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Adolescent and Pediatric Healthcare

Works Count: 40046

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Description

This cluster of papers focuses on supporting the transition of adolescents with chronic conditions from pediatric to adult health care, addressing challenges, readiness assessment, self-management, and the experiences of young adults with special health care needs. It also explores the perspectives of patients, parents, and healthcare providers, as well as the impact of transitional care programs on diabetes control and hospital admission rates.

Keywords

Adolescents; Transition; Chronic Conditions; Medical Home; Young Adults; Health Care; Pediatric to Adult Care; Special Health Care Needs; Self-Management; Mental Health Services

Rapid estimate of adult literacy in medicine: a shortened screening instrument.

1993-06-01

Terry C. Davis , Sandra W. Long , Robert H. Jackson +4 more

This study was conducted to validate a shortened version of the Rapid Estimate of Adult Literacy in Medicine (REALM). This screening instrument is designed to be used in public health … This study was conducted to validate a shortened version of the Rapid Estimate of Adult Literacy in Medicine (REALM). This screening instrument is designed to be used in public health and primary care settings to identify patients with low reading levels. It provides reading grade estimates for patients who read below a ninth-grade level. The REALM can be administered in one to two minutes by personnel with minimal training.Two hundred and three patients in four university hospital clinics (internal medicine, family practice, ambulatory care, and obstetrics/gynecology) were given the REALM and three other standardized reading tests: the reading recognition section of the Peabody Individual Achievement Test-Revised (PIAT-R), the Wide Range Achievement Test-Revised (WRAT-R), and the Slosson Oral Reading Test-Revised (SORT-R). One hundred inmates at a state prison were also given the REALM twice, one week apart, to determine test-retest reliability.The REALM correlated well with the three other tests. (Correlation coefficients were 0.97 [PIAT-R], 0.96 [SORT-R], and 0.88 [WRAT-R].) All correlations were significant at P < .0001. Test-retest reliability was 0.99 (P < .001).The REALM provides an estimate of patient reading ability, displays excellent concurrent validity with standardized reading tests, and is a practical instrument for busy primary care settings.

The Test of Time: Predictors and Effects of Duration in Youth Mentoring Relationships

2002-04-01

Jean Baldwin Grossman , Jean E. Rhodes

The effects and predictors of duration in youth mentor relationships were examined. The study included 1,138 young, urban adolescents (Mean age 12.25), all of whom applied to Big Brothers Big … The effects and predictors of duration in youth mentor relationships were examined. The study included 1,138 young, urban adolescents (Mean age 12.25), all of whom applied to Big Brothers Big Sisters programs. The adolescents were randomly assigned to either the treatment or control group, and administered questions at baseline and 18 months later Adolescents in relationships that lasted a year or longer reported the largest number of improvements, with progressively fewer effects emerging among youth who were in relationships that terminated earlier. Adolescents who were in relationships that terminated within a very short period of time reported decrements in several indicators of functioning. Older adolescents, as well as those who had been referred for services or had sustained emotional, sexual or physical abuse, were most likely to be in early terminating relationships, as were married volunteers aged 26-30 and those with lower incomes. Several dyadic factors were also found to be related to earlier terminations, including race, gender, and relationship quality.

Chronic Conditions, Socioeconomic Risks, and Behavioral Problems in Children and Adolescents

1990-03-01

Steven L. Gortmaker , Deborah Walker , Michael Weitzman +1 more

Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality … Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11 699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions—particularly mental health services—remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.

Diabetes Care for Emerging Adults: Recommendations for Transition From Pediatric to Adult Diabetes Care Systems

2011-10-15

Anne L. Peters , Lori M. Laffel

During childhood and adolescence, there is a gradual shift from diabetes care supervised by parents and other adults to self-care management. The actual change from pediatric to adult health care … During childhood and adolescence, there is a gradual shift from diabetes care supervised by parents and other adults to self-care management. The actual change from pediatric to adult health care providers signals a more abrupt change that requires preparation by patients, their families, and their health care providers. A number of publications from the U.S. and other countries have highlighted substantial gaps in care during this transition period between pediatric and adult care that often arise in later adolescence and the subsequent developmental stage of life termed “emerging adulthood.” This is a critical time when patients not only assume responsibility for their diabetes self-care and interactions with the health care system but when they become more independent, potentially moving out of their parents’ home to attend college or to join the workforce (1). In the context of these transitions and the developmental issues of this age-group, gaps in diabetes care can result in suboptimal health care utilization, deteriorating glycemic control, increased occurrence of acute complications, emergence of chronic complications of diabetes that may go undetected or untreated, and psychosocial, behavioral, and emotional challenges. With the increasing incidence of both type 1 and type 2 diabetes in childhood, adolescence, and young adulthood, there is an increase in the absolute numbers of youth with diabetes in this transition period, highlighting the need for a framework of care and education for this population and a call for additional research in this area. Substantial challenges relating to the transitional period include the following:

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Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home

2018-10-22

Patience H. White , W. Carl Cooley

Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The … Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.

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Reliability and validity of the PAS‐ADD Checklist for detecting psychiatric disorders in adults with intellectual disability

1998-04-01

S Moss , Helen Prosser , Helen Costello +5 more

The PAS‐ADD Checklist is a screening instrument specifically designed to help staff recognize mental health problems in the people with intellectual disability for whom they care, and to make informed … The PAS‐ADD Checklist is a screening instrument specifically designed to help staff recognize mental health problems in the people with intellectual disability for whom they care, and to make informed referral decisions. The instrument consists of a life‐events checklist and 29 symptom items scored on a four‐point scale. Scores are combined to provide three threshold scores. The crossing of any of these thresholds indicates the need for a fuller assessment. The items are worded in everyday language, making the Checklist suitable for use by individuals who do not have a background in psychopathology. The present paper presents the results of a number of studies evaluating the reliability and validity of the Checklist. Factor analysis of Checklists completed on a community sample of 201 individuals yielded eight factors, of which seven were readily interpretable in diagnostic terms. Internal consistency of the scales was generally acceptable. Inter‐rarer reliability in respect to individual items gave a fairly low average Kappa of 0.42. However, agreement on case identification, the main purpose of the Checklist, was quite good, with 83% of the decision being in agreement. Validity in relation to clinical opinion was also satisfactory, case detection rising appropriately with the clinically judged severity of disorder. The PAS‐ADD Checklist is published and distributed by the Hester Adrian Research Centre, Manchester, England, from where further information and order forms are available on request.

Non-compliance and transfer from paediatric to adult transplant unit

2000-05-22

Alan R. Watson

A National Profile of Caregiver Challenges Among More Medically Complex Children With Special Health Care Needs

2011-11-01

Dennis Z. Kuo , Eyal Cohen , Rishi Agrawal +2 more

<h3>Objectives</h3>To profile the national prevalence of more medically complex children with special health care needs (CSHCN) and the diversity of caregiver challenges that their families confront.<h3>Design</h3>Secondary analysis of the 2005-2006 … <h3>Objectives</h3>To profile the national prevalence of more medically complex children with special health care needs (CSHCN) and the diversity of caregiver challenges that their families confront.<h3>Design</h3>Secondary analysis of the 2005-2006 National Survey of Children With Special Health Care Needs (unweighted n = 40 723).<h3>Setting</h3>United States–based population.<h3>Participants</h3>National sample of CSHCN.<h3>Main Exposure</h3>More complex CSHCN were defined by incorporating components of child health and family need, including medical technology dependence and care by 2 or more subspecialists.<h3>Main Outcome Measures</h3>Caregiver challenges were defined by family-reported care burden (including hours providing care coordination and home care), medical care use (on the basis of health care encounters in the last 12 months), and unmet needs (defined by 15 individual medical care needs and a single nonmedical service need).<h3>Results</h3>Among CSHCN, 3.2% (weighted n = 324 323) met criteria for more complex children, representing 0.4% of all children in the United States. Caregivers of more complex CSHCN reported a median of 2 (interquartile range, 1-6) hours per week on care coordination and 11 to 20 (interquartile range, 3->21) hours per week on direct home care. More than half (56.8%) reported financial problems, 54.1% reported that a family member stopped working because of the child's health, 48.8% reported at least 1 unmet medical service need, and 33.1% reported difficulty in accessing nonmedical services.<h3>Conclusions</h3>Extraordinary and diverse needs are common among family caregivers of more complex CSHCN. Enhanced care coordination support, respite care, and direct home care may begin to address the substantial economic burden and the multiple unmet needs that many of these families face.

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Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children With Autism

2002-12-01

David S. Mandell , John Listerud , Susan E. Levy +1 more

Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics

2011-03-08

Teresa Adeltoft Ajslev , Camilla Schou Andersen , Michael Gamborg +2 more

Patterns and Costs of Health Care Use of Children With Medical Complexity

2012-11-27

Eyal Cohen , Jay G. Berry , Ximena Camacho +3 more

Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well … Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada.Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period.The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA.Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care.

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The Patient-Centered Outcomes Research Institute (PCORI) National Priorities for Research and Initial Research Agenda

2012-04-17

Joe V. Selby , Anne C. Beal , Lori Frank

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

Transitions: A Central Concept in Nursing

1994-06-01

Karen Schumacher , Afaf lbrahim Meleis

Transition is a concept of interest to nurse researchers, clinicians, and theorists. This article builds on earlier theoretical work on transitions by providing evidence from the nursing literature. A review … Transition is a concept of interest to nurse researchers, clinicians, and theorists. This article builds on earlier theoretical work on transitions by providing evidence from the nursing literature. A review and synthesis of the nursing literature (1986–1992) supports the claim of the centrality of transitions in nursing. Universal properties of transitions are process, direction, and change in fundamental life patterns. At the individual and family levels, changes occurring in identities, roles, relationships, abilities, and patterns of behavior constitute transitions. At the organizational level, transitional change is that occurring in structure, function, or dynamics. Conditions that may influence the quality of the transition experience and the consequences of transitions are meanings, expectations, level of knowledge and skill, environment, level of planning, and emotional and physical well‐being. Indicators of successful transitions are subjective well‐being, role mastery, and the well‐being of relationships. Three types of nursing therapeutics are discussed. A framework for further work is described

Transition from child-centered to adult health-care systems for adolescents with chronic conditions

1993-11-01

Robert W. Blum , Dale C. Garell , Christopher H. Hodgman +4 more

Maternal Infection Requiring Hospitalization During Pregnancy and Autism Spectrum Disorders

2010-04-22

Hjördís Ósk Atladóttir , Poul Thorsen , Lars Østergaard +4 more

Epidemiologic studies of exposure to prenatal infection and risk of schizophrenia and autism

2012-04-05

Alan S. Brown

In this review, we provide a synopsis of work on the epidemiologic evidence for prenatal infection in the etiology of schizophrenia and autism. In birth cohort studies conducted by our … In this review, we provide a synopsis of work on the epidemiologic evidence for prenatal infection in the etiology of schizophrenia and autism. In birth cohort studies conducted by our group and others, in utero exposure to infectious agents, prospectively obtained after biomarker assays of archived maternal sera and by obstetric records was related to an increased risk of schizophrenia. Thus far, it has been demonstrated that prenatal exposure to influenza, increased toxoplasma antibody, genital-reproductive infections, rubella, and other pathogens are associated with schizophrenia. Anomalies of the immune system, including enhanced maternal cytokine levels, are also related to schizophrenia. Some evidence also suggests that maternal infection and immune dysfunction may be associated with autism. Although replication is required, these findings suggest that public health interventions targeting infectious exposures have the potential for preventing cases of schizophrenia and autism. Moreover, this work has stimulated translational research on the neurobiological and genetic determinants of these conditions.

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Antifragile: Things That Gain from Disorder

2013-11-01

Jeff Holman

By nature of my profession, Nassim Taleb thinks that I’m a scam artist, a charlatan and a turkey. But do not feel bad for me, because if you are reading … By nature of my profession, Nassim Taleb thinks that I’m a scam artist, a charlatan and a turkey. But do not feel bad for me, because if you are reading this publication you likely either carry out...

Adolescents with a chronic condition: challenges living, challenges treating

2007-03-28

Susan M. Sawyer , Sarah Drew , Michele S Yeo +1 more

Measuring the Transition Readiness of Youth with Special Healthcare Needs: Validation of the TRAQ—Transition Readiness Assessment Questionnaire

2009-12-29

Gregory S. Sawicki , Katryne Lukens-Bull , Xiaoping Yin +5 more

The aim of this study was to develop the Transition Readiness Assessment Questionnaire (TRAQ), a measure of readiness for transition from pediatric to adult healthcare for youth with special health … The aim of this study was to develop the Transition Readiness Assessment Questionnaire (TRAQ), a measure of readiness for transition from pediatric to adult healthcare for youth with special health care needs (YSHCN).We administered TRAQ to 192 YSHCN aged 16-26 years in three primary diagnostic categories, conducted factor analysis, and assessed differences in TRAQ scores by age, gender, race, and primary diagnosis type.Factor analysis identified two TRAQ domains with high internal consistency: Skills for Self-Management and Skills for Self-Advocacy. Each domain had high internal consistency. In multivariate regression models, older age and a primary diagnosis of an activity limiting physical condition were associated with higher scores in Self-Management, and female gender and a primary diagnosis of an activity limiting physical condition were associated with higher scores in Self-Advocacy.Our initial validation study suggests the TRAQ is a useful tool to assess transition readiness in YSHCN and to guide educational interventions by providers to support transition.

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The adolescent with a chronic condition. Part I: developmental issues

2004-09-21

J.-C. Suris , Pierre Michaud , Russell Viner

The prevalence of chronic conditions among adolescents is difficult to assess due to the lack of quality data focusing specifically on this age group, as well as the diversity in … The prevalence of chronic conditions among adolescents is difficult to assess due to the lack of quality data focusing specifically on this age group, as well as the diversity in methodology and definitions used. However, surveys carried out by self administered questionnaires among in-school adolescent populations indicate that around 10% of adolescents suffer from such a condition. The aim of this paper is to analyse the reciprocal effects of chronic conditions and adolescent development by reviewing the effect of chronic disease on growth and puberty and on psychosocial development, and the effect of developmental issues on the course and management of chronic disease.

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Economic Burden of Childhood Autism Spectrum Disorders

2014-02-11

Tara A. Lavelle , Milton C. Weinstein , Joseph P. Newhouse +3 more

OBJECTIVE: To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes. METHODS: We used national data from the Medical Expenditure Panel Survey … OBJECTIVE: To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes. METHODS: We used national data from the Medical Expenditure Panel Survey linked to the National Health Interview Survey and a study-specific survey to estimate the annual utilization and costs for health care, school, ASD-related therapy, family-coordinated services, as well as caregiver time in children aged 3 to 17 years, with and without parent-reported ASD. Regression analyses estimated the association between ASD diagnosis and cost, controlling for child gender, age, race/ethnicity, insurance status, household income, country region and urban/rural classification, and non–ASD-related illnesses. RESULTS: Children with parent-reported ASD had higher levels of health care office visits and prescription drug use compared with children without ASD (P &lt; .05). A greater proportion of children in the ASD group used special educational services (76% vs 7% in the control group, P &lt; .05). After adjusting for child demographic characteristics and non–ASD-associated illnesses, ASD was associated with $3020 (95% confidence interval [CI]: $1017–$4259) higher health care costs and $14 061 (95% CI: $4390–$24 302) higher aggregate non–health care costs, including $8610 (95% CI: $6595–$10 421) higher school costs. In adjusted analyses, parents who reported that their child had ASD did not have significantly higher out-of-pocket costs or spend more time on caregiving activities compared with control parents. CONCLUSIONS: The economic burden associated with ASD is substantial and can be measured across multiple sectors of our society. Previous analyses that focused on health care underestimated this economic burden, particularly for school systems.

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Improving the transition between paediatric and adult healthcare: a systematic review

2011-03-08

Ryan Crowley , Ingrid Wolfe , K Lock +1 more

<h3>Introduction</h3> The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent … <h3>Introduction</h3> The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent services need to be improved, there is little empirical data on which policies can be based. <h3>Objectives</h3> To systematically review the evidence of effectiveness of transitional care programmes in young people aged 11–25 with chronic illness (physical or mental) or disability, and identify their successful components. <h3>Design</h3> A systematic literature review in July 2010 of studies which consistently evaluated health outcomes following transition programmes, either by comparison with a control group or by measurement pre-intervention and post-intervention. <h3>Results</h3> 10 studies met the inclusion criteria, six of which showed statistically significant improvements in outcomes. Descriptive analysis identified three broad categories of intervention, directed at: the patient (educational programmes, skills training); staffing (named transition co-ordinators, joint clinics run by paediatric and adult physicians); and service delivery (separate young adult clinics, out of hours phone support, enhanced follow-up). The conditions involved varied (eg, cystic fibrosis, diabetes mellitus), and outcome measures varied accordingly. All six interventions that resulted in significant improvements were in studies of patients with diabetes mellitus, with glycosylated haemoglobin level, acute and chronic complications, and rates of follow-up and screening used as outcome measures. <h3>Conclusions</h3> The most commonly used strategies in successful programmes were patient education and specific transition clinics (either jointly staffed by paediatric and adult physicians or dedicated young adult clinics within adult services). It is not clear how generalisable these successful studies in diabetes mellitus will be to other conditions.

Childhood chronic illness: prevalence, severity, and impact.

1992-03-01

Paul W. Newacheck , Walter Taylor

BACKGROUND. Using data from the 1988 National Health Interview Survey, this article presents national estimates of the prevalence and impact of childhood chronic conditions. METHODS. Proxy responses to a checklist … BACKGROUND. Using data from the 1988 National Health Interview Survey, this article presents national estimates of the prevalence and impact of childhood chronic conditions. METHODS. Proxy responses to a checklist of child health conditions administered for 17,110 children under 18 years of age were used. Conditions were classified as chronic if they were first noticed more than 3 months prior to the interview or if they were the type that would ordinarily be of extended duration, such as arthritis. RESULTS. An estimated 31% of children were affected by chronic conditions. Among these children, highly prevalent conditions included respiratory allergies 9.7 per 100, repeated ear infections 8.3 per 100 and asthma 4.3 per 100. These children can be divided into three groups: 66% with mild conditions that result in little or no bother or activity limitation; 29% with conditions of moderate severity that result in some bother or limitation of activity, but not both; and 5% with severe conditions that cause frequent bother and limitation of activity. The 5% with severe conditions accounted for 19% of physician contacts and 33% of hospital days related to chronic illness. CONCLUSIONS. Childhood chronic conditions have highly variable impacts on children's activities and use of health care.

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Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK

2013-01-01

Patrick D. McGorry , Tony Bates , Max Birchwood

Summary Despite the evidence showing that young people aged 12-25 years have the highest incidence and prevalence of mental illness across the lifespan, and bear a disproportionate share of the … Summary Despite the evidence showing that young people aged 12-25 years have the highest incidence and prevalence of mental illness across the lifespan, and bear a disproportionate share of the burden of disease associated with mental disorder, their access to mental health services is the poorest of all age groups. A major factor contributing to this poor access is the current design of our mental healthcare system, which is manifestly inadequate for the unique developmental and cultural needs of our young people, if we are to reduce the impact of mental disorder on this most vulnerable population group, transformational change and service redesign is necessary. Here, we present three recent and rapidly evolving service structures from Australia, Ireland and the UK that have each worked within their respective healthcare contexts to reorient existing services to provide youth-specific, evidence-based mental healthcare that is both accessible and acceptable to young people.

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Maternal Infections and Subsequent Psychosis Among Offspring

2001-11-01

Stephen L. Buka

We tested the hypothesis that maternal infections during pregnancy are associated with the subsequent development of schizophrenia and other psychoses in adulthood.We conducted a nested case-control study of 27 adults … We tested the hypothesis that maternal infections during pregnancy are associated with the subsequent development of schizophrenia and other psychoses in adulthood.We conducted a nested case-control study of 27 adults with schizophrenia and other psychotic illnesses and 54 matched unaffected control subjects (matched for sex, ethnicity, and date of birth) from the Providence, RI, cohort of the Collaborative Perinatal Project. We retrieved stored blood samples that had been obtained from these mothers at the end of pregnancy. These samples were analyzed for total class-specific immunoglobulins and for specific antibodies directed at recognized perinatal pathogens capable of affecting brain development.Maternal levels of IgG and IgM class immunoglobulins before the mothers were delivered of their neonates were significantly elevated among the case series (t = 3.06, P =.003; t = 2.93, P =.004, respectively, for IgG and IgM immunoglobulin-albumin ratios). Secondary analyses indicated a significant association between maternal antibodies to herpes simplex virus type 2 glycoprotein gG2 and subsequent psychotic illness (matched t test = 2.43, P =.02). We did not find significant differences between case and control mothers in the serum levels of IgA class immunoglobulins, or in specific IgG antibodies to herpes simplex virus type 1, cytomegalovirus, Toxoplasma gondii, rubella virus, human parvovirus B19, Chlamydia trachomatis, or human papillomavirus type 16.The offspring of mothers with elevated levels of total IgG and IgM immunoglobulins and antibodies to herpes simplex virus type 2 are at increased risk for the development of schizophrenia and other psychotic illnesses in adulthood.

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Advancing Paternal Age and the Risk of Schizophrenia

2001-04-01

Dolores Malaspina , Susan Harlap , Shmuel Fennig +4 more

Background: A major source of new mutations in humans is the male germ line, with mutation rates monotonically increasing as father's age at conception advances, possibly because of accumulating replication … Background: A major source of new mutations in humans is the male germ line, with mutation rates monotonically increasing as father's age at conception advances, possibly because of accumulating replication errors in spermatogonial cell lines. Method:We investigated whether the risk of schizophrenia was associated with advancing paternal age in a population-based birth cohort of 87907 individuals born in Jerusalem from 1964 to 1976 by linking their records to the Israel Psychiatric Registry.Results: Of 1337 offspring admitted to psychiatric units before 1998, 658 were diagnosed as having schizophrenia and related nonaffective psychoses.After controlling for maternal age and other confounding factors (sex, ethnicity, education [to reflect socioeconomic status], and duration of marriage) in proportional hazards regression, we found that paternal age was a strong and significant predictor of the schizophrenia diagnoses, but not of other psychiatric disorders.Compared with offspring of fathers younger than 25 years, the relative risk of schizophrenia increased monotonically in each 5-year age group, reaching 2.02 (95% confidence interval, 1.17-3.51)and 2.96 (95% confidence interval, 1.60-5.47) in offspring of men aged 45 to 49 and 50 years or more, respectively.Categories of mother's age showed no significant effects, after adjusting for paternal age.Conclusions: These findings support the hypothesis that schizophrenia may be associated, in part, with de novo mutations arising in paternal germ cells.If confirmed, they would entail a need for novel approaches to the identification of genes involved in schizophrenia.

Health Care Transition: Youth, Family, and Provider Perspectives

2005-01-01

John Reiss , Robert W. Gibson , Leslie R. Walker

Objective. This study examined the process of health care transition (HCT) posing the following questions: What are the transition experiences of youths and young adults with disabilities and special health … Objective. This study examined the process of health care transition (HCT) posing the following questions: What are the transition experiences of youths and young adults with disabilities and special health care needs, family members, and health care providers? What are promising practices that facilitate successful HCT? What are obstacles that inhibit HCT? Methods. A qualitative approach was used to investigate these questions. Focus group interviews were conducted. Content and narrative analyses of interview transcripts were completed using ATLAS.ti. Results. Thirty-four focus groups and interviews were conducted with 143 young adults with disabilities and special health care needs, family members, and health care providers. Content analysis yielded 3 content domains: transition services, which presents a chronological understanding of the transition process; health care systems, which presents differences between pediatric and adult-oriented medicine and how these differences inhibit transition; and transition narratives, which discusses transition experience in the broader context of relationships between patients and health care providers. Conclusion. This study demonstrated the presence of important reciprocal relationships that are based on mutual trust between providers and families and are developed as part of the care of chronically ill children. Evidence supports the need for appropriate termination of pediatric relationships as part of the transition process. Evidence further supports the idea that pediatric and adult-oriented medicines represent 2 different medical subcultures. Young adults’ and family members’ lack of preparation for successful participation in the adult health care system contributes to problems with HCT.

Atopic eczema: its impact on the family and financial cost

1997-02-01

John Su , Andrew S. Kemp , George A. Varigos +1 more

<h3>OBJECTIVE</h3> To evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management. <h3>DESIGN</h3> Cross sectional survey. <h3>SETTING</h3> Paediatric dermatology and paediatric diabetology … <h3>OBJECTIVE</h3> To evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management. <h3>DESIGN</h3> Cross sectional survey. <h3>SETTING</h3> Paediatric dermatology and paediatric diabetology outpatient clinics. <h3>PATIENTS</h3> Parents of 48 randomly selected children with atopic eczema and 46 with insulin dependent diabetes mellitus. <h3>MAIN OUTCOME MEASURES</h3> The impact on family score, the reported cost of relevant medical treatments, medical consultations, relevant hospitalisation, and income loss. <h3>RESULTS</h3> Families of children with moderate or severe atopic eczema had a significantly higher impact on family score than families of diabetic children. A conservative estimate of the annual personal financial cost of managing mild, moderate, and severe eczema was Aus$330, 818, and 1255, respectively. The financial cost to the community for the management of atopic eczema in the study groups was greater. The personal financial cost of managing eczema was greater than for asthma. <h3>CONCLUSION</h3> Childhood atopic eczema has a profound impact on the social, personal, emotional, and financial perspectives of families.

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Prevalence and Correlates of Successful Transfer From Pediatric to Adult Health Care Among a Cohort of Young Adults With Complex Congenital Heart Defects

2004-03-01

Graham J. Reid , M. Jane Irvine , Brian W. McCrindle +4 more

Objectives. More than 85% of children born today with chronic medical conditions will live to adulthood, and many should transfer from pediatric to adult health care. The numbers of adults … Objectives. More than 85% of children born today with chronic medical conditions will live to adulthood, and many should transfer from pediatric to adult health care. The numbers of adults with congenital heart defects (CHDs) are increasing rapidly. Current guidelines recommend that just over half of adult CHD patients should be seen every 12 to 24 months by a cardiologist with specific CHD expertise at a regional CHD center, because they are at risk for serious complications (eg, reoperation and/or arrhythmias) and premature mortality. The present study aimed to determine the percent of young adults with CHDs who successfully transferred from pediatric to adult care and examine correlates of successful transfer. Design. Cross-sectional study with prevalence data from an entire cohort. Setting and Patients. All patients (n = 360) aged 19 to 21 years with complex CHDs who, according to current practice guidelines, should be seen annually at a specialized adult CHD center were identified from the database of the cardiology program at the Hospital for Sick Children in Toronto, Canada, a pediatric tertiary care center. Of these patients, 234 completed measures about health beliefs, health behaviors, and medical care since age 18 years. Main Outcome Measure. All 15 specialized adult CHD centers in Canada formed the Canadian Adult Congenital Heart (CACH) Network. Attendance for at least 1 follow-up appointment at a CACH center before the age of 22 years was ascertained for all eligible patients. Attendance at a CACH center provides a clear criterion for successful transfer. Results. In the total cohort, 47% (95% confidence interval [CI]: 42–52) had transferred successfully to adult care. There was no difference in rates of successful transfer between patients consenting to complete questionnaires (48%) and those who declined (47%). More than one quarter (27%) of the patients reported having had no cardiac appointments since 18 years. In multivariate analyses of the entire cohort, successful transfer was significantly associated with more pediatric cardiovascular surgeries (odds ratio [OR]: 2.47; 95% CI: 1.40–4.37), older age at last visit to the Hospital for Sick Children (OR: 1.29; 95% CI: 1.10–1.51), and documented recommendations in the medical chart for follow-up at a CACH center. In multivariate analyses of the patients completing questionnaires, successful transfer was significantly related to documented recommendations and patient beliefs that adult CHD care should be at a CACH center (OR: 3.64; 95% CI: 1.34–9.90). Comorbid conditions (OR: 3.13; 95% CI: 1.13–8.67), not using substances (eg, binge drinking; OR: 0.18; 95% CI: 0.07–0.50), using dental antibiotic prophylaxis (OR: 4.23; 95% CI: 1.48–12.06), and attending cardiac appointments without parents or siblings (OR: 6.59; 95% CI: 1.61–27.00) also correlated with successful transfer. Conclusions. This is the first study to document the percent of young adults with a chronic illness who successfully transfer to adult care in a timely manner. Patients were from an entire birth cohort from the largest pediatric cardiac center in Canada, and outcome data were obtained on all eligible patients. Similar data should be obtained for other chronic illnesses. There is need for considerable improvement in the numbers of young adults with CHDs who successfully transfer to adult care. At-risk adolescents with CHDs should begin the transition process before their teens, should be educated in the importance of antibiotic prophylaxis, should be contacted if a follow-up appointment is missed, and should be directed to a specific CHD cardiologist or program, with the planned timing being stated explicitly. Adult care needs to be discussed in the pediatric setting, and patients must acquire appropriate beliefs about adult care well before transfer. Developmentally appropriate, staged discussions involving the patient, with and without parents, throughout adolescence may help patients acquire these beliefs and an understanding of the need for ongoing care. Improved continuity of pediatric care and provision of clear details for adult follow-up might be sufficient to cause substantive improvements in successful transfer. An understanding of why patients drop out of pediatric care may be needed to improve the continuity of care throughout adolescence. Almost one quarter of the patients believed adult care should be somewhere other than at a CACH center despite opposite recommendations. For these patients, a single discussion of adult care during the final pediatric visit may be too little, too late. In addition to earlier discussions, multiple mechanisms such as referral letters and transition clinics are needed. Similarly, patients engaging in multiple risky or poor health behaviors such as substance use may need more intensive programs to make substantial changes in these behaviors, which hopefully would lead to successful transfer. Overall, these data support the view that transition to adult care (a planned process of discussing and preparing for transfer to an adult health center) is important and should begin well before patients are transferred. The future health of adults with chronic conditions may depend on our ability to make these changes.

Transition: a literature review

2006-06-08

Debbie Kralik , Kate Visentin , Antonia van Loon

Aim. This paper reports a comprehensive literature review exploring how the term ‘transition’ has been used in the health literature. Background. The meaning of transition has varied with the context … Aim. This paper reports a comprehensive literature review exploring how the term ‘transition’ has been used in the health literature. Background. The meaning of transition has varied with the context in which the term has been used. The last 3 decades have seen altered understandings in the concept of transition in the social science and health disciplines, with nurses contributing to more recent understandings of the transition process as it relates to life and health. Method. The CINAHL, Medline, Sociofile and Psychlit databases were accessed and papers published between 1994 and 2004 were retrieved to answer the questions ‘How is the word transition used?’ and ‘What is the concept of transition informing?’ Transition theoretical frameworks were also explored. Findings. Widespread use of the word ‘transition’ suggests that it is an important concept. Transitional definitions alter according to the disciplinary focus, but most agree that transition involves people's responses during a passage of change. Transition occurs over time and entails change and adaptation, for example developmental, personal, relational, situational, societal or environmental change, but not all change engages transition. Reconstruction of a valued self‐identity is essential to transition. Time is an essential element in transition and therefore longitudinal studies are required to explore the initial phase, midcourse experience and outcome of the transition experience. Conclusion. Transition is the way people respond to change over time. People undergo transition when they need to adapt to new situations or circumstances in order to incorporate the change event into their lives. Transition is a concept that is important to nursing; however, to further develop understandings, research must extend beyond single events or single responses. Longitudinal comparative and longitudinal cross‐sectional inquiries are required to further develop the concept.

Pediatric Self-management: A Framework for Research, Practice, and Policy

2012-01-05

Avani C. Modi , Ahna L. H. Pai , Kevin A. Hommel +6 more

Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective … Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions.

A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

2008-08-01

Pamela M. Kato , Steve W. Cole , Andrew S. Bradlyn +1 more

OBJECTIVE. Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral … OBJECTIVE. Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma. METHODS. A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group. The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54). RESULTS. Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life. CONCLUSIONS. The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

2011-02-22

Eyal Cohen , Dennis Z. Kuo , Rishi Agrawal +4 more

Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem … Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living. Although these children are at risk of poor health and family outcomes, there are few well-characterized clinical initiatives and research efforts devoted to improving their care. In this article, we present a definitional framework of CMC that consists of substantial family-identified service needs, characteristic chronic and severe conditions, functional limitations, and high health care use. We explore the diversity of existing care models and apply the principles of the chronic care model to address the clinical needs of CMC. Finally, we suggest a research agenda that uses a uniform definition to accurately describe the population and to evaluate outcomes from the perspectives of the child, the family, and the broader health care system.

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Transition to adult health care for adolescents and young adults with chronic conditions

2003-10-01

David S. Rosen , Robert W. Blum , Maria T. Britto +2 more

Transition of care for adolescents from paediatric services to adult health services

2016-04-29

Fiona Campbell , Katie Biggs , Susie Aldiss +5 more

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Facilitating Treatment Adherence

1987-01-01

Donald Meichenbaum , Dennis C. Turk

Facilitating treatment adherence: A practitioner's guidebook

1989-09-01

A Consensus Statement on Health Care Transitions for Young Adults With Special Health Care Needs

2016-04-30

Age Limit of Pediatrics

2017-08-21

Amy Peykoff Hardin , Jesse M. Hackell , Geoffrey R. Simon +6 more

Pediatrics is a multifaceted specialty that encompasses children's physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although … Pediatrics is a multifaceted specialty that encompasses children's physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. The decision to continue care with a pediatrician or pediatric medical or surgical subspecialist should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet these needs.

Emerging Adulthood as a Critical Stage in the Life Course

2017-11-20

David L. Wood , Tara Crapnell , Lynette Lau +4 more

The age of adolescence

2018-01-30

Susan M. Sawyer , Peter Azzopardi , Dakshitha Wickremarathne +1 more

Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home

2011-06-28

W. Carl Cooley , Paul J. Sagerman

Optimal health care is achieved when each person, at every age, receives medically and developmentally appropriate care. The goal of a planned health care transition is to maximize lifelong functioning … Optimal health care is achieved when each person, at every age, receives medically and developmentally appropriate care. The goal of a planned health care transition is to maximize lifelong functioning and well-being for all youth, including those who have special health care needs and those who do not. This process includes ensuring that high-quality, developmentally appropriate health care services are available in an uninterrupted manner as the person moves from adolescence to adulthood. A well-timed transition from child- to adult-oriented health care is specific to each person and ideally occurs between the ages of 18 and 21 years. Coordination of patient, family, and provider responsibilities enables youth to optimize their ability to assume adult roles and activities. This clinical report represents expert opinion and consensus on the practice-based implementation of transition for all youth beginning in early adolescence. It provides a structure for training and continuing education to further understanding of the nature of adolescent transition and how best to support it. Primary care physicians, nurse practitioners, and physician assistants, as well as medical subspecialists, are encouraged to adopt these materials and make this process specific to their settings and populations.

A Consensus Statement on Health Care Transitions for Young Adults With Special Health Care Needs

2002-12-01

This policy statement represents a consensus on the critical first steps that the medical profession needs to take to realize the vision of a family-centered, continuous, comprehensive, coordinated, compassionate, and … This policy statement represents a consensus on the critical first steps that the medical profession needs to take to realize the vision of a family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent health care system that is as developmentally appropriate as it is technically sophisticated. The goal of transition in health care for young adults with special health care needs is to maximize lifelong functioning and potential through the provision of high-quality, developmentally appropriate health care services that continue uninterrupted as the individual moves from adolescence to adulthood. This consensus document has now been approved as policy by the boards of the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians-American Society of Internal Medicine.

Transitions through adolescence: interpersonal domains and context

1996-12-01

A Mixed Methods Study to Understand the Role of Knowledge in Transition among Youth with Sickle Cell Disease

2025-06-24

Ashima Singh , Mahua Dasgupta , M. Muska Nataliansyah +7 more | Blood Advances

Sex-Based Differences in Pediatric Mental Health Hospitalizations at US Acute Care Hospitals

2025-06-23

JoAnna K. Leyenaar , Seneca D. Freyleue , Mary Arakelyan +2 more | JAMA

This study examines sex-based differences in pediatric mental health hospitalizations and the change in hospitalization number over time. This study examines sex-based differences in pediatric mental health hospitalizations and the change in hospitalization number over time.

Rights-Based Priorities for Children with SEND in the Post-COVID-19 Era: A Multi-Method, Multi-Phased, Multi-Stakeholder Consensus Approach

2025-06-23

Emma Ashworth , Lucy Bray , Amel Alghrani +2 more | Children

Background: The provision of education, health, and social care for children with special educational needs and disabilities (SEND) in England has long been criticised for its inequities and chronic underfunding. … Background: The provision of education, health, and social care for children with special educational needs and disabilities (SEND) in England has long been criticised for its inequities and chronic underfunding. These systemic issues were further exacerbated by the onset of the COVID-19 pandemic and the accompanying restrictions, which disrupted essential services and resulted in widespread unmet needs and infringements on the rights of many children with SEND. This study aimed to use a three-phase consensus-building approach with 1353 participants across five stakeholder groups to collaboratively develop evidence-informed priorities for policy and practice. The priorities sought to help address the longstanding disparities and respond to the intensified challenges brought about by the pandemic. Methods: A total of 55 children with SEND (aged 5–16), 893 parents/carers, and 307 professionals working in SEND-related services participated in the first phase through online surveys. This was followed by semi-structured interviews with four children and young people, ten parents/carers, and 15 professionals, allowing for deeper exploration of lived experiences and priorities. The data were analysed, synthesised, and structured into five overarching areas of priority. These were subsequently discussed and refined in a series of activity-based group workshops involving 20 children with SEND, 11 parents/carers, and 38 professionals. Results and Conclusions: The consensus-building process led to the identification of key priorities for both pandemic response and longer-term recovery, highlighting the responsibilities of central Government and statutory services to consider and meet the needs of children with SEND. These priorities are framed within a children’s rights context and considered against the rights and duties set out in the United Nations Convention on the Rights of the Child (1989). Priorities include protecting and promoting children with SEND’s rights to (1) play, socialise, and be part of a community, (2) receive support for their social and emotional wellbeing and mental health, (3) feel safe, belong, and learn in school, (4) access health social care services and therapies, and (5) receive support for their parents/carers and families. Together, they highlight the urgent need for structural reform to ensure that children with SEND receive the support they are entitled to—not only in times of crisis but as a matter of routine practice and policy.

Correction: Developing consensus outcome measures in juvenile systemic sclerosis: a global survey of pediatric rheumatologists and literature review

2025-06-23

Natalia Vasquez‐Canizares , Clare Pain , Francesco Zulian +7 more | Pediatric Rheumatology

Improving the transition from pediatric to adult epilepsy care: An expert opinion

2025-06-21

Flavio Villani , Francesca Bisulli , Francesca Darra +2 more | Epilepsy & Behavior

Co-creating gender-transformative interventions for adolescent mental, sexual, and reproductive health and rights: Influence of context and actors on process and content in Niger, Ghana, and Burkina Faso

2025-06-21

Lauren J. Wallace , Natasha Afua Darko , Aïssa Diarra +7 more | African Journal of Reproductive Health

This paper explores how context and actors influence processes and content efforts to co-create gender transformative primary health care systems for adolescents in West Africa and draws out lessons for … This paper explores how context and actors influence processes and content efforts to co-create gender transformative primary health care systems for adolescents in West Africa and draws out lessons for co-creation of effective adolescent mental, sexual, and reproductive health and rights (AMSRHR) interventions in low and middle income countries. The study design was a multi country case study with the case defined as "processes, context, actors and content of co-creation of gender-transformative adolescent mental, sexual, and reproductive health interventions". Data are from mixed qualitative sources in two research phases: a situational/context analysis and co-creation/data validation workshops. Findings reveal that while national AMSRHR policies promote gender-sensitive approaches, actual programmes remain largely gender-neutral or gender-blind. Important considerations in co-creating AMSRHR interventions include how to effectively engage powerful stakeholders with diverse positions, pay attention to gendered power imbalances in co-creation processes, and raise critical consciousness of complex AMSRHR issues through non-threatening, participatory approaches.

Barriers and Enablers to Accessing a Young Adult Peer Support Group for Proton Beam Therapy Patients

2025-06-19

Karthica Santhagunanathan , Mark Ngo | Journal of Adolescent and Young Adult Oncology

There is consensus among health care professionals that the needs of young adults (YAs) are poorly met. A service evaluation was performed, using semi-structured interviews to explore how YAs (n … There is consensus among health care professionals that the needs of young adults (YAs) are poorly met. A service evaluation was performed, using semi-structured interviews to explore how YAs (n = 9) perceive peer support. Findings highlighted the importance of peer support in enhancing the patient experience by fostering meaningful connections and offering opportunities to serve as positive role models to others. Many YAs feel disconnected from their friends, making peer support a valuable source of normality. Participants expressed a preference for weekly 45-60-minute sessions and highlighted the importance of effective promotion and relevant discussion topics to encourage engagement.

Quality of life outcomes and predictors for youth with intellectual disability and rare diseases

2025-06-19

Lucía Morán , Asunción Monsalve , Yolanda Fontanil Gómez +3 more | Research in Developmental Disabilities

The concept of quality of Life (QoL) has become particularly relevant in the field of intellectual disability (ID). However, the existing scientific literature on QoL of people with ID and … The concept of quality of Life (QoL) has become particularly relevant in the field of intellectual disability (ID). However, the existing scientific literature on QoL of people with ID and rare diseases (RDs) is very limited. Therefore, this study aimed to analyze individual QoL of children and youth with RDs and to evaluate the impact of personal and contextual factors on their QoL. The sample was composed of 114 Spanish participants with ID and RDs, aged between 4 and 21 years. The KidsLife Scale was applied. This instrument includes 96 items, third-person formulated, organized across eight QOL domains: physical wellbeing, material wellbeing, emotional wellbeing, interpersonal relationships, social inclusion, rights and personal development. Descriptive statistics were calculated and correlation coefficients and multiple linear regression were computed. The most elevated scores were achieved in physical well-being and material wellbeing, whereas the lowest scores were shown in social inclusion and self-determination domains. Sex, level of support needs, percentage of disability and size of the organization were predictive factors of QoL scores. These outcomes shed light into priority areas and predictors that should be considered in the development of individualized supports, organizational approaches and policy initiatives intended to promote the QoL of children and youth with RDs and ID.

Specific content for education and self-management programs for people with pulmonary fibrosis: a co-creation, multiphase, mixed-method study

2025-06-19

Thomas Riegler , Anja Frei , Markus Wirz +6 more | ERJ Open Research

Study question This study aimed to identify and establish comprehensive and specific patient education and self-management (PESM) content created by people with pulmonary fibrosis (PF) and healthcare professionals (HCPs). Methods … Study question This study aimed to identify and establish comprehensive and specific patient education and self-management (PESM) content created by people with pulmonary fibrosis (PF) and healthcare professionals (HCPs). Methods We employed a sequential, multiphase mixed-method approach (qualitative → quantitative → qualitative) incorporating co-creation elements including interviews with people with PF and HCPs, a two-round Delphi study with HCPs, and subsequent interviews with people with PF to validate the developed content. Results In phase 1, we interviewed 11 people with PF and 6 healthcare experts in PF. Based on these interviews, we derived 319 items which we distributed in Delphi surveys to 260 HCPs (phase 2). 96 HCPs participated in both Delphi rounds and agreed on 150 out of finally 343 (24 additionally created) items (44%) in seven topics: Staying well with PF; Keeping fit and strong with PF; Managing breathlessness; Managing cough; Managing fatigue; Managing symptoms of anxiety, depression, and panic; Using oxygen therapy. In phase 3, 6 people with PF validated the developed content of phase 2. Answer to the question We identified specific, clinically relevant, and meaningful PESM content for PF through a co-creation approach with people with PF and HCPs. The findings not only inform current and future PESM programs, patients, and clinicians, but also highlight specific areas for future research.

Adherence to Type 1 Diabetes Care Visits After Transfer From Pediatric to Adult Care: A Prospective Cohort Study

2025-06-18

Simon Lafontaine , Élise Mok , Jennifer Frei +5 more | Diabetes Spectrum

OBJECTIVE The objectives of this study were to describe health care utilization by adolescents and young adults with type 1 diabetes after transfer from pediatric to adult care and to … OBJECTIVE The objectives of this study were to describe health care utilization by adolescents and young adults with type 1 diabetes after transfer from pediatric to adult care and to determine predictors of nonadherence to diabetes care visits after this transition. RESEARCH DESIGN AND METHODS This was a prospective cohort study following adolescents with type 1 diabetes for 18 months after their last pediatric visit from 2017 to 2021. We assessed health care utilization using Quebec health administrative data. The primary exposure was delay in establishing adult diabetes care, defined as a delay &gt;6 months between the last pediatric and the first adult diabetes care visit. Secondary exposures were self-reported self-efficacy, transition readiness, and diabetes distress before transferring to adult care. The primary outcome was nonadherence, defined as having gap(s) &gt;6 months between adult diabetes care visits. Secondary outcomes were ≥1 diabetes-related emergency department (ED) visit and ≥1 diabetes-related hospitalization. We used multivariable logistic regression to identify predictors of nonadherence to diabetes care visits after transition to adult care. RESULTS Fifteen of 74 participants (20%) had delays in establishing adult diabetes care. Twenty participants (27%) were nonadherent to adult diabetes care visits. Six participants (8.1%) had ≥1 ED visit and 1 (1.4%) was hospitalized after transferring to adult care. Delay in establishing adult care was associated with subsequent nonadherence to adult diabetes care visits (adjusted odds ratio 29.9, 95% CI 5.3–169.9). CONCLUSION Health care utilization after transfer to adult care is suboptimal in young adults with type 1 diabetes. Delayed transfer of care puts young adults at risk of disengaging from adult diabetes care.

Racial and Ethnic Differences in Mental Health Service Use Among Adolescents

2025-06-18

Yanlei Ma , C. Penaloza Ramos , Hefei Wen +1 more | JAMA Network Open

Importance The delivery of mental health services to US adolescents has changed significantly in recent years, especially with the increased use of telemental health. More data are needed to understand … Importance The delivery of mental health services to US adolescents has changed significantly in recent years, especially with the increased use of telemental health. More data are needed to understand the implications for racial and ethnic differences in adolescent mental health care use. Objective To examine racial and ethnic differences in mental health service use among US adolescents in the most recent national survey data. Design, Setting, and Participants This cross-sectional study used 2022 to 2023 US national survey data to estimate racial and ethnic differences in mental health service use through weighted logistic regressions, controlling for sociodemographic characteristics and health status. Adolescents participating in the National Survey on Drug Use and Health in 2022 to 2023 were included. Exposure Racial and ethnic group. Main Outcomes and Measures Dichotomous indicators of mental health treatment type included receipt of any mental health visit (medical setting), prescription medication, support group, or peer support specialist or recovery coach service. Treatment settings were assessed with indicators of mental health services received in outpatient, telehealth, school, inpatient, and emergency department settings. Results The overall sample included a total of 23 541 adolescents aged 12 to 17 years (8351 aged 14-15 years [weighted percentage = 35.1%]; 12 167 male [weighted percentage = 51.1%]; 6057 Hispanic [weighted percentage = 26.0%], 1202 non-Hispanic Asian, Hawaiian, or Other Pacific Islander [weighted percentage = 6.2%], 3239 non-Hispanic Black [weighted percentage = 13.8%], 10 756 non-Hispanic White [weighted percentage = 49.7%], and 2287 other non-Hispanic race or ethnicity [weighted percentage = 4.3%]), of whom 5994 individuals had experienced a major depressive episode. The model-adjusted percentage of adolescents receiving any mental health visit was 31.7% (95% CI, 30.4%-33.1%) among non-Hispanic White adolescents and was significantly lower among members of racial and ethnic minority groups, ranging from 21.9% (95% CI, 19.5%-24.3%) among non-Hispanic Black adolescents to 25.6% (95% CI, 23.6%-27.6%) among Hispanic adolescents (all P &amp;lt; .001). Significant differences were also seen in prescription medication use and receipt of care in outpatient, school, and telemental health settings. For example, 17.0% (95% CI, 16.0%-18.0%) of non-Hispanic White adolescents received a telemental health visit after adjustment, but this percentage ranged from 8.1% (95% CI, 5.4%-10.8%) among non-Hispanic Asian, Hawaiian, or Other Pacific Islander adolescents to 12.0% (95% CI, 10.4%-13.6%) among Hispanic adolescents (all P &amp;lt; .001). Few to no racial or ethnic differences were observed in receipt of mental health services from support groups, peer support specialists or recovery coaches, inpatient or residential settings, or emergency departments. Similar patterns were observed among adolescents with past major depressive episodes. Conclusions and Relevance In this study, substantial racial and ethnic differences were observed in US adolescent mental health service use after the COVID-19 pandemic, particularly in psychotropic medication use and clinical outpatient, school, and telemental health settings. These findings highlight the need to improve mental health access for adolescent members of racial and ethnic minority groups.

Dyadic Coping Discrepancies in Adolescents With Chronic Diseases and Their Parents: A Latent Profile Analysis Approach

2025-06-18

Yingying Huang , Meijia Chen , Liping Zhang +2 more | Journal of Clinical Nursing

ABSTRACT Aims To identify subgroups of dyadic coping discrepancies between adolescents with chronic diseases and their parents using latent profile analysis, and to examine variations among these subgroups in socio‐demographic … ABSTRACT Aims To identify subgroups of dyadic coping discrepancies between adolescents with chronic diseases and their parents using latent profile analysis, and to examine variations among these subgroups in socio‐demographic characteristics, family resilience and psychological adjustment outcomes. Design Cross‐sectional study. Methods Between June 2022 and August 2023, 318 adolescent–parent dyads were recruited from three paediatric hospitals in China. Adolescents and their parents completed the General Information Questionnaire, the Dyadic Coping Inventory, the Chinese version of the Family Resilience Scale and the Chinese version of the Psychological Adjustment Scale. Results A three‐class solution provided an optimal fit, identifying the following subgroups: adolescent–parent dyadic coping similarity group (61%), low adolescent–high parent dyadic coping group (20%) and high adolescent–low parent dyadic coping group (19%). Multiple logistic regression analyses indicated that family resilience among adolescents and their parents significantly influenced the classification of dyadic coping discrepancies. A one‐way ANOVA demonstrated significant differences in psychological adjustment among the three subgroups. Conclusion This study identified distinct patterns of dyadic coping discrepancies between adolescents with chronic diseases and their parents, highlighting the variability in coping strategies within these dyads. Family resilience significantly influenced dyadic coping patterns, with higher levels of family resilience associated with more effective dyadic coping. Furthermore, the dyadic coping profiles were significantly associated with the psychological adjustment of adolescents and parents, highlighting the critical role of dyadic coping in individual well‐being. Reporting Method This study adhered to the STROBE checklist. Patient or Public Contribution No patient or public contribution. Impact Our findings provide valuable insights for health professionals to design tailored interventions and implement stratified care addressing the unique needs of adolescents and their parents. Prioritising support for individuals with lower family resilience is critical, as are targeted dyadic coping interventions is essential to enhance the psychological adjustment of adolescents with chronic diseases and their parents.

The Ever-Evolving Relationship of Living With Inflammatory Bowel Disease

2025-06-18

Susan N. Peck , Jennie G. David | PEDIATRICS

Transfer to Adult Care in Epilepsy

2025-06-18

Rianne J.M. Goselink , Hampus Hörling , Anna Eklund +2 more | Neurology Clinical Practice

Improved Transition Management of Adolescents and Young Adults With Allergy and/or Asthma: An <scp>EAACI</scp> Task Force Report on a Follow‐Up European Survey

2025-06-17

N. Atzert , Claudia Gore , Rebecca Knibb +7 more | Allergy

ABSTRACT Background Adolescents and young adults (AYA) with asthma and allergies have unexpectedly high mortality and morbidity. A survey in 2019 amongst healthcare professionals (HCPs) in Europe highlighted significant gaps … ABSTRACT Background Adolescents and young adults (AYA) with asthma and allergies have unexpectedly high mortality and morbidity. A survey in 2019 amongst healthcare professionals (HCPs) in Europe highlighted significant gaps in transition care, which negatively impacts patients' outcomes. Since then, an evidence‐based guideline and practical toolbox for effective transition of AYA with asthma and allergies have been published. Aims To assess HCPs' perspectives, practice and challenges on transition care for AYA with asthma and allergies, including the impact of the recent guideline, potential differences across countries and changes since 2019. Methods Cross‐sectional online survey‐based study. European HCP managing AYA with allergies and/or asthma were invited to participate in May–June 2023. Results 511 responses were collected. Amongst respondents, 60%–70% were familiar with the guideline and toolbox, and found them helpful. At least for selected patients, 50%–85% of respondents adhered to some guideline recommendations and initiatives/resources for transition care such as simplifying medication regimes, seeing AYA on their own or producing transition reports. We observed improvements compared to 2019 in areas such as prioritising transition, training, assessment of psychosocial issues and transition readiness, access to other HCP, transfer and post‐transfer feedback systems. However, 20% of respondents had no transition process and around 50% had no transition‐specific elements. Sixty percent found transition care ‘very’ or ‘moderately challenging’, with transition not being prioritised, time constraints and limited expertise on psychosocial issues as leading problems. Significant differences were observed in transition practice across countries. Conclusion Despite improvement in training and approach towards transition care, challenges and limitations persist in effectively implementing evidence‐based guidelines. Raising greater awareness about the need for, and the positive impact of high‐quality transition care amongst policy‐makers, HCP, and patients/families remains a key priority to unlock resources for training and effective implementation at a national/international level.

The Transition Care Index: Standardizing comprehensive transition and transfer for young adults with inflammatory bowel disease

2025-06-17

H Michel , Jennifer L. Dotson , Jennie G. David +6 more | JPGN Reports

Abstract Objectives In young adults with inflammatory bowel disease (IBD), the time following transfer to adult care is high‐risk for adverse outcomes. We used quality improvement (QI) methods to standardize … Abstract Objectives In young adults with inflammatory bowel disease (IBD), the time following transfer to adult care is high‐risk for adverse outcomes. We used quality improvement (QI) methods to standardize care, decrease variation, and improve preparation of young adults during the transition/transfer process. Methods We created the IBD Transition Care Index (TCI), a list of 10 variables whose completion was felt to represent a more comprehensive transition/transfer process. Variables were organized into three domains: Disease Control/Physical Health, Psychosocial Well‐being, and Transition/Transfer Preparation. We educated patients, caregivers, and providers on the value of completing the TCI to deliver complete, multidisciplinary preparation. We recorded variable completion in a database, reviewed results regularly with providers, and compared rates of variable completion between IBD‐focused and general gastroenterology (GI) physicians. Results Three hundred twenty‐two patients transferred to adult care during the project period (211 pre‐intervention and 121 post‐intervention). In the overall cohort, the mean percentage of TCI variables completed increased from a baseline of 62%–71% in the post‐intervention period, with a significant increase in the rate of multidisciplinary IBD annual visit (IBD AV) attendance (51% vs. 62%, p = 0.03). Patients cared for by general GI physicians had significantly increased rates of both overall TCI variable completion (54% vs. 72%, p = 0.02) and IBD AV attendance (34% vs. 57%, p = 0.02) in the pre‐ versus post‐intervention period. Conclusions Care Indexes such as the TCI can be used to reduce variability and standardize complex clinical processes like transition/transfer for young adults with IBD, with the goal of improving patient outcomes.

G-CHIME framework to examine adolescent addiction recovery in alternative peer groups: a qualitative analysis

2025-06-17

Emily A. Hennessy , Alana Johnston , Angela Nash +1 more | Addiction Research & Theory

Assessing Adolescent Involvement in Type 1 Diabetes Treatment: A Scoping Review of Person‐Reported Outcome Instruments

2025-06-17

Rikke Bjerre Lassen , Caroline Bruun Abild , Kurt Kristensen +2 more | Acta Paediatrica

ABSTRACT Aim The aim of this study was to identify and map the content, structure, and application of person‐reported outcome instruments used to assess the experience of treatment involvement among … ABSTRACT Aim The aim of this study was to identify and map the content, structure, and application of person‐reported outcome instruments used to assess the experience of treatment involvement among adolescents with type 1 diabetes. Methods Studies were identified in PubMed, Embase, CINAHL, PsycINFO, JSTOR, and MedNar. We included studies that used instruments that assess treatment involvement among adolescents (aged 11–18 years) with type 1 diabetes. All review steps involved two reviewers. Data extraction, charting, and analysis were guided by a template focusing on the content, structure, and application of instruments. Results This scoping review identified 23 instruments used in 52 studies, measuring different kinds of treatment involvement among adolescents with type 1 diabetes, e.g., communication with clinicians, clinicians' commitment, and shared decision‐making. Both instrument length and response formats varied across instruments. Some instruments were applicable in adolescents, whereas others were suitable for use in adults. Conclusion This review details the use of several instruments assessing treatment involvement experiences among adolescents with type 1 diabetes. The findings of this review can guide clinicians and researchers on optimal instrument content, structure, and application to implement a person‐centred care practice in paediatric diabetes care.

Gut Microbiota in Postpartum Depression: Pathogenesis and Treatment Perspectives - a review

2025-06-13

Irmina Czerepak , Marcin Kapij , Hubert Bochenek +7 more | Journal of Education Health and Sport

Introduction and purpose: Postpartum depression (PPD) is a prevalent and serious mood disorder following childbirth, affecting approximately 10-20% of new mothers worldwide. PPD not only impacts a mother’s mental health … Introduction and purpose: Postpartum depression (PPD) is a prevalent and serious mood disorder following childbirth, affecting approximately 10-20% of new mothers worldwide. PPD not only impacts a mother’s mental health but also her relationship with her infant, her family, and the psychosocial development of the child. While numerous factors (genetic, hormonal, psychosocial, immunological) contribute to its pathogenesis, growing evidence underscores the central importance of the gut-brain axis and gut microbiota dysbiosis. This article aims to summarise current knowledge on crucial role of gut microbiota in the onset, progression and therapeutic possibilities of PPD.Description of the state of knowledge: Gut microbes influence PPD through the gut-brain axis, impacting neuroendocrine systems, immune responses, and neurotransmitter production. In particular, alterations in gut microbiota composition such as reduced levels of short-chain fatty acid-producing bacteria and an increased abundance of pro-inflammatory taxa have been linked to immune dysregulation, heightened stress responses, and altered neurotransmitter metabolism in PPD. Studies show that microbial dysbiosis correlate with PPD symptoms, while interventions like probiotics and dietary changes offer promising therapeutic avenues.Summary: This review summarizes current evidence on the gut–brain axis in depression, observed gut microbiota changes in PPD, mechanistic pathways linking dysbiosis to postpartum mood disturbances, and emerging microbiota-targeted therapies, including probiotics and fecal microbiota transplantation (FMT).

Payment of Participants with Disability in Research: A Scoping Review and Framework

2025-06-13

Jennifer Smith‐Merry , Damian Mellifont | Social Sciences

Payment of people participating in research is a common practice in research. Research ethics guidelines often require additional scrutiny of payment practices and research practices more generally for groups identified … Payment of people participating in research is a common practice in research. Research ethics guidelines often require additional scrutiny of payment practices and research practices more generally for groups identified as vulnerable, including people with disability. However, the existing guidelines are vague, and often conflict, meaning that it is difficult for researchers to determine what is appropriate in relation to the payment of participants in research. This situation is addressed in this paper, which provides a review of the existing research on the topic of payment of participants considered ‘vulnerable’ in research. We followed a systematic approach to our scoping review, thematically analysed the data identified and reported our results according to the PRISMA-ScR guide for scoping reviews. Fifteen papers met the inclusion criteria and were included in this review. Where studies included empirical findings, most studies were based in the US and Canada, with a small number from European, African, and Asian countries. The key ethical concepts identified in the papers were consent, justice, and reciprocity, which were positioned in relation to coercion and concerns about undue influence from payment. The papers consistently identified economic precarity as being a shared factor across the groups identified as vulnerable which placed them at risk of coercion in relation to payment. The papers also strongly identified context as being an important consideration in both mitigating and enhancing risks around the payment of participants. A framework for considering the payment of participants is offered which responds to the areas identified in the papers. It focuses on the research environment, research situation, participant group, risks and benefits of the research, individual context, relational context, and research practices. This framework is provided as a resource for researchers considering the payment of people with disability in research, and those identified as vulnerable in research more broadly.

56-OR: Behavioral Family Systems Therapy (BFST) Skills Inventory for Youth with Type 1 Diabetes—Psychometric Analyses

2025-06-13

KRISTEN A. TORRES , JENNA SHAPIRO , FLORA S. RICHEY +7 more | Diabetes

Introduction and Objective: Youth receiving BFST for diabetes experienced improved diabetes self-management, parent-adolescent communication, and HbA1c. The BFST Skills Inventory (BFST-SI) was developed to assess intervention fidelity and family skills. … Introduction and Objective: Youth receiving BFST for diabetes experienced improved diabetes self-management, parent-adolescent communication, and HbA1c. The BFST Skills Inventory (BFST-SI) was developed to assess intervention fidelity and family skills. While this measure has been used in numerous intervention studies for youth with diabetes, it has yet to be validated. This study aimed to examine the psychometric properties of the BFST-SI in youth participating in Novel Interventions in Children’s Health Care (NICH), a health equity intervention for youth with diabetes experiencing high social needs, medical risks, and healthcare costs. Methods: Youth participating in NICH at 3 academic medical centers completed the BFST-SI (N=127) and the Diabetes Strengths and Resilience Measure (DSTAR; N=48). The 20 BFST-SI items were examined using exploratory factor analysis with maximum likelihood extraction and direct oblimin rotation. Items with low item-to-total correlations and factor loadings (&lt;0.3) were removed. Results: Youth with complete demographic data had a mean age of 15.4+1.9 years and mean HbA1c of 11.9+2.1%, with 96% on Medicaid. Fifteen items were retained and loaded onto 3 factors. Cronbach’s α was reliable for the total scale (α=.90) and each factor (α=.82-.89), which we labeled Family Problem Solving (6 items), Challenging Family Patterns (4 items), and Family Respect and Collaboration (5 items). BFST-SI total scores were correlated with DSTAR scores (r=.47, p&lt;.01). Conclusion: The BFST-SI is a psychometrically sound measure used to assess BFST-D fidelity and family skill outcomes. This study adds to the extant literature demonstrating that family communication and problem-solving are critical skills for families of youth with diabetes. Screening for BFST skills will help identify families needing additional communication intervention and aid in treatment development and evaluation for youth with diabetes and their families. Disclosure K.A. Torres: None. J. Shapiro: None. F.S. Richey: None. D. Naranjo: Consultant; Sanofi. A. Reed: None. J.C. Wong: Research Support; Abbott, Dexcom, Inc., Tandem Diabetes Care, Inc. M. Gonzales Granados: None. M.E. Hilliard: None. M.A. Harris: None. D.V. Wagner: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

1501-P: Association of Unmet Health-Related Social Needs with Glycated Hemoglobin and Health Care Utilization among Youth and Young Adults with Youth-Onset Type 1 Diabetes

2025-06-13

EMMANUEL F. JULCEUS , JASON A. MENDOZA , EDWARD A. FRONGILLO +6 more | Diabetes

Introduction and Objective: Various health-related social needs (HRSNs) are associated with diabetes outcomes, but little is known about their joint effects. We evaluated the association of the number of unmet … Introduction and Objective: Various health-related social needs (HRSNs) are associated with diabetes outcomes, but little is known about their joint effects. We evaluated the association of the number of unmet HRSNs with hemoglobin A1c (HbA1c), acute diabetes complications, and healthcare utilization among youth and young adults (YYA) with youth-onset type 1 diabetes (T1D), and whether the associations are buffered by food assistance. Methods: Using cross-sectional data of 814 YYA with T1D from the multicenter SEARCH Food Security Cohort study (2019-2021), logistic regression models were performed to test associations between the sum of self-reported unmet HRSNs and HbA1c, self-reported acute diabetes complications and health care utilization in the past 12 months, adjusting for demographic and clinical variables. Results: The percentage of YYA affected by HRSNs included 22.4% with health care insecurity, 15.1% with food insecurity, 7.1% with unreliable transportation, and 2.4% with unstable housing. Only 9.8% received food assistance. About 66%, 23%, 9%, and 2% of YYA with T1D had 0, 1, 2, or 3 unmet HRSNs, respectively. Each additional unmet HRSN was associated with higher odds of HbA1c &gt;9.0% (OR 1.7, 95% CI 1.3-2.2), diabetic ketoacidosis (OR 1.8, 95% CI 1.4-2.3), emergency room visit (OR 1.5, 95% CI 1.2-1.8), urgent care visit (OR 1.3, 95% CI 1.0-1.6), and hospitalization (OR 1.5, 95% CI 1.2-2.0). Food assistance buffered the association between the number of unmet HRSNs with hospitalization (p=0.03); odds ratios for those with and without food assistance were 0.9 (95% CI 0.5-1.6) and 1.8 (95% CI 1.3-2.5). Conclusion: Each additional unmet HRSN in YYA with T1D was associated with 30-80% higher odds of poor diabetes management and non-routine health care utilization, food assistance buffered the association with hospitalization, showing the benefit of identifying and addressing HRSNs jointly. Disclosure E.F. Julceus: None. J.A. Mendoza: None. E.A. Frongillo: None. C. Rudisill: None. A. Bellatorre: None. F. Malik: None. T.A. Bekelman: None. C. Pihoker: None. A.D. Liese: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461)

1948-LB: Health Care Provider Perspectives on Unmet Needs to Address Diabulimia in Adults with T1D—Results of Semi-structured Interviews

2025-06-13

Heather Stuckey-Peyrot , Candace Bordner , Ann Goebel-Fabbri +4 more | Diabetes

Introduction and Objective: Restriction of insulin for the purpose of weight loss, diabulimia, occurs in 1 out of 11 adults with T1D and is associated with increased morbidity and mortality. … Introduction and Objective: Restriction of insulin for the purpose of weight loss, diabulimia, occurs in 1 out of 11 adults with T1D and is associated with increased morbidity and mortality. This qualitative study focused on identification, prevention, and treatment of this high-risk condition, and included 2 sets of interviews: one with diabetes healthcare professionals (HCPs) to determine knowledge and experience with diabulimia, and with mental health professionals (MHCP) to address issues discussed by HCPs, such as how best to initiate conversations when eating disorders (EDs) are suspected. Strategies to help educate HCPs on EDs, particularly diabulimia, were a topic of high priority. Methods: HCPs and MHCPs were identified by study team members for inclusion and screened; interviews were recorded and transcribed. Codebooks were developed, with coding performed by two researchers until an acceptable kappa was reached kappa &gt;0.70 (MAXQDA), with identification of themes by the research team. Results: Interviews were conducted with 17 HCPs. Themes included a lack of: (a) formal training on EDs, especially diabulimia; (b) knowledge about how best to initiate conversations and communicate with patients after EDs were identified; and (c) diabetes mental health professionals available for referral. There were 9 MHCPs who responded in the interviews with their perspectives on: (a) best practices for patient-centered communication and confidence after an ED is identified; (b) preparation for opening up difficult conversations around EDs; and (c) types of resources and trainings to develop for HCPs. Conclusion: HCPs identified a need for more resources and education to help identify, discuss, and treat diabulimia in adults with T1D. MHCPs underlined the need for tailored resources and experiential, case-based live trainings for HCP. Future interviews of people with T1D in recovery from diabulimia can help guide best practices to identify and manage the life-threatening condition of diabulimia. Disclosure H.L. Stuckey-Peyrot: Consultant; Eli Lilly and Company. C. Bordner: None. A.E. Goebel-Fabbri: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sequel Med Tech. Research Support; Dexcom, Inc. A. Prokop: None. T. Kushner: None. L.M. Laffel: Advisory Panel; Boehringer-Ingelheim, Sanofi, MannKind Corporation, Medtronic, Vertex Pharmaceuticals Incorporated, Tandem Diabetes Care, Inc, Insulet Corporation. Research Support; Dexcom, Inc. Advisory Panel; Sequel Med Tech. Other Relationship; Janssen Pharmaceuticals, Inc. Consultant; Arbor Biotech. Funding Breakthrough T1D 3-SRA-2024-1457-M-B

690-P: Participant Characteristics and Engagement in a Young Adult Diabetes Transition Clinic

2025-06-13

R. Pandit , Ines Guttmann‐Bauman , Rachael Mullin +2 more | Diabetes

Introduction and Objective: Young adults with type 1 diabetes (T1D) are vulnerable when transitioning from pediatric to adult care. The Young Adult Diabetes Clinic (YADC) employs a multidisciplinary model to … Introduction and Objective: Young adults with type 1 diabetes (T1D) are vulnerable when transitioning from pediatric to adult care. The Young Adult Diabetes Clinic (YADC) employs a multidisciplinary model to facilitate this transition through a single-session orientation led by a behavioral health specialist. We aim to understand the impact of the YADC, participant characteristics, and patterns of engagement. Methods: The YADC involves a half-day session with orientation, peer-to-peer icebreakers, and discussion of transition-related topics, followed by diabetes education and medical provider visits. YADC participation, demographic and clinical data, including age, zip code (urban vs. rural), insurance status, visit type (virtual vs. in-person), referral source (internal vs. external), technology use (CGM, CGM + pump, or none), T1D Distress Assessment System (T1DDAS) scores, A1c, and visit completion were tracked or manually extracted via chart review. No statistical software or analysis was applied. Results: Of 214 participants (2021-2024, mean age = 20), 27% (N=58) fully participated in YADC, 19% (N=40) partially participated, and 54% (N=116) did not participate. Among 17 full participants (August 2023-June 2024): mean age = 21 years (SD = 1.8); mean A1c = 9% (SD = 2.4); 47% used CGM, 41% CGM + pump, and 11% used neither; 14 were urban residents and 3 were rural residents. Most (70%) had private insurance; 29% had Medicaid. Within 6 months following the YADC session, 9 of 17 completed medical visits, 8 of 17 completed diabetes education, and none accessed additional behavioral health care. Diabetes distress scores were collected for all 10 patients who attended in 2024. Conclusion: Characterizing participants in YADC and non-YADC visits will help highlight patterns of engagement and potential barriers to care. Future research should explore how to enhance program accessibility particularly for underserved groups, address psychosocial barriers, and assess the long-term impact of YADC participation on diabetes management outcomes. Disclosure R. Pandit: None. I. Guttmann-Bauman: None. R. Mullin: None. R.D. Tweet: Other Relationship; Lilly Diabetes. F. Joarder: None.

694-P: Which Young Adults (YA) with Type 1 Diabetes (T1D) Return to Pediatrics during the Transition to Adult Care?

2025-06-13

Stephanie Camey , SAMANTHA A. CARREON , Charles G. Minard +7 more | Diabetes

Introduction and Objective: Transition from pediatric to adult diabetes care is a complex process for YA with T1D. However, little is known about demographic and clinical characteristics of YA who … Introduction and Objective: Transition from pediatric to adult diabetes care is a complex process for YA with T1D. However, little is known about demographic and clinical characteristics of YA who return to pediatric care after initiating the transfer to adult care. We explored characteristics of YA who did or did not return to pediatric care after their planned final pediatric appointment. Methods: At baseline of a trial, 100 YA with T1D reported demographic and medical information; HbA1c via medical chart or dried blood spot. We tracked pediatric visits over 12 mos and YA reported challenges with transition at follow-up. T-tests and χ2 tests assessed characteristics of YA who did or did not return to pediatric care. Results: As noted in the Table, 34% of YA returned to pediatric care for 59 visits (49 outpatient, 10 emergency care). Only age was significantly associated with return to pediatric care (p=0.015). Common challenges included busy/time constraints, difficulty scheduling, easier to stay in pediatrics. Conclusion: A sizable subset of YA with T1D return to pediatrics after planning to transfer to adult care. While relatively younger YA were more likely to return, we cannot predict who returns to pediatrics. Individualized support is needed in preparation for and during transfer between pediatric and adult care. Thus, the role of pediatric clinicians is not complete until YA establish in adult care. Disclosure S. Camey: None. S.A. Carreon: None. C.G. Minard: None. W. Levy: None. S. Lyons: None. C. Macke: None. R. Streisand: None. T.S. Tang: None. S. Mckay: None. B.J. Anderson-Thomas: None. S. Devaraj: None. M.E. Hilliard: None. Funding National Institutes of Diabetes and Digestive and Kidney Diseases (1R01DK119246) (PI: M Hilliard); (3R01DK119246-03S1) (PI: M. Hilliard; Mentee: S. Carreon), 1K26DK138332 (PI: M Hilliard)

1896-LB: Enhancing Diabetes Transition of Care—The BUILT Program’s Impact on Young Adults

2025-06-13

J. Pfieffer , LARRY A. FOX , M.N. Mortensen | Diabetes

Introduction and Objective: Building Up Independent Lives for Teens (BUILT) is a program for young adults with diabetes to transition to adult care. This structured program addresses gaps in knowledge, … Introduction and Objective: Building Up Independent Lives for Teens (BUILT) is a program for young adults with diabetes to transition to adult care. This structured program addresses gaps in knowledge, self-management, and healthcare navigation. Methods: The BUILT program uses the “Got Transition’s” Six Core Elements framework from the American Diabetes Association with both in-person and virtual sessions. The Readiness Assessment for Diabetes in Youth (READDY) measured knowledge and self-management skills in four key areas: diabetes knowledge, navigation/independent management, health behaviors, and insulin management. Therapy dogs assisted with patient engagement. Motivational strategies were used to encourage patient participation. Results: Initial results from the first 10 graduates showed measurable improvements in diabetes knowledge, independent management, and insulin skills, demonstrating the effectiveness of the structured transition approach. Pre - and post-assessment scores across three partner sites revealed a 10-20% increase in measured competencies regarding the 3 lowest scored questions on READDY. Conclusion: The BUILT program successfully improved diabetes self-management skills, enhanced patient confidence, and engagement in care. Expansion and long-term tracking will help optimize the approach and outcomes for young adults transitioning out of pediatric diabetes care. Disclosure J.E. Pfieffer: None. L.A. Fox: Advisory Panel; KiHealth. Research Support; Dexcom, Inc. M. Mortensen: None.

1188-P: Perspectives on Adult to Pediatric Adaptations of a Type 1 Diabetes (T1D) Specialty Community Health Worker (CHW) Model

2025-06-13

CHARLOTTE CHEN , MOLLY FINNAN , MARGARET G. MAYNARD +5 more | Diabetes

Introduction and Objective: The T1D-CATCH (Collaboration Around Technology using Community Health workers) study is an ongoing randomized clinical trial currently testing whether 6 months of coincident social needs and diabetes … Introduction and Objective: The T1D-CATCH (Collaboration Around Technology using Community Health workers) study is an ongoing randomized clinical trial currently testing whether 6 months of coincident social needs and diabetes technology navigation by a T1D specialty CHW will improve uptake and meaningful use of technology among underserved young adults with T1D. We explored post-intervention feedback to adapt and scale this intervention to underserved youth with T1D who exhibit similar inequitable patterns of technology use. Methods: We conducted semi-structured individual interviews with completers of the T1D-CATCH intervention to explore acceptability and feasibility and included a pediatric adaptation domain. We recorded, transcribed, and analyzed interviews using inductive coding and two independent coders. Results: We included 22 intervention completers (mean age 25 yrs, 54% female, n=12 Hispanic, n=10 Black). Participants noted great interest in the T1D-CATCH intervention for pediatrics both for youth and caregivers. Common themes identified for the benefit of the T1D-CATCH intervention included the availability of a trusted member of the community providing simplified information on diabetes technology for caregivers, providing navigation to initiation and maintenance of supplies for diabetes technology, and the ability to create peer support networks for youth and their families. Participants expressed that if access to T1D-CATCH was provided at a younger age, it would have been greatly beneficial in the early diagnosis phase, where navigation to crucial mental health services were needed for themselves and their caregivers. Conclusion: T1D-CATCH participants were enthusiastic about adapting the model for a pediatric population, noting critical importance at both the early diagnosis phase and wraparound support for both youth and their families. Disclosure C. Chen: None. M. Finnan: None. M.G. Maynard: None. A. Adamu: None. S. Sanchez: None. A. Talla: None. P.M. Mathias: None. S. Agarwal: Research Support; Dexcom, Inc. Funding American Diabetes Association (CDTR-15)

1220-P: Bridge Into Adulthood—Global Practice on Transitioning Youth with Type 1 Diabetes from Pediatric to Adult Care—Findings from SWEET Database and Center Survey

2025-06-13

Barbara Piccini , Reinhard W. Holl , FAISAL MALIK +7 more | Diabetes

Introduction and Objective: The transition process from pediatric to adult type 1 diabetes (T1D) care is poorly explored. We aimed to assess transition for youth living with T1D worldwide. Methods: … Introduction and Objective: The transition process from pediatric to adult type 1 diabetes (T1D) care is poorly explored. We aimed to assess transition for youth living with T1D worldwide. Methods: SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) database was analyzed (2016-2023, centers &gt;20 patients, &gt; 5-year data). Transfer was assumed in T1D patients 14-24 years with no visits for ≥2 years. Age at transfer was evaluated across regions. A survey developed by pediatric and adult diabetologists was distributed to all SWEET centers. Results: Among 33,418 transferred patients (104 centers, 51% male), age at T1D transfer was 18.7 years in Asia/Middle East/Africa, 18.4 in North America/Canada, 18.0 in Europe, 17.2 in Australia/New Zealand and 17.0 in South America (p &lt;0.0001). Female gender and higher HbA1c were associated with earlier transfer (- 0.1 year, p &lt;0.0002; - 0.08, p &lt;0.0001), longer duration and larger centers with later transfer (p &lt;0.0001). Of 160 surveyed centers, 79 responded: 43 in Europe, 20 Asia/Middle East/Africa, 8 North America, 6 South America, 2 Australia/New Zealand, 87% academic, 74% exclusively pediatric, 57% with age limit for pediatric care reimbursement. Annually, 80% of centers transferred &lt;50 patients; 13% of centers transferred at 20+ years, 41% at 18-20, 27% at 16-18 and 9% at 14-16 years (no transfer: 6%). Structured transition was absent in 34% of centers. Key drivers for transfer included age (83% of centers), reimbursement policies (8%) and patient request (4%). Metabolic control (60%), psychiatric comorbidity (63%) and teen pregnancy (59%) influenced transfer, while technology use and T1D complications did not. Conclusion: This study highlights the global variability in T1D transition and the lack of structured transition in many centers. More efforts are needed to enhance transition preparation and a successful transfer for youth with T1D. Disclosure B. Piccini: Advisory Panel; Sanofi. R.W. Holl: None. F. Malik: None. C. de Beaufort: None. N.S. Elbarbary: None. V. Iotova: Other Relationship; Pfizer Inc, Novo Nordisk, AstraZeneca, Rezolute Bio, Medtronic, Novartis Pharmaceuticals Corporation, Novo Nordisk. C. Kanaka-Gantenbein: Research Support; Abbott, Amgen Inc. Advisory Panel; Kyowa Kirin Co., Ltd. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc, Sanofi. H. Kim: None. J.M. Leung: None. J. Mirza: None. L. Preechasuk: None. S. Toni: Consultant; Abbott. Advisory Panel; Sanofi.

59-OR: Innovative Health Equity Intervention for Youth with Diabetes Deemed High Risk, High Needs, and High Cost—Understanding the Role of Co-occurring Mental Health Diagnoses

2025-06-13

Leslie Hicks , Kristen Torres , L Lévy +7 more | Diabetes

Introduction and Objective: Novel Interventions in Children’s Healthcare (NICH) has shown improved health outcomes for youth with diabetes experiencing inequity. NICH does not specifically target symptoms of mental health diagnoses … Introduction and Objective: Novel Interventions in Children’s Healthcare (NICH) has shown improved health outcomes for youth with diabetes experiencing inequity. NICH does not specifically target symptoms of mental health diagnoses (MHD)s, but never excludes youth and caregivers from enrollment and evaluation due to MHDs. Given uncertainty regarding role in NICH outcomes, this study explores prevalence of MHDs and related health outcomes for youth in NICH. Methods: Youth with diabetes (N=30; T1D=26, T2D=4) who participated in NICH at two new healthcare systems were included. Chart review collected HbA1c, emergency department visits, and days admitted one year prior to and during NICH enrollment. Provider-reported social drivers of health and MHD presence for youth and caregivers were also included. Non-parametric t-tests examined differences in health outcomes during NICH for those with and without MHDs. Results: Youth mean age was 13.2 years; 57% of youth were from historically marginalized racial and ethnic groups; 76% of youth and 53% of caregivers had a MHD. Youth with a MHD experienced higher mean A1c prior to NICH (12.8±1.4%) compared to youth without (12.1±2.2%; p&lt;.03). Decreased mean HbA1c from baseline to post-NICH was found for all youth in NICH (12.6+1.7% to 11.2+2.3%; p&lt;.001), youth with a MHD (12.8±1.4% to 11.8±2.3%; p&lt;.02), youth of caregivers with a MHD (13.1±1.8% to 11.3±2.6%; p&lt;.01), and youth of caregivers without a MHD (12.1±1.5% to 11.1±2.0%; p&lt;.03). Youth of caregivers without a MHD also demonstrated a decrease in mean days admitted while in NICH (8.3±7.8 to 4.1±5.8; p&lt;.01). All other baseline findings and changes over time were nonsignificant. Conclusion: NICH implementation at new sites continues to demonstrate clinically and statistically significant improvements in HbA1c. Co-occurring MHD in youth and caregivers served by NICH are common. NICH demonstrates improved HbA1c regardless of presence of MHD for youth with T1D or their caregivers. Disclosure L.D. Hicks: None. K.A. Torres: None. L.J. Levy: None. D. Naranjo: Consultant; Sanofi. A. Reed: None. J.C. Wong: Research Support; Abbott, Dexcom, Inc., Tandem Diabetes Care, Inc. K.B. Spiro: None. N.A. Cisneros: None. I.C. Gomez: None. M.A. Harris: None. D.V. Wagner: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

55-OR: Understanding the Unseen—Caregiver Adverse Childhood Experiences and the Health of Youth with Type 1 Diabetes (T1D)

2025-06-13

Kevin P. McMullen , Kristen Torres , JENNIFER RAYMOND +7 more | Diabetes

Introduction and Objective: Adverse childhood experiences (ACEs) are known to impact the health and well-being of those living with T1D. Less is known regarding how ACEs of a primary caregiver … Introduction and Objective: Adverse childhood experiences (ACEs) are known to impact the health and well-being of those living with T1D. Less is known regarding how ACEs of a primary caregiver (parent, grandparent, etc.) may indirectly impact youth with chronic health conditions - potentially via influence on parenting practices. The current study investigates the relationship between caregiver ACEs, parenting practices, and health of youth with T1D. Methods: Youth (N=158) ages 12-17 years, with T1D for ≥1 year, and an HbA1c ≥ 10% in the past year were enrolled from 5 academic medical centers. Youth caregivers reported on parenting practices (Alabama Parenting Questionnaire) and their own ACEs (ex: experience of racial discrimination, parental death). Chart review collected HbA1c and ED visits 12 months prior to enrollment and ED visits 6 months following study enrollment. Chi square tests, bivariate correlations, and independent t-tests were conducted. Results: Youth mean age was 14.5+2 years with mean HbA1c of 11.1+2%. Less than 50% of youth were Non-Latinx white; 15.2% Latinx; 14.1% Black. Youth whose caregivers experienced specific ACEs were more likely to experience an ED visit than youth whose caregivers did not (parental divorce: 51.4% vs. 28.9%, p&lt;.01; parental incarceration: 61.1% vs. 36.5%; p&lt;.05; racial discrimination: 60.9% vs. 35.6%; p&lt;.05). Youth of caregivers who experienced racial discrimination had more ED visits (M=1.4+1.4) than youth of caregivers who did not (M=0.7+1.6; p&lt;.05). Caregiver experience of racial discrimination correlated with lower positive parenting (r=-.18) and poorer supervision (r=.17; p&lt;.05). Conclusion: Findings demonstrate that ACEs in caregivers raising youth with T1D are associated with parenting practices and youth health. Given prior associations between parenting practices and T1D outcomes, and these findings regarding caregiver ACEs, healthcare systems should consider caregiver experiences and functioning as prime areas for potential screening and intervention. Disclosure K.A. McMullen: None. K.A. Torres: None. J. Raymond: None. M.A. Clements: Consultant; Glooko, Inc. Research Support; Dexcom, Inc., Abbott. D. Naranjo: Consultant; Sanofi. J.C. Wong: Research Support; Abbott, Dexcom, Inc., Tandem Diabetes Care, Inc. A. Reed: None. S.R. Melnick: None. M.A. Harris: None. D.V. Wagner: None. Funding JDRF

1190-P: Social Determinants of Health Barriers in Newly Diagnosed Pediatric T1D and T2D Patients

2025-06-13

JASMINE ROBERTS , SARAH L. HOLLY , ROXANNA E. VELASQUEZ +3 more | Diabetes

Introduction and Objective: Adverse social determinants of health (SDOH) can negatively impact diabetes care and management. Despite efforts to provide more equitable care, disparities remain among marginalized youth. Identifying SDOH … Introduction and Objective: Adverse social determinants of health (SDOH) can negatively impact diabetes care and management. Despite efforts to provide more equitable care, disparities remain among marginalized youth. Identifying SDOH barriers early in diabetes diagnosis can allow resources to be put in place to support families navigating a new disease. We identified the prevalence of SDOH barriers in newly diagnosed T1D and T2D patients. Methods: SDOH screening was implemented at the time of diagnosis in a large academic center serving a diverse T1D and T2D population. Caregivers who identify any barriers are provided with tailored resources and ongoing support from a Diabetes Health Coach. Comparisons among T1D and T2D new onset patients were made to assess population patterns and prevalence of identified barriers. Results: 112 SDOH screens were completed over 14 months (n=97 T1D; n= 15 T2D). Barriers were identified in 53% (n=8) of the T2D population compared to 29% (n=28) of the T1D population. Mental health and food insecurity were the most identified barriers, regardless of diagnosis. 54% (n=15) of T1D and 13% (n=1) of T2D caregivers reported more than one barrier. Food insecurity and mental health were marked by 50% of the T2D patient caregivers who identified barriers. Conclusion: SDOH barriers are seen in about a third of newly diagnosed patients, showing the importance of screening for barriers among all new onset patients. Nearly half of newly diagnosed T2D patients have at least one SDOH barrier, while more than half of newly diagnosed T1D patients experience more than one barrier. Without identifying and addressing SDOH barriers that families have, individualized and complete diabetes care cannot be fully achieved. Disclosure J. Roberts: None. S.L. Holly: None. R.E. Velasquez: None. L. DeAnna: None. D. Patrick: None. S. Majidi: Speaker's Bureau; Sanofi. Funding CareFirst BlueCross BlueShield

671-P: Examination of Transition Readiness (TR) and HbA1c in the Year after Discharge from Pediatric Type 1 Diabetes (T1D) Care

2025-06-13

Jessica S. Pierce , Amy Milkes , Shilpa Gurnurkar +1 more | Diabetes

Introduction and Objective: Assessment of young adults’ (YA) TR levels can provide insight into their ability to successfully transition to adult T1D healthcare. We assessed TR and HbA1c over the … Introduction and Objective: Assessment of young adults’ (YA) TR levels can provide insight into their ability to successfully transition to adult T1D healthcare. We assessed TR and HbA1c over the year after discharge from pediatric T1D care in a pilot observation study. We hypothesized that TR levels would increase as YA transitioned and that higher TR levels would relate to lower A1c. Methods: We used the READDY (Readiness of Emerging Adults with Diabetes Diagnosed in Youth) survey to measure TR at 3 timepoints: baseline (discharge from pediatric T1D care), 6-, and 12-months-post-discharge. READDY items are divided into four domains: Diabetes Knowledge, Health System Navigation, Insulin Self-Management, and Health Behaviors, and are scored on a 5-point Likert scale (1=Haven’t thought about it; 5=Yes, I can do this). Domain mean scores of 1-3 are considered low TR; scores 4-5 are high TR. We ran paired sample t-tests for READDY domains between baseline and 6-mos, 6- and 12-mos, and baseline and 12-mos. We ran Pearson correlations between READDY domains at all 3 timepoints and A1c at 12-mos. Results: 24 YA identified as 58% female, 50% NHW, 29% Medicaid, 63% on pumps, 71% on CGM; baseline M±SD age=18.5±1.0 yrs, A1c=9.3±2.0%. Mean READDY domain scores range was 1-1.5. The only significant change was on the Diabetes Knowledge domain, which decreased between baseline and 12-mos. (t=3.11, p=0.01). The correlation between the Health Systems Navigation domain at baseline and A1c at 12-mos approached significance (r=-0.62, p=0.06). Conclusion: Most TR scores were low and remained relatively stable during transition from pediatric T1D care, indicating that interventions are needed to increase TR. Results also suggest that 1) YA may need refresher education courses to improve diabetes knowledge during the transition, 2) YA ability to navigate the health system may have the greatest impact on glycemic outcomes, and 3) Larger, fully powered longitudinal studies are needed to identify additional modifiable targets for TR interventions. Disclosure J.S. Pierce: None. A. Milkes: None. S. Gurnurkar: None. S.R. Patton: None. Funding DK020593, Vanderbilt Diabetes and Research Training Center Pilot & Feasibility Program

1200-P: Parental Preferences for Novel Resources about Health Care Transition for Their Adolescent/Young Adult with Type 1 Diabetes

2025-06-13

Kate Diaz Roldan , LAUREN E. WISK | Diabetes

Introduction and Objective: The importance of a timely healthcare transition (HCT) from pediatric to adult care among adolescents/young adults (AYA) with type 1 diabetes (T1D) is widely accepted. Most prior … Introduction and Objective: The importance of a timely healthcare transition (HCT) from pediatric to adult care among adolescents/young adults (AYA) with type 1 diabetes (T1D) is widely accepted. Most prior work has focused on interventions targeting youth preparation for HCT, with less attention to what resources parents need to assist their child with HCT. We sought to develop novel resources to prepare parents for HCT and to engage them in formatively evaluating these resources using qualitative, user-centered design methods. Methods: Parents of a child with T1D (aged 13-26 years) were recruited from a large health system and completed approximately a 1-hour interview where they were asked about their experiences with HCT and preferences for novel, parent-focused resources. Interviews were professionally transcribed, coded by the research team, and an inductive analysis was used to extract themes. Results: 17 parents were interviewed (mean age 50.5±8.1; 94% women; 59% white non-Hispanic). Parents did not receive guidance to prepare them for their child's HCT. Parents whose child was post-HCT expressed that information about transition would have been useful. Parents whose child had not yet transitioned were mixed regarding the perceived helpfulness of such information. Parents responded favorably to the inclusion of actual quotes from youth with T1D about their own HCT (“...I love that quote about Simon, because I wish that [my child] could say that now...”). Parents were mixed about the inclusion of data about HCT (“...I’m not a graph person like this”, “This is a very small percentage...but...can relate to all of this”). When asked about resources, parents mentioned written information or a HCT plan would be helpful. Conclusion: Parents identified a need for novel resources given wide variability in current practices and support during this process. Critical feedback has been incorporated in the development of an educational intervention. Disclosure K. Diaz Roldan: None. L.E. Wisk: None. Funding NIDDK (R03 DK132439)

1206-P: Medical and Demographic Correlates of Session Attendance among Historically Minoritized Youth with T1D in a CGM Behavioral Intervention

2025-06-13

AMANDA G. PERKINS , EMMA STRATON , CHRISTINE H. WANG +4 more | Diabetes

Introduction and Objective: Historically minoritized youth with T1D have disproportionately low CGM use despite evidence of its benefit for glycemic control. This population is also historically excluded from diabetes technology … Introduction and Objective: Historically minoritized youth with T1D have disproportionately low CGM use despite evidence of its benefit for glycemic control. This population is also historically excluded from diabetes technology research. ROUTE-T1D is a 3-session, nurse practitioner-led family behavioral intervention to promote CGM use among a racially minoritized population. Methods: Participants included 60 youth with T1D ages 10-15 years and &lt;75% CGM wear-time. The intervention focused on problem solving and positive communication related to CGM. Medical and demographic correlates of session attendance were examined using independent samples t-tests, chi-square, Fishers or Fisher-Freeman-Halton exact tests. Results: Overall session attendance was high at 75%. Greater caregiver education was significantly associated with greater session attendance (Table 1). Conclusion: High session engagement suggests the intervention was accessible to a diverse study population and demonstrates the feasibility of including diverse populations in diabetes technology research. Future approaches should target accessibility for caregivers with lower education levels. Small sample size limits statistical power and larger studies are needed to understand how systemic racism impacts exclusion of racially minoritized people in diabetes technology research. Disclosure A.G. Perkins: Research Support; Tandem Diabetes Care, Inc, Dexcom, Inc. E. Straton: None. C.H. Wang: None. J. Barber: Stock/Shareholder; Boston Scientific Corporation, UnitedHealth Group, AbbVie Inc. L. Gallant: None. S. Majidi: Speaker's Bureau; Sanofi. R. Streisand: None. Funding NIDDK (R01DK131026)

Gambling and adolescents: a public health crisis demanding immediate action

2025-06-12

Luana Stangherlin dos Santos , Júlio César Claudino dos Santos | Pediatric Research

Empowering Health Professional Students With Robust Mentorship

2025-06-12

Helena J. Chapman , Bienvenido A. Veras‐Estévez | The Clinical Teacher

Chronic GVHD: one more promising player enters the arena

2025-06-12

Francis Ayuk | Blood

Paid family leave and reduced acute respiratory infections in young infants: Does everyone benefit equally?

2025-06-09

Katherine A. Ahrens , Jennifer A. Hutcheon , Erin Strumpf +3 more | American Journal of Epidemiology

Abstract Background and Objectives: To examine whether the effect of a paid family leave program on acute care encounters for respiratory tract infections (RTI) among young infants differed by subgroups. … Abstract Background and Objectives: To examine whether the effect of a paid family leave program on acute care encounters for respiratory tract infections (RTI) among young infants differed by subgroups. Methods: We examined 52943 hospitalizations and emergency department visits between Oct 2015 and Feb 2020 among infants aged ≤8 weeks in New York, which introduced paid family leave in January 2018, and four New England control states (Massachusetts, New Hampshire, Vermont, Maine). We conducted a controlled time series analysis that compared observed counts in New York during the putative respiratory virus season (Oct-Mar) in each population subgroup to those predicted in the absence of the policy. Results: Absolute reductions in RTI-related acute care encounters among young infants were greater for Hispanic as compared to non-Hispanic white infants (5.60 fewer cases per 1000 infants [95% CI: -8.74 to -2.51]) and for encounters paid for by Medicaid as compared to private payer (4.22 fewer cases per 1000 [95% CI: -6.45, -2.18]). Findings by Child Opportunity Index 2.0 quintiles showed no clear pattern. Conclusions: Our findings suggest the program may have larger benefits for infants from less advantaged groups.