The `Inventing Adulthoods' study seeks to document transitions to adulthood reported by over 100 young people living in five contrasting communities in the UK over a five-year period. A principal aim of the study is to identify `critical moments' in young people's biographies and to explore how these moments are implicated in processes of social inclusion and exclusion. This article reports on an analysis of the first of three rounds of one-to-one interviews. We begin by mapping young people's critical moments, exploring the relationship between the social and geographical location in which they live and the kinds of events that they report as having particular biographical significance. We suggest that the character of these `critical moments' is socially structured, as are young people's responses to them. The argument is illustrated by case studies that show the interaction of choice, chance and opportunity in three young people's lives.

* The perinatal necropsy rate in most of the United Kingdom fails to reach the minimum target of 75% * The quality of many perinatal postmortem examinations is considered poor * Present findings show that necropsy discloses the main cause of death in 18% of perinatal and infants deaths and other new information in a further 8% of deaths * Clinically important information is more likely to emanate from a good quality necropsy * Clinicians should take a more positive attitude towards postmortem examinations net increase in the number classified as dying of a congenital anomaly was only 4% as compared with 10% reported by Duley.'6 The classification was most frequently changed in spontaneous abortions and stillbirths, and so for epidemiological surveys it is particularly important to obtain a necropsy in these settings.This study has shown that necropsy is an invaluable investigation which is currently underused. The rate is likely to increase only if clinicians take a more positive attitude and realise how much clinically relevant information can be obtained from a good quality examination.We thank local convenors, district coordinators, and pathologists for help with data collection, and Professor D P Davies for reviewing the manuscript. We are particularly grateful to the survey administrator, Mrs J M Hopkins, for dedication to the project. The all Wales perinatal survey incorporates the confidential enquiry into stillbirths and deaths in infancy and is funded by the Welsh Office.

Traditionally adulthood and citizenship have been synonymous. Yet adulthood is changing. In this paper we explore how young people's evolving understandings of adulthood may contribute towards an understanding of citizenship within the broader context of increasingly extended and fragmented transitions. The paper draws on a unique qualitative longitudinal data set in which 100 young people, from contrasting social backgrounds in the United Kingdom, have been followed over a five-year period using repeat biographical interviews. We present first the themes that emerged from a cross-cut analysis of the first of three rounds of interviews distinguishing between relational and individualised understandings of adulthood. We then present a model we developed to capture the ways that young people sought out opportunities for competence and recognition in different fields of their lives. Finally a case study that follows a young woman through her three interviews illustrates how these themes can appear in an individual trajectory. We offer the model and case study as a way of exploring a more subjective approach to citizenship in which participation is not deferred to some distant future in which economic independence is achieved, but is understood as constantly constructed in the present.

Background Poor transitions to adult care from child and adolescent mental health services may increase the risk of disengagement and long-term negative outcomes. However, studies of transitions in mental health care are commonly difficult to administer and little is known about the determinants of successful transition. The persistence of health inequalities related to access, care, and outcome is now well accepted including the inverse care law which suggests that those most in need of services may be the least likely to obtain them. We sought to examine the pathways and determinants of transition, including the role of social class. Method A retrospective systematic examination of electronic records and case notes of young people eligible to transition to adult care over a 4-year period across five Health and Social Care NHS Trusts in Northern Ireland. Results We identified 373 service users eligible for transition. While a high proportion of eligible patients made the transition to adult services, very few received an optimal transition process and many dropped out of services or subsequently disengaged. Clinical factors, rather than social class, appear to be more influential in the transition pathway. However, those not in employment, education or training (NEET) were more likely (OR 3.04: 95% CI 1.34, 6.91) to have been referred to Adult Mental Health Services (AMHS), as were those with a risk assessment or diagnosis (OR 4.89: 2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively. Conclusions Despite the importance of a smoother transition to adult services, surprisingly, few patients experience this. There is a need for stronger standardised policies and guidelines to ensure optimal transitional care to AMHS. The barriers between different arms of psychiatry appear to persist. Joint working and shared arrangements between child and adolescent and adult mental health services should be fostered.

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