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Aim: To identify barriers and facilitators impacting the implementation of a comprehensive transfer program aimed at parents of adolescents with chronic illness in clinical practice. Design: A real‐time, qualitative process evaluation. Methods: Individual interviews were conducted with 10 nurses and seven physicians from paediatric and adult outpatient clinics: Nephrology, hepatology, neurology, and rheumatology. Data were analysed through the lens of normalization process theory. Results: Themes were framed within the theory's four components. (1) Coherence: Healthcare professionals' views on their core tasks and on the parents' role influenced their perception of the program. (2) Cognitive participation: A named key worker, autonomy, and collaboration impacted healthcare professionals' involvement in the program. (3) Collective action: Department prioritization and understanding of the program's aim were key factors in its successful delivery. (4) Reflective monitoring: Participants experienced that the program helped parents during transfer but questioned if the program was needed by all families. Conclusion: We identified three barriers: Healthcare professionals' lack of understanding of the parental role during transfer, top‐down decisions among nurses, and physicians' uncertainty about their role in joint consultations. Facilitators: Healthcare professionals' understanding of the program's purpose and expected effect, the nurses' significant role as named keyworkers, and good collaboration across paediatric and adult departments. Implications for the Profession and/or Patient Care: Implementation strategies should be developed before implementing a transfer program in clinical practice. Impact: Implementing a parental transfer program in clinical practice can be challenging. Therefore, for successful implementation, it is crucial to identify barriers and facilitators.Barriers and facilitators exist at the personal, professional, and organizational levels, and it is important to understand them.The results of this qualitative study could support the implementation of transfer programs in other settings. Reporting Method: Consolidated criteria for reporting qualitative studies (COREQ). Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community?: Nurses' and physicians' experiences of ownership of the transfer program is essential for successful implementation.Clinics should appoint a named keyworker, preferably a nurse, as the driving force during the implementation of a transfer program.Nurses and physicians should receive training about the purpose, justification, and expected effect of a transfer program before implementation. [ABSTRACT FROM AUTHOR]

This study examined whether the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 demonstrated measurement invariance between young adolescents aged 10–16 years with a physical illness and older adolescents aged 15–19 years from the general population. Young adolescent data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117) and older adolescent data come from the Canadian Community Health Survey-Mental Health (n = 1851). Multiple-group confirmatory factor analysis was used to test measurement invariance. WHODAS 2.0 scores were compared across morbidity subgroups using multiple regression. Measurement invariance of the WHODAS 2.0 was demonstrated: (χ2=635.2(144), p<.001; RMSEA = 0.059 (0.054, 0.064); CFI = 0.967; TLI = 0.970; and, SRMR = 0.068). Adjusting for data source, sex, race, immigrant status, and household income, WHODAS 2.0 scores were associated with morbidity status in a dose–response manner: physical illness only (B = 1.50, p<.001), mental illness only (B = 2.92, p<.001), and physical–mental comorbidity (B = 4.44, p<.001). Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents – a group that previously demonstrated measurement invariance with an adult sample. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course. The 12-item self-administered WHODAS 2.0 is one of the most widely used measures of disability and functioning. Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents and adults in Canada. Researchers and health professionals can be confident that differences in 12-item self-administered WHODAS 2.0 scores are real and meaningful. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this concept analysis was to define the concept of transitional care as it applied to adolescents with chronic health conditions as they transfer from pediatric to adult care. Design and Methods: Walker and Avant's eight step method was used to guide this concept analysis. An electronic search of the literature using CINAHL, PubMed, and MEDLINE was conducted in March of 2022. Articles were included if they were peer‐reviewed articles published in English between 2016 and 2022 and aided in the development of the concept. Results: A total of 14 articles met inclusion criteria within the search. These articles were used to identify the defining attributes of transitional care as it applied to adolescents with chronic disease. These attributes were empowerment, a comprehensive process, and transfer completion. The antecedents identified were aging, readiness, and support. For an individual to begin the transition process all of these must be present. Consequences include growth, independence, and improved quality of life and health outcomes. Model, borderline, related, and contrary cases were presented to exemplify the concept. Practice Implications: Adolescents and young adults with chronic disease require unique care as they transition to adulthood. Defining the concept of transitional care as it relates to this population provided a foundation of knowledge that has implications for nursing practice. This conceptual structure provided a foundation of knowledge for theory development and encouraged widespread use of transition programs. Future research should explore the long‐term outcomes of specific interventions used during transitional care. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of chronic illness in childhood implies frequent hospitalizations and, consequently, the interruption of school attendance. This study aimed to understand the process of school reintegration of children and adolescents with chronic illness from the mothers' perspective. Method: A qualitative descriptive‐exploratory study was conducted with mothers who experienced the process of school reintegration of their child or adolescent, aged between 8 and 17 years old, and diagnosed with chronic illness. The participants were recruited by convenience and interviewed at the paediatric unit of a children's hospital. Data collection was interrupted when the data set was sufficient to answer the research question. The interviews were analysed using inductive thematic analysis. The study was approved by the research ethics committee. Results: Eleven interviews were conducted, 10 with mothers and one with a grandmother, who played the maternal role. Participants' age ranged between 33 and 58 years old. A theme was developed—"School reintegration under the maternal vigilance"—which encompasses four subthemes: (1) What matters? My child's health comes first; (2) How to keep in touch with the school? (3) Back to the school: Are we ready? (4) Sharing vigilance: reality and expectations. The themes highlighted a cyclical, dynamic, and subjective school reintegration process, constantly permeated by maternal vigilance. Conclusion: A new understanding about school reintegration was evidenced, from the perspective of mothers of children and adolescents with different chronic illnesses. Mothers and children experience a nonlinear and recurrent process of leaving and returning to school, surrounded by a lack of communication and continuity in school activities. The results of this study may assist health professionals in planning care focused on the needs of the school reintegration of this population. [ABSTRACT FROM AUTHOR]

Copyright of Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS) is the property of Universidade Federal do Triangulo Mineiro, Instituto de Ciencias da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to know the experiences of family members of adolescents diagnosed with Type 1 Diabetes Mellitus, related to coexistence, care, and changes generated by the chronic disease. Method: qualitative study conducted between November 2017 and May 2018 with 48 family members of adolescents with Type 1 Diabetes Mellitus, members of the social network Facebook. Data analyzed according to content analysis. Results: most participants were mothers, living in the Midwest of Brazil, aged between 41 and 60 years, with a college degree, and employed. Three categories were constructed to address family coexistence, constant care, and adaptations required by the chronic disease. Final considerations: family members of adolescents diagnosed with Type 1 Diabetes Mellitus experienced daily challenges, permeated by difficulties, fears, guilt and uncertainty about the future. Among the challenges were highlighted the changes resulting from the chronic condition in the routine, constant care, exclusive dedication to the teenager. The chronic disease enabled the adoption of healthy lifestyle habits and greater family complicity. [ABSTRACT FROM AUTHOR]

Background: Patient and Public Involvement (PPI) of young people with a chronic condition (YPCC) receives increasing attention. However, evidence of its impact is lacking. This study explores the impact of PPI on outcomes of projects in health and social care, using quantitative measures. Methods: Data were collected from projects funded by a 4‐year participatory program addressing the social position of YPCC. These projects addressed challenges associated with, for example, going to college with a physical disability, transitions in care and finding a job. Project coordinators filled out project reports with questions about PPI, that is, to what extent were YPCC involved, were they involved as co‐deciders and were they involved in developing the project idea. YPCC filled out questionnaires with questions about PPI, that is, the number of PPI activities and self‐perceived importance for the project. They also answered questions about the influence of the project on their social position. Based on these questions, a project outcome scale was developed. Results: The data concerned 17 projects and 146 YPCC. Variation existed in project outcomes, of which 27% was associated with differences between projects. Using multilevel analyses, a significant relation was found between the self‐perceived importance of YPCC for the project and the project outcomes they experience (0.232, p < 0.01). There was no significant association with the other PPI variables. Conclusions: This study provided some first quantitative evidence that PPI has a positive impact on the YPCC involved. It is suggested that the meaningfulness of PPI matters more to them than the number of activities and amount of influence provided to YPCC. We strongly recommend conducting more research that critically examines impact of PPI. [ABSTRACT FROM AUTHOR]

Objective: to analyze narratives about the experience of hope of families in the context of pediatric chronic illness. Method: a narrative research using Family Systems Nursing as a conceptual framework. Three families of children and adolescents diagnosed with complex chronic illness participated in this study, totaling 10 participants. Data collection was developed using family photo-elicitation interviews. Family narratives were constructed and analyzed according to inductive thematic analysis with theoretical data triangulation. Results: the analytical theme - Waves of Family Hope in the Context of Pediatric Chronic Illness - is composed of four different types of hope: uncertain hope, caring hope, latent hope, and expectant hope. Movement through these hopes generates a driving energy and depends on a number of factors: support, information, searching for normality, and thoughts and comparisons. Conclusion: the results highlight the interaction and reciprocities of the members of the family unit, and the dynamics of hope, and illustrate the different types of hope and the factors that influence them. This study highlights the experience of hope as a family resource rather than just an individual resource, and supports health professionals in the planning of family care considering hope as an essential and dynamic family resource. [ABSTRACT FROM AUTHOR]

This study examined associations between chores engagement, self-management, and transition readiness in youth with chronic conditions. Youths with various chronic conditions attending a therapeutic camp, and their parents participated. Responses of 165 campers and their parents were analyzed (mean camper age 12.3 ± 2.6 years, 47.9% males, 79.4% White). The most common diagnoses were diabetes, spina bifida, cerebral palsy, and sickle cell anemia. Youth who completed chores manifested higher overall health care transition readiness ( β ^ = 5.17, p =.026) and better communication with providers ( β ^ = 2.98, p =.006) than youth who completed no chores. Higher chores frequency was not more predictive of higher health care transition readiness scores above and beyond the effects of having chores at all. These results suggest that responsible health care behaviors are related to similar actions in other areas of life. Assignment of chores may promote self-management and health care transition readiness in youth with chronic conditions. [ABSTRACT FROM AUTHOR]

Initial evidence suggests that the WHO Disability Assessment Schedule (WHODAS 2.0) is valid and reliable in general youth populations; however, its psychometric properties in specific subgroups are less established. The primary objective was to test for measurement invariance of the 12-item WHODAS 2.0 in an epidemiological sample of youth aged 15 to 19 years with and without physical or mental conditions. Using data from 1,851 youth in the Canadian Community Health Survey–Mental Health, invariance was tested using multiple-group confirmatory factor analysis. Within-domain item correlations were significant and ordinal coefficient alphas were.91,.94,.93, and.92 for the healthy control, physical, mental, and comorbid groups, respectively. Partial measurement invariance was demonstrated for the WHODAS 2.0, with evidence of noninvariance for item residuals and factor variances related to cognition and participation. While these domain-specific comparisons may be biased, valid comparisons of overall disability across subgroups of youth can be made with confidence. [ABSTRACT FROM AUTHOR]

Background: The involvement of young people with a chronic condition in research and implementation projects in health and social care receives growing attention. Yet, there is a lack of conceptual clarity of this so‐called 'Patient and Public Involvement' (PPI) and methods to systematically evaluate it are absent. This scoping review aimed to gain insight into developments in the existing literature on PPI of young people with a chronic condition by mapping reported definitions, goals, activities, experiences and impact. Methods: We conducted searches in Cinahl, Embase, PsycINFO, PubMed and Scopus. Included articles described involvement of young people with a chronic condition in research and implementation projects, contained empirical data, were written in English and were published after 1990. Two researchers independently carried out the data extraction. Results: Twenty‐three studies out of 4993 initial hits met the inclusion criteria. We found great variation in definitions and operationalizations of PPI. Reflections of authors on the process of PPI and its impact were similar and did not change over the years. Discussion and conclusion: Limited progress in the evidence base of the impact of PPI with young people with a chronic condition was found. Over the years, studies continue to report similar experiences and challenges. In order to move forward, we suggest future research to make connections to existing work instead, to include thorough descriptions of what is understood by PPI and how this is translated into activities, and to use systematic and objective, but also flexible, methods to measure its impact. [ABSTRACT FROM AUTHOR]

The transition of chronically ill adolescents and young adults to adult health care is poorly managed, leading to poor outcomes due to insufficient disease knowledge and a lack of requisite skills to self-manage their chronic disease. This review analyzed 33 articles published between 2009 and 2019 to identify factors associated with transition readiness in adolescents and young adults with chronic diseases, which can be used to design effective interventions. Studies were predominantly cross-sectional survey designs that were guided by interdisciplinary research teams, assessed adolescents and young adults ages 12–26 years, and conducted in the outpatient setting. Modifiable factors, including psychosocial and self-management/transition education factors, and non-modifiable factors, including demographic/ecological and disease factors, associated with transition readiness were identified. Further research is necessary to address gaps identified in this review prior to intervention development, and there is a need for additional longitudinal studies designed to provide perspective on how transition readiness changes over time. [ABSTRACT FROM AUTHOR]

Background: The way adolescents with chronic illness (ACI) cope with adversity is associated with their resilience potential, which is also built through the relationship established with nurses. Objectives: To identify resilience-promoting nursing interventions in ACI; to assess resilience in ACI; and to establish an association between their level of resilience and the received interventions. Methodology: An exploratory sequential mixed-methods study was conducted. First, a qualitative study was conducted with a focus group of 8 nurses from a pediatric hospital, resulting in a list of resilience-promoting nursing interventions (LIER). Then, a quantitative study was conducted where a questionnaire was applied to 32 ACI (including the Resilience Scale and the LIER obtained in the first study). Results: Nurses reported several resilience-promoting nursing interventions. In a sample of 32 ACI, the level of resilience was average and higher in the adolescents with neurological diseases and in girls. A low correlation was found between the level of resilience and the nursing interventions. Conclusion: The results should be disseminated, and increased investment should be made so that the promotion of resilience in ACI clearly results from nursing interventions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this integrative review was to synthesize previous research on perceptions of school health care among school-aged children and adolescents with chronic diseases. Methods: This study was performed in accordance with Whittemore and Knafl's stages of an integrative review (problem identification, literature search, data evaluation, data analysis, and presentation of the results). Four databases (PubMed, CINAHL, Embase, and Web of Science) were used to retrieve relevant articles. Results: Eighteen articles were included in this review. We identified five thematic categories: peer-related issues, a safe school environment, self-perception of an existing disease, self-management, and a supportive school environment. Conclusion: It is necessary to establish a school health care system with a supportive environment for children and adolescents with chronic diseases. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the socioeconomic status, medical use and expenditures for infants (1–5 years), juveniles (6–12 years), and adolescents (13–19 years) with a chronic condition or disease to determine factors affecting health spending. Methods: Data from 3,677 minors (< 20 years old, without disabilities) were extracted from the Korea Health Panel (2015) database. Results: Minors with chronic conditions or diseases were older (juveniles, and adolescents; p < 0.001), and included a higher proportion of Medicaid recipients (p = 0.004), a higher use of hospital outpatient care (p < 0.001), and higher medical expenditure (p < 0.001) compared to minors without chronic conditions or diseases. Boys were more likely to have a chronic condition or disease than girls (p = 0.036). Adolescents and juveniles were more likely than infants to have a chronic condition or disease (p = 0.001). Medicaid recipients were more likely to have a chronic condition or disease than those who were not Medicaid recipients (p = 0.008). Minors who had been hospital outpatients were more likely to have a chronic condition or disease, compared with minors who had not been an outpatient (p = 0.001). Having a chronic condition or disease, was a factor increasing medical expenditure (p = 0.001). Medical expenditure was higher in infants than in juveniles and adolescents (p = 0.001). Infants had higher rates of medical use when compared with juveniles and adolescents (p = 0.001). Conclusion: These findings suggest that systematic health care management for minors with chronic conditions or diseases, is needed. [ABSTRACT FROM AUTHOR]

The coordination of primary care is pivotal to the management of chronic conditions. However, current systems may not be as efficient or effective as one would hope. This article addresses to the managers and health teams in the primary care setting and their challenges regarding children and adolescents with chronic conditions in Brazil. A qualitative study was conducted with 26 primary care professionals and managers using thematic content analysis. The results showed a scarcity of specialists for referrals and a lack of professional training for dealing with this specific group of patients. It is necessary to improve health information systems to ensure the continuity of care. Current health care of children and adolescents with chronic conditions is neither efficient nor effective. For this type of care to be comprehensive, the health needs of this population must be addressed and the operational structure of the health care network must be strengthened. [ABSTRACT FROM AUTHOR]

Introduction: We sought to understand the association between youthful self-harm and subsequent chronic disease-related healthcare utilization and whether self-harm reflects unique vulnerability in comparison with severe psychiatric disorders.Methods: We used a retrospective matched cohort design with statewide, all-payer, individually linked emergency department (ED) data from California, USA. Risk of future ED visits for common chronic conditions in adolescence (headaches, asthma, epilepsy, diabetes, and gastrointestinal disorders, assessed using ICD-9 diagnoses) were compared between three adolescent study groups presenting to an ED in 2010: self-harm patients (n = 5,484), patients with psychiatric complaints but no self-harm (n = 14,235), and patients with other complaints (n = 16,452). Cohort follow-up ended on Sept. 30, 2015. Analyses were adjusted for patients' prior histories of ED utilization for chronic conditions as well as patient- and area-level sociodemographic characteristics.Results: Risk of subsequent ED visits was higher among self-harm patients compared to non-psychiatric control patients for subsequent epilepsy- (aRR = 1.77, 95% CI [1.42, 2.21]). Risk of subsequent ED visits was higher among psychiatric patients compared to non-psychiatric control patients for subsequent headache- (aRR = 1.31, 95% CI [1.21, 1.42]), and epilepsy-related problems (aRR = 1.85, 95% CI [1.55, 2.21]). Self-harm patients were at higher risk than psychiatric patients for subsequent gastrointestinal disorder (aRR = 1.76, 95% CI [1.03, 3.01]).Conclusions: Findings suggest that self-harm behavior and psychiatric disorders are associated with increased ED utilization for subsequent chronic disease-related ED utilization. Chronic disease among adolescent psychiatric patients should be attended to, potentially involving new models of clinical follow-up care. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/objective: Simultaneous engagement in risk behaviors for chronic non-communicable diseases (NCDs) might exert a synergistic effect on adolescent health. This study aimed to identify risk behavior patterns for NCDs in adolescents and analyze associated factors.Methods: Cross-sectional study conducted between 2009 and 2011, with 1,716 participants aged 10-17 years of a cohort study in Central-West Region, Brazil. Demographic, economic, anthropometric, and lifestyle characteristics were collected. Risk behaviors evaluated were alcohol consumption, tobacco experimentation, insufficient physical activity, sedentary behavior, skipping breakfast, and low diet quality. Principal component analysis was used to identify patterns of risk behaviors and multiple linear regression analysis to quantify the association between independent variables and patterns of risk behavior.Results: Three patterns of risk behaviors were identified: "legal drugs", "diet and screens", and "silent". After adjustment, legal drugs pattern showed direct association with age (β = 0.13; 95% CI = 0.09; 0.16) and inverse association with maternal education (β = -0.07; 95% CI = -0.14; -0.01). Diet and screens pattern were directly associated with female gender (β = 0.14; 95% CI = 0.04; 0.23), age (β = 0.11; 95% CI = 0.08; 0.14), and economic class (β = 0.15; 95% CI = 0.04; 0.25). Silent pattern was directly associated with maternal education (β = 0.09; 95% CI = 0.03; 0.15), being overweight (β = 0.17; 95% CI = 0.06; 0.28), and female gender (β = 0.32; 95% CI= 0.22; 0.41).Conclusions: Three risk behavior patterns were identified and the associated factors were socioeconomic status, age, and female gender. [ABSTRACT FROM AUTHOR]

Copyright of Avances en Enfermería is the property of Editorial Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The effect of vitamin D on bone metabolism is well known. It has recently been shown to be also associated with cardiovascular diseases, obesity, infections, autoimmunity, and cancer. The aim of our study was to evaluate vitamin D deficiency in childhood chronic diseases. Material and Methods: A total of 438 cases followed-up for vitamin D deficiency/insufficiency (25 OHD level < 30 ng/ mL) in our clinic between 2005 and 2011 and who had an additional chronic disorder were evaluated retrospectively. Results: The mean age of the cases was 12.8±4.6 years and the female/male ratio 1.29 Accompanying disorders included diabetes mellitus, obesity, Turner syndrome, congenital adrenal hyperplasia, myopathy, autoimmune and rheumatic diseases, central nervous system diseases and malignancies. The vitamin D deficiency/insufficiency incidence ranged between 62.5 and 95.0% in the children/adolescents with chronic disease. The mean 25 OHD level was 17±6.6 ng/ml. Hypocalcemia or a similar ion imbalance was not found in any group. Conclusion: Considering the multisystemic effects of vitamin D, 25 OHD levels should be monitored in chronic diseases in childhood and supplementation provided if necessary. This may lead to an improvement in the course of the underlying disease as well. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Health care transition of adolescents with chronic conditions may be unsuccessful when patients have not acquired the necessary skills and developmental milestones. It is therefore critical for health care providers to assess the readiness for transition of their adolescent patients. This is currently hindered by the lack of a recognised, well-established transitionreadiness assessment tool. Methods We conducted a systematic review of all transition-readiness tools for adolescents with chronic medical conditions published in peer-reviewed journals. Tools were rated by the methodological quality of the validation studies, and the psychometric measurement qualities of each tool. Results Ten different assessment tools were identified. Seven targeted specific diseases and 3 tools were generic. Most tools were poorly validated with only one tool, the Transition Readiness Assessment Questionnaire (TRAQ) demonstrating adequate content validity, construct validity, and internal consistency. Conclusion The TRAQ was the best-validated transition-readiness tool, with additional benefits of disease-neutrality. Further research should focus on testing the predictive validity of this tool, and exploring correlation with transition-outcomes, in an international population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the clustering of risk behaviors for chronic non-communicable diseases and their associated factors among adolescents from Southern Brazil. Methods: In 2008, a survey was conducted with 3990 adolescents aged 14–15years (mean: 14.3; SD: 0.6) from the 1993 Pelotas Birth Cohort Study. Clustering was determined by comparing observed (O) and expected (E) prevalence of all possible combinations of the four risk factors investigated (smoking, alcohol intake, low fruit intake, and physical inactivity). We carried out Poisson regression to evaluate the effect of individual characteristics on the presence of at least three risk behaviors. Results: All risk factors tended to cluster together (O/E prevalence=3.0), especially smoking and alcohol intake (odds ratio to present on behavior in the presence of other >5.0). Approximately 15% of adolescents displayed three or more risk behaviors. Females (adjusted OR=1.55), people 15years and older (OR=1.47), with black skin color (OR=1.23), and of low socioeconomic level (OR=1.29) were more likely to display three or more risk factors. Conclusion: These findings suggest that lifestyle-related risk factors tend to cluster among adolescents. Identifying subgroups at greater risk of simultaneously engaging in multiple risk behaviors may aid in the planning of preventive strategies. [Copyright &y& Elsevier]

Purpose: We examined whether associations of adolescent intelligence with chronic diseases in adulthood are explained by socioeconomic factors, health behaviors, or common sources of variance in intelligence and chronic disease risk. Methods: A prospective cohort study (Wisconsin Longitudinal Study) of high school graduates and their siblings with intelligence assessed in adolescence and chronic diseases reported in adulthood (n = 10,168; mean age 53.9 and n = 9051; mean age 64.8 in two follow-ups). Results: After adjustment for age and sex, greater intelligence was associated with lower risk of heart disease (odds ratio per 1 SD advantage in intelligence 0.93; 95% confidence interval 0.87−0.99), circulation problems (0.85; 0.79−0.92), stroke (0.80; 0.70−0.91), and diabetes (0.88; 0.81−0.95). Participants’ risk of stroke and circulation problems also was predicted by their sibling’s intelligence, suggesting potential common causes for intelligence and cerebrovascular diseases. Sibling analysis provided no support for shared family environment in explaining associations between intelligence and disease outcomes because between-families and within-siblings regression models were not different. Adjusting for common risk factors had little impact on these associations. In contrast, adjusting for adult socioeconomic status attenuated the associations by 25%−100% (66% on average). Conclusions: Multiple mechanisms may link intelligence with occurrence of chronic diseases of major public health importance. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Abstract: The prevalence of 15 common obesity-related chronic health conditions was examined in a convenience sample of adolescents, ages 12–18 years old, with mobility and non-mobility limitations (n =208 and 435, respectively). In both groups, overweight adolescents (BMI≥85th %ile) had a significantly higher number of obesity-related chronic health conditions than their counterparts with healthy weight status (2.74 versus 1.74 for the mobility limitation group, and 1.79 versus 1.45 for the non-mobility limitation group). Prevalence of high blood cholesterol was significantly higher among overweight adolescents than healthy weight adolescents across the two groups. While prevalence of asthma and early maturation appeared to increase as a function of body weight for both groups, a significant difference was found only in the group with non-mobility limitations. Across the two groups, there was a clear tendency toward a higher prevalence of chronic health conditions in overweight adolescents compared to their healthy weight counterparts. Greater efforts must be made to address the higher rates of obesity-related health conditions in youth with disabilities during childhood and adolescence to avoid significant health consequences and health care costs in adulthood. [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Psiquiatria is the property of Asociacion Colombiana de Psiquiatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Because of remarkable advances in the treatment of preterm birth, physicians increasingly encounter adult patients who were born preterm. However, research now shows that improved early survival may come at the expense of future health risks, including increased respiratory, cardiovascular, and kidney disease, diabetes and metabolic syndrome, and neuropsychiatric disorders. Unfortunately, this knowledge is not yet reflected in patient care. The NIH recently convened a conference of multidisciplinary international experts who called for better awareness among physicians regarding adult outcomes of preterm birth, which is critically needed for enabling them to identify and provide better care for these patients across the life course. This Letter aims to promote awareness of this issue among physicians in order to inform long-term patient care and policy. The continued high (~10%) prevalence of preterm birth and unprecedented numbers who are surviving into adulthood mean that the long-term health effects will have a growing clinical and public health impact in the future. [ABSTRACT FROM AUTHOR]

Abstract: Background: Adults with chronic disease are often unable to meet medication and food needs, but no study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. Methods: Cross-sectional analysis of data from chronically ill participants (self-report of arthritis, diabetes mellitus, cancer, asthma, chronic obstructive pulmonary disease, stroke, hypertension, coronary heart disease, or presence of a “psychiatric problem”) aged ≥20 years, in the 2011 National Health Interview Survey. We fit logistic regression models to identify factors associated with food insecurity, cost-related medication underuse, or both. Results: There were 9696 adult National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. Adults who reported food insecurity were significantly more likely to report cost-related medication underuse (adjusted odds ratio [aOR] 4.03). Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic (aOR 1.58), non-Hispanic black (aOR 1.58), and have more chronic conditions (aOR per additional chronic condition 1.56) than patients reporting neither. They also were less likely to have public, non-Medicare insurance (aOR 0.70) and report participation in the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children (aOR 0.39). Conclusions: Approximately 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both. WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse. [Copyright &y& Elsevier]