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Indian Pediatr 2019;56: 700 |
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Clippings
Theme: Adolescent Pediatrics
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Preeti M Galagali
Email:
[email protected]
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Population-level impact and herd effects following the
introduction of human papilloma virus vaccination (Lancet 2019;
pii:S0140-6736(19)30298-3. doi:10.1016/S0140-6736(19)30298-3. [Epub
ahead of print])
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This systematic review and meta-analysis of 65 studies covering 60
million individuals from 14 high-income countries with a 9-year
post-vaccine surveillance data of a 3-dose ‘girls only’ Human Papillioma
Virus (HPV) vaccine programs, revealed reduction in prevalence of HPV
16, 18 by 83% (RR 0·17, 95% CI 0·11, 0·25) in girls aged 13-19 years,
and by 66% (RR 0·34, 95% CI 0·23, 0·49) in women aged 20-24 years. For
HPV 31, 33, 45, the reduction was 54% (RR 0·46, 95% CI 0·33, 0·66) in
girls aged 13-19 years. Anogenital warts decreased by 67% (RR 0·33, 95%
CI 0·24, 0·46) in girls aged 15-19 years, 54% (RR 0·46, 95% CI 0.36,
0.60) in women aged 20-24 years, 31% (RR 0·69, 95% CI 0·53, 0·89) in
women aged 25-29 years, 48% (RR 0·52, 95% CI 0·37, 0·75) in boys aged
15-19 years, and 32% (RR 0·68, 95% CI 0·47, 0·98) in men aged 20-24
years. There was a decrease in CIN2+ by 51% (RR 0·49, 95% CI 0·42, 0·58)
in girls aged 15-19 years, and 31% (RR 0·69, 95% CI 0·57, 0·84) in women
aged 20-24 years. Cross protection with non-vaccine serotypes, herd
immunity in older women and boys, and increased protection in countries
with high vaccination coverage and those immunizing multiple age cohorts
were demonstrated.
These results should be extrapolated with caution to
low- and middle-income countries (LMIC) that harbour 85% of the global
cervical cancer load. Nevertheless, this study provides compelling
evidence for the efficacy of HPV vaccine programs, and for planning
similar studies in LMIC. Vaccination is an important strategy to
eliminate cervical cancer under WHO coordinated action plan released in
May 2018.
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Stress and coping among urban school-going adolescents in
India (BMC Psychol. 2019;7:31)
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Poor stress management can lead to mental disorders and suicide. An
exploratory qualitative study was conducted through focussed group
discussions with 191 adolescents belonging to middle and low
socioeconomic status at New Delhi and Goa. Thematic framework analysis
was used to identify causes of stress, impacts and coping strategies.
Common stressors included academic pressure, difficulties in romantic
relationships, negotiating parental and peer influences, violence,
threats to personal safety, and gender discrimination. Stress resulted
in anger, rumination and loss of concentration. Adolescents mainly used
emotion-focused coping strategies (e.g., distraction,
escape-avoidance), and less commonly problem-focused coping (e.g.,
instrumental support seeking). A few used drugs and indulged in
self-harm to overcome stress.
This study highlights the need to provide contextually
relevant counseling to distressed adolescents, and partner with parents,
peers and schools to enhance the repertoire of healthy coping skills.
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Emotion differentiation moderates the
relationship between naturalistic stress exposure and adolescent
depression (Emotion. 2019. doi:10.1037/emo0000630. [E
Pub Ahead of Print])
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Emotional intelligence is integral to health and psychosocial
well-being. This longitudinal study conducted in USA over 1.5 years on
233 adolescents aged 13 to 17 years explored the association between
negative emotion differentiation (NED), stressful life events (SLE) and
depression. NED is the ability to identify and label discrete negative
emotions. NED, depression and SLE were assessed using a semi-structured
interview with diagnosis-blind team coding based on the contextual
threat method. Using descriptive analysis and bivariate correlation, it
was determined that a low NED is depressogenic in the context of a
highly stressful environment.
Labelling negative emotions is a prerequisite for
learning coping skills. For distressed adolescents, especially those in
conflict zones and victims of natural disasters and abuse, nurturing a
high NED would prevent the onset of depression.
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