Volume 31, Issue 1

Purpose Accumulating life stress is a driving factor underlying the most pervasive, incapacitating health conditions in 21st century, First World societies. The most widely supported strategy, for remediating the negative health consequences of elevated life stress, is physical activity (PA). Evidence also suggests accumulating life stress impedes PA uptake. Thus, ironically, persistently elevated life stress not only negatively impacts multiple dimensions of health, simultaneously it may also reduce likelihood of participation in the most effective remediating strategy, PA. This study sought to compare patterns of PA uptake in adolescents of low socioeconomic status (SES) backgrounds, a significant risk factor for elevated biopsychosocial stress, with more affluent age-matched peers. Related health behaviours such as smoking and alcohol consumption were also analysed. Methods PA patterns were determined using the Physical Activity Questionnaire for High School (PAQA). Stress scores were assessed using the 10-item perceived stress scale (PSS-10). Results PA scores were significantly different between groups (p < 0.05). Low SES participants were significantly less active every day (p < 0.05), excepting Saturdays ( U  = 31.0, Z = −1.594, p = < 0.05). Spearman’s correlation demonstrated an inverse relationship between total stress and PA during spare time (r s  = −0.61, n = 10, p = < 0.05). Conclusion These findings add to mounting evidence suggesting excessively accumulating life stress, not only diminishes health, but simultaneously reduces PA uptake in vulnerable populations. Thereby highlighting the bidirectional relationship between stress and PA. These findings support proposals that conventional Physical Education practice should be re-framed to not only provide PA during school years, but to promote lifelong interest in PA.

Objective Sensitivity about appearance is one of the sine qua non of adolescence and adolescents’ self-esteem effecting their socialization processes. We explored if verruca vulgaris, a common visible infectious skin disease, affects social anxiety levels and self-esteem in adolescents compared to controls. Also, the difference in sociodemographic properties between two groups and the effect of clinical properties (the distribution and number of warts) on these parameters were investigated in the patient group. Materials and methods The study group consisted 98 adolescents (49 controls and 49 patients) without other medical/psychiatric diseases. The Sociodemographic form (SDF), the Çapa Social Phobia Scale for Children and Adolescents (ÇCASPS) and the Rosenberg Self-Esteem Scale (RSES) were completed by both groups. Results There was no difference in social anxiety levels and self-esteem between the two groups. Also, the control and patient groups were found matched. However, lower self-esteem was the only factor that increased the risk for social phobia in the patient group. Conclusion Verruca vulgaris distributed in hands and face in adolescents were not found to be related with higher social anxiety and lower self-esteem. However, clinicians should monitor psychiatric symptoms and especially lower self-esteem should be taken into account.

Purpose The main aim of this research is to explore measures of smart phone usage, smart phone addiction, and their associations with demographic and health behavior-related variables among dental students in Saudi Arabia. Methods A Cross sectional study involving sample of 205 dental students from Qaseem Private College were surveyed for smart phone use and addiction using the short version of the Smartphone Addiction Scale for Adolescents (SAS-SV). Results Smart phone addiction was seen in 136 (71.9%) of the 189 students. The findings from our study revealed that high stress levels, low physical activity, higher body mass index (BMI), longer duration of smart phone usage, higher frequency of usage, shorter time period until first smart phone use in the morning and social networking sites (SNS) were associated significantly with the smart phone addiction. Conclusion The current research gives the information about the extent of smart phone over usage and addiction among the dental students in Saudi Arabia with indication of the predictors of addiction and the need for further research in the area with comprehensible interpretation to spread the awareness of the smart phone addiction.

Background The phenomenon of street children is a bio-psychological and social issue that not only harms children, but also endangers the health of a society. In line with the national programs for the development and promotion of street children’s health in Iran, health policy making and essential strategies for this group of children will be presented in this paper. This paper will discuss the main issues and challenges of street children’s health and, also, health policy and guidelines for this population. Methods In this review study, the keywords; street children, health, challenges, policy, and health policy making were searched through PubMed, SID, Iranmedex, World Health Organization (WHO), Emro, the Cochran Library, Medline and Google scholar to collect data. The search resulted in 84 related resources from which 48 cases that were more relevant to this research and covered the issue more comprehensively, were used. All data published during 2002–2015 have been included in this paper. Results Key concepts including street children and their health, health policy, strategies to improve the health of street children, health policy approaches for street children, the WHO’s strategies, and social support program for street children must be considered in the health policy making processes for street children, as precise identification of the relevant information makes planning more effective in health policy making for this group of children. Conclusion The phenomenon of street children is a growing problem in the world and it has turned into a serious concern in many countries including Iran. The findings of this study can be used for identifying necessary measures in order to use research outcomes more effectively in policy making processes and reforming street children’s health policies in Iran.

Background The age at the time of the first sexual intercourse is declining, and the prevalence of smoking is increasing in adolescent girls in developed countries. Objective To assess the relationship between menarche and tobacco smoking and sexual activity in adolescent girls. Subjects Girls between 14 and 18 years, attending primary or secondary school. Methods Socio-demographic characteristics (age, living place, educational level of parents, self-estimated financial background), onset and parameters of periods, and risk behaviors (smoking, sexual activity) were measured by self-administered questionnaires. A multivariate logistic regression analysis was used to assess the relationship between tobacco use and sexual activity and socio-demographic characteristics, menarche and presence of other risk behaviors. Results Adolescent girls who had an earlier onset of their periods were about twice as likely to smoke as girls with later onset of their first period [odds ratio (OR): 2.28, confidence interval (CI): 1.14–4.55]. Being sexually active meant more than 7-fold odds of being a regular tobacco user (OR: 7.24, CI: 4.39–11.94). Regarding sexual activity, increasing age (OR: 4.42, CI: 3.45–5.67) and regular smoking (OR: 7.07, CI: 4.24–11.80) increased, while poor financial status decreased (OR: 0.35, CI: 0.13–0.97) the odds of being sexually active. Conclusion In light of these findings, the reconsideration of health and sexual education in Hungary is needed. Implementation of these programs at an earlier age should be desirable to avoid unfavorable consequences, such as early pregnancy.

Background Compulsive Internet use has emerged as a contemporary addictive behavior. Our aim was to investigate the reasons for Greek adolescents with type 1 diabetes mellitus (T1DM) and their families to use the Internet and additionally to investigate the level of Internet use and its associations to demographic, socio-economic parameters and glycemic control. Methods Patients with T1DM, aged >12 years and their parents were recruited during their regular visits to the Pediatric Diabetes Clinic. A similar group of healthy children, age- and sex-matched served as a control group. All participants were asked to fill out the Greek translated version of the Internet Addiction Test (IAT). Caregivers of patients with T1DM were asked to complete a second questionnaire consisting of questions regarding demographic and socio-economic data of the family and data concerning disease management. Results Thirty-five patients with T1DM (mean decimal age of 14.95 ± 1.90 years) and 35 controls participated in the study. Nine patients were on an insulin pump whereas the rest were on multiple daily injections. The mean total score of the patients’ IAT questionnaires was significantly lower compared to the controls (26.26 ± 12.67 vs. 39.91 ± 18.55, p = 0.003). Controls were characterized as exhibiting moderate addictive behavior at a significantly higher percentage than patients (31.43% vs. 2.86%, p = 0.002). All patients on insulin pumps demonstrated normal Internet use. Mild addictive behavior was associated with a lower parental educational level. Finally, level of Internet use (IAT score) was positively associated to glycemic control (HbA 1c value) with a correlation that was approaching significance (r = 0.315, p = 0.065). Conclusions Adolescents with T1DM and especially those on an insulin pump exhibit normal Internet use compared to their healthy peers. Time consumed on Internet correlates reversibly with glycemic control.

Background When treating recalcitrant and severe childhood obesity, pharmaceutical options are limited and few patients qualify for bariatric surgery. A prolonged inpatient program serves as an alternative treatment. The purpose of this project was to describe the development of a medically supervised inpatient weight management program and evaluate its effectiveness. Methods This is a retrospective chart review of 18 patients [4–18 years, mean body mass index (BMI) 50.2 kg/m 2 ] admitted to an inpatient pediatric weight management program from October 2011 through December 31, 2012 to evaluate the biometric, laboratory, sleep and behavioral changes that occurred from admission to discharge from the program. Results Average weight loss was 15% (6.9%–21.5%, p = 0.0001), the decrease in BMI was 15.1% (1.61–21.57, p = 0.0001), systolic blood pressure and diastolic blood pressure decreased by 7.2% (p = 0.003) and 10.3% (p = 0.040), respectively. The reduction in heart rate was 15% (p = 0.013). Upon admission, nine patients had obstructive sleep apnea syndrome (OSAS), of which one was treated with tonsillectomy and six were not compliant with home positive airway pressure (PAP) therapy. At discharge, three patients no longer required PAP and five required decreased PAP settings. Upon admission, seven patients met the criteria for an internalizing disorder. At discharge, symptom reduction was noted. Conclusion An intensive pediatric inpatient weight management program leads to successful weight loss, improvement in hemodynamic parameters, reduction in OSA treatment requirements and symptom improvement in anxiety and depressive disorders in obese children.

Background The prevalence of obesity has increased globally, with childhood and adolescent obesity being more common in developed countries. There has been no study on teenage obesity in Bhutan. In this study, we aimed to assess the prevalence of obesity in Bhutan for the first time in order to provide a baseline for future researchers. Methods The investigation, which included 392 adolescents, aimed to identify the prevalence of overweight and obesity and its contributing factors. Anthropometric measurements, food recall and knowledge, attitude, behaviour and environment questionnaires were administered. The body mass index (BMI) cut-off points for adolescents matched with those of the US Centers for Disease Control and Prevention. Results The prevalence of overweight and obesity among the participants were 7.1% and 1.5%, respectively. The prevalence of obesity was 1.0% in females and 0.5% in males (p < 0.001). There were significant (p < 0.001) correlations between BMI and other variables; however, Pearson’s χ 2 test uncovered no significant associations. BMI also had no significant associations with attitude, behaviour, environment and distance travelled to school. Food recall results revealed the following findings for average food consumption: total energy intake, 3522.6 kcal; fat, 47.6 g; carbohydrate, 690.2 g; protein, 90.5 g; fibre, 20.3 g; and sodium, 12.5 g. Conclusion The results of this study clarified the prevalence of obesity among adolescents in Bhutan, who require appropriate strategies for combating overweight and obesity.

Background Family planning services recognize reproductive health as the joint responsibility of both men and women. Efforts need to be shifted to men’s own sexual health in order to achieve the Millennium Development Goals (MDGs) for reduction of maternal mortality and HIV transmission. Aims To determine the methods of contraception used by young adult men and factors that influence their choice of contraceptive. Methodology A cross-sectional descriptive study was done using structured questionnaires to extract relevant information from consented young male adult between ages of 16 and 24 years of Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Nigeria. Data was coded using Microsoft Excel and was analyzed using the SPSS version 17. Results The majority of the respondents 212 (71.6%) had had sexual intercourse. Mean age at first sexual debut was 17.8 ± 2.5 years. The majority of the respondents 124 (58.5%) did not use any contraceptives during their first sexual experience and over 1/5th (21.2%) of respondents had impregnated a partner in the past with the majority, 39 (86.7%) of such pregnancies resulting in an induced abortion. Frequency of religious services attendance showed a statistically significant difference with respondents that were sexually active or had previous sex (p < 0.001). Conclusion Male involvement and education about contraceptive methods, use and consistency of contraception could have a drastic reduction in unwanted pregnancies and also a reduction in abortion complications.

Background Digital technologies make family managing more complicated, as parents are worried about their children’s well-being and want to protect them from excessive Internet use. Objective The objective of this study was to investigate both youths’ and parents’ views on strategies and rules set at home to regulate and monitor Internet use. Subjects Thirty-five adolescents (19 females), aged between 11 and 18 years, and 27 parents (17 mothers) from the French-speaking part of Switzerland participated in different focus groups. Methods Using a qualitative approach, results were analyzed using the grounded theory. Results Eight different mediation strategies emerged. One relevant finding is that rules regarding problematic content were never mentioned, while rules about screen time and location of use were numerous. This might indicate that parents are more worried about the time spent in front of the screen than about the actual activities their children engage in. Conclusions It could be recommended to parents to keep striving for an environment contributing to open discussion and exchange on Internet use, even if their digital literacy is lower than their youngsters’ are.

Background Evidence-based Internet depression prevention intervention programs are not readily available for Arab youth, but may be effective in this group. Cultural adaptation of evidence-based Western psychotherapy is an important step toward better prevention and treatment of depressive illness in the Arab community. Project CATCH-IT is an Internet-based depression prevention intervention tool that is tailored for adolescents and young adults. Methods The PEN-3 theoretical framework was used for the cultural adaptation of Project CATCH-IT for Arab adolescents. First, a narrative review of existing research about depression in Arab nations was performed. Next, expert opinions about applicability and societal values were obtained. This model was then used to suggest relevant changes to the CATCH-IT modules. These modifications were applied to create sample webpages from the culturally adapted version of CATCH-IT for Arab youth. Results The narrative review, expert opinions and resultant PEN-3 analysis suggest that Internet-based depression interventions are effective, private and confidential. To be most effective, religious leaders and fathers should be the stakeholders approached for dissemination and adequate usage of the service. Arab themes, quotes, language and relevant stories must be incorporated. Conclusion This study sets the background for future studies and research for implementation of the Arabic version of CATCH-IT for the prevention of depression. Using the contextual information provided in this paper to make the necessary changes, huge strides can be made in providing cost-effective and accessible Internet-based interventions to Arab youth.

Today, available time for physical activity has been continuously decreasing, whilst, school-time physical education (PE) classes appear to be the only real option for many adolescents to engage in physical activity and exercise. The aim of the present study was to investigate fitness and health related parameters over one academic year, and after the summer holidays for adolescents who do not engage in out-of-school physical activities. Participants were 153 students (age: 15–17 years; boys n = 86) who exercised only during PE (2 × 45-min periods per week). Body fat, flexibility, handgrip strength, squat jump, 30 m sprint and cardiorespiratory fitness were examined at the beginning and end of a school year, and after the ensuing summer holidays. The boys improved handgrip and flexibility, but no other significant improvement was observed over the school year in any of the examined physical fitness parameters, or obesity indices. Instead, the girls’ cardiorespiratory fitness decreased over the summer holidays. It seems that exercising only twice a week during school PE classes is insufficient to induce significant improvements in physical fitness, body composition and health parameters.

The study aimed to assess gender differences among Kuwaiti adolescents in healthy living choices that impact the risk of obesity. A cross-sectional multistage cluster design was employed with a representative sample of 2672 students aged 13–15 years who completed a self-administered Global School-based Student Health (GSHS) survey. The study found that around 48.0% of adolescents were overweight and obese. More boys than girls were obese (28.2% vs. 22.3%, p < 0.0001). However, boys were more likely than girls to report healthy food choices regarding fruit (38.1% vs. 33.2%), and vegetables (21.8% vs. 16.7%). Only 20.7% of adolescents reported physical activity for more than 60 min/day, predominately by boys rather than girls (30.8% vs. 10.5%, respectively, p < 0.0001). Multivariate analysis revealed that male gender, skipping breakfast and physical inactivity were significantly correlated with the risk of overweight and obesity among adolescents. These results suggest that lifestyle education for promoting healthy body masses targeting adolescents should take gender into account.

Objective: To determine the prevalence, secular trends and associations of heart disease in a large unscreened, otherwise basically healthy, adolescent population. Subjects and methods: Cross-sectional study of the cardiac status of 113,694 adolescents from the northern district of Israel, who completed the profiling process between the ages of 16 and 19, including all essential measures over a 22-year period. Results of imaging were categorized as either isolated valvar or structural abnormalities, and their clinically significant subgroups defined prospectively. The findings were correlated with the socio-demographic and anthropometric data and non-cardiac health conditions. Results: Of those sent for echocardiography, 1257 (0.93% of the total population) had isolated valvar disease and 216 (0.19%) had structural abnormalities, with 20% of both groups considered significant. Females had lower prevalence of heart disease. There was peak prevalence in the second 5-year period. Tall subjects or a past history of rheumatic fever had more valvar abnormalities. Thin subjects or those with skeletal anomalies had more structural abnormalities. Significant valvar and structural anomalies were more common in subjects with learning disorders, endocrine disorders and diabetes mellitus. Fewer valvar abnormalities were diagnosed in obese subjects. Heart disease was more common in those with non-solid tumors. Conclusion: Appreciable numbers of potentially healthy adolescents were found to have heart disease. There appeared to be an association with body size, skeletal abnormalities and relatively common medical disorders, the cause of which remains to be determined in prospective studies that could change the way common adolescent disease should be followed.