Volume 30, Issue 2

Objective: Early intervention with evidence-based treatment is important to halt the progression from early manifestations of personality disorder traits to adult personality disorders. The purpose of this study is to evaluate dialectical behaviour therapy (DBT) modified for an adolescent population with borderline personality disorder (BPD), offered within a stepped-care model. Methods: Seven adolescents (M=1, F=6, Mage=16.86) diagnosed with either BPD or BPD traits participated in a modified 15-week DBT group. The group was offered within a stepped-care model, which required participants to have previously completed an 8-week distress-tolerance module. Pre/post scores on self-report measures of BPD symptomatology, including impulse control, emotional regulation and awareness, anxiety, depression, and substance use, were collected. Results: Participants showed a post-treatment decrease in anxiety symptoms (large effect size) and disruptive behaviours (medium effect size). There was also an increase in emotional symptoms (medium effect size) and hyperactivity/inattention (medium effect size). Conclusion: The modified DBT group shows promise in alleviating symptoms of anxiety and some of the disruptive behaviours associated with BPD. The increase in emotional symptoms may be due to the expressive nature of DBT, and may contribute to their eventual therapeutic processing in the next step of the program.

Background: Adolescents spend an increasing amount of their time engaged in screen using activities. The present study aimed at identifying parental factors associated with screen time among Greek adolescents. Methods: A sample of 1141 adolescents, as well as their parents, participated in this survey. Adolescents were asked to complete a questionnaire about time spent on screen-viewing behaviors. Respectively, parents completed a questionnaire concerning family predictors. Multiple regression analysis was used to determine correlates of adolescent screen-viewing with family predictors. Results: The mean screen time per weekday was 193 min. Adolescents, whose parents had received up to secondary school education, spend more time in screen-viewing compared with the other groups. Controlling adolescents’ gender and age, all the family variables (perceived rules, parental modeling, parents’ screen related sedentary behavior, parental concern for screen viewing, support for physical activity, parental education) were statistically significant in predicting adolescent screen time with Perceived Rules recording a higher negative beta value (β=−0.18, p<0.00). Conclusion: Perceived parental screen time rules play a role in the amount of screen time among adolescents. Interventions that focus on parental limit setting development and physical activity support may be effective in decreasing screen time among youth aged 13–15 years.

Background: Despite changing sexual norms and mores generally perceived to be permissive of sexual expression, parents continue to serve as gateways to uptake of reproductive health services and commodities in our cultural settings. However, their support for adolescent uptake of human papilloma virus (HPV) vaccine are not well explored and documented. This study aims to assess parental knowledge and awareness of HPV infection and cervical cancer and their support for HPV vaccination for their adolescent children. Methods: In a descriptive cross sectional study 612 parents from in Ibadan North Local Government Area were interviewed using a pre-tested semi structured interviewer administered questionnaire to assess the awareness of HPV infection and cervical cancer as well as parental support for the vaccine. Results: Only a few of the respondents were aware of HPV infection (10.5%) and the HPV vaccine (6.5%), respectively. About 64.3% of those that were aware of HPV knew it can be transmitted through sexual intercourse. However, 78.4% supported the administration of the vaccine to their adolescent daughters. Reported reasons for not supporting HPV vaccination were high cost of the vaccine (32.2%) and lack of awareness of the vaccine (49.2%). Earning a monthly income above the minimum wage of 18,000 Naira increases the likelihood of parental support for HPV vaccination uptake for adolescents (p<0.001). Conclusion: Ignorance and poverty remain as barriers to widespread coverage of the vaccine among adolescents. Health education and promotion on HPV infection and the HPV vaccine to the general public and subsidization of the vaccine to promote its uptake is advocated.

Background: Acne vulgaris is a visible skin disease commonly seen in adolescence. As it affects the appearance, it is likely to bring stress to the adolescent’s life regarding sensitivity about their appearance. Objective: The aim of the study was to investigate the social anxiety level, acne-specific life quality, and self-esteem among adolescents with acne vulgaris. In addition, we evaluated the relationship between these parameters, clinical severity, and sociodemographic data. Methods: One hundred and two adolescents with acne vulgaris, aged 12–17 years without any psychiatric or medical comorbidity were recruited. The control group consisted of 83 adolescents in the same age range, who had neither psychiatric disease nor acne. Sociodemographic form (SDF), Capa Social Phobia Scale for Children and Adolescents (CSPSCA), and Rosenberg Self-esteem Scale (RSES) were applied to both groups. Additionally, the severity of acne was determined with Global Acne Grading System (GAGS), and life quality of the patients was evaluated with Acne Quality of Life Scale (AQOL). Results: There was no significant difference in social anxiety levels and self-esteem between the study and control groups. Life quality impairment and high social anxiety levels, as well as low self-esteem, were found to be associated regardless of the clinical severity. Conclusion: Clinicians should be aware of the psychiatric comorbidities when treating adolescents with acne vulgaris. Especially, low self-esteem and life quality impairment should warn clinicians to predict high social anxiety levels in adolescent acne patients.

With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%–20% of the patients in mental health outpatient facilities and 15%–40% in mental health inpatient facilities. Further, while 75%–80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.

Background: Orofacial pain may have an impact on quality of life. It may affect the overall well-being of an individual. Objective: To assess the prevalence of orofacial pain and its impact on quality of life in early adolescents in Indore city, India. Methods: This was a cross-sectional study which included a total of 800 children selected from various public and private schools located in Indore city, India. A questionnaire was developed which collected information on sociodemographic characteristics and previous dental visits. The severity of pain was assessed using Von Korff pain scale and quality of life using the General Health Questionnaire 12 (GHQ-12). The chi-square test and logistic regression analysis were performed. Results: The overall prevalence of orofacial pain was found to be 17.9%. Toothache (10.1%) was found to be the most prevalent orofacial pain followed by temporomandibular joint pain (4.3%). The highest severity of pain (Grades 3 and 4) was reported for toothache followed by temporomandibular joint pain. The results of the logistic regression model showed that the prevalence of orofacial pain (odds ratio=7.18, p-value<0.0001 a ) was strongly associated with poor quality of life. Conclusion: The orofacial pain has a negative influence on the quality of life of adolescents. Effective policies should be created to improve the quality of life of adolescents focusing on oral health education and prevention of oral diseases.

Objective: To elucidate the immune status of representative infectious diseases among Japanese youth, we retrospectively investigated serum antibody levels in university students, partly comparing these to immunization records and infectious disease histories confirmed by the maternal and child health (MCH) handbooks. Materials and methods: In total, 168 Japanese female university students, aged 20–21 years, were included. Data were collected from examinations of antibody titers against measles, rubella, varicella-zoster (VZ), mumps, and hepatitis B (HB) and C (HC) viruses, and from QuantiFERON ® -TB Gold tests, between 2011 and 2015. Records of immunization and infectious disease histories were available from MCH handbooks for students who agreed with the use of their data for this study (n=23). Results: All students had positive antibodies, detected by enzyme immunoassay (EIA), against measles, rubella, VZ, and mumps; however, seroprevalences within the range of seroprotective antibody levels were 38.1% (64/168), 67.9% (114/168), 95.9% (141/147), and 89.8% (132/147), respectively. The students had probably not been infected with HB, HC, or tuberculosis at the time of the examinations. Discussion: The study indicated that a two-dose vaccine for measles and rubella (MR) might not be sufficient to produce antibodies at seroprotective levels. Therefore, we propose that health care workers, including students, should receive an additional MR vaccine, even if they have received two doses of MR vaccine or if they have unknown histories of immunizations or infectious diseases. Further investigations in these areas will be needed.

Photovoice is a participatory action research method in which people are given cameras and asked to take pictures of specific issues within their community. It is often used among marginalised populations. This method helps people capture specific issues within their community using photographs, critically discuss these issues within a group and present their findings to inform policies within their community. Photovoice has been used in developed countries and among adult participants; however, the extent to which it has been used in developing countries and among adolescent participants is yet to be extensively reported. In this paper, we describe the use of photovoice among male and female adolescents aged 15–19 years who participated in the qualitative phase (phase I) of the Well-being of Adolescents in Vulnerable Environments (WAVE) study in Ibadan, Nigeria. The main study was conducted among adolescents residing in disadvantaged communities within five global cities (Baltimore, USA; Ibadan, Nigeria; Johannesburg, South Africa; New Delhi, India and Shanghai, China). Our findings revealed that adolescents in Ibadan were very eager to participate, remained fully engaged throughout the process and the data obtained were rich and detailed. Some challenges encountered with using this method were that younger adolescents had a tendency to attain saturation when taking pictures much earlier than older adolescents; however, they equally discussed the pictures taken enthusiastically. Overall, our findings affirm that photovoice as a data collection method can be successfully used in research among adolescents in developing countries like Nigeria.

Background: Many Kenyan adolescents die following pregnancy and childbirth complications. Maternal health services (MHS) utilisation is key to averting such poor outcomes. Our objectives were to understand the characteristics of adolescent mothers in Kenya, describe their MHS utilisation pattern and explore factors that influence this pattern. Methods: We collected demographic and MHS utilisation data of all 301 adolescent mothers aged 15–19 years included in the Kenya Demographic Health Survey 2008/2009 (KDHS). Descriptive statistics were used to characterise them and their MHS utilisation patterns. Bivariate and multivariate analyses were used to test associations between selected predictor variables and MHS utilisation. Findings: Eighty-six percent, 48% and 86% of adolescent mothers used ante-natal care (ANC), skilled birth attendance (SBA) and post-natal care (PNC), respectively. Adolescent mothers from the richest quintile were nine (CI=2.00–81.24, p=0.001) and seven (CI=3.22–16.22, p<0.001) times more likely to use ANC and SBA, respectively, compared to those from the poorest. Those with primary education were four (CI=1.68–9.64, p<0.001) and two (CI=0.97–4.81, p=0.043) times more likely to receive ANC and SBA, respectively, compared to uneducated mothers, with similar significant findings amongst their partners. Urban adolescent mothers were six (CI=1.89–32.45, p=0.001) and four (CI=2.00–6.20, p<0.001) times more likely to use ANC and SBA, respectively, compared to their rural counterparts. The odds of Maasai adolescent mothers using ANC was 90% (CI=0.02–0.93, p=0.010) lower than that of Kalenjin mothers. Conclusions: Adolescent MHS utilisation in Kenya is an inequality issue. To address this, focus should be on the poorest, least educated, rural-dwelling adolescent mothers living in the most disadvantaged communities.

The United Nations’s (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-à-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential – obstacles notwithstanding – enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.

Introduction: The changes in the eating habits associated with physical inactivity are directly related to the increase in the prevalence of obesity and associated diseases such as diabetes mellitus (DM), metabolic syndrome and cardiovascular diseases. Objective: The aim of this study was to investigate the relationship between the frequency of consumption of some food groups (snacks, fruits, vegetables and candies), physical exercise, nutritional classification and biochemical profile in children. Methods: After the approval of the Ethics Committee, we studied 882 schoolchildren ranging between 6 and 10 years of age. Biochemical and anthropometric evaluations were performed and questionnaires were used in order to check the eating habits and physical activity. Results: Our results showed that we may relate the consumption of snacks, fruits, vegetables or candies with modifications in the glycemia, triglycerides, total cholesterol, HDL-c, and LDL-c but we did not observe association with the nutritional classification. It is noteworthy to say that almost 50% of the studied children were overweight or obese and many presented alterations in the lipid and glucose levels. Conclusion: Our results also show that many children have abnormal levels of lipids and glycemia and a great number of them are classified as overweight or obese. In this context, we can say that urgent approaches are needed to be carried out by a multidisciplinary team in order to improve the diet and reduces the risk factors in this population of children and prevent secondary diseases in adolescence and adulthood.

Background: An emerging pattern of increasing median age at first birth among women has been well documented in Western countries. A similar but less remarkable trend is being experienced in sub-Saharan Africa. There is a paucity of information in Sub-Saharan Africa about awareness of age-related fertility decline. The aim of this study was to assess the perception of fertility, childbirth intentions and parenting attitudes among university students. Materials and methods: A cross-sectional survey of 231 female and 158 male students randomly selected university undergraduates in Nigeria using a self-reported questionnaire. Results: The respondents overestimated the ages of slight (92.1%) and marked decline (89.4%) in female fertility. The chance of pregnancy after unprotected sex during ovulation was overestimated by 93.1% of the respondents. Over three-quarters of them overestimated the success rate of in-vitro fertilization. The sources of information regarding fertility issues were mainly school (40.1%), the media (20.6%) and family members (18.8%). About 98.7% of the childless respondents reported an intention to have children in the future. The mean number of children desired was 3.29±1.14. Females desire to have their first and last children earlier than males (p=0.000). The perceived potential obstacles to having the desired children were the pursuit of career aspirations (35.5%) and the pursuit of personal interests (20.8%). Conclusions: Misconceptions about fertility issues have grave implications for involuntary childlessness and secondary infertility. Comprehensive family planning education that will address the misconceptions about female fecundity and parenting issues are required.

Background: The American College Health Association’s, National College Health Assessment (ACHA’s NCHA) estimates 46.1% of college students reported being vaccinated in the last year. Objective: 1) To understand the college student’s knowledge, attitude, and beliefs in regards to influenza vaccination; 2) To establish recommendations in a population where high risk transmission does not consistently translate into high vaccination rates. Methods: Utilizing the health belief model (HBM), a cross-sectional study of college student perspectives of influenza vaccination was conducted. Results: Student beliefs regarding vaccination-associated illness and the importance of vaccination did influence vaccination behavior. However, student perceptions of being at risk for the flu and the lack of barriers to vaccination were not found to be significant indicators of vaccination behavior. Conclusion: For this particular population, vaccination promotion efforts may be most effectively targeted in the sophomore and junior years. Findings of this study inform efforts among University Health Services regarding seasonal flu prevention and vaccination on the college campus.

Factitious disorders are characterized by physical or psychological symptoms that are intentionally produced or feigned in order to assume the sick role. “Munchausen’s syndrome” is one of these disorders and often is under-recognized or only suspected after unnecessary investigations. We report the case of a 15-year-old boy who came to our notice because of reduced urine output and recurrent abdominal pain during the previous 3 months. The patient attended several emergency room visits and he had been hospitalized for 1 month in an adult internal medicine department because of “oliguria”. He had undergone several invasive investigations with normal results before the diagnosis of Munchausen’s syndrome was made. General pediatricians and practitioners should be aware that suspecting Munchausen’s syndrome in the first instance in the management of a patient showing discrepancies between reported urinary symptoms and the detectable clinical signs could avoid unnecessary and invasive exams.

Many studies suggest that testosterone plays a role in the regulation of mood and behavior. Most but not all investigations of the relationship between testosterone and suicidality found relations between testosterone and suicidal behavior. The balance of evidence is in favor of the view that testosterone is involved in the pathophysiology of suicidality. The author has previously proposed that suicidal behavior in adolescents and young adults is associated with high testosterone levels, whereas suicidality in older men is associated with decreased testosterone levels. However, both high and low testosterone levels can be observed in adolescent, young, middle-aged and older men. In this article, the author proposes that both high and low testosterone levels may play a role in suicidal behavior in men of any age.

A 17-year-old mixed race male has been followed in our adolescent clinic for severe obesity, dysmorphic features, and behavioral issues. Among other interventions, he has received symptomatic treatment for hypertension, insulin resistance, and attention deficit hyperactivity disorder. Genetic investigation identified a 16p11.2 microdeletion, commonly associated with severe obesity and developmental delay. We present the clinical history, treatment, and implications for this patient.