Volume 34, Issue 4

E-health could play an important role in the global response to Coronavirus disease 2019 (COVID-19). This paper aims to outline the roles of using e-health in the control and management of COVID-19 based on current perspectives. Many databases and health organizations were searched. The results indicated that there are significant roles of e-health in strengthening the efforts to control and manage this COVID-19 pandemic through improving safe coordination and communication, affording an alternative for education and training, analyzing the data, and providing safe care. Further studies are recommended to evaluate the role of e-health in the control and management of COVID-19.

Objectives It is widely accepted that sexual and reproductive health in adolescents are among the health priorities in the world that affects health aspects and the formation of beliefs and socioeconomic development in the community. However, achieving goals related to sexual and reproductive health is not possible without awareness and participation of the adolescents. On the other hand, proper knowledge about such issues can prevent many problems in this regard. Methods This qualitative study was carried out for one month in schools of Alborz University of Medical Sciences using content analysis. Data were collected from semi-structured, individual and in-depth interviews with female students. In addition, data analysis was performed using guided qualitative content analysis (theory-based). Results Analysis of the data led to the extraction of 11 primary codes classified in six categories of protection motivation constructs (perceived sensitivity, perceived severity, response efficiency, response cost, self-efficacy, and internal rewards) and two additional categories (communications and social contexts). Conclusion All interviewees found themselves exposed to sexually transmitted diseases and emphasized sexual self-care even though the majority of these individuals had inadequate self-efficacy.

Introduction The health practices of pregnant women can affect maternal and fetal health, and pregnancy outcomes. Understanding the predictors of health practices in adolescent pregnant women can help improve these practices. The present study aimed to determine the predictors of health practices in adolescent pregnant women. Materials and methods This cross-sectional study was conducted on 316 adolescent pregnant women in health centers of Tehran (capital of Iran). The participants were selected through the census method. The data were collected using the socio-demographic, obstetrics and health practices questionnaires and analyzed using Pearson correlation coefficient, independent t -test, one-way ANOVA, and general linear model. Results The mean score of health practice was 135.29 ± 9.08, ranging from 34 to 170. The highest and the lowest mean score pertained to the avoidance of harmful drugs and opiates subscale (29.79) and the balance of rest and exercise subscale (13.15), respectively. The general linear model showed that a lower level of education, a history of abortion, lack of involvement in pre-pregnancy counseling, and delayed attendance for prenatal care, reduced the health practice score. However, high level of emotional support from the spouse increased the health practice score. Conclusions The findings highlighted the factors effective on health practices including involvement in pre-pregnancy counseling, early prenatal care and emotional support for the adolescent pregnant woman.

Objectives The involvement of adolescents in violent behaviors is becoming an important public health problem that is concerning physicians as it is associated with a decrease in adult life quality. In this context, bullying is a type of aggressive behavior that occurs repeatedly in interpersonal relationship where power imbalance exists increasing the risk of physical and psychosocial problems in all its intervenient. Prevalence of bullying in Portuguese adolescents is estimated to be ranging from 16.2 to 27.5%. Sleep disorders are a well-known problem related to bullying situations, either as a consequence or a risk factor; estimated prevalence in adolescence is 25% worldwide. In the present study we aimed to investigate the association between sleep quality and the involvement in school bullying in Portuguese adolescents in two high schools. Methods Data collected from a cross-sectional survey addressing questions on bullying behaviors and sleep quality was analyzed using SPSS 22.0. A two-tailed p-value of less than 0.05 was considered significant for all tests. Results We have included 171 adolescents, mean age of 14.39 ± 1.149 years, 59.6% were boys; prevalence of bullying behaviors was 28.1%. Among the students 15.2% were identified as “pure victims”, 8.8% as “pure bullies”, 4.1% as “bully-victims” and 71.9% as “neutrals”. “Pure bullies” and “bully-victims” present higher Athens Insomina Scale (AIS) scores (p = 0.004) and higher prevalence of insomnia (p = 0.004). The prevalence of insomnia was significantly higher in the group involved in bullying behaviors comparing with the neutrals (58.3% vs 30%, p = 0.001). We verified that 65.4% of the reported bullying situations took place inside the school and 8.8% of those teachers did nothing to help the victim and in 17.5% school staff took the same attitude. Conclusions We found a prevalence of bullying behaviors higher than the one reported in previous studies and a prevalence of insomnia of 38.0%, proving that bullying and sleep disturbances are two major problems in adolescence which may increase future risk for psychiatric symptoms, involvement in criminal activities, hyperactive, and inattentive behaviors. We verified a strong relation between insomnia and involvement in bullying situations with those who are involved reporting difficulties in sleep induction. The group of “bully-victims” was identified as potentially being the one with the most troubled adolescents since they combine characteristics of both bullies and victims. The authors conclude that there should be an investment in school-based interventions that help recognize and reduce school bullying and change lifestyle behaviors that may negatively influence adolescents' development.

Objectives This study aimed to determine the pattern of aggression among senior secondary school students in Calabar and the psychosocial factors that are associated with it. Methods A descriptive cross-sectional study of 453 randomly selected senior secondary school students utilizing a self-administered Socio-demographic questionnaire obtain data regarding age, gender etc. and a brief interview using the Modified Overt Aggression Scale (MOAS) to determine aggression. Results The mean weighted MOAS score was 26.94 ± 0.02. Males had significantly higher weighted MOAS total score than females (t=6.466, p<0.001). There was no gender difference in their aggression against objects but the older adolescents scored higher than the younger ones (t=2.029, p=0.043). Males scored higher in verbal aggression (t=3.064, p=0.002) and physical aggression (t=7.002, p<0.001). In the aggression against self-domain, females scored higher than males (t=1.961, p=0.050). All the domains of aggression correlated positively with the total weighted MOAS score, the strongest being with physical aggression (r=0.908, p=0.000). Conclusions Gender appears to play a significant role in aggression among the participants. That females scored higher in aggression to self may have implications for prevention of suicide among youths.

Objectives Increased levels of aggression and desensitization of adolescents has been witnessed as a result of exposure to violent social/electronic media content. It is imperative for policymakers to study such behavioral outcomes in order to make sound policies regarding media literacy. The objective of the study therefore was to assess relationship between violent electronic/social media exposure and level of aggression. Methods A cross sectional study was conducted among adolescents aged 9–19 years in peri-urban slum of Karachi. Content-based Media Exposure scale and Buss and Perry questionnaire, internationally validated tools were used to collect data. Level of aggression was the main outcome variable which was analyzed. Results Four hundred and twenty-two adolescents participated in the survey. Usage of television was significantly higher in the younger age group whereas the effect of watching violent content among the adolescents varied. It was observed that 153 (36.3%) respondents felt stressed and 24 (5.7%) felt aggressive after watching violent content on electronic and social media. The contents showing people who fight (39.6 ± 5.6, p-value<0.05), who steal (39.5 ± 7.5, p-value=<0.05) and destroyed someone else’s belongings (40.6 ± 7.6, p-value=<0.05) had a significant effect on the level of aggression. Regression analysis predicted a strong positive association of exposure of violent content with level of aggression (β=0.43). Conclusions The usage of violent content on social and electronic media was popular among adolescents, and produced negative effects on the behavior of adolescents. Measures should be taken to introduce media literacy of the children in Pakistan, especially in the peri-urban slums.

Objectives Young adults with cerebral palsy (CP) face potential challenges. The transition to young adulthood is characterized by significant changes in roles and responsibilities. Furthermore, young adults with chronic conditions face a transfer from pediatric care to adult healthcare. This study explores how living with CP affects young adults in general, and specifically which psychosocial, medical and healthcare needs are particularly important during this phase of life. Methods A qualitative study with data from individual, semi-structured, in-depth interviews with six young adults with CP (ages 21–31 years) were transcribed verbatim and analyzed. The participants were selected to provide a maximum variation in age, gender, Gross Motor Function Classification System score and educational background. A descriptive thematic analysis was used to explore patterns and identify themes. Results Three themes were identified: “Being a Young Adult”, “Development in Physical Disability and New Challenges in Adulthood” and “Navigating the Healthcare System”. The three themes emerged from 15 sub-themes. Our findings emphasized that young adults with CP faced psychosocial challenges in social relationships, participation in education and work settings and striving towards independence. The transition to young adulthood led to a series of new challenges that the young adults were not prepared for. Medical challenges included managing CP-related physical and cognitive symptoms and navigating adult health care services, where new physicians with insufficient knowledge regarding CP were encountered. Conclusion The young adults with CP were not prepared for the challenges and changes they faced during their transition into adulthood. They felt that they had been abandoned by the healthcare system and lacked a medical home. Better transitional care is urgently needed to prepare them for the challenges in young adulthood.

Introduction Timely donation of organs has helped many get a new life. But in India, the pace of Organ Donation and Transplant (ODT) has been disturbingly sluggish. There is a wide gap between patients who need transplants and the organs that are available in India. Doctors can play a pertinent role in decreasing this gap. Therefore, the present study was done to assess the knowledge, attitude, and perception of the medical students in India regarding Organ Donation (OD). Material and Methods A cross-sectional study was carried out among the undergraduate students (n=1463) in 10 different medical colleges across the country. Data were collected electronically through Google forms by using a pre-designed, semi-structured, self-administered questionnaire. Results About 65% of students had a positive attitude regarding ODT. Most of the students acknowledged that Internet sources (57.7%) and print media (46.5%) played a significant role in their awareness. 83% of the students felt that there is a need for effective laws to regulate the process of ODT. It was encouraging that most of the students (69.6%) were not biased for the type of recipients for the organ. Conclusion In the face of acute shortage of donated organs in India, the medical students can be the torchbearers of a positive change. Topics on ODT should be stressed in the initial years and during the early clinical exposure through rapid implementation of the revised Medical curriculum. They can motivate the general public and patients during their routine interactions to make this idea more accessible and acceptable.

Objectives Pediatric chronic abdominal pain (CAP) is typically managed in primary care settings, although specialty referrals may help patients access the full range of biopsychosocial treatment options. We investigated patterns of specialty referral (gastroenterology or mental health) among children with CAP seen in an academic pediatric primary care clinic. Methods We retrospectively identified patients age 4–17 years visiting our primary care clinic in 2016–2017 for abdominal pain, identified using International Classification of Diseases (ICD) codes. We excluded patients whose symptoms did not persist for 3 months or who were referred to a specialist before their symptoms had persisted for 3 months. Referral outcomes were assessed through December 2018. Results Of 320 patients with qualifying ICD codes, 253 were excluded because their symptoms did not persist for 3 months; 31 had already been referred to a specialist within 3 months of pain onset; and one chart could not be accessed. Of the remaining 34 patients (22/12 girls/boys, median age 10 years) 10 (29%) were referred to a gastroenterologist and none were referred to mental health specialists. No clinical or demographic factors reached statistically significant associations with gastroenterology referral, although pain duration was shorter among patients who were referred. Conclusions Children with CAP managed in our primary care clinic were seldom referred to specialists after their pain persisted over 3 months. Increasing focus on cognitive-behavioral therapies for chronic pain, and the low specialty referral rate, indicates that primary care practices should be prepared to offer these treatment modalities to children with CAP.

Objectives Transitional care for adolescents with congenital malformations, such as anorectal malformations (ARM), is described sparsely in the literature and referred to as being inadequate. In order to organize future successful healthcare structures, knowledge of patient-reported important aspects of transition is required. The aim of the study was therefore to explore the needs and expectations of transitional- and adult healthcare among adolescents and adults born with ARM. Methods Two tertiary paediatric surgical centres, in collaboration with two tertiary pelvic floor centres, in Sweden and Norway, conducted a qualitative study, involving adolescents and adults born with ARM in focus group discussions regarding transitional care. Discussions were analyzed by qualitative content analysis. Ethical approval was obtained. Results Sixteen participants (10 women) with a median age of 24 (19–47) years, born with mixed subtypes of ARM were included in gender-divided focus groups. Participants emphasized a need for improved knowledge of ARM, both among patients and adult care providers. Participants identified a need for support with coping strategies regarding challenging social- and intimate situations due to impaired bowel function. Participants pin-pointed well-functioning communication between the patient and the paediatric- and adult care providers as a key factor for a successful transitional process. Further, participants emphasized the importance of easy access to specialized adult healthcare when needed, suggested to be facilitated by appointed patient navigators. Conclusion Adolescents and adults born with ARM identify improved knowledge of ARM, well-functioning communication and easy access to specialized adult care as key components of a successful transition.

Background As digital interventions to improve health become widespread globally, it is critical to include target end-users in their design. This can help ensure interventions are maximally beneficial among intended populations. Objectives To generate the content of a digital educational support group, administered through WhatsApp, for new adolescent mothers and establish participants’ cellular access and WhatsApp use. Participants Adolescent mothers with new babies. Methods We completed a two-phase user-centered design process. In phase I design sessions, participants discussed their postpartum experiences and completed an activity to elucidate their health and wellbeing information needs. In phase II sessions, participants individually identified which health information topics were important to them, then all topics were prioritized as a group. Phase II participants also completed a brief survey on cell phone access and WhatsApp use. Results Phase I included 24 participants, 21 of whom completed phase II. Priority health and wellbeing information topics in the postpartum period were identified as: child growth and development, understanding your baby, common childhood illnesses, breastfeeding, childhood nutrition, family planning, and self-care. Of phase II participants, 45% had cellular phone access and none had a data plan. Cellular service was inconsistently obtained with data packages or Wi-Fi. 30% of participants had no experience using WhatsApp. Conclusions Participants identified numerous health information needs, which will serve as the content for our planned digital support group and provides valuable insight for health care providers globally. Less than half of participants had consistent cellular phone access, and none had reliable access to cellular service.

Objectives The rate of condom and other contraception use varies depending on social, personal and sexual characteristics. We present a study covering various contraceptive means, considering sexual orientation and considering a large panel of co-variables among Swiss resident young adults. Methods Data were obtained from a self-administrated national survey on sexual behavior. Participants (N=4703, 49% males) were divided into three groups based on the mean of contraception used at last intercourse: CONDOM (55.1, 54.3% males), CONTRACEPTIVE (34.3, 43.1% males) and NON-USE (10.5, 50.7% males). By gender, groups were compared on sociodemographic and personal characteristics, contraception used at first intercourse (FI) and sexual life. Results Globally, 90% of participants used a reliable contraception at last intercourse. Compared to the CONDOM group, participants in the CONTRACEPTIVE group were more likely to have already used a contraceptive at FI, and individuals in the NON-USE group were more likely to have had a non-use or to have used a contraceptive only at FI. Conclusions Contraception at FI seems to have a considerable impact on the further use of contraception. It seems thus essential to make all necessary efforts in order to promote the best contraception and protection at FI.

Objectives World Health Organization (WHO) suggests intake of five servings (400 g) of fruits and vegetables (F&V) per day to ensure an adequate dietary fibre and to reduce the risk of non-communicable diseases. Risk factor survey of Non-Communicable Diseases (2007–08), reports that only 1% population in Tamil Nadu, South India consumed more than five servings a day. So we aimed to assess the effectiveness of nutrition education in improving the daily intake of fruit and vegetable servings and stage of behaviour change among college students. Methods A pre-post intervention study was conducted among undergraduate students from two selected women’s colleges in urban Puducherry, South India during September–October 2019. The two English departments were randomly allocated into intervention group (IG), control group (CG) and 75 students in each group were chosen by systematic random sampling. IG received 30 min of nutrition education programme; which includes importance and minimum daily intake of fruits & vegetables, local availability, cost and awareness about myths and misconceptions. CG received pamphlets regarding healthy dietary intake. Knowledge regarding portion sizes, average daily servings of fruit & vegetable intake and stage of behaviour change were assessed at baseline and after one month of intervention. Results There was a significant increase in knowledge regarding portion sizes (28– 64%) after intervention in IG (p<0.001) compared to CG (24– 40%). The knowledge regarding the required number of servings of fruits (27–56%) and vegetables (15–58%) also increased significantly (p<0.001) in the IG. Intake of fruits, vegetables and juices in the last 24 h were significantly increased in IG compared to CG (p<0.001). There was a significant increase (p=0.002) in contemplation and preparation stage (13–34%) in IG after intervention. Conclusions A well designed nutrition education programme is an effective tool in promoting healthy eating habits among adolescents. It enabled a significant increase in knowledge regarding portion sizes of F&V and daily intake of fruits and vegetables.

Objectives Parents play a significant role in promoting of healthy sexuality in adolescents. The purpose of the present study was to assess the effectiveness of a sexuality education intervention program to enhance parent–adolescent sexual communication. Methods This study was a randomized controlled field trial. Parents of male adolescent aged 13–16 years were recruited from eight public all-boys high schools in Karaj, Iran. A multi-stage stratified random sampling method was used and 102 parents were assigned into intervention and control groups. The recruitment and data collection process lasted from February to November 2019. Self-report demographic questionnaire and six general parenting and parent–adolescent sexual communication measures were used to assess the impact of intervention. Sexuality education program was presented for the parents of intervention group, in the form of four weekly 2-h sessions. Parents were assessed at the baseline, within one week post-intervention, and three-month follow-up to evaluate the outcome variables. The data were analyzed using the Chi -square test, two-sample t-test, general linear model analyses, and Bonferroni test. Results In terms of parent–adolescent general communication, parental monitoring, parent–adolescent communication about sex-related topics, parent’s sexual communication skills, parent’s self-efficacy, and responsiveness to sexual communication. There were no significant differences between intervention and control groups at the baseline (p>0.05). Compared to controls, intervention parents reported more improvement in general communication across the time; however, significant differences were not observed regarding general communication and parental monitoring (p=0.94, p=0.95). Parents in the intervention group significantly differed from those in the control group for the mean scores of parent–adolescent communication about sex-related topics (p=0.04), parent’s sexual communication skills (p=0.04), parent’s self-efficacy (p=0.002), and responsiveness (p<0.001) to sexual communication at each follow-up. Conclusions We identified the educational program as a promising tool for improving parent–adolescent communication regarding sexuality-related issues. This program provides the evidence for implementation of parent-based sexuality education programs.

Objectives Weight control behavior is a strategy for weight loss or weight gains that range from healthy to unhealthy. This study is aimed to determine the prevalence of weight control behaviors and their related factors in adolescent girls in Tehran. Methods Adolescent girls in the last grade of high school (n=491) that were selected by a multi-stage sampling method completed a cross-sectional survey (2018) in Tehran city in Iran. Data were collected using questionnaires (standard and researcher-made) by the self-report method and analyzed using descriptive and inferential statistics, including Chi-square, independent t-test, and logistic regression. Results 17.5% of adolescents had healthy, 60.6% had unhealthy, 15.8% had extreme unhealthy weight control behaviors, and 6.1% had no weight control behaviors. 74.8% of adolescents were in the normal body mass index (BMI) percentile. Unhealthy weight control behaviors were observed more than healthy behaviors at all BMI levels. Weight control behaviors had significant relationships with weight control intention (p=0.005), family (p=0.016) and peers (p=0.011) encouragement to weight control, engagement of relatives in weight control behaviors (p=0.016), anxiety (p<0.001), and age (p=0.030). BMI has a positive correlation with body weight satisfaction (p<0.001) and body weight perception (p<0.001). The results of logistic regression showed that increasing anxiety score can increase the possibility of engaging in unhealthy weight control behaviors (odd ratio=1.086, p=0.006). Conclusions Considering that a significant percentage of adolescents have unhealthy and extreme unhealthy weight control behaviors, and some of these behaviors leave irreversible effects on the health of this age group, design, and implementation of educational programs to prevent such behaviors seem imperative.