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Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.

From an ethical point of view, the inclusion of children and young people in research is problematic due to their inability to give informed consent and meaningfully express their views. The ethical aspects of research are multiplied if the research participant might have experienced child abuse, neglect, exploitation, or other forms of violence or assisted in such acts. Talking about victimization might be difficult and generate a sense of betrayal of attachment figures. On the other hand, the usual ethical procedure of asking parents or other caretakers to give consent for their children to discuss issues of maltreatment gives them the power to act as gatekeepers to stop children from participating in research. Therefore, researchers should contemplate if parental consent should be waived and how research can be developed to mobilise children's agency and ensure their meaningful cooperation in researching different aspects of violence that affect them. This chapter presents and critically analyses different research examples and discusses their ethical dimensions from a children's rights perspective. The research questions start with discussing the utility of consulting children in research on maltreatment; the gatekeeping role of caregivers; the distress and harm eventually caused to children and young people by participation in research and the benefits of participation for children. The survey examples discussed lead to the conclusions that research on maltreatment might sometimes cause distress; caregivers' power to refuse consent for their children's participation in research on maltreatment can alter epidemiologic data and impede children's right to express their opinion on issues that are central to their lives and therefore, it should be waived; consulting children is essential for collecting data on and improving responses to child maltreatment; and children's contribution to research on maltreatment depends on the adopted methodologies of the research, more advanced forms of participation, and training children to express their opinions, thus enriching scientific knowledge and promoting change.

The purpose of this paper is to explore perceived barriers to accessing and using adolescent health services in Ghana.

The study was a qualitative study adopting a case study design. In total, 24 adolescents were recruited from four adolescent health facilities in Tema, a suburb of Ghana, using convenient sampling. In-depth interviews with respondents were conducted coupled with the taking of field notes and personal observations. Data collection took place between January and May 2017. Data were transcribed, managed and coded for themes. Thematic analysis was guided by Braun and Clarke’s (2006) Framework.

The findings of this study revealed that majority of the respondents were females (54 percent) older adolescents (above 15 years (60 percent), students (79 percent)), had junior high school education and stayed with their biological parent(s) (70 percent). Adolescents in this study perceived four main barriers that restrict their access to or use of adolescent health services. The barriers were found at the facility level, provider level, community level and personal level.

The findings of this study provide evidence-based information for planning adolescent health care interventions that would improve adolescents’ access to and use of health services in Ghana.

Based on an extensive literature review, this chapter outlines key developments in global health and research during the last century with focus on the emergence of violence and child maltreatment as international public health priorities. Violence has been known to humans for millennia, but only in the late 1990s was it recognised as a global public health issue. Every year, an estimated 1 billion children are exposed to trauma, loss, abuse and neglect. Child maltreatment takes a social and economic toll on countries. Research initiated in 1985 found child maltreatment to be associated with increased disease, disability and premature death in adult survivors. The global availability of data on child maltreatment is, however, sporadic with low validity and reliability. Few global experts have consulted and involved the survivors of child maltreatment, as the experts by experience, in their attempts to provide a more comprehensive picture of reality. Youth and adult survivors of child maltreatment are often traumatised by the experience, and it is important to use trauma-informed approaches to prevent re-traumatisation. Participatory and inclusive research on child maltreatment is only in its infancy. There is a need for more inclusive research, designed by survivors for survivors, hereby strengthening local capacity building and informing policymakers from the bottom up. This chapter reviews lessons learnt and provides recommendations for how to enhance the participation and inclusion of the experts by experience in research on child maltreatment.

Incidents of violence perpetrated through digital technology platforms or facilitated by these means have been reported, often in high-income countries. Very little scholarly attention has been given to the nature of technology-facilitated violence and abuse (TFVA) across sub-Saharan Africa (SSA) despite an explosion in the use of various technologies. We conducted a literature review to identify and harmonize available data relating to the types of TFVA taking place in SSA. This was followed by an online survey of young adults through the SHYad.NET forum to understand the nature of TFVA among young adults in SSA. Our literature review revealed various types of TFVA to be happening across SSA, including cyberbullying, cyberstalking, trolling, dating abuse, image-based sexual violence, sextortion, and revenge porn. The results of our online survey revealed that both young men and women experience TFVA, with the most commonly reported TFVA being receiving unwanted sexually explicit images, comments, emails, or text messages. Female respondents more often reported repeated and/or unwanted sexual requests online via email or text message while male respondents more often reported experiencing violent threats. Respondents used various means to cope with TFVA including blocking the abuser or deleting the abused profile on social media.

The excessive consumption of alcohol in numerous countries in the world, combined with the progressively younger age of the consumers, made it necessary for companies to use instruments of communication aimed at the development of consumption responsibility, so as to prevent reckless behaviour and the health risks thereto associated. The purpose of this paper is to assess the visibility and effectiveness of responsible consumption messages used for the sale of the product “beer” (on packaging and in advertisements); the study used a sample audience made up of teenagers and young adults from southern Italy.

The methodology used was that of the focus group. Three interview sessions were conducted, one dedicated to teenagers, age 16–17 years, and two dedicated to young adult panels, age 20–24 years. A ten-question questionnaire was designed prior to the conduction of the focus groups, and it was used in all the sessions.

The study shows the weak efficacy of the “drink responsibly” communication campaigns carried out by beer manufacturers. The totality of the interviewees failed to remember the existence of the “drink responsibly” messages and, even after supplementary visual stimulation, they were mostly disinterested, defining the fact that companies from the alcoholic drinks industry carry out consumption awareness campaigns as an out-and-out nonsensical contradiction.

The survey draws attention to the perception by young audiences of the more recent “drink responsibly” communication campaigns carried out by beer manufacturers, aiming at encouraging a more responsible attitude to alcohol consumption. There still are not many such inquests aimed at determining the response of young people to the use of slogans and commercials connected to responsible drinking in the literature; therefore, this study aimed at filling this gap. In fact, the authors believe this study is important for assessing the effectiveness of such instruments for achieving greater responsibility in the use of alcoholic drinks, so as to develop better awareness in the ranks of youths. Among the new communication strategies that were proposed to the participants, there were video commercials containing responsible consumption messages and the new prohibition marks placed directly on the product labels.

The study aims to explore the types of simulated games and gambling platforms used by adolescents, adolescent’s experiences, motivations and behaviors vis-à-vis simulated gambling and the potential interrelationships between simulated and monetary forms gambling.

Data was obtained from a qualitative longitudinal panel study with three waves of individual interviews. A cohort of 51 young Danes, with varying levels of gambling involvement, were interviewed three times, with a 10-12 frequency from 2011 to 2014. In total, 149 interviews were conducted over the 4-year period.

Enjoying social interactional effects appeared to be the main reasons young people engage in simulated gambling games. The study documented characteristics of both a catalyst pathway and a containment pathway emphasizing that for some young people simulated gambling may increase the likelihood of involvement in real money gambling while it may decrease it for others.

The sample was relatively limited and it involved participants from only one of the five Danish regions. The sample reflects the culture, rural/urban configuration and gambling market of a specific geographic region.

Some forms of simulated digital gambling may provide players with excitement and unrealistic conceptions of winning chances, which, in turn, may encourage participation in real forms of gambling. This may call for regulatory policies aiming at the structural features of simulated gambling products and their rapid global spread. Consumer campaigns aimed at both young people themselves and their parents may be considered.

Few studies have provided insights into the meanings and motivations of young people engaged in simulated gambling. The current study is among the first to explore adolescent’s experiences, motivations and behaviors vis-à-vis simulated gambling and the potential interrelationships between simulated and monetary forms gambling.

Many researchers have reported that vitamin D can affect brain development as well as brain function. The prevalence of vitamin D deficiency in the Saudi population is 81% and it is more among women than among men. Though many studies have been done to find out the factors influencing the academic performance of Health sciences students, there is not adequate evidence regarding the influence of vitamin D level on academic performance. Therefore, this study aims to find out the association if any, between the vitamin D level and academic performance of health sciences students.

After obtaining the ethical committee approval, the data was collected from 86 female medical students, 70 female applied medical sciences students and 57 nursing students of Northern Border University. The detailed questionnaire contained the aim of the study, demographic characteristics and academic performance predictors such as self-efficacy, academic motivation, academic engagement and social engagement. The vitamin D levels were measured by an enzyme-linked immunosorbent assay (ELISA) machine (BioTek) which is available in the local hospital. The multiple linear regression analysis was used to find out the association between vitamin D levels and academic performance.

This study showed that vitamin D level had a significant association with the overall performance of the students as well as their self-efficacy.

Since there is a lot of stress among health sciences students due to subject overload and inadequacy of time, the health aspects are often overlooked. This study emphasizes the importance of early screening of vitamin D levels and early intervention in those with low vitamin D levels for better academic performance.

There is very little awareness of the impact of vitamin D deficiency on academic motivation, academic engagement, social engagement and self-efficacy among medical and health sciences students. This study can increase awareness.

There are very few studies done to find out the association between Vitamin D level and academic performance. This study is unique as it has highlighted the association between vitamin D level and grade point average (GPA) and also the association between vitamin D level and academic predictors such as self-efficacy, academic motivation, academic engagement and social engagement.