Teenage pregnancy matters in refugee setup: early pregnancy among adolescent girls in Kule refugee camp, Gambella, Ethiopia

BACKGROUND

An estimated 21 million adolescent girls become pregnant with nearly half of these pregnancies being unintended, and more than half end in unsafe abortion in low and middle-income countries every year. Teenage pregnancy causes serious health, social, and economic consequences around the globe. Despite it is a common problem in the whole community it is more devastating when this occurs in a refugee setup. This study assessed the magnitude of teenage pregnancy in the Kule refugee camp, in Ethiopia.

METHODS

A community-based mixed cross-sectional study was done among 422 adolescent girls. Participants were selected using a systematic sampling technique. A structured, pre-tested, and interviewer-administered questionnaire was used to collect the data. Binary and multivariable logistic regression was used to identify associated factors. Adjusted odds ratio with 95% CI was used to show the strength and direction of the association. For the qualitative part, four focused group discussion sessions were done, and participants were selected purposely. Thematic analysis was used to analyze, and the finding was triangulated with quantitative findings.

RESULT

A total of 146 adolescents (34.6%, 95% CI: (29.9, 38.9)) have experienced pregnancy at least one time. Age (≤ 16) [AOR = 0.48, 95% CI: (0.27, 0.85)], not attending school [AOR = 3.59, 95% CI: (1.2, 10.8)], having a mother with no history of teenage pregnancy [AOR = 0.45, 95% CI: (0.21, 0.98)], being unmarried [AOR = 0.21, 95% CI: (0.12, 0.36)], and having a sister/s with a history of teenage pregnancy [AOR = 2.22, 95% CI: (1.33, 3.7)] were significantly associated factors.

CONCLUSION

More than one-third of adolescents experience teenage pregnancy. The magnitude of teenage pregnancy was high which may lead to serious health consequences for both the mother and their fetus. Addressing cultural barriers and strengthening adolescent reproductive health education to decrease intergenerational transmission of teenage pregnancy through community awareness and strengthening reproductive parent-adolescent Sexual and Reproductive Health communication are important measures to tackle the problem.

Prevalence of vitamin E inadequacy, dietary intake and sources of alpha-tocopherol, and predictors of alpha- and gamma-tocopherol status in adolescent girls in Central Mozambique

An adequate alpha-tocopherol status is important for females at reproductive age. We studied the dietary intake and sources of alpha-tocopherol and alpha- and gamma-tocopherol status indicators in 14-19-year-old girls in Central Mozambique. We also explored factors associated with alpha- and gamma-tocopherol status. The participants (n 508) were from the cross-sectional ZANE Study that was conducted in 2010. We recruited two separate samples, one in January-February and the other in May-June. We collected venous blood samples and conducted 24 h dietary recall interviews. At the time of blood sampling, 11 % of participants were pregnant and 10 % were lactating. In the total sample, both seasons combined, the median intake of alpha-tocopherol was 6⋅7 mg/d, the mean plasma alpha- and gamma-tocopherol concentrations were 13⋅5 and 0⋅75 μmol/l, respectively, and the prevalence of vitamin E inadequacy (alpha-tocopherol <12 μmol/l) was 36⋅7 % (95 % CI: 31⋅9-42⋅0 %). Season and lactation status were significant predictors of alpha-tocopherol status regardless of which the three indicators (plasma concentration, alpha-tocopherol:total cholesterol ratio, gamma-tocopherol:alpha-tocopherol ratio) were used. Being a lactating mother was negatively associated and having a blood sample taken in January-February, when the main sources of alpha-tocopherol were mango and dark green leafy vegetables, was positively associated with alpha-tocopherol status. In conclusion, vitamin E inadequacy was common in Central Mozambique, and the status may fluctuate due to seasonal changes in the diet. We suggest that lactating mothers are specifically at risk of poor alpha-tocopherol status in resource-poor settings.

Birth-related posttraumatic stress disorder and negative childbirth experience related to maternal functioning among adolescent mothers: a cross-sectional study

BACKGROUND

Adolescent pregnancy is an important issue in terms of reproductive health. Adolescent mothers have to overcome two crises at the same time: motherhood and maturity. Childbirth experience and posttraumatic stress disorder may influence the mother's perception of her infant and postpartum care behaviors.

METHODS

This cross-sectional study was conducted on 202 adolescent mothers referring to health centers in Tabriz and its suburbs between May and December, 2022. Data were collected by PTSD Symptom Scale, Childbirth Experience Questionnaire 2.0, and Barkin Index of Maternal Functioning. The association between childbirth experience, posttraumatic stress disorder and maternal functioning was assessed by multivariate analysis.

RESULTS

After adjusting the effect of socio-demographic and obstetric characteristics, the score of maternal functioning among mothers without posttraumatic stress disorder was statistically significantly higher than mothers with posttraumatic stress disorder diagnosis [β (95% CI) = 2.30 (0.39 to 4.20); p = 0.031]. The score of maternal functioning increased with the increase in the childbirth experience score [β (95% CI) = 7.34 (3.87 to 10.81); p < 0.001]. The score of maternal functioning among mothers with wanted sex of baby was statistically significantly higher than unwanted sex of baby [β (95% CI) = 2.70 (0.37 to 5.02); p = 0.023].

CONCLUSION

Healthcare professionals should pay special attention to improving maternal functioning among adolescent mothers. One of the important actions can be to create a positive experience of childbirth for avoiding of posttraumatic stress disorder following birth and counseling with mothers who stated sex of fetus is undesired.

Prevalence and factors associated with teenage pregnancy in Sierra Leone: evidence from a nationally representative Demographic and Health Survey of 2019

BACKGROUND

Globally, teenage pregnancy remains a public health concern because of the associated maternal and perinatal morbidity and mortality. To address the extensive social, political and economic effects of teenage pregnancy, there is need for current epidemiological evidence on its prevalence and associated factors, especially from low resource settings where the burden is highest.

METHODS

We used data from the 2019 Sierra Leone Demographic and Health Survey (SLDH), which included 3,427 female adolescents. Multistage stratified sampling was used to select study participants. Teenage pregnancy was defined as those who had ever either had a child, or terminated a pregnancy, or were currently pregnant. Multivariable logistic regression was conducted to determine the factors associated with teenage pregnancy using SPSS version 25(Armonk, NY: IBM Corp).

RESULTS

The prevalence of teenage pregnancy was 22.1% [758/3,427]. Of these, 17.8%, (608/3427), had ever had childbirth, 4.2%, (144/3427), were pregnant, and 1.2%, (40/3427) had ever terminated a pregnancy. After adjusting for confounders, the odds of teenage pregnancy among married girls were about 15 times more than the odds among those who were not married (aOR; 15.31, 95% CI: 11.17-20.98) while the odds of teenage pregnancy among girls from the poorest households were 2.5 times more than the odds among girls from the richest households.

CONCLUSION

The prevalence of teenage pregnancy in Sierra Leone is high. To reduce teenage pregnancy, the government of Sierra Leone and its partners should target married, older teenagers and those from poor households. Policies giving teenage mothers a second chance by encouraging them to return to school after childbirth should be encouraged as an alternative to early marriages.

Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022

BACKGROUND

Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia.

METHODS

This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies.

RESULTS

Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment.

CONCLUSION

From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.

Teenage first-time mothers' perceptions about their health care needs in the immediate and early postpartum period in Uganda

Background

Teenagers have higher risks for complications during the intrapartum and postpartum periods. Although facility-based postpartum care focusses on preventing complications in mothers and babies, it is not understood what teenage-mothers’ perceptions are about their health care needs in the early postpartum period.

Methods

An exploratory descriptive qualitative study was conducted in four health facilities in Uganda. In-depth interviews with 42 first-time teenage mothers aged 14 to 19 years were conducted between March and April 2020. Thematic analysis was done.

Results

Two themes emerged, Health promotion and Rehabilitation and counseling. Teenage first time mothers desired to receive information about key issues like self and newborn care, breast feeding, immunization and family planning. They noted that health workers need to monitor their vital signs which aids in early diagnosis of complications, disease prevention/treatment of current conditions. Others felt that health workers are key in arbitrating between them and their estranged parents and also help to link them to community based organizations that can provide them with counseling and life skills.

Conclusions

Teenage first-time mothers have many health care needs during the immediate and early postpartum period. This is a missed opportunity to provide health education and link them to sexual reproductive health services including family planning, breastfeeding clinics and other community based programs which provide life skills or continuing education for girls. Focusing on these needs and integration of services is key in providing holistic care to the teenagers. We propose that further research be done to explore how their health care needs change at 6 months post-delivery.

Evaluating the effect of childhood and adolescence asthma on the household economy

OBJECTIVE

To evaluate the relationship between asthma control, family income and family costs of asthma in a population of children-adolescents; to detail the family costs of asthma in this age range; and to compare asthma costs for the families of children-adolescents and adults.

METHODS

The authors invited asthmatic subjects who attended a scheduled spirometry test at the Jundiaí School of Medicine (FMJ). The FMJ performs all spirometry tests requested by staff physicians who serve at the public healthcare system in the municipality. Volunteers responded to the ACQ, the Asthma Family Costs Questionnaire and underwent a spirometry test.

RESULTS

The authors included 342 children-adolescents. Families of children-adolescents taking maintenance therapy and families of those reporting uncontrolled asthma symptoms were more likely to report any expenditure with asthma during the preceding month. In this age range, the smallest expenditures were on diagnostic tests and medical consultations, while home expenditures to avoid asthma triggers were the highest ones. As compared to adults' families, the children and adolescents families reported a greater proportion of income committed with asthma. Expenditures with transportation to healthcare facilities for asthma care were greater in the families of children-adolescents as compared to the values reported by the adults' families; in contrast, loss of income due to asthma was smaller in the families of children-adolescents.

CONCLUSIONS

Children-adolescents' asthma affects the household economy. The authors believe researchers should assess this outcome when designing studies about asthma. Finally, the study's data support the necessity of public policies in low-resource communities to minimize the economic impact of children and adolescents' asthma.

Teenage pregnancies in Western Greece: experience from a university hospital setting

PURPOSE

Teenage pregnancies have consistently been associated with preterm labor in a wide range of studies. Evidence regarding the incidence and potential complications of teenage pregnancies in Greece is at present scarce. The aim of this study was to evaluate the perinatal outcomes as well as the risk of perinatal and obstetric complications of teenage pregnancies.

METHODS

This retrospective study was conducted at the Department of Obstetrics and Gynecology of the University Hospital of Patras, Greece, and all data recorded concerned the year 2019 (January-December). We retrospectively reviewed 643 cases of singleton pregnancies divided into two groups, as follows: Group A included women of average maternal age (AMA) (20-34 years old), and Group B included teenagers, defined as women less than 20 years old. Data regarding demographic and pregnancy characteristics as well as obstetric and neonatal complications were collected.

RESULTS

Teenage pregnancies accounted for 6.7% of all deliveries. We detected significantly higher rates of preterm births (p = 0.025), primiparity (p < 0.001), and negative marital status (p < 0.001) in teenage mothers compared to pregnant women of AMA. There were no significant differences concerning other factors between the two groups.

CONCLUSIONS

The findings of the present study raise concern regarding the perinatal, obstetric, and social consequences of teenage pregnancies in Greece. Extended studies that will include further information on antenatal care and detailed socioeconomic factors (i.e., level of education, income, and ethnicity) are required to formulate reliable conclusions concerning teenage pregnancies and their effect on maternal and neonatal health.

Influence of socio-economic factors on prevalence of teenage pregnancy in Nigeria

The study utilized the theory of fertility as initiated by Davis and Blakes (1956) and developed by Bongaarts in 1978 to underscore why teenage fertility has remained high in Nigeria. This study investigates women socio-economic factors influencing pregnancy in Nigeria. A total sample of 8448 female teenagers with pregnancy experiences were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). The study revealed that 19% of young girls with 15-19 years have experienced teenage pregnancy in Nigeria. More importantly, the socio-economic factors with significant influence on teenage pregnancy are: respondents with age 18-19 years (33.2 percent), rural (27.2 percent), Islamic religion (25.2 percent), North-west (28.5 percent), poorest (32 percent), no educational (43.7 percent), married/living with partners (73.9 percent), employed (21.5 percent), visited any health facility in the last 12 months (42 percent) and those who were informed about family planning at a health facility (84.3 per cent) . There is need for sound education for females in Nigeria that will equip girls and women with adequate knowledge needed to make informed decisions on matters relating to sexual and reproductive health, hence resulting in the actualization of the SDG 5.

Evaluation of psychological reactions among teenage married girls in Palestinian refugee camps in Jordan

INTRODUCTION

Girls married at an early age are more likely to be victims of violence from their husbands or their in-laws. This may lead them to experience mental problems such as post-traumatic stress, depression, and/or anxiety. There are a lack of data related to the psychological reactions among teenage married girls living at the Palestinians refugee camps.

AIM

This study aimed to evaluate depression, anxiety, and stress symptoms among teenage married girls in Palestinian refugee camps in Jordan. It also aimed to identify factors correlating with the study selected psychological reactions.

METHODS

A cross-sectional, descriptive correlational design was used. The participants were recruited using non-probability sampling methods. The mental health symptoms were measured using the Depression, Anxiety, and Stress Scale (DASS).

RESULTS

A total of 205 participants were included in the study. Their mean age was 16.90 (SD ± 0.96) years. Of the participants, 39.6%, 35.6%, and 9.8% experienced moderate to extremely severe levels of depression, anxiety, and stress symptoms, respectively. There were significant relationships between all the mental health symptoms and participant age, parent's educational level, and exposure to previous trauma.

CONCLUSION

A high proportion of females living in Palestinian refugee camps married in their teenage years experienced moderate to severe mental health symptoms, particularly anxiety and depression. These results inform the need for psychological support to girls who are affected by teenage marriage.

Declining health risk exposure among Chicago public high school students: Trends from the Youth Risk Behavior Survey 1997-2017

There have been improvements nationally in teenagers' self-reported health risk since the 1990s. This study provides an overview of trends in substance use, sexual health, violence and victimization, and suicide risk among Chicago Public High School (CPS) students over a 20-year period. We compared responses to 29 identically worded items from the 1997, 2007, and 2017 Chicago Youth Risk Behavior Survey (YRBS) in the four domains. We show changes in responses across individual items, mean changes across the four domains, and change in the proportion of students with highest risk exposure (≥10 affirmative responses). Analyses control for CPS students' grade, sex, and race/ethnicity. Reductions in substance use, sexual health risk, and violence and victimization (30, 40% and 40% in the mean number of affirmative responses, respectively) were observed. Suicide risk showed an initial improvement from 1997 to 2007, only to worsen by 2017 and show little difference from 1997. There was an approximate 70% decrease in the likelihood of being in the high multiple risk category (≥10 affirmative responses) in 2017 compared to 1997 (OR 0.33; CI 0.22-0.49). In alignment with national trends, our study documents significant improvement in Chicago public high school students' long-term health risk exposure over the 20-year study period, with the notable exception of suicide risk. This study emphasizes the need to invest in strategies both inside and outside of the classroom to mitigate the effect of adversity and promote protective factors, which are at the root of academic success and overall wellbeing.

Association of anthropometric measures across the life-course with refractive error and ocular biometry at age 15 years

Background

A recent Genome-wide association meta-analysis (GWAS) of refractive error reported shared genetics with anthropometric traits such as height, BMI and obesity. To explore a potential relationship with refractive error and ocular structure we performed a life-course analysis including both maternal and child characteristics using data from the Avon Longitudinal Study of Parents and Children cohort.

Methods

Measures collected across the life-course were analysed to explore the association of height, weight, and BMI with refractive error and ocular biometric measures at age 15 years from 1613children. The outcome measures were the mean spherical equivalent (MSE) of refractive error (dioptres), axial length (AXL; mm), and radius of corneal curvature (RCC; mm). Potential confounding variables; maternal age at conception, maternal education level, parental socio-economic status, gestational age, breast-feeding, and gender were adjusted for within each multi-variable model.

Results

Maternal height was positively associated with teenage AXL (0.010 mm; 95% CI: 0.003, 0.017) and RCC (0.005 mm; 95% CI: 0.003, 0.007), increased maternal weight was positively associated with AXL (0.004 mm; 95% CI: 0.0001, 0.008). Birth length was associated with an increase in teenage AXL (0.067 mm; 95% CI: 0.032, 0.10) and flatter RCC (0.023 mm; 95% CI: 0.013, 0.034) and increasing birth weight was associated with flatter RCC (0.005 mm; 95% CI: 0.0003, 0.009). An increase in teenage height was associated with a lower MSE (− 0.007 D; 95% CI: − 0.013, − 0.001), an increase in AXL (0.021 mm; 95% CI: 0.015, 0.028) and flatter RCC (0.008 mm; 95% CI: 0.006, 0.010). Weight at 15 years was associated with an increase in AXL (0.005 mm; 95% CI: 0.001, 0.009).

Conclusions

At each life stage (pre-natal, birth, and teenage) height and weight, but not BMI, demonstrate an association with AXL and RCC measured at age 15 years. However, the negative association between refractive error and an increase in height was only present at the teenage life stage. Further research into the growth pattern of ocular structures and the development of refractive error over the life-course is required, particularly at the time of puberty.

Alcohol consumption and consequences in adolescents in 68 low and middle-income countries - a multi-country comparison of risks by sex

AIMS

Alcohol use is a leading risk factor for disease burden among youth. This study estimated sex differences in the prevalence of alcohol use and consequences among adolescents living in low and middle-income countries (LMIC).

DESIGN

Multi-staged cross-sectional international standardized self-report questionnaires administered in the classroom.

SETTING

The Global school-based student health survey (GSHS) comprised adolescents from 68 LMIC between 2003-2014.

PARTICIPANTS

271,156 students aged 13-17 years old.

MEASUREMENTS

Alcohol measures included: past month alcohol consumption, history of intoxication and alcohol-related problems. Regions were based on the World Health Organization definitions: Africa, America, Eastern Mediterranean, Europe, South-east Asia, and Western Pacific.

FINDINGS

Overall, males had higher odds of alcohol use (OR = 2.38 [1.91-2.96]), a history of intoxication (OR = 2.64 [2.11-3.31]), and alcohol-related problems (OR = 1.72 [1.41-2.10]) than females. All regions recorded overall greater odds of alcohol use by males versus females; five regions (excluding Europe) recorded greater odds of intoxication in males; and three regions (America, South-east Asia, and Western Pacific) recorded greater odds of alcohol-related problems amongst males. However, there were country-level differences - in some countries, adolescent drinking rates and consequences were comparable by sex. Countries with the highest odds of alcohol use among males compared to females were Indonesia, Myanmar, Cambodia, Tuvalu, Morocco, Senegal, Kiribati, and Thailand.

CONCLUSIONS

Among adolescents living in LMIC, males had on average two-fold higher odds of drinking alcohol and experiencing adverse consequences. Growing affluence and improvements in sex equality in societies may increase the future prevalence of hazardous drinking in females in LMICs.

Kinematic risky driving behavior among younger and older drivers: Differences over time by age group and sex

Objective: This research examined the incidence rates of elevated gravitational force events (kinematic risky driving, KRD) among 16- to 17-year-old drivers compared to those of 18- to 20-year-old, 21- to 25-year-old, and 35- to 55-year-old drivers over a 12-month period. Methods: Data were sampled from the Strategic Highway Research Program 2 (SHRP2) naturalistic driving study that recruited a U.S. national sample of study participants. General linear mixed models (GLIMMIX) for recurrent events were used to estimate KRD incident rates for age cohorts in 3-month periods. Results: KRD incidence rates for 16- to 17-year-old drivers were higher than the rates for older drivers at each 3-month period. Analyses of individual differences for the 12-month period indicated that incidence rates for the 16- to 17-year-old group were 1.84 times higher than the rates for 18- to 20-year-old drivers, 2.86 higher than those for 21- to 25-year-old drivers, and 4.92 times higher than those for 35- to 55-year-old drivers. The incident rate for 16- to 17-year-old males was 1.9 times higher than that for same-aged females in the first 3 months and 2.3 times higher over 12 months. Over the study period, KRD rates of 16- to 17-year-old participants declined 24.5% among females and 18.0% among males. Conclusions: KRD rates were higher among younger relative to older, more experienced drivers and did not decline over time, consistent with a protracted period of risky driving behavior. The persistently higher KRD rate among young drivers suggests the need to enhance crash prevention approaches, such as feedback about abrupt maneuvering, to young drivers and their parents.

Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

Background

Adolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example.

Methods

This study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS.

Results

This study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use.

Conclusions

In the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7451-4) contains supplementary material, which is available to authorized users.

Accidental Finding of Atherosclerosis with 90% Stenosis of the Coronary Artery In a 17-Year-Old White Male

Atherosclerotic cardiovascular disease is the leading cause of death in the United States, though no case reports of teenage deaths due to the disease were found after extensive literary research. A case is presented of a 17-year-old male driver involved in a motor vehicle collision. Autopsy examination revealed multiple blunt force injuries. Approximately 3 mm of the middle portion of the left anterior descending coronary artery displayed about 90% atherosclerotic stenosis. It was determined that the cause of death was ventricular fibrillation due to atherosclerotic cardiovascular disease. The consultation with the parents and possible finding of hypercholesterolemia are discussed in the report.

Implementation of the Family Nurse Partnership programme in England: experiences of key health professionals explored through trial parallel process evaluation

BACKGROUND

The Family Nurse Partnership (FNP) programme was introduced to support young first-time mothers. A randomised trial found FNP added little short-term benefit compared to usual care. The study included a comprehensive parallel process evaluation, including focus groups, conducted to aid understanding of the introduction of the programme into a new service and social context. The aim of the focus groups was to investigate views of key health professionals towards the integration and delivery of FNP programme in England.

METHODS

Focus groups were conducted separately with Family Nurses, Health Visitors and Midwives at trial sites during 2011-2012. Transcripts from audio-recordings were analysed thematically.

RESULTS

A total of 122 professionals participated in one of 19 focus groups. Family Nurses were confident in the effectiveness of FNP, although they experienced practical difficulties meeting programme fidelity targets and considered that programme goals did not sufficiently reflect client or community priorities. Health Visitors and Midwives regarded FNP as well-resourced and beneficial to clients, describing their own services as undervalued and struggling. They wished to work closely with Family Nurses, but felt excluded from doing so by practical barriers and programme protection.

CONCLUSION

FNP was described as well-resourced and delivered by highly motivated and well supported Family Nurses. FNP eligibility, content and outcomes conflicted with individual client and community priorities. These factors may have restricted the potential effectiveness of a programme developed and previously tested in a different social milieu. Building Blocks ISRCTN23019866 Registered 20/04/2009.

"They say that I have lost my integrity by breaking my virginity": experiences of teen school going mothers in two schools in Lusaka Zambia

Background

Adolescent school-going mothers return to school in the rekindled hope of obtaining an education. However, their re-introduction into the school environment requires adequate support from teachers, fellow pupils, and the community. The purpose of this study was to explore the experiences of school-going mothers in Lusaka to understand their coping mechanism in the process of re-integration.

Method

This is a qualitative case study. We conducted in-depth interviews with 24 school going mothers between the ages of 16–19, purposively selected from 2 schools in Lusaka district. Audio-recorded interviews were transcribed, coded using Nvivo 10 software and analysed using thematic analysis.

Results

The girls reported experiencing stigmatization, discrimination, mockery and abuse from their teachers. Some community members labelled, humiliated, gossiped about and isolated the girls from their friends and classmates because of fear of ‘contamination’. Families forced some girls into early marriages making them feel rejected. These experiences resulted in low self-esteem, inferiority complex, poor performance in their academic work and identity crises in the young mothers. Therefore, because of the experiences the girls faced, they developed certain behaviours such as beer drinking, truancy and running away from home. They found it difficult to adjust to motherhood while doing their schoolwork.

Conclusion

There is a need for the teachers to undergo training on how to handle young mothers and have a flexible time-table to accommodate adolescent school going mothers when they miss lessons to attend to their babies. Non-parenting school girls should be counseled so that they do not stigmatize adolescent mothers. Parents need to be educated on how to deal with adolescent mothers in the community. The guidance office should have a qualified psychosocial counselor to help create a conducive learning environment for adolescent mothers, by helping them with missed lessons and seeing to it that they are not stigmatized.

ADVANCED, RECURRENT, INVASIVE CRIBIFORM CARCINOMA OF THE BREAST IN A 17-YEAR-OLD MALE: A CASE REPORT

INTRODUCTION

Male breast cancers (MBC) are relatively rare, accounting for about 1% of all male cancers in the US and 0.6% of breast cancers worldwide. In Nigeria, though the incidence varies per region, with a range of 3.4 to 9%, it is noted to be increasing. Gynaecomastia is a well-documented predisposing factor as well as endogenous and exogenous oestrogen. The most common histological subtype of male breast cancer is the invasive ductal carcinoma. Invasive cribriform carcinoma, ICC, is an extremely rare variant, with no more than 10 cases reported worldwide and, when present, has been diagnosed in patients above 40 years old.

CASE REPORT

We present the case of a 17 year-old, male undergraduate student, who presented to our clinic on account of a recurrent, painless, right breast lump. Three years earlier he had had a right breast lump excised at another health facilityand this was diagnosed histopathologicallyas invasive cribriform carcinoma. The only known predisposing factor was an initial lump, excised when he was 10 years old, and diagnosed histologically as gynaecomastia.He had surgical excision and axillary lymph node clearance,and histopathology re-confirmed high grade invasive cribriform carcinoma with multiple lymph node metastases, while immunohistochemistry showed a triple negative signature. He was thereafter referred for adjuvant treatment and has responded well to radiotherapy.

CONCLUSION

There is need for a high index of suspicion in all cases of gynaecomastia, and all such patients should be followed up. Prompt intervention, recourse to histology, and where indicated, immunohistochemistry, are important.

Deliberate Self-harm among Young People Begins to Increase at the Very Early Age: a Nationwide Study

BACKGROUND

Suicide in young people is one of most common cause of death; and deliberate self-harm (DSH) is important indicator of suicide. It is currently unclear how old the rate begins to increase or when it reaches to the same level with adults. The purpose of this study was to find beginning age of DSH and compare their characteristics with adults.

METHODS

This study retrospectively reviewed 5 years of nationwide prospective registry named Emergency Department-based Injury In-depth Surveillance (EDIIS) registry composed of all injured patients who were admitted to twenty tertiary university hospital emergency departments. Injured patients aged 29 years or younger from January 1, 2011 to December 31, 2015 were included. Incidence rate of DSH in all age was described. Patients were stratified by age: early teenage (11-15 years), late teenage (16-19 years), and early adulthood (20-29 years). Data of early teenage group were compared to those of other groups for examining their characteristics.

RESULTS

Among 588,549 injury patients, 8,400 patients reported DSH. The rate began to rise at age 11 and reach at age 16 which was equivalent to that of age 20 to 29. Early teenage had significantly higher excess mortality ratio based injury severity score (EMR-ISS) and had almost same level without significant difference in operation incidence or mortality compared to late teenage and early adulthood.

CONCLUSION

DSH rate began to rise at age 11, reaching adulthood level at age 16 in Korea.

Teenage Trauma Patients Are at Increased Risk for Readmission for Mental Diseases and Disorders

BACKGROUND

Most studies of readmission after trauma are limited to single institutions or single states. The purpose of this study was to determine the risk factors for readmission after trauma for mental illness including readmissions to different hospitals across the United States.

MATERIALS AND METHODS

The Nationwide Readmission Database for 2013 and 2014 was queried for all patients aged 13 to 64 y with a nonelective admission for trauma and a nonelective readmission within 30 d. Multivariable logistic regression was performed for readmission for mental diseases and disorders.

RESULTS

During the study period, 53,402 patients were readmitted within 30 d after trauma. The most common major diagnostic category on readmission was mental diseases and disorders (12.1%). The age group with the highest percentage of readmissions for mental diseases and disorders was 13 to 17 y (38%). On multivariable regression, the teenage group was also the most likely to be readmitted for mental diseases and disorders compared to 18-44 y (odds ratio [OR] 0.45, P < 0.01) and 45-64 y (OR 0.24, P < 0.01). Other high-risk comorbidities included HIV infection (OR 2.4, P < 0.01), psychosis (OR 2.2, P < 0.01), drug (OR 2.0, P < 0.01), and alcohol (OR 1.4, P < 0.01) abuse.

CONCLUSIONS

Teenage trauma patients are at increased risk for hospital readmission for mental illness. Efforts to reduce these admissions should be targeted toward individuals with high-risk comorbidities such as HIV infection, psychosis, and substance abuse.

Teenage pregnancy complicated by primary invasive ovarian cancer: association for oncologic outcome

Objective

To examine survival of teenage women with pregnancies complicated by primary ovarian cancer.

Methods

This is a secondary analysis of a previously organized systematic literature review of primary ovarian cancer diagnosed during pregnancy. Cases eligible for analysis were patients whose age at cancer diagnosis and survival outcome were known (n=201). Pregnancy and oncologic outcome were then examined based on patient age.

Results

These were comprised of 95 (47.3%) epithelial ovarian cancers (EOCs), 82 (40.8%) malignant germ cell tumors (MGCTs), and 24 (11.9%) sex-cord stromal tumors (SCSTs). Teenage pregnancy was seen in 21 (10%) cases, and was highest among the SCST group compared to the other cancer types (EOC, 1.1%; MGCT, 14.6%; and SCST, 29.2%, p<0.001). Live birth rates, neonatal weight, full term delivery rates, and Cesarean section rates were similar between the teenage group and the non-teenage group (all, p>0.05); however, teenage pregnancy was significantly associated with an increased risk of serious maternal/neonatal adverse events (50% vs. 22.7%, p=0.013). On univariable analysis, teenage pregnancy was significantly associated with decreased ovarian cancer-specific survival (5-year rate: age ≥30, 79.6%; age 20–29, 87.2%; and age <20, 41.6%; p<0.001). On multivariable analysis controlling for calendar year, cancer type, cancer stage, and gestational age at ovarian cancer diagnosis, teenage pregnancy remained an independent prognostic factor for decreased ovarian cancer-specific survival compared to women aged ≥30 (adjusted-hazard ratio=4.71; 95% confidence interval=1.17–18.9; p=0.029).

Conclusion

Teenage women with pregnancies complicated by primary ovarian cancer may be at increased risk of poor survival from ovarian cancer.

Naturalistic assessment of the learner license period

The purpose of this study was to describe the characteristics and progression of practice driving during the learner license period in a sample of teenagers. During the first and last 10h of practice driving, we examined (1) the amount, variety and complexity of conditions of practice; (2) the nature of parental instruction; and (3) errors that teens made while driving. Data were collected from 90 teens and 131 parents living in Virginia, USA, using in-vehicle cameras, audio recorders, GPS and trip recorders. Based on data collected from the instrumented vehicles, teens practiced for 46.6h on average, slightly higher than the GDL requirement for their jurisdiction, though half did not complete the required 45h of practice and only 17% completed the required 15h of night time driving. Exposure to diverse roadways increased over the practice driving period, which averaged 10.6 months. Most driving instruction occurred in reaction to specific driving situations, such as navigating and identifying hazards, and could be characterized as co-driving. Higher order instruction, which relates to the tactics or strategies for safe driving, was less frequent, but remained stable through the practice driving period. Instruction of all forms was more likely following an elevated gravitational force (g-force) event. Errors decreased over time, suggesting improvements in manual and judgment skills, but engagement in potentially distracting secondary tasks increased (when an adult was in the vehicle). A small percentage of trips occurred with no passenger in the front seat, and the g-force rate during these trips was almost 5 times higher than trips with an adult front-seat passenger. Taken collectively, these findings indicate (1) most teens got at least the required amount of supervised practice, but some did not; (2) instruction was mainly reactive and included some higher order instruction; (3) teens driving skills improved despite increased exposure to complex driving conditions, but secondary tasks also increased. Opportunities remained for improving the quality and variability in supervision and enhancing the development of skills during the lengthy period of practice.

Lifestyle advice provision to teenage and young adult cancer patients: the perspective of health professionals in the UK

PURPOSE

Health professionals are an important source of information for teenage and young adult (TYA) cancer patients. However, little is known about health professionals' provision of lifestyle advice to young people with cancer who are in their care.

METHODS

An online survey was distributed to health professionals within the UK who identified themselves as working with TYA cancer patients. Health professional awareness of lifestyle guidance, provision of lifestyle advice to young people and views on lifestyle information format and delivery were explored.

RESULTS

Ninety-five health professionals (44% nurses; 28% allied health professionals; 17% physicians) completed the survey. The majority (72%) of respondents were aware of some lifestyle guidance for cancer patients. However, less than half of TYA health professionals (46%) were able to successfully recall the source of the guidelines and less than a third reported proving specific advice to the majority of their patients on weight management, smoking, alcohol consumption and sun safety. Many health professionals (38%) felt that they were not the right person to provide advice and cited lack of resources as a key barrier to advice provision. The majority (95%) reported being interested in a resource containing relevant lifestyle information that could be given to young people with cancer.

CONCLUSIONS

TYA health professionals' awareness of lifestyle guidance and provision of advice regarding health behaviour is sub-optimal. Clear and comprehensive guidance written specifically for TYA health professionals could overcome the reported barriers and improve professionals' confidence in addressing and providing advice on lifestyle to young people with cancer.

Risk Factors for Pilonidal Sinus Disease in Teenagers

OBJECTIVE

To investigate the risk factors for pilonidal sinus in teenagers.

METHODS

Between January 2013 and September 2015, 55 teenage patients who underwent surgery due to pilonidal sinus disease (PSD) in the Department of Pediatric Surgery, Sakarya University Teaching and Research Hospital were included in this study. Age, gender, body mass index (BMI), number of baths taken per week, time spent sitting per day, family history, and skin color were examined as risk factors. The control group comprised of healthy teenagers without pilonidal sinus disease.

RESULTS

Out of the total 42 teenagers, 23 (54.8 %) were girls and 19 (45.2 %) were boys. Patients were classified as obese, overweight, or normal according to their BMI (14.3 %, 31 %, and 54.8 %, respectively). The number of baths taken per week in the PSD group was lower than that in the control group [odds ratio (OR): 3.690; p = 0.004]. The family history of PSD was significantly higher in teenagers with PSD, compared to the control group (OR: 8.652; p = 0.005). No differences were detected between the PSD and control groups with respect to sitting for ≥ 6 h per day (OR: 3.212; p = 0.028). Skin color was not found to be affected by PSD in teenagers (OR: 1.294; p = 0.392).

CONCLUSIONS

Heredity and the number of baths taken per week were found to significantly affect the incidence of PSD, whereas other variables (gender, age, BMI, skin color, and time spent sitting per day) did not exhibit any significant influence on the rate of incidence.

Nature and Prevalence of Menstrual Disorders among Teenage Female Students at Zagazig University, Zagazig, Egypt

STUDY OBJECTIVE

To determine the nature and prevalence of menstrual disorders among teenage girls.

DESIGN

An observational descriptive cross-sectional study.

SETTING

Zagazig University Students' Hospital, Zagazig, Egypt.

PARTICIPANTS

A representative sample of female students who attended the university pre-enrollment medical examination.

INTERVENTIONS

Self-administered questionnaire covering items on the adolescents' demographic data and menstruation characteristics.

MAIN OUTCOME MEASURES

Information about menarche, body mass index, physical exercise, cycle length and regularity, duration of menses, menstrual blood loss, dysmenorrhea, and premenstrual syndrome.

RESULTS

A total of 285 questionnaires were analyzed. Mean age at menarche was 12.3 ± 1.5 years. Oligomenorrhea was reported by 18 participants (6.3%) and 5 others (1.8%) mentioned having polymenorrhea. Hypomenorrhea was noted in 25 students (8.8%), and hypermenorrhea was reported by 12 (4.2%). Irregular periods were mentioned by 24 students (8.4%). Dysmenorrhea was reported in 188 students (66.0%). Of these, 81 (28.4%) graded their pain as mild, 69 (24.2%) as moderate, and 38 (13.3%) as severe. Premenstrual syndrome was mentioned by 160 girls (56.1%). Consulting somebody regarding their menstrual problems was reported by 36 students (12.6%).

CONCLUSION

Our results are not greatly different from those in other parts of the world. Data on nature and prevalence of menstrual disorders and their effect on young women's health status, quality of life, and social integration suggest that management of these disorders should be given more attention within the available reproductive health care programs. Further research into prevalence of and risk factors for menstrual disorders and their morbidity is warranted and anxiously awaited.

Previous Pregnancies Among Young Women Having an Abortion in England and Wales

PURPOSE

The purpose of this study was to use national statistics on abortions carried out in England and Wales to more precisely estimate the proportion of young women aged <20 years obtaining an abortion who have had one or more previous pregnancies.

METHODS

Secondary analysis of abortion data from the Office of National Statistic and the Department of Health by parity for women aged <20 years, ordinarily residing in England and Wales, from 1992 to 2013.

RESULTS

Over the past 20 years, the proportion of teenagers in England and Wales having an abortion as a result of a subsequent pregnancy increased by 33% (from .172 in 1992 to .229 in 2013). Most of this increase occurred before 2004, and the proportion now appears to have stabilized. In 2013, 22.9% of the young women aged <20 years who underwent an abortion had had at least one previous pregnancy (either a birth or an abortion). Only a minority (<5% of young women who obtained an abortion) had had more than one previous pregnancy.

CONCLUSIONS

The findings show that nearly one in four teenagers presenting for an abortion have already been in contact with health services for a previous birth or abortion. Greater policy emphasis must be placed on the accurate identification of the proportion of teenage pregnancies that occur as a result of a subsequent pregnancy and developing more effective "secondary prevention" interventions to help the first-time pregnant and parenting teenagers manage their future reproductive lives and prevent further unplanned pregnancies.

Survival patterns in teenagers and young adults with cancer in the United Kingdom: Comparisons with younger and older age groups

AIMS

We aimed to describe and compare survival in teenagers and young adults (TYAs) with cancer to that of younger children and older adults, to identify sub-populations at greater or lesser risk of death.

METHODS

We compared survival in cancer patients diagnosed in the United Kingdom aged 13-24 years (TYAs) to those aged 0-12 (children) and 25-49 years (adults) using the National Cancer Data Repository. All cases had a first cancer diagnosis between 1st January 2001 and 31st December 2005 with censor date 31st December 2010 or death if earlier.

RESULTS

We found six distinct statistically significant survival patterns. In pattern 1, the younger the age-group the better the 1- and 5-year survival (acute lymphoid leukaemia, carcinoma of ovary and melanoma). In pattern 2, TYAs had a worse 5-year survival than both children and young adults (bone and soft tissues sarcomas). In pattern 3, TYAs had a worse 1-year survival but no difference at 5-years (carcinoma of cervix and female breast). In pattern 4, TYAs had better 1-year survival than adults, but no difference at 5 years (carcinoma of liver and intrahepatic bile ducts, germ cell tumours of extra-gonadal sites). In pattern 5, the younger the age-group the better the 5-year survival, but the difference developed after 1-year (acute myeloid leukaemia, carcinoma of colon and rectum). In pattern 6, there was no difference in 1- and 5-year survival between TYAs and adults (testicular germ cell tumours, ovarian germ cell tumours and carcinoma of thyroid).

CONCLUSION

TYAs with specific cancer diagnoses can be grouped according to 1- and 5-year survival patterns compared to children and young adults. To further improve survival for TYAs, age-specific biology, pharmacology, proteomics, genomics, clinician and patient behaviour studies embedded within clinical trials are required.

Trends in survival for teenagers and young adults with cancer in the UK 1992-2006

Background

Although relatively rare, cancer in teenagers and young adults (TYA) is the most common disease-related cause of death and makes a major contribution to years of life lost in this age group. There is a growing awareness of the distinctive needs of this age group and drive for greater understanding of how outcomes can be improved. We present here the latest TYA survival trends data for the United Kingdom (UK).

Methods

Using national cancer registry data, we calculated five-year relative survival for all 15–24 year olds diagnosed with cancer or a borderline/benign CNS tumour in the UK during the periods 1992–1996, 1997–2001 and 2002–2006. We analysed trends in survival for all cancers combined and for eighteen specified groups that together represent the majority of TYA cancers. We compared our data with published data for Europe, North America and Australia.

Results

Five-year survival for all cancers combined increased from 75.5% in 1992–1996 to 82.2% in 2002–2006 (P < 0.001). Statistically significant improvements were seen for all disease groups except osteosarcoma, rhabdomyosarcoma, non-gonadal and ovarian germ cell tumours and ovarian and thyroid carcinomas. During the earliest time period, females had significantly better survival than males for five of the twelve non-gender-specific disease groups. By the latest period, only melanomas and non-rhabdomyosarcoma soft tissue sarcomas had differential survival by gender. Survival in the UK for the most recent period was generally similar to other comparable countries.

Conclusion

Five-year survival has improved considerably in the UK for most cancer types. For some disease groups, there has been little progress, either because survival already approaches 100% (e.g. thyroid carcinomas) or, more worryingly for some cancers with poor outcomes, because they remain resistant to existing therapy (e.g. rhabdomyosarcoma). In addition, for a number of specific cancer types and for cancer as a whole males continue to have worse outcomes than females.

Epidemiology of injury in male adolescent Gaelic games

OBJECTIVES

There is a lack of epidemiological research in adolescent Gaelic games, with previous research primarily focusing on elite adult males. This study aimed to prospectively capture the epidemiology of injury in male adolescent Gaelic games over one year.

DESIGN

Prospective cohort study.

METHODS

Two hundred and ninety two (15.7±0.8 years) male adolescent Gaelic footballers and hurlers took part in a one year prospective epidemiological study. Injuries were assessed weekly by a certified Athletic Rehabilitation Therapist and an injury was defined as any injury sustained during training or competition resulting in restricted performance or time lost from play. An injury report form was utilised to standardise injury information.

RESULTS

Match injuries were more frequent in Gaelic footballers (9.26 per 1000h) and hurlers (11.11 per 1000h) than training injuries (2.69 and 3.01 per 1000h, respectively). Over a quarter of injuries in adolescent Gaelic footballers (26.7%) and hurlers (26.5%) were overuse in nature. Recurrent injuries were also frequent, particularly in adolescent Gaelic footballers (47.3%). Lower limb injuries predominated (football 74.7%, hurling 58%), particularly in the knee (18.7%, 20.0%) and ankle (12.0%, 10.0%). Hamstring injuries were more frequent in footballers (13.3%), with lower back injuries more common in hurlers (22.0%). Minor injuries were common in hurling (61.7%), with moderate (20.8%) and severe (37.5%) injuries predominant in Gaelic football.

CONCLUSIONS

Injuries are frequent in adolescent Gaelic games and this study sets the scene for the establishment of injury prevention strategies for this at risk population.

Adolescent health: present status and its related programmes in India. Are we in the right direction?

Adolescence is a phase of rapid growth and development during which physical, physiological and behavioural changes occur. They constitute more than 1.2 billion worldwide, and about 21% of Indian population. Morbidity and mortality occurring in this age group is mostly due to preventable causes. Young and growing children have poor knowledge and lack of awareness about physical and psychological changes that occurs during adolescence and the ill health affecting them. Existing Adolescent health programmes focus on rendering services like immunization, health education for sexual and reproductive health, nutritional education and supplementation, anemia control measures and counseling. Adolescent health programmes are fragmentary at present and there is no comprehensive programme addressing all the needs of adolescents. Access and availability of health care services are severely limited. Lack of accurate information, absence of proper guidance, parent's ignorance, lack of skills and insufficient services from health care delivery system are the major barriers. Interventions should focus on providing psychological and mental health services and behaviour change communication towards leading a healthy lifestyle, restricting advertisement related to junk food products, awareness creation about reproductive and sexual health, educating parents to prevent early marriage, teenage pregnancy and to counsel their children on nutrition and reproductive health. Universal coverage of Adolescent friendly clinics is highly recommended. To be cost effective, all health services addressing adolescent should come under single programme. This review is intended to create awareness among the stakeholders about the importance of strengthening adolescent health services in order to meet their felt needs.

Are risk factors for drug use and offending similar during the teenage years?

BACKGROUND

This paper explores whether at different stages of the developmental cycle of adolescence, drug use and offending are associated with a similar set of risk factors relating to: socio-structural position, informal social control, deviant peer group contexts, and deviant lifestyle behaviours.

METHODS

Multivariate regression was used to analyse data from the Edinburgh Study of Youth Transitions and Crime (ESYTC) self-report questionnaire.

RESULTS

Early in the teenage years drug use was associated with a similar set of factors to offending. These include weak bonds to parents and teachers, and deviant lifestyle behaviours. However, later in the teenage years there were differences, e.g. drug use was associated with higher socio-economic status and importance of school, and a number of factors which were associated with offending were not associated with drug use, e.g. parent-child conflict, gang membership and hanging around.

CONCLUSION

Results show that the factors included here are more appropriate to understanding offending than drug use. Different risk factors are associated with drug use and offending in the older, but not younger teens. It is argued that later in the teenage years drug use should be understood and addressed differently to offending. This is particularly important given the tendency for the 'drugs problem' to increasingly be dealt with as a 'crime problem' (Duke, 2006).

Modified Limberg flap technique in the treatment of pilonidal sinus disease in teenagers

BACKGROUND

Pilonidal sinus disease (PSD) is most common in young adults but can also affect teenagers. Although many techniques have been used to treat pilonidal sinus disease in adults, few studies have compared treatment methods for the condition in teenagers. In this study, we aimed to compare the modified Limberg flap technique with the excision and primary closure technique, both of which are used routinely in adults and teenage patients.

MATERIALS AND METHODS

This study was a retrospective review of 40 teenaged patients who underwent surgery in a single pediatric surgery center over ~2 years. The patients' age, gender, body mass index (BMI), number of sinuses, surgery technique and any complications were recorded. The patients underwent excision and primary repair or rhomboid excision and a modified Limberg flap.

RESULTS

Of the 40 patients, 22 (55%) were female, and 18 (45%) were male. The mean age of all the patients was 15.20 ± 1.31 (12-17) years. The average number of sinuses was 3.18 ± 0.90 (1-5). Of the patients, 52.5% (n=21) had a high body mass index. These patients were obese (n=4) and overweight(n=17). Pilonidal sinus excision and primary repair were performed in 8 (20%) of the patients, while the remaining 32 (80%) underwent the modified Limberg flap technique. Complications were observed in 87.5% of the patients undergoing excision and primary repair, and in 15.6% of those who underwent the modified Limberg flap technique. Recurrence was observed with only the primary repair technique (37.5%).

DISCUSSION

When compared with adults, teenage pilonidal sinus disease occurs more frequently in females. In this study, no correlation existed between the number of sinuses, symptoms, BMI and postoperative complications. Based on the results of this study, the modified Limberg flap technique has a low complication rate when used to treat pilonidal sinus disease in teenagers.

Adverse reproductive outcomes associated with teenage pregnancy

INTRODUCTION

It is debated whether teenage pregnancy is associated with an adverse reproductive outcome. This study assessed the reproductive outcomes in teenage pregnancy in Nepal, a developing setting.

METHODS

A hospital based retrospective cohort study of 4,101 deliveries to compare the outcomes between teenage and non-teenage pregnancies.

RESULTS

Pregnancy in teenagers was associated with significantly increased risk (P<0.05) of delivery of very and moderately preterm births and Low Birth Weight babies. There was no significant difference in risk of having small for gestational age babies, low APGAR score at birth at 1 min and 5 min, stillbirth, neonatal death, and post partum hemorrhage. However, the risk of having delivery by episiotomy, vacuum or forceps and Caesarean section was significantly lower (P<0.05) among teenage mothers.

CONCLUSION

Teenage women were more likely to have preterm births and low birth weight babies. However, they were less likely to have delivery by episiotomy, forceps or vacuum and Caesarean sections. In other respects, there were no significant differences between teenage and non-teenage mothers.