The need for transition of care for adult survivors of chronic conditions of childhood onset is an area that has received increasing attention in the healthcare literature; however, gaps in understanding and implementation persist. The complexity of transitioning from pediatric to adult care environments present numerous challenges for patients, their families, and health care providers. Ineffectual transitions can result in increased morbidity, a decline in quality of life, and unnecessary health care spending. The fundamental challenges in transitions of care for this population originates from a lack of institutional support to develop structured transition protocols. Healthcare institutions lack impetus to develop transition programs as their utility has not been sufficiently demonstrated because of inadequate research upon which to base clinical decisions. Therefore, patients transitioning from pediatric to adult care often confront difficulties ranging from fragmented care coordination to extended lapses continuous care, which can exacerbate the progression of their chronic conditions. The primary aim of this study is to examine the current literature regarding the ability of pediatric to adult transition programs for survivors of chronic disease to determine whether they are effective in delaying disease progression. The secondary aim is to examine whether evidence exists to demonstrate cost effectiveness of such interventions. Subsequently we explore potential barriers to adoption for healthcare institutions to adopt pediatric to adult transition care programs on a broad scale. This systematic review employs methodology to extract, analyze and synthesize data from relevant peer-reviewed articles, observational studies, and clinical trials. Preliminary findings indicate that improving transition protocols can indeed enhance patient outcomes, potentially reduce hospital readmissions, and may thereby be cost-effective for health care organizations. We posit that providing optimized transitions of care during this vulnerable life stage could enhance patient outcomes for managing various chronic conditions of childhood onset supporting the argument that better transitions of care are not only desirable but also achievable and worthwhile goals for health care systems to adopt. By examining the intricacies of transitioning care for adult survivors of chronic conditions of childhood onset, we aim to open a critical dialog and make recommendations for future research and clinical practice that may significantly impact health care practices, models, and policies thereby potentially and significantly impacting health for adult survivors. / Urban Bioethics

First-generation and low-income college graduates are an invisible minority within medicine that has gone largely unstudied. I explored their unique experiences to better understand how diversity and inclusion can be improved. Through gathering stories from students, residents, and attending physicians, I identified unique challenges that they face, and formulated strategies to address them. First-generation college graduates in medicine have a unique set of strengths, challenges, and opportunities that position them to be valuable physicians in the communities that they serve. The American Medical Association states that when minority students finish medical school and residency, they go on to serve society in a way that has not been done before. Furthermore, they are more likely to serve underserved and minority populations, in turn fostering justice and equity in medicine. Some of the qualities that most first-generation college graduates possess that make them well-suited to become successful physicians are resilience, self-motivation, and efficacy. Paving the path for future physicians is a tremendous pressure that can motivate or overwhelm them as they trailblaze their way through medicine. There is an accumulated disadvantage as they are more likely to be underprepared academically, to have less guidance, and to have more financial struggles. First-generation students have several traits that characterize them as an at-risk population in higher education; they take longer to complete their bachelor’s degree and have lower degree aspirations when compared with their peers. They also face moral distress and a growing disconnect as they balance their familial obligations with academics and experience social mobility. Though these are factors that impact their success in college, they do not cease to pose issues when they successfully enter medical school and have to navigate the culture and hierarchy of medicine, as well as the disparate allocation of resources in medical school as they are not deemed as underrepresented in medicine. By understanding these factors, administrators can strengthen pipeline programs and support systems. In supporting the next generation of first-generation physicians at all stages of their training, they can promote a workforce as diverse as the patients it serves. / Urban Bioethics

American children growing up in poor urban communities experience a disproportionate amount of direct and indirect violence in addition to the challenges of growing up with limited resources. Due to high amounts of physical and structural violence in these communities, urban youth are at increased risk for complex post-traumatic stress disorder (C-PTSD) and its associated sequelae, such as asthma, obesity, diabetes, and behavioral problems. Evidence demonstrates that sexual abuse and repeated interpersonal trauma leads to more intense symptomatology than traditional post-traumatic stress disorder (PTSD), and traumatic events in early childhood predisposes one to a C-PTSD reaction. This literature review of complex trauma serves to further validate the need for modern psychiatry to recognize C-PTSD as a diagnosis and to identify treatment interventions for this vulnerable population. / Urban Bioethics