Adolescent and Youth Health: Development and Future Challenges

Acne Vulgaris is primarily a chronic inflammatory process of the pilosebaceous unit, clinical presentation as comedones (open=blackheads, closed=white heads), papules, pustules or even cystic lesions in the face, chest, shoulders and upper back.
Acne is the commonest skin compliant as it affects up to 70-85% of adolescents, only 10-20% of them request medical advice. Symptoms of acne may begin at the age of 8-12 years but usually at 15-18ys and began to involute by the age of 25, but 10-12% of females and 3% of males continue to have clinical acne until 45 years of age [1,5].
The aim of this retrospective study was to evaluate the incidence of acne between dermatology patients in Palestine.

Materials & Methods : we looked through our records during 2000-2009 and collected data of acne patients seen during this period.

Results : During this period we had treated 5528 persons complaining of acne (1674 males and 3854 females). Table 1 shows the year distribution of acne patients and they constituted 9-12% of our Dermatology patients.
Table 2 shows the age distribution of 727 acne pts (215 males & 512 females) seen during 2009. Acne presents in some of our patients by the age of 10ys but most of them were between the age of 16-25ys (531 /727) and 39 females had acne lesions between 31-50ys as pustules mainly in the chin but just few males had acne lesions above 30ys of age in the shoulders and back.
Table 3 shows the month distribution of acne patients during 2009 and revealed that acne pts report all the year and most of them report more regularly than other Der. pts. for periods more than 1 year.

Discussion :
Acne is a common complaint between Der. pts. in Palestine (9-12%). Females report more frequently than males 5:2, most of the patients presented by the age of (16-25ys) with mild to moderate degree of acne. Many of the female patients are psychologically disturbed and need special attention and enough time to explain that acne will involute by time and it is very important to avoid squeezing of lesions which may lead to permanent scaring.
In the management of acne we depend on using systemic antibiotics as Tetracycline 500ml/d, Doxycycline, Azithromycine or Erythromycin. Local treatment in the form of Benzoil peroxide 5-10%, Clindamycin, Erythromycin or Azaleic acid [1,3,4]. Tritinoids locally are helpful in dealing with comedones. Systemic Isotritinoid is used only in severe cases of pustules or nodulocystic Acne.

Summary :
5528 (1674 males & 3854 females) acne patients were seen by us in Palestine during the period 2000-2009 which forms 9-12% of our dermatology patients. Acne was one of the most common skin diseases in Palestine [2]. Male to female ratio between our patients was 2:5. Most of our patients were between the age of 16-25ys (531/727) during 2009. Traditional methods of treatment were enough for management of most of the patients. Systemic Isotritinoin was only used in severe cystic and nodulocystic acne. Further studies are needed to evaluate the incidence of acne in the Palestinian community.

Purpose: The study aimed at assessing the needs of youth in an age group (11-19) years in the Jerusalem Governorate to drug awareness and to what extent they are knowledgeable of the drug problem in their local community.
What is innovative about this study? It was the 1st study in the Governorate of Jerusalem/ Palestine which tackled the need of youth for awareness & prevention programs on drugs.

Methods: Two research instruments were used in the Case Study methodology: the Focus Group and the Questionnaire and both instruments were tested for validity and reliability.
The sample (male & female) youth was chosen from the Jerusalem Governorate for the 8 focus groups (61) and (320) students chosen for the questionnaire.

Results/findings: The researcher reached to the following findings:
1. The examinees are aware of the widespread concepts and idioms that relate to drug use, though differences in understanding the meaning of those concepts varied from one geographical area to the other in the Jerusalem Governorate.
2. The results insured the need of youth for drugs awareness and prevention programs at all ages..
The results indicated the effect of peers as friends on youth decision-making towards the use of drugs.

Conclusions: The study results & recommendations led Al-Sadiq Al-Taieb Association to develop the methodology of its work related to Drug Awareness and Prevention programs with schools, youth at risk, and youth camps , taking into consideration the hasten changes in the technical information system such as the Internet, the SMS , etc on the life of youth. Programs were introduced such a ” Empowering and Activating the Role of Youth in the Community through Drama” , Awareness programs for Youth at Risk, and Youth Summer Camps, Voluntary work, and contribution of youth in the Awareness and Prevention inspired the sense of responsibility of youth towards their community problems.

Objective: To investigate associations of overweight and of weight dissatisfaction with demographic characteristics, body image, health complaints, risk behaviors and physical (in)activity in adolescents in Palestine.
Design and subject: The Palestinian Health Behavior in School-aged Children is a cross sectional survey of 17715 adolescents (48% boys and 52% girls) in a representative sample of grades 6, 8, 10 &12. Students completed a modified version of the international WHO collaborative Health Behavior in School-aged Children (HBSC 2004) questionnaire. Binary logistic regression analysis was used to examine interactions of weight status and dieting status and investigate associations.
Results: 16.5% of the adolescents were overweight nevertheless approximately one third (32%) of the adolescents were dissatisfied with their weights (either dieting or perceived a need to diet). One fifth (20.5%) of the adolescents (16% boys and 24% girls) were dissatisfied with their weights while they were nonoverweight. More overweight boys and more boys dissatisfied with
their weights had highly educated mothers and were found in high affluent families (p<0.001). In both genders, especially girls, weight dissatisfaction regardless of weight status was positively associated with most of the selected variables, (P<0.001), whereas overweight was not except for the perception of body weight (P<0.001) and few other variables (P<0.05).
Conclusion: Weight dissatisfaction among non overweight Palestinian adolescents is high especially in girls. Regardless of the weight status, weight dissatisfaction is positively associated with most variables of body image, health complaints, risk behaviors and physical (in)activity in adolescents in Palestine. These results are useful for health professionals to plan for health education programs to promote healthy lifestyle among adolescents.

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.

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.

Purpose:
the present study was designed to investigate the social representations of trauma and ways in which trauma is defined (i.e., meanings assigned to trauma) and acted on (i.e., reactions or responses) among Palestinians living in protracted conflict situations in the Gaza Strip. Examining potential cultural variations may have implications for the definition of trauma in the current psychiatric nosology, as well as for the design and delivery of clinical and community interventions

Methods:
This is a qualitative exploratory study employing ethnographic interviews with key informants. The interview used a semi structured questionnaire composed of open-ended questions. Informants were asked to describe their daily life and current events in the Gaza Strip. Specific questions elicited local expressions of distress, the meaning of traumatic experiences, the nature of coping strategies, and ways of healing practiced by Palestinians

Results/findings:
The interviews indicated that people in Gaza use three main categories to describe their traumatic experiences: sadma, faji’ah, and musiba. The study also identified local idioms of distress associated with mental ill-health conditions. The relationships among these terms and their meanings are the focus of this article. The study also identified some local expressions used to describe mental suffering and mental ill-health conditions. These idioms are commonly used and are culturally accepted.

Conclusions:
The most widely used frameworks for assessing the psychological suffering of individuals exposed to war, torture, and political violence have centered on the construct of PTSD When applied to non-Western contexts, this approach has given rise to at least two different critiques. The construct of PTSD captures only one aspect of the complex responses of people suffering from recurrent trauma. Collective exposure to trauma and culturally distinctive meanings of trauma may be associated with diverse health outcomes that may require different intervention approaches to address both individual and community levels of distress. The results of this pilot study suggest that the everyday idioms, social representations, and meanings of trauma in the Gaza Strip can be classified into three main types according to the severity and duration of the events, the symptoms associated with the experience, the patterns of resort to treatment, and the potential long-term reactions

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.

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

Acne vulgaris is a common dermatosis affecting 80% of the adolescents,so it is considered as one of the most important disease in dermatology,because of its frequency and of its effects on quality of life,evev in what is considered by most doctors as mild forms.
Effective management of acne remains a challenge .
Hormonal therapy is one of the systemic treatments required for at least 2% of female acne patients whow have signs of the over production of androgens.
Understanding the underlying causes of these signs is very important for better ersults.

Purpose:
To examine the effects of amenorrhea on fertility and pregnancy outcome in women with anorexia nervosa

Methods:
The method used was a model for literature-based theses of Friberg et al (2006). In search of the literature database PubMed was used. Articles were reviewed following the models of Polit et al (2006) and Willman et al (2006) and quality was assessed according to criteria from the SBU (1999). Inclusion and exclusion criteria were formulated. The analysis was conducted in three stages, the selected studies, read the (first stage), similarities and differences were examined (second step), and the results then interpreted and grouped into five different themes (third step).

Results/findings:
The following five themes were identified: (1) Features of anorexia nervosa (AN) is the refusal to maintain body weight for age and height, fear of gaining weight, self-evaluation, press on the weight, shape and appearance (Zerbe 2006). AN is accompanied with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and Cholecystokinin) and leptin are involved in the regulation of human appetite, and in many ways they are changed in AN. AN appears to be a reflection of the female ability to alter maturation rates and reproductive function in response to environmental conditions (Surbey 1987). (2) Amenorrhea: is one of the diagnostic criteria of AN (Rollins et al 1978). It occurs when there is a shortage of calories due to inadequate nutrient intake for the amount of consumed energy
(Laughlin et al 1998). Increased secretion of adrenocorticotropic hormone and proopiomelanocortin seems to be secondary to starvation. Hypothalamic amenorrhea, not only related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone reflects nutritional loss. (Støving 1999). Patients with moderate to severe AN often has a hypoestrogenic amenorrhea, which exposes these patients to osteoporosis and pathological fractures (Yager 2000). Approximately 85% of patients will have spontaneous return of menstruation within six months after reaching a weight of 90% of ideal body weight (Golden 1997) (3) Hormone replacement therapy (HRT): Since AN is accompanied by amenorrhea, HRT used to improve the patient's bone density and begin menstruation. The evidence supports the use of HRT in patients with AN is feeble. Because estrogen induces monthly menstrual bleeding, the anarotic patient may believe that her body works well when it is not. There is a clinical consensus recommends that menstruation does not occur artificially in anorectic patients (Grin Spoon 2002), nutritional stabilization, to prevent bone loss remain the cornerstone of treatment. (4) Spontaneous weight gain: is accompanied by a significant increase in trunk adiposity and estrogen use may not protect against the accumulation of central fat with weight gain (Grin Spoon et al 2001). Several studies have failed to show any positive correlation between the HRT and bone mineral density (Hay 1999, Golden et al 2002). (5) Pregnancy outcome: In severe malnutrition, ovaries seem small, and have no follicles (de Zwaan 1997). The physical appearance of a woman can reveal muscle wasting, minimal breast tissue, and vaginal atrophy. A few of the women cease to menstruate and are not fertile during difficult periods (Bulik 1999). A history of infertility can be an indicator of previous eating disorders. In a study among women who were introduced to treat infertility, showed that as many as 17% had a diagnosed eating disorder (Stewart 1987). Actively ill women and women with a history of AN have a higher rate of miscarriage than healthy women (Gieleghem 2002). A higher rate of caesarean section (Franko et al 2000), a 40% in the number of low birth weight babies and increased incidence of premature delivery (Conti 1998) were reported. Furhermore, Bulik et al (1999) reported no differences between women with a history of AN and controls on rate of pregnancy, mean number of pregnancies per female, or age at first pregnancy.

Conclusions:
Amenorrhoea is a common cause to encourage women to apply for gynecological evaluation. Medical providers should help patients and their families to have access to multidisciplinary care with a mental health provider, dietician, dentist and experienced medical provider. Primary care physicians have a crusial role to note the severity of this chronic mental illnesses while assessing the patient's physical status. Future research aimed at prevention of AN by early identification and education leading to a better understanding of this life-threatening illness

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 .

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

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.