypes: Negative Emotional Experiences Associated with Lesbian Identity, Traditional Masculine Gender Expression, and Traditional Gender Role-Based Sexual Scripts. Each theme is discussed in light of its possible contribution to lesbian identity development.

  12. Assessing disease disclosure in adults with cystic fibrosis: the Adult Data for Understanding Lifestyle and Transitions (ADULT) survey Disclosure of disease in adults with cystic fibrosis

    PubMed Central

    2010-01-01

    Background As more patients with cystic fibrosis (CF) reach adulthood and participate in age-appropriate activities (e.g. employment, dating), disclosure of medical status becomes more important. This study assessed rates of disclosure and its perceived impact on relationships using the Adult Data for Understanding Lifestyle and Transitions (ADULT) online survey. Methods Adults with CF participated in the survey via the United States national network of CF Centers. Descriptive and inferential statistics were utilized. Results Participants (n = 865) were more likely to disclose to relatives (94%) and close friends (81%) than to dating partners (73%), bosses/supervisors/teachers (51%) or co-workers (39%). Respondents generally reported a neutral/positive effect on relationships following disclosure. Negative effects of disclosure were infrequent, but more likely with dating partners or bosses/supervisors/teachers. Results also indicated that disclosure may be influenced by severity of lung disease and gender, with those having normal/mild lung disease less likely to disclose their diagnosis to both co-workers (p < 0.01) and bosses/supervisors/teachers (p < 0.01), and women being more likely to disclose to close friends (p < 0.0001) and dating partners (p < 0.05) than men. Conclusions Most adults with CF disclosed their disease to relatives and close friends. Individuals with severe CF lung disease were more likely to disclose their diagnosis to coworkers and supervisors/teachers. It may be helpful to provide support for disclosure of disease in situations such as employment and dating. PMID:20831811

  13. Assessing disease disclosure in adults with cystic fibrosis: the Adult Data for Understanding Lifestyle and Transitions (ADULT) survey Disclosure of disease in adults with cystic fibrosis.

    PubMed

    Modi, Avani C; Quittner, Alexandra L; Boyle, Michael P

    2010-09-10

    As more patients with cystic fibrosis (CF) reach adulthood and participate in age-appropriate activities (e.g. employment, dating), disclosure of medical status becomes more important. This study assessed rates of disclosure and its perceived impact on relationships using the Adult Data for Understanding Lifestyle and Transitions (ADULT) online survey. Adults with CF participated in the survey via the United States national network of CF Centers. Descriptive and inferential statistics were utilized. Participants (n = 865) were more likely to disclose to relatives (94%) and close friends (81%) than to dating partners (73%), bosses/supervisors/teachers (51%) or co-workers (39%). Respondents generally reported a neutral/positive effect on relationships following disclosure. Negative effects of disclosure were infrequent, but more likely with dating partners or bosses/supervisors/teachers. Results also indicated that disclosure may be influenced by severity of lung disease and gender, with those having normal/mild lung disease less likely to disclose their diagnosis to both co-workers (p < 0.01) and bosses/supervisors/teachers (p < 0.01), and women being more likely to disclose to close friends (p < 0.0001) and dating partners (p < 0.05) than men. Most adults with CF disclosed their disease to relatives and close friends. Individuals with severe CF lung disease were more likely to disclose their diagnosis to coworkers and supervisors/teachers. It may be helpful to provide support for disclosure of disease in situations such as employment and dating.

  14. Study protocol: longitudinal study of the transition of young people with complex health needs from child to adult health services

    PubMed Central

    2013-01-01

    Background Young people with complex health needs have impairments that can limit their ability to carry out day-to-day activities. As well as coping with other developmental transitions, these young people must negotiate the transfer of their clinical care from child to adult services. The process of transition may not be smooth and both health and social outcomes may suffer. Increasingly, policy-makers have recognised the need to ensure a smoother transition between children’s and adult services, with processes that are holistic, individualised, and person-centred; however, there is little outcome data to support proposed models of care. This study aims to identify the features of transitional care that are potentially effective and efficient for young people with complex health needs making their transition. Methods/Design Longitudinal cohort study. 450 young people aged 14 years to 18 years 11 months (with autism spectrum disorder and an additional mental health problem, cerebral palsy or diabetes) will be followed through their transition from child to adult services and will contribute data at baseline, 12, 24 and 36 months. We will collect data on: health and wellbeing outcomes (participation, quality of life, satisfaction with services, generic health status (EQ-5D-Y) and condition specific measure of disease control or management); exposure to proposed beneficial features of services (such as having a key worker, appropriate involvement of parents); socio-economic characteristics of the sample; use of condition-related health and personal social services; preferences for the characteristics of transitional care. We will us regression techniques to explore how outcomes vary by exposure to service features and by characteristics of the young people. These data will populate a decision-analytic model comparing the costs and benefits of potential alternative ways of organising transition services. In order to better understand mechanisms and aid

  15. Distinct Trajectories in the Transition to Adulthood: Are Children of Immigrants Advantaged?

    ERIC Educational Resources Information Center

    Hao, Lingxin; Woo, Han S.

    2012-01-01

    Studies on children of immigrants have generally ignored distinct developmental trajectories during adolescence and their role in the transition to adulthood. This study identifies distinct trajectories in cognitive, sociobehavioral, and psychological domains and estimates their consequences for young adults. Drawing data from a nationally…

  16. Development and Preliminary Psychometric Properties of the Transition Competence Battery for Deaf Adolescents and Young Adults.

    ERIC Educational Resources Information Center

    Bullis, Michael; Reiman, John

    1992-01-01

    The Transition Competence Battery for Deaf Adolescents and Young Adults (TCB) measures employment and independent living skills. The TCB was standardized on students (N from 180 to 230 for the different subtests) from both mainstreamed and residential settings. Item statistics and subtest reliabilities were adequate; evidence of construct validity…

  17. A Review of the Approaches Investigating the Post-16 Transition of Young Adults with Learning Difficulties

    ERIC Educational Resources Information Center

    Carroll, Catherine

    2015-01-01

    Investigations into the lives and transition from compulsory schooling of young adults with a disability, including a learning difficulty (LD), are increasing. The emerging consensus is one which points to this group of young people experiencing greater difficulties and poorer outcomes compared to the general population. How these investigations…

  18. Suicide in Older Adults: The Role of Emotions and Cognition

    PubMed Central

    Szanto, Katalin; Alexopoulos, George S.

    2014-01-01

    Suicide in older adults is a significant clinical concern. In this review of recent findings, we concentrate on the role of emotions and cognition in suicide risk and behavior in older adults. We discuss the epidemiology of suicide in older adults, integrate recent findings on non-psychotic major depression, schizophrenia and suicidal ideation, explore the relationship of emotion regulation with suicide, present recent advances on suicide in demented patients, and describe the latest developments on cognition and decision processes in suicide. PMID:25226883

  19. Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology.

    PubMed

    Tuomainen, H; Schulze, U; Warwick, J; Paul, M; Dieleman, G C; Franić, T; Madan, J; Maras, A; McNicholas, F; Purper-Ouakil, D; Santosh, P; Signorini, G; Street, C; Tremmery, S; Verhulst, F C; Wolke, D; Singh, S P

    2018-06-04

    Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

  20. The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services.

    PubMed

    Belling, Ruth; McLaren, Susan; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim; Hovish, Kimberly; Islam, Zoebia; White, Sarah; Singh, Swaran P

    2014-07-01

    To investigate the organisational factors that impede or facilitate transition of young people from child and adolescent (CAMHS) to adult mental health services (AMHS). Thirty-four semi-structured interviews were conducted with health and social care professionals working in child and adult services in four English NHS Mental Health Trusts and voluntary organisations. Data were analysed thematically using a structured framework. Findings revealed a lack of clarity on service availability and the operation of different eligibility criteria between child and adult mental health services, with variable service provision for young people with attention deficit hyperactivity disorder, autism spectrum disorders and learning disabilities. High workloads and staff shortages were perceived to influence service thresholds and eligibility criteria. A mutual lack of understanding of services and structures together with restrictive eligibility criteria exacerbated by perceived lack of resources can impact negatively on the transition between CAMHS and AMHS, disrupting continuity of care for young people. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. (Dis)-Trust in transitioning ventilator-dependent children from hospital to homecare.

    PubMed

    Manhas, Kiran Pohar; Mitchell, Ian

    2015-12-01

    Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear. To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children. We followed methods described by Franco Carnevale. We used a sociologically grounded theoretical orientation-trust-to re-interpret qualitative data for an ethical inquiry into a specific facet of that data. The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government. The Conjoint Health Research Ethics Board at the University of Calgary approved this study. First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities' allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural-urban, medical-family, and professional-personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition. The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their

  2. Gender-Role Attitudes and Behavior across the Transition to Parenthood

    ERIC Educational Resources Information Center

    Katz-Wise, Sabra L.; Priess, Heather A.; Hyde, Janet S.

    2010-01-01

    On the basis of social structural theory and identity theory, the current study examined changes in gender-role attitudes and behavior across the first-time transition to parenthood and following the birth of a second child for experienced mothers and fathers. Data were analyzed from the ongoing longitudinal Wisconsin Study of Families and Work.…

  3. Food security in older adults: community service provider perceptions of their roles.

    PubMed

    Keller, Heather H; Dwyer, John J M; Edwards, Vicki; Senson, Christine; Gayle Edward, H

    2007-01-01

    Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as "the need for personalization of service". Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

  4. Role Balance and Depression among College Students: The Moderating Influence of Adult Attachment Orientations

    ERIC Educational Resources Information Center

    Lopez, Frederick G.; Fons-Scheyd, Alia

    2008-01-01

    This study examined interrelationships among role balance perceptions, adult attachment orientations, and depression within an ethnically diverse, mixed-gender sample of college students. Adult attachment orientations--and particularly attachment avoidance--significantly interacted with students' role balance levels to predict their depression…

  5. The role of foreign direct investment in the nutrition transition.

    PubMed

    Hawkes, Corinna

    2005-06-01

    To examine the role of foreign direct investment (FDI) in the nutrition transition, focusing on highly processed foods. Data on FDI were identified from reports/databases and then compiled and analysed. A review of published literature on FDI into the food sector was conducted. The nutrition transition is a public health concern owing to its connection with the rising burden of obesity and diet-related chronic diseases in developing countries. Global health leaders are calling for action to address the threat. Highly processed foods often have considerable fat, sugar and salt content, and warrant closer examination. FDI into food processing, service and retail has risen rapidly since the 1980s, mainly from transnational food companies (TFCs) in developed countries. As FDI has risen, so has the proportion invested in highly processed foods for sale in the host market. FDI has proved more effective than trade in generating sales of highly processed foods, and enables TFCs to cut costs, gain market power and obtain efficiencies in distribution and marketing. The amount of FDI targeted at developing countries is increasing; while a disproportionate share enters the larger developing economies, foreign affiliates of TFCs are among the largest companies in low- and low- to middle-income countries. The effect of FDI is to make more highly processed foods available to more people. FDI has made it possible to lower prices, open up new purchasing channels, optimise the effectiveness of marketing and advertising, and increase sales. FDI has been a key mechanism in shaping the global market for highly processed foods. Notwithstanding the role of demand-side factors, it has played a role in the nutrition transition by enabling and promoting the consumption of these foods in developing countries. Empirical data on consumption patterns of highly processed foods in developing countries are critically needed, but since FDI is a long-term investment vehicle, it is reasonable to

  6. Transition from Pediatric to Adult Health Care for Youth with Disabilities and Chronic Illnesses. CYDLINE Reviews.

    ERIC Educational Resources Information Center

    Minnesota Univ., Minneapolis. National Center for Youth with Disabilities.

    The annotated bibliography is intended to give health care providers and planners background information and other resources on health transition issues for young adults with chronic health conditions. The 23 bibliographic citations date from 1972 to 1989 and are grouped into the following categories: U.S. demographics and health services…

  7. Preparing Adolescents With Chronic Disease for Transition to Adult Care: A Technology Program

    PubMed Central

    Terrones, Laura; Tompane, Trevor; Dillon, Lindsay; Pian, Mark; Gottschalk, Michael; Norman, Gregory J.; Bartholomew, L. Kay

    2014-01-01

    BACKGROUND: Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving. METHODS: Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time. RESULTS: MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls. CONCLUSIONS: Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD. PMID:24843066

  8. Preparing adolescents with chronic disease for transition to adult care: a technology program.

    PubMed

    Huang, Jeannie S; Terrones, Laura; Tompane, Trevor; Dillon, Lindsay; Pian, Mark; Gottschalk, Michael; Norman, Gregory J; Bartholomew, L Kay

    2014-06-01

    Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving. Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time. MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls. Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD. Copyright © 2014 by the American Academy of Pediatrics.

  9. Adult Roles & Functions. Objective Based Evaluation System.

    ERIC Educational Resources Information Center

    West Virginia State Vocational Curriculum Lab., Cedar Lakes.

    This book of objective-based test items is designed to be used with the Adult Roles and Functions curriculum for a non-laboratory home economic course for grades eleven and twelve. It contains item banks for each cognitive objective in the curriculum. In addition, there is a form for the table of specifications to be developed for each unit. This…

  10. Parent Expectations Mediate Outcomes for Young Adults with Autism Spectrum Disorder.

    PubMed

    Kirby, Anne V

    2016-05-01

    Understanding the complex relationships among factors that may predict the outcomes of young adults with autism spectrum disorder (ASD) is of utmost importance given the increasing population undergoing and anticipating the transition to adulthood. With a sample of youth with ASD (n = 1170) from the National Longitudinal Transition Study-2, structural equation modeling techniques were used to test parent expectations as a mediator of young adult outcomes (i.e., employment, residential independence, social participation) in a longitudinal analysis. The mediation hypothesis was confirmed; family background and functional performance variables significantly predicted parent expectations which significantly predicted outcomes. These findings add context to previous studies examining the role of parent expectations on young adult outcomes and inform directions for family-centered interventions and future research.

  11. A biopsychosocial model for the management of patients with sickle-cell disease transitioning to adult medical care.

    PubMed

    Crosby, Lori E; Quinn, Charles T; Kalinyak, Karen A

    2015-04-01

    The lifespan of patients with sickle-cell disease (SCD) continues to increase, and most affected individuals in high-resource countries now live into adulthood. This necessitates a successful transition from pediatric to adult health care. Care for transitioning patients with SCD often falls to primary care providers who may not be fully aware of the many challenges and issues faced by patients and the current management strategies for SCD. In this review, we aim to close the knowledge gap between primary care providers and specialists who treat transitioning patients with SCD. We describe the challenges and issues encountered by these patients, and we propose a biopsychosocial multidisciplinary approach to the management of the identified issues. Examples of this approach, such as transition-focused integrated care models and quality improvement collaboratives, with the potential to improve health outcomes in adulthood are also described.

  12. Transitions in Loneliness Among Older Adults: A 5-Year Follow-Up in the National Social Life, Health, and Aging Project.

    PubMed

    Hawkley, Louise C; Kocherginsky, Masha

    2018-04-01

    A substantial portion of the older adult population suffers from frequent feelings of loneliness, but a large proportion remains relatively unscathed by loneliness. To date, research examining both protective and risk factors for loneliness has not included data from the United States. The present study used the first two waves of data from the National Social Life, Health, and Aging Project to examine sociodemographic, structural, and functional factors thought to be associated with loneliness in older adults. Functional limitations and low family support were associated with an increase in loneliness frequency (as were more strained friendships) and with transitioning from nonlonely to lonely status. Better self-rated health, higher levels of socializing frequency, and lower family strain were associated with transitioning from lonely to nonlonely status. Interventions that target these factors may be effective in preventing and reducing loneliness and its effects on health and well-being in older adults.

  13. [Transition from pediatric to adult health care services for adolescents with chronic diseases: Recommendations from the Adolescent Branch from Sociedad Chilena de Pediatría].

    PubMed

    Zubarew, Tamara; Correa, Loreto; Bedregal, Paula; Besoain, Carolina; Reinoso, Alejandro; Velarde, Macarena; Valenzuela, María Teresa; Inostroza, Carolina

    2017-01-01

    The Adolescent Branch from Sociedad Chilena de Pediatría supports the implementation of planned programs for transition from child to adult health centers, oriented to adolescents with chronic diseases, in order to ensure an appropriate follow-up and a high-quality health care. Recommendations for care are set out in the FONIS and VRI PUC project carried out by the Division of Pediatrics of the Universidad Católica de Chile: “Transition process from pediatric to adult services: perspectives of adolescents with chronic diseases, caregivers and health professionals”, whose goal was to describe the experience, barriers, critical points, and facilitators in the transition process. Critical points detected in this study were: existence of a strong bond between adolescents, caregivers and the pediatric team, resistance to transition, difficulty developing autonomy and self-management among adolescents; invisibility of the process of adolescence; and lack of communication between pediatric and adult team during the transfer. According to these needs, barriers and critical points, and based on published international experiences, recommendations are made for implementation of gradual and planned transition processes, with emphasis on the design and implementation of transition policies, establishment of multidisciplinary teams and transition planning. We discuss aspects related to coordination of teams, transfer timing, self-care and autonomy, transition records, adolescent and family participation, need for emotional support, ethical aspects involved, importance of confidentiality, need for professional training, and the need for evaluation and further research on the subject.

  14. Two-Year Institution Part-Time Nurse Faculty Experiences During Role Transition and Identity Development: A Phenomenological Study.

    PubMed

    Owens, Rhoda A

    This study explored two-year institution part-time nurse faculty's perceptions of their experiences during their role transitions from nurses in clinical practice to part-time clinical instructors. Part-time nurse faculty enter academia as expert clinicians, but most have little or no training in the pedagogy of effective student learning. A phenomenological study was used to explore the faculty role transition experiences. Findings support the proposition that six participants transitioned from their expert clinician to instructor identities; however, two continue in the process. Critical to this process are relationships with individuals in their environments, past and present experiences, the incentive to learn to be better instructors, and the importance of support and training. A model emerged, Process of Role Transition and Professional Identity Formation for Part-Time Clinical Instructors at Two-Year Institutions, that is potentially useful for administrators in developing individualized orientation and professional development programs.

  15. Transitions during cephalopod life history: the role of habitat, environment, functional morphology and behaviour.

    PubMed

    Robin, Jean-Paul; Roberts, Michael; Zeidberg, Lou; Bloor, Isobel; Rodriguez, Almendra; Briceño, Felipe; Downey, Nicola; Mascaró, Maite; Navarro, Mike; Guerra, Angel; Hofmeister, Jennifer; Barcellos, Diogo D; Lourenço, Silvia A P; Roper, Clyde F E; Moltschaniwskyj, Natalie A; Green, Corey P; Mather, Jennifer

    2014-01-01

    Cephalopod life cycles generally share a set of stages that take place in different habitats and are adapted to specific, though variable, environmental conditions. Throughout the lifespan, individuals undertake a series of brief transitions from one stage to the next. Four transitions were identified: fertilisation of eggs to their release from the female (1), from eggs to paralarvae (2), from paralarvae to subadults (3) and from subadults to adults (4). An analysis of each transition identified that the changes can be radical (i.e. involving a range of morphological, physiological and behavioural phenomena and shifts in habitats) and critical (i.e. depending on environmental conditions essential for cohort survival). This analysis underlines that transitions from eggs to paralarvae (2) and from paralarvae to subadults (3) present major risk of mortality, while changes in the other transitions can have evolutionary significance. This synthesis suggests that more accurate evaluation of the sensitivity of cephalopod populations to environmental variation could be achieved by taking into account the ontogeny of the organisms. The comparison of most described species advocates for studies linking development and ecology in this particular group. © 2014 Elsevier Ltd All rights reserved.

  16. Health Care Transition in Patients With Type 1 Diabetes

    PubMed Central

    Garvey, Katharine C.; Wolpert, Howard A.; Rhodes, Erinn T.; Laffel, Lori M.; Kleinman, Ken; Beste, Margaret G.; Wolfsdorf, Joseph I.; Finkelstein, Jonathan A.

    2012-01-01

    OBJECTIVE To examine characteristics of the transition from pediatric to adult care in emerging adults with type 1 diabetes and evaluate associations between transition characteristics and glycemic control. RESEARCH DESIGN AND METHODS We developed and mailed a survey to evaluate the transition process in emerging adults with type 1 diabetes, aged 22 to 30 years, receiving adult diabetes care at a single center. Current A1C data were obtained from the medical record. RESULTS The response rate was 53% (258 of 484 eligible). The mean transition age was 19.5 ± 2.9 years, and 34% reported a gap >6 months in establishing adult care. Common reasons for transition included feeling too old (44%), pediatric provider suggestion (41%), and college (33%). Less than half received an adult provider recommendation and <15% reported having a transition preparation visit or receiving written transition materials. The most recent A1C was 8.1 ± 1.3%. Respondents who felt mostly/completely prepared for transition had lower likelihood of a gap >6 months between pediatric and adult care (adjusted odds ratio 0.47 [95% CI 0.25–0.88]). In multivariate analysis, pretransition A1C (β = 0.49, P < 0.0001), current age (β = −0.07, P = 0.03), and education (β = −0.55, P = 0.01) significantly influenced current posttransition A1C. There was no independent association of transition preparation with posttransition A1C (β = −0.17, P = 0.28). CONCLUSIONS Contemporary transition practices may help prevent gaps between pediatric and adult care but do not appear to promote improvements in A1C. More robust preparation strategies and handoffs between pediatric and adult care should be evaluated. PMID:22699289

  17. GIS-measured walkability, transit, and recreation environments in relation to older Adults' physical activity: A latent profile analysis.

    PubMed

    Todd, Michael; Adams, Marc A; Kurka, Jonathan; Conway, Terry L; Cain, Kelli L; Buman, Matthew P; Frank, Lawrence D; Sallis, James F; King, Abby C

    2016-12-01

    An infrequently studied question is how diverse combinations of built environment (BE) features relate to physical activity (PA) for older adults. We derived patterns of geographic information systems- (GIS) measured BE features and explored how they accounted for differences in objective and self-reported PA, sedentary time, and BMI in a sample of older adults. Senior Neighborhood Quality of Life Study participants (N=714, aged 66-97years, 52.1% women, 29.7% racial/ethnic minority) were sampled in 2005-2008 from the Seattle-King County, WA and Baltimore, MD-Washington, DC regions. Participants' home addresses were geocoded, and net residential density, land use mix, retail floor area ratio, intersection density, public transit density, and public park and private recreation facility density measures for 1-km network buffers were derived. Latent profile analyses (LPAs) were estimated from these GIS-based measures. In multilevel regression models, profiles were compared on accelerometer-measured moderate-to-vigorous PA (MVPA) and sedentary time and self-reported PA, adjusting for covariates and clustering. Analyses were conducted in 2014-2015. LPAs yielded three profiles: low walkability/transit/recreation (L-L-L); mean walkability/transit/recreation (M-M-M); and high walkability/transit/recreation (H-H-H). Three PA outcomes were more favorable in the HHH than the LLL profile group (difference of 7.2min/day for MVPA, 97.8min/week for walking for errands, and 79.2min/week for walking for exercise; all ps<0.02). The most and least activity-supportive BE profiles showed greater differences in older adults' PA than did groupings based solely on a 4-component walkability index, suggesting that diverse BE features are important for healthy aging. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Asthma Self-Management Goals, Beliefs and Behaviors of Urban African American Adolescents Prior to Transitioning to Adult Health Care.

    PubMed

    Gibson-Scipio, Wanda; Gourdin, Dustin; Krouse, Helene J

    2015-01-01

    Adolescence is a unique time of development incorporating a transition from child centered to adult centered health care. This transition period can be particularly challenging for individuals with a chronic disease such as asthma. Inadequate transition planning during adolescence may place an already vulnerable population such as African American adolescents with known health disparities in asthma prevalence, morbidity and mortality at risk for a continuation of poor health outcomes across the lifespan. Central to transition planning for these youth is the core element of developing and prioritizing goals. The purpose of this qualitative study was to explore the asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning from pediatric to adult health care. A focus group composed of 13 African American adolescents with asthma ages 14-18 years from an urban population was conducted. Responses from transcripts and field notes were reviewed using an iterative process to best characterize asthma self-management goals and beliefs that emerged. Four core themes were identified: 1) medication self-management, 2) social support, 3) independence vs. interdependence, and 4) self-advocacy. Medication self-management included subthemes of rescue medications, controller medications and medication avoidance. The social support theme included three subthemes: peer support, caregiver support and healthcare provider support. Findings suggest that adolescents with asthma form both short term and long term goals. Their goals indicated a need for guided support to facilitate a successful health care transition. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Challenges associated with transition to caregiver role following diagnostic disclosure of Alzheimer disease: a descriptive study.

    PubMed

    Ducharme, Francine; Lévesque, Louise; Lachance, Lise; Kergoat, Marie-Jeanne; Coulombe, Renée

    2011-09-01

    The prevalence of Alzheimer's disease is rising. The large number of new cases identified each year means that many new families will set upon a long trajectory of caring for a relative with dementia. Diagnostic disclosure of Alzheimer's disease marks the official transition to the caregiver role, yet this early period of the caregiver career have rarely been studied. Based on Meleis's theoretical framework for role transition, the objectives of this study were to document the characteristics of the caregiving context during the transition to the caregiver role following diagnostic disclosure of Alzheimer's disease and to compare these characteristics by caregiver gender and kinship tie to the relative. A descriptive design was used. Data were collected using standardized measures selected in accordance with the role transition theoretical framework. The sample recruited in Quebec (Canada) cognition clinics comprised 122 caregivers of an elderly relative diagnosed with Alzheimer's disease in the past nine months. Findings reveal the context of care to be marked by several challenges for caregivers. The majority of caregivers receives little informal support, has poor knowledge of available formal services, and has difficulty planning ahead for the relative's future care needs. Caregivers themselves report a lack of preparedness to provide care. Compared with men caregivers, women seem to have more problems controlling disturbing thoughts about their new caregiver role and to experience more family conflicts and psychological distress. Compared with offspring caregivers, spouse caregivers are less able to respond to the relative's disruptive behaviors, make less use of problem-solving strategies, and report fewer family conflicts. The challenges faced by caregivers during the transition to the caregiver role are sensitive to nursing interventions. Pro-active interventions from the outset of the caregiving career, such as early assessment of caregiver needs for

  20. Role of thermal heating on the voltage induced insulator-metal transition in VO2.

    PubMed

    Zimmers, A; Aigouy, L; Mortier, M; Sharoni, A; Wang, Siming; West, K G; Ramirez, J G; Schuller, Ivan K

    2013-02-01

    We show that the main mechanism for the dc voltage or dc current induced insulator-metal transition in vanadium dioxide VO(2) is due to local Joule heating and not a purely electronic effect. This "tour de force" experiment was accomplished by using the fluorescence spectra of rare-earth doped micron sized particles as local temperature sensors. As the insulator-metal transition is induced by a dc voltage or dc current, the local temperature reaches the transition temperature indicating that Joule heating plays a predominant role. This has critical implications for the understanding of the dc voltage or dc current induced insulator-metal transition and has a direct impact on applications which use dc voltage or dc current to externally drive the transition.

  1. Adolescents' Perceptions of Transition Importance, Readiness, and Likelihood of Future Success: The Role of Anticipatory Guidance.

    PubMed

    Syverson, Erin Phillips; McCarter, Robert; He, Jianping; D'Angelo, Lawrence; Tuchman, Lisa K

    2016-10-01

    Expert consensus supports anticipatory guidance around health care transition (HCT), but little is known about its impact on adolescents' perceptions of HCT. This study aimed to evaluate the frequency of HCT anticipatory guidance delivery and the effect it had on participants' perceptions of HCT. Adolescents (n = 209) with special health care needs were administered National Survey for Children with Special Health Care Needs transition assessment questions, then reported perceptions of transition importance, readiness, and likely future success. Over half of the participants reported no history of discussion about transition to an adult provider (64%) or insurance needs (67%); just under half (43%) had not discussed their changing health care needs. In participants reporting receipt of anticipatory guidance, ratings of transition readiness and future success were significantly higher than those who received no anticipatory guidance, supporting that HCT anticipatory guidance has a significantly positive impact on adolescents' perceptions of the HCT process. © The Author(s) 2016.

  2. Socio-technical transition as a co-evolutionary process: Innovation and the role of niche markets in the transition to motor vehicles

    NASA Astrophysics Data System (ADS)

    Birky, Alicia K.

    2008-10-01

    Significant reductions in greenhouse emissions from personal transportation will require a transition to an alternative technology regime based on renewable energy sources. Two bodies of research, the quasi-evolutionary (QE) model and the multi-level perspective (MLP) assert that processes within niches play a fundamental role in such transitions. This research asks whether the description of transitions based on this niche hypothesis and its underlying assumptions is consistent with the historical U.S. transition to motor vehicles at the beginning of the 20th century. Unique to this dissertation is the combination of the perspective of the entrepreneur with co-evolutionary approaches to socio-technical transitions. This approach is augmented with concepts from the industry life-cycle model and with a taxonomy of mechanisms of learning. Using this analytic framework, I examine specifically the role of entrepreneurial behavior and processes within and among firms in the co-evolution of technologies and institutions during the transition to motor vehicles. I find that niche markets played an important role in the development of the technology, institutions, and the industry. However, I also find that the diffusion of the automobile is not consistent with the niche hypothesis in the following ways: (1) product improvements and cost reductions were not realized in niche markets, but were achieved simultaneously with diffusion into mass markets; (2) in addition to learning-by-doing and learning-by-interacting with users, knowledge spillovers and interacting with suppliers were critical in this process; (3) cost reductions were not automatic results of expanding markets, but rather arose from the strategies of entrepreneurs based on personal perspectives and values. This finding supports the use of a behavioral approach with a micro-focus in the analysis of socio-technical change. I also find that the emergence and diffusion of the motor vehicle can only be understood by

  3. Functional role of adult hippocampal neurogenesis as a therapeutic strategy for mental disorders.

    PubMed

    Jun, Heechul; Mohammed Qasim Hussaini, Syed; Rigby, Michael J; Jang, Mi-Hyeon

    2012-01-01

    Adult neurogenesis, the process of generating new neurons from neural stem cells, plays significant roles in synaptic plasticity, memory, and mood regulation. In the mammalian brain, it continues to occur well into adulthood in discrete regions, namely, the hippocampus and olfactory bulb. During the past decade, significant progress has been made in understanding the mechanisms regulating adult hippocampal neurogenesis and its role in the etiology of mental disorders. In addition, adult hippocampal neurogenesis is highly correlated with the remission of the antidepressant effect. In this paper, we discuss three major psychiatric disorders, depression, schizophrenia, and drug addiction, in light of preclinical evidence used in establishing the neurobiological significance of adult neurogenesis. We interpret the significance of these results and pose questions that remain unanswered. Potential treatments which include electroconvulsive therapy, deep brain stimulation, chemical antidepressants, and exercise therapy are discussed. While consensus lacks on specific mechanisms, we highlight evidence which indicates that these treatments may function via an increase in neural progenitor proliferation and changes to the hippocampal circuitry. Establishing a significant role of adult neurogenesis in the pathogenicity of psychiatric disorders may hold the key to potential strategies toward effective treatment.

  4. Transition into adult healthcare services in Scotland: findings from a study concerning service users at the Scottish Spina Bifida Association.

    PubMed

    Levy, Sharon; Wynd, Andrew H D; Carachi, Robert

    2014-11-01

    Literature on interventions that enable young people with spina bifida and/or hydrocephalus to have smooth transition, into adult healthcare services, stress the need for the process to start early and to include all family members. The study reported here was set to quantify and articulate the experiences of service users who are or due to be going through the transition process in Scotland today. Focus group sessions, in the North of Scotland and in the 'Central Belt', captured rich qualitative data. A survey, sent to eligible participants on the Spina Bifida National database, offered complimentary data source. Despite the fact that the number of returned questionnaires was low (n = 20), data analysis identified a number of core recurring themes. These include issues concerning Communications, Respect, Choice and Control. Findings suggest that there is a significant chasm between the political rhetoric and the reality faced by young people with spina bifida moving to adult healthcare services. A possible way to facilitate successful transition of young people is using personal healthcare information as the locus for needed change. More research is needed to ascertain whether a 'Person-Centred Record', which is set to empower young people on their transition pathway, is an appropriate transition tool. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. Navigating emotions and relationship dynamics: family life review as a clinical tool for older adults during a relocation transition into an assisted living facility.

    PubMed

    O'Hora, Kendra A; Roberto, Karen A

    2018-01-16

    Relocation for the purpose of receiving care may be one of the more challenging transitions for older adults. The purpose of this study was to facilitate a family life review (FLR) session aimed at enhancing family relationships and assisting older adults in coping with the challenges associated with a relocation. Fourteen dyads comprised of older adults who relocated to an assisted living facility (ALF) and a chosen family member or friend participated in a FLR session and semi-structured follow up interview. Data were analyzed using the constant comparative method and triangulated with descriptive statistics. Emergent themes suggested participating in FLR influenced families by raising emotions, systemically thinking, and navigating the relocation. FLR facilitated positive connections, enhanced existing relationships, and promoted self-acceptance. Families indicated mutual storytelling was enjoyable and reminded them of the urgency to share their story. FLR allowed dyads to reflect and thus prompted a renewed perspective on some of the more challenging components of the relocation transition. Study findings provide insight into how families organize individual and interpersonal narratives and use these narratives during transitional times. FLR can aid families in making a smoother and fulfilling move to an ALF and other late life transitions.

  6. Mothers' and Fathers' Roles in Caring for an Adult Child with an Intellectual Disability

    ERIC Educational Resources Information Center

    Rowbotham, Michelle; Carroll, Annemaree; Cuskelly, Monica

    2011-01-01

    To date, there have been few studies of mothers' and fathers' roles in caring for their adult children with intellectual disabilities. The present study investigated the care-giving roles of mother and father couples caring for their adult offspring with an intellectual disability, their psychological health, and the demands and satisfaction of…

  7. Mothers of young adults with intellectual disability: multiple roles, ethnicity and well-being.

    PubMed

    Eisenhower, A; Blacher, J

    2006-12-01

    Two opposing perspectives--role strain and role enhancement--were considered as predictive of women's psychological and physical health. The authors examined the relation between multiple role occupancy (parenting, employment, marriage) and well-being (depression and health) among mothers of young adults with intellectual disability (ID). Participants were 226 mothers aged 35-70 years old caring for a young adult aged 16-26 years old with moderate to severe/profound ID. Mothers were of either Latino ethnicity (n=117) or Anglo (n=109). Mothers' ethnicity and degree of acculturation and young adults' adaptive behaviour and behaviour problems were examined as potential moderators. Mothers who were employed, married, or both reported better well-being than mothers who were both unemployed and unmarried, especially when their offspring had relatively higher adaptive functioning. This relationship between role occupancy and well-being was fully mediated by socio-economic status (SES) factors. Results did not suggest a role enhancement effect, but instead indicated a role shortage effect; unemployed, unmarried mothers experienced markedly poor well-being, while all other mothers experienced comparable well-being. Well-being scores were higher for Anglo than for Latino mothers; this relationship was entirely accounted for by SES. In Latina mothers, the relation between role occupancy and well-being was moderated by degree of acculturation. Findings suggest that multiple roles benefit mothers of young adults with ID primarily through their impact on socio-economic resources. For more acculturated Latina mothers, occupying more roles predicted better well-being even after controlling for SES. Latina mothers who were unemployed and unmarried had lower SES, and this group emerged as at particular risk. The latter group may benefit most from respite assistance and other interventions aimed at addressing their physical and mental health.

  8. Alcohol Advertising on Boston's Massachusetts Bay Transportation Authority Transit System: An Assessment of Youths' and Adults' Exposure

    PubMed Central

    Nyborn, Justin A.; Wukitsch, Kimberly; Nhean, Siphannay

    2009-01-01

    Objectives. We investigated the frequency with which alcohol advertisements appeared on Massachusetts Bay Transportation Authority (MBTA) transit lines in Boston, MA, and we calculated adult and youths' exposure to the ads. Methods. We measured the nature and extent of alcohol advertisements on 4 Boston transit lines on 2 separate weekdays 1 month apart in June and July of 2008. We calculated weekday ad exposure for all passengers (all ages) and for Boston Public School student passengers (aged 11–18 years). Results. Alcohol ads were viewed an estimated 1 212 960 times across all Boston-area transit passengers during an average weekday, reaching the equivalent of 42.7% of that population. Alcohol ads were viewed an estimated 18 269 times by Boston Public School student transit passengers during an average weekday, reaching the equivalent of 54.1% of that population. Conclusions. Advertisers reached the equivalent of half of all Boston Public School transit passengers aged 11 to 18 years and the equivalent of nearly half of all transit passengers in the Boston area with an alcohol advertisement each day. Because of the high exposure of underage youths to alcohol advertisements, we recommend that the MBTA prohibit alcohol advertising on the Boston transit system. PMID:19890170

  9. Roles for Hedgehog signaling in adult organ homeostasis and repair

    PubMed Central

    Petrova, Ralitsa; Joyner, Alexandra L.

    2014-01-01

    The hedgehog (HH) pathway is well known for its mitogenic and morphogenic functions during development, and HH signaling continues in discrete populations of cells within many adult mammalian tissues. Growing evidence indicates that HH regulates diverse quiescent stem cell populations, but the exact roles that HH signaling plays in adult organ homeostasis and regeneration remain poorly understood. Here, we review recently identified functions of HH in modulating the behavior of tissue-specific adult stem and progenitor cells during homeostasis, regeneration and disease. We conclude that HH signaling is a key factor in the regulation of adult tissue homeostasis and repair, acting via multiple different routes to regulate distinct cellular outcomes, including maintenance of plasticity, in a context-dependent manner. PMID:25183867

  10. How to Facilitate Transition to Adulthood? Innovative Solutions from Parents of Young Adults with Profound Intellectual Disability

    ERIC Educational Resources Information Center

    Gauthier-Boudreault, Camille; Couture, Mélanie; Gallagher, Frances

    2018-01-01

    Background: At age 21, access to specialised services for youth with profound intellectual disability is reduced. Few studies have focused on parents' views concerning potential solutions to ease the transition to adulthood, and most existing solutions target young adults with less severe intellectual disability. The aim of this study is to…

  11. Transition from metabolic adaptation to maladaptation of the heart in obesity: role of apelin.

    PubMed

    Alfarano, C; Foussal, C; Lairez, O; Calise, D; Attané, C; Anesia, R; Daviaud, D; Wanecq, E; Parini, A; Valet, P; Kunduzova, O

    2015-02-01

    Impaired energy metabolism is the defining characteristic of obesity-related heart failure. The adipocyte-derived peptide apelin has a role in the regulation of cardiovascular and metabolic homeostasis and may contribute to the link between obesity, energy metabolism and cardiac function. Here we investigate the role of apelin in the transition from metabolic adaptation to maladaptation of the heart in obese state. Adult male C57BL/6J, apelin knock-out (KO) or wild-type mice were fed a high-fat diet (HFD) for 18 weeks. To induce heart failure, mice were subjected to pressure overload after 18 weeks of HFD. Long-term effects of apelin on fatty acid (FA) oxidation, glucose metabolism, cardiac function and mitochondrial changes were evaluated in HFD-fed mice after 4 weeks of pressure overload. Cardiomyocytes from HFD-fed mice were isolated for analysis of metabolic responses. In HFD-fed mice, pressure overload-induced transition from hypertrophy to heart failure is associated with reduced FA utilization (P<0.05), accelerated glucose oxidation (P<0.05) and mitochondrial damage. Treatment of HFD-fed mice with apelin for 4 weeks prevented pressure overload-induced decline in FA metabolism (P<0.05) and mitochondrial defects. Furthermore, apelin treatment lowered fasting plasma glucose (P<0.01), improved glucose tolerance (P<0.05) and preserved cardiac function (P<0.05) in HFD-fed mice subjected to pressure overload. In apelin KO HFD-fed mice, spontaneous cardiac dysfunction is associated with reduced FA oxidation (P<0.001) and increased glucose oxidation (P<0.05). In isolated cardiomyocytes, apelin stimulated FA oxidation in a dose-dependent manner and this effect was prevented by small interfering RNA sirtuin 3 knockdown. These data suggest that obesity-related decline in cardiac function is associated with defective myocardial energy metabolism and mitochondrial abnormalities. Furthermore, our work points for therapeutic potential of apelin to prevent myocardial

  12. The Role of Proximity Effects in Transition-Edge Sensor Design and Performance

    NASA Technical Reports Server (NTRS)

    Smith, Stephen J.

    2012-01-01

    Transition-edge sensor (TES) microcalorimeters and bolometers are under development by numerous groups worldwide for a variety of applications involving the measurement of particle and photon radiation. Recent experimental and theoretical progress has led to the realization that the fundamental physics of some TES systems involves the longitudinal proximity effect between the electrical bias contacts and the TES. As such, these devices are described as SS'S (or SN'S) weak-links exhibiting Fraunhofer-like magnetic field dependence, and exponential temperature dependence, of the critical current. These discoveries, for the first time, provide a realistic theoretical framework for predicting the resistive transition as a function of temperature, current and magnetic field. In this contribution, we review the latest theoretical and experimental results and investigate how proximity effects play an important role in determining the resistive transition characteristics, which ultimately determines the dynamic range and energy resolution of TES detectors. We investigate how these effects could be utilized in device design to engineer desired transition characteristics for a given application.

  13. Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study.

    PubMed

    Gorter, Jan Willem; Stewart, Deb; Cohen, Eyal; Hlyva, Oksana; Morrison, Andrea; Galuppi, Barb; Nguyen, Tram; Amaria, Khush; Punthakee, Zubin

    2015-05-06

    To assess use, utility and impact of transition interventions designed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare. A 4-year mixed-method prospective cohort study. 2 academic paediatric hospitals (13 clinics) in Canada. 50 adolescents (42% male; mean age 17.9±0.9 years; 20 underlying diagnoses) with transfer to adult care planned within 1 year. The Youth KIT (an organisational tool that includes goal setting activities); an online transition mentor. Frequency of use, utility and impact of the transition interventions; goal achievement; post-transfer qualitative interviews with youth. 50 participants were enrolled during their last year of paediatric care; 36 (72%) were followed into adult care. All participants had access to the transition interventions from enrolment until the end of the study (exposure time: 12-47 months). Most youth (85%) reported using the medical/health section of the Youth KIT at least once; 20 (40%) participants engaged in chats with the mentor. The overall perceived utility of both interventions was modest; the Youth KIT received the highest ratings for 'help with goal setting': (mean (SD): 4.2 (2.3)) on a 7-point Likert scale. 45 (90%) participants set 294 transition goals. Goal achievement performance and satisfaction increased over time (p≤0.001). The qualitative evidence revealed reasons behind the variability in use and utility of the interventions, the interconnectedness of life-course and healthcare transitions, and the need for stronger partnerships between paediatric and adult healthcare systems. Participants' perceptions about the utility of the Youth KIT and the online mentor were modest. Transition supports need to be carefully tailored, timed and integrated into healthcare systems. Individualised goal setting may be an important 'active ingredient' in optimising transition supports and outcomes. Interventions that focus on youth only are

  14. Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study

    PubMed Central

    Gorter, Jan Willem; Stewart, Deb; Cohen, Eyal; Hlyva, Oksana; Morrison, Andrea; Galuppi, Barb; Nguyen, Tram; Amaria, Khush; Punthakee, Zubin

    2015-01-01

    Objectives To assess use, utility and impact of transition interventions designed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare. Design A 4-year mixed-method prospective cohort study. Setting 2 academic paediatric hospitals (13 clinics) in Canada. Participants 50 adolescents (42% male; mean age 17.9±0.9 years; 20 underlying diagnoses) with transfer to adult care planned within 1 year. Interventions The Youth KIT (an organisational tool that includes goal setting activities); an online transition mentor. Main outcome measures Frequency of use, utility and impact of the transition interventions; goal achievement; post-transfer qualitative interviews with youth. Results 50 participants were enrolled during their last year of paediatric care; 36 (72%) were followed into adult care. All participants had access to the transition interventions from enrolment until the end of the study (exposure time: 12–47 months). Most youth (85%) reported using the medical/health section of the Youth KIT at least once; 20 (40%) participants engaged in chats with the mentor. The overall perceived utility of both interventions was modest; the Youth KIT received the highest ratings for ‘help with goal setting’: (mean (SD): 4.2 (2.3)) on a 7-point Likert scale. 45 (90%) participants set 294 transition goals. Goal achievement performance and satisfaction increased over time (p≤0.001). The qualitative evidence revealed reasons behind the variability in use and utility of the interventions, the interconnectedness of life-course and healthcare transitions, and the need for stronger partnerships between paediatric and adult healthcare systems. Conclusions Participants’ perceptions about the utility of the Youth KIT and the online mentor were modest. Transition supports need to be carefully tailored, timed and integrated into healthcare systems. Individualised goal setting may be an important

  15. Transitional Care

    ERIC Educational Resources Information Center

    Naylor, Mary; Keating, Stacen A.

    2008-01-01

    Transitional care encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings. High-quality transitional care is especially important for older adults with multiple chronic conditions and complex therapeutic regimens, as well as for their…

  16. Adolescents with Type 1 Diabetes: transition between diabetes services.

    PubMed

    Visentin, Kate; Koch, Tina; Kralik, Debbie

    2006-06-01

    The research aimed to develop a sustainable and coordinated approach to facilitating the transition between diabetes services for adolescents. The objectives were to: (1) involve key diabetes health delivery stakeholders in expressing their concerns and issues about current service delivery and ways to improve same, and (2) reveal from the perspective of the adolescents living with Type 1 Diabetes their experiences surrounding the process of transition. This paper presents research that sought to identify the major concerns and issues that stakeholders had about transition and to reveal the experience of transition for the adolescent with Type 1 Diabetes. Key representatives from seven public diabetes services in Adelaide, South Australia worked collaboratively to answer the objectives of this inquiry. Approach. Interview data were generated and analysed using a response focus framework provided by fourth generation evaluation research. In this study, the focus was on common concerns, claims and issues raised by health care professionals (n = 21) and adolescents (n = 10) aged between 15 and 18 years about transferring from children's to adult diabetes services. Data revealed education and dietetic advice was reactive rather than proactive and that the paediatric model of care is philosophically and practically different to the adult model of diabetes care. Three phases of transition were identified: preparation, formal transition and evaluation. Our findings indicated that these stages of transition were not being fully implemented in health units. The project findings have set the scene to establish a multidisciplinary working party to work collaboratively across agencies to develop effective transition pathways. The role of diabetes nurse educators and dietitians in South Australia is under-used throughout the transition process. Diabetes nurse educators are in an ideal position to prepare, coordinate and evaluate transitional processes.

  17. Nutrition Transition and Obesity Among Teenagers and Young Adults in South Asia.

    PubMed

    Jayawardena, Ranil; Ranasinghe, Priyanga; Wijayabandara, Maheshi; Hills, Andrew P; Misra, Anoop

    2017-01-01

    Obesity among teenagers/adolescents and young adults is associated with significant adverse short and longer-term effects on health. To date, no narrative reviews have evaluated nutrition transition and its contribution to the obesity epidemic among adolescents and young adults in the South Asian (SA) region. Data were retrieved by a four-stage systematic search process. A search of the online Pub- Med/Medline, SciVerse Scopus and Web of Science databases was performed. The age groups were defined as follows; teenage:13-19 years, adolescence:10-18 years and young adult:19-24 years. Among teenagers/adolescents, the prevalence of overweight ranged from 11.0% (Sri Lanka) to 19.0% (India), while obesity ranged from 2.4% (Sri Lanka) to 11.0% (Pakistan). In young adults, prevalence of overweight ranged between 7.9% (Nepal) to 15.0% (Pakistan), while obesity showed a much wider variation (0.005%[Nepal] - 22.8%[India]). Nutritional risk factors associated with overweight/ obesity among SAs of this age group included reduced fruit and vegetable consumption, a total vegetarian diet, consumption of fast food and soft drinks, and skipping breakfast. Other contributing factors identified were: adding extra salt to meals, eating meals outside of the home, frequently visiting restaurants and eating while watching television. Daily milk/yoghurt consumption and a family supper have shown a protective effect against overweight/obesity. Overweight and obesity are common amongst teenagers/adolescents and young adults of the SA region. Several food types and habits were identified as being associated with overweight/ obesity in this population. Identifying common protective and contributory factors is very important for the development of a shared regional preventive strategy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  18. Intergenerational Profiles of Socioeconomic (Dis)advantage and Obesity During the Transition to Adulthood

    PubMed Central

    Scharoun-Lee, Melissa; Adair, Linda S.; Popkin, Barry M.; Kaufman, Jay S.; Suchindran, Chirayath M.

    2012-01-01

    Investigations of socioeconomic status (SES) and health during the transition to adulthood in the United States are complicated by the later and more varied transitions in residence, employment, schooling, and social roles compared with previous generations. Parental SES is an important influence during adolescence but cannot sufficiently capture the SES of the independent young adult. Typical, single SES indicators based on income or education likely misclassify the SES of young adults who have not yet completed their education or other training, or who have entered the labor force early with ultimately lower status attainment. We use a latent class analysis (LCA) framework to characterize five intergenerational SES groups, combining multidimensional SES information from two time points—that is, adolescent (parental) and young adult (self) SES data. Associations of these groups with obesity, a high-risk health outcome in young adults, revealed nuanced relationships not seen using traditional intergenerational SES measures. In males, for example, a middle-class upbringing in adolescence and continued material advantage into adulthood was associated with nearly as high obesity as a working poor upbringing and early, detrimental transitions. This intergenerational typology of early SES exposure facilitates understanding of SES and health during young adulthood. PMID:21491185

  19. Anxiety and Depression during Transition from Hospital to Community in Older Adults: Concepts of a Study to Explain Late Age Onset Depression

    PubMed Central

    Lalor, Aislinn F.; Brown, Ted; Robins, Lauren; Lee, Den-Ching Angel; O’Connor, Daniel; Russell, Grant; Stolwyk, Rene; McDermott, Fiona; Johnson, Christina; Haines, Terry P.

    2015-01-01

    The transition between extended hospitalization and discharge home to community-living contexts for older adults is a critical time period. This transition can have an impact on the health outcomes of older adults such as increasing the risk for health outcomes like falls, functional decline and depression and anxiety. The aim of this work is to identify and understand why older adults experience symptoms of depression and anxiety post-discharge and what factors are associated with this. This is a mixed methods study of adults aged 65 years and over who experienced a period of hospitalization longer than two weeks and return to community-living post-discharge. Participants will complete a questionnaire at baseline and additional monthly follow-up questionnaires for six months. Anxiety and depression and their resulting behaviors are major public health concerns and are significant determinants of health and wellbeing among the ageing population. There is a critical need for research into the impact of an extended period of hospitalization on the health status of older adults post-discharge from hospital. This research will provide evidence that will inform interventions and services provided for older adults after they have been discharged home from hospital care. PMID:27417775

  20. Early marijuana initiation: The link between prenatal marijuana exposure, early childhood behavior, and negative adult roles.

    PubMed

    Goldschmidt, Lidush; Richardson, Gale A; Larkby, Cynthia; Day, Nancy L

    We investigated the associations among gestational factors including prenatal marijuana exposure (PME), child behavior at age 3, early age of onset of marijuana use (EAOM, <15years), and adult roles at 22years. Participants were drawn from the Maternal Health Practices and Child Development (MHPCD) Project, a longitudinal study of prenatal substance exposure in offspring who have been studied for over 22years since the prenatal phase. Data from the prenatal, birth, 3-, and 22-year phases (N=608) were used in the present study. Age of onset of offspring substance use was determined based on data from the 14-, 16-, and 22-year phases. The subjects were of lower socioeconomic status, 43% were Caucasian and the remaining were African-American, and 48% were males. Early childhood behavior was significantly (p<0.05) related to EAOM after controlling for PME, birth and childhood environmental risk factors, and Conduct Disorder. EAOM was significantly associated with negative adult roles including increased risk of being arrested (p<0.001), lower educational attainment (p<0.001), having a child without being married (p<0.05), and unemployment at 22years (p<0.001). The correlations between PME and negative adult roles and between early childhood behavior and negative adult roles were also statistically significant. Pathway analysis demonstrated that EAOM significantly mediated the associations between PME and fulfillment of adult roles and between early childhood behavior and adult roles. There are a number of intervention points that could be targeted that would have a long-term impact on lowering the probability of EAOM and less success in adult roles. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Transition to adulthood: delays and unmet needs among adolescents and young adults with asthma.

    PubMed

    Scal, Peter; Davern, Michael; Ireland, Marjorie; Park, Kyong

    2008-04-01

    To examine the effect of the transition to adulthood on financial and non-financial barriers to care in youth with asthma. With National Health Interview Survey data from 2000 to 2005, we examined delays and unmet needs because of financial and non-financial barriers, evaluating the effect of adolescent (age, 12-17 years; n = 1539) versus young adult age (age, 18-24 years; N = 833), controlling for insurance, usual source of care, and sociodemographic characteristics. We also simulated the effects of providing public insurance to uninsured patients and a usual source of care to patients without one. More young adults than adolescents encountered financial barriers resulting in delays (18.6% versus 8%, P < .05) and unmet needs (26.6% versus 11.4%, P < .05), although delays caused by non-financial barriers were similar (17.3% versus 14.9%, P = not significant). In logistic models young adults were more likely than adolescents to report delays (odds ratio [OR], 1.45; 95% CI, 1.02-2.08) and unmet needs (OR, 1.8; 95% CI, 1.29-2.52) caused by financial barriers. Delays and unmet needs for care caused by financial reasons are significantly higher for young adults than they are for adolescents with asthma.

  2. Pediatric Renal Transplantation: Focus on Current Transition Care and Proposal of the "RISE to Transition" Protocol.

    PubMed

    Raina, Rupesh; Wang, Joseph; Krishnappa, Vinod; Ferris, Maria

    2018-01-16

    The transition from pediatric to adult medical services is an important time in the life of an adolescent or young adult with a renal transplant. Failure of proper transition can lead to medical non-adherence and subsequent loss of graft and/or return to dialysis. The aim of this study was to conduct a systematic review and survey to assess the challenges and existing practices in transition of renal transplant recipient children to adult services, and to develop a transition protocol. We conducted a literature review and performed a survey of pediatric nephrologists across the United States to examine the current state of transition care. A structured transition protocol was developed based on these results. Our literature review revealed that a transition program has a positive impact on decline in renal function and acute rejection episodes, and may improve long-term graft outcomes in pediatric kidney transplant patients. With a response rate of 40% (60/150) from nephrologists in 56% (49/87) of centers, our survey shows inconsistent use of validated tools despite their availability, inefficient communication between teams, and lack of use of dedicated clinics. To address these issues, we developed the "RISE to Transition" protocol, which relies on 4 competency areas: Recognition, Insight, Self-reliance, and Establishment of healthy habits. The transition program decreases acute graft rejection episodes, and the main challenges in transition care are the communication gap between health care providers and inconsistent use of transition tools. Our RISE to transition protocol incorporates transition tools, defines personnel, and aims to improve communication between teams.

  3. The role of upper mantle mineral phase transitions on the current structure of large-scale Earth's mantle convection.

    NASA Astrophysics Data System (ADS)

    Thoraval, C.

    2017-12-01

    Describing the large-scale structures of mantle convection and quantifying the mass transfer between upper and lower mantle request to account for the role played by mineral phase transitions in the transition zone. We build a density distribution within the Earth mantle from velocity anomalies described by global seismic tomographic models. The density distribution includes thermal anomalies and topographies of the phase transitions at depths of 410 and 660 km. We compute the flow driven by this density distribution using a 3D spherical circulation model, which account for depth-dependent viscosity. The dynamic topographies at the surface and at the CMB and the geoid are calculated as well. Within the range of viscosity profiles allowing for a satisfying restitution of the long wavelength geoid, we perform a parametric study to decipher the role of the characteristics of phase diagrams - mainly the Clapeyron's slopes - and of the kinetics of phase transitions, which may modify phase transition topographies. Indeed, when a phase transition is delayed, the boundary between two mineral phases is both dragged by the flow and interfere with it. The results are compared to recent estimations of surface dynamic topography and to the phase transition topographies as revealed by seismic studies. The consequences are then discussed in terms of structure of mantle flow. Comparisons between various tomographic models allow us to enlighten the most robust features. At last, the role played by the phase transitions on the lateral variations of mass transfer between upper and lower mantle are quantified by comparison to cases with no phase transitions and confronted to regional tomographic models, which reflect the variability of the behaviors of the descending slabs in the transition zone.

  4. Evaluation of Outcomes in Adolescent Inflammatory Bowel Disease Patients Following Transfer From Pediatric to Adult Health Care Services: Case for Transition.

    PubMed

    Cole, Rebecca; Ashok, Dhandapani; Razack, Abdul; Azaz, Amer; Sebastian, Shaji

    2015-08-01

    We aimed to evaluate the impact of a transition service on clinical and developmental outcomes in adolescent Inflammatory Bowel Disease (IBD) patients on transfer to adult health care services. We reviewed the records of IBD patients diagnosed in pediatric care following their transfer/attendance to the adult IBD service. The data on patients who attended the transition service were compared with those who did not pass through the transition service. Seventy-two patients were included in the study 41M and 31F. Forty-four patients went through the transition system (Group A), and 28 had no formalized transition arrangement before transfer (Group B). A significantly higher number of Group B patients needed surgery within 2 years of transfer when compared with patients in Group A (46% vs. 25%, p = .01). Sixty-one percent of patients in Group B needed at least one admission within 2 years of transfer when compared with 29% of Group A patients (p = .002). Nonattendance at clinics was higher in Group B patients with 78% having at least one nonattendance, whereas 29% of Group A failed to attend at least one appointment (p = .001). In addition, drug compliance rates were higher in the transition group when compared with Group B (89% and 46%, respectively; p = .002). A higher proportion of transitioned patients achieved their estimated maximum growth potential when completing adolescence. There was a trend toward higher dependence on opiates and smoking in Group B patients. In adolescent IBD patients, transition care is associated with better disease specific and developmental outcomes. Prospective studies of different models of transition care in IBD are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  5. Visual Arts and Older Adult Learners in Retirement

    ERIC Educational Resources Information Center

    Hunt, Irma

    2012-01-01

    The purpose of this study was to explore the role of visual arts and its impact on successful aging and older adult learners in retirement. Retirement is one of the most important economic, psychological, and social transitions in most people's lives. Longevity has increased in the last sixty years such that in 2010, the average person can…

  6. Strategies for a successful organizational transition. Identifying staff roles and fulfilling their needs during changing times.

    PubMed

    Herbst, D S; Dimmick, J E

    1995-01-01

    For a successful reorganization of the laboratory, there is a role for each staff member to play during the transition. The role of those in laboratory administration is that of leading change agent. Corporate support staff, such as those in a human resources department, can advise the laboratory director in their areas of expertise. The role of the medical and technical supervisory staff is that of chief implementers of the plan. General laboratory staff has a confusing dual role--not only must they continue to provide laboratory services during the transition, but they also may have to change what they are doing and how they are doing it. Success also depends on meeting the individual personal needs of staff. Laboratory directors and administrators want to make a meaningful contribution to health care. Corporate support staff need to feel that they are a part of the change process. Supervisors' needs vary--coping with the loss of identity, position, or territory will be difficult for some; others will want to be involved in all stages of planning and implementation. The major need of the general laboratory staff is stability. Strategies are listed for each staff grouping to help the laboratory director coordinate staff roles and satisfy staff needs during the transition period.

  7. "Kids Who Smoke Think that They Can Be Adults as Well": Children's Smoking and Transitions to Adulthood

    ERIC Educational Resources Information Center

    Milton, Beth S.; Dugdill, Lindsey; Porcellato, Lorna A.; Springett, R. Jane

    2008-01-01

    This article aims to explore the ways in which preadolescents associate smoking with transitions to adulthood, in the context of sociological theories of childhood, using data from the Liverpool Longitudinal Study of Smoking. The research found that at age 9 many of the cohort argued that smoking was more acceptable for adults because they had…

  8. Understanding the relationship transitions and associated end of life clinical needs of young adults with life-limiting illnesses: A triangulated longitudinal qualitative study

    PubMed Central

    Johnston, Bridget; Jindal-Snape, Divya; Pringle, Jan; Gold, Libby; Grant, Jayne; Dempsey, Raymond; Scott, Ros; Carragher, Pat

    2016-01-01

    Background: Care of young adults with life-limiting illnesses can often be complex due to the fact that they are growing and developing within the continuing presence of their illness. There is little research conducted nationally and internationally, which has examined the life issues of young adults or taken a longitudinal approach to understand such issues over a period of time. Aim: To gain clear understanding of one particular and pertinent life issue—relationship transition—occurring in the context of being a young adult with a life-limiting illness and the clinical needs arising from this. Design: This was a triangulated, longitudinal, qualitative study involving young adults with life-limiting illnesses and their significant others, namely, family members and healthcare professionals. Semi-structured interviews were conducted with participants and analysed using thematic analysis. Clinical case note reviews were also carried out. Setting/participants: A total of 12 young adults (aged between 17 and 23 years) from 2 hospices and 22 nominated significant others participated in a total of 58 interviews. Results: Thematic analysis revealed 4 main themes and 11 subthemes. The main themes were ‘Dependence dichotomy’, ‘In it together’, ‘Biographical uncertainty’, and ‘Conserving integrity’. These themes helped to establish the nature of relationship transitions that the young adult participants from the study experienced and additionally allowed insight into their possible needs at their end of life. Conclusion: This study has identified the nature of relationship transitions pertinent to young adults and has highlighted associated end of life clinical needs. This study can influence further research into the transitions and end of life needs of this particular patient group receiving palliative care, while informing the lacking evidence base which exists internationally. PMID:27781097

  9. Coping Styles and Gender-Role: Some Implications for Mexican American Adult Education.

    ERIC Educational Resources Information Center

    Evans, Stephanie; Crockett, Stanley

    Passive coping behavior and traditional role-gender definitions affect learning needs of segments of the Mexican American adult community and may affect the behavioral development of younger family members. Networking within the community is useful in defining and meeting learning needs of adult Mexican Americans by creating cooperative,…

  10. The Role of Preschool Relational and Physical Aggression in the Transition to Kindergarten: Links with Social-Psychological Adjustment

    ERIC Educational Resources Information Center

    Gower, Amy L.; Lingras, Katherine A.; Mathieson, Lindsay C.; Kawabata, Yoshito; Crick, Nicki R.

    2014-01-01

    Research Findings: The transition to kindergarten has important ramifications for future achievement and psychosocial outcomes. Research suggests that physical aggression may be related to difficulty during school transitions, yet no studies to date have examined the role of relational aggression in these transitions. This article examines how…

  11. Women at Midlife: Implications for Theories of Women's Adult Development.

    ERIC Educational Resources Information Center

    Lippert, Laurel

    1997-01-01

    Discusses research on midlife transitions in women and its implications for theories of women's adult development. Presents findings on menopause, the postparental period, and the roles of women at midlife. Offers several theoretical approaches in light of research findings and makes recommendations for future research. Suggests implications for…

  12. Exploring the role of knowledge of condition and psycho-social profiles of young people with epilepsy during transition.

    PubMed

    Gray, Victoria; Palmer, Lucy; Whelby, Kayleigh; Vinten, Jacqui; Gait, Lucy

    2017-08-01

    Transitioning from paediatric to adult care can be a particularly challenging time for young people with epilepsy and research has shown that there are a range of factors which may influence a young person's ability to successfully cope with this difficult time. The following study aimed to explore the psychosocial characteristics of this transitioning population, as well as investigate how knowledgeable the young person and their parent/carer are of their own condition throughout transition. Young people with epilepsy were recruited from two specialist epilepsy clinics in the North West and allocated to one of three groups; Group 1 pre-transition, Group 2 transitioning, and Group 3 post-transition. Results found that the young person's knowledge increased significantly throughout transition, whilst parent/carer's knowledge decreased. In addition, anxiety was found to be significantly lower in Group 2 (transitioning group) compared to Group 1 (pre-transition) and Group 3 (post-transition) and a number of significant gender differences were also identified across the groups. The study highlights the importance of considering all relevant psychosocial factors, such as anxiety, gender and the degree of knowledge the individual holds of their own condition during the transition process in order to develop psycho-educational programmes and transition pathways. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The Neural Representation of Consonant-Vowel Transitions in Adults Who Wear Hearing Aids

    PubMed Central

    Tremblay, Kelly L.; Kalstein, Laura; Billings, Cuttis J.; Souza, Pamela E.

    2006-01-01

    Hearing aids help compensate for disorders of the ear by amplifying sound; however, their effectiveness also depends on the central auditory system's ability to represent and integrate spectral and temporal information delivered by the hearing aid. The authors report that the neural detection of time-varying acoustic cues contained in speech can be recorded in adult hearing aid users using the acoustic change complex (ACC). Seven adults (50–76 years) with mild to severe sensorineural hearing participated in the study. When presented with 2 identifiable consonant-vowel (CV) syllables (“shee” and “see”), the neural detection of CV transitions (as indicated by the presence of a P1-N1-P2 response) was different for each speech sound. More specifically, the latency of the evoked neural response coincided in time with the onset of the vowel, similar to the latency patterns the authors previously reported in normal-hearing listeners. PMID:16959736

  14. The Occupational Transition Process to Upper Secondary School, Further Education and/or Work in Sweden: As Described by Young Adults with Asperger Syndrome and Attention Deficit Hyperactivity Disorder.

    PubMed

    Baric, Vedrana Bolic; Hemmingsson, Helena; Hellberg, Kristina; Kjellberg, Anette

    2017-03-01

    The aim was to describe the occupational transition process to upper secondary school, further education and/or work, and to discover what support influences the process from the perspectives of young adults with Asperger syndrome or attention deficit/hyperactivity disorder. This qualitative study was performed in Sweden and comprised interviews with 15 young adults recruited from community based day centres. Support influencing the process included: occupational transition preparation in compulsory school, practical work experience in a safe environment, and support beyond the workplace. The overall understanding shows that the occupational transition process was a longitudinal one starting as early as in middle school, and continuing until the young adults obtained and were able to remain in employment or further education.

  15. A Systematic Review of the Role of Gender in Securing and Maintaining Employment Among Youth and Young Adults with Disabilities.

    PubMed

    Lindsay, Sally; Cagliostro, Elaine; Albarico, Mikhaela; Srikanthan, Dilakshan; Mortaji, Neda

    2018-06-01

    Purpose There is a critical need for gender-specific vocational supports for young adults with disabilities as they transition to employment. We conducted a systematic review to explore the role of gender in securing and maintaining employment. Methods Systematic searches of seven databases identified 48 studies meeting our inclusion criteria. Using a narrative synthesis approach, these studies were analyzed in terms of the characteristics of the participants, methodology, results, and quality of the evidence. Results Among the 48 studies, 112,473 participants (56% male), mean age (of the total sample) was 21, represented across ten countries. Twenty-one studies reported that young men with disabilities had better employment outcomes than women with disabilities. Eight studies showed that females with disabilities had better employment outcomes than males. Five studies reported that there were no gender differences in employment outcomes for youth with various disabilities. With regards to maintaining employment, men with disabilities often work more hours and have better wages compared to women with disabilities. There are several gender-related barriers and facilitators to maintaining employment including social supports and gender role expectations. Conclusions Our findings highlight that there is a critical need for gender-specific vocational supports for young adults with disabilities.

  16. Racial and ethnic differences in leaving and returning to the parental home: The role of life course transitions, socioeconomic resources, and family connectivity

    PubMed Central

    Lei, Lei; South, Scott J.

    2016-01-01

    BACKGROUND Although Black and Hispanic young adults in the U.S. are less likely than Whites to move out of the parental home and more likely than Whites to return, reasons for these differences have not been clearly identified. OBJECTIVE This study examines the ability of racial/ethnic disparities in life course transitions, socioeconomic resources, and family connectivity to account for racial/ethnic differences in leaving and returning home. METHODS Using data from the 2005–2011 waves of the Panel Study of Income Dynamics’ Transition into Adulthood study (N=1,491, age 18 to 26), we estimated discrete-time event history models predicting the timing of moving out of and back into the parental home. RESULTS Although no single factor completely explained racial-ethnic differences in the timing of leaving and returning to the parental home, the bulk of the Black-White differences in both home-leaving and home-returning was explained by group differences in transitions into adult roles, the ability to afford independent living, and connections to the origin family. These factors also explained most of the Mexican-White difference in home-leaving. However, only a small portion of the Hispanic-White difference in returning home was attributable to the proposed explanatory variables. CONCLUSION Explanations for racial and ethnic differences in the timing of leaving and returning to the parental home need to consider a broad array of life course characteristics in which Black, Hispanic, and White youth differ. The factors that explain Black-White differences in home-leaving and home-returning may differ from those that explain Hispanic-White differences in these behaviors. PMID:27110219

  17. The role of media and public opinion efforts in the transit field : the Detroit region case study.

    DOT National Transportation Integrated Search

    2014-03-01

    This study, one of seven comprising the report Factors that Inhibit and Enable Effective Regional Transit in Southeastern : Michigan, explores the role of media and public opinion efforts in developing support for regional transit initiatives. The go...

  18. Incorporating the Six Core Elements of Health Care Transition Into a Medicaid Managed Care Plan: Lessons Learned From a Pilot Project.

    PubMed

    McManus, Margaret; White, Patience; Pirtle, Robin; Hancock, Catina; Ablan, Michael; Corona-Parra, Raquel

    2015-01-01

    This pediatric-to-adult health care transition pilot project describes the process and results of incorporating the "Six Core Elements of Health Care Transition (2.0)" into a Medicaid managed care plan with a group of 35 18-23 year olds who have chronic mental health, developmental, and complex medical conditions. The pilot project demonstrated an effective approach for customizing and delivering recommended transition services. At the start of the 18-month project, the Medicaid plan was at the basic level (1) of transition implementation of the Six Core Elements with no transition policy, member transition readiness assessment results, health care transition plans of care, updated medical summaries, transfer package for the adult-focused provider, and assurance of transfer completion and consumer feedback. At the conclusion of the pilot project, the plan scored at level 3 on each core element. The primary reason for not scoring at the highest level (4) was because the transition elements have not been incorporated into services for all enrollees within the plan. Future efforts in managed care will benefit from starting the transition process much earlier (ages 12-14), expanding the role of nurse care managers and participating pediatric and adult-focused clinicians in transition, and offering payment incentives to clinicians to implement the Six Core Elements of Health Care Transition. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration.

    PubMed

    Kristof, Lorand; Fortinsky, Richard H; Kellett, Kathy; Porter, Martha; Robison, Julie

    2017-01-01

    This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver's perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.

  20. Epilepsy in transition from child care to adult service: a missing link in sub-Saharan Africa.

    PubMed

    Adebiyi, Ayoade; Lagunju, IkeOluwa; Ogunniyi, Adesola

    2017-07-01

    Epilepsy is a common chronic neurological disease which predominantly affects children and young adults. The disease is highly stigmatised and transition from child care to adult services is not routine in many low- and middle-income countries. Where a treatment system follows routines which cannot be sustained in such countries because of specialised manpower challenges, it becomes imperative that appropriate care models be sought for patients whose seizures fail to remit in childhood. In teaching hospitals, well-organised, multidisciplinary meetings and a planned transfer between paediatric and adult neurologists will be feasible. However, an alternative model is advocated at the community level where the majority of the patients reside which involves task shifting to general practitioners and community healthcare workers. The latter can organise home visits to ensure management compliance. This will ensure better seizure outcomes and a good quality of life for epileptic patients.

  1. Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care.

    PubMed

    Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D

    2018-04-01

    The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.

  2. Methodology used in comparative studies assessing programmes of transition from paediatrics to adult care programmes: a systematic review.

    PubMed

    Le Roux, E; Mellerio, H; Guilmin-Crépon, S; Gottot, S; Jacquin, P; Boulkedid, R; Alberti, C

    2017-01-27

    To explore the methodologies employed in studies assessing transition of care interventions, with the aim of defining goals for the improvement of future studies. Systematic review of comparative studies assessing transition to adult care interventions for young people with chronic conditions. MEDLINE, EMBASE, ClinicalTrial.gov. 2 reviewers screened comparative studies with experimental and quasi-experimental designs, published or registered before July 2015. Eligible studies evaluate transition interventions at least in part after transfer to adult care of young people with chronic conditions with at least one outcome assessed quantitatively. 39 studies were reviewed, 26/39 (67%) published their final results and 13/39 (33%) were in progress. In 9 studies (9/39, 23%) comparisons were made between preintervention and postintervention in a single group. Randomised control groups were used in 9/39 (23%) studies. 2 (2/39, 5%) reported blinding strategies. Use of validated questionnaires was reported in 28% (11/39) of studies. In terms of reporting in published studies 15/26 (58%) did not report age at transfer, and 6/26 (23%) did not report the time of collection of each outcome. Few evaluative studies exist and their level of methodological quality is variable. The complexity of interventions, multiplicity of outcomes, difficulty of blinding and the small groups of patients have consequences on concluding on the effectiveness of interventions. The evaluation of the transition interventions requires an appropriate and common methodology which will provide access to a better level of evidence. We identified areas for improvement in terms of randomisation, recruitment and external validity, blinding, measurement validity, standardised assessment and reporting. Improvements will increase our capacity to determine effective interventions for transition care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  3. Methodology used in comparative studies assessing programmes of transition from paediatrics to adult care programmes: a systematic review

    PubMed Central

    Le Roux, E; Mellerio, H; Guilmin-Crépon, S; Gottot, S; Jacquin, P; Boulkedid, R; Alberti, C

    2017-01-01

    Objective To explore the methodologies employed in studies assessing transition of care interventions, with the aim of defining goals for the improvement of future studies. Design Systematic review of comparative studies assessing transition to adult care interventions for young people with chronic conditions. Data sources MEDLINE, EMBASE, ClinicalTrial.gov. Eligibility criteria for selecting studies 2 reviewers screened comparative studies with experimental and quasi-experimental designs, published or registered before July 2015. Eligible studies evaluate transition interventions at least in part after transfer to adult care of young people with chronic conditions with at least one outcome assessed quantitatively. Results 39 studies were reviewed, 26/39 (67%) published their final results and 13/39 (33%) were in progress. In 9 studies (9/39, 23%) comparisons were made between preintervention and postintervention in a single group. Randomised control groups were used in 9/39 (23%) studies. 2 (2/39, 5%) reported blinding strategies. Use of validated questionnaires was reported in 28% (11/39) of studies. In terms of reporting in published studies 15/26 (58%) did not report age at transfer, and 6/26 (23%) did not report the time of collection of each outcome. Conclusions Few evaluative studies exist and their level of methodological quality is variable. The complexity of interventions, multiplicity of outcomes, difficulty of blinding and the small groups of patients have consequences on concluding on the effectiveness of interventions. The evaluation of the transition interventions requires an appropriate and common methodology which will provide access to a better level of evidence. We identified areas for improvement in terms of randomisation, recruitment and external validity, blinding, measurement validity, standardised assessment and reporting. Improvements will increase our capacity to determine effective interventions for transition care. PMID:28131998

  4. The Role of Postural Support in Young Adults' Control of Stationary Kicking

    ERIC Educational Resources Information Center

    Sidaway, Ben; Bouchard, Matthew; Chasse, Julie; Dunn, Jonathan; Govoni, Andrea; McPherson, Breanne; Roy, Katherine; Anderson, David I.

    2017-01-01

    Purpose: The requirement for postural stability during the performance of motor skills has been clearly demonstrated in infants, but the necessity for such a postural substrate is not well documented in adults. The present study investigated the role of postural stability during a ballistic ball-kicking task in adults by providing varying degrees…

  5. Mothers of Young Adults with Intellectual Disability: Multiple Roles, Ethnicity and Well-Being

    ERIC Educational Resources Information Center

    Eisenhower, A.; Blacher, J.

    2006-01-01

    Background: Two opposing perspectives--role strain and role enhancement--were considered as predictive of women's psychological and physical health. The authors examined the relation between multiple role occupancy (parenting, employment, marriage) and well-being (depression and health) among mothers of young adults with intellectual disability…

  6. Transition from Pediatric to Adult OI Care

    MedlinePlus

    Moving from Pediatric to Adult Care Introduction Teen and young adult years are a critical time for major life changes. An ... for youth who have OI is moving from pediatric care into the adult care system. Children’s hospitals ...

  7. From the clinical to the managerial domain: the lived experience of role transition from radiographer to radiology manager in South-East Queensland.

    PubMed

    Thompson, Alarna M N; Henwood, Suzanne M

    2016-06-01

    This study seeks to add to current literature a descriptive account of the lived experience of radiographers' transition to, and experiences of, management roles and identifies additional resources and support that are perceived as being beneficial for this transition. This study employed a descriptive phenomenological stance. Using purposive sampling, six South-East Queensland based private practice radiology managers, who had held their position for longer than 3 months, participated in audiotape recorded in-depth interviews exploring their transition to, and experiences of management in radiology. Thematic analysis was used to describe and make meaning of the data. Overall, five central themes emerged through thematic analysis of the data. The results indicate that all participants' had an underlying drive to succeed during their role transition and highlight the importance of a comprehensive orientation by a mentor; the training and support to enable preparation for the role, especially in the area of people management skills and communication; the importance of access to networking opportunities and the importance of concise expectations from higher management. Role transition can be marred with uncertainty, however; key suggestions indicate the importance of having support mechanisms in place before, during and after transitioning to a managerial role.

  8. The Role of the Community in Transition to the Adult World for Students with Disabilities

    ERIC Educational Resources Information Center

    Hoover, Ariel

    2016-01-01

    Community activities can be an important part of the transition to adulthood, but many students with disabilities miss those experiences because they are not offered in their community or high school. This lack of opportunities in schools may account for the discrepancy that is found after high school graduation between the employment rates of…

  9. The Role of Language in Adult Education and Poverty Reduction in Botswana

    NASA Astrophysics Data System (ADS)

    Bagwasi, Mompoloki

    2006-05-01

    This study examines the role of language in reducing poverty in Botswana through adult-education programs. Because language is the medium through which human beings communicate and grow intellectually and socially, it should form the basis of any discussion involving the relation between development and education. In order best to respond to societal changes and bridge the gap between the less privileged and the more privileged, adult-education programs should be guided by language policies that are sensitive to this pivotal role that language plays. Language is important in any discussion of poverty reduction because it determines who has access to educational, political and economic resources. The author recommends that adult-education programs in Botswana take account of the multilingual nature of society and so allow learners to participate freely, make use of their indigenous knowledge, and enhance their self-esteem and identity.

  10. Does productive role occupancy prevent depression among older rural Chinese adults? A latent difference score analysis.

    PubMed

    Hsiao, Hsin-Yi; Xu, Ling; Chi, Iris; Silverstein, Merril

    2014-01-01

    Depression has been reported as common among older rural Chinese adults, who often face limited access to healthcare services and resources. Empirical studies conducted in the West have shown beneficial effects of productive engagement on psychological well-being. However, the mechanisms by which engagement in productive activities leads to and results from improved mental health remain unclear. Utilizing role enhancement and social resource theories, the present study investigated the relationship between productive role occupancy and depression among older Chinese adults in rural areas over 8 years. Using four waves of data from the Well-Being of Elderly in Anhui Province of China study, we employed bivariate latent different score analysis to examine the temporal sequence of productive role occupancy and depression among 1696 older adults. Findings indicated that trajectories of productive role occupancy and depression rose across the four waves. There is evidence for self-feedback effects in productive role occupancy and depression. Depression had a significant effect on subsequent changes in productive role occupancy (β = -0.042, p = 0.000), whereas productive role occupancy had no significant effect on subsequent changes in depression. The mental well-being of participants worsened over time. Engaging in productive activities had no effect on mental health status, and rural older adults with poor mental health were less likely to engage in productive activities over time. Findings suggest that psychological well-being as a personal resource significantly affects how productively Chinese adults age in late life.

  11. Social Networks and Health Among Older Adults in Lebanon: The Mediating Role of Support and Trust

    PubMed Central

    Antonucci, Toni C.; Ajrouch, Kristine J.; Abdulrahim, Sawsan

    2015-01-01

    Objectives. Despite a growing body of literature documenting the influence of social networks on health, less is known in other parts of the world. The current study investigates this link by clustering characteristics of network members nominated by older adults in Lebanon. We then identify the degree to which various types of people exist within the networks. This study further examines how network composition as measured by the proportion of each type (i.e., type proportions) is related to health; and the mediating role of positive support and trust in this process. Method. Data are from the Family Ties and Aging Study (2009). Respondents aged ≥60 were selected (N = 195) for analysis. Results. Three types of people within the networks were identified: Geographically Distant Male Youth, Geographically Close/Emotionally Distant Family, and Close Family. Having more Geographically Distant Male Youth in one’s network was associated with health limitations, whereas more Close Family was associated with no health limitations. Positive support mediated the link between type proportions and health limitations, whereas trust mediated the link between type proportions and depressive symptoms. Discussion. Results document links between the social networks and health of older adults in Lebanon within the context of ongoing demographic transitions. PMID:25324295

  12. Turner syndrome: transition from pediatrics to adulthood.

    PubMed

    Rubin, Karen R

    2008-09-01

    To highlight the importance of an improved, seamless, and effective transition from pediatric to adult care, especially for medically complex conditions such as Turner syndrome (TS). The morbidities in adult patients with TS are reviewed, including features of the metabolic syndrome, congenital and acquired cardiovascular conditions, osteopenia and osteoporosis, autoimmune thyroid disease, and obesity, and psychobehavioral issues are addressed, in terms of promoting the development of independent self-care and autonomy in adolescent patients. An essential component of high-quality health care, transition for adolescents with TS needs to be reengineered as a staged process initiated during early-stage adolescence (about age 12 years), when exogenous estrogen therapy is begun in coordination with the final phase of growth hormone therapy. At this time, the focus of care shifts from the parent to the adolescent and from maximizing final adult height to inducing puberty with gradually increasing doses of estrogen. During this transition, the development of healthful and independent healthcare behaviors should be promoted to prepare patients with TS for the adult responsibility of self-care. During the final phase of transition, an adult care plan should be formulated in collaboration with the adolescent with TS and her providers of adult care to improve the likelihood that she will continue to be carefully monitored in a way that optimizes her adult health and longevity. The transitional period from pediatrics to adulthood is the ideal time for patients with TS to be made aware of their health history and health needs and of the evolving impact of TS into adulthood.

  13. Building a National Framework for Adolescent and Young Adult Hematology and Oncology and Transition from Pediatric to Adult Care: Report of the Inaugural Meeting of the "AjET" Working Group of the German Society for Pediatric Oncology and Hematology.

    PubMed

    Escherich, Gabriele; Bielack, Stefan; Maier, Stephan; Braungart, Ralf; Brümmendorf, Tim H; Freund, Mathias; Grosse, Regine; Hoferer, Anette; Kampschulte, Rebecca; Koch, Barbara; Lauten, Melchior; Milani, Valeria; Ross, Henning; Schilling, Freimut; Wöhrle, Dieter; Cario, Holger; Dirksen, Uta

    2017-06-01

    Adolescents and young adults (AYAs) with hemato-oncological problems constitute a heterogenous group with characteristic particularities, specific needs, and age-related clinical and unique psychosocial features. Strong collaboration between pediatric and adult hemato-oncology settings is essential to address their needs appropriately. This is not only true for patients who first become ill during adolescence or young adulthood, but equally so for people who contract hemato-oncological diseases congenitally or as younger children and who are now becoming old enough to leave the pediatric setting and have to transit into "adult" medical care. Efforts to create environments that meet the specific needs of the AYA population affected by hemato-oncological diseases have been initiated in many countries. Due to international variations between societies in general and healthcare infrastructures in particular, the challenges posed to creating such environments vary considerably from country to country. Aiming at addressing these on a national basis for Germany, a dedicated Working Group on Adolescents, Young Adults, and Transition (Arbeitsgemeinschaft Adoleszenten, junge Erwachsene, Transition, AjET) was established. This meeting report depicts the content and discussions of the first interdisciplinary conference on treatment, transition, and long-term follow-up in AYAs with cancer or chronic/inborn hematological diseases. The AjET group of the German Society for Pediatric Oncology and Hematology (GPOH) intends to increase the national awareness for AYAs; strengthen the collaboration of pediatric and adult care givers; and initiate, promote, and coordinate collaborative activities in the fields of basic and translational research, clinical care, and long-term follow-up aimed at improving the current situation.

  14. Issues in Transition.

    ERIC Educational Resources Information Center

    McNair, Jeff, Ed.; Kronick, Nancy, Ed.

    Six papers address issues in the transition of students with disabilities into the adult world of work. In "Workplace Support," Jeff McNair defines "support," differentiates types of support, and considers various foci of intervention. The second paper titled, "Cross-Cultural Transition: An Exigent Topic for Study" by Nancy Kronick, reviews…

  15. Implications of an Advice-Giving and Teacher Role on Language Production in Adults with Dementia

    ERIC Educational Resources Information Center

    Dijkstra, Katinka; Bourgeois, Michelle; Youmans, Gina; Hancock, Adrienne

    2006-01-01

    Purpose: The purpose of the two studies described in this paper was to assess whether adults with dementia could assume an advice-giving role (Study 1) and a teacher role (Study 2) despite their cognitive impairments. So far, no research on adults with dementia has compared language production in a social conversation condition with that in an…

  16. 'Talking a different language': an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services.

    PubMed

    McLaren, Susan; Belling, Ruth; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim; Hovish, Kimberly; Islam, Zoebia; White, Sarah; Singh, Swaran P

    2013-07-03

    Organizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential. The study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England. A cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and joint meetings. Cultural

  17. Transition to adulthood of female garment-factory workers in Bangladesh.

    PubMed

    Amin, S; Diamond, I; Naved, R T; Newby, M

    1998-06-01

    This article examines data from a study on garment-factory workers in Bangladesh to explore the implications of work for the early socialization of young women. For the first time, large numbers of young Bangladeshi women are being given an alternative to lives in which they move directly from childhood to adulthood through early marriage and childbearing. Employment creates a period of transition in contrast to the abrupt assumption of adult roles at very young ages that marriage and childbearing mandate. This longer transition creates a period of adolescence for young women working in the garment sector that is shown to have strong implications for the women's long-term reproductive health.

  18. [The transition process from paediatric to adult services: A perspective from hospitalised adolescent sufferers of chronic diseases].

    PubMed

    Inostroza Quezada, Carolina; Correa Venegas, María Loreto; Besoain Arrau, Carolina; Reinoso Medinelli, Alejandro; Velarde Lizama, Macarena; Valenzuela Mujica, María Teresa; Bedregal García, Paula; Zubarew Gurtchin, Tamara

    2016-01-01

    Chronic illnesses during adolescence are a big challenge for the patient, his or her family, and health care providers. The transition from paediatric health services to adult health services involves a programmed and planned transfer process of adolescent sufferers of chronic illnesses, in order to maintain a high quality of life and bio-psycho-social development. There is currently no transition model. The objective of the study is to understand the transition process from the perspective of hospitalised adolescents to collaborate towards the design of a model that meets the needs studied. Semi-structured interviews with 13 adolescent sufferers of chronic illnesses, hospitalised in two healthcare centres in Santiago, Chile, in one analytical-relational study, supported by qualitative methodology. In the analysis, 5 major themes stand out: experience of living with the illness, the importance of the doctor-patient relationship, the concept of limited autonomy to the pharmacology, the absence of the transition process as such, and the identification of barriers and needs for an adequate transition. This study is new in Chile in that it explores the phenomenom of the transition of adolescents with chronic illnesses. It emphasises the need to reinforce the concept of self-care and autonomy from early stages of care, and the importance of early planning of a healthy transition process, in accordance to the detected needs of the adolescents themselves. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  19. The role of the hippocampus in transitive inference

    PubMed Central

    Zalesak, Martin; Heckers, Stephan

    2009-01-01

    Transitive inference (TI) is the ability to infer the relationship between items (e.g., A>C) after having learned a set of premise pairs (e.g., A>B and B>C). Previous studies in humans have identified a distributed neural network, including cortex, hippocampus, and thalamus, during TI judgments. We studied two aspects of TI using fMRI of subjects who had acquired the 6-item sequence (A>B>C>D>E>F) of visual stimuli. First, the identification of novel pairs not containing end items (i.e., B>D, C>E, B>E) was associated with greater left hippocampal activation when compared to the identification of novel pairs containing end items A and F. This demonstrates that the identification of stimulus pairs requiring the flexible representation of a sequence is associated with hippocampal activation. Second, for the three novel pairs devoid of end items we found greater right hippocampal activation for pairs B>D and C>E compared with pair B>E. This indicates that TI decisions on pairs derived from more adjacent items in the sequence are associated with greater hippocampal activation. Hippocampal activation thus scales with the degree of relational processing necessary for TI judgments. Both findings confirm a role of the hippocampus in transitive inference in humans. PMID:19216061

  20. Substance use changes and social role transitions: proximal developmental effects on ongoing trajectories from late adolescence through early adulthood.

    PubMed

    Staff, Jeremy; Schulenberg, John E; Maslowsky, Julie; Bachman, Jerald G; O'Malley, Patrick M; Maggs, Jennifer L; Johnston, Lloyd D

    2010-11-01

    Substance use changes rapidly during late adolescence and early adulthood. This time in the life course is also dense with social role changes, as role changes provide dynamic context for individual developmental change. Using nationally representative, multiwave longitudinal data from age 18 to 28, we examine proximal links between changes in social roles and changes in substance use during the transition to adulthood. We find that changes in family roles, such as marriage, divorce, and parenthood, have clear and consistent associations with changes in substance use. With some notable exceptions, changes in school and work roles have weaker effects on changes in substance use compared to family roles. Changes in socializing (i.e., nights out for fun and recreation) and in religiosity were found to mediate the relationship of social role transitions to substance use. Two time-invariant covariates, socioeconomic background and heavy adolescent substance use, predicted social role status, but did not moderate associations, as within-person links between social roles and substance use were largely equivalent across groups. This paper adds to the cascading effects literature by considering how, within individuals, more proximal variations in school, work, and family roles relate to variations in substance use, and which roles appear to be most influential in precipitating changes in substance use during the transition to adulthood.

  1. Substance Use Changes and Social Role Transitions: Proximal Developmental Effects on Ongoing Trajectories from Late Adolescence through Early Adulthood*

    PubMed Central

    Staff, Jeremy; Schulenberg, John E.; Maslowsky, Julie; Bachman, Jerald G.; O’Malley, Patrick M.; Maggs, Jennifer L.; Johnston, Lloyd D.

    2010-01-01

    Substance use changes rapidly during late adolescence and early adulthood. Not coincidentally, this time in the life course is also dense with social role changes, as role changes provide dynamic context for individual developmental change. Using nationally representative, multiwave longitudinal data from age 18 to 28, we examine proximal links between changes in social roles and changes in substance use during the transition to adulthood. We find that changes in family roles, such as marriage, divorce, and parenthood, have clear and consistent associations with changes in substance use. With some notable exceptions, changes in school and work roles have weaker effects on changes in substance use compared to family roles. Changes in socializing (i.e., nights out for fun and recreation) and in religiosity were found to mediate the relationship of social role transitions to substance use. Two time- invariant covariates, socioeconomic background and heavy adolescent substance use, predicted social role status, but did not moderate associations, as within-person links between social roles and substance use were largely equivalent across groups. This paper adds to the cascading effects literature by considering how, within individuals, more proximal variations in school, work, and family roles relate to variations in substance use; and which roles appear to be most influential in precipitating changes in substance use during the transition to adulthood. PMID:20883590

  2. New graduate registered nurse transition into primary health care roles: an integrative literature review.

    PubMed

    Murray-Parahi, Pauline; DiGiacomo, Michelle; Jackson, Debra; Davidson, Patricia M

    2016-11-01

    To summarise the literature describing new graduate nurse transition to professional practice within the primary health care (PHC) setting. There is a plethora of research literature spanning several decades about new graduate nurse transition in the acute care setting. Yet, the experiences of new graduate nurse in the PHC setting is unremarkable particularly considering the increasing demand for skilled health care workers and focus of health reform to provide care where people work and live. Electronic data bases, Academic Search Complete, EBSCO, Medline, PsycINFO, CINHAL, and ERIC were searched using a combination of terms and synonyms arising from three key concepts which identify the phenomenon; 'transition', 'new graduate registered nurse' and 'primary health care. An inclusive search strategy placed no limits on language or publication date. Of the 50 articles located and examined for relevance; 40 were sourced through databases and 10 from Google Scholar/Alerts and hand-searching references. None of the 19 articles retained for analysis addressed all key concepts. Some challenges of researching the professional transition of graduate nurses in PHC settings included, an absence of definitive transition models, a dearth of literature and deference to acute care research. Nursing in PHC settings, particularly the client's home is notably different to hospital settings because of higher levels of isolation and autonomy. Societal changes, health reform and subsequent demand for skilled workers in PHC settings has caused health care providers to question the logic that such roles are only for experienced nurses. Implications arise for education and health service providers who desire to close the theory practice gap and mitigate risk for all stakeholders when next generation nurses have limited opportunities to experience PHC roles as undergraduates and newly graduated registered nurses are already transitioning in this setting. © 2016 John Wiley & Sons Ltd.

  3. Gold fillings unravel the vacancy role in the phase transition of GeTe

    NASA Astrophysics Data System (ADS)

    Feng, Jinlong; Xu, Meng; Wang, Xiaojie; Lin, Qi; Cheng, Xiaomin; Xu, Ming; Tong, Hao; Miao, Xiangshui

    2018-02-01

    Phase change memory (PCM) is an important candidate for future memory devices. The crystalline phase of PCM materials contains abundant intrinsic vacancies, which plays an important role in the rapid phase transition upon memory switching. However, few experimental efforts have been invested to study these invisible entities. In this work, Au dopants are alloyed into the crystalline GeTe to fill the intrinsic Ge vacancies so that the role of these vacancies in the amorphization of GeTe can be indirectly studied. As a result, the reduction of Ge vacancies induced by Au dopants hampers the amorphization of GeTe as the activation energy of this process becomes higher. This is because the vacancy-interrupted lattice can be "repaired" by Au dopants with the recovery of bond connectivity. Our results demonstrate the importance of vacancies in the phase transition of chalcogenides, and we employ the percolation theory to explain the impact of these intrinsic defects on this vacancy-ridden crystal quantitatively. Specifically, the threshold of amorphization increases with the decrease in vacancies. The understanding of the vacancy effect sheds light on the long-standing puzzle of the mechanism of ultra-fast phase transition in PCMs. It also paves the way for designing low-power-consumption electronic devices by reducing the threshold of amorphization in chalcogenides.

  4. Food Security in Older Adults: Community Service Provider Perceptions of Their Roles

    ERIC Educational Resources Information Center

    Keller, Heather H.; Dwyer, John J. M.; Edwards, Vicki; Senson, Christine; Edward, H. Gayle

    2007-01-01

    Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food…

  5. TRANSFER FROM PEDIATRIC TO ADULT ENDOCRINOLOGY.

    PubMed

    Jones, Marybeth R; Robbins, Brett W; Augustine, Marilyn; Doyle, Jackie; Mack-Fogg, Jean; Jones, Heather; White, Patience H

    2017-07-01

    Adult and pediatric endocrinologists share responsibility for the transition of youth with type 1 diabetes from pediatric to adult healthcare. This study aimed to increase successful transfers to adult care in subspecialty practices by establishing a systematic health care transition (HCT) process. Providers from the adult and pediatric endocrinology divisions at the University of Rochester Medical Center met monthly to customize and integrate the Six Core Elements (6CEs) of HCT into clinical workflows. Young adult patients with type 1 diabetes having an outpatient visit during a 34-month pre-post intervention period were eligible (N = 371). Retrospective chart review was performed on patients receiving referrals to adult endocrinology (n = 75) to obtain (1) the proportion of patients explicitly tracked during transfer from the pediatric to adult endocrinology practice, (2) the providers' documentation of the use of the 6CEs, and (3) the patients' diabetes control and healthcare utilization during the transition period. The percent of eligible patients with type 1 diabetes who were explicitly tracked in their transfer more than doubled compared to baseline (11% vs. 27% of eligible patients; P<.01). Pediatric providers started to use transition readiness assessments and create medical summaries, and adult providers increased closed-loop communication with pediatric providers after a patient's first adult visit. Glycemic control and healthcare utilization remained stable. Successful implementation of the 6CEs into pediatric and adult subspecialty practices can result in improvements of planned transfers of pediatric patients with type 1 diabetes to adult subspecialty providers. 6CEs = six core elements; AYA = adolescent and young adult; DKA = diabetic ketoacidosis; ED = emergency department; HbA1c = hemoglobin A1c; HCT = health care transition.

  6. Evidence-Based Instructional Strategies for Transition. Brookes Transition to Adulthood Series

    ERIC Educational Resources Information Center

    Test, David W.

    2012-01-01

    To meet the high-stakes requirements of IDEA's Indicator 13, professionals need proven and practical ways to support successful transitions for young adults with significant disabilities. Now there's a single guidebook to help them meet that critical goal--straight from David Test, one of today's most highly respected authorities on transitions to…

  7. Transitioning Adult Education Students into Community College

    ERIC Educational Resources Information Center

    Humpherys, Bryce Ralph

    2012-01-01

    At both a national and state level there is a growing need for skilled workers in the labor force. Educating low skilled adults is one way to address this need. Adult education programs teach low skilled adults basic academic skills to prepare them for work and life in U.S. society. Until recently little attention was paid to transitioning…

  8. The Role of Religiosity in Influencing Adolescent and Adult Alcohol Use in Trinidad

    ERIC Educational Resources Information Center

    Rollocks, Steve C. T.; Dass, Natasha; Seepersad, Randy; Mohammed, Linda

    2008-01-01

    This study examined the role of religiosity among adolescents' and adults' alcohol use in Trinidad. A stratified random sample design of 369 adolescents and 210 adult parents belonging to the various religious groups in Trinidad was employed. Participants were randomly selected from various educational districts across Trinidad. Adolescent…

  9. The role of molecular gas in galaxy transition in compact groups

    NASA Astrophysics Data System (ADS)

    Lisenfeld, U.; Alatalo, K.; Zucker, C.; Appleton, P. N.; Gallagher, S.; Guillard, P.; Johnson, K.

    2017-11-01

    Compact groups (CGs) provide an environment in which interactions between galaxies and with the intra-group medium enable and accelerate galaxy transitions from actively star forming to quiescent. Galaxies in transition from active to quiescent can be selected, by their infrared (IR) colors, as canyon or infrared transition zone (IRTZ) galaxies. We used a sample of CG galaxies with IR data from the Wide Field Infrared Survey Explorer (WISE) allowing us to calculate the stellar mass and star formation rate (SFR) for each galaxy. Furthermore, we present new CO(1-0) data for 27 galaxies and collect data from the literature to calculate the molecular gas mass for a total sample of 130 galaxies. This data set allows us to study the difference in the molecular gas fraction (Mmol/M∗) and star formation efficiency (SFE = SFR/Mmol) between active, quiescent, and transitioning (I.e., canyon and IRTZ) galaxies. We find that transitioning galaxies have a mean molecular gas fraction and a mean SFE that are significantly lower than those of actively star-forming galaxies. The molecular gas fraction is higher than that of quiescent galaxies, whereas the SFE is similar. These results indicate that the transition from actively star-forming to quiescent in CG galaxies goes along with a loss of molecular gas, possibly due to tidal forces exerted from the neighboring galaxies or a decrease in the gas density. In addition, the remaining molecular gas loses its ability to form stars efficiently, possibly owing to turbulence perturbing the gas,as seen in other, well-studied examples such as Stephan's Quintet and HCG 57. Thus, the amount and properties of molecular gas play a crucial role in the environmentally driven transition of galaxies from actively star forming to quiescent. Full Table 2 is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/607/A110

  10. Age-related changes in the ease of dynamical transitions in human brain activity.

    PubMed

    Ezaki, Takahiro; Sakaki, Michiko; Watanabe, Takamitsu; Masuda, Naoki

    2018-06-01

    Executive functions, a set of cognitive processes that enable flexible behavioral control, are known to decay with aging. Because such complex mental functions are considered to rely on the dynamic coordination of functionally different neural systems, the age-related decline in executive functions should be underpinned by alteration of large-scale neural dynamics. However, the effects of age on brain dynamics have not been firmly formulated. Here, we investigate such age-related changes in brain dynamics by applying "energy landscape analysis" to publicly available functional magnetic resonance imaging data from healthy younger and older human adults. We quantified the ease of dynamical transitions between different major patterns of brain activity, and estimated it for the default mode network (DMN) and the cingulo-opercular network (CON) separately. We found that the two age groups shared qualitatively the same trajectories of brain dynamics in both the DMN and CON. However, in both of networks, the ease of transitions was significantly smaller in the older than the younger group. Moreover, the ease of transitions was associated with the performance in executive function tasks in a doubly dissociated manner: for the younger adults, the ability of executive functions was mainly correlated with the ease of transitions in the CON, whereas that for the older adults was specifically associated with the ease of transitions in the DMN. These results provide direct biological evidence for age-related changes in macroscopic brain dynamics and suggest that such neural dynamics play key roles when individuals carry out cognitively demanding tasks. © 2018 Wiley Periodicals, Inc.

  11. Role of transit service providers in land development.

    DOT National Transportation Integrated Search

    2013-06-01

    While various transit development initiatives, such as integrated transit and land development and transit-oriented development, have been proposed in the past, many transit agencies in the United States are experiencing declining ridership and incre...

  12. Mothers of Young Adults with Intellectual Disability: Multiple Roles, Ethnicity, and Well-Being

    PubMed Central

    2011-01-01

    Background Two opposing perspectives--role strain and role enhancement—were considered as predictive of women’s psychological and physical health. The authors examined the relation between multiple role occupancy (parenting, employment, marriage) and well-being (depression and health) among mothers of young adults with intellectual disability (ID). Method Participants were 226 mothers aged 35-70 years caring for a young adult aged 16-26 years with moderate to severe/profound ID. Mothers were either of Latino ethnicity (n=117) or Anglo (n=109). Mothers’ ethnicity and degree of acculturation and young adults’ adaptive behaviour and behaviour problems were examined as potential moderators. Results Mothers who were employed, married, or both reported better well-being than mothers who were both unemployed and unmarried, especially when their offspring had relatively higher adaptive functioning. This relationship between role occupancy and well-being was fully mediated by socio-economic (SES) factors. Results did not suggest a role enhancement effect, but instead indicated a role shortage effect; unemployed, unmarried mothers experienced markedly poor well-being, while all other mothers experienced comparable well-being. Well-being scores were higher for Anglo than for Latino mothers; this relationship was entirely accounted for by SES. In Latina mothers, the relation between role occupancy and well-being was moderated by degree of acculturation. Conclusions Findings suggest that multiple roles benefit mothers of young adults with ID primarily through their impact on socio-economic resources. For more acculturated Latina mothers, occupying more roles predicted better well-being even after controlling for SES. Latina mothers who were unemployed and unmarried had lower SES, and this group emerged as at particular risk. The latter group may benefit most from respite assistance and other interventions aimed at addressing their physical and mental health. PMID

  13. Predicting the transition from juvenile delinquency to adult criminality: Gender-specific influences in two high-risk samples.

    PubMed

    Rhoades, Kimberly A; Leve, Leslie D; Eddy, J Mark; Chamberlain, Patricia

    2016-12-01

    Most juvenile offenders desist from offending as they become adults, but many continue and ultimately enter the adult corrections system. There has been little prospective examination of which variables may predict the latter transition, particularly for women. Our aim was to find out, for men and women separately, what variables identifiable in adolescent offenders predict their continuation of offending into adult life. Participants were 61 male and 81 female youths who had been referred from the juvenile justice system for chronic delinquency and recruited into randomised controlled trials comparing Multidimensional Treatment Foster Care with group care ('treatment as usual'). All participants had attained adulthood by the time of our study. We first examined gender differences in childhood risk factors and then used Cox proportional-hazards models to estimate the relationship of potential risk factors to first adult arrest. Results indicated that, for men, juvenile justice referrals alone predicted risk of any first adult arrest as well as arrest for felony arrest specifically. Each additional juvenile referral increased the risk of any adult arrest by 9% and of adult felony arrest by 8%. For women, family violence, parental divorce and cumulative childhood risk factors, but not juvenile justice referrals, were significant predictors of adult arrest. Each additional childhood risk factor increased the risk of adult arrest by 21%. Women who experienced parental divorce were nearly three times more likely to be arrested as an adult, and those who experienced family violence 2.5 times more so than those without such experiences. We found preliminary evidence of gender differences in childhood risk factors for adult offending, and, thus potentially, for the development and use of interventions tailored differently for girls and boys and young men and young women to reduce their risk of becoming adult recidivists. Copyright © 2015 John Wiley & Sons, Ltd. Copyright

  14. "Just take your medicine and everything will be fine": Responsibilisation narratives in accounts of transitioning young people with HIV into adult care services in Australia.

    PubMed

    Newman, Christy E; Persson, Asha; Miller, Angela; Brown, Rebecca J

    2016-01-01

    Young people who have grown up with perinatally acquired HIV in wealthy nations are increasingly transitioning into adult care settings which expect more independence and self-regulation than paediatric care. Drawing on the first qualitative study on growing up with HIV in Australia, this paper examines "responsibilisation" narratives in semi-structured interviews conducted with young people with HIV and their paediatric and adult care providers. Three dominant narratives were identified: responsibilisation as imperative, practice and contest. This suggests that while young people growing up with HIV in an advanced liberal setting such as Australia may value the independence of adult care, and appreciate the need to take responsibility for their health, the practices involved in becoming a responsible health citizen are shaped by individual histories and circumstances, and in some cases, can lead to serious contestation and conflict with care providers. Placing a stronger emphasis on what young people can gain from taking an active role in managing their health may more successfully foster responsibilisation, rather than focusing on what they will lose. Clinicians could benefit from greater support regarding how to engage young people with the elements of responsibilisation likely to resonate more meaningfully at different points in their lives.

  15. Roles of Engineering Correlations in Hypersonic Entry Boundary Layer Transition Prediction

    NASA Technical Reports Server (NTRS)

    Campbell, Charles H.; Anderson, Brian P.; King, Rudolph A.; Kegerise, Michael A.; Berry, Scott A.; Horvath, Thomas J.

    2010-01-01

    Efforts to design and operate hypersonic entry vehicles are constrained by many considerations that involve all aspects of an entry vehicle system. One of the more significant physical phenomenon that affect entry trajectory and thermal protection system design is the occurrence of boundary layer transition from a laminar to turbulent state. During the Space Shuttle Return To Flight activity following the loss of Columbia and her crew of seven, NASA's entry aerothermodynamics community implemented an engineering correlation based framework for the prediction of boundary layer transition on the Orbiter. The methodology for this implementation relies upon similar correlation techniques that have been is use for several decades. What makes the Orbiter boundary layer transition correlation implementation unique is that a statistically significant data set was acquired in multiple ground test facilities, flight data exists to assist in establishing a better correlation and the framework was founded upon state of the art chemical nonequilibrium Navier Stokes flow field simulations. Recent entry flight testing performed with the Orbiter Discovery now provides a means to validate this engineering correlation approach to higher confidence. These results only serve to reinforce the essential role that engineering correlations currently exercise in the design and operation of entry vehicles. The framework of information related to the Orbiter empirical boundary layer transition prediction capability will be utilized to establish a fresh perspective on this role, and to discuss the characteristics which are desirable in a next generation advancement. The details of the paper will review the experimental facilities and techniques that were utilized to perform the implementation of the Orbiter RTF BLT Vsn 2 prediction capability. Statistically significant results for multiple engineering correlations from a ground testing campaign will be reviewed in order to describe why only

  16. Implicit Attitude Toward Caregiving: The Moderating Role of Adult Attachment Styles

    PubMed Central

    De Carli, Pietro; Tagini, Angela; Sarracino, Diego; Santona, Alessandra; Parolin, Laura

    2016-01-01

    Attachment and caregiving are separate motivational systems that share the common evolutionary purpose of favoring child security. In the goal of studying the processes underlying the transmission of attachment styles, this study focused on the role of adult attachment styles in shaping preferences toward particular styles of caregiving. We hypothesized a correspondence between attachment and caregiving styles: we expect an individual to show a preference for a caregiving behavior coherent with his/her own attachment style, in order to increase the chance of passing it on to offspring. We activated different representations of specific caregiving modalities in females, by using three videos in which mothers with different Adult Attachment states of mind played with their infants. Participants' facial expressions while watching were recorded and analyzed with FaceReader software. After each video, participants' attitudes toward the category “mother” were measured, both explicitly (semantic differential) and implicitly (single target-implicit association task, ST-IAT). Participants' adult attachment styles (experiences in close relationships revised) predicted attitudes scores, but only when measured implicitly. Participants scored higher on the ST-IAT after watching a video coherent with their attachment style. No effect was found on the facial expressions of disgust. These findings suggest a role of adult attachment styles in shaping implicit attitudes related to the caregiving system. PMID:26779060

  17. Health Literacy and Social Capital: What Role for Adult Literacy Partnerships and Pedagogy?

    ERIC Educational Resources Information Center

    Black, Stephen; Balatti, Jo; Falk, Ian

    2013-01-01

    This paper makes the case for adult literacy (including numeracy) practitioners to play a greater role in health literacy initiatives in Australia. The paper draws on data from a national research project that investigated adult literacy partnerships and pedagogy viewed from a social capital perspective. The primary purpose of the project was to…

  18. Youth experiences of transition from child mental health services to adult mental health services: a qualitative thematic synthesis.

    PubMed

    Broad, Kathleen L; Sandhu, Vijay K; Sunderji, Nadiya; Charach, Alice

    2017-11-28

    Adolescence and young adulthood is a vulnerable time during which young people experience many development milestones, as well as an increased incidence of mental illness. During this time, youth also transition between Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). This transition puts many youth at risk of disengagement from service use; however, our understanding of this transition from the perspective of youth is limited. This systematic review aims to provide a more comprehensive understanding of youth experiences of transition from CAMHS to AMHS, through a qualitative thematic synthesis of the extant literature in this area. Published and unpublished literature was searched using keywords targeting three subject areas: Transition, Age and Mental Health. Studies were included if they qualitatively explored the perceptions and experiences of youth who received mental health services in both CAMHS and AMHS. There were no limitations on diagnosis or age of youth. Studies examining youth with chronic physical health conditions were excluded. Eighteen studies, representing 14 datasets and the experiences of 253 unique service-users were included. Youth experiences of moving from CAMHS and AMHS are influenced by concurrent life transitions and their individual preferences regarding autonomy and independence. Youth identified preparation, flexible transition timing, individualized transition plans, and informational continuity as positive factors during transition. Youth also valued joint working and relational continuity between CAMHS and AMHS. Youth experience a dramatic culture shift between CAMHS and AMHS, which can be mitigated by individualized and flexible approaches to transition. Youth have valuable perspectives to guide the intelligent design of mental health services and their perspectives should be used to inform tools to evaluate and incorporate youth perspectives into transitional service improvement

  19. Vulnerable Youth and Transitions to Adulthood

    ERIC Educational Resources Information Center

    Xie, Rongbing; Sen, Bisakha; Foster, E. Michael

    2014-01-01

    This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth.

  20. Neurogenesis in the embryonic and adult brain: same regulators, different roles

    PubMed Central

    Urbán, Noelia; Guillemot, François

    2014-01-01

    Neurogenesis persists in adult mammals in specific brain areas, known as neurogenic niches. Adult neurogenesis is highly dynamic and is modulated by multiple physiological stimuli and pathological states. There is a strong interest in understanding how this process is regulated, particularly since active neuronal production has been demonstrated in both the hippocampus and the subventricular zone (SVZ) of adult humans. The molecular mechanisms that control neurogenesis have been extensively studied during embryonic development. Therefore, we have a broad knowledge of the intrinsic factors and extracellular signaling pathways driving proliferation and differentiation of embryonic neural precursors. Many of these factors also play important roles during adult neurogenesis, but essential differences exist in the biological responses of neural precursors in the embryonic and adult contexts. Because adult neural stem cells (NSCs) are normally found in a quiescent state, regulatory pathways can affect adult neurogenesis in ways that have no clear counterpart during embryogenesis. BMP signaling, for instance, regulates NSC behavior both during embryonic and adult neurogenesis. However, this pathway maintains stem cell proliferation in the embryo, while it promotes quiescence to prevent stem cell exhaustion in the adult brain. In this review, we will compare and contrast the functions of transcription factors (TFs) and other regulatory molecules in the embryonic brain and in adult neurogenic regions of the adult brain in the mouse, with a special focus on the hippocampal niche and on the regulation of the balance between quiescence and activation of adult NSCs in this region. PMID:25505873

  1. Experiences of Habitual Physical Activity in Maintaining Roles and Functioning among Older Adults: A Qualitative Study

    PubMed Central

    Svantesson, Ulla; Willén, Carin

    2016-01-01

    Physically active older adults have reduced risk of functional restrictions and role limitations. Several aspects may interrelate and influence habitual physical activity (PA). However, older adults' own perspectives towards their PA need to be addressed. The aim of this study was to explore the experiences of habitual physical activity in maintaining roles and functioning among older adult Palestinians ≥60 years. Data were collected through in-depth interviews based on a narrative approach. Seventeen participants were recruited (aged 64–84 years). Data were analyzed using a narrative interpretative method. Findings. Three central narratives were identified, “keep moving, stay healthy,” “social connectedness, a motive to stay active,” and “adapting strategies to age-related changes.” Conclusion. Habitual physical activity was perceived as an important factor to maintain functioning and to preserve active roles in older adults. Walking was the most prominent pattern of physical activity and it was viewed as a vital tool to maintain functioning among the older adults. Social connectedness was considered as a contributing factor to the status of staying active. To adapt the process of age-related changes in a context to stay active, the participants have used different adapting strategies, including protective strategy, awareness of own capabilities, and modifying or adopting new roles. PMID:28078141

  2. The role of space telescopes in the characterization of transiting exoplanets.

    PubMed

    Hatzes, Artie P

    2014-09-18

    Characterization studies now have a dominant role in the field of exoplanets. Such studies include the measurement of an exoplanet's bulk density, its brightness temperature and the chemical composition of its atmosphere. The use of space telescopes has played a key part in the characterization of transiting exoplanets. These facilities offer astronomers data of exquisite precision and temporal sampling as well as access to wavelength regions of the electromagnetic spectrum that are inaccessible from the ground. Space missions such as the Hubble Space Telescope, Microvariability and Oscillations of Stars (MOST), Spitzer Space Telescope, Convection, Rotation and Planetary Transits (CoRoT), and Kepler have rapidly advanced our knowledge of the physical properties of exoplanets and have blazed a trail for a series of future space missions that will help us to understand the observed diversity of exoplanets.

  3. "If I had been given that information back then": An interpretive description exploring the information needs of adults with cerebral palsy looking back on their transition to adulthood.

    PubMed

    Freeman, M; Stewart, D; Cunningham, C E; Gorter, J W

    2018-06-11

    Young people with cerebral palsy (CP) and their families have identified lack of information received during the transition to adulthood as a barrier to successful outcomes. To date, few studies have explored the information needs, preferences, timing, and method of provision from the perspective of individuals with CP. The methodological approach to this qualitative study was interpretive description. Nine adults living with CP, between the ages of 20 and 40, were purposively recruited in Ontario, Canada, to explore, retrospectively, their information needs during the transition to adulthood. Participants completed a 1-hour interview that explored their experiences seeking and receiving information. Interviews were transcribed verbatim, and data were analysed to create a thematic description of adults' experiences with information. Three themes emerged: (a) "Recognizing and supporting information needs," which highlighted the importance of support systems to assist young people in receiving and seeking information throughout the transition; (b) "Getting creative," which highlighted strategies young people use when confronted with environmental barriers when seeking information; and (c) "Gaps and advice for the future," which highlighted the need for real-life opportunities, during the transition to adulthood, to experience some of the responsibilities of adult life. Clinicians assisting young people with CP need purposefully to foster knowledge and skills during the transition to adulthood. They should be not only providers of information but also enablers of opportunities for immersion in real-life experiences to prepare for adult life. It is important for young people to have the opportunity to discuss challenges and exchange information with their peers. © 2018 John Wiley & Sons Ltd.

  4. MET: roles in epithelial-mesenchymal transition and cancer stemness

    PubMed Central

    Jeon, Hye-Min

    2017-01-01

    In a number of cancers, deregulated MET pathway leads to aberrantly activated proliferative and invasive signaling programs that promote malignant transformation, cell motility and migration, angiogenesis, survival in hypoxia, and invasion. A better understanding of oncogenic MET signaling will help us to discover effective therapeutic approaches and to identify which tumors are likely to respond to MET-targeted cancer therapy. In this review, we will summarize the roles of MET signaling in cancer, with particular focus on epithelial-mesenchymal transition (EMT) and cancer stemness. Then, we will provide update on MET targeting agents and discuss the challenges that should be overcome for the development of an effective therapy. PMID:28164090

  5. Father role: A comparison between teenage and adult first-time fathers in Thailand.

    PubMed

    Sriyasak, Atcharawadee; Almqvist, Anna-Lena; Sridawruang, Chaweewan; Häggström-Nordin, Elisabet

    2015-09-01

    In this study, we compared perceived father roles among teenage and adult first-time fathers in Thailand. The design was cross-sectional and comparative, and the sample involved 70 teenage and 70 adult fathers, whose children were 2-6 months old. The fathers were recruited from 32 primary healthcare centers in the western region of Thailand. Three validated, self-reported questionnaires with multiple-choice questions were used for data collection. Differences between the two groups were analyzed using χ(2)-test and the Mann-Whitney U-test. The results revealed differences between teenage and adult fathers concerning income, educational level, and intention to have a baby. The teenage father group had a lower sense of competence, and scored lower on childrearing behavior and father-child relationship than the adult father group. These findings provide healthcare professionals with increased knowledge and understanding of teenage fathers' needs in preparing for parenthood. Given that we now know the importance of positive father roles in children's lives, health authorities should be expected to provide resources to help support these fathers. © 2015 Wiley Publishing Asia Pty Ltd.

  6. The Role of Magma During Continent-Ocean Transition

    NASA Astrophysics Data System (ADS)

    Bastow, Ian; Keir, Derek; Rooney, Tyrone; Kendall, J.-Michael

    2010-05-01

    Passive margins worldwide are often considered magmatic because they are characterised by thick sequences of extrusive and intrusive igneous rocks emplaced around the time of continental breakup. Despite the global abundance of such margins, however, it is difficult to discriminate between different models of both extension and melt generation, since most ruptured during Gondwana breakup >100Ma and the continent-ocean transition (COT) is now hidden by thick, basaltic seaward dipping reflectors (SDRs). These margins are no longer tectonically active so the roles of faulting, stretching and magma intrusion in accommodating extension, and timing of SDRs emplacement during rift evolution have to be inferred from rifting models or from the geological record preserved at the fully developed passive margin. Similarly mantle processes during COT development have long since ceased, so whether breakup was characterized by broad thermal upwelling, small-scale convection or a fertile geoscientific mantle remains ambiguous. The East African rift in Ethiopia offers a unique opportunity to address all these problems because south-to-north it exposes subaerially the transition from continental rifting and incipient sea-floor spreading within a young flood basalt province. Here we present a suite of geophysical and geochemical observations from Ethiopia that document the significance of magma intrusion and extrusion as rifting evolves from an initially broad zone of stretching and faulting to a narrower axial graben in which magma injection dominates strain.

  7. Growing Financial Assets for Foster Youths: Expanded Child Welfare Responsibilities, Policy Conflict, and Caseworker Role Tension.

    PubMed

    Peters, Clark M; Sherraden, Margaret; Kuchinski, Ann Marie

    2016-10-01

    The study reported in this article explores the role child welfare workers play in elevating the financial capability (FC) of foster youths transitioning to adulthood. It draws on an examination of Opportunity Passport, a component of the Jim Casey Youth Opportunities Initiative, which operates across the United States. The authors held in-depth, structured interviews with eight staff and 38 current and former foster youths age 18 years and older in four sites across three states. Findings indicate that (a) program participants require professional financial assistance that is beyond the role of the traditional child welfare caseworker; (b) caseworkers who address FC in young adults face uncertainty in their roles; and (c) broader policies relevant to young adults transitioning to adulthood exhibit tension, if not conflict, regarding enhancing FC. The authors highlight the importance of expanding the role of caseworkers to incorporate elements of FC in serving the needs of foster youths.

  8. Social networks and health among older adults in Lebanon: the mediating role of support and trust.

    PubMed

    Webster, Noah J; Antonucci, Toni C; Ajrouch, Kristine J; Abdulrahim, Sawsan

    2015-01-01

    Despite a growing body of literature documenting the influence of social networks on health, less is known in other parts of the world. The current study investigates this link by clustering characteristics of network members nominated by older adults in Lebanon. We then identify the degree to which various types of people exist within the networks. This study further examines how network composition as measured by the proportion of each type (i.e., type proportions) is related to health; and the mediating role of positive support and trust in this process. Data are from the Family Ties and Aging Study (2009). Respondents aged ≥60 were selected (N = 195) for analysis. Three types of people within the networks were identified: Geographically Distant Male Youth, Geographically Close/Emotionally Distant Family, and Close Family. Having more Geographically Distant Male Youth in one's network was associated with health limitations, whereas more Close Family was associated with no health limitations. Positive support mediated the link between type proportions and health limitations, whereas trust mediated the link between type proportions and depressive symptoms. Results document links between the social networks and health of older adults in Lebanon within the context of ongoing demographic transitions. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. The important role of water in growth of monolayer transition metal dichalcogenides

    NASA Astrophysics Data System (ADS)

    Kastl, Christoph; Chen, Christopher T.; Kuykendall, Tevye; Shevitski, Brian; Darlington, Thomas P.; Borys, Nicholas J.; Krayev, Andrey; Schuck, P. James; Aloni, Shaul; Schwartzberg, Adam M.

    2017-06-01

    2D transition metal dichalcogenides (TMDs) are commonly grown by chemical vapor deposition using transition metal oxides as solid precursors. Despite the widespread use of this technique, challenges in reproducibility, coverage, and material quality are pervasive, suggestive of unknown and uncontrolled process parameters. In this communication, we demonstrate the impact of water vapor on this growth process. Our results show a direct correlation between gas phase water content and the morphology of TMD films. In particular, we show that the presence of water enhances volatilization, and therefore the vapor transport of tungsten and molybdenum oxide. Surprisingly, we find that water not only plays an important role in volatilization but is also compatible with TMD growth. In fact, carefully controlled humidity can consistently produce high quality, luminescent materials.

  10. Women Facing the Multiple Role Challenge. Adult Women Studying Social Work and Adult Education in Canada: A Study of Their Multiple Role Experiences and of Supports Available to Them. Final Report.

    ERIC Educational Resources Information Center

    Home, Alice M.

    A study examined the multiple role experiences of 20 adult women studying social work and adult education in 7 programs throughout Canada and the supports available to the women. Also interviewed during the study were two professors and the department head from each program, a field instructor, several program coordinators, and five employers.…

  11. North/South Differences Among Italian Emerging Adults Regarding Criteria Deemed Important for Adulthood and Life Satisfaction

    PubMed Central

    Piumatti, Giovanni; Garro, Maria; Pipitone, Laura; Di Vita, Angela Maria; Rabaglietti, Emanuela

    2016-01-01

    The main goal of this study was to compare Northern and Southern Italian emerging adult university students, regarding the importance attributed to criteria for adulthood and the levels of life and education satisfaction. Self-report questionnaires were filled by 475 Northern and Southern Italian University students (Age M = 22.91, 76% females, n = 359). Multivariate analysis of variance revealed that Southern emerging adults were more likely to place importance on family capacities, norm compliance, interdependence and role transitions as criteria for achieving adulthood than Northern emerging adults. Regarding gender differences, females were more likely to believe in the importance of norm compliance than males, while males were more likely to espouse the importance of legal transitions. Finally, emerging adults from the North reported higher levels of life satisfaction than their Southern counterparts. We interpreted these findings in light of socio-economical and gender socialization differences among Northern and Southern Italian emerging adults. PMID:27298636

  12. Transitioning Adults to College: Adult Basic Education Program Models. NCSALL Occasional Paper

    ERIC Educational Resources Information Center

    Zafft, Cynthia; Kallenbach, Silja; Spohn, Jessica

    2006-01-01

    While the majority of adults who take the General Educational Development (GED) test do so in order to continue their education, few go on to enter postsecondary education. Yet, these same adults stand to make substantial economic and personal gains when they use their adult secondary credential to move from the ranks of high school dropout to…

  13. Nursing Role Transition Preceptorship

    ERIC Educational Resources Information Center

    Batory, Susan M.

    2014-01-01

    The preceptorship clinical experience in a practical nursing (PN) program at a Midwestern community college is considered crucial to the PN students' transition from novice nurse to professional nurse. However, no research has been available to determine whether the preceptorship clinical accomplishes its purpose. A case study was conducted to…

  14. Mass transit : bus rapid transit shows promise

    DOT National Transportation Integrated Search

    2001-09-17

    The U. S. General Accounting Office (GAO) was asked to (1) examine the federal role in supporting Bus Rapid Transit; (2) compare the capital costs, operating costs, and performance characteristics of Bus Rapid Transit and Light Rail systems; and (3) ...

  15. The Evolution of Work Values during the School-to-Work Transition: The Case of Young Adults in the "Missing Middle"

    ERIC Educational Resources Information Center

    Masdonati, Jonas; Fournier, Geneviève; Pinault, Mathieu; Lahrizi, Imane Z.

    2016-01-01

    Adopting a mixed method design, this paper explores the configuration and evolution of work values of 64 young adults in transition from education to employment. Qualitative analyses point out the existence of four categories of work values: interesting tasks, good relationships, self-fulfillment, and attractive work conditions. Quantitative…

  16. The Role of Adult-Born Neurons in the Constantly Changing Olfactory Bulb Network

    PubMed Central

    Malvaut, Sarah; Saghatelyan, Armen

    2016-01-01

    The adult mammalian brain is remarkably plastic and constantly undergoes structurofunctional modifications in response to environmental stimuli. In many regions plasticity is manifested by modifications in the efficacy of existing synaptic connections or synapse formation and elimination. In a few regions, however, plasticity is brought by the addition of new neurons that integrate into established neuronal networks. This type of neuronal plasticity is particularly prominent in the olfactory bulb (OB) where thousands of neuronal progenitors are produced on a daily basis in the subventricular zone (SVZ) and migrate along the rostral migratory stream (RMS) towards the OB. In the OB, these neuronal precursors differentiate into local interneurons, mature, and functionally integrate into the bulbar network by establishing output synapses with principal neurons. Despite continuous progress, it is still not well understood how normal functioning of the OB is preserved in the constantly remodelling bulbar network and what role adult-born neurons play in odor behaviour. In this review we will discuss different levels of morphofunctional plasticity effected by adult-born neurons and their functional role in the adult OB and also highlight the possibility that different subpopulations of adult-born cells may fulfill distinct functions in the OB neuronal network and odor behaviour. PMID:26839709

  17. The Effect of an Extended Wilderness Education Experience on Ill-Structured Problem-Solving Skill Development in Emerging Adult Students

    ERIC Educational Resources Information Center

    Collins, Rachel H.

    2014-01-01

    In a society that is becoming more dynamic, complex, and diverse, the ability to solve ill-structured problems has become an increasingly critical skill. Emerging adults are at a critical life stage that is an ideal time to develop the skills needed to solve ill-structured problems (ISPs) as they are transitioning to adult roles and starting to…

  18. A systematic review of mentorship programs to facilitate transition to post-secondary education and employment for youth and young adults with disabilities.

    PubMed

    Lindsay, Sally; R Hartman, Laura; Fellin, Melissa

    2016-07-01

    Youth with disabilities experience barriers in transitioning to Post-Secondary Education (PSE) and employment. Mentorship programs provide a promising approach to supporting youth through those transitions. This paper aims to identify the effective components of mentorship programs and describe participants' experiences. We undertook a systematic review of mentorship interventions for youth and young adults with disabilities. We searched seven electronic databases for peer-reviewed articles published in English between 1980 and 2014. We included articles that examined mentorship interventions focused on PSE or employment outcomes among youth, aged thirty or younger, with physical, developmental, or cognitive disabilities. Of the 5068 articles identified, 22 met the inclusion criteria. For seven mentorship interventions, at least one significant improvement was reported in school- or work-related outcomes. Mentorship programs with significant outcomes were often structured, delivered in group-based or mixed formats, and longer in duration (>6 months). Mentors acted as role models, offered advice, and provided mentees with social and emotional support. Evidence suggests that mentorship programs may be effective for helping youth with disabilities transition to PSE or employment. More rigorously designed studies are needed to document the impact of mentorship programs on school and vocational outcomes for youth with disabilities. Implications for Rehabilitation Mentorship interventions have the potential to effectively support youth with disabilities as they transition to post-secondary education and employment. Youth should consider participating in formal mentorship interventions, and clinicians and educators should encourage them to do so, to enhance social, educational, and vocational outcomes. When developing interventions, clinicians should consider incorporating the effective components (i.e. duration, content, format) of mentorship interventions identified in

  19. Symposium 6: Young people, artificial nutrition and transitional care. The nutritional challenges of the young adult with cystic fibrosis: transition.

    PubMed

    Morton, Alison M

    2009-11-01

    Cystic fibrosis (CF) is a complex multisystem disorder affecting mainly the gastrointestinal tract and respiratory system. Intestinal malabsorption occurs in approximately 90% of patients. In the past, malnutrition was an inevitable consequence of disease progression, leading to poor growth, impaired respiratory muscle function, decreased exercise tolerance and immunological impairment. A positive association between body weight and height and survival has been widely reported. The energy requirements of patients with CF vary widely and generally increase with age and disease severity. For many young adults requirements will be 120-150% of the age-related estimated average requirement. To meet these energy needs patients are encouraged to eat a high-fat high-energy diet with appropriate pancreatic enzyme supplements. Many patients are unable to achieve an adequate intake as a result of a variety of factors including chronic poor appetite, infection-related anorexia, gastro-oesophageal reflux and abdominal pain. Oral energy supplements and enteral tube feeding are widely used. Nutritional support has been shown to improve nutritional status and stabilise or slow the rate of decline in lung function. With such emphasis on nutritional intake and nutritional status throughout life, poor adherence to therapies and issues relating to body image are emerging. The median survival of patients with CF is increasing. CF is now considered a life-limiting disease of adulthood rather than a terminal childhood illness. With increased longevity new challenges are emerging that include the transition of young adults with CF to adult services, CF-related diabetes, disordered eating, osteoporosis, liver disease and transplantation.

  20. What Does It Take to Be an Adult in Austria? Views of Adulthood in Austrian Adolescents, Emerging Adults, and Adults

    ERIC Educational Resources Information Center

    Sirsch, Ulrike; Dreher, Eva; Mayr, Eva; Willinger, Ulrike

    2009-01-01

    The present study examined the defining features of emerging adulthood, subjects' conceptions of the transition to adulthood, and the perceived adult status in Austria. The sample consisted of 775 subjects (226 adolescents, 317 emerging adults, 232 adults). Results showed that most Austrian emerging adults feel themselves to be between adolescence…

  1. High-latitude ocean ventilation and its role in Earth's climate transitions

    PubMed Central

    MacGilchrist, Graeme A. ; Brown, Peter J.; Evans, D. Gwyn; Meijers, Andrew J. S.; Zika, Jan D.

    2017-01-01

    The processes regulating ocean ventilation at high latitudes are re-examined based on a range of observations spanning all scales of ocean circulation, from the centimetre scales of turbulence to the basin scales of gyres. It is argued that high-latitude ocean ventilation is controlled by mechanisms that differ in fundamental ways from those that set the overturning circulation. This is contrary to the assumption of broad equivalence between the two that is commonly adopted in interpreting the role of the high-latitude oceans in Earth's climate transitions. Illustrations of how recognizing this distinction may change our view of the ocean's role in the climate system are offered. This article is part of the themed issue ‘Ocean ventilation and deoxygenation in a warming world’. PMID:28784714

  2. Role of Seasonal Transitions and Westerly Jets in East Asian Paleoclimate

    NASA Astrophysics Data System (ADS)

    Chiang, J. C. H.; Fung, I. Y.; Wu, C. H.; Cai, Y.; Edman, J. P.; Liu, Y.; Day, J. A.; Bhattacharya, T.; Mondal, Y.; Labrousse, C.

    2014-12-01

    The summer rainfall climate of East Asia underwent large and abrupt changes in response to precessional forcing, glacial-interglacial cycles as well as abrupt changes to the North Atlantic during the last glacial. Current interpretations of said changes are typically formulated in terms of modulation of summer monsoon intensity, and do not account for the known complexity in the seasonal evolution of East Asian rainfall, which exhibits sharp transition from the Spring regime to the Meiyu, and then again from the Meiyu to the summertime. We explore the interpretation that East Asian rainfall climate undergoes a modulation of its seasonality during said paleoclimate changes. Following previous suggestions, we focus on role of the westerly jet: namely that the latitude of this westerly jet relative to Tibet is critical in determining the stepwise transitions in East Asian rainfall seasons. In support of this linkage, we show evidence from observational data for such a linkage in the timing of the Meiyu and Summer transitions, with more northward-shifted westerlies associated with earlier transitions. We similarly suggest that East Asian paleoclimate changes resulted from an altered timing in the northward evolution of the jet and hence the seasonal transitions, in particular the transition of the jet from south of the Plateau to the north that determines the seasonal transition from Spring rains to the Meiyu. In an extreme scenario - which we speculate the climate system tended towards during stadial (cold) phases of D/O stadials and periods of low Northern Hemisphere summer insolation - the jet does not jump north of the Plateau, essentially keeping East Asia in prolonged Spring conditions. We show that this hypothesis can explain a key paleoproxy signature of D/O stadials over East Asia, namely the heavier mean δ18O of precipitation as recorded in speleothem records. The southward jet position prevents the low-level monsoonal flow - which is isotopically light

  3. Depressive Symptoms of Older Adults Living Alone: The Role of Community Characteristics.

    PubMed

    Kim, Kyeongmo; Lee, Minhong

    2015-03-01

    Although some evidence suggests that community characteristics may play an important role in the development of depressive symptoms among older adults, current literature has not attended to the role of community characteristics in depression in South Korea. This study begins to address this gap in the literature by examining the relationship of community characteristics and depressive symptoms, controlling for individual characteristics. Using a cross-sectional design and probability sampling, we surveyed 949 older adults living alone in 70 communities in the Busan metropolitan area in South Korea in 2012. A multilevel logistic regression analysis was conducted to test the hypothesis that community characteristics are predictive of depressive symptoms. We find that both the proportion of older adults and the number of senior citizen facilities in a community are associated with depressive symptoms, whereas community poverty is not related to depressive symptoms. Men with lower income, with lower levels of functional abilities, and without stronger family and friend social networks have a higher risk of depressive symptoms. Implications for research, practice, and policy are discussed. © The Author(s) 2015.

  4. Effective process or dangerous precipice: qualitative comparative embedded case study with young people with epilepsy and their parents during transition from children’s to adult services

    PubMed Central

    2013-01-01

    Background Transition from children’s to adult epilepsy services is known to be challenging. Some young people partially or completely disengage from contact with services, thereby risking their health and wellbeing. We conducted a mixed-method systematic review that showed current epilepsy transition models enabling information exchange and developing self-care skills were not working well. We used synthesised evidence to develop a theoretical framework to inform this qualitative study. The aim was to address a critical research gap by exploring communication, information needs, and experiences of knowledge exchange in clinical settings by young people and their parents, during transition from children’s to adult epilepsy services. Method Qualitative comparative embedded Case study with 2 'transition’ cases (epilepsy services) in two hospitals. Fifty-eight participants: 30 young people (13–19 years) and 28 parents were interviewed in-depth (individual or focus group). Clinical documents/guidelines were collated. 'Framework’ thematic analysis was used. The theoretical framework was tested using themes, pattern matching and replication logic. Theory-based evaluation methods were used to understand how and why different models of service delivery worked. Results A joint epilepsy clinic for young people 14–17 years coordinated by children’s and adult services was more likely to influence young people’s behaviour by facilitating more positive engagement with adult healthcare professionals and retention of epilepsy-related self-care information. Critical success factors were continuity of care, on-going and consistent age-appropriate and person centred communication and repeated information exchange. Three young people who experienced a single handover clinic disengaged from services. Psychosocial care was generally inadequate and healthcare professionals lacked awareness of memory impairment. Parents lacked knowledge, skills and support to enable their

  5. Transitions of care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK Study): a study of protocols in Greater London.

    PubMed

    Singh, Swaran P; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim

    2008-06-23

    Although young people's transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in England is a significant health issue for service users, commissioners and providers, there is little evidence available to guide service development. The TRACK study aims to identify factors which facilitate or impede effective transition from CAHMS to AMHS. This paper presents findings from a survey of transition protocols in Greater London. A questionnaire survey (Jan-April 2005) of Greater London CAMHS to identify transition protocols and collect data on team size, structure, transition protocols, population served and referral rates to AMHS. Identified transition protocols were subjected to content analysis. Forty two of the 65 teams contacted (65%) responded to the survey. Teams varied in type (generic/targeted/in-patient), catchment area (locality-based, wider or national) and transition boundaries with AMHS. Estimated annual average number of cases considered suitable for transfer to AMHS, per CAMHS team (mean 12.3, range 0-70, SD 14.5, n = 37) was greater than the annual average number of cases actually accepted by AMHS (mean 8.3, range 0-50, SD 9.5, n = 33). In April 2005, there were 13 active and 2 draft protocols in Greater London. Protocols were largely similar in stated aims and policies, but differed in key procedural details, such as joint working between CAHMS and AMHS and whether protocols were shared at Trust or locality level. While the centrality of service users' involvement in the transition process was identified, no protocol specified how users should be prepared for transition. A major omission from protocols was procedures to ensure continuity of care for patients not accepted by AMHS. At least 13 transition protocols were in operation in Greater London in April 2005. Not all protocols meet all requirements set by government policy. Variation in protocol-sharing organisational units and transition process

  6. Integrating transition theory and bioecological theory: a theoretical perspective for nurses supporting the transition to adulthood for young people with medical complexity.

    PubMed

    Joly, Elizabeth

    2016-06-01

    To present a discussion of a theoretical perspective developed through integrating Meleis' Transition Theory and Bronfenbrenner's Bioecological Theory of Human Development to inform nursing and advanced nursing practice supporting the transition to adulthood for young people with medical complexity. Theoretical perspectives to inform nursing practice in supporting successful transition are limited, yet nurses frequently encounter young people with medical complexity during the transition to adulthood. Discussion paper. A literature search of CINAHL and Medline was conducted in 2014 and included articles from 2003-2014; informal discussions with families; the author's experiences in a transition program. The integrated theoretical perspective described in this paper can inform nurses and advanced practice nurses on contextual influences, program and intervention development across spheres of influence and outcomes for the transition to adulthood for young people with medical complexity. Young people and their families require effective reciprocal interactions with individuals and services across sectors to successfully transition to adulthood and become situated in the adult world. Intervention must also extend beyond the young person to include providers, services and health and social policy. Nurses can take a leadership role in supporting the transition to adulthood for young people with medical complexity through direct care, case management, education and research. It is integral that nurses holistically consider developmental processes, complexity and contextual conditions that promote positive outcomes during and beyond the transition to adulthood. © 2016 John Wiley & Sons Ltd.

  7. Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse.

    PubMed

    Griffiths, Jane; Ewing, Gail; Wilson, Charlotte; Connolly, Michael; Grande, Gunn

    2015-02-01

    UK District Nurses have an important role in enabling a good death. Patients and families need to know the patient is approaching the dying phase, yet evidence suggests breaking bad news about the patient's transition to dying rarely happens. District Nurses spend a lot of time with patients and families during the dying phase and are ideally placed to recognise and discuss the transition to dying. To explore the role of District Nurses in breaking bad news of transition to dying. Qualitative focus groups. Primary care (District Nurse service); Four National Health Service Trusts, North West England. A total of 40 District Nurses across the Trusts, all Registered General Nurse qualified. Median number of years as a District Nurse was 12.5. All had palliative cancer patients on their caseloads. District Nurses' role in breaking bad news of transition to dying was challenging, but the conversation was described as essential preparation for a good death. Four main challenges with the conversations were patients' responses to the prognosis (unawareness, denial and anger), timing the conversation, complexities of the home environment and limited preparation in this aspect of their work. District Nurses are with patients during their last weeks of life. While other colleagues can avoid breaking bad news of transition to dying, District Nurses have no choice if they are to provide optimal end of life care. While ideally placed to carry out this work, it is complex and they are unprepared for it. They urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care. © The Author(s) 2014.

  8. Transition to Living.

    ERIC Educational Resources Information Center

    Repetto, Jeanne B.

    2003-01-01

    Discussion of transition for students with disabilities emphasizes transition skills needed for life beyond work. The importance of assisting students in planning for their life roles as workers, family members, friends, consumers, and community members is discussed. Suggestions are offered to better prepare students for all their life roles by…

  9. THE ROLE OF METASTABLE STATES IN POLYMER PHASE TRANSITIONS: Concepts, Principles, and Experimental Observations

    NASA Astrophysics Data System (ADS)

    Cheng, Stephen Z. D.; Keller, Andrew

    1998-08-01

    Polymer phases can be described in the same way as phases in other condensed matter using a number density operator and its correlation functions. This description requires the understanding of symmetry operations and order at different atomic and molecular levels. Statistical mechanics provides a link between the microscopic description of the structure and motion and the macroscopic thermodynamic properties. Within the limits of the laws of thermodynamics, polymers exhibit a rich variety of phase transition behaviors. By definition, a first-order phase transition describes a transformation that involves a sudden change of thermodynamic properties at its transition temperature, whereas higher-order phase transitions are classified as critical phenomena. Of special interest is the role of metastability in phase and phase transition behaviors. Although a metastable state possesses a local free energy minimum, it is not at the global equilibrium. Furthermore, metastable states can also be associated with phase sizes. Metastable behavior is also observed in phase transformations that are impeded by kinetic limitations along the pathway to thermodynamic equilibrium. This is illustrated in structural and morphological investigations of crystallization and mesophase transitions, liquid-liquid phase separation, vitrification, and gel formation, as well as combinations of transformation processes. In these cases, the metastable state often becomes the dominant state for the entire system and is observed over a range of time and size scales. This review describes the general principles of metastability in polymer phases and phase transitions and provides illustrations from current experimental works in selected areas.

  10. ‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services

    PubMed Central

    2013-01-01

    Background Organizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential. Methods The study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England. Results A cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and

  11. Induced adult stem (iAS) cells and induced transit amplifying progenitor (iTAP) cells-a possible alternative to induced pluripotent stem (iPS) cells?

    PubMed

    Heng, Boon Chin; Richards, Mark; Ge, Zigang; Shu, Yimin

    2010-02-01

    The successful derivation of iPSC lines effectively demonstrates that it is possible to reset the 'developmental clock' of somatic cells all the way back to the initial embryonic state. Hence, it is plausible that this clock may instead be turned back half-way to a less immature developmental stage that is more directly applicable to clinical therapeutic applications or for in vitro pharmacology/toxicology screening assays. Such a suitable developmental state is postulated to be either the putative transit amplifying progenitor stage or adult stem cell stage. It is hypothetically possible to reprogram mature and terminally differentiated somatic cells back to the adult stem cell or transit amplifying progenitor stage, in a manner similar to the derivation of iPSC. It is proposed that the terminology 'Induced Adult Stem Cells' (iASC) or 'Induced Transit Amplifying Progenitor Cells' (iTAPC) be used to described such reprogrammed somatic cells. Of particular interest, is the possibility of resetting the developmental clock of mature differentiated somatic cells of the mesenchymal lineage, explanted from adipose tissue, bone marrow and cartilage. The putative adult stem cell sub-population from which these cells are derived, commonly referred to as 'mesenchymal stem cells', are highly versatile and hold much therapeutic promise in regenerative medicine, as attested to by numerous human clinical trials and animal studies. Perhaps it may be appropriate to term such reprogrammed cells as 'Induced Mesenchymal Stem Cells' (iMSC) or as 'Induced Mesenchumal Progenitor Cells' (iMPC). Given that cells from the same organ/tissue will share some commonalities in gene expression, we hypothesize that the generation of iASC or iTAPC would be more efficient as compared to iPSC generation, since a common epigenetic program must exist between the reprogrammed cells, adult stem cell or progenitor cell types and terminally differentiated cell types from the same organ/tissue.

  12. Role of antioxidants and trace elements in health and immunity of transition dairy cows.

    PubMed

    Spears, Jerry W; Weiss, William P

    2008-04-01

    A number of antioxidants and trace minerals have important roles in immune function and may affect health in transition dairy cows. Vitamin E and beta-carotene are important cellular antioxidants. Selenium (Se) is involved in the antioxidant system via its role in the enzyme glutathione peroxidase. Inadequate dietary vitamin E or Se decreases neutrophil function during the perpariturient period. Supplementation of vitamin E and/or Se has reduced the incidence of mastitis and retained placenta, and reduced duration of clinical symptoms of mastitis in some experiments. Research has indicated that beta-carotene supplementation may enhance immunity and reduce the incidence of retained placenta and metritis in dairy cows. Marginal copper deficiency resulted in reduced neutrophil killing and decreased interferon production by mononuclear cells. Copper supplementation of a diet marginal in copper reduced the peak clinical response during experimental Escherichia coli mastitis. Limited research indicated that chromium supplementation during the transition period may increase immunity and reduce the incidence of retained placenta.

  13. Roles of GasderminA3 in Catagen-Telogen Transition During Hair Cycling.

    PubMed

    Bai, Xiufeng; Lei, Mingxing; Shi, Jiazhong; Yu, Yu; Qiu, Weiming; Lai, Xiangdong; Liu, Yingxin; Yang, Tian; Yang, Li; Widelitz, Randall B; Chuong, Cheng-Ming; Lian, Xiaohua

    2015-09-01

    Hair follicles undergo cyclic behavior through regression (catagen), rest (telogen), and regeneration (anagen) during postnatal life. The hair cycle transition is strictly regulated by the autonomous and extrinsic molecular environment. However, whether there is a switch controlling catagen-telogen transition remains largely unknown. Here we show that hair follicles cycle from catagen to the next anagen without transitioning through a morphologically typical telogen after Gsdma3 mutation. This leaves an ESLS (epithelial strand-like structure) during the time period corresponding to telogen phase in WT mice. Molecularly, Wnt10b is upregulated in Gsdma3 mutant mice. Restoration of Gsdma3 expression in AE (alopecia and excoriation) mouse skin rescues hair follicle telogen entry and significantly decreases the Wnt10b-mediated Wnt/β-catenin signaling pathway. Overexpression of Wnt10b inhibits telogen entry by increasing epithelial strand cell proliferation. Subsequently, hair follicles with a Gsdma3 mutation enter the second anagen simultaneously as WT mice. Hair follicles cannot enter the second anagen with ectopic WT Gsdma3 overexpression. A luciferase reporter assay proves that Gsdma3 directly suppresses Wnt signaling. Our findings suggest that Gsdma3 has an important role in catagen-telogen transition by balancing the Wnt signaling pathway and that morphologically typical telogen is not essential for the initiation of a new hair cycle.

  14. Roles of GasderminA3 in catagen- telogen transition during hair cycling

    PubMed Central

    Bai, Xiufeng; Lei, Mingxing; Shi, Jiazhong; Yu, Yu; Qiu, Weiming; Lai, Xiangdong; Liu, Yingxin; Yang, Tian; Yang, Li; Widelitz, Randall Bruce; Chuong, Cheng-Ming; Lian, Xiaohua

    2015-01-01

    Hair follicles undergo cyclic behavior through regression (catagen), rest (telogen) and regeneration (anagen) during postnatal life. The hair cycle transition is strictly regulated by the autonomous and extrinsic molecular environment. However, whether there is a switch controlling catagen-telogen transition remains largely unknown. Here we show that hair follicles cycle from catagen to the next anagen without transitioning through a morphologically typical telogen after Gsdma3 mutation. This leaves an ESLS (epithelial strand-like structure) during the time period corresponding to telogen phase in WT mice. Molecularly, Wnt10b is upregulated in Gsdma3 mutant mice. Restoration of Gsdma3 expression in AE (alopecia and excoriation) mouse skin rescues hair follicle telogen entry and significantly decreases the Wnt10b-mediated Wnt/β-catenin signaling pathway. Overexpression of Wnt10b inhibits telogen entry by increasing epithelial strand cell proliferation. Subsequently, hair follicles with a Gsdma3 mutation enter the second anagen simultaneously as WT mice. Hair follicles cannot enter the second anagen with ectopic WT Gsdma3 overexpression. A luciferase reporter assay proves Gsdma3 directly suppresses Wnt signaling. Our findings suggest Gsdma3 plays an important role in catagen-telogen transition by balancing the Wnt signaling pathway, and that morphologically typical telogen is not essential for the initiation of a new hair cycle. PMID:25860385

  15. “Missing Pieces” – Functional, Social, and Environmental Barriers to Recovery for Vulnerable Older Adults Transitioning From Hospital to Home

    PubMed Central

    Greysen, S. Ryan; Hoi-Cheung, Doug; Garcia, Veronica; Kessell, Eric; Sarkar, Urmimala; Goldman, Lauren; Schneidermann, Michelle; Critchfield, Jeffrey; Pierluissi, Edgar; Kushel, Margot

    2014-01-01

    Background Recent interventions to improve transitions in care for older adults focus on hospital discharge processes. Limited data exists on patient concerns for care at home after discharge, particularly for vulnerable older adults. Design We used in-depth, in-person interviews to describe barriers to recovery at home after leaving the hospital for vulnerable, older adults. We purposefully sampled by age, gender, race, and English proficiency to ensure a wide breadth of experiences. Interviews were independently coded by two investigators using the constant comparative method. Thematic analysis was performed by the entire research team with diverse backgrounds in primary care, hospital medicine, geriatrics, and nursing. Setting and Participants We interviewed vulnerable older adults (low income/health literacy, and/or Limited English Proficiency) who were enrolled in a larger discharge interventional study within 30 days of discharge from an urban public hospital. All participants were interviewed in their native language (English, Spanish, or Chinese). Results We interviewed 24 patients: mean age 63 (55–84), 66% male, 67% Non-white, 16% Spanish-speaking, 16% Chinese-speaking. We identified an overarching theme of “missing pieces” in the plan for post-discharge recovery at home from which three specific sub-themes emerged: (1) functional limitations and difficulty with mobility and self-care tasks; (2) social isolation and lack of support from family and friends; (3) challenges from poverty and the built environment at home. In contrast, patients described mostly supportive experiences with traditional focuses of transition care such as following prescribed medication and diet regimens. Conclusion Hospital-based discharge interventions that focus on traditional aspects of care may overlook social and functional gaps in post-discharge care at home for vulnerable older adults. Post-discharge interventions that address these challenges may be necessary to

  16. Prebiotic coordination chemistry: The potential role of transition-metal complexes in the chemical evolution

    NASA Technical Reports Server (NTRS)

    Beck, M.

    1979-01-01

    In approaching the extremely involved and complex problem of the origin of life, consideration of the coordination chemistry appeared not only as a possibility but as a necessity. The first model experiments appear to be promising because of prebiotic-type synthesis by means of transition-metal complexes. It is especially significant that in some instances various types of vitally important substances (nucleic bases, amino acids) are formed simultaneously. There is ground to hope that systematic studies in this field will clarify the role of transition-metal complexes in the organizatorial phase of chemical evolution. It is obvious that researchers working in the fields of the chemistry of cyano and carbonyl complexes, and of the catalytic effect of transition-metal complexes are best suited to study these aspects of the attractive and interesting problem of the origin of life.

  17. The roles of adult siblings in the lives of people with severe intellectual and developmental disabilities.

    PubMed

    Hall, Sarah A; Rossetti, Zach

    2018-05-01

    Siblings of people with intellectual and developmental disabilities (IDD) often assume key roles to support their brothers and sisters. For people with more significant support needs, siblings may undertake additional roles and responsibilities throughout their lives. The purpose of the present study was to identify and describe the roles of adult siblings who have a brother or sister with severe IDD. Seventy-nine adult siblings from 19 to 72 years of age completed an online survey with open-ended questions about the roles they play in their relationships with their brother or sister. Thematic analysis resulted in identification of several roles including caregiver, friend (social partner), advocate, legal representative, sibling (teacher/role model), leisure planner and informal service coordinator. Siblings assume key roles in the lives of people with IDD and need support from family and professionals to perform these roles. © 2017 John Wiley & Sons Ltd.

  18. "Hit the ground running": perspectives of new nurses and nurse managers on role transition and integration of new graduates.

    PubMed

    Chernomas, Wanda M; Care, W Dean; McKenzie, Jo-Ann Lapointe; Guse, Lorna; Currie, Jan

    2010-01-01

    The workplace for new graduates must be a constructive learning environment to facilitate their development. Nurse managers need new graduates who can "hit the ground running." Conflict between the needs of new nurses and the realities of the workplace often creates role confusion and tension in new graduates and threatens employers' ability to retain them. As part of a larger study that examined the effectiveness of a new strategy on new nurse retention and workplace integration, we conducted focus groups with new nurses and nurse managers. This paper discusses the perspectives of new nurses on their role transition from graduates to practising professionals and the perspectives of nurse managers on the workplace integration of new nurses. The thematic findings integrate new nurses' perspectives on their needs during role transition with the perspectives of nurse managers in meeting those needs. The discussion includes strategies to facilitate successful transition and integration of new nurses into the workplace within the context of recruitment and retention.

  19. Transient, but not persistent, adult food insecurity influences toddler development.

    PubMed

    Hernandez, Daphne C; Jacknowitz, Alison

    2009-08-01

    In this study, we examined characteristics associated with experiencing persistent and transitional adult food insecurity and how persistent and transitional adult food insecurity influences toddler cognitive and motor development, along with toddler's weight and health status. Using the first 2 waves of the Early Childhood Longitudinal Study-Birth Cohort, 4 mutually exclusive variables capturing persistent and transitional adult food insecurity were created to capture those adults that experience adult food insecurity in the following: both waves, in 1 wave (at 9 or 24 mo after birth), and never experience food insecurity. We used logistic regression models to estimate characteristics associated with the likelihood of experiencing persistent and transitional adult food insecurity. Ordinary least squares regression models were used to estimate how persistent and transitional adult food insecurity influences toddler development. Similar factors influenced one's likelihood of experiencing adult transitional and persistent food insecurity; individuals who experienced any food insecurity were more economically disadvantaged. Thus, outreach efforts do not need to vary by duration of food insecurity. Whereas negative effects of food insecurity on school-aged children are found in the literature, it appears toddlers are buffered from the effects of persistent adult food insecurity. Our findings suggest that toddlers residing with a temporarily food-insecure adult compared with a never food-insecure adult experienced immediate, but small, negative effects on their development. Hence, outreach and assistance may lessen immediate impacts of food insecurity on toddler development.

  20. Begin the Between: Planning for the Transition from High School to Adult Life for Youth with Developmental Disabilities. Second Edition.

    ERIC Educational Resources Information Center

    Matuszak, Trish; And Others

    This guide was developed to provide an overview of the major elements of the transition planning process from school to the adult system of supports and services for youth with developmental disabilities and their families. The workbook format is intended to enable families to be proactive at each stage of the planning process. Initial sections…

  1. High-latitude ocean ventilation and its role in Earth's climate transitions.

    PubMed

    Naveira Garabato, Alberto C; MacGilchrist, Graeme A; Brown, Peter J; Evans, D Gwyn; Meijers, Andrew J S; Zika, Jan D

    2017-09-13

    The processes regulating ocean ventilation at high latitudes are re-examined based on a range of observations spanning all scales of ocean circulation, from the centimetre scales of turbulence to the basin scales of gyres. It is argued that high-latitude ocean ventilation is controlled by mechanisms that differ in fundamental ways from those that set the overturning circulation. This is contrary to the assumption of broad equivalence between the two that is commonly adopted in interpreting the role of the high-latitude oceans in Earth's climate transitions. Illustrations of how recognizing this distinction may change our view of the ocean's role in the climate system are offered.This article is part of the themed issue 'Ocean ventilation and deoxygenation in a warming world'. © 2017 The Authors.

  2. Are the health needs of young people with cerebral palsy met during transition from child to adult health care?

    PubMed

    Solanke, F; Colver, A; McConachie, H

    2018-05-01

    The transition from child to adult health care is a particular challenge for young people with cerebral palsy, who have a range of needs. The measurement of reported needs, and in particular unmet needs, is one means to assess the effectiveness of services. We recruited 106 young people with cerebral palsy, before transfer from child services, along with their parents to a 3-year longitudinal study. Reported needs were measured with an 11-item questionnaire covering speech, mobility, positioning, equipment, pain, epilepsy, weight, control of movement, bone or joint problems, curvature of the back, and eyesight. Categorical principal component analysis was used to create factor scores for bivariate and regression analyses. A high level of reported needs was identified particularly for control of movement, mobility, and equipment, but these areas were generally being addressed by services. The highest areas of unmet needs were for management of pain, bone or joint problems, and speech. Analysis of unmet needs yielded two factor scores, daily living health care and medical care. Unmet needs in daily living health care were related to severity of motor impairment and to attending nonspecialist education. Unmet needs tended to increase over time but were not significantly (p > .05) related to whether the young person had transferred from child services. Reporting of unmet needs can indicate where service development is required, and we have shown that the approach to measurement can be improved. As the number of unmet health needs at the start of transition is considerable, unmet health needs after transition cannot all be attributed to poor transitional health care. The range and continuation of needs of young people with cerebral palsy argue for close liaison between adult services and child services and creation of models of practice to improve coordination. © 2018 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd.

  3. Gender Shift through Adulthood: Educational Responses to Changing Lifespan Roles.

    ERIC Educational Resources Information Center

    Wolf, Mary Alice

    An interesting area of adult development is "gender shift": the transition from the traditional life patterns or ways of making meaning that are associated with stereotypically male or female roles. One may experience the wish to fulfill those parts of one's personality often associated with feminine or masculine constructs not yet explored.…

  4. Transition from pediatric to adult health care: expectations of adolescents with chronic disorders and their parents.

    PubMed

    Rutishauser, Christoph; Akré, Christina; Surìs, Joan-Carles

    2011-07-01

    The aim of this study was to assess the expectations of adolescents with chronic disorders with regard to transition from pediatric to adult health care and to compare them with the expectations of their parents. A cross-sectional study was carried out including 283 adolescents with chronic disorders, aged 14-25 years (median age, 16.0 years), and not yet transferred to adult health care, and their 318 parents from two university children's hospitals. The majority of adolescents and parents (64%/70%) perceived the ages of 18-19 years and older as the best time to transfer to adult health care. Chronological age and feeling too old to see a pediatrician were reported as the most important decision factors for the transfer while the severity of the disease was not considered important. The most relevant barriers were feeling at ease with the pediatrician (45%/38%), anxiety (20%/24%), and lack of information about the adult specialist and health care (18%/27%). Of the 51% of adolescents with whom the pediatric specialist had spoken about the transfer, 53% of adolescents and 69% of parents preferred a joint transfer meeting with the pediatric and adult specialist, and 24% of these adolescents declared that their health professional had offered this option. In summary, the age preference for adolescents with chronic disorders and their parents to transfer to adult health care was higher than the upper age limits for admission to pediatric health care in many European countries. Anxiety and a lack of information of both adolescents and their parents were among the most important barriers for a smooth and timely transfer according to adolescents and parents.

  5. Role of entropy and structural parameters in the spin-state transition of LaCoO3

    NASA Astrophysics Data System (ADS)

    Chakrabarti, Bismayan; Birol, Turan; Haule, Kristjan

    2017-11-01

    The spin-state transition in LaCoO3 has eluded description for decades despite concerted theoretical and experimental effort. In this study, we approach this problem using fully charge self-consistent density functional theory + embedded dynamical mean field theory (DFT+DMFT). We show from first principles that LaCoO3 cannot be described by a single, pure spin state at any temperature. Instead, we observe a gradual change in the population of higher-spin multiplets with increasing temperature, with the high-spin multiplets being excited at the onset of the spin-state transition followed by the intermediate-spin multiplets being excited at the metal-insulator-transition temperature. We explicitly elucidate the critical role of lattice expansion and oxygen octahedral rotations in the spin-state transition. We also reproduce, from first principles, that the spin-state transition and the metal-insulator transition in LaCoO3 occur at different temperature scales. In addition, our results shed light on the importance of electronic entropy in driving the spin-state transition, which has so far been ignored in all first-principles studies of this material.

  6. The nuclear receptor tailless is required for neurogenesis in the adult subventricular zone

    PubMed Central

    Liu, Hai-Kun; Belz, Thorsten; Bock, Dagmar; Takacs, Andrea; Wu, Hui; Lichter, Peter; Chai, Minqiang; Schütz, Günther

    2008-01-01

    The tailless (Tlx) gene encodes an orphan nuclear receptor that is expressed by neural stem/progenitor cells in the adult brain of the subventricular zone (SVZ) and the dentate gyrus (DG). The function of Tlx in neural stem cells of the adult SVZ remains largely unknown. We show here that in the SVZ of the adult brain Tlx is exclusively expressed in astrocyte-like B cells. An inducible mutation of the Tlx gene in the adult brain leads to complete loss of SVZ neurogenesis. Furthermore, analysis indicates that Tlx is required for the transition from radial glial cells to astrocyte-like neural stem cells. These findings demonstrate the crucial role of Tlx in the generation and maintenance of NSCs in the adult SVZ in vivo. PMID:18794344

  7. Structured Transition Protocol for Children with Cystinosis

    PubMed Central

    Raina, Rupesh; Wang, Joseph; Krishnappa, Vinod

    2017-01-01

    The transition from pediatric to adult medical services has a greater impact on the care of adolescents or young adults with chronic diseases such as cystinosis. This transition period is a time of psychosocial development and new responsibilities placing these patients at increased risk of non-adherence. This can lead to serious adverse effects such as graft loss and progression of the disease. Our transition protocol will provide patients, families, physicians, and all those involved a structured guide to transitioning cystinosis patients. This structured protocol depends on four areas of competency: Recognition, Insight, Self-reliance, and Establishment of healthy habits (RISE). This protocol has not been tested and therefore challenges not realized. With a focus on medical, social, and educational/vocational aspects, we aim to improve transition for cystinosis patients in all aspects of their lives. PMID:28913329

  8. Transition Care for Children With Special Health Care Needs

    PubMed Central

    Davis, Alaina M.; Brown, Rebekah F.; Taylor, Julie Lounds; Epstein, Richard A.

    2014-01-01

    BACKGROUND: Approximately 750 000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS: We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS: We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS: The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. PMID:25287460

  9. Roles of strain and domain boundaries on the phase transition stability of VO2 thin films

    NASA Astrophysics Data System (ADS)

    Jian, Jie; Chen, Aiping; Chen, Youxing; Zhang, Xinghang; Wang, Haiyan

    2017-10-01

    The fundamental phase transition mechanism and the stability of the semiconductor-to-metal phase transition properties during multiple thermal cycles have been investigated on epitaxial vanadium dioxide (VO2) thin films via both ex situ heating and in situ heating by transmission electron microscopy (TEM). VO2 thin films were deposited on c-cut sapphire substrates by pulsed laser deposition. Ex situ studies show the broadening of transition sharpness (ΔT) and the width of thermal hysteresis (ΔH) after 60 cycles. In situ TEM heating studies reveal that during thermal cycles, large strain was accumulated around the domain boundaries, which was correlated with the phase transition induced lattice constant change and the thermal expansion. It suggests that the degradation of domain boundary structures in the VO2 films not only caused the transition property reduction (e.g., the decrease in ΔT and ΔH) but also played an important role in preventing the film from fracture during thermal cycles.

  10. Role of zonal flow predator-prey oscillations in triggering the transition to H-mode confinement.

    PubMed

    Schmitz, L; Zeng, L; Rhodes, T L; Hillesheim, J C; Doyle, E J; Groebner, R J; Peebles, W A; Burrell, K H; Wang, G

    2012-04-13

    Direct evidence of zonal flow (ZF) predator-prey oscillations and the synergistic roles of ZF- and equilibrium E×B flow shear in triggering the low- to high-confinement (L- to H-mode) transition in the DIII-D tokamak is presented. Periodic turbulence suppression is first observed in a narrow layer at and just inside the separatrix when the shearing rate transiently exceeds the turbulence decorrelation rate. The final transition to H mode with sustained turbulence and transport reduction is controlled by equilibrium E×B shear due to the increasing ion pressure gradient.

  11. Transitioning the Allergy/Immunology Patient from Childhood to Adulthood.

    PubMed

    Hoyte, Flavia C L

    2017-06-01

    Allergic disorders and immunodeficiencies are generally chronic and even lifelong conditions, often changing over time, making the cautious transition of care from childhood to adulthood particularly important. Many, but not all, patients can continue to receive their care from the same physician as they transition through adolescence and emerging adulthood, made possible because allergy/immunology training programs require cross-training in the care of both pediatric and adult patients. Although keeping the same physician makes the transition easier for many allergy/immunology patients, even these patients face psychosocial issues unique to adolescents and emerging adults, including increased autonomy, risk-taking behavior, and medical self-management. Successful transition for patients with chronic allergic and immunologic conditions involves an understanding of the natural history of these conditions by patients and physicians alike, a gradual increase in self-management depending on individual readiness, and careful communication between pediatric and adult specialists as care is transitioned. [Pediatr Ann. 2017;46(6):e229-e234.]. Copyright 2017, SLACK Incorporated.

  12. Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD).

    PubMed

    Sillman, Christina; Morin, Joanne; Thomet, Corina; Barber, Deena; Mizuno, Yoshiko; Yang, Hsiao-Ling; Malpas, Theresa; Flocco, Serena Francesca; Finlay, Clare; Chen, Chi-Wen; Balon, Yvonne; Fernandes, Susan M

    2017-02-15

    Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  13. Application of Guided Imagery to Facilitate the Transition of New Graduate Registered Nurses

    PubMed Central

    Boehm, Laura B.; Tse, Alice M.

    2016-01-01

    Traditionally, the new graduate registered nurse (RN) transition has included a didactic and skills-based orientation accompanied by a period of preceptored practice. However, these methods do not ensure that new RNs are in a state of reduced anxiety to fully interact with their new environment. Transition to practice may cause anxiety, and the new graduate RN may perceive moderate to severe stress. One method of stress reduction is the use of guided imagery, which has shown strong potential with a variety of populations undergoing stressful events. Today, new graduate RNs expect institutions to facilitate orientation to their new employment settings and assist in the transition to their role as a professional nurse. This article proposes a model that incorporates guided imagery for refining the new graduate RN transition process. The model can be adapted for use in the context of orienting other adult learners to unfamiliar practice situations. PMID:23330588

  14. Moderating role of marital quality in older adults' depressed affect: beyond the main-effects model.

    PubMed

    Bookwala, Jamila; Franks, Melissa M

    2005-11-01

    We examine the role of three indicators of marital quality (marital disagreement, marital happiness, and time spent together) as moderators of the association between physical disability and depressed affect among married older individuals (N=1,044). We found support for the moderating role of marital disagreement wherein the detrimental effect of disability on depressed affect was significantly heightened among older adults with more disagreements with their spouse; a moderating effect was not detected for marital happiness or time spent together. We conclude that, in addition to its main effect on older adults' depressed affect, marital quality (as indicated by marital disagreement) plays a significant stress-moderating role in the physical disability-depressed affect link.

  15. Rethinking Healthcare Transitions and Policies: Changing and Expanding Roles in Transitional Care

    ERIC Educational Resources Information Center

    Moreño, Patricienn K.

    2014-01-01

    The breakdown of care transitions between various healthcare facilities, providers, and services is a major issue in healthcare, and accounts for over US$15 billion in healthcare expenditures annually. The transition between inpatient care and home care is a very delicate period where, too often, chronically ill patients get worse and wind up back…

  16. Role of Seasonal Transitions and Westerly Jets in East Asian Paleoclimate

    NASA Astrophysics Data System (ADS)

    Chiang, J. C. H.; Fung, I. Y.; Wu, C. H.; Cai, Y.; Edman, J. P.; Liu, Y.; Day, J. A.; Bhattacharya, T.; Mondal, Y.; Labrousse, C.

    2015-12-01

    The summer rainfall climate of East Asia underwent large and abrupt changes during past climates. However, current interpretations of said changes are typically formulated in terms of modulation of summer monsoon intensity, and do not account for the known complexity in the seasonal evolution of East Asian rainfall, which exhibits sharp transition from the Spring regime to the Meiyu, and then again from the Meiyu to the Summer regime. We explore the interpretation that East Asian rainfall climate undergoes a modulation of its seasonality during said paleoclimate changes. Following previous suggestions we focus on role of the westerlies over Asia, that its latitude relative to Tibet is critical in determining the stepwise transitions in East Asian rainfall seasons. In support of this linkage, we show from observational data that the interannual co-variation of June (July-August) rainfall and upper tropospheric zonal winds show properties consistent with an altered timing of the transition to the Meiyu (Summer), and with more northward-shifted westerlies for earlier transitions. We similarly suggest that East Asian paleoclimate changes resulted from an altered timing in the northward evolution of the jet and hence the seasonal transitions, in particular the transition of the jet from south of the Plateau to the north. In an extreme scenario - which we speculate the climate system tended towards during stadial (cold) phases of D/O stadials and periods of low Northern Hemisphere summer insolation - the jet does not jump north of the Plateau, essentially keeping East Asia in prolonged Spring conditions. We argue that this hypothesis provides a viable explanation for a key paleoproxy signature of D/O stadials over East Asia, namely the heavier mean d18O of precipitation as recorded in speleothem records. The southward jet position prevents the low-level monsoonal flow - which is isotopically light - from penetrating into the interior of East Asia; as such, precipitation

  17. Psychosocial Challenges/Transition to Adulthood.

    PubMed

    Frederick, Carla

    2016-08-01

    Advances in the health care of individuals with cystic fibrosis have resulted in more than half of the population older than the age of 18 living longer, fuller lives. This success brings about the need for new areas of improvement and development including the mastery of transitioning from pediatric to adult health care and attention to psychosocial needs. This article reviews key components of the process of transitioning to adult care and some important psychosocial considerations. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases.

    PubMed

    Foster, Helen E; Minden, Kirsten; Clemente, Daniel; Leon, Leticia; McDonagh, Janet E; Kamphuis, Sylvia; Berggren, Karin; van Pelt, Philomine; Wouters, Carine; Waite-Jones, Jennifer; Tattersall, Rachel; Wyllie, Ruth; Stones, Simon R; Martini, Alberto; Constantin, Tamas; Schalm, Susanne; Fidanci, Berna; Erer, Burak; Demirkaya, Erkan; Ozen, Seza; Carmona, Loreto

    2017-04-01

    To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. The military and the transition to adulthood.

    PubMed

    Kelty, Ryan; Kleykamp, Meredith; Segal, David R

    2010-01-01

    Ryan Kelty, Meredith Kleykamp, and David Segal examine the effect of military service on the transition to adulthood. They highlight changes since World War II in the role of the military in the lives of young adults, focusing especially on how the move from a conscription to an all-volunteer military has changed the way military service affects youths' approach to adult responsibilities. The authors note that today's all-volunteer military is both career-oriented and family-oriented, and they show how the material and social support the military provides to young servicemen and women promotes responsible membership in family relationships and the wider community. As a result, they argue, the transition to adulthood, including economic independence from parents, is more stable and orderly for military personnel than for their civilian peers. At the same time, they stress that serving in the military in a time of war holds dangers for young adults. The authors examine four broad areas of military service, focusing in each on how men and women in uniform today make the transition to adulthood. They begin by looking at the social characteristics of those who serve, especially at differences in access to the military and its benefits by socio-demographic characteristics, such as age, gender, race and ethnicity, social class, and sexual orientation. Military service also has important effects on family formation, including the timing of marriage and parenthood, family structure, and the influence of military culture on families. Family formation among servicemen and women, the authors observe, is earlier and more stable than among civilians of the same age. The authors then consider the educational and employment consequences of service. Finally, they scrutinize the dangers of military service during times of war and examine the physical and psychological effects of wartime military service. They also note the sexual trauma endured both by male and female military

  20. The Role of Vocational Education in Preparing Young People for Adult Life and Employment. A Discussion Paper.

    ERIC Educational Resources Information Center

    Wood, Derek E.

    Vocational education has a role to play in transition education, especially in relation to postsecondary institutions and to initial employment. Recent overseas developments in vocational education and the transition from school to working life have implications for contemplated changes in senior secondary school curriculum, assessment, and…

  1. Parental Divorce and Couples' Adjustment during the Transition to Parenthood: The Role of Parent-Adult Child Relationships

    ERIC Educational Resources Information Center

    Bouchard, Genevieve; Doucet, Danielle

    2011-01-01

    In this study, the authors examined the associations between parental divorce, quality of relationships with parents, and dyadic adjustment during transition of 114 couples to parenthood. Data were collected during the third trimester of pregnancy and at 9 months postpartum. As predicted, the authors found that women from divorced families…

  2. Learning through Transitions: The Role of Institutions

    ERIC Educational Resources Information Center

    Zittoun, Tania

    2008-01-01

    In this paper two models are proposed for analysing transitions in education. Firstly, transitions are the processes that follow ruptures perceived by people. They include learning, identity change, and meaning making processes. Secondly, processes of change are observed through a semiotic prism, articulating self-other-object-sense of the object…

  3. Role of pneumococcal vaccination in prevention of pneumococcal disease among adults in Singapore.

    PubMed

    Eng, Philip; Lim, Lean Huat; Loo, Chian Min; Low, James Alvin; Tan, Carol; Tan, Eng Kiat; Wong, Sin Yew; Setia, Sajita

    2014-01-01

    The burden of disease associated with Streptococcus pneumoniae infection in adults can be considerable but is largely preventable through routine vaccination. Although substantial progress has been made with the recent licensure of the new vaccines for prevention of pneumonia in adults, vaccine uptake rates need to be improved significantly to tackle adult pneumococcal disease effectively. Increased education regarding pneumococcal disease and improved vaccine availability may contribute to a reduction in pneumococcal disease through increased vaccination rates. The increase in the elderly population in Singapore as well as globally makes intervention in reducing pneumococcal disease an important priority. Globally, all adult vaccines remain underused and family physicians give little priority to pneumococcal vaccination for adults in daily practice. Family physicians are specialists in preventive care and can be leaders in ensuring that adult patients get the full benefit of protection against vaccine-preventable diseases. They can play a key role in the immunization delivery of new and routine vaccines by educating the public on the risks and benefits associated with vaccines. Local recommendations by advisory groups on vaccination in adults will also help to tackle vaccine preventable diseases in adults.

  4. Role of pneumococcal vaccination in prevention of pneumococcal disease among adults in Singapore

    PubMed Central

    Eng, Philip; Lim, Lean Huat; Loo, Chian Min; Low, James Alvin; Tan, Carol; Tan, Eng Kiat; Wong, Sin Yew; Setia, Sajita

    2014-01-01

    The burden of disease associated with Streptococcus pneumoniae infection in adults can be considerable but is largely preventable through routine vaccination. Although substantial progress has been made with the recent licensure of the new vaccines for prevention of pneumonia in adults, vaccine uptake rates need to be improved significantly to tackle adult pneumococcal disease effectively. Increased education regarding pneumococcal disease and improved vaccine availability may contribute to a reduction in pneumococcal disease through increased vaccination rates. The increase in the elderly population in Singapore as well as globally makes intervention in reducing pneumococcal disease an important priority. Globally, all adult vaccines remain underused and family physicians give little priority to pneumococcal vaccination for adults in daily practice. Family physicians are specialists in preventive care and can be leaders in ensuring that adult patients get the full benefit of protection against vaccine-preventable diseases. They can play a key role in the immunization delivery of new and routine vaccines by educating the public on the risks and benefits associated with vaccines. Local recommendations by advisory groups on vaccination in adults will also help to tackle vaccine preventable diseases in adults. PMID:24729726

  5. Mind how you cross the gap! Outcomes for young people who failed to make the transition from child to adult services: the TRACK study

    PubMed Central

    Islam, Zoebia; Ford, Tamsin; Kramer, Tami; Paul, Moli; Parsons, Helen; Harley, Katherine; Weaver, Tim; McLaren, Susan; Singh, Swaran P.

    2016-01-01

    Aims and method The Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK) study was a multistage, multicentre study of adolescents' transitions between child and adult mental health services undertaken in England. We conducted a secondary analysis of the TRACK study data to investigate healthcare provision for young people (n = 64) with ongoing mental health needs, who were not transferred from child and adolescent mental health services (CAMHS) to adult mental health services mental health services (AMHS). Results The most common outcomes were discharge to a general practitioner (GP; n = 29) and ongoing care with CAMHS (n = 13), with little indication of use of third-sector organisations. Most of these young people had emotional/neurotic disorders (n = 31, 48.4%) and neurodevelopmental disorders (n = 15, 23.4%). Clinical implications GPs and CAMHS are left with the responsibility for the continuing care of young people for whom no adult mental health service could be identified. GPs may not be able to offer the skilled ongoing care that these young people need. Equally, the inability to move them decreases the capacity of CAMHS to respond to new referrals and may leave some young people with only minimal support. PMID:27280035

  6. Mind how you cross the gap! Outcomes for young people who failed to make the transition from child to adult services: the TRACK study.

    PubMed

    Islam, Zoebia; Ford, Tamsin; Kramer, Tami; Paul, Moli; Parsons, Helen; Harley, Katherine; Weaver, Tim; McLaren, Susan; Singh, Swaran P

    2016-06-01

    Aims and method The Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK) study was a multistage, multicentre study of adolescents' transitions between child and adult mental health services undertaken in England. We conducted a secondary analysis of the TRACK study data to investigate healthcare provision for young people (n = 64) with ongoing mental health needs, who were not transferred from child and adolescent mental health services (CAMHS) to adult mental health services mental health services (AMHS). Results The most common outcomes were discharge to a general practitioner (GP; n = 29) and ongoing care with CAMHS (n = 13), with little indication of use of third-sector organisations. Most of these young people had emotional/neurotic disorders (n = 31, 48.4%) and neurodevelopmental disorders (n = 15, 23.4%). Clinical implications GPs and CAMHS are left with the responsibility for the continuing care of young people for whom no adult mental health service could be identified. GPs may not be able to offer the skilled ongoing care that these young people need. Equally, the inability to move them decreases the capacity of CAMHS to respond to new referrals and may leave some young people with only minimal support.

  7. Role of Halides in the Ordered Structure Transitions of Heated Gold Nanocrystal Superlattices

    PubMed Central

    2015-01-01

    Dodecanethiol-capped gold (Au) nanocrystal superlattices can undergo a surprisingly diverse series of ordered structure transitions when heated (Goodfellow, B. W.; Rasch, M. R.; Hessel, C. M.; Patel, R. N.; Smilgies, D.-M.; Korgel, B. A. Nano Lett.2013, 13, 5710–5714). These are the result of highly uniform changes in nanocrystal size, which subsequently force a spontaneous rearrangement of superlattice structure. Here, we show that halide-containing surfactants play an essential role in these transitions. In the absence of any halide-containing surfactant, superlattices of dodecanethiol-capped (1.9-nm-diameter) Au nanocrystals do not change size until reaching about 190–205 °C, at which point the gold cores coalesce. In the presence of halide-containing surfactant, such as tetraoctylphosphonium bromide (TOPB) or tetraoctylammounium bromide (TOAB), the nanocrystals ripen at much lower temperature and superlattices undergo various ordered structure transitions upon heating. Chloride- and iodide-containing surfactants induce similar behavior, destabilizing the Au–thiol bond and reducing the thermal stability of the nanocrystals. PMID:26013597

  8. Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK Study): A study of protocols in Greater London

    PubMed Central

    Singh, Swaran P; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim

    2008-01-01

    Background Although young people's transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in England is a significant health issue for service users, commissioners and providers, there is little evidence available to guide service development. The TRACK study aims to identify factors which facilitate or impede effective transition from CAHMS to AMHS. This paper presents findings from a survey of transition protocols in Greater London. Methods A questionnaire survey (Jan-April 2005) of Greater London CAMHS to identify transition protocols and collect data on team size, structure, transition protocols, population served and referral rates to AMHS. Identified transition protocols were subjected to content analysis. Results Forty two of the 65 teams contacted (65%) responded to the survey. Teams varied in type (generic/targeted/in-patient), catchment area (locality-based, wider or national) and transition boundaries with AMHS. Estimated annual average number of cases considered suitable for transfer to AMHS, per CAMHS team (mean 12.3, range 0–70, SD 14.5, n = 37) was greater than the annual average number of cases actually accepted by AMHS (mean 8.3, range 0–50, SD 9.5, n = 33). In April 2005, there were 13 active and 2 draft protocols in Greater London. Protocols were largely similar in stated aims and policies, but differed in key procedural details, such as joint working between CAHMS and AMHS and whether protocols were shared at Trust or locality level. While the centrality of service users' involvement in the transition process was identified, no protocol specified how users should be prepared for transition. A major omission from protocols was procedures to ensure continuity of care for patients not accepted by AMHS. Conclusion At least 13 transition protocols were in operation in Greater London in April 2005. Not all protocols meet all requirements set by government policy. Variation in protocol

  9. Patterns of Longitudinal Transitions in Menthol Use Among U.S. Young Adult Smokers

    PubMed Central

    Villanti, Andrea C.; Williams, Valerie F.; Richardson, Amanda; Pearson, Jennifer L.; Vallone, Donna M.

    2015-01-01

    Introduction: Menthol is the only characterizing flavor in cigarettes that was not banned as part of the 2009 Family Smoking Prevention and Tobacco Control Act. This longitudinal study explores the role of menthol in smoking initiation and progression. Purpose (a) to examine young adult patterns of menthol cigarette use including switching between menthol and non-menthol and (b) to describe associations between these patterns of menthol use and cessation related intentions and behaviors. Additional data on the role of menthol in cigarettes on smoking uptake and maintenance is needed to inform proposed policy making at the local, state, and national levels. Methods: Using 3 time points from a longitudinal national sample of young adults aged 18–34 years (N = 267 smokers), patterns of menthol use over 1 year were defined among smokers as: (a) remained menthol smoker; (b) remained non-menthol smoker; (c) switched from menthol to non-menthol; and (d) switched from non-menthol to menthol. Associations were assessed between current menthol cigarette use and cessation intentions and behaviors. Results: Significant predictors of current menthol cigarette use at 1 year included initiation with menthol (OR = 8.26), Black race (OR = 23.60), and higher scores on the Allen menthol taste subscale (OR = 1.53). Menthol smokers were more likely to report intention to quit but no differences existed between menthol and non-menthol users in ever making a quit attempt. Conclusions: Most young adults stay with the product that they start smoking with. Menthol smokers were interested in quitting, but less interested in next 30-day action than non-menthol smokers. PMID:25480932

  10. The Role of Transitions in ESL Instruction

    ERIC Educational Resources Information Center

    Steinman, Linda

    2013-01-01

    Transitions in ESL contexts generally refer to those linking words placed between sentences and between paragraphs. Transitions in writing (and in speaking) are helpful; they facilitate coherence and cohesion when used correctly. Understanding them when reading allows us to join the writer in seeing why and how idea B follows idea A. In this…

  11. Gender roles and binge drinking among Latino emerging adults: a latent class regression analysis.

    PubMed

    Vaughan, Ellen L; Wong, Y Joel; Middendorf, Katharine G

    2014-09-01

    Gender roles are often cited as a culturally specific predictor of drinking among Latino populations. This study used latent class regression to test the relationships between gender roles and binge drinking in a sample of Latino emerging adults. Participants were Latino emerging adults who participated in Wave III of the National Longitudinal Study of Adolescent Health (N = 2,442). A subsample of these participants (n = 660) completed the Bem Sex Role Inventory--Short. We conducted latent class regression using 3 dimensions of gender roles (femininity, social masculinity, and personal masculinity) to predict binge drinking. Results indicated a 3-class solution. In Class 1, the protective personal masculinity class, personal masculinity (e.g., being a leader, defending one's own beliefs) was associated with a reduction in the odds of binge drinking. In Class 2, the nonsignificant class, gender roles were not related to binge drinking. In Class 3, the mixed masculinity class, personal masculinity was associated with a reduction in the odds of binge drinking, whereas social masculinity (e.g., forceful, dominant) was associated with an increase in the odds of binge drinking. Post hoc analyses found that females, those born outside the United States, and those with greater English language usage were at greater odds of being in Class 1 (vs. Class 2). Males, those born outside the United States, and those with greater Spanish language usage were at greater odds of being in Class 3 (vs. Class 2). Directions for future research and implications for practice with Latino emerging adults are discussed.

  12. Transition from paediatric to adult care of adolescent patients with congenital heart disease: a pathway to optimal care.

    PubMed

    Strijbosch, A M M; Zwart, R; Blom, N A; Bouma, B J; Groenink, M; Boekholdt, S M; de Winter, R; Mulder, B J M; Backx, A P

    2016-11-01

    Adolescents with congenital heart disease transition from a paediatric to an adult setting. This is associated with loss-to-follow-up and suboptimal care. Increasing numbers of patients justify a special program. In this study we evaluated the cooperative program between paediatric and adult cardiology departments in a tertiary referral centre. In this retrospective study, patients with congenital heart disease with at least one appointment scheduled at the transition program between January 2010 and January 2015 were included. They were seen by a paediatric cardiologist at the age of 15 years in the paediatric department and from age 18 to 25 in the adult department. Demographic and medical data were collected from the electronic patient files. A total of 193 patients (105 males, 88 females) were identified. Sex distribution was almost equal. Most patients were 18-21 years of age. The largest group, 128 patients (67 %), lived within 50 kilometres of our hospital. Paediatric cardiologists referred 157 (81 %) of patients. General practitioners and cardiologists from outside our centre were important referrers for patients lost to follow-up, together accounting for 9 %. A total of 34 (18 %) patients missed an appointment without notification. Repeat offenders, 16 of 34 patients, formed a significant minority within this group. A total of 114 (59 %) patients were attending school, 46 (24 %) were employed, and 33 (17 %) patients were inactive. Activities are in line with capabilities. A nurse practitioner was involved with the 7 % with complex and psychosocial problems. Moderately severe congenital heart defects formed the largest patient category of 102 (53 %) patients. In 3 % of patients the diagnosis had to be revised or was significantly incomplete. In 30 (16 %) patients, cardiac diagnosis was part of a syndrome. Of the 193 patients, 117 (92 %) were in NYHA class I, with 12 (6 %) and 4 (2 %) patients falling into classes

  13. Changes in HbA1c and Weight Following Transition to Continuous Subcutaneous Insulin Infusion Therapy in Adults With Type 1 Diabetes.

    PubMed

    Mehta, Sanjeev N; Andersen, Henrik Ullits; Abrahamson, Martin J; Wolpert, Howard A; Hommel, Eva E; McMullen, William; Ridderstråle, Martin

    2017-01-01

    Historically, intensive insulin therapy for type 1 diabetes (T1D) has improved glycemic control at the risk of adverse weight gain. The impact of continuous subcutaneous insulin infusion therapy (CSII) on weight in the current era remains unknown. We assessed changes in hemoglobin A1c (HbA1c) and weight in adults with T1D transitioning to CSII at 2 diabetes centers in Denmark and the United States. Patients with T1D, aged ≥18 years, managed with multiple daily injections (MDI) who transitioned to CSII between 2002 and 2013 were identified using electronic health record data from the Steno Diabetes Center (n = 600) and Joslin Diabetes Center (n = 658). Changes in HbA1c and weight after 1 year was assessed overall and by baseline HbA1c cut points. Multivariate regression assessed correlates of HbA1c reduction. In adults with T1D transitioning to CSII, clinically significant HbA1c reductions were found in patients with baseline HbA1c 8.0-8.9% (Steno, -0.7%; Joslin, -0.4%) and baseline HbA1c ≥9.0% (Steno, -1.1%; Joslin, -0.9%) ( P < .005 for all). Overall, there was no significant change in weight after 1 year at either center. Modest (<2%) weight gain was noted in patients with baseline HbA1c ≥9% at Steno (1.1 ± 0.3 kg, P < .0001) and Joslin (1.7 ± 1.1, P < .005). In multivariate models, HbA1c reduction was associated with higher HbA1c, older age, female sex at Steno ( R 2 = .28, P < .005), but only higher baseline HbA1c at Joslin ( R 2 = .19, P < .005). Adults with T1D with suboptimal glycemic control significantly improved HbA1c without a negative impact on weight 1 year after transitioning from MDI to CSII.

  14. Transition of Care in Adolescents With Cerebral Palsy: A Survey of Current Practices.

    PubMed

    Bolger, Ashlee; Vargus-Adams, Jilda; McMahon, Mary

    2017-03-01

    Transition of care from pediatric to adult health care providers for youth with special needs (including cerebral palsy [CP]) is of current interest because these individuals are now living well into adulthood. Studies have attempted to identify barriers to transition, ideal timing for transition of care, and key elements for successful transition programs. These studies often encompass a wide range of diagnoses, and results cannot be fully applied to those with CP. To identify and describe current transition-of-care (TOC) practices and beliefs among physician providers of adolescents with CP in multidisciplinary CP clinics. Descriptive survey. Multidisciplinary CP clinics in the United States. Physician leaders in the aforementioned CP clinics. Respondents completed an electronic survey. Responses were deidentified and reported in aggregate by the use of descriptive statistics. Electronic survey addressing 3 domains: demographics of clinics, current opinions/practices related to TOC processes, and perceived barriers to successful TOC. Fifteen surveys were sent with 11 returned (response rate = 73%). TOC practices varied among clinics surveyed. Fifty-five percent of clinics had a structured transition program, but only one transitioned 100% of their patients to adult providers by 22 years of age. Only one clinic had an absolute upper age limit for seeing patients, and 36% of clinics accepted new patients older than 21 years. No respondent was "completely satisfied" with their transition process, and only one respondent was "moderately satisfied." The majority of respondents felt the ideal care setting for adults with CP was a comprehensive, multidisciplinary adult-focused clinic in an adult hospital/clinic with primarily adult providers. They noted the top 3 perceived barriers to successful TOC were limited adult providers willing to accept CP patients, concern about the level of care in the adult health care system, and lack of financial resources. Current TOC

  15. Validating Kohler's Taxonomy of Transition Programming for adolescents with intellectual disability in the Chinese context.

    PubMed

    Xu, Tianxi; Dempsey, Ian; Foreman, Phil

    2016-01-01

    School-to-work transition programmes play a crucial role in the achievement of post-secondary outcomes for young adults with intellectual disability (ID). Although special education in China has progressed in the last two decades, systematically planned transition education and services are not usually available for Chinese school leavers. The present study aimed to validate Kohler's Taxonomy of Transition Programming (KTTP) in the Chinese context for adolescents with ID. Five Chinese transition experts reviewed KTTP items, 14 Chinese transition teachers and 14 parents of adolescents with ID who would transition from school in the next 12 months were interviewed, and 329 transition teachers were surveyed. Most items in KTTP were found to be important and relevant to the Chinese context. Based on KTTP, a modified transition framework appropriate to the Chinese context was generated. The Chinese transition framework may assist parents and professionals to better support adolescents with ID in China. Future validation checks of the framework will add confidence that the framework captures the essential components of effective transition practices appropriate in the Chinese context. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Social Identity and the Transition to Entrepreneurship: The Role of Group Identification with Workplace Peers

    ERIC Educational Resources Information Center

    Obschonka, Martin; Goethner, Maximilian; Silbereisen, Rainer K.; Cantner, Uwe

    2012-01-01

    What role does social identity play in the transition from employed work to entrepreneurship? It was expected that social identity affects the cognitive processes that, according to the theory of planned behavior (TPB), underlie the formation of entrepreneurial intentions. Focusing on academic scientists' intentions to commercialize research…

  17. Role of Entropy and Structural Parameters in the Spin State Transition of LaCoO3

    NASA Astrophysics Data System (ADS)

    Chakrabarti, Bismayan; Birol, Turan; Haule, Kristjan

    The spin state transition in LaCoO3 has eluded description for decades despite concerted theoretical and experimental effort. In this study, we approach this problem using fully charge consistent Density Functional Theory + Dynamical Mean Field Theory (DFT+DMFT). We show, from first principles, that LaCoO3 cannot be described by a single, pure spin state at any temperature, but instead shows a gradual change in the population of higher spin multiples as temperature is increased. We explicitly elucidate the critical role of the lattice expansion and oxygen octahedral rotations in the spin state transition. We also show that the spin state transition and the metal-insulator transition in the compound occur at different temperatures. In addition, our results shed light on the importance of electronic entropy, which has so far been ignored in all first principles studies of this material.

  18. Quick Guide: Mental Health-Secondary Transition

    ERIC Educational Resources Information Center

    National Technical Assistance Center on Transition, 2016

    2016-01-01

    Recently researchers have begun focusing on young adults with mental health disorders transitioning into adulthood. Research exploring the importance of mental health support in secondary transition have yielded positive outcomes. For example, strong collaboration between educational and mental health agencies ensuring academic, employment, and…

  19. Supporting the Transition into Employment: A Study of Canadian Young Adults Living with Disabilities.

    PubMed

    Jetha, Arif; Bowring, Julie; Furrie, Adele; Smith, Frank; Breslin, Curtis

    2018-04-25

    Objective To examine the job accommodation and benefit needs of young adults with disabilities as they transition into employment, and their perceived barriers to meeting support needs. Methods An online survey was conducted of 155 Canadian young adults with disabilities (mean age = 25.8 years). Respondents were either employed or seeking employment, and were asked about their need for health benefits, and soft (e.g., flexible scheduling) and hard accommodations (e.g., ergonomic interventions), and perceived accommodation barriers. Disability characteristics (e.g., disability type), demographic details and work context information were collected. Multivariable logistic analyses were conducted to examine the factors associated with a greater need for health benefits and hard and soft accommodations. Result Participants reported having a physical (79%), psychological (79%) or cognitive/learning disability (77%); 68% had > 1 disability. Over half (55%) were employed. Health benefits and soft accommodations were most needed by participants. Also, an average of six perceived accommodation barriers were indicated; difficulty with disability disclosure was most frequently reported. More perceived accommodation barriers were associated with a greater need for health benefits (OR 1.17, 95% CI 1.04-1.31) and soft accommodations (OR 1.13, 95% CI 1.01-1.27). A psychological disability was a associated with a greater need for health benefits (OR 2.91, 95% CI 1.09-7.43) and soft accommodations (OR 3.83, 95% CI 1.41-10.42). Discussion Employers can support the employment of young adults with disabilities through provision of extended health benefits and soft accommodations. Addressing accommodation barriers could minimize unmet workplace need, and improve employment outcomes for young adults with disabilities as they begin their career and across the life course.

  20. Exposing Baccalaureate Nursing Students to Transitional Care.

    PubMed

    OʼConnor, Melissa; Arcamone, Angelina; Amorim, Frances; Hoban, Mary Beth; Boyd, Regina M; Fowler, Lauren; Marcelli, Theresa; Smith, Jacalyn; Nassar, Kathleen; Fitzpatrick, M Louise

    2016-10-01

    Management and facilitation of care transitions from hospital to alternative settings requires skill and attention to avoid adverse events. Several interprofessional organizations and nurse leaders have called for the expansion and redesign of undergraduate nursing curricula to include care transitions. Yet there is little evidence describing how undergraduate baccalaureate nursing students are educated on this critical topic or how successful they are in improving student knowledge about care transitions. To address this gap, an in-classroom and clinical experience was implemented to prepare students to manage and facilitate care transitions from the hospital to alternative settings-including the home. Perceptions of undergraduate nursing students and home healthcare nurse preceptors were assessed via an electronic survey that was emailed to participants. Forty-eight responses to the survey were received. Students agreed this experience contributed to their understanding of caring for adults and older adults who are experiencing a care transition and they had a good understanding of care transitions to apply to their future nursing courses. Home healthcare nurse preceptors agreed they were able to demonstrate transitional care and that students were engaged. Future work should include expanding transitional care immersion to other care settings as well as the inclusion of additional healthcare disciplines in care transition education.