Transition aux soins adultes : une vue d'ensemble [Transition to adult care: an overview]

De nos jours, près de 90% des enfants atteints d'une maladie chronique survivent au-delà de l'âge de vingt ans et doivent passer de la pédiatrie aux soins adultes et de l'enfance à l'adolescence et à l'âge adulte. Selon la Society for Adolescent Medicine and Health (SAHM), les objectifs d'une transition organisée et coordonnée aux soins adultes pour les jeunes malades chroniques devraient permettre d'optimiser leur santé et de faciliter la réalisation de leur potentiel maximal.1 En conséquence, bien que le but principal de la transition soit la continuité des soins, elle n'est pas limitée au transfert (le passage de l'information et du patient de la pédiatrie aux soins adultes) mais est beaucoup plus large et inclut la préparation à la vie adulte. Ainsi donc, la transition devrait commencer tôt pendant l'adolescence, finir quand le patient devient un jeune adulte et englober trois parties : une phase de préparation en pédiatrie, une de transfert de la pédiatrie aux soins adultes et une dernière d'engagement aux soins adultes. Nowadays nearly 90% of children with a chronic condition survive to adulthood and must make the transition from pediatric to adult care. This transition must include not only the continuity of care but also the preparation for adult life so that these young people can develop their full potential. Divided into three phases (preparation, transfer and engagement), the transition process should be adapted to adolescents and ensure access to quality care.

Quand Bradley Manning devint Chelsea. De la NBC à Wikipédia, l'espace public comme scène d'une transition de genre

Scène de phénoménalisation de Chelsea Manning, l'espace public est aussi son lieu de naissance. En effet, le 22 août 2013, Bradley Manning, ex-analyste du renseignement en Irak alors incarcéré dans une prison militaire américaine pour avoir délivré des documents confidentiels à WikiLeaks, fait savoir dans un communiqué de presse remis à la NBC qu'il se sent avoir toujours été une femme. Il demande également à être désigné désormais sous le prénom de « Chelsea ». Cette auto-déclaration identitaire de genre est en réalité proférée par la journaliste du Today Show, lors de l'entretien qu'elle mène avec l'avocat de Manning. Une fois la demande transmise, la journaliste et l'avocat se réfèrent à Manning au féminin. C'est ainsi qu'un plateau de télévision s'est transformé en la scène d'une transition de genre. Mais l'annonce de Manning a eu des effets, durables, bien au-delà de cette scène locale. Ainsi, au sein de la scène globale qu'est l'encyclopédie en ligne Wikipédia, les contributeurs ont débattu, parfois avec acharnement, de l'opportunité de renommer la page de l'article intitulé « Bradley Manning » pour consacrer sa féminité nouvellement acquise. Sur la base d'une analyse énonciative, notre article montre comment le Today Show du 22 août 2013 a transformé la déclaration de Manning en un performatif. Restituant la trajectoire d'(in)félicité de ce performatif, il s'attache également à ethnographier les pages « discussion » de la Wikpédia anglophone et francophone.

TRANSITION IN ENDOCRINOLOGY: Hypogonadism in adolescence.

Puberty is a remarkable developmental process with the activation of the hypothalamic-pituitary-gonadal axis culminating in reproductive capacity. It is accompanied by cognitive, psychological, emotional, and sociocultural changes. There is wide variation in the timing of pubertal onset, and this process is affected by genetic and environmental influences. Disrupted puberty (delayed or absent) leading to hypogonadism may be caused by congenital or acquired etiologies and can have significant impact on both physical and psychosocial well-being. While adolescence is a time of growing autonomy and independence, it is also a time of vulnerability and thus, the impact of hypogonadism can have lasting effects. This review highlights the various forms of hypogonadism in adolescence and the clinical challenges in differentiating normal variants of puberty from pathological states. In addition, hormonal treatment, concerns regarding fertility, emotional support, and effective transition to adult care are discussed.

A comparison of indices of glucose metabolism in five black populations: data from modeling the epidemiologic transition study (METS).

BACKGROUND: Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries. METHODS: We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition. RESULTS: Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m(2) in men and from 25.8 to 34.8 kg/m(2) in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA. CONCLUSION: Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics.

Association of car ownership and physical activity across the spectrum of human development : Modeling the Epidemiologic Transition Study (METS).

BACKGROUND: Variations in physical activity (PA) across nations may be driven by socioeconomic position. As national incomes increase, car ownership becomes within reach of more individuals. This report characterizes associations between car ownership and PA in African-origin populations across 5 sites at different levels of economic development and with different transportation infrastructures: US, Seychelles, Jamaica, South Africa, and Ghana. METHODS: Twenty-five hundred adults, ages 25-45, were enrolled in the study. A total of 2,101 subjects had valid accelerometer-based PA measures (reported as average daily duration of moderate to vigorous PA, MVPA) and complete socioeconomic information. Our primary exposure of interest was whether the household owned a car. We adjusted for socioeconomic position using household income and ownership of common goods. RESULTS: Overall, PA levels did not vary largely between sites, with highest levels in South Africa, lowest in the US. Across all sites, greater PA was consistently associated with male gender, fewer years of education, manual occupations, lower income, and owning fewer material goods. We found heterogeneity across sites in car ownership: after adjustment for confounders, car owners in the US had 24.3 fewer minutes of MVPA compared to non-car owners in the US (20.7 vs. 45.1 minutes/day of MVPA); in the non-US sites, car-owners had an average of 9.7 fewer minutes of MVPA than non-car owners (24.9 vs. 34.6 minutes/day of MVPA). CONCLUSIONS: PA levels are similar across all study sites except Jamaica, despite very different levels of socioeconomic development. Not owning a car in the US is associated with especially high levels of MVPA. As car ownership becomes prevalent in the developing world, strategies to promote alternative forms of active transit may become important.

Late careers and the transition to retirement in Switzerland

A substantial body of life-course research has considered occupational trajectories in Switzerland focusing either on early or middle adulthood careers. However, the issue of the last working period and the retirement transition is receiving increasing attention for several reasons: the permanence of low birth rates associated with an ageing population, a high proportion of active old workers, continuous changes in the timing of retirements, and active ageing policies aiming at keeping people working after the state pension age. Moving forward on this topic, the present doctoral thesis aimed to offer new insights on the dynamics of the final career phase and the transition to retirement in Switzerland through a life-course approach. Concerning the main results, this thesis provides consistent evidences on the great influence of longterm familial and employment trajectories as well as individual positional factors on (i) the vulnerability during the last working period, (ii) the timing of retirement, (iii) the voluntariness of late retirement, and (iv) the financial well-being of retirees. In this way, this thesis offers significant contributions to the life-course, gender, and social policy research focused on ageing processes. -- Un ensemble considérable de recherches sur les parcours de vie a examiné les trajectoires professionnelles en Suisse, en mettant l'accent sur la carrière professionnelle des jeunes et, plus tard, à l'âge adulte. Toutefois, l'étude de la fin de la carrière professionnelle (c'est-à-dire de 50 ans jusqu'à la retraite) reçoit une attention croissante pour plusieurs raisons: la persistance du faible taux de natalité associé à une population vieillissante, la forte proportion de travailleurs âgés actifs, des évolutions continues dans le moment du départ à la retraite, et des politiques visant à maintenir les personnes âgées au travail après l'âge légal de la retraite. Pour aller de l'avant sur ce sujet, la présente thèse de doctorat vise à offrir de nouvelles perspectives sur la fin de carrière et la transition à la retraite en Suisse, en mobilisant les outils de la sociologie des parcours de vie. En ce qui concerne les principaux résultats, cette thèse fournit des preuves cohérentes sur la grande influence des trajectoires professionnelles et familiales ainsi que des facteurs positionnels sur (i) la vulnérabilité au cours de la période de travail avant la retraite, (ii) le moment de départ à la retraite, (iii) le caractère volontaire de la retraite tardive, et (iv) le bien-être financier des retraités. Ainsi, cette thèse fournit d'importantes contributions à la recherche sur les parcours de vie, sur les étu es genre, et sur les politiques sociales, focalisées sur le processus de vieillissement.

Forest Transition in Madagascar's Highlands: Initial Evidence and Implications

Madagascar is renowned for the loss of the forested habitat of lemurs and other species endemic to the island. Less well known is that in the highlands, a region often described as an environmental "basket-case" of fire-degraded, eroded grasslands, woody cover has been increasing for decades. Using information derived from publically available high- and medium-resolution satellites, this study characterizes tree cover dynamics in the highlands of Madagascar over the past two decades. Our results reveal heterogeneous patterns of increased tree cover on smallholder farms and village lands, spurred by a mix of endogenous and exogenous forces. The new trees play important roles in rural livelihoods, providing renewable supplies of firewood, charcoal, timber and other products and services, as well as defensible claims to land tenure in the context of a decline in the use of hillside commons for grazing. This study documents this nascent forest transition through Land Change Science techniques, and provides a prologue to political ecological analysis by setting these changes in their social and environmental context and interrogating the costs and benefits of the shift in rural livelihood strategies.

Bayesian Networks for the Age Classification of Living Individuals: a Study on Transition Analysis

Over the past few decades, age estimation of living persons has represented a challenging task for many forensic services worldwide. In general, the process for age estimation includes the observation of the degree of maturity reached by some physical attributes, such as dentition or several ossification centers. The estimated chronological age or the probability that an individual belongs to a meaningful class of ages is then obtained from the observed degree of maturity by means of various statistical methods. Among these methods, those developed in a Bayesian framework offer to users the possibility of coherently dealing with the uncertainty associated with age estimation and of assessing in a transparent and logical way the probability that an examined individual is younger or older than a given age threshold. Recently, a Bayesian network for age estimation has been presented in scientific literature; this kind of probabilistic graphical tool may facilitate the use of the probabilistic approach. Probabilities of interest in the network are assigned by means of transition analysis, a statistical parametric model, which links the chronological age and the degree of maturity by means of specific regression models, such as logit or probit models. Since different regression models can be employed in transition analysis, the aim of this paper is to study the influence of the model in the classification of individuals. The analysis was performed using a dataset related to the ossifications status of the medial clavicular epiphysis and results support that the classification of individuals is not dependent on the choice of the regression model.