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Oral pre-exposure prophylaxis (PrEP) is a critical intervention for HIV prevention among key populations (KP) in Nigeria. However, little is known about its coverage among adolescent and young key populations (AYKP). Using the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among KP, including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), we assessed the awareness and uptake of PrEP among AYKP (15-24 years) in Nigeria. We performed weighted descriptive statistics and logistic regression analyses. Of the 6882 AYKP included in this study, 36.1% were aware of PrEP, ranging from 47.9% in MSM to 19.8% in FSW. Compared with FSW, MSM (aOR = 3.7, 95%CI = 3.22-4.35) and TG (aOR = 2.6, 95%CI = 2.18-2.98) had significant higher odds of PrEP awareness. Among those aware of PrEP, 24.5% had ever taken PrEP. The uptake of PrEP varied by KP group: TG (28.1%), MSM (25.3%), PWID (18.0%), and FSW (14.4%). MSM (aOR = 2.6, 95%CI = 1.72-4.07) and TG (aOR = 2.7, 95%CI = 1.71-4.14) had significant higher odds of PrEP uptake relative to FSW. The awareness and uptake of PrEP among AYKP in Nigeria is low. This calls for more awareness creation about PrEP addressing the barriers that limit its uptake.

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PURPOSE: User participation is important in the delivery of health- and social services. Yet, our knowledge regarding how user participation is experienced from the perspective of those who use these services is limited. This study aims to develop knowledge regarding how young persons living with disabilities experience becoming independent in user participation. MATERIALS AND METHODS: This qualitative study is inspired by Constructivist Grounded Theory. Nine young persons between 16 and 25 years of age and living with a disability, participated in the interviews. RESULTS: The results revealed that user participation for young persons is a socially situated, relational, and skills-dependent process. User participation is characterized as a process, consisting of increasing skills, gradually reducing parental support, and responding to interactions with professionals. The three categories are strongly reciprocal and interrelated, forming the unifying core category of Striving towards independence in user participation. CONCLUSION: We theorize about the Interrelated process of becoming independent in user participation for young persons with disabilities. This theory highlights the need to understand the interrelatedness of user participation, allowing for a recognition of the complexity of user participation, showing it as a process involving developing skills, and gradually becoming independent and skilled in user participation.Implications for rehabilitationYoung persons with disability rely on support from parents as well as professionals to become independent in user participationProfessionals should acknowledge that user participation is a learning process and allow for time and resources to aid this processFocusing on increasing health literacy alone is not sufficient to ensure user participation for young persons with disability.

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BACKGROUND: Young key populations (YKP) contribute to the burden of HIV in Nigeria and are a priority population for oral pre-exposure prophylaxis (PrEP). However, their uptake of PrEP remains low. We assessed the main barriers to PrEP uptake and the variation among YKP (15-24 years) in Nigeria. METHODS: This study was a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), in 12 states in Nigeria. A closed-ended question asking the main reason for not taking PrEP among KP who had never taken PrEP was included in the surveillance questionnaire. We collapsed the responses into six barrier themes. Using multinomial logistic regression analysis, we examined the association between the barriers (dependent variable) and KP group (independent variable), controlling for age, educational attainment, religion, marital status, employment status, and geopolitical zone. RESULTS: A total of 1776 YKP were included in this study. The most cited barriers by KP group were: lack of access (28.3%) and fear of side effects (28.3%) by FSW; lack of interest (37.1%) by MSM; low risk perception (65.5%) by PWID; and lack of access (34.4%) by TG. The odds of reporting fear of side effects, lack of access, lack of interest, and nonspecific/others reasons were significantly different by KP group. CONCLUSIONS: The barriers limiting the uptake of PrEP among YKP vary by KP group. Our results highlight the need for KP-specific interventions to improve the uptake of PrEP among YKP in Nigeria.

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BACKGROUND: Adolescents and youths are currently one of the main sub-populations responsible for most Human Immunodeficiency Virus (HIV) new cases in Nigeria due to their high-risk sexual practices. Yet, most Nigerian adolescents have poor HIV knowledge and are not aware of their HIV status. STUDY OBJECTIVES: We assessed respondents' HIV knowledge, their attitude to screening, testing practice and identified predictors of HIV screening among youths (15-24 years old) in Iwo, Osun State, Nigeria. METHODS: Cross-sectional design was employed and a multistage sampling method was used to recruit 360 eligible schooling youths in three secondary schools (private and public coeducational schools). A semi-structured, interviewer administered questionnaire was used for data collection. Both descriptive and inferential statistics were carried out at p<0.05. RESULTS: Mean age (±SD) of the respondents was 15±4.71 years. The majority (75.6%) of the respondents had heard about HIV. Overall, only 57.6% of respondents possessed a comprehensive knowledge of HIV but a majority (80.6%) of them had a positive attitude to HIV screening. Only 20.6% of the respondents had ever screened for HIV, 70.0% of them had pre-and post-test counselling. The most prevalent reason for non-screening is fear of getting a positive result (48.3%). Predictors of HIV screening uptakes included respondents' age (AOR = 2.95; 95%CI = 2.25-6.01), school type (AOR = 2.9;95%CI = 1.99-11.25), class level (AOR = 3.21;95% CI = 2.13-8.12) and attitude to screening (AOR = 2.51;95% CI = 2.01-6.39). CONCLUSION: Despite a high awareness rate and overwhelming positive attitude, HIV screening practice was low in the study setting. There is a need for health policymakers to further prioritise adolescents and youths in the race to end HIV epidemics in Nigeria.

CONTEXTE: Les adolescents et les jeunes sont actuellement l'une des principales sous-populations responsables de la plupart des nouveaux cas de virus de l'immunodéficience humaine (VIH) au Nigeria en raison de leurs pratiques sexuelles à haut risque. Pourtant, la plupart des adolescents nigérians ont une faible connaissance du VIH et ne sont pas conscients de leur statut sérologique. OBJECTIFS DE L'ÉTUDE: Nous avons évalué les connaissances des répondants sur le VIH, leur attitude à l'égard du dépistage, les pratiques de dépistage et identifié les facteurs prédictifs du dépistage du VIH chez les jeunes (15-24 ans) à Iwo, dans l'État d'Osun, au Nigeria. MÉTHODES: Une étude transversale a été employée et une méthode d'échantillonnage à plusieurs niveaux a été utilisée pour recruter 360 jeunes scolarisés éligibles dans trois écoles secondaires (privées et publiques). Un questionnaire semi-structuré, administré par un enquêteur, a été utilisé pour la collecte des données. Des statistiques descriptives et inférentielles ont été réalisées à p<0,05. RÉSULTATS: L'âge moyen (±SD) des personnes interrogées était de 15±4,71 ans. La majorité (75,6 %) des personnes interrogées avaient entendu parler du VIH. Dans l'ensemble, seulement 57,6 % des personnes interrogées avaient une connaissance approfondie du VIH, mais la majorité d'entre elles (80,6 %) avaient une attitude positive à l'égard du dépistage du VIH. Seules 20,6 % des personnes interrogées avaient déjà effectué un dépistage du VIH, mais 70 % d'entre elles avaient bénéficié d'un conseil avant et après le test. La raison la plus fréquente de l'absence de dépistage est la peur d'obtenir un résultat positif (48,3 %). Les facteurs prédictifs de la participation au dépistage du VIH comprenaient l'âge des répondants (AOR=2,95 ; 95%CI=2,25-6,01), le type d'école (AOR=2,9;95%CI=1,99-11,25), le niveau de classe (AOR=3,21;95% CI=2,13-8,12) et l'attitude à l'égard du dépistage (AOR=2,51;95% CI=2,01-6,39). CONCLUSION: Malgré un taux de sensibilisation élevé et une attitude très positive, la pratique du dépistage du VIH était faible dans le contexte de l'étude. Il est nécessaire que les décideurs en matière de santé accordent une plus grande priorité aux adolescents et aux jeunes dans la course à l'éradication de l'épidémie de VIH au Nigéria. Mots clés: VIH/SIDA, Adolescents, Jeunes, Jeunes, Nigeria.

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Background: The prevalence of HIV among young people aged 15-19 years in Nigeria is estimated as 3.5%, the highest among West and Central African countries. Comprehensive knowledge of HIV is associated with increased awareness of preventive interventions and a reduction in the spread of HIV. Therefore, this article seeks to assess and determine the associated factors of comprehensive HIV knowledge among youths in Nigeria. Methods: The study used the 2018 Nigerian Demographic Health Survey, a cross-sectional survey that employed a two-stage cluster sampling method. Comprehensive knowledge of HIV was assessed based on five questions. The data were analysed separately for men and women aged 15-24 years. A multivariable log-binomial regression model was used to determine factors associated with comprehensive HIV knowledge. All analysis was performed using Stata 15.0 and adjusted for weighting, clustering and stratification. Results: A total of 15,267 women and 4019 men aged 15-24 years were included in this study. The prevalence of comprehensive knowledge of HIV was higher among women than among men (42.6% versus 33.7%; p < 0.001) and lower among younger ages 15-17 years compared with other ages. The findings revealed that age, ethnicity, wealth, education and exposure to mass media were statistically significant factors associated with comprehensive knowledge of HIV. In addition, religion, place of residence, phone ownership, internet use, currently working and having initiated sex were significant factors among women and modern contraceptive use among men. Conclusion: Key findings from this study imply that public health programmes in Nigeria should focus on providing information on HIV/AIDS using different approaches, including comprehensive sex education as well as health promotion and education strategies in the formal and informal sectors. Because media exposure is a common and cost-effective way of public health promotion and education in modern times, emphasis could also be placed on using this channel to reach the target population.

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Ehlers-Danlos syndromes (EDS) represent a group of rare inherited disorders that affect connective tissues. There are 13 types of disease, most of them affecting joints or skin; symptoms usually include loose joints, joint pain, stretchy velvety skin, abnormal scar formation. However, the most serious type of disease is vascular EDS (vEDS), or EDS type 4 because patients may suffer vessels dissections or internal organs lesions, followed by bleeding, which endangers patient's life, but also thromboembolic events. We present two clinical cases of vEDS managed in our clinic in 1 year distance. In both cases, patients were active young persons (in their thirties, and respectively, twenties), both with multiple non-traumatic vascular dissections, and severe ocular complications: arterio-venous fistula with massive exophthalmia, and central retinal artery occlusion, respectively. Both cases were challenging since the life of the patients were threatened by their condition. However, in both cases, prompt treatment and finding the right trigger of the ocular pathology and vascular injuries helped doctors to provide proper and prompt medical care, in order to prevent future similar events to happen and to preserve a good quality of life for these patients.

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BACKGROUND: ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons' mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses. OBJECTIVE: This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years. METHODS: A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2. RESULTS: Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention. CONCLUSIONS: Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more.

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PURPOSE: The use of Information and communications technologies (ICT) in the public sector is widespread and on the increase. There is a need to develop knowledge regarding the end users experiences of using ICT to engage with services. This study aims to provide knowledge regarding young persons with disabilities or chronic disease experience using ICT to engage with health- and social care services. MATERIALS AND METHODS: Nine young persons between 16 and 25, living with chronic disease or physical disability, participated in this study. The data was collected using semi-structured interviews. The interviews were recorded, transcribed verbatim and analysed using Constructivist Grounded Theory. RESULTS: Three categories were identified that reflected the young persons' experiences with using ICT to engage with health and social care services. (1) Navigating in an information overflow, (2) Experiencing disparate dialogues, (3) Utilising the potential of ICT. The young persons experienced that ICT used for engaging with health and social care services did not necessarily fit their need, yet, they saw how ICT had potential to increase engagement with services, especially with an increased focus on dialogue. The findings can be subsumed by the core category Inaccessible Possibilities, illustrating both the potentials and the challenges ICT presented. CONCLUSION: The study shows that although young persons are perceived as digitally native, they experienced challenges using ICT to engage with health- and social services. The poor fit of ICT combined with navigation- and accessibility issues, hinder engagement. However, ICT inhabit a potential to increase engagement, especially communication.IMPLICATIONS FOR REHABILITATIONYoung persons' experiences show that ICT can be useful for enhancing engagement with health and social care servicesICT provided by health and social services does not necessarily meet young persons need for dialogueAn increased focus on accessibility and design is necessary to ensure people with disabilities access to ICT used by health- and social care services.

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Background Behavioral problems among young persons with intellectual disabilities (IDs) are pronounced, and it has been of significant concern for field practitioners. Different investigators have used various techniques and methods to study behavioral problems among persons with intellectual disabilities. Objective The study was conducted to examine the concept of behavioral problems from persons with intellectual disabilities. Materials and Methods Persons with ID ( n = 13) with DSM 5 diagnosis of mild ID (IQ: 50-69) in ages ranging from 16 to 27 years were selected. For the present study, the qualitative method using Focused Group Discussion (FGD) was used. Results The results suggest that persons with intellectual disabilities have an adequate understanding of their behavioral problems and can make efforts to control their anger and aggression. Conclusion The study's findings showed that persons with an intellectual disability did not have knowledge of only the concept of behavioral problems, but they also employed methods to overcome these behavioral problems. The community needs to be made aware of this to get better opportunities in community participation, thus helping them contribute to society.

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This study investigated whether the content of different community-based intergenerational programs (IGPs) affects their perceived impact on older and younger participants. Data were collected through direct structured questionnaires administered to 84 older, and 96 younger participants, and were assessed using both quantitative and qualitative analyses. Different IGP types involved participants with differing background characteristics and were associated with different benefits and challenges. In art programs, older participants reported being more active and younger participants indicated more awareness of others, but also greater stress. Learning programs contributed to older persons' happiness, and younger persons' acquisition of new skills, but were also associated with divergent expectations between young and old, and a perception that young participants lacked commitment. Assistance programs attracted older participants with greater needs, and were associated with such benefits as alleviating older persons' loneliness, improving younger participants' satisfaction from helping, but also involved challenges pertaining to the relationship termination. Generally, older participants reported more benefits than younger persons. The results highlight the need to differentiate between IGP types, a distinction not addressed in previous studies. The combination of activity content and participant characteristics and needs may lead to different perceived program impacts.

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BACKGROUND: In the last decade, there has been a rapid increase in research on the use of artificial intelligence (AI) to improve child and youth participation in daily life activities, which is a key rehabilitation outcome. However, existing reviews place variable focus on participation, are narrow in scope, and are restricted to select diagnoses, hindering interpretability regarding the existing scope of AI applications that target the participation of children and youth in a pediatric rehabilitation setting. OBJECTIVE: The aim of this scoping review is to examine how AI is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with disabilities or other diagnosed health conditions in valued activities. METHODS: We conducted a comprehensive literature search using established Applied Health Sciences and Computer Science databases. Two independent researchers screened and selected the studies based on a systematic procedure. Inclusion criteria were as follows: participation was an explicit study aim or outcome or the targeted focus of the AI application; AI was applied as part of the provided and tested intervention; children or youth with a disability or other diagnosed health conditions were the focus of either the study or AI application or both; and the study was published in English. Data were mapped according to the types of AI, the mode of delivery, the type of personalization, and whether the intervention addressed individual goal-setting. RESULTS: The literature search identified 3029 documents, of which 94 met the inclusion criteria. Most of the included studies used multiple applications of AI with the highest prevalence of robotics (72/94, 77%) and human-machine interaction (51/94, 54%). Regarding mode of delivery, most of the included studies described an intervention delivered in-person (84/94, 89%), and only 11% (10/94) were delivered remotely. Most interventions were tailored to groups of individuals (93/94, 99%). Only 1% (1/94) of interventions was tailored to patients' individually reported participation needs, and only one intervention (1/94, 1%) described individual goal-setting as part of their therapy process or intervention planning. CONCLUSIONS: There is an increasing amount of research on interventions using AI to target the participation of children and youth with disabilities or other diagnosed health conditions, supporting the potential of using AI in pediatric rehabilitation. On the basis of our results, 3 major gaps for further research and development were identified: a lack of remotely delivered participation-focused interventions using AI; a lack of individual goal-setting integrated in interventions; and a lack of interventions tailored to individually reported participation needs of children, youth, or families.

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INTRODUCTION: Several evaluations of deaths in persons of advanced age associated with SARS-CoV­2 can be found in the international literature. The aim of this work was the evaluation of deaths associated with SARS-CoV­2 of persons of younger or middle age (up to 50 years) at the Institute of Legal Medicine in Hamburg, Germany, with presentation of frequency, comorbidities and disease courses. MATERIAL AND METHODS: A total of 735 SARS-CoV-2-associated cases of decedents with registered addresses in Hamburg were evaluated in 2020 at the Institute of Legal Medicine in Hamburg, Germany, using various examination methods. The selection and performance of the respective methods was based on the consent given by the relatives. In addition, more autopsies of decedents with a registered address outside Hamburg and positive SARS-CoV­2 detection were performed. RESULTS AND CONCLUSION: Of the 735 decedents 9 with a registered Hamburg address and 3 of the deaths studied with an external registered address (n = 12; 7 men and 5 women) were aged 50 years or younger, with an average age of 39.8 years. Essentially, there were cardiovascular, neurological, and malignant pre-existing diseases, as well as obesity. The SARS-CoV­2 was detected post-mortem for the first time in two cases; these were found to have a virus-independent cause of death. Of the individuals 7 died from COVID-19 pneumonia, 3 individuals from the consequences of the necessary intensive medical treatment.Several studies have demonstrated an association between obesity and severe SARS-CoV-2-related disease progression, particularly in younger patients and this was confirmed in the legal medicine study population.

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BACKGROUND: There is often a great urgency to be inclusive when conducting research and to focus efforts with groups and communities that can be referred to as marginalised. This is especially the case in research concerning medical devices aimed at children and young people (CYP). Although involvement methodology has developed over the last two decades, it can be challenging to involve and engage CYP with confidence and clarity of purpose. MAIN BODY: Our aim was to provide a reflective narrative account of the involvement of CYP, over a period of 5 years, in a research project from conception of a new paediatric medical device through to practical application. We explored a model of patient and public involvement (PPI) through the Nottingham Young Persons Advisory Group (YPAG), part of the National Institute for Health Research (NIHR) GenerationR Alliance, in a NIHR funded research project. The YPAG designed and created a model of the human gut, co-designed the Transicap™ mini-capsules and their packaging, co-produced patient information sheets, came up with the idea to disseminate through a project website and co-wrote and created animation videos. The YPAG involvement continued through the writing and award of the follow-on research grant (MAGIC2). During this process the YPAG modified the clinical study protocol insisting that all participants in the control arm were given the imaging test results as well, save for a delayed reading compared to the intervention arm. CONCLUSION: Involvement of the YPAG over the last 5 years, led to the development of a mutually beneficial partnership, enabling genuine knowledge exchange between researchers and CYP. This influenced the design, plans and actions of the MAGIC study and well into the subsequent MAGIC2 follow-on project. Moreover, these involvement models applied within a feasibility study setting, have enhanced the realism and pragmatism of the study, contributing to the project's overall success.

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Sexually transmitted infections (STIs) and HIV disproportionately affect young persons; gay, bisexual and other men who have sex with men (GBMSM) and transgender women; persons of colour; and the U.S. South. Complex issues contribute to these high STI/HIV rates. Our community-based participatory research (CBPR) partnership conducted a community-driven needs assessment to inform an intervention addressing STI/HIV disparities and related social determinants of health (SDH) among young GBMSM and transgender women of colour in a high-incidence STI/HIV community in North Carolina. In 2018, in-depth interviews were conducted with 21 community members and 29 community organisation representatives to explore needs, priorities and assets. Interview data were analysed using constant comparison, an approach to grounded theory, and an empowerment theory-based planning process was used to develop multilevel intervention strategies based on findings. Thirteen themes emerged from the interviews that were organised into five domains: health (e.g., limited health services use; need for lesbian, gay, bisexual and transgender [LGBT]-friendly providers; prioritisation of mental health and gender transition and limited knowledge of and access to pre-exposure prophylaxis [PrEP] for HIV); employment (e.g., employment as a priority and relying on sex work to 'make ends meet'); education (e.g., barriers to education and needs for training to improve employment opportunities); social support (e.g., few welcoming activities and groups; strong informal support networks and little interaction between GBMSM and transgender women) and discrimination (e.g., frequent experiences of discrimination and the impact of frontline staff on services use). Three strategies - community-based peer navigation, use of social media, and anti-discrimination trainings for organisations - were identified and integrated into a new intervention known as Impact Triad. CBPR was successfully applied to identify needs, priorities and assets and develop a multilevel intervention focused on health disparities and SDH among young GBMSM and transgender women of colour in the U.S. South.

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This article explores the experiences of HIV-positive adolescents disclosing their status to romantic partners in Bulawayo, Zimbabwe. Disclosure of HIV status continues to be one of the most pressing issues facing adolescents, especially those in relationships, yet health care workers have minimal tailored guidance on how to approach this except to encourage full disclosure. Motives for disclosure were: guilty conscience; legal and ethical obligations; preventing partners being infected; and supportive people, honesty and trust. Disclosure was done on a one-on-one basis in public spaces such as roadsides where the adolescents usually met, or in health care facilities through the help of health care workers, and through mobile phones using WhatsApp. Results revealed that disclosure was associated with negative and positive outcomes ranging from disruption of relationships, depression, breaches of confidential information and, in some instances, relationship and marriage assurance. However, results clearly showed that adolescents living with HIV struggle with disclosure because the process is complex and loaded with emotions and the outcomes can be unpredictable and difficult to handle. Optimism towards treatment, social support, rationalisation, and social comparison through attributing new meanings to the disease were employed to deal with negative outcomes of disclosure. Therefore, the development and implementation of evidence-based initiatives to raise awareness and train the youth to disclose is recommended. Through their experiences, we can learn what works well and what needs to be strengthened.

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INTRODUCTION: Increasing demands from public and private healthcare coupled with national initiatives in patient-oriented research has led to an increase in avenues to allow patients to be directly involved in research. In particular, the push towards participation of children and youth has resulted in the formation of pediatric patient advisory groups with broad partnerships and consultation requests across the globe. However, there is a lack of evidence to examine the challenges in formation and training of young persons' advisory groups (YPAGs) and management processes required thereafter. PURPOSE AND OBJECTIVES: This study's purpose is to document YPAG formation and training protocols around the world, highlight common strengths, and evaluate pitfalls and challenges. The results from this study will subsequently inform the development of standardized training protocols for children and youth to be piloted globally. METHODS: In this study, 17 select YPAG team leaders from 7 countries were surveyed to determine current training techniques used within existing groups. 17 youth representatives and 16 team leaders were then interviewed to gather further qualitative data on facilitators and barriers that aid or prevent successful initiation and maintenance of these groups. Qualitative interview data was coded and analyzed using NVivo by two independent reviewers (SYC, VWLT). Any inconsistencies in thematic analysis was confirmed by a third reviewer (JB). RESULTS: The most common training topics include consent and assent (64.71%), clinical trials (64.71%), and patient safety (70.59%). There are significant discrepancies to the amount of training received by each team. Most YPAGs out of the 17 groups receive no formal training (58.82%) while training sessions in the remaining 7 groups vary in both duration and frequency. Collectively, meetings ranged from 15  minutes to 6  hours long, with the majority of team meetings being 2-3  hours long (58.82%). The most common training facilitators are a positive relationship with a local hospital (82.35%) and access to a dedicated team coordinator (64.71%). 70.59% of team leaders identified a lack of access to appropriate educational materials available as a drawback to the impact of their YPAG, making this the greatest common barrier. CONCLUSION: Bringing children and youth to the forefront of paediatric trials and clinical research facilitates appropriate patient representation in subsequent research decision-making. There is an urgency to create and implement standardized protocols for the training of children and youth, especially in preparation for national and international research consultations. This low barrier framework may be of special interest to lower-middle-income countries who wish to encourage community participation in healthcare.

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BACKGROUND: Recent evidence indicates that elevating plasma nitrites through dietary nitrates (NO3-) supplementation is associated with enhanced muscle efficiency, fatigue resistance and performance. Beetroot (in various forms) is the dominant source of dietary NO3- primarily due to its vast availability and the simple form of preparation suitable for final consumption. After a few years of research and experimentation, our scientific team identified alternative source rich with dietary NO3- as possible nitric oxide precursor, amaranth (Amaranthus hypochondriacus) with a standardized concentration 9-11% of NO3-. This study aimed to evaluate the effect of single-dose (±400 mg of dietary NO3-) and long-term (6 days) supplementation of amaranth concentrate derived dietary NO3- on aerobic capacity in physically active young people. METHODS: We conducted a randomized, double-blind, placebo-controlled human study. Thirteen healthy and physically active young male participants were randomized into experimental and placebo groups. The aerobic capacity was tested during increasing cycling exercise (ICE) with pulmonary gas exchange recording and analysis. RESULTS: The peak power of the ICE, the maximum oxygen consumption and the first ventilatory threshold were significantly increased after long-term consumption of dietary amaranth (from 4.44 ± 0.50 to 4.55 ± 0.43 W/kg; from 37.7 ± 2.7 to 41.2 ± 5.4 mL/kg/min and from 178.6 ± 30.3 to 188.6 ± 35.2 W, p < 0.05; respectively) in experimental group. CONCLUSIONS: Long-term (6 days) use of dietary NO3- from amaranth may improve the aerobic capacity during ICE in young physically active male persons. It can be recommended as the nutritional supplement during last week of preparation for competition in endurance events.

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OBJECTIVE: Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16-18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person's readiness for transition, and their outcomes at the transfer boundary. DESIGN: MILESTONE prospective study. SETTING: Eight European Union (EU) countries participating in the EU-funded MILESTONE study. PARTICIPANTS: The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people. RESULTS: The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported. CONCLUSION: The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person. TRIAL REGISTRATION NUMBER: ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.

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