Exploring young adults' experiences with food allergy during their teenage years: A practice research study.

INTRODUCTION: Symptoms of anxiety, eating disorders and social isolation are prevalent among teenagers with food allergy compared to peers without. Treatment of teenagers with food allergy focus on preventing anaphylactic reactions, with little attention to promoting social and emotional well-being. The aim of the study was to explore young adults' perspectives on everyday life with food allergy during their teenage years to improve future clinical practice. METHODS: Critical psychological practice research. During a 2-day camp the perspectives of 10 young adults (18-23 years) were explored through participant observation and informal interviews. Three follow up interviews were conducted. A co-researcher group discussed preliminary results, clinical challenges and ways forward. RESULTS: Being together with peers with food allergy was crucial, fostering belonging and normalisation. The shift in responsibility of managing the risk feels overwhelming and stressful during teen age. Self-understanding was influenced when managing food allergy in social contexts, inducing feelings of burden and isolation. Acceptance and understanding from social relations became important for all participants, and they all underlined desire for being viewed as individuals rather than being defined by their allergy. CONCLUSION: Support from other peers with food allergy is crucial for the participants. Transition to independently managing risks introduces uncertainty and social constraints, affecting self-understanding and interactions. Clinicians should prioritise peer support and empower teenagers in managing the risk and psychosocial challenges.

Tracing human life trajectory using gut microbial communities by context-aware deep learning.

The gut microbial communities are highly plastic throughout life, and the human gut microbial communities show spatial-temporal dynamic patterns at different life stages. However, the underlying association between gut microbial communities and time-related factors remains unclear. The lack of context-awareness, insufficient data, and the existence of batch effect are the three major issues, making the life trajection of the host based on gut microbial communities problematic. Here, we used a novel computational approach (microDELTA, microbial-based deep life trajectory) to track longitudinal human gut microbial communities' alterations, which employs transfer learning for context-aware mining of gut microbial community dynamics at different life stages. Using an infant cohort, we demonstrated that microDELTA outperformed Neural Network for accurately predicting the age of infant with different delivery mode, especially for newborn infants of vaginal delivery with the area under the receiver operating characteristic curve of microDELTA and Neural Network at 0.811 and 0.436, respectively. In this context, we have discovered the influence of delivery mode on infant gut microbial communities. Along the human lifespan, we also applied microDELTA to a Chinese traveler cohort, a Hadza hunter-gatherer cohort and an elderly cohort. Results revealed the association between long-term dietary shifts during travel and adult gut microbial communities, the seasonal cycling of gut microbial communities for the Hadza hunter-gatherers, and the distinctive microbial pattern of elderly gut microbial communities. In summary, microDELTA can largely solve the issues in tracing the life trajectory of the human microbial communities and generate accurate and flexible models for a broad spectrum of microbial-based longitudinal researches.

Transition to Comfort Care Only and End-of-Life Trajectories in an Acute Geriatric Unit: A Secondary Analysis of the DAMAGE Cohort.

OBJECTIVES: Comfort care for a dying patient increases the quality of the end of life. End-of-life situations are frequently managed in acute geriatric units (AGUs), and transition to comfort care only is often necessary. However, the frequency of transition to comfort care and the latter's putative link with the end-of-life trajectory (sudden death, cancer, organ failure, and frailty with or without dementia) have not previously been studied in acute geriatric units. We sought to (1) describe end-of-life trajectories and the transition to comfort care only, and (2) analyse the relationship between the two, prior to death in an AGU. DESIGN: A secondary analysis of a subgroup of the DAMAGE cohort (a prospective multicentre cohort of 3509 patients aged 75 years and over and admitted consecutively to an AGU). SETTING/PARTICIPANTS: DAMAGE patients who died in an AGU after a stay of at least 48 hours. METHODS: Data on the end-of-life trajectory and the transition to comfort care only were extracted from medical records. RESULTS: Of the 177 included patients, 123 (69.5%) transitioned to comfort care only in the AGU. A frailty trajectory (in patients living with dementia or not) accounted for nearly 70% of deaths. Paradoxically, only frailty among people living without dementia was not significantly associated with a more frequent transition to comfort care [odds ratio (95% confidence interval): 1.44 (0.44-4.76), relative to a patient dying suddenly]. CONCLUSIONS AND IMPLICATIONS: Transition to comfort care only is frequent in AGUs and is linked to the end-of-life trajectory (except for frail patients living without dementia). The frailty trajectory is one of the most frequent, and, therefore, physicians must be aware of the need to improve practice in this context.

Using Life Trajectories Analysis to Characterize Suicide Attempts in Prison.

Background: Suicide in prison is a major problem and several risk factors have been identified in the literature (e.g., period of incarceration, depressive disorders). Aims: The study examined the impact of several risk factors for suicide attempts before and during incarceration using life trajectory analysis of inmates by interviews with informants. Method: The lifetime of inmates with a history of suicide attempts (ISA; n = 20) or without (IWSA; n = 29) was recounted on a life chart according to four main domains (health, life events, relationships, and judiciary domain) organized in two different periods (predetention and current detention). Life charts were compared between the two groups and a predictive model of suicide risk was constructed using logistic regression and receiving operating characteristic curve analysis. Results: Before detention, more depressive experiences were observed in ISA than in IWSA, and ISA reported more behavioral disorders than IWSA during current detention. Moreover, the total burden for ISA was greater than that for IWSA. The predictive model identified three dimensions for differentiating ISA from IWSA: mood disorders before detention, behavioral disorders, and the quality of relationships with nuclear family during detention. Limitations: Interviews with inmates would have been informative. Conclusion: The accumulation of life events and behavioral manifestations should be incorporated in the developmental trajectory as a therapeutic model regarding suicide in prison.

Place of death among older people in Finland and Norway.

Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.

Suicide amongst the Inuit of Nunavut: An Exploration of Life Trajectories.

This article reports results of the life trajectories from 92 Inuit who died by suicide, matched for age and gender with 92 living-controls. A proxy-based procedure and semi-structured interviews with informants were conducted to obtain trajectories of developmental events occurring over the life course for suicide and community-matched controls. Results from this research indicate two different trajectories that differentiate the control-group from the suicide-group throughout the life course. Even though the number of suicide attempts are similar between both groups, the suicide-group had a more important burden of adversity, which seemed to create a cascading effect, leading to suicide.

'It's like being a slave to your own body in a way': a qualitative study of adolescents with chronic fatigue syndrome.

BACKGROUND: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a relatively common disabling illness in adolescents that may limit participation in daily life. AIM: This study explored interactions between the illness experiences of adolescents with CFS/ME, their occupational lives and expectations for the future. METHODS: Seven adolescents with CFS/ME were interviewed. The interviews were analyzed using thematic analysis. RESULTS: Three themes were developed. 'Being ruled by an unfamiliar and inexplicable body', which illustrated that altered and strange bodies seemed to separate and disrupt the participants from their former occupational lives. 'On the sideline of life with peers', which demonstrated that the informants spent time at home, doing undemanding activities instead of participating in activities with peers. 'A coherent connection between present and future life', which was reflected by how the participants eventually accepted their situation and rebuilt a meaningful occupational life and value of self. CONCLUSION: CFS/ME made the body unfamiliar and disconnected informants from participating in their usual daily occupations. A coherent interaction between body, occupational life and social self was achieved by taking their new body into account and adjusting their occupations accordingly. This practice enabled the participants to hope for a better future life.

Long-term implications of feed energy source in different genetic types of reproductive rabbit females: I. Resource acquisition and allocation.

To achieve functional but also productive females, we hypothesised that it is possible to modulate acquisition and allocation of animals from different genetic types by varying the main energy source of the diet. To test this hypothesis, we used 203 rabbit females belonging to three genetic types: H (n=66), a maternal line characterised by hyper-prolificacy; LP (n=67), a maternal line characterised by functional hyper-longevity; R (n=79), a paternal line characterised by growth rate. Females were fed with two isoenergetic and isoprotein diets differing in energy source: animal fat (AF) enhancing milk yield; cereal starch (CS) promoting body reserves recovery. Feed intake, weight, perirenal fat thickness (PFT), milk yield and blood traits were controlled during five consecutive reproductive cycles (RCs). Females fed with CS presented higher PFT (+0.2 mm, P0.05), particularly for those fed with AF. Moreover, LP females fed with AF progressively increased PFT across the RC, whereas those fed with CS increased PFT during early lactation (+7.3%; P<0.05), but partially mobilised it during late lactation (-2.8%; P<0.05). Independently of the diet offered, LP females reached weaning with similar PFT. H females fed with either of the two diets followed a similar trajectory throughout the RC. For milk yield, the effect of energy source was almost constant during the whole experiment, except for the first RC of females from the maternal lines (H and LP). These females yielded +34.1% (P<0.05) when fed with CS during this period. Results from this work indicate that the resource acquisition capacity and allocation pattern of rabbit females is different for each genetic type. Moreover, it seems that by varying the main energy source of the diet it is possible to modulate acquisition and allocation of resources of the different genetic types. However, the response of each one depends on its priorities over time.

Temperament and Character Profiles of Group-Based Suicide Cases.

BACKGROUND: Personality and character traits may be a key predisposing factor to consider in the life course of people who are vulnerable to suicide. AIMS: The aim of this study is first to explore the possible presence of different subgroups of suicide decedents based on developmental profiles of adversity, and secondly to examine the association of personality and character dimensions (covariates) with the trajectory outcome. METHOD: A total of 90 cases of suicide decedents were analyzed using growth mixture modeling (GMM). RESULTS: Results generated two different life trajectories and identified specific temperament profiles. Subjects assigned to the trajectory of high burden of adversity demonstrated a greater predisposition for harm avoidance and those in the trajectory characterized by low burden of adversity displayed greater predisposition for self-directedness. CONCLUSION: Our results add to the literature by suggesting that different subgroups of suicide completers show a predisposition for either harm avoidance or self-directedness.

Significant Morbidity and Mortality Among Hospitalized End-Stage Liver Disease Patients in Medicare.

CONTEXT: For end-stage liver disease (ESLD) patients, care focuses on managing the life-threatening complications of portal hypertension, causing high resource utilization. OBJECTIVES: To describe the end-of-life trajectory of hospitalized ESLD patients in Medicare. METHODS: Using a 5% random sample of Medicare fee-for-service beneficiaries, we performed a retrospective cohort study, identifying hospitalized ESLD and heart failure (HF) patients (2007-2011). Index hospitalization end points included mortality, discharge to hospice, and length of stay. Postdischarge end points included all-cause mortality, rehospitalization, hospice enrollment, and days alive and out of hospital (DAOH). Follow-up was at one and three years after index hospitalization discharge. A reference cohort of decompensated HF patients was used for baseline comparison. RESULTS: At one year, the ESLD cohort (n = 22,311) had 209 DAOH; decompensated HF (n = 85,397) had 252 DAOH. Among ESLD patients, inpatient mortality was 13.5%; all-cause mortality was 64.9%. For these outcomes, rates were higher in those with ESLD than HF. In the ESLD group, rehospitalization rate was 59.1% (slightly lower than the HF group), hospice enrollment rate was 36.1%, and there were higher than expected cancer rates. For hospice-enrolled patients, the median length of time spent in hospice was nine days. The HF cohort had lower hospice enrollment, but more days enrolled. CONCLUSION: The results of this study show that morbidity and mortality rates associated with end of life in ESLD are substantial. There is an acute need for alternative approaches to manage the care of ESLD patients.

[Suicide among the French National Police forces: Implication of life events and life trajectories]. / Suicide dans la Police nationale française : trajectoires de vie et facteurs associés.

OBJECTIVES: Research indicates that suicide rates are high among members of law enforcement. Our objectives were: (1) to determine life events implicated in suicide mortality among French law enforcement; and (2) to describe the different life trajectories of police officers who deceased by suicide. METHODS: All suicides of police officers which occurred during 2008 (n=49) were explored using the psychological autopsy method. Key informants were: a supervisor, a colleague and a member of the family or a close friend. Each of them were interviewed by trained psychologists using standardized questionnaires exploring: sociodemographic characteristics, life events, social integration and support, health service use, mental health with the Composite International Diagnostic Interview short form (CIDI-SF), occupational stress with the Spielberger Inventory, impulsiveness with the Barratt Impulsiveness Scale and aggressiveness with the Brown-Goodwin Lifetime Aggression Scale. Information was then summarized in a timetable life trajectory of all life areas. All cases were finally appraised by at least two experts in order to identify the determinants of the suicide and to determine psychiatric diagnoses. For each period of time, a burdensomeness score was determined, from 6 (no adversity) to 1 (adversities in each sphere of life). RESULTS: Of the 49 cases of suicide, two were excluded and 39 were investigated and appraised (response rate: 39/47=83%). Eighty-two percent of the suicide cases were men and the mean age at death was 35years. In more than half of the cases, police officers used their service weapon to commit suicide. All deceased police officers were suffering from mental health symptoms (primarily depression). Of them, two thirds had used healthcare for this distress. The main other cause of suicide was problems in the married life (70% of the cases). Four distinct types of life trajectories of adversities could be identified by a qualitative analysis. DISCUSSION: It is the first time such a study was performed in France, and results are concordant with those of the literature. This study showed that all deceased police officers were suffering from mental disorders and that there was not one single profile of life trajectory: screening and support of police officers in distress need to be prioritized. Moreover, results suggested that the availability of the service weapon during off-duty periods should be reconsidered. This study helped the Home ministry to elaborate and improve strategies to prevent suicide among police officers.

Development of a six-month prognostic index in patients with advanced chronic medical conditions: the PALIAR score.

CONTEXT: Efforts in developing useful tools to properly identify the end-of-life trajectory of patients with advanced medical diseases have been made, but the calibration and/or discriminative power of these tools has not been optimal. OBJECTIVES: Our objective was to develop a new, reliable prognostic tool to identify the probability of death within six months in patients with chronic medical diseases. METHODS: This was a multicenter, prospective, observational study in 41 Spanish hospitals, which included 1778 patients with one or more of the following: advanced conditions such as heart failure, respiratory failure, chronic renal failure, chronic liver disease, and/or chronic neurological disease. All patients were followed over six months. Each factor independently associated with death in the derivation cohort (884 patients from eastern areas of Spain) was assigned a prognostic weight, and the score was calculated by summing up the factors. The score's accuracy in the validation cohort (894 patients from western areas of Spain) was assessed by analyzing its calibration and discriminative power; we also calculated sensitivity, specificity, and positive and negative predictive values. RESULTS: Mortality in the derivation/validation cohorts was 37.6%/37.7%, respectively. We identified six independent predictors of mortality (≥85 years, three points; New York Heart Association Class IV/Stage 4 dyspnea on the modified Medical Research Council, 3.5 points; anorexia, 3.5 points; presence of pressure ulcer(s), three points; Eastern Cooperative Oncology Group Performance Status of three or more, four points; and albuminemia ≤2.5g/dL, four points). Mortality in the derivation/validation cohorts according to risk group was 20%/21.5% for patients with zero points; 33%/30.5% for those with 3-3.5 points; 46.3%/43% for those with four to seven points; and 67%/61% for those who reached 7.5 or more points, respectively. The calibration was good (Hosmer-Lemeshow test, P=0.39), as was the discriminative power (area under the receiver operating characteristic curve of 0.69 [0.66-0.72]). The sensitivity (85%), specificity (86%), positive and negative predictive values (64% and 80%, respectively) at 180 days were high. CONCLUSION: The PALIAR score is a precise and reliable tool for identifying the end-of-life trajectory in patients with advanced medical diseases.

Anormais, bárbaros e bárbaras: trajetórias de vida e homossexuais e clínica psicológica / Abnormal and barbarians: gay's life trajectories and psychological clinic

O artigo aborda a forma como as práticas das clínicas psicológicas se confrontam com a diversidade sexual, a partir da análise das trajetórias de vida de cinco sujeitos homossexuais que passaram por atendimento psicológico. Como ferramenta de pesquisa empírica foram utilizadas entrevistas baseadas na perspectiva das trajetórias de vida. Nas entrevistas foi utilizada uma questão inicial: Como a questão da orientação sexual foi abordada durante o tratamento psicológico? O objetivo da pergunta inicial foi estimular o/a entrevistado/entrevistada a relatar impressões do atendimento psicológico em relação à homossexualidade. Utilizou-se para a análise os conceitos de formação discursiva e enunciado, oriundos da perspectiva arqueológica de Foucault, acoplada à abordagem genealógica apresentada pelo autor. O instrumental teórico foi embasado em Michel Foucault e Judith Butler. Nossa análise indica que o/a homossexual ainda ocupa, na clínica psicológica especificamente e na sociedade em geral, o lugar de anormal e de bárbaro/bárbara. A perspectiva teórica utilizada toma os conceitos de dispositivo da sexualidade e heteronormatividade como centrais para a compreensão da resistência conservadora das práticas clínicas frente aos avanços institucionais de reconhecimento social da homossexualidade.(AU)

This article discusses the way psychological clinical practice deals with sexual diversity, analyzing life trajectories of five homosexual subjects that went through psychological treatment. The research instrument used was interviews based on life history's approach. We proposed an initial question: How your sexual orientation was approached in your psychological treatment? The goal of this question was to stimulate the interviewed to describe his/hers comprehension of psychological therapy in relation to homosexuality. In the analysis we used the concepts of discursive formation and enunciation from Foucault's archeological perspective in combination of his genealogical approach. The theoretical frame was constructed based on Michel Foucault's and Judith Butler's contributions. Our analysis indicates that the homosexual is still considered in psychological practice as well in society in general as the abnormal, the barbarian. The theoretical perspective that guides the study takes heteronormativity and sexuality device (dispositif) as central concepts to understand clinical practice resistance to the institutional progress of homosexuality social recognition.(AU)

Anormais, bárbaros e bárbaras: trajetórias de vida e homossexuais e clínica psicológica / Abnormal and barbarians: gay's life trajectories and psychological clinic

O artigo aborda a forma como as práticas das clínicas psicológicas se confrontam com a diversidade sexual, a partir da análise das trajetórias de vida de cinco sujeitos homossexuais que passaram por atendimento psicológico. Como ferramenta de pesquisa empírica foram utilizadas entrevistas baseadas na perspectiva das trajetórias de vida. Nas entrevistas foi utilizada uma questão inicial: Como a questão da orientação sexual foi abordada durante o tratamento psicológico? O objetivo da pergunta inicial foi estimular o/a entrevistado/entrevistada a relatar impressões do atendimento psicológico em relação à homossexualidade. Utilizou-se para a análise os conceitos de formação discursiva e enunciado, oriundos da perspectiva arqueológica de Foucault, acoplada à abordagem genealógica apresentada pelo autor. O instrumental teórico foi embasado em Michel Foucault e Judith Butler. Nossa análise indica que o/a homossexual ainda ocupa, na clínica psicológica especificamente e na sociedade em geral, o lugar de anormal e de bárbaro/bárbara. A perspectiva teórica utilizada toma os conceitos de dispositivo da sexualidade e heteronormatividade como centrais para a compreensão da resistência conservadora das práticas clínicas frente aos avanços institucionais de reconhecimento social da homossexualidade

This article discusses the way psychological clinical practice deals with sexual diversity, analyzing life trajectories of five homosexual subjects that went through psychological treatment. The research instrument used was interviews based on life history's approach. We proposed an initial question: How your sexual orientation was approached in your psychological treatment? The goal of this question was to stimulate the interviewed to describe his/hers comprehension of psychological therapy in relation to homosexuality. In the analysis we used the concepts of discursive formation and enunciation from Foucault's archeological perspective in combination of his genealogical approach. The theoretical frame was constructed based on Michel Foucault's and Judith Butler's contributions. Our analysis indicates that the homosexual is still considered in psychological practice as well in society in general as the abnormal, the barbarian. The theoretical perspective that guides the study takes heteronormativity and sexuality device (dispositif) as central concepts to understand clinical practice resistance to the institutional progress of homosexuality social recognition

Homicídio entre jovens de uma periferia de Salvador, Bahia: um relato de experiência sobre a violência e o desenvolvimento humano / Homicide among youngsters in the periphery of Salvador, Bahia: an experience report on violence and human development

Este artigo trata de uma pesquisa em andamento quanto a homicídios ente jovens em uma periferia de Salvador, Bahia. Parte de trajetórias de jovens assassinados utilizando uma metodologia etnográfica composta pela análise sistemática de recortes de diários e cadernos de campo coletados durante muitos anos de estudos sobre a juventude no campo. Identifica as repercussões no desenvolvimento humano em contexto das trajetórias de jovens assassinados. organizada nos tópicos: continuum; antecipação; trajetória: genealogia e repercussão. São apresentados três casos de jovens assassinados e suas repercussões sobre a família, os jovens, o bairro e o assassino. Conclui-se que alguns elementos ou indícios presentes no cotidiano do jovem podem permitir o mapeamento de trajetórias de marginalização que, identificadas, possibilitam uma ação preventiva(AU)

This article deals with the results of an ongoing research on juvenile homicides in the periphery of Salvador, Bahia. It approaches the trajectories of murdered adolescents, using an ethnographical methodology composed by the systematic analysis of sections of field diaries collected during many years of field studies on adolescents. The study identifies the repercussions on human development in context of the murdered youths' trajectories, organized in topics: continuum, anticipation, trajectory, genealogy and repercussion. Three cases of murdered youths are presented, along with their repercussions on the family, on the neighborhood and on the murderer. It is concluded that some elements or indexes seen in the adolescent's daily life enable to map the trajectories of marginalization that, once identified, could help to prevent the future murder.(AU)