Protection Of Reproductive Health Research Articles

Reproductive Behavior of Adolescent Girls: Analysis of Risk Factors, Prospects of Prevention and Education

INTRODUCTION: Caring of reproductive health of children and adolescents in the society, especially of adolescent girls as a group most vulnerable to risks in the reproductive sphere, continues to be of high importance. The studies confirm that education and awareness about reproductive health can reduce the probability of problems occurring. The existing legal regulations emphasize the importance of providing accurate and timely information of reproductive health. AIM: Scientific justification of the strategy of forming safe reproductive behavior of adolescent girls on the basis of the peculiarities of their current reproductive behavior taking into account the opinion of specialists in the fields of education and healthcare. MATERIALS AND METHODS: To assess the peculiarities of reproductive behavior of adolescent girls, an anonymous questionnaire survey of 400 adolescent girls was conducted. To determine the expectations of the participants of the sex education process, as well as the main directions of preventive work and education, a survey of 400 parents of adolescent girls, 86 pediatricians, 34 obstetricians-gynecologists and 420 teachers was conducted. For all groups of participants, author’s questionnaires were developed. RESULTS: The reproductive behavior of adolescent girls living in the territory of the Novosibirsk region, is characterized by early start of sex life (15.90 ± 0.14 years), promiscuity (1.70 ± 1.10 partners), refusal to use effective means of contraception. Parents of adolescent girls emphasize the leading role of the family in sex education, suggesting participation of doctors and teachers in the process, but remain dissatisfied with the intensity of preventive measures. A similar problem is emphasized by specialists in the healthcare and education systems who indicate the possibility of conducting preventive work with adolescent girls remotely. In the opinion of pediatricians and obstetricians-gynecologists, providing preventive information on the reproductive health and behavior, will not only create safe reproductive behavior for modern adolescents, but is also an effective strategy of improving the system of reproductive health protection. CONCLUSION: The study identified features of the reproductive behavior of adolescent girls that characterize it as risky. The results emphasize the need for an integrated approach to assessing and maintaining the health of adolescent girls, and also focus attention on the importance of educational work in this age group. The study serves as a basis for further preventive strategies in the field of reproductive health and education.

Reproductive Behavior of Adolescent Girls: Analysis of Risk Factors, Prospects of Prevention and Education

INTRODUCTION: Caring of reproductive health of children and adolescents in the society, especially of adolescent girls as a group most vulnerable to risks in the reproductive sphere, continues to be of high importance. The studies confirm that education and awareness about reproductive health can reduce the probability of problems occurring. The existing legal regulations emphasize the importance of providing accurate and timely information of reproductive health. AIM: Scientific justification of the strategy of forming safe reproductive behavior of adolescent girls on the basis of the peculiarities of their current reproductive behavior taking into account the opinion of specialists in the fields of education and healthcare. MATERIALS AND METHODS: To assess the peculiarities of reproductive behavior of adolescent girls, an anonymous questionnaire survey of 400 adolescent girls was conducted. To determine the expectations of the participants of the sex education process, as well as the main directions of preventive work and education, a survey of 400 parents of adolescent girls, 86 pediatricians, 34 obstetricians-gynecologists and 420 teachers was conducted. For all groups of participants, author’s questionnaires were developed. RESULTS: The reproductive behavior of adolescent girls living in the territory of the Novosibirsk region, is characterized by early start of sex life (15.90 ± 0.14 years), promiscuity (1.70 ± 1.10 partners), refusal to use effective means of contraception. Parents of adolescent girls emphasize the leading role of the family in sex education, suggesting participation of doctors and teachers in the process, but remain dissatisfied with the intensity of preventive measures. A similar problem is emphasized by specialists in the healthcare and education systems who indicate the possibility of conducting preventive work with adolescent girls remotely. In the opinion of pediatricians and obstetricians-gynecologists, providing preventive information on the reproductive health and behavior, will not only create safe reproductive behavior for modern adolescents, but is also an effective strategy of improving the system of reproductive health protection. CONCLUSION: The study identified features of the reproductive behavior of adolescent girls that characterize it as risky. The results emphasize the need for an integrated approach to assessing and maintaining the health of adolescent girls, and also focus attention on the importance of educational work in this age group. The study serves as a basis for further preventive strategies in the field of reproductive health and education.

Complexity of the legal nature of the right to reproduction

This article examines reproductive health as an important component of physical and mental well-being in modern society. It focuses on a wide range of services and information covering sexual and reproductive health, contraception, family planning, STD treatment, pregnancy and childbirth. It is indicated that the effectiveness of reproductive health protection is supported by international norms, including the Sustainable Development Goals No. 3, and is based on the principles of dignity, equality and the right to free choice. It is emphasized that reproductive health is a fundamental human right, which is directly related to the right to life and health. Research in this area helps to clarify the effectiveness of legal norms and protection measures, the article also highlights the problem of discrimination, particularly on the basis of gender, in the context of reproductive health, and emphasizes the importance of combating this inequality. In addition, the article points to the importance of access to information about reproductive health as a key aspect of human rights that contributes to public education and awareness. The article also considers the complex nature of the right to reproduction, which includes biological, legal, ethical and social aspects that interact with each other and require a careful balance between human rights, ethical principles and social needs. It is motivated that the right to reproduction implies the right of each individual to make free choices regarding sexual behavior, family planning and access to quality reproductive health services, but the realization of these rights may face ethical and moral dilemmas, as well as different approaches to legal regulation in different countries. Also important is the social aspect, which includes the availability and quality of reproductive health services, as well as taking into account socio-cultural norms and values. It was found that all these aspects require a careful balance between human rights, ethical principles and social needs, in order to ensure adequate protection and support of the reproductive health of each person.

CONCEPT AND LEGAL ANALYSIS OF THE CRIME OF ABORTION IN CRIMINAL PROCEEDINGS

This article reveals the concept of the crime of criminal abortion (abortion) and its characteristics, as well as a legal analysis of the crime of criminal abortion (abortion). Also, based on scientific analysis, national laws and legal documents are highlighted, as well as a number of declarations on the protection of reproductive health and the rights of pregnant women from various attacks. In addition, artificial termination of pregnancy in a place outside a medical institution in the case of criminal termination of pregnancy (abortion), medically possible cases of artificial termination of pregnancy are opinions expressed by legal scholars on the basis of scientific and comparative analysis.

Analysis of the activities of the reproductive health protection system of children and adolescents of Saint Petersburg in 2020–2021

Analysis of the activities of the reproductive health protection system of children and adolescents of Saint Petersburg in 2020–2021

Protection of reproductive health of children: problems of gender and age discrimination

Research objectives: to investigate the problems of gender and age discrimination in the modern discourse on the protection of children’s reproductive health, to analyze the most important issues including the concept of child reproductive health, normative guarantees in the field of children’s reproductive health, protection of reproductive children’s health in the context of achieving the Sustainable Development Goals of the United Nations, social obstacles to the proper realization of children’s reproductive rights, etc.
 Materials and methods. A survey was based on the author’s developed questionnaires in order to find out the level of reproductive health and sexual violence among children. The focus group was formed by 540 children: 288 girls and 252 boys aged 15–18 living in Lviv, Ivano-Frankivsk and Zakarpattia regions. The research period covered the years 2021–2023. The error of the obtained results, taking into account the number of respondents, was 2–3.5%. The questionnaires are designed for anonymous and quick filling.
 Results. Today’s problems and challenges of an environmental, pandemic, and military nature are partially offset by rapid and continuous improvements in social and economic conditions, along with changes in demographics, lifestyles, the environment, and innovations in medical and therapeutic technologies. In general, there is sufficient number of normative protection guarantees that exist at the normative level. However, the problem is manifested in the fact that declarative norms are often ineffective, as they do not entail real guarantees of an organizational and institutional nature regarding the protection and protection of children’s medical rights. Despite the special needs and vulnerabilities that children face, most services are not organized to recognize or meet these needs.
 Conclusions. It is substantiated that the family is the most important institution in the socialization of a child, and its life experience plays an important role in ensuring that the child is a healthy individual in the broad sense of this concept, which includes physical and psychological criteria. It has been established that characteristics and relationships in the family, especially in the preschool period (the most critical process of children’s development) can positively or negatively affect the structure of the child’s personality. Sudden changes and extraordinary events experienced by the family in the process of adaptation to social changes can cause the family to experience a crisis situation.

The certain aspects of organization of medical care of women in period of pregnancy and delivery in the Republic of Bashkortostan

Health protection of women of reproductive age is a priority direction of state policy. In protection of reproductive health of women no small importance is played by development of organization of primary medical sanitary care and specialized medical care of women during pregnancy and delivery. The study was carried out in the Republic of Bashkortostan and covered period of 2017-2021. It was established that the number of women of fertility age decreased up to 3,9% that became one of causes of reduction of birth rate from 12.1‰ to 9.8‰ respectively. At that, the level of maternal mortality increased up to 8.9 times (from 4.1 to 36.8 per 100,000 born alive). In 2021, out of 37,775 women who completed their pregnancy, 99.3% were examined by therapist and only 92.2% passed such an examination prior to 12 weeks of their pregnancy. On the gestation period of 11-4 weeks, 91.3 % of pregnant women were subjected to ultrasound examination of fetus with detection of maternal serum markers and 94.4% of pregnant women were examined at the 19-21 weeks of pregnancy. Among pregnant women, rate of diseases and pathological conditions that preceded or developed during pregnancy slightly increased. Increasing of morbidity of anemia, diseases of endocrine system, including diabetes mellitus, was noted. The deterioration of particular indicators of organization of medical care of women according to profile "obstetrics and gynecology" occurred during period of COVID-19 pandemic. The implementation of three-level system of organization of medical care resulted in significant reduction of number of obstetric and gynecological hospital beds.

Modern women choose contraceptive vaginal ring

This survey introduces up-to-date statistic data on women’s reproductive health considering current control methods. It includes literature analysis on the contraceptive vaginal ring (CVR) use. Evidential medicine proves that CVR is a long-standing, safe and effective birth control method. CVR usage definitely wins the battle against oral contraception and prolonged contraception methods. The survey includes current patients’ survey results concerning CVR usability particularly during sex. VR’s effect on vagina microbiota and cervix epithelium is also covered, considering the discussions on cervix cancer increase caused by long-term use of combined hormonal contraceptives. Recently, there has been some positive trend towards the protection of reproductive health. However, we have to admit that there are still many unresolved issues, in particular, unavailability of adequate family planning counselling services and advanced effective birth control methods. The pharmaceutical market is saturated with various birth control methods. A careful analysis of medical history details and test results makes it easy to choose the best possible and safe birth control method with due regard of the patients’ wishes. Bearing in mind the less pronounced systemic effect, ease of use, and a favourable safety profile, the choice of CVR as a birth control method seems to be the best solution for women

Single-cell RNA sequencing reveals the fragility of male spermatogenic cells to Zika virus-induced complement activation

Zika virus (ZIKV) is a potential threat to male reproductive health but the mechanisms underlying its influence on testes during ZIKV infection remain obscure. To address this question, we perform single-cell RNA sequencing using testes from ZIKV-infected mice. The results reveal the fragility of spermatogenic cells, especially spermatogonia, to ZIKV infection and show that the genes of the complement system are significantly upregulated mainly in infiltrated S100A4 + monocytes/macrophages. Complement activation and its contribution to testicular damage are validated by ELISA, RT‒qPCR and IFA and further verify in ZIKV-infected northern pigtailed macaques by RNA genome sequencing and IFA, suggesting that this might be the common response to ZIKV infection in primates. On this basis, we test the complement inhibitor C1INH and S100A4 inhibitors sulindac and niclosamide for their effects on testis protection. C1INH alleviates the pathological change in the testis but deteriorates ZIKV infection in general. In contrast, niclosamide effectively reduces S100A4 + monocyte/macrophage infiltration, inhibits complement activation, alleviates testicular damage, and rescues the fertility of male mice from ZIKV infection. This discovery therefore encourages male reproductive health protection during the next ZIKV epidemic.

Reproductive technologies in solving the problems of infertility of the population (Part I)

The article provides an overview of scientific information on modern approaches to reproductive health protection, innovative methods for early detection of disorders and timely correction of reduced reproductive capabilities of the body, including infertility. The main physiological factors of reproductive disorders are genetic predisposition, mitochondrial dysfunctions, genomic instability, oxidative stress, etc. In particular, mitochondria make a significant contribution to the regulation of various physiological aspects of reproductive function, including the development of oocytes and embryos, as well as spermatogenesis and fertilization. Oocyte dysfunction associated with aging is becoming an increasingly pressing medical and economic problem in modern society, where women are postponing family formation. Maternal metabolic disorders such as obesity and type II diabetes are associated with hyperlipidemia and increased concentrations of free fatty acids in ovarian follicular fluid. Oocyte maturation under these lipotoxic conditions leads to increased levels of oxidative stress, mitochondrial dysfunction, decreased competence in oocyte development, and poor IVF results.As a result, it was revealed which modern approaches influence the solution of the problem of reproductive disorders, the risk factors for reproductive health were assessed, and methods were proposed to reduce the influence of these factors.

Осведомленность студентов медицинского колледжа о формировании репродуктивного здоровья

The study objective is to assess awareness of medical college students about formation of reproductive health. 80 female students from a medical college were surveyed concerning formation of their menstrual function; this survey was followed by an interview of 126 female students and 81 male students from medical colleges about their awareness of reproductive health protection and attitude to hygienic education regarding this topic. Data were processed using Statistica 13.0 (StatSoft, USA). 83.8% girls had their periods between 11 and 14, whereas in 7.5% of girls they started at the age of 15 and older. During the interview, 22.5% of girls had an irregular menstrual cycle. The conducted study revealed an insufficient awareness of students from a medical college of reproductive health formation. It produces a negative effect on their own health and will prevent subsequent effective hygienic education of different categories of population as far as this issue goes.

Current issues of protection of reproductive health in population residing in cold climate regions (literature review)

Relevance. 40% of the total number of employees are constantly or periodically engaged in work in open areas and in unheated industrial premises. Given that more than 70% of the country’s territory is in cold climate areas, the tasks of preserving their health are a priority. The original articles on the assessment of adverse effects of natural and climatic factors in cold climate regions on the reproductive health of the population, presented in databases and information systems: RSCI, CyberLeninka, Scopus, Web of Science and meeting the criteria for compliance with the stated purpose and quality of research, were analyzed. A significant part of reproductive losses has been proven to be related to the exposure to a number of occupational risk factors; however, workers’ engagement in outdoor operations with a higher risk of cold stress in combination with other factors remains one of the least studied problems of preventive medicine. Considering more than 70% of the country’s territory to be represented by cold climate regions, where up to 40% of the total workforce are permanently or periodically engaged in outdoor works and in unheated industrial premises, the protection of their health is a national priority. A total of two hundred three full-text publications were identified by targeted search, of which 132 fully met these inclusion criteria. Conclusion. As a result of a systematic review of published works available in national and international bibliographic indexing systems, including the results of our own research, engagement in work operations in cold climate regions has been proved to be associated with the risk of functional overstrain of most human life-supporting systems leading to health impairments. To date, there have been identified a significant number of occupational risk factors including chemical, physical, biological, psycho-emotional and ergonomic ones that might induce adverse effects on the reproductive health of women and men such as acute and chronic damage to reproductive functions, fetal development impairment and increased early perinatal mortality. At the same time, the role of cooling weather and climatic factors in the occurrence of such disorders, primarily among workers who systematically perform work operations outside heated industrial premises in cold climate regions there is least studied.

Protection of reproductive health: international and national experience

Objectives: consideration at the scientific level of the problem of the nation’s reproductive health protection in the context of international regulation and individual national experience.Materials and methods. The statistical method and the author’s survey method were used for the collection and effective processing of public information. 200 women and 100 men aged 21 to 45 were selected as respondents. It was used a direct interview with respondents. The survey was conducted in Kyiv, Lviv, and Volyn regions in 2020–2022. International monitoring reports, global and national statistics, doctrinal developments of scientists of foreign countries (among them Great Britain, China, USA) were also used.Results. The main causes of impaired human reproductive health are: environmental, socio-economic (unresolved issues of abortion and proper contraception, violence against women and children) and medical problems. In Ukraine, neither specialized legislative acts nor bylaws contain a comprehensive strategy for the protection of reproductive health, which causes gaps in the legal regulation and social security of this area. Gender discrimination is a widespread phenomenon in our country. We must state the discriminatory situations and oppression of both sexes in the reproductive sphere. There are no systematic mechanisms for the prevention of this problem, and the attention of state legal, scientific and public institutions to this problem is insufficient.Conclusions. Legal policy in the field of reproductive health needs a complementary approach and renewal of strategic understanding at the level of the state legal policy. Only comprehensive consideration of reproductive health problems in Ukraine can ensure their solution. Reproductive counseling should be proactive and encouraged because its implementation is beneficial for the patient’s mental health, quality of life, and adherence to treatment. Providing reproductive health education improves knowledge, attitudes and practices in the field of human reproduction.

Информированность студенток по вопросам охраны репродуктивного здоровья

The study was aimed to define the female students’ awareness of the reproductive health protection issues. A survey was conducted in 2021–2022 in order to study the onset of menstrual cycles and age at menarche in 372 female students of medical and non-medical universities and colleges of the Central Federal District. The survey of 530 female students concerning their knowledge about the reproductive health protection issues and their attitude towards sexuality education for children and adolescents was also conducted. Statistical processing was performed using the Statistica 10.0 software package (StatSoft, USA). Insufficient knowledge about the reproductive health protection issues among students was reported: the contingency coefficient for the presence of real menstrual disorder and the students’ belief of having problems was low (Pearson contingency coefficient = 0.31, р ≤ 0.05).

Правові засади управління процесами надання медичних послуг із допоміжних репродуктивних технологій в Україні

Проаналізовано чинні нормативно-правові акти, які становлять законодавче підґрунтя надання медичних послуг із допоміжних репродуктивних технологій в Україні різної юридичної сили, виявлено прогалини регламентації, перспективні напрями для розвитку галузі. Визначено та досліджено міжнародний, національний і відомчий рівні регулювання надання медичних послуг у цій сфері. Встановлено, що державна політика у сфері охорони репродуктивного здоров’я населення виходить за межі компетенції винятково сфери охорони здоров’я і набуває ознак першочергових завдань національної політики. Завдяки аналізу п’яти законопроектів, які мають регулювати надання медичних послуг у цій сфері, визначено основні тенденції розвитку державної політики, такі як лібералізація законодавства, розширення спектру послуг, розширення джерел фінансування тощо.

Implementation of primary and secondary prevention measures of diseases in Moscow

Introduction. Preventive health care (preventive medicine or prophylaxis) implies a set of measures aimed at preventing the development of diseases, as opposed to their treatment of diseases. Disease prevention is based on interventions that can be classified as primary, secondary and tertiary prevention measures. Objective. To describe the primary and secondary prevention measures implemented in the city of Moscow. Materials and methods. For the purpose of the study, an information search was carried out according to a formulated request and a systematic analysis of the data obtained. Results. The analysis of the main measures implemented in the city of Moscow in relation to disease prevention has been carried out. The events on immunization of the population, on smoking cessation, getting rid of alcohol dependence, organization of rational nutrition and diet, protection of reproductive health and prevention of chronic non-infectious diseases are consecrated. The activity of executive authorities in relation to strengthening the health of the population of the city of Moscow is consecrated.

The role of staffing in the context of protection of reproductive health of the younger generation in the Russian Federation

Special attention should be paid to the planning of human resources in health care, since this problem in the healthcare sector is quite urgent at present (there is a gradual decrease in nursing and medical personnel). The purpose of this study is to determine the role of staffing in the context of protection of reproductive health of the younger generation in the Russian Federation. The main analytical base of the research was statistical data and materials of domestic and foreign literary sources, periodicals, including various electronic resources. Research methods included: statistical method, study and generalization of experience, content analysis. In the course of the study, the issues of staffing with specialists in the conditions of protecting the reproductive health of the younger generation in the Russian Federation were analyzed, taking into account comparable indicators in the general structure of medical and mid-level medical personnel of various specialties; the experience of specialists in obstetrics and urological and andrological service has been studied, taking into account the resource capabilities of medical organizations. One of the main directions in the study of reproductive health is timely prevention, especially on the basis of antenatal clinics or health centers, medical prevention centers. Thus, we can conclude that staffing in the framework of the protection of adolescents’ reproductive health plays an important role, while in order to improve the situation with the participation of the state, it is necessary to revise and work out new programs for the development of human resources potential in health care, as well as to create adequate conditions for their implementation at various hierarchical levels of management, including the introduction of additional measures for social support and advanced training of specialists in this profile.

The role of staffing in the context of protection of reproductive health of the younger generation in the Russian Federation

Special attention should be paid to the planning of human resources in health care, since this problem in the healthcare sector is quite urgent at present (there is a gradual decrease in nursing and medical personnel). The purpose of this study is to determine the role of staffing in the context of protection of reproductive health of the younger generation in the Russian Federation. The main analytical base of the research was statistical data and materials of domestic and foreign literary sources, periodicals, including various electronic resources. Research methods included: statistical method, study and generalization of experience, content analysis. In the course of the study, the issues of staffing with specialists in the conditions of protecting the reproductive health of the younger generation in the Russian Federation were analyzed, taking into account comparable indicators in the general structure of medical and mid-level medical personnel of various specialties; the experience of specialists in obstetrics and urological and andrological service has been studied, taking into account the resource capabilities of medical organizations. One of the main directions in the study of reproductive health is timely prevention, especially on the basis of antenatal clinics or health centers, medical prevention centers. Thus, we can conclude that staffing in the framework of the protection of adolescents’ reproductive health plays an important role, while in order to improve the situation with the participation of the state, it is necessary to revise and work out new programs for the development of human resources potential in health care, as well as to create adequate conditions for their implementation at various hierarchical levels of management, including the introduction of additional measures for social support and advanced training of specialists in this profile.

ФОРМУВАННЯ ГОТОВНОСТІ ДО ВІДПОВІДАЛЬНОГО БАТЬКІВСТВА В СТАРШОКЛАСНИКІВ ІНТЕРНАТНИХ ЗАКЛАДІВ ЯК НАУКОВО-ПЕДАГОГІЧНА ПРОБЛЕМА

The article is devoted to the peculiarities of readiness for responsible parenting among the senior high school students of boarding schools caused by: 1) specificity of students (social orphanhood, the derivation syndrome, lack of the possibility to gain parents’ positive social experience); 2) features of organization of boarding students’ everyday life (forced adaptation to a large number of peers; limitation of the range of gender role); 3) considering of potential opportunities of extracurricular activities in boarding schools; 4) sensitivity of early adolescence in the context of this problem (developing of the ideals of femininity and masculinity, looking to the future, making life plans). The structure of the notion of “readiness for responsible parenting among senior high school students of boarding schools” is defined in the article. It includes such components as: cognitive component – knowledge of legislative basis for family and marriage; knowledge of family functions; understanding the essence of parenting; understanding the importance of parenting; knowledge skills on reproductive culture and family pedagogy; emotional-value component – values, needs, positive motivation towards making a family and having children in future; enrichment of the emotional sphere with feelings of happiness, love, concern for the other people; activity-behavioural component – ability of harmonious interaction with other people; need of improving oneself as a future parent; skills of improvement and protection of reproductive health. The criteria of “readiness for responsible parenting among the senior high school students of boarding schools” are defined according to the components of readiness for responsible parenting of students, namely: cognitive criterion (knowledge of the functions of modern family; understanding the essence of parenting; knowledge of basis reproductive healthy), emotional-value criterion (positive motivation towards making a family and having children in future; emphatic ability; need for communication and interpersonal interaction), activity-behavioural criterion (ability of harmonious interaction with other people; skills improvement and protection of the reproductive health; need of improving oneself as a future parent). The results obtained have shown that 25,8 % of senior high school students of boarding schools have the high level of readiness for responsible parenting; 34,3 % of senior high school students have the middle level and 39,8 % of senior high school students have the low level of readiness for responsible parenting. Key words: readiness for responsible parenting, high school students of boarding schools, structure, criteria and indicators of readiness for responsible parenting, peculiarities of formation of readiness for responsible parenting, pedagogical conditions.

FEATURES OF THE FORMATION OF THE REPRODUCTIVE POTENTIAL OF ADOLESCENT GIRLS IN A LARGE INDUSTRIAL CITY

Protection of the reproductive health of adolescent girls is a priority medical and social problem. The aim of the study was to provide a scientific justification for improving the system of medical and social assistance aimed at preserving the reproductive potential of girls, taking into account the characteristics of urbanized territories. It is shown that on the industrial territory of the city, an environment is formed that hinders the formation of reproductive potential: high prevalence of unfavorable environmental, medico-biological, social and hygienic factors, a higher prevalence of somatic and gynecological pathology of adolescent girls was established. Taking into account the peculiarities of the territory allows us to develop an effective algorithm of medical, social and preventive care for the protection of reproductive health of children and adolescents.