Volume 32, Issue 3

The purpose of this article is to review the literature regarding the relationships between alexithymia, fibromyalgia (FM), and psychological distress among adolescents. Google Scholar and databases were searched using alexithymia, fibromyalgia, psychological distress, and adolescent keywords. Studies that examine the relationship between alexithymia and fibromyalgia and the contribution of psychological distress on this relationship among adolescents are lacking. However, based on previous studies on adult samples and theoretical background, there are possible relationship between alexithymia and fibromyalgia as well as possible mediating effect of psychological distress on this relationship in adolescents. Further studies are recommended to examine the relationships between alexithymia, fibromyalgia, and psychological distress among adolescents.

Background Sex before marriage among Muslim adolescents is becoming a serious issue in Muslim societies exemplified by an increasing incidence of teenage pregnancy. Sexual abstinence is an optimal goal for adolescent health from an Islamic perspective. Muslim adolescent girls’ perceptions have not been investigated, therefore, we lack understanding of their strengths and the risks that may contribute to outcomes such as pregnancy or sexually transmitted infections. Objective The purpose of this investigation was to characterize Muslim adolescent girls’ perceptions of sexual abstinence. Methodology This participatory action study was conducted at an Islamic school in southern Thailand. Twenty-five girls, ages 12–14 years old, were purposively selected to participate in the study. Content analysis was used for data analysis. Results Two salient themes were discovered that characterize Muslim adolescent girls’ perceptions about sexual abstinence: sexual abstinence is a means of self-protection and sex outside marriage is restricted by Islam, but it seems to be difficult to adhere to. Conclusions Religious values, family and peers play a central role in shaping thoughts and decisions about abstaining from sex. The integration of religious principles with building practical refusal skills, is needed to promote Muslim adolescent health.

Objective Human adenovirus-36 (Ad-36) infection has been implicated as a risk factor for obesity. This study aims to measure Ad-36 antibody prevalence among obese and healthy-weight Midwestern US adolescents. Methods Obese and healthy-weight subjects 10–18 years of age attending an adolescent clinic in Missouri, USA, were tested for Ad-36 antibodies via ELISA assay. All subjects were measured for height and weight to determine body mass index (BMI). χ 2 analysis was used to compare Ad-36 antibody prevalence between the two groups. Results Ad-36 antibodies were tested on 41 obese and 37 control subjects. The subjects’ mean age at the time of sample collection was 15.6 years (SD 2.0). Ad-36 antibody prevalence was 43.9% among the obese group and 21.6% among the control group (p = 0.038). Discussion The findings show that statistically more obese Missouri adolescents test positive for Ad-36 antibodies than their healthy-weight peers, consistent with previous findings suggesting a correlation between Ad-36 infection and obesity.

Objectives To check whether excess in abdominal adiposity and metabolic factors were associated with blood pressure abnormalities in non-obese adolescents. Methods We randomly selected 1100 adolescent students, aged 12–18 years, from schools and classrooms in the city of Constantine, Algeria. Among them 179 were overweight and 51 were obese (IOTF criteria). Waist circumference (WC) was considered high if >74 cm in boys and 75 cm in girls (mean of WC of all population studied). Hypertension (HBP) and prehypertension (preHBP) were defined by the NHBPEP’s 2004 criteria. Results The prevalence of HBP/preHBP were 13.0%/12.4% with no difference between boys and girls. The percentages of HBP/preHBP patients were 15.6%/15.6% in overweight adolescents, 5.9%/31.4% in obese adolescents and 12.9%/10.6% in adolescents with normal body weight (p < 0.0001). In obese adolescents, the prevalence of HBP was higher among boys than girls (36% vs. 27%, p = 0.002). In normal and overweight adolescents, the prevalence of HBP and preHBP was similar in boys and girls (11.9% vs. 11.0% and 14.7% vs. 12.1%); the association of WC (high vs. not high) with HBP was found in boys (16.1% vs. 8.8%, p = 0.009) but not in girls (12.1% vs. 10.2%), and with preHBP in girls (15.5% vs. 8.0%, p = 0.029) but not in boys (16.2% vs. 13.6%). Waist circumference [OR: 1.04 (1.03–1.06); p < 0.0001] and HOMA index [OR: 1.65 (1.13–2.39); p = 0.009] were associated with an increased risk of HBP. Conclusion In non-obese adolescents, a high WC, defined by values over the mean WC observed in our population, is associated with a higher risk of HBP in boys.

Background Oral health is not merely the absence of oral disease and dysfunction, but also influences the subject’s social life and dento-facial self confidence. Objective To assess and correlate self perceived psychosocial impact of dental aesthetics among young adults based on gender. Subjects A convenience sample of Young adults of degree college in the age group of 18–23 years of Hyderabad city, India. Method Self perceived psychosocial impact of dental aesthetics was assessed using the psychosocial impact of dental aesthetics questionnaire (PIDAQ). The dental aesthetic index (DAI) was used to evaluate dental aesthetics among participants which includes 10 parameters of dento-facial anomalies related to both clinical and aesthetic aspects of the anterior teeth. Results The majority of the study population were 18 years of age (96; 31.4%) with a mean age of 19.2 ± 1.1 years. When the mean total score and individual domain scores of PIDAQ was compared based on gender, females showed higher statistical mean (p ≤ 0.05) for all except the psychology impact domain (p = 0.12). Based on DAI grading and gender, among both males [70 (32.9%)] and females [31 (33.3%)] the majority of them had a DAI score of ≤25 (grade1; normal/minor dental malocclusion). A significant negative correlation was observed between DAI, with PIDAQ and its domains (p ≤ 0.05) except for the dental self confidence (p = 0.72). Conclusion This study had examined the relationship between self-perceived psychosocial impact and dental aesthetics. So, early preventive or interceptive procedures should be carried out to prevent further psychosocial impacts on human life.

Background Health care providers are often the first point of contact for the victims of violence against women (VAW). Therefore, it is important to understand their perception about VAW. Objective To assess the proportion of female medical students who experienced violence, and elicit their perception regarding the same. Methods It was a cross-sectional study undertaken among 50 medical and 50 nursing students of a medical college in Central Delhi. A self-administered, questionnaire was used for data collection. Results Of the total, 18% had experienced molestation while 77% had experienced eve-teasing during their lifetime. But, only 2% reported the incident to police. Perception regarding the victim’s role and self-determination was favorable amongst the female students. However, only 39% knew some basic self-defense techniques. Conclusion The proportion of students who experienced eve-teasing in their lifetime was high. The study highlighted the need to make the female students more pro-active and competent in terms of tackling violence.

Background Despite the need to curb the menace resulting from the negative trajectory of disruptive behaviour disorders (DBD) in societies of the world today, there is yet a dearth of locally standardised tools for the early detection of these disorders in Nigeria. This study was aimed at standardising the DBD teacher rating scale (DBD-TRS) to be culturally specific using teachers’ ratings of their students. Objectives To establish norm scores for the three categories of DBD on the DBD-TRS, to evaluate the reliability, validity, predictive power, sensitivity and specificity of DBD-TRS items for identifying DBD symptoms amongst children/adolescents between the ages of 4 and 16 years. Methods A cross-sectional survey of the five divisions of Lagos was conducted using multi-stage sampling technique. A randomly selected sample of teachers from a selection of regular schools across the five divisions of Lagos retrospectively rated systematically selected samples of their students in absentia; by referring to the names in their class registers for the recently concluded school session. The DBD-TRS and the previously validated strengths and difficulties questionnaire (SDQ) were used for the ratings. Results Ratings were completed for 1508 children/adolescents by 197 teachers from 30 regular schools. The norm scores for the three categories of DBD were determined by gender, age, and grade/class. Satisfactory psychometric properties were established for the DBD rating scale. All DBD items had high negative predictive power and positive predictive power, high specificity, and low false positive rates. However, ADHD items had lower PPP (0.23–0.55). Conclusion The DBD rating scale demonstrated sufficient technical merits to be used as a preliminary tool for identifying children that may require further clinical evaluation by mental health experts for behavioural disorders.

Background Almost 7.2%–10.6% of patients survive CPR in Iran. Most of them experience post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG). There are limited studies to assessing the correlation between these two psychological outcomes among CPR survivors. Objective This study aimed to examine the correlation between PTSD and PTG among CPR survivors in South-East Iran. Subjects Using Quota sampling, 163 CPR survivors in two provinces in the South-East of Iran were selected to participate in this study. Method A descriptive-correlational study was used to fulfill the aim of the study. The impact of Event Scale-Revised (IES-R) for assessing PTSD and Post-traumatic growth questionnaires were used to assess PTG. Results The mean score of PTSD was 39.89 and according to the cutoff point, 87.1% of participants suffered from PTSD. The mean score of PTG was 78.6. PTSD and PTG had significant negative correlation. The result of multi-variate logistic regression showed that only the PTG score predicted PTSD (Odds ratio = 0.79, CI = 0.72–0.87; and p < 0.001). The result of multi-variate linear regression indicated that PTSD, time passed since CPR, and physical disability caused by CPR predicted PTG score significantly. Conclusion This study provides CPR survivors and health care personnel with some valuable insights about cultural aspects of PTSD and PTG among CPR survivors and that PTG is positively influenced by physical disability and time passed since CPR. CPR survivors may gain positive experience and valuable insight in group meetings and discussions with their counterparts.

Background Sex dialogue is one of the most critical and challenging topics between mothers and adolescents. The knowledge and skills of mothers in sex dialogue with their daughters are essential. The purpose of this study is to determine the effect of group counseling based on communication skills on mothers through their sex dialogue with their daughters. Methods A randomized controlled field trial was conducted on 168 couples of mothers and their daughters selected by the stratified matching method and randomly divided into two control and intervention groups. The mothers in the intervention group participated in a communication-based consultation in groups consisting of 6–12 people for 6–7 weekly sessions, each one lasting 60 min. The data collection tool was a Persian-translated questionnaire by Jaccard for sex dialogue between mother and daughter. The data were analyzed using Chi-square (χ 2 ), ANOVA with repeated measures and modified post hoc Bonferroni tests. Results There was a significant difference in the mean score of mother-daughter sex dialogue 1 week after intervention between the intervention (34.48 ± 8.74) and control (40.44 ± 9.49) groups (p = 0.001) and 1 month after the intervention between the intervention (30.41 ± 10.07) and control (42.47 ± 9.62) groups (p < 0.001). Conclusion Through applying communication skills, an increase in mother-daughter sex dialogue frequency was observed after group counseling. Therefore, it is suggested to promote mother-daughter communication skills by accessing the mothers via schools, health centers and with the aid of midwifery counselors, midwives and other trained caretakers.

Background The prevalence of obesity among youths has become a public health problem. The trend in the prevalence of obesity among high school students in Mississippi has not been examined in the last 17 years. Methods The data from the Mississippi High School Youth Risk Behavior Survey from 1999 to 2015 were used to determine the prevalence of obesity. The definition of obesity was based on age- and sex-specific body mass index (BMI) of more than 95th percentile, according to 2000 Centers for Disease Control and Prevention (CDC) growth charts. The differences in the groups were examined using the univariate t-test statistical analysis at p < 0.05 and frequency distribution to determine the percentage differences. Results There was a decline in the prevalence of obesity from 1999 to 2015 among Whites but no significant decrease among Blacks. The prevalence based on race in 2105 was 18.9%, which is higher than 14.4% in 1999 and remaining years. The rate of obesity based on race and sex was 27.7% among Blacks and 15.9% among White males in 2015. The Black females had prevalence of 20.6%, which is higher than their White counterpart (12.1%) in 2015 and previous years. Conclusion The prevalence of obesity among Blacks was higher when compared to White students. There was an increased prevalence of obesity in males over females. Students in 9th and 10th grade had a higher prevalence of obesity than those in 11th and 12th grade.

Background One of the most prevalent problems in work places that is considered as an important risk factor for the health of the employee is job burnout (JB). JB could be harmful to employees, their families and society. Therefore, decreasing JB among individuals and determining factors associated with it is important to improve the working environment and prevent its negative outcomes. This study aims to elicit the conditions and factors that cause job burnout among nurses of the Razi Psychiatric Hospital, Iran. Methods This study was a descriptive correlational and cross-sectional survey which the demographic and occupational burnout variables of nurses were measured. The study was conducted from January to April 2016. Accordingly, with a type I error probability of 0.05 and a power of 0.80, the sample size was determined to be 100 nurses for each group (men and women). Then, 200 were selected in the Razi Psychiatric Hospital (of whom approx. 60% worked in a rotating shift schedule). The data were collected in two phases: the first step was created by the authors, including gathering demographic data with questionnaire such as gender, age, marital status, education level, years of professional experience, hours of overtime working per month, shift schedules, and their working hospitals and wards. The second step was the Maslach burnout inventory (MBI), human services survey (HSS) version, developed by Maslach and Jackson to assess the three dimensions of burnout. Descriptive statistics (frequency distribution) were used for integrating the demographic variables. Additionally, logistical regression was applied to realize the association between demographic characteristics with the job burnout in SPSS software V.19. Results Our findings indicated that age, hours of work per week, nursing skills, management experience and work experiences accounted for 30% of the variance of depersonalization. Formal employment was significantly associated with emotional exhaustion (p < 0.04). Also, sex was significantly associated with low personal accomplishment (p < 0.006). Conclusion The employment status and gender of nurses participating in the study has an effect on emotional exhaustion and personal achievement. Paying more attention to gender in the nursing profession and the change in their work status to a stable and formalized format can lead to a reduction in job burnout among nurses.

Background Nursing students play a role in promotion of public health as health promoters and professional care providers. Therefore, health-promoting behaviors in nursing students and their self-efficacy for health practices are important in providing better services to patients and clients. With regard to the importance of these factors in the academic progress of students, this study was conducted to examine the level of health-promoting behaviors among nursing students and its relationship with self-efficacy for health practices and academic achievement. Methods This descriptive and correlational study was conducted on 217 nursing students of a large university of medical sciences in the south of Iran in 2016. Data were collected using the Persian version of the health promotion lifestyle profile (HPLP II), self-rated abilities for health practices scale (SRAHPS) and the grade point average of the students (levels A, B, C). Results The mean health-promoting behaviors (2.48 ± 0.35) and self-efficacy for health practices of the students (2.55 ± 0.62) were moderate. The mean score of the students’ academic achievement was at level B (16.02 ± 1.85). The health-promoting behaviors were significantly correlated with self-efficacy for health practices (r = 0.623, p < 0.0001) and academic achievement (r = 0.285, p < 0.0001). Moreover, self-efficacy for health practices was significantly correlated with academic achievement (r = 0.282, p < 0.0001). Conclusion The correlation between the health-promoting behaviors and health self-efficacy with academic achievement can be a good basis in devising health and educational programs for students. In planning for promoting academic achievement and health-promoting behaviors of students, it is essential to pay special attention to enhancement of self-efficacy for health practices.

Background The field of adolescent medicine is an emerging area of specialization in Thailand. Adolescent medicine was made a mandatory rotation in general pediatric residency training programs for the class of 2013. Objective This study aims to explore the difference in pediatric residents’ confidence and the frequency in providing aspects of care to adolescents. Subjects Participants included two groups of pediatric residents; the former curriculum group (FCG) in 2012 and the mandatory curriculum group (MCG) in 2015. Methods Participants in this cross-sectional study answered a 41-item self-administered questionnaire and results were analyzed by descriptive statistics. Results There were 91 participants, 50.05% were in the MCG. The FCG reported a higher percentage of feeling “more confident” on physical examination (p = 0.031, V = 0.23) and growth assessment (p = 0.040, V = 0.22). The MCG reported a higher percentage of “more frequently” carrying out the psychosocial assessment (p = 0.035, V = 0.22). Conclusion The FCG reported higher levels of confidence than the MCG in most of the items, while the MCG reported higher levels of frequency in providing care. The psychosocial (HEEADSSS) assessment, a key aspect of the adolescent clinical visit, was the item that the MCG reported doing more frequently than the FCG which remained significant when only the postgraduate year of training (PGY) 4s were compared.

Background Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women’s Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations. Methods This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions. Results The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39–2.37). Conclusion Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.

Purpose Many adolescent girls in Nigeria do not test for HIV despite being at high risk. While the influence of psychosocial factors on HIV testing has been examined, there is less evidence regarding the impact of assets and control of assets on HIV testing. This study investigated the protective effects of specific adolescent girls’ assets on decision-making regarding HIV testing. Methods Cross-sectional data from the 2013 Nigeria Demographic and Health Survey was analyzed. The main outcome variables were self-reports of having been tested for HIV and knowledge of a place that offers HIV testing. Binary logistic regression was used with employment, education, wealth index, home ownership, land ownership and decision making as potential predictors. Demographic characteristics were controlled in the analysis. Results Age [odds ratio (OR = 1.49)], employment (OR = 3.38), education (OR = 3.16), wealth index (OR = 1.33) and decision making (OR = 3.16) were positively associated with HIV testing. Age (OR = 1.20), employment (OR = 1.33), education (OR = 1.38), wealth (OR = 1.64), land ownership (OR = 1.42), and decision making (OR = 1.26) were positively associated with knowledge of an HIV testing location. Conclusion Our findings suggest that assets play an important role with HIV testing decisions for adolescent girls. Further research to elucidate the specific asset-based needs of adolescent girls will be needed to enhance decisions surrounding uptake of HIV testing and receipt of test results in Nigeria.

Background Yoga is very effective in improving health especially cardio-respiratory fitness and also overall performance in adolescents. There are no large numbers of randomized controlled studies conducted on comparing yoga with physical activity for cardio-respiratory fitness in adolescent school children with large sample size. Objective Aerobic training is known to improve physical and cardio-respiratory fitness in children. Cardio-respiratory fitness is an important indicator of health in children. In this study we evaluate the effects of yoga versus physical exercise training on cardio-respiratory fitness in adolescent school children. Subjects Eight hundred two school students from 10 schools across four districts were recruited for this study. Methods In this prospective two arm RCT around 802 students were randomized to receive daily one hour yoga training (n = 411) or physical exercise (n = 391) over a period of two months. VO 2 max was estimated using 20 m shuttle run test. However, yoga (n = 377) and physical exercise (n = 371) students contributed data to the analyses. Data was analysed using students t test. Results There was a significant improvement in VO 2 max using 20 m Shuttle run test in both yoga (p < 0.001) and exercise (p < 0.001) group following intervention. There was no significant change in VO 2 max between yoga and physical exercise group following intervention. However, in the subgroup with an above median cut-off of VO 2 max; there was a significant improvement in yoga group compared to control group following intervention (p = 0.03). Conclusion The results suggest yoga can improve cardio-respiratory fitness and aerobic capacity as physical exercise intervention in adolescent school children.

Objective To investigate the prevalence, associated factors, and control level of asthma in Jordanian high school students. Methods A descriptive, comparative, cross sectional design was used and a cluster sample of 2691 students (mean age = 14.5 years, 51.0% girls), drawn from eight randomly selected public high schools in Northern Jordan, participated in the study. Each student had the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire completed in the classroom between February and May, 2015. Results The prevalence of recent wheezing in the last 12 months was 11.7% whereas the prevalence of diagnosed asthma was 6.2%. About 49% of students experienced cough all the time, and 33.5% experienced waking up at night due to wheezing some of the time. About 30.9% of students reported moderate to big exercise-induced asthma. The mean total Asthma Control Test (ACT) score was 5.85 (SD = 3.56) with all of students reporting uncontrolled asthma during the last month. Higher rates of asthma symptoms were reported by females, 10th graders, and students with negative family history. Importantly, students with diagnosed asthma or recent wheezing reported higher rates of ever smoking tobacco vs. non-asthmatics (p < 0.000); dual (18.6% vs. 9.8%), cigarettes only (11.2% vs. 7.3%), and waterpipe only (18.0% vs. 14.7%). Conclusion Overall, students with asthma or wheezing had increased rates of tobacco smoking. Policies need to be set and enforced to provide a better environment for these youth, especially making all schools smoke-free zones. A multifaceted, comprehensive awareness and management program is required in schools to control and manage asthma symptoms.

Background Providing care for chronic disease such as HIV is a growing challenge in the world. In order to address the challenges of linkage and care in chronic disease management, we need to identify factors that can influence people to get more involved in self-care. This study was part of an extensive qualitative study conducted in Tehran, Iran in 2016. Methods The data were collected through semi-structured interviews conducted on 25 women with HIV, and were analyzed using grounded theory. Four main themes were identified as facilitating self-care among participants: health system support, clinicians’ support, family support and improved life expectancy. Sub-themes that emerged were free HIV tests; free medication; free membership in positive clubs; free psychological consultation; positive attitudes and friendly behavior from clinic staff; telephone follow up; support from husbands, mothers and peers; hope for recovery; hope for the future; and love for own children. Results Our results showed that, providing appropriate support and services, as well as a positive attitude of society towards HIV positive women, can contribute to adherence to self-care in young women with HIV. Conclusion Understanding the facilitating factors based on the patients’ experiences can contribute to the development of new policies and procedures to improve the care of these patients.

Background Due to their presence in clinical educational settings when dealing with patients, medical science students are more affected by mental disorders than other students. Some experts believe that spiritual intelligence enhances people adaptability and compatibility and creates calm in humans, especially in stressful situations. Objective The objective of this study was to investigate the relationship between spiritual intelligence and aggression among students of medical sciences in the southeast of Iran. Methods This analytical-descriptive study was conducted among bachelor students of Medical Sciences in the Southeast of Iran and examples of the research were selected from the Schools of Nursing and Midwifery, Public Health, Paramedical and Management by a stratified random sampling method. To examine samples questionnaires were used which examined students’ demographic information, and included King’s 24-item Questionnaire of Spiritual Intelligence and the Buss-Perry Aggression Questionnaire (AQ). After completing the questionnaires, data were analyzed using statistical analysis software (SPSS version18) with a significance level (p < 0.05). Results The results showed that there is a significant negative correlation between spiritual intelligence and aggression of students (r = −0/19, p = 0/001). Results also showed that Students of Medical Sciences in the Southeast of Iran with a spiritual intelligence average score of 52.28 have an average spiritual intelligence and those with an aggression average score of 78.57 have higher aggression than average. Conclusion The results showed that with increasing spiritual intelligence, aggression decreases. The results can be used by policymakers and managers to take steps to reduce aggressive behaviors and mental disorders and for the promotion of spiritual intelligence of students of medical sciences.

Objective Delayed childbearing has gradually started to become the norm for higher educational students, with possible increased future fertility risks and psychological distress as a consequence. What do female students expect from their general practitioners (GP) and other health care providers (HCPs) with regard to delaying childbearing? We also looked into indicators that can be used by HCPs to detect female university students who have issues regarding delayed childbearing. Methods Cross sectional study: A total of 398 female students (mean age 21.83; SD = 2.4) from at least three different universities completed the questionnaire (distributed through the Internet and at a students’ health service). Potential predictors for having an issue regarding delayed childbearing were assessed with multivariate logistic regression. Results Thirteen percent of 398 female students experienced being childless as more or less problematic. Forty-nine percent thinks having children deserves more attention and 33% of the students expect attention from their GP regarding a possible desire to have children during contraceptive consultations. Four factors demonstrated significant associations with having an issue concerning delayed childbearing: age (these issues also occur in younger students), worrying about fertility, not opting for an abortion if pregnant and dissatisfaction with current contraceptive use. Conclusion HCPs should discuss delayed childbearing with female students, addressing both the decrease of fertility after a certain age (30), the limited range of fertility methods, and the possible negative physical and psychological consequences of postponement. These elements could be included into programmes of sexual and reproductive health training and into pre-conception care and pre-conception education.

Psychotropic management of a first psychotic break is challenging for many psychiatrists. The literature shows that the use of cannabis is widespread in psychotic individuals. The literature also points to young males being most at risk for substance abuse. Studies also show that obstructive sleep apnea and the stress of the military lifestyle contribute to the development of psychosis. Here, we present a case study of a young non-combat veteran with a medical history of obstructive sleep apnea who presented to the Emergency Department of a Veteran’s Affairs hospital with symptoms consistent with a first psychotic break. On routine admission laboratory work, his urine toxicology screen was positive for cannabis. Given the widespread use of cannabis in individuals with psychosis, we suggest that it plays an important role in the regulation of psychosis and behavior.