Explore the vast range of titles available.

Emerging adulthood, the developmental stage between ages 18 and 25, presents unique barriers to former foster youth, who experience higher rates of unplanned pregnancy and homelessness and poorer educational attainment than their peers during this time. This study uses interviews with 20 youth formerly in foster care who exhibit better-than-average outcomes to explore contextual aspects of resilience during emerging adulthood, elucidating how both relational and organizational support contribute to their resiliency. Implications for social work policy and practice are discussed.

A long-standing belief in the value of independence has led to an emphasis on self-sufficiency in our programming, policy, and practice responses toward youth aging out of the foster care system— an ideal that often is difficult for young people to achieve. However, a growing body of research on interdependence suggests that healthy connections to trusted adults may better help youth navigate the transition to adulthood. Semi-structured interviews conducted with 20 youth explored conceptualizations of independence in the context of emancipation. Using thematic content analysis, themes indicate contradictory and deterministic ideas about self-sufficiency and adulthood. Findings imply tensions between independence and a developmentally normative need for interdependence during the period of emerging adulthood.

Emerging adulthood, the developmental stage between ages 18 and 25, presents unique barriers to former foster youth, who experience higher rates of unplanned pregnancy and homelessness and poorer educational attainment than their peers during this time. This study uses interviews with 20 youth formerly in foster care who exhibit better-than-average outcomes to explore contextual aspects of resilience during emerging adulthood, elucidating how both relational and organizational support contribute to their resiliency. Implications for social work policy and practice are discussed.

A long-standing belief in the value of independence has led to an emphasis on self-sufficiency in our programming, policy, and practice responses toward youth aging out of the foster care system--an ideal that often is difficult for young people to achieve. However, a growing body of research on interdependence suggests that healthy connections to trusted adults may better help youth navigate the transition to adulthood. Semi-structured interviews conducted with 20 youth explored conceptualizations of independence in the context of emancipation. Using thematic content analysis, themes indicate contradictory and deterministic ideas about self-sufficiency and adulthood. Findings imply tensions between independence and a developmentally normative need for interdependence during the period of emerging adulthood.

BackgroundCigarette smoking is the strongest risk factor for COPD. Smoking burden is frequently measured in pack-years, but the relative contribution of cigarettes smoked per day versus duration towards the development of structural lung disease, airflow obstruction and functional outcomes is not known.MethodsWe analysed cross-sectional data from a large multicentre cohort (COPDGene) of current and former smokers. Primary outcome was airflow obstruction (FEV1/FVC); secondary outcomes included five additional measures of disease: FEV1, CT emphysema, CT gas trapping, functional capacity (6 min walk distance, 6MWD) and respiratory morbidity (St George’s Respiratory Questionnaire, SGRQ). Generalised linear models were estimated to compare the relative contribution of each smoking variable with the outcomes, after adjustment for age, race, sex, body mass index, CT scanner, centre, age of smoking onset and current smoking status. We also estimated adjusted means of each outcome by categories of pack-years and combined groups of categorised smoking duration and cigarettes/day, and estimated linear trends of adjusted means for each outcome by categorised cigarettes/day, smoking duration and pack-years.Results10 187 subjects were included. For FEV1/FVC, standardised beta coefficient for smoking duration was greater than for cigarettes/day and pack-years (P<0.001). After categorisation, there was a linear increase in adjusted means FEV1/FVC with increase in pack-years (regression coefficient β=−0.023±SE0.003; P=0.003) and duration over all ranges of smoking cigarettes/day (β=−0.041±0.004; P<0.001) but a relatively flat slope for cigarettes/day across all ranges of smoking duration (β=−0.009±0.0.009; P=0.34). Strength of association of duration was similarly greater than pack-years for emphysema, gas trapping, FEV1, 6MWD and SGRQ.ConclusionSmoking duration alone provides stronger risk estimates of COPD than the composite index of pack-years.Trial registration numberPost-results; NCT00608764.

BackgroundWhile some retrospective studies have suggested that β-blocker use in patients with COPD is associated with a reduction in the frequency of acute exacerbations and lower mortality, there is concern that their use in patients with severe COPD on home oxygen may be harmful.MethodsSubjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2–4 COPD participating in a prospective follow-up of the COPDGene cohort, a multicentre observational cohort of current and former smokers were recruited. Total and severe exacerbation rates were compared between groups categorised by β-blocker use on longitudinal follow-up using negative binomial regression analyses, after adjustment for demographics, airflow obstruction, %emphysema on CT, respiratory medications, presence of coronary artery disease, congestive heart failure and coronary artery calcification, and after adjustment for propensity to prescribe β-blockers.Results3464 subjects were included. During a median of 2.1 years of follow-up, β-blocker use was associated with a significantly lower rate of total (incidence risk ratio (IRR) 0.73, 95% CI 0.60 to 0.90; p=0.003) and severe exacerbations (IRR 0.67, 95% CI 0.48 to 0.93; p=0.016). In those with GOLD stage 3 and 4 and on home oxygen, use of β-blockers was again associated with a reduction in the rate of total (IRR 0.33, 95% CI 0.19 to 0.58; p<0.001) and severe exacerbations (IRR 0.35, 95% CI 0.16 to 0.76; p=0.008). Exacerbation reduction was greatest in GOLD stage B. There was no difference in all-cause mortality with β-blocker use.Conclusionsβ-Blockers are associated with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction. The findings of this study should be tested in a randomised, placebo-controlled trial.Trial registration number(ClinicalTrials.gov NCT00608764).

Michael Cho and colleagues report a genome-wide association study of risk for chronic obstructive pulmonary disease (COPD) in a large, multi-ancestry cohort. They identify 22 genome-wide significant loci, including 13 not previously associated with COPD and 4 not previously associated with any lung function trait. Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide 1 . We performed a genetic association study in 15,256 cases and 47,936 controls, with replication of select top results ( P < 5 × 10 −6 ) in 9,498 cases and 9,748 controls. In the combined meta-analysis, we identified 22 loci associated at genome-wide significance, including 13 new associations with COPD. Nine of these 13 loci have been associated with lung function in general population samples 2 , 3 , 4 , 5 , 6 , 7 , while 4 ( EEFSEC , DSP , MTCL1 , and SFTPD ) are new. We noted two loci shared with pulmonary fibrosis 8 , 9 ( FAM13A and DSP ) but that had opposite risk alleles for COPD. None of our loci overlapped with genome-wide associations for asthma, although one locus has been implicated in joint susceptibility to asthma and obesity 10 . We also identified genetic correlation between COPD and asthma. Our findings highlight new loci associated with COPD, demonstrate the importance of specific loci associated with lung function to COPD, and identify potential regions of genetic overlap between COPD and other respiratory diseases.