Volume 26, Issue 2

Background: The transition from pediatric to adult health care can be challenging for adolescents with chronic illnesses. As a result, many adolescents are unable to transfer to adult health care successfully. Adequate measurement of transition readiness and transfer satisfaction with disease management is necessary in order to determine areas to target for intervention towards improving transfer outcomes. Objectives: This study aims to systematically review and critically appraise research on transition readiness and transfer satisfaction measures for adolescents with chronic illnesses as well as to assess the psychometric quality of these measures. Methods: Electronic searches were conducted in MEDLINE, EMBASE, CINAHL, PsychINFO, ERIC, and ISI Web of Knowledge for transition readiness and transfer satisfaction measures for adolescents with chronic health conditions. Two reviewers independently selected articles for review and assessed methodological quality. Results: In all, eight readiness and six satisfaction measures met the inclusion criteria, for a total of 14 studies, which were included in the final analysis. None of these measures have well-established evidence of reliability and validity. Most of the measures were developed ad hoc by the study investigators, with minimal to no evidence of reliability and/or validity using the Cohen criteria and COSMIN checklist. Conclusion: This research indicates a major gap in our knowledge of transitional care in this population, because there is currently no well-validated questionnaire that measures readiness for transfer to adult health care. Future research must focus on the development of well-validated transition readiness questionnaires, the validation of existing measures, and reaching consensus on outcomes of successful transfer.

Background: With the advancements in knowledge about health promotion, public health professionals have been seeking determinants of personal health behaviors. The purpose of this study was to assess the prevalence of health risk behaviors and its associated factors in a sample of Kyrgyz university students. Methods: In a cross-sectional survey, health risk behaviors among a sample of randomly selected university students were assessed. The sample included 837 university students from health sciences undergraduate courses of the State Medical Academy in Kyrgyzstan. The students were 358 (42.8%) males and 479 (57.2%) females in the age range of 18–29 years (Median age=21.3 years, SD=1.5). Results: On average, students engaged in 9.4 (SD=2.3) out of 23 health risk behavior practices (range, 3–18). Generally, there was a high rate of insufficient fruit and vegetable intake (86.4%), eating red meat at least once a day (62%), usually adding salt to meals (78.3%), skipping breakfast (50.5%), current tobacco use (49.7%) and two or more sexual partners in the past 12 months (46.1%) among men, and never using a condom with a primary partner in the past 3 months (90.9%) among women. Furthermore, 60.8% of the women were physically inactive. In bivariate analysis among men, the lack of perceived benefits was associated with health risk behavior. In multivariate analysis among women, poorer family background, being Russian, high personal constraints or stress, and better subjective health were associated with the health risk behavior index. Conclusions: Students had a high proportion of health risk behavior practices. Several high health risk practices were identified, including poor dietary behavior, physical inactivity, sexual risk behavior, and tobacco use. Gender specific predictors identified included sociodemographic characteristics and social and health variables, which can be utilized in health promotion programs.

The Internet provides significant benefits for learning about the world, but excessive Internet use can lead to negative outcomes. The aim of this study was to determine the associations between heavy Internet use and health-promoting behaviour, health risk behaviour and health outcomes among university students. The sample included 860 undergraduate university students chosen at random from Mae Fah Luang University in Thailand. Of the participants, 27.3% were male and and 72.7% were female in the age range of 18–25 years (M age=20.1 years, SD=1.3). Overall, students spent on average 5.3 h (SD=2.6) per day on the internet, and 35.3% engaged in heavy internet use (6 or more hours per day). In multivariate logistic regression adjusting for sociodemographics, lack of dental check-ups, three health risk behaviours (sedentary lifestyle, illicit drug use and gambling) and three health outcomes [being underweight, overweight or obese and having screened positive for post-traumatic stress disorder (PTSD)] were found to be associated with heavy Internet use. The results from this study may support the importance of developing early protective and preventive actions against problematic Internet use to promote university student health.

Background: Lipid metabolism is profoundly disturbed in chronic liver diseases (CLD). Moreover, patients with cirrhosis displayed chronically elevated serum insulin (SI) concentrations. Objectives: The aim of this work was to assess fasting lipid profile (FLP) and SI levels among Egyptian patients with CLD and their relation to severity of liver disease. Methods: A total of 40 Egyptian children with CLD were compared with 30 age-, sex-, and pubertal stage-matched controls. All subjects were subjected to history and auxological assessment; their FLP, fasting blood glucose (FBG) and SI were measured; and their fasting glucose/insulin (G/I) ratios were calculated. Results: Total cholesterol (TC, p=0.006), triglycerides (TG, p=0.03), low density lipoproteins (LDL, p=0.034), and SI (p<0.001) were significantly higher while high density lipoproteins (HDL, p<0.001) and G/I ratio (p<0.001) were significantly lower as serum albumin decreased; these were also lower among cases with a progressive decrease going from child A to C. Of the 40 studied cases, eight (20%) had hypercholesterolemia, 13 (32.5%) had hypertriglyceridemia, 17 (42.5%) had low HDL and 9 (22.5%) had high LDL, 32 (80%) had hyperinsulinemia (HI), and 11 (27.5%) had insulin resistance (IR). Conclusions: Dyslipidemia and HI were frequent findings in patients with CLD, which worsened with increased severity of CLD.

Background: Adolescents are at high risk of acquiring sexually transmitted diseases (STDs). However, little is known about differences in knowledge and risk behaviors across nationalities. The objective of this study was to assess and compare the knowledge and perceptions of STDs and the sexual risk behaviors in Latino adolescents in the United States (US) and the Dominican Republic (DR). Methods: A survey was administered to 364 high school students after obtaining parental consent. The questionnaire asked about demographics, sources of STD information, risk behaviors, and knowledge of syphilis, gonorrhea, and human immunodeficiency virus (HIV). Mean percentage scores were calculated to compare correct responses by nationality, gender, and sexual activity. Predictors of self-reported high risk sexual behavior were identified by multivariable logistic regression analysis. Results: In all, 242 (66%) US and 122 (34%) DR students were interviewed. Of these, 52% were males. Median age was 15 years (range, 13–18). Sexual activity was reported by 40% of the participants and did not differ by gender (p=0.43) or national origin (p=0.53), although it was greater for adolescents older than 15 years of age (60% vs. 35%, p<0.001). US students identified abstinence as an effective STD prevention method more often than their counterparts (p=<0.001). Knowledge of specific STDs was higher in girls (p=0.002) and Dominicans (p=0.003). Predictors of high risk behavior were male gender (OR<uni-003D;2.50, 95% CI 1.35–4.63) and being sexually active (OR<uni-003D;3.09, 95% CI 1.71–5.59). Conclusions: Sexual activity at an early age was prevalent, and knowledge of STDs low in these two groups of high school students. Males and sexually active individuals were more likely to engage in high risk behaviors. Girls and Dominican students exhibited greater knowledge of specific STDs.

Adolescents and young adults are at high risk of human immunodeficiency virus (HIV) infection in sub-Saharan Africa. Previous reports have found that university students in Africa comprise a sexually active population, although the prevalence of HIV or sexually transmitted infections (STI) has not been measured. We conducted a cross-sectional survey of students from five large universities in Kampala, Uganda, using respondent-driven sampling. We asked students to complete behavioral questionnaires and provide biological samples to test for HIV, Chlamydia trachomatis , Neisseria gonorrhoeae , Treponema pallidum , Trichomonas vaginalis , and bacterial vaginosis. We enrolled 649 students and obtained interpretable data from 640. Around 50% of the respondents were male, and the mean age was 22 years. An estimated 0.8% (95% CI 0.0–2.0) of male students had Chlamydia infection, approximately 4.3% (95% CI 2.0–7.0) had syphilis, 0.4% (95% CI 0.0–0.9) had HIV, and none had gonorrhea. An estimated 32.6% (95% CI 22.4–40.8) of women had bacterial vaginosis, 2.5% (95% CI 0.7–6.3) had Chlamydia infection, 1.7% (95% CI 0.5–3.6) had syphilis, 1.0% (95% CI 0.0–2.4) had gonorrhea, 0.9% (95% CI 0.0–4.2) had trichomoniasis, and 0.9% (95% CI 0.0–1.8) had HIV. We found no significant risk factors for HIV or other STI among males. We also found that not using a condom during the latest sexual intercourse was significantly associated with HIV infection, other STI, or bacterial vaginosis (OR 2.16; 95% 1.26–3.78) among females. We conclude that while university students are sexually active and there is substantial risk for syphilis, there is little evidence of substantially increased HIV risk among them.

Background: Simultaneous polydrug use (SPU) may represent a greater incremental risk factor for human health than concurrent polydrug use (CPU). However, few studies have examined these patterns of use in relation to health issues, particularly with regard to the number of drugs used. Methods: In the present study, we have analyzed data from a representative sample of 5734 young Swiss males from the Cohort Study on Substance Use Risk Factors. Exposure to drugs (i.e., alcohol, tobacco, cannabis, and 15 other illicit drugs), as well as mental, social and physical factors, were studied through regression analysis. Results: We found that individuals engaging in CPU and SPU followed the known stages of drug use, involving initial experiences with licit drugs (e.g., alcohol and tobacco), followed by use of cannabis and then other illicit drugs. In this regard, two classes of illicit drugs were identified, including first uppers, hallucinogens and sniffed drugs; and then “harder” drugs (ketamine, heroin, and crystal meth), which were only consumed by polydrug users who were already taking numerous drugs. Moreover, we observed an association between the number of drugs used simultaneously and social issues (i.e., social consequences and aggressiveness). In fact, the more often the participants simultaneously used substances, the more likely they were to experience social problems. In contrast, we did not find any relationship between SPU and depression, anxiety, health consequences, or health. Conclusions: We identified some associations with SPU that were independent of CPU. Moreover, we found that the number of concurrently used drugs can be a strong factor associated with mental and physical health, although their simultaneous use may not significantly contribute to this association. Finally, the negative effects related to the use of one substance might be counteracted by the use of an additional substance.

Objectives: The sexual and reproductive health of adolescents is of utmost importance in many nations (especially in developing countries). Sexual behavior varies from location to location and the outcome (when negative) creates great concerns mainly due to the consequential impact on health and development. This study aimed at comparing sexual behavior of in-school adolescents in rural and urban areas of Osun state. Methods: A comparative cross sectional study was conducted. A total of 760 in-school adolescents were recruited using multistage sampling technique. Pre-tested questionnaires were administered after ethical considerations. Data were analysed and p-value was placed at 0.05. Results: A total of 380 rural and 380 urban adolescents participated in this study with a mean age of 14.90±2.44 and 14.34±2.31 years, respectively. About one-fifth (20.1%) had experienced their first sex (66% of rural and 34% of urban). The mean age at first sex was 14.05 years±2.3 years (13.89±2.3 years for rural and 14.37±2.3 years for urban). Only 76 (49.7%) sexually experienced respondents had used condom in the past (45.5% of rural, 57.7% of urban). Half of the urban respondents used condom during their first sex while only a quarter of their rural counterparts had done so (p=0.003). Conclusion: Sexual behavior was commoner among the rural respondents than their urban counterpart. There is an urgent need for sexuality education especially among rural adolescents in the study area.

Context: Adolescents comprise 22.5% of the population, which forms a significant part of the entire population. It is only recently that we have acknowledged the need for a separate specialty to handle adolescent problems and ailments. Aims: The aim of the present study is to study the health profile of the adolescents girls presenting to the tertiary care hospital situated in New Delhi, India. Materials and methods: The study was conducted on 316 adolescent girls who presented to the adolescent clinic at Smt Sucheta Kriplani Hospital, New Delhi. Apart from recording the various health problems to which they presented, a detailed HEADSS assessment was done for each case. Results: Majority of the adolescents (60.74%) presented with menstrual problems, 78.48% discussed their problems with their parents, and 91.77% agreed on common things with them. About 69.62% were attending school or college, while 30.37% had either left or never attended school. Majority of the adolescents (77.84%) had only a few friends, 62.96% watched TV in their free time, and only 7.27% performed regular exercise. In addition, 0.94% adolescents in the study group were married. Among the 313 unmarried adolescents, 3.83% were dating and 4.47% were sexually active. There was a low incidence of teenage pregnancy (0.94%) reported in the unmarried study population. History of contraceptive use was present in only 1.26% cases, and only 5.06% of the adolescents had knowledge of HIV. Conclusions: Adolescent health must be viewed with a comprehensive approach comprising of social, mental, physical and emotional aspects. The active involvement of the entire society, including parents and teachers, must also be encouraged towards the healthy development of adolescents.

Studies show that the age of first sexual intercourse is directly correlated with risky sexual behavior among civilian populations. However, few studies have looked at the age of first intercourse and its consequence among soldiers. A study was conducted to examine the age of first sexual experience and sexual practices among soldiers surveyed at a large military post. The survey consisted of 31 fixed-choice items that focused on the soldiers’ sexual knowledge, beliefs and behaviors. A total of 450 soldiers were included in the sample. Respondents were divided into three main categories by age groupings of first sexual experience as follows: under 14 years of age, between the ages of 14 to 17 years, and over 18 years. All values were analyzed using frequency distributions with calculations of means, standard deviations, and range. Results showed that soldiers who had their first sexual experience under the age of 14 were more likely to participate in risky sexual behaviors than those whose first sexual experience occurred when soldiers were over the age of 18.

Background: Prehypertension is a new category of blood pressure, and is considered a cardiovascular risk factor. The aim of this study was to estimate the prevalence of prehypertension and its associated factors in young adults in the Philippines. Methods: Undergraduate university students from all areas of study in the University of the Philippines-Visayas were invited to participate. Prehypertension was defined as systolic blood pressure between 120 and 139 mm Hg and/or diastolic blood pressure between 80 and 89 mm Hg. Blood pressure, anthropometric, health behavior, and psychosocial stress variables were measured. Results: A total of 754 university students were included in the analysis (mean age, 18.3±1.4 years, 74.3% women). Prehypertension prevalence was 13.9% (36.1% in men, 6.8% in women), and hypertension prevalence was 2.4% (6.6% in men, 1.1% in women). The condition of prehypertension was associated with body mass index obesity (OR: 5.14, CI: 2.70 to 9.79), male gender (OR: 9.41, CI: 5.41 to 16.36), living off campus on their own (OR: 3.18, CI: 1.35 to 7.48), living with parents or guardians (OR: 2.83, CI: 1.20 to 6.60), and 19 years of age (OR: 2.81, CI: 1.55 to 5.11). Conclusion: One out of every 7 young adults presented with prehypertension. This condition is associated with established risk factors.

Introduction: Obesity among children is a major risk factor for chronic diseases. School interventions programs can represent a mean to implement healthy nutrition attitudes at early ages. Our objective was to evaluate the effects of a school intervention program to promote healthy nutrition among adolescents, in terms of knowledge, behaviors and intention. Methods: Quasi experimental study among urban students in Sousse, Tunisia with 2 groups, intervention and control. The intervention group had an interactive program integrated with school courses that promoted healthy nutrition habits. Both groups had a pre post evaluation. Results: 2200 students aged from 12 to 16 participated to the pre post evaluation. In the intervention group, there were significant changes form pre to post test in knowledge, intentions, and behaviors. In the control group, almost no significant changes were observed. Conclusion: School intervention programs can represent an interesting approach to promote healthy nutrition habits among adolescents.

Background: Most university students in Nigeria are sexually active and engage in high risk sexual behaviors. The aim of this study was to assess the acceptability and use of female condoms in the context of HIV prevention in order to provide basic information that can stimulate female condom programming to promote sexually transmitted infection and HIV prevention among youths in tertiary institutions. Materials and methods: A descriptive, cross-sectional study was carried out among 810 undergraduate students of the University of Port Harcourt from October to November 2011, using a stratified sampling method and self-administered questionnaires. Results: Most of the students, 589 (72.7%) were sexually active; 352 (59.7%) reported having just one sexual partner, while 237 (40.3%) had multiple partners. The mean number of sexual partners in the past six months was 2.2±0. Consistent condom use was reported among 388 (79.2%) students, 102 (20.8%) reported occasional usage, while 99 (16.8%) did not use condoms at all. Only 384 (65.2%) of the students had ever been screened for HIV. Although 723 (89.3%) were aware of female condoms, only 64(8.9%) had ever used one due to unavailability, high cost, and difficulty with its insertion. Nevertheless, 389 (53.8%) of the students expressed willingness to use them if offered, while 502 (69.4%) would recommend it to friends/peers. Conclusion: This study highlights significant challenges in the use of female condoms among university students. These include unavailability, high cost, and difficulty with insertion. Therefore, deliberate efforts using social marketing strategies, appropriate youth-friendly publicity, and peer education must be exerted to provide affordable female condoms and promote usage; such efforts should target vulnerable youths in Nigerian tertiary institutions.

Background: In Tunisia, little is known about the association between tobacco use and other chronic disease risk factors. This is the case for both adults and children. It is important to know the characteristics of young smokers to facilitate the creation and implementation of future programs for tobacco prevention. Aim: The aim of this study was to determine the association between tobacco use and other lifestyle factors among schoolchildren in Tunisia. Methods: We conducted a 2009/2010 cross-sectional questionnaire survey of 4003 randomly selected school children aged 13 years old (7th and 9th grades) to evaluate their knowledge, attitudes towards, and beliefs about the three risk factors for chronic disease (unhealthy diet, physical inactivity, and tobacco use). Written informed consent was obtained from each child’s parents who allowed their child to participate. Results: The mean age of our sample was 13.36±1.28 years. The proportions of daily smokers were 2.2% and 0.1% among boys and girls, respectively. The proportions of irregular smokers were 9.1% and 1.5% among boys and girls, respectively. In our population, 19.1% (n=767) had ever experimented to smoke, with 29.8% among boys and 9% among girls (p<0.001). The proportions of schoolchildren who reported daily participation in physical activity were different between smokers and nonsmokers with 17.7% and 11.5%, respectively (p=0.03). Concerning eating habits, there was no significant difference in the consumption of fruits and vegetables; however, smokers frequently ate more high fat foods and in fast food restaurants. Similar results were found while comparing regular smoking children with those who experimented but who never became hooked on smoking. Conclusion: This study and previous research suggest the importance of early intervention in adolescents on smoking and combing these efforts with interventions focusing on physical activity and dietary habits.

Objective: This work aims to study self-esteem in adolescents with diabetes, asthma and epilepsy; compare the results with those of the representative sample of healthy adolescents; and evaluate the predictive value of certain demographic, family-related, and disease-related factors on self-esteem. Methods: A total of 148 chronically ill adolescents and 301 matched healthy counterparts completed the Rosenberg Self Esteem Scale and the “I think I am” questionnaire. Adolescents’ parents answered socio-economic status questions. Disease severity was evaluated by doctors of the outpatient clinic. Results: Comparison analysis of the three disease groups revealed highest self-esteem perception in adolescents with diabetes, and lowest in adolescents with epilepsy. Unexpectedly, adolescents with diabetes scored higher than their healthy counterparts. There were no significant differences between the reports of adolescents with asthma and controls. In the epilepsy group, self-esteem was predicted mostly by disease severity and socio-economic status in diabetes and asthma groups, as well as by age and gender. Conclusion: The maintenance of positive self-esteem in adolescents with diabetes and asthma is a very reassuring finding. The other results of our study provide support for recognizing adolescents with epilepsy as a vulnerable group in the society. A multidisciplinary professional approach targeted on adolescents with epilepsy is needed, with focus on factors connected with maturation and gender issues.

Aim: This study explored the influence of gender on the mental health literacy (MHL) of young people. Method: In all, 370 young people (aged 17–22 years) completed one of two questionnaires, in which they had to label/provide a diagnosis for nine vignettes of people with different mental health disorders. Half the vignettes had a male and the other half had a female character. They also rated the vignette person on nine scales. Results: There was much variance in recognition for the different disorders, with a range of 77.0%–27.3% of participants “correctly” labeling the vignettes. Very few gender differences were found, but age and experience of/education in mental health were found to be positively correlated with MHL. Conclusion: Gender differences in MHL may not be as great as previously thought. Although some disorders were recognized by the majority of participants, there are still common disorders that were not.

A 13-year-old Hispanic female presented with symptoms of abdominal pain, amenorrhea, and unintentional weight loss of 11 kg. Preliminary investigation yielded no immediate causes, and an initial differential included inflammatory bowel disease (IBD), celiac disease, as well as viral, bacterial, or parasitic gastrointestinal infection. Evaluation of these potential diagnoses yielded negative results; thus, the team thought that the patient may be suffering from anorexia nervosa. The patient was discharged to outpatient care, and was treated in our adolescent health clinic, where repeat laboratory testing yielded a positive Giardia -antigen test. The patient was placed on metronidazole, rapidly gained weight, and resumed menstruation soon after. The final diagnosis was chronic giardiasis. Chronic giardiasis is a rare and enigmatic disease that presents with many symptoms similar to chronic gastrointestinal disorders (e.g. IBD and celiac disease) and anorexia nervosa. Practitioners involved in the diagnosis and treatment of anorexia nervosa should be aware of this disorder and include it in differential diagnoses of patients presenting with anorexia nervosa symptoms.

This article presents two cases of adolescent males who were admitted to our inpatient psychiatric unit with a psychotic, disorganized presentation. Both males had a genetic vulnerability to mental illness and reported significant substance use. Their symptoms were refractory to treatment and required the use of clozapine. Both patients experienced significant side effects, which limited the maximum daily dose of clozapine. However, they responded to a dose that was much lower than that typically used in adults. There is significant evidence in the literature about cannabis use triggering psychotic breaks in vulnerable individuals. We speculate that substance use (including synthetic cannabinoids) triggers treatment-resistant psychosis that requires the use of clozapine. Further, lower doses of clozapine may be sufficient to treat the substance-induced psychotic symptoms than those typically used in adult schizophrenia.