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1.
Integr Cancer Ther ; 23: 15347354241253846, 2024.
Article in English | MEDLINE | ID: mdl-38721848

ABSTRACT

Vikil 20 is an herbal formula produced in Ghana and is widely marketed as a product to boost immunity as well as for general well-being. However, the pharmacological effect of this herbal preparation has not been proven scientifically. Therefore, this study was aimed at investigating the antioxidative as well as the anti-prostate cancer effects of the product. To assess the antioxidative effect of Vikil 20, the DPPH and ABTS activities were investigated. The total phenolic content was investigated using the Folin-Ciocalteu method. The cytotoxic effect of Vikil 20 against prostate cancer (PC-3) cells as well as normal (RAW 264.7) cells was investigated using the MTT assay whereas its anti-metastatic effect was analyzed using the cell migration assay. The effect of Vikil 20 on cell adhesion was analyzed via the cell adhesion assay whereas its effect on TNF-α secretion was investigated using a TNF-α detection kit. Vikil 20 demonstrated significant antioxidant effects by suppressing 57.61% and 92.88% respectively of DPPH and ABTS radicals at 1000 µg/mL with total phenolic contents of 140.45 mg GAE/g. Vikil 20 suppressed the proliferation of PC-3 cells by reducing the number of viable cells to 49.5% while sparing the RAW, 264.7 cells. Further, Vikil 20 significantly suppressed both cellular migration and adhesion of prostate cancer cells. Finally, suppression of cellular migration and adhesion is associated with a reduction in TNF-α secretion by PC-3 cells. Taken together, Vikil 20 was found to possess significant antioxidant and anti-prostate cancer effects in vitro.


Subject(s)
Antioxidants , Cell Movement , Cell Proliferation , Plant Extracts , Prostatic Neoplasms , Male , Humans , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Cell Proliferation/drug effects , PC-3 Cells , Antioxidants/pharmacology , Cell Movement/drug effects , Mice , Animals , RAW 264.7 Cells , Free Radicals/metabolism , Plant Extracts/pharmacology , Cell Adhesion/drug effects , Cell Line, Tumor , Tumor Necrosis Factor-alpha/metabolism , Phenols/pharmacology
2.
Int J Food Sci ; 2023: 5337150, 2023.
Article in English | MEDLINE | ID: mdl-36684413

ABSTRACT

To assess the contamination of processed chilli pepper and tomatoes, a report over the past four decades since the establishment of the Rapid Alert System for Food and Feed (RASFF) was retrieved and analysed. Out of the 887 notification reports assessed for eligibility, 446 were found regarding chilli pepper and tomato contamination. This study identified India as the country of origin with the highest number of reported cases relating to chilli pepper contamination. Italy and Türkiye were the countries with the highest number of reported cases regarding the exportation of adulterated tomatoes to other countries according to the RASFF report. Unauthorized dyes such as Sudan I, III, IV, orange II, rhodamine B, and para red were reported to have been detected in either chilli pepper or tomato in the supply chain. Almost all unauthorized dyes in this study were found to be more than the range (0.5 to 1 mg/kg) of the detection limit of Sudan dye and other related dyes using analytical methods set by the European Union. Unapproved pesticides by the European Union (EU) found in this study were acetamiprid, chlorothalonil, chlorpyrifos, dimethoate, methomyl, monocrotophos, omethoate, oxamyl, and thiophanate methyl. The present study indicates the persistence of chilli pepper and tomato contamination with harmful dyes and pesticide residues despite the ban on the use of certain chemicals in the food chain.

3.
Toxicol Rep ; 9: 1189-1197, 2022.
Article in English | MEDLINE | ID: mdl-36518390

ABSTRACT

Milk and dairy products are the most important nutritional foods among all age groups. Aflatoxin M1 (AFM1) contaminates milk and makes its consumption potentially dangerous. Infants are mostly at risk because they are typically fed as many as six and more times per day, which is indeed a disquieting concern. This study aimed at evaluating AFM1 levels especially above international (European Food Safety Authority, EFSA) (0.05 µg/kg) and local (Ghana Standards Authority, GSA) (0.5 µg/kg) standards and cancer risks associated with the ingestion of raw cow milk (n = 120) sampled from Southern Ghana (Greater Accra, Volta, Western and Eastern Regions). AFM1 were measured with High-Performance Liquid Chromatography with a Fluorescence Detector (HPLC-FLD). Risk assessments were also conducted using models prescribed by the Joint FAO/WHO Expert Committee on Additives (JECFA). Out of the 120 samples analyzed for AFM1, 67 (55.8%) tested positive, 63 (52.5%) exceeded the limits of EFSA and were between the range 0.06 ± 0.001-3.52 ± 0.5 µg/kg whereas 50(41.7%) within the range of 0.50 ± 0.03-3.52.01 ± 0.5 µg/kg exceeded GSA limits. Risk assessments of AFM1 for infants, toddlers, children, adolescents, and adults ranged between 0.06 and 2.03 ng/kg bw/day, 197.04-6666.67, 0-0.0323 ng aflatoxins/kg bw/day and 1.94 × 10-3- 0.07 cases/100,000 person/yr respectively for Estimated Daily Intake (EDI), Margin of Exposure (MOE), Average Potency, and Cancer Risks. It was concluded that the consumption of raw milk posed adverse health effects on all age categories studied for the regions investigated. The use of raw cow milk may cause some problems and endanger the health of people of different age groups due to noncompliance with prescribed regulatory limits.

4.
Sci Rep ; 12(1): 12562, 2022 07 22.
Article in English | MEDLINE | ID: mdl-35869134

ABSTRACT

Brukina is a millet based fermented milk product which is consumed as a beverage in Ghana. It is however prone to aflatoxin M1 (AFM1) contamination, which is a serious health challenge for low and middle-income countries in subtropical regions. This study aimed at evaluating AFM1 levels and cancer risks associated with brukina (n = 150) sampled from different locations of the Greater Accra Region of Ghana. AFM1 were measured with High-Performance Liquid Chromatography (HPLC) connected to a Fluorescence Detector (FLD).Cancer risk assessments were also conducted using models prescribed by the Joint FAO/WHO Expert Committee on Additives (JECFA). Out of the 150 samples analyzed for AFM1, 80/150 (53%) tested positive between the range 0.00 ± 0.001-3.14 ± 0.77 µg/kg. Cancer risk assessments of AFM1 produced outcomes which ranged between 0.64 and 1.88 ng/kg bw/day, 0.31-9.40, 0.0323, and 1.94 × 10-3-0.06 for cases/100,000 person/yr for Estimated Daily Intake (EDI), Hazard Index (H.I), Average Potency, and Cancer Risks respectively for all age categories investigated. It was concluded that the consumption of brukina posed adverse health effects on the majority of the age categories in the different locations of Greater Accra Region since the calculated H.Is were greater than one (> 1). Therefore, contamination of brukina with AFM1 should be considered a high priority in public health and Ghana's cancer risk management actions.


Subject(s)
Aflatoxin M1 , Neoplasms , Aflatoxin M1/analysis , Animals , Edible Grain/chemistry , Food Contamination/analysis , Ghana/epidemiology , Humans , Milk/chemistry , Millets , Neoplasms/epidemiology , Neoplasms/etiology
5.
Int J Food Sci ; 2022: 7195890, 2022.
Article in English | MEDLINE | ID: mdl-35784191

ABSTRACT

Spices and herbs are widely used food ingredients that enhance most organoleptic features of prepared foods. They are also used for medicinal and preservative purposes. Spices and herbs are potential carriers of bacteria, yeasts, and molds due to the nature of cultivation, harvest methods, storage conditions, packaging procedures, distribution, sale, and general handling. Although some fungi have been identified to be associated with most spices and herbs elsewhere in the world, little has been done on the presence of fungi in spices and herbs in Ghana. This study sought to identify the toxicogenic fungal profiles, mycotoxins (aflatoxins) present in some herbs, bay leaf (Laurus nobilis) and garden egg leaves ("gboma") (Solanum macrocarpon), and spices, ginger (Zingiber officinale) and "dawadawa"(Parkia biglobosa), as well as to investigate the antimicrobial properties of the selected herbs and spices. The decimal reduction technique was used to plate onto Dichloran Rose Bengal Chloramphenicol (DRBC) agar media plates for fungal growth. Aflatoxin detection was carried out with high-performance liquid chromatographer connected to a fluorescence detector (HPLC-FLD). Antimicrobial properties were carried out using the agar diffusion method on solidified, freshly prepared Mueller-Hinton agar. A total of 12 species belonging to 7 genera, Aspergillus (niger, flavus, fumigatus, and ochraceus), Fusarium (oxysporum, verticillioides), Mucor (racemosus), Penicillium (digitatum, expansum), Rhizopus (stolonifer), Rhodotorula sp., and Trichoderma harzianum, were identified as fungal contaminants. Fusarium oxysporum was the most predominant species identified. Fresh ginger recorded the greatest number of colony-forming units (3.71 log10 CFU/g) with bay leaves recording the least number of colony counts (2.36 log10 CFU/g). Mycotoxin concentration detected in gboma was2.06 ± 0.07 µg/kgand in dawadawa was2.13 ± 0.09 µg/kg; however, mycotoxins were not detected in bay leaf and ginger. Ginger exhibited antibacterial activity against all bacteria ranging from 7.0 ± 0.0 mm to 12.0 ± 5.66 mm zones of inhibition. Ginger, bay leaf, and gboma extracts displayed fair antimicrobial activity against the bacteria investigated. On the other hand, dawadawa generally produced the least resistance against the five bacterial species but exhibited the highest zone of inhibition. All samples were slightly acidic with pH readings ranging from 5.81 to 6.76.

6.
Sci Rep ; 11(1): 23339, 2021 12 02.
Article in English | MEDLINE | ID: mdl-34857860

ABSTRACT

Mycotoxin contamination of foodstuffs is a serious food safety concern globally as the prolonged ingestion of these toxins has the tendency to worsen the risk of hepatocellular carcinoma. This study aimed at estimating ochratoxin A (OTA) and aflatoxin (AF) levels above international (European Food Safety Authority, EFSA) and local (Ghana Standards Authority, GSA) standards as well as the health risks associated with the consumption of maize (n = 180) sampled from six (6) regions representing the agro-ecological zones of Ghana. OTA and AF were measured with High-Performance Liquid Chromatography with a Fluorescence detector. Out of the 180 samples analyzed for total aflatoxins (AFtotal), 131/180 tested positive and 127 (70.50%) exceeded the limits of EFSA and ranged 4.27-441.02 µg/kg. While for GSA, 116 (64.44%) of samples exceeded this limit and ranged between 10.18 and 441.02 µg/kg. For OTA, 103/180 tested positive and 94 (52.22%) of samples between the range 4.00-97.51 µg/kg exceeded the tolerable limit of EFSA, whereas 89 (49.44%) and were in the range of 3.30-97.51 µg/kg exceeded the limits of GSA. Risk assessment values for total aflatoxins (AFtotal) ranged between 50 and 1150 ng/kg bw/day, 0.4-6.67, 0-0.0323 aflatoxins ng/kg bw/day and 1.62-37.15 cases/100,000 person/year for Estimated Daily Intake (EDI), Margin of Exposure (MOE), Average Potency, and Cancer Risks respectively. Likewise, ochratoxin (OTA) values were in the ranges of 8.6 × 10-3-450 ng/kg bw/day, 0.05-2059.97, 0-0.0323 ochratoxins ng/kg bw/day and 2.78 × 10-4-14.54 cases/100,000 person/year. Consumption of maize posed adverse health effects in all age categories of the locations studied since the calculated MOE values were less than 10,000.


Subject(s)
Aflatoxins/poisoning , Food Contamination/analysis , Foodborne Diseases/epidemiology , Ochratoxins/poisoning , Zea mays/toxicity , Adolescent , Adult , Child , Child, Preschool , Female , Ghana/epidemiology , Humans , Infant , Infant, Newborn , Limit of Detection , Male , Middle Aged , Poisons/toxicity , Risk Assessment , Young Adult
7.
Article in English | MEDLINE | ID: mdl-34966438

ABSTRACT

The study investigated the influence of Annona muricata extracts on the action of selected antibiotics against biofilm-forming MRSA. The various parts of the plant were processed into powder and extracted with ethanol or hot water and then screened for the presence of phytochemicals. The modulatory effect of the Annona muricata extract was also tested on some antibiotics against Methicillin-resistant Staphylococcus aureus (MRSA). The findings from this study revealed that the various parts of the Annona muricata extract (ethanolic and aqueous) contained different proportions of secondary metabolites. Varied antimicrobial activities were observed when the extract of the A. muricata was exposed to MRSA strain at a concentration of 100 mg/mL. The stem recorded the highest (17.00 and 18.00 mm) inhibitory activity against MRSA for both the aqueous and the ethanolic extract, respectively, and this was not different from the control, tetracycline. Again, the results on the modulatory action indicated that out of the 10 extracts of A. muricata, 4 of them antagonized the activity of ampicillin against the tested MRSA by a factor of 0.5 folds and the rest potentiated the drug within 1-4 folds, respectively. On the other hand, the various test extracts significantly potentiated the efficacy of streptomycin and tetracycline against the MRSA by a range of 1-32 folds with the aqueous root extract recording the highest synergistic effect and ethanol seed extract with the least effect. The findings of this study support the antibacterial activities of the A. muricata plant parts.

8.
Article in English | MEDLINE | ID: mdl-34650615

ABSTRACT

Microbial etiology of diarrhea is a significant cause of death, especially in children in developing countries. The presence of microbes that are resistant to current treatment options for diarrhea suggests the need to find newer antimicrobial agents for treatment. Therefore, this study focused on investigating the antimicrobial effect of some Ghanaian chewing sticks commonly used for oral hygiene, Azadirachta indica, Garcinia afzelii, and Garcinia kola, against selected diarrhea-causing organisms. From the stem and bark of each plant, 70% methanolic extract was experimented on Salmonella and Shigella species, namely, Shigella sonnei, Shigella flexeneri, Salmonella typhinirium enterica, Salmonella typhi attenuated, and Klebsiella oxytoca for microbial susceptibility using the agar well diffusion method. Additionally, the antioxidant profile of the methanolic extracts were investigated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical, 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulphonic) acid (ABTS) scavenging activities, and ferric-reducing antioxidant potential (FRAP) assays, while the total polyphenolic content was determined using the Folin-Ciocalteau reagent. G. afzelii and A. indica stem demonstrated the highest antimicrobial effect, inhibiting the growth of all test organisms. Additionally, the extracts demonstrated high antioxidant potential and were found to possess significant amounts of phenolic compounds. Therefore, methanolic extracts of G. afzelii and A. indica stem are promising candidates for the identification of safe novel compounds to mitigate diarrheal diseases.

9.
Int J Food Sci ; 2021: 2005502, 2021.
Article in English | MEDLINE | ID: mdl-34977232

ABSTRACT

Drying is one of the traditional means of preserving food. However, various drying methods can influence the nutritional and bioactive constituents of the food product. This study is aimed at evaluating the effect of different drying methods on the proximate composition, physicochemical properties, and minor constituents of palm oil fruit mesocarp. Two varieties of fresh oil palm fruit (dura and tenera) were processed to separate the mesocarp from the other part of the fruit. The fresh fruit mesocarp was divided into five groups and subjected to different drying methods. Proximate and physicochemical characteristics of the oil palm fruit mesocarp were determined. The dried mesocarp had low moisture content (1.49-3.28%), high crude fat content (78.10-90.60%), carbohydrate (4.41-15.12%), crude protein (0.93-3.40%), and ash (0.53-1.15%). The free fatty acid (FFA) (1.06-3.54) and acid value (AV) (2.17 to 8.83 mgKOH/g) were lower because the samples were heated at 100°C for 30 min. The lower pH, FFA, AV, titratable acidity, moisture content, and high antioxidant activity of the oil palm fruit products could be an indication of shelf stability against microbial contamination and rancidity.

10.
J Environ Public Health ; 2020: 9083716, 2020.
Article in English | MEDLINE | ID: mdl-32454843

ABSTRACT

Objective: The integrity and the wholesomeness of the food served to school pupils cannot be overlooked, especially when one considers the magnitude of health and sanitation issues that are plaguing the West African nations. This study aimed to investigate some of the personal hygiene practices by the pupils and the hygienic conditions in which food is cooked and served to these school-going children under the Ghana School Feeding Programme (GSFP). Design: A cross-sectional and descriptive survey research designs were used in the study. Purposive and simple random sampling techniques were employed in selecting participants. Participants. There were 720 respondents for the study, comprising 600 pupils, 60 teachers, and 60 kitchen staff members from 20 schools. Information was obtained using questionnaire, observation, and unstructured interview instruments. Results: Findings from the study revealed that the majority of pupils (92% in Wa and 65% in Cape Coast) did not wash their hands with soap under running water. No hand washing centers for pupils were also seen in most of the schools studied. Majority of the cooks did not have health certificate, and neither had attended any in-service training in two years. In both Wa and Cape Coast municipal schools, none of the kitchen staff admitted that pupils and teachers ever complained about the meals they served to the pupils. Conclusion: The GSFP in basic schools forms part of the integral diet of the school children; hence, provision of good quality food can affect the health, learning, and physical activities of these children. Observational checklist revealed that most of the kitchen staff do not strictly adhere to basic food hygiene practices, and this affects the wholesomeness of the food served to the children. There is, therefore, a need for kitchen staff training on hygiene and food preparation practices.


Subject(s)
Dietary Services/statistics & numerical data , Health Knowledge, Attitudes, Practice , Hygiene , Schools , Child , Cities , Cooking/standards , Cross-Sectional Studies , Dietary Services/standards , Female , Ghana , Hand Disinfection/methods , Hand Disinfection/standards , Humans , Hygiene/education , Hygiene/standards , Male , Surveys and Questionnaires
11.
Toxicol Rep ; 7: 360-369, 2020.
Article in English | MEDLINE | ID: mdl-32123666

ABSTRACT

Arsenic (As), mercury (Hg), Cadmium (Cd) and lead (Pb) are toxic heavy metals that naturally occur in the ecosystem. Their levels are on the rise due to anthropogenic activities posing threat to aquatic wildlife and humans. In Ghana, pollution of some water bodies has led to unsafe consumption of riverine fishes as well as a shortage of treated potable water principally because the cost of treating polluted water has become expensive across the country. This study aimed to assess the As, Hg, Pb and Cd concentrations in water and fishes from rivers Pra and Ankobrah where activities of artisanal gold mining were carried out resulting in gross pollution of the water bodies. An experimental study was performed to ascertain the levels of As, Hg, Pb and Cd in fish species of Nile tilapia (Oreochromis noliticus) and mudfish (Clarias anguillaris) and aquatic media (water) from the Pra and River Ankobrah basins using the Atomic Absorption Spectrophotometer (AAS) (Varian AA240FS). Both river water samples recorded ranges of 0- 0.0040, 0.0060- 0.0387, 0 - 0.0020, 0.006-0.0093 mg/l for Cadmium, Lead, Arsenic and Mercury respectively. For Cadmium and Arsenic, their levels were comparable (p > 0.05). However, detected values for Lead and Mercury were no comparable (p < 0.05). Toxic metals concentrations in the rivers decreased in the order of Hg > Pb > Cd > As. For the fish samples, values ranged 0-0.08, 0.04-0.42, 0-0.04, and 0.40- 0.60 mg/kg for Cadmium, Lead, Arsenic and Mercury respectively. Generally, appreciably high values were obtained for Mercury. Toxic metals concentrations in the rivers decreased in the order of Hg > Pb > Cd > As. Human health risk assessment from heavy metal exposure through fish consumption from the Rivers for both children and adults showed no significant non-carcinogenic adverse health risk to humans since all calculated values for Hazard Quotient (HQ) were <1. Nonetheless, Target Hazard Quotient (THQ) values calculated for children and adult exposure to Cadmium and Mercury were>1 which implied a likely cause of adverse effects during a person's lifetime.

12.
BMC Pregnancy Childbirth ; 20(1): 160, 2020 Mar 14.
Article in English | MEDLINE | ID: mdl-32169034

ABSTRACT

INTRODUCTION: Geophagia although pleasurable and somewhat a necessity among pregnant women, also comes along with its own attendant problems such as exposure to potentially hazardous substances like bacteria, fungi, helminthes and ova, radioactive materials, and toxic elemental minerals in the soil depending on the geographical location. METHODOLOGY: This study evaluated the potential health risk involved during the exposure of pregnant women to toxic elemental minerals via the consumption of clay as pica (geophagia). Elemental mineral analysis was carried out using Buck Scientific 210VGP Flame Atomic Absorption Spectrophotometer (Buck Scientific, Inc. East Norwalk, USA). Risk assessment methods were also used to ascertain the various risks factors and the overall risk level. RESULTS: Concentrations of the macro elements investigated were 1.38 ± 1.5, 2.40 ± 1.5, 7.74 ± 1.5, 4.01 ± 1.0, 13.24 ± 2.2 and 13.76 ± 2.1 mg/Kg for iron (Fe), copper (Cu), zinc (Zn), potassium (K), magnesium (Mg) and sodium (Na) respectively. While that for the micro elements were 1.63 ± 0.03 µg/Kg, 4.72 ± 0.8, 0.53 ± 0.02 and 1.85 ± 0.3 mg/kg respectively for arsenic (As), manganese (Mn), lead (Pb) and nickel (Ni). Estimated Daily Intake (EDI), Hazard Quotient (HQ), Target Hazard Quotient (THQ) and Total Target Hazard Quotient (TTHQ) values ranged 0.611-5.44 (mg/kg Bw/day), 6.26 × 10- 4 - 106.5, 0.067-10.34 and 15 respectively. CONCLUSION: There is the likelihood of posing adverse health problems when clay samples obtained from Anfoega which is sited in the Volta region of Ghana is consumed due to the fact that the HQ's of these elemental minerals were > 1 which points to high content of Manganese (Mn) and Nickel (Ni). It is also likely to cause adverse health problems in an individual's life time since THQ for Arsenic, Lead and Nickel were above 1. Ultimately, the cumulative effect of these toxicants were exceedingly great (≤ 15) which implied a high level of unsafety associated with this clay. Per the results from this study, it is not safe for pregnant women to consume clay as pica since these toxic elements may cause detrimental effects on the foetus of the unborn child.


Subject(s)
Clay/chemistry , Metals, Heavy/analysis , Pica , Trace Elements/analysis , Female , Ghana , Humans , Kaolin/chemistry , Pregnancy , Risk Assessment
13.
Pan Afr Med J ; 34: 113, 2019.
Article in English | MEDLINE | ID: mdl-31998429

ABSTRACT

INTRODUCTION: Kaolin is a type of clay consumed mostly by women especially pregnant women of which the act of clay eating is termed geophagy. Different people use this type of clay for diverse purposes. Notwithstanding, most Ghanaians consume this clay out of cravings, taste and smell. There have been some attendant problems with the consumption of clay especially by pregnant women. This research sought to assess the mineral and microbial contents of kaolin and address the perceptions of pregnant women on geophagy. METHODS: This study employed a cross-sectional convenient sampling method to sample 217 pregnant women and sellers of clay (Ayilo). A face-to-face interview was conducted to administer a structured questionnaire to respondents. Mineral and microbial analyses were also conducted on the ore of the kaolin mined from Anfoega in the Volta Region of Ghana using standardized procedures. RESULTS: Results from this study suggests geophagy prevalence of 48.4% (n=217) among pregnant women in the Ho municipality of Ghana. Results obtained also suggest smell and taste of the clay, influenced the consumption by these pregnant women to a large extent. Strikingly, majority of the respondents had no knowledge on the adverse health implications clay consumption had on the human body. The physiological state of pregnancy also cause many to use it to treat nausea, other accompanying discomfort and in some instances to quench their hunger. Traces of Lead, Nickel and Arsenic were found in the clay. Common microorganisms identified were Bacillus, Pseudomonas, Mucor and Aspergillus spp. CONCLUSION: Geophagy is a common practice among pregnant women living in the Ho municipality in the Volta region, Ghana. Most of them consumed it for varied reasons. Although there are beneficial minerals, accumulated effects of these heavy metals can lead to various complications in pregnancy. The clay also contained pathogenic microorganisms. These pathogens have a whole range of deleterious effects on the human body ranging from gastrointestinal infections to cancer and so may not be safe to consume clay products from Anfoega, Ghana.


Subject(s)
Health Knowledge, Attitudes, Practice , Kaolin/chemistry , Pica/epidemiology , Pregnancy Complications/epidemiology , Adolescent , Adult , Clay/chemistry , Cross-Sectional Studies , Female , Ghana/epidemiology , Humans , Middle Aged , Minerals/chemistry , Mining , Pregnancy , Prevalence , Surveys and Questionnaires , Young Adult
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