Volume 33, Issue 4

Over the past decade, opioid abuse/misuse has grown from a local problem into a national crisis, causing the U.S. Health and Human Services (HSS) to declare a public health emergency. The number of those dying from opioid abuse has increased, especially among adolescents. Since 2014, death rates due to opioid overdose have been highest in persons aged 15–19 years. This systematic review examines past and present research concerning opioid abuse/misuse and seeks to bring more attention to the growing opioid epidemic affecting adolescents aged 12–25 years nationwide. Keywords such as “adolescent”, “opioid”, “overdose”, “opioid misuse”, and phrases including “opioid use and race”, “income status and opioids”, were used to find common demographic trends which can be attributed to this population. The process of gathering and disseminating information currently available on this subject helps highlight a somewhat taboo subject involving vulnerable members of our community. It is imperative that healthcare providers, in particular, those who treat adolescents, have access to current research and resources that support efforts to combat this persistent issue. In addition, this information will prove useful to those who have the ability to change policies and how this current crisis is being managed. Results from the research indicate that opioid abuse/misuse in adolescents is rising and race, gender and income play a role in the abuse/misuse of opioids. Likewise, the research proves that more opportunities for education and access to adequate treatment are paramount to ending the prevalence of opioid abuse/misuse.

Introduction Neuropathy is one of the most common complications of diabetes, which causes many problems for diabetic patients. Thus, the aim of the present study was to investigate the prevalence of neuropathy among type 1 diabetic adolescents by systematic review and meta-analysis. Materials and methods This study is a systematic review and meta-analysis, which reviewed articles published from 2001 to September 1, 2018. The search process was carried out in the Google Scholar search engine and domestic and international databases such as Magiran, SID, Iranmedex, IranDoc, Medlib, PubMed, Scopus, Science Direct, Springer, Wiley Online Library, Web of Science, Ebsco and Cochrane using Persian and English keywords based on MESH conformity. All the research steps were carried out by two members of the research team who were familiar with systematic reviews and meta-analysis data, using the software CMA. Analysis of meta-regression and the use of a random effects model were introduced and analyzed. Findings When a systematic search was carried out on the reviewed articles, five of them were included in the meta-analysis phase. The sample size was 484, and the prevalence of diabetic peripheral neuropathy (DPN) in type 1 diabetic patients was 28.2% [confidence interval (CI) = 19.5–39.1]. The findings of the meta-regression analysis showed that the DPN prevalence rate decreased with increasing age (Q = 5.77 p = 0.016), and the results of more recent studies showed an increase in the DPN incidence rate (Q = 20.62, p < 0.001). Conclusion The findings of the present study revealed that although the prevalence of neuropathy in diabetic adolescents was not high, the prevalence was significant. Considering the increasing prevalence of diabetes and its impact on the health status of patients, appropriate interventions should be conducted to prevent diabetes and subsequent diabetic neuropathy.

Background One of the components of a healthy life is attending to spiritual needs, which can reduce harmful behaviors. The aim of the present study was to evaluate the relationship between spiritual health (SH) and health-promoting lifestyle (HPL) among students of Guilan University of Medical Sciences. Materials and methods The present cross-sectional study was conducted on 360 nursing and midwifery students at Guilan University of Medical Sciences. The data were collected using a self-administered socio-demographic questionnaire, Health-Promoting Lifestyle Profile-II (HPLP-II) and the Spirituality Well-being Scale (SWBS). Data were analyzed using SPSS-21 using descriptive and inferential statistics. Results The results of the present study showed that the mean and standard deviation of the students’ HPLP-II scores as 84 ± 28 and the mean and standard deviation of SWBS scores was 90 ± 15. Also, there was a statistically significant relationship between HPLP-II scores and SWBS scores (r = 0.032). Conclusion The finding of this study showed that SH impacts on a HPL. It is recommended for policy-makers and health providers due to the positive role of SH in improving HPLs.

Introduction Islamic lifestyle refers to a way of life, whose main source is extracted from the divine book and is done in accordance with the divine rules. Therefore, the present study was conducted to determine the relationship between lifestyle and general health of adolescents. Materials and methods This cross-sectional descriptive study was conducted in 2016 on 416 secondary school students in the city of Ilam. Sampling method was that Ilam city was divided into five clusters based on geographic area and two schools were included in the study from each cluster. Data were collected using an Islamic life style questionnaire and a general health questionnaire and they were analyzed using descriptive statistics tests and SPSS16 software. Results The findings showed that the mean SD of total score of Islamic lifestyle and general health was 162.48 (30.54) and 25.55 (11.13), respectively. In the classification of general health scores of adolescents, it was shown that 249 (59.9%) students had desirable general health; 165 (39.7%) of them had good general health and 2 (0.5%) of them had unfavorable general health. There was also a positive and significant relationship between Islamic lifestyle and general health (p < 0.001). Conclusion Considering the existence of the relationship between Islamic lifestyle and general health of adolescents, it is necessary to provide the needed context to increase their general health by maintaining and improving the Islamic lifestyle of adolescents.

Purpose There is little information on youth gambling in Ghana even though there is an unprecedented emergence of various types of gambling and gambling venues throughout the country. The aim of this cross-sectional exploratory study was to examine the role of perceived social difficulties and perceived protective social factors in participation and attitudes of Ghanaian youth towards gambling using data from a school-based survey (n = 770). Methods Participants completed measures on perceived social difficulties, perceived protective social factors, attitudes towards gambling and participation in four types of gambling. Results Sports betting was the most common form of gambling. There were significant differences in gambling participation with males gambling more than females. Youth who reported more perceived social difficulties from family and friends had a more positive attitude and a negative attitude towards gambling, respectively. Youth who reported higher protective social factors from family and teachers were less likely to have a negative attitude towards gambling. In all situations, high frequency gambling resulted in a more positive attitude towards gambling. Conclusion Perceived social difficulties influences Ghanaian youths to have a positive attitude towards gambling, however, protective social factors from family and teachers may help youth to have a negative attitude towards gambling, gamble less and consequently achieve academic success.

Background and objectives Tonsillectomy is one of the most commonly used pediatric surgeries with high stress levels for children and their parents. The present study was designed and implemented regarding the fact that limited studies have ever been carried out about the effects of complementary therapies such as acupressure on the preoperative anxiety levels in children throughout the world. Materials and methods Present study was a randomized clinical trial that was done in three groups with 144 children aged 5–12 years undergoing tonsillectomy. In present study, the children were allocated in three groups: intervention, control and sham. In the intervention group, the acupressure was applied on the Yintang point and in the sham group, was applied at a sham acupoint. No intervention was performed in the control group. Before and after intervention, the pediatric anxiety levels were measured using instruments. The results were analyzed using descriptive and inferential statistics such as the Kruskal-Wallis and Wilcoxon tests, chi-square (χ2) and analysis of variance (ANOVA) test. The significance level was considered p < 0.05. Results The total anxiety score in children was (70.39 ± 20.93) in the control group, (67.83 ± 16.78) in the intervention group and (71.40 ± 21.82) in the sham group, not significant difference (p > 0.05). The different in the overall anxiety score among children before intervention compare to after intervention was as following: Control group (–3 ± 17.46), intervention group (8.42 ± 32.98) and sham group (–4.32 ± 24.47). Conclusion Like other surgical procedures, the tonsillectomy has serious stress for children. Our study demonstrates that the acupressure has a significant effect on the level of preoperative anxiety in children undergoing surgery. Therefore, nurses can use this technique to reduce the pediatric anxiety.

Introduction Agricultural injuries are an important factor in mortality and morbidity for populations of preadolescents globally. Working preadolescents in agricultural sector are exposed to occupational risks and injury in India. Objective This study mainly assesses the nature of injuries among the preadolescent agricultural workers of West Bengal, India. Methods The survey was done by collecting the data on agricultural injuries from the Hooghly district of West Bengal. The injury data for 7 years between years 2010 and 2016 were collected by conducting a survey and personal interviews with the victims. The questionnaire-based approach was used for data collection information on the injury characteristics. Results The agricultural injury incident rate was 8.99 (male) and 7.89 (female) per 1000 workers/year. The leading causes of farm injuries were hand tools (65.7%). The most frequently involved tools were spades and sickles. The main cause of hand tool injuries was repetitive work, which lead to fatigue and slippage of hand tools from the hand. The study indicated that preadolescent workers are highly prone to injuries in their occupation, mostly affecting the toes (27.8% and 26.3%) and fingers (24.8% and 25%) in both male and female preadolescents, which consequently affected their health, productivity and work performance. Conclusion This study concludes that (1) agricultural injuries affecting different body parts such as toes, fingers, feet and ankles. (2) Occurrence of injuries was much higher among males than females. (3) Hand tools accounted for the majority of injuries followed by farm machinery. (4) Cut injuries are the main ones followed by lacerations, abrasions, sprains and contusions.

Background Overweight and obesity in adolescence are associated with several negative health indicators; the association with flourishing, an indicator of overall well-being, is less clear. Objectives To examine associations between weight status and indicators of flourishing and academic engagement in adolescents. Subjects Analyses included 22,078 adolescents (10–17 years) from the 2016 National Survey of Children’s Health. Methods Adolescents were grouped according to body mass index (BMI) classification; outcomes included indicators of flourishing and academic engagement. Logistic regression models assessed the odds of each outcome comparing adolescents with overweight and adolescents with obesity to healthy weight adolescents. Results For flourishing, adolescents with overweight and adolescents with obesity were less likely to stay calm during a challenge (17% and 30%, respectively; p < 0.01); adolescents with obesity were 30% less likely to finish a task they started (p < 0.001), and 34% less likely to show interest in new things (p < 0.001) in comparison to healthy weight peers. Adolescents with obesity were 26% less likely to care about doing well in school (p < 0.001), and adolescents with overweight and adolescents with obesity were significantly less likely to complete all required homework (19% and 34%, respectively) (p < 0.001), in comparison to healthy weight peers. Conclusions A comprehensive approach to addressing overweight and obesity in adolescence should target improving academic engagement and flourishing to promote overall well-being.

Objective Victims of peer aggression, categorized broadly as face-to-face aggression (FA) and/or cyber-aggression (CA), are themselves at elevated risk for perpetrating aggressive behavior against others. Studies to date have not formally examined whether experiencing multiple forms of FA or CA is associated with even further increased likelihood of aggressive behavior towards others. Methods Data from the 2014 National Survey of Children’s Exposure to Violence III were analyzed for youth aged 10–17. Based on self-report responses regarding past-year experience, two broad victimization categories were defined: FA (verbal/relational aggression and/or physical assault/intimidation and/or property victimization) and CA (Internet harassment and/or cell-phone harassment). Logistic regression adjusting for age, sex and race/ethnicity compared victim sub-groups against corresponding non-victims with respect to self-report of aggressive behaviors towards others. Results The sample (n = 1959) was 51.3% male and 77.5% White; 39.6% reported >1 form of FA and 7.9% reported >1 form of CA. Whereas victims of physical assault/intimidation or property damage were more likely than non-victims to perpetrate aggression [adjusted odds ratio (aOR) = 4.44 and 5.17, respectively), victims of both were strikingly at greatest risk (aOR = 20.29). Similarly, victims of Internet harassment or cell-phone harassment were more likely than non-victims to perpetrate aggression (aORs = 6.18 and 9.40, respectively), while victims of both were even more likely (aOR = 15.32). Students who experienced >1 form of both FA and CA were the most likely to engage in aggressive behaviors (aOR = 38.03). Conclusion Victims of multiple forms of FA or CA are more likely to perpetrate aggression compared to non-victims and those victimized in fewer ways.

Background Oral cancer is most common cancer globally and is one of the most life-threatening conditions worldwide. Aim To assess the knowledge and awareness of oral cancer and the impact of pictorial warnings on the willingness to quit tobacco in young tobacco consumers in India. Methods This cross-sectional study included 250 young tobacco consumers from Ranchi, Jharkhand. A pretested validated questionnaire was used that collected information on knowledge and awareness of oral cancer from the respondents. The responses were estimated on a three-point scale (No/Don’t know/Yes). p-Value <0.05 was considered statistically significant. Results The majority of the respondents were aware of oral cancer (92.0%). Educational status was significantly associated with a good knowledge of awareness of oral cancer and its associated risk factors (p-Value <0.05). Media was identified as the main source for spreading oral cancer awareness (69.1%). The majority of the people were aware of the pictorial warnings on tobacco products (96.1%). However, the pictorial warnings seem to have a very low impact on willingness to quit tobacco by the respondents (20.0%). Conclusion Alternative strategies need to be employed by the government to motivate people to quit tobacco consumption. Dental health education should be provided and educational pamphlets should be distributed to create awareness about the harmful effects of tobacco consumption.

Background To provide successful transfer from childhood to adult-oriented healthcare is one of the priorities of survivorship care plans. Purpose This study describes adolescent and young adult childhood cancer survivors’ conditions at the moment of the transition to adult care deepening their biological, psychological, social and assistant state and their associations with socio-demographic and clinical characteristics. Methods A biopsychosocial check-list in four health domains (biological, psychological, social and assistant) was filled in by healthcare professionals (oncologists, psychologists, social workers and nurses) through qualitative interviews and clinical observations of 79 survivors (58% boys; M age = 20 years old) at the moment of the transition from the Pediatric Oncology Unit to the Transition Unit of the Childhood Cancer Survivors. Results At the moment of transition, 38% of survivors showed a positive condition in all the four health domains without any kind of impairment. Biological (37%) and psychological areas (44%) were found to be those with major incidence of impairments. Association phenomena were found between psychological and social condition (p < 0.05) and between social and assistant condition (p < 0.05). Biological condition was also significantly associated with the type of cancer (χ = 6,2414, p < 0.05). Conclusion Although many survivors entered in adult care system without any impairment, the biopsychosocial approach highlighted that there is a presence of impairments in at least one of the main health domains.

Introduction Physical activity (PA) is proven to be an effective strategy to avert the life threatening cardiovascular diseases. There is need for developing feasible aids to improve compliance to PA. Hence, we conducted a study among medical college students a) to assess the prevalence of recommended PA level and b) to assess the effectiveness of installing a smartphone application (app) in improving PA. Methodology A quasi-experimental study was conducted among medical college students in Puducherry, India. The baseline PA was assessed using the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements such as height and weight were measured as per World Health Organization (WHO) standards. A smartphone app (Runtastic) was installed on the mobile phones of all study participants. At the end of 1 month, the end line PA and anthropometric measurements were captured using same scales. Results Of the total 350 students who were included, the mean age of the participants was 18.9 (0.9) years and 58% of them were male. The proportion of participants with the WHO recommended level of PA increased from 81% at the baseline to 91% after 1 month of installation of the mobile app (p < 0.001). There was also a statistically significant increase in the leisure time PA [median (interquartile range – IQR) of metabolic equivalents (METS): 0 (0–1600) vs. 1260.0 (0–1920)]. Clinically significant change was not seen in body mass index (BMI) though the reduction was statistically significant [(mean (standard deviation – SD) of BMI: 22.54 (2.49) vs. after intervention 22.46 (2.47); p = 0.018]. Conclusion This quasi-experimental study conducted among medical college students reported significant improvement in total and leisure time PA.

Background Adolescents should be empowered to improve their reproductive and sexual health needs. The present study aimed to investigate effects of protection motivation theory-based education on student girls’ reproductive and sexual health self-care. Methods This randomized controlled trial was conducted in parallel on 90 female students living in dormitories of the Alborz University of Medical Sciences in Iran. The data collection lasted from January 2017 to May 2018. Convenience sampling was performed, and samples were put into intervention and control groups by block randomization. The intervention group received six educational sessions based on the protection motivation theory(PMT). The data collection tool of this research consisted of the protection motivation theory and reproductive health self-care questionnaires. Results There was no significant difference between control and intervention groups in demographic characteristics. The results of the repeated measures test indicated that the reproductive health self-care variable had a significant change (p = 0.000), and there was a significant difference between groups (p = 0.000). The total score of the Protection Motivation Theory Questionnaire was not changed over time (p = 0.54) and there was no significant difference between groups (p = 0.51) according to results of the repeated measures test. Conclusion According to effects of an educational intervention based on the protection motivation theory, it is suggested to utilize this model as an educational framework for adolescents’ reproductive and sexual health by healthcare providers, schools and universities as well as holding periodic courses educating adolescents within short-term intervals in order to achieve the higher sustainability of the educational results.

Aim We aimed to establish a normative range of surface skin temperature (SST) changes due to blood redistribution in adolescents and to register the time needed for complete postural change-related blood redistribution. Methods The healthy volunteers (age 15–18, n = 500, M 217, F 283) were recruited for this prospective multicenter study. The volunteers were asked to keep one extremity down and another extremity up in supine rest, sitting with straight legs, and upright rest. We obtained temperature readings being taken from the tips of the middle fingers and temperature readings from the tips of the first toes at the ambient temperature of 25 °C and 30 °C. The control group consisted of a 100 of adult volunteers. Results The resting temperature of the middle fingers for a sitting participant was 28.6 ± 0.8 °C. The physiological change of this temperature during body position changes was 4.5 ± 1.1 °C and for most of the participants remained within the 26.5–31.5 °C range at 25 °C. For the toe, physiological skin temperature range was 25.5–33 °C. At 30 °C, these ranges were 27–33 °C for the fingers and 27–34 °C for the toes. On average, 2–3 min were needed for such temperature changes. Conclusion At normal room temperature, the SST of thermoneutral adolescents may vary within a range of approximately 5 °C only due to the blood redistribution in the body. This range is specific for each person due to individual peculiarities of the vasomotor activity. This normative range of SSTs should be taken into account during investigations of thermoregulation.

Background Assessment of reproductive health (RH) needs is necessary for describing the status of women’s RH and identification of the actions needed. This study aimed to develop and validate a questionnaire for the assessment of the women’s RH needs. Materials and methods A sequential exploratory mixed method study (qualitative and quantitative) was conducted with Iranian women of reproductive age (age 15–49 years) living in Rasht. The qualitative exploratory phase was used to explain the concept and dimensions of RH needs. The qualitative exploratory phase was used to develop and validate a questionnaire. Results The results of the qualitative section, RH needs consists of two themes “Reproductive Health Education Needs” and “Reproductive Health Services Features”. A Women’s Reproductive Health Needs Assessment Questionnaire (WRHNAQ) was designed with 19 items. The content validity ratio (CVR) and content validity index (CVI) of the questionnaire were 0.89 and 0.93, respectively. The instrument’s internal consistency was confirmed by an alpha coefficient of 0.881. Conclusion The results of this study showed that the WRHNAQ is a culturally sensitive, valid and reliable scale for assessing the RH needs. The WRHNAQ will be helpful for identifying needs and need-based intervention.

Background With the rising trend of sexual engagement among Vietnamese young adults in recent years, concerns were raised over the issue of premarital sex and its potential health consequences. In order to prevent such consequences and further promote health, an in-depth understanding of factors influencing young people to have premarital sex would be valuable. Objective To generate a grounded theory explaining factors influencing engagement in premarital sex among Vietnamese young adults. Subjects Vietnamese adults aged 18–24 who have voluntarily engaged in premarital sex (n = 18). Method The study was conducted using the grounded theory approach by Glaser. Purposive and theoretical sampling was used. Ten in-depth interviews and three additional focus group discussions were carried out. The interviews were audio-recorded and transcribed verbatim. Data analysis involved using the constant comparative method and open and theoretical coding. Sampling, data collection and data analysis happened simultaneously until theoretical saturation was achieved. Results The grounded theory is constructed around six emergent themes: (a) desire as the ‘direct cause’; (b) the facilitators; (c) social changes; (d) media; (e) peer and (f) absence of family. The latter four themes are ‘indirect causes’ that influence through desire and the facilitators. Conclusion The study has contributed a grounded theory that identified the factors and described their relationships in a comprehensive way. It suggested a need for a reliable source of information to be tailor-designed to suit young people. Additionally, the stigma of talking about sex needs to be reduced to allow for more open discussions on sex and sexual health.

Aim The aim of this study was to compare the normative dental needs and sociodental needs in a sample of 18–21-year-old students in Davangere city in South India. Method This cross-sectional survey was conducted on a sample of 250 students aged 18–21 years. Data was collected using a self-administered questionnaire and clinical examination. The normative needs were assessed by different indices. The impact of oral diseases on their quality of life was assessed using the standard Oral Impact on Daily Performance (OIDP) scale and propensity-related needs (PRNs) were assessed using three standard questions. Results About 85.6% of the subjects fulfilled the criteria for professionally judged normative treatment need. Among them, 42% of the subjects were suffering from emergency/progressive oral conditions and the remaining 43.6% subjects were suffering from non-progressive oral conditions. In turn, a total of 28.4% of the subjects with non-progressive oral conditions fulfilled the criteria of impact-related treatment need. Finally, only 1.2% had sociodental needs (high PRNs). Conclusions A substantial reduction in treatment needs were found with the sociodental approach among youths in India. The considerable proportion of the children with impact-related need (IRN) did not have a high behavioral propensity, hence potentially needing alternative interventions and programs.

Introduction Intimate partner violence (IPV) refers to acts of physical/sexual violence, emotional/psychological abuse and controlling behaviour by a current or former intimate partner. Understanding the attitudes and perspectives of adolescents towards IPV can help in its prevention. The study aimed to assess the knowledge about various domains of IPV and self-reported prediction of perpetrating IPV among adolescents in Madurai city, South India. Methods Students pursuing engineering, medicine and humanities were recruited conveniently. A structured self-administered questionnaire developed to cater to the objectives was used. After descriptive analysis, a modified Poisson regression with robust variance estimation was used to identify factors associated with one’s self-reported prediction of becoming an IPV perpetrator and adjusted relative risks [0.95 confidence interval (CI)] were calculated. The project was approved by the Institute’s Ethics Committee. Results Of the 369 students, 40% were aware of IPV prevalence among women in India. About 85% agreed with societally prescribed gender roles. More males than females found gender roles manifesting as IPV acceptable (p = 0.003). Only 6.8%, more females than males (p = 0.01), believed that no violence is permissible in intimate relationships. About 55% definitely did not foresee themselves becoming IPV perpetrators. Belief in gender roles [odds ratio (OR) = 3.85; 95% CI: 1.26, 11.74] and being a professional course student (2.48; 1.25, 4.91) were significantly associated with foreseeing oneself as an IPV perpetrator. Conclusion Knowledge about IPV and its redressal mechanisms among adolescents is poor. A significant proportion of them believe in gender roles and perceive violence within an intimate relationship as acceptable. Positively influencing adolescents’ beliefs in gender roles may help to control IPV and nurture healthier relationships.

Background and objectives High-risk behaviors are considered to be a serious threat among adolescents. This study aimed to investigate the frequency of unhealthy and high-risk behaviors and their relationship with demographic features in adolescents living in Shiraz, Iran. Materials and methods The present descriptive, cross-sectional study was conducted on 483 students in the 10th grade of high school. The data were collected using a demographic information form and a modified adolescents high-risk behaviors questionnaire. The reliability of the questionnaire was assessed using the test-retest method. Afterwards, the data were entered into the SPSS statistical software (IBM), version 22 and were analyzed using the chi-square (χ 2 ) test, logistic regression analysis and one-way analysis of variance (ANOVA). Results High-risk health behaviors were significantly correlated to adolescents’ gender, parents’ occupations and education levels, length of residency in Shiraz and talking about important things with one’s parents (p < 0.03). Gender predicted 52% of variance of bullying behaviors at school [Exp(B) = 0.502, p < 0.03, 95% confidence interval (CI) = 0.261–0.996]. In fact, most high-risk behaviors were associated with gender (p < 0.001). Indeed, bullying was mostly reported in boys, while being hopeless or sad, suicide attempts and appropriate weight loss behaviors were mostly reported among girls. Additionally, the frequency of smoking cigarettes and using hookahs was higher among girls compared to boys (23.1% for smoking cigarettes and 39.6% for using hookahs). However, no significant correlation was observed between gender and smoking cigarettes and using hookahs (p > 0.704 for smoking cigarettes and p > 0.118 for using hookahs). The most prevalent high-risk behaviors were physical fighting (51.1%), being sad or hopeless (35.2%), alcohol abuse (26.7%), overweight (14.7%) and obesity (8.1%) in both genders. Based on the results, only 26.5% of the adolescents had sufficient physical activity. Besides, the adolescents’ weight scores were significantly correlated to eating green salads (p < 0.01), which was seen more among overweight adolescents. Conclusion The findings indicated that adolescents’ gender and their parents’ roles should be taken into consideration in designing health promotion programs, such as mental health and its related skills. This would eventually result in the prevention and reduction of unhealthy habits.

Background The most common high-risk behaviors that have profound and adverse effects on the health of the community take place in the university environment. Nowadays, the necessity of exploring ways to correct and reduce the high-risk behaviors requires identification of its determinant factors. Therefore, the present study aimed to investigate the correlation between spiritual health and high-risk behaviors among university students in the southeast of Iran in 2017–2018. Method This survey was a cross-sectional study. The population was all students studying at three central Universities in Kerman. Eight hundred and four students participated in the survey using a quota sampling method. The research instrument was a demographic questionnaire and the 20-item spiritual well-being Palutzian and Ellison scale and the Iranian Adolescent Riskiness Scale (IARS), which includes 39 items for high-risk behaviors. Results The mean total score of high-risk behaviors was 79.16 ± 24.6 which was lower than the median (117). The spiritual health of the majority of subjects (66.7%) was moderate with an average of 90.65 ± 16.64. There was a significant negative correlation between the students’ spiritual health and their high-risk behaviors. Conclusion It is necessary and essential to plan and implement spiritual-based interventions to reduce the incidence of high-risk behaviors.

Aim Adolescence is characterized by dynamic brain development in which the interaction with the social environment shapes the capabilities an individual takes forward into adult life. Improvement of adolescent psychological health depends on the recognition of their needs during this critical transition period. This study aimed to explain the concept of psychological health needs from the perspectives of male adolescents to improve the health of both adolescents and society. Method In this qualitative study with a content analysis approach, 52 male adolescents aged 13–18 years participated in 10 semi-structured individual interviews and seven focus group discussions. They expressed their experiences and opinions regarding psychological health needs. Purposive sampling was performed to recruit the adolescents in different areas of Tehran in 2017. Collected data was analyzed using the conventional content analysis method. Results The findings were divided into two main themes and five sub-themes including ‘self-esteem (self-cognition and Suitable relationship between teen and family)’, ‘Well-being and calmness (Intellectual affinity, Rich leisure time, Religious beliefs)’. Conclusion To promote emotional health in adolescents, it is necessary to plan for the empowerment of community, family, schools by health authorities and devise appropriate health policies.

Background Adherence to a Mediterranean dietary pattern (MDP) has been reported to decrease chronic diseases. Objective The aim of the present study was to determine the association between nutrition knowledge (NK) and adherence to MDP in Iranian female adolescents. Subjects This cross-sectional study was conducted on 297 female adolescents aged 15–18 years. Methods The participants were interviewed using a valid and structured questionnaire to collect information on socio-demographic, lifestyle and anthropometric variables. Dietary intakes were assessed using a validated 168-item Food Frequency Questionnaire (FFQ). Adherence to MDP was measured by the Mediterranean-Style Dietary Pattern Score (MSDPS). Each participant’s NK was determined using a 20-item NK questionnaire. Results The mean ± standard deviation (SD) age and body mass index (BMI) of participants were 16.1 ± 0.9 years and 22.3 ± 4.6 kg/m 2 , respectively. The median [interquartile range (IQR)] of the NK score and the MSDPS were 80.0 (68.0–87.0) and 15.2 (11.9–19.5), respectively. The odds ratio (OR) of higher adherence to MDP in the highest tertile of the NK score was 2.19 [95% confidence interval (CI): 1.22–3.95; p for trend = 0.009], compared to the lowest tertile after adjusting for age and energy intake. In a multivariable-adjusted model, after further adjustment for BMI, mother’s/father’s education level, mother’s/father’s employment status, parent’s marital status and physical activity, the subjects in the highest tertile of the NK score had higher adherence to MDP compared with those in the lowest tertile (OR = 2.05; 95% CI, 1.09–3.83; p for trend = 0.013). Conclusion Our findings support the hypothesis that a higher NK score is significantly associated with a higher MDP adherence score in Iranian female adolescents.

Background This study attempts to assess the differentials of cognitive development and nutrition of school children in tribal areas of Jharkhand, India. Methodology A cross-sectional study was carried out in 16 schools of Jharkhand amongst 962 children during the period of November to December 2017. Anthropometry, hemoglobin and IQ tests were assessed along-with their socio-demographic characteristics using standard procedures after obtaining their guardian’s consent. Various tests of significance were used such as an independent sample t-test and Fisher’s exact test along with multinomial logistic regression for determination of predictors for low-normal to borderline IQ among school children. Results Stunting and thinness were noted in 38% and 35% children, respectively, whereas anemia and low IQ were observed in more than 4/5th of the total children assessed. Anemia was more common in children >12 years of age and IQ was lower in tribal ethnic children (p < 0.05) amongst socio-demographic characteristics. Among the predictors, only tribal ethnicity appeared to be associated with low IQ [odds ratio (OR)-1.85; 95% confidence interval (CI) – 1.25, 2.75]. Conclusion Despite various nutrition-related programs being run in government schools, the malnutrition and hemoglobin status of the children presents a poor picture. Cognitive development of children particularly tribal children is unsatisfactory and needs to be worked upon by government agencies.

Background Confidential youth consultations aiming at enhancing adolescent autonomy are a cornerstone of transitional care. At the same time, parental support is essential. These conflicting considerations result in a clinical dilemma. Objective The aim of this study was to examine the attitudes of parents to chronically ill adolescents regarding confidential youth consultations and to explore the underlying reasons. Methods A sequential explanatory mixed methods design consisting of a cross-sectional questionnaire survey (n = 117) and three focus group interviews among parents (n = 12) to chronically ill adolescents (12–19 years) was used. Quantitative data were analyzed descriptively. Qualitative data were analyzed using King’s template method. Results The parents preferred independent youth consultations starting around the age of 14–15 years. Around 60% of the parents had one or more concerns regarding independent youth consultations. Although 64% of the parents supported conditional or full confidentiality during adolescence, 95% wanted information even though their child did not consent. In the qualitative analysis, the parents described caring for a child with chronic disease as a term of life perceiving themselves as an “octopus” with numerous roles related to daily care and treatment and at the same time with thoughts and worries regarding the future. We found four themes: ‘a life with chronic disease’, ‘responsibility’, ‘protection’ and ‘apprenticeship’. The parents’ attitudes were influenced by their roles and their perception of the adolescent’s competences as well as their experience with the healthcare system. Conclusions Our findings suggest that parents need transitional care too.

Introduction There is an increasing trend of malocclusion among children, so it is necessary to identify the cause of the tooth wear so that the orthodontist can treat the patient accordingly. It is necessary to determine the wear patterns of different malocclusions. Therefore, the aim of our study was to compare the patterns of tooth wear among two categories of Angle’s class II malocclusions, i.e. class II division 1 and class II division 2. Material and methods The sample consisted of 100 pretreatment orthodontic patients in the age group of 15–25 years with Angle’s class II malocclusion and were divided into following two groups: (a) Group 1: 50 subjects with full cusp Angle’s class II division 1 malocclusion. (b) Group 2: 50 subjects with full cusp Angle’s class II division 2 malocclusion. Clinical examination of the patients for tooth wear was done supplemented with dental casts, intraoral photographs and intraoral radiographs. Then each group was assessed for severity of tooth wear according to modified tooth wear index (TWI) given by de Carvalo Sales-Peres et al. Scores were subjected to statistical analysis and the pattern of tooth wear among the two groups of class II malocclusion was compared. A correlation between the gender of the patient and the tooth wear was also determined. The level of statistical significance (p-value) was less than 0.05. Results The class II division 1 subjects showed statistically greater wear on the occlusal surfaces of the maxillary canines, first, second premolar and first molar, and the occlusal surfaces of the mandibular first molars. The class II division 2 subjects showed statistically greater tooth wear on the labial surfaces of the mandibular central and lateral incisors, the incisal surface of maxillary and mandibular incisors, the palatal surfaces of the maxillary second premolars, first and second molars. In class II division 1 subjects, the tooth wear was significant on the buccal surface of maxillary canines, occlusal surface of mandibular first premolars and second molars in males. In class II division 2 subjects, the tooth wear was significant on the buccal surface of mandibular canines, palatal surface of maxillary central incisors in females and palatal surface of maxillary first premolars in males. Conclusions The results of this study suggested that the two categories of Angle’s class II malocclusion have different tooth-wear patterns. The wear patterns were different in both the sexes. Men showed higher occlusal wear scores than did women. The findings also suggest that tooth wear in relation to malocclusion is physiologic and is due to dissimilar interocclusal arrangement.

Background Readmission after hospital discharge is common in adolescents with eating disorders. Studies on the association between rapidity of weight gain and readmission are inconsistent. With an emphasis on more rapid weight gain during hospitalization, the effect of this strategy on readmission rates warrants further investigation. Objective This project explored the relationship between rate of weight gain during hospitalization and medically necessitated readmissions. Subjects Eighty-two patients who: were admitted due to an eating disorder during a 5-year period; achieved weight restoration to ≥84% of ideal body weight (IBW); had a follow-up visit with the adolescent medicine service after discharge; and, had information available on rate of weight gain. Methods Data were extracted from medical records. Multiple logistic regression was used to analyze the effect of rate of weight gain on readmission. The effect of a comorbid psychiatric diagnosis was tested for an interaction. Results Of patients 20.7% required readmission. The median rate of weight gain was 118.6 g/day [interquartile range (IQR) = 91.8–150.8]. There was a 1.8 times [95% confidence interval (CI) = 0.9–3.6, p = 0.087] greater odds of readmission with each increase in weight gain quartile after adjusting for potential confounders. Patients in the lowest rate of weight gain quartile and no psychiatric co-morbidity had a significantly lower predicted probability of readmission (25.1%) compared to those with a psychiatric comorbidity and in the highest quartile of rate of weight gain (48.4%). Conclusion Patients with eating disorders who have rapid inpatient weight gain and psychiatric co-morbidities may be at increased risk for readmission.

Aim Individuals living in a hot environment appear to face increased risk of dehydration. Currently there is not extensive literature on the adolescent population in relation to hydration. The aim of the present study was to assess hydration status and total water intake (TWI) at school, of adolescents living in a hot environment, and to investigate the association of hydration and TWI with various subjective feelings. Methods The hydration status of 141 adolescents (boys n = 102), age 15–17 years, was assessed via urine specific gravity (USG), at the beginning (07:30 am) and at the end (1:30 pm) of one school day. TWI from fluids and solid food was assessed via detailed food and fluid records. Subjective feelings (i.e. thirst, alertness, ability to concentrate) were recorded by specific scales. Results Ninety percent of the students arrived dehydrated at school (USG >1.020). Thirteen students were hydrated (USG <1.020), 67 students were slightly dehydrated (USG 1.021–1.029), and 50 students were seriously dehydrated (USG >1.030). There was no difference in TWI between the three groups (765 ± 451 mL). TWI correlated with alertness (p = 0.005) and the ability to concentrate (p = 0.015), and inversely correlated with fatigue (p = 0.015). Seriously dehydrated students felt less alert in the morning (p < 0.035) whereas the feeling of thirst was similar between all groups. Conclusions The prevalence of the dehydration of the adolescents during school time appeared to be extremely high, and thirst was not driving those adolescents to drink enough. Apart from health concerns, school performance could be affected by dehydration and inadequate water intake.

Head and neck cancer (HNC) is killing young people yearly. The knowledge of HNC risk factors and its symptoms among this population group may go a long way in HNC prevention among them. This study aims to: determine the level of awareness of HNC; determine the prevalence of HNC risk factors; and explore the knowledge of HNC risk factors, HNC symptoms, as well as family history of HNC among youth in the international communities (with focus on the Canadian and Nigerian youth). Methods A sample of 801 youth were surveyed using an e-questionnaire. The questionnaire obtained information from each participant about their: socio-demographic information; knowledge of HNC, its risk factors, and its manifestations; and family history of HNC. Data obtained from the participants were analyzed using the Statistical Analysis Software (SAS Version 9.4 for Windows). Results The majority (73%) of the surveyed youth (n=801) were residing in Nigeria, seven-tenths of them were between the age 18 and 24 years, and 53% were females. Less than 10% had a history of smoking, 7% were active smokers, and 24% had history of oral sex (of which 57% (108/109) of them had a lifetime history of more than one oral sexual partner). Around half (51%) of the participants had never heard of HNC before. Only 4% knew of a family member who had suffered/is suffering from HNC. Half of the participants were not sure whether HNC can manifest without initial complaint, pain, or symptoms. Only 9% of the participants erroneously believed that HNC is a contagious disease. Comparative analyses among subgroups revealed that a higher proportion of those participants who were: from Canada; young adults; and males generally knew about HNC when compared with the proportions recorded among those in the adolescents; females, and Nigerian participants’ categories. Lastly, 76% of the participants showed interest in knowing more about HNC. Conclusion The majority of the surveyed youth demonstrated poor knowledge of HNC. Also, a significant proportion of them are at risk of developing HNC disease in future, if they keep indulging in HNC risky behaviors. There exists the need to conduct community health education programs on HNC among youth in these surveyed communities.

Introduction Classical Phenylketonuria (PKU) is a metabolic disease characterized by high phenylalanine (phe) levels in blood and brain. PKU patients are commonly treated with low phe diet supplemented with amino acid free formula. High Phe levels minimize brain tryptophan concentration, the pressure of serotonin, which is responsible for the appearance of depression symptoms. Both amino acids share the same pathway for entering CNS via BBB. Aimed to determine the effect of psychological support on different education status depressed PKU patients via adherence to their diet. Methods PKU patients (n = 110) were divided into groups according to their education status: Primary school, High school, University degree. All patients were tasted with a Patient Health Questionnaire (PHQ-9) standardized for Greek population. Psychological support was performed in every depressed patient ones per two weeks for three successive months under the same conditions. Phe blood levels were measured before psychological support and every 15–20 days till the end of the study. Results Only 2/110 (1.8%) participance had finished Primary school and were healthy. 72/110 (65.5%) High School, out of them 29 were depressed and 36/110 (32.7%) achieved a University degree, only 6 suffered from depression. High phe blood levels were measured in the depressed patients, which dropped near to normal after the end of their psychological support. Referring to depression symptoms, all participance except one presented amelioration of their mood. Conclusions Psychological support is beneficial on depressed PKU patients graduated with High School or University degree via adherence to their special diet.

Introduction Young people’s transition into adulthood is intertwined with the worlds of education and work. Poor health in adolescence has been associated with poorer education and employment outcomes in adulthood. This paper explores the impact of arthritis on the educational and early work experiences of young people with arthritis. Methods We undertook a supplementary secondary analysis of a qualitative dataset comprising narrative and semi-structured interviews of 39 young people who had been diagnosed with arthritis in childhood, adolescence or young adulthood. Results Our findings illustrate how young people living with arthritis are faced with a range of added disruptions and challenges in their educational/vocational lives. There is an important element of resilience associated with the process of making a career choice and acting upon personal aspirations. Appropriate support and flexibility in the workplace/educational setting can enable successful outcomes, but disclosure is not a straightforward process for young people living with arthritis. Conclusions It is paramount that health providers consistently and effectively address self-advocacy skills with the young person, particularly during educational and vocational transitions. Alongside this, there is the need to further strengthen the health-school/work interface to ensure that young people living with chronic illness can meet their full potential in adulthood.

Introduction Acoustic reflex (AR) is a valuable clinical test for hearing diagnosis. Parameters of AR such as its amplitude and threshold have been commonly reported in research. Acoustic reflex latency (ARL) has not been widely studied and more research is warranted to determine its basic properties and clinical usefulness. The present study aimed to determine the influences of stimulation mode and stimulus frequency on ARL. Methods In this study, 52 healthy young adults were enrolled (mean age = 23.2 ± 0.8 years, 61.8% were males). They underwent the standard AR testing and ARL values were computed. Both ipsilateral and contralateral recordings were made at 500, 1000, 2000 and 4000 Hz frequencies. Results The ARL values obtained are consistent with the findings from the previous studies. Two-way analysis of variance (ANOVA) revealed that the ARL values were not statistically influenced by either stimulation mode (p = 0.061) or stimulus frequency (p = 0.598). Conclusion Among young adults, ARL does not appear to be influenced by stimulation mode and stimulus frequency. Further large scale research is warranted to support the present study’s findings. The preliminary normative data for ARL obtained in this study can serve as the reference for future research involving this particular population.

Participation of adolescents and young adults (AYAs) with cancer in randomized clinical trials (RCTs) is necessary to advance treatments and psychosocial programs. Exploring AYAs experiences in an RCT will inform strategies to support recruitment and retention. A qualitative design was used to study the experiences of 13 AYAs in the Stories and Music for Adolescent and Young Adult Resilience during Transplant I (SMART I) trial. Key themes included: Weighing the Pros and Cons; Randomization Preferences; Completing Measures; and Worthwhile Experience. The experiences of AYAs during RCTs can bring insights that inform the design and management of AYA trials. Strategies include improving assent/consent processes, design of electronic interfaces and encouraging researcher flexibility.