http://doi.org/10.33698/NRF0167 -Nisha Chauhan, Sushma Kumara Saini, Karobi Dass
Abstract: Adolescents are the large segment of Indian population. Lifestyle choices adopted during this time continues into adulthood. Since adolescents are the future manpower of the nation it is essential to know about their lifestyle practices so as to lay the foundation of healthy adult life. An exploratory study was undertaken with a view to explore the lifestyle of adolescent girls living in Dadu Majra Colony, Chandigarh. Sample size consisted of 128 adolescent girls in the age group 15-19 years of age selected through systematic random sampling technique among the total population of 640 adolescent girls. Data was collected through interview method using semi-structured interview schedule which was validated by experts in the field of Nursing, Community Medicine and Dietetics. The results of the study revealed that most of the subjects were leading sedentary life style. There were very few subjects involved in vigorous activities and most of them were engaged in indoor activities like doing household chores, watching TV and listening to music for as long as seven hours a day. Dietary habits of adolescents consisted of consumption of large amount of junk food items and inadequate consumption of pulses and fruits. They perceived themselves to be overweight in spite of having normal weight and carried on weight loss practices. In order to have healthy adolescents in future health professionals, school teachers, community leaders, social organizations and youth groups should focus on creating awareness among the adolescents on issues like dietary habits and physical activity.
Keywords Adolescent, Lifestyle Introduction
Adolescence refers to the period of transition from childhood to adulthood when the person is not yet an adult but no longer child.1 As per World Health Organization,
Correspondence at: Nisha Chauhan Sister Grade-II Nehru Hospital PGIMER, Chandigarh. adolescence is a period of life that is extended from 10-19 years. In India adolescents comprise a sizeable population. There are 225 million adolescents comprising nearly one-fifth of the total population (21.8 percent). Female adolescents comprise 46.9 percent and male adolescents 53.1 percent of the total adolescent population. The adolescents in India suffer from various health problems like under nutrition, high risk behavior, sexually transmitted diseases, teenage pregnancy and anaemia.3 Lifestyle choices have an impact throughout life and it can be measured by health behaviour, leisure-time activities and social relations.4,5 Physical activity during adolescence takes a back seat as levels of physical activity decreases during this period. Shiely F et al did a study among Irish adolescents and found that physical activity levels were lower than those required for health benefits and only a minority of young people satisfied the international recommendations.6 High use of T.V. and video among adolescents have resulted in technology based sedentary and were adopting weight loss measures like skipping meal, exercising, starving , binge eating and diet pills. 13 Chaudhary SM et al studied socio- demographic factors associated with anemia in 296 adolescent girls and came out with the findings which stated that a high prevalence of anemia was there in subjects from lower socio-economic strata and among those whose parents were less educated.10 The adolescents are the future prospects of our country and a healthy nation can be built by the adolescents who have sound health. The behaviours and lifestyles learned or adopted during adolescence will influence health of an individual both in the present and in the future. Since various lifestyle choices are adopted by the adolescents, there arises a need to study their lifestyle pattern.
Objective behaviour. 7 another study on physical activities of adolescents reported that older girls spent most of their leisure time by watching TV, sewing, and gossiping.8 Insufficient physical activity results in higher
B.M.I. in adolescents.9 In one of the studies in India, girls were found to have higher B.M.I. as compared to boys.10 There is another issue of poor dietary habits common among adolescents. Various studies have shown skipping of breakfast and lunch, more consumption of fast food items and less intake of fresh fruits and vegetables among adolescents.11-12 A study on adolescents reported that adolescents perceived themselves to be overweight as compared to their actual weight status and half of the girls belonging to all weight categories desired weight loss To explore the ‘lifestyle’ of adolescent girls living in Dadu Majra Colony, U.T. Chandigarh.
Materials and methods
The study was conducted in Dadu Majra Colony, U.T, Chandigarh. Dadu Majra Colony is a resettled colony and is chosen purposively for the study because of the familiarity with the area. It is situated on north-west corner of Chandigarh and is at a distance of 5 Km. from National Institute of Nursing Education (NINE), PGIMER, Chandigarh and 12 km from ISBT. Sector-43, Chandigarh. Target population included all the adolescent girls (15-19 years) residing in Dadu Majra Colony, Chandigarh. A survey was conducted to identify the adolescent girls (15-19 years) and the number was found to be 640. Systematic random sampling method was adopted to select the sample for the study. By using systematic random sampling technique every fifth adolescent girl was taken as a sample among 640 adolescent girls to obtain a representative sample size of 128 adolescent girls. Tool included the guidelines to explore the lifestyle of adolescent girls, Survey proforma and semi-structured interview schedule. Tool was validated by experts in the field of nursing, Community Medicine and dietetics. To assess the feasibility of the study, a pilot study was conducted at village Dhanas which has a similar setting like Dadu Majra Colony. The study was found to be feasible. Interview schedule was valid and provided the needed information. Some questions were reframed.Permission to conduct the study was taken from the Principal, NINE, PGI, Chandigarh. Medical Officer of the area was informed about the objectives of study and data collection. Informed verbal consent was taken from adolescent. They were informed about the purpose of study and freedom was given to be a part of study or refuse as per their wish. They were assured that the data so collected will be used for research purpose only and confidentiality of the data will be maintained. For the adolescents who gave consent interview was conducted as per interview schedule. Privacy was maintained while conducting interview. Approximately 30 to 45 minutes were spent with each adolescent for interview. Data was coded and analyzed by using SPSS -16 version.
RESULTS Socio demographic profile of subjects
Table 1 describes the socio- demographic profile of the subjects. Age of the subjects ranged from 15-19 years with mean age of 16.97 ± 1.47. Nearly one fourth of them were 15 years old. Majority of them belonged to Hindu religion (90%) followed by Muslim (3.9%), Sikh (3.9%) and Christian (2.3%). One third of the subjects had passed 10+2. At the time of study, 71.8% of them were studying in school, college or other educational institutes. Half of them were studying in school. Rest of them were undertaking studies in graduation /diploma in computer/ vocational courses like stitching, beauty culture etc. Out of 128 subjects, 6 were self employed in some form of occupation like stitching, taking tuitions and working as house maid while 3 subjects are working in private sector like Visa Office and Call Centre. In regards to type of family 70% were living in nuclear families and 30% in joint family. Per capita family income of subjects ranged from Rs 142/- to Rs 5000/- per month with mean income Rs 1448.85. Half of them (52%) had per capita income in the range of Rs 500/- to Rs 1500/-
Eating pattern of subjects
Table 2 illustrates the eating pattern of subjects. About two third of the subjects (60.9%) were consuming three meals a day followed by 29.7% two meals a day. Six of the subjects (4.7%) consumed one meal in a day and same percentage consumed 4 meals in a day. Habits of skipping breakfast were observed among 41% subjects. Among them 45(84.9%) skipped breakfast almost daily. Two third of subjects (64%) were observing fast. Among them almost 24% Table 1: Socio-demographic profile of subjects
| Variables | n (%) |
| *Age(in yrs) 15 | 31(24.2) |
| 16 | 21(14.8) |
| 17 | 26(21.1) |
| 18 | 24(18.8) |
| 19 | 27(21.1) |
| Religion Hindu |
115(89.8) |
| Muslim | 5(3.9) |
| Sikh | 5(3.9) |
| Christian | 3(2.3) |
| Educational status Illiterate |
4(3.1) |
| Primary class | 28(21.9) |
| Middle class | 34(26.6) |
| Matriculation | 38(29.7) |
| 10+2 | 24(18.8) |
| Present education Studying |
92(71.9) |
| Not studying | 36(28.1) |
| Occupation of adolescent Not working |
119(93.0) |
| Self employed | 6(4.7) |
| Private job | 3(2.3) |
| Family type Joint |
39(30.5) |
| Nuclear | 89(69.5) |
| **Per capita income(in Rs) Till < 500 |
17(13.3) |
| 501-1500 | 67(52.3) |
| 1501-2500 | 31(24.2) |
| 2501-3500 | 8(6.3) |
| 3501-4500 | 3(2.3) |
| >4501 | 2(1.6) |
*Range =15-19 years Mean + SD= 16.97± 1.4
**Range = Rs 142/- – Rs 5000/- Mean ± SD= Rs1448.85/- ± 954.73
were observing the fast for 2-4 times a month and 76% were observing fast occasionally i.e.1- 2 times in a year.
Table 2: Eating pattern of subjects.
N=128
| Variables | n (%) |
| No of meals eaten daily | |
| One | 6(4.7) |
| Two | 38(29.7) |
| Three | 78(60.9) |
| Four | 6(4.7) |
| No of adolescents skipping breakfast | 53(41.4) |
| Frequency of breakfast | |
| skipping / week n=53 | |
| 1-2 times/week | 4(7.5) |
| 3-4 times/week | 4(7.5) |
| 5-7 times/week | 45(84.9) |
| Fasting | 82(64.1) |
| Frequency of fasting (n=82) | |
| 2-4 times/ month | 20(24.4) |
| 1-2 times / year | 62(75.6) |
Consumption of food products among subjects:Table 3 demonstrates the consumption of different food products by the subjects. The cereals were consumed in adequate quantity by 62% subjects i.e. 3 or>3 times/day. Other 36% subjects consumed cereals 1-2 times/day and 1.6% consumed 4-6 times/week. Vegetables were consumed in adequate quantity by 96.87% subjects i.e. 3 or>3 times/day or 1-2 times/day. Rest of the subjects consumed vegetables 4-6 times/week (1.6%) or 2-3 times/week (.8%). Pulses were consumed in adequate quantity by 29.0% subjects. Rest of the subjects consumed pulse 4-6 times/week (19.5%), 2-3 times/week (37.5%), once/week (7%), once/15 days (3.1%) and 3.9% consumed sometimes only.Fruits were consumed in adequate quantity by 27.4% i.e. consuming fruits 1-2 times a day or 4-6 times in a week. The other reported the consumption of fruits 2-3 times/week (26.6% ), once a week (18%), and 17.1% consumed sometimes. Salad was consumed in adequate quantity by 32.3% subjects 1-2 times a day. Others consumed 4-6 times/week (5%), 2-3 times/week (10%), once a week by (10%), once/15 days (4%) and sometimes only (38.3%). The milk products were consumed in adequate amount by 53 subjects i.e. consuming daily, 50 (39.1%), consumed milk products 1-2 times a day, 2 subjects (1.6%) consumed milk products 4-6 times a week. Others consumed milk products 2-3 times a week (10.9%), once/ a week (7%), once in 15 days (0.8%) while 51 subjects (39.84%) consumed milk products sometimes only.High intake of junk food was reported by 57.9% subjects i.e. 1-2 times a day or 4-6 times in a week or 2-3 times/week. Other reported consumption of junk food once in a day or once in 15 days (23.6%). Consumption of sweet food was reported in high amount among 21.9% subjects i.e. 1-2 times/ a day or 4-6 times a week or 2-3 times a week. Others reported consuming sweet foods once a week (15.6%), once in 15 days (7%) and sometimes (55%).Very few subjects reported eating meal from outside home. Only 2 subjects reported eating food from outside once a week and once in 15 days. Rest of them (98.4%) ate food outside sometimes only.
Table 3: Frequency of consumption of various food products by subjects.
N=128
| Consumption of food products | 3 or>3 times/ day | 1-2 times
/day |
4-6
times/ week |
2-3
times/ week |
Once/ week | Once/ 15 days | Some- times |
| Cereals | 80(62.5) | 46(35.9) | 2(1.6) | ——– | ——– | ——– | ——– |
| Vegetables | 43(33.6) | 81(63.2) | 2(1.6) | 1(0.8) | 1(0.8) | ——– | ——– |
| Pulse | 2(1.6) | 35(27.4) | 25(19.5) | 48(37.5) | 9(7.0) | 4(3.1) | 5(3.9) |
| Fruit | ——– | 18(14.1) | 17(13.3) | 34(26.6) | 23(18.0) | 14(10.9) | 22(17.1) |
| Salad | ——– | 42(32.3) | 6(4.9) | 13(10.3) | 13(10.3) | 5(3.9) | 49(38.3) |
| Milk products | 1(0.8) | 50(39.1) | 2(1.6) | 14(10.9) | 9(7.0) | 1(0.8) | 51(39.8) |
| Junk food | ——– | 35(27.3) | 10(7.8) | 29(22.8) | 22(17.2) | 8(6.4) | 24(18.5) |
| Sweet food | ——– | 11(8.6) | 3(2.4) | 14(10.9) | 20(15.6) | 9(7.0) | 71(55.5) |
| Meal outside home | ——– | ——– | ——– | ——– | 1(0.8) | 1(0.8) | 126(98.4) |
Deliberate change in food habits among subjects:Table 4 illustrates the change in food habits and the reasons for change in food habits by subjects. One third (33%) of subjects adopted certain changes in food habits. Among them 60% decreased intake of fat/ junk food/sugar to decrease weight, 19% reduced fat intake to avoid pimples, 12% reduced sugar intake to avoid dental caries/ diabetes, 7% decreased intake of fat to avoid fullness/ indigestion and 1% increased intake of fat to increase weight.
Table 4: Deliberate change in food habits
|
among subjects
perceived themselves to be overweight and 20% perceived themselves underweight. The actual weight status of adolescents was assessed with body mass index-for-age percentile for girls (2-20 years) which is developed by the National Center for Health Statistics and the findings revealed that 73% subjects had normal weight, 3% were overweight and 23% were found underweight.
Table 5: Difference between perceived weight status and actual weight status
N=128
|
N=128
Subjects gave more than one response.
Perceived and actual weight status of subjects
Table 5 illustrates the perceived and actual weight status of subjects. Nearly half
*Body mass index-for-age percentile as per National Centre for Health Statistics.
Measures used by the subjects for gaining and losing weight
Table 6 shows the measures used by the subjects for gaining and losing weight. The subjects practiced weight gain measures like increased quantity and frequency of meal (10.9%), increased intake of milk and ghee (6.2%), increased intake of junk food (1.5) . The reported increase in weight was in the range of 1-5kg. Measures for weight loss were taken by 45.3% subjects. Among them 17.9% decreased quantity and frequency of meal, 10.9% decreased intake of fat rich food of the subjects (46.1%) perceived themselves to be normal weight, while 34% items, 12.5% did exercise and yoga, 1.5% decreased intake of junk food, 0.78% took weight lose capsule-leptos and 1.5% drank nimbu paani and hot water daily. The decrease in the weight was in the range of 1-8 kg.
Physical activity
Table 7 depicts physical activities carried by the by the subjects. The activities included moderate activities, vigorous physical activities and the walking habits of subjects to school/college/job place. Almost all the subjects were involved in moderate activities in the form of house hold activities like cleaning/mopping of the floor, washing clothes, cooking meal etc. Adequate amount of time in moderate activities in a week was spent by 95.31% subjects among them two third of the subjects (68%) spent 9-12 hours a week in household activities. In vigorous activities (dance, sports, exercise and walk), adequate amount of time in a week was spent by 61.71% subjects. Among them 28 subjects (21.8%) spent time of 90-180 minutes in vigorous activities in a week. Rest of the subjects 46(36%) did not involve themselves in any kind of Vigorous activity (dance, sports and exercise).
Daily hours spent on study
A total of 92 subjects who were studying among these 37% spent 6-8 hours on study followed by 35% spending a time of 8-10 hours a day. This time includes the study at home and tuitions.
Table 6: Measures for gaining / losing weight
N=128
| Variables | n (%) |
| Number of subjects practicing weight gain measures
*Type of weight gain measures practiced Increased quantity and frequency of meal Increased intake of junk food Increase intake of milk and ghee Total weight gain(Kg) 1-3 4-5 >5 Did not measure weight No change in weight Number of subjects practicing weight loss measures * Type of weight loss measures practiced Decreased intake of fat rich food items Decreased quantity and frequency of meal Exercise and Yoga Decreased intake of junk food Weight lose capsule (leptos) Others- Drank nimbu paani / hot water daily Decrease in weight No change 1-4 Kg 5-8 Kg Did not measure weight |
24(18.7)
14(10.9)
2(1.5) 8(6.2)
5(3.9) 3(2.3) 1(0.7) 5(3.9) 9( 7.0) 58(45.3)
14(10.9)
23(17.9)
16(12.5) 2(1.5) 1(0.7) 2(1.5)
14(10.9) 14(10.9) 7(5.4) 9(7.0) |
*Subjects gave more than one response
Table 7: Time spent in physical activities in a week
N=128
| Physical activity | 30-45
minutes |
45-90
minutes |
90-180
minutes |
3-6
hours |
6-9
hours |
9-12
hours |
| Moderate activity (Household activities, walking to school/ college/ job place) | ——— | 4(3.1) | 20(15.6) | 12(9.4) | 5(3.9) | 87(68.0) |
| Vigorous activity (dance, sports and exercise) | 3(2.3) | 19(14.8) | 28(21.9) | 11(8.6) | 12(9.4) | 9(7.0) |
Note: 46(36%) subjects were not involved in vigorous activities
Time spent by subjects on various leisure time activities in a week
Table 8 demonstrates the time spent by
Discussion
Adolescents are the assets of a nation as they constitute larger chunk of population the subjects in a week on various leisure time nearly 22% as per the census 2001.2 The activities. TV viewing was mostly reported by the subjects (93.7%). Some subjects viewed TV daily for 4 hours to more than 7 hours in a day. Playing videogames was reported by 13.28% subjects and some of them spend 2- 3 hours per day on playing video games. Listening to music was the second most common leisure time activity found among (64.1%) subjects. Interest in other recreational activities like dance was reported by 25 subjects (19.5%)) and the time duration ranged from less than 1 hour to 12-15 hours per week. There was 1 subject dancing once in a month. Reading habits like reading of newspaper and comics/novel were reported by 66 subjects and 58 subjects respectively. There were 24 subjects who went for outing. Two subjects did yoga, 4 were engaged in net chatting, 4 in painting and 11 subjects were engaged in stitching.lifestyle adopted during this period continues into adulthood and makes an impact on their health. The study has been done on adolescents to explore their lifestyle from various aspects like physical activity and dietary habits. Physical health gets influenced by the eating habits and the involvement of adolescents in the physical activities.The target population included all the adolescent girls (15-19 years) residing in Dadu Majra Colony, Chandigarh. It has a population of approx. 18,000 people. A survey was conducted to identify the adolescent girls (15-19 years) and the number was found to be 640 which is lower than the expected value. By using systematic random sampling technique every fifth adolescent girl was taken as a sample among 640 adolescent girls to obtain a
Table 8: Time spent on leisure time activities in a week
N=128
| Leisure Activities | £1 hours | 1-3
hours |
3-6
hours |
6-9
hours |
9-12
hours |
12-15
hours |
*³15 hours & above |
| Watching TV (n=120) | 8(6.7%) | ——— | ——— | 41(34.1%) | 2(1.7%) | 53(44.2%) | 16(13.3%) |
| Playing Videogames (n=17) | ——— | ——— | ——— | 12(70.6%) | ——— | ——— | 5(29.4%) |
| Listening to music (n=82) | 3(3.6%) | 18(22.0%) | 15(18.3%) | 12(14.6%) | ——— | 18(22.0%) | 16(19.5%) |
| Dancing (n=25) | 10(40.0%) | ——— | ——— | 10(40.0%) | ——— | 5(20.0%) | ——— |
| Reading newspaper (n=66) | 11(16.7%) | 11(16.7%) | 3(4.5%) | 38(57.6%) | ——— | 3(4.5%) | ——— |
| Reading magazine (n=42) | 13(31.0%) | 15(35.7%) | 10(23.8%) | 4(9.5%) | ——— | ——— | ——— |
| Reading Comics (n=16) | 1(6.3%) | 3(18.7%) | 8(50.0%) | 4(25.0%) | ——— | ——— | ——— |
| Going for outing (n=24) | ——— | 2(8.3%) | 22(91.7%) | ——— | ——— | ——— | ——— |
| Doing Yoga (n=2) | 2(100%) | ——— | ——— | ——— | ——— | ——— | ——— |
| Net Chatting (n=4) | ——— | ——— | 2(50.0%) | 1(25.0%) | ——— | 1(25.0%) | ——— |
| Painting (n=4) | ——— | 3(75.0%) | ——— | 1(25.0%) | ——— | ——— | ——— |
| Stitching (n=11) | ——— | 4(36.3%) | 3(27.3%) | ——— | 1(9.1%) | 3(27.3%) | ——— |
representative sample size of 128 adolescent girls. Age of adolescent girls ranged from 15-19 years with mean age of 16.97 years. One fourth of total adolescent population were 15 years old. Majority of the adolescents belonged to Hindu religion followed by Muslim, Sikh and Christian religion. Currently, 72% adolescents were pursuing studies in school, college and in institutes offering vocational courses. Eating habits of adolescents in the study were found to be varying. Only two third of the subjects (60.9%) were consuming three meals a day and many of the subjects (41%) were found in the habit of skipping breakfast. Cereals and vegetables were consumed in adequate quantity. There were few subjects who were eating fruits, milk/milk products regularly. High intake of junk food and sweets was reported by most of the subjects. Similar findings were found in various studies which have shown skipping of breakfast and lunch, more consumption of fast food items and fewer intakes of fresh fruits and vegetables among adolescents. 14,11 Socio-cultural factors lay considerable emphasis on weight and appearance. The information on actual versus perceived weight status showed that more subjects perceive themselves to be overweight but were having normal weight. The girls adopted various measures like decreased quantity and frequency of meal, decreased intake of fat rich food items, exercise and yoga, decreased intake of junk food, intake of weight loss capsule (leptos) and yogic exercises (anulom-vilom, kapaal bhati), drank nimbu paani and hot water daily. Augustine and Poojara have also shown in their study that adolescents perceived themselves to be overweight as compared to their actual weight status and half of the girls belonging to all weight categories adopted weight loss measures like exercising, skipping meal, starving , binge eating and diet pills.13 The present study revealed that very few subjects spent time in vigorous activities and were engaged in indoor activities like watching TV, listening to music for as long as seven hours a day. Other leisure time activities were net chat, stitching, playing videogame etc. There were very few subjects involved in outdoor activities like sports. This points toward sedentary lifestyle among the adolescents. Other studies have also shown similar findings that adolescent girls are physically inactive due to various reasons like social inhibitions i.e. parental restrictions, lack of available facilities for playing and lack of interest in games. As the adolescents are the foundation years for life style adaptation in rest of the years so there is a need on the part of parents, teachers and health professionals to motivate them towards healthy life style by practicing physical activities and eating healthy food. This can give rise to future healthy generation.
References
- Stuart Adolescent psychiatric nursing. Principles and practices of psychiatric nursing. 8th ed. Mosby Elsevier. 2008; 8:753
- Handout Adolescent growth and development. Available f rom URL: http://www.whoindia.org/LinkFiles/AdolescentHealth_and_Development_(AHD)_ANM_Han dout02.pdf. Accessesd on 20.4.10.
- Kishore J. Reproductive and child health progrmme-II. National health programmes of 7th ed. Century publications. 2007;7: 137-139,572
- H.O. Defining and assessing risks to health. W.H.O. 2002:13
- Koivusilta LK, Rimpela AH, Rimpela Health-related lifestyle in adolescence—origin of social class differences in health? Health Education Research 1999;June;14;3:339-355
- Shiely F, Donncha Meeting the international adolescent physical activity guidelines. Ir Med J 2009;Jan;102(1):9-15
- Atkin AJ, Atkin AJ, Gorely T, Biddle SJ, Marshall SJ, Cameron Critical hours: physical activity and sedentary behaviour of adolescents after school. Pediatr Exerc Sci 2008 Nov;20(4):446- 56
- Roy S, Dasgupta A. Physical activity pattern among the adolescents of a rural community in West Bengal. Indian J Community Med 2009;34:366-367.
- Patrick K , Norman GJ, Calfas KJ, Sallis JF, Zabinski MF, Rupp J, Cella J. Diet, physical activity and sedentary behaviours as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med 2004 Apr;158(4): 385-
- Chaudhary SM, Vasant A study of anaemia among adolescent females in the urban area of Nagpur. Indian Journal Of Community Medicine 2008 Oct;33:243-24
- Al Sabbah H, Vereecken C, Kolsteren P, Abdeen Z, Maes L. Food habits and physical activity patterns among Palestinian adolescents: findings from the national study of Palestinian school children. Public Health Nutrition 2007;Jul;10(7):739-46.12
- Dietery habits and nutritional status in adolescents over Europe. An overview of current studies in the Nordic countries. Eur J Clin Nutr 2000;Mar;54:S21-8.
- Augustine LF, Poojara RH. Prevalence of obesity, weight perceptions and weight control practices among urban college going Indian Journal of Community Medicine. 2003;28;4.
- Fasting Magnus H , Nilsen Tom IL, Holmen Turid L and Vik Torstein. Life style related to blood pressure and body weight in BMC P u b l i c H e a l t h . 2 0 0 8 ; 8 : 1 1 1 . 2007;Jul;10(7):739-46.