Volume 31, Issue 4

Background Successful transition to adult healthcare is particularly important for congenital heart disease (CHD) patients who have undergone palliative surgery, as they risk adverse events if not followed closely. This study examines young people at the worst end of the CHD spectrum who are born with a single ventricle (pumping heart chamber), and who undergo a series of operations that culminate in the Fontan surgical procedure. Purpose To explore adolescents with a Fontan circulation, and their parents’, readiness for transition to adult care and pre-implementation of a transition program. Methods Seventeen adolescents (15–18 years) and 15 of their parents completed questionnaires at the start of their first transition clinic. Results Adolescents reported poor knowledge about their Fontan circulation, and 41% had a poor understanding of the purpose of their medications/treatments. Over half of the adolescents had poor knowledge around medical help-seeking (when, who, how). Most reported feeling comfortable with discussing their medical issues with their cardiologist, but considerably less so about sensitive adolescent issues, in particular, emotional wellbeing. Parents reported high levels of anxiety around transition to adult care services. Conclusion Findings pre-program indicate poor adolescent health knowledge, a lack of focus in health services on emotional wellbeing and high parental anxiety. These findings highlight the need for dedicated programs that focus on early preparation, parental involvement and acknowledgment, transition as a process, strong integration and prioritisation in the health system with a youth-friendly and holistic focus, in particular, around emotional wellbeing.

Youth suicide is a major global mental health problem. This review looks at the epidemiology, risk and protective factors associated with youth suicide, and global strategies to address this important issue. To better understand factors contributing to youth suicide, global gender differences in suicide were examined. Global rates of suicide amongst young men are higher than young women. However, there are anomalously higher rates of female youth suicide in India and China, and possible causes of this are examined further. It is likely that underestimation of youth suicide is a major factor affecting the accuracy of suicide epidemiology. Risk factors for youth suicide are varied. Psychiatric factors include various psychiatric illnesses, substance use (particularly amongst refugee and homeless youth). Psychosocial risk factors include family conflict, physical and sexual childhood abuse, isolation, socioeconomic disadvantage, discrimination and acculturation. Vulnerable populations are at increased risk, including refugee/immigrant/indigenous youth, those in foster care and homeless youth. Protective factors can include family cohesion and strong interpersonal relationships, as well as increased access to care. Global strategies to prevent youth suicide include reducing lethal means to suicide and reducing harmful media reporting. Various psychosocial interventions may be helpful, including individual support, and family, school and community based interventions. Strategies can also increase evaluation of psychiatric disorders and access to care, as well as promote psycho-education and reduce stigma against mental illness.

Background Research on living with a chronic disease (CD) in adolescence is increasing. However, studies on the relevance of psychosocial factors are still needed. The present review, focuses on the impact of living with a CD in adolescence on on quality of life (QoL), health-related quality of life (HRQoL) and psychosocial factors. Methods A literature review of articles identified through PubMed, PsycINFO and PsycARTICLES (these last two ones comprise the Ebsco Host platform) and original peer-reviewed research papers, published between 2010 and 2015, with no restrictions regarding the format/source of interventions, randomized controlled trials (RCTs) or types of comparisons were included. Results Eighteen papers met the inclusion criteria and contradictory results were found: the majority showed a significantly higher risk of impairment on QoL/HRQoL and psychosocial factors, whereas others reported a significantly lower risk of impairment (highlighting possible protective factors), or no significant differences. Heterogeneity in the assessment procedures and substantial difficulties in considering adolescence as a single and independent age group, were also noted. Conclusion The higher risk of impairment and the heterogeneity observed between cohorts, reinforce the need to work towards consensual procedures, which allow for more accurate comparisons among studies. Additionally, it conveys the challenge to find more effective interventions. Furthermore, it is highly suggested to routinely assess HRQoL/psychosocial factors within an individualized framework, to considerer adolescents as a single/independent group, to emphasize potential protective factors, and, to increase youth’s participation in their own adaptation process and in health promotion in general. These are possible future directions that could enable multidisciplinary responses to improve HRQoL and psychosocial care in adolescents with a CD.

Background The objective of the study was to evaluate the effectiveness of a school-based physical activity and nutritional behavior intervention, on the reduction of clustering of chronic diseases risk factors among school children. Materials and methods A quasi-experimental school-based intervention was conducted with an intervention group and a control group in the region of Sousse in Tunisia. The intervention was implemented between 2010 and 2013, with data collected at pre and at post intervention. Studied risk factors were: smoking, sedentary behavior, low fruit and vegetable intake and obesity. Odds ratios (ORs) were used to calculate the clustering of two risk factors. We calculated ORs in each group before and after the intervention. Results In the intervention group, the prevalence of adolescents that had no risk factors has significantly increased (p = 0.004). In the control group the prevalence of adolescents carrying two or more risk factors has increased (p = 0.06). The results showed that all risk factors tended to cluster together in both groups. In the intervention group, the calculated OR for smoking and sedentary behavior decreased after assessment (OR = 5.93) as well as the OR for smoking and low fruit and vegetable intake (OR = 3.26). In the control group, all ORs increased, showing an enhancement of the association. Conclusion This study showed the effectiveness of a school-based intervention in reducing the clustering of chronic diseases risk factors.

The aim of the study is to add to the body of knowledge on less researched aspects of female adolescent health in Nigeria. It specifically explored the menarche or first period narratives of 136 young women, focusing on the contents of the discussion that ensued with whom they told when they first got their period using qualitative methodology. It also explores sources of premenstrual information and how the menstrual period is managed. The sample consisted of 136 undergraduate females in Redeemer’s University, Ede, Nigeria. Almost all of the respondents (95%) received information about menstruation from mothers, female relatives and school lessons prior to menarche. The majority of the respondents first told either their mother or a female relative when they first got their period and viewed menarche as a crisis. Two salient themes emerged from the contents of the narratives; celebration and advice. The advice theme was further explored and three advice patterns were identified: being a woman, hygiene and changed dynamics in relationships with males. Data from the present study suggests that only certain aspects of the menstruation discourse have evolved. All respondents reported using sanitary towels during their menstrual period with the majority experiencing cramps regularly and (61%) using pharmalogical agents for remedy. It is envisaged that findings from the study will be useful in future health intervention programmes and research on female adolescent health in Nigeria and elsewhere.

Renal lymphangiectasia is a rare benign condition of the lymphatic system. Primarily, the diagnosis is based upon characteristic imaging findings along with biochemical analysis of aspirated fluid. No definitive algorithm exists for treating this condition owing to its rarity. The literature describes various modes of management ranging from conservative management to nephrectomies. We present a case of bilateral renal lymphangiectasia managed with percutaneous drainage along with sclerotherapy. Our initial findings show a favorable outcome with this approach.

Trichotillomania is characterized by recurring hair pulling behavior and repeated attempts to decrease or stop the behavior. This behavior can cause a trichobezoar, which is a mass of hair found in the stomach. Patients with diagnosed celiac disease may have an urge to swallow their hair due to iron or folat deficiency, which is called pica. We report a case of an 11-year old girl with celiac disease who has had trichotillomania for a duration of 2 years, and required an operation due to residual gastric hair mass. In this case trichotillomania was more likely caused by behavioral disorders secondary to celiac disease, rather than the iron deficiency due to malabsorption.

Background Metabolic syndrome (MS) in adolescents is a risk factor for type 2 diabetes and cardiovascular diseases. Objective The present study aimed to determine the prevalence of MS in 14–18-year-old girls. Methods This analytical case-control study was conducted on 3200 high school students with polycystic ovarian syndrome (PCOS). PCOS was confirmed by an endocrinologist after detection of clinical hyperandrogenism (acne, hirsutism and alopecia) and oligomenorrhea, rejection of hypothyroidism and hyperprolactinemia and performance of abdominal sonography. In the second stage, the prevalence of MS was compared between 70 girls with PCOS and 45 healthy girls using the ATPIII, Cooki and Ferranti scales. The study data were collected using a demographic questionnaire, body mass index (BMI) graph, the WC graph and standard blood pressure graph in adolescents. Then, the data were analyzed using the t-test and the χ 2 -test. Results Based on the Ferranti scale, the prevalence of MS was 10.4% and 0% in the case and control groups, respectively. The highest prevalence was related to hyperandrogenism and polycystic ovaries phenotype (11.6% vs. 0%, p = 0.05). Based on the Cooki and ATPIII scales, the prevalence of this disorder was 4.1% in the case group and 0.67% in the control group, with the highest rate being related to hyperandrogenism, oligomenorrhea and polycystic ovaries phenotype (7.5% vs. 0%, p = 0.28). Conclusion In comparison to the control group, the prevalence of MS in the patients with PCOS was 10-fold higher according to the Ferranti scale and nearly 3.5-fold higher based on the Cooki and ATPIII scales. Thus, long-term follow-up is suggested in these patients.

Introduction Emerging adults are particularly vulnerable to body image dissatisfaction and social anxiety. These bring about a host of negative outcomes, including compromised social adjustment and well-being. Fear of negative evaluation has been shown to be a core element of social anxiety, but it is rarely considered in studies of body image and its effects on social anxiety. This study aimed to bridge this gap by examining the role of fear of negative evaluation in the association between body image dissatisfaction and social anxiety. Methods A cross-sectional study using 80 Thai undergraduates (mean age of 21 years) was conducted by self-reported (questionnaire) measures. Body image dissatisfaction was measured with the short version of the Body Shape Questionnaire (BSQ-8C), fear of negative evaluation with the Brief Fear of Negative Evaluation Scale, and social anxiety with the Interaction Anxiousness Scale (IAS). Correlation and mediation analyses were conducted to assess how these constructs were related to one another. Results The key hypothesis was supported: positive associations were found among body image dissatisfaction, fear of negative evaluation and social anxiety, and the association between body image dissatisfaction and social anxiety was mediated by fear of negative evaluation. Discussion Generalizing from the current findings, ideas for possible amelioration of social anxiety are discussed.

Background While a large number of patients with eating disorders (EDs) engage in excessive exercise (EE), both for weight control and mood regulation, there has been minimal research evaluating the relationship between EE and demographic and psychological factors, especially in adolescent patients. Purpose The goals of this study were to identify the occurrence of EE compared to other ED behaviors and to develop a regression model examining psychological, behavioral and demographic predictors of EE among adolescents with EDs. Methods Demographic and clinical information was determined for 217 adolescent patients in several levels of care (126 outpatient, 61 day program, 28 inpatient) with diagnoses of anorexia nervosa (AN) (24.9%), bulimia nervosa (BN) (25.8%), and eating disorder not otherwise specified (EDNOS) (49.3%). These patients presented to a large ED program and completed a series of questionnaires on admission to the program. Descriptive statistics, t-tests, chi-square analyses and multiple logistic regression were utilized to describe the population of adolescent patients and develop the model for predicting EE. Results Forty-seven percent of patients indicated they participated in EE in the past 4 weeks, compared to 32% for binge eating, 35% for vomiting and 15% for laxative use; 42% of patients with anorexia nervosa participated in EE, compared to 54% with bulimia nervosa and 49% with EDNOS. The regression model that was developed to predict EE, which included factors of depression, anxiety, dietary restraint, age, body mass index (BMI), diagnosis and level of care, correctly classified EE in 71.5% of cases. Dietary restraint and BMI were the two factors found to be significantly associated with EE. Conclusions Forty-seven percent of adolescent patients presenting for treatment of an ED reported participating in EE. This was larger than the numbers of patients reporting other ED behaviors that are commonly assessed, indicating the need for psychoeducation for multidisciplinary treatment teams, assessment, prevention, and clinical treatment services for this problematic behavior. It is important that those who treat patients with ED assess for and monitor EE behaviors that can complicate the treatment.

Purpose To compare the nutritional intake of adolescents with eating disorders (EDs) to recommended Daily Values of macronutrients and micronutrients, using the Nutrition Data Systems for Research (NDSR); to determine if nutritional content varied among the different sub-types of EDs; and to use the Healthy Eating Index 2010 (HEI-2010) as a measurement of diet quality in this population. Methods Forty-six adolescents referred to an ED Program were recruited for inclusion in this study. A detailed 24-h dietary recall from each participant was obtained and a detailed nutritional analysis was generated, allowing for calculation of the HEI-2010. Descriptive statistics were calculated to determine baseline characteristics of the study population and to determine associations and differences between ED subtypes. Results Average daily caloric intake was below recommended values in the study population. Despite this, the distribution of macronutrients was within the ranges recommended for older children and adolescents by the Dietary Guidelines for Americans, 2010. Micronutrient content varied considerably. The study population had a mean HEI-2010 score of 60.1, falling within the “needs improvement” category. A majority of the participants had insufficient caloric intake for the HEI to be applicable. Conclusion Results suggest that adolescents with EDs have a surprisingly normal distribution of macronutrient intake. Although using a diet quality assessment tool such as the HEI-2010 has been helpful in analyzing overall diet quality in the general population, the restrictive caloric intake which characterizes the ED population prevents the utility of such a guide for most patients with EDs.

Purpose Mental health disorders are a pressing issue among adolescents around the world, including in India. A better understanding of the factors related to poor mental health will allow for more effective and targeted interventions for Indian adolescents. Methods The Indian Adolescent Health Questionnaire (IAHQ), a validated questionnaire designed specifically for use in schools, was administered to approximately 1500 secondary students in three private urban Indian schools in 2012. The Strengths and Difficulties Questionnaire (SDQ) module assessed mental health. Linear regression was used to predict SDQ scores. The biopsychosocial framework was used as an organizing framework to understand how each explanatory variable in the final model might impact the SDQ score. Results One thousand four hundred and eight students returned IAHQ surveys (93.9% response rate); 1102 students completed questions for inclusion in the regression model (78.3% inclusion rate). Statistically significant (p < 0.05) independent variables associated with SDQ scores were gender, level of overall health, negative peer pressure, insults from peers, kindness of peers, feeling safe at home, at school, or with friends, and grades. Discussion Schools have a role to play in improving adolescent mental health. Many of the significant variables in our study can be addressed in the school environment through school-wide, long-term programs utilizing teachers and lay counselors. The IAHQ and SDQ can be used by schools to identify factors that contribute to poor mental health among students and then develop targeted programs to support improved mental health.

Background Akershus University Hospital has since 2012 worked systematically towards improving the process of transfer for adolescents from the Department for Paediatric and Adolescent Medicine (DPAM) to adult services in our hospital. Objective To improve the transfer process of adolescents we aimed at moving from a more administrative focus on transfers to a transition programme. The aim was both short-term and long-term gains, namely quality improvement of the healthcare we are providing and valued health promotion outcomes. Methods A guided transition programme for adolescents was developed, piloted and introduced. It was developed in close collaboration with our youth council. An e-learning programme and a handbook for health care professionals were developed for implementation. Results Data from the pilot testing the transition programme show that the adolescent participants found the information material to be relevant. They reported that it was used actively by the health professionals in their consultations and that they found this to be helpful. It was crucial that the management acknowledged and took responsibility for the programme. We experienced that a shared understanding of the adolescent patient in both sending and receiving departments was crucial. Conclusion Adolescent medicine should include competence and professionalism. Health care personnel must possess knowledge, skills and attitude that enable good, health promoting encounters. Further evaluation of pre- and post-implementation clinical outcomes, of patient empowerment and of satisfaction among employees will need to follow for evaluation of the effectiveness of this transition programme.

Background Household food insecurity has a substantial contribution to poor health outcomes among young children and adolescents. Food insecurity also affects optimal cognitive development and physiological function of these vulnerable groups. There is a gap of documented data regarding the association of food insecurity and morbidity among school adolescents in Ethiopia. Objective The aim of this study is to assess the interrelationship of household food insecurity and morbidity report among school adolescent in Jimma zone, Ethiopia. Methods A community based cross-sectional study was done from October to November, 2013. Data were gathered using structured questionnaires through interview of students and their caregivers. A total of 1000 students were selected by using simple random sampling methods using their rosters as a frame. Data were also checked for missing values and outliers, and analyzed using SPSS version 16.0. Regression analyses were used to see the strength of association between independent and dependent variables using odds ratios and 95% of confidence intervals. Results Adolescents from food insecure households had more reported illness (39.3%) than adolescents from food secure households (24.7%) (p < 0.001). Adolescents from food insecure households were two times more exposed to morbidity [AOR = 2.04(1.32, 3.14)] than adolescents from food secure households. This study also showed that males had 48% less reported illness [AOR = 0.52(0.01, 0.23)] than females. Adolescents who had attended health education had less reported illness [AOR = 0.57(0.38, 0.86)] than those who did not ever attend. This study also showed that having a farmer [AOR = 0.46(0.28, 0.74)] and government employee [AOR = 0.33 (0.17, 0.64)] father were inversely associated with adolescent morbidity. Conclusion The findings of this study showed that household food insecurity, female gender and lack of attending health education had a significant contribution to adolescent morbidity. Therefore, there is a need to improve household income earning capacity and strengthen school based health and nutrition education to prevent adolescent morbidity. The findings of this study can also be used to lead the development of programs aimed at preventing adolescent morbidity by notifying policymakers and other stakeholders about the association of morbidity with household food insecurity.

Background Physical activities during leisure time as well as school hours have changed over the past few years, with adolescents being less physically active and adopting a sedentary lifestyle. Objective The overall objective of this mixed-methods study was to evaluate the feasibility of introducing a 4-min Tabata interval training into a lower secondary school context. A further aim was to evaluate the possible effects on: coordination, balance, and strength. Methods The study was conducted as an intervention study with a mixed-method approach. Forty-three children, aged 7–9 years, participated in the intervention group. Additionally, 13 children were recruited as a control group. The intervention itself was delivered by the teachers and was performed for 4-min every day in a classroom setting. All participants performed physical tests before and after the intervention period to evaluate the Tabata training. After the completion of the 6-week Tabata interval training, the four teachers were interviewed. Results The push-ups (p = 0.004), kneeling push-ups (p = 0.03), and standing long jump (p = 0.01) improved in the intervention group after 6 weeks. No differences were observed between the genders. The teachers experienced that it worked well to integrate the Tabata interval training in the classroom setting. Conclusion After 6 weeks, a school-based Tabata intervention program improved physical performance. The teachers saw no obstacles in including the Tabata intervention program in a classroom setting and pointed out several positive aspects such as an increased energy level and development in the children’s movement patterns.