Adult Life Outcomes Research Articles

Housing First for older homeless adults with mental illness: a subgroup analysis of the At Home/Chez Soi randomized controlled trial.

This study compares the effect of Housing First on older (≥50years old) and younger (18-49years old) homeless adults with mental illness participating in At Home/Chez Soi, a 24-month multisite randomized controlled trial of Housing First. At Home/Chez Soi, participants (n=2148) were randomized to receive rent supplements with intensive case management or assertive community treatment, based on their need level for mental health services, or usual care in their respective communities. A subgroup analysis compared older (n=470) and younger (n=1678) homeless participants across baseline characteristics and 24-month outcomes including housing stability (primary outcome), generic and condition-specific quality of life, community functioning, physical and mental health status, mental health symptom severity, psychological community integration, recovery, and substance use (secondary outcomes). At 24months, Housing First significantly improved the percentage of days stably housed among older (+43.9%, 95% confidence interval [CI]: 38.4% to 49.5%) and younger homeless adults (+39.7%, 95% CI: 36.8% to 42.6%), compared with usual care, with no significant differences between age groups (difference of differences=+4.2%, 95% CI: -2.1% to 10.5%, p=0.188). Improvements from baseline to 24months in mental health and condition-specific quality of life were significantly greater among older homeless adults than among younger homeless adults. Housing First significantly improved housing stability among older and younger homeless adults with mental illness, resulting in superior mental health and quality of life outcomes in older homeless adults compared with younger homeless adults at 24months. Copyright © 2017 John Wiley & Sons, Ltd.

Childhood Maltreatment Linked with a Deterioration of Psychosocial Outcomes in Adult Life for Southern Brazilian Transgender Women.

A history of childhood maltreatment (HCM) has been associated with detrimental psychiatric outcomes. This is particularly true for transgender, for whom there is initial evidence that HCM may be associated with psychiatric morbidity. Our study aimed to further characterize the relationship between HCM and the development of mental disorder in adult life, based on a sample of Brazilian transgender women. Cross-sectional data were collected from a consecutive sample of 289 transgender women who attended the Hospital Clínicas clinic for gender dysphoria, in Porto Alegre, between 1998 and 2014. Our results demonstrated a greater risk of deteriorating mental health amongst participants who had experienced HCM. Given the disproportionally high rate of HCM in transgender persons, we advocate for greater assistance for transgender persons.

Adult Life Adjustment of Vulnerable Youths. The Relationship Between Criminal History, Employment History and Adult Life Outcomes

This article examines adult outcomes of vulnerable youths. The sample consists of 251 boys and girls who were institutionalized in a Dutch juvenile justice institution in the 1990s. Information on personal and childhood characteristics was extracted from treatment files that were compiled during their stay in the institution. In addition, conviction data was used to determine subjects’ criminal careers. Conducting face-to-face interviews with these former JJI detainees when they were on average 34 years old, we collected retrospective information on employment history and several important current life course outcomes. Group-based trajectory modeling was used to identify distinct offending and employment groups. Results showed that previously institutionalized youths experience difficulties adjusting to conventional adult life. Most personal and childhood characteristics exert no significant effect on adult outcomes. Criminal behaviour in young adulthood does impact adult life outcomes, as the two chronic offender groups show more difficulties in conventional adult life domains. Employment is associated with better adult outcomes, as the two employment groups that have an increasing or high employment rate in adulthood show higher levels of adult life adjustment. Adult life adjustment in this sample of previously institutionalized youths is mainly explained by events during young adulthood, and not so much by childhood risk factors. Ties to employment appear to facilitate transitions in other life domains, thereby promoting life success in adulthood.

Postschool Services and Postschool Outcomes for Individuals With Mild Intellectual Disability

Understanding the relationship between services and outcomes is important for students with disabilities. While research exists regarding relationships between services and supports provided in school and adult life outcomes for students with disabilities, less attention is paid to the supports and services provided after students exit high school. This study was a secondary data analysis of the National Longitudinal Transition Study−2 (NLTS2) to explore the postschool experiences and services received by individuals with mild intellectual disability and to understand the relationship between receipt of postschool services and postschool outcomes. The main findings for this secondary analysis were the lack of postschool services and supports provided to individuals with mild intellectual disability, and a lack of benefit in terms of postschool outcomes if postschool services were received.

Stature, Skills and Adult Life Outcomes: Evidence from Indonesia

ABSTRACTWe investigate the effect of height on earnings, occupational choices and a subjective measure of wellbeing among Indonesian men. We explore the extent to which height captures the effects of endowments set before entry in the labour market. Physical and cognitive skills, co-determined with stature early in life, do not explain much of the height earnings premium directly. Yet, human capital more broadly, including cognition, educational attainment and other factors related to childhood conditions, explains around half of the height premium and does so through occupational sorting. Indeed, taller workers tend to have more education, and educated workers tend to work in more lucrative occupations that require brain and social skills, not brawn. The unexplained share of the height earnings premium may reflect a specific role of stature on social interaction, labour market advantages or self-assurance. We also find a height premium in happiness, half of which simply accounts for the educational and earnings advantages of taller workers.

Resilience and Quality of Life

The construct of resilience is key to understanding adaptation to disability from a strengths-based perspective. The objective of this study was to examine the impact of factors identified in Kumpfer’s resilience model on quality of life (QOL) outcomes for adults with spinal cord injury (SCI), specifically taking into account injury characteristics, self-efficacy, resiliency characteristics, and social support using hierarchical regression analysis. Participants included 255 adults with SCI. Findings revealed that the overall model accounted for 75% of the variance in QOL outcomes. In particular, coexisting pain, participation self-efficacy, core self-evaluation, resiliency characteristics, cognitive strength, general health, and social support independently contributed to the variance in QOL scores. Implications of these findings for developing theory-driven, strengths-based approaches for improving rehabilitation outcomes for individuals with SCI are discussed.

The impact of sport on health status, psychological well-being and physical performance of adults with haemophilia.

There is increasing recognition that sport is important for individuals with haemophilia; however, there remains a paucity of data of the importance of this in adults, many of whom already have joint pathology related to childhood bleeds and treatment access. This multicentre, cross-sectional study presents the impact of sport on health-related quality of life (HRQoL), physical performance and clinical outcomes in adults with haemophilia. Fifty adults aged 35.12±14.7 with mild (n = 12), moderate (n = 10), or severe (n = 28) haemophilia A (70%) or B (30%) from four haemophilia centres across the United Kingdom participated in the study. A total of 64% were overweight/obese according to their BMI; median orthopaedic joint scores using the WFH Orthopaedic Joint Score (OJS) were 6 (range 0-48). On a VAS pain scale (range of 0-10), patients reported mean score of 5.66 ± 2.4. 36% of participants reported not doing any sport, mainly due to their physical condition. However, 64% of participants reported undertaking sporting activity including contact sports, mostly twice per week in average 4 h week(-1) . Participating in sport did not have a statistically significant impact on HRQoL; except in the domain 'sport and leisure' of the Haem-A-QoL. Patients doing more sport reported significantly better HRQoL than those doing less sport (P < 0.005). Those doing sport for more than 4 h week(-1) had a significantly better physical performance than patients doing less sport (assessed with Hep-Test-Q). Encouraging physical activity and sport in older patients with haemophilia may have a direct impact on their HRQoL; thus, education about sport activity should be incorporated into routine haemophilia care.

Characterizing Objective Quality of Life and Normative Outcomes in Adults with Autism Spectrum Disorder: An Exploratory Latent Class Analysis.

This study aims to extend the definition of quality of life (QoL) for adults with autism spectrum disorder (ASD, n = 180, ages 23-60) by: (1) characterizing the heterogeneity of normative outcomes (employment, independent living, social engagement) and objective QoL (physical health, neighborhood quality, family contact, mental health issues); and (2) identifying predictors of positive normative outcomes and good objective QoL. Findings of an exploratory latent class analysis identified three groups of adults with ASD-Greater Dependence, Good Physical and Mental Health, and Greater Independence. Findings indicate that better daily living skills, better executive function, and more maternal warmth are associated with assignment to better outcome groups. Findings have implications for interventions designed to enhance achievement of normative outcomes and objective QoL.

Psychosocial interventions for improving quality of life outcomes in adults undergoing strabismus surgery.

Strabismus, also known as squint, can have a debilitating effect on a person's self-esteem, quality of life and mood, as well as increase their feelings of social anxiety and avoidance behaviour. Strabismus surgery can improve both the alignment of a person's eyes and, in appropriate cases, relieve symptoms such as double vision. However, evidence indicates that not all patients experience a meaningful improvement in their quality of life postsurgery. Pre-surgical psychosocial interventions have been found to improve patient reported outcomes in other long-term conditions. To assess the effects of psychosocial interventions versus no intervention on quality of life and psychosocial outcomes in adults undergoing strabismus surgery. We searched CENTRAL (which contains the Cochrane Eyes and Vision group Trials Register) (2016, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2016), EMBASE (January 1980 to February 2016), Latin American and Caribbean Health Sciences (LILACS) (January 1982 to February 2016), PsycINFO (January 1967 to February 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 February 2016.We also manually searched the British Orthoptic Journal, proceedings of the European Strabismological Association (ESA), International Strabismological Association (ISA) and published transactions from the meetings of European Strabismus Association (ESA) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS). These were searched from 1980 to present. We also carried out handsearches of Psychology and Health, British Journal of Health Psychology, Health Psychology and Annals of Behavioral Medicine. We planned to include randomised controlled trials (RCTs), including cluster-RCTs, in which effectiveness of a psychosocial intervention had been evaluated in patients due to undergo strabismus surgery. Two review authors independently reviewed the search results for eligibility. None of the 88 studies we identified met the inclusion criteria of this Cochrane review. We found no evidence that evaluated the impact of psychosocial interventions on patients undergoing squint surgery. We believe future research should focus on developing and evaluating the use of targeted psychosocial interventions to improve a patient's quality of life after strabismus surgery.

The Norwegian Translation of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale: Validation and Assessment of QoL in 313 Adults With ADHD

Objective: The aim of the study was to validate the Norwegian version of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life (AAQoL) scale and to explore Quality of Life (QoL) and functional outcomes in adults with ADHD. Method: A total of 313 adults with ADHD participated in the study. Data were collected from medical records and self-report questionnaires. Confirmatory factor analysis was performed to assess the model fit of the translated AAQoL. Chi-square statistics and t tests were used to investigate sample characteristics. Results: The analyses showed acceptable model fit between data and the model. Chi square = 863.179 (371 df, p < .0000), root mean square error of approximation (RMSEA) = 0.069 (90% confidence interval [CI]), comparative fit index (CFI) = 0.873, and Tucker–Lewis index (TLI) = 0.821. Cronbach’s alpha range for the scales was .761 to .869. The sample was characterized by poor QoL and impairment. Conclusion: The translated AAQoL is showing good initial indications of validity with acceptable psychometric properties in the sample. ADHD was associated with impairments in QoL, symptoms, and functional outcomes.

Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial.

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

How Does Early Deprivation Relate to Later-Life Outcomes? A Longitudinal Analysis

Measures of material deprivation are increasingly used as alternatives to traditional poverty indicators. While there exists extensive literature focusing on the impact that growing up in a (financially) poor household has on future success, little is known about how material deprivation relates to long-run outcomes. This study uses longitudinal data from the 1970 British Cohort Study to assess the relationship between material deprivation and outcomes in adult life. We control for an extensive set of observable characteristics, and further employ value-added analysis and generalized sensitivity analysis to assess the nature of this relationship. We find that deprivation relates to a diverse set of outcome variables, but the magnitude of the conditional relationships are generally small. Immaterial indicators of family quality show relatively stronger ties to future outcomes, especially with respect to non-cognitive skills.

Examining outcomes associated with adult life engagement for young adults with high incidence disabilities

BACKGROUND: This study examines adult outcomes of young adults with high incidence disabilities. We examined variables across 5 postschool outcome constructs: (a) gainful employment, (b) community living and participation, (c) ongoing and advanced education, (d) social connections and positive relationships, and (f) health and well-being. OBJECTIVE: We compare specific outcomes among three disability groups often described as having high incidence disabilities: learning disabilities, emotional disabilities and attention deficit hyperactivity disorder. METHODS: Descriptive statistics were calculated using procedures that accounted for the weighted and stratified design of the NLTS2 including the calculation of appropriate estimated standard errors. Therefore, these results are representative of the national population of youth in the high incidence disability groups identified RESULTS: Results across all major life domains indicated that students from these three groups were more similar in achievement of adult life outcomes. CONCLUSIONS: Implications of these results include the extension of previous postschool outcomes research beyond employment and postsecondary education to develop a comprehensive view of adult life engagement. In addition, future research regarding the influence of similar school transition experiences can be anticipated, given the similarity of outcomes.

Explaining Functioning Disparities Associated with Social Participation and Functioning in SCI

To examine race/ethnicity differences in quality of life outcomes in adults with a spinal cord injury (SCI) and whether these gaps are attributable to differences in socioeconomic background and health risk behaviors.

Binocular pattern deprivation interferes with the expression of proteins involved in primary visual cortex maturation in the cat.

BackgroundBinocular pattern deprivation from eye opening (early BD) delays the maturation of the primary visual cortex. This delay is more pronounced for the peripheral than the central visual field representation within area 17, particularly between the age of 2 and 4 months [Laskowska-Macios, Cereb Cortex, 2014].ResultsIn this study, we probed for related dynamic changes in the cortical proteome. We introduced age, cortical region and BD as principal variables in a 2-D DIGE screen of area 17. In this way we explored the potential of BD-related protein expression changes between central and peripheral area 17 of 2- and 4-month-old BD (2BD, 4BD) kittens as a valid parameter towards the identification of brain maturation-related molecular processes. Consistent with the maturation delay, distinct developmental protein expression changes observed for normal kittens were postponed by BD, especially in the peripheral region. These BD-induced proteomic changes suggest a negative regulation of neurite outgrowth, synaptic transmission and clathrin-mediated endocytosis, thereby implicating these processes in normal experience-induced visual cortex maturation. Verification of the expression of proteins from each of the biological processes via Western analysis disclosed that some of the transient proteomic changes correlate to the distinct behavioral outcome in adult life, depending on timing and duration of the BD period [Neuroscience 2013;255:99-109].ConclusionsTaken together, the plasticity potential to recover from BD, in relation to ensuing restoration of normal visual input, appears to rely on specific protein expression changes and cellular processes induced by the loss of pattern vision in early life.Electronic supplementary materialThe online version of this article (doi:10.1186/s13041-015-0137-7) contains supplementary material, which is available to authorized users.

Exploring assistive technology and post-school outcomes for students with severe disabilities

Purpose: This study sought to understand the extent to which students with severe disabilities receive assistive technology in school and out-of-school, and the relationship between receipt of assistive technology in school and post-school outcomes for these students. Method: This study was a secondary analysis of the National Longitudinal Transition Study-2 (NLTS2) from the USA. To analyze the data in this correlational study, researchers conducted frequency distributions, Chi Square Tests of Associations, significance tests and logistic regressions. Results: The main results suggest (a) receipt of assistive technology in school varied greatly by disability identification; (b) receipt of assistive technology post-school also varied by disability identification, but receipt was generally lower; and (c) few statistically significant post-school outcome differences existed between students who received assistive technology and those who did not. Conclusion: An under-utilization of assistive technology exists in practice in the USA for students with severe disabilities.Implications for RehabilitationAn under-utilization of assistive technology for secondary students and adults with severe disabilities likely exists.A need exists for improved collaboration between professionals in rehabilitation and professionals in schools to ensure continuation of needed services or aids, such as assistive technology.Additional research is needed to better understand the adult life (or post-school) outcomes of individuals with severe disabilities, factors from PK-12 schooling or post-school services that positively and negative impact those outcomes.

Traumatic brain injury and adverse life events: Group differences in young adults injured as children

Objectives: To investigate whether individuals with a history of traumatic brain injury (TBI) experience a greater number of adverse life events (ALE) compared to controls, to identify significant predictors of experiencing ALE and whether the severity of childhood TBI negatively influences adult life outcomes.Design: A total of 167 individuals, injured prior to age 18, 5 or more years post-injury and 18 or more years of age, were recruited in the Canterbury region of New Zealand, with 124 having sustained childhood TBI (62 mild, 62 moderate/severe) and 43 orthopaedic injury controls. Participants were asked about ALE they had experienced and other adult life outcomes.Results: Individuals with a history of TBI experienced more ALE compared to controls. The number of ALE experienced by an individual was associated with more visits to the doctor, lower education level and lower satisfaction with material standard of living.Conclusions: Childhood TBI is associated with an increased number of ALE and adult negative life outcomes. Understanding factors that contribute to negative outcomes following childhood TBI will provide an avenue for rehabilitation and support to reduce any problems in adulthood.

Quality of life outcomes in surgically treated adult scoliosis patients: a systematic review.

The aim of this systematic review was to identify prospective studies reporting the impact of surgical intervention on health-related quality of life (HRQL) outcomes for adults with scoliosis at a minimum 2 year follow-up. An electronic database search was conducted for January 2000-November 2013 in conjunction with a reference list search of two related systematic reviews for prospective studies of adults with scoliosis reporting HRQL outcome measure. Methodological quality of included articles was assessed using the Downs and Black checklist. Cohen's d effect size was calculated for Scoliosis Research Society Questionnaire (SRS) and Oswestry Disability Index (ODI) outcomes for included studies and pooled data. The database and reference list searches returned 349 potential articles; three articles met the inclusion criteria. Downs and Black scores ranged from 18/28 to 21/28 (fair-good quality evidence). Total number of 188 patients were treated surgically and had a mean age of 38 years or older. All studies showed significant improvement in reported HRQL outcomes for at least a 2 year follow-up. The Cohen's d effect size for SRS was d = 1.4 (n = 188, 95 % CI; 0.9, 1.8) and for ODI d = 0.9 (n = 120, 95 % CI; 0.4, 1.4). Findings from this review suggest surgery improves HRQL in patients with adult scoliosis at a minimum 2 year follow-up. However, these findings are based on limited data of fair to good quality which needs to be taken into consideration when interpreting the results and highlights the need for additional high quality prospective studies.

Conversational turn-taking in adults with acquired brain injury

Background: Social communication problems are a major contributor to negative life outcomes for adults with brain injury, yet the basic skill deficits underlying these problems are poorly understood.Aim: To examine one aspect of social communication that may have a negative impact on social interactions: the ability to successfully take turns in a conversation.Methods & Procedures: Seventeen adults with traumatic brain injury and two with bilateral strokes, and their typical peers matched for age and sex, viewed video-recorded conversations and indicated when they could join in the conversation. Turn timing was compared between groups using a novel statistical method designed for this study.Outcomes & Results: There was a significant between-groups difference in timing of turn-taking but no significant difference in number of turns. The novel analysis method revealed between-groups differences in responding to specific conversational cues.Conclusions: Adults with brain injury may miss or misinterpret verbal and non-verbal cues to turn-taking, which could contribute to conversation partners’ perceptions of impaired conversation skills in adults in this population.

Outcomes in adult life among siblings of individuals with autism.

Little is known about adult siblings of individuals with autism. We report on cognitive, social and mental health outcomes in 87 adult siblings (mean age 39years). When younger all had been assessed either as being "unaffected" by autism (n=69) or as meeting criteria for the "Broader Autism Phenotype" (BAP, n=18). As adults, all scored within the average range on tests of intelligence, numeracy and literacy. "Unaffected" siblings were functioning well in terms of jobs, independence and social relationships. Levels of social relationships and employment were significantly lower in the BAP group; autism traits and mental health problems were significantly higher. The data suggest that the "broader autism phenotype" is a meaningful concept but more sensitive diagnostic measures are required.