The web of our life is of a mingled yarngood and ill together.

Shakespeare, Alls Well That Ends Well.

The 1.2 billion people aged 10 to 19 make up about 20% of the global population, (85% of whom live in developing countries). One in every five people in the world is an adolescent Adolescents constitute 25% of the population of Egypt (UNICEF 2007). Youth Ages (10-24), 2006-------- 23,300,000. Reference: population reference bureau (PRB).

Adolescent is defined by WHO as a person between 10-19 years of age. Youth is defined , as those persons between the ages of 15 and 24 years, Within the category of "youth", it is also important to distinguish between teenagers (13-19) and young adults (20-24).

A cycle of positive outcomes can result from having a larger, bettereducated workforce with fewer children to support children who will in turn be more educated and employable, provided that institutions are strengthened and viable economic policies are in place.

Most countries in Africa are projected to have more working-age adults per child in 2030 than they did in 2006. A large workforce with fewer children to support creates a window of opportunity to save money on health care; improve the quality of education; increase economic output because of more people working; invest more in technology and skills to strengthen the economy; and create the wealth needed to cope with the future aging of the population. This window of opportunity is the demographic dividend (or bonus).

1. 2.

Investing in the health of adolescents helps prevent the estimated 1.4 million deaths that occur globally every year due to road traffic injuries, violence, suicide, HIV and pregnancy related causes. It promotes the adoption of healthy behaviours that help prevent health problems that occur later in life, such as cardiovascular diseases and lung cancer resulting from physical inactivity and tobacco use initiated during adolescence.

Youth capacity for learning is greater than for older ages. Thus, youth poverty represents missed opportunities to acquire skills in school or on the job, or good health habits, and these problems can be extremely difficult to remedy.

Life-course events (e.g. leaving school, starting work, getting married, having children) play a significant role in shaping vulnerability to poverty. These life events are more likely to occur during the 18-29 age interval.

Youth living in poverty face deprivations of many of their rights: to survive, to learn, to work, to participate, and to be protected. Income Poverty is known as the material incapability of securing a decent living standard (providing basic needs) based on which individuals status is defined as poor or not.

At the national level, 23% of children under age 15 years were in poverty in 2008-09. Poverty rates peak dramatically for teenagers between 15 to 17 years at 27 % rising to almost 29% for young adults between 18 and 20 years.

Net enrollment rate reached 13.9% for poor youth aged 18-24 years. At the age of 20 years, 11.7% of poor females and 13.6% of poor males were enrolled in education.

Unpaid workers are more common among the poor than the non poor. The share of unpaid workers in total employment is at 24.7 and 19% for the poor and non poor. youth make up as much as 36 % of the total working-age population and three in five of Africa's unemployed are youth.

Source: International Labour Office, Global Employment Trends for Youth 2008

Some youth with few job prospects and little hope of future advancement may see little alternative to criminal activities or joining armed conflicts. "Unemployed and underemployed [youth] are more exposed to conflicts and illegal activitiesmany of them fall prey to rebel groups. (Office of the Chief Economist, Africa Region at the World Bank).

World Population (in Billions): 1950-2050

Source: United Nations Population Division, World Population Prospects, The 2008 Revision.

Population Ages 15-24 by World Region: 1950 and 2050

1950
Source: Carl Haub and Mary Mederios Kent, 2009 World Population Data Sheet.

2050

Population by Age and Sex, Less Developed Countries: 2009

Source: United Nations Population Division, World Population Prospects, The 2008 Revision.

With almost half of the world's population under age 25, investments in young people are vital to improve economic and social outcomes and achieve the Millennium Development Goals (MDGs). The United Nations proclaimed Aug. 12, 2010, the start of an International Year of Youth

1. 2. 3. 4. 5. 6. 7.

More than 1.8 million young people aged 15 to 24 die each year, mostly due to preventable causes. About 16 million girls aged 15 to 19 give birth every year. Young people, 15 to 24 years old, accounted for 40% of all new HIV infections among adults in 2008. In any given year, about 20% of adolescents will experience a mental health problem, most commonly depression or anxiety. An estimated 150 million young people use tobacco. Approximately 565 young people aged 10 to 29 die every day through interpersonal violence. Road traffic injuries cause an estimated 1000 young people to die every day.

About 16 million girls aged 15 to 19 years give birth every year - roughly 11% of all births worldwide. The vast majority of adolescents births occur in developing countries.
The formulation and enforcement of laws that specify a minimum age of marriage, and better access to contraceptive information and services can decrease tooearly pregnancies

To highlight the urgency of reproductive health needs of youth, an international conference was convened in 2008 in Abuja, Nigeria. Among the recommendations in the Call to Action is the expansion of three types of programs: Age-appropriate sexual and reproductive health educational interventions. Youth-friendly health services with community outreach. Comprehensive information campaigns.

In any given year, about 20% of adolescents will experience a mental health problem, most commonly depression or anxiety. The risk is increased by experiences of violence, humiliation, devaluation and poverty, and suicide is one of the leading causes of death in young people. Building life skills in children and adolescents, and providing them with psychosocial support in schools can help promote mental health. If problems arise, they should be detected and managed by competent and caring health workers.

The majority of tobacco users began when they were adolescents, an estimated 150 million young people use tobacco. Half of those users will die prematurely as a result of tobacco use. Banning tobacco advertising, raising the prices of tobacco products and laws prohibiting smoking in public places reduce the number of smokers.

Violence is one of the leading causes of death among young people, particularly males: an estimated 565 young people aged 10 to 29 years die every day through interpersonal violence. For each death, an estimated 20 to 40 youths require hospital treatment for a violence-related injury. Promoting nurturing relationships between parents and children early in life. Providing training in life skills. Reducing access to alcohol and lethal means help prevent violence. Effective and empathetic care for adolescent victims of violence and ongoing support can help deal with both the physical and the psychological consequences of violence.

Unintentional injuries are a leading cause of death and disability among young people. Road traffic injuries take the lives of a staggering 1000 young people every day. Advising young people on driving safely, strictly enforcing laws that prohibit driving under the influence of alcohol and drugs. Increasing access to reliable and safe public transportation can reduce road traffic accidents in young people. If road traffic crashes occur, prompt access to effective trauma care can be life saving.

Egyptian figures Nutritional Status of Youth and Young Adults. 5 % of never-married males age 10-19 and 6 % of never-married females age 10-19 in Egypt were classified as overweight. At the other end of the scale, 5 % of males and 3 % of females were considered to be underweight. (EDHS 2008)

Stunted growth represent 18 % of adolescent. 47 % of adolescents are anemic. 46 % are infested with parasites. Only 50 % use the school health insurance system. In 50% of marriages the girl was married before age 20.

The stillbirth and infant death rate for adolescents was 45 and 75/1000. 20% of boys and 30 % of girls were well informed regarding STDs, while in regard AIDS, 75 % of boys and 65 % of girls were well informed. 68% of adolescent express their opinions to their parents. 30 % of adolescent state they dont have role model.

20 % of adolescent observed violence between their parents. 15 % report being hit on the mouth. Overall prevalence of FGM of girls 13-19 is 86%. {National Adolescent Strategy, Ministry of Health and Population, (RH-IEC) United Nation Population Fund. (2004)}

To be healthy and free of disease To pursue their goals and dreams. To be protected from all forms of abuse. The right to be educated. They should be treated equally without discrimination due to gender . The right to have access to appropriate medical care.

EQUITABLE: All adolescents, not just certain groups, are able to obtain the health services they need. ACCESSIBLE: Adolescents are able to obtain the services that are provided. ACCEPTABLE: Health services are provided in ways that meet the expectations of adolescent clients. APPROPRIATE: The health services that adolescents need are provided. EFFECTIVE: The right health services are provided in the right way and make a positive contribution to the health of adolescents . (World Health Organization, Department of Child and Adolescent Health and Development. Global consultation on adolescent friendly health services: a consensus statement, Geneva, 79 March 2001 (WHO/FCH/CAH/02.18). Geneva, World Health Organization, 2002. ).

In terms of barriers to seeking help, the following were cited: how they were received/treated when accessing services poor information or misinformation about existing services institutional bureaucracy belief/perception that seeking help is a sign of weakness belief that can resolve problem without help cost issues, including transportation costs restriction of mobility by family or community. (Costello J, Pickens L & Fenton J (2001). Social supports for children and families: A matter of connections. Chicago, Chapin Hall Centre for Children at the University of Chicago (Draft manuscript).)

What is quality of life?

an individuals perception of their position in life in

the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. (World Health Organization, Quality of Life (QoL) Group, 1993)

Quality of Life is Determined by

The extent to which hopes and ambitions are matched by

experience. Appraisal of ones current state against some ideal. The things people regard as important in their lives. (Alison J. 2001).

 Quality of life measures

are increasingly used to supplement objective clinical or biological measures of disease to assess the quality of service, the need for health care, the effectiveness of interventions, and in cost utility analyses.

Concepts related to quality-of-life

Quality-of-life; All personal and environmental factors

related to subjects life; may or may not include health issues. Health-related quality-of-life: Physical, psychological and social aspects related to health. Health status: Physical and symptomatic factors

 Functional status: Ability to perform desired activities,

including level of symptoms while doing activities; external, observable. Well-being: Psychological factors and sense of life satisfaction; internal, self-reported. Satisfaction; Patient attitudes toward health and degree of approval of status.

Why is QOL important to measure?

Person centered means of assessing distress

/function Called for following improvement in health care intervention. Accountability of social and educational services. Facilitates multi-dimensional assessment (Skevington & Gillison, 2006)

Health Related Quality of Life can be then defined

as an integrative measure of physical and emotional well-being, level of independence, social relationships and their relationship to salient features of their environment (HRQOL Group (1995). World Health Organisation quality of life assessment: position paper from the World Health Organisation. Social Science and Medicine, 41, 1403.).

Adolescent quality of life

It can include structural factors such as educational and

employment opportunities, personal factors such as attitude and beliefs, and community factors. It can encompass other aspects of life such as the importance of peers , and family.

social environment?
Three basic psychological needs: Autonomy Feeling that one is the origin of ones actions Competence Feeling effective, and having the opportunity to demonstrate efficacy Relatedness Feeling valued by and connected to others around you

Items in the Quality of Life Profile: Adolescent Version

Being:
1.

2.

3.

Physical Being My appearance - how I look , Making healthy choices - alcohol, drugs, smoking. Psychological Being Being independent Knowing where I am going Spiritual Being Having hope for the future Feeling that life has meaning

belonging
1. 2.

3.

Physical Belonging The earth and its environment Feeling safe at school, in the neighbourhood and when I go out. Social Belonging Being appreciated by others The friends I have Community Belonging Being able to access social services on my own Having things to do in community in spare time

becoming
1. 2. 3.

Practical Becoming Looking after myself and my appearance The work I do at a job while still a student. Leisure Becoming Participating sports and recreation activities Visiting and spending time with others Growth Becoming Planning for a job or career Solving my problems

Health-Related Quality of Life (HRQOL) scale items, South Carolina {Youth Risk Behaviour Survey (YRBS)}
1. Self-perceived health: Would you say that in general your health is: a. Excellent b. Very good c. Good d. Fair e. Poor? 2. Recent physical health: Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? 3. Recent mental health: Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? 4. Recent activity limitation: During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Core Healthy Days Measures

1. Would you say that in general your health is excellent, very good, good, fair, or poor? 2. Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? 3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? 4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
Centre for Disease Control and Prevention. Measuring Healthy Days. Atlanta, Georgia: CDC, November 2000.

Conclusion
It has become accepted that increasing one's quality of life

(QOL) via health promotion efforts and medical care interventions is a desirable outcome for adolescents. Monitoring adolescent QOL appear to be primarily related to mental and physical health. Although mental and physical health both contribute significantly to adolescent quality of life, mental health appears to make greater contributions.

 However, adolescents may also be considering other

health-related constructs in addition to their physical and mental functioning such as Coping styles, social support, and social bonding.