Public Health Commons^™

Predictive Modeling Of Influenza In New England Using A Recurrent Deep Neural Network, Alfred Amendolara

Theses

Predicting seasonal variation in influenza epidemics is an ongoing challenge. To better predict seasonal influenza and provide early warning of pandemics, a novel approach to Influenza-Like-Illness (ILI) prediction was developed. This approach combined a deep neural network with ILI, climate, and population data. A predictive model was created using a deep neural network based on TensorFlow 2.0 Beta. The model used Long-Short Term Memory (LSTM) nodes. Data was collected from the Center for Disease Control, the National Center for Environmental Information (NCEI) and the United States Census Bureau. These parameters were temperature, precipitation, wind speed, population size, vaccination rate and …

Psychoeducation “Aku Peduli” For Parent With Typically Developing Children At An Inclusive Kindergarten, Andi Nur Zamzam Arman, Farida Kurniawati

ASEAN Journal of Community Engagement

This study examined the effectiveness of “AKU PEDULI” psychoeducation in helping the parents of typically developing children to increase their knowledge of special needs children and inclusive education at an inclusive kindergarten. “AKU PEDULI” is abbreviated from Anak Berkebutuhan Khusus dan Pendidikan Inklusif (Special Needs Children & Inclusive Education). Quantitative methods were used in both the pre-test and post-test parts of the research. Six mothers aged 28–34 years, of typically developing children were selected to participate in the study through accidental sampling. Participants were required to be parents of typically developing children who attend an inclusive kindergarten and who have …

Histopathological Diagnosis Of Diseases Affecting Amphibians Inhabiting Kihansi Gorge, Tanzania, Joshua J Malago

Tanzania Journal of Science

Kihansi gorge is a natural habitat to Kihansi spray toad (KST), Nectophrynoides asperginis. The toad is extinct in its natural habitat partly due to diseases. Efforts to successfully re-introduce it are primed by awareness and mitigation of prevalent diseases at the gorge. This study aimed at exploring the prevalent amphibian diseases at and around Kihansi gorge. A total of 182 individuals from Petropedetes yakusini (n = 60), Nectophrynoides tornieri (n = 60) and Leptopelis uluguruensis (n = 62) species were collected, humanely sacrificed, fixed in formalin, routinely processed, sectioned, stained with haematoxylin and eosin and analysed for diseases by histopathology. …

Mers-Cov Infection In South Korea And Strategies For Possible Future Outbreak: Narrative Review, Chulwoo Park

Faculty Publications

Although there were some positive viewpoints from international press and academia that the Republic of Korea (hereafter South Korea) successfully controlled the Middle East Respiratory Syndrome (MERS) outbreak in 2015, the domestic point of view towards the MERS response in South Korea was critical. As people in the world’s 11th largest economy, South Koreans criticized the failure of hospitals’ initial response to the MERS index case and the lack of a proper control strategy for secondary and tertiary cases. To contain the MERS outbreak, South Korea implemented mainly three MERS control and intervention strategies: quarantine and isolation system, temporary closure …

Efek Asi Eksklusif Terhadap Stunting Pada Anak Usia 6-59 Bulan Di Kabupaten Bogor Tahun 2019, Hardya Gustada Hikmahrachim, Rinawati Rohsiswatmo, Sudarto Ronoatmodjo

Jurnal Epidemiologi Kesehatan Indonesia

Stunting, atau perawakan pendek, berhubungan erat dengan hambatan kemampuan kognitif dan kualitas hidup. Prevalensi stunting di Indonesia mencapai 30,8% tahun 2018. Stunting dipengaruhi pemenuhan nutrisi di awal kehidupan, salah satunya melalui ASI eksklusif. Meskipun cakupan ASI eksklusif di Indonesia sudah 74,5%, hubungan stunting dengan ASI eksklusif seringkali tidak konsisten akibat keberagaman kuantitas dan kualitas ASI. Penelitian ini ingin mengetahui efek ASI eksklusif terhadap stunting di Kabupaten Bogor, sebagai salah satu daerah tinggi stunting di Indonesia. Penelitian dengan desain potong lintang ini dilaksanakan di Puskesmas Kecamatan Ciampea, Kabupaten Bogor, pada Februari sampai April 2019. Kriteria inklusi adalah balita usia 6-59 bulan …

Violent Conflict And Breastfeeding: The Case Of Iraq, Vidya Diwakar, Michael A. Malcolm, George Naufal

Economics & Finance Faculty Publications

Background: This study explores the relationship between armed conflict and breastfeeding practices of Iraqi mothers. To date, the relationship between violent conflict and breastfeeding is surprisingly understudied. Especially in the Middle East, which is conflict-prone and has a young population, research on war and household behavior is critical for promoting recovery and sustainable development. Methods: This study employs a unique pairing of the Iraq Body Count Database and the 2006 and 2011 Multiple Indicator Cluster Surveys for Iraq. We use probit models to explore the association between armed conflict and several breastfeeding outcomes – whether a child was ever breastfed, …

Social Ecological Factors Affecting Substance Abuse In Ghana (West Africa) Using Photovoice, Ahmed Kabore, Evans Afriyie-Gyawu, James Awuah, Andrew R. Hansen, Ashley Walker, Melissa Hester, Moussa Aziz Wonadé Sié, Dhruv Medarametla, Nicolas Meda

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Introduction: substance abuse is an important public health issue affecting West Africa; however, there is currently a dearth of literature on the actions needed to address it. The aim of this study was to assess the risks and protective factors of substance abuse in Ghana, West Africa, using the photovoice method.

Methods: this study recruited and trained 10 participants in recovery from substance abuse and undergoing treatment in the greater Accra region of Ghana on the photovoice methodology. Each participant received a disposable camera to take pictures that represented the risk and protective factors pertinent to substance abuse …

Intervention For Cognitive Reserve Enhancement In Delaying The Onset Of Alzheimer's Symptomatic Expression (Increase), A Randomized Controlled Trial: Rationale, Study Design, And Protocol, Daniela C. Moga, Brooke F. Beech, Erin L. Abner, Frederick A. Schmitt, Riham H. El Khouli, Ashley I. Martinez, Lynne Eckmann, Mark Huffmyer, Rosmy George, Gregory A. Jicha

Pharmacy Practice and Science Faculty Publications

BACKGROUND: The course of Alzheimer's disease (AD) includes a 10-20-year preclinical period with progressive accumulation of amyloid β (Aβ) plaques and neurofibrillary tangles in the absence of symptomatic cognitive or functional decline. The duration of this preclinical stage in part depends on the rate of pathologic progression, which is offset by compensatory mechanisms, referred to as cognitive reserve (CR). Comorbid medical conditions, psychosocial stressors, and inappropriate medication use may lower CR, hastening the onset of symptomatic AD. Here, we describe a randomized controlled trial (RCT) designed to test the efficacy of a medication therapy management (MTM) intervention to reduce inappropriate …

Hubungan Wilayah Tempat Tinggal Dengan Pemberian Asi Ekslusif Pada Anak 0-5 Bulan Di Indonesia (Analisis Data Survei Demografi Kesehatan Indonesia) Tahun 2017, Andi Karnila, Krisnawati Bantas

Jurnal Epidemiologi Kesehatan Indonesia

ASI ekslusif dapat mencegah morbiditas dan mortalitas pada anak. Wilayah tempat tinggal perkotaan dan pedesaan memiliki keterkaitan dengan praktek pemberian ASI ekslusif. Penelitian ini bertujuan untuk menganalisis hubungan antara wilayah tempat tinggal dengan praktek pemberian ASI ekslusif pada anak 0-5 bulan di Indonesia. Desain studi penelitian yaitu cross sectional menggunakan data sekunder Survei Demografi Kesehatan Indonesia. Penelitian ini dilaksanakan diseluruh provinsi di Indonesia. Variabel dalam penelitian ini terdiri dari ASI ekslusif sebagai variabel dependen, wilayah tempat tinggal sebagai variabel independen dan variabel perancu yang terdiri dari umur ibu, pendidikan ibu, paritas, kondisi depresi ibu, status bekerja, status ekonomi, status pernikahan, …

Pemberantasan Sarang Nyamuk 3m Plus Terhadap Kejadian Demam Berdarah Dengue Di Puskesmas Payung Sekaki Kota Pekanbaru; Studi Kasus Kontrol, Tyagita Widya Sari, Retno Putri

Jurnal Epidemiologi Kesehatan Indonesia

Demam Berdarah Dengue (DBD) adalah penyakit menular yang disebabkan oleh virus Dengue dan ditularkan melalui gigitan nyamuk Aedes aegypti. Dinas Kesehatan Provinsi Riau melaporkan jumlah kasus DBD sebanyak 277 dan Case Fatality Rate (CFR) DBD sebesar 1,4% pada tahun 2016, di mana kasus terbanyak berasal dari Kota Pekanbaru yaitu 58 kasus dengan CFR sebesar 0%. Adapun, CFR DBD di wilayah kerja Puskesmas Payung Sekaki meningkat dari 0% pada tahun 2015 menjadi 0,7% pada tahun 2016. DBD merupakan penyakit berbasis lingkungan yang dapat dicegah dengan melakukan tindakan pengendalian vektor, antara lain dengan pemberantasan sarang nyamuk (PSN) dan tindakan pencegahan lainnya. Akan …

Pengaruh Inisiasi Menyusu Dini Terhadap Kematian Neonatal Pada Bayi Berat Lahir >2500 Gram Dan Pada Bayi Berat Lahir Rendah Di Indonesia, Ana Maina Rezky, Asri C. Adisasmita

Jurnal Epidemiologi Kesehatan Indonesia

Kematian balita banyak terjadi pada masa neonatal. Inisiasi menyusu dini merupakan salah satu bentuk perawatan esensial saat lahir dan sebagai kunci awal dalam meningkatkan kelangsungan hidup bayi neonatal. Penelitian ini bertujuan mengetahui pengaruh inisiasi menyusu dini terhadap kematian neonatal pada bayi berat lahir > 2500 gram dan pada bayi berat lahir rendah di Indonesia. Penelitian ini menggunakan data yang bersumber dari Survei Demografi dan Kesehatan Indonesia tahun 2012. Data yang dikumpulkan dalam SDKI diperoleh melalui wawancara responden menggunakan kuesioner. Metode pengambilan sampel yang digunakan dalam SDKI yakni pertama melakukan pemilihan sejumlah primary sample unit (PSU) secara probability proportional to size (PPS), …

Association Of Obesity And Negative Acid-Fast Bacilli Finding Among Pulmonary Tuberculosis Patients With Type 2 Diabetes Mellitus, Nadya Magfira, Md Ikhsan Mokoagow, Ida Ayu Kshanti, Helda Helda

Jurnal Epidemiologi Kesehatan Indonesia

non-diabetes mellitus population. However, it’s effect on PTB in type 2 diabetes mellitus (T2DM) patient is unclear. The study aims to determine the association between obesity and PTB in patient with T2DM. A cross sectional study was held in in-patient, The Department of Internal Medi cine, Fatmawati General Hospital from January 2015 to December 2017. This study includes patient with T2DM who had been diagnosed with PTB and age > 18 years old. In this study negative Acid-fast-bacilli (AFB) founding defined as patient’s sputum is negative by smear microscopy, while obesity define as body mass index > 24.9 kg/m2. From 363 PTB …

Faktor-Faktor Yang Berkontribusi Terhadap Kejadian Luar Biasa Hepatitis A Di Pesantren X Kab. Cirebon, Januari 2018, Ima Ananda, Syahrizal Syarif, Ade Nurlina

Jurnal Epidemiologi Kesehatan Indonesia

Kejadian luar biasa Hepatitis A di Pondok Pesantren X pada bulan Januari 2018 merupakan KLB Hepatitis A pertama di Kabupaten Cirebon. Penelitian ini bertujuan untuk mengidentifikasi faktor risiko kejadian suspek Hepatitis A di Pondok Pesantren X Kabupaten Cirebon. Penelitian ini menggunakan desain kasus kontrol dengan jumlah kasus 30 orang dan kontrol 53 orang. Populasi penelitian adalah seluruh santri Pondok Pesantren X Kabupaten Cirebon. Kasus adalah suspek hepatitis A yaitu santri Pondok Pesantren X yang mengalami gejala jaundice dan air kencing berwarna seperti teh pada periode Desember 2017-Januari 2018. Kontrol adalah santri Pondok Pesantren X yang tidak mengalami gejala jaundice dan …

Kinerja Rumah Sakit Swasta Dengan Pembayaran Ina Cbgs Di Era Jaminan Kesehatan Nasional: Casemix, Casemix Index, Hospital Base Rate, Atik Nurwahyuni, Ery Setiawan

Jurnal Ekonomi Kesehatan Indonesia

Private hospitals must monitor their performance using indicators commonly used in DRG payment systems: casemix, casemix index and hospital base rate. This study aims to analyze the performance of private hospitals including casemix, casemix index and hospital base rate. This cross sectional study was conducted with a sample of 7 hospitals selected purposively representing private hospital type B, C, and D in 6 provinces. Casemix and CMI RS are strongly influenced by the hospital capacity, which the hospitals class B have higher casemix and CMI than class C and D hospitals. There is a phenomenon, CMI in class C hospitals …

Kajian Literatur Sistematis: Skema Pengendalian Biaya Dalam Asuransi Kesehatan Nasional Di Beberapa Negara, Eka Pujiyanti, Ery Setiawan, Euis Ratna Sari, Indah Pratiwi Suwandi

Jurnal Ekonomi Kesehatan Indonesia

Cost-containment is one of several strategies to ensure the financial sustainability of the National Health Insurance scheme. Several cost-containment models were commonly globally, such as cost-sharing, capping, and others. This review aims to determine the costs and impacts of implemented policy schemes as cost-containment instruments in various countries. We performed a systematic review from several primary databases (Proquest, Pubmed, and Cochrane Library) with the primary intervention are the cost-sharing methods. The results of our review focused on the cost containment scheme from the government perspective, in which the context of social insurance can be a modification of payment systems, cost-sharing, …

Analisis Biaya Satuan (Unit Cost) Dengan Metode Activity Based Costing (Abc) Di Poliklinik Jantung Rsu Dr. H. Koesnadi Bondowoso, Sumiati Sumiati, Eri Witcahyo, Andrei Ramani

Jurnal Ekonomi Kesehatan Indonesia

Determination of rate calculated based on unit cost, based on Bondowoso Regent Regulation Number 62 of 2017, RSU dr. H. Koesnadi Bondowoso unit cost calculates using the Double Distribution method. Double Distribution (DD) method is not appropriate to be applied because it does not reflect activity, method based on activity, precise and accurate so that it can provide the right information is Activity Based Costing (ABC) method. RSU Dr. H. Koesnadi Bondowoso has not made unit cost calculation using Activity Based Costing (ABC) method, especially for outpatient installation. The purpose of this research is unit cost analysis with Activity Based …

Kemampuan Dan Kemauan Pasien Umum Rawat Inap Dalam Membayar Pelayanan Kesehatan Rawat Inap Di Rumah Sakit Umum Kaliwates Kabupaten Jember, Yanuar Anafia, Eri Witcahyo

Jurnal Ekonomi Kesehatan Indonesia

testRational rates were determined by calculating unit costs into account characteristics of product as information related ability and willingness to pay. Ability and willingness were calculated for quality control and cost at the hospital. Community satisfaction index in Kaliwates General hospital released number of customer satisfaction that hasn’t met the standard was rate of inpatient services. Results of preliminary study on general inpatients were 70% having an estimated rate of less than rate set by the hospital, 20% said rates were less affordable and 10% couldn’t estimate rates, then this study was calculate ability and willingness to pay for inpatient …

Analysis Of Risk For Class Shifting And Determinants Of Bpjs Kesehatan Membership Using Generalized Ordered Logit-Unconstrained Partial Proportional Odds Model, Siskarossa Ika Oktora, Ika Yuni Wulansari, Geri Yesa Ermawan

Jurnal Ekonomi Kesehatan Indonesia

The main source of funding of BPJS Kesehatan comes from the different premium class in which the participant registered. The medical benefits among classes are equivalent, except inpatient facilities. But when the improvement health degree is not linear with the incurred costs, problem would arise. This study aims to analyze class shifting and determinants of BPJS Kesehatan membership. Around 1.53 percent of participants access higher classes, while 5.62 percent access lower classes. Class III participants with inpatient status severity level 2 and 3, reaching 41% and 43%, respectively. In addition, 60% of non-PBI participants are Class II premium participants; most …

Clostridium Difficile In Asia: Opportunities For One Health Management, Deirdre A. Collins, Thomas V. Riley

Research outputs 2014 to 2021

Clostridium difficile is a ubiquitous spore-forming bacterium which causes toxin-mediated diarrhoea and colitis in people whose gut microflora has been depleted by antimicrobial use, so it is a predominantly healthcare-associated disease. However, there are many One Health implications to C. difficile, given high colonisation rates in food production animals, contamination of outdoor environments by use of contaminated animal manure, increasing incidence of community-associated C. difficile infection (CDI), and demonstration of clonal groups of C. difficile shared between human clinical cases and food animals. In Asia, the epidemiology of CDI is not well understood given poor testing practices in many countries. …

Sex Differences In Becoming A Current Electronic Cigarette User, Current Smoker And Current Dual User Of Both Products: A Longitudinal Study Among Mexican Adolescents, Rosibel Rodríguez-Bolaños, Edna Arillo-Santillán, Inti Barrientos-Gutiérrez, Luis Zavala-Arciniega, Charity A. Ntansah, Jim Thrasher

Faculty Publications

This study aimed to assess sex differences in predictors for becoming a current exclusive electronic cigarette (e-cigarette) user, current exclusive smoker, or current dual user (concurrent smoking and e-cigarette use). This longitudinal study included 2399 females and 2177 males who had tried neither cigarettes nor e-cigarettes at baseline and attended 57 middle schools in the three largest cities in Mexico. We estimated multinomial logistic models stratified by sex. At follow-up, the prevalence of current exclusive e-cigarette use was 6.4% for males and 5.5% for females; current exclusive smoking was similar among males (3.6%) and females (3.5%); dual use was 2.4% …

Risk Factors And Mortality Rates Associated With Invasive Group B Streptococcus Infections Among Patients In The Us Veterans Health Administration, Robin L.P. Jump, Brigid Wilson, Daniel Baechle, Sunah Song, Federico Perez

Faculty Scholarship

IMPORTANCE The incidence of invasive infections caused by group B Streptococcus (GBS) continues to increase in the United States. Although diabetes is a key risk factor for invasive GBS, the influence of long-term glycemic control is not well characterized; other risk factors and mortality rates associated with specific types of invasive GBS infections are unknown. OBJECTIVE To investigate risk factors and mortality rates associated with specific invasive GBS infectious syndromes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used US Veterans Health Administration data to assess active users of the Veterans Affairs health care system between January 1, 2008, and December …

Community-Based Responses To Negative Health Impacts Of Sexual Humanitarian Anti-Trafficking Policies And The Criminalization Of Sex Work And Migration In The Us, Heidi Hoefinger, Jennifer Musto, P.G. Macioti, Anne E. Fehrenbacher, Nicola Mai, Calum Bennachie, Calogero Giametta

Publications and Research

System-involvement resulting from anti-trafficking interventions and the criminalization of sex work and migration results in negative health impacts on sex workers, migrants, and people with trafficking experiences. Due to their stigmatized status, sex workers and people with trafficking experiences often struggle to access affordable, unbiased, and supportive health care. This paper will use thematic analysis of qualitative data from in-depth interviews and ethnographic fieldwork with 50 migrant sex workers and trafficked persons, as well as 20 key informants from legal and social services, in New York and Los Angeles. It will highlight the work of trans-specific and sex worker-led initiatives …

Rates Of Benign Heart Tumors Diagnosed In Florida Hospitals: 1988-2012, Robert B. Hood, Elliott Smith, Richard B. Early, Zachary Weber, Sharona B. Ross, Alexander S. Rosemurgy Ii, Randall E. Harris

Florida Public Health Review

No abstract provided.

: Examining How Factors Associated With Patients, Physicians, Hospitals, And Surrounding Communities Affect Primary And Repeat Cesarean Delivery Through A Social-Ecological Lens, Christina Ventura-Dipersia

Dissertations and Theses

Background: Childbirth is one of the most common reasons for hospitalization in the U.S., and Cesarean delivery (i.e., surgical childbirth) is costlier and has a higher likelihood of birth-related complications, maternal rehospitalization, and postpartum medical care utilization than vaginal delivery. The rate of Cesarean delivery in the United States (U.S.) has increased in recent years by over 60%, from 20.7% of all births in 1996 to 32.9% of all births in 2011. As Although this increasing trend of Cesarean delivery incidence has also been seen in other countries, the rate of Cesarean delivery has been rising more steadily within …

Validity Study Of The R-Pla, A Resilience Scale For People Living With Hiv, Jinxiang Hu, Julianne M. Serovich, Monique J. Brown, Judy A. Kimberly, Yi-Hsin Chen

Faculty Publications

This study provides psychometric assessment of a resilience scale with a sample of women living with HIV. Baseline data were used from a longitudinal HIV disclosure study of 124 women aged between 18-63 collected between 2001 and 2004 in a large Midwestern city. The Rasch model was used to examine the psychometric properties of the resilience scale. Results indicated that the resilience instrument meets the Rasch model application assumptions. Evidence of validity suggested the resilience instrument demonstrated good item and person fit, as well as good item and person reliability. Most items showed measurement invariance across different age and racial …

Burden And Risk Of Non-Aids Defining Cancers In Hiv-Infected Persons Receiving Antiretroviral Therapy, Brittney L. Dickey

Theses & Dissertations

The burden of cancers not previously associated with an HIV infection, called non-AIDS defining cancers (NADCs), have increased in the years since highly active anti-retroviral therapy has been introduced. The studies in this dissertation attempted to quantify this burden via incidence and mortality compared to the general population. Further, an assessment of risk factors and creation of a predictive risk model, a nomogram, were utilized to better understand how factors associated with demographics, lifestyle, and immune response affected risk for an NADC diagnosis once therapy was initiated and HIV better controlled. Standardized incidence and mortality ratios showed that burden of …

Towards A “Rescue Ready” Mindset: Can Lifeguard Teams Learn Lessons From The Attributes Of Chronic Unease?, Billy Rj Doyle, Jonathon Webber

International Journal of Aquatic Research and Education

Highly Reliable Organisations (HROs) are safety-centric organisations that operate in complex environments alongside risky technologies and processes. There is a high risk of catastrophe and error in these settings, the consequences of which may result in loss of life, financial cost, and damage to the environment. “Chronic unease” is a concept originally adopted by Royal Dutch Shell describing a mindset that has five predictable attributes that contribute to an individual’s and organisational safety culture. The authors of this paper describe the attributes of chronic unease in the context of lifeguard operations. A case study of a dangerous and dynamic rescue …

Small Molecules That Inhibit Tnf Signalling By Stabilising An Asymmetric Form Of The Trimer, James O'Connell, John Porter, Boris Kroeplien, Tim Norman, Stephen Rapecki, Rachel E. Davis, David Mcmillan, Tracy Arakaki, Alex Burgin, David Fox Iii, Tom Ceska, Fabien Lecomte, Alison Maloney, Alex Vugler, Bruce Carrington, Benjamin P. Cossins, Tim Bourne, Alastair Lawson

Faculty Publications

Tumour necrosis factor (TNF) is a cytokine belonging to a family of trimeric proteins; it has been shown to be a key mediator in autoimmune diseases such as rheumatoid arthritis and Crohn's disease. While TNF is the target of several successful biologic drugs, attempts to design small molecule therapies directed to this cytokine have not led to approved products. Here we report the discovery of potent small molecule inhibitors of TNF that stabilise an asymmetrical form of the soluble TNF trimer, compromising signalling and inhibiting the functions of TNF in vitro and in vivo. This discovery paves the way for …

After-Action Report: Tabletop Exercise On Opioid Crisis Response And Resilience, Alexander Siedschlag, Tiangeng Lu

Publications

AGENCY BRIEFINGS The opioid overdose epidemic has been characterized as the worst public health crisis in Pennsylvania, and the nation. Not only practitioners but also institutions of higher education with high research capacity, such as Penn State, are applying existing and developing new instruments to address opioid the crisis. Identifying best practices of preventing, protecting from, mitigating against, responding to, and recovering from opioid overdose outbreak is necessary for public health and safety and important for the overall homeland security enterprise, in consistency with the objectives of the Quadrennial Homeland Security Reviews (QHSR), the National Preparedness Goal (NPG), and the …

Sexting Among Adolescents: Examining The Association Between Sexting And Self-Esteem, Hanaah Fannin

Physician Assistant Studies | Student Capstone Presentations

The primary objective of this study is to provide a systematic review of the published literature, examining the association between sexting and self-esteem in adolescents, and to identify gaps in existing knowledge to provide recommendations for future research.