Pre-transition Period Research Articles

Rapid uptake of adjunctive corticosteroids for critically ill adults with septic shock following publication of ADRENAL trial. A multicenter, retrospective analysis of prescribing practices in Queensland Intensive Care Units

BackgroundSeptic shock is common and associated with significant morbidity and mortality. The ADRENAL trial examined the use of hydrocortisone in patients with septic shock, demonstrating no difference in patient-centred outcomes but a decrease in the time to shock resolution. The change in clinical practice related to the publication of the ADRENAL trial is currently unknown. MethodsA retrospective cohort study examining the use of hydrocortisone in patients with septic shock was conducted in 12 intensive care units (ICUs). A segmented linear regression was performed to identify a stepwise change in hydrocortisone administration and 90-day mortality associated with the publication of the ADRENAL trial. ResultsWe included 4,198 patients with a mean age of 58 years (standard deviation, SD17), and the median noradrenaline equivalent score (NEE) was 0.07 µg/kg/min (IQR 0.02 – 0.17). Segmented regression analysis for hydrocortisone administration identified two breakpoints, 3 months before and 6 months after publication, leading to three periods: Pre-publication, Transition and Post-publication. Compared to the pre-publication period, the Transition and Post-publication cohorts had a higher proportion of hydrocortisone administration (28% vs. 34% vs. 43%; p < 0.0001). Furthermore, after adjustment for temporal change, the transition period had a significant change in the slope of the proportion of patients receiving hydrocortisone (-0.1% per month vs. +1.4% per month; p = 0.026), whereas this was not statistically significant during the post-publication period (+0.1% per month, p = 0.66). After adjusting for confounders, the Transition and Post-publication periods were independently associated with an increase in hydrocortisone (OR 1.4, 95% CI 1.14 – 1.77; p = 0.0015 and OR 2.03; 95% CI 1.74 – 2.36; p < 0.001, respectively). Furthermore, after adjusting for confounders, when compared to the Pre-transition period, the use of hydrocortisone was associated with a statistically significant decrease in 90-day mortality (14% vs. 24% absolute difference, aHR for hydrocortisone effect -0.81; 95% CI 0.65 – 0.99; p = 0.044). ConclusionPublication of the ADRENAL trial changed clinical practice in Queensland ICUs with increased prescription of hydrocortisone for patients with septic shock with an associated reduction in mortality.

Identity Transition of English Pre Service Teachers Studying at Teacher Profession Education Program

The identity transition of four prospective professional teachers while undergoing a professional development program is essential to consider. This research aims to understand the dynamics and processes that allow professional identities to develop and change. This research uses qualitative research and Schlossberg's transition model as a framework. The research participants were four prospective teachers from the Teacher Professional Education program. Data collection was carried out using the narrative inquiry method. The data analysis technique uses qualitative descriptive analysis. This study found that identity trajectories from the pre-transition period contributed to their current identity transition. Their previous change in identity was because teaching is an honorable profession with other perceived benefits, such as economic and cultural capital. In this program, prospective teachers said there was a transformation in their professional experience. The study emphasizes the importance of continuing education for prospective teachers to become professional teachers. Teacher education plays a vital role in ensuring that teachers have a strong foundation in the theory and practice of education. Qualified teachers are critical in providing effective and quality education to students, so teacher education is essential to the education system.

The oceanic mixed layer changes along with the state transition of the Beaufort Gyre

Recent state transition of the Beaufort Gyre has drawn great interest in the Arctic research community, but how the upper ocean hydrographic structure varies with this transition remains poorly understood. The upper ocean mixed layer plays an important role in climatic and ecological processes. Therefore, we analyze the Ice-Tethered Profiler (ITP) observations over the last two decades (2004–2022) to investigate the long-term trend of the mixed layer in the Arctic Ocean’s Beaufort Gyre (BG) from an observational perspective. Results show that the linear trend of the BG surface mixed layer depth (MLD) before and after 2015 has changed significantly, characterized by the vanishing or even reversal of the significant deepening trend. This transition is most pronounced in winter. The BG winter mixed layer is significantly cooler, saltier and denser in the mid-transition period (2013–2017) compared to the pre-transition period (2004–2012), but becomes significantly warmer, fresher and lighter in the post-transition period (2018–2022). The transition feature of the depth of maximum buoyancy frequency in the upper BG is similar to that of MLD, while this maximum decreases significantly in both the mid- and post-transition period when compared to their previous period. The deepening signal of MLD is propagated eastward, which coincides with the recent transition of BG position and freshwater distribution. Mechanism analysis further reveals that the reversal of winter MLD trend before and after 2015 may be due to changes in surface wind stirring and Ekman pumping. This study extends the investigation of the recent state transition of BG considering the upper hydrographic structure.

193: PROGRAM-WIDE TRANSITION FROM HEPARIN TO BIVALIRUDIN ANTICOAGULATION IN ADULT ECMO: A COST ANALYSIS

Introduction: Bivalirudin is becoming an increasingly popular alternative to heparin for extracorporeal membrane oxygenation (ECMO) anticoagulation due to its short half-life, organ-independent metabolism, thrombin inhibition without the need for a co-factor, and its ability to bind clot-bound and freely circulating thrombin. The objective of this study was to compare the cost implications of bivalirudin and heparin during adult ECMO support. Methods: A retrospective analysis of adults supported on ECMO who received heparin or bivalirudin for anticoagulation between January 2014 and January 2022 at Mayo Clinic was performed. In November 2017, the Mayo Clinic ECMO program transitioned from heparin to bivalirudin as the primary anticoagulant of choice, which separated the pre- and post-transition groups. Cost data were estimated using Wholesale Acquisition Costs and laboratory reimbursement schedules. Cost data were normalized to duration of ECMO support, compared between the pre- and post-transition groups, and were summarized in United States Dollar ($). Results: A total of 126 patients (123 heparin, 3 bivalirudin) in the pre-transition period and 275 patients (82 heparin, 193 bivalirudin) in the post-transition period were included. Antithrombin administration was more frequent in the pre-transition group (31% vs. 12%, p < 0.0001), as were number of coagulation assays per ECMO day (6.1 vs. 5.4, p = 0.0004). The post-transition group had significantly less costs from antithrombin assessments ($1.03 vs. $11.78, p < 0.0001) and antithrombin supplementation ($0 [IQR $0, $0] vs. $0 [IQR $0, $312.82], p < 0.0001) per day of ECMO support. The aggregate costs per patient were similar in the heparin ($333 vs. $248, p = 0.5690) and bivalirudin ($2723 vs $1720, p = 0.4659) groups pre- and post-transition, respectively. Survival at 28-days was greater in the post-transition group (75% vs. 64%, p = 0.0286). Conclusions: Antithrombin assessment and supplementation comprised a majority of anticoagulant-related costs in heparin-based ECMO patients, which was significantly reduced following transition to bivalirudin-based anticoagulation. When considering laboratory and drug costs in aggregate, there is a favorable association between bivalirudin and heparin anticoagulation in adult ECMO patients.

Does a ‘reform’ socialist legacy serve as an asset or a liability for democratic transformation? Considering some roots of ‘orbanism’

ABSTRACT A commonly held assumption in the transition literature suggests that earlier successes with reforms in Central and East European countries would serve as an asset when the regime changed. Taking Hungary as a case in point, the author revisits the legacies from pre-transition period, calling for differentiating between short and long-term effects of the reform legacy. Emphasised is that Western stakeholders tended to misjudge the starting position of transition nations, generally. This inquiry exposes the role of institutions of democracy, market order, and rule of law in socio-economic transformation, highlighting the contradiction between formal institutional conformity with EU rules and the diverging tendencies in some countries concerning substance of market (e.g. competition) and liberal democracy (checks and balances, separation of constitutional branches). The Hungarian case assists in explaining the emergence of symptoms of a crony state, and the seemingly high-level of tolerance for organised corruption and favouritism.

The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda

BackgroundAlthough donor transitions from HIV programs are more frequent, little research exists seeking to understand the perceptions of patients and providers on this process. Between 2015 and 2017, PEPFAR implemented the ´geographic prioritization´ (GP) policy in Uganda whereby it shifted support from 734 ‘low-volume’ facilities and 10 districts with low HIV burden and intensified support in select facilities in high-burden districts. Our analysis intends to explore patient and provider perspectives on the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda.MethodsWe report qualitative findings from a larger mixed-methods evaluation. Six facilities were purposefully selected as case studies seeking to ensure diversity in facility ownership, size, and geographic location. Five out of the six selected facilities had experienced transition. A total of 62 in-depth interviews were conducted in June 2017 (round 1) and November 2017 (round 2) with facility in-charges (n = 13), ART clinic managers (n = 12), representatives of PEPFAR implementing organizations (n = 14), district health managers (n = 23) and 12 patient focus group discussions (n = 72) to elicit perceived effects of transition on HIV service delivery. Data were analyzed using thematic analysis.ResultsWhile core HIV services, such as testing and treatment, offered by case-study facilities prior to transition were sustained, patients and providers reported changes in the range of HIV services offered and a decline in the quality of HIV services offered post-transition. Specifically, in some facilities we found that specialized pediatric HIV services ceased, free HIV testing services stopped, nutrition support to HIV clients ended and the ‘mentor mother’ ART adherence support mechanism was discontinued. Patients at three ART-providing facilities reported that HIV service provision had become less patient-centred compared to the pre-transition period. Patients at some facilities perceived waiting times at clinics to have become longer, stock-outs of anti-retroviral medicines to have been more frequent and out-of-pocket expenditure to have increased post-transition.ConclusionsParticipants perceived transition to have had the effect of narrowing the scope and quality of HIV services offered by case-study facilities due to a reduction in HIV funding as well as the loss of the additional personnel previously hired by the PEPFAR implementing organizations for HIV programming. Replacing the HIV programming gap left by PEPFAR in transition districts with Uganda government services is critical to the attainment of 90–90-90 targets in Uganda.

Adapting Family Size and Composition: Childhood Mortality and Fertility in Rural Spain, 1750–1949

An event-history analysis of ten rural villages in Spain from 1750 to 1949 indicates that the likelihood of parents having additional children was influenced by the number of their surviving children and the children’s sex composition. Parents whose children had a low survival rate had more children than parents whose children generally survived. Exclusively having daughters during the pre-transitional period also reflected, to a limited degree, the likelihood of new conception. The results suggest that some families adapted their reproductive behavior to their desired objectives. In the pre-transitional period, as well as during the transition itself, decisions to control or encourage fertility often appear to have been based on family size and composition.

The Contrasting Effects of Education on Fertility over Time Casalguidi, 1819–1960

AbstractEducation has been frequently claimed to shape demographic outcomes. Mortality, fertility, and nuptiality have all been attested to be affected to some extent by education attainment. This article investigates the effects of education on fertility over time in a rural Italian community once controlled for potential confounders. Using individual-level data drawn from various sources, the study analyzes the role of education in shaping reproductive behaviors not only during the demographic transition (1890–1960) but also in the pretransitional period (1819–59). The results highlight the contrasting effects of literacy on fertility, which passed from a positive association in the ancien régime to a negative one in the transitional phase. Educated couples were therefore forerunners in the process of fertility decline because they were not only in the position to be the most pressed to control reproduction but also because they were likely aware of reproductive mechanisms, had the knowledge of more effective birth-control methods, had the economic possibility to get them, and had the necessary capacity to use them.

\u201cObjectively terrifying\u201d: a qualitative study of youth\u2019s experiences of transitions out of child and adolescent mental health services at age 18

BackgroundMental health issues presenting in childhood often persist into adulthood, usually requiring youth to transition from child and adolescent mental health services to adult mental health services at 18 years. Discontinuity of care during this transition period is well-documented and can leave youth vulnerable to adverse mental health outcomes. There is growing recognition of the need to improve transition-related care for youth leaving the child and adolescent mental health system. However, the perspectives and experiences of youth have not always been forefront in these discussions, and in particular, the perspectives of youth in the pre-transition period. This study qualitatively explores transition-related knowledge and experiences of youth both prior-to and after transition.MethodsA purposive sample of youth aged 16–19 years was recruited from two child and adolescent mental health programs. Youth were enrolled as part of a longitudinal follow-up study and had the opportunity to opt into this study. Interviews were transcribed and coded using NVivo11 software. Main themes were distilled through descriptive analysis following the principles of directed content analysis. The study followed the principles of participatory action research, engaging youth with lived experience navigating transitions in each stage of the study.ResultsIn-depth, semi-structured interviews were conducted with 14 pre-transition and 8 post-transition youth. All youth reported having either a mood and/or anxiety disorder for which the majority were receiving treatment at the time of the interview. The participants’ experiences were distilled into six major themes. Youth advocated for being considered partners in transition planning and to have increased control over transition-related decisions. Youth also made specific recommendations on how to improve continuity of care during the transition process.ConclusionsTransition planning should be individualized for each youth based on their developmental needs, transition readiness and ongoing mental health needs. Transition pathways, co-designed with youth and caregivers, should be developed to guide providers in transition best practices. Obtaining both the pre- and post-transition experiences of youth is crucial for developing a more complete of understanding of youth perspectives and implementing guidelines that improve transition quality and experiences.

Effect of an Electronic Health Record Transition on the Provision of Recommended Well Child Services in Pediatric Primary Care Practices.

We sought to determine the effect of transitioning between electronic health record (EHR) systems on the quality of preventive care in a large pediatric primary care network. To study this, we performed a retrospective chart analysis of 42 primary care practices from the Pediatric Physicians' Organization at Children's who transitioned EHRs. We reviewed 24 random encounters per week distributed evenly across 6 age categories before, during, and after a transition period. We reviewed encounter documentation for age-appropriate well child services, per American Academy of Pediatrics/Bright Futures guidelines. Logistic regression and statistical process control analysis were used. In the pretransition period, 84.5% of all recommended elements were documented versus 86.4% posttransition (P = .04). Documentation of age-appropriate anticipatory guidance showed significant positive change (69.0% to 80.2%, P = .005), but it was the only subdomain with a statistically significant increase. These increases suggest that EHR transitions have the opportunity to affect the delivery of preventive care.

Quantifying natural and anthropogenic impacts on runoff and sediment load: An investigation on the middle and lower reaches of the Jinsha River Basin

Study regionThe middle and lower reaches of the Jinsha River Basin (MLJRB). Study focusThe main objective is to evaluate the impact of climate change and anthropogenic activities to the water and sediment resources of the studied region in 1960—2015. The variation of runoff and suspended sediment load is first analyzed with regard to their trends and abrupt change. Different factors attributable to the variation are then quantitatively separated. New hydrological insights for the regionThe annual runoff and sediment load across the MLJRB both decreased abruptly and coincidently in the recent two decades, with the transitional years detected to be 2006 and 2002, respectively. Comparing the post-transition period to the pre-transition period, runoff decreased 14.7% and sediment load decreased 63%. Climate change is the major contribution for the decrease in runoff, which explains 56.3% of the reduction, and impoundment of large reservoirs and water consumption contributed 18.6% and 2.7% respectively. The other 22.5% was ascribed to water-soil conservation and other factors. In contrast to water resources, human activities were dominant in sediment reduction, including 44.9% caused by large reservoirs, 1% from increased water consumption and 35% by conservation measures and other potential factors. Remarkably, almost 90% of the sediment load can be trapped as the direct consequence of the construction and operation of two huge dams, Xiluodu and Xiangjiaba, since 2013.

Association of Surgical Setting and Deployment of a New Electronic Health Record With Ophthalmic Operative Times

Determining the association of surgical setting and implementation of a new electronic health record (EHR) system with ophthalmic operative times is important for surgical planning and resource allocation. To assess the associations of surgical setting and EHR system replacement with operative times for ophthalmic surgery. This case series included ophthalmic surgeries from July 2015 to November 2016 in 2 ambulatory surgical centers and 1 hospital outpatient department in a single academic eye institute. Operative times from consecutive surgical cases performed by board-certified ophthalmologists were extracted from 2 EHR systems. Those performed after replacement EHR system implementation were divided into three 50-day time categories (immediate posttransition, intermediate posttransition, and late posttransition periods). Multivariable regression analyses assessed the associations of surgical setting (hospital outpatient department vs ambulatory surgical center) with total operating room times for comparable surgeons performing cataract surgery and deployment of a new EHR system in the OR on several operative time measures. Data were evaluated from November 2016 to March 2018. Room duration, procedure duration, turnaround time, and total OR time. A total of 11 064 cases performed by 76 surgeons were included in this analysis. The mean total OR time was 2.9 (95% CI, 0.5-5.4; P = .02) minutes longer in the immediate posttransition period and 1.2 (95% CI, 0.1-2.2; P = .04) minutes longer in the intermediate posttransition period relative to surgeries performed before EHR system replacement. No difference in the total OR time was found between the late posttransition and pretransition periods. Relative to ambulatory surgical centers, the mean total OR time was 15.9 (95% CI, 14.7-17.0) minutes longer, and the mean turnaround time was 5.1 (95% CI, 4.3-6.0) minutes longer at the hospital outpatient department for comparable surgeons performing cataract surgery (P < .001 for both). The mean total OR time per case lengthened after the replacement of an EHR system in the OR, but this increase was small (shorter than 3 minutes) and limited to surgeries performed during the first 100 days after the EHR system transition. Modeling to assess surgical setting demonstrated all operative time measures were longer for cataract cases performed at the hospital outpatient department relative to those at ambulatory surgical centers. These data have implications for the fiscal and logistical management of ophthalmic surgery.

Secondary school transition for students with special educational needs in Ireland

ABSTRACTThe transition from primary to secondary school represents one of the key junctions in the educational career of young people. Research has shown that much of the challenge in this transition stems from changing social structures and encountering different learning environments. However, the transition experiences of students with special educational needs (SEN) have received relatively little attention. Drawing on large-scale longitudinal data from over 7000 young people, we examine the extent to which students with different SEN experience additional transition barriers to their peers. The findings show that young people with SEN are more likely to experience a negative transition to secondary school. Furthermore, the type of need matters and students with general learning disabilities and intellectual disabilities are three times more likely to experience poor transition compared to young people without SEN. Transition experiences also vary by gender and socio-economic status, with girls and lower socio-economic groups more at risk. This paper highlights the importance of supporting students through to their second year in secondary education, promoting positive teacher–student interactions and providing additional supports for those with lower achievement in primary school. For students with disabilities, the research highlights a need for more effective transition supports, particularly during the pre-transition period.

CHARACTERISTICS OF HUMAN RESOURCES MANAGEMENT MODEL IN PUBLIC ADMINISTRATION OF REPUBLIC OF SERBIA: CONTEMPORARY TRENDS AND CHALLENGES

Human resources management in the public administration of the Republic of Serbia is a combined model of good practices from the European administrative area and the remaining stereotypes from pre-transition period. Introduction of the public servant system with all features of contemporary public servant related legislation was a necessity that accompanied overall reform of the public administration in Serbia. The process of introducing human resources management function in the Serbian public administration has been encumbered with application of two different legal models that define the status of public servants: public servant related legislation is applied to employees in executive branches of the central government (ministries, government departments and offices), and the status of employees in city and municipal administrations is stipulated in obsolete laws, adopted over 20 years ago. It should be noted that employees in public sector are still prone to old habits in their work, which altogether reduces successful reforms in this area. This paper provides a description of the current state of affairs and opens certain questions: whether the modern human resources (HR) management in Serbia’s public sector is understood and accepted in the right way; and whether it is possible, by means of applying specific methods, to strengthen awareness of public employees concerning their actual position and responsibility to establish a new public administration, adjusted to the citizens’ needs, requirements and expectations. Relying on a decade-long personal engagement in this field, the author analyzes the current circumstances and provides critical remarks and recommendations.

The impact of the adoption of a patient rostering model on primary care access and continuity of care in urban family practices in Ontario, Canada

BackgroundGreater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs. Although patient rostering is considered to be a cornerstone of a high performing primary care system and is believed to improve continuity and access, few studies have examined these relationships. This study examined the impact of the adoption of a patient rostering enhanced fee-for-service model (eFFS) on continuity, coordination of specialized care, and access.MethodA population-based longitudinal study was conducted using health administrative data from urban family practices in Ontario, Canada. Family physicians that transitioned from traditional FFS (tFFS) to eFFS between 2004 and 2013 were followed overtime. Physicians providing comprehensive primary care that had at least 4 years of pre-transition and 2 years of post-transition data were eligible. Patients were attributed to physicians on an annual basis by determining the provider that billed the largest dollar amount over a 2 year period. Outcomes of interest were the usual provider of care index (UPC), a referral index (RI) (% of total primary care referrals for a physician’s roster made by the main provider), and emergency department (ED) visits for family practice sensitive conditions (FPSCs). Mixed-effects segmented linear and logistic regressions were used to examine changes in outcomes while controlling for patient and provider contextual factors.ResultsPrior to transitioning, UPC was decreasing at a rate of 0.27%/year (95% CI: -0.34 to − 0.21, p < 0.0001). Following the transition, UPC began decreasing by an additional 0.59%/year (95% CI: -0.69 to − 0.49, p < 0.0001) relative to the pre-transition rate. RI decreased by an additional 0.34%/year (95% CI: -0.43 to − 0.24, p < 0.0001) relative to the pre-transition period, where it had been stable. The transition had minimal impact on FPSC ED visits.ConclusionContinuity and coordination of specialized care slightly decreased upon transition from tFFS to eFFS. This is likely due to physicians working in groups and sharing patients following the transition to the eFFS model. Adoption of an enrolment model with after-hours care did not decrease non-urgent ED use, which may reflect the small impact that primary care access has on these types of ED visits.

BIM Transition Process in Construction Companies

Building Information Modeling (BIM) is considered among the most challenging developments in the Architectural, Engineering, and Construction (AEC) industries. BIM is a software based three-dimensional design process that helps the AEC staff obtain and manage the digitally represented building data to support engineering, construction, procurement, and installation activities. The diffusion of the BIM approach in the construction industry has gained acceleration in the last decade. With the advances in information technologies, existence of highly capable commercial software packages, and mandates dictated by the clients, many construction companies have started to employ BIM in their projects. This study aims to investigate the BIM transition process in the construction companies. An interview has been conducted with the executives of a Turkish construction company to analyze the BIM transition process, through three main phases: pre-transition period, transition period, and post-transition period. In the pretransition period, the motivations of the company to adopt the BIM approach are examined. In the transition period, the challenges encountered and preventive measures taken are indicated. In the post-transition period, the short- and long-term effects of adopting the BIM approach are discussed. The study is expected to guide the construction professionals that intend to implement BIM in their transition process.

Towards a BIM-based System Integrated to a Virtual Reality Platform

Building Information Modeling (BIM) is considered among the most challenging developments in the Architectural, Engineering, and Construction (AEC) industries. BIM is a software based three-dimensional design process that helps the AEC staff obtain and manage the digitally represented building data to support engineering, construction, procurement, and installation activities. The diffusion of the BIM approach in the construction industry has gained acceleration in the last decade. With the advances in information technologies, existence of highly capable commercial software packages, and mandates dictated by the clients, many construction companies have started to employ BIM in their projects. This study aims to investigate the BIM transition process in the construction companies. An interview has been conducted with the executives of a Turkish construction company to analyze the BIM transition process, through three main phases: pre-transition period, transition period, and post-transition period. In the pretransition period, the motivations of the company to adopt the BIM approach are examined. In the transition period, the challenges encountered and preventive measures taken are indicated. In the post-transition period, the short- and long-term effects of adopting the BIM approach are discussed. The study is expected to guide the construction professionals that intend to implement BIM in their transition process.

How was the fertility transition carried out? Analysis of fertility control strategies and their evolution in rural Aragon, Spain (1880-1955)

The aim of this article is to analyse the fertility control strategies employed by families during the fertility transition and to understand their evolution over time. To achieve that goal, this study identified the use and popularization of stopping and spacing. This analysis employed data on the inhabitants of 10 rural villages in the Huerva River valley in north-eastern Spain. The results revealed that in the first stages of the fertility transition, the same fertility control strategies used in the pre-transitional period were employed. However, stopping quickly became the most common strategy. Although women exercised some type of control over fertility at some point in their lives from the beginning of the fertility transition, it was not until the late 1920s that women who were controlling outnumbered those who were not (on 1 July of each year).

Perspective of Family Members of Transitions to Alternative Levels of Care in Anglo-Saxon Countries.

This scoping review explores circumstances surrounding the decision about, and eventual experience of, transitioning older adults into alternative levels of housing (ALH), such as long-term care. This topic is examined from a family member perspective, given their exposure and involvement in the care of older adult relatives during this transitional period. The scoping review methodology is based on the framework of Arksey and O'Malley and subsequent recommendations from Levac, Colquhoun, and O'Brien. Approximately 470 articles were reviewed covering the period between 2000 and November 2014; 37 articles met inclusion criteria. A temporal organization of themes was used to describe the experiences of family members in the pretransition, active transition, and posttransition periods of moving older adult relatives into ALH. This paper highlights the transitional period as a time of crisis, with a lack of planning, support, and transparent discussion. This study identifies a need for future research on the potential benefits of family support groups, interim transitional housing options, different models of ALH, changing roles in the posttransition period, and the need for a comprehensive list of housing options for older adults. Results have the potential to inform policy/practice and improve the lives of older adults and their family.

Estimativas de mortalidade para o Rio Grande do Norte em um contexto de pré-transição demográfica

Para períodos anteriores ao início da transição demográfica há poucos trabalhos quantitativos sobre o impacto da mortalidade na população. Com base nessa lacuna, o presente artigo estimou indicadores de mortalidade para o Rio Grande do Norte no contexto de pré-transição demográfica, utilizando dados do século XIX provenientes de mapas estatísticos de população (1801 e 1805) e de recenseamentos (1872 e 1890). Para lidar com as informações de população e óbito, empregou-se método de Growth Balance de Brass (1975), tabelas de vida de Coale e Demeny (1996), funções extraídas do The Human Mortality Database e técnica de padronização indireta. Como resultados, verificou-se que a mortalidade no Rio Grande do Norte se mostrou mais intensa na população infantil e naquela acima de 50 anos, que representam os segmentos mais vulneráveis às condições adversas como as secas e as doenças infecciosas. Obteve-se também uma expectativa de vida ao nascer de 32,6 anos, valor muito próximo às estimativas de Mortara (1941) para o Brasil entre 1870 e 1890. Sugerem-se novos estudos para o período de pré-transição demográfica e maior utilização de técnicas quantitativas em análises voltadas para o passado brasileiro.