Induced Abortion According to Socioeconomic Status in Chile.

STUDY OBJECTIVE: The Chilean legislation forbids induced abortion, so little is known of the young women who have abortions and what determinants are associated with this practice. In this study we examined the association between adolescents and young women who have had induced abortions and socioeconomic status and compared them with counterparts who reported not having a history of abortion. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES: Drawing on the 2015 Chilean National Youth Survey, a population-based sample of general community youth aged 15-29 years, we conducted a study on 2439 sexually active females. Bivariate and multiple logistic regression was used to examine the relationship between participants who had induced abortions and participants that had not according to socioeconomic status (low, middle, high), while controlling for demographic, sexual behavior, and cultural covariates. RESULTS: 5.15% (n = 129) of participants declared having induced an abortion in the past. Participants with high socioeconomic status had 4.89 (95% confidence interval, 1.44-16.51) higher odds of induced abortion compared with participants with low socioeconomic status. Those with middle socioeconomic status had 1.8 (95% confidence interval, 1.02-3.24) higher odds of induced abortion compared with those with low socioeconomic status. Urban or rural residence, indigenous identification, age of sexual debut, contraceptive use at the time of sexual debut, adolescent pregnancy, and religious and political identification did not correlate with induced abortion rates. CONCLUSION: In Chile, where induced abortion is legally restricted, a social gradient was found in the chance of having had an induced abortion according to socioeconomic status; adolescent and young women with higher socioeconomic advantage reported more induced abortions compared with those with low socioeconomic status.

Prevalence of Chlamydia Trachomatis, Neisseria Gonorrhoeae, and Trichomonas Vaginalis Infection in Chilean Adolescents and Young Adults.

STUDY OBJECTIVE: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infection in sexually active Chilean adolescents and young adults. A comparative analysis was performed between genders to identify demographic, clinical, and sexual behavior characteristics to predict the occurrence of C trachomatis. DESIGN: Analytical observational study. SETTING: Santiago, Chile. PARTICIPANTS: Two hundred eighty-six sexually active volunteers aged 24 years or younger (171 female and 115 male); 82.9% (237/286) of them were classified as having high socioeconomic status. INTERVENTIONS: Confidential survey and self-collected samples (urine for men and vaginal swabs for women). MAIN OUTCOME MEASURES: Prevalence, demographic characteristics, symptoms, and sexual behavior characteristics. RESULTS: The prevalence rate of C trachomatis was 8.7% (10/115) in men and 8.8% (15/171) in women (P = .58). N gonorrhoeae was detected in 1 subject, whereas no T vaginalis cases were detected. In multivariate analysis, having some college education was protective (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.09-0.89), whereas having a higher number of sexual partners was a risk factor (OR, 1.19; 95% CI, 1.1-1.3) for C trachomatis infection. The latter was also predicted by postcoital bleeding (OR, 4.6; 95% CI, 1.30-16.23) in the female model. CONCLUSION: C trachomatis infection rates were similar between both genders. Protective characteristics for the occurrence of this infection were having some college education, lower number of sexual partners, and if female, the absence of postcoital bleeding. This study highlights the importance of C trachomatis screening among the Chilean affluent population younger than 25 years. However, further studies are needed in a more diverse and representative sample to recommend universal screening in Chilean adolescents and young adults.

Síndrome de Hemivagina Obstruida, Útero Didelfo y Agenesia Renal Ipsilateral (OVHIRA), Drenado Parcialmente por Fístula Útero-Uterina Espontánea / Obstructed Hemivagina Syndrome, Uterus didelphys and Ipsilateral Renal Agenesis (OVHIRA), Partially Drained by Spontaneous Uterine-Uterine Fistula

RESUMEN Antecedentes: El síndrome de hemivagina obstruida, útero didlefo y anomalía renal ipsilateral (OVHIRA) es una malformación mülleriana infrecuente. Objetivo: Se presenta un caso con una complicación no antes descrita y se hace una revisión de la literatura hasta la fecha. Caso clínico: Mujer de 12 años de edad con antecedentes de diagnóstico de útero bicorne y agenesia renal derecha en la infancia. Veintidós meses post menarquia consulta por algia pelviana y dismenorrea premenstrual. Ecografía revela hematómetra en cuerpo uterino izquierdo, de 142 x 69 x 61 mm. Resonancia nuclear magnética (RNM) describe además un hematocolpos de 7 x 10 cm y un tabique vaginal transverso de hemivagina izquierda. Se diagnostica OHVIRA y se planifica cirugía para resecar el tabique. Días antes del la cirugía, la paciente tiene episodio de metrorragia. Ecográficamente se constata una disminución considerable del volumen de hematómetra. En la cirugía se pesquisa fístula uterina que comunica útero obstruido izquierdo con útero no obstruido derecho por donde había drenado espontáneamente la hematómetra. Al resecar el tabique vaginal izquierdo se termina de drenar hematómetra y hematocolpos. Al alta, paciente se maneja con dilatación vaginal progresiva por seis meses para evitar la estenosis del tabique. Conclusión: Se presenta una complicación no descrita, fístula útero uterina, de una malformación mülleriana infrecuente (OVHIRA). El proceso diagnóstico meticuloso, la cirugía bien planificada y la dilatación vaginal prolongada permitieron tener éxito en su manejo.

ABSTRACT Background: Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome (OHVIRA) is an uncommon Müllerian anomaly. Objective: A case is described and the main complications related to the syndrome are reviewed. Case report: Female, 12 years old, with a medical history of a bicornuate uterus and right renal agenesis diagnosed at birth. Twenty-two months post menarche she seeks medical attention due to pelvic pain, menometrorrhagia and premenstrual dysmenorrhea. An ultrasound revealed a hematometra, of 142 x 69 x 61 mm, in the left uterus. Magnetic resonance imaging also described a 7 x 10 cm hematocolpos and a transverse vaginal septum of the left hemivagina. OHVIRA is diagnosed and surgery is planned to resect the septum. Two days before the surgery, the patient has an episode of abundant metrorrhagia. Ultrasonographically a considerable decrease in the volume of the hematometra is observed. In surgery, a uterine fistula is discovered which communicates the left obstructed uterus with the right unobstructed uterus, where the hematometra had been partially drained. During the procedure, the left vaginal septum is resected, which completes the drainage of the hematometra and hematocolpos. At discharge, the patient undergoes progressive vaginal dilation for six months to avoid stenosis of the septum. Conclusion: An utero-uterine fistula has not been previously described as a complication of OHVIRA. The meticulous diagnostic process, the well planned surgery and the prolonged vaginal dilation allowed for a successful management.

[Adolescents find it easy to collect their own samples to study sexually transmitted infections]. / Adolescentes encuentran fácil tomar sus propias muestras para estudio de infecciones de transmisión sexual.

BACKGROUND: As alternative for patients that fear genital examination, we assessed adolescent's comfort and ease with self-collected samples for nucleic acid amplification testing for sexually transmitted infections. PATIENTS AND METHODS: Sexually active Chilean adolescents and youth under 25 years (174 males and 117 females) were enrolled. Females used self-collected vaginal swabs and males collected first-stream urine. A satisfaction survey evaluating self-sampling system was applied. RESULTS: Self-collection was considered easy in 99.3% of the interviewees (CI 95% 0.88-0.98). In women, 79.3% preferred vaginal self-collected samples than pelvic exam (CI 95% 0.73-0.85). In men, 80.3% preferred self-collected first-stream urine to urethral swabs (CI 95% 0.73-0.87). Assuming that self-collected sampling were available, 89.6% of women (CI 95% 0.85-0.94) and 93.2% of men (CI 95% 0.89-0.98) would be prone to be tested more often. Ease of self-collected sampling is not associated with age, gender, educational level or poverty. CONCLUSIONS: Chile currently does not have sexually transmitted infections surveillance or screening programs for youth and adolescents. Given self-collected sampling's good acceptability, it could be successfully used when these programs are implemented.

Adolescentes encuentran fácil tomar sus propias muestras para estudio de infecciones de transmisión sexual / Adolescents find it easy to collect their own samples to study sexually transmitted infections

Background: As alternative for patients that fear genital examination, we assessed adolescent's comfort and ease with self-collected samples for nucleic acid amplification testing for sexually transmitted infections. Patients and Methods: Sexually active Chilean adolescents and youth under 25 years (174 males and 117 females) were enrolled. Females used self-collected vaginal swabs and males collected first-stream urine. A satisfaction survey evaluating self-sampling system was applied. Results: Self-collection was considered easy in 99.3% of the interviewees (CI 95% 0.88-0.98). In women, 79.3% preferred vaginal self-collected samples than pelvic exam (CI 95% 0.73-0.85). In men, 80.3% preferred self-collected first-stream urine to urethral swabs (CI 95% 0.73-0.87). Assuming that self-collected sampling were available, 89.6% of women (CI 95% 0.85-0.94) and 93.2% of men (CI 95% 0.89-0.98) would be prone to be tested more often. Ease of self-collected sampling is not associated with age, gender, educational level or poverty. Conclusions: Chile currently does not have sexually transmitted infections surveillance or screening programs for youth and adolescents. Given self-collected sampling's good acceptability, it could be successfully used when these programs are implemented.

Introducción: Como alternativa para pacientes que temen al examen genital o para aquellos asintomáticos, se evaluó la satisfacción de adolescentes con el sistema de autotoma -muestra tomada por el propio paciente- para amplificación de ácidos nucleicos y determinación de infecciones de transmisión sexual (ITS). Material y Método: Se enrolaron 174 mujeres y 117 hombres menores de 25 años sexualmente activos. Las mujeres se realizaron autotoma con tórula vaginal. Los hombres, autotoma de orina de primer chorro. Se aplicó encuesta de satisfacción. Resultados: A 99,3%, le resultó fácil obtener muestras mediante autotoma (IC 95% 0,88-0,98). En mujeres, 79,3% prefirió la autotoma vaginal por sobre el examen pélvico (IC 95% 0,73-0,85). En hombres, 80,3% prefirió la autotoma de orina por sobre el hisopado uretral (IC 95% 0,73-0,87). Si la autotoma estuviera disponible, 89,7% de las mujeres (IC 95% 0,85-0,94) y 93,2% de los hombres (IC 95% 0,89-0,98) estarían dispuestos a someterse a un examen de ITS en forma más seguida. Encontrar fácil la autotoma no se asoció con edad, género, escolaridad ni pobreza. Conclusiones: Chile aún no tiene programas de vigilancia o detección de ITS para jóvenes y adolescentes. Dada la buena aceptabilidad de la autotoma, se podría emplear exitosamente cuando estos programas se implementen.

Type of primary education is associated with condom use at sexual debut among Chilean adolescents.

BACKGROUND: Although condom use in adolescence is related to higher lifetime educational attainment, the association between primary education (from kindergarten to eighth grade) and adolescent sexual behavior is not well understood. This study examined the association between type of school in which primary education was completed-public, charter, or private-and condom use at sexual debut among Chilean adolescents. METHODS: Drawing on the 2009 Chilean National Youth Survey, a population-based sample of general community youth aged 15 to 29 years, we conducted a study of the 4217 participants who reported onset of sexual activity during adolescence. Bivariate and multple logistic regression was used to examine the relationship between type of primary school attended (60.1% public, 30.3% charter, and 9.6% private) and condom use at sexual debut while controlling for sociodemographic characteristics and sexual behavior. RESULTS: Compared with students who completed their primary education in private or charter schools, students who completed their primary education in public schools had 1.85 (95% confidence interval, 1.12-3.04) and 1.67 (95% confidence interval, 1.26-2.23) higher odds, respectively, of not using condoms at sexual debut. Odds were similar for students living in urban settings, whereas there were too few students attending private schools in rural areas to allow meaningful estimates. CONCLUSIONS: Independent of household income, primary schooling is associated with sexual health behaviors among Chilean adolescents living in urban areas and can serve as a target for public health interventions designed to prevent sexually transmitted infections in adolescence.

Prevalencia de Chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes chilenas / Rates of Chlamydia trachomatis and Neisseria gonorrhoeae in Chilean adolescents

Background: Chlamydia trachomatis and Neisseria gonorrhoeae are common sexually transmitted diseases among young women and little has been doing to study them in Chilean adolescents. Aim: Determine the rates of C trachomatis and N gonorrhoeae in Chilean young women. Material and methods: Urine samples were obtained from 203 sexually active females under 25 year-old, who attended hospitals from either high or low-income areas in Chile's capital, Santiago. C trachomatis and Ngonorrhoeae were detected by nucleic acid amplification testing. Results: Seven percent of samples were positive for C trachomatis. AU samples were negative for N gonorrhoeae. Among pregnant women, 19 percent of samples were positive for C trachomatis, while non-pregnant women were positive on 5.5 percent (p =0.04). Systematic use of barrier contraception was referring by 12 percent of women. AU of the latter was free of C trachomatis. No association was observing between age, number of sexual partners, age of first sexual intercourse, and presence of uro-gynecological symptoms, socioeconomic status and the rate of C trachomatis. Conclusions: Seven percent of this group of Chilean young women was infected with C trachomatis. The figure rises to 19 percent if pregnant. Surveillance and screening programs should been implemented to prevent sequels on this vulnerable population.

[Rates of Chlamydia trachomatis and Neisseria gonorrhoeae in Chilean adolescents]. / Prevalencia de Chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes chilenas.

BACKGROUND: Chlamydia trachomatis and Neisseria gonorrhoeae are common sexually transmitted diseases among young women and little has been doing to study them in Chilean adolescents. AIM: Determine the rates of C trachomatis and N gonorrhoeae in Chilean young women. MATERIAL AND METHODS: Urine samples were obtained from 203 sexually active females under 25 year-old, who attended hospitals from either high or low-income areas in Chile's capital, Santiago. C trachomatis and Ngonorrhoeae were detected by nucleic acid amplification testing. RESULTS: Seven percent of samples were positive for C trachomatis. AU samples were negative for N gonorrhoeae. Among pregnant women, 19% of samples were positive for C trachomatis, while non-pregnant women were positive on 5.5% (p =0.04). Systematic use of barrier contraception was referring by 12% of women. AU of the latter was free of C trachomatis. No association was observing between age, number of sexual partners, age of first sexual intercourse, and presence of uro-gynecological symptoms, socioeconomic status and the rate of C trachomatis. CONCLUSIONS: Seven percent of this group of Chilean young women was infected with C trachomatis. The figure rises to 19% if pregnant. Surveillance and screening programs should been implemented to prevent sequels on this vulnerable population.

Retroareolar cysts in the adolescent.

BACKGROUND: Retroareolar cysts present in female adolescents with palpable subareolar masses that can have concomitant inflammatory changes. The purpose of this study was to report our cases of retroareolar cysts and thus to contribute to a better knowledge and understanding of this entity. METHODS: Forty-six girls were diagnosed with retroareolar cysts between December 2000 and July 2002. A retrospective chart review is presented with the clinical and ultrasonographic findings. RESULTS: Age at presentation was 10 to 20 years. The reason for consultation was acute mastalgia and inflammation in 31 cases and palpable nodule in 15 cases. Two patients had areolar discharge. Ultrasonographic imaging in the 46 girls showed retroareolar simple cysts, either multiple or bilateral. The cysts had thin walls and were round, oval, or elongated with a variable diameter always less than 20 mm. They had liquid content with an echogenic or calcific sediment. When retroareolar cysts presented with inflammatory changes, antibiotics and nonsteroidal anti-inflammatory drugs were used. Inflammatory changes disappeared in approximately seven days. All patients experienced favorable outcomes. CONCLUSIONS: Retroareolar cysts are a benign form of breast disease in the adolescent. Further investigation is needed to completely understand the pathophysiology, epidemiology, and natural history of this diagnosis.

Doppler color del territorio útero-placentario y su relación con la ubicación placentaria: grupos de resistencia normal y elevada / Color doppler of uterine-placental area and it relation with placental ubication: normal and high resistance groups

Se estudiaron 42 embarazos entre 20 y 40 semanas, 26 con resistencia de arterias uterinas (AU), normal definidas como grupo A, y 16 con valores de resistencia de AU aumentadas, Grupo B. Se establecieron 3 categorías de ubicación placentaria: Tipo 1, placenta central; tipo 2, lateralizada, que cruza la línea media del útero; tipo 3, lateral, que no cruza línea media del útero. Se estableció la relación sístole diástole (rel S/D) con un equipo Doppler Dupplex Color, en cinco puntos diferentes del TVUP; arteria uterina derecha e izquierda en unión cérvico ístmica, AU alta en el punto sobresaliente de la pared uterina y espacio intervelloso (EIV). Para el análisis de los resultados se utilizó el programa estadístico Statview (Macintosh). Las placentas tipo 2 predominaron en el grupo A y las placentas tipo 3 predominaron en el grupo B. Las placentas tipo 2 y 3 se localizaron preferentemente en el lado derecho del útero. La rel S/D fue mayor en el grupo B que el el A en los 5 puntos medidos. En ambos grupos, la rel S/D promedio fue menor en las mediciones derechas que izquierdas. En el grupo B, las pacientes que tenían la placenta en el lado izquierdo tenían una rel S/D significativamente más alta en la arteria uterina no placentaria, esta relación no se observó claramente en las pacientes con placenta derecha. Los patrones de localización placentaria lateral tienden a expresar valores de resistencia elevados en TVUP. Cuando se encuentra un valor de Doppler uterino alterado, todos lo valores del TVUP tienden a estar alterados. En pacientes con patología la resistencia de ambas AU es mayor cuando la placenta es derecha que cuando es izquierda. Se propone la clasificación de ubicación placentaria como método de screening para detectar pacientes de riesgo que requieran estudio subsecuente de velocidades de flujo en el TVUP