Volume 28, Issue 4

Background: A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems among Dutch medical students and, second, to study which study-related and personal factors present a risk of these mental health problems. Methods: A 1-year prospective longitudinal study was performed among medical students of two medical faculties in the Netherlands (n=951). Health problems and study-related and personal factors were measured with an online questionnaire. Mental health problems were assessed by depression and/or anxiety symptoms (BSI-DEP and BSI-ANG). Univariate and multivariate hierarchical logistic regression analyses were performed to examine which of the study-related and personal factors predict mental health problems. Results: At follow-up, 36%, 28% and 48% of the medical students reported symptoms of depression, anxiety and mental health problems, respectively. The incidence between 2010 and 2011 for depression was 20%, 17% for anxiety and 25% for mental health problems. Students who are worried about their own health during medical education are at an increased risk of future mental health problems (OR 2.0 [1.3–2.9], p=0.00). Excessive drinking behavior is a protective factor in this study (OR 0.7 [0.5–0.9], p=0.02). Conclusion: This study shows that only two out of nine factors are significantly associated with mental health problems among Dutch medical students, one risk factor and one protective factor.

Objective: This study assesses the basic nutritional knowledge of fourth year medical/osteopathic school graduates entering a pediatric residency program and compares the knowledge of the medical students to that of the patients and parents who completed the same survey previously. Methods: Medical and osteopathic school graduates entering a pediatric residency program completed an 18-question nutrition survey during resident orientation in June of 2011 and 2012. Results: The incoming interns averaged answering 52% of the questions correctly. Interns did better than both groups but the only statistically significant difference was between the interns and the non-eating disorder adolescents and their parents (p<0.001). Conclusion: Incoming residents to a pediatric residency program appear to be deficient in basic nutritional knowledge. With the ever increasing burden of obesity and its associated co-morbidities on society, it is imperative that medical education focuses on preparing physicians to appropriately counsel all populations on proper nutrition.

Background: Physical activity provides fundamental health benefits and plays a positive role in physical well-being. The aim of this present study was to investigate whether a 6-month physical activity program could influence physical self-esteem and frequency of physical activity in physically inactive female high school students in short- and long-term periods and whether personality traits were related to physical activity behaviour and compliance with the program. Methods: The study was a cluster-randomised controlled intervention study including 104 physically inactive female high school students aged 16–19 years, 60 females in an intervention group and 44 females in a control group. The intervention group exercised at sport centres at least once per week during a 6-month period. Questionnaires were used for evaluation. Results: At a 6-month follow up, the intervention group improved physical self-perception in all subdomains and significantly improved physical condition, physical self-worth and self-related health compared to the control group. At 1-year follow up, 25 females out of 53 females were still physically active, and all ratings remained almost the same as at the 6-month follow up. There were no particular personality traits that were dominant in the groups. Conclusion: A 6-month physical activity program can positively influence physical self-esteem and the frequency of physical activity, both from a short- and long-term perspective.

Hypertension has become increasingly common among adolescents. This study aimed to investigate the prevalence of hypertension and its association with anthropometric indexes among pre-university students. This was a cross-sectional study carried out among pre-university students of a public university. Anthropometric measurements were conducted using mobile stadiometers, digital body fat scales and measuring tapes. Body fat percentage was measured with a body composition analyzer, and blood pressure was determined using digital blood pressure monitors. Statistical analyses were done using Statistical Package for Social Sciences (SPSS) Statistics 20. A total of 218 respondents participated in the study. The prevalence of hypertension at risk was 7.3%, which was higher among males (16.7%). About 22% of the respondents were overweight and obese. The majority of males had a normal waist circumference (WC) (75.9%), but almost half of females had a WC value in the unhealthy category (47.0%). Females had higher conicity indexes and body fat compared to males. Respondents who were found to have hypertension at risk had a higher prevalence of being overweight and having unhealthy WC and waist-to-height ratio and had high conicity indexes and a high percentage of fat. Risk factors independently associated with hypertension at risk included male gender (odds ratio=4.213, 95% CI, 1.238–14.342) and body mass index (odds ratio=7.865, 95% CI, 1.165–53.099). Regular screening of hypertension at risk among adolescents and initiation of early treatment for those affected should be conducted to avoid further complication in later life.

Background: Theories of self-care management, particularly the development of self-efficacy or confidence in one’s ability to manage health-related goals, tasks, and challenges may provide a useful framework for developing programs to improve transition from pediatric to adult care for youth and young adults with sickle cell disease (SCD). Objective: The aim of this study was to evaluate the hypothesis stating that ratings of self-efficacy is positively associated with self-ratings of transition readiness. Subjects: A total of 113 individuals with SCD aged 14–26 years at two distinct sites of care were recruited for the study. Materials and methods: Participants completed the Transition Intervention Program Readiness for Transition ( TIP-RFT ) assessment, the Sickle Cell Self-Efficacy Scale and the Sickle Cell Stress –Adolescent scale. Results: In multivariate regression models, self-efficacy was positively associated with scores on the total TIP-RFT and on the Education/Vocation Planning and Independent Living Skills scales. Older age was independently associated with higher scores on the Independent Living Skills scale and higher stress levels were independently associated with lower scores on Education/Vocation Planning scale. Conclusion: The TIP-RFT assessment, along with measures of self-efficacy and stress, appear to be useful measures of overall transition readiness for youth and young adults with SCD. Future studies should evaluate whether self-management skill development and health outcomes are indeed affected by programs to improve readiness for transition from pediatric to adult care.

Background: Adolescent health concerns are an important source of information that should be considered when planning school and community health promotion policies, programs and services. Adolescence is a critical period of human development and the health concerns of adolescents can point to important issues that may be eclipsed by epidemiologic and other clinical sources of information. This study aimed to assess the health concerns of adolescents living in Tehran, Iran and to examine associations between selected demographics and the health concerns reported by participants. Methods: This study was a population-based cross-sectional survey in 2011. Data were collected from a stratified random cluster sample of 915 adolescents, aged 14–18 years, living in Tehran, using the Persian version of the Adolescent Health Concern Inventory (AHCI-P). The data were analyzed using the χ 2 , Mann-Whitney and Kruskal-Wallis tests and logistic regression analysis. Results: The mean numbers of health concerns in girls and boys were 48 (±27.6) and 44.5 (±27.4) respectively. The highest ranking health concern subscale for both girls and boys was The Future , and “being successful” was endorsed as the most prominent concern in the subscale. Female (OR: 1.42, CI 95%: 1.08–1.87), mother’s educational level (OR: 2.23, CI 95%: 1.07–4.65) and living in northern (OR: 1.76, CI 95%: 1.13–2.74) and western (OR: 2.02, CI 95%: 1.30–3.16) regions of Tehran were significant predictors of a higher level of health concerns. Conclusion: Findings can be used to inform school and public health promotion policies, programs and supportive services designed to improve the overall health and well-being of adolescents.

Background: Adolescence is a critical period and is associated with physical and psycho-social changes induced by puberty, which builds personality, behavior, and future health of the adolescents. This study aimed to determine the adolescent’s knowledge and attitude toward pubertal health and his/her socio-demographic predictors. Methods: This cross-sectional study was performed on 1017 adolescent girls who were in the second and third grades of secondary schools in Tabriz, Iran, in 2013. The sampling method was random. The general linear model was used to determine the social-demographic predictors of the adolescent’s knowledge and attitude about pubertal health. Results: The mean (standard deviation) score of knowledge and attitude was 53.2 (13.7) and 66.7 (11.5), respectively (from an attainable score range of 0–100). The variables of educational level, economic status, household members, obtaining information about the puberty, and age of menarche were predictors of knowledge. Educational level, the most feeling at menarche, and source of the most information about puberty were predictors of attitude (p<0.05). Conclusion: The findings of this study show that the knowledge and attitude of adolescents about pubertal health are moderate. Thus, it is necessary to educate the girls about pubertal health to enable them to have a healthy reproductive life in the future.

Background: The contraceptive pill is widely used. An accurate knowledge is necessary for correct use. Objective: This study sheds light on adolescents’ knowledge, attitude and behavior in regard to contraceptive use, in the year 2014. The goal is to provide general practitioners (GP) with information about the potential gaps in knowledge concerning contraceptive use in order to give better counseling and prevent high-risk behavior in adolescents. Methods: A quantitative descriptive study was carried out among 14–25-year-old female and male adolescents. Data were collected through a web-based survey using the online survey software Qualtrics (Qualtrics, Provo, UT, USA) and was distributed via the social networking site Facebook. Results: The survey was started by 1185 participants. The most popular contraceptive method among females is the oral contraceptive pill (63.7%). Four out of ten females (42.6%) do not know that when using an emergency pill, they must still take their regular contraceptive pill on the same day. The majority of female respondents (80.0%) go to their general practitioner for a prescription for the pill. Ninety-five percent (95.1%) of the females would feel comfortable asking their GP for extra information about the drug. The sex of the GP does not influence the likelihood of female patients seeking more information. The Internet also seems to serve as an important source of information. We defined a female subgroup, called “vulnerable”. The majority of females in the non-vulnerable group (70.4%) protected themselves before their first sexual contact instead of only half of the members in the vulnerable group (51.0%). Conclusion: The level of knowledge among adolescents about contraception is not alarming, but there are a few blind spots. Eliminating these gaps should be the aim of the doctor and pharmacologist.

Background: Though research findings have indicated that family characteristics have a bearing on sexual behavior, there is a paucity of published literature on the role of family functionality and parental characteristics on adolescent sexual decision-making. This study was designed to assess the role of family function and parental influence on sexual behavior of in-school youths in secondary schools in a sub-urban area of Southwest Nigeria. Methods: A descriptive cross-sectional study was conducted among secondary school students using semi-structured interviewer-assisted questionnaire. Information was obtained on the sexual behavior and parent-child characteristics. Family functionality was assessed using family APGAR standardized instrument. Association was established using χ 2 -test for qualitative variables and t-test for quantitative variables at p=0.05. Results: Mean age of respondents was 14.8±2.2 years. Majority were from monogamous family setting (70.7%) and lived with their families (75.6%). About a quarter (26.8%) was from dysfunctional families and 9.2% had ever had sexual intercourse. Recent sexual engagement in the preceding 1 month was reported (47.4%). The mean score for parental monitoring, father-child communication, mother-child communication, and parental disapproval of sex were 10.4±2.2, 9.3±2.3, 9.8±2.4, and 10.4±2.3, respectively. There was a significant association between parental monitoring ( t =3.9, p≤0.001), mother-child communication ( t =3.03, p=0.003), and parental disapproval of sex ( t =5, p≤0.001); and sexual experience. Conclusion: This study showed that parental influence had a vital role in the sexual behavior of young persons. Advocacy and health education interventions are needed among parents regarding their role in the sexual behavior of in-school youths.

Background: The rising prevalence of non-communicable diseases (NCDs) has become a serious public health issue. Among the multi-factorial drivers behind NCDs are modifiable health risk factors, most notably, physical inactivity. Objective: In response to the nearly global policy priority of encouraging regular participation in physical activity, the objective of the present study is to examine the factors that determine participation in physical activity among Malaysian adolescents. Methods: Nationally representative data consisting of a large sample size was used. A censored regression model was developed to estimate the likelihood of participation and time spent on physical activity. Results: There are significant relationships between physical activity and gender, ethnicity, self-rated academic performance, maternal education, household size and time spent on physical education. Conclusion: The present study provides new insights into the factors affecting physical activity participation among adolescents. Specifically, self-rated excellent academic performance, household size and physical education can increase the likelihood of being physically active. Evidence of the present study implies that policy makers should pay special attention to females, Chinese, adolescents with self-rated poor academic performance and adolescents who have low maternal education.

Background: Outpatient clinic visits are a window of opportunity to address health risk behaviors and promote a healthier lifestyle among young people. The HEADS (Home, Education, Eating, Activities, Drugs [i.e. substance use including tobacco, alcohol, and illegal drugs], Sexuality [including contraception], Safety, Self-harm) interview is a feasible way of exploring health risk behaviors and resilience. Objective: The purpose of this study was to evaluate how often HEADS topics were addressed according to young patients and staff in pediatric and adult outpatient clinics. Methods: We conducted a questionnaire survey among young patients and health care professionals at a tertiary university hospital. Young patients reported on their cumulative experience and staff reported on their usual practice. Results: A total of 290 young patients aged 12–22 years (78% having a chronic condition) and 97 health care professionals participated. We found only small reported differences between staff and young patients regarding whether home, education, and activity were addressed. However, staff reported twice the rate of addressing smoking, alcohol, illegal drugs, sexuality, and contraception compared to young patients. Young patients reported that smoking, alcohol, illegal drugs, sexuality, and contraception were addressed significantly more at adult clinics in comparison to pediatric clinics. After controlling for age, gender and duration of illness, according to young patients, adjusted odds ratios for addressing smoking at adult vs. pediatric clinics was 2.47 (95% confidence interval [CI]: 1.26–4.83), alcohol 2.84 (95% CI:1.45–5.57), illegal drugs 4.20 (95% CI:1.69–10.44), sexuality 3.54 (95% CI: 1.67–7.50), contraception 3.68 (95% CI:1.61–8.41), and any of the above 2.95 (95% CI: 1.47–5.91). Conclusion: According to young patients, smoking, alcohol, illegal drugs, sexuality, and contraception were not routinely addressed at a tertiary hospital, and especially at paediatric clinics, these issues were seldom addressed.

Purpose: Studies of adolescents with somatic symptoms with no identified organic cause make a clear connection between the health and wellbeing of the adolescent and the functioning of the family. There has been little systematic examination of the role of family functioning in treatment. We aim to determine whether there was an association between family functioning and treatment outcome in this 12 month prospective study. Methods: Fifty adolescents aged between 12 and 17 years (M=14.4, SD=1.32) and their parents were recruited. All adolescents presented with one or more physical symptoms as their primary complaint. Adolescent functioning and family relationships were measured at recruitment, 4 months into treatment and 12 months later. Generalised estimating equations (GEE) analyses were conducted to examine the relationships between the variables of interest. Results: Results suggested significant improvements in adolescent outcomes between baseline and 4 months (all p<0.01), which were sustained to 12 months (all p<0.01). Adolescents from healthier families at initial presentation had significantly improved psychosocial functioning over the course of the study (all p<0.001). Conclusion: Our findings highlight the importance of taking a family approach to the treatment of adolescents with medically unexplained symptoms.

Superior mesenteric vein (SMV) thrombosis is a rare, potentially life-threatening complication of intra-abdominal infection. Here we present a case of massive SMV thrombosis secondary to appendicitis in a 13-year-old boy. He presented with vague abdominal pain and associated symptoms, persistently elevated serum inflammatory markers and a pyrexia of unknown origin. Sonography proved inconclusive, and a definitive diagnosis was made by abdominal contrast-enhanced computed tomography. He was treated with antibiotics and anticoagulation before interval elective laparoscopic appendectomy. The non-specific nature of the presenting symptoms makes SMV thrombosis an important differential to consider when dealing with such patients.

Traditional classroom teaching is the standard of education. However, there may be some students who feel uncomfortable approaching their teachers and may feel more at ease if they ask for assistance from their peers. There are two types of student-to-student tutoring methods that are supplements to classroom learning: peer tutoring between same-age students and cross-age tutoring between different-age children. Cross-age tutoring programs in which the tutor is 2–3 years older than the tutee have been reported to be more effective than those between same-age students in promoting student responsibility, empowerment and academic performance. A pilot online cross-age tutoring program was launched in September 2014 at Crescent School. A new website was designed, created and implemented with the permission and regular monitoring of the Student Services faculty for the online program – Crescent School Virtual Learning (vLearning). The program was well received and will undergo evaluation in the future.

Advancements in medicine have increased the likelihood that children with chronic illnesses will survive childhood. The success in treatment for their conditions has not been matched by methods to effectively facilitate their transition to adult care. This short report describes lessons learned in building a hospital-wide health care transition (HCT) planning infrastructure that could help patients transition from pediatric to adult-based care regardless of disease/disability. A solid foundation on which to build a hospital-based HCT planning program includes the following: focusing on structure and processes needed to facilitate medical transition; conducting a baseline assessment of current transition policy/practice; building an understanding of the complexity and necessity of transition planning; identifying advocates for transition planning and adult providers who will accept youth with chronic medical conditions; and establishing methods to evaluate transition program building activities. The implementation of any HCT program will depend on creating a culture that expects successful HCT to be the culmination of successful pediatric care. Hospital support (resources, staff training and an expanded infrastructure into which the program can fit) is necessary for a sustainable HCT planning program.