Band 29, Heft 6

Background: Malnutrition and infection are major barriers to educational access and achievement in low-income countries and also work in conjunction with each other in deteriorating wellness and productivity of school adolescents. Methods: A quasi-experimental design was used to evaluate the effectiveness of school-based nutrition education using a peer-led approach, health promotion through school media and health clubs. Data were collected at baseline, midline and end line from sampled participants. To account for the effect of time trend, the difference was measured using a repeated measure analysis. Variables that have p≤0.25 in the bivariate analyses were entered into multivariables to determine the independent effect of interventions. Results: There is a significant difference in food variety between food secure and insecure households (p<0.01). A significant improvement of animal source dietary intake was observed among intervention schools (p<0.001) that was significantly associated with an intervention [adjusted odds ratio (AOR)=0.26, confidence interval (CI): 0.16, 0.42], male gender (AOR=0.48, CI: 0.31, 0.73) and household economic status (AOR=1.69, CI: 1.01, 2.84). The control group had high body mass index (BMI) at baseline, but a significant improvement was observed among the intervention schools, which positively associated with male gender (AOR=4.13, CI: 2.38, 7.15) and having a middle-income family (AOR=2.93, CI: 1.92, 6.15). Conclusion: This study showed that by integrating a dietary intervention into school-based activities, there might be significant improvements in dietary intake of primary school adolescents. Therefore, school-based nutrition education programs should be a part of comprehensive school health programs to reach the students and potentially their families.

Sexual risk-taking among adolescents, leads to several negative sexual and reproductive health outcomes such as unwanted pregnancies and sexually transmitted infections (STIs). This study assessed sexual risk behaviours and associated factors among in-school adolescent females in Ijebu-Ode, Nigeria. A cross-sectional study was carried out among 131 female adolescents selected via multi-stage sampling from senior secondary schools in Ijebu-Ode, southwest Nigeria. Data was collected using a validated, semi-structured, self-administered questionnaire and analysed using SPSS 17.0. Relevant descriptive and inferential statistics were calculated, with p set at <0.05. Participation was fully voluntary. The mean age of respondents was 16±1.3 years. Thirty-eight (14.5%) of respondents were sexually exposed with the mean age of sexual debut being 13.4±2.8 years. Participants with sexual exposure reported vaginal sex (89.5%), digital sex (36.8%) and oral sex (5.3%). A total of 42.1% had multiple sexual partners, 47.4% used condoms during sex. Only 13% of the respondents were engaged in sexual risk-taking. Factors associated with sexual risk-taking include: age, type of school, father being alive, having a boyfriend, age of boyfriend, low self-esteem and a history of non-consensual sex. Sexually-active adolescents engaged in risky sexual behaviours. Comprehensive sexuality education, behaviour change communication and adolescent-friendly services will adequately address the situation.

Background: Technological development is the main cause for reduced physical activity in populations, increasing the risk of illness and decreasing average life expectancy. A correlation exists between increased physical exercise (PE) and health improvement. The academic curriculum attributes to lack of PE due to sedentary lifestyle and inability to find free time. The purpose of this study was to characterize PE among students in relation to World Health Organization (WHO) recommendations and examined the correlation between activity level and grade point average (GPA). We also included an evaluation of the student’s willingness to exercise as part of an elective course program. Methods: We used a five experts validated questionnaire, distributed online. The sampling frame was undergraduate students of the Faculty of Social Welfare and Health from the University of Haifa (184 students). Statistical processing was done using SPSS software using the χ 2 test and Pearson’s correlation. Results: Of the participants 70.7% do not comply with WHO recommendations. Seventy-five percent showed willingness to perform PE if it was part of the curriculum. No significant correlations were found between PE or WHO recommendations and GPA. Conclusion: This is a pioneer study among university students. Continued research is needed to characterize the PE in academic institutions.

Introduction: Although a number of management strategies are available for adolescent substance abusers, the outcomes are limited due to high drop out. The factors related to drop out in adolescent substance users, especially in low and middle income countries (LAMIC) have been sparsely studied. Objective: To study the personal, family and clinical variables related to immediate drop out in adolescent substance abusers. Materials and methods: A retrospective outpatient chart review was carried out for adolescent substance abusers aged 12–19 years from January 2012 to December 2014. Results: Of the 89 patients, 57 (64%) dropped out immediately. The majority of adolescent substance users were >17 years (85%), having some education (90%), belonging to a joint family (76%), having good family support (66%). Drop out was higher in those with later onset and less duration of substance abuse (3.42 vs. 2.36, p=0.014), not currently employed/attending school (OR=2.65, 95% CI=1.04–6.70), not having a psychiatric comorbidity, using a single substance and abusing cannabis. Factors like school drop out, background, family type and support and the relationship to the accompanying person were not associated with immediate drop out. Conclusion: Later onset, lesser duration of substance use, not currently employed/attending school, absence of psychiatric illness and using cannabis were associated with drop out from outpatient treatment. These factors must be thoroughly addressed in substance abuse interventions.

Objective: Dysmenorrhea is the most common gynecologic condition experienced by menstruating women and has significant medical and psychosocial impacts. The objective of this study was to determine the prevalence and the problems related to menstruation, self-care strategies and their relations with pain severity in female students of Tabriz University of Medical Sciences. Methods: This cross sectional study was carried out among 197 unmarried and healthy female medical students during April 2013 to July 2013. A standardized questionnaire was given to participants to complete, which included questions about demographic information, prevalence and severity of pain, self-care strategies and its effectiveness. Results: The prevalence of dysmenorrhea was 98.4% (95% confidence interval=97.6%–99.2%). Almost 76% (149) of students reported limitation of daily activities. The most common method for relief pain were: taking analgesics (64.3%), rest (61.9%), taking herbal medicine (11.7%), and applying hot compress on area of pain (22.3%). Obtaining information about self-care strategies offered from family and friends 79 (41%) were more common than scientific articles 56 (28.7%) and the Internet 43 (22%). Significant relations were observed between self-care strategies’ scales and pain severity. Conclusion: The results indicated that dysmenorrhea was highly prevalent among female medical students and is a major problem affecting their life. A variety of treatments is available for dysmenorrhea but most of the participants did not seek medical advice and they used self-care strategies. However, further studies focusing on health education and routine screening for menstrual problems are recommended.

Introduction: Hookah use among the Indian adolescents is on the rise without them being aware of its tobacco content. This prevalence study highlights the issues associated with hookah use among high school students of five cities of Central India. Methods: A study among 3500 students of high schools was undertaken to estimate the prevalence of hookah users and its associated factors including initiation/cessation, patterns, perceptions and behavior. Responses were received from 225 hookah users. Results: The prevalence of hookah users in the present study was found to be 6.4% (225). Most of the subjects first learned about hookah use from friends (64.5%) and smoked hookah in hookah lounges (90.7%). Generally, the adolescents were aware of various lounges in their locality. Conclusion: This study suggests that the use of hookahs is attracting adolescents at a very early age and is attributed to the presence of hookah lounges in various cities of Central India. Hence, the legality of hookah lounges in India should be reconsidered.

Introduction: Sleep is an important physiological condition that plays a role in the physical and emotional development of adolescents. The aim of the study is to determine some sleep characteristics of adolescents living in the city of Ribeirão Preto (SP). Methods: This is a cross-sectional descriptive study conducted at 14 schools in the city of Ribeirão Preto (SP) including adolescents aged 10–19 years using a questionnaire about sleep habits. The χ 2 test was used to determine differences between genders with the aid of the EPI-INFO 7 software, with the level of significance set at p<0.05. Results: A total of 535 adolescents (65% girls) were included in the study. Of these, 47.7% studied during the morning period and 10.3% had a job and studied in the evening period. Regarding sleep duration, 242 (45%) slept <9 h per night during week days and 256 (48%) during the weekends (Saturday and Sunday). Of the total number of adolescents studied, 75.5% reported that they went to bed when they felt sleepy, 90% reported delay in falling asleep, 84.3% used some type of electronic equipment before going to sleep, and 44% reported that they woke up during the night. In the morning, 70.3% needed to be awakened, and 44.7% reported a delay in waking up. During daytime, 70% felt somnolent and 34% reported that they slept during the day. Girls reported that they felt more daytime sleepiness (71.3%) and slept more during the day (62.1%) than boys (28.7% and 37.9%, respectively). Conclusion: The study showed that almost half the adolescents investigated sleep less than the minimum time considered ideal. Furthermore, most of the adolescents went to the bed when they felt sleepy, used electronic devices before falling sleep, had difficulties falling asleep, need to be awaken in the morning and felt sleepy during the day.

Background: In order to understand the mechanisms involved in how overweight adolescents adhere to weight management and perceive its benefits, a few variables have been identified, namely, body mass index (BMI), body self-esteem (BSE) and positive perspective of life (PPL). Methods: In a sample of 112 adolescents, we investigated whether BMI would predict adolescents’ self-efficacy/adherence (SEA) to weight management and perception of its benefits. A structural equation modeling approach was chosen. We hypothesized that perceived quality of life (PQL) would mediate the relationships between BMI and SEA and between BMI and perception of benefits (PB). Results: The results suggested that BMI is not directly associated with SEA and PB. However, PQL was identified as a mediator between BMI and SEA and PB. Conclusion: These findings bring important implications for understanding overweight adolescents’ adherence to weight management. There is evidence that adolescents’ adherence to weight management and PB are not predicted by their BMI. However, it has been shown that PQL mediates this process. For a long time, health professionals have been too focused on BMI. Time has come to be more focused on quality of life and how to improve it.

The study examines the barriers to disclosure of child maltreatment among adolescent girls. Stratified random sampling was done among classes 7 to 12 of government girls’ schools of a semi-urban area of Delhi, and a total of 1060 adolescent girls participated. Almost 33% of victims of physical abuse, 50% of sexual abuse, 30% of emotional abuse, and 40% of neglect did not disclose their experiences to any support group. The most frequent confidante, in almost two-thirds of cases of all forms of abuse was a friend of the study participant. Among the study participants who did not disclose abuse, the most common reason for nondisclosure was a feeling of shame or embarrassment (40%–80% for physical abuse, 55%–80% for sexual abuse, and 55% for emotional abuse). Among the study participants who did not disclose neglect, 70% reported that they did not do so because they had no expectation of help from anyone.

Objective: This study examined posttraumatic growth (PTG) in young childhood cancer survivors (CCS) and type 1 diabetics (DM), with physically healthy peers as the control group (CG). Anxiety and depression as negative mental outcomes in the three groups, as well as fear of progression in DM and CCS were examined. Methods: A total of 107 participants with ages ranging from 18 to 35 years were examined: CCS (n=33), type 1 diabetics (n=39) and peers without a history of chronic disease (n=35). PTG and negative psychosocial outcomes were assessed with self-report questionnaires. Results: There was a significant difference between the groups regarding PTG. On a subscale level DM reported higher appreciation of life (p=0.024), higher personal strength (p=0.010), and more new possibilities (p=0.010) compared to CG. CCS experienced higher spiritual changes than DM (p=0.050). DM reported higher levels of anxiety compared to CCS (p=0.026) and CG (p=0.049). Depression was higher in DM compared to CG (p=0.003). Fear of progression was higher in DM compared to CCS (p<0.001). Conclusion: These findings show that psychological growth was experienced by young CCS and participants with DM. Furthermore, these findings highlight that adolescents with a significant health diagnosis in childhood or youth can undergo a similar or even more positive psychosocial development as peers without a history of chronic disease. However, young type 1 diabetics seem to be a more vulnerable group in terms of anxiety, depression and fear of progression.

Background: Obsessive-compulsive disorder (OCD) is considered to be a significant impairment in childhood and adolescence. According to cognitive theories, parents’ external criticism and emotional self-regulation are among the variables that can directly or indirectly affect obsessive beliefs. Objective: The present study aimed to examine the mediating role of emotional self-regulation in the relationship between parents’ external criticism and obsessive beliefs in adolescents. Methods: In this study, 547 high school students aged between 15 and 18 years were selected using multi-stage cluster random sampling. An obsessive beliefs questionnaire-child version (OBQ-CV), a self-regulatory orientations scale, and a perceived criticism questionnaire were used to collect data. Pearson’s correlation was used to investigate the relationship between the study variables. For analysis of the mediation model, structural equation modeling using the AMOS software was employed. Results: The fitness indices for the four-factor structure of the OBQ, two-factor structure of the emotional self-regulation instrument, and single-factor structure of parents’ external criticism were reported as favorable [root mean square error of approximation (RMSEA)<0.1]. External criticism was associated only indirectly with obsessive beliefs through emotional self-regulation. The two variables of emotional self-regulation and external criticism explained 47% of the variance in obsessive beliefs. Conclusion: This study showed that self-regulation can mediate in the relationship between parents’ external criticism and obsessive beliefs in adolescents that could have implications for parents’ behaviors and positive emotional regulatory processes. In order to identify other potential mechanisms of parents’ criticism on obsessive beliefs, further studies are necessary, especially in clinical samples.

Background: In Nigeria, adolescents are highly vulnerable to sexually transmitted infections (STIs) which have the potential of jeopardising their future reproductive lives if poorly treated. Objective: To determine the prevalence and health care seeking behaviour for STIs among secondary school adolescents in Ado, South-Western Nigeria. Subjects: Male and female adolescents aged 10–19 years. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 560 adolescents selected from public and private secondary schools in Ado Local Government Area (LGA) of Ekiti State, using a multistage sampling technique. The data were analyzed using descriptive and inferential statistics. Analyzed data were presented in the form of tables and charts. Results: Two hundred and fifty-one (47.1%) respondents had previous symptoms of STIs. The commonest symptoms among the males were penile discharge (30.5%), painful micturition (30.5%) and stomach pain with swollen testes (25.4%). The commonest symptoms among the females were genital itching (27.6%), genital sores (14.1%) and painful micturition (13.1%). Only 26.7% sought treatment from a health facility; 37.0% did nothing; 15.9% went to patent medicine stores, 10.0% used herbs; the rest did self-medication or prayed. Conclusion: The prevalence of STI symptoms among adolescents in Ado-Ekiti is high but their health care seeking behaviour is poor. Health education about the dangers of untreated STI and the importance of seeking treatment early, targeted at adolescents, should be intensified.

Background: Effective communication skills have been found to be one of the pivotal factors in building positive interpersonal relationships. Little is known about nursing undergraduates’ perspectives on communicating with patients. Objective: This study aimed to explore nursing students’ perspectives and experiences of nurse-patient communication in their clinical placement. Methods: The participants included 21 second-year undergraduates and 21 first-year master’s students. Interviews were conducted in Cantonese and then transcribed in Chinese and translated into English. A content analysis approach was adopted to analyze the data. Results: Five themes emerged from the interview data. ‘The necessity of nurse-patient communication’ reveals why the students valued nurse-patient communication. ‘The conversation contents’ describes the content of the conversations that students typically had with patients. The third theme is ‘self-reflection on the nurse-patient communication’. The last two themes, ‘the communication pattern in different hospital settings’ and ‘the obstacles impeding nurse-patient communication’, are about the students’ communication styles in different hospitals and the barriers they encounter. Discussion: To improve students’ communication skills, educators and clinical staff should listen to students, enhance students’ reflective skills and strengthen their confidence. Conclusion: Through understanding students’ difficulties in the nurse-patient communication experience and the skills that they lack, educators can provide them with helpful recommendations to improve their communication skills in clinical practice. Practice implications: The results of this study reveal that students’ nurse-patient communication skills need to be improved.

Following the International Conference on Population and Development Adolescent Reproductive and Sexual Health (ARSH) was recognized as a top development priority in India’s National Population Policy 2000. In 2006 a separate ARSH strategy was articulated within the National Rural Health Mission. In Jharkhand, one of the poorest and least developed states in India, in 2008 the state government launched a Tarunya Project in collaboration with EngenderHealth. The project provided cascading ARSH training to government staff at secondary care facilities and strengthened outreach activities to enhance community engagement. After 5 years of implementation, the project was evaluated by a team from the World Health Organization. The evaluation found that the project provided training and ongoing backstopping support to strengthen the ARSH readiness of health facilities. The project’s intervention efforts contributed to improvement in quality and initial use of ARSH services. The performance of health facilities was appreciated by clients. But there was little correspondence between the project’s monitoring and the period of exposure of the facilities to the project’s interventions and service quality. The evaluation also showed that handholding and backstopping by the project were still very much needed.

In adolescence, Kawasaki disease (KD) may present with varied clinical pictures, and the classic clinical criteria are often insufficient to establish the diagnosis. This report presents a clinical case of KD in an adolescent and a brief review of the relevant literature, based on a PubMed search using the terms “adolescence” and “KD”. A 13-year-old girl presented with fever, rash, hepatomegaly, and ultrasonographic evidence of abdominal lymphadenopathy. On week 2 after onset of symptoms, the patient developed desquamation of the extremities and thrombocytosis. Echocardiography was normal during the acute illness and remained unchanged at 2-year follow-up. Clinicians should be aware that, in adolescents, KD poses a diagnostic challenge and rarely corresponds to the classic presentation. On retrospective analysis, we believe that abdominal lymphadenopathy should have been recognized as a substitute manifestation of the classic symptom of cervical lymphadenopathy to establish the diagnosis of this fearsome systemic vasculitis syndrome.

Self-inserted foreign bodies in the bladder is an uncommon entity in males due to the lengthy urethra. Here we present a case of insulated electric wire present in the urinary bladder of a 15-year-old male inserted for sexual arousal. Diagnosis was made by history and radiological investigation and it was removed by cystoscope with an uneventful recovery.

Clinical research involving children and adolescents with obesity is challenging due to recruitment, transportation barriers, parents/guardians working multiple jobs and the need to coordinate the schedule of the participant and the parent/guardian. We describe recruitment efforts and successes for a longitudinal observational study of adolescents with obesity.