RESUMO
La adolescencia es un período de cambios dinámicos y profundos y representa, para el pediatra, desafíos particulares. En este nuevo volumen se han seleccionado temas específicos con el fin de actuailizar el conocimiento y transmitir pautas de abordaje desde una mirada interdisciplinaria. Entre sus aspectos sobresalientes se incluyen: El estudio de temas de interés especial como el abordaje del adolescente en la consulta de salud mental, los marcos legales vinculados al ejercicio de los derechos individuales, la sexualidad incorporando los aspectos de género y diversidad, así como las problemáticas relacionadas con el embarazo, la anticoncepción y las enfermedades de transmisión sexual en esta etapa de la vida. También se incluyen capítulos sobre el consumo problemático de sustancias y el impacto de las enfermedades crónicas en adolescentes. El enfoque práctico y la discusión de casos clínicos ubicando al pediatra en un papel central como coordinador de la atención interdisciplinaria y la inclusión en cada capítulo de aspectos clave y lecturas recomendadas. Una obra actualizada que aporta información científica y la experiencia de los profesionales del Hospital Garrahan dedicada a todos los miembros del equipo de salud que atienden y cuidan adolescentes dondequiera que trabajen al servicio de la salud infantil.
Assuntos
Humanos , Adolescente , Gravidez na Adolescência , Infecções Sexualmente Transmissíveis , Adolescente/legislação & jurisprudência , Medicina do Adolescente , Psiquiatria do Adolescente , Psicologia do Adolescente , Anticoncepção , Sexualidade , Transtornos Relacionados ao Uso de Substâncias , Saúde do AdolescenteRESUMO
INTRODUCCIÓN: La mayoría de las adolescentes que dan a luz cada año no planifican el embarazo. Otras optan por interrumpirlo, muchas veces en condiciones inseguras. OBJETIVOS: Caracterizar a la población de adolescentes que tienen un evento obstétrico y analizar cómo los diferentes contactos con el sistema de salud en torno al evento obstétrico inciden en la adopción y adherencia a métodos anticonceptivos (MAC). MÉTODOS: Se realizaron encuestas aplicadas a una muestra no representativa de adolescentes de 14 a 20 años, hospitalizadas por un parto o un aborto en instituciones públicas de Pilar (provincia de Buenos Aires), San Juan y Posadas, en tres ocasiones: antes del alta hospitalaria, a los 80 y a los160 días posevento. RESULTADOS: Sólo 4 de cada 10 adolescentes egresaron de la internación con un MAC. El control posevento fue la instancia de mayor acceso aunque no siempre se obtuvo el método de preferencia. A los 160 días del evento obstétrico, 8 de cada 10 adolescentes usaban un MAC. Las fallas en la calidad y continuidad de uso detectadas indican que una alta proporción está expuesta al riesgo de un embarazo no buscado. CONCLUSIONES: Es fundamental aumentar la cobertura y calidad de la consejería anticonceptiva posaborto y posparto, para muchas la primera oportunidad de tener una discusión cara a cara sobre métodos con personal calificado. Se requiere diversificar la oferta para incluir los métodos de mediano (inyectables) y largo plazo (dispositivo intrauterino e implante subdérmico).
INTRODUCTION: Most teenage girls giving birth every year do not plan their pregnancy. Others choose to interrupt it, often under unsafe conditions. OBJECTIVES: To describe the profile of adolescents who have an obstetric event and analyze how contacts with the health care system around the obstetric event influence contraceptive uptake and adherence. METHODS: Surveys were applied to a non-representative sample of postpartum or postabortion hospitalized teenage girls in public health institutions of Pilar, San Juan and Posadas before hospital discharge and 80 and 160 days after the obstetric event. RESULTS: Only 4 out of 10 adolescents left the hospital with a contraceptive method. Postpartum and postabortion care checkups were the moments of greater accessibility to contraception, though adolescents not always received the method of their choice. One hundred and sixty days after the obstetric event, 8 out of 10 adolescents were using a contraceptive method. Problems identified in the quality and continuity of use suggest a high proportion of them are exposed to unplanned pregnancies. CONCLUSIONS: Increasing the coverage and quality of contraceptive counseling in postabortion and postpartum adolescents is key, since this may be the first opportunity to discuss methods face to face with qualified personnel. A wide range of methods including medium (injectable) and long-acting methods (intrauterine devices and sub-dermal implants) should be offered.
Assuntos
Adolescente , Aborto , Adolescente , Anticoncepção , Período Pós-PartoRESUMO
The article analyzes the factors that facilitate or hinder access and effective use of contraception by 18- and 19-year-olds living in the cities of Resistencia (province of Chaco), Posadas (province of Misiones) and Santiago del Estero (province of Santiago del Estero) as well as the health regions V and VII of the province of Buenos Aires. Data comes from a survey applied to a purposeful sample of 480 adolescent females (including respondents without children, with one child, and with more than one child) and 21 semi-structured interviews with a population of the same profile. In response to the survey, 74.2% reported using contraception "always" and 12.2% "most of the time." The pill and condoms were the most widely used methods (41.7% and 37.0% respectively). Only 13.2% used a mid- to long-term method (intrauterine device or injectable contraceptive). The main reasons reported by those who "never" use a method (13.6%) were: wanting to become pregnant (27.6%) and partner refusal (27.6%). The interviews revealed difficulties in the use of contraception methods and deficits in contraception counseling.
Assuntos
Anticoncepção/estatística & dados numéricos , Gravidez na Adolescência/psicologia , Adolescente , Argentina , Anticoncepção/métodos , Anticoncepção/psicologia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Gravidez , Gravidez na Adolescência/prevenção & controle , Pesquisa Qualitativa , Comportamento Sexual/psicologia , Adulto JovemRESUMO
RESUMEN El artículo analiza los factores que favorecen o dificultan el acceso a los métodos de anticoncepción y a su uso efectivo por parte de adolescentes residentes en las ciudades de Resistencia (Chaco), Posadas (Misiones) y Santiago del Estero (Santiago del Estero) y en las regiones sanitarias V y VII (Buenos Aires). Los datos provienen de una encuesta aplicada a una muestra intencional de 480 adolescentes de 18 y 19 años (sin hijos, con un hijo y con más de un hijo), y de 21 entrevistas semiestructuradas con población de similares características. El 74,2% de las encuestadas reportó usar un método anticonceptivo “siempre” y un 12,2% “la mayoría de las veces”. Los métodos más utilizados fueron la píldora (40,7%) y el preservativo (37,0%). Solo el 13,2% utilizaba un método de mediana o larga duración (inyectable o dispositivo intrauterino). Los principales motivos reportados por quienes “nunca” usaban métodos (13,6%) fueron estar buscando un embarazo (27,6%) y la oposición de la pareja (27,6%). Las entrevistas revelaron dificultades con el uso de los métodos y déficits en la consejería anticonceptiva.
ABSTRACT The article analyzes the factors that facilitate or hinder access and effective use of contraception by 18- and 19-year-olds living in the cities of Resistencia (province of Chaco), Posadas (province of Misiones) and Santiago del Estero (province of Santiago del Estero) as well as the health regions V and VII of the province of Buenos Aires. Data comes from a survey applied to a purposeful sample of 480 adolescent females (including respondents without children, with one child, and with more than one child) and 21 semi-structured interviews with a population of the same profile. In response to the survey, 74.2% reported using contraception “always” and 12.2% “most of the time.” The pill and condoms were the most widely used methods (41.7% and 37.0% respectively). Only 13.2% used a mid- to long-term method (intrauterine device or injectable contraceptive). The main reasons reported by those who “never” use a method (13.6%) were: wanting to become pregnant (27.6%) and partner refusal (27.6%). The interviews revealed difficulties in the use of contraception methods and deficits in contraception counseling.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Gravidez na Adolescência/psicologia , Anticoncepção/estatística & dados numéricos , Argentina , Gravidez na Adolescência/prevenção & controle , Comportamento Sexual/psicologia , Entrevistas como Assunto , Anticoncepção/métodos , Anticoncepção/psicologia , Pesquisa Qualitativa , Acessibilidade aos Serviços de SaúdeRESUMO
ISSUE: Hand hygiene is a cost-effective measure to reduce microbial transmission (Teare EL, Cookson B, French GL, et al. UK handwashing initiative. J Hosp Infect. 1999;43:1-3.) and is considered to be the most important measure to prevent healthcare-associated infections (Pittet D, Allegranzi B, Sax H, Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641-52). Unfortunately, the compliance rate of healthcare workers (HCWs) with recommended hand hygiene procedures is less than expected. INITIAL ASSESSMENT: In order to estimate the effect of a multimodal intervention on improving healthcare workers' compliance with hand hygiene in eleven intensive care units (ICUs) from 11 hospitals of Buenos Aires, a randomized cluster-stepped wedge trial was designed. CHOICE OF SOLUTION AND IMPLEMENTATION: A multimodal intervention was designed based on practices characterized by being evidence-based, low cost and suggested by qualitative research: (i) leadership commitment, (ii) surveillance of materials needed to comply with hand hygiene and alcohol consumption, (iii) utilization of reminders, (iv) a storyboard of the project and (v) feedback (hand hygiene compliance rate). EVALUATION: The study enrolled 705 participants, comprising nurses (66.4%), physicians (25.8%) and other HCW (7.8%) along 9 months of observation. Compliance with hand hygiene in the control group was 66.0% (2354/3565) vs. 75.6% (5190/6864) in the intervention group. Univariate analysis showed an association between the intervention and hand hygiene compliance (odds ratio, OR 1.17; 95% confidence interval (CI), 1.13-1.22). The effect was still present after adjustment by calendar's time and providers' characteristics-age, gender and profession (OR 1.08; 95% CI, 1.03-1.14). LESSONS LEARNED: His study supports that a multimodal intervention was effective to improve compliance with hand hygiene in ICUs.
Assuntos
Infecção Hospitalar/prevenção & controle , Higiene das Mãos/organização & administração , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Recursos Humanos em Hospital , Argentina , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Desinfecção das Mãos/normas , Higiene das Mãos/normas , Humanos , Controle de Infecções/normas , Unidades de Terapia Intensiva/normas , Liderança , MasculinoRESUMO
Este artículo examina el calendario y contexto en el que ocurre la iniciación sexual en base a una encuesta a 1571 mujeres adolescentes y jóvenes en tres capitales provinciales y en el área metropolitana de Buenos Aires. En primer lugar, se analiza la edad a la que ocurre el debut sexual para las diferentes generaciones. Seguidamente, se aborda el rol que juegan el contexto de crianza, la escolaridad y el inicio de relaciones románticas en precipitar o retrasar la iniciación sexual. Finalmente, se describen las circunstancias en que ocurre la iniciación, incluyendo el vínculo con la pareja, el uso de anticoncepción, y el lugar que cumplen la escuela, la familia y el grupo de pares como fuente de información respecto de la sexualidad y los métodos anticonceptivos. El análisis compara la experiencia de las adolescentes con las de las jóvenes para identificar cambios generacionales en las circunstancias relativas al debut sexual.
O artigo examina o calendário e o contexto em que ocorre a iniciação sexual com base em uma pesquisa com 1.571 mulheres adolescentes e jovens em três capitais provinciais e na área metropolitana de Buenos Aires. Em primeiro lugar, analisa-se a idade em que acontece a estreia sexual para as diferentes gerações. Em seguida, aborda-se o papel que representam o contexto de criação, a escolaridade e o início de relações românticas em precipitar ou atrasar a iniciação sexual. Finalmente, descrevem-se as circunstâncias em que ocorre a iniciação, incluindo o vínculo com o parceiro, o uso de anticoncepcional, e o lugar que cumprem a escola, a família e o grupo de pares como fonte de informação em relação à sexualidade e aos métodos anticoncepcionais. A análise compara a experiência das adolescentes com as das jovens para identificar mudanças entre gerações nas circunstâncias relativas à estreia sexual.
The article examines the timing and context of sexual initiation based on a survey of 1571 female adolescents and young women (18 to 24 y.o.) in three Argentinean provinces and the metropolitan area of Buenos Aires. Firstly, we describe the age at which sexual debut took place for different generations. Then, we analyze the role played by family, school and romantic relations in precipitating or delaying sexual initiation. Finally, we describe the circumstances of debut, including type of relation with partner, use of contraception, and the role played by school, family and peers regarding information on sexuality and contraception. We compare the experience of adolescents and young women to identify generational changes in the timing and context of the transition to sexual initiation.
Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adolescente , Adulto Jovem , Anticoncepção , Comportamento Sexual , Sexualidade/etnologia , Aconselhamento Sexual , Argentina/etnologia , Família , Parceiros SexuaisRESUMO
INTRODUCCIÓN El embarazo no planeado a edades tempranas y su repitencia afectan sobre todo a las adolescentes socialmente vulnerables y pueden tener consecuencias negativas en su salud y bienestar. OBJETIVOS Dentro de una perspectiva crítica y reflexiva, indagar sobre los factores que conducen a la maternidad en la adolescencia y a su repitencia, así como su relación con las trayectorias educativas y laborales. Analizar las percepciones de mujeres jóvenes de sectores vulnerables sobre los efectos de la maternidad precoz en la transición a la vida adulta, con un enfoque de trayectoria vital. MÉTODOS Se efectuó un estudio exploratorio descriptivo, con una estrategia metodológica cualitativa. Se realizaron entrevistas semiestructuradas a mujeres de 20-24 años usuarias de servicios públicos de salud del Gran Mendoza, con o sin experiencia de maternidad en la adolescencia. El análisis de las entrevistas siguió una lógica cualitativa inductiva. RESULTADOS Los hallazgos revelan múltiples factores asociados al embarazo no planeado en la adolescencia y a su repitencia. Se destacan vulnerabilidad social y escasa agencia, dificultad para tomar decisiones autónomas o en consenso con la pareja sobre el uso de anticoncepción, adscripción a modelos tradicionales de género, deserción escolar y naturalización de la maternidad como destino próximo e inexorable en ausencia de alternativas en el terreno educativo o laboral. DISCUSIÓN Hay una fuerte incidencia de variables culturales en las percepciones y experiencias de las entrevistadas en torno al embarazo y la maternidad en la adolescencia. El sector salud sólo puede dar respuesta a una parte de esta problemática. En el diseño o ajuste de políticas públicas específicas, que necesariamente deberían ser intersectoriales, no pueden soslayarse las dimensiones subjetivas del fenómeno analizado.
Assuntos
Gravidez na Adolescência , Anticoncepção , Saúde de Gênero , Vulnerabilidade SocialRESUMO
This article focuses on the contraceptive and reproductive experiences and needs of people living with HIV and on public health services' responses to them in Argentina. Data collected through a national survey amongst people living with HIV (N=841) and semi-structured interviews (N=89) explored the perspectives of both health-care users and HIV/AIDS program coordinators and providers. The survey revealed that 55% of women and 30% of men had had children after their HIV diagnosis and that half of those pregnancies had been unintended. At the time of the survey in 2006, 73% of men and 64% of women did not want a (new) pregnancy. The vast majority report systematic condom use, but acknowledge difficulties complying with this recommendation. Dual protection (i.e., condom use plus another method) is low among those who do not want children or another pregnancy (8% of women and 9% of men reported using it). Mostly women and heterosexual men without children either expressed their wish or were seeking to be parents. Institutional and cultural barriers to friendly and/or effective contraceptive and reproductive counselling were identified. Most physicians encourage only condom use while a minority refers patients to family planning providers or talk with them about contraception. A lack of updated information about interactions between antiretroviral drugs and hormonal contraception and/or intrauterine devices was not infrequent among providers. Users reported having being discouraged or blamed by health professionals when they revealed they wanted to have (or were expecting) a baby. Professionals and program directors' attitudes regarding reproduction range from not acknowledging people's wishes, to providing useful information or referral. Whether wanted or unexpected, parenthood is a challenge for many of the people living with HIV. Social and biomedical responses still need to be refined in order to fully respect people's rights and succeed in preventing (re)infection as well as unwanted pregnancies. Drawing on study results, recommendations to enhance the provision of adequate information and services to help people prevent unwanted pregnancies or reproduce as safely as possible are discussed.
Assuntos
Atitude do Pessoal de Saúde , Dissidências e Disputas , Infecções por HIV , Acessibilidade aos Serviços de Saúde , Direitos Sexuais e Reprodutivos/psicologia , Comportamento Sexual/estatística & dados numéricos , Argentina , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Competência Cultural , Coleta de Dados , Serviços de Planejamento Familiar , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Masculino , Gravidez , Gravidez não Desejada , Saúde Pública , Direitos Sexuais e Reprodutivos/estatística & dados numéricosRESUMO
In Argentina adolescent pregnancy is still regarded as a public health problem or a "social epidemic". However, it is necessary to ask from which perspective and for whom it is a problem, and what type of problem. This article presents the findings of a large quantitative and qualitative study conducted in five Northern provinces and two metropolitan areas of Argentina in 2003-2004. Based on the results of a survey of adolescent mothers (n=1,645) and ten focus group discussions with adolescent girls and boys, it addresses the connections between school dropout, pregnancy and poverty, and makes recommendations on how to tailor health care and sexuality education to address local realities. The findings indicate a need to develop educational activities to promote safer sex and address gender power relations in programmes working with deprived communities. Sexuality education with a gender and rights perspective, and increasing accessibility to contraceptive methods for adolescent girls and boys is also crucial. Antenatal and post-partum care, as well as post-abortion care, should be improved for young women and viewed as opportunities for contraceptive counselling and provision. Male participation in pregnancy prevention and care also needs to be promoted.
Assuntos
Medicina Baseada em Evidências , Gravidez na Adolescência/prevenção & controle , Política Pública , Aborto Induzido , Adolescente , Adulto , Argentina , Anticoncepção , Coleta de Dados , Feminino , Grupos Focais , Promoção da Saúde , Humanos , Masculino , Enfermagem Materno-Infantil , Gravidez , Cuidado Pré-Natal , Sexo Seguro , Educação SexualRESUMO
OBJECTIVE: To explore the role of obstetricians and gynaecologists in reproductive public health policies in Argentina. MATERIAL AND METHODS: Combination of quantitative methods (survey, n=467) and qualitative methods (semistructured interview, n=35; focus groups, n=6). RESULTS: The great majority of respondents believe that abortion and contraception are serious public health issues. Seven out of 10 considered the implementation of family planning services and post-abortion contraceptive counseling to be priorities. One-half favored promoting social debate on abortion. The great majority thought that de-criminalization of abortion would help to diminish maternal mortality and that abortion should not be penalized when the womans life or health is at risk, or in cases of rape or fetal malformations. CONCLUSIONS: Abortion and contraception are important issues for physicians. Advocacy efforts within this community need to focus on an integral vision of health, emphasizing their social responsibility.