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1.
Int J Public Health ; 69: 1606499, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38961855

RESUMO

Objectives: We aimed to assess later-life health responses to childhood and lifetime adversity in a cohort of rural, Black South African adults. Methods: We performed ordinary least squares regression using two waves of data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) to estimate a decline in cognitive, mental, and physical health over approximately 3 years. Our analytic sample consisted of 1,993 women and 1,496 men. Results: Associations between several types of adversity and health outcomes point to declines in health. At the same time, many adverse experiences are associated with improvements in cognitive, mental, and physical health in later life. The direction of the association varied by type of exposure, health outcome, and gender. Conclusion: In populations exposed to many adversities during life, specific adverse experiences may sometimes be associated with greater improvements (and not just greater decline) in health in later life. Further research is needed to unpack the mechanisms at play in these populations.


Assuntos
Nível de Saúde , Saúde Mental , Humanos , Masculino , Feminino , África do Sul , Estudos Longitudinais , Pessoa de Meia-Idade , Idoso , Cognição , Adulto , Experiências Adversas da Infância/estatística & dados numéricos , População Rural
2.
Artigo em Inglês | MEDLINE | ID: mdl-38963773

RESUMO

Purpose: This study examines nonsuicidal self-injury (NSSI) in adolescent and emerging adult survivors of childhood cancer, aiming to gain a first understanding of the phenomenon, its relation to general and cancer-specific functioning, and the stability of NSSI engagement over time. Methods: Dutch-speaking survivors (n = 125, age range = 14-25 years) participated in the first three annual waves of the Longitudinal Identity Study of Childhood Cancer Survivors study. Descriptive characteristics of lifetime NSSI were calculated. Multivariate analysis of variance (MANOVA) and χ2-analyses were performed to examine differences in demographic and clinical characteristics between survivors with and without lifetime NSSI. To assess differences in general and cancer-specific functioning between survivors with and without lifetime NSSI, two MANOVA analyses were performed. Finally, prevalence rates of current NSSI across the three waves were calculated, followed by χ2-analyses to explore differences in current NSSI over time. Results: The prevalence and characteristics of lifetime NSSI engagement resembled those in the general population. Although demographic and clinical characteristics were unrelated to NSSI engagement, several meaningful differences were found in both general and cancer-specific functioning between survivors with and without NSSI. Survivors with lifetime NSSI experienced more depressive symptoms and difficulties with identity formation (i.e., lower levels of identity synthesis and higher levels of identity confusion). In addition, they experienced more post-traumatic stress symptoms and cancer-related worries, and identified less as a "cancer patient." Conclusions: This study provides a first understanding of NSSI engagement in survivors of childhood cancer, mapping the characteristics of NSSI and its associations with both general and cancer-specific functioning.

3.
Disabil Rehabil ; : 1-9, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38967010

RESUMO

PURPOSE: The transition to adulthood is one of the most challenging and complex processes for autistic youth and their families. Few evidence-based transition support programs exist, and those that have garnered support require long-term commitments and resources that may prohibit participation by families with financial and time limitations. The current study investigated the feasibility and initial promise of a brief, caregiver-focused educational transition program for families of autistic youth delivered in the community over a single day. METHODS: Quantitative informant-report and qualitative interview data were collected from 12 caregivers of autistic youth before and after program participation. Using a partially mixed sequential equal status design, quantitative and qualitative data were integrated to evaluate change in caregiver transition knowledge and empowerment, as well as caregivers' perceptions of program feasibility, acceptability, and usefulness. RESULTS: Caregivers reported significant increases in knowledge of transition-related topics and sense of empowerment regarding their family life. Caregiver perceptions of the intervention suggest they found it feasible, acceptable, and useful. CONCLUSIONS: Short-term transition programming may be a helpful option for caregivers who seek transition supports for autistic youth.


The transition to adulthood is a stressful and complex process for autistic adolescents and their caregivers.Many caregivers lack time, financial resources, and access to comprehensive transition supports.Brief educational support is a potential alternative for aiding caregivers in planning for and assisting with adolescents' postsecondary training/education, employment, social, and living arrangements.The Planning for your Loved Ones Future (PLOF) intervention showed promise in improving caregiver knowledge about transition and sense of empowerment, and was described as feasible, accessible, and helpful by those who participated in a pilot study.

4.
Arch Osteoporos ; 19(1): 58, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38960953

RESUMO

In a Norwegian youth cohort followed from adolescence to young adulthood, bone mineral density (BMD) levels declined at the femoral neck and total hip from 16 to 27 years but continued to increase at the total body indicating a site-specific attainment of peak bone mass. PURPOSE: To examine longitudinal trends in bone mineral density (BMD) levels in Norwegian adolescents into young adulthood. METHOD: In a prospective cohort design, we followed 980 adolescents (473 (48%) females) aged 16-19 years into adulthood (age of 26-29) on three occasions: 2010-2011 (Fit Futures 1 (FF1)), 2012-2013 (FF2), and 2021-2022 (FF3), measuring BMD (g/cm2) at the femoral neck, total hip, and total body with dual x-ray absorptiometry (DXA). We used linear mixed models to examine longitudinal BMD changes from FF1 to FF3. RESULTS: From the median age of 16 years (FF1), femoral neck BMD (mean g/cm2 (95% CI)) slightly increased in females from 1.070 (1.059-1.082) to 1.076 (1.065-1.088, p = 0.015) at the median age of 18 years (FF2) but declined to 1.041 (1.029-1.053, p < 0.001) at the median age of 27 years (FF3). Similar patterns were observed in males: 16 years, 1.104 (1.091-1.116); 27 years, 1.063 (1.050-1.077, p < 0.001); and for the total hip in both sexes (both p < 0.001). Total body BMD increased from age 16 to 27 years in both sexes (females: 16 years, 1.141 (1.133-1.148); 27 years, 1.204 (1.196-1.212), p < 0.001; males: 16 years, 1.179 (1.170-1.188); 27 years, 1.310 (1.296-1.315), p < 0.001). CONCLUSION: BMD levels increased from 16 to 18 years at the femoral and total hip sites in young Norwegian females and males, and a small decline was observed at the femoral sites when the participants were followed up to 27 years. Total body BMD continued to increase from adolescence to young adulthood.


Assuntos
Absorciometria de Fóton , Densidade Óssea , Colo do Fêmur , Humanos , Adolescente , Feminino , Masculino , Noruega/epidemiologia , Adulto Jovem , Adulto , Estudos Longitudinais , Colo do Fêmur/diagnóstico por imagem , Estudos Prospectivos , Estudos de Coortes
5.
J Autism Dev Disord ; 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38963473

RESUMO

The underrepresentation of individuals with profound autism (who require 24/7 access to care) in autism research has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to those needs. This study explored caregiver perspectives on service needs, barriers to accessing care, and treatment priorities to guide treatment development and improvement of service delivery. A sequential mixed-methods design integrated quantitative survey data (n = 423; Mage = 18.89 years; 26.7% female) with qualitative interviews (n = 20) with caregivers of adolescents and adults with profound autism. Quantitative findings indicated regular socialization opportunities were the most frequently endorsed unmet service need (60.3% of caregivers), followed by primary health care with autism-trained staff (59.3%), social skills instruction (55.8%), life skills instruction (51.3%), and behavioral support (47.3%). Higher likelihood of needing social activity groups was associated with elevated emotional reactivity, higher language level, minoritized ethnicity, and lower household income. Greater need for specialized primary health care was associated with lower income, while the need for social and life skills instruction was associated with increased age and elevated dysphoria. Qualitative analysis identified 10 themes that converged and expanded quantitative findings by highlighting a pervasive shortage of individualized, goal-oriented services, common barriers to care, and the priority of developing centralized treatment settings that coordinate care throughout adulthood. This study identified pressing service needs for adolescents and adults with profound autism in the United States. These insights are crucial for improving the accessibility and quality of clinical care.

6.
J Youth Adolesc ; 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38963580

RESUMO

Numerous studies have sought to determine whether low self-esteem acts as a risk factor for depressive symptoms (i.e., a vulnerability model) or whether depressive symptoms lead to a decrease in self-esteem (i.e., a scar model). Although both models have received some support, very little research has: (a) addressed this question across critical life transitions likely to modify this pattern of associations, such as the transition to adulthood; (b) sought to identify the psychological mechanisms (i.e., mediators) underpinning these associations. The present study was designed to address these two limitations, focusing on the directionality of the associations between depressive symptoms and self-esteem from mid-adolescence to early adulthood while considering the role of motivational factors, namely mastery (intrinsic/extrinsic) and performance (approach/avoidance) goals as conceptualized in achievement goal theory. A sample of 707 Finnish adolescents aged 15-16 (52.1% boys) was surveyed six times up to the age of 25. Results from a cross-lagged panel model (CLPM) revealed that depressed individuals were more likely to have low self-esteem, although self-esteem protected against depressive symptoms between ages 16-17 to 20-21. Moreover, while self-esteem promoted mastery-extrinsic goals which in turn reinforced self-esteem, depressive symptoms promoted performance-avoidance goals which led to more depressive symptoms and lower self-esteem. Overall, these findings highlight (1) the long-lasting negative consequences of depressive symptoms on self-esteem and (2) the crucial role played by academic motivation in explaining the development of depressive symptoms and self-esteem over time. In turn, these results help refine the vulnerability and scar models, and suggest that motivational factors should be considered in prevention and intervention efforts among young populations.

7.
Int J Dev Disabil ; 70(4): 719-729, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38983498

RESUMO

Definitions of adulthood for people with intellectual disability are often complicated, with milestones being markedly different for this population. This is then associated with difficulties for both the people with intellectual disability and their parents, who are closely involved in this transitional period. This paper aims to report on parents' perception and experience of adulthood for their son or daughter with an Intellectual Disability (ID). Qualitative data were collected through 30 - 60-minute phone interviews with eight parents of a person with an intellectual disability aged 15 or older (mean parent age = 60; mean child age = 23). Thematic analysis found that Perception of Adulthood encompassed themes of Independence and Normality. Experiences of Adulthood were categorised under Government Services, Responsibility and Social Supports. Findings of this research provide information for the growing literature around adulthood for people with intellectual disability, as well as how to amend policies and procedures for services that cater to people with intellectual disability and their parents during this transition.

8.
Eur J Psychotraumatol ; 15(1): 2372994, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38984740

RESUMO

Background: Adverse childhood experiences (ACEs) have negative impacts on women with children, including psychosocial and general health problems. However, there is limited research investigating ACEs identifying the characteristics of distinct subgroups according to the frequency of ACEs.Objective: Utilizing the national dataset of the Family with Children Life Experience 2017, this study aimed to classify patterns of ACEs based on the total number of types of ACEs and the types of predominant events, and to examine differences in general and psychological characteristics, as well as experiences of violence in adulthood among the classes identified.Method: A total of 460 Korean mothers raising infants or toddlers participated. Latent class analysis was performed to classify the patterns of ACEs, while t-tests and Chi-square tests were used to examine differences in general and psychological characteristics and experiences of violence between the ACEs subgroups.Results: The participants were classified into two subgroups: the 'high-ACEs group' and the 'low-ACEs group'. The high-ACEs group exhibited higher rates of child abuse, workplace violence perpetration and victimization, as well as lower self-esteem, higher depression levels, and increased suicidal thoughts compared to those of the low-ACEs group.Conclusion: The findings highlight the significant role of ACEs on the formation of an individual's psychological characteristics and their propensity to experience additional violence even into adulthood, as perpetrators and as victims. It is noteworthy how the influence of ACEs extends across generations through child abuse. These findings offer insights for developing interventions aimed at mitigating the negative effects of experiences of violence on mothers raising young children.


Two distinct subgroups were identified according to the frequency of ACEs: the 'high-ACEs group' and the 'low-ACEs group'.Compared to those of the low-ACEs group, the high-ACEs group presented higher rates of child abuse, workplace violence perpetration and victimization, lower self-esteem, higher depression levels, and increased suicidal thoughts.The low self-esteem induced by ACEs may contribute to the amplification of psychological vulnerabilities and the occurrence of additional violent experiences even in adulthood.


Assuntos
Experiências Adversas da Infância , Análise de Classes Latentes , Mães , Humanos , República da Coreia , Feminino , Mães/psicologia , Mães/estatística & dados numéricos , Experiências Adversas da Infância/estatística & dados numéricos , Adulto , Lactente , Pré-Escolar , Depressão/psicologia , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Autoimagem , Vítimas de Crime/psicologia , Vítimas de Crime/estatística & dados numéricos
9.
Qual Health Res ; : 10497323241253412, 2024 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-39025117

RESUMO

This article provides original insight into women's experiences of adulthood diagnoses of attention deficit hyperactivity disorder (ADHD) and autism. Research exploring experiences of adulthood diagnoses of these conditions is emerging. Yet, there is no research about the gendered experiences of an adulthood combined ADHD and autism (AuDHD) diagnosis. This article addresses this gap through interpretative phenomenological analysis of email interviews with six late-diagnosed AuDHD women revealing the complex interplay between late diagnosis, being a woman, and combined diagnoses of ADHD and autism. It underscores how gender norms and stereotypes contribute to the oversight and dismissal of women's neurodivergence. Interpretative phenomenological analysis reveals the inextricability of femininity and neurotypicality, the gendered burden, discomfort, and adverse consequences of masking, along with the adverse outcomes of insufficient masking. Being an undiagnosed AuDHD woman is a confusing and traumatising experience with profound and enduring repercussions. The impact of female hormones exacerbated participants' struggles with (peri)menopause often being a catalyst for seeking diagnosis after decades of trauma. The epistemic injustice of not knowing they were neurodivergent compounded this trauma. Diagnosis enabled participants to overcome epistemic injustice and moved them into a feminist standpoint from which they challenge gendered inequalities relating to neurodiversity. This article aims to increase understanding and representation of late-diagnosed AuDHD women's lived experiences. The findings advocate for trauma-informed pre- and post-diagnosis support which addresses the gendered dimension of women's experiences of being missed and dismissed as neurodivergent. There needs to be better clinical and public understanding of how AuDHD presents in women to prevent epistemic injustice.

10.
J Affect Disord ; 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39025438

RESUMO

BACKGROUND: This study adopts individual and societal-level approaches to examine the contribution of childhood risk factors to major depressive episodes (MDE) in 2526 American young adults. METHODS: Nationally representative data from the 2017 U.S. Panel Study of Income Dynamics - Transition into Adulthood Supplement were analyzed using multivariate methods to assess the impact of parental mental illness, childhood adversities, childhood mental disorders, and childhood physical conditions. Adjusted odds ratios and population attributable risk proportions (PARPs) are calculated to estimate the proportion of MDE cases related to risk factors. RESULTS: The 12-month prevalence of positive screens for MDE was 25.4 %. Approximately 34 % of these were attributable to childhood mental disorders, 24 % to childhood physical conditions, 21 % to childhood adversities, and 16 % to parental mental illness. Childhood and parental depression were critical risk factors, both at the individual (odds ratio exceeding 2) and societal (PARP approximately 24 %) levels. Gender-specific risk factors were identified, with childhood physical abuse and childhood anxiety disorders constituting risk factors for females, and childhood externalizing disorders and childhood headaches as risk factors for males. Approximately 60 % of U.S. young adult MDE cases are attributable to risk factors before age 18. LIMITATIONS: Possible over reporting of MDE may have biased the associations between predictors and depression. CONCLUSIONS: Exposure to depression at a young age-one's own or parental depression-is a robust risk factor for both genders. Policies and interventions focused at alleviating the societal burden of depression should value its generational transmission.

11.
J Affect Disord ; 362: 468-476, 2024 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-39013521

RESUMO

BACKGROUND: Low optimism and high pessimism have predicted depressive symptoms in several studies, but the associations in the other direction, from depressive symptoms to future optimism and pessimism, have been unexplored. We examined bidirectional associations of optimism and pessimism with depressive symptoms in adulthood. METHODS: A population-based sample of 4011 Finnish adults (55 % women) was analyzed with a 15-year prospective follow-up period from age 31 to age 46. Optimism and pessimism were measured with the Life Orientation Test-Revised, and depressive symptoms were measured with the Symptom Checklist-25. Temporal associations were investigated with cross-lagged panel models. RESULTS: According to the model fit indices (RMSEA < 0.04, CFI ≥ 0.97) optimism and pessimism had bidirectional relationships with depressive symptoms: optimism predicted lower depressive symptoms (ß = -0.09, p < .001), and depressive symptoms predicted lower optimism (ß = -0.10, p < .001) in the follow-up. Also, pessimism predicted higher depressive symptoms (ß = 0.08, p < .001), and depressive symptoms predicted higher pessimism (ß = 0.09, p < .001) in the follow-up. In the participants with clinically high depressive symptoms at age 31, the predictive associations from optimism and pessimism to depressive symptoms remained, but associations in the other direction were attenuated. LIMITATIONS: The follow-up study included only two time points with a 15-year time gap, which does not consider the possible fluctuation in the study variables between the measured times. CONCLUSION: Dispositional optimism and pessimism may have bidirectional relationships with depressive symptoms in adulthood when the baseline depressive symptoms are below the clinical level.

12.
Neuropsychol Rehabil ; : 1-25, 2024 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-39031777

RESUMO

BACKGROUND: Depression, anxiety, and stress are persistent and co-occurring symptoms in survivors of childhood traumatic brain injury (TBI), and often impact on health-related quality of life (HRQoL). This paper explored emotional distress symptom clusters and associated factors in young adults with childhood TBI. METHODS: We included 54 young adults who sustained mild (n = 14), moderate (n = 27), and severe (n = 13) childhood TBI, at 20 years post-injury. The Depression Anxiety Stress Scale was administered. Cluster group membership was identified using two-step clustering and hierarchical clustering methods, and associated factors were assessed with multiple regression models. RESULTS: Two symptom cluster groups were identified, including a No Distress (n = 66%) and an Elevated Distress (n = 33%) group, with the latter showing significantly higher symptoms of depression, anxiety, and stress (all p < .001). Elevated Distress group membership was linked to tobacco use and poor sleep quality, while poor HRQoL was associated with younger age at injury and Elevated Distress group membership. CONCLUSIONS: Using cluster methodology, we showed that one-third of young adults with childhood TBI had elevated emotional distress symptoms. This underscores the complex emotional profile of this subgroup and the need for assessment, analysis, and treatment methods that target a range of symptoms rather than relying on single-diagnostic protocols.

13.
J Affect Disord ; 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39029677

RESUMO

BACKGROUND: This longitudinal study assessed the prospective link between childhood maltreatment and sleep quality in adulthood, with a specific focus on examining whether different coping style tendencies influence these associations. METHODS: The baseline sample included 1600 adult participants, with 1140 participants successfully followed up 5 years later. The key variables were measured using the Childhood Trauma Questionnaire (CTQ), Simplified Coping Style Questionnaire (SCSQ), and Pittsburgh Sleep Quality Index (PSQI). Generalized linear mixed models were employed to estimate unstandardized ß estimates and 95 % confidence intervals (95%CIs). Structural equation modeling was used to test the mediation model. RESULTS: Individuals reported childhood maltreatment at baseline were at an increased risk for sleep disturbances at follow-up. Childhood maltreatment negatively predicted the baseline coping style tendency (ß = -0.29, P < 0.001), the baseline coping style tendencies negatively predicted the follow-up sleep quality (ß = -0.10, P < 0.001), and childhood maltreatment positively predicted the follow-up sleep quality (ß = 0.42, P < 0.01). The mediating effect of baseline coping style tendencies between childhood maltreatment and the follow-up sleep quality was significant, with an effect value of 0.03. LIMITATIONS: First, the sample was from a single province (Shandong), which limits the generalizability of the findings. Second, recall bias was unavoidable in this adult sample study. CONCLUSIONS: Developing positive coping strategies is an important way to reduce the risk of sleep problems in adults with a history of childhood maltreatment.

14.
Front Psychiatry ; 15: 1370601, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39026527

RESUMO

Introduction: At present, the incidence of adolescent depression is increasing each year, having a wide and profound impact on adolescents. This study investigated the mood state of mid-to-late adolescents and young adults and analyzed related factors; clarified the incidence of depression, suicide, and self-injurious thoughts/behaviors in this population; and conducted relevant analysis of related factors of depression and anxiety. Methods: Study subjects were students aged 14-25 years, from three high schools and one university in Liaoning Province. Study subjects were evaluated using several questionnaires that combined online and offline methods. Specifically, the Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Simplified Coping Style Questionnaire (SCSQ), Child Depression Inventory (CDI), the Chinese version of the Spence Child Anxiety Scale (SCAS), and a general questionnaire were utilized. Single-factor ANOVA, t-test, Chi-square, and multiple regression analysis were used to analyze the data. Results: The results showed that, among the 14-17-year-old subjects, the incidence of depression was 336 (14.7%), the incidence of anxiety was 763 (33.5%). Among the 18-25-year-old subjects, the incidence of depression was 34 (8.6%), the incidence of anxiety was 7 (1.8%). In the general questionnaire, 2081 (77.8%) individuals were depressed, 689 (25.8%) had thoughts of self-injury, and 323 (12.1%) had self-injurious behaviors. Among the 14-17-year-old subjects, 1789 (78.46%) were depressed, 689 (30.22%) had self-injury thoughts, and 319 (1.71%) had self-injurious behaviors. Among the 18-25-year-old subjects, 292 (73.92%) were depressed, but 4 (1.01%) had self-injurious behaviors. The incidence of depression and anxiety in adolescents is high, presenting with a certain risk of self-injury. However, age is an important factor in the occurrence of depression and anxiety; among the 18-25-year-old subjects, the incidence of depression (8.6% vs. 4.7%) and anxiety (1.8% vs. 33.5%) was lower than that among the 14-17-year-old population. Through comparative analysis, adolescents aged 14-17 remained at high risk of depression and anxiety. Discussion: In the analysis of risk factors for depression and anxiety, relationships with classmates, teachers, and parents were reported as important influencing factors of emotional state. Further, a good coping style was found to be protective against depression and anxiety.

15.
Artigo em Inglês | MEDLINE | ID: mdl-39012058

RESUMO

Development of the respiratory system can be affected by the use of drugs during pregnancy, as the prenatal phase is highly sensitive to pharmacological interventions, resulting in long-term consequences. The deleterious effects of external cannabinoids during gestation may be related to negative interference in central nervous system formation, cardiorespiratory system function, and behavioral disorders. Nevertheless, the impact of external cannabinoids on cardiorespiratory network development, chemosensitivity, and its future consequences in adulthood is still unclear. We evaluated the effects of prenatal exposure to a synthetic cannabinoid (WIN 55,212-2, 0.5 mg.kg-1.day-1) on the cardiorespiratory control and panic-like behavior of male and female rats in adulthood. Exogenous cannabinoid exposure during pregnancy resulted in a sex-dependent difference in breathing control. Specifically, males showed increased chemosensitivity to CO2 and O2, while females exhibited decreased sensitivity. Altered cardiovascular control was evident, with prenatally treated males and females being more susceptible to hypertension and tachycardia under adverse environmental conditions. Moreover, WIN-treated males exhibited higher fragmentation of sleep episodes, while females displayed anxiolytic and panicolytic behavioral responses to CO2. However, no changes were observed in the mechanical component of the respiratory system, and there were no neuroanatomical alterations, such as changes in the expression of CB1 receptors in the brainstem or in the quantification of catecholaminergic and serotonergic neurons. These findings highlight that external interference in cannabinoid signaling during fetal development causes sex-specific long-lasting effects for the cardiorespiratory system and behavioral responses in adulthood.

16.
J Adolesc Health ; 2024 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-39007790

RESUMO

PURPOSE: To characterize the primary ethical issue and contextual features of ethics consultation for patients aged 18-26 years based on setting (adult vs. pediatric). METHODS: A retrospective review of 965 ethics consultation notes to identify patients aged 18-26 years cared for in the pediatric or adult setting between January 1, 2016-December 31, 2020. We collected demographic information and used conceptual content analysis to identify the primary ethical issue and contextual features for each consult and analyzed these using descriptive statistics. RESULTS: We identified 46 consults (30 adult and 16 pediatric) for 40 unique patients (28 adult and 12 pediatric). The median age was 19 years in the pediatric setting and 24 in the adult setting. Fifty-three percent were female, 95% non-Hispanic, 68% White, and 76% were inpatient. The primary ethical issue in the adult setting was Refusal of Recommended Treatment (20%), while the dominant contextual issue was Communication Disputes/Conflicts Between the Staff and Patient (23%). The primary ethical issue for the pediatric setting was Goals of Care (31%) and the dominant contextual feature was concerns for Quality of Life (31%). DISCUSSION: The primary ethical issues and related contextual features this population experiences differ based on setting. Improved understanding of adolescent and young adult development, especially related to values formation, decision-making, and communication skills training may ameliorate some of these challenges. Referral patterns for this age group overall and particularly for patients on the ends of the spectrum and inpatients raise concerns for ethics consultation use. Further education about ethics services is recommended.

17.
Psychoneuroendocrinology ; 167: 107118, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38954980

RESUMO

The existing literature consistently finds that emotional experiences and cortisol secretion are linked at the within-person level. Further, relationship partners tend to covary in emotional experience, and in cortisol secretion. However, we are only beginning to understand whether and how an individuals' emotions are linked to their relationship partners' cortisol secretion. In this project, we harmonized data from three intensive measurement studies originating from Canada and Germany to investigate the daily dynamics of emotions and cortisol within 321 older adult couples (age range=56-87 years). Three-level multilevel models accounted for the nested structure of the data (repeated assessments within individuals within couples). Actor-Partner Interdependence Models were used to examine the effect of own emotional experiences (actor effects) and partner emotional experiences (partner effects) on momentary and daily cortisol secretion. Adjusting for age, sex, education, comorbidities, assay version, diurnal cortisol rhythm, time spent together, medication, and time-varying behaviors that may increase cortisol secretion, results suggest that higher relationship partner's positive emotions are linked with lower momentary cortisol and total daily cortisol. Further, this association was stronger for older participants and those who reported higher relationship satisfaction. We did not find within-couple links between negative emotions and cortisol. Overall, our results suggest that one's relationship partner's positive emotional experience may be a protective factor for their physiological responding, and that these more fleeting and day-to-day fluctuations may accumulate over time, contributing to overall relationship satisfaction.


Assuntos
Emoções , Hidrocortisona , Saliva , Humanos , Hidrocortisona/metabolismo , Hidrocortisona/análise , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Emoções/fisiologia , Saliva/química , Saliva/metabolismo , Cônjuges/psicologia , Parceiros Sexuais/psicologia , Relações Interpessoais , Alemanha , Canadá , Satisfação Pessoal , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia
18.
Prev Med ; 186: 108066, 2024 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-39004315

RESUMO

BACKGROUND: Research indicates harmful associations between parental weight-focused conversations and markers of pediatric health and well-being. However, little is known about the prevalence and consequences of parent conversations focused on weight or health behaviors (i.e., physical activity or nutrition) with emerging adult children. METHODS: Data are from the 2018 follow-up survey of the population-based EAT 2010-2018 (Eating and Activity over Time) in cohort from Minneapolis-St. Paul, MN. Participants were emerging adults at follow-up with ages 18-26. Regression models adjusted for sociodemographic characteristics were conducted. RESULTS: Over two-thirds (68%) of mothers and 44% of fathers engaged in weight-focused conversations with their emerging adult children; 25% of both parents reported engaging in conversations focused only on health behaviors; and 8% of mothers and 26% of fathers reported not engaging in either type of conversation. Health-focused conversations by both parents were associated with lower body mass index (BMI) and disordered eating behaviors, higher intake of fruit and vegetables, and psychosocial well-being in emerging adult children. Weight-focused conversations with both parents were associated with higher BMI and disordered eating behaviors in emerging adults. There were gender moderated associations of paternal conversations about weight and health with vegetable intake, binge eating, and depressive symptoms. DISCUSSION: The high prevalence and negative health outcomes associated with weight-focused conversations coupled with the low prevalence and positive health outcomes associated with health-focused conversations by parents suggests the need for public health messaging and intervention development aimed at reducing parental weight talk with emerging adult children.

19.
Res Hum Dev ; 21(1): 26-49, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39036538

RESUMO

Using data from Monitoring the FutureStudy that include 31 cohorts of high school seniors (1976 to 2006) who were followed from ages 19-30, weidentified heterogeneity in union formation trajectories andits covariates (cohort, sex, race/ethnicity, and parental education). We identified nine trajectorieswith approximately 40% following a single to married sequence (with variation in the timing of the sequence), about 35% remaining single, and the remaining respondents showing considerable heterogeneity.Recent cohortswere more likely to remain single and experience more transitions, women made earlier transitions, and Blackrespondents were less likely to follow pathways entailing marriage.

20.
Emerg Adulthood ; 12(4): 539-552, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38934010

RESUMO

The aim of this study was to verify whether the links between features of best-friendship quality (intimacy, reliable alliance, conflict) and well-being indicators (self-esteem, loneliness) change from early emerging adulthood to early established adulthood. The moderating effect of gender and investment in romantic life on these links was examined as well. For the purpose, 346 individuals (58% women) completed questionnaires at age 20 and again at age 30. Multilevel analysis were performed for each well-being indicators separately. The results showed reliable alliance to be associated with both well-being indicators, and intimacy to be associated with loneliness. Age moderated the effect of intimacy on self-esteem, whereas investment in romantic life moderated the effect of reliable alliance. Finally, triple interactions emerged between conflict, gender and age in their associations with self-esteem and loneliness, underscoring particularities for men. These results underscore the most influential features of friendship quality for well-being.

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