Premature Graying Research Articles

Formulation and evaluation of polyherbal hair gel formulation

Dandruff is a skin condition with symptoms includes flaking and sometimes mild itchiness cause to the scalp. They are many bacteria, fungus causing scalp infections which lead to further hair problems or skin issues. There is one of the common conditions candidiasis which is typically caused on the skin or mucus membrane caused by candida. Herbal extract of gauva leaves, amla and aloe found to be effective in treating Candidiasis. Guava leaves are rich in Vitamin B & C that helps in nourishing hair and also aids hair growth. Guava leaves shows antibacterial and antifungal activity on gram positive and gram negative bacteria. Vitamin C present in Amla which is 20 times more than that of orange; which prevents premature graying of hairs, it also providesluster to hairs and strengthen follicles. Gauva leaves extract was evaluated by Cup and plate method against the fungus C. albicans and bacteria S. aureus. Herbal Gel was formulated and evaluated by using Carbopol 934, triethanolamine etc. A polyherbal hair gel was found to be effective against candidiasis along with this it nourished the hair and prevent premature graying.

Premature graying of hair observed as the commonest cutaneous association in vitiligo in a comparative cross-sectional study: a component to be pondered

Premature graying of hair observed as the commonest cutaneous association in vitiligo in a comparative cross-sectional study: a component to be pondered

Serum Micronutrient Levels In Premature Canities: A Systematic Review and Meta-analysis.

Background: Premature canities, also known as premature graying of hair, is the graying of hair before 20 years old in Caucasians, before 25 years old in Asians, and before 30 years old in African–Americans. The risk factors for premature canities are multifactorial. The role of micronutrient deficiency has long been suggested to be involved in the etiopathogenesis of premature canities. The management of premature canities remains limited and far from satisfactory; hence, knowing what vitamins and minerals can help in treating premature canities is vital. Aim: This study aims to analyze serum vitamin B12, iron, ferritin, copper, calcium, and zinc levels in premature canities. Methods: The MEDLINE/PubMed electronic database, Cochrane library, ClinicalTrials.gov, EBSCO, Scopus, ProQuest, Cambridge Core, reference lists, conference proceedings, and researchers in fields of eligible studies were searched. Twelve studies (n = 1791 subjects) were included in qualitative analysis of which nine studies (n = 1381 subjects) were included in meta-analysis. Serum levels of micronutrients (vitamin B12, iron, ferritin, copper, calcium, and zinc) were compared in the premature canities and nonpremature canities groups. Result: Pooling of data using fixed-effects model found the overall effect mean difference serum vitamin B12 level was −0.697 ± 0.105 (95% CI = −0.904 to −0.490), p < 0.001. The overall mean difference serum iron level was 0.146 ± 0.105 (95% CI = −0.058 to 0.350), p = 0.161. The overall mean difference serum ferritin level was 0.720 ± 0.071 (95% CI = 0.585 to 0.854), p < 0.001. The overall mean difference serum copper level was 0.230 ± 0.118 (95% CI = −0.003 to 0.463, p = 0.053. The overall mean difference serum calcium level was −0.443 ± 0.114 (95% CI = −0.655 to −0.212), p < 0.001. The overall mean difference serum zinc level was −0.104 ± 0.138 (95% CI = 0.377 to 0.170, p = 0.457. Qualitative analysis showed that vitamin B12 plays an important role in DNA synthesis in the proliferation of hair follicle cells and in melanogenesis. Iron, ferritin, copper, calcium, and zinc also play important roles in stabilizing and increasing tyrosinase activity in several stages of the melanogenesis process. Conclusion: The meta-analysis showed that serum levels of vitamin B12, ferritin, and calcium were significantly lower in premature canities. Although the lower serum iron, copper, and zinc levels were not significantly different in premature canities compared with nonpremature canities. Qualitative analysis found that deficiency of vitamin B12, iron, ferritin, zinc, copper, and calcium can affect the physiology of hair melanogenesis that causing premature canities.

Premature graying of hair: A concise review

Authors have attempted to provide a short concise and clinically relevant review on premature graying of hairs with the focus of updated pathogenesis, rational investigations, and treatment options. Premature graying of hairs is a fairly common clinical condition faced by dermatologists, however, very scarce therapeutic options are available for successful management of gray hairs. The role of antioxidants is not yet established firmly in the therapeutic armamentarium of premature graying of hairs. Authors have summarized the currently available therapeutic options for the treatment of premature graying of hairs.

Liver histology in short telomere syndrome: A case report and review of the literature

Abstract Introduction/Objective Short telomere syndrome (STS) is a genetically inherited syndrome resulting in premature telomere shortening. STS encompasses a spectrum of clinical manifestations, including dyskeratosis congenita, premature hair graying, bone marrow failure, immunodeficiency, pulmonary fibrosis and liver disease. Liver histopathologic features in STS patients have not been well characterized. Methods/Case Report A 46-year-old man presented for dyspnea and cryptogenic cirrhosis. He had a complicated medical history significant for immune thrombocytopenic purpura and splenectomy, recurrent respiratory tract infections, pneumonia, sepsis, primary immunodeficiency, pulmonary mucosa-associated lymphoid tissue lymphoma, and severe hepatopulmonary syndrome. He and his brother had gray hair in their late 20s. He also had a long history of intermittently elevated liver enzymes starting at age 33. A liver biopsy performed 12 years before showed chronic portal inflammation with hepatocellular damage without significant fibrosis. These clinical manifestations prompted an evaluation for a possible telomere biology disorder, which revealed the telomere length was critically short and fell at or below the first percentile for age, supportive of the diagnosis. The most recent liver biopsy showed marked portal lymphocytic inflammation with interface hepatitis, bile ductular reaction and frequent foci of lobular inflammation with focal hepatocyte dropout. Some hepatocytes around the portal tracts were swollen with feathery degeneration and occasional Mallory-Denk bodies. A Rhodanine stain highlighted copper granules in the periportal hepatocytes, suggesting chronic cholestasis. Trichrome and reticulin stains demonstrated portal/periportal/pericellular/perisinusoidal fibrosis and focal bridging fibrosis. Results (if a Case Study enter NA) NA Conclusion Partly due to the rarity of STS and the risk of bleeding associated with biopsies, liver histology was described in only few limited studies with small samples of STS patients, including inflammation, nodular regenerative hyperplasia, steatohepatitis, hemosiderosis, cholestasis, cirrhosis, and large cell change of hepatocytes. Our case and others suggest liver disease associated with STS demonstrates a spectrum of histopathology. Being aware of these histomorphologic features in STS is important for establishing the correct diagnosis.

Melanogenesis Markers Expression in Premature Graying of Hair: A Cross-Sectional Study

Background: Studies on mice and aging human hair follicles provide compelling evidence that graying of hair results from premature differentiation of melanocyte stem cells in the niche/bulge. Objective: The aim of this study was to analyze whether differentiation of melanocyte stem cells is responsible for premature graying of hair (PGH). Methods: Twenty-five patients with PGH (n = 25) attending the dermatology department were recruited. Five unpigmented and 5 pigmented hairs were obtained per patient by separating individual follicles after 1 mm punch biopsies. The hairs were dissected at a distance of 2 mm from the bulb to separate the stem cells (upper segment – US) from the melanocytes (lower segment – LS). RNA was extracted from hair follicle US and LS, and expression of GP100, tyrosinase (TYR), and tyrosinase-related protein-1 (TYRP1) genes was quantified using Qiagen one-step RT-PCR kit. Results: We found melanogenesis gene expression in both temporary (US) and permanent (LS) segments of unpigmented and pigmented hair follicles. When compared between the US and LS of white hair, the expression of TYR and GP100 was much higher in US than LS, suggestive of melanogenesis in the bulge. Similarly, when compared between white and black US, the expression of all 3 genes was higher in white US than black US, although not statistically significant. Limitations: Low samples size and lack of data pertaining to the expression of genes at protein level are the limitations of current study. Conclusion: Even though this pilot study data yielded key information about the expression of GP100, TYR, and TYRP-1 at the mRNA level, further studies quantifying the expression of these genes at protein level are needed to provide additional clues to further address the results in detail.

A CROSS-SECTIONAL SURVEY STUDY TO ASSESS THE PREVALENCE OF PALITYA IN YOUTH WSR TO PRAKRITI

Ayurveda is a science of vast knowledge of Ahar, Vihar and Prakriti. In this modern era due to stress, lifestyle changes, eating habits and many psychological and environmental factors are responsible for premature greying of hair. The present cross-sectional survey study was planned to know about etiological factors of Palitya in youth and the prevalence of Prakriti also. Total 500 patients of premature canities fulfilling the criteria of inclusion as per GSS1 were selected from O.P.D. of department Rog Nidana and Vikriti Vigyana, National Institute of Ayurved, Jaipur. A structured questionnaire will be administered to each subject of Nidanatmaka survey to collect data on Prakriti, Socio-demographic profile, Dietary patterns and other Ayurvedic variables. Results: Max. 37% have Akala bhojana,36.4% having Vishmagni,35 and 32% habituated to Katu and Lavan Rasa,42% consuming Amla Rasa, and max.36.4% were having Vata -Pitta Prakriti. Overall, it was observed that in youth diet, dietary habits were prone to vitiate Pitta dosha. especially in the Pitta Prakriti persons. The faulty dietary habits like Vishamashana, Adhyashana, Ajeernashana, Amla-Lavana Rasa Atisevana can accelerate the process of greying hair. Keywords: Premature canities, Prakriti

Epidemiological and Biochemical Factors (Serum Ferritin and Vitamin D) Associated with Premature Graying Of Hair

Abstract Background Premature graying of hair (PHG) is defined as graying of hair before the age of 20 years in Caucasians and before 30 years in Blacks. Several factors contribute to development of hair graying as genetics, environmental factors, life style and stressful events. Also, many biological markers were associated with development of hair graying as vitamin D, ferritin, vitamin B12 and many other electrolytes as calcium and magnesium. Aim of the study assess various epidemiological factors and biochemical variables (serum ferritin and vitamin D) associated with premature graying of hair. Patients and methods The current study included 75 premature hair graying patients, and 75 apparently healthy controls of matched age and sex. Assessment of epidemiological, clinical characteristics, estimation of serum levels of vitamin D and ferritin was done for included subjects. Results We detected positive correlation of sedentary life style, stress perception and family history with PHG development. No significant difference of vitamin D between the two groups, while low serum ferritin was significantly associated with PHG patients.

Premature Hair Greying - Magnitude and Associated Factors: A cross-sectional study in a university in Mysuru

Background: Premature hair greying (PHG) refers to the diffuse loss of hair color at an age earlier than that is generally accepted as physiological. Studies have found that it affects self-esteem and social life. Our efforts were to estimate the prevalence among students <25years and understand the associated factors. Design and Methods: A cross-sectional study using a simple random sampling technique was used to survey 358 students at a university in Mysuru. The data were analyzed using SPSS v22. The association and relationship of PHG with attributed risk factors and various socio-clinical factors have been analyzed using Chi-Square Test, Independent sample t-test, and Mann Whitney U-test. A p-value of less than 0.05 has been considered statistically significant. Results: In this study, the prevalence of PHG was 28.2%. We observed that PHG was associated with male gender, obesity, and positive paternal, maternal, and family history of PHG. The relation of PHG with lower dietary iron intake, tobacco smoking amount, and frequency was also found in this study. However, no association between PHG and psychological stress, alcohol consumption, dietary Vitamin B12, and D intake, shampoo, and oil usage frequency was found. Conclusion: We recommend that further studies should be done to check if weight reduction, smoking cessation, and maintenance of dietary iron adequacy can help in preventing PHG.

Knowledge, practice and adverse reactions amongst Hair dye users - A cross sectional study

Introduction: Colour of hair is most conspicuous phenotype of human beings and plays an important role in one's overall physical beauty. Premature hair greying (PHG) has caused the increased use of various hair dyes in population though it has adverse effects. Aim- To assess knowledge, practice of hair dye users with purpose, frequency of use and adverse reactions if any on hair, scalp, skin. Methodology: A cross-sectional study was conducted on participants from PCMC region by interview method using a questionnaire (20 questions) specially prepared pertaining to use of hair dye and adverse reactions to it. Statistical Analysis-The demographic data is expressed as mean ± standard deviation, quantitative data expressed as percentages. Results: A total 98subjects including 75.5% and 24.5% females and males respectively. The participants started using hair dye at an age of 25 (±3.03) years. Herbal and Synthetic dyes were used by 36.74% and 63.27% respectively. Frequency of use in a year was 4-5 times in 58.16%. Adverse reactions of dye on body of hair like dryness46.94%, loss of hair 30.62%, change in texture and thinning were reported. 29.59% of subjects showed ill effects during dyeing of scalp while in 68.36% of subjects after the dyeing process was complete. Conclusion: Majority Population started hair dyeing at very early age using Chemical dyes even though they perceived herbal dyes were safe. They continued hair colouring despite adverse reactions, which indicates aesthetic importance of hair colour and need of research in the field of Ayurveda for developing safe, natural hair dye.

Waardenburg syndrome type 2A in a large Iranian family with a novel MITF gene mutation

BackgroundThe characteristics of Waardenburg syndrome (WS) as a scarce heritable disorder are sensorineural hearing loss and deficits of pigmentation in the skin, hair, and eye. Here, clinical features and detection of the mutation in the MITF gene of WS2 patients are reported in a sizable Iranian family.MethodsA man aged 28-years represented with symptoms of mild unilateral hearing loss (right ear), complete heterochromia iridis, premature graying prior to 30 years of age, and synophrys. In this research, there was a sizable family in Iran comprising three generations with seven WS patients and two healthy members. Whole exome sequencing was applied for proband for the identification of the candidate genetic mutations associated with the disease. The detected mutation in proband and investigated family members was validated by PCR-Sanger sequencing.ResultsA novel heterozygous mutation, NM_198159.3:c.1026dup p.(Asn343Glufs*27), in exon 9 of the MITF gene co-segregated with WS2 in the affected family members. The variant was forecasted as a disease-causing variant by the Mutation Taster. According to the UniProt database, this variant has been located in basic helix-loop-helix (bHLH) domain of the protein with critical role in DNA binding.ConclusionsA frameshift was caused by a nucleotide insertion, c.1026dup, in exon 9 of the MITF gene. This mutation is able to induce an early termination, resulting in forming a truncated protein capable of affecting the normal function of the MITF protein. Helpful information is provided through an exactly described mutations involved in WS to clarify the molecular cause of clinical characteristics of WS and have a contribution to better genetic counseling of WS patients.

Standardization of Amarantha hair oil with special reference to identification of β-sitosterol as major component having 5α-reductase inhibitory activity/hair growth promoting activity

<p class="abstract"><strong>Background:</strong> Androgenetic alopecia is a common form of hair loss in both men and women. Synthetic drugs like minoxidil and finastride are available treatment for androgenetic alopecia, however, use of these drugs on long term basis may cause many side effects. Hence there was a need to have an effective and safe alternative option. Ari Healthcare Pvt. Ltd. has developed Amarantha hair oil (herbal hair oil) to be used for dandruff, hair fall and premature greying of hair. The aim was to standardize Amarantha hair oil with special reference to identification of β-sitosterol as major component having 5α-reductase inhibitory activity/hair growth promoting activity.</p><p class="abstract"><strong>Methods:</strong> Amarantha hair oil was prepared by using various herbal ingredients which contains β-sitosterol as active marker compound. Amarantha hair oil was evaluated for appearance, weight per ml, refractive index, acid value, saponification value, peroxide value, TLC Identification of β-sitosterol, assay of β-sitosterol content using high performance thin layer chromatography (HPTLC) and microbiological tests. Also accelerated stability study was performed.<strong></strong></p><p class="abstract"><strong>Results:</strong> All the parameters tested were within normal limits. Amarantha hair oil was stable in accelerated stability study. We found that almost all the ingredients of formulation contain β-sitosterol when analysed using HPTLC. Amarantha hair oil contains 0.52% of β-sitosterol.</p><p class="abstract"><strong>Conclusions:</strong> All the ingredients and Amarantha hair oil contain β-sitosterol that helps in promotion of hair growth.</p><p> </p>

Vitiligo – Study In view of familial occurence

Vitiligo – Study In view of familial occurence

Waardenburg Syndrome

Background: Waardenburg syndrome (WS) is an autosomal dominant inherited genetic condition that manifests with sensorineural deafness and pigmentation defects of the skin, hair, and iris. This genetically and clinically heterogeneous disease accounts for 2% of the congenitally deaf population. Objectives: The aim of our study is to determine epidemiological and clinical characteristics of this group to improve the management, especially for the hearing impairment. Methods: Seven cases were diagnosed during the examination of children with suspected congenital deafness. Results: The age of our children ranged from 1.3 to 5 years, with a median age of 3.6 years, with female predominance; no consanguineous marriage and fetal or perinatal history have been reported; there was family history of premature greying in four cases and deafness in two cases. Two patients had WS Type 1 with a dystopia canthorum, while four cases had WS Type 2. There was one patient with Waardenburg Klein or Shah syndrome. The otoscopy was normal in all children. Evoked auditory potentials, otoacoustic emissions, and tonal audiometry were performed; they had shown a congenital, sensorineural bilateral, and profound hearing loss >100 dB in all cases. All children had received a cochlear implantation followed by speech reeducation. A genetic consultation was carried out for all our children. Conclusion: WS is a relatively common genetic cause of sensorineural hearing loss. Early diagnosis and improvement of hearing impairment are most important for psychological and intellectual development of the children with WS.

ECLIPTA ALBA (BHRINGRAJ): A PROMISING HEPATOPROTECTIVE AND HAIR GROWTH STIMULATING HERB.

Plants are the primary source of food, shelter, and various remedial approaches. They are being in use for treating various kinds of human ailments across the world since the ancient times. One of such important plants is Eclipta alba hassk (Asteraceae) which is commonly known as Bhringraj and false daisy. This plant is known for its extra-ordinary therapeutic properties. It is one of most widely used plant in traditional systems of medicines such as Ayurvedic, Unani, Sidha, homeopathy, Chinese, and folk. Each part of this medicinal plant contains many important phytochemical constituents such as coumestans, triterpenes, flavonoids, steroids, polypeptides, and saponins. It is majorly used for enhancing the growth, strength, and blackening of hair. It is used as the main ingredient in many hair oils. It significantly treats problems related to hair such as hair fall, dandruff, premature greying, and baldness. E. alba exhibits many other important biological properties such as anticancer, anti-bacterial, anti-viral, anti-stress, and immunomodulatory. Thus, this medicinal plant is playing a vital role in the medical field and cosmetic industry. The present review is a summary of phytomedicinal importance of E. alba in Ayurveda as well as folk medicine system.

Biomarker of Oxidative Stress in Premature Hair Graying at Young Age

BACKGROUND: Gray hair is a physiological process of aging that occurs in everyone. Premature hair graying (PHG) is the term when early hair gray at an unusual age. The causes of PHG are multifactorial, genetic, nutritional, and environmental, including oxidative stress. Free radicals caused interference with cellular responses that cause direct damage to various proteins and DNA in the long term. The body’s defense mechanisms likely antioxidant enzymes, including catalase, glutathione peroxidase (GPx), and superoxide dismutase (SOD) was activated against free radicals. AIM: We aimed to evaluate markers of oxidative stress and associated with severe graying at young age. MATERIALS AND METHODS: We recruited consecutive 40 respondents with PHG and healthy controls, male sex and aged <25 years. The severe graying was graded with total of gray hair. The serum samples were collected to detect oxidative stress markers through malondialdehyde (MDA), SOD, catalase, and GPx measurement with enzyme-linked immunosorbent assay. RESULTS: Serum MDA concentration was higher but not significantly (p > 0.05), while serum SOD, catalase, and GPx level, indicators of antioxidant were significantly lower (p < 0.001, p = 0.017 and p < 0.001, respectively) in PHG compared to controls. The correlation between oxidative stress and graying severity was not significant (p > 0.05), but the association between onset and severity of graying was significant (p < 0.001). CONCLUSIONS: Respondents with PHG had increased of pro-oxidants and decreased of antioxidants compared than controls. The severity of graying is equivalent to the level of oxidative stress. The supplement of antioxidants is likely recommended in PHG.

Malignancy Risk in Lung Transplant Recipients with Short Telomere Length

<h3>Purpose</h3> Short telomere lengths (TL) are seen in 10% of lung transplant recipients (LTRs) with interstitial lung disease (ILD). Short TL and immunosuppression predispose to carcinogenesis. We assess whether LTRs with short TLs have a compounded malignancy risk. <h3>Methods</h3> This is a single-center retrospective analysis from 1/2012 - 1/2017. LTR records were queried for TL, malignancy, and cancer risk factors. TL was assayed in ILD candidates with cytopenias, abnormal liver function and coagulation, splenomegaly, premature graying, or ILD family history. Lymphocyte TL was assessed via flow-FISH (Repeat Dx) and was age-adjusted; values <10^th percentile were defined as short. LTRs were administered standard induction and maintenance immunosuppression, and antimicrobial prophylaxis. . LTRs underwent age-appropriate cancer screening. Statistical analysis was performed using SSS (StatCorp); Fisher's Exact, Pearson's Chi square, and Wilcoxon's rank sum tests were used for binary, categorical and continuous data, respectively. P-values ≤ 0.05 were significant. <h3>Results</h3> 19/233 (8.2%) LTRs had short TLs. There were no inter-cohort differences in baseline traits (<b>Table 1</b>). Five (26.3%) LTRs with short TLs developed malignancy, compared to 45 (21%) patients with presumed normal TLs. There was a significant difference in hematologic malignancy rate in those with short TLs (40% vs. 0%, p=0.009). There was no difference in time to cancer diagnosis or survival (<b>Table 3</b>). <h3>Conclusion</h3> LTRs with short TLs may be predisposed to hematologic malignancy. Study limitations include size, the single-center, retrospective design, and that only a sub-set of patients had TL measured.

Disseminated Nonsegmental Vitiligo Associated With Halo Nevi and Premature Gray Hair

Halo nevi (HN) are acquired melanocytic nevi circumferentially surrounded by a depigmented patch. HN are commonly associated with vitiligo and can be associated with uveal, mucosal, or cutaneous melanoma in certain patient populations. HN may also have localized leukotrichia of terminal hair overlying the nevus. We report a less common triad of rapid-onset HN, nonsegmental vitiligo, and premature hair graying (PHG) of scalp hair.

Cutaneous manifestations in Moyamoya angiopathy: A review.

Moyamoya angiopathy (MA) is a progressive cerebrovascular disease with a poorly understood pathophysiology. It is mainly characterized by progressive bilateral stenosis of the terminal intracranial part of the supraclinoid internal carotid arteries and the proximal parts of the middle and anterior cerebral arteries. This results in early-onset ischemic or hemorrhagic strokes. The disease may be idiopathic (known as Moyamoya disease) or associated with other heritable or acquired conditions, including type 1 neurofibromatosis or other RASopathies, sickle cell disease, Down syndrome, or autoimmune disorders (known as Moyamoya syndrome). Apart from the brain, other organ manifestations including cutaneous ones have also been described in MA patients. A literature research on PubMed was performed for articles mentioning the cutaneous association in MA and published between 1994 and October 2020. The present review summarizes the cutaneous associations as well as the coincidental dermatological findings seen in MA patients. Those include changes in the epidermis, dermis, or skin appendages for example café-au-lait spots, hypomelanosis of Ito, livedo racemosa, hemangiomas, premature graying of hair, chilblains etc.

Study of quality of life in patients with premature graying of hair in Western Indian population

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Quality of life in patients with premature graying of hair is an under studied topic in Indian population. Its onset in adolescence may have a significant effect on the developing psyche of an individual sufferer impairing academic and work related performance and can be associated with low self esteem, low confidence which can further be associated with depression. Aim was&lt;strong&gt; &lt;/strong&gt;to objectively evaluate the impact of premature canities on QoL and early identification of patients in need of medical and psychological intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The impact on QoL was calculated with the help of a modified and prevalidated questionnaire based on the dermatology life quality index proposed by Finley and Kahn. One hundred patients with onset of canities before the age of 25 years were enrolled, after approval by the institutional ethical committee.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean modified DLQI score recorded was 14.3±6.76. Total of 71% patients were found to have a very large to extremely large effect on the QoL. Guilt, mood fluctuation and need for medical intervention were reported frequently. The comparison between DLQI scores of boys and girls was not significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients of premature canities were found to have profound impact on their QoL, attributable to their perception of the disease. Considering the age group affected, it could have a long‑term detrimental effect on their psychological and social wellbeing.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;