The Short Version of the Italian Maastricht Vital Exhaustion Questionnaire (MVEQ): Psychometric Properties and Relationships with Anxiety, Depression, and Stress in a Community Sample of Older Adults.

Vital Exhaustion (VE) refers to a physical and mental state of excessive fatigue, feelings of demoralization, hopelessness, and increased irritability. The short form of the Maastricht Vital Exhaustion Questionnaire (MVEQ) is a widely used measure to assess VE. Despite its utility is broadly recognized, the validity and reliability of the scale have yet to be examined in the Italian context. The present study aimed to evaluate the psychometric properties of the shortened MVEQ in a community sample of Italian older adults. A total of 722 older adults (Mage = 72.97, SD = 7.71; 60.4% females) completed the MVEQ, as well as other self-report questionnaires assessing anxiety, depression and stress in order to evaluate the criterion-related validity of the scale. A confirmatory factor analysis (CFA) was conducted to examine the original MVEQ latent structure. Internal consistency was assessed through model-based omega coefficient. Test-retest reliability was examined by re-administering the MVEQ after three months to a subsample of 568 participants. Factorial invariance tests across gender were conducted by means of multi-group CFAs. The one-factor model showed an acceptable fit to the data. The MVEQ yielded a reliable total score (ω = 0.822) and showed moderate-to-large correlations with measures of anxiety, depression, and stress (r range 0.30 to 0.75, ps < 0.001). Test-retest reliability was supported by an Intraclass Correlation Coefficient (ICC) of 0.661. Lastly, the scale was factorially invariant across gender. Overall, the MVEQ provided evidence of reliability and criterion-related validity in a sample of Italian older adults and may be useful for both clinical and research practices.

Breathing out dental fear: A feasibility crossover study on the effectiveness of diaphragmatic breathing in children sitting on the dentist's chair.

BACKGROUND: Anxiety related to the dental context is a clinically significant challenge. In children, dental fear is often accompanied by disruptive and uncooperative behaviours that can render treatment difficult. Although techniques to reduce children's anxiety exist, many have not been formally evaluated. DESIGN: Diaphragmatic breathing has been shown to reduce fear and anxiety, but few investigations have evaluated whether it can reduce dental anxiety in children. This crossover study tested the effectiveness and feasibility of diaphragmatic breathing in twenty children undergoing dental care. RESULTS: Compared with the treatment as usual, such a simple technique had significant benefits on mood, self-reported pain and autonomic balance, thus reducing sympathetic activation. CONCLUSION: Diaphragmatic breathing is a low-cost, easy-to-implement technique suitable for daily dental practice, and is a promising tool for reducing negative effect and physiological distress in children with dental anxiety that results in more cooperative behaviours and reduced visit time.

Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID-19 outbreak.

Hospital staff are at the frontline in the COVID-19 outbreak. The stressors they experience may induce sleep problems in a population already at risk. Sleep deprivation, long shifts and insomnia in hospital staff have been associated with individual, organizational and public health hazards. These include increased risk of mental and somatic disorders, altered immune responses, medical errors, misunderstandings, drowsy driving and burnout. In March 2020, the World Health Organization called for providing access to mental health and counselling for health professionals involved in the COVID-19 outbreak. To answer this call, we propose practical advice for the management of sleep problems (sleep deprivation, insomnia and shift work) that can be included in supportive interventions. The advice is based on psychobiological principles of sleep regulation and on guidelines for the treatment of insomnia and was implemented within an initiative offering psychological support to the staff of three university hospitals in Rome.

Eating self-efficacy: validation of a new brief scale.

PURPOSE: Eating self-efficacy (ESE) is the belief in one's ability to self-regulate eating. Social and emotional situations may be differently challenging depending on the individual eating habits, body mass index and affects. Several ESE scales have been developed but most of them focus on weight management, dieting or healthy eating. The aim of the study was to validate a new brief scale assessing ESE in situations in which people face social or emotional pressures for excessive food intake. METHODS: Study 1: A sample of 412 volunteer females (age M = 25.44 ± 5.03) completed a first 25-item version of the scale. Exploratory factor analysis (EFA) was conducted for selecting a subgroup of items composing the ESE brief scale (ESEBS). Study 2 assessed its psychometric properties through a Confirmatory Factor Analysis (CFA), analyzing the responses of 410 volunteer adults (273 females, 137 males). RESULTS: EFA of Study 1 evidenced a bifactorial structure. Four items for each factor were selected, explaining 63% of the variance. Study 2 confirmed the good fit of the bifactorial model (CFI = 0.9589; χ2 (19) = 62.852, p < 0.001; RMSEA = 0.075; SRMR = 0.040) and provided support for the measurement invariance of the scale across gender. The internal consistency was as follows: Social (α = 0.786), Emotional (α = 0.820). The concurrent validity of the subscales was demonstrated by significant latent negative correlations with measures of eating disorders and emotional eating. CONCLUSIONS: The 8-items ESEBS appears as a valid and reliable instrument to assess eating self-efficacy related to social and emotional situations. Future studies should evaluate its potential use in non-clinical and clinical research and interventions. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Positive Orientation and Health-related Quality of Life in Adult Patients Born With Anorectal Malformations.

OBJECTIVES: Anorectal malformations (ARMs) are rare congenital colorectal anomalies, which may have a negative impact on health-related quality of life (HRQoL) due to long-lasting consequences, like fecal incontinence. The aim of the present study was to test whether a pervasive mode of appraising and viewing life experiences from a positive stance (ie, positivity) mediates the effect of fecal continence on HRQoL. METHODS: Participants were enrolled from the Italian Association for Anorectal Malformations. Adult patients with ARMs who completed measures of fecal continence (Hirschsprung Disease/Anorectal Malformation Quality of Life Questionnaire), positivity (Life Satisfaction Scale, Rosenberg Self-esteem Scale, and Life Orientation Test), and mental/physical HRQoL (SF-36) were included. Data were analyzed using the PROCESS macro for SPSS statistical software (Model 4). RESULTS: The study included 66 adult patients with ARMs. Mediated regression analyses showed a significant total effect in which patients with higher fecal continence perceived higher physical (ß = 0.210, SE = 0.038, 95% CI [0.133, 0.286]) and mental HRQoL (ß = 0.226, SE = 0.056, 95% CI [0.115, 0.338]) than patients with lower fecal continence. The indirect effects were also significant, indicating that positivity mediated the impact of fecal continence on physical (ß = 0.026, SE = 0.017, 95% CI [0.002, 0.068]), and mental HRQoL (ß = 0.146, SE = 0.058, 95% CI [0.047, 0.275]). CONCLUSIONS: The findings extend previous literature on ARM patients and additional evidence that an optimistic view of oneself, one's life, and one's future contribute to explain the effects of functional impairments on quality of life.

Knowledge and sources of information on umbilical cord blood donation in pregnant women.

The use of umbilical cord blood (UCB) holds promise for the treatment of a wide spectrum of diseases. However, information on UCB donation is not widespread or accurate among expectant women. The aim of this study is to evaluate pregnant women's knowledge of UCB donation, their main sources of information and their satisfaction with the knowledge possessed. Women (N = 375) in the last semester of pregnancy completed questionnaires evaluating sociodemographics, knowledge of UCB donation, past donation, sources of information, satisfaction with the information and the desire to have received more information. Women were aware of the possibility of donating UCB (97.5%) although, on average, they reported not having enough knowledge of donation possibilities, procedures to be followed and uses of UCB (2.51, on a 5-point scale). Considering knowledge satisfaction, 28% were not at all satisfied. Only 2.8% felt fully prepared and the great majority (75.2%) would have liked to have received more information. The main source of information was the Internet (51.2%). Gynecologists and midwives were indicated by only 24.4% and 18.6% of women, respectively. Age and education were significantly correlated with UCB knowledge. Chi-square tests evidenced that those who reported professional sources of information (gynecologists, obstetricians, prenatal courses) did not need additional information. Conversely, mothers who turned to other mothers for information were more likely to desire further information. Most mothers report the Internet as the main source of information. Providing accurate information through official sources may result in a more positive attitude toward donation.

Psychometric properties of the FertiQoL questionnaire in Italian infertile women in different stages of treatment.

BACKGROUND: Reliable Fertility-specific QoL measures can be obtained through the FertiQoL, a questionnaire with six-subscales that consider different core aspects of the person's wellbeing and way of behaving during treatment. OBJECTIVE: Examine the psychometric properties of all six-subscales of the Italian FertiQoL in a sample of infertile women and explore the effects of the ART treatment phases. METHOD: 323 women, in three different treatment stages (Diagnostic, Stimulation, Transfer), completed the FertiQoL. Raw data were subject to Confirmatory Factor Analysis (CFA), and a structural equation modelling (SEM) was used to validate the hypothesised model. RESULTS: CFA shows a good fit of the data to the FertiQoL hierarchical model (chi-square/df = 1.989, CFI = 0.88, RMSEA = 0.055). After the deletion of 2 items, all FertiQoL scales have good internal consistency. SEM showed that the ART treatment phase was positively associated with fertility-related QoL scores both in the Relational (ß = 0.14, p < 0.05) and in the Tolerability (ß = 0.17, p < 0.05) subscales. CONCLUSION: All scales of the Italian FertiQoL version maintain good psychometric characteristics; Tolerability and Relational subscales are sensitive to the treatment stage and thus providing relevant information for the medical staff.

Exploring the relationship between umbilical blood cord donation and the impact of social distance on altruism and trust.

Allogeneic umbilical cord blood (UCB) donation is a pro-social behaviour directed to strangers that has a certain cost for the donor. Although the promotion of such behaviour is an important goal for many countries' health systems, little is known about the reasons that would lead to it. With this study, we explored how the impact of social closeness on altruism and trust could be related to UCB donation in a sample of new-mothers (N = 167). Participants played hypothetical Dictator and Trust games with socially close (e.g., parents) or distant (e.g., strangers) others. They donated more money to parents and siblings compared to cousins, friends and strangers and they trusted more parents, siblings and friends than cousins and strangers. Interestingly, the lower the impact of social closeness on altruism (i.e., generosity towards socially distant others), the higher the intention and the actual probability of UCB donation. A mediation analysis has shown that the relationship between social closeness on altruism and UCB donation was mediated by objective intention to donate (i.e., having followed all the procedures needed). These findings show that other-oriented motivations towards distant others might have important practical implications in identifying the targets of interventions for the promotion of UCB donation.

Is the association between precarious employment and mental health mediated by economic difficulties in males? Results from two Italian studies.

BACKGROUND: Flexible employment is increasing across Europe and recent studies show an association with poor mental health. The goal of the current study is to examine this association in the Italian population to assess the possible mediating role of financial strain. METHODS: Data were obtained by two Italian cross-sectional studies (PASSI and HIS) aimed at monitoring the general population health status, health behaviours and determinants. Mental health status was assessed using alternatively two validated questionnaires (the PHQ-2 and the MCS-12 score) and Poisson regression models were performed to assess if precarious work was associated with poor mental health. A formal mediation analysis was conducted to evaluate if the association between precarious work and mental health was mediated by financial strain. RESULTS: The analyses were performed on 31,948 subjects in PASSI and on 21,894 subjects in HIS. A nearly two-fold risk of depression and poor mental health was found among precarious workers, compared to workers with a permanent contract, which was strongly mediated by financial strain. CONCLUSIONS: Even with the limitations of a cross-sectional design, this research supports that precarious employment contributes through financial strain to reduce the mental health related quality of life and to increase mental disorders such as symptoms of depression or dysthymia. This suggests that when stability in work cannot be guaranteed, it would be appropriate to intervene on the wages of precarious jobs and to provide social safety nets for ensuring adequate income.

Sexual well-being in adolescent and young adults born with arm: the perspective of the patients.

PURPOSE: Sexual well-being and sexual functioning are understudied in patients born with ARM. The aim of this exploratory study was to investigate sexual history, main fears, and problems encountered during sexual relationships. METHODS: Before participating in a sexual education intervention, 21 adolescents or young adults (12 males; mean 28.8; SD 10.6) born with ARM, answered a ten-item questionnaire specifically developed to evaluate sexual well-being. Percentages and Chi-square were calculated. RESULTS: 52.4% were married/had a partner. The majority (71%) declared that had sexual relationships. Mean age of the first sexual relationship was 18.8 (2.7) and 22.7 (3.8) for males and females, respectively. Females reported both more fear and experience of pain during sexual intercourse, compared to males. Main experienced problems and fears for male patients were loss of feces and premature ejaculation, followed by the fear of lack of erection and managing contraception. Main experienced problems and fears in females were loss of feces, pain, lack of desire, and lack of lubrication. In only few cases, patients asked for advices to a pediatric surgeon or to an adult surgeon specialized in ARM. CONCLUSIONS: Adult and adolescent patients may benefit of andrological/gynecological evaluation, psychological support, and sexual counseling to improve their sexual well-being.

Sleep quality as predictor of BMI in non-depressed caregivers of people with dementia.

PURPOSE: Although most cross-sectional and longitudinal studies of children and adolescents have found a link between short duration of sleep and obesity, the literature related to adults provides a non-consensual framework. The aim of the present study was to examine the association between sleep quality and BMI in a population of caregivers looking after people suffering from dementia, with a view to identifying the moderating role of depressive symptoms in the relationship between sleep problems and BMI. METHODS: A total of 117 subjects took part in the study, filling in a Sociodemographic Questionnaire, the Pittsburgh Sleep Quality Index, the Eating behavior Questionnaire and The Center for Epidemiologic Studies-Depression. RESULTS: Depressive symptoms were greater in females than in males. The sample was divided into two subgroups based on depressive-symptom scores. Only within the subsample with low depressive symptoms, higher sleep disturbances influenced BMI positively. Within this subsample of participants with low depressive symptoms, the variables that seem to play a pivotal role in explaining a high BMI are: female gender, sleep problems, and diet quality, while within the subsample with high depressive symptoms only the female gender factor was found to influence BMI. CONCLUSIONS: Depressive symptoms seem to act as moderators in the relationship between sleep and BMI. They should be evaluated to identify the risk of high BMI, and to differentiate clinical intervention, at least in this population, which experiences the stress of caregiving chronically, though not suffering from clinical eating disorders. LEVEL OF EVIDENCE: Level II, cross-sectional study.

The relationship between caregiving self-efficacy and depressive symptoms in family caregivers of patients with Alzheimer disease: a longitudinal study.

BACKGROUND: Caregiving for a relative with dementia has been associated with negative consequences for mental health. Self-efficacy has been shown to correlate negatively with depression but the long-term association between caregiver burden, caregiver self-efficacy, and depressive symptoms, remains still largely unexplored. The aim of the present study was to evaluate whether different self-efficacy domains partially mediated the relationship between caregiving burden and depression. METHODS: A three-wave design was used, with initial assessment and follow-ups three months later and one year later. One hundred seventy caregivers of patients with AD responded to measures of caregiver burden, caregiving self-efficacy, and depressive symptoms. Data were analyzed by means of structural equation models. RESULTS: The tested model provided support for the guiding hypothesis. Burden at the time of the first assessment (T1) significantly influenced depression one year later and the relationship between burden at time one and depressive symptoms one year later was partially mediated by self-efficacy for controlling upsetting thoughts. CONCLUSIONS: The findings of the present study provide evidence that, along a considerable length of time, the effects of caregiver burden on depressive symptoms can be explained by the caregivers' efficacy beliefs in controlling upsetting thoughts related to the caregiving tasks. Interventions for caregivers of patients with AD may help them in tackling negative thoughts about the caregiving role.

Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: A comparative study.

The aim of this study was to evaluate caregiver burden and quality of life (QoL) in active treatment settings and hospice care for 76 family caregivers of advanced cancer patients, using the Medical Outcomes Study Short Form and the Caregiver Burden Inventory. Compared to the active group, the hospice group reported significantly lower QoL scores in mental component summary score and higher scores in general health subscale and in physical component summary score. Future research needs to further investigate the complexities of caregivers' needs, especially in the emotional and mental domains, and offer effective, clinically proven interventions.

VALIDATION OF THE ITALIAN VERSION OF THE COPING INVENTORY FOR STRESSFUL SITUATIONS-SHORT VERSION AMONG HOSPITAL-BASED NURSES.

The psychometric properties of the Italian version of the Coping Inventory for Stressful Situations-Short Version (CISS-SV-21 items) were tested. In a group of 1,291 hospital-based nurses (77.8% women), four alternative factor models of the CISS-SV were tested using confirmatory factor analysis (CFA). The four models were: M1, the original CISS-SV-21 items three-factor model corresponding to three dimensions (task-oriented, emotion-oriented, and avoidance-oriented coping); M2, the four-factor model corresponding to four dimensions (task-oriented, emotion-oriented, contact a friend-oriented, and treat oneself-oriented) of the CISS-SV (21 items); M3, the three-factor model of the CISS-SV (20 items) made up by the same factor structure of M1 without including Item 1; finally, the four-factor M4 of the CISS-SV (20 items), consisting of the same dimensions of the M2 model without including Item 1. The results of the CFA showed that the M4 factor model was the model that was best able to account for the data (RMSEA = 0.06, 90%CI = 0.05, -0.06; CFI = 0.90). Reliability was supported by alphas ranging from .72 to .82. The CISS-SV has acceptable validity and reliability for measuring the coping strategies of nurses.

The role of transplant-related stressors and social support in the development of anxiety among renal transplant recipients: the direct and buffering effects.

Several studies have shown a relevant presence of anxiety feelings among renal transplant patients. This study examines the impact of transplant-related stress and social support on anxiety. Two hypotheses were examined: H1: High transplant-related stressors and low social support are related to high anxiety (additive hypothesis); H2: Social support moderates the detrimental impact of transplant-related stressors on anxiety (buffer hypothesis). One hundred and four kidney transplant recipients (54% male), with a mean age of 50.8 (SD = 12.6), volunteered to participate in a cross-sectional study that included a face-to-face interview and several self-administered scales. Hierarchical regression analyses indicated that higher transplant-related stressors are associated with higher levels of anxiety (F change (2, 92) = 17.4, p < .001, ∆R(2) = 24%), but, contrary to our prediction, social support was not directly related with anxiety. However, social support has a moderating effect on the relationship between high transplant-related stressors and anxiety (F change (1, 91) = 5.2, p < .05, ∆R(2) = 3%). The results are consistent with the hypothesis that social support has a buffering role on the patients' distress following renal transplantation and suggest that their psychological well-being could benefit from enhancing the perception of social support in post-operative care.

Psychometric properties of the Maslach Burnout Inventory for Human Services among Italian nurses: a test of alternative models.

AIM: The purpose of this study was to test the factor structure of an Italian version of the Maslach Burnout Inventory for Human Service employees. In addition we examined the reliability and construct validity of the scale. BACKGROUND: There is increasing evidence that nurses are at risk of experiencing burnout. Despite the vast international use of the Maslach Burnout Inventory-Human Service Survey, its factor structure and reliability are not beyond question. METHOD: In a sample of nurses (N = 1613) six alternative factor models of the instrument were tested using confirmatory factor analysis. Furthermore, we examined the invariance of the pattern of factor loadings of the model that better fitted the data across gender groups. To test construct validity, participants completed four subscales of Symptoms Check List 90-R. Internal consistency was evaluated computing Cronbach's alpha estimates of the scales. The study was conducted in 2007 and 2008 in Italy. RESULTS: The factor analysis provided support for a 20-item version identifying the three original dimensions. The model was found to be factorially invariant between men and women. Correlations between the latent MBI-HSS dimensions and distress variables were in line with theoretical predictions. Reliability was supported by acceptable Cronbach's alpha indexes. CONCLUSION: The Maslach Burnout Inventory-Human Service Survey has acceptable validity and reliability for measuring burnout among nurses, and can help healthcare managers to offer interventions to reduce burnout among nurses. Limitations of the study and suggestions for further research are highlighted.

Psychological profiles of individuals with type 2 diabetes and their association with physical and psychological outcomes: a cluster analysis.

OBJECTIVES: This study aimed to identify clusters of participants with Type 2 diabetes mellitus (T2DM) at risk for developing psychological and somatic distress symptoms. Moreover, we investigated whether the different clusters were associated with glycemic control, sleep, and physical activity levels.Design and main outcome measures. In a cross-sectional design, participants with T2DM (n = 269) completed questionnaires on psychological and somatic distress, sleep disorders and physical activity. RESULTS: Cluster analyses yielded three groups: a) "high self-confident and low demoralised"; b) "low support and low involvement"; c) "high consequences, high demoralisation and nagging". The groups were distinguished by the social, cognitive, and vital exhaustion variables and significant differences in diabetes-related psychological distress and physical activity. The measure of glycemic control did not differ between clusters. The "high self-confident and low demoralised" group displayed the lowest scores on psychological distress compared to the other clusters. CONCLUSIONS: Results suggest that social cognitive dimensions and affective states play a key role in defining clusters in participants with T2DM. Thus, we need to consider the psychological profiles of participants with T2DM when designing interventions to improve self-management strategies.

Psychosocial and behavioural predictors of immune response to influenza vaccination: a systematic review and meta-analysis.

High variability of influenza vaccine efficacy requires the identification of modulators of immunisation that may be targeted as adjuvants in health psychology interventions. Psychosocial and behavioural variables such as psychological stress, greater negative and lower positive affectivity, poor sleep, loneliness, and lack of social support, have been associated with abnormal immune and inflammatory responses and negative health outcomes, yet their effects in modulating vaccine efficacy are yet to be fully understood. We conducted an updated systematic review of longitudinal and experimental studies examining the effects of such variables in predicting immune response to influenza vaccine. PubMed, Medline, PsycINFO, CINAHL and Scopus were searched up to November 2022. Twenty-five studies met the inclusion criteria for qualitative synthesis and 16 provided data for meta-analysis. Low positive and high negative affect were associated with low antibodies and weak cell-mediated immunity following vaccination in qualitative synthesis. Literature on sleep disturbance, loneliness and social support was limited and yielded inconsistent results. Psychological stress was associated with poorer antibody response in meta-analysis. In conclusion, findings from this review suggest a need for further longitudinal and experimental studies on these factors to support their inclusion as target variables in vaccine adjuvant interventions.

The Transition of Care for Patients with Anorectal Malformations and Hirschsprung Disease: A European Survey.

This study aimed at evaluating how transition of care is currently being organized in the European Reference Networks (ERNs) health care providers (HCPs) in pediatric areas and in the Anorectal Malformation Network (ARM-Net) Consortium hospitals. An online questionnaire was sent to a total of 80 surgeons, members of or affiliated members of three networks: ARM-Net Consortium, ERN eUROGEN, and ERN ERNICA. Complete information were obtained for 45 HCPs, most of which deal with transition and still see a few adult patients (ca. 10%). Gynecological, gastroenterological, urological, colorectal, and continence issues were the major problems described by adult patients to their physicians, and in line with these prevalent complaints, they are referred to the appropriate adult specialists. Forty percent of patients complain about sexual and fertility problems, but the percentage of andrologists and sexologists involved in the caring of adult patients with ARM/Hirschsprung's disease is low, just above 10.9%. Most hospitals deal with transition, but three basic criteria (i.e., presence of: [1] an official written transitional program, [2] a transitional coordinator, and [3] written information on transition to be handled to patients) are jointly met only by six HCPs. According to the responders, the most important issue requiring improvement is the lack of interest and of specific preparation by adult specialists. The overall results of this exploratory survey confirm the need for the development of comprehensive programs for transition in these rare and complex diseases, and identify the hospitals that, in collaboration with the networks, could share best practices in organizing structured transitional pathways and well follow-ups.

Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture.

BACKGROUND: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. METHODS: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. RESULTS: In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. CONCLUSION: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. LEVEL OF EVIDENCE: III.