Objective Based on social ecological theory, this study was designed to examine the unique relationships between multi-level ecological factors and psychological symptoms in young adults with spina bifida (SB). Method A sample of 61 individuals with SB, 18–25 years of age, completed standardized self-report measures of attitude toward SB, satisfaction with family functioning, Chronic Care Model (CCM) services, and depressive and anxiety symptoms. A chart review yielded SB clinical data. Results High rates of depressive and anxiety symptoms were found. Hierarchical regression analysis identified the proximal individual (attitude toward SB) and family (satisfaction with family functioning) factors as more strongly related to depressive symptoms than the distal healthcare system factor (CCM services). Self-reported pain was the only ecological factor associated with anxiety symptoms. Conclusions Study findings provide a potential foundation for multi-factor screening of young adults with SB at risk for psychological symptoms.

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This paper describes how Gillette Specialty Healthcare developed a program to meet the specialty-care outpatient and in-patient needs of children with cerebral palsy (CP) and other serious congenital disabilities as they made the transition to early adulthood. The program began in 2001, with the opening of a pilot clinic for adult outpatients. Several years later, the hospital opened a small in-patient unit for selected patients. Careful planning, consultation with staff, and partnerships with caregivers were crucial to program development. Attention to the physical environment was also essential. Utilizing an integrative model of care, the patient, caregivers, and the program service providers create a comprehensive plan of care that reflects each patient's needs, preferences, and priorities. The Gillette program, when evaluated over the long term, may serve as a model for meeting the emerging needs of the young adult with CP.

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A systematic review of the pressure management performance of support surfaces (beds, mattresses, overlays, and the utilization of linens), using a standardized testing methodology, provided qualitative and quantitative information needed to support cost-effective purchasing decisions and resulted in the reduction of hospital-acquired pressure ulcers. In the 30 months since implementation of the new surfaces, use guidelines, and educational programs, zero surface-related stage 3, 4 and unstaged pressure ulcers have occurred despite a high-risk patient population.