Factores socioeducativos asociados al no uso de métodos anticonceptivos en universitarias de cuatro países de Latinoamérica / Socio-educational factors associated with the non-use of contraceptive methods in university students from four Latin American countries

INTRODUCCIÓN: El cuidado anticonceptivo es importante una vez que se inicia la vida sexual, pero esto no ha sido medido en distintas realidades de Latinoamérica. OBJETIVO: Determinar los factores socio-educativos asociados al no uso de métodos anticonceptivos en universitarias de cuatro países de Latinoamérica. METODOLOGÍA: Estudio transversal analítico, se encuestó a estudiantes mujeres que ya habían iniciado su vida sexual, se le preguntó por el uso de condón (preservativo), método del ritmo, anticoncepción oral y anticoncepción oral de emergencia. Estas fueron descritas y asociadas a variables socio-educativas. RESULTADOS: El 7% (47) no usaba ninguno de los 4 métodos anticonceptivos; al realizar el análisis multivariado, no hubo diferencias estadísticamente significativas según el país, el año de estudios o si eran católicas/cristianas (todos los valores p>0,05), en cambio, las de universidades particulares tuvieron un mayor porcentaje de ausencia de uso de los 4 métodos anticonceptivos (RPa: 2,52; IC95%: 1,24-5,14; valor p=0,010). Según el uso de alguno de los 4 métodos, el país donde se encuestó tuvo muchas diferencias entre el uso de uno u otro método; el año de la carrera no estuvo asociado al no uso de alguno de los cuatro métodos; las que fueron católicas o cristianas usaron menos la anticoncepción oral (p<0,001) y las que estudiaban en universidades particulares usaron más el método del ritmo (p<0,05). CONCLUSIONES: Un porcentaje importante no usó ninguno de los cuatro métodos anticonceptivos más comunes, estando esto asociado al tipo de universidad.

INTRODUCTION: The care of contraception is important once you start the sex lives, but this hasn't been measured in different realities of Latin-America. OBJECTIVE: To determine the socio-educational factors associated with non-use of contraceptive methods in universities in four Latin American countries. METHODOLOGY: Cross-sectional study. Surveyed women students, who have started their sexual lives. They were asked about the use of condoms, rhythm method, birth control pills and next day pill. These're described and associated to variables socio-educational. RESULTS: 7% (47) did not use any of the 4 contraceptive methods; when performing the multivariate analysis, there were no statistically significant differences by country, the year of study or if they were Catholic/Christian (all values p>0.05), on the other hand, those of particular universities had a higher percentage of non- take care of yourself with one of the 4 methods (RPa: 2,52; IC95%: 1,24-5,14; value p=0,010). According to the use of one of the 4 methods, the country where it was surveyed had many differences between the use of one or the other method; the year of the degree was not associated with the non-use of any of the four methods; those who were Catholic or Christian used less oral contraception (p <0.001) and those who studied at private universities used the rhythm method more (p <0.05). CONCLUSIONS: A significant percentage did not use any of the four most common contraceptive methods, this being associated with the type of university.

Nivel de conocimiento sobre métodos anticonceptivos y salud reproductiva en adolescentes mexicanos de medio rural / Level of knowledge about contraceptive methods and reproductive health in Mexican adolescents in rural area

INTRODUCCIÓN la información sobre anticoncepción es importante antes que se inicie la vida sexual. OBJETIVO determinar el nivel de conocimiento y uso de métodos anticonceptivos por adolescentes en medio rural. MÉTODOS estudio transversal analítico, se encuestó a adolescentes de 15-19 años de edad de ambos sexos, que asistían a un centro de salud rural, 70% sin vida sexual y 30% que ya habían iniciado su vida sexual. Se empleó una cuestionario auto-administrado que incluyó variables sociodemográficas, socioeducativas y de uso de métodos anticonceptivos. RESULTADOS el nivel de conocimientos fue medio en 38% y bajo en 31%. El condón fue el método anticonceptivo más utilizado (88%) y del que se tenía más conocimiento. Tiene un conocimiento bajo el 48,7%, el 30% y el 29,7% de adolescentes de 15, 16 y 17 años respectivamente. El conocimiento va aumentando con la edad; es "medio y alto" en 48,7% y 86,6% a los 15 y 19 años, respectivamente. Se observa que a mayor conocimiento, mayor uso de métodos anticonceptivos. CONCLUSIONES es necesaria mayor información sobre el uso adecuado de los métodos anticonceptivos en la escuela y en la familia a nivel rural antes del inicio de la vida sexual, para prevenir las enfermedades de transmisión sexual y los embarazos no deseados.

INTRODUCTION information on contraception is important before sexual life begins. OBJECTIVE to determine the level of knowledge and use of contraceptive methods by adolescents in rural areas. METHODS analytical cross-sectional study, surveyed adolescents aged 15-19 years of both sexes, who attended a rural health center, 70% without sexual life and 30% who had already started their sexual life. A self-administered questionnaire was used that included sociodemographic, socio-educational and use of contraceptive variables. RESULTS the level of knowledge was medium in 38% and low in 31%. The condom was the most widely used contraceptive method (88%) and the most widely known. 48,7%, 30%, and 29,7% of adolescents aged 15, 16, and 17, respectively, have low knowledge. Knowledge increases with age; it is "medium and high" in 48,7% and in 86,6% at 15 and 19 years, respectively. It is observed that the greater the knowledge, the more frequent use of contraceptive methods. CONCLUSIONS more information is needed on the proper use of contraceptive methods at school and in the family at the rural level before the start of sexual life, to prevent sexually transmitted diseases and unwanted pregnancies.

Social Determinants of Health and their influence on the choice of birth control methods / Determinantes Sociales de la Salud y su influencia en la elección del método anticonceptivo / Determinantes Sociais da Saúde e sua influência na escolha do método contraceptivo

ABSTRACT Objective: To verify the association between Social Determinants of Health and birth control methods used by women of childbearing age. Methods: Documentary and retrospective study, performed at a Brazilian Natural Birth Center with evaluation of the medical records of patients seen between 2003 and 2011 (n=2410). Data were collected on identification and general history, gynecological, sexual and obstetric. Results: Hormone birth control methods were the most used among participants (25.0%); followed by barrier methods (21.5%) and surgical methods (19.3%). Statistical associations were observed regarding age, menarche, onset of sexual activity, pregnancy, miscarriage, smoking, hypertension, marital status, gynecological care and schooling with the choice of methods. Conclusion: The results confirm the importance of studies involving Social Determinants of Health, since they interfere in the way women choose birth control methods and the risks that this choice may pose to their health.

RESUMEN Objetivo: Verificar la asociación entre los Determinantes Sociales de la Salud y el método anticonceptivo utilizado por mujeres en edad fértil. Métodos: Estudio documental y retrospectivo, realizado en un Centro de Parto Natural con evaluación de los prontuarios de pacientes atendidos entre 2003 y 2011 (n=2410). Se recogieron datos de identificación e histórico general, ginecológico, sexual y obstétrico. Resultados: Se destacaron los métodos hormonales como los más utilizados entre las participantes de la investigación (25,0%), seguido por los métodos de barrera (21,5%) y por los métodos quirúrgicos (19,3%). Se observaron asociaciones estadísticas sobre edad, menarquia, inicio de la vida sexual, embarazo, aborto, tabaquismo, hipertensión, estado civil, cuidado ginecológico y escolaridad con la elección de los métodos. Conclusión: Los resultados ratifican la importancia de estudios que involucran a los Determinantes Sociales de la Salud, Determinantes Sociales de la Salud que interfieren en la forma en que las mujeres escogen los métodos anticonceptivos y los riesgos que esa elección puede suponer para su salud.

RESUMO Objetivo: Verificar a associação entre os Determinantes Sociais da Saúde e o método contraceptivo utilizado por mulheres em idade fértil. Métodos: Estudo documental e retrospectivo, realizado em um Centro de Parto Natural com avaliação dos prontuários de pacientes atendidas entre 2003 e 2011 (n=2410). Foram coletados dados de identificação e histórico geral, ginecológico, sexual e obstétrico. Resultados: Destacaram-se os métodos hormonais como os mais utilizados entre as participantes da pesquisa (25,0%), seguido pelos métodos de barreira (21,5%) e pelos métodos cirúrgicos (19,3%). Foram observadas associações estatísticas acerca da idade, menarca, início da vida sexual, gravidez, aborto, tabagismo, hipertensão, estado civil, cuidado ginecológico e escolaridade com a escolha dos métodos. Conclusão: Os resultados ratificam a importância de estudos envolvendo os Determinantes Sociais da Saúde, visto que interferem na forma como as mulheres escolhem os métodos contraceptivos e os riscos que essa escolha pode representar para a sua saúde.

Contraceptive behavior of Portuguese higher education students / Comportamiento anticonceptivo de estudiantes portugueses en la educación superior / Comportamentos contraceptivos de estudantes portugueses do ensino superior

ABSTRACT Objective: To characterize the contraceptive practices of higher education students and to identify factors that contribute to the use of different contraceptive methods. Method: A cross-sectional, descriptive correlational study was carried out with a sample of 1946 students, with a mean age of 21 years (20.74±2.32), who attended courses at a University in the North of Portugal. Results: Of the factors studied, the female gender, younger ages, previous behavior of condom use, knowledge about contraception, attitude and self-efficacy for condom use were associated with safer contraceptive choices. Conclusion: Investing in sexual education for young people is an important public health strategy that can empower youth to make more appropriate choices and improve adherence to contraceptive methods, reducing the risk of unintended pregnancies and sexually transmitted diseases.

RESUMEN Objetivo: Caracterizar las prácticas anticonceptivas de los estudiantes de educación superior e identificar los factores que contribuyen a la utilización de diferentes métodos anticonceptivos. Método: Se trata de un estudio transversal, descriptivo correlacional, en una muestra de 1.946 estudiantes, con edad promedio de 21 años (20,74±2,32), frecuentadores de cursos de una Universidad del norte de Portugal. Resultados: De los factores estudiados, el género femenino, la edad menor, el comportamiento anterior de uso del preservativo, el conocimiento sobre anticoncepción, la actitud y la auto-eficiencia para usar el preservativo estaban asociados a las alternativas anticonceptivas más seguras. Conclusión: Invertir en la educación sexual de los jóvenes adultos es una estrategia de salud pública importante, que puede potenciar elecciones más adecuadas y mejorar la adhesión a la anticoncepción, disminuyendo el riesgo de embarazos indeseados y de infecciones sexualmente transmisibles.

RESUMO Objetivo: Caracterizar as práticas contraceptivas de estudantes do ensino superior e identificar fatores que contribuem para a utilização dos diferentes métodos contraceptivos. Método: Foi realizado um estudo transversal, descritivo-correlacional, numa amostra de 1946 estudantes, com idade média de 21 anos (20,74±2,32), que frequentavam cursos de uma Universidade do norte de Portugal. Resultados: Dos fatores estudados, o gênero feminino, as idades mais novas, o comportamento anterior de usar o preservativo, o conhecimento sobre contracepção, a atitude e autoeficácia para usar o preservativo estiveram associados a escolhas contraceptivas mais seguras. Conclusão: Investir na educação sexual dos jovens adultos é uma importante estratégia de saúde pública, que pode potenciar escolhas mais adequadas e melhorar adesão à contracepção, diminuindo o risco de gravidez indesejada e de infeções sexualmente transmissíveis.

Determinantes en la elección de anticonceptivos en adolescentes consultantes en un centro de atención de salud sexual y reproductiva / Determinants in the choice of contraceptives in adolescents consulting in a sexual and reproductive health care center

ANTECEDENTES: Preferencias personales y prioridades son factores importantes a considerar cuando se elige un método anticonceptivo, y son aspectos claves en la toma de decisiones de la población adolescente. OBJETIVO: Identificar los factores más relevantes al seleccionar un método anticonceptivo y sus razones para elegir o rechazar cada uno de los métodos anticonceptivos disponibles en adolescentes. MATERIAL Y MÉTODOS: Estudio transversal analítico. Un cuestionario anónimo y auto-administrado se aplicó a 116 adolescentes que consultaron durante un año a un centro de salud sexual y reproductiva. RESULTADOS: El inyectable fue el método que más conocen y que más usan, seguido de la píldora. La eficacia, protección contra ITS y regular los períodos menstruales son las tres más importantes razones para elegir un MAC. Mientras que las razones más importantes para no elegir la píldora fue tener que recordar su uso cada día. En el caso del implante, el miedo y dolor al colocarlo y removerlo fue la razón más importante. CONCLUSIÓN: A pesar que la confiabilidad y uso de larga duración pueden ser muy importantes ventajas para posponer embarazo en adolescentes, el miedo al dolor e inserción hacen que los métodos de larga duración como el implante y dispositivos intrauterinos sean menos atractivos para adolescentes.

BACKGROUND: Personal preferences and priorities are important factors to consider when choosing a contraceptive method, key aspects in the decision making of the adolescent population. OBJECTIVE: To identify the most relevant factors when selecting a contraceptive method and its reasons for choosing or rejecting each of the contraceptive methods available in adolescents. MATERIAL AND METHODS: Analytical cross-sectional study. An anonymous and self-administered questionnaire was administered to 116 adolescents who consulted for a year in a sexual and reproductive health center. RESULTS: The injectable method was the most known and most used followed by the pill. Efficacy, protection against STIs and regulation of menstrual bleeding are the three most important reasons for choosing a MAC. While the most important reasons for not choosing the pill was to have to remember its use every day, in the case of the implant, it was the fear and pain to place it and removed it. CONCLUSIONS: Although reliability and long-term use may be very important advantages in postponing pregnancy in adolescents, fear of pain and insertion make long-lasting methods such as implant and intrauterine devices less attractive for adolescents.

Contraception for adolescents with chronic rheumatic diseases / Contracepção para adolescentes com doenças reumáticas crônicas

ABSTRACT Contraception is an important issue and should be a matter of concern in every medical visit of adolescent and young patients with chronic rheumatic diseases. This narrative review discusses contraception methods in adolescents with juvenile systemic lupus erythematosus (JSLE), antiphospholipid syndrome (APS), juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). Barrier methods are safe and their use should be encouraged for all adolescents with chronic rheumatic diseases. Combined oral contraceptives (COC) are strictly prohibited for JSLE and APS patients with positive antiphospholipid antibodies. Reversible long-acting contraception can be encouraged and offered routinely to the JSLE adolescent patient and other rheumatic diseases. Progestin-only pills are safe in the majority of rheumatic diseases, although the main concern related to its use by adolescents is poor adherence due to menstrual irregularity. Depot medroxyprogesterone acetate injections every three months is a highly effective contraception strategy, although its long-term use is associated with decreased bone mineral density. COC or other combined hormonal contraceptive may be options for JIA and JDM patients. Oral levonorgestrel should be considered as an emergency contraception method for all adolescents with chronic rheumatic diseases, including patients with contraindication to COC.

RESUMO A contracepção é uma questão importante e deve ser um motivo de preocupação em toda consulta médica de pacientes adolescentes e jovens com doenças reumáticas crônicas. Esta revisão narrativa discute métodos contraceptivos em adolescentes com lúpus eritematoso sistêmico (LES), síndrome antifosfolipídica (SAF), artrite idiopática juvenil (AIJ) e dermatomiosite juvenil (DMJ). Os métodos de barreira são seguros e todos os adolescentes com doenças reumáticas crônicas devem ser incentivados a usá-los. Os contraceptivos orais combinados (COC) são estritamente proibidos para pacientes com LESJ e SAF com anticorpos antifosfolípides positivos. A contracepção reversível de ação prolongada pode ser incentivada e oferecida rotineiramente a paciente adolescente com LES e outras doenças reumáticas. As pílulas que contêm somente progestina são seguras na maior parte das doenças reumáticas, embora a principal preocupação relacionada com seu uso por adolescentes seja a baixa adesão em decorrência da irregularidade menstrual. As injeções de acetato de medroxiprogesterona de depósito a cada três meses são uma estratégia altamente eficaz de contracepção, embora o seu uso em longo prazo esteja associado à diminuição na densidade mineral óssea. Contraceptivos orais combinados ou outros contraceptivos hormonais combinados podem ser opções para pacientes com AIJ e DMJ. O levonorgestrel oral deve ser considerado como um método de contracepção de emergência para todas as adolescentes com doenças reumáticas crônicas, incluindo pacientes com contraindicação para COC.

Nutritional aspects of children and adolescents with epidermolysis bullosa: literature review

Epidermolysis Bullosa is a genetic disorder that affects mainly the skin, however, all others systems are influenced. The nutritional care of children and adolescents with Epidermolysis Bullosa is a key treatment strategy, since the energy needs are increased due to the disease's metabolism, burdening the immune system and cicatrization process, symptoms caused by the disease hinder the intake and adequate absorption of nutrients, which may result in inadequate growth and development. Because this is a rare disease, there are few professionals who know the characteristics of both the clinical evolution and nutritional and dietary treatments. This literature review discusses the latest knowledge on energy and specific nutrient requirements to the dietary treatment and monitoring of children and adolescents with Epidermolysis Bullosa.

Structural Equation Modeling on Contraception Behavior of Unmarried Men and Women in Korea: Gender Difference

PURPOSE: The purpose of this study was to test and validate a model to predict contraception behavior in unmarried men and women. METHODS: Data were collected from a questionnaire survey of 180 unmarried men and 186 unmarried women 20 years of age or over who had sexual relationships in the past 6 months. Participants were from Seoul, Kyunggi, Daegu, and Busan and data collection was done from February 19 to April 16, 2013. RESULTS: Model fit indices for the hypotheoretical model fitted to the recommended levels. Out of 15 paths, 11 were statistically significant in both. Predictors of contraception behavior in unmarried men and women were intention to use contraception and self-efficacy for contraception. Exposure to sexual content was directly significant to the intention in men only. Self-efficacy for contraception was affected by perceived threat of pregnancy and gender role attitude. In women, the two predictors were also significant except for the effect of exposure to sexual contents. CONCLUSION: Results indicate that an intervention program which increases self-efficacy in unmarried men and women contributes to effective contraception behavior. In addition, proper sexual education programs using positive aspect of mass media can help develop active participation for contraception behavior.

Experiences of intimate-partner violence and contraception use among ever-married women in Jordan

This study explored the relationship between intimate partner violence [IPV] and current contraception use among ever-married women in Jordan. Analysing a sample [n = 3434] from the 2007 Jordan demographic and health survey, women who reported ever experiencing severe physical violence from their husband were significantly less likely to use contraception than women who did not report severe physical violence [OR = 0.34]. Conversely, women who reported ever experiencing sexual IPV were significantly more likely to use contraception [OR = 1.50]. Emotional and less severe physical IPV were not significantly related to contraception use. Education, wealth, age, number of children, and fertility preferences were positively associated with contraception use, while residence in the Badia area and consanguineous marriages were negatively associated with contraception use. The findings have implications for the provision of IPV screening and contraception services in Jordan, as well as the specification of services for women most vulnerable to IPV

Reprodução na juventude: perfis sociodemográficos, comportamentais e reprodutivos na PNDS 2006 / Youth and reproduction: demograhic, behavioral and reproductive profiles in the PNDS-2006

OBJETIVO: Analisar características sociodemográficas e do comportamento sexual e reprodutivo de mulheres jovens. MÉTODOS: Estudo populacional transversal com representatividade nacional sobre o comportamento sexual, contraceptivo e reprodutivo de 2.991 mulheres de 15 a 20 anos na Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher 2006. As jovens foram classificadas em três grupos: iniciaram a vida sexual e engravidaram antes dos 20 anos (grupo A); iniciaram a vida sexual e não engravidaram antes dos 20 (grupo B) e não iniciaram a vida sexual (grupo C). Mulheres de até 25 anos foram consideradas para o estudo das razões da gravidez e de suas implicações na vida. As análises estatísticas consideraram os pesos e o planejamento amostral complexo. A associação entre duas variáveis categóricas foi avaliada pelo teste tipo qui-quadrado. Quanto às comportamentais, utilizou-se modelo linear global. RESULTADOS: Mulheres do grupo A eram principalmente negras, mais pobres e com menor escolaridade. Tiveram a primeira relação sexual mais precocemente, comportamento contraceptivo mais desprotegido e menor conhecimento da fisiologia da reprodução em relação ao grupo B; as jovens do grupo C caracterizaram-se por maior frequência à escola e a preservação da virgindade para o casamento foi alegada por um 1/3 desse grupo. Para as mulheres com até 25 anos, a gravidez antes dos 20 foi percebida como tendo implicações mais positivas que negativas na vida amorosa, conjugal, social e autoestima. CONCLUSÕES: Há associação significativa entre gravidez antes dos 20 anos com maior pobreza e menor escolaridade. Na ausência de melhores condições de vida e de oportunidades, a gravidez, embora não prevista, configura-se como "projeto de vida" e não sua mera ausência.

OBJECTIVE: Analyze the sociodemographic characteristics and the sexual and reproductive behavior of young women. METHODS: A cross-sectional nationally representative study was performed about sexual, contraceptive and reproductive behavior with 2,991 women age 15 to 20 years in the National Survey on Demography and Health of Women and Children, 2006. The women were classified into three groups: sexual initiation and pregnancy before the age of 20 (group A); sexual initiation but no pregnancy before the age of 20 (group B) and no sexual initiation (group C). Women until age 25 years were included in the study about reasons for becoming pregnant and the implications for their lives. Statistical analysis considered survey weights and the complex sample design. The association between two categorical variables was assessed by chi-square test. The behavior variables were assessed using a global linear model. RESULTS: Women in group A were mainly black, poorer and with lower education level. These women had an early sexual initiation, less safe contraceptive behavior and less knowledge of reproduction physiology in comparison with group B; young women in group C were characterized by greater attendance at school and 1/3 of this group claimed to maintain their virginity until marriage. For women up to the age of 25, pregnancy before 20 years was perceived as having more positive than negative impacts upon their love life, spousal relationships, social lives and self-esteem. CONCLUSIONS: There is a significant association between pregnancy before the age of 20 and higher poverty and lower educational level. In the absence of better living conditions and opportunities, pregnancy, although unplanned, becomes "a plan for life", and is not seen as a lack of life planning.

Adding the Standard Days Method® to the contraceptive method mix in a high-prevalence setting in Peru / Adición del Método de Días Fijos® a la combinación de métodos anticonceptivos en un entorno de alta prevalencia de anticoncepción en el Perú

OBJECTIVE: To determine what contribution the Standard Days Method® (SDM) makes to the contraceptive mix offered by regular health services in areas of Peru where contraceptive prevalence rates (CPR) are already high. METHODS: SDM was added to the family planning methods offered by the Ministry of Health in two provinces in Peru in September 2002. Retrospective interviews were conducted in March-June 2004 with 1 200 women who had chosen SDM as their contraceptive method and had used it for 2-20 months. Data were also obtained from the databases of the participating health services. The evaluation covered SDM demand, whether or not clients were switching to SDM from other modern methods, and SDM continuation and effectiveness. RESULTS: Demand for SDM stabilized at 6 percent of all new family planning users. Most users had not been using any reliable contraception at the time they started using SDM. About 89 percent of those who began using SDM at least 6 months before the interview were still using it at 6 months. The 12-month typical use pregnancy rate was estimated to be around 10.0 per 100 women years. CONCLUSIONS: Adding SDM to a program's existing contraceptive method mix can increase coverage even in an already high-CPR setting. Most women who choose SDM do not switch from any other modern family planning method. Continuation compares well with other modern user-directed methods. SDM effectiveness, when offered in regular service delivery circumstances, compares well to efficacy trial findings.

OBJETIVO: Definir la contribución del Método de Días Fijos® (MDF) a la combinación de métodos anticonceptivos que ofrecen los servicios de salud en dos provincias del Perú, donde las tasas de prevalencia de anticoncepción ya son altas. MÉTODOS: El MDF se agregó a los métodos de planificación familiar ofrecidos por el Ministerio de Salud en dos provincias en el Perú en septiembre del 2002. Entre marzo y junio del 2004, se llevaron a cabo entrevistas retrospectivas a 1 200 mujeres que habían escogido este método anticonceptivo y lo habían usado durante un período de 2 a 20 meses. Se obtuvo también información a partir de las bases de datos de los servicios de salud que participaron en el estudio. Se recogieron datos para determinar la demanda del MDF, si las usuarias hicieron la transición del MDF a otros métodos modernos por el de los días fijos y con la continuidad del uso del método y su eficacia. RESULTADOS: La demanda del MDF se estabilizó en 6 por ciento de todas las nuevas usuarias de planificación familiar. La mayoría de ellas no estaba utilizando otro método de anticoncepción en el momento de comenzar a usar este método. Cerca de 89 por ciento de las mujeres que habían empezado a usar el MDF al menos 6 meses antes de la entrevista, todavía lo estaban usando 6 meses después. Se calculó que la tasa de embarazo con un uso típico del método durante 12 meses fue alrededor de 10,0 por 100 años-mujer. CONCLUSIONES: La adición del MDF a las opciones de métodos anticonceptivos propuestos por un programa puede aumentar la cobertura, incluso en entornos que ya cuentan con una alta tasa de prevalencia de anticoncepción. La mayoría de las mujeres que eligieron el MDF no había usado antes otro método moderno de planificación familiar. La continuación de su uso es comparable con la continuación de otros métodos modernos que dependen del usuario. La eficacia del MDF, cuando se ofrece en un contexto de prestación de servicios regulares es comparable con los resultados que se obtuvieron en el estudio de eficacia.

Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil / Fatores de risco para o arrependimento da laqueadura tubária: resultados de um estudo de caso-controle em Pernambuco, Brasil

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

Um estudo do tipo caso controle foi conduzido em um hospital público de ensino no Recife, Pernambuco, Brasil, em 1997, para investigar os fatores de risco para o arrependimento da realização da laqueadura tubária, comparando mulheres laqueadas que solicitaram ou realizaram a reversão da laqueadura tubária com mulheres também laqueadas que não solicitaram e não se submeteram a esta cirurgia. As mulheres que mostraram uma maior probabilidade de arrependimento foram as esterilizadas quando jovens, as que não foram responsáveis pela decisão da cirurgia, as que realizaram a esterilização até o 45º dia pós-parto e as que adquiriram informações sobre métodos contraceptivos depois da laqueadura tubária. Morte de filhos, parceiros sem filhos anteriores à união atual e a mudança de parceiro após a laqueadura tubária também estiveram associados com a solicitação ou realização de reversão da laqueadura. Deve-se avaliar o perfil psicológico e sócio-demográfico das mulheres e seus motivos para solicitar a laqueadura tubária e aconselhá-las para o planejamento familiar a fim de reduzir os riscos de arrependimento futuro.

Conhecimento objetivo e percebido sobre contraceptivos hormonais orais entre adolescentes com antecedentes gestacionais / Objective and perceived knowledge of oral contraceptive methods among adolescent mothers

A elevada freqüência de gestação precoce no Brasil e, particularmente, em Teresina (21,5 por cento), Piauí, motivou o presente estudo, cuja meta foi identificar os níveis de conhecimento objetivo e percebido sobre contraceptivos hormonais orais, bem como variáveis reprodutivas e sócio-demográficas preditoras de elevado conhecimento. Realizou-se estudo transversal com 278 adolescentes com idade de 15 a 19 anos de idade, com antecedentes reprodutivos, internadas em quatro maternidades de Teresina, em 2006. Regressão logística foi a base da análise estatística. Quase 98 por cento das adolescentes apresentaram baixo conhecimento tanto objetivo quanto percebido. Apenas o maior número de gestações foi preditor de elevado conhecimento objetivo para anticoncepcionais orais. Os baixos níveis de conhecimento objetivo e percebido das adolescentes sobre o uso de anticoncepcionais orais revelam a suscetibilidade das jovens ao comportamento sexual de risco. Sugere-se a utilização de abordagem mais interativa com os adolescentes para elevar o nível de conhecimento tanto objetivo quanto percebido deles, e assim reduzir a incidência e reincidência da gravidez indesejada na adolescência e suas conseqüências negativas na vida destas jovens e de sua prole.

The high rate of early pregnancy in Brazil and particularly in Teresina (21.5 percent), Piauí State, motivated the current study, the aim of which was to identify levels of objective and perceived knowledge on oral contraceptives, as well as predictive reproductive and socio-demographic variables for high knowledge. A cross-sectional study was performed including 278 teenage mothers (15-19 years), with their childbearing history, admitted to four maternity hospitals in Teresina in 2006. Logistic regression provided the basis for the statistical analysis. Nearly 98 percent of the adolescent mothers showed low objective and perceived knowledge of oral contraceptives. High parity was the only predictor of increased objective knowledge on oral contraceptives. The adolescents' low level of objective and perceived knowledge on use of oral contraceptives emphasized their susceptibility to risky sexual behavior. The findings emphasize the need for a more interactive approach with adolescents concerning their level of objective and perceived knowledge, to reduce the occurrence and repetition of unwanted teenage pregnancy and its negative consequences for the lives of these young mothers and their children.

Idade e uso de preservativo na iniciação sexual de adolescentes brasileiros / Age and condom use at first sexual intercourse of Brazilian adolescents

OBJETIVO: Analisar a idade e o uso do preservativo na iniciação sexual de adolescentes brasileiros em dois períodos: 1998 e 2005. MÉTODOS: Amostras representativas da população urbana brasileira foram entrevistadas em inquérito domiciliar por duas pesquisas, realizadas em 1998 e 2005. Dentre os entrevistados, 670 jovens (16 a 19 anos) sexualmente ativos foram selecionados para o estudo, 312 de 1998 e 358 de 2005. Para análise dos dados ponderados foram utilizados o teste qui-quadrado de Pearson e o teste exato de Fisher (±<5 por cento). RESULTADOS: Em 2005, 61,6 por cento dos jovens entrevistados tinham iniciado-se sexualmente, cuja idade média foi 14,9 anos, sem diferenças significativas para os jovens entrevistados em 1998. O uso de preservativo na primeira relação sexual aumentou significativamente em relações estáveis (48,5 por cento em 1998 vs. 67,7 por cento em 2005) e casuais (47,2 por cento em 1998 vs. 62,6 por cento em 2005) em quase todos os segmentos. Persistiram as diferenças relacionadas à iniciação sexual e ao uso de preservativos segundo gênero, cor da pele e escolaridade, tal como observado em 1998. A diminuição no uso de preservativo entre os jovens que se iniciaram sexualmente antes dos 14 anos, em todos os contextos de parceria, foi expressiva na região Sudeste e entre os mais escolarizados. CONCLUSÕES: Como em outros países, observou-se tendência à estabilização da idade da iniciação sexual entre jovens de 15 a 19 anos. O adiamento do início da vida sexual, mais freqüente entre os jovens mais escolarizados, deve ser tema discutido no planejamento da educação dos adolescentes para a sexualidade e prevenção das IST. Quanto à diminuição da vulnerabilidade ao HIV, é relevante e significativo o incremento no uso de preservativo na iniciação sexual.

OBJECTIVE: To analyze age and condom use at first sexual intercourse among Brazilian adolescents at two periods: 1998 and 2005. METHODS: Representative samples of the Brazilian urban population were interviewed during a household survey for two studies, carried out in 1998 and 2005. Interviewees included 670 sexually active young people (aged 16 to 19) who were selected for the study, 312 in 1998 and 358 in 2005. Pearson's chi-square test and Fisher's exact test (±<5 percent) were used to analyze the weighted data. RESULTS: In 2005, 61.6 percent of young interviewees had practiced sex and the average age for first intercourse was 14.9, with no significant difference to young interviewees in 1998. Condom use during first sexual intercourse increased significantly in both stable relationships (48.5 percent in 1998 vs. 67.7 percent in 2005) and casual relationships (47.2 percent in 1998 vs. 62.6 percent in 2005) across almost all segments. There were differences by gender, skin color and schooling for both age of first sexual intercourse and condom use, as per findings in 1998. Decreases in condom use for young people who were sexually active before the age of 14, across all types of partnerships, were marked in the Southeast region and for people with more schooling. CONCLUSIONS: As in other countries, there was a trend towards the stabilizing of the age of first sexual intercourse for young people aged 15 to 19. The postponement of the first sexual intercourse is more frequent among youth with more years of schooling, a theme that should be discussed in the planning of sexual education and STI prevention initiatives for adolescents. In terms of reductions in vulnerability to HIV, the increase in condom use at first sexual intercourse is both relevant and significant.

Factores asociados al uso de anticonceptivos en estudiantes de enseñanza media de la comuna de Temuco / Associated factors with the use of contraceptives in secondary school students from the commune of Temuco

Objetivo: Conocer la práctica sexual de los adolescentes en la comuna de Temuco, uso de anticonceptivos, razones de no uso y factores relacionados. Método: Estudio de corte transversal. Se utilizó muestreo por conglomerados, estratificando proporcionalmente por tipo de establecimiento en 698 estudiantes. Se aplicó un cuestionario anónimo y autoadministrado. Resultados: El 35,4 por ciento manifiesta haber tenido alguna vez relaciones sexuales, la edad de inicio promedio en mujeres fue 15,5 años y en hombres 14,3 (p=0,000), de éstos el 37 por ciento manifiesto haber usado un método en su primera relación sexual. El 17 por ciento de los estudiantes refiere actividad sexual actual, 41,9 por ciento en mujeres y 58,1 por ciento en hombres, diferencias significativas (p=0,013); de este grupo, el 51,2 por ciento usa algún método anticonceptivo (p=0,000). Entre las razones de no uso destacan: relaciones sexuales imprevistas, "no se le ocurrió", vergüenza de solicitarlos en farmacias o consultorios y falta de dinero para adquirirlos, falta de conversación con la pareja y percepción de invulnerabilidad frente a un embarazo. Conclusiones: Se observa tendencia a la disminución del inicio precoz de las relaciones sexuales; asimismo ausencia de protección anticonceptiva en la primera relación sexual. El uso de métodos anticonceptivos es mayor a lo reportado en otros estudios chilenos; factores relacionados con la pareja y la conversación con profesionales de salud se asocian al uso, mostrando el rol de los agentes de salud en la prevención de riesgos en la salud sexual y reproductiva.

Objective: To know sexual practice of adolescents in the commune of Temuco, use of contraceptives, related reasons of nonuse and factors. Method: Cross section study. A sampling by conglomerates was used, stratifying proportionally by type of establishment, obtaining 698 students. An anonymous and self administrated questionnaire was applied. Results: 35.4 percent declare to have had sexual relations, the average age of beginning in women was 15.5 years and in men 14.3 (p=0.000) and, of these only 37 percent declare to have used a contraceptive method in their first sexual relation. 17 percent of the students refer to having sexual activity at present, 41.9 percent in women and 58.1 percent in men, being this statistically significant differences by sex (p= 0.013); of this group, 51.2 percent use some contraceptive method (p=0.000) Some of the reasons for not using, we can emphasize: unexpected sexual relations, "it was not thought of", shame to ask for them in pharmacies or doctor's offices and lack of money to acquire them, lack of conversation with the partner and perception of being invulnerable against a pregnancy. Conclusions: A tendency is observed to the diminution of precocious beginning of sexual relations in adolescents, also absence of contraceptive protection in the first sexual relation. The use of contraceptive methods is greater than those reported in other Chilean studies, factors related to the partner and conversations with health professionals are associated to their use, relieving the roll of health agents in the prevention of risks of sexual and reproductive health.

Comportamientos sexuales y diferencias de género en adolescentes usuarios de un sistema público de salud universitario / Sexual behavior and gender differencesamong adolescents consultingat a university public health system

Background: The predetermined gender roles and the emphasis on reproductive responsibility on women, excluding men, have negative consequences on their sexual reproductive health and satisfactory sexual practices. Aim: To describe and analyze changes in sexual practices and gender differences in adolescents of the lower-middle socioeconomic level, users of public health system who started their sexual activity. Material and methods: We studied 4,971 adolescents of both sexes aged between 12 and 19 years, who consulted in a clinic for adolescents between the years 1990 and 2005. Several variables related to adolescent sexuality were considered. Uni and bivariate analysis were carried out and a model of stratified lineal regression per sex was fixed to explain the following variables: age at which sexual activity is initiated, number of sexual partners, time period between start of dating and the start of sexual activity along time. Results: The average age when men and women start their sexual activity was 15.7 and 15.5years, respectively. Along years and among women but not men, there was a reduction in the age of start of sexual activity and an increase in the number of sexual partners. The mean íapse between start of dating and the start of sexual activity in men and women was 6.2 and 7.5 months, respectively. This figure had an 11.696 and 13.9 percent reduction per year of study in females and males, respectively. Conclusions: There is an increasing expansion of sexual roles in adolescents, but certain patterns of contradictory conservative reasoning are maintained.

Saber e prática contraceptiva e prevenção de DST/HIV/AIDS em universitários da área da saúde / Knowledge, contraceptive practice and HIV/AIDS prevention among university students

Trata-se de uma pesquisa qualitativa, cujo objeto de estudo consiste na análise da prática dos universitários acerca da contracepção e controle das DSTS/HIV/AIDS. E teve como objetivo identificar o método contraceptivo de preferência no universo dos universitários, bem como descobrir os aspectos que pesam na hora dessa escolha e se há relação na escolha desse método contraceptivo com a prevenção das doenças. Os resultados alertam para a necessidade de mudanças na atitude dos futuros profissionais de saúde, seja na maneira atual de ensino, seja no modo de oferecer suporte para que estes realmente entendam a importância e necessidade das práticas sexuais seguras, associadas ao uso de métodos contraceptivos.

Descriptive research of qualitative approach, with the study object about college medicine and nursing students concerning the contraceptive choice and DST/SIDA control. Identifying the contraceptive method choice between these graduating, and to evidence if they associate the methods to the prevention of the DST's/SIDA or not. The data were collected by semi-structured interviews in ribbon cassette. The produced data were reorganized and analyzed based on theoretical referencial. Results alert for changes in students attitudes needs either in current education way, to offer support so that they really understand the importance and necessity of safe sexual practical, and associates contraceptive methods to sexual diseases, HIV/AIDS control beyond planned pregnancy prevention.

Investigación descriptiva cualitativo sobre el conocimento de los estudiantes de infermage e medicina de la universidad y de cuidado referentes la opción anticonceptiva y al control de DST/SIDA. Identificando la opción anticonceptiva del método entre éstos que gradúan, y la evidencia si ellos métodos del associate a la prevención del DST's/SIDA o no. Los datos fueron recogidos por entrevistas semi structuralized en cassette de cinta. Los datos producidos foran reorganizados y analizados basado en referencial teórico. Los resultados alertan para cambio de las actitudes de los estudiantes, de la educación de modo que realmente entiendan la importancia y la necesidad de práctico sexual seguro, y a los métodos anticonceptivos asociados a enfermedades sexuales, control de HIV/SIDA y prevención del embarazo.

Uso del preservativo en adolescentes nuligestas con uso de anticonconceptivos hormonales / Condom use by in nulliparous adolescent using the hormonal contraceptive method

El propósito del presente estudio es explorar las frecuencias del uso del condón en adolescentes usuarias regulares de un método anticonceptivo, como también conocer las razones de no uso del condón en aquellas que no lo usan. Se incluyó una muestra intencionada de adolescentes varones para conocer diferencias de género. Metodología, estudio exploratorio descriptivo de corte transversal. Se selecciono una muestra de adolescentes usuarias de anticonceptivos consultantes en CEMERA entre el 4 y 30 de Julio del año 2004. La recolección de la información se realizó a través de una encuesta auto administrada a 205 adolescentes. Las variables estudiadas fueron edad, sexo, frecuencia y razones de uso y no uso del condón. La información fue ingresada a una planilla Excel, y se realizó análisis uni y bi variado, a través del programa STATA 8.0. Resultados, un 82,4 por ciento de la muestra corresponde a mujeres y un 17,6 por ciento a hombres. El 52,4 por ciento corresponde a adolescentes entre 16 y 17 años. Un 49,7 por ciento no ocupó nunca el condón durante el último mes y sólo un 7,3 por ciento lo ocupó siempre en sus relaciones sexuales. Las razones de no uso del condón fueron en un 25,8 por ciento por estar utilizando un método anticonceptivo, un 17,5 por ciento por tener pareja única, un 16,4 por ciento por que no le gusta, un 14,4 por ciento por incomodidad. Al analizar las variables por edad y sexo, no se apreciaron diferencias estadísticamente significativas. Se concluye que si bien el uso del condón ha ido aumentando en la población adolescente, aún sigue ligado a la prevención de embarazo y no a la prevención de Infecciones de Transmisión Sexual y que el presente estudio no presenta diferencias de género en los resultados.

The intention of the present study is to explore the frequencies of the use of condom in regular usuary adolescents of a contraceptive method, as also to know the reasons for non use of condom in which they do not use it. A deliberate sample of adolescent men was included to know differences sort. Methodology, descriptive exploratory study of cross section. I select a sample of usuary adolescents of consultants contraceptives in CEMERA between 4 and 30 of Julio of year 2004. The harvesting of the information was made through a survey administered to 205 adolescents. The studied variables were age, sex, frequency and reasons of use and nonuse of condom. The information was entered a list Excel, and analysis was made uni and bi varied, through program STATA 8.0. Results, a 82.4 percent of the sample correspond to women and a 17.6 percent to men. 52.4 percent correspond to adolescents between 16 and 17 years. A 49.7 percent never occupied condom during the last month and only a 7.3 percent always occupied it in their sexual relations. The reasons of use of condom were not in a 25.8 percent to be using a contraceptive method, a 17.5 percent to have unique pair, a 16.4 percent so that it does not like, a 14.4 percent by uncomfortable. When analyzing the variables by age and sex, were not appraised statistically significant differences. One concludes that although the use of condom has been increasing in the adolescent population, still follows bound to the prevention of pregnancy and not the prevention of Infections of Sexual Transmission and that the present study does not present/display differences of sort in the results.

[Knowledge, attitudes and practices about contraception in an urban population]

We studied knowledge, attitudes and practices [KAP] regarding contraception of 1003 married women [aged 15-49 years] randomly recruited from private clinics [490 women] and community clinics [512 women] in Beirut in the year 2000. A st and ardized KAP questionnaire was administered to the 2 groups and differences between the groups were analysed. Contraceptive methods were used by two-thirds of the women. The private clinics group reported a significantly higher socioeconomic status and educational level than the community clinics group. Despite the free availability of contraceptive methods in the community clinics, the women's level of knowledge of, attitude towards and practice of contraception was significantly lower than those of women in the private clinics. Knowledge, attitudes and practices toward contraception did not depend on the free availability of contraceptive methods but rather on the socioeconomic and educational level of the women