Evaluación de un curso online de educación sexual integral escolar de autoaprendizaje para público en general: curso MOOC / Evaluation of a comprehensive scholar sexual education course self-learning online to general population: MOOC course

Introducción: La educación sexual integral escolar es recomendada por la UNESCO, la OMS, la UNICEF y las NN.UU. Objetivo: Evaluación de un curso de educación sexual integral escolar on line de autoaprendizaje para público general, tipo MOOC (Massive Online Open Course), gratuito. Método: Constituido por 17 capítulos, 17 conferencias, 213 preguntas, 14 videos/talleres con 76 preguntas, curso en radio FM 102.5 UCH y 3 películas originales. Sin fecha de término. Resultados: Se inscribieron voluntariamente 230 estudiantes: el 88% provenientes de Chile, el 6% del extranjero y el 6% sin identificación. El 93% eran menores de 29 años, el 60% de sexo femenino y el 94% con educación media o universitaria. El tiempo de ejecución del curso fue menos de 50 días en el 6%, de 100 a 300 días en el 78,7%, y de 301 a 399 días en el 15%. De los 751 inscritos a diciembre de 2021, terminaron el primer módulo 230 (30,6%), el segundo 207 (28%), el tercero 199 (26%), el cuarto 184 (25%) y el quinto 177 (24%). De los 230 que iniciaron el primer módulo terminaron el curso 177 (77%). La evaluación final del cumplimiento de los objetivos de los cinco módulos del curso como bueno/excelente fue la siguiente: primero 89%, segundo 91%, tercero 92%, cuarto 93% y quinto 94%; para los cinco módulos fue 92% (intervalo de confianza del 95% [IC95%]: 90,9-92,7). La evaluación final de la calidad del desarrollo del curso como buena/excelente fue la siguiente: primero 92% (IC95%: 90,5-94,0) segundo 92% (IC95%: 90,1-93,9%), tercero 93% (IC95%: 91,2-94,9%), cuarto 94% (IC95%: 91,8-95,4%) y quinto 96% (IC95%: 92,0-98,4%); para los cinco módulos fue 93% (IC95%: 92,1-93,7%). Conclusiones: La evaluación de los participantes en el Cumplimiento de los Objetivos y en la Calidad del Desarrollo, en los 19 temas temas del curso alcanza un promedio de 92% y 93%, respectivamente.

Introduction: The comprehensive scholar sexual education is recommended by UNESCO, WHO, UNICEF and UN. Objective: Evaluation of comprehensive scholar sexual education course for general public, MOOC free. Method: On line course with 17 chapters, 17 conferences, 213 questions, 14 videos/workshops with 76 questions, course FM Radio 102.5 and 3 original films. Without date of term. Results: 230 free and voluntary student inscriptions: 88% were coming from Chile, 6% from other countries and 6% without identification. 93% were 29 years old or less, 60% were women and 94% with high school or university education. The periods of course execution were: 50 days or less in 6%, between 100 and 300 days in 78.7% and between 301 and 399 days in 15% on. From the 751 initial inscriptions at December/2021, 230 complete the first module (30,6%), 207 (28%) the second module, 199 (26%) the third module, 184 (25%) the fourth module and 177 (24%) the fifth module. From 230 initial of first module, finish 177 (77%). The final evaluation of the mastery of course objectives as good and excellent were: first module 89%, second module 91%, third module 92%, fourth module 93% and fifth module 94%; for the total course was 92% (95% confidence interval [95%CI]: 90.9-92.7). The course development quality were qualified as good and excellent in 92% (95%CI: 90.5-94.0) first module, 92% (95%CI: 90.1-93.9%) second module, 93% (95%CI: 91.2-94.9%) third module, 94% (95%CI:91.8-95.4%) fourth module and 96% (95%CI: 92.0-98.4%) fifth module; for the total course 93% (95%CI: 92.1-93.7%). Conclusions: The participants evaluation of the course, was 92% and 93% for the Mastery and Development Quality, respectively.

Conducta suicida, consumo de sustancias psicoactivas y calidad de vida en adolescentes chilenos / Suicidal behavior, psychoactive substances use and quality of life in chilean adolescents

BACKGROUND: Suicidal behavior is a public health problem, and adolescents are one of the main risk groups. Aim: To analyze the association among suicidal behavior, consumption of psychoactive substances, and Health Related Quality of Life (HRQoL) in adolescents attending schools in Valparaiso, Chile. MATERIAL AND METHODS: Five hundred-fifty adolescents enrolled in a public school participated in the study. HRQoL was evaluated through KIDSCREEN-27, while suicidal behavior and the consumption of psychoactive substances were measured with the Global School-based Student Health Survey (GSHS). RESULTS: The prevalence of suicidal behavior was higher in women and in those who used tobacco or marijuana in the last month. Respondents with a bad perception of physical well-being reported a higher frequency of suicidal ideation than those with a good perception (Odds ratio (OR): 2.24; 95% confidence: 1.49-3.36). Likewise the frequency of suicidal ideation was higher in those with a bad perception of psychological well-being (OR: 3.87; 95%CI: 2.09-7.71), and a bad perception of autonomy and relation with parents (OR:2.46; 95%CI: 1.34-4.54). Suicide planning was also associated with dimensions of autonomy and relation with parents (OR: 2.32; 95% CI: 1.23-4.38) and dimensions of friends and social support (OR: 1.86; 95%CI:1.05-3.28). Suicide attempt was associated with the dimensions of friendship and social support (OR: 1.83; 95%CI: 1.02-3.28) and school environment (OR: 1,92; 95%CI: 1,23-3,01). Conclusions: Suicide ideation is associated with worse physical and psychological well-being. Suicide planning and suicide attempt is associated with a worse perception about the relation with parents or friends, social support, and school environment.

[Suicidal behavior, psychoactive substances use and quality of life in chilean adolescents]. / Conducta suicida, consumo de sustancias psicoactivas y calidad de vida en adolescentes chilenos.

BACKGROUND: Suicidal behavior is a public health problem, and adolescents are one of the main risk groups. AIM: To analyze the association among suicidal behavior, consumption of psychoactive substances, and Health Related Quality of Life (HRQoL) in adolescents attending schools in Valparaiso, Chile. MATERIAL AND METHODS: Five hundred-fifty adolescents enrolled in a public school participated in the study. HRQoL was evaluated through KIDSCREEN-27, while suicidal behavior and the consumption of psychoactive substances were measured with the Global School-based Student Health Survey (GSHS). RESULTS: The prevalence of suicidal behavior was higher in women and in those who used tobacco or marijuana in the last month. Respondents with a bad perception of physical well-being reported a higher frequency of suicidal ideation than those with a good perception (Odds ratio (OR): 2.24; 95% confidence: 1.49-3.36). Likewise the frequency of suicidal ideation was higher in those with a bad perception of psychological well-being (OR: 3.87; 95%CI: 2.09-7.71), and a bad perception of autonomy and relation with parents (OR:2.46; 95%CI: 1.34-4.54). Suicide planning was also associated with dimensions of autonomy and relation with parents (OR: 2.32; 95% CI: 1.23-4.38) and dimensions of friends and social support (OR: 1.86; 95%CI:1.05-3.28). Suicide attempt was associated with the dimensions of friendship and social support (OR: 1.83; 95%CI: 1.02-3.28) and school environment (OR: 1,92; 95%CI: 1,23-3,01). CONCLUSIONS: Suicide ideation is associated with worse physical and psychological well-being. Suicide planning and suicide attempt is associated with a worse perception about the relation with parents or friends, social support, and school environment.

Prevalencia y características de objetores de conciencia a la Ley 21. 030 en instituciones públicas / Prevalence and characteristics of conscientious objectors to Law 21. 030 in public institutions

INTRODUCCIÓN: La Ley 21.030 permite la objeción de conciencia al personal de salud al interior del pabellón y a las instituciones privadas. Ha sido considerada conflicto de intereses no monetario, al anteponer los valores personales, afectando el cumplimiento del deber profesional. OBJETIVOS: Establecer la prevalencia de funcionarios/as objetores/as en los hospitales de la red pública del país y caracterizarles según edad, género y nacionalidad. MÉTODO: Estudio cuantitativo, analítico y transversal. Se utilizaron medidas de tendencia central y dispersión. Para medir la asociación entre variables sociodemográficas, profesión y causal objetada, se utilizaron las pruebas de χ2, exacta de Fisher y de Kruskal-Wallis. RESULTADOS: En 57 hospitales, se observa una mayor frecuencia de objetores en causal 3. En 443 objetores, la mediana de edad fue de 43 años, el 64,8% mujeres y el 87,4% de nacionalidad chilena. En las zonas centro y sur del país se concentra la mayor proporción de hospitales con más del 50% de objetores. CONCLUSIONES: La dificultad para obtener información impide conocer cabalmente la magnitud de la objeción de conciencia. Resulta preocupante la alta prevalencia de objetores, específicamente en la causal violación. La objeción no puede operar como barrera que vulnere los derechos y la dignidad de las mujeres.

INTRODUCTION: Law 21.030 incorporates conscientious objection for health personnel inside the surgical ward and allows its invocation by private institutions. It has been considered a conflict of interest, not monetary, by putting personal values first, affecting the fulfillment of professional duty. OBJECTIVE: To establish the prevalence of objectors in the countrys public network hospitals and characterize them according to age, gender, and nationality. METHOD: Quantitative, analytical, and cross-sectional study. Central and dispersion trend measures were used. For measuring the association between sociodemographic variables, profession and causal objected, test χ2, Fisher exact and Kruskal-Wallis test were used. RESULTS: In 57 hospitals, a higher frequency of objectors were observed in the third causal. In 443 objectors, the median age was 43 years, 64.8% are women, and 87.4% are Chilean. The central and southern areas of the country have the highest proportion of hospitals, with more than 50% objectors. CONCLUSIONS: The difficulty for obtaining the information prevents fully knowing the magnitude of conscientious objection in Chile. The high prevalence of objectors, specifically in the causal violation is worrying. The conscientious objection cannot operate as a barrier that violates the rights and dignity of women.

Cambios en el uso de anticonceptivos, embarazos no planificados e hijos en adolescentes chilenas entre 1997 y 2018 / Changes in the use of contraceptives, unplanned pregnancies and children in Chilean adolescents between 1997 and 2018

INTRODUCCIÓN: El embarazo en las adolescentes ha persistido como un problema de salud pública y social en Chile, afectando a las adolescentes más vulnerables y reflejando las desigualdades. OBJETIVO: Describir los cambios en el uso de anticonceptivos, embarazos no planificados e hijos en adolescentes chilenas entre 1997 y 2018. MÉTODO: Estudio ecológico de series temporales entre los años 1997 y 2018. Se midió la asociación entre variables sociodemográficas y efectividad del método anticonceptivo para los años 2006 y 2018, mediante la prueba estadística de Rao-Scott. Se estimaron tendencias del porcentaje de uso de métodos anticonceptivos según su eficacia y presencia de embarazos no planificados e hijos con modelos de regresión lineal (método de Prais-Winsten). RESULTADOS: Se observó un aumento en la frecuencia de adolescentes sexualmente activas y en el uso de anticonceptivos, especialmente píldoras e inyectables. La serie temporal de uso de anticonceptivos fue no estacionaria, la tendencia fue creciente (coeficiente: 4,59; intervalo de confianza del 95% [IC95%]: 3,43-5,74; p = 0,001), aumentando 4,59% cada 3 años. Las series de embarazos no planificados y tener hijos fueron series temporales no estacionarias y ambas presentaron una tendencia decreciente (coeficiente: −4,78; IC95%: −6,32 a −3,24; p = 0,002; y coeficiente: −3,93; IC95%: −6,18 a −1,68; p = 0,008), disminuyendo un 4,78% y un 3,93%, respectivamente, cada 3 años. CONCLUSIONES: El aumento en el uso de anticonceptivos en adolescentes ha ido unido a una importante disminución en los embarazos no planificados y los hijos en esta población.

INTRODUCTION: Adolescent pregnancy has persisted as a public and social health problem in Chile, affecting the most vulnerable adolescents and reflecting inequalities. OBJECTIVE: To describe the changes in the use of contraceptives, unplanned pregnancies and children in Chilean adolescents between 1997 and 2018. METHOD: Ecological study of time series between the years 1997 and 2018. The association between sociodemographic variables and the effectiveness of the contraceptive method for the years 2006 and 2018 was measured using the Rao-Scott statistical test. Trends in the percentage of use of contraceptive methods were estimated according to their efficacy and presence of unplanned pregnancies and children with linear regression models (Prais-Winsten method). RESULTS: An increase in the frequency of sexually active adolescents and the use of contraceptives, especially pills and injectables, was observed. The time series of contraceptive use was non-stationary, the trend was increasing (coefficient: 4.59; 95% confidence interval [95% CI]: 3.43-5.74; p = 0.001), increasing 4.59% every three years. The time series, unplanned pregnancies and having children were non-stationary time series, both showed a decreasing trend (coefficient: −4.78; 95%CI: −6.32 to −3.24; p = 0.002; and coefficient: −3.93; 95% CI: −6.18 to −1.68; p = 0.008), decreasing 4.78% and 3.93%, respectively, every 3 years. CONCLUSIONS: The increase in the use of contraceptives in adolescents has been linked to a significant decrease in unplanned pregnancies and children in this population.

Pregnant again? Perspectives of adolescent and young mothers who and do not experience a repeat pregnancy in adolescence.

Introduction: Teen pregnancy remains a major social and public health issue in developing countries. Each additional child compromises the development of both the mother and children. Scarce studies have been performed in Latin America.Purpose: This study explores and analyzes individual and family factors associated with repeat pregnancies during adolescence to better elucidate the phenomenon.Methods: Qualitative-descriptive study. Thirty semi-structured interviews were conducted with mothers 20 years of age or younger from urban areas of Santiago, Chile. Participants were divided into Repeat Pregnancy (RP) and No Repeat Pregnancy (NRP) groups. Qualitative data analysis was based on elements of grounded theory.Results: The RP group generally related life stories reflecting greater psychosocial vulnerability. Most of the RP group dropped out of school after their first pregnancy to focus on parenting and had a passive attitude towards contraception. In contrast, members of the NRP group actively sought long-term contraceptive methods, motivated largely by the desire to continue their education to improve their living conditions and achieve greater personal fulfilment. They tended to have family support networks that facilitated school retention.Conclusion: Key differences between groups included use of contraception, focus on life projects, and motivation to finish school. Prevention strategies should promote long-term contraceptive methods, offer strategies to help young mothers continue their education, facilitate achievement of personal projects, and provide support for parenting.

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.

Patrón de sangrado uterino en adolescentes usuarias de implante anticonceptivo subdérmico de etonogestrel / Uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant

Objetivo: Describir las características del patrón sangrado uterino de las adolescentes que usan el implante anticonceptivo sudérmico de etonogestrel (IASE) que concurren a un centro especializado en salud sexual y reproductiva de adolescentes en Santiago, Chile, y su asociación con variables biopsicosocial. Método: Estudio de cohorte retrospectiva de las usuarias de IASE. Los datos fueron analizados utilizando la ecuación de estimación generalizada, análisis de sobrevida de Kaplan Meier y test de log-rank. Resultados: La cohorte incluyó a 62 adolescentes. La media de edad fue de 16,2 años. Las participantes recibieron asesoramiento anticonceptivo antes de la inserción del IASE, y fueron seguidas durante tres años. Los patrones de sangrado más frecuentes durante el primer año fue el de amenorrea (40,5%) y el sangrado aceptable (27,1%), mientras que el menos frecuente fue prolongado y/o sangrado frecuente (15,8%). De acuerdo con el análisis de sobrevida, la única variable biopsicosocial asociado con patrón prolongado y/o sangrado frecuente fue condición médica previa. Cinco adolescentes (8%) se retiraron el IASE. Conclusiones: El IASE es una opción anticonceptiva segura y altamente eficaz para las adolescentes, independientemente de la paridad. La consejería es de gran importancia para fomentar la tolerancia y la adhesión al implante.

Objectives: To describe uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant (ENG implant) attending a specialized adolescent sexual and reproductive health centre in Santiago, Chile, and test their association with bio-psychosocial variables. Methods: A retrospective cohort study of ENG implant users was conducted and data were analysed using the Generalized Estimating Equation, Kaplan Meier Survival Analysis and Log-Rank Test. Results: The cohort included 62 adolescents with and average age at inclusion of 16.2 years. Participants received contraceptive counselling prior to insertion of an ENG implant, and were followed up for three years. The most frequent bleeding patterns during the first year were amenorrhea (40.5%) and acceptable bleeding (27.1%), whilst the least frequent was prolonged and/or frequent bleeding (15.8%). According to the survival analysis, the only bio-psychosocial variable associated with prolonged and/or frequent bleeding was prior medical condition. Five adolescents (8%) withdrew from the treatment. Conclusions: The ENG implant is a safe and highly effective contraceptive option for adolescents, regardless of parity. Counselling is of great importance to foster tolerance and adherence to the ENG implant.

[The legal framework to prevent teenage pregnancies]. / Conocimientos y práctica clínica de los proveedores de salud para la prevención del embarazo adolescente según marco legal chileno.

BACKGROUND: There are legal regulations about sexual and reproductive rights of adolescents. However, this legal framework (LF) may have contradictory elements: there are laws assuring confidentiality and access to contraception at any age but there are other laws that consider any sexual contact with an adolescent younger than 14 a sexual assault, whose report to the legal authorities in mandatory. AIM: To explore the knowledge and clinical practice of primary health care (PHC) providers regarding prevention of teenage pregnancy. MATERIAL AND METHODS: Qualitative study collecting data using semi-structured interviews made to midwives and directors of PHC centers. Analysis of the data was based on Grounded Theory. RESULTS: There is a differentiated clinical care for pregnancy prevention among adolescents if they are over 14 years old. This is due to the LF, specifically to the sexual crime’s law (19,927) and the law about regulation of the fertility (20,418). The differences affect health care, access and counseling about contraception and confidentiality. Healthcare of teenagers under the age of 14 is perceived as problematic for providers, due to the possible legal implications. CONCLUSIONS: The LF causes insecurity on health care providers and derives in a differentiated clinical approach according to the patient´s age. This is a barrier to provide timely and confidential access to counseling and contraception.

Conocimientos y práctica clínica de los proveedores de salud para la prevención del embarazo adolescente según marco legal chileno / The legal framework to prevent teenage pregnancies

Background: There are legal regulations about sexual and reproductive rights of adolescents. However, this legal framework (LF) may have contradictory elements: there are laws assuring confidentiality and access to contraception at any age but there are other laws that consider any sexual contact with an adolescent younger than 14 a sexual assault, whose report to the legal authorities in mandatory. Aim: To explore the knowledge and clinical practice of primary health care (PHC) providers regarding prevention of teenage pregnancy. Material and Methods: Qualitative study collecting data using semi-structured interviews made to midwives and directors of PHC centers. Analysis of the data was based on Grounded Theory. Results: There is a differentiated clinical care for pregnancy prevention among adolescents if they are over 14 years old. This is due to the LF, specifically to the sexual crime’s law (19,927) and the law about regulation of the fertility (20,418). The differences affect health care, access and counseling about contraception and confidentiality. Healthcare of teenagers under the age of 14 is perceived as problematic for providers, due to the possible legal implications. Conclusions: The LF causes insecurity on health care providers and derives in a differentiated clinical approach according to the patient´s age. This is a barrier to provide timely and confidential access to counseling and contraception.

Calidad de vida relacionada con la salud en estudiantes universitarios de primer año / Health-related quality of life of first-year university Students

OBJETIVO: Calidad de Vida Relacionada con la Salud (CVRS) en estudiantes universitarios de primer año. MATERIAL Y MÉTODO: Estudio observacional, transversal y analítico en estudiantes de 17 a 18 años de primer año de 14 Facultades, 2 Institutos y 1 Programa de Bachillerato. Se aplicó el test Kidscreen-52, enviado por correo electrónico a 3.738 estudiantes. Contestaron 1.277 (34,16%). Análisis con programa WINSTEPS y expresión con puntajes Rasch. RESULTADOS: Las dimensiones Bienestar Físico, Estado de Ánimo y Emociones y Autonomía con menos de 42 puntos Rasch, y otras dos, Bienestar Psicológico, Amigos y Apoyo Social tuvieron puntajes significativamente menores a lo encontrado en adolescentes chilenos de edad comparable, en mujeres, escolares de establecimientos municipales de bajo nivel socioeconómico, con Índice de Vulnerabilidad Escolar (IVE) o con discapacidad o problema de salud o enfermedad crónica. Las diferencias son mayores en Facultades con más demanda académica. Este primer estudio revela información no conocida, trascendente para estudiantes, académicos y sus autoridades. Se sospecha que posiblemente ocurre en otras universidades. CONCLUSIONES: Los estudios de Calidad de Vida estudiantil son factibles de aplicar en instituciones de educación superior en beneficio de educandos y educadores. Este estudio es un insumo para diagnóstico y evaluación de las políticas salud y apoyo estudiantil y aporta a la orientación de la docencia. En el futuro podrían aplicarse instrumentos de medición de la Calidad de Vida en estudiantes de otras edades y en otros estamentos universitarios con test validados en Chile, combinado con estudios de Factores de Riesgo.

OBJETIVE: To evaluate the health-related quality of life (HRQoL) of first-year university students at the University of Chile in 2015 MATERIAL AND METHOD: Observational, transversal, and analytical study of first year students, 17 to 18 years of age, attending 14 Faculties, 2 Institutes, and 1 Bachelor Program of the University of Chile. Delivery of Kidscreen-52 test by email to 3,738 students, of which 1,277 replied (34.16%). The Winsteps program model and Rasch punctuation were used. RESULTS: The dimensions Physical Well-being, State of Mood and Emotions, and Autonomy scored less than 42 Rasch points, and the other two dimensions ­ Psychological Well-being and Friends and Social Support - had significantly lower scores than those found in Chilean adolescents of a comparable age, in women, in students of lower socio-economical levels in municipal public schools with a Scholar Vulnerability Index, or those with a disability, health problem, or chronic illness. The differences are greater in Faculties with heavier academic demands. Discussion: This first study gives new information in an area seldom studied, which is important for students, academics, and authorities. It is suspected that similar results would be found in other university settings. CONCLUSIONS: HRQoL studies are feasible to apply in institutions of higher education, to benefit both students and educators. This study contributes to the diagnosis and evaluation of public policies on student support, and for teaching strategies. In the near future, HRQoL instruments could be applied with other students and other members of the university community, in combination with studies on risk factors

Efectos secundarios en adolescentes chilenas usuarias de implante anticonceptivo subdérmico de etonogestrel / Side effects of etonogestrel contraceptive implants in Chilean adolescents

OBJETIVO: Analizar los efectos secundarios del uso del implante anticonceptivo subdermico de etonogestrel (IASE) en adolescentes chilenas. Personas, material y método: Estudio analítico de una cohorte de adolescentes usuarias de IASE entre los años 2007 y 2012. RESULTADOS: Se indicó el IASE en 62 adolescentes. La edad promedio en el momento de la colocación del IASE fue de 16,2 años. El 88,7% de las adolescentes habían iniciado actividad sexual. El 83,9% refirió alguna patología: un 25,8% un problema médico de salud y un 58,1% una patología mental. El 15,5% eran obesas. El 65,3% no presentó efectos secundarios en los primeros 3 meses de uso del IASE. El efecto secundario más frecuente el primer año fue la cefalea (15,9%) y en el segundo año la mastalgia (15,9%). Durante el tercer año de uso el 73,4% no presentó efectos secundarios. El porcentaje de adolescentes obesas se elevó desde el 15,5 hasta el 22,6% desde el inicio del uso del IASE hasta el final, y el porcentaje de adolescentes de bajo peso también aumentó, desde un 3,5 hasta un 7,6%. Se observó un incremento de peso de 4,217 kg al tercer año de uso y un aumento del índice de masa corporal de 1,67 kg/m2 el último año (p= 0,001 y 0,001, respectivamente). Durante el periodo del estudio se realizaron 5 extracciones prematuras del IASE (8%): en 2 casos por deseo de embarazo, en 1 por metrorragia que no respondió a tratamiento, en 1 por aumento de peso y en 1 por exacerbación del acné. No se produjeron embarazos durante el uso del IASE y hubo 15 adolescentes que recambiaron el IASE. CONCLUSIONES: Los efectos secundarios afectaron a un porcentaje bajo de adolescentes y la extracción del IASE por esta causa se dio en 2 casos. Contar con profesionales capacitados en el asesoramiento en salud y un mejor acceso al IASE podría aumentar el uso de este método anticonceptivo, contribuyendo así a disminuir el número de embarazos no deseados

OBJECTIVE: To assess the side effects with the use of etonogestrel subdermal contraceptive implant (ESQ) in Chilean adolescents. PATIENTS AND METHODS: Cohort users ESCI adolescents between 2007 and 2012. RESULTS: It was indicated ESQ 62 teenagers. The average age at inclusion was 16.2 years. 88.7% of adolescents had initiated sexual activity. 25.8% reported a medical pathology and 58.10/o a mental health pathology. I 5.50/o were obese. 65.3 o/o do not have any side effects the first three months of using ESQ. The most common side effect was headache first year, 15.90/o in the second year breast pain I 5.90/o. During the third year of use 73.40/o did not have any side effects. The nutritional obesity rose from 15.50/o to 22.60/o since the beginning of the use of ESQ until the end, while the emaciated nutritional status also increased from 3.50/o to 7.60/o. Weight gain in 4.217 kilograms in the third year of use and an increase in body mass index of 1.67 kilos/ m2 last year is observed (p= 0.006 and p= 0.007). There were 5 (8o/o) removals, two desire pregnancy, metrorhagia not responded to treatment, and by a weight gain due to exacerbation of acne were performed. No pregnancies occur during use of ESQ and were 15 teenagers to continue with ESQ. CONCLUSIONS: Side effects occurred in a small percentage and removal of IASE for this cause occurred in two cases. Have professionals trained in counselling and improved access to ESQ, could increase the use of this, helping to reduce the number of unwanted pregnancies

[Influence of bullying on the quality of life perception of Chilean students]. / Bullying y calidad de vida relacionada con la salud en adolescentes escolares chilenos.

BACKGROUND: Bullying has a negative impact on the perception of adolescents of their quality of life. AIM: To analyze the association between being bullied and health related quality of life in Chilean adolescents. MATERIAL AND METHODS: The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. RESULTS: Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. CONCLUSIONS: Bullying is associated with a lower quality of life perception among Chilean students.

Bullying y calidad de vida relacionada con la salud en adolescentes escolares chilenos / Influence of bullying on the quality of life perception of Chilean students

Background: Bullying has a negative impact on the perception of adolescents of their quality of life. Aim: To analyze the association between being bullied and health related quality of life in Chilean adolescents. Material and Methods: The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. Results: Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. Conclusions: Bullying is associated with a lower quality of life perception among Chilean students.

Calidad de vida relacionada con la salud en adolescentes chilenos, según autopercepción de discapacidad, enfermedad o problemas de salud crónicos / Health-Related Quality of Life according to perceivedmorbidity in Chilean adolescents

Objetivo. Relacionar la morbilidad percibida de adolescentes chilenos con su calidad de vida relacionada con la salud. (CVRS). Método. Análisis comparativo en adolescentes chilenos con y sin morbilidad percibida, según la Clasificación Internacional de Enfermedades (CIE10). Información obtenida a través de un estudio nacional, aplicando un cuestionario de medición de calidad de vida relacionada con salud (KIDSCREEN-52), adaptado culturalmente y validado en Chile en 2009. Se analizó por las variables de sexo, edad, tipo de establecimiento escolar y zonas del país. Se analizó las 10 dimensiones de calidad de vida del KIDSCREEN que se expresan como puntajes Rasch. Para el análisis de las diferencias de medias entre las variables se utilizó la prueba de Chi2 y t de Student. Se aplicó el software STATA 10.0 y SAS 9.1 Resultados. Se determina la morbilidad autopercibida a nivel nacional, la cual es más frecuente en mujeres, adolescentes menores, estudiantes de establecimientos escolares particulares y zona norte del país. El cuestionario demuestra que los puntajes Rasch más bajos de CVRS se alcanzan en adolescentes con morbilidad percibida. Conclusión. Las peores CVRS en adolescentes con morbilidad autopercibida , fue en mujeres, adolescentes mayores, del sector público de la educación y de la zona norte del país. La información es un aporte nuevo y útil para futuros programas de salud juveniles del sector público.

Objective. To correlate Chilean adolescents’ perceived morbidity with their Health-Related Quality of Life (HRQoL). Method. Comparative analysis of Chilean adolescents with and without perceived morbidity classified according to the International Classification of Diseases (ICD10). Information was collected through a national study, applying the KIDSCREEN-52 questionnaire, adapted culturally and validated in Chile in 2009. The ten quality life dimensions, expressed as Rasch points, were analyzed by sex, age, type of school and zones of the country. To analyze the mean differences between the variables, the Chi squared and Student’s t-test were used. The software used were STATA 10.0 and SAS 9. Results. The self perceived morbidity was assessed across the country and was more frequent in women, adolescents of younger age, students from private schools and from the north zone of the country. The lowest HRQoL Rasch points were determined in adolescents with perceived morbidity. Conclusion. The worst HRQoL in adolescents was found in those with self perceived morbidity, women, higher adolescent age, students from public schools and from the north of the country. This finding is new and a useful contribution for future national public health programs concerning adolescents.

Factores que facilitan la conversación sobre sexualidad entre padres e hijos/as de primer ciclo de enseñanza básica / Factors that facilitate the talking about sexuality between parents and sons / daughters of first cycle of basic education

Objetivo: Determinar los factores que facilitan la conversación sobre sexualidad entre padres e hijos/as de primer ciclo de enseñanza básica. Método: Estudio de diseño transversal y analítico. Se estudiaron 210 padres de ambos sexos con hijos/as cursando el primer ciclo de enseñanza básica de tres colegios de la Región Metropolitana, uno municipalizado, uno particular subvencionado y uno particular pagado, los cuales contestaron una encuesta que formaba parte de un diagnóstico previo a la aplicación de un Programa de Educación Sexual destinado a niños/as del primer ciclo de enseñanza básica. Se ajustó un modelo de regresión logística múltiple para identificar aquellos factores que facilitan la conversación de sexualidad entre padres e hijos/as. Resultados: Los factores que aumentan la posibilidad de los padres de sentirse bien al conversar de sexualidad con sus hijos son: hijos que cursan 3º a 4º básico, padres que habían asistido anteriormente a un curso de educación sexual y estiman tener alto nivel de conocimiento en educación sexual. Conclusiones: Los resultados muestran la necesidad de capacitar a los padres en educación sexual para que puedan abordar estos temas con sus hijos a más temprana edad.

Objective: To determine the factors that facilitate the talking about sexuality between parents and children the first cycle of basic education. Method: This is a cross-sectional and analytical study. We studied 210 parents of either sex with sons / daughters studying the first cycle of basic education in three schools in the metropolitan region, one public, one private subsidized and one private, which answered a survey that was part of a previous diagnosis of the implementation of a sex education program aimed at children the first cycle of basic education. Multiple logistic regression model to identify factors that facilitate conversation about sexuality between parents and sons / daughters was used. Results: Factors that increase the probability of parents to feel good to talk about sexuality with their children include: children enrolled in 3rd-4th grade, parents who had previously attended a course in sex education and estimated to have high level of knowledge on sex education. Conclusions: The results show the need to train parents in sex education so that they can address these issues with their children at a younger age.

Comparative performance of a combined injectable contraceptive (50 mg norethisterone enanthate plus 5mg estradiol valerate) and a combined oral contraceptive (0.15 mg levonorgestrel plus 0.03 mg ethinyl estradiol) in adolescents.

STUDY OBJECTIVE: To compare in a regular non-clinical trial experience the efficacy, acceptability, and continuation rates of an injectable contraceptive containing 50 mg norethisterone enanthate plus 5mg estradiol valerate (IC) and an oral contraceptive containing 0.15 mg levonorgestrel plus 0.03 mg ethinyl estradiol (OC), among adolescent users. DESIGN: A total of 251 adolescents ages 14-19 were followed during 12 months. The IC group (124 subjects) was studied for 1044 cycles and the OC group (127 subjects) was studied for 1368 cycles. The users were not assigned in a random selection. Information was collected from clinical records. Groups were compared using Pearson chi-square, odds ratio (95% confidence interval), t-test, and proportion difference test. RESULTS: The IC group had significant differences in baseline social risk, confidence, psychiatric problems, consumption of alcohol, and number of sexual partners. At 12 months, the IC group showed significant decrease in weight and increase in hypermenorrhea. In the OC group, dysmenorrhea decreased, and hypomenorrhea and regular cycles were significantly more frequent. One pregnancy occurred in the OC group (Pearl Index: 0.88). Final continuation rates at 12 months were 41.9% and 37.8% for IC and OC, respectively. CONCLUSIONS: The monthly injectable is a recommended contraceptive option for adolescents, especially for those facing psychosocial risk factors.

Libido and orgasm in middle-aged woman.

OBJECTIVES: Determine which social, demographic and sexual function variables that most influence libido or desire and orgasm domains in the premenopausal and postmenopausal women. METHODS: A cross-sectional analysis of 231 Colombian-born women, aged 40-62 years. The sexual function was measured by self-questionnaire. The analysis was performed by using the chi2-test and multivariate regression analysis. The sexual function was divided in five domains: desire, arousal, lubrication, orgasm, pain; additionally satisfaction was included. RESULTS: The women with a higher level of education and with a good perception of their satisfaction with their partners, reported better performance in the desire. Age and the non existence of sexual partner influenced in a negative way on the desire. In sexual active women the orgasm was negatively influenced by low satisfaction scores, lack of emotional closeness with their partners and low educational level. High scores in lubrication and desire were associated with a good performance in the orgasm. The hormone therapy (HT) was associated with better scores in orgasm. CONCLUSIONS: Age, level of education, the presence or lack of sexual partner, degree of satisfaction with emotional closeness with the partner and adequate lubrication, influence the desire and orgasm domains in a significant way. By identifying these associations we can then perform some inexpensive interventions. Improving lubrication for menopausal women. Including men in educational activities to sensitize them toward women's feelings. Organizing educational campaigns for middle-aged women to demystify that sexuality is only for young people.

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.