The effects of sexual violence experienced in childhood and adolescence on undergraduate students.

OBJECTIVE: This study aims to investigate the prevalence of adolescents and young adults who were victims of sexual violence at some point in their lives and to compare the presence of depressive and anxious symptoms, quality of life, and use of alcohol, tobacco, and illegal drugs among this population and those who were not abused. METHODS: Validated questionnaires and instruments were applied in a group of university students to assess: sexual profile and behavior, socioeconomic status, presence or not of sexual violence (Questionnaire on Exposure to Traumatizing Events), depressive (Beck Depression Inventory) and anxious symptoms (Beck Anxiety Inventory), quality of life (World Health Organization's Quality of Life Assessment) and the use or abuse of tobacco, alcohol, and illegal drugs (Smoking, Alcohol, and Substance Involvement Screening Test). RESULTS: Out of the 858 students who participated, 71 (8.3%) were victims of sexual violence, 52 girls (73.2%). In the victims of violence group there were more students who already had the first sexual intercourse (p = 0.029), students who already had become pregnant (p = 0.001), students with higher scores for depressive (p < 0.001) and anxious symptoms (p = 0.001), students with worse quality of life (p < 0.001), and who used more tobacco (p = 0.008) and marijuana (p = 0.025) as well as abused hypnotics or sedatives (p = 0.048) than in the non-victim group. CONCLUSION: The abuses are presented in several forms and affect, even in long term, the survivors' life. The sexual violence theme should be addressed and widely discussed in all spheres of society in order to mobilize, to sensitize, and provide society with knowledge, demystifying this subject and drawing attention to this important social issue.

The effects of sexual violence experienced in childhood and adolescence on undergraduate students / Os impactos da violência sexual vivida na infância e adolescência em universitários

ABSTRACT OBJECTIVE: This study aims to investigate the prevalence of adolescents and young adults who were victims of sexual violence at some point in their lives and to compare the presence of depressive and anxious symptoms, quality of life, and use of alcohol, tobacco, and illegal drugs among this population and those who were not abused. METHODS: Validated questionnaires and instruments were applied in a group of university students to assess: sexual profile and behavior, socioeconomic status, presence or not of sexual violence (Questionnaire on Exposure to Traumatizing Events), depressive (Beck Depression Inventory) and anxious symptoms (Beck Anxiety Inventory), quality of life (World Health Organization's Quality of Life Assessment) and the use or abuse of tobacco, alcohol, and illegal drugs (Smoking, Alcohol, and Substance Involvement Screening Test). RESULTS: Out of the 858 students who participated, 71 (8.3%) were victims of sexual violence, 52 girls (73.2%). In the victims of violence group there were more students who already had the first sexual intercourse (p = 0.029), students who already had become pregnant (p = 0.001), students with higher scores for depressive (p < 0.001) and anxious symptoms (p = 0.001), students with worse quality of life (p < 0.001), and who used more tobacco (p = 0.008) and marijuana (p = 0.025) as well as abused hypnotics or sedatives (p = 0.048) than in the non-victim group. CONCLUSION: The abuses are presented in several forms and affect, even in long term, the survivors' life. The sexual violence theme should be addressed and widely discussed in all spheres of society in order to mobilize, to sensitize, and provide society with knowledge, demystifying this subject and drawing attention to this important social issue.

RESUMO OBJETIVO: Investigar a prevalência de adolescentes e adultos jovens que foram vítimas de violência sexual em algum momento da vida e comparar a presença de sintomas depressivos e ansiosos, qualidade de vida e uso de álcool, tabaco e drogas ilícitas entre esta população e a que não sofreu abuso. MÉTODOS: Aplicaram-se questionários e instrumentos validados, em uma população de estudantes universitários, para avaliar: perfil e comportamento sexual, nível socioeconômico, presença ou não de violência sexual (Questionário sobre a Exposição a Eventos Traumatizantes), sintomas depressivos (Inventário de Depressão de Beck) e ansiosos (Inventário de Ansiedade de Beck), qualidade de vida (World Health Organization's Quality of Life Assessment) e o uso ou abuso de tabaco, álcool e drogas ilícitas (Teste para Triagem do Envolvimento com Fumo, Álcool e Outras Drogas). RESULTADOS: Dos 858 alunos que responderam à pesquisa, 71 (8,3%) foram vítimas de violência sexual, sendo 52 meninas (73,2%). No grupo vítima de abuso havia mais alunos que já tinham tido a coitarca (p = 0,029), alunas que já engravidaram (p = 0,001), estudantes com maiores escores para sintomas depressivos (p < 0,001) e ansiosos (p = 0,001), alunos com pior qualidade de vida (p < 0,001) e que usavam mais tabaco (p = 0,008) e maconha (p = 0,025) bem como abusavam de hipnóticos ou sedativos (p = 0,048) que no grupo não vítima. CONCLUSÃO: Os impactos causados pelo abuso são diversos e afetam, mesmo no longo prazo, a vida dos sobreviventes. Abordar o tema e o discutir, amplamente, em todas as esferas da sociedade é uma forma de mobilizar, sensibilizar e instrumentalizar o coletivo, desmistificando o assunto e chamando atenção para essa importante questão social.

Adapted version of the Pubertal Development Scale for use in Brazil.

OBJECTIVE: To determine whether scores in an adapted version of the self-assessment Pubertal Development Scale into Portuguese match those from the gold standard in pubertal development (Tanner scale). METHODS: This was a cross-sectional study with a convenience sample of 133 children and adolescents aged nine to 17 years (59 males; mean age of 13 years and six months, with standard deviation = 25 months). Youngsters completed the Pubertal Development Scale and were then examined by specialists in adolescent medicine. RESULTS: Exact absolute agreement of pubertal stages were modest, but significant associations between measures (correlation; intra-class correlation coefficients of consistency) showed that the Pubertal Development Scale adequately measures changes that map onto pubertal development determined by physical examination, on par with international publications. Furthermore, scores obtained from each Pubertal Development Scale question reflected adequate gonadal and adrenal events assessed by clinical ratings, mostly with medium/high effect sizes. Latent factors obtained from scores on all Pubertal Development Scale questions had excellent fit indices in Confirmatory Factor Analyses and correlated with Tanner staging. CONCLUSIONS: We conclude that self-assessment of body changes by youngsters using the Portuguese version of the Pubertal Development Scale is useful when estimates of pubertal progression are sufficient, and exact agreement with clinical staging is not necessary. The Pubertal Development Scale is, therefore, a reliable instrument for use in large-scale studies in Brazil that aim at investigating adolescent health related to pubertal developmental. The translated version and scoring systems are provided.

Adapted version of the pubertal development scale for use in Brazil

ABSTRACT OBJECTIVE To determine whether scores in an adapted version of the self-assessment Pubertal Development Scale into Portuguese match those from the gold standard in pubertal development (Tanner scale). METHODS This was a cross-sectional study with a convenience sample of 133 children and adolescents aged nine to 17 years (59 males; mean age of 13 years and six months, with standard deviation = 25 months). Youngsters completed the Pubertal Development Scale and were then examined by specialists in adolescent medicine. RESULTS Exact absolute agreement of pubertal stages were modest, but significant associations between measures (correlation; intra-class correlation coefficients of consistency) showed that the Pubertal Development Scale adequately measures changes that map onto pubertal development determined by physical examination, on par with international publications. Furthermore, scores obtained from each Pubertal Development Scale question reflected adequate gonadal and adrenal events assessed by clinical ratings, mostly with medium/high effect sizes. Latent factors obtained from scores on all Pubertal Development Scale questions had excellent fit indices in Confirmatory Factor Analyses and correlated with Tanner staging. CONCLUSIONS We conclude that self-assessment of body changes by youngsters using the Portuguese version of the Pubertal Development Scale is useful when estimates of pubertal progression are sufficient, and exact agreement with clinical staging is not necessary. The Pubertal Development Scale is, therefore, a reliable instrument for use in large-scale studies in Brazil that aim at investigating adolescent health related to pubertal developmental. The translated version and scoring systems are provided.

[Regional differences in knowledge, attitudes, and practice in emergency contraceptive use among health sciences university students in Brazil]. / Diferenças regionais de conhecimento, opinião e uso de contraceptivo de emergência entre universitários brasileiros de cursos da área de saúde.

The aim of this study was to evaluate regional differences in knowledge, attitudes, and practice in emergency contraception use among Brazilian university students. A sample of university students answered a semi-structured questionnaire on knowledge, attitudes, and practice related to emergency contraception and sexual behavior. Fisher's exact test and ANOVA were used for statistical analysis. Statistical significance was set at p < 0.05. Ninety-six percent (n = 588) of the students had heard of emergency contraception, and 19% (n = 111) knew all the situations in which emergency contraception is indicated, with statistical differences between regions of the country. Forty-two percent of sexually active women in the sample had already used emergency contraception; 35% (n = 207) of students equated emergency contraception with abortion; and 81% (n = 473) thought emergency contraception involves health risks. No significant difference was observed between regions of the country regarding use and attitudes towards emergency contraception. Inter-regional differences in knowledge had no impact on students' attitudes and practice in emergency contraception. National awareness-raising campaigns are needed to improve knowledge on emergency contraception.

Diferenças regionais de conhecimento, opinião e uso de contraceptivo de emergência entre universitários brasileiros de cursos da área de saúde / Regional differences in knowledge, attitudes, and practice in emergency contraceptive use among health sciences university students in Brazil

O objetivo deste estudo foi avaliar as diferenças regionais de conhecimento, opinião e uso de anticoncepção de emergência entre universitários brasileiros. Questionário semi-estruturado abordando conhecimento, opinião, experiência com anticoncepção de emergência e comportamento sexual foi aplicado a adolescentes de universidades brasileiras. Para análise estatística utilizou-se o teste exato de Fisher e ANOVA. Diferenças foram significantes quando o valor de p < 0,05. Cerca de 96 por cento (n = 588) dos estudantes já tinham ouvido falar sobre anticoncepção de emergência, 19 por cento (n = 111) conheciam as situações nas quais está indicada, com diferenças inter-regionais; 42 por cento das meninas que tinham vida sexual ativa já tinham feito uso do método; 35 por cento (n = 207) dos estudantes consideravam contracepção de emergência abortiva e 81 por cento (n = 473) achavam que traz riscos à saúde, sem diferença significativa entre as regiões nas questões relativas a uso e à opinião. As diferenças inter-regionais sobre conhecimento não impactaram no uso e na opinião dos adolescentes sobre anticoncepção de emergência. Programas nacionais devem ser conduzidos para melhorar o conhecimento sobre o método.

The aim of this study was to evaluate regional differences in knowledge, attitudes, and practice in emergency contraception use among Brazilian university students. A sample of university students answered a semi-structured questionnaire on knowledge, attitudes, and practice related to emergency contraception and sexual behavior. Fisher's exact test and ANOVA were used for statistical analysis. Statistical significance was set at p < 0.05. Ninety-six percent (n = 588) of the students had heard of emergency contraception, and 19 percent (n = 111) knew all the situations in which emergency contraception is indicated, with statistical differences between regions of the country. Forty-two percent of sexually active women in the sample had already used emergency contraception; 35 percent (n = 207) of students equated emergency contraception with abortion; and 81 percent (n = 473) thought emergency contraception involves health risks. No significant difference was observed between regions of the country regarding use and attitudes towards emergency contraception. Inter-regional differences in knowledge had no impact on students' attitudes and practice in emergency contraception. National awareness-raising campaigns are needed to improve knowledge on emergency contraception.

Capacitação na atenção à saúde do adolescente: experiência de ensino / Training in adolescent health care: teaching experience

Trabalho realizado para aferir a instrumentalização recebida por pediatras em curso de Capacitação em Atenção à Saúde Integral do Adolescente. O curso foi realizado no Setor de Medicina do Adolescente da Unifesp, com 10 por cento dos pediatras que atuam na rede municipal de saúde da cidade de São Paulo, com atividades teóricas, teórico-práticas, visitas técnicas, supervisão de intervenções/casos e atualizações nas temáticas prioritárias desta faixa etária. Foram realizados pré e pós-testes com questões de múltipla escolha, um questionário aberto. Dos 120 pediatras inscritos, 85 completaram o curso, 73 (85,8 por cento) eram do sexo feminino, a mediana do tempo de atuação em pediatria foi de 18 anos. Se perceberam mais capazes de melhorar a qualidade no atendimento, trabalhar em grupos/equipe multiprofissional, desenvolver ações educativas, diagnosticar melhor doenças e situações de risco, fazer prevenção de doenças, discutir casos e estratégias com outros profissionais, multiplicar conhecimento. Os resultados obtidos sugerem que o modelo de capacitação desenvolvido é adequado para instrumentalizar o profissional já inserido no mercado de trabalho, embora, pela característica do conhecimento médico, deva haver um processo permanente de aquisição de novos conhecimentos e refinamento dos já adquiridos.

This study aimed to assess the operational education received by pediatricians in a training course on Comprehensive Health Care for Adolescents. The course was held at the Department of Adolescent Medicine of UNIFESP and included 10 percent of the pediatricians working in the São Paulo municipal health system, with theoretical and practical activities, technical visits, intervention/case supervision, and support for updates in the most relevant health conditions in this age bracket. The pediatricians were tested before and after the course with multiple-choice questions and with a open-ended questionairy. Of the 120 pediatricians enrolled, 85 completed the course, 73 (85.8 percent) of whom were women. They had been working as pediatricians for an average of 18 years. Perceived themselves as more capable of providing better health care, working in multi-professional teams, developing educational activities, diagnosing diseases and risk situations, preventing diseases, discussing cases and strategies with other professionals, and multiplying knowledge. The results suggest that the training model is suitable for providing operational education to professionals already in the job market, althougn requires continuous acquisition of new knowledge and the refinement of previously acquired knowledge.

Anorexia nervosa: estudo de caso com uma abordagem de sucesso / Anorexia nervosa: a case account with a successful approach

A anorexia nervosa (AN) é doença grave de etiologia multifatorial, que envolve predisposição genética, fatores socioculturais, vulnerabilidades biológicas e também psicológicas. Caracteriza-se por séria restrição alimentar auto-imposta, com conseqüências orgânicas e psíquicas graves, e alta taxa de mortalidade. O objetivo deste artigo é descrever um caso de AN, tratado em grupo psicoterápico, heterogêneo, de adolescentes, sem focar no comportamento anoréxico. Analisaram-se as implicações da doença nos aspectos familiar, social, na escolaridade e na sexualidade da paciente. O método terapêutico empregado, em grupo heterogêneo, sem focar no comportamento anoréxico, mostrou-se eficaz tanto na aderência ao tratamento quanto na evolução do caso.(AU)

Anorexia nervosa (AN) is a severe disease of multifactorial etiology, that involves genetic predisposition, sociocultural factors, biological and psychological vulnerabilities. This article aims to analyze the kind of psychotherapeutic treatment used, in heterogenous group, without focusing on the anorexic behaviour through the description of a case of AN. We have also approached the implications of the disease in the social and family aspects, in the education and sexuality of the patient. The kind of psychotherapeutic treatment used, in heterogenous group, without focusing in the anorexic behaviour, proved effective in the adherence to treatment as well as in the evolution of the case.(AU)

Anorexia nervosa: estudo de caso com uma abordagem de sucesso / Anorexia nervosa: a case account with a successful approach

A anorexia nervosa (AN) é doença grave de etiologia multifatorial, que envolve predisposição genética, fatores socioculturais, vulnerabilidades biológicas e também psicológicas. Caracteriza-se por séria restrição alimentar auto-imposta, com conseqüências orgânicas e psíquicas graves, e alta taxa de mortalidade. O objetivo deste artigo é descrever um caso de AN, tratado em grupo psicoterápico, heterogêneo, de adolescentes, sem focar no comportamento anoréxico. Analisaram-se as implicações da doença nos aspectos familiar, social, na escolaridade e na sexualidade da paciente. O método terapêutico empregado, em grupo heterogêneo, sem focar no comportamento anoréxico, mostrou-se eficaz tanto na aderência ao tratamento quanto na evolução do caso.

Anorexia nervosa (AN) is a severe disease of multifactorial etiology, that involves genetic predisposition, sociocultural factors, biological and psychological vulnerabilities. This article aims to analyze the kind of psychotherapeutic treatment used, in heterogenous group, without focusing on the anorexic behaviour through the description of a case of AN. We have also approached the implications of the disease in the social and family aspects, in the education and sexuality of the patient. The kind of psychotherapeutic treatment used, in heterogenous group, without focusing in the anorexic behaviour, proved effective in the adherence to treatment as well as in the evolution of the case.

Proporção de anemia de acordo com o estadiamento puberal, segundo dois critérios diagnósticos / Anemia proportion according to pubertal stage using two diagnostic criteria

OBJETIVO: Identificar a proporção de anemia ferropriva e sua distribuição por estadiamento puberal, em pacientes atendidos em ambulatório de adolescência, e comparar os valores de corte habitualmente utilizados na adolescência para esse diagnóstico. MÉTODOS: Estudo retrospectivo, por análise de 453 prontuários dos pacientes atendidos de janeiro a dezembro de 2003, no Centro de Atendimento e Apoio ao Adolescente do Departamento de Pediatria da Universidade Federal de São Paulo, Escola Paulista de Medicina. Destes, 215 (47,0 por cento) rapazes e 238 (53,0 por cento) moças. Utilizaram-se os testes de Kappa e McNemar para avaliar as concordâncias e discordâncias entre dois critérios distintos; teste "t" de Student para determinar as diferenças entre hemoglobina e índices hematimétricos nos grupos anêmico e não anêmico; e teste de Mann-Whitney para comparar os valores de hematócrito. RESULTADOS: A proporção de anemia, segundo os critérios adotados, foi de 7,50 por cento (n=34) e 6,84 por cento (n=31) na população; por estadiamento puberal encontrou-se, no sexo feminino, maior proporção nos estágios de mama 3 (30,00 por cento) e 4 (50,00 por cento) e no sexo masculino, em genitais 3 (40,00 por cento), havendo concordância entre os dois critérios. CONCLUSÃO: Embora baixa, a proporção de anemia é relevante. A concordância obtida entre os valores propostos mostra que é possível usar qualquer um dos critérios. Há predomínio de anemia nas moças em estágio de mamas 3 e 4, justificado pela maior necessidade de ferro e perdas menstruais, que ocorrem nessas fases, respectivamente; nos rapazes, a proporção maior em estágio 3 (fase de aceleração de crescimento) pode sugerir que eles já estavam depletados antes de entrar na puberdade.

OBJECTIVE: To identify the proportion and distribution of iron-deficiency anemia according to pubertal stage in patients seen at an outpatient clinic for adolescents and compare cutoff values normally used in adolescence for this diagnosis. METHODS: This retrospective study reviewed 453 medical records of patients seen from January to December 2003 at the Centro de Atendimento e Apoio ao Adolescente of the Pediatrics Department of the Federal University of São Paulo, Escola Paulista de Medicina (Adolescent Medicine Clinic from the Federal University of São Paulo). Of these, 215 (47.0 percent) were males and 238 (53 percent) were females. The Kappa and McNemar tests were used to assess the agreement and disagreement between two distinct criteria; the Student's "t"-test was used to determine differences in hemoglobin and hematometric values between anemic and non-anemic patients; the Mann-Whitney test was used to compare hematocrit values. RESULTS: According to the adopted criteria, the proportion of anemia in the population was 7.50 percent (n=34) and 6.84 percent (n=31). Considering pubertal stage and gender, a higher proportion was found among females with breast stage 3 (30.00 percent) and 4 (50.00 percent) and among males with genital stage 3 (40.00 percent). Both criteria were in agreement. CONCLUSION: The proportion of anemia is relevant, although low. The agreement obtained between the proposed values shows that it is possible to use any of the criteria. Anemia predominates among females with breast stages 3 and 4, justified by the higher need of iron and menstrual losses that occur in these stages, respectively; in males, the higher proportion in stage 3 (growth spurt) may suggest that iron stores were already depleted before they entered puberty.

Prevalência de dismenorréia em pacientes avaliadas no Centro de Atendimento e Apoio ao Adoloscente da Universidade Federal de São Paulo / Prevalence of dysmenorrhea in Teenagers Assisted in the Federal University of São Paulo

Objetivo: determinar a prevalência de dismenorréia e suas características na população de adolescentes atendidas em ambulatório. Métodos: estudo retrospectivo, por meio de análise de prontuários das pacientes matriculadas no serviço de janeiro de 1997 a março de 2003. Resultados: dos 197 prontuários estudados, correspondentes a pacientes com menarca, 25 (12,7 por cento)não continham informação sobre a presença ou a ausência de dismenorréia; dos 172 nos quais havia essa informação, 104 (60,5 por cento) não apresentavam dismenorréia e 68 (39,5 por cento) revelavam sua existência, quando as adolescentes eram questionadas diretamente. Observou-se maior frequência de dismenorréia na faixa etária de 13 a 16 anos de idade. Com relação à intensidade da dor, 25 (78,1 por cento) consideravam fraca, 2 (6,2 por cento), moderada e 5 (15,7 por cento) forte. Das pacientes dismenorréicas, no tocante aos ciclos menstruais, 38 (63,3 por cento) apresentavam ciclos regulares e 22 (36,7 por cento) irregulares. Conclusão: há necessidade de interrogatório dirigido para diagnóstico e melhor caracterização da dismenorréia, visto que essa queixa quase não aparece espontaneamente em consultas de ambulatório geral.

Vacinação na adolescência / Adolescent immunization

Objetivo: Revisão do esquema vacinal na adolescência. Métodos: Foram avaliados, por meio do MEDLINE e do LILACS, os periódicos nacionais e internacionais mais relevantes dos últimos quatro anos, além de alguns artigos citados nessas publicações, com relação ao tema vacinação na adolescência, bem como as normas de vacinação determinadas pelo Programa Nacional de Imunizações (PNI). Conclusão: É fundamental reafirmar a necessidade da vacinação do adolescente e esclarecer as dúvidas sobre o esquema vacinação.