•Longitudinal multilevel-models.•Decrease in all dimensions of scholastic well-being in the course of the first year in secondary education.•Gender differences in initial values and changes in ...several dimensions of scholastic well-being.•Educational track as strongest influencing factor on positive attitudes towards school and scholastic self-concept.•Lower social problems, physical complaints and worries of students in girls’ schools.
Scholastic well-being is highly relevant, as it is connected with achievement and successful coping with critical life events. Since well-being in school is a multidimensional construct, it is necessary to analyze trajectories of these multiple dimensions to get a deeper understanding of changes and influencing factors. The empirical base for differential development of scholastic well-being for girls and boys, students with and without migration background and students attending medium and academic educational tracks is inconsistent. Additionally, there is a lack of findings regarding students’ well-being in co-educational versus single-sex schools. Therefore, the current study aims at analyzing changes in all six dimensions of scholastic well-being during the 5th grade for specific groups of students (boys and girls, students with and without migration backgrounds, students attending medium and academic educational tracks and in co-educational versus single-sex schools). Based on a sample of N = 1,042 students in Catholic schools (80.5% female, 25.8% with migration background, 48.9% in a medium educational track, 54.3% in single-sex schools) who participated in three measurement time points, longitudinal multi-level analyses were calculated. Results reveal a decrease in all dimensions of scholastic well-being over time. Additionally, they illustrate the causal role of time-stable covariates, such as gender, educational track, migration background, and co-educational versus single-sex schooling. The results show slightly different trajectories for male and female students. Thus, the presented study builds upon results of previous studies by providing further information on short-term changes of scholastic well-being and different trajectories for specific groups of students.
Despite rapid modernization and improving gender equity in China in recent decades, traditional values prevail in many areas of life, including sexual behavior. This study aimed to explore gender ...differences in sexual knowledge, sexual attitudes and sexual behaviors, as well as preferences for sex education among undergraduates in China.
A cross-sectional study surveyed 5965 undergraduates (62.8% females), aged 15 to 24 years from nine universities in Zhejiang, Henan and Yunnan provinces, from September to November 2019.
Of the total sample, 158 (2.6%) self-identified as homosexual, 287 (4.8%) as bisexual and 324 (5.4%) stated they were unclear about their sexual identity. The mean sexual knowledge score out of 12 was 6.16 ± 2.54 points. Ever having sexual intercourse was reported by 18.7% (27.0% males, and 13.9% females). Students from urban backgrounds, and those with homosexual and bisexual orientation were more likely to have had sexual intercourse. Most students (72.5%) reported that they would prefer to receive sex education from on-line sources.
Female students are significantly more conservative in sexual attitudes and sexual behaviors. Low levels of sexual knowledge contribute to risk behaviors among Chinese adolescents. China needs to develop and widely disseminate on-line sex education, with practical, age-appropriate content.
Women's empowerment has a direct impact on maternal and child health care service utilization. Large scope measurement of contraceptive use in several dimensions is paramount, considering the nature ...of empowerment processes as it relates to improvements in maternal health status. However, multicountry and multilevel analysis of the measurement of women's empowerment indicators and their associations with contraceptive use is vital to make a substantial intervention in the Sub-Saharan Africa context. Therefore, we investigated the impact of women's empowerment on contraceptive use among women in sub-Saharan Africa countries.
Secondary data involving 474,622 women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 32 Sub-Saharan Africa region was used in this study. Contraceptive use was the primary outcome variable. Multilevel analysis was conducted to examine the impact of women's empowerment on contraceptive use. Percentages were conducted in univariate analysis. Furthermore, multilevel logistic regression models were used to analyze the association between individual, compositional and contextual factors of contraceptive use.
Results showed large disparities in the number of women who reportedly ever use contraceptive methods; this range from as low as 6.7% in Chad and as much as 72% in Namibia. More than one-third of the respondents had no formal education and more than half were active labor force. Contraceptive use was significantly more common among respondents from the richest households (28.5% versus 18.9%). Various components of women's empowerment were positively significantly associated with contraceptive use after adjusting for demographic and socioeconomic factors. There was a significant variation in the odds of contraceptive use across the 32 countries (σ
= 1.12, 95% CrI 0.67 to 1.87) and across the neighbourhoods (σ
= 0.95, 95% CrI 0.92 to 0.98).
Our findings suggest that an increase in contraceptive use and by better extension maternal health care services utilization can be achieved by enhancing women's empowerment. Also, an increase in decision-making autonomy by women, their participation in labour force, reduction in abuse and violence and improved knowledge level are all key issues to be considered. Health-related policies should address inequalities in women's empowerment, education and economic status which would yield benefits to individuals, families, and societies in general.
Background
Children with adverse childhood experiences (ACEs) are more likely to develop Attention‐Deficit/Hyperactivity Disorder (ADHD). The reverse relationship – ADHD predicting subsequent ACEs – ...is vastly understudied, although it may be of great relevance to underserved populations highly exposed to ACEs.
Methods
Participants were 5‐ to 15‐year‐olds (48% females) with (9.9%) and without ADHD (DSM‐IV criteria except age of onset) in a longitudinal population‐based study of Puerto Rican youth. In each wave (3 yearly assessments, W1‐3), ten ACEs (covering parental loss and maladjustment and child maltreatment) were examined, plus exposure to violence. Logistic regression models examined ADHD (including subtypes) and subsequent risk for ACEs. Also considered were interactions by age, sex, number of W1 ACEs, and recruitment site.
Results
Children with W1 ADHD were more likely to experience subsequent adversity (OR: 1.63; 95% CI: 1.12–2.37) accounting for child age, sex, public assistance, maternal education, site, disruptive behavior disorders, and W1 ACEs. Inattentive (OR: 2.00; 95% CI: 1.09–3.66), but not hyperactive/impulsive or combined ADHD, predicted future ACEs.
Conclusions
ADHD predicts subsequent risk for ACEs, and the inattentive presentation may confer the most risk. Inattentive presentations could pose a bigger risk given differences in symptom persistence, latency to access to treatment, and treatment duration. The present study suggests a pathway for the perpetuation of adversity, where bidirectional relationships between ADHD and ACEs may ensnare children in developmental pathways predictive of poor outcomes. Understanding the mechanism underlying this association can help the development of interventions that interrupt the cycle of adversity exposure and improve the lives of children with ADHD.
As the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban ...student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills.
From April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record.
USP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit.
Results suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care.
Gaps still exist in medical education about the sexual health needs of sexual diverse populations, and little is known about how translatable current learning modules are to patient encounters. ...Efforts at an academic medical institution have been made to address this need, including a two-hour adolescent sexuality workshop during the Core Clerkship in Pediatrics. This workshop's efficacy was evaluated in an objective structured clinical examination (OSCE) given to rising fourth-year medical students, where the standardized patient case focused on an adolescent cisgender male with dysuria and in a new, same-sex relationship.
Performance of students who completed the workshop prior to the OSCE (n = 48) were compared to those of students who did not participate in the workshop prior to the OSCE (n = 17). The encounters were recorded and transcribed, and the deidentified transcripts were scored on a rubric focusing on five domains: sexual identity disclosure, behavioral assessment, psychosocial history, counseling and anticipatory guidance, and relationship building.
Student's t-test comparison of the scores found significantly higher scores for the psychosocial history domain (p = .04), particularly concerning disclosure of a new boyfriend and recent sexual activity (p = .008), for students who had the workshop before the OSCE.
Students who took the adolescent sexuality workshop performed better in gathering psychosocial information in an OSCE encounter a sexual minority adolescent. These results affirm prior work that active learning on sexual diverse health in medical school curricula may prepare students for effective engagement with adolescents exploring their sexuality.
Integrating digital technologies into sexual health education can offer advantages for connecting with adolescents, particularly populations who may be underserved through common school-based ...approaches. This study assessed the effectiveness of In the Know, an in-person, group-based sexual health education program integrating digital technologies, codesigned with adolescents.
The study design was a cluster randomized trial with 1,263 adolescents aged 13-19 in 95 cohorts, implemented in community-based organizations and schools throughout Fresno County, California. Participants completed a baseline survey and a follow-up survey 3 months later. Two-level mixed-effects regression models with random intercepts for cohort were used to estimate the intervention's impact on unprotected sex, use of clinical health services, knowledge of local sexual health services, technology use to find or schedule services, and sexual health knowledge at the 3-month follow-up.
The average age of participants was 15.7 years, and the majority identified as Hispanic (71%). In adjusted analyses, intervention group participants were more likely to use clinical services (42.7% vs. 33.2%, p = .009) and reported greater sexual health knowledge at 3 months (57.6% of items answered correctly vs. 50.7%, p = .001). No significant differences were observed in the other outcomes by study group.
In the Know participants demonstrated greater use of clinical health services and sexual health knowledge at 3 months. The study findings show the potential for incorporating user-centered design and technology into sexual health education to better support adolescents who may have limited access to this important information.
Abstract
Background
Pneumonia is a leading cause of death worldwide. It is a particularly serious burden in older people, as they tend to have a weakened immune response. Identifying the role of oral ...self-care and pneumococcal vaccination in healthy, independent older people can aid pneumonia prevention among them. This study investigated the associations between oral self-care, pneumococcal vaccination, and pneumonia experience among independent older people.
Methods
This cross-sectional study used data from the 2016 Japan Gerontological Evaluation Study. We used machine learning to examine the association between oral self-care and the experience of pneumonia over the previous year, stratified by pneumococcal vaccination. The covariates were sex, age, years of education, equivalent annual income, medical history of stroke, oral health status (choking, dryness, number of teeth), and smoking status. The analysis included 17 217 independent older people aged 65 and over.
Results
The prevalence of pneumonia experienced among those who brushed their teeth once or less per day was 4.5% and 5.3% for those with and those without pneumococcal vaccinations, respectively. In the unvaccinated group, the odds ratio of pneumonia experience for those who brushed their teeth once or less a day was 1.57 (95% confidence interval: 1.15–2.14) compared to those who brushed their teeth 3 or more times a day. By contrast, there was no significant association between the frequency of toothbrushing and the experience of pneumonia among people who received pneumococcal vaccination.
Conclusions
Oral care influenced the experience of pneumonia among independent older people who did not receive pneumococcal vaccination.
Introduction: The lack of accurate and timely sex education would endanger the physical and mental health of adolescents. Parents play an important role in the sexual education of adolescents, but ...they meet some challenges especially in Iran. The aim of this study was to describe the experiences and perceptions of parents' challenges of sexual education of male adolescents. Method: This qualitative study was conducted using content analysis method in 2016. Data were collected by semi-structured group interviews with 25 parents of 10-19-year-old adolescents who were living in Ahvaz and selected using purposive sampling method. Data were analyzed by qualitative content analysis. Results: After data analysis, 29 codes, 7 sub-themes (contradiction of parental views, parental confusion, barriers to communication with adolescents, the multiplicity and complexity of the sources of sexual information, cultural taboos, the lack of understanding of the need for sexual education, the missed role of school in sexual education) and one main theme (challenges of sexual education in male adolescents) were obtained. Conclusion: The results of this study show that parents had inadequate skills in communicating with male adolescents, most of which derived from cultural taboos such as shame and hide and fear of breaking divorce between parents and adolescents. Therefore, the parental empowerment for the sexual education of adolescents with institutionalizing formal sexual education in the form of child-rearing practices is essential.
There are insufficient epidemiological studies on the impact of age at first sexual intercourse (AFS) and age at first live birth (AFB) on postpartum depression (PPD) in pregnant women, and the ...conclusions of these studies are inconsistent.
We performed a Mendelian randomization (MR) study to determine the causal relationship between AFS or AFB and the risk of PPD. The summary data were extracted from genome-wide association study (GWAS) summary datasets. We selected the instrumental variables according to the
value of exposure-related single nucleotide polymorphisms (
<5 ×10
for AFS and
<5 ×10
for AFB) and estimated the linkage disequilibrium using the clump parameter (10,000 kb, r
< 0.001). Single nucleotide polymorphisms were considered instrumental variables that were significantly associated with exposure factors without linkage disequilibrium. The F-statistics of the instrumental variables should all be larger than 10. A random-effects model of IVW was constructed as the main method in our study.
MR studies based on GWAS data revealed that both AFS (OR = 0.4,
0.001) and AFB (OR = 0.38,
0.001) were negatively correlated with the risk of PPD. Early AFS and early AFB should be studied as possible risk factors for PPD in the future. Public health departments should attach importance to sex education for young girls. The results of our TSMR should be verified by high-quality prospective epidemiological studies in the future.
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