Transitioning youth to adult healthcare: new tools from the Illinois Transition Care Project.

PURPOSE: To improve youths' transition to adult healthcare, especially for youth with disabilities, The Illinois Transition Care Project created separate, yet complementary, curricula for pediatric and adult-oriented providers. METHODS: Content from the curricula was tested by practicing physicians. The project created a library of skill worksheets with functional goals for patients. All methods included opportunities to teach life skills to patients to independently manage their conditions. The curricula used Maintenance of Certification (MOC) Part 4 credit as an incentive for physician participation. RESULTS: Pediatric pilot data indicate improvement across all sites and activities. Adult medicine results indicate increased perceived importance and feasibility of accepting young adult patients with childhood conditions. Patient/parent reviewers indicate the tools are understandable, interesting, and effective. CONCLUSIONS: Findings suggest the curricula, with MOC Part 4 credit for physicians, are effective in improving transition care. Project results provided new information on population management for transitioning youth and on the use of MOC Part 4 credit as an incentive. Findings have implications for primary care and specialty physicians, team-based care, teaching self-management skills to patients and methods for engaging adult-oriented physicians in the transition process.

Immunization referral practices of pediatricians in the United States.

OBJECTIVE: Concerned about alarmingly low rates of immunization among some young US children as well as disturbing trends in vaccine availability and delivery, the American Academy of Pediatrics sought to examine national trends in referral for immunization among US pediatricians. METHODS: A self-administered eight-page questionnaire on issues in childhood immunization was mailed to a random sample of the AAP's 36,000 US resident members. Four rounds of the survey yielded a sample size of 1246, for a response rate of 77%. RESULTS: A majority of respondents reported referral of some patients for immunization; reported reasons for referral focused on issues of cost to the patient. Personal characteristics of pediatricians (age and gender) were not related to referral practices. Pediatricians practicing in solo or group settings were 2.8 times as likely as those in clinics or other settings to refer patients for immunization. Those in nonmetropolitan areas were nearly twice as likely as those in large metropolitan areas to refer for immunization. When setting and location were controlled, pediatricians who reported that their states had programs to provide all vaccines free or at reduced cost were much less likely to indicate that they referred patients for immunization. CONCLUSIONS: A majority of US pediatricians refer some of their patients to other providers for immunizations because of financial reasons. Children outside of metropolitan areas may be at particular risk for problems of availability of and access to immunizations. This study raises, once again, the issue of differential health care access for children based on payment mechanisms.

Working with groups in patient education.

Group processes are an effective means of helping individuals change their behavior. Of six types of group events, three have particular relevance in the health-care setting: individually oriented change groups, group-process oriented change groups, and focused-criterion groups. The role health professionals can play in designing and implementing group discussion methods is presented.

Problem solving, contention, and struggle: how siblings resolve a conflict of interests.

In a laboratory setting, 48 sibling dyads age 4 and 6 or 6 and 8 years negotiated the division of six toys. Findings revealed that, in general, children reached divisions while using a preponderance of constructive problem-solving strategies, rather than contentious tactics. The degree of conflict of interests and the quality of sibling relationships predicted the children's use of problem-solving and contentious negotiation strategies, and was related to the types of resolutions achieved. Dyads experiencing low conflict of interests resolved their differences quickly. High conflict of interests coupled with positive relationships and constructive negotiation resulted in longer negotiations and creative, agreeable resolutions. High conflict of interests coupled with more negative relationships and destructive negotiations resulted in children's failures to reach agreement. Developmental differences indicated that older siblings within the pairs took the lead in negotiation, and benefited slightly more from the divisions. Furthermore, children in older dyads were more sophisticated and other oriented in their negotiations.

Do mitigating circumstances influence family reactions to physical aggression?

The influence of mitigating circumstances on family reactions to physical aggression was investigated. 40 families, each with a 2- and a 4-year-old child, were observed during home interactions, and parents' and older children's beliefs concerning mitigation were also assessed. Although parents considered sibling physical aggression to be a serious transgression, they believed that mitigated aggression of both of their children was more excusable and they intervened less often to prohibit mitigated than nonmitigated aggression, even when the aggression was severe. Older children also believed that mitigated aggression deserved less punishment. Provocation, reciprocity, and lack of aggressive intent occurred as mitigating circumstances in the observations. When family members' reactions to these individual circumstances were examined, discrepancies arose in judgments of which specific mitigations justified aggression. These findings were discussed in terms of the clarity of a parent's message, children's appraisals of it, differing conflict roles, and society's impact.

The social nature of early conflict.

The conflicts of 24 pairs of previously unacquainted 21-month-old children were examined for social hallmarks at several levels of analysis. Each child was observed with the same partner for 15 min on 3 consecutive days. On the fourth day half the dyads were rearranged such that each child now was paired with a new partner; the remaining children returned to meet their usual partners. Conflicts were defined dyadically as 1 child's protesting, resisting, or retaliating against an act by the peer; 217 were recorded across the 4 days, 84% of which were struggles over toys. The disputes possessed a patterned interactive structure and explicit communicative content, and 75% of the object struggles were preceded or followed by socially pertinent events. The extent of conflict neither increased nor decreased over days, nor were there reliable differences between acquainted peers on the fourth day. However, the outcome of 1 conflict affected the next; a child who lost a dispute was more likely than the winner to initiate the next. Moreover, the findings suggested that dyadic as well as dispositional factors influenced conflictual behavior; the children's tendency to initiate disputes on the fourth day could be predicted from their initiations on the first 3 days for both groups, but prediction of their tendency to yield to the peer's demands for objects was only possible for the group who retained the same partners.

Training consultation to the cairo family planning association, egypt.

A case history of the consultation process between the Cairo Family Planning Association in Egypt and a Ford Foundation short-term health education and training consultant. The viewpoint is that of the consultant and the then resident Ford population and family planning program advisor. Gordon and Ronald Lippitt's six phases of the consulting process are used as a framework for presentation.

A social relations analysis of toddler peer relationships.

We examined whether young children form different relationships with specific peers. Using the social relations model, effects of individuals as either actors or partners were distinguished from effects of relationships. Relationship effects are inferred when behavior within a dyad cannot be predicted from behavior that both partners give and receive in other social contexts. 32 20- or 30-month-old children were each paired with 2 partners (same age and gender) and observed for 18 40-min play sessions. The social relations analysis indicated that children differed consistently in their initiation of interaction (actor effects) and in the conflict contributions they elicited from their peers (partner effects). Relationship effects were found in games and contingent interaction, and were generally reciprocal. Relationship effects emerged gradually; in contrast, neither actor nor partner effects increased over time. Results were discussed in the context of definitions of relationships and peer relationships of young children.

Pilot study of discussion groups of "worried well" patients in an ambulatory care setting.

Two pilot discussion groups were conducted for patients who met selected criteria indicating they were worried well patients (not requiring conventional medical care services). The objective of the groups was to explore and demonstrate the feasibility of utilizing an educational approach conducted by paraprofessional personnel, under physician supervision, for helping to meet the needs of such patients, thereby reducing utilization of more expensive physician resources. The findings indicated that 50 percent of the patients reduced the number of visits to the physician, and 60 percent perceived the experience as helpful.

Bicycle helmet counseling by pediatricians: a random national survey.

A random sample of 1201 pediatricians who are members of the American Academy of Pediatrics completed questionnaires regarding bicycle injury prevention counseling. Of the 871 pediatricians in the sample who provide health supervision, 80% reported that they discuss bicycle helmet use with their patients at least once before the patient reaches the age of 12 years. Provision of bicycle helmet counseling did not vary significantly by pediatricians' age, gender, or practice location. The most important predictor of provision of bicycle helmet counseling was professional experience with injured children, including having had a patient who experienced a serious injury or death due to a bicycle accident in the last year.

A familial pericentric inversion of chromosome 22 with a recombinant subject illustrating a 'pure' partial monosomy syndrome.

A family in which a pericentric inversion of chromosome 22, inv(22)(p11q12), is segregating is described. Special reference is made to a unique recombinant subject with a 'pure' partial monosomy 22 syndrome of maternal origin. An attempt has been made to correlate the phenotypic abnormalities with monosomy for the segment 22q12----qter.

Comparing outcomes in a statewide program for adolescent mothers with outcomes in a national sample.

One-year outcomes for 1,004 participants in a statewide program for pregnant and parenting teenagers were compared with outcomes for 790 adolescent mothers included in the National Longitudinal Survey of Youth. The program group was substantially younger and included more black women and fewer married teenagers than the national sample. Controlling for these and other baseline differences revealed that program participants were significantly more likely than the national sample to be enrolled in school, to be employed and to have avoided a subsequent pregnancy 12 months later. Several baseline variables, including age at first birth, ethnicity, education and living arrangements, were also predictive of one-year outcomes.