[A Cognitive Behavioural-Based Intervention in Reducing Test Anxiety in High School Students: A Pilot Cluster Randomized Controlled Trial]. / Intervenção de Base Cognitivo-Comportamental na Redução da Ansiedade Perante os Testes em Alunos do Ensino Secundário: Estudo Piloto Aleatorizado e Controlado Por Clusters.

INTRODUCTION: School-age test anxiety is an important risk factor for school performance. Notwithstanding, few studies seek to identify which strategies are effective in improving test anxiety. The aim of this study was to assess whether a cognitive-behavioural intervention for high school students could significantly reduce test anxiety. MATERIAL AND METHODS: Two-arm, cluster-randomized controlled, unblinded, parallel, trial. Participants were 10th grade students from Alves Martins High School in Viseu, Portugal. Students were randomized at class level to receive a cognitive-behavioural-based intervention combined with mindfulness, psychoeducation, and relaxation techniques, or to a control group with no intervention. Participants' anxiety levels were measured using the Test Anxiety Questionnaire. The analysis of the effect of the intervention was carried out on an intention-to-treat basis at the class level, using multilevel mixed effects models and Bayesian modelling. RESULTS: The intervention had a significant effect in reducing test anxiety (d = 0.81, 95% CI 0.45;1.17, Bayes factor = 31.3). Male gender was an independent risk factor for smaller reductions in anxiety levels. The intervention was more effective in reducing the worry component of test anxiety (d = 0.76, 95% CI 0.41;1.11, Bayes factor = 19.9) than the emotionality component (d = 0.63, 95% CI 0.31;0.95, Bayes factor = 6.6). CONCLUSION: A cognitive-behavioural intervention specifically designed to reduce test anxiety, using a combination of mindfulness, psychoeducation and relaxation techniques, was effective in reducing test anxiety levels. TRIAL REGISTRATION: Retrospectively registered on clinicaltrials.gov (NCT05481099) in 08/01/2022.

Introdução: A ansiedade face aos testes é um importante fator condicionante da performance escolar. Contudo, são escassos os estudos que procuram identificar quais as estratégias eficazes na sua melhoria. Este estudo teve como objetivo testar a eficácia de uma intervenção cognitivo-comportamental na redução da ansiedade face aos testes em alunos do ensino secundário. Material e Métodos: Estudo experimental, aleatorizado por clusters (turmas), controlado, sem ocultação, com dois grupos paralelos, com alunos do 10.º ano da Escola Secundária Alves Martins em Viseu, Portugal. Os alunos foram aleatorizados ao nível da turma para receber uma combinação de técnicas cognitivas e comportamentais, de mindfulness, psicoeducação e técnicas de relaxamento, ou para um grupo controlo sem intervenção. Os níveis de ansiedade dos participantes foram medidos através do Questionário de Ansiedade face aos Testes. A análise do efeito da intervenção foi realizada na base de intenção de tratar ao nível da turma recorrendo a modelos de efeitos mistos multinível e modelação bayesiana. Resultados: A intervenção teve um efeito significativo na redução da ansiedade face aos testes (d = 0,81, IC 95% 0,45;1,17, fator de Bayes = 31,3). Pertencer ao sexo masculino revelou-se um fator de risco independente para uma menor redução nos níveis de ansiedade. O efeito da intervenção foi mais pronunciado na redução da preocupação face aos testes (d = 0,76, IC 95% 0,41;1,11, fator de Bayes = 19,9) quando comparado com a emocionalidade (d = 0,63, IC 95% 0,31;0,95, fator de Bayes = 6,6). Conclusão: Uma intervenção especificamente desenhada para reduzir a ansiedade face aos testes, usando uma combinação de técnicas cognitivas e comportamentais de mindfulness, psicoeducação e técnicas de relaxamento, foi eficaz na redução dos níveis de ansiedade. Registo do Estudo: Estudo registado a posteriori (registo retrospetivo) em ClinicalTrials.gov com o número NCT05481099 em 01/08/2022.

Portuguese Validated Versions of the Alcohol Use Disorders Identification Test: A Systematic Review Protocol.

INTRODUCTION: Alcohol consumption ranks among the top ten risk factors contributing to the global disease burden. Several international organizations recommend the use of the Alcohol Use Disorders Identification Test to screen for at-risk drinkers. However, a fully validated Portuguese version of this test is lacking. The aim of this study is to systematically review validated versions of the Alcohol Use Disorders Identification Test in the Portuguese language, the documented problems and solutions in its application and proposed cut-offs to identify at-risk drinkers. MATERIAL AND METHODS: A systematic search will be performed in Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online and SciELO databases, along with grey literature searches to identify validation studies of the AUDIT in Portuguese. Two authors will independently extract data and assess the studies' methodological quality, using QUADAS-2 and CASP checklists. DISCUSSION: This review will compare different validation studies of the Alcohol Use Disorders Identification Test in Portuguese-speaking countries, reporting, where possible, the psychometric properties, performance characteristics, suggested cut-offs and any documented limitations and suggestions. The results of this review could be used to propose an update of the alcohol screening and brief intervention guidelines in Portugal. The results could also prove useful to support the implementation of alcohol screening delivery by healthcare providers in Portugal and other official Portuguese-speaking countries. CONCLUSION: This review will provide important information on the validity of the Alcohol Use Disorders Identification Test as a screening tool for at-risk drinking in Portugal and other official Portuguese speaking countries.

Introdução: O consumo de álcool é um importante fator de risco modificável. Várias organizações internacionais recomendam a utilização do Alcohol Use Disorders Identification Test para identificar consumidores excessivos de álcool. No entanto, não parece haver uma versão totalmente validada deste questionário em português. O objetivo deste estudo é identificar versões validadas do Alcohol Use Disorders Identification Test em português, problemas e soluções na sua aplicação, e pontos de corte para identificar consumidores excessivos. Material e Métodos: Será realizada uma revisão sistemática dos estudos de validação do AUDIT em português existentes nas bases de dados Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online e SciELO, bem como na literatura cinzenta. Dois autores extrairão informação, e avaliarão a qualidade dos estudos selecionados, de forma independente, utilizando as grelhas QUADAS-2 e CASP. Discussão: Esta revisão irá comparar estudos de validação do Alcohol Use Disorders Identification Test em português e reportar, se descrito, propriedades psicométricas, características de desempenho, pontos de corte sugeridos, limitações e sugestões documentadas. Os resultados poderão ser importantes para propor uma revisão da norma de orientação clínica portuguesa sobre o rastreio e intervenções breves nos consumidores de álcool. Por outro lado, os resultados poderão ser utilizados para apoiar a implementação do rastreio do consumo de álcool na prática clínica em Portugal e noutros países de língua oficial portuguesa. Conclusão: Esta revisão irá fornecer informação relevante sobre a validade do Alcohol Use Disorders Identification Test como método de rastreio do consumo excessivo de álcool em Portugal e noutros países de língua oficial portuguesa.

Efficacy of a theory-driven program to implement alcohol screening and brief interventions in primary health-care: a cluster randomized controlled trial.

BACKGROUND AND AIMS: Screening and brief interventions (SBI) in primary health-care practices (PHCP) are effective in reducing reported alcohol consumption, but have not been routinely implemented. Most programs seeking to improve implementation rates have lacked a theoretical rationale. This study aimed to test whether a theory-based intervention for PHCPs could significantly increase alcohol SBI delivery. DESIGN: Two-arm, cluster-randomized controlled, parallel, 12-month follow-up, trial. SETTING: PHCPs in Portugal. PARTICIPANTS: Staff from 12 PHCPs (n = 222, 81.1% women): nurses (35.6%), general practitioners (28.8%), receptionists (26.1%) and family medicine residents (9.5%); patients screened for alcohol use: intervention n = 8062; controls n = 58. INTERVENTION AND COMPARATOR: PHCPs were randomized to receive a training and support program (n = 6; 110 participants) tailored to the barriers and facilitators for implementing alcohol SBIs following the principles of the Behavior Change Wheel/Theoretical Domains Framework approach, or to a waiting-list control (n = 6; 112 participants). Training was delivered over the first 12 weeks of the trial. MEASUREMENTS: The primary outcome was the proportion of eligible patients screened (unit of analysis: patient list). Secondary outcomes included the brief intervention (BI) rate per screen-positive patient and the population-based BI rate (unit of analysis: patient list), and changes in health providers' perceptions of barriers to implementation and alcohol-related knowledge (unit of analysis: health provider). FINDINGS: The implementation program had a significant effect on the screening activity in the intervention practices compared with control practices at the 12-month follow-up (21.7% vs. 0.16%, intention-to-treat analysis, p = 0.003). Although no significant difference was found on the BI rate per screen-positive patient (intervention 85.7% vs. control 63.6%, p = 0.55, Bayes factor = 0.28), the intervention was effective in increasing the population-based BI rate (intervention 0.69% vs. control 0.02%, p = 0.006). Health providers in the intervention arm reported fewer barriers to SBI implementation and higher levels of alcohol-related knowledge at 12-month follow-up than those in control practices. CONCLUSION: A theory-based implementation program, which included training and support activities, significantly increased alcohol screening and population-based brief intervention rates in primary care.

Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework.

BACKGROUND: Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients' alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners' and primary care nurses' routine delivery of alcohol SBI in adults. METHODS: A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). RESULTS: Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were 'Environmental Context and Resources' (n = 158, e.g. lack of time), 'Beliefs about Capabilities' (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and 'Skills' (n = 99, e.g. lack of training). CONCLUSIONS: This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016052681.

Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial.

BACKGROUND: Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. OBJECTIVE: To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. METHODS: We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. CONCLUSION: This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. TRIAL REGISTRATION: clinicaltrials.gov NCT02968186.

Improving the attitudes of primary care practitioners toward adolescent care: a pre-post intervention pilot study.

Background Investing in adolescent health is among the most cost-effective health measures. Primary care practitioners are ideally positioned to deliver such interventions. However, several barriers hinder them from engaging with adolescents. Objective To pilot test the impact of a 1-day training session on adolescent health on the attitudes of primary care practitioners toward adolescent care. Subjects Participants were family physicians and nurses enrolled in a 1-day training session on adolescent health. Methods A non-randomized, pre-post intervention study with no control group. Data on barriers for providing care to adolescents, preferred pediatric age group and attitudes toward adolescent care were collected immediately prior. Participants' attitudes were measured again immediately after training. Results Most participants reported they preferred to attend pediatric groups other than adolescents. The most frequently reported barriers were: excessive amount of time needed and lack of training. Participants reported positive pre-training attitudes, with mean scores above the midpoint of the scale in all dimensions. Significant positive improvements were observed after training in Adequacy, Self-esteem and Satisfaction. Subgroup analysis showed that at baseline, professionals who preferred to work with adolescents had significantly more positive attitudes in Adequacy, Self-esteem and Satisfaction. After training there was a general improvement in attitudes in both groups, with attenuation of the differences between them. Conclusion Participation in a 1-day tailored educational intervention on adolescent health had a positive impact on the attitudes of primary care practitioners, regardless of their preferred age group. This improvement may lead to more active engagement with adolescents and substantial health gains.

Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review Protocol.

INTRODUCTION: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions. OBJECTIVE: To identify factors influencing general practitioners/family physicians' and primary care nurses' routine delivery of alcohol screening and brief intervention in adults. MATERIAL AND METHODS: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework. DISCUSSION: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care. CONCLUSION: This review will provide important information for implementing alcohol screening and brief intervention in primary health care.Systematic Review Registration: PROSPERO CRD42016052681.

Introdução: O consumo de álcool é um importante fator de risco a nível mundial. Apesar de serem recomendadas por muitas instâncias nacionais e internacionais, a deteção e intervenção breve no consumo de álcool ainda não está integrada na prática da maioria dos profissionais de saúde dos Cuidados de Saúde Primários. Objetivo: Identificar as barreiras e os facilitadores à implementação da deteção e intervenção breve nos consumos de álcool nos Cuidados de Saúde Primários por parte dos Médicos e Enfermeiros de Família. Material e Métodos: Será realizada uma revisão sistemática da literatura nas seguintes bases de dados: Medline, CINAHL, CENTRAL, e PsycINFO. Dois autores irão, de forma independente, extrair os dados, e avaliar a qualidade dos estudos selecionados. A qualidade dos estudos quantitativos será avaliada através das checklists do NIH National Heart, Lung, and Blood Institute, enquanto a dos estudos qualitativos será avaliada através da checklist CASP. Os resultados serão apresentados numa síntese narrativa, estruturada em torno das barreiras e facilitadores identificados, e analisados à luz dos domínios teóricos da Behavioural Change Wheel/Theoretical Domains Framework. Discussão: Esta revisão sistemática descreverá as barreiras e os facilitadores à implementação da deteção e intervenção breve nos consumos de álcool nos Cuidados de Saúde Primários. Ao estabelecer a ligação entre estes fatores e os diferentes domínios teóricos da Behavioural Change Wheel/Theoretical Domains Framework, esta revisão sistemática vai facilitar o desenho de programas que visem a implementação destas boas práticas neste nível de cuidados. Conclusão: Esta revisão contribuirá com informação importante para a implementação da deteção e intervenção breve nos consumos de álcool nos Cuidados de Saúde Primários. Registo: PROSPERO CRD42016052681.

Can Doctors Be Divided Into Groups Based on Their Attitudes to Addressing Alcohol Issues in Their Patients? Analyses From a Survey of Portuguese General Practitioners.

BACKGROUND: The effectiveness of interventions to increase general practitioners' management of alcohol problems is affected by their attitudes toward at-risk drinkers. Tailoring training programs to general practitioners' attitudes may be useful in increasing alcohol screening and brief advice. OBJECTIVES: to determine whether general practitioners could be divided into distinct groups based on their attitudes toward at-risk drinkers. Another aim of this study was to develop and validate a model for classifying general practitioners into distinct groups. METHODS: A total of 234 general practitioners answered the questionnaire. Physicians' attitudes toward patients with hazardous or harmful alcohol use were measured with the Short Alcohol and Alcohol Problems Perception Questionnaire. Cluster analysis was performed to identify distinct general practitioner groups based on their attitudes toward at-risk drinkers. Logistic regression analysis was used to develop a model for predicting group membership. RESULTS: Cluster analysis identified two distinct groups of general practitioners, one with more positive attitudes (adequacy = 10.8 ± 1.6, legitimacy = 11.8 ± 1.7, motivation = 9.8 ± 1.7, satisfaction = 8.1 ± 1.9, and self-esteem = 9.7 ± 2.1), the other with more negative attitudes (adequacy = 8.9 ± 1.8, legitimacy = 11.0 ± 1.8, motivation = 7.8 ± 1.6, satisfaction = 5.7 ± 2.0, and self-esteem = 6.8 ± 1.7). The predictors in the final model were self-esteem, motivation, and adequacy. The model predicted general practitioner groups on the training set with 90.4% accuracy (area under receiver operating characteristic [ROC] curve = 0.96), and maintained its predictive performance when applied to the test set (accuracy 93.6%, area under ROC curve = 0.97). CONCLUSIONS: General practitioners could be divided into distinct groups based on their attitudes toward at-risk drinkers. These findings may prove useful in designing alcohol-specific training programs for general practitioners.

Differences between Groups of Family Physicians with Different Attitudes towards At-Risk Drinkers: A Post Hoc Study of the ODHIN Survey in Portugal.

Introduction. We have recently shown that family physicians can be classified into two groups based on their attitudes towards at-risk drinkers: one with better and the other with worse attitudes. Objective. To compare the two groups regarding demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Methods. A random sample of 234 Portuguese family physicians who answered the Optimizing Delivery of Health Care Interventions survey was included. The questionnaire asked questions on demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Results. Family physicians with better attitudes were younger (p = 0.005) and less experienced (p = 0.04) and with higher male proportion (p = 0.01). This group had more hours of postgraduate training (p < 0.001), felt more prepared to counsel risky drinkers (p < 0.001), and considered themselves to have better counselling efficacy (p < 0.001). More family physicians in the group with worse attitudes considered that doctors cannot identify risky drinkers without symptoms (p = 0.01) and believed counselling is difficult (p = 0.005). Conclusions. Family physicians with better attitudes had more education on alcohol and fewer barriers to work with at-risk drinkers. These differences should be taken into account when designing implementation programs seeking to increase alcohol screening and brief advice.

Childhood obesity, thyroid function, and insulin resistance ­ is there a link? A longitudinal study.

BACKGROUND: Serum thyroid stimulating hormone (TSH) levels are frequently elevated in obese children and are most likely to be associated with insulin resistance. However, clinical relevance of this association remains unclear. OBJECTIVES: To assess the prevalence of hyperthyrotropinemia; to analyze the relationship between TSH and homeostasis model assessment - insulin resistance (HOMA-IR); and to verify whether TSH levels and HOMA-IR vary with weight loss in obese children. SUBJECTS AND METHODS: Retrospective longitudinal study with data from baseline and 1 year after lifestyle intervention in a pediatric obese group (344 children were recruited and 100 among them completed follow-up). For postintervention analysis, three groups were considered according to body mass index-standard deviation score (BMI-SDS) variations: ≤-0.5 (significant weight loss); 0.5-0 (weight loss); and >0 (weight gain). Statistical analysis was performed using SPSS 19.0®. RESULTS: The prevalence of increased TSH levels was 9.3%. At baseline TSH (p=0.007), fT4 (p=0.006), and HOMA-IR (p<0.001) were positively correlated to BMI-SDS (n=344). Weight reduction was verified in 67 out of 100 cases but significant loss was present in only 21 cases. Decreases in both TSH and BMI-SDS were independently associated with decreases in HOMA-IR (p=0.005 and p=0.016, respectively). There was no correlation between TSH and BMI-SDS variation. Significant decreases in the HOMA-IR (p=0.006) were only achieved in the significant weight loss group. CONCLUSIONS: The prevalence of hyperthyrotropinemia was lower than previously reported. However, cutoff values were adjusted to pubertal stage, suggesting an over report in other studies. Insulin resistance and TSH were positively correlated, independent of body status. Although weight loss was not associated with TSH variation, a decrease in TSH levels was independently associated with decreases in HOMA-IR.

Managing alcohol problems in general practice in Europe: results from the European ODHIN survey of general practitioners.

AIMS: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems. METHODS: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year. RESULTS: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients. CONCLUSION: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.

A score for assessing the risk of first-time adolescent pregnancy.

BACKGROUND: Adolescent pregnancy is an important health issue. Prevention programs are usually aimed at the prevention of repeat pregnancy, ignoring the adolescents at risk of becoming pregnant for the first time. OBJECTIVES: To analyse if socio-economic status, family type and mother's age at first pregnancy are risk factors for adolescent pregnancy and to design a risk score of first-time adolescent pregnancy. METHODS: A case-control study was performed: cases were primiparous adolescents and controls were primiparous adult women. Participants were asked about their socio-economic status and family structure during adolescence and the age at which their mothers' first pregnancy occurred. Odds ratio (OR) and 95% confidence intervals were calculated. A first-time adolescent pregnancy risk score was designed based on a multiple logistic regression model. RESULTS: Sixty-six adolescents and 140 adults were interviewed. Belonging to a family other than nuclear or extended types was an independent risk factor for adolescent pregnancy (OR 9.37, 95% CI 3.36-38.07). Low socio-economic status and having a mother with history of adolescent pregnancy were not independent risk factors (OR 1.04, 95% CI 0.34-5.11 and OR 1.13, 95% CI 0.42-4.32, respectively), achieving significance only when simultaneously present (OR 6.01, 95% CI 2.36-20.79). The presence of all these factors determined the highest adolescent pregnancy probability (OR 10.49, 95% CI 3.43-51.00). A first-time adolescent pregnancy risk assessment score was designed, with an estimated sensitivity of 75.8% and specificity of 75.0%. CONCLUSIONS: Adolescent pregnancy is associated with unfavorable precedents that can be used to identify adolescents at increased risk of early pregnancy.

[Causes and consequences of glycated hemoglobin variability on pediatric population]. / Causas e consequências da variabilidade da hemoglobina glicada numa população pediátrica.

BACKGROUND: Type one diabetes mellitus is the second most frequent disease in childhood, presenting with serious complications when inadequately controlled. The most useful measure of metabolic control is hemoglobin A1c (HbA1c), being essential the awareness of the causes of its variability. AIM: to evaluate the effect of age and time of disease on HbA1c; to evaluate the relationship between HbA1c and serum lipid and microalbuminuria values. METHODS: Observational, transversal and analytic study, based on data obtained in the files of all patients that attain the Pediatric Diabetic Consult. The studied variables were: sex, actual age, diagnostic age, metabolic control and chronic complications. Statistical analysis was made with Excel2003® and SPSS 15.0®. A significance level of 5% was adopted. RESULTS: a 96 diabetic population was obtained. Last year HbA1c average was 8,3% and was less than 7,5% in one third of the cases. Adolescent's HbA1c (8,4%) was significantly higher than in children (7,8%) (p=0,03). Diabetics with a disease longer than five years presented higher HbA1c values (9% vs. 7,8%; p<0,01). Microalbuminuria was present in 9% and lipid abnormalities in 10%. The ones with dyslipidemia had a significantly higher HbA1c (9,7% vs. 8%; p=0,001) as well as the ones with microalbuminuria (10% vs. 8%; p<0,001). CONCLUSIONS: In this study it was verified that adolescents and diabetics with a longer time of disease have higher HbA1c. It was also verified that the consequences of a poor metabolic control, such as microalbuminuria and lipid disorder, can be observed even at pediatric age.