Volume 33, Issue 6

Background Despite recognition of the important role of health workers in providing adolescent-friendly sexual and reproductive health services (AFSRHS), evidence on strategies for improving performance is limited. This review sought to address: (1) which interventions are used to improve health worker performance in delivering AFSRHS? and (2) how effective are these interventions in improving AFSRHS health worker performance and client outcomes? Methods Building on a 2015 review, a search for literature on 18 previously identified programs was conducted to identify updated literature and data relevant to this review. Data was systematically extracted and analyzed. Results Due to the parent review’s eligibility criteria, all programs included health worker training. Otherwise, supervision was the most frequently reported intervention used (n=10). Components and methods related to quality of trainings and supervision varied considerably in program reports. Nearly half of programs described employing processes to ensure availability of basic medicines and supplies (n=7). Other interventions (policies, standards, and job descriptions [n=5]; refresher trainings [n=5]; job aids or other reference material [n=3]) were less commonly reported to have been employed. No discernible patterns emerged in the relationship between interventions and outcomes of interest. Conclusions Multi-faceted complementary strategies are recommended to improve health worker performance to deliver AFSRHS; however, this was uncommonly reported in the programs that we reviewed. Effectiveness and cost-effectiveness evaluations of interventions and intervention packages are needed to guide efficient use of limited resources to enhance health worker capacity to deliver AFSRHS. In the interim, programs should be developed and implemented based on available existing evidence on improving health worker performance within and outside adolescent health. Implications and contribution This review is the first to examine the interventions commonly used to improve health worker performance in delivering AFSRHS. The findings indicate a need for additional effectiveness and cost-effectiveness evaluations of such interventions. In the meantime, existing evidence on improving health worker performance within and outside adolescent health must be integrated more thoughtfully into program planning and implementation.

This study investigated the association between sleep disorders and depression in adolescents, PubMed/MedLine, SciELO and Lilacs databases were consulted, with an interval of 7 years (2013–2019), in English, Portuguese and Spanish. An integrative review was carried out where after analyzing the inclusion criteria, 616 articles were selected for reading titles and abstracts and 94 of these were selected for full reading. After the full reading, 15 articles were elected to be part of this review. Results show that both sleep disorders are risk factors for depression, as depression can be a risk factor for sleep disorders. Insomnia was the most frequent sleep disorder in adolescence, besides being considered a public health problem. It is concluded that sleep disorders and depressive symptoms are associated and present with great frequency in the adolescent public.

Objectives The study assessed the prevalence and associated factors of behavioural risk factors of non-communicable diseases (NCDs) among adolescents in four Caribbean countries. Content In all 9,143 adolescents (15 years = median age) participated in the cross-sectional “2016 Dominican Republic, 2016 Suriname, 2017 Jamaica, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS)”. Eight behavioural risk factors of NCDs were assessed by a self-administered questionnaire. Summary Prevalence of each behavioural NCD risk factor was physical inactivity (84.2%), inadequate fruit and vegetable intake (82.2%), leisure-time sedentary behaviour (49.6%), daily ≥2 soft drinks intake (46.8%), ever drunk (28.6%), twice or more days a week fast food consumption (27.6%), having overweight/obesity (27.4%), and current tobacco use (13.8%). Students had on average 3.6 (SD=1.4), and 79.0% had 3–8 behavioural NCD risk factors. In multivariable linear regression, psychological distress and older age increased the odds, and attending school and parental support decreased the odds of multiple behavioural NCD risk factors. Outlook A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered and several factors independently contributing to multiple behavioural NCD risk factors were identified.

Previous studies have identified several key barriers to Physical Education, Physical activity and Sport (PEPAS). However, there is a paucity of qualitative evidence investigating why young people do and do not participate in PA and the relationship between their levels of participation at different stages of life. This study builds on a previous study and aims to investigate the barriers to PEPAS in adolescents at transition stage. The extant literature highlights that instilling regular PA throughout life strongly relies on developing physical literacy through participation in high quality physical education. Despite the understanding of the importance of high quality physical education, there is an over emphasis on the short term outcomes of physical education (PE) sessions which have been noted to overemphasise immediate physical activity rather than focus on educational outcomes important to physical literacy. Anecdotally, the recent Covid 19 Global pandemic and subsequent lockdown has resulted in a digitalisation of PE in schools and a subsequent reliance of PA programmes based on adult fitness classes, which may not necessarily be categorised as PE in its true sense. Twenty-four respondents aged 16–19 were divided into five focus groups. Data were analysed verbatim using NVivo following the guidelines by Braun and Clark (2006) on thematic analysis. The findings indicated that most respondents equated PE with team sports. Findings suggest that Physical Educators need to acknowledge how past and present experience of PE impacts young people’s future motivation to continue PA beyond school. Delivery of traditional PE lessons, prioritising sporting ability, can act as a participation barrier to pupils who consider themselves “non-sporty”. Accordingly, a shift towards inclusive pedagogical models with an emphasis on a holistic approach, may best promote the physical literacy necessary for the competence and confidence to continue movement in a lifelong capacity.

Low self-esteem and negative body image expose girls to many risks and damages. Cognitive-behavior counseling is one of the ways of improving body image and self-esteem. The aim of this systematic review was to determine the effects of cognitive-behavior therapy on body image and self-esteem of adolescent girls. The English (Cochrane library, Web of sciences, EBSCO, PubMed, Google Scholar) and Persian (SID, MagIran) databases were searched without any time limit. The quality of included studies in terms of risk of bias was assessed using Cochran handbook and the quality of evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis was performed using RevMan software. Heterogeneity of studies was analyzed by index I 2 . Subgroup analysis was performed on the basis of outcome evaluation intervals (after intervention, one month and two months later). A total of 2,664 articles were accessed in different databases of which 2,655 articles were excluded and finally nine studies were systematically reviewed. Meta-analysis results on seven studies (228 participants) showed that the group receiving cognitive-behavior counseling was significantly better than the control group regarding body image (Standardized Mean Difference [SMD]: 13.01; 95% CI: 10.68 to 15.34; I ²=26.1%). Likewise, meta-analysis results on two studies (50 participants) showed that self-esteem was not significantly different between the group receiving cognitive-behavior counseling and the control group (SMD: 1.13; 95% CI: −0.7 to 2.32, I ²=73%). Meta-analysis results of this study represent effectiveness of cognitive-behavior therapy on body image of adolescent girls; however, since the number of studies in the field of self-esteem is low, more trials in this field with stronger designs are suggested.

Reproductive health is a broad concept that encompasses mortality, morbidity, and quality of life associated with the reproductive system, mechanism, and incidents encountered at all ages by men and women. Orthodox Indian society finds the conversation on reproductive health to be a taboo and discourages open conversations about it. Polycystic ovary syndrome (PCOS) is a reproductive-age metabolic endocrine disorder found in females. Females suffering from PCOS are prone to reproductive, metabolic, and cardiovascular disorders. In this paper, we will systematically review about effect of PCOS on Reproductive Health of Women. The numerous electronic databases such as: BMJ, LANCET, PUBMED, Unicef Website, WHO Website and Google Scholar have been comprehensively searched for studies linked to PCOS, its various effects and effect on women’s reproductive health. For additional analyses, we have reviewed reference lists of reviews and collected papers. The effects of PCOS on women’s reproductive health have been verified by several scientific reports worldwide. PCOS is a hormonal condition, as per multiple reports, with the ability to lead to different outcomes. It still appears to be a common cause among females of infertility. An integral aspect of the treatment of this disease is the early diagnosis of long-term morbidities by effective screening tests. In the future, studies must concentrate on the missing holes in our growing perception of this disease. Several studies have confirmed that reproductive morbidity, including irregular uterine bleeding, abortion, miscarriage, and other risk of pregnancy during reproductive years, is associated with PCOS. PCOS is an amalgam of physiological and psychosocial dysfunction, not just an endocrine disorder.

Obesity has been identified mainly as a raise in the body’s adiposity leading to prolonged overshoot of caloric intake over expenditure. Obesity has significant health-altering implications which have been shown to be implicated in the pathogenesis and progression of other diseases through its extensive physiological assaults. The prevalence of overweight and obesity has been an increasing epidemic worldwide. The number of obese births was even on the increase, with an increasing number of women of reproductive age registering as obese. Obesity is related to adverse perinatal outcomes and increased morbidity and mortality in pregnant women. The potential risk for multiple antenatal, postpartum, intrapartum, and neonatal complications is maternal obesity. Greater risk of developing Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), pre-eclampsia, risk of venous embolism, increased need for labor induction, and cesarean sections in the mother have been recorded in a comprehensive analysis of pregnancy complications associated with obesity. The link between obesity, gestational diabetes, and pregnancy outcomes will be briefly shown in this article.

Mindfulness has been widely studied in Western psychology for reducing psychological distress. However, several scholars noted that in the East, where the concept originated, mindfulness may be understood differently. In Eastern cultures such as Thailand, mindfulness is not only employed to deal with suffering but also to promote well-being. To the best of our knowledge, no studies have been undertaken to evaluate the relationship between traditional mindfulness and eudaimonic well-being in Eastern contexts. In the present study, we investigated the relationships between mindfulness and eudaimonic well-being in Thai contexts. We also explored the mediating roles of rumination and emotion dysregulation on this relationship. Data were collected from 312 Thai undergraduates who completed a measure of Eudaimonic Well-Being, the Freiburg Mindfulness Inventory, the Rumination–Reflection Questionnaire, and the Difficulties in Emotion Regulation Scale. Results largely supported our hypotheses. Mindfulness was found to have a positive and direct association with eudaimonic well-being. Rumination and emotion dysregulation partially mediated this association. Additionally, both rumination and emotion dysregulation had negative and direct association with eudaimonic well-being. The findings highlight the positive influences of mindfulness on well-being. The benefits of mindfulness for improvement of eudaimonic well-being through reducing rumination and emotion dysfunction are discussed.

Less vascular resistance, higher vascular permeability and improved cardiac output include anatomical and physiological changes related to pregnancy. These are needed to accommodate an increase in plasma volume and ensure significant organ infusion. Nevertheless, increases in oestrogen levels may lead to an increase in the risk of coagulation and thrombosis. Increased levels of progesterone increase the risk of thrombosis due to vasodilation, vascular stasis and edoema in these situations. The increased resistance in preeclampsia maternal systemic blood arteries can create high blood pressure that can interfere with blood flow in numerous organs (including liver, kidneys, brain and placenta). The risk of issues such as pulmonary edoema, placental abruption, pneumonia of aspiration, renal failure, hepatic failure and stroke in pregnant women is increased by Preeclampsia and eclampsia. Some peripheral neuropathies (carpal tunnel syndrome, peripheral facial palsy) and central neurological conditions (seizure, migraine, stroke, epilepsy) may become more common during pregnancy because of the exacerbation of the pre-existing neurologic condition or the onset of neurological disturbance caused by pregnancy physiological changes (such as headache or vascular disorders). During the three trimesters of pregnancy, neurological disorders are both peripheral and central. Therefore, an early and correct diagnosis is required to improve pregnancy care, treatment and perinatal outcomes. The aims of this paper are to identify, define and manage the most prevalent peripheral and centrally occurring neurological disorders in the pregnancy.

Polycystic ovarian syndrome (PCOS) is the most frequent endocrine disorder among women of reproductive age. Some of the indications and symptoms of PCOS include amenorrhoea, hirsutism, infertility, obesity, acne vulgaris and androgenic alopecia. PCOS is a crippling condition that affects a woman’s identity, mental health and overall quality of life (QOL). In persons with PCOS, anxiety and sadness are assumed to be multifactorial. According to some specialists, physical symptoms like acne, hirsutism and obesity have been linked to psychiatric morbidities. Many aspects of it remain unknown, including its cause, progression throughout life, symptom spectrum and level of morbidity. PCOS is a complex disease that has an impact on many aspects of a person’s health, including their mental health. Anxiety and depression are three times as common in PCOS patients as in non-PCOS people. Anxiety and depression symptoms are also more common and more intense in those with PCOS. There isn’t enough research on the prevalence of anxiety and depression in patients with PCOS. It’s unclear what causes persons with PCOS to be more anxious and depressed. It could be the result of PCOS symptoms, hormonal changes, or a combination of factors that are currently unclear. Our review article will help to highlight the most recent research on anxiety and depression in PCOS women.

Background Foodborne diseases non-communicable diseases (NCDs) are the main reason of death, accounting for 38 million (68%) of the 56 million premature deaths worldwide in 2012. Lower-middle and middle-income countries accounted for nearly three-quarters of all NCD fatalities (28 million), as well as the bulk of illness and premature death (82%). An excessive consumption of added sugar is source of worry for its link to unhealthy nutrition quality, overweight, and the risk of NCDs among adolescents. A further source of worry is the link among free sugar consumption and tooth cavities in young adults. Dental infections are the most common NCDs worldwide in young adults, and despite significant advances in management and cure in recent decades, issues remain, resulting in pain, anxiety, functional limitations (which include failing school grades and attendance in children), and social severe disability due to missing teeth. Objectives The purpose of this report is to give suggestions on how to consume added sugar in order to mitigate the possibility of NCDs in children and young adults, with an emphasis on the care and mitigation of obesity and metabolic syndrome and tooth decay among young adults. Methods and materials The Keywords like adolescent, Health, Dental Caries, Obesity, Sugar Intake, Recommendation have been used to evaluate the standard of evidence discovered via current systematic reviews of the scientific literature relating to significance of sugar intake consumption and its effect in young adults. Results The relevant data from prospective studies was judged to be of good quality, but data from nationwide population-based studies was judged to be of extremely low quality. Free sweeteners should be used in moderation during one’s life, according to the World Health Organization (strong recommendation 1). WHO advises limiting natural sugar consumption to very little about 10% of total calorie intake among both grownups and children 2 (strong recommendation). Conclusions There is a significant association of prevalence of tooth decay, obesity due to sugar consumption at an alarming rate hence regulators as well as curriculum developers can utilize the recommendation reviewed by us to compare current free sugar intake levels in their nations to a benchmark. They may also be used to design ways to reduce free sugar consumption through a wide variety of social health initiatives, if required.

Objectives This study aimed to estimate the extent of smoking experience among high and middle school adolescents in Southern Tunisia and to delineate its potential associated factors. Methods We conducted a cross-sectional study among middle and high school-adolescents in the governorate of Sfax, South of Tunisia in the 2017–2018 school-years. A questionnaire was anonymously administered to a representative sample of 1,210 school-adolescents randomly drawn. Results The mean age of the school-adolescents was 15.6 ± 4.2 years. The prevalence of lifetime smoking was 16.7% (95% CI=[14.7–18.8%]) (boys 32.6%; girls 5.9%;p<0.001). Among the respondents, 13.9% (95% CI=[11.9–15.8%]) were current smokers. In multivariate logistic regression analysis, independent associated factors of current smoking were male gender (Adjusted (AOR)=10.2; p<0.001), 16–17 and 18–19-year age-groups (AOR=2; p=0.005 and AOR=2.6; p=0.001, respectively), below average academic performance (AOR=5.2; p=0.012), divorced parents (AOR=3.9; p=0.007), family monthly income ≥800 dollars (AOR=2.1; p=0.001), having a part time job (AOR=3.9; p<0.001) and a perceived high stress level (AOR=1.98; p=0.008). Secondhand smoke (AOR=1.8; p=0.011) and concomitant alcohol drink (AOR=14.56; p<0.001) were independent predictors of current smoking, while high education level of the father was independently associated with lower prevalence of current smoking (AOR=0.17; p<0.001). Conclusion The prevalence of lifetime and current smoking were relatively high in Southern Tunisian middle and high schools. Multilevel influences on youth smoking behavior had been identified, which reflected the need to conceive appropriate school interventions and effective antismoking education program.

Objectives Physical fitness is an important indicator of health and longevity. This can reduce morbidity and mortality of Non-communicable diseases. We aimed to assess the physical fitness among early adolescents and its association with age, gender and obesity. Methods We conducted a cross sectional analytical study in a public school in Puducherry, south India among early adolescents (aged 10–14 years). We assessed the physical fitness components like body composition (body mass index, waist circumference), muscular strength and endurance (hand grip test, curl up test), flexibility (sit and reach test, shoulder stretch test), agility (shuttle run test) and cardio respiratory and endurance (600-yard run test). Results A total of 263 children were included; 141 (54%) were girls. 30 children (11%) were thin and 57 (22%) were either obese or overweight. Overall, median (IQR) right- and left-hand grip strength was 10 (6–14) and 13 (7–18) unit of kg respectively. Median (IQR) curl-ups performed in a minute were 14 (10–20). About 13% of children failed to perform left shoulder stretch. Children aged 12–14 years had higher median (IQR) right hand grip strength [14.5 (12–22) unit of kg] compared to children aged 10 and 11 years [6 (4–12) unit of kg] and this difference was statistically significant (p<0.001). The performance was similar in all tests between boys and girls except for left hand grip strength; boys had higher grip strength compared to girls (p=0.02). In girls, children who belonged to thinner BMI category performed better than obese children in shuttle run test (p=0.03). Conclusion There was a significant difference in physical fitness based on age except in left and right shoulder stretch test. Since the prevalence of overweight/obesity was high in adolescents, creating awareness and enabling environment related to the physical fitness is important.

Objective Our study sought to assesses the knowledge and awareness of individual sickle cell genotype among adolescents. Methods Participants were recruited from a large school in Southeast Nigeria where adult prevalence of sickle cell trait is 25%. Data was collected through a 50-item survey with previously pretested questions that assessed awareness of individual genotype, general knowledge of sickle cell disease, perception of sickle cell trait and sickle cell anaemia (SCA). Additionally, self-reported genotype was compared to the school’s admission records to determine accuracy of self-reported genotype. The knowledge scores were summed on a binary basis with one point assigned for a correct answer while zero was given for an incorrect response. Results Four hundred and nine (409) students were approached and enrolled in the study. A vast majority (94%) of the respondents reported being aware of their genotype and two-thirds had the awareness during school admission. However, in specific knowledge of sickle cell, majority (89.7%) of the participants miscalculated the probability of having a child with SCA in married carrier couple and 71.9% misidentified the proportion of Nigerians with sickle cell trait. Assessing level of knowledge of sickle cell, only very few of the adolescents (7.3%) were found with the expected high knowledge scores of 7–8. Conclusion Although a significant proportion of respondents were aware of their genotype, most were unaware of the implications of sickle cell trait and thought that people with sickle cell trait also have symptoms of sickle cell disease. Also, only a few of the respondents have the expected level of sickle cell knowledge. A focused educational intervention among this age group is crucial as they embark on making reproductive health decisions.

Objectives This study was done to investigate popularity, awareness, perceptions, and motivations regarding water pipe smoking (WPS) among medical sciences students in 2017. Methods This cross sectional study was done among 385 medical sciences student in 2017.The systematic random sampling was used to recruit subjects. Multidimensional questionnaire (demographic characteristics, awareness, perceptions, action, and water pipe motivators) was used. t-test, ANOVA, X2, and logistic regression was used to analyze the data by SPSS. Results The mean ages of participants were 22 ± 2.64 and 89% were male. The majority of the study sample was from health school. Most participants reported having smoked before. Family entertainment was found to be the most common motivator for WPS. The second one was to be fun. WPS use was significantly associated with age (odds ratio [OR], 0.17; 95% Confidence Interval [CI], 0.04–0.61); awareness (OR, 1.55; 95% CI, 1.35–1.78); and perception (OR, 0.71; 95% CI, 0.65–0.78). Conclusions Results show that WPS is very popular among Iranian youth. In designing public health programs, policy makers should consider the motivators for inclination to WPS. Intervention should focus on addressing students' perception and awareness regarding WPS.

Background Health literacy is one of the goals of public health and the key challenge of health education in the 21st century. This study aimed to determine E-health literacy and correlates among medical sciences students in Karaj, Iran 2017. Methods This cross-sectional study was performed on a thousand students of Alborz University of Medical Sciences. A multi-sectional questionnaire was used to collect data. The first section included age, major, marital status; educational grade, mother and father education, socioeconomic status, health status, membrane in social network and the second compromised a validated Persian version of the E-health literacy. We used t -test and analysis of variance (ANOVA) to compare the mean of variables and for categorical variables x2 was used with SPSS version 19. Results The mean age of the subjects was 25.5 ± 5.6 years, of which 65.3% were male. The medical students constituted the most number of participants (28.6%). Mean eHEALS score was 26.11 ± 6.6 years. There was a significant difference between female and male regarding E-health literacy (P = 0.04). Internet was the most commonly used sources for health information (67%), the majority of the students were members of one of the social networks (77.7%) that telegram and Instagram were among the most popular networks. Conclusion Improving search skills and assessing of health resources in students, especially in medical and Para-medical sciences, is recommended. Social networks can be used as channels for the transmission of the health messages due to high usage among students.

Objective In this international study, the prevalence of Eating disorders (EDs) was determined among university students and identified associated demographic and behavioral factors predicting disorders using data from three European countries. Methods The survey was conducted in Hungary, Poland, and Ukraine in 2018. Registered full-time students completed an online anonymous questionnaire. Students provided data about socioeconomic characteristics, body mass index (BMI), EDs, physical fitness and sport practice, psychological distress (stress, anxiety, depression), life orientation, alcohol, tobacco, and cannabis use. Data were analyzed using SPSS 24.0 software. Results From the 1965 returned questionnaires 1950 were analyzed, because of the missing data (67.3% female, mean age of the total participant’s 21.40 ± 3.83 years old). EDs were observed in 26.3% of students. In logistic regression, EDs were predicted by female sex, higher BMI, single marital status, elevated psychological distress and limited access to health care. Conclusion EDs are relatively common in university students especially in females. Students with higher distress and BMI, limited access to health care and living without partner are at risk for EDs. This result highlights the need for a public health approach. Universities are the last chance where students can be screened in an organized setting and offer interventions early when treatment is likely to be most effective.

Objectives Regular tooth brushing, at least twice a day, is effective for the control and prevention of dental caries and periodontal disease, and regular hand washing with soap can effective prevent infections. The study aimed to assess the prevalence, associated factors of oral, hand hygiene behaviour, and associated factors among adolescents in six Southeast Asian countries. Methods The sample consisted of 36,173 adolescent school children (median age 14 years), from Bangladesh, Indonesia, Laos, Philippines, Thailand, and Timor-Leste that participated in the cross-sectional “Global School-based Student Health Survey” (GSHS) in 2014–2015. Results Results indicated that 17.1% of students reported <twice a day tooth brushing and sub-optimal (not always) hand washing behaviour (44.8% before meals, 31.9% after toilet use, and 55.8% with soap). In adjusted logistic regression analysis, male sex, health risk behaviour (<daily fruit and <daily vegetable consumption, sedentary behaviour), psychological distress, and lack of peer and parental or guardian support were associated with sub-optimal oral hygiene, and male sex, health risk behaviour (tobacco use, < daily fruit, <daily vegetable consumption, sedentary behaviour, physical inactivity), psychological distress and lack of peer and parental support were associated with sub-optimal hand washing hygiene behaviour. Conclusions Poor oral and hand hygiene behaviour was identified. Several factors associated with poor hygiene behaviour were identified that can help in designing programmes for promotion of adequate oral and hand hygiene practices.

Objectives Physical activity and sports can be used to reduce stress and anxiety by increasing aerobic capacity and muscle endurance, gain positive behavioral changes and improve their self-discipline, use time well, adopt positive lifestyle such as regular eating and sleeping, which will result in an increase in school success. There are no comprehensive study that examines the academic performance of licensed student athletes and the factors influencing their success rates. The aim of this study was to evaluate the academic performance and related factors in licensed athletes. Methods One hundred eleven licensed athletes at junior high school level were enrolled. Participants filled out questionnaires specifically designed to assess for factors affecting academic performance, where personal and familial factors as well as school performance was taken into consideration. Their academic success rates were evaluated out of mean grade points before as well as after professional sports activities. Academic fields that were graded were, namely, mathematics, life sciences, language, and grammar studies as well as social sciences. Fifty one of participants lived in Ankara (Group 1) and the other 60 lived in Kahramanmaraş (Group 2). The effects of sport and other factors that may affect school success in all groups and between the groups were evaluated before and after sports. Results The age of the athletes were 14.1 ± 2.3 years, 49.5% were male. The grades of athletes before they started competing in professional sports were 80.4 ± 10.6 for mathematics, 80.5 ± 12.5 for sciences, 82.7 ± 9.5 for language studies, and 83.6 ± 9.3 for social sciences. Following a mean period of 4.3 ± 3.1 years of professional sports, the grades of athletes were, with the same order for respective discipline were, 81.6 ± 10.9, 82.4 ± 11.9, 84.3 ± 9.4, and 85.5 ± 8.5. Following sports activities, academic performance in life sciences, language, and grammar studies as well as social sciences showed a significant improvement where grades for mathematics did not show any significant change (p=0.054). The most important factor that improves school performance is the financial status of the family. In Group 1 demonstrated grade improvements following sports activities only in social sciences, whereas Group 2 athletes showed such an improvement for all the disciplines (p<0.05). Conclusions Licensed athletes’ school success during the junior high school period showed a significant increase after sports in this study. The most important factors that affected the academic performance were the socioeconomic status of the family.

Objectives Risk-taking behaviors among adolescents can negatively affect different dimensions of their health. This study was conducted to identify the gender-based differences in risk-taking behaviors among high school students in a Muslim population. Methods Grade 10 students studying in high schools located in Kerman Province, Iran were enrolled through cluster sampling (n=2,676), and data were collected using a well-validated questionnaire about violence, sexual behaviors, and traffic-related conduct over the past 12 months. The tool also consisted questions regarding drug use over the past 30 days and over lifetime (i. e., current and ever use of drugs, respectively) Results The number of female participants was 1,407 (52.6%). The boys who had girlfriends (33.0%) were almost twice as many as the girls who had boyfriends (17.1%). Among the respondents, 27.8 and 12.0% of the boys and girls engaged in physical fighting, respectively. Overall, the prevalence of water pipe use in the last 30 days (18.7%) and over lifetime (43.5%) was higher than that of the consumption of other substances. The second and third most popular substances used in the past 30 days among boys and girls were alcohol and cigarettes and cigarettes and alcohol, respectively. On the whole, marijuana figured in the lowest lifetime use among the respondents. Conclusions The rate of risk-taking behaviors in female students was lower than in males, and this difference was more evident than in Western countries. This discrepancy seems to be more obvious in cases where the religious prohibition of a behavior is greater such as extramarital intimacy.

Objectives Lesbian, gay, bisexual, transgender and questioning (LGBTQ) patients report alarming rates of identity-based discrimination in healthcare settings. Despite the health risks and challenges impacting LGBTQ young adults, little is known about their healthcare experience, especially in Turkey. This study aimed to increase the knowledge base on LGBTQ young individuals’ experiences when accessing health care in an attempt to address the myriad of health disparities they might face. Methods Participants were recruited from the division of Adolescent Medicine at Hacettepe University, and also from an LGBTQ support group. Participants’ responded to open-ended items asking about their experiences in the healthcare setting, in particular to any case of discrimination and reasons for non-disclosure of gender identity/orientation. Results A total of 24 LGBTQ youth completed the interview, mean age 21.1 years. Overall participants reported alarming rates of identity-discrimination and non-disclosure when accessing health care. Additionally, participants reported high rates of postponing care as they felt they would be subjected to LGBTQ-based discrimination. Furthermore results suggest that transgender individuals face additional healthcare challenges compared with their LGB and cisgender counterparts. Conclusions To the best of our knowledge this is the first study in Turkey to evaluate the experiences of LGBTQ youth accessing medical care. This study shows that similar to barriers observed in previous studies on LGBTQ individuals, discrimination when accessing healthcare is a serious problem. Increasing knowledge concerning the discrimination LGBTQ people face when accessing healthcare is essential to decreasing healthcare disparities.

Objectives To determine contraceptive uptake, reasons for non-use and predictors of use. Methods We conducted a cross-sectional study among girls in advanced-level secondary schools in the Rukwa region of Tanzania. Using probability proportional to size (PPS), we recruited a random sample of 660 girls out of 1447-targeted participants. A tool for data collection was a questionnaire. Data analyses included univariate analysis to describe study participants and Poisson regression analysis to assess the effect of independent factors to the dependent variable. A 5%-level of significance was used in multivariate analysis. Results More than 40% of the girls report being sexually active and only 25% reported current use of modern contraceptives. The main reported main method being use of male condoms (93%). Barriers for non-use of contraceptives included fear of side effects, fear of being perceived or labeled as promiscuous, inadequate knowledge about contraceptives and for religious reasons. The predictor for using modern contraceptives was attending class sessions about modern contraceptives. Conclusions Although girls in advanced-level secondary schools are sexually active, the use of modern contraceptives is still low. Girls report several barriers frustrating their intention to use contraceptives, mainly based on misconceptions and lack of knowledge.

Objectives this study, regarding the importance and significance of self-concept in children’s psychological health and considering the strong role of art in meeting psychological needs, aimed at investigating the effect of poetry reading on the self-concept of Adolescents. Methods This study was a classic experimental design of pre-test and posttest with two groups of intervention and control in the academic year 2016–2017. The research population included Adolescents who were studying in the city of Aq Qaladar in the province of Golestan, Iran. Sixty students. Data collecting tools included two questionnaires and “Piers-Harris Children’s Self-Concept” scale. The experimental groups were provided with poetry reading in eight group sessions of 60 min for 4 weeks. The poems were approved by 10 teachers with 10 years of experience, and the supervisor. Finally, paired t -test and independent t -test were used to analyze data using SPSS 16 (SPSS Statistics is a software package used for interactive, or batched, statistical analysis). Results Adolescents self-concept in the control group was 57.9(4.33) and in the experimental group 62.4(4.28) out of 80 questionnaires which showed a significant difference between the two groups (p < 0.001). Which demonstrated the effectiveness of poetry reading on Adolescents self-concept. Conclusions Considering the positive impact of poetry reading on adolescent self-esteem, this intervention is recommended to improve adolescent self-esteem.

Background Acne and menstrual symptoms are highly prevalent among young women. Since both acne and menstrual symptoms have similar hormonal pathogenesis, it is highly suggested that the two conditions are associated. Herein, we conducted this study to assess the relationship between acne and menstrual symptoms among young women. Subjects and methods In this population-based cross-sectional study, a multi-stage random sampling approach was used to include 3065 young women (18–25 years) from Egypt. Women were interviewed for their socio-demographic characteristics, gynecological history, premenstrual and menstrual symptoms, and history of acne and perimenstrual acne flare during the past 6 months. Results The mean age of women was 21.5 ± 2.2 and their age of menarche was 13.1 ± 1.5 years. During the previous 6 months, 44.8% of participants had acne. After adjusting for socio-demographic and gynecological characteristics, acne was associated with most menstrual symptoms with odds ratios (ORs) and 95% confidence intervals (CIs) as follows: [premenstrual symptoms: 1.23 (1.05–1.44) for irritation or nervousness, 1.45 (1.24–1.68) for fatigue, 1.37 (1.15–1.62) for breast tenderness, 1.48 (1.21–1.80) for abdominal bloating, and 1.36 (1.11–1.66) for nausea or vomiting], [menstrual symptoms: 1.63 (1.19–2.23) for dysmenorrhea and 1.24 (1.06–1.45) for dysmenorrhea requiring drugs], and [symptoms severity: 1.44 (1.24–1.68) for missing events and 1.38 (1.16–1.64) for medical consultation]. Of acne patients, 56.7% reported perimenstrual acne flare: 58.5% before menses, 35% during menses, and 6.5% after menses. Conclusion This study supports the concept that acne is associated with menstrual symptoms. Physicians should consider screening for menstrual symptoms among young women with acne.

Objectives To describe individual, interpersonal, and environmental factors and sexual risk behaviors among Thai Muslim adolescents. Methods We recruited adolescents from four schools and one vocational college on the Southern border of Thailand during October 2018 to January 2019. We used password-protected online questionnaires for each respondent to protect their privacy. Results We recruited N = 700 participants of which 9% were sexually experienced. Of those participants, many had never used a condom (41.3%) or considered taking contraceptive pills (71.4%). Moreover, 54% of them have had sexual intercourse more than once. Some had been infected with an STI (17.5%), and (14.3%) became pregnant more than once. Adolescents reported individual factors such as high religiosity (58.7%), and (47.6%) practiced Islam daily with no differences between boys and girls. Girls had significantly higher refusal of sex self-efficiency than boys (96 vs. 119.5, p < 0.05). In the interpersonal factors, boys had more uninvolved parenting style, lower parental monitoring, higher parental approval of sex, and higher perceived peer norm than girls. The environmental factors besides cultural norms impacted girls and boys equally. Conclusions We showed low rates of sexual activity, but in those adolescents who were sexually active we showed high rates of lack of knowledge and higher rates of sexual risk behaviors. Individual, interpersonal, and environmental factors all influenced sexual risk behaviors. We recommend comprehensive sexuality education that includes Islamic context for adolescents and their parents embedded in policy, religious, and community cultural practices.

Objectives Physical fitness in children and adolescents determines their health status and predicts if they are prone to co-morbidities that may extend in adulthood. The initial literature on the benefits of being physically fit was limited to the musculoskeletal and cardio-respiratory systems. The recent trends have shown that physical fitness has an effect on the neurological system as well. Considering physical inactivity to be a problem in today’s world and the growing evidences on physical fitness being related to cognition and academic performance, there is a need to explore more on these relationships. Thus, this study aims to find the correlation between physical fitness with academic performance and cognitive functions in adolescent urban school children. Hypothesis There is an association between physical fitness with academic performance and cognitive function. Methodology Three hundred and ninteen children were approached out of which 107 children consented for assessment. Their physical fitness was measured using the Progressive Aerobic Cardiovascular Endurance Run (PACER) test, the cognitive function was assessed using the Stroop test and the academic performance were taken from their final exam grades of 2019. Results A moderate positive correlation was found between physical fitness with cognitive function (r=0.528), with academic performance (r=0.545) and with self-reported physical activity per week (r=0.427). A fair negative correlation was found between physical fitness and Body Mass Index (BMI) (r=0.296). Conclusion This study confirms that physical fitness is positively associated with cognitive function, academic performance and self-reported physical activities and has a negative correlation with BMI.

Objectives Adolescent pregnancy in Guatemala is a multifactorial issue contributing to maternal and child mortality as well as negative social and economic outcomes. While multiple organizations have identified this as an important area for improvement, little has been published on methods for reducing rates of adolescent pregnancy in resource-limited settings. We characterized the effects of a brief intervention on the knowledge and attitudes towards sexual health of high schoolers in a rural Guatemalan community. Methods We created a condensed, 2-h sexual education course, which was taught to over 500 high school students in San Juan Sacatepequez, Guatemala. Students completed pre- and post-intervention surveys assessing their knowledge about pregnancy prevention and attitudes toward contraception use. Chi-square tests were used to assess the difference between the pre- and post-intervention responses as well as the responses between male and female participants. Results Analysis of the survey results revealed significant improvements in all questions assessing knowledge regarding pregnancy prevention (p<0.01). Our pre-intervention survey revealed that male participants possessed greater knowledge regarding pregnancy prevention (p<0.01). Following the intervention, several areas of initial difference between male and female students’ knowledge disappeared, including knowledge of what a contraceptive is, awareness that one sexual relation is sufficient for pregnancy, and recognition that condoms can prevent sexually transmitted infections. Conclusions This study demonstrates that brief, school-based sexual health courses are low-resource, feasible interventions to significantly increase knowledge about contraception and sexual health in resource-limited settings and improve the disparities in knowledge between male and female participants.

Objectives The present study aimed to examine the mediational role of maladaptive cognitive schema in the association between stressful life events, which are operationalised as major (i. e. negative life events) and minor (i. e. daily hassles) life stressors, and depressive symptoms among adolescents. Methods A cross-sectional correlational study was conducted to recruit participants across four selected states of Kedah, Kelantan, Melaka and Selangor in Peninsular Malaysia. This study involved a total of 1,032 adolescents from 25 government secondary schools, identified using probability proportional to size cluster sampling technique. Data were collected through a self-report questionnaire. Results Using structural equation modelling analyses, findings revealed a full mediation effect of maladaptive cognitive schema between negative life events and depressive symptoms, and a partial mediation effect between daily hassles and depressive symptoms. Conclusions This study provided valuable insights about the significance of maladaptive cognitive schema as a mediator in the stress-depression association and advanced the understanding of mechanism underlying development of depressive symptoms among adolescents in Malaysia. Findings also benefit the clinical practice in the development of targeted depression prevention and intervention programs.

Objectives The study aimed to assess the prevalence and correlates of sexual risk behaviours among adolescents in four Southeast Asian countries. Methods In the cross-sectional “Global School-Based Student Health Survey (GSHS)”, 24,423 adolescents (mean age 14.1 years, SD=1.7) from Indonesia, Laos, Thailand and Timor-Leste responded to a questionnaire in 2015. Results Overall, 8.5% of the students (11.0% males and 6.3% females) ever had sex, ranging from 5.3% in Indonesia to 26.4% in Timor-Leste. Among the sexually active, 49.3% (55.9% males and 36.8% females) had their first sexual intercourse before the age 14 years, ranging from 16.1% in Laos to 73.9% in Indonesia, 59.7% (62.6% males and 53.5% females) had multiple sexual partners, ranging from 55.5% in Timor-Leste to 63.4% in Indonesia, 46.9% (46.8% males and 46.5% females) did not use a condom at last sex, ranging from 37.0% in Thailand to 65.3% in Indonesia, 49.8% (53.7% males and 43.7% females) had not used or did not know of the use of birth control at last sex, ranging from 40.6% in Thailand to 61.5% in Timor-Leste, and 54.2% (54.9% males and 47.0% females) engaged in multiple sexual risk behaviour, ranging from 45.9% in Laos to 78.0% in Indonesia. In adjusted logistic regression analysis, male sex, older age, food insecurity, tobacco use, alcohol use, ever cannabis and/or amphetamine use, psychological distress, and school truancy were associated with two or more and/or multiple sexual risk behaviours. Conclusions A high proportion of students engaged in various sexual risk behaviours calling for a scale up comprehensive sexuality education and integration of substance use and mental health into such intervention programmes in this adolescent school population.

Objectives This study aims to explore the utilization rate and factors influencing the use of HCT services among young females in Ikorodu, Lagos State, Nigeria. Methods This study was a descriptive cross-sectional survey of 404 females, aged 15–24 years, residing in Ikorodu, Nigeria. Study tool was a questionnaire. Collected data was analyzed using the SPSS version 16 software. Results The mean age (±SD) of the respondents was 19.3 (±2.6) years and 90.1% were single. Only 148 (36.6%) respondents had ever utilized the HCT service, of which only 40.5% of them were adolescents. Amongst those that had ever utilized HCT services (n=148), only 60.1% of them did so within 12 months prior to the study while only 33.8% of them initiated the demand for testing themselves. According to the respondents, the top two barriers to the utilization of HCT services were: fear of discrimination (82.9%); and fear of unavailability of access to treatment (68.0%), while the top two factors that facilitates its use were: the adoption of counseling-before-testing approach in the HCT service centers (85.9%); and peoples' need for HIV status declaration prior to getting a job employment/marriage partner (85.1%). Conclusions The study shows that utilization of HCT service remains low among the respondents. There is an urgent need to encourage the utilization of HCT services among young females in Ikorodu, Nigeria.

Objectives University students are at high risk of practicing the smoking habit being exposed to smoking peers and easier cigarette availability. Methods This study aims to explore prevalence, attitude and pattern of tobacco smoking and quitting among Beni-Suef University students. A cross-sectional study was conducted from March to May 2019. A total of 4,599 students were selected by using randomized multi-stage sampling using self-administered questionnaire for data collection. Results The mean age of students found to be smokers was 20.8 ± 1.42 years. Males: Females' ratio was 2:1 (66 vs.34%). Prevalence of smoking was 17.4%. Students of non-medical and non-health colleges showed a significant high smoking rate (18.8 and 18.3% respectively) than students in health faculties (15.2%); p=0.017. Participants believed that they might smoke because of: peers' pressure (73.3%), stress (71.4%), imitating popular figures (61.7%) and availability of money (60.4%). Regarding smoking provinces; 86.1% did smoke in coffee-shops, 73.1% in university yards and only 16.87% used to smoke at home Regarding the attitudes of smokers and nonsmokers towards smoking; the acceptance of indoor smoking was significantly higher (85.6%) among smokers than non-smokers (6.42%); p=0.0001. Of note; 51.2% of smokers versus 86.3% of non-smokers agreed to ban smoking in public places (P=0.001). Majority of smokers (72.1%) had the desire to stop smoking while (57.8%) tried to stop smoking but failed. Conclusions Smoking is becoming a habit among university students and initiative of a smoke free environment should be encouraged and subject and method.

Introduction Evidence suggests that the quality of family relationships is associated with health locus of control in family members. The present study aimed to determine the correlation between the health locus of control and adolescent-parent attachment. Materials and Methods In this descriptive, analytical cross-sectional study, at each of these 10 schools, 40 students aged 14 and 15, will be randomly selected among Behbahan middle schools. 400 students were selected. Rotters Locus of Control Scale and the Inventory of Parent and Peer Attachment (IPPA) were used for data collection. Data were analyzed using SPSS software and Pearson correlation coefficient, t -test and ANOVA statistical techniques. Results Findings showed that the mean and standard deviation of attachment level to father (95.97±19.66), mother (99.62±15.60) friends (93.78±17.59) were all high. Between source of health control (intrinsic, affective, and luck), parental attachment and peers have predictive power (beta=0.263, p≤0.001). Conclusion According to the findings, to increase attachment to parents, it is better that Intervention should also be carried out on the father and the mother and health Locus control will be increased.

Objectives Body image is widely related to behavioral factors in adolescents and negative levels has been associated to poor physical and mental health. This study analyzed the association of physical activity and sedentary behavior with body dissatisfaction in adolescents. Methods Data from 15,632 adolescents between 11 and 17 years from the Brazilian National Scholar Health Survey – PeNSE 2015 were analyzed. Body dissatisfaction was self-reported. Sedentary behavior was assessed by hours in television (TV) viewing and in overall sitting behaviors. Physical activity was assessed by amount of time in domains of active commuting, physical education classes at school, and physical activities outside the school. Analyses were adjusted by age, ethnicity, body mass index, and scholarity of mother. Results Body dissatisfaction prevalence was 18.5%, being higher in girls than boys (24.2 vs. 12.7%, p < 0.001). Female gender (OR = 2.35), higher age-group (OR = 1.64), high scholarity of mother (OR = 1.43), and had overweight/obesity (OR = 2.38/4.81) were positively related to body dissatisfaction. Higher sedentary time was associated with body dissatisfaction in adolescents when compared to less than 2 h/day of sedentary time (OR varying from 1.45 to 2.14). Physical activity was negatively associated with adolescent body dissatisfaction in all assessed domains, with odds ratio varying from 0.66 to 0.89. Conclusions Body dissatisfaction showed an independent association of with total sedentary behavior (positively) and with different domains of physical activity (negatively) in a large scholar sample of Brazilian adolescents.

Objectives The improvement in the/reaction time is important, as it is an indicator of cognitive function. Therefore, there is a need, especially for adolescents in the form of techniques or courses that can improve the reaction time. Yoga was found to cause a better improvement in the health of the individuals. The present study intended to show the effects of Bhramari pranayama (Bhr.P) on reaction time in the healthy adolescents. Methods Of the 730 potential subjects screened, 520 apparently healthy adolescents randomly assigned to either the Bhr.P group (n-260) or control group (n-260). Bhr.P group practiced the bhramari pranayama for 3 days in a week for 6 months. The Auditory Reaction Time (ART) and the Visual Reaction Time (VRT) were assessed before and after Bhr.P pranayama practice. Results Bhr.P group shows significant shortening of response time in both VRT (from 267.13 ± 52.65 to 249.87 ± 39.41 ms) and ART (from 237.42 ± 48.12 to 227.91 ± 34.60 ms) after 6 months of Bhr.P practice. In control group subjects, no such significant changes were found (p > 0.05). Conclusions Shortening of RT implies an improvement in the information processing and reflexes. This beneficial effect of Bhr.P on reaction time can be used for improving cognitive function in the adolescents for their academic performances.

Objective To ascertain the prevalence and correlated factors of providing consultation on sexual orientation and the characteristics of school nurses in high schools in Japan. Methods Participants were school nurses working in high schools in Aichi prefecture. Items investigated included background, experiences in providing counselling on sexual orientation, the availability of materials and resources for students, and learning experiences concerning how to handle sexual orientation concerns. We divided the respondents into two groups: one group who have provided counselling on sexual orientation before and one group with no such experience. Chi square tests were utilized to compare the responses between groups. Results Among the respondents, 38.9% (n = 140) had previous experience of providing counselling to students on sexual orientation. The group with experience of providing counselling is more likely to have 10–29 years of experience, to work at a senior high school, to be informed on notifications from the Ministry of Education, to have experience of learning how to provide counselling on sexual orientation, and to be aware of effective resources. Conclusion In Japan, it is expected that the support needs related to LGBTI will become more obvious in the future and efforts to create an environment in which it is easy for young people to consult with school nurses or other support figures are necessary.

The study aimed to estimate the prevalence and correlates of fruit and vegetable (FV) intake among adolescents in the “2015 Laos Global School-Based Student Health Survey (GSHS)”. The study sample consisted of 3,683 school adolescents with a median age of 16 years from Laos that responded to the 2015 cross-sectional GSHS. The prevalence of inadequate fruit consumption (<2/day) was 74.0%, inadequate vegetable consumption (<3/day) 78.5%, and inadequate FV consumption (<5/day) 83.7%. In adjusted logistic regression analysis, physical inactivity (adjusted odds ratio = AOR: 1.43, 95% confidence interval=CI, 1.061.93) was positively, and being overweight or obese (AOR: 0.65; 95% CI, 0.450.95), soft drink consumption (AOR: 0.55; 95% CI, 0.440.69), fast food consumption (AOR: 0.59; 95% CI, 0.470.74), and peer support (AOR: 0.69; 95% CI, 0.540.88) were negatively associated with inadequate FV consumption. A high proportion of inadequate FV consumption was found and strategies to increase FV consumption in this population may take into account sociodemographic, lifestyle, peer and parental factors.