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The increasing lifespan in our society emphasizes the importance of maximizing the well-being for older individuals. The objective of this research was to identify disparities in current physical fitness between older adults who engaged in regular exercise during their youth and those who did not. Additionally, the study aimed to determine the factors contributing to current levels of physical activity. This cross-sectional study involved a retrospective examination of the exercise habits of seniors. A total of 76 participants (35.5% male, aged between 60–80) underwent evaluation using the Fullerton Functional Fitness Test. The key findings of the study are as follows: 1. Seniors who consistently exercised during their younger years demonstrated superior physical fitness, including cardiorespiratory fitness. 2. Generally, individuals who engaged in exercise during their youth were more likely to maintain an active lifestyle in later life. 3. Current levels of physical activity were associated with regular exercise during youth and the absence of chronic diseases. [ABSTRACT FROM AUTHOR]

Screening for depression may identify persons for HIV prevention services and to ensure linkage to care for ART and mental health. We assessed factors associated with depressive symptoms using multiple logistic regression among 15- to 29-year-old gay, bisexual or other men who have sex with men (MSM) and transgender women who have sex with men (TGW) attending HIV prevention clinics at Silom Community Clinic or Bangrak Hospital in Bangkok or Rainbow Clinic in Nakhon Sawan, Thailand. We defined depressive symptoms as a self-report of feelings of sadness that impacted daily life in the past one month. Among 192 MSM, 51 TGW, and 11 gender-questioning persons screened: 12.6% met the criteria for depression; 5.9% had new HIV diagnosis. Independently associated factors which increase the risk of depressive symptoms included: studying in a private school (AOR 7.17); experiencing any type of bullying (AOR 2.8); having a partner with HIV (AOR 4.1); and learning about the study from sources other than a friend (AOR 4.2). Given many youths had depressive symptoms, screening for depression and connection to mental health services would be beneficial in sexual health settings to meet the needs of HIV-vulnerable youth. [ABSTRACT FROM AUTHOR]

Māori adolescents are more likely to have lived through an array of adverse experiences due to unequal exposure to social disadvantage that Indigenous Māori face in Aotearoa New Zealand. Most of this disadvantage arises from intergenerational inequity resulting from the British colonial process. This study aimed to investigate how disadvantage manifests in the backgrounds of Māori adolescents with harmful sexual behaviours. Background characteristics in a sample of 1024 males (aged between 12 and 17), who were referred to a treatment programme for harmful sexual behaviour, were analysed and comparisons made between Māori and non-Māori on risk factors. Māori exhibited higher rates of risk factors (substance abuse, familial criminality, physical abuse victimisation and family violence) at different contextual levels (i.e. individual, family, school). Risks of school exclusion and sexual abuse victimisation were similar across ethnicities. Recommendations are made for prevention/treatment efforts that use holistic and culturally informed approaches. Culturally appropriate treatment for Māori with harmful sexual behaviours (HSBs) is recommended. This needs to be led by Māori, for Māori and with Māori, including whānau/family-based treatment and prevention. [ABSTRACT FROM AUTHOR]

Trunk muscles' function and characteristics are of great importance for both static and dynamic tasks in different sports, and abnormalities of trunk flexors and extensors might be associated with low back pain (LBP). The aim of this study was to provide a comprehensive evaluation of the functional, morphological and contractile properties in trunk flexors and extensors of young gymnasts with and without LBP. Young gymnasts (14/25 females, 14–18 y) were screened for the presence of chronic LBP. Abdominal and lumbar muscles were tested for function (McGill's endurance tests), thickness (ultrasound), and contractile responses (tensiomyography). An 8-sessions physiotherapy intervention including postural reeducation was performed by a subsample of 10 subjects with LBP. LBP was found to be associated to higher flexors-to-extensors endurance ratio (OR 11.250, 95% CI: 1.647–76.849, p = 0.014), reduced mean lumbar multifidus thickness (OR 16.500, 95% CI: 2.246–121.228, p = 0.006), and reduced mean erector spinae radial displacement (OR 16.500, 95% CI: 2.246–121.228, p = 0.006). The physiotherapy intervention was found to reduce LBP symptoms and it was associated with a significant improvement in the flexors-to-extensors ratio (p < 0.001). This study provides preliminary evidence of functional, morphological, and contractile trunk muscles' alterations associated with chronic LBP in young gymnasts, and presents the effects of a postural reeducation program on symptoms and muscles' functional properties. [ABSTRACT FROM AUTHOR]

Adolescents with chronic illnesses face unparalleled challenges. To better understand these challenges and their impact on mental well-being, the Strengths and Difficulties Questionnaire Dysregulation Profile (SDQ-DP) was employed as a clinical assessment tool. The primary aim of our cross-sectional study conducted at a tertiary care center was to assess the prevalence of high SDQ-DP scores and its association with depressive symptoms, suicidal behaviors, and health-related quality of life (HRQoL) among adolescents aged 10–18 years diagnosed with various chronic illnesses. Among the 130 participants, 11.5% exhibited high SDQ-DP scores. Adolescents with high SDQ-DP scores displayed significantly higher rates of depression (aOR 12.37, 95% CI 2.15–71.19), suicidal ideation (aOR 18.68, 95%CI 2.72–128.33), suicidal plan (aOR 23.02, 95%CI 3.48–152.24), suicidal attempt (aOR 25.48, 95%CI 2.83–229.17) and diminished HRQoL (p < 0.001). This study has supported the correlation between high SDQ-DP scores and compromised mental well-being, highlighting the tool's clinical significance. [ABSTRACT FROM AUTHOR]

Few studies have explored polysubstance use among youths aging out of foster care, despite higher rates of substance misuse for youths exiting foster care than those in the general population. Polysubstance use has been linked to substance use disorders, health problems, cognitive impairment, suicide, and overdose. This study investigates understudied risk and protective factors associated with polysubstance use with data from 384 youth who turned 17 years old between December 1, 2001, and June 30, 2003, and were transitioning out of foster care from the Missouri Children's Division. We conducted bivariate analyses with chi-square tests for categorical variables and Analysis of Variance with continuous independent variables. Then we conducted a multinomial logistic regression to explore differences between individuals who used 1 or no substances, individuals who used only alcohol and marijuana, and individuals who used 2 or more substances. Bivariate analyses found that being white, having deviant peers, and living in a more disordered neighborhood were risk factors for polysubstance use. Multinomial logistic regression results found that being white (RR = 6.89, p <.001), having deviant peers (RR = 1.15, p <.001), and living in a more disordered neighborhood (RR = 1.13, p <.05), increased the risk engaging in polysubstance use. Similar to findings in other studies, we found that deviant peers and neighborhood disorder increase the risk of polysubstance use, but family support, church attendance, and spirituality were not protective against polysubstance use. Interventions should work to reduce deviant peer relationships among foster youth. [ABSTRACT FROM AUTHOR]

The number of patients seeking transgender healthcare is growing, and there is a potential impact of gender-affirming therapies on fertility. The use of fertility preservation (FP), particularly among transgender adolescents, has been limited. We aimed to examine differences in FP counselling, referral and utilisation between male-to-female (MtF) and female-to-male (FtM) transgender adolescents. A retrospective review of the medical records of patients ages 12–17 seen at an academic medical centre between 2012 and 2017 with a diagnosis of gender dysphoria was conducted. A total of 22 MtF and 45 FtM adolescents were included. The counselling on the potential fertility impact of gender-affirming therapy was documented in 55%, and of those counselled, 73% were counselled before receiving medication. There was no significant difference between the timing of counselling for MtF versus FtM adolescents. Of patients with documented reproductive wishes, 77% reported either desire for adopted children or no desire for biological children. Among patients offered FP referral, 2 (22.2%) MtF and 3 (12.5%) FtM patients accepted; both MtF patients cryopreserved sperm. While most adolescents were counselled on the fertility impact of gender-affirming therapy, there is room for improvement as 45% of patients had no documented counselling. The rate of transgender adolescents pursuing FP consultation and gamete cryopreservation was low, consistent with prior studies in this population. [ABSTRACT FROM AUTHOR]

Objective: The overall objective in the study was to compare self-reported hearing based on a single question (“how good would you currently rate your hearing?”) to measure hearing loss determined by audiometry in a cohort of adolescents. Prevalence of audiometrically measured hearing loss and frequencies of self-reported poor hearing as well as factors that have an impact on self-reported hearing were examined. Design: Baseline and 5-year follow-up data of the Ohrkan study were used. Participants filled in a questionnaire and underwent audiometric measurements. Study sample: Data from 979 adolescents were analysed. Participants were 54.7% female and aged between 13 and 18 years at baseline and 17–21 years at 5-yr follow-up. Results: The single question on self-reported hearing ability achieved a sensitivity of 41.9% and a positive predictive value of 7.1% at baseline. For the 5-yr follow-up, sensitivity was 40.0%, positive predictive value was 13.9%. Factors influencing self-reported poor hearing were gender, tinnitus, “muffled” ears after exposure to loud noise (e.g. after a concert) and low-frequency hearing loss. Conclusions: The single question about hearing ability used in the Ohrkan study is not sufficient to replace audiometry to detect hearing loss as defined in the study in adolescents. [ABSTRACT FROM AUTHOR]

There are studies reporting different results on whether there is an increased incidence of cardiovascular problems in autism spectrum disorder (ASD). The aim of this study was to examine carotid intima-media thickness (cIMT), an early marker of atherosclerosis in children and adolescents with ASD. This single-center case-control study was conducted in a tertiary care hospital. Eighty-five children (36 children with autism and 49 healthy controls) aged 6–18 were enrolled. After a clinical interview, Children's Global Assessment Scale (CGAS) and Autism Behavior Checklist (ABC) were filled out and laboratory measures were collected for ASD group. Anthropometric measurements (height, weight, waist and hip) of each participant were assessed. The cIMT was measured with an ultrasound probe on both sides of the neck. Age, gender, body mass index percentile and waist/hip ratio adjusted right/left common carotid arteries IMT and right/left bulb IMT were statistically significantly higher in the autism group than controls (0.45 ± 0.01 mm and 0.55 ± 0.01 mm, respectively, p < 0.001). We performed multiple linear regression analysis to determine statistically significant related factors of the cIMT in ASD. Early onset of autism symptoms were related with high carotid IMT (β = −0.496, p = 0.01). These findings suggest that atherosclerosis may begin earlier in children with ASD, which is one of the most common neurodevelopmental disorders in childhood. The cIMT measurement, which is an easy and noninvasive method in the cardiovascular assessment and follow-up can be recommended for clinical use for individuals with ASD. [ABSTRACT FROM AUTHOR]

Self-injurious behavior has been defined as an act directed at oneself that results in tissue damage. The aim of this study was to verify the prevalence of self-injurious behavior and the presence of oral lesions among adolescents in foster care. This is a cross-sectional study that was carried out in the shelters of the city of Recife (Brazil), with adolescents between 10 and 17 years of age, of both genders, by census survey. Data were collected through document analysis, application of the questionnaire (FASM), and physical examination, in the second half of 2021. The data were systematized by SPSS software using descriptive and inferential statistics. A total of 81 adolescents participated of the research. The average age of the patients evaluated was 13.65 years and the majority were male. As for clinical characteristics, 75.3% had one or more self-injurious behavior. Of these, the most frequent were: poking wounds 53.1%, biting oneself 40.7%, and cutting the skin 34.6%. The most observed oral lesion was linea alba 14.8%. In the association between self-injurious behavior and oral lesions, trauma and dental wear, age group, gender, shelter care situation and violence no association was recorded (p > 0.05). Self-injurious behavior may have a high occurrence percentage among adolescents in shelter/foster care. However, the adolescents had a low prevalence of changes in the oral cavity that could suggest self-injurious behavior. No association was recorded between the variables studied. [ABSTRACT FROM AUTHOR]

The increasing prevalence of children with obesity has contributed to a higher risk of developing cardiometabolic comorbidities. Adversity and chronic stress are negatively linked to cardiometabolic outcomes, and resilience is positively associated with improved outcomes. However, whether resilience is protective against metabolic disturbances preceding disease presentation is less understood. This study explored correlations between stress, anthropometrics, and metabolic parameters with resilience (total, individual, family, peers, school, community), and determined which resilience domains predict metabolically unhealthy obesity. Adolescents with obesity (n = 39; 12–18y) completed anthropometrics, an oral glucose tolerance test, the Adolescent Resilience Questionnaire, and Perceived Stress Scale. Lower stress (r = −0.70, p < 0.001), BMI (r = −0.42, p = 0.01), fat mass (ρ = −0.41, p = 0.01), and fat-free mass (ρ = −0.41, p = 0.01) were associated with greater resilience. Greater school resilience was associated with lower risk for having metabolically unhealthy obesity (odds ratio = 0.87, 95% Confidence Intervals, 0.78–0.98, p = 0.02). Our findings suggest that resilience is associated with lower adiposity, and that lower school resilience is an independent predictor of having metabolically unhealthy obesity. Further work exploring correlations between school resilience, perceived stress, and metabolic outcomes, would optimize programs for obesity-related chronic conditions. [ABSTRACT FROM AUTHOR]

Prior studies examining prehospital characteristics related to return of spontaneous circulation (ROSC) in pediatric out-of-hospital cardiac arrest (OHCA) are limited to structured data. Natural language processing (NLP) could identify new factors from unstructured data using free-text narratives. The purpose of this study was to use NLP to examine EMS clinician free-text narratives for characteristics associated with prehospital ROSC in pediatric OHCA. This was a retrospective analysis of patients ages 0–17 with OHCA in 2019 from the ESO Data Collaborative. We performed an exploratory analysis of EMS narratives using NLP with an a priori token library. We then constructed biostatistical and machine learning models and compared their performance in predicting ROSC. There were 1,726 included EMS encounters for pediatric OHCA; 60% were male patients, and the median age was 1 year (IQR 0–9). Most cardiac arrest events (61.3%) were unwitnessed, 87.3% were identified as having medical causes, and 5.9% had initial shockable rhythms. Prehospital ROSC was achieved in 23.1%. Words most positively correlated with ROSC were "ROSC" (r = 0.42), "pulse" (r = 0.29), "drowning" (r = 0.13), and "PEA" (r = 0.12). Words negatively correlated with ROSC included "asystole" (r = −0.25), "lividity" (r = −0.14), and "cold" (r = −0.14). The terms "asystole," "pulse," "no breathing," "PEA," and "dry" had the greatest difference in frequency of appearance between encounters with and without ROSC (p < 0.05). The best-performing model for predicting prehospital ROSC was logistic regression with random oversampling using free-text data only (area under the receiver operating characteristic curve 0.92). EMS clinician free-text narratives reveal additional characteristics associated with prehospital ROSC in pediatric OHCA. Incorporating those terms into machine learning models of prehospital ROSC improves predictive ability. Therefore, NLP holds promise as a tool for use in predictive models with the goal to increase evidence-based management of pediatric OHCA. [ABSTRACT FROM AUTHOR]

This quality improvement activity examined Safety Planning Intervention (SPI) over two 3-monthly periods for presentations from 13–17-year-olds with suicidal risk to a regional hospital Emergency Department (ED). We collected patient demography, presentation characteristics, presentation rate, and clinician use of SPI, including those under Emergency Examination Authorities (EEAs). An education workshop was offered between the audits, aimed to increase clinician (social work, psychology, nursing, and psychiatry) knowledge of SPIs. The annual ED presentation rate for suicide risk for 15–17-year-olds was 1,520 per 100,000 persons. More presentations were female, non-Indigenous persons, and fewer than half presented voluntarily. Most presentations were for suicide attempt followed by suicide threat. In the first audit clinicians initiated SPIs in fewer than 50% of cases and completed SPIs in 15%. Whereas in the second audit where SPIs were initiated by clinicians in 69% of cases and fully completed in 49%, less than half the presentations with EEAs received a completed SPI. Indigenous persons, although a lower proportion of presentations, were overrepresented for the population. Following the education workshop, there was an improvement in SPI completion, reflecting the benefits of education and training to clinical staff. Lastly, this study highlights the benefit of conducting audits as quality improvement activities for patient care. IMPLICATIONS The international literature indicates an increase in child and youth suicide attempts. This increase requires preparedness from social workers and other clinicians (psychology, nursing, and psychiatry) who offer front-line healthcare for these presentations. Safety plans are best-practice and tailored strengths-based plans undertaken between a clinician and client so that the client feels confident knowing where to go and to whom to talk to avoid further suicide attempts. Social workers play an important role in undertaking safety plans with clients (especially those who are particularly vulnerable) in hospital and community settings to maximise client outcomes. [ABSTRACT FROM AUTHOR]

Globally, mental health problems have been reported to be more common in youth living with HIV (YLWH) than in the general population, but routine mental health screening is rarely done in high-volume HIV clinics. In 2019, YLWH in a large HIV clinic in Botswana were screened using the Generalized Anxiety Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in a pilot standard-of-care screening programme. Two-way ANOVA was used to describe the effects of age group (12–<16, 16–<20 and 20–25 years old) and sex on GAD-7 and PHQ-9 scores. Chi-square statistics were used to compare characteristics of YLWH with and without potential suicidality/self-harm symptoms based on question 9 in the PHQ-9. Among 1 469 YLWH, 33.1%, 44.3% and 15.0% had anxiety, depression and potential suicidality/self-harm symptoms respectively. YLWH of 20–25 years old and 16–<20 years old had higher GAD-7 scores compared to 12–<16-year-olds (p = 0.014 and p = <0.001 respectively). Female YLWH of 20–25 years old had higher PHQ-9 scores compared to 12–<16-year-olds (p = 0.002). There were no other sex–age dynamics that were statistically significant. Female YLWH endorsed more thoughts of suicidality/self-harm than males (17% versus 13%, p = 0.03 respectively). Given the proportion of YLWH with mental health symptoms, Botswana should enhance investments in mental health services for YLWH, especially for young female adults who bear a disproportionate burden. [ABSTRACT FROM AUTHOR]

Injury is a major cause of morbidity and mortality in children. However, the epidemiology and prehospital care for pediatric unintentional injuries in Asia are still unclear. A total of 9,737 pediatric patients aged <18 years with unintentional injuries cared for at participating centers of the Pan-Asian Trauma Outcome Study (PATOS) from October 2015 to December 2020 were reviewed retrospectively. Patients were divided into two groups: those <8 and those ≥8 years of age. Variables such as patient demographics, injury epidemiology, Injury Severity Score (ISS), and prehospital care were collected. Injury severity and administered prehospital care stratified by gross national income were also analyzed. Pediatric unintentional injuries accounted for 9.4% of EMS-transported trauma cases in the participating Asian centers, and the mortality rate was 0.88%. The leading cause of injury was traffic injuries in older children aged ≥8 years (56.5%), while falls at home were common among young children aged <8 years (43.9%). Compared with younger children, older children with similar ISS tended to receive more prehospital interventions. Uneven disease severity was found in that older children in lower-middle and upper-middle-income countries had higher ISS compared with those in high-income countries. The performance of prehospital interventions also differed among countries with different gross national incomes. Immobilizations were the most performed prehospital intervention followed by oxygen administration, airway management, and pain control; only one patient received prehospital thoracentesis. Procedures were performed more frequently in high-income countries than in upper-middle-income and lower-middle-income countries. The major cause of injury was road traffic injuries in older children, while falls at home were common among young children. Prehospital care in pediatric unintentional injuries in Asian countries was not standardized and might be insufficient, and the economic status of countries may affect the implementation of prehospital care. [ABSTRACT FROM AUTHOR]

Purpose: Lexical stress abilities were investigated in individuals with autism spectrum disorder (ASD) compared to typically developing (TD) controls. We hypothesised that individuals with ASD would demonstrate atypical prosody on lexical and phrase stress tasks and are perceived by listeners as sounding unnatural. Method: A between-group study was conducted to investigate lexical stress abilities among adolescents (12–20 years) with ASD (n = 11) compared to TD controls (n = 11) matched for age and gender. Two tasks were administered to assess the ability to receptively and expressively distinguish nouns from verbs and a noun phrase from a compound noun. Receptive tasks required participants to select visual stimuli corresponding with the utterance they heard. Expressive tasks were rated using perceptual judgments of accuracy, perceptual and acoustic measurements of duration and perceptual ratings of "naturalness." Result: Individuals with ASD performed with significantly less accuracy on all prosody tasks, significantly longer duration of utterances, and were rated as sounding "unnatural" at a significantly higher rate than controls. Conclusion: This study provides converging evidence that supports atypical prosody is influenced by longer duration of utterances and less accurate lexical and phrase stress. The clinical implications of this study support early assessment and intervention of prosodic disorders in ASD. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare recovery time and duration of active rehabilitation following concussion between adolescents with and without attention-deficit/hyperactivity disorder (ADHD). A retrospective cohort study was conducted among adolescents presenting to a specialty concussion clinic. One-quarter of the eligible episodes of care were selected. The final sample included 540 adolescents (ages 13–17 years, median age 15 years; 49.8% girls), of which 65 (12.0%) had a pre-injury diagnosis of ADHD. Days to recovery and days of active rehabilitation were examined. ADHD was not associated with recovery time (ADHD: median = 49 days, IQR = 25–77; No ADHD: median = 47 days, IQR = 29–85) in univariate (Z = −0.45; p = 0.65) or multivariable analyses (Hazard Ratio: 1.17 (0.85–1.61); χ2(1) = 0.95; p = 0.33). The duration of active rehabilitation services received did not differ between youth with ADHD (median = 38.5 days, IQR = 27.5–54.5) and without ADHD (median = 37.5 days, IQR = 18.5–66) in univariate (Z = −0.19; p = 0.85) or multivariable analyses (Hazard Ratio: 1.04 (0.67–1.63); χ2(1) = 0.03; p = 0.85). Our findings support accumulating evidence that ADHD, in and of itself, is not a risk factor for longer recovery or worse outcomes following pediatric concussion. [ABSTRACT FROM AUTHOR]

Youth living with perinatally acquired HIV (YLPHIV) have been found to have a range of mental disorders. Some adult HIV studies have linked mental health to adverse metabolic outcomes due to dysregulation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, but this association has not previously been explored in YLPHIV. We investigated the association of mental health measures with metabolic outcomes in YLPHIV and HIV-uninfected youth (HIV-U) and linear regression was used to assess the adjusted associations. Overall, 203 YLPHIV (median age = 10.7years; 52% female; mean duration on ART 8 years, 12% CD4 count <500 cells/µL, 18% viral load >50 copies/mL) and 44 HIV-U (median age = 10.3 years; 55% female) were enrolled. YLPHIV had higher median total cholesterol (4.2 vs 3.9 mmol/L, p = 0.049) and triglyceride (0.9 vs 0.7 mmol/L, p < 0.001) compared to HIV-U. We found higher percentage of poor functional competence (40% vs 25%, p = 0.02) and self-concept (23% vs 9%, p = 0.03) and higher depression (6% vs 2%, p < 0.01), anger (6% vs 2%, p = 0.04) and disruptive behaviour (4% vs 0%, p < 0.01) in YLPHIV as compared to HIV-U. Among YLPHIV, higher scores of anger were associated with higher total cholesterol and higher low-density lipoprotein (ß = 0.010, p = 0.041 and ß = 0.012, p = 0.048 respectively) and disruptive behaviour with higher low-density lipoprotein (ß = 0.010, p = 0.043) after adjusting for age, sex and BMIZ. This is the one of first study to investigate the association of mental health with metabolic outcomes among YLPHIV. The association of increased anger and disruptive behaviour with increased lipid concentration is a novel finding. Further longitudinal studies are needed to evaluate the causal relationships between mental health and metabolic outcomes. [ABSTRACT FROM AUTHOR]

Street-connected young people (SCYP) in the Republic of Georgia are vulnerable to HIV/AIDS. We conducted a mixed-methods study utilizing a triangulation design with N = 20 SCYP aged 11–18 (50% female; M = 13.95 years; SD = 2.11) recruited from two cities in Georgia. SCYP completed a close-ended survey and an in-depth interview on their perceptions of romantic and exchange sex relationships. Quantitative analyses examined gender differences in perceptions of romantic and exchange sex partners, and qualitative data was analyzed using a thematic analysis approach. Quantitative findings indicated that a higher proportion of female than male SCYP endorsed engaging in HIV-related transmission behaviors with exchange sex partners. Thematic analysis contextualized survey findings by elucidating the ways in which females negotiated a highly gendered risk environment that elevated their vulnerability to HIV. Study results highlight the need for gender-responsive programming to address the HIV prevention needs of both male and female SCYP in the Republic of Georgia. [ABSTRACT FROM AUTHOR]

There are several studies showing contradictory results on concurrent emotional and behavioural problems of children and adolescents who stutter (CAWS). This study aimed to identify whether there is a difference between Turkish-speaking CAWS and their typically developing peers (TDP) in emotional and behavioural problems. The study group consisted of 45 CAWS, aged between 3.40 and 15.92 years, and the control group consisted of 45 TDP, aged between 3.15 and 16.80 years. Participants were divided into three age groups: early childhood (0–6 years), middle childhood (7–11 years) and adolescence (12–18 years). CAWS and TDP were compared separately in each age group with Mann–Whitney U tests. Assessments of emotional and behavioural problems were conducted with the Child Behaviour Checklist (CBCL) for Ages 1.5–5 and the CBCL for Ages 6–18. In early childhood, CAWS had significantly higher emotional reactivity, anxiety/depression, somatic complaints, withdrawal, sleep problems, attention problems and aggressive behaviour scores than TDP. In middle childhood and adolescence, CAWS had significantly higher anxiety/depression, withdrawal/depression, social problems, attention problems, rule-breaking behaviour and aggressive behaviour scores compared to TDP. In adolescence, somatic problems and thought problems scores were also significantly higher in AWS than TDP. We concluded that emotional and behavioural problems associated with stuttering are noticeable from early childhood to adolescence. Cooperation with mental health professionals may be needed to improve the quality of speech therapy in CAWS. [ABSTRACT FROM AUTHOR]

Smoking is an important problem in adolescence. Early developmental trajectories are also associated with cigarette smoking. The present study aims to evaluate the separation-individuation process and use of transitional objects in daily smoker adolescents. The research included 97 adolescents who were daily smokers and 210 adolescents who were nonsmokers. Transitional object assessment questionnaire, strength and difficulties questionnaire- adolescent form(SDQ), children's depression inventory(CDI) and state-trait anxiety inventory for children(STAI-C), separation and individuation test of adolescence(SITA) were applied. SITA subscales scores of engulfment anxiety, need denial, and rejection expectancy was higher and separation anxiety, teacher enmeshment, nurturance seeking scores were statistically significantly lower in smoker adolescents than nonsmokers. In logistic regression analysis, separation anxiety(odds ratio [OR] 0.93; 95% confidence interval[CI] 0.87-0.98), teacher enmeshment(OR 0.93; 95% CI 0.88-0.98), practicing mirroring(OR 1.05; 95% CI 1.02,1.08) and rejection expectancy (OR 1.06 95% CI 1.02,1.11) were found to be predictors of daily smoking. The use of a childhood transitional object for feeling tired and the use of an adolescent transitional object for feeling anxious and tired was found to be significantly higher in smokers. There are some differences in the process of separation-individuation and the use of transitional objects in the smoker group. This suggests that early developmental characteristics may be associated with smoking. Further studies are needed to better understand the causal relationship between smoking and the separation-individuation process and transitional object use. [ABSTRACT FROM AUTHOR]

Pediatric seizures commonly trigger emergency medical services (EMS) activation and account for approximately 5–15% of all pediatric 911-EMS calls. More than 50% of children with active seizure activity do not receive prehospital antiepileptic drugs, potentially because they are not recognized by EMS. The purpose of this study is to evaluate specificity and sensitivity of paramedic identification of pediatric seizures and to describe the characteristics of unrecognized seizures. This is an 18-month prospective cohort study at a single, pediatric emergency department (ED). EMS patients ≤15 years old with a prehospital provider impression of seizure were included. Upon ED arrival, a data collection form, which included the EMS verbal report and patient's clinical status, was completed by the attending emergency physician. The primary outcome was sensitivity and specificity of paramedic identification of active seizure. Secondary outcomes included characteristics of missed seizures, ED interventions, and disposition. Descriptive statistics, sensitivity, and specificity were computed. Patient characteristics and clinical outcomes were compared. Surveys were completed for 349 patients (Median 3, IQR = 3.4). Fifty-two of the patients (15%) were actively seizing upon arrival at the ED. Sensitivity was 54% and specificity was 96% for paramedic identification of active seizure. Common features of missed cases were abnormal vital signs (75%), gaze deviation (50%) and clenched jaw (33%). Of these, 37% required intubation and 53% were admitted to the intensive care unit. Paramedics were highly specific, but not sensitive in identifying active seizures on ED arrival. Patients with unrecognized seizures presented most commonly with abnormal vital signs and gaze deviation. [ABSTRACT FROM AUTHOR]

Objective: Worldwide research trends on the prevalence of hearing loss within young rural populations are scarce. Current evidence suggests extended high-frequency audiometry could be a sensitive predictor to detect subclinical hearing loss. This study aimed to determine the prevalence of hearing loss through conventional pure tone (0.25-8 kHz) and extended high-frequency (9-20 kHz) audiometry tests in a group of adolescents aged 13 to 19 years old from two rural areas of Colombia. A sociodemographic and associated factor for hearing loss questionnaire was applied. Design: Cross-sectional study. Study Sample: Three hundred sixty-six adolescents aged 13 to 19 years old from two rural municipalities in Colombia: Soracá, and Palmas del Socorro. Results: Hearing loss prevalence assessed through pure tone audiometry was 3.28% in right ears and 3.83% in left ears while through extended high-frequency audiometry was 14.21% and 13.11%, respectively. Associated factors found by the logistic regression were age (OR: 1.36; CI 95% 1.13-1.64) and obesity (OR: 3.74; CI 95% 1.07-13.11). Conclusions: Using 15 dB as the normal hearing threshold parameter for audiometric frequencies, our results suggest that extended high-frequency hearing loss is already widespread among rural adolescents. This highlights the need for research on extended high-frequency audiometry in rural schoolaged children. [ABSTRACT FROM AUTHOR]

Human Papillomavirus (HPV) is responsible for 26,900 cancer cases yearly, including genital and oropharyngeal cancers. Despite providing nearly 100% protection against cancer-causing strains of HPV, only 68.9% of teenagers receive even one dose of the HPV9 vaccine. To increase HPV9 vaccine series initiation rates among 11–14 year-olds. Vaccine rates were examined before and after multi-modal protocol implementation at a nurse-run, walk-in immunization clinic. Initiation increased from 17.9% in 2017 to 35.5% in 2018. Use of same way/same day recommendation practices and inclusion of non-clinician staff could improve quality of care and decrease HPV-related disease. [ABSTRACT FROM AUTHOR]

Background: In the West African sub-region, the recreational use of psychoactive substances has increased. Adolescent substance use is commonly found among students. This study was aimed at determining the prevalence and pattern of substance use among secondary school students in Ilorin, Nigeria. Methods: Using a multistage sampling technique, data from 2,001 students was analyzed. Instruments used were a sociodemographic questionnaire and a modified WHO Students' Drug Use Survey Questionnaire. Results: The overall lifetime use of substances was 83.7%, while overall current use was 62.4%. Non-prescription use of antibiotics and analgesics was prevalent (53% and 15.8%, respectively). The psychoactive substances most commonly used were stimulants, alcohol and organic solvents, with a current use of 7.1%, 3.5% and 3.5% respectively (N = 2001). The overall mean age at first use was 13.45 ± 1.49, while many organic solvent users started at age 10. Conclusions: The recreational use of psychoactive substances is common among school children in Ilorin. The age of onset is in early adolescence, or earlier for substances like organic solvents that are easily accessible. The prevalent use of alcohol, a gateway drug, is a call for action. [ABSTRACT FROM AUTHOR]

Background: In contemporary society internet and digital competencies are used to perform activities. Aim: The aim of this study is to investigate opportunities and risks of internet use as perceived by the parents of adolescents with intellectual disabilities (ID) in comparison with a national reference group of parents of adolescents. Methods: This was a cross-sectional study with group comparisons using a national survey. Analyses were carried out using Fisher's exact test and logistic regression to control for confounding factors. Results: A significantly higher proportion of parents of adolescents with ID perceive opportunities associated with internet use and playing games, and a lower proportion perceive risks with negative consequences, compared with the reference group. Significantly more parents of adolescents with ID perceive their adolescent never use smartphones and social media compared with the reference group. Fewer parents of adolescents with ID have concerns about online risks for their adolescents compared with the reference group. Conclusion and Significance: The results provide new knowledge for occupational therapists to support positive risk-taking in internet-use for adolescents with ID, in collaboration with their parents, to enable the development of digital competencies and digital participation in everyday life in a digitalised society. [ABSTRACT FROM AUTHOR]

Background: The prevalence and patterns of substance use and its related risk factors in street children are significant for policymakers. The present study was conducted in six cities of Iran to explore the prevalence rate of drug use disorders and their associated high-risk behaviors among street children. Methods: This cross-sectional study was conducted in 2016 among 856 street children in Iran. The samples were recruited through Time-Location Sampling (TLS) method. Trained interviewers administered the questionnaires. The applied questionnaire consisted of modules concerning sociodemographic characteristics and risky behaviors. We used bivariate and multiple logistic regression models to identify factors associated with drug use disorders. Results: Of 856 street children participants, 5.28% (CI 95%: 3.84, 7.04) reported lifetime drug use. According to the final multivariable model, factors including nationality (AOR = 4.79, 95% CI 1.57, 14.56), father's history of drug use (AOR = 3.25, 95% CI 1.43, 7.41), and alcohol use (AOR = 5.63, 95% CI 2.43, 13.07) were independently associated with lifetime drug use. Conclusion: The children with Iranian nationality, father's history of drug use, and alcohol use had significantly higher odds of lifetime drug use. This study calls for the development of an urgent plan to implement appropriate interventions for street children, particularly high-risk ones in Iran. [ABSTRACT FROM AUTHOR]

Objective: Few data are available about drug use among Iraqi society, especially among people within the most vulnerable period, adolescence and secondary education. Hence, this study was designed to determine the prevalence and to examine the epidemiological factors associated with drug use among secondary school students. Methods: A descriptive cross-sectional school-based study was designed and students were selected using a multistage sampling method during the period from March through April 2018 in Al-Hilla city – Babil – Iraq. In the first stage, 15 secondary schools were selected using cluster sampling. Students at each secondary school, one study hall classroom per grade level were randomly selected to participate in the second stage of this study. Chi-square was used to determine if certain factors are associated significantly (pvalue ≤0.05) with drug use. Results: The overall prevalence of drug use was (9.5%) (most of them were male). Other important aspects of drug use (e.g., source of acquiring drug) among the target population were reported. A significant association between drug use and some important factors was found. Conclusion: High prevalence of drug use was shown among the students and some factors appear to play a crucial role in drug use initiation, which necessitates preventive measures. [ABSTRACT FROM AUTHOR]

Objective(s): The prevalence of adolescent obesity is high among the various ethnic groups native to the Pacific region (European, Melanesian and Polynesian). An important factor of weight gain or loss is body size satisfaction; however, little is known about adolescent body self-perception in the Pacific region. Design: Body dissatisfaction was evaluated using the Stunkard Figure Rating Scale in a sample of 699 adolescents from rural and urban areas of New Caledonia. The socio-demographic factors associated with higher body dissatisfaction were determined by multiple linear regression modeling. Results: Our results showed a high rate of body dissatisfaction (over 70%) in the adolescents. Body dissatisfaction was strongly related to the body mass index z-score. Melanesians boys had higher body dissatisfaction scores when they felt 'too thin' while Melanesian girls showed lower body dissatisfaction when they felt 'too fat.'. Conclusion: These results showed that social pressure for thinness or musculature may be different among adolescents living in New Caledonia. These results should be taken into account in education overweight prevention programs. [ABSTRACT FROM AUTHOR]

The effects of a resilience enhancement programme on resilience, depression, anxiety, and problem drinking among female runaway youths living in shelters were evaluated. Participants were 32 youths (16 experimental and 16 control participants), assessed at pre-test, post-test, and one-month follow-up. The programme incorporated five protective factors associated with resilience: self-esteem, self-regulation, relational skills, problem-solving skills, and goal-setting skills. There were significant group-by-time interaction effects for resilience, anxiety, and problem drinking at one-month follow-up. The preliminary results suggest that providing female runaway youths with this programme focusing on protective factors may enhance resilience and mitigate anxiety, and problem drinking. [ABSTRACT FROM AUTHOR]

Introduction: Much research have focused on self-esteem and substance use among adolescents. Little is known about the relationship between self esteem and social acceptance of colleagues who are known as substance users. The study explored this relationship among high school students in Lagos, Nigeria. Methods: A cross-sectional survey was done using structured questionnaires and case description scenarios among 221 high school students in several public senior secondary schools in Lagos, Nigeria. Results: Study revealed that majority of the participants were more willing to socially accept and be intimate with colleagues who take alcohol in almost all the case scenarios. Colleagues who abused marijuana and cocaine were more socially acceptable to majority of the participants in many case scenarios than those who abused nicotine. Choice of association with colleagues who abused substances was not related to self-esteem. Conclusion: Social acceptance of substance users among adolescents may be influenced by the perception of socially desirable qualities and not necessarily the substance use. Social associations with substance users may be limited to the school environment. Social acceptance of substance user was related to self esteem evaluation of participants. [ABSTRACT FROM AUTHOR]

Social network sites (SNSs) are relatively new phenomena, and the relationship between SNSs and psychopathology remains unclear. The purpose of this study was to evaluate the type of SNSs depressed adolescents use and the incidence of depressive disclosure on SNSs among them. The study was designed to be cross-sectional. The sample consisted of 53 adolescents diagnosed with depressive disorder, as confirmed by K-SADS-PL, and 55 non-depressed adolescents. The Children’s Depression Inventory, Social Anxiety Scale and Social Network Use Questionnaire were administered. The primary finding was that the amount of time spent on the Internet and on SNSs was significantly higher among depressed adolescents than non-depressed adolescents. Additionally, depressed adolescents reported significantly higher disclosure of anhedonia, worthlessness, guilt, loss of concentration, irritability and thoughts of suicide on SNSs. The intensity of the depression sharing was significantly higher in the depressed group. Depressed young people use social networks to express their symptoms. Adolescents’ disclosure on social networks may be able to guide relatives, friends and mental health professionals. [ABSTRACT FROM PUBLISHER]

Truant youths are likely to engage in a number of problem behaviors, including sexual risky behaviors. Previous research involving non-truant youths has found sexual risk behaviors to be related to marijuana use and depression, with differential effects for male and female youths. Using data collected in a National Institute on Drug Abuse (NIDA)-funded, prospective intervention project, results are reported of a male-female, multi-group, longitudinal analysis of the relationships among truant youth baseline sexual risk behavior, marijuana use, and depression, and their sexual risk behavior over four follow-up time points. Results indicated support for the longitudinal model, with female truants having higher depression scores, and showing stronger relationships between baseline depression and future engagement in sexual risk behavior, than male truants. Findings suggest that incorporating strategies to reduce depression and marijuana use may decrease youth sexual risk behavior. [ABSTRACT FROM AUTHOR]

Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the “Youth Counseling Needs Survey” (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths’ psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010–July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11–18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths’ psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling. [ABSTRACT FROM PUBLISHER]

Purpose:We investigated whether active video gaming (AVG) could bring about regular, enjoyable, physical exercise in children treated for brain tumours, what level of physical activity could be reached and if the children’s physical functioning improved. Methods:Thirteen children, aged 7–17 years, were randomised to either AVG or waiting-list. After 10–12 weeks they crossed-over. Weekly Internet coaching sessions were used to sustain motivation and evaluate enjoyment. Energy expenditure (EE) levels were measured as Metabolic Equivalent of Task (MET), using a multisensory activity monitor. Single-blinded assessments of physical functioning were done, using the Bruininks–Osteretsky Test of Motor Performance, second edition, evaluating participants before and after the intervention period, as well as comparing the randomisation groups after the first period. Results:All patients completed the study. AVG sessions (mean duration 47 minutes) were performed on 72% of all days. Mean EE level during AVG sessions was 3.0 MET, corresponding to moderate physical activity. The Body Coordination score improved by 15% (p = 0.021) over the intervention period. Conclusions:In this group of childhood brain tumour survivors, home-based AVG, supported by a coach, was a feasible, enjoyable and moderately intense form of exercise that improved Body Coordination.Implications for RehabilitationChildhood brain tumour survivors frequently have cognitive problems, inferior physical functioning and are less physically active compared to their healthy peers.Active video gaming (AVG), supported by Internet coaching, is a feasible home-based intervention in children treated for brain tumours, promoting enjoyable, regular physical exercise of moderate intensity.In this pilot study, AVG with Nintendo Wii improved Body Coordination. [ABSTRACT FROM AUTHOR]

In this paper, three different statistical approaches were used to investigate short-term tracking of cardiorespiratory and performance-related physical fitness among adolescents. Data were obtained from the Oporto Growth, Health and Performance Study and comprised 1203 adolescents (549 girls) divided into two age cohorts (10–12 and 12–14 years) followed for three consecutive years, with annual assessment. Cardiorespiratory fitness was assessed with 1-mile run/walk test; 50-yard dash, standing long jump, handgrip, and shuttle run test were used to rate performance-related physical fitness. Tracking was expressed in three different ways: auto-correlations, multilevel modelling with crude and adjusted model (for biological maturation, body mass index, and physical activity), and Cohen’s Kappa (κ) computed in IBM SPSS 20.0, HLM 7.01 and Longitudinal Data Analysis software, respectively. Tracking of physical fitness components was (1) moderate-to-high when described by auto-correlations; (2) low-to-moderate when crude and adjusted models were used; and (3) low according to Cohen’s Kappa (κ). These results demonstrate that when describing tracking, different methods should be considered since they provide distinct and more comprehensive views about physical fitness stability patterns. [ABSTRACT FROM PUBLISHER]

Although 12-step literature posits inconsiderate behaviors to characterize alcoholics and addicts, there is little data to support this association among adolescent populations. Using a matched-pair study design with 579 youths ages 14 to 18 (52% female, 30% minority), a significant, dose-response relationship was found between greater alcohol and drug use severity and increased likelihood of driving under the influence, having unprotected sex with and without a history of sexually transmitted incidence, and low volunteerism among boys. Findings suggest that alcohol and drug use severity is associated with poor awareness of the impact of behaviors on others. [ABSTRACT FROM AUTHOR]

Adolescents living with HIV (ALHIV) face many psychosocial challenges, including HIV disclosure to others. Given the importance of socialization during the adolescent transition process, this study investigated the psychological and social factors influencing self-disclosure of own HIV status to peers. We examined social HIV self-disclosure to peers, and its relationship to perceived HIV-related stigma, self-efficacy to disclose, self-esteem, and social support among a sample ofn= 582 ALHIV aged 13–17 years in Kampala, Uganda, and Western Kenya. Data were collected between February and April 2011. Among them, 39% were double orphans. We conducted a secondary data analysis to assess the degree of social disclosure, reactions received, and influencing factors. Interviewer-administered questionnaires assessed medical, socio-demographic, and psychological variables (Rosenberg self-esteem scale; self-efficacy to disclose to peers), HIV-related stigma (10-item stigma scale), and social support (family–life and friends). Descriptive, bivariate, and logistic regression analyses were performed with social self-disclosure to peers with gender as covariates. Almost half of ALHIV had told nobody (except health-care providers) about their HIV status, and about 18% had disclosed to either one of their friends, schoolmates, or a boy- or girlfriend. Logistic regression models revealed that having disclosed to peers was significantly related to being older, being a paternal orphan, contributing to family income, regular visits to the HIV clinic, and greater social support through peers. Low self-efficacy to disclose was negatively associated to the outcome variable. While social self-disclosure was linked to individual factors such as self-efficacy, factors relating to the social context and adolescents’ access to psychosocial resources play an important role. ALHIV need safe environments to practice disclosure skills. Interventions should enable them to make optimal use of available psychosocial resources even under constraining conditions such as disruptive family structures. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the association between utilization of HIV testing and condom use amongst Cameroonian youths/adolescents who are not known to be HIV-infected. Worldwide, HIV is spreading most quickly amongst youths/adolescents. Between 44% and 82% of sexually active youths in Cameroon report inconsistent condom use. Data regarding utilization of HIV testing and condom use are lacking. A cross-sectional survey was administered to 431 youths ages 12–26 years in Cameroon from September 2011 to December 2011. Data on sociodemographics, sexual risk behaviors, self-reported HIV status, and condom use were collected. We compared rates of inconsistent condom use between those with known HIV negative status who utilized testing (HIV-N) and those with unknown status due to unutilized testing (HIV-U). Inconsistent condom use was defined as responding “never,” “sometimes,” or “usually,” while consistent condom use was defined as responding “always” to questions regarding frequency of condom use. Generalized estimating equations were applied to assess the association between HIV testing and inconsistent condom use, adjusting for other confounders. Of 414 eligible respondents, 205 were HIV-U and 209 were HIV-N. HIV-U subjects were younger (mean age = 16.4 vs. 17.9,p< 0.001) and more likely to report living in an urban area (p= 0.002) than HIV-N subjects. Seventy-two percent (137/191) of sexually active youths reported inconsistent condom use. After adjusting for potential confounders, HIV-U status (odds ratio [OR] = 3.97, 95% confidence interval [CI] = 1.68–6.01) was associated with inconsistent condom use. Similarly, female gender (OR = 3.2, 95% CI = 1.29–7.89) was associated with inconsistent condom use, while older age at sexual debut was associated with a decreased risk for inconsistent condom use (OR = 0.67, 95% CI = 0.56–0.81). Cameroonian adolescents report high rates of inconsistent condom use which we found to be associated with self-reported unknown HIV status due to unutilized HIV testing. Successful HIV prevention programs among African youths/adolescents may benefit from expanded HIV testing programs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the efficacy of a school-based case management intervention in reducing teen-pregnancy. A nonrandomized intervention/comparison schools mixed-method evaluation design was employed. Participants included 203 pregnant and parenting teens with annual follow-up over a 3-year period. The results indicated that the time to repeat pregnancy was delayed among pregnant teens, high school drop-out rates were reduced among parenting teens, and pregnant teens were less likely to deliver before 36 weeks in the intervention versus the comparison school. Case management at a school setting is a promising approach to decrease repeat teen pregnancy. [ABSTRACT FROM AUTHOR]

Parent and peer relationships are important social resources for adolescents. South African research on adolescents' relationships, however, underemphasises these relationships as potential positive resources. Studies also tend to use samples from urban populations, while rural and semi-rural adolescent populations are neglected. This study focused on White and Coloured adolescents living in one South African semi-rural community and their ratings of positive and negative relationship qualities in relationships with parents and peers. Using the Network of Relationships Inventory (NRI), we found that mothers, best friends and romantic partners were relatively equal sources of social support. Mothers' high ratings for support, conflict and punishment may point to mothers bearing the primary responsibility for child care. Fathers' low support ratings raise concern as father involvement is important for adolescents' well-being. White participants overall rated their relationship higher for support and lower for negative qualities than the Coloured participants. [ABSTRACT FROM PUBLISHER]

Poor adherence to antiretroviral therapy (ART) contributes to disease progression and emergence of drug-resistant HIV in youth with perinatally acquired HIV infection (PHIV +), necessitating reliable measures of adherence. Although electronic monitoring devices have often been considered the gold-standard assessment in HIV research, they are costly, can overestimate nonadherence and are not practical for routine care. Thus, the development of valid, easily administered self-report adherence measures is crucial for adherence monitoring. PHIV+youth aged 7–16 (n= 289) and their caregivers, enrolled in a multisite cohort study, were interviewed to assess several reported indicators of adherence. HIV-1 RNA viral load (VL) was dichotomized into >/≤400 copies/mL. Lower adherence was significantly associated with VL >400 copies/mL across most indicators, including ≥1 missed dose in past seven days [youth report: OR = 2.78 (95% CI, 1.46–5.27)]. Caregiver and combined youth/caregiver reports yielded similar results. Within-rater agreement between various adherence indicators was high for both youth and caregivers. Inter-rater agreement on adherence was moderate across most indicators. Age ≥13 years and living with biological mother or relative were associated with VL >400 copies/mL. Findings support the validity of caregiver and youth adherence reports and identify youth at risk of poor adherence. [ABSTRACT FROM AUTHOR]

Research indicates that adolescents in low-income countries have an early sexual debut and engage in risky sexual behaviours. Few studies in low-income countries however, have explored the factors that influence young people's sexual behaviours. This study examined individual, family and peer-level factors associated with premarital sexual behaviours in the Lao People's Democratic Republic (PDR). A cross-sectional survey was undertaken with unmarried youth aged 18 to 24 years (N= 1200) in Vientiane Capital City. Logistic regression models, controlling for confounding variables, were employed to test for the contribution of factors influencing premarital sexual activity. Most respondents held positive attitudes towards premarital sex, with males having more liberal attitudes than females (mean score of 2.68 vs. 2.32,p< 0.001). Prevalence of premarital sexual activity was higher among males than females (44.7% and 19.2%, respectively). Predictors of premarital sex for males were age, sexual attitudes, perceived parental expectations regarding sex, dating and peer influence. For females, predictors were father's level of education, parent-youth sexual communication, peer influence and liberal sexual attitudes. The results highlight the role of parent-youth interaction and peer influence. The results suggest the need for a range of strategies at the individual, peer and family level, as well as a gender-specific focus. [ABSTRACT FROM PUBLISHER]

Theories of suicidal behavior suggest that the desire to die can arise from disruption of interpersonal relationships. Suicide research has typically studied this from the individual's perspective of the quality/frequency of their social interactions; however, the field of attachment may offer another perspective on understanding an individual's social patterns and suicide risk. This study examined attachment along with broader family functioning (family adaptability and cohesion) among 236 adolescent psychiatric inpatients with (n = 111) and without (n = 125) histories of suicide attempts. On average, adolescents were 14 years of age and Hispanic (69%). Compared to those without suicide attempts, adolescent attempters had lower self-reported maternal and paternal attachment and lower familial adaptability and cohesion. When comparing all three types of attachment simultaneously in the logistic regression model predicting suicide attempt status, paternal attachment was the only significant predictor. Suicide attempt group was also significantly predicted by self-rated Cohesion and Adaptability; neither of the parent ratings of family functioning were significant predictors. These findings are consistent with the predictions of the Interpersonal Theory of Suicide about social functioning and support the efforts to develop attachment-based interventions as a novel route towards suicide prevention. [ABSTRACT FROM PUBLISHER]

Little information exists on the levels of psychiatric disorders among substance abusing adolescents in Ireland. The aim of the study is examine the pattern of psychiatric disorders and explore for gender differences among adolescents with a substance use disorder (SUD) in Ireland. A cross-sectional descriptive study and retrospective review of medical records on the 144 most recent admissions at the Youth Drug and Alcohol (YoDA) service, Dublin was carried out. Overall, 48% of the patients had a lifetime history of psychiatric disorders. Deliberate self-harm (DSH) was the most common condition (27.1%), followed by attention deficit hyperactivity disorder (20.8%) and depression (10.4%). Conduct disorder and oppositional defiant disorder were infrequently diagnosed. Compared with boys, the girls were more likely to have a lifetime history of psychiatric disorders (odds ratio 3.7;p = 0.005). These findings provide the first prevalence data on psychiatric disorders in a clinically representative sample of Irish adolescents with SUDs. Adolescent addiction services should have the skills to assess and manage co-occurring mental health problems. There is a need for further studies to examine DSH among adolescents with SUDs. [ABSTRACT FROM AUTHOR]

Lifetime experience of selling sex among adolescents was investigated together with sociodemographic correlates, parent–child relationship, and the existence of people to confide in. Changes over time regarding the selling of sex were investigated through a comparison of data from 2004 and 2009. This study was carried out using 3,498 adolescents from a representative sample of Swedish high school students with a mean age 18.3 years. Of these adolescents, 1.5% stated that they had given sexual services for reimbursement and both male and female buyers existed. The adolescents who had sold sex had a poorer parent–child relationship during childhood and had fewer people to confide in about problems and worries. Changes over time were found especially regarding the Internet as a contact source and also immigrant background. [ABSTRACT FROM PUBLISHER]

Aims and objectives: The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Background: Approximately 26,000 young persons exit foster care annually in the United States. Once they 'age out' of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. Design: The design is descriptive and cross-sectional. Methods: A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. Results: The sample was majority male and white; ages were 16-25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Conclusions: Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. Relevance to clinical practice: It is important that nurses, who serve homeless youth populations, conduct a risk assessment profile, in order to ascertain a history of foster care placement, link former foster youth to social service agencies that provide risk reduction/health promotion education, and advocate for stable housing. [ABSTRACT FROM AUTHOR]

Objectives: This article examines how aspects of a specific locality, history and set of practices interact to produce an obesogenic environment. The Analysis Grid for Environments Linked to Obesity (ANGELO) framework and a biocultural approach are used to examine one obesogenic environment – that experienced by British Bangladeshi adolescents (ages 11–14 years old) in Tower Hamlets, East London. Interdisciplinary literature and methods explore how physical, economic, cultural, and political pressures in school, street, and home micro-environments influence eating patterns and practices. Design: This ethnographic research included living on a council estate and working as an assistant physical education teacher in two secondary schools in Tower Hamlets. Anthropometric and socioeconomic characteristics were collected from the young people whose physical education classes I assisted (n=447). Then interviews and questionnaires were completed with a subsample of participants (n=165) drawn from the first phase of research to understand the factors that influence eating patterns. Results: Among this group of adolescents, interwoven cultural and structural pressures encourage frequent consumption of energy-dense foods in their schools, streets, and homes. They were exposed to factors that have led to the widespread increase in the prevalence of overweight and obesity such as the increased availability and affordability of energy-dense foods. In addition, they faced cultural and structural pressures associated with being the adolescent children of immigrants from Bangladesh and living in an economically depressed neighborhood. Conclusion: To develop a comprehensive understanding of the factors that may lead to weight gain in different ethnic, geographic and socioeconomic contexts it is important to examine the pressures specific to that context that might influence the variety and frequency of food consumption. This type of research may lead to the identification of points of intervention that are specific to the pressures and sensitivities of particular environments. [ABSTRACT FROM PUBLISHER]

The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected children and adolescents aged between 6 and 18 years and their guardians were interviewed. Seventy-nine (48.8%) of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8%), Social phobia (12.8%), Oppositional Defiant Disorder (12.1%) and Attention Deficit Hyperactivity Disorder (12.1%). Twenty-five per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric morbidity in HIV-infected children is higher than that found in children in the general population. There is therefore a need to integrate psychiatric services into the routine care of HIV-infected children. [ABSTRACT FROM AUTHOR]

The prevalence of drug abuse has been reported to be up to 17.0% in Iran. The aim of this study was to investigate the prevalence of two frequently abused substances—cannabis and opium—in samples of the young population in Isfahan, Iran. In a survey done from January 2005 to December 2006, 537 individuals aged 13–20 years were recruited using a multistage probability sampling method. Demographic and clinical data were recorded through face-to-face interviews, physical examinations, and reviews of the patients’ medical records by trained interviewers. Morphine and cannabis were detected by Enzyme–Linked Immunosorbent Assay (ELISA) on each blood sample. The rates of morphine and cannabis abuse were 2.2% and 3.2%, respectively. They were abused in 0.5% and 15.3% of cigarette smokers as well. Male-to-female ratio in addicts was 4:1, and the mean age of addicts was 17.54 ± 1.86 years old. There was a significant relationship between male gender and addiction (P = 0.002). The prevalence of substance abuse in urban and rural areas was 6.3% and 9.5%, respectively. A total of 2.5% of rural females were addicted, compared to 2.4% in Isfahan (city). In Isfahan, opium was the most commonly abused substance while in rural areas cannabis was the most commonly abused. Substance abuse among adolescents has increased dramatically and has a significant negative effect on society. It seems that substance abuse is more prevalent than it is estimated. Therefore, developing and implementing appropriate solutions for solving this problem seems necessary. [ABSTRACT FROM AUTHOR]