Ramiro Molina

Family planning and adolescent pregnancy.

High adolescent fecundity principally affects developing countries. In spite of a decrease in the incidence of pregnancies in the developing countries over the past 13 years, the differences that exist with respect to developed countries turn adolescent fecundity into an indicator of the level of development of countries. The impact of adolescent pregnancy is evident in maternal and perinatal morbidity and mortality. Nonetheless, in addition to the age involved in precocious pregnancy, it also reflects previous conditions such as malnutrition, infectious diseases and deficiencies in the health care given to pregnant adolescents. The most important impact lies in the psychosocial area: it contributes to a loss of self-esteem, a destruction of life projects and the maintenance of the circle of poverty. This affects both adolescent mothers and fathers; the latter have been studied very little. Intervention with comprehensive health services and the maintenance of the education of adolescent mothers and fathers prevents repeat pregnancies. Evidence shows success in the prevention of the first pregnancy when the intervention includes comprehensive sexual education, the existence of preferential sexual and reproductive health services for adolescents, the handout of modern contraceptives gauged to the adolescence stage of the subjects and the existence of an information network. There is little research in contraception for adolescents, and for this reason, the indications given are projections of data obtained from adults.

Factores asociados a la continuidad del uso anticonceptivo en adolescentes solteras nulíparas

BACKGROUND Factors such as personal issues, family, sexuality and sexual partner characteristics are strongly associated with contraceptive continuation among single, nulliparous female adolescents. AIM To determine factors associated to contraceptive maintenance among female nulliparous adolescents. MATERIAL AND METHODS A cohort of 2,811 adolescents, who confidentially requested contraception in a sexual and reproductive health university center from 1990 to 2006 was analyzed. Two years after the request, their clinical records were reviewed to determine the time and length of contraception. Using life table analysis, the variables related to continuation or discontinuation of contraception were identified. RESULTS Factors associated with a longer contraceptive use were a lower age at the moment of initiating the method, a better academic achievement and aspirations, higher schooling of the partner, higher age of the mother, having an adolescent mother, supervision of permissions by people different than parents and not attending to religious services. Variables associated with a higher risk for abandonment were a higher age of the adolescent, greater number of sexual partners, lack of communication with parents, non-catholic religious affiliation, use of oral hormonal contraceptive, greater number of siblings, commenting sexual issues with relatives or friends, having a partner without academic activity or working and to live without parents. CONCLUSIONS Several personal, familial and environmental factors influence contraceptive use continuity among adolescents.

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.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. Language: es

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.

Calidad de vida relacionada con la salud en estudiantes universitarios de primer año

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.

Placental phospholipid composition, impact of maternal nutritional status

Abstract The influence of moderate maternal malnutrition on phospholipids and in the content of different types of fatty acids of the total placental phospholipids was investigated. Analysis of placental tissue lipids demonstrated that moderate maternal malnutrition increased total lipids when expressed per mg DNA. The rise in total lipid was due mainly to an increase in phospholipids and sterols content. The increase in phospholipid content was due primarily to phosphatidylcholine, phosphatidylinositol and sphingomyelin. Fatty acid composition of placental phospholipids showed marked differences between the malnourished and the control group. In the placentas of the malnourished group, phospholipids showed and accumulation of saturated fatty acid (14:0) and retention of highly insaturated fatty acids of the n3 and n6 series. These findings suggest that placenta of malnourished pregnant women suffer an alteration of phospholipids composition which may have functional significance for this organ and for fetal growth.