Although the scarcity of both inancial and human re- sources limits what can be provided, this paper outlines several options for using existing resources in Brazil more eficiently. Overall, the following four main actions are recommended: (1) to increase capacity building around child and adolescent mentalhealth care for health pro- fessionals already working in the public health system; (2) to improve the curriculum for undergraduate training of healthcare workers, especially psychologists, to bet- ter prepare them to assist childrenandadolescents with mentalhealth problems in the public health system; (3) to increase the number of specialized psychologists and child psychiatrists in the public system, offering them higher salaries and better career opportunities; (4) to favor intersector collaboration (e.g. health, education, juvenile justice, child welfare) to more effectively assist childrenandadolescents with mentalhealth problems. Addressing these gaps in the current system could have immediate impacts on access to care for many childrenandadolescents in need. Although these types of struc- tural modiications could ameliorate problems with access to care, additional barriers must be taken into account, including cultural beliefs related to mentalhealth (e.g., beliefs in the inluence of evil spirits); stigma; a lack of awareness about mental disorders among parents, teachers andhealth professionals; a lack of information about exist- ing public services; a lack of transportation or inexistence of services near the chidren's househod; inancial costs for the family; and a lack of trust or fear regarding treatment. Finally, the lack of research focused on child and ado- lescent mentalhealth services must be addressed. Although some studies have emerged, data in this ield remains scarce. 13,45 Future research must be encouraged to create a
Severe physical punishment of childrenandadolescents by mother and/or mother’s husband or partner is frequent in the studied community. Child mentalhealth problems and mother childhood experience of harsh physical punishment are both correlates of severe physical violence against childrenandadolescents in the family environment. Therefore, when intrafamilial violence occurs, child/adolescent mentalhealth may be compromised. Despite the impossibility of establishing sequence in time when examining child mentalhealth problems and maltreatment in a cross-sectional study, child mentalhealth status must be addressed when dealing with intrafamilial violence. In addition, another impact of suffering physical abuse in childhood to be considered is the increased risk of victims becoming perpetrators in the next generation. Study results indicate the urgent need of larger population- based studies to identify factors associated with intrafamilial violence against childrenandadolescents in different regions of Brazil. It could help the development of intervention models sensitive to local community characteristics.
the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K- SADS-PL) based on mother/main caregiver report. K- SADS-PL is a semi-structured psychiatric interview that ascertains diagnostic status based on DSM-IV criteria including five diagnostic groups: (i) affective disorders (depression disorders [major depression, dysthymia] and mania, hypomania); (ii) psychotic disorders; (iii) anxiety disorders (social phobia/agoraphobia/specific phobia/obses- sive-compulsive disorder/separation anxiety disorder/gener- alized anxiety disorder/panic disorder/posttraumatic stress disorder); (iv) disruptive behavioral disorders (ADHD/con- duct disorder/oppositional defiant disorder); and (v) substance abuse, tic disorders, eating disorders, and elimination disorders (enuresis/encopresis) . Evidence of convergent validity of the Brazilian version of the K-SADS-PL was found by comparison to the Child Behavior Checklist (CBCL) . In addition, K-SADS-PL is one of the few validated diagnostic instruments in Brazil to measure psychiatric disorders in childrenandadolescents. For the present study, any psychiatric disorder was defined as children/adolescents having one or more of the disorders included in these five psychiatric diagnostic groups (excluding enuresis/encopresis) in the past 12 months.
Accumulating data suggest that skipping meals is associated with snaking eating among childrenandadolescents. The study by Gayle Savige et al. showed that students who eat snack food mostly are more likely to skip meals (6). Students reported many reasons that contributed to skip meals such as watching television, playing computer games or reading books (12). Previous study indicated that having a little time in the morning and not feeling hungry were two major reasons for skipping breakfast among Australian pupils (13). Unhealthy snacking behavior is particularly prevalent among childrenandadolescents that have a high level of fat, sugar, and low level of essential micronutrients. The results of Lien et al’s study indicated that there is a significant relationship between soft drink consumption andmentalhealthand conduct problems (14). Also, data showed that mental problems like anxiety, dizziness, and worthless is common among adolescents who consumed mostly soft drinks, sweets, chocolate and other unhealthy foods (8, 15). This association was observed between high intakes of salty snacks, sweets, and cakes with violent behaviors among adolescents (16).
Bullying and conduct behaviours. Items measuring at school and cyber bullying assessed past 12 months occurrence, and were adapted from the World Health’s Organization’s Health Behaviour of School-aged Children (HBSC) study [4,17]. Bullying was defined as repeatedly being teased by one or more people, being hurt or upset, or being left out of thing on purpose . Students were asked if they were bullied at school since September. Response options included (1) was not bullied at school since September; (2) physical attacks (for example, beat you up, pushed or kicked you); (3) verbal attacks (for example, teased, threatened, spread rumours about you); (4) stole from you or damaged your things. Options 2 through 4 were combined to ensure sufficient cases. Cyber bullying was measured by asking, ‘‘In the last 12 months, how many times did other people bully or pick on you through the Internet?’’ Response options included (1) don’t use the internet; (2) never; (3) once; (4) 2 or 3 times; (5) 4 or more times. Options 1 and 2, and 3 through 5 were combined to represent having been cyber bullied. Students were also queried if they bullied other students since September. Response options included (1) did not bully other students since September; (2) physical attacks (for example, beat up, pushed or kicked them); (3) verbal attacks (for example, teased, threatened, spread rumours about them); (4) stole from them or damaged their things. Options 2 through 4 were combined.
common in the west, and over the world. In 2012, the European Union Youth (EUY) reported that 10-20% of young people suffer from mental illnesses while one out of five struggles are related to emotional and behavior problems 21 . As it is known, majority of adolescents in the world are healthy, though 20% may experience mentalhealth issues 22 . In a recent survey, it was reported that almost 15-20% of Norwegian children aged between 3-17 have had less functioning abilities due to mental problems such as anxiety, depression, and behavioral disorders 1 . In total, due to the psychological and biological changes there are more psychological challenges around adolescents 1 . During the growth process, children might face some pressures from the family, school and other social settings that expect them to display good performance, and adjust rapidly with changing developments in the society 8,10 . This is very challenging for children, their teachers, and their parents for achieving positive mental healthy mindsets 23 .
The family members included nine mothers, two aunts, and one father, ranging from 23 to 45 years of age; two were illiterate, seven had eight or less years of education, and four had more than eight years of education; three were employed, one was unemployed, and eight were homemak- ers. Half of the families lived in the municipality under study and the other half lived in other mu- nicipalities in the state. The chronic diseases of these children/adolescents included thalassemia; asthma; chronic renal failure; laryngotracheo- malacia requiring tracheostomy; liver cirrhosis; chronic liver disease; HIV; Tay-Sachs disease; congestive heart failure; heart disease; rheumatic fever; mental retardation; cerebral palsy; esoph- ageal atresia; systemic lupus erythematosus; tu-
The Pediatric Quality of Life Inventory (PedsQL) is a pediatric general health profile instrument, developed by Varni and colleagues and specifically designed for use with adolescentsandchildren . The PedsQL is a validated measure of depressive symptoms in young adolescents, and is used as an assessment measure for children’s mentalhealth . The outcome variable was the emotional functioning subscale of the PedsQL. This variable comprised summed scores on the questions ‘‘I feel afraid or scared’’; ‘‘I feel sad’’; ‘‘I feel angry’’; ‘‘I have trouble sleeping’’; ‘‘I worry about what will happen to me’’ (0 if it is never a problem; 1 if it is almost never a problem; 2 if it is sometimes a problem; 3 if it is often a problem; 4 if it is almost always a problem). These items are reversed scored and linearly transformed to a 0–100 scale, such that higher scores indicate better quality of life. PedsQL scores were normally distributed and z-scored standardised to yield eventual beta coefficients interpretable as standard deviations (b-z).
Regarding dental injury, dental trauma was the most common type, different from the result obtained by Gassner et al. (7). Munante Cardenas et al. (4) found a prevalence of tooth avulsion as dental injury. Spring and Cote (18) reported that dentoalveolar factures were more frequent, which are often excluded from statistical studies on facial trauma. In this study, nasal fractures were also more common, in agreement with the findings of Anderson (19). In the opposite direction, several studies observed mandible fractures as the most frequent (4-6,9). Keniry (20) states that the mandible is the bone most commonly affected by fractures, whereas those of the zygoma are rare.
or when the imaging exams suggested the disease in symptomatic patients. Latent tuberculosis infection was diagnosed in asymptomatic patients who had been in contact with the disease and whose tuberculin skin test (TT) was positive (≥5mm in children aged 2 years or more or those with any immunosuppressive condition; and ≥10mm in children younger than 2 years of age). All children had received the BCG vaccine at birth. Latent tuberculosis infection was also diagnosed when the active disease was not confirmed in patients whose TT was positive, but with no index case identified.
The indigenous adolescent population that wishes to pursue studies must move to educational centers located in the nearest cities. For young people this causes several changes, because they must adapt to the urban life, urban youth groups and the lyceum. Since they have few economic resources, urban insertion takes place in the poorest areas of the city where they can find a place to live and study. In these areas there is an urban subculture marked by the territorial control of youth gangs, who exercise violence as a means to prevail and gain respect from the population and its adversaries. Therefore, the process of socialization occurs not with the Western culture, but with the juvenile culture of the favela, with its urban music, the game of dominoes and gambling, and also with urban drugs, alcohol and violence component, which they would take with them to return to their communities of origin.
puberty development among the boys in the sample, the analyses made on the results of the 1st year of the study permit to conclude that boys and girls with a higher level of pubertal development try-out tobacco smoking at an earlier age. On the other hand, even if it is possible to identify a tendency towards a fatty food diet and higher levels of physical exercise among boys, the girls seem to be more sensitive to higher levels of emotional stress with the emergence of pubertal transformations. The authors have not managed to prove the hypothesis according to which the interaction between puberty stage andhealth behaviours would be mediated by the youngster’s stress levels and psychological difficulties. Finally, Fulkerson et al. (2004) identified a significant association between depressive symptoms (measured through a dimensional psychometric instrument) and a set of health risk attitudes and behaviours (preoccupations about weight associated with resistance to a balanced diet, disordered eating behaviour and substance use) among the secondary students of both sexes enrolled in their study (which average age is 14.9 for boys and 14.7 for girls). It should be pointed out that among girls there is a proportional correlation between the levels of depressiveness andhealth risk behaviours whereas among boys the authors identify a “threshold effect” which separates, for the same variables, the adolescents who belong to the subgroups with a moderate/high level of depressive symptoms from those who belong to the subgroup with a low level of depressive symptoms;
Methods: Retrospective study of children enrolled in a family health unit (FHU), evaluated at the last health surveillance visit who are 3 years of age or older. Demographic and anthropometric data and the last blood pressure values were analysed as well as the existence of an association between overweight and obesity and hypertension using Excel ® and SPSS ® . Results: A sample of 1,625 was obtained, 14.7% of the patients were overweight and 9.4% were obese. Blood pressure was evaluated in 1,325 patients (81.5%), of who 6.9% had blood pressure values from 90th to <95th percentile or blood pressure equal or exceeding 120/80 mmHg in adolescents; 2.4% had blood pressure from 95th percentile to the 99th percentile plus 5 mmHg and 0.2% had blood pressure above the 99th percentile plus 5 mmHg. We found an association between overweight and obesity and blood pressure values ≥ P90 (p < 0.001); there was a strong association between overweight or obesity and blood pressure values ≥ P95 (adjusted residues 3.6); children without overweight or obesity had a strong association with normal blood pressure values (adjusted residues 5.0). Discussion: About 25% of the sample are overweight or obese, 10% have blood pressure ≥ P90 and there is a statistically significant association between overweight or obesity and increased blood pressure values. Lifestyle change and weight control are crucial to avoiding the early development of hypertension.
Other barriers and facilitators that were identified in this review also emphasize the importance of user-centered design methods when developing DHIs for CYP . Through co-design workshops and focus groups with CYP, developers can ensure that a DHI’s design is age appropriate, (eg, little text and using youth-engaging language) by putting a greater focus on videos and pictures, while keeping the platform user friendly. Moreover, CYP mentioned factors such as reward systems and reminders, which fall under the umbrella of persuasive design methods and have been explored in previous research [36,79]. The positive influence of these methods on user engagement and adherence to DHIs has been supported; however, quantifiable evidence from trials is still lacking [36,79]. With respect to reminders, past research has indicated a positive impact on engagement. However, excessive and undue reminders have also been shown to have opposing effects . Evidence from previous studies has suggested that specific behavior change techniques, such as goal setting or self-monitoring tools, relate to higher engagement . This review did not extensively investigate these techniques and therefore cannot fully suggest their potential positive effects on the engagement of CYP. However, the findings of this review justify that designing DHIs with CYP in mind would be ideal to promote usage, adherence, and positive user experience and to address the barriers that some of the reviewed studies suggest. Comparison of Research Retention Rates With Other Studies
Objecive: To idenify the risk factors as- sociated with mentalhealth issues in ado- lescents. Method: An integraive review was conducted in four databases with pu- blicaions from 2007 to 2013. The terms Adolescent andMentalHealth were used to search adequate aricles as DeCs/MeSH bases. Results: Publicaions were found in diferent journals in diferent ields of knowledge and the quanitaive research was the most frequent. The mentalhealth issues were categorized as individual fac- tors; drug related factors, school factors, family factors, social factors and STDs/Aids related factors. The most addressed cate- gory was individual factors, with 23 publi- caions. Conclusion: The integraive review allowed to point important quesions to be addressed in prevenive acions by the health professional, including the nurse, to create a space that works with risk condi- ioning factors in adolescents for mentalhealth aggravaion.
using the pain subscale of the Taiwanese QOL Questionnaire for Adolescents. The severities of depression, suicidality, anxiety, and alcohol abuse were also examined. Objectives: This study examined the associations between pain-related quality of life (QOL) and sociodemographic characteristics and those between pain-related QOL andmentalhealth problems such as depression, suicidality, anxiety, and alcohol abuse. Methods: The association of sociodemographic factors with pain-related QOL was examined through multiple regression analysis. The association of pain-related QOL with mentalhealth problems was examined through logistic regression analysis. Results: The boys exhibited a higher level of satisfaction with pain-related QOL than did the girls. Older age was significantly associated with a lower level of satisfaction with pain-related QOL. Residential background, parental marital status, and parental education levels were not significantly associated with the level of satisfaction with pain-related QOL. Increased risks of depression, suicidality, anxiety, and alcohol abuse were significantly associated with a low level of satisfaction with pain-related QOL. Discussion: A low level of satisfaction with pain-related QOL is significantly associated with the risk of poor mentalhealth. Adolescents with the correlates of low satisfaction with pain-related QOL should be monitored for the risk of mentalhealth problems.
Subjective sleep quality is assessed in the PSQI by questioning during the past month how would you classify your sleep quality, as “very good”, “good”, “bad” or “very bad”. From the seven domains of the PSQI, is considered the most “qualitative” subscale (Buysse et al., 1989, Buysse et al., 2008). This could help explain why in the present model with the three countries it was not associated to depression, anxiety nor stress. As well, since ours is a non-clinical population, the levels of depression, anxiety and stress are low which could underestimate the effect of this subjective aspect of sleep quality. Previous studies confirmed that different people interpret their sleep quality through different aspects of sleep, such as, sleep duration (Bastien et al., 2003), sleep latency (Kecklund et al., 2003), day sleepiness (Hayley et al., 2013), daily mood and physical feelings on waking (Webb et al., 1976), among others. Thus, how people interpret their sleep quality may relate to other aspects of people´s life besides the mentalhealth complaints (e.g., age and gender (Kaplan et al., 2017; Mellor et al., 2014), pre-existing physical andmentalhealth (Chen et al., 2005), economic and working status (Arber et al., 2009; Chen tel al., 2005) and country of origin (Hollan, 2013)). For instance, in our sample, when analyzing each country, subjective sleep quality relates to depression in the Spanish population, and to stress in the Portuguese population. As well, the influence of country on the relationship between subjective sleep quality andmentalhealth was significant only when comparing Portuguese and Brazilians, and in the case of stress. That is, although subjective sleep quality was not significantly associated in the all sample to mentalhealth, the way it related to stress it was different between Portuguese and Brazilians.
The child or adolescent and the respective parent/guardian were interviewed so as to obtain identification and sociode- mographic data, such as: name, sex, age, date of birth, origin, birthplace, household income, number of family members, and school data. Also during the interview, we obtained informa- tion about clinical data of the child/adolescent. Having these data, we collected objective and subjective information regard- ing the signs and symptoms of the nursing diagnosis Impaired Comfort, presented by the childrenandadolescents, namely: Anxiety, Crying, Inability to relax, Restlessness, Irritability, Grief, Fear, Disturbed sleep pattern, Report of lack of satisfaction with the situation, Report of lack of feeling comfortable with the situ- ation, Report of hunger, Report of pruritus, Report of feeling hot, Report of feeling cold, Report of feeling uncomfortable, Report of symptoms of distress, and Sighs.