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

UNLABELLED: 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. CONCLUSION: 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.

The health of adolescents around a world in transition.

Since several years, the health of adolescents is on the agenda of ministers, decision makers and health professionals. Around the world, while there has been a steady decrease of the death rates among young children, this is not the case for young people. This is mainly linked with the fact that mortality and morbidity during this period of life is largely linked with non communicable diseases and conditions, including deaths from injuries, suicide, homicides and drug abuse. Unplanned pregnancies, illegal abortions, newly acquired HIV infections are also situations that have short and long term consequences. This paper reviews the epidemiological data pertaining to adolescent health and disease. It proposes evidence-informed avenues as how to address these issues in the field of health care (e.g. adolescent friendly services) and of prevention and health promotion. It also stresses the importance of creating safe environments for the development and well-being of young people and thus, of an interdisciplinary and inter sectorial approach to their complex health problems and challenges.

Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model

In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.

Transición a la vida adulta de jóvenes con discapacidad intelectual. La opinión de los profesionales de servicios escolares y postescolares = Transition to adulthood of young people with intellectual disabilities. Views of professionals from school and postschool services

La transición a la edad adulta y vida activa es un proceso extremadamente complejo para los jóvenes con discapacidad. Para plantear propuestas de actuación que mejoren sus oportunidades de conseguir objetivos relacionados con la inclusión laboral y social en la vida adulta es imprescindible el diagnóstico en profundidad del contexto en que se construyen y desarrollan los procesos de transición. En este artículo se presenta un estudio en el que se ha aplicado el método Delphi con el propósito de obtener datos sobre la adecuación de los servicios o dispositivos que trabajan con jóvenes con discapacidad a lo largo de su proceso de transición a la edad adulta y vida activa, tanto en el escenario escolar como en el postescolar. Se han constituido dos paneles de expertos, uno con profesionales del ámbito educativo y otro con profesionales que trabajan en servicios postescolares. En ambos casos, los ejes temáticos son: visión del proceso de transición, aspectos curriculares y organizativos de los servicios, existencia de itinerarios de apoyo sistematizados, trabajo colaborativo entre profesionales, acciones de orientación con familias, adecuación de las alternativas postescolares, la formación de los profesionales, y coordinación de servicios. El análisis de los cuestionarios permite constatar las principales dificultades percibidas por los expertos en cada uno de los ámbitos y establece líneas básicas de actuación para mejorar los procesos de tránsito, entre las cuales destaca la necesidad de reforzar el papel de los equipos multiprofesionales en la articulación de redes de trabajo interprofesional

Is the wage curve formal or informal? Evidence for Colombia

Using microdata from the 2002-2006 Colombian Continuous Household Survey, we find an elasticity of individual wages to local unemployment rates of -0.07. However, the elasticity for informal workers is significantly higher, a result which is consistent with efficiency wage theoretical models and relevant for regional labour markets analysis in developing countries.

Biopsies de la prostate en 2015: quelle biopsie pour quel patient [Prostate biopsy: which strategy for which patient?].

L'adoption de l'IRM dans le parcours diagnostique a déterminé la transition des biopsies aléatoires aux biopsies ciblées vers les lésions visibles à l'imagerie. L'utilisation de logiciels rendant possible la fusion d'images IRM et échographiques permet d'améliorer significativement la précision diagnostique de ces biopsies. De plus, pour déterminer l'éligibilité d'un patient à une thérapie focale, davantage de précision diagnostique est requise au niveau de toute la glande ; par conséquent, des biopsies avec une densité d'échantillonnage plus élevée par voie transpérinéale peuvent être proposées.Les nouvelles techniques de biopsie de la prostate permettent une prise en charge personnalisée grâce à une meilleure caractérisation de l'agressivité et de l'extension locale du cancer de la prostate. The adoption of multiparametric MRI within the diagnostic pathway has allowed urologists to move from random biopsy to targeted biopsy directed towards MR-visible lesions. The use of software for MR to TRUS fusion may enhance the diagnostic accuracy of targeted biopsy. To determine the eligibility for tissue-preserving approaches, further precision is required, and template prostate mapping biopsy may be offered. The employment of novel biopsy techniques provide better characterisation of the disease, and allows a tailored approach to a single subject.

Receiver operating characteristic (ROC) curve for classification of18F-NaF uptake on PET/CT

Abstract Objective: To assess the cutoff values established by ROC curves to classify18F-NaF uptake as normal or malignant. Materials and Methods: PET/CT images were acquired 1 hour after administration of 185 MBq of18F-NaF. Volumes of interest (VOIs) were drawn on three regions of the skeleton as follows: proximal right humerus diaphysis (HD), proximal right femoral diaphysis (FD) and first vertebral body (VB1), in a total of 254 patients, totalling 762 VOIs. The uptake in the VOIs was classified as normal or malignant on the basis of the radiopharmaceutical distribution pattern and of the CT images. A total of 675 volumes were classified as normal and 52 were classified as malignant. Thirty-five VOIs classified as indeterminate or nonmalignant lesions were excluded from analysis. The standardized uptake value (SUV) measured on the VOIs were plotted on an ROC curve for each one of the three regions. The area under the ROC (AUC) as well as the best cutoff SUVs to classify the VOIs were calculated. The best cutoff values were established as the ones with higher result of the sum of sensitivity and specificity. Results: The AUCs were 0.933, 0.889 and 0.975 for UD, FD and VB1, respectively. The best SUV cutoffs were 9.0 (sensitivity: 73%; specificity: 99%), 8.4 (sensitivity: 79%; specificity: 94%) and 21.0 (sensitivity: 93%; specificity: 95%) for UD, FD and VB1, respectively. Conclusion: The best cutoff value varies according to bone region of analysis and it is not possible to establish one value for the whole body.

Sticky income inequality in the Spanish transition (1973-1990)

This paper investigates the evolution of income inequality in Spain during its transition to democracy, suggesting a method for the correction of under-reporting of earnings and profits in the Household Budget Surveys’ data. The contribution is twofold: the methodological proposal, based on income expenditure discrepancy and scaling-up to National Accounts, improves on previous work, and can be convenient for similar historical sources in other countries. Secondly, its application results in an alternative history of the distribution of income in this case, changing the levels and also the observed trend. Previous literature asserted a substantial equalization, related to the democratization process, while after the adjustment inequality in disposable income is shown to have been quite persistent.

Cultural Diffusion Was the Main Driving Mechanism of the Neolithic Transition in Southern Africa

It is well known that the Neolithic transition spread across Europe at a speed of about 1 km/yr. This result has been previously interpreted as a range expansion of the Neolithic driven mainly by demic diffusion (whereas cultural diffusion played a secondary role). However, a long-standing problem is whether this value (1 km/yr) and its interpretation (mainly demic diffusion) are characteristic only of Europe or universal (i.e. intrinsic features of Neolithic transitions all over the world). So far Neolithic spread rates outside Europe have been barely measured, and Neolithic spread rates substantially faster than 1 km/yr have not been previously reported. Here we show that the transition from hunting and gathering into herding in southern Africa spread at a rate of about 2.4 km/yr, i.e. about twice faster than the European Neolithic transition. Thus the value 1 km/yr is not a universal feature of Neolithic transitions in the world. Resorting to a recent demic-cultural wave-of-advance model, we also find that the main mechanism at work in the southern African Neolithic spread was cultural diffusion (whereas demic diffusion played a secondary role). This is in sharp contrast to the European Neolithic. Our results further suggest that Neolithic spread rates could be mainly driven by cultural diffusion in cases where the final state of this transition is herding/pastoralism (such as in southern Africa) rather than farming and stockbreeding (as in Europe)

Formal Education, Mismatch and Wages After Transition: Assessing the Impact of Unobserved Heterogeneity using Matching Estimators

This paper studies the incidence and consequences of the mismatch between formal education and the educational requirements of jobs in Estonia during the years 1997-2003. We fi nd large wage penalties associated with the phenomenon of educational mismatch. Moreover, the incidence and wage penalty of mismatches increase with age. This suggests that structural educational mismatches can occur after fast transition periods. Our results are robust for various methodologies, and more importantly regarding departures from the exogeneity assumptions inherent in the matching estimators used in our analysis

Epithelial-to-mesenchymal transition mediates docetaxel resistance and high risk of relapse in prostate cancer

Molecular characterization of radical prostatectomy specimens after systemic therapy may identify a gene expression profile for resistance to therapy. This study assessed tumor cells from patients with prostate cancer participating in a phase II neoadjuvant docetaxel and androgen deprivation trial to identify mediators of resistance. Transcriptional level of 93 genes from a docetaxel-resistant prostate cancer cell lines microarray study was analyzed by TaqMan low-density arrays in tumors from patients with high-risk localized prostate cancer (36 surgically treated, 28 with neoadjuvant docetaxel þ androgen deprivation). Gene expression was compared between groups and correlated with clinical outcome. VIM, AR and RELA were validated by immunohistochemistry. CD44 and ZEB1 expression was tested by immunofluorescence in cells and tumor samples. Parental and docetaxel-resistant castration-resistant prostate cancer cell lines were tested for epithelial-to-mesenchymal transition (EMT) markers before and after docetaxel exposure. Reversion of EMT phenotype was investigated as a docetaxel resistance reversion strategy. Expression of 63 (67.7%) genes differed between groups (P < 0.05), including genes related to androgen receptor, NF-k B transcription factor, and EMT. Increased expression of EMT markers correlated with radiologic relapse. Docetaxel-resistant cells had increased EMT and stem-like cell markers expression. ZEB1 siRNA transfection reverted docetaxel resistance and reduced CD44 expression in DU-145R and PC-3R. Before docetaxel exposure, a selected CD44 þ subpopulation of PC-3 cells exhibited EMT phenotype and intrinsic docetaxel resistance; ZEB1/CD44 þ subpopulations were found in tumor cell lines and primary tumors; this correlated with aggressive clinical behavior. This study identifies genes potentially related to chemotherapy resistance and supports evi-dence of the EMT role in docetaxel resistance and adverse clinical behavior in early prostate cancer.