Volume 34, Issue 6

Objectives To estimate the pooled prevalence estimates of the malocclusion among child and adolescent population of India. Contents A comprehensive electronic search was carried to find studies related to assessing malocclusion in Indian children and adolescent population. Indices and classifications considered for pooled analysis were Dental Aesthetic Index, Index of Orthodontic Treatment Needs, Angles classification and terminal plane relationship of primary secondary molars. An eligibility criterion was prepared and quality assessment was done for all the eligible studies. Initial search produced 1090 titles. After removal of duplicates, 850 records were left for further screening. Eighty one articles were found eligible for full text reading. Finally 60 studies were included in this meta-analysis. Pooled prevalence was used to estimate overall effect, with 95% confidence intervals (CI). Statistical difference between the two genders was calculated using chi square test. Summary and outlook The high prevalence of malocclusion is a public health problem around the world. The current status of burden of malocclusion among Indian children and adolescents is not known. Results of this pooled analysis showed that prevalence of malocclusion among Indian children and adolescents has increased since the last national oral health survey. Prevalence of malocclusion ranged from 28.4% (CI 25.02, 31.9) to 66.7% (CI 50.7, 81.06) depending on the type of index or classification used for recording. Boys recorded higher cumulative prevalence than girls. These findings can be utilized by oral health policy makers to draft measures required for reducing this burden of malocclusion.

Objectives This review explored the relationship between knowledge among children and adolescents and their dietary behaviour. Content Potentially eligible original research articles were identified through a systematic search in PubMed, SCOPUS, Web of Science and WHO Virtual Health Library from 2000 to 2018. From the initial search, a total of 7,258 research articles were obtained. Duplicate studies were identified and removed. Observational studies on children and adolescents (5–19 years) of any gender, ethnicity and country were included in which the outcome measured was either a scoring of/ association between nutrition knowledge and practices. After screening using the inclusion criteria, 13 studies were selected for this paper. Summary and Outlook Four studies reported non-significant association between overall nutrition knowledge and practices. Only two studies found a significant association, out of which one showed a weak association highlighting that nutrition knowledge is not sufficient to result in healthy eating. Other factors which showed significant but weak associations with knowledge/practices included age, gender, nutritional status and lifestyle, peer influence, parents’/guardians’ knowledge, education and occupation level. The causal relationship couldn’t be examined in the present review due to the cross-sectional nature of the studies. Besides imparting knowledge through nutrition education interventions, there is a need for holistic behaviour change strategies including supporting food skills like menu planning, food shopping and cooking to encourage healthy eating habits among children. These interventions should target children from an early age, involving family/parents, teachers and peers to facilitate improvement in the food environment for sustainable change.

Objectives Water polo is a physically demanding contact sport involving swimming, overhead throwing, and wrestling/defending that can result in acute injuries. The objective of this study was to characterize water polo-related injuries among adolescents and young adults treated at United States (US) emergency departments (EDs). Methods Cases were water polo-related injuries among patients age 13–25 years reported to the National Electronic Injury Surveillance System (NEISS) during 2000–2019. The distribution of the national injury estimates was determined for selected variables. Results A total of 418 water polo-related injuries among patients age 13–25 years treated at US EDs during 2000–2019 were identified, resulting in a national estimate of 15,426 injuries. The patient was age 13–18 years in 73.5% of the injuries, 19–22 years in 20.5%, and 23–25 years in 6.0%; 62.1% of the patients were male and 37.9% female. The injury occurred at a place of recreation or sports in 63.4% of the injuries and a school in 21.4%. The most common diagnoses were a laceration (19.4%), strain or sprain (17.8%), contusion or abrasion (17.6%), or fracture (13.0%). The affected body part was 53.6% head and neck, 31.1% upper extremity, 8.0% trunk, 6.5% lower extremity, and 0.7% other/unknown. The patient was treated, released, or transferred in 98.3% of the injuries. Conclusion The majority of patients were adolescents and male. Most of the injuries occurred at a place of recreation or sports or school. The most commonly reported injuries were laceration and strain or sprain and most often affected the head and neck.

Objectives The top causes of adolescents’ mortality in Australia and worldwide are mostly preventable and many stem from psychosocial difficulties. The HEEADSSS screening is a widely accepted screening tool in assessing young people’s psychosocial wellbeing. This retrospective audit was done to evaluate the service implementation of an electronic-HEEADSSS (e-HEEADSSS) screening system in a regional hospital’s paediatric in-patient setting in Western Australia. The aim is to examine and compare the uptake rate of conventional HEEADSSS screening in 2018 and e-HEEADSSS screening in 2019, and to examine the relevant outcome and disclosure rate by the young person. Methods This retrospective audit (pre-post cross sectional study) is reported using the STROBE guideline. It was done over two different time frames: Pre e-HEEADSSS implementation (September–December 2018) and Post e-HEEADSSS implementation (September–December 2019). Inclusion criteria includes: All paediatric inpatients aged 12–16 years old. Exclusion criteria includes: Admission under other disciplines or clinically unstable/unsuitable patients. The uptake rate of conventional-HEEADSSS (2018) in comparison to e-HEEADSSS screening (2019) was examined. Other relevant data was extracted and analysed. Results The sample size pre-implementation was 26 while post-implementation was 24. The uptake rate increased from 12% (conventional-HEEADSSS) to 54% (e-HEEADSSS), a 450% increment with the e-HEEADSSS system implementation (Fisher Exact Test, p=0.005). More than half of young people who completed their e-HEEADSSS screening had concerns/flags which required management by the clinicians. 86% of patients in the e-HEEADSSS group with concerns/flags were acted appropriately by the treating clinicians prior to discharge. The overall disclosure rate of e-HEEADSSS was 93% with highest disclosure rate for ‘Drugs’ domain. Conclusions There is significant increase in uptake rate with high disclosure rate using e-HEEADSSS screening device when compared to conventional HEEADSSS screening in the paediatric in-patient setting. The e-HEEADSSS is a better screening tool for in-patient setting and should be implemented widely.

Objectives This study aimed to assess the relationship between intelligence quotient and oral health conditions among intellectually disabled children. Methods A cross-sectional study was conducted among 13–15 year old intellectually disabled children at National Institute of Mental Health, Hyderabad. The survey comprised of classification of intellectually disabled children based on their intelligent quotient (IQ) levels along with clinical oral examination using World health organization (WHO) oral health assessment form (2013). Statistical analysis was done using SPSS 21.0. p<0.05 was statistically significant. Results The mean age of study participants was 13.73 ± 3.04 years. Based on IQ levels, majority of the participants had moderate retardation (41.8%) and when oral health problems were compared, greater than 50% had gingivitis with mean DMFT scores of 2.48 ± 2.1. A significant higher mean DMFT scores were observed with profound retardation (4.74 ± 2.17) (p=0.000) whereas greater preponderance for oral health problems was observed among moderately retarded subjects. Conclusions Overall majority of the study participants were moderately retarded children and had gingivitis. The higher mean DMFT score was observed with profound retardation with statistical significance. However, Greater percentage of oral health problems were among moderately retarded children. Hence intellectually disabled children should be encouraged to take care about oral health themselves under the guidance of their care takers.

Background Given that social media is quickly penetrating clinical practice, it is essential to explore how these technologies can be used to improve patient-centered care. This is particularly important for healthcare professionals caring for adolescents and young adults (AYA), amid whom the use of social media is nearly universal and whose medical and psychosocial needs are often underestimated by the pediatric or adult oncology settings in which they are treated. Objectives To examine the perspectives of various medical professionals on the emerging role of social media in AYA oncology. Methods Three focus groups were performed with Swiss healthcare professionals involved in the care of AYA patients with cancer. The focus groups were analyzed using thematic coding. Results Healthcare professionals caring for AYA cancer patients in Switzerland are reluctant to step into the social media sphere because they find it difficult to navigate professional boundaries in an unfamiliar space where different contexts collapse. Nurses and younger healthcare professionals who tend to have a more intimate relationship with AYA, often lack virtual mentorship to know how to maintain online professionalism. Adolescents and young adults cancer-related social media presence was unknown to our participants which resulted in missed occasions to inform, educate and care for this often underserved population of cancer patients. Conclusions More practical guidance is needed to help healthcare professionals with how to integrate social media into clinical practice. Setting up fruitful collaborations between medical institutions and existing AYA support groups online might be the best way forward.

Objective The Centers for Disease Control & Prevention (CDC) recommends that the human papillomavirus (HPV) vaccine series be initiated at ages 11–12 years, but many children never follow-through with the series. By examining differences in clinic-specific vaccine series follow-through rates across four clinics, we aimed to identify best practices related to communication around the vaccine and pathways to follow-through. Methods We used the electronic medical record (EMR) to retrospectively analyze HPV vaccine follow-through at four clinic settings. We limited the sample to children ages 11–17 who received a dose of the vaccine series at any of the clinics between January 2015 and June 2018. The primary outcome was follow-through of the HPV vaccine series within 18 months of initiation. Results A total of 3,813 patients were included in this study, 29% of which followed through with the HPV vaccine series. There was significant variability of vaccine follow-through among the clinics (p<0.001), with the Med/Peds clinic having the highest rate of follow-through (32%). After adjusting for confounding variables, multivariable analysis found that Med/Peds and Family Medicine had higher odds of HPV vaccine series follow-through than the Pediatrics clinic. Conclusions We found that the likelihood of vaccine series follow-through was highest when the series was started in the Med/Peds and Family Medicine clinics, compared to Pediatrics and Adolescent Medicine. These results suggest that further qualitative research is needed to understand what communication strategies are most effective at facilitating HPV vaccine uptake among adolescents, and how the most effective strategies can be shared among clinics.

Objectives Adequate knowledge about oral health at a young age is essential in establishing good oral health related behaviors and in developing a positive attitude towards oral health. This study aims to assess the oral health knowledge, attitude and practice of adolescent children aged 15–17 years in Kuwait. Methods This cross-sectional survey was conducted in 12 randomly selected public schools in Kuwait using a two-stage cluster sampling method. An Arabic questionnaire with 29 questions were distributed to the students from selected classes. The questionnaire was divided into four sections: the first section gathered information on the sociodemographic characteristics of the participants; the second section assessed the oral health knowledge of the respondents; the third section assessed the students’ attitude towards professional dental care and the last section assessed the students’ oral health behaviors and practice. Frequency distributions were obtained for each variable and the differences between genders were analyzed using chi-squared statistics and the mean difference in the knowledge and attitude scores were analyzed using independent sample t-test. Results A total of 3,091 students aged 15–17 years (52.8% girls) participated in this study. The mean (SD) knowledge score of the respondents was 8.62 (2.53) and this was significantly higher for girls compared to boys (p < 0.001). Significantly higher percentage of girls than boys knew the role of diet and oral hygiene in preventing caries (p < 0.001). Knowledge about dental plaque was very limited in this population. Majority of the respondents believed that regular dental visits were essential (87.1%). The mean (SD) attitude score of the respondents was 3.30 (2.72) and this was significantly higher for girls compared to boys (p < 0.001). Majority of the students used toothbrush and toothpaste to clean their teeth (60%). Conclusion Significant gender differences were observed in the oral health knowledge and attitudes in this population. School based oral health promotion programs can be effective in promoting good oral health attitudes and practice among children.

Background Despite the assurance of free medical access through the universal health insurance system, over the past three decades Japanese youth have experienced an increase in developmental and behavioral problems, psychosomatic disorders, and psychiatric illnesses. Objectives To identify the challenges in promoting comprehensive preventive health services to adolescents in Japan, specifically in Tokyo. Methods A cross-sectional online survey was conducted of physicians who are members of the Tokyo Pediatric Association. The questionnaire assessed primary care pediatricians’ practice settings and their attitudes toward outpatient services to adolescent patients. Results Out of 617 member pediatricians, 69 valid responses were obtained. Majority were private pediatricians. 52% indicated that they had specialties in addition to general pediatrics; however, no one reported specializing in adolescent medicine. Approximately 70% answered the optimal patient encounter time would be under 10 min. More than 90% of respondents reported challenges providing health services to adolescent patients. Nearly half indicated that they did not routinely evaluate height, heart rate or blood pressure. Few providers asked about reproductive health, violence, or smoking/alcohol use. Conclusion This survey is the first exploration of adolescent health care in an urban area of Japan. While the sample is small, the magnitude of challenges was great with limited training in adolescent medicine, severe time constraints and limited appreciation for the value of health screening at each encounter. Developing a standardized practical assessment tool for adolescent patients may help guide primary care pediatricians to better meet the needs of their adolescent patients.

Objectives Physical inactivity and poor physical fitness in children and adolescents are growing public health problems globally. This study aimed to investigate the correlation between Body Mass Index (BMI) and three physical fitness components, including overall fitness, according to the Swedish Physical power, Mental harmony and Social capacity profile (FMS profile). Another aim was to investigate the test-retest reliability of the FMS questionnaire and fitness tests. Methods A total of 3,692 male and female adolescents in Sweden, between year 2004 and 2013, aged from 16 to 18 years old, were included. Height and weight data were collected to calculate the Body mass index (BMI). The participants performed physical fitness tests, which measure cardio-respiratory fitness, muscular strength and flexibility. The test-retest study included 18 adolescents, aged 16. They answered the FMS questionnaire and participated in the fitness tests with one-week interval. Results A weak inverse relationship between BMI and physical fitness was found: r=−0.06 to −0.07 (p<0.05) for flexibility, r=−0.13 to 0.10 (p<0.001) for strength, r=−0.14 to −0.33 (p<0.001) for cardiorespiratory fitness, and r=−0.15 to −0.27 (p<0.001) for overall fitness. In the test-retest study, the ICC’s for strength, flexibility and balance were 0.94, 0.96 and 0.89, respectively. The ICC’s for the questions regarding lifestyle ranged from 0.75 to 1.00 and for diet, physical activity and drugs were 0.56, 0.44 and 0.58, respectively. The correlation was stronger in overweight/obese individuals compared to normal weight individuals. Conclusion Overweight and obese individuals scored lower in the fitness tests compared to their normal weight counterparts. The test-retest study revealed that the FMS questionnaire and fitness tests are reliable tools.

Background Associations between mental health and dermatology have generated a new branch of study called psychodermatology, which includes relevant conditions to the adolescent population. However, there is limited research focusing on this field and this specific population. Objective To estimate the prevalence of dermatological pathologies in the Colombian adolescent population and their possible associations with mental health conditions. Methods We performed a secondary analysis of the Colombian National Mental Health Survey results. A representative sample of the adolescent Colombian population answered questions regarding dermatological conditions and mental health disorders. We estimated the prevalence and evaluated associations using the chi squared independence test. Results Of 1753 adolescents, 8.3% (CI95%=[6.8–10.1]) had dermatitis or skin allergies and 4.5% (CI95%=[3.3–6.1]) acne. For dermatitis, we found associations with age, education, and family dysfunction (p-Values=0.024; <0.001; 0.046 respectively). Acne was associated with age, sex, educational level, the number of social groups involved in, alcohol consumption, psychoactive substances use and previous violent experiences (respective p-Values=0.007; 0.004; 0.005; 0.036; 0.002; 0.003; 0.044). Regarding mental health, dermatological conditions were associated with depression, affective disorders, suicide attempt and suicide ideation. Conclusion Our results are the first to describe the prevalence of these disorders in Colombia. This is an exploratory study; nonetheless, it is of great value since it is the first to describe these associations in adolescents in a middle-income country, which should be considered during clinical examinations. Further longitudinal studies evaluating possible causal relationship between psychiatric and dermatological conditions are fundamental to establish causal links.

Objectives To investigate the association between sitting posture during the use of school furniture and changes in the spine in adolescents. Methods A cross-sectional study was conducted with 240 students. The sitting position on school furniture was collected five times (3, 6, 9, 12, and 15 min). Postural alteration of the spine was identified by direct observation in front of a symmetograph. Screening for scoliosis was obtained by Adams test. Results The presence of the factor away from the table presented higher percentages at times 3, 6, 9, and 15 min (24.2, 25, 29.2, and 26.7%, respectively). At 12 min, the highest frequency was the presence of poorly positioned lower limbs (25.8%). Associations were observed between poor sitting posture with changes in head anteriorization and retroversion of the pelvis among women and with thoracic hyperkyphosis in men. Conclusions The findings suggest that there are sex-dependent associations between poor sitting posture during use of school furniture and spinal alterations in adolescents.

Objectives Dietary patterns and physical activity have significant influence on weight status. Despite numerous studies related to this topic, there is no existing research which provides complete population-based studies that identify the most significant predictors of pediatric obesity. Therefore, it has become the major goal of our study. Subjects and methods Three hundred school students between 10 and 17 years of age were participating in our study. All of them are currently attending various schools in city of Ternopil, Ukraine. Anthropometric measurements were performed for all participants. Information about food consumption and physical activity was obtained from distributed questionnaire. Logistic regression was used to identify the significant predictors of obesity. Results Lack of physical activity during week (OR=2.59 [95% CI 1.10–6.08]), long screen time in weekdays (OR=2.94 [95% CI 1.13–7.69]) and weekends (OR=3.63 [95% CI 1.55–8.50]), frequent consumption (OR=2.60 [95% CI 1.30–5.19]) and high amounts (OR=2.52 [95% CI 1.26–5.05]) of sweet beverages, fast-food consumption (OR=30.97 [95% CI 1.46–657.60]) and overeating (OR=3.99 [95% CI 1.26–5.05]) have increased chance to be overweight in children 10–17 years of age (p<0.05). Conclusion Decreased frequency in moderate physical activity per week, increased amount of sugar-sweetened beverages, fast-food consumption per day and food consumption without hunger, appear to be the most significant predictors of overweight and obesity among Ukrainian school-aged children.

Objectives Significant variation in cultural and socio-economic factors across different countries means that modification of existing guidelines for youth-friendly health services are needed. Furthermore, including the views and perspectives of young people in developing health services add significant value. The aim of this study was to develop a national guideline for youth-friendly health services using the Delphi method. Methods We invited young people with chronic conditions, managers of paediatric, psychiatric and relevant adult departments and health care professionals with experience and interest in adolescent medicine to participate. The initial list of elements was constructed based on international guidelines and systematic reviews. The study consisted of three electronic questionnaire rounds assessing relevance, importance and whether the elements were essential/very important, respectively. We used 70% agreement as cut-off. Results More than 70% of participants agreed that only one element was essential: ‘Young people should be actively involved in decisions about their treatment and encouraged and supported to ask questions about their illness and treatment’. Additionally, 18 elements reached more than 70% agreement, when the ‘essential’ was combined with the ‘very important’ category. We grouped these 19 elements into five themes: 1) staff competences and workflow, 2) developmentally appropriate communication, 3) focus on youth life, including mental health 4) youth participation and shared decisions, and 5) autonomy and transitional care. Conclusion This guideline for a youth-friendly health care system may serve as inspiration for concrete changes, both locally and internationally, as it was developed together by young people, staff, and management.