Search

Neste trabalho, buscamos apresentar os resultados de recente análise dinâmica contextual sobre as oportunidades e barreiras para a saúde sexual e reprodutiva dos jovens brasileiros. Na realização da pesquisa, revimos a literatura acadêmica mais recente, identificamos as principais ações governamentais e não-governamentais sobre essa temática e entrevistamos alguns especialistas da área. No decorrer deste trabalho, apresentamos os principais temas, concepções e ações, quando o assunto é saúde sexual dos jovens, e identificamos algumas das lacunas nas pesquisas e intervenções de educação não-formal até a inserção da educação sexual nos parâmetros curriculares nacionais na segunda metade da década de 1990. Finalizando, apresentamos uma agenda de ações e estudos no sentido de fomentar estratégias mais eficazes de promoção da saúde sexual e reprodutiva dos jovens brasileiros.

A partir da perspectiva das várias epidemias de HIV/AIDS que coexistem em mesmo espaço, bem como dos dados epidemiológicos do Brasil, acredita-se serem observáveis as variações já descritas alhures - feminilização, pauperização, juvenilização e interiorização - como resultado das profundas desigualdades da sociedade brasileira. Foram examinadas as contribuições de três vertentes de análise dos aspectos sócio-econômicos da AIDS: 1) pesquisas e teorias sociológicas a respeito do impacto da reestruturação econômica e transformação social global recentes e sua relação com a saúde pública; 2) literatura transcultural e transnacional em antropologia e sociologia dedicada aos fatores estruturais que conformam o curso da epidemia em diferentes conjunturas; e 3) corpo de pesquisas antropológicas e sociológicas concernentes aos efeitos sinérgicos do HIV/AIDS, exclusão social, e problemas sociais associados nos bolsões de extrema pobreza encontrados nas grandes cidades de países centrais. Conclui-se que as políticas de prevenção do HIV/AIDS devem abordar, de forma integrada, as várias dimensões que determinam as diferenciadas vulnerabilidades à epidemia, dependendo, portanto, de transformações sociais substantivas.

Abstract Background Empathy is important to patient care. The prevailing view is that empathy declines during university medical education. The significance of that decline has been debated. This paper reports the findings in respect of two questions relating to university medical education: 1. Do men and women medical students differ in empathy? 2. Does empathy change amongst men and women over time? Methods The medical course at the University of Cambridge comprises two components: Core Science (Years 1-3) and Clinical (Years 4-6). Data were obtained from repeated questionnaire surveys of medical students from each component over a period of four years: 2007-2010. Participation in the study was voluntary. Empathy was measured using two subscales of the Interpersonal Reactivity Index: IRI-EC (affective empathy) and IRI-PT (cognitive empathy). We analysed data separately for men and women from the Core Science and Clinical components. We undertook missing value analyses using logistic regression separately, for each measure of empathy, to examine non-response bias. We used Student's t-tests to examine gender differences and linear mixed effects regression analyses to examine changes over time. To assess the influence of outliers, we repeated the linear mixed effects regression analyses having excluded them. Results Women displayed statistically significant higher mean scores than men for affective empathy in all 6 years of medical training and for cognitive empathy in 4 out of 6 years - Years 1 and 2 (Core Science component) and Years 4 and 5 (Clinical component). Amongst men, affective empathy declined slightly during both Core Science and Clinical components. Although statistically significant, both of these changes were extremely small. Cognitive empathy was unchanged during either component. Amongst women, neither affective empathy nor cognitive empathy changed during either component of the course. Analysis following removal of outliers showed a statistically significant slight increase in men's cognitive empathy during the Core Science component and slight decline in women's affective empathy during the Clinical component. Again, although statistically significant, these changes were extremely small and do not influence the study's overall conclusions. Conclusions Amongst medical students at the University of Cambridge, women are more empathetic than men (a generally observed phenomenon). Men's affective empathy declined slightly across the course overall, whilst women's affective empathy showed no change. Neither men nor women showed any change in cognitive empathy during the course. Although statistically significant, the size of such changes as occurred makes their practical significance questionable. Neither men nor women appear to become meaningfully less empathetic during their medical education at the University of Cambridge.

Abstract Background The national Cancer Reform Strategy recommends delivering care closer to home whenever possible. Cancer drug treatment has traditionally been administered to patients in specialist hospital-based facilities. Technological developments mean that nowadays, most treatment can be delivered in the out-patient setting. Increasing demand, care quality improvements and patient choice have stimulated interest in delivering some treatment to patients in the community, however, formal evaluation of delivering cancer treatment in different community settings is lacking. This randomised trial compares delivery of cancer treatment in the hospital with delivery in two different community settings: the patient's home and general practice (GP) surgeries. Methods/design Patients due to receive a minimum 12 week course of standard intravenous cancer treatment at two hospitals in the Anglia Cancer Network are randomised on a 1:1:1 basis to receive treatment in the hospital day unit (control arm), or their own home, or their choice of one of three neighbouring GP surgeries. Overall patient care, treatment prescribing and clinical review is undertaken according to standard local practice. All treatment is dispensed by the local hospital pharmacy and treatment is delivered by the hospital chemotherapy nurses. At four time points during the 12 week study period, information is collected from patients, nursing staff, primary and secondary care teams to address the primary end point, patient-perceived benefits (using the emotional function domain of the EORTC QLQC30 patient questionnaire), as well as secondary end points: patient satisfaction, safety and health economics. Discussion The Outreach trial is the first randomised controlled trial conducted which compares delivery of out-patient based intravenous cancer treatment in two different community settings with standard hospital based treatment. Results of this study may better inform all key stakeholders regarding potential costs and benefits of transferring clinical services from hospital to the community. Trial registration number ISRCTN: ISRCTN66219681

The stellar mass distribution in star-forming regions, stellar clusters and associations, the initial mass function (IMF), appears to be invariant across different star-forming environments, and is consistent with the IMF observed in the Galactic field. Deviations from the field, or standard, IMF, if genuine, would be considered strong evidence for a different set of physics at play during the formation of stars in the birth region in question. We analyse N -body simulations of the evolution of spatially and kinematically substructured star-forming regions to identify the formation of binary star clusters, where two (sub)clusters which form from the same Giant Molecular Cloud orbit a common centre of mass. We then compare the mass distributions of stars in each of the subclusters and compare them to the standard IMF, which we use to draw the stellar masses in the star-forming region from which the binary cluster(s) form. In each binary cluster that forms, the mass distributions of stars in one subcluster deviates from the standard IMF, and drastically so when we apply similar mass resolution limits as for the observed binary clusters. Therefore, if a binary subcluster is observed to have an unusual IMF, this may simply be the result of dynamical evolution, rather than different physical conditions for star formation in these systems. [ABSTRACT FROM AUTHOR]

Recent research provides compelling evidence that the decay of short-lived radioisotopes (SLRs), such as 26Al, provided the bulk of energy for heating and desiccation of volatile-rich planetesimals in the early solar system. However, it remains unclear whether the early solar system was highly enriched relative to other planetary systems with similar formation characteristics. While the solar system possesses an elevated level of SLR enrichment compared to the interstellar medium, determining SLR enrichment of individual protoplanetary disks observationally has not been performed and is markedly more difficult. We use N -body simulations to estimate enrichment of SLRs in star-forming regions through two likely important SLR sources: stellar winds from massive stars and supernovae (SNae). We vary the number of stars and the radii of the star-forming regions and implement two models of stellar-wind SLR propagation for the radioisotopes 26Al and 60Fe. We find that for 26Al enrichment the solar system is at the upper end of the expected distribution, while for the more SNae-dependent isotope 60Fe we find that the solar system is comparatively very highly enriched. Furthermore, combined with our previous research, these results suggest that the statistical role of 26Al-driven desiccation on exoplanet bulk composition may be underestimated in typical interpretations of the low-mass exoplanet census, and that 60Fe is even less influential as a source of heating than previously assumed. [ABSTRACT FROM AUTHOR]

School value-added models are widely applied to study, monitor, and hold schools to account for school differences in student learning. The traditional model is a mixed-effects linear regression of student current achievement on student prior achievement, background characteristics, and a school random intercept effect. The latter is referred to as the school value-added score and measures the mean student covariate-adjusted achievement in each school. In this article, we argue that further insights may be gained by additionally studying the variance in this quantity in each school. These include the ability to identify both individual schools and school types that exhibit unusually high or low variability in student achievement, even after accounting for differences in student intakes. We explore and illustrate how this can be done via fitting mixed-effects location scale versions of the traditional school value-added model. We discuss the implications of our work for research and school accountability systems. [ABSTRACT FROM AUTHOR]

Background: As many as 70% of remand prisoners have admitted to being under the influence of alcohol when committing the crime leading to their imprisonment. Providing support and advice regarding alcohol consumption can be effective in some groups of people. There is little evidence regarding this for men on remand in prison. Objective: To pilot the study measures and evaluation methods to assess the feasibility of conducting a future definitive multicentre, pragmatic, parallel group, randomised controlled trial. Design: A two-arm, parallel group, individually randomised pilot study of a self-efficacy-enhancing psychosocial alcohol intervention to reduce levels of alcohol consumption for males on remand in prison and on liberation. Setting: Two purposively selected prisons in Scotland and England. Participants: Adult men on remand in prison with an Alcohol Use Disorders Identification Test score of ≥ 8. Intervention: The APPRAISE intervention delivery comprised four steps: Step 1: 1 × 40-minute face-to-face session, delivered by a trained practitioner from Change Grow Live in prison. Steps 2, 3 and 4: 20-minute sessions conducted by phone, on or as close as possible to days 3, 7 and 21 post liberation. Control: assessment, screening and referral onto further alcohol support options. Main outcome measures: Recruitment and retention rates, completion of follow-ups, outcome measures at 12 months and interventions delivered. The primary outcome for the pilot study was alcohol consumed in the 28 days prior to Time Point 2, assessed using the extended Alcohol Use Disorders Identification Test-C. Results: Of 182 men on remand approached across two study sites, 132 were randomised (90 in England; 42 in Scotland) with 46 randomised to intervention and 44 to care as usual in England and 22 randomised to intervention and 20 to care as usual in Scotland. A total of 53 in-prison interventions were delivered. One day-3 post-liberation intervention was delivered, no day-7 and one day-21. At 12 months, of 132 randomised, 18 (13%) were followed up, 53 (40%) were not liberated; 47 (36%) were uncontactable and 14 (11%) had been released but could not be located. Data completeness was 96% at baseline and 8% at 12 months. The process evaluation reported good acceptability of the intervention with investment in time, capacity and space to support implementation identified. The economic study produced guidance on how to assess costs associated with implementing the APPRAISE intervention which could be applied more broadly. Harms: No adverse events or side effects were noted. Conclusions: A future definitive trial would be possible, but only if follow-up mechanisms can be addressed as well as full access to recidivism and health data. Collaboration with the probation service in future could offer the opportunity to develop a robust process and system to optimise follow-up post liberation. Dedicated resources to support the intervention delivery both in and out of the prison setting are recommended. Limitations: Coronavirus disease discovered in 2019 impacted recruitment and follow-up, with access to prisons restricted. We were unable to deliver the post-liberation element of the intervention. We did not include probation services or other agencies in the trial. Trial registration: This trial is registered as Current Controlled Trials ISRCTN36066. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/44/11) and is published in full in Public Health Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information. Plain language summary: What was the question?: We know many men on remand report being under the influence of alcohol at the time of their arrest. Having a short conversation providing alcohol support and advice (known as an 'intervention') can be effective. However, we do not know if an alcohol intervention for men on remand in prison is possible to deliver or if we can 'test' the benefit of it. The aim of the study was to 'test' an intervention named APPRAISE using a small study, for men on remand in one Scottish and one English prison. What did we do?: We aimed to get 180 men in this study. Men taking part were asked to tell us about their alcohol drinking. Men reporting 'risky' drinking were split into two groups by chance. One group were to be given the APPRAISE intervention while in prison and once released. The other group did not receive the intervention. We then set out to measure their drinking levels after 12 months. We interviewed different people involved in the study to find out what they thought. What did we find?: We successfully recruited 132 men but had to stop due to coronavirus disease discovered in 2019 , as we were unable to go into the prisons. We delivered 53 out of 68 interventions in prison but not once men were released; we were only able to contact 18 out of 132 men at 12 months. People we interviewed stated that having an intervention to reduce risky drinking would be acceptable; however, this would require investment, time, space, capacity and trust. What does this mean?: Before we can plan a larger study we need to identify the best way to locate men once released from prison, to deliver the whole intervention and measure its effect on drinking levels. Scientific summary: The prevalence of at-risk drinking, which includes drinking at levels that harm a person's health, is far higher amongst those in contact with the criminal justice system (73%). For those on remand in prison, the prevalence is between 62% and 68%. This compares to 35% in the general population. Alcohol brief interventions (ABIs) are a secondary prevention activity, aimed at those individuals who are drinking in a pattern that is likely to be harmful to health and/or well-being. Similarly, the theoretical validity of a self-efficacy-enhancing alcohol intervention in other settings has shown evidence of potential effect. Study aims and objectives: Objective 1: to pilot the study measures and evaluation methods to assess the feasibility of conducting a future definitive multicentre, pragmatic, parallel-group randomised controlled trial. Is it feasible to conduct a future multicentre RCT of a self-efficacy-enhancing psychosocial alcohol intervention for men on remand? Can we obtain reasonable estimates of the parameters necessary to inform the design and sample size calculation for a future definitive multicentre RCT? This includes standard deviations of potential continuous primary outcomes and estimates of recruitment met across trial arms and study, retention and follow-up rates. How well do participants complete the questionnaires necessary for a future definitive RCT? Can we collect economic data needed for a future definitive RCT? Can we access recidivism data from the Police National Computer (PNC) databases for trial participants? Can we access health data from routine National Health Service (NHS) data sources for trial participants? Objective 2: to assess intervention fidelity. What proportion of the interventions are delivered as per protocol? Is there any evidence of contamination between the two conditions and/or between those workers delivering the intervention? To what extent was the intervention changing process variables consistent with the underpinning theory? Objective 3: to qualitatively explore the feasibility and acceptability of a self-efficacy-enhancing psychosocial alcohol intervention and study measures to staff and for men on remand and on liberation. How acceptable are the trial and intervention procedures (including context and any barriers and facilitators) to the following key stakeholders: men on remand in prison and on liberation; prison staff (including healthcare staff); commissioners; policy-makers and third-sector partners? Objective 4: to assess whether operational progression criteria for conducting a future definitive randomised controlled trial are met across trial arms and study sites and, if so, develop a protocol for a future definitive trial. (Operational progression criteria are based on previous research results.) Do the two prisons invited to the study agree to take part? Based on knowledge from previous data, do at least 90 eligible participants consent to take part and be randomised across the trial arms? Do at least 70% of participants who consent to the trial receive the intervention? Are at least 60% of those who received the intervention followed up at 12 months across trial arms and study sites? Objective 5: to ascertain what alcohol services are available in male remand prisons and how coronavirus disease discovered in 2019 has affected services. To ascertain what alcohol services are currently provided within male remand prisons. To explore the prison governors' understanding of brief interventions. To understand how the coronavirus disease discovered in 2019 pandemic has impacted the services available in male remand prisons. To identify whether the impact of the COVID-19 pandemic upon services could be avoided in the future. Methods: Phase 1 pilot trial: Phase I was a two-arm, parallel-group, individually randomised pilot study of a self-efficacy-enhancing psychosocial alcohol intervention for men on remand in prison to provide data, including economic, recidivism and health data, on feasibility and an assessment of the likely impact of the APPRAISE intervention to inform the feasibility of a future definitive multicentre RCT. The Phase I pilot trial was undertaken in two prison settings, one in Scotland and one in England. Those eligible to participate were adult men detained on remand in either the Scottish study site or the England study site who had been in prison for 3 months or less and had an Alcohol Use Disorders Identification Test (AUDIT) screening score of 8 or more. The original recruitment target was 180 participants, 90 at each study site. The target was reached at the England study site; however, restricted access to the prison estates due to COVID-19 meant we were unable to recruit any further participants at the Scottish study site. As a result, we recruited 132 participants (90 in England and 42 in Scotland), who were randomised. In England, 46 participants were randomised to the intervention and 44 to care as usual. For participants in Scotland, 22 were randomised to the intervention and 20 to care as usual. Allocation was conducted at the level of the participants, randomised to the active or control intervention using stratified block randomisation by site, via sealed envelopes, based on a predetermined random number allocation carried out by the study Trials Unit. The APPRAISE intervention focused on enhancing self-efficacy and comprised four steps: Step 1 comprised a 1 × 40-minute face-to-face session in which the nine elements were delivered by an interventionist in the prison setting. Steps 2, 3 and 4 were 20-minute booster sessions to be delivered by phone, on or as close as possible to days 3, 7 and 21 post liberation. Interventions were delivered by Change Grow Live practitioners who had received prior training in intervention delivery. Care as usual across both sites comprised an alcohol assessment and referral onto further alcohol support options if requested. Due to COVID-19 restrictions, access to both study sites for the research assistants (RAs) and research team was halted, resulting in liberation data not being accessible. There was limited capacity of the interventionists to follow up on liberation data of those in the intervention group or deliver post-liberation intervention. Data were collected at TP0 before randomisation (baseline), TP1 (6 months) and TP2 (12 months). Follow-up assessments were attempted where participants had been (a) not liberated, (b) liberated and in the community or (c) liberated and then re-incarcerated, and were conducted by phone; hard copies of the follow-up questionnaire were sent by post with an accompanying letter to be completed and returned to the study team via a pre-paid envelope, or via hard copy in prison. As a result, modifications were made to the follow-up method to also include contact via text message, WhatsApp, Facebook and an electronic Qualtrics link to the survey sent by phone or e-mail. The case report forms (CRFs) were adapted to facilitate self-completion. The primary outcome was alcohol consumed in the 28 days prior to TP2 (12-month follow-up), assessed using the extended AUDIT-C. The following secondary outcome measures were used across the three time points: Warwick-Edinburgh Mental Well-being Scale (WEMWBS); Drinking Refusal Self-efficacy Questionnaire – revised (DRSEQ-R); Negative Alcohol Expectancy Questionnaire (NAEQ); EuroQol-5 Dimensions, five-level version; Readiness to Change Ruler; Economic Form 90. Results: Of 182 men on remand approached across two study sites, 132 were randomised (90 in England; 42 in Scotland) with 46 randomised to intervention and 44 to care as usual in England, and 22 randomised to intervention and 20 to care as usual in Scotland. A total of 53 in-prison interventions were delivered. One day-3 post-liberation intervention was delivered, no day-7 post-liberation intervention was delivered and one day-21 post-liberation intervention was delivered. At 12 months out of all 132 randomised, 18 were followed up, 53 (40%) were not liberated, 47 (36%) were uncontactable and 14 (11%) had been released but could not be located. Data completeness was 96% at baseline and 8% at 12 months. Mindful of the very small sample sizes and that as such caution should be applied, provisional indications suggest that self-efficacy may be a determinant of alcohol consumption and further exploration of interventions targeting self-efficacy should be considered. We were able to develop a micro-costing methodology protocol and collect provisional scoping of routine data sources to support future cost-effectiveness analyses. We were unable to access both PNC and NHS data for participants in either study prison. Phase II process evaluation and survey: In Phase II, the aim of the process evaluation was threefold: first, to assess how the intervention was implemented, second, to undertake some preliminary exploration of change mechanisms underpinning the intervention, and third, to assess the acceptability and context within which the intervention was delivered through interviews with study participants and key stakeholders involved in supporting the trial. A survey of prisons in Scotland and England was conducted to ascertain what alcohol services were available for men on remand in prisons and how COVID-19 had affected these services. Study records and semistructured interviews provided the data for the process evaluation. Purposive sampling was used for interviews. Due to COVID-19 , the target of 40 interviews was not attainable. Thematic analyses using a NPT lens to support thematic identification. All interviews were digitally recorded and transcribed verbatim ahead of analysis. High levels of practitioner behaviour change skills were identified from the Behaviour Change Counselling Index (BECCI) scores of the four intervention delivery sessions recorded at the Scotland site. Differences in median dose delivered between study sites were noted. CGL intervention training evaluation was positive. From the data available evidence of contamination was limited. Fifteen semistructured interviews were conducted with three participant groups [remand participants, Change Grow Live (CGL) team and wider stakeholders] from across the two study sites. The themes generated suggested a strong acceptability of the intervention with investment in time, capacity and space identified to support implementation, as well as the buy-in from all stakeholders, development of trust and relationships as key facilitators to supporting behaviour change. From 59 prisons in Scotland and England, successful e-mails were sent to 55 prison governors. Seventeen (31%) were completed. The findings confirmed that the COVID-19 pandemic had undoubtedly impacted upon alcohol and wider prison services available to men on remand. Strengths of the study: The APPRAISE study is, to the best of our knowledge, the first pilot trial of an alcohol-focused self-efficacy-enhancing intervention for men on remand. The study provides significant insight into the feasibility and acceptability of pilot trials for this particular population. The ethical approval process for the prison setting across devolved countries provided useful insights into how to navigate the submission and approvals process across a range of ethics committees. The study provided good evidence of the feasibility of recruitment, training interventionists and subsequent in-prison delivery of the APPRAISE intervention to 73% of men on remand, randomised to the intervention, within a highly complex prison setting. The economic findings provide valuable insights, as we believe this to be the first of its kind for this type of intervention in this setting. Useful insight was gained regarding the access to PNC and NHS Service Use Data. The process evaluation provided insights into the perspectives of the remand participants, the intervention delivery team and wider stakeholders on the acceptability and feasibility of intervention implementation. Our patient and public involvement (PPI) colleague, a co-applicant on the study, provided unique insights and guidance throughout the study. Limitations of the study: Protracted multiple ethical approvals across devolved countries and processes meant a significant delay in recruitment commencing, particularly for the Scotland site. We were unable to deliver the post-liberation elements of the intervention. The onset of the COVID-19 pandemic resulted in prison restrictions and no access to the prison site, meaning we were unable to identify if participants had been released or not at 6 months, with no access at the England site at 12 months and very limited access at the Scotland site at 12 months. Although the COVID-19 pandemic was undoubtedly a factor in the low percentage followed up, only 13% (18/132) of those who received the intervention were followed up at 12 months. Changes to the study protocol to include self-completion of follow-up data may have made it difficult for participants to complete the survey, resulting in larger proportions of missing data as compared to RA survey completion at baseline, where missing data were minimal. We did not include probation services in the trial, which on reflection would have strengthened our post-liberation follow-up process. Recommendations regarding a definitive randomised trial: From the study progression criteria for a full RCT , we have identified the following recommendations: Buy-in for a research trial of this nature in prison requires significant pre-study trust and relationship development, buy-in from the prison estate, governor, prison officers, peer mentors and embedded third-sector services. Recruitment and randomisation of men on remand to a future APPRAISE RCT are possible, with trust in the research team an important factor. Training team members of existing alcohol services to deliver APPRAISE as per protocol is possible. Delivery of the in-prison APPRAISE intervention is possible and would require appropriate space, time and team member capacity. Economic evaluation is possible. Post-liberation intervention delivery and follow-up would only be possible if there was a robust follow-up process identified and in place. Further exploration of the inclusion of and collaboration with the probation service in the service delivery and implementation of the APPRAISE intervention, and that of voluntary groups and agencies at local community levels engaged specifically in post-discharge support services, may offer higher success rates of post-liberation intervention delivery and a more robust follow-up process. PPI membership should be strengthened to reflect the complexity of the prison setting and the range of stakeholders within the criminal justice system. Conclusion: Addressing alcohol harm in prisons, at what can be considered a 'teachable moment', can provide men with an opportunity for reflection on their risky drinking and their current position. Many men on remand do not have the opportunity to access mainstream prison health or public health services. An intervention such as APPRAISE offers an opportunity to provide an extended behavioural-based alcohol intervention to men on remand. The APPRAISE study has identified that despite the complexities of ethical approval and the time taken to build relationships and trust, it is possible to undertake key elements of a future RCT , but not all, namely follow-up. Further focused research needs to be undertaken to explore, identify and develop a robust process and system to optimise follow-up post liberation. The evidence base to meet the needs of men on remand in relation to risky drinking remains weak. However, there are opportunities to build on the work of APPRAISE to ensure equal access to interventions that have the potential to positively impact their relationship with and use of alcohol. Trial registration: This trial is registered as Current Controlled Trials ISRCTN36066. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref. 17/44/11) and is published in full in Public Health Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

The Department for Education (DfE) has suggested that the key to attainment is a good transition. Within the context of low post-16 participation rates and inadequate transition procedures, and arising from the position that relationships are vitally important to wellbeing, this empirical research aimed to explore the lived experiences of young people (YP) who have transitioned from and to specialist settings. This was achieved by answering the following research questions: How do young people with education, health and care plans make sense of relationships during transition to further education? How might young people's constructions of relationships help prepare them for adulthood? Informed by a meta-ethnographical review within a qualitative methodological paradigm, an idiographic approach was used to interview four YP in a specialist sixth-form college in a local authority (LA) in the north east of England. Interpretative phenomenological analysis (IPA) was used to analyse data from semi-structured interviews and two superordinate themes were constructed. The first theme, 'People', contains the subthemes school feeling like a family, decision making, separation/being in it together, and teachers as mentors. Findings suggest that relationships developed within school are different in nature and serve a different purpose to those developed in college. The second theme 'Purpose of college', contains the following subthemes: college as a stepping stone and learning independent skills. There are tentative links between YP's autonomy in decision making and the role of teachers as mentors to preparing for adulthood. Implications for educational psychology practice are discussed and limitations of the study are acknowledged.