Adolescent and Youth Health: Development and Future Challenges

Purpose: Clarify the suitable age to perform refractive surgery
Background: Refractive disorders are very common among teenagers in any community, and many treatment modalities are suggested to solve such visual problems.
Method: Literature review. The main points that will be presented:
1. Development of the eye & vision
2. Visual problems of teenagers
3. Treatment modalities & prevention
Conclusion: Refractive surgery is like any other surgical procedure, and may be done after complete assessment of the patient’s situation in the proper age and letting him/her understand completely what he/she can gain.

Purpose: define the limits of age in which the deaf young patients can benefit from cochlear implant
Background: deafness of young population is very common in Palestinian society, and the up to date “cochlear implant” is requested to be done for every deaf patient in any age, which is actually a misuse of this solution
Method: Literature review. The main points that will be presented:
1. Definition of cochlear implant
2. Candidates for implantation
3. Requirements of cochlear implant
4. post implantation Rehabilitation
Conclusion: best age for cochlear implant is before language acquisition

Drugs do more harm to a teen‟s brain than anyone could ever imagine. Our teens are exposed to drugs i.e.Nicotine, Caffeine, amphetamines, prescription drugs--- just to mention few. Unfortunately a drug is a pleasure producing chemical.Drugs make the young feel good, but are the pleasure they get worth the price we all pay?Drugs are extremely appealing to teens “Some drugs produce extraordinary levels of pleasure “. Drugs basically activate chemical pathways in the brain that are associated with feelings of well being and euphoria, or in other words work by modifying the chemistry of pleasure.If teens get in trouble with drugs, they stop being interested in things they used to be interested in. This is an important sign.Teen brains are very easily injured by drugs and take a long time to repair. Adolescent brain is a very unique structure. Recent advances on drug addiction will be presented.

Introduction
Most of our body functions work under the influence of hormones secreted by glands like , thyroid , adrenal and ovaries

Some hormonal changes can affect the skin &hair of women , such as :
a)Testesterone levels in women though present primarily in males but in limited quantities in females
b)Ovarian disorders
c)Adrenal gland disorders

Hirsutism
Hirsustism in unusual places , which occurs in 10-20% of women and this a source of anxiety and social problem to women which cause them an embarrassment and felling of shame

Etiology of Hirsutism
1)Idiopathic Hirsutsim
2)Genetics and ethic reasons
3)Hormonal Imbalances
4)Drugs
5)Ovarian cause : such as polycystic ovarian syndromes which is a common disorder affecting 3-10% of reproductive age women .patients presents with constellations of symptoms including hirsutism , virilization an ovulation , amenorrhea and obesity

Diagnosis :
1)Testosterone , LH and sex hormones level
2)Fasting blood sugar &insulin level
3)CT or MRI of the pelvic to look for ovaries and adrenal glands

Treatment
Symptomatic treatment
Waxing and chemical creams
In case of severe acne , also contra indicated in pregnant and women trying to conceive

Surgical Treatment
1) Excision of one third of each ovary , this is very effective process in regulating ovulations
2) Laparoscopic surgery

Role of the family
*guidance and attention
*medical consultation
*address the disease , do not hide it

Role of society , especially schools
*Health education
*Guidance

Role of the girls :
*She should share any unusual things she might feels
*Open up with family and community

Summary, conclusion and recommendation
*Hormonal disorders in young girls do really exist
*The importance of health education and promotion in childhood and adulthood
*The importance of the role of ministry of education
*treatment and attention for children (adolescent girls) is a family duty, community and governmental. this is an ethical, professional duty for the family and community in general
*Address the problem directly
*There is no problem without a solution
*Addressing the disease early will reduce the consequences of late diagnosis

Purpose:
To optimize a system focused on early detection and early intervention in psychosis for adolescents and young adults(16y-30y). The goal is to reduce DUP (duration of untreated psychosis) through integrated and trans disciplinary teams, also implementing knowledge and specific skills of professionals, and organizing meetings with general population, The purpose is to reduce stigma and improve accessibility to appropriate care; this should lead to a reduction in both, incidence (short term) and prevalence (long term, 10-20 years) of psychosis in the area of Trieste.

Methods:
To start a collaboration between Children and Adolescents Services and the Department of Mental Health in order to support the 16-30 group (prevention and early intervention in psychosis). The community based system in town has a long history and the emphasis is currently put on facilitating the access of young people to more youth friendly services and trans disciplinary teams. In the initial phase GPs and teachers are vital partners of the project; families and carers are already involved through courses and meetings.
-To organize courses in the local schools focused on health education and detailed information in view of fighting stigma and facilitate contacts or request of help.
-To involve the media
-To start a help-line
-To organize training for GPs about early detection of psychosis and set a strong referral system for young people at risk.
-To start youth friendly services taking care of the environment and settings.

Results/findings:
Expected results from the second year (time zero) on:
-in the first six months, 15% increase of referrals; in the second six months a further 20% increase.
-50% reduction of assessments in the hospital crisis ward
-increase of first contacts at the CMHC (Community Mental Health Centres)
Evaluation of the new pathways of care through:
- RCT
-Self-evaluating questionnaires to GPs
Formal definition and approval of procedures and pathways of the project focused on adolescents and young adults, with particular attention to carers.

Conclusions:
This is a pilot project in the region of Friuli Venezia Giulia.
The methodology is sufficiently flexible, therefore adaptable to various settings.
If successful, it could represent a national model of an integrated multidisciplinary approach to prevention and early detection of psychosis.
The plan is to cooperate with similar initiatives on the national level, e.g. with Rome and Milan.

Purpose:The aims of our study are to identify the main causes of acne, and what factors make it scare. Also to take some information about treatment, and social impact of acne.

Methods:A cross sectional observation design easy conducted in Al-Quds University students to assess the major causes of acne, social impact of acne, effective of treatment.
Total of 100 students at Al – Quds University completed questionnaires. The questionnaires consisted of general questions about the life style and nutrition; also consist of many questions about the causes of acne, severity, treatment, and the social impact of acne. The finding of the study was discussed with other results. Statistical package for social science (spss) version 16 was used for data entry and analysis.

Results/findings:Acne was found in 57.8 % of the studied sample, female have more chance to develop acne then men, 69.9 % of acne people in our sample are female. Regarding the causes of acne, 96.6% of the studied sample have acne during stress, 76.3% of acne people have a family history of acne, 71.7 % of female have acne during menstrual cycle, 79.6 % of acne people their acne increase and become scare after eating fatty food, 76.8 % also their acne increase after scratching it, and after shaving acne increase in 73.2 % of the acne people.
In addition to that, 49.2 % of the acne people their acne was concentrated in the face, only 8.5% in the back, and 42.4 % in more than one region. Most acne people 26.7 % their acne was moderately distribution, and only 8.5 % have severe acne.
According to the treatment, 42.4 % have visited a doctor, and only few people19.2 % who have large improvement after treatment , 34.6 % of acne people say that the cost of treatment including drugs is expensive , and 42.3 % the cost of treatment was moderate .
Acne affect people lifestyle in 56.00% of acne people, 45.7 % fell depression and upset because of acne.

Conclusions:
Stress, menstrual cycle, and family history are the major causes for acne, and there are many factors that increase the severity of acne, also we can conclude that acne affect people lifestyle.

Purpose:
State the primary purpose of the study, including the main research questions or hypotheses being addressed, emphasizing what is innovative about this research.

Methods:
Quantitative studies should include design, participants, measures and analyses. Qualitative studies should include a reference to the approach being adopted (e.g. discourse analysis, grounded theory) and describe the method of data generation, (e.g. interviews, transcripts of conversations, written accounts). Reviews should include details of the procedures adopted (e.g. literature search, inclusion/exclusion criteria and methods of analysis).

Results/findings:
Quantitative studies should include a summary of the results, which can contain numerical data, qualitative studies should include an indication of the main results of the analysis (e.g. examples of themes, categories, responses, discourses to be reported). Reviews should include a summary of the main findings that will be discussed in the paper. This section should present specific findings, rather than suggesting that „results will be discussed‟.

Conclusions:
Some discussion of the possible contribution to, or implications for, the advancement of adolescents health knowledge, methods or practice

Conclusion:
Eyes consider as one of the most important gift which Allah gives for human .
Eyes are one of the five senses which we depend on throughout our life . Allah speaks to Mohammad in aful speech blaming him for his behavior towards abed Allah bin abey maktoum , the blind .When Mohammad met him he said "peace be upon who Allah blamed me" .
Visionis a gift that needs much care . Eyes may be affected by special illness like redness , viruses , and soon . such these illnesses may cause lose sight for ever.
Look : vision difficult : train family , how to treat those who have vision difficulties ,social program / south – west bank 2007.
Study aims to:
1. know how Palestinian ministry of education programs join vision difficulties partial oral in side class room .
2. know the reality of joining those who have sight difficulties in governmental schools .
3. show or appear environmental difficulties which affect joining sight difficulties .
4. explain the Palestinian experiment and special companies programs which work with the abnormal persons .
The study has answers to the following questions
1.how to join vision difficulties in normal school.
2.what are the difficulties that the head masteries face by renting schools to accept entrance vision difficulties .
3.what is the role of social programs that work with vision difficulties .
The study reaches to good results :-
1. education is for all Palestinians whatever their ethnic or religious background or his difficulties schools open their doors to all people who want to study .
2. guides in this section try to submit all necessary things which are important for those who have vision difficulties like glasses , lenses , white stakes through companies or local companies.
3. w\education guide must be concerned by those who have difficulties and he must open a file to every one in his school .
4. The patient must be displayed to ahealth committee which decides, after a medical examination, the amount of the disability. Then an observer ,an assistant and a special hall are offered by the directorate for the student while doing the general examinations.
Recommendation :
1.enhance the tie between local society and schools to benefit from school join .
2.put teachers in a good atmosphere who works with those abnormal students and give them gifts .
3.concentrate on the cooperative education , work in groups and depend on the note in education .
Towards researches and future studies recommended :
1.submit Briel system for blind students .
2.submit Briel computer sighted (mobser) in each directorate .
According to academic study recommended of :
1.making an explanation study to reality through
input -operation -output .
2.making a comparative study between Palestinian explanations and Arab foreign experiment .
3.making studies in order to put a whole vision or future vision to future school which collect all students normal and abnormal .

Since the implementation low of premarital testing for thalassemia, there has been a great reduction in the number of new cases of thalassemia major. The number of new cases has dropped from around 40 cases per to only three or four cases.
It is hoped that within the next few years, the number of new cases drop to zero. This
needs understanding the inheritance of different types of thalassemia and related
conditions, studying the recent new cases of thalassemia major and trying to take actions
on preventing further new cases.

The World Health Organisation (WHO) defines “adolescence” as the age 10 -19 and “youth”as age 15-24, using the term “young people” to refer to the combination of groups (age 10-24). According to the PCBS 2005 (Palestinian Central Bureau of Statistics) the age group 10-24 comprises about 32% of population , and only 50% of them have health insurance. One of important health challenges facing youth in Palestine is a high percent of smoking , other important challenges are physical and mental wellness, nutrition needs,reproductive health needs ,and important medical health needs.
Traditional health systemin Palestine has provided services to youth among either pediatric services or adult services without being tailored to this age group needs. According to WHO the key points for Youth freindly services(YES) include full participation of young people in peer education and life skills
They should be integrated with other services and sectors, health providers should be trained in youth friendly approaches, counselling &communication,and finally must ensure privacy, confidentiality and quality of care .
Services can be provided on a static facility basis (out patient, in patient), or out reach or mobile basis by a range of different service providers.
Youth health services can be integrated through one or more of the following models; primary health care, student health facilities, educational system, Youth Centres or Out reach services for especially vulnerable young people .
In Palestine an assessment of the youth needs must be done in order to decide about the best model/s to adopt while we are moving to provide youth freindly health services.

Purpose:Vitamin B12, which is normally involved in the metabolism of every cell of the body, is important for the normal functioning of the brain and the nervous system, and for the formation of the blood, but also fatty acid synthesis and energy production. The serum measure used to assess vitamin B12 status of a population cut-offs recommended by WHO is <150 pmol/L (200 pg/mL). The cut-off of 150 pmol/L represents the serum
concentration below which clinical symptoms of deficiency (e.g. neurological, cognitive and hematological) start to appear. The aim of this study is to determine the prevalence of vitamin B12 among palestinian adolescents (10-18 years old) in north West Bank and to assess associated sociodemographic variables. Methodology: A cross-sectional study was conducted by collecting data randomly from 404 adolescents (10-18 years old) from Tulkarm and Qalqilia districts. Vitamin B12, Haemoglobin (Hb) and Mean corpuscular volume (MCV) levels were determined alongside a designed questionnaire to obtain different demographic and other factors from participants. Results: The overall Hb (<12 g/dl), B12 (< 200 pmole/L) and MCV (>92 fl) levels among participants were 18%, 44%, and 2.5%, respectively. Based on these results, the study concluded that B12 deficiency among our school children participants is 2.5%. There were no significant associations between rates of haematological levels and associated factors such as place of residence, family income, number of family members as well as food habits (P-value > 0.05). Conclusion: The study recommends a comprehensive study covering all areas in Palestine to determine the normal level of vitamine B12.

Purpose:
To investigate the prevalence and concordance of Human papillomavirus (HPV) and Chlamydia trachomatis (CT) in paired urine and cervical smear samples in Palestinian women.
Methods:
Cervical and urine specimens from 109 women (17-28 years old) visited governmental or private obstetrics and gynecology clinics for various reasons in the West Bank were randomly collected as a part of cohort study and stored at -20C ْ before phenol-chloroform DNA extraction were performed. All samples were tested using LCR-E7 PCR assay for detection HPV E6 and E7 genes and a new cryptic plasmid -PCR method for detection CT. Written agreement forms were received for participation in this project from all women.
Results/findings:
HPV DNA was detected in 6.4% (7/109) of cervical samples and 2.7% (3/109) of urine samples. 9.2% (10/109) of cervical samples and 6.4% (7/109) of urine samples were positive for CT; 0.9% (1/109) were positive for HPV or CT in urine samples alone.
Conclusions:
Urine samples can replace conventional cervix swabs for the detection of CT but not for HPV detection. The high prevalence illustrates the need for social education or prevention programs such as vaccination for these sexually transmitted infections should be considered in Palestine.

Purpose:
The main purpose of the report is to provide national figures to describe the nutrition status for the adolescents among schoolchildren yearly. The hypothesis was: are the adolescents among schoolchildren have a good nutrition status according to the WHO growth standards? The expected results will highlight the national nutrition status of the adolescents among schoolchildren for the first time in yearly based figures.

Methods:
National Nutrition Surveillance System (NNSS) was used as a tool for gathering the data, data entry, data cleaning, data analysis, and result interpreting.
The data was collected from 270 schools in West Bank and Gaza Strip (260 government, 10 private Schools and no UNRWA schools since they do not have 10th-grade schools) that contain the grade 10. These schools have unified anthropometric measuring equipment, data collection form and staff training, and were selected according to the PCBS formula. The sample size was 2,683 students (2,039 Females and 1,692 Males).
Data gathering was done using a unified form that was designed on national levels through the Nutrition technical committee. The form was filled by health supervisors in schools. All hard copies were transferred to nutrition department, in which all data was entered on excel sheet. The data was cleaned using special programs these designed by nutrition department.
The data was analyzed using special programs these designed by nutrition department
depending Athro 2009 soft ware.

Results/findings:
The palpable goiter prevalence was 2.7%, visible goiter 0.2%, Anemia 10.1%, underweight (Wt/Age) 5.8%, Stunting Wt/Ht)14.7%, wasting (BMI/age) 2.8%, overweight (BMI/age) 17%, Obesity (BMI/age) 5.8%.
For food intake among schoolchildren adolescents, the home breakfast prevalence was 60.4%, food intake at school 88.3%, no home breakfast neither food intake at school 7.2%, meal intake 10.1%, candy intake 32.9%, chips 44.9%, sandwich intake 71.9%, fruits 36.1% and fortified food 26.7%.

Conclusions:
The results indicate a satisfied nutrition status among schoolchildren adolescents in Palestine, but some nutritional indicators is giving an alarm for further deterioration like anemia 10.1%, stunting 14.7%, overweight 17% and no home breakfast neither food intake at school 7.2%. the schoolchildren adolescents need further nutrition education and attention.

Aim: Sleep disorders negatively affect the quality of life and learning of university students. Such disorders have not been studied among students in the Middle East. The aim of the study was to determine the prevalence of sleep disorders in a university undergraduate population in Palestine.

Methods: The study group included 400 students of An-Najah National University / Palestine. Sleep patterns and disorders were assessed by a self-administered questionnaire.

Results: Sleep quality was reported as “excellent” in only 21.8% and was significantly associated with some symptoms of insomnia but not parasomnias. The use of sleeping aid in the previous week was reported by less than 1% of participants. About 42% of the participants had gone to bed after midnight. About 19.2% of the participants had sleep latency more than one hour. About 40.1% of the participants experienced early morning awakenings at least three nights per week. Sleep talking (ST) was the most common symptom of parasomnia. About 6.7% of the participants reported ST at least three nights per week. About 48.8% experienced daytime sleepiness during classes at least 3 times per week. Sleep latency was significantly longer in males than females.

Conclusion: The study showed that insomnia related symptoms, parasomnia, and daytime sleepiness are important and common among undergraduate university students.