Características clínicas de pacientes con Lupus Eritematoso Sistémico, al debut y en recaídas

Introducción. Las formas clínicas de presentación del lupus eritematoso sistémico (LES) son variadas, así como las recaídas que ocurren en el curso de la enfermedad. Objetivo. Describir las formas de presentación del debut y las recaídas de pacientes con LES. Metodología. Estudio observacional, descriptivo, de corte transversal, de pacientes con LES, que acudieron al Hospital Nacional, durante el periodo 2022 a 2023. Las variables analizadas fueron las variables sociodemográficas, clínicas y de laboratorio, al debut y durante las recaídas. Resultados. Se incluyeron 47 pacientes, entre 14 y 68 años de edad (media: 29,6 ±12 años), 91,5% del sexo femenino, 59,5% del interior del país, con educación secundaria (68,1%) y ocupación ama de casa (55,3%). El tiempo de enfermedad fue en promedio 48,7 ±37.1 meses. La forma más frecuente de debut fue la poli-artralgia (55,3%), seguido de nefritis (27,7%). En la recaída, la nefritis fue más frecuente (44,7%), seguida de dolor poliarticular (40,4%). La causa de recaída más frecuente fue el abandono del tratamiento (34,0%). Conclusión. La mayoría de las pacientes eran mujeres jóvenes que debutaron la enfermedad con artralgias, seguida de la afectación renal. Las recaídas se presentaron con nefritis. La causa principal de las recaídas fue el abandono del tratamiento.

Introduction: The clinical forms of presentation of systemic lupus erythematosus (SLE) are varied, as well are the relapses that occur in the course of the disease. Objective: To describe the onset and relapses in a cohort of patients with SLE. Methodology. Observational, descriptive, cross-sectional study of patients with SLE who attended the National Hospital, during the period 2022 to 2023. The variables analyzed were sociodemographic, forms of onset and relapses. Results: 47 patients between 14 and 68 years of age (mean: 29.6 ±12 years) were included in the study, 91.5% female, 59.5% from the interior of the country, with secondary education (68.1%) and housewife occupation (55.3%). The duration of illness was on average 48.7 ±37.1 months. The most common form of onset was polyarthralgia (55.3%), followed by nephritis (27.7%). In relapse, nephritis was more frequent (44.7%), followed by polyarticular pain (40.4%). The most frequent cause of relapse was treatment abandonment (34.0%). Conclusion: The majority of patients were young women who presented the disease with arthralgia, followed by kidney involvement. Relapses presented with nephritis. The main cause of relapses were treatment abandonment.

Outro uso do início do tratamento analítico: as entrevistas preliminares como direção da assistência aos colaboradores / Autre utilisation du début du traitement analytique: les entretiens préliminaires comme direction du service d'assistance aux collaborateurs / Another use of the start of analytical treatment: the preliminary interviews as a direction for the assistance to the employees

Este artigo se fundamenta na articulação entre (1) ferramentas teóricas fornecidas em curso de aperfeiçoamento em psicologia do colaborador e (2) experiências de atuação clínica em um projeto de psicanálise aplicada para assistência aos colaboradores de uma instituição hospitalar. O trabalho é permeado pela questão de como sustentar a prática clínica de orientação psicanalítica na instituição. Neste sentido, argumenta-se que é possível encontrar na psicanálise lacaniana bases para formalizar a experiência de atendimento aos colaboradores. Especificamente, no enquadre do início do tratamento analítico - da sondagem diagnóstica em Freud, e das entrevistas preliminares em Lacan. A articulação tangencia o problema da "entrada" e da "inserção" do psicólogo que estabelece na psicanálise aplicada a efetividade de sua atuação em instituição hospitalar.

Cet article s'appuie sur l'articulation entre (1) des outils théoriques dispensés dans un cours de perfectionnement en psychologie du personnel, et (2) des expériences de pratique clinique dans un projet de psychanalyse appliquée pour assister les employés d'un établissement hospitalier. La question de ce travail est de savoir comment soutenir la pratique clinique d'orientation psychanalytique au sein de cette institution hospitalière. En ce sens, on avance qu'il est possible de trouver, dansla psychanalyse lacanienne, des bases pour formaliser l'expérience d'assistance des collaborateurs. Plus précisément, dans le cadre du début du traitement analytique du sondage diagnostic de Freud, ainsi que dans les entretiens préliminaires de Lacan. L'articulation touche au problème de "l'entrée" et de "l'insertion" du psychologue qui établit dans la psychanalyse appliquée l'efficacité de sa performance dans un établissement hospitalier.

This article is based on the articulation between (1) theoretical tools provided by a course in employee psychology and (2) experiences of clinical practice in an applied psychoanalysis project to assist the employees of a hospital institution. The work is permeated by the question of how to sustain the psychoanalytically oriented clinical practice in the institution. Therefore, it is argued that it is possible to find in Lacanian psychoanalysis bases to formalize the experience of assisting personnel. Specifically, within the frame of the beginning of the analytic treatment - of the diagnostic investigation in Freud, and in the preliminary interviews in Lacan. The study analyses the problem of "entry" and "insertion" of the psychologist who establishes the effectiveness of his performance in applied psychoanalysis at a hospital institution.

Sexual coercion at sexual debut and associated factors among young females in rural areas of Boset District, Eastern Ethiopia: a mixed method study

Objectives: Assess the prevalence and associated factors of sexual coercion at sexual debut among young females in rural areas of Boset district, Oromia Region, Eastern Ethiopia. Methods: Cross-sectional community-based study design was conducted using both qualitative and quantitative data collection methods. A sample of 632 young females aged 10-24 years was taken from six rural Kebeles by systematic random sampling for quantitative and data were collected using a pre-tested structured questionnaire. The collected data was analyzed using SPSS version 23. Principally Binary Logistic regression model was fitted. Moreover, eight focus group discussions targeting different groups were held and analyzed thematically. Results: The prevalence of sexual coercion at sexual debut was 36.5% (95%CI: 34.6%- 38.4%) among sexually active respondents. Married young female (AOR, 0.71; 95%CI: 0.42, 0.81), living away from their parents (AOR, 5.07; 95%CI: 1.07,24.01), age group of 15- 19 years (AOR, 0.19; 95%CI: 0. 06, 0.54), alcohol consumption (AOR, 2.44; 95%CI: 1.17, 5.08) and Khat chewing (AOR, 8.30; 95%CI: 1.89, 36.38) were factors predicting the likelihood of having sexual coercion at sexual debut. Conclusion: Sexual coercion at sexual debut is a major public health problem among young females in the study community. The emerging program interventions need to take this problem into consideration

Caracterización clínico-epidemiológica en pacientes discapacitados visuales por retinosis pigmentaria. Sancti Spíritus. 2009-2019 / Clinical and epidemiological characterization in visual impaired patients due to retinitis pigmentosa. Sancti Spíritus. 2009-2019

RESUMEN Fundamento: La retinosis pigmentaria constituye una causa de discapacidad visual que provoca alteraciones psicológicas y sociales al paciente. Objetivo: Describir las características clínicas y epidemiológicas en pacientes discapacitados visuales por retinosis pigmentaria de la provincia Sancti Spíritus. Metodología: Se realizó un estudio descriptivo, que incluyó 140 pacientes discapacitados visuales afectados por retinosis pigmentaria. Resultados: El grupo etario entre los 29 y 56 años fue el más afectado (78.1 %), el 65 % era del sexo masculino, predominó el color blanco de la piel (87.1 %), sobresalió la catarata como la afección ocular (13.6 %), el 16.4 % presentó hipertensión arterial; la mayoría de los discapacitados no presentó hábitos tóxicos (55 %), prevaleció el debut precoz en el 70 % de los casos. La forma típica de la enfermedad se observó en el 98.5 % de los enfermos, el 67 % manifestó un estadio clínico de la enfermedad grado IV, así como la herencia autosómica recesiva en el 36.4 %. Conclusiones: Predominio de los enfermos en los grupos etario entre 29 y 56 años, masculino, color blanco de la piel; la catarata como patología ocular más frecuente junto a la hipertensión arterial dentro las enfermedades sistémicas; la mayoría de los discapacitados no presentó hábitos tóxicos. El debut precoz, la forma típica, el estadio IV de la enfermedad, así como la herencia autosómica dominante prevalecieron en el estudio.

ABSTRACT Background: Retinitis pigmentosa is a cause of visual impairment that causes psychological and social alterations to the patient. Objective: To describe the clinical and epidemiological characteristics in visual impaired patients due to retinitis pigmentosa in Sancti Spíritus province. Methodology: A descriptive study was carried out, which included 140 visual impaired patients affected by retinitis pigmentosa. Results: The age group between 29 and 56 years old was the most affected (78.1 %), 65 % were male, white skin predominated (87.1 %), cataract stood out as an eye condition (13.6 %), 16.4 % presented arterial hypertension; most of the disabled did not present toxic habits (55 %), early debut prevailed in 70 % of cases. The typical form of the disease was observed in 98.5 % of patients, 67 % showed a clinical stage of grade IV disease, as well as autosomal recessive inheritance in 36.4 %. Conclusions: Prevalence of patients in the age groups between 29 and 56 years, male, white skin color; cataract as the most frequent ocular pathology together with arterial hypertension within systemic diseases; the majority of the disabled patients did not show toxic habits. Early debut, typical form, stage IV disease, and autosomal dominant inheritance prevailed in the study.

Factores asociados al inicio de vida sexual y al embarazo adolescente en Colombia. Estudio de corte transversal / Factors associated with the beginning of sexual life and adolescent pregnancy in Colombia. Cross-sectional study

RESUMEN Introducción: En Colombia, entre el año 2008 y 2014 el 23.4% de los nacimientos fueron producto de embarazos adolescentes, los cuales tienen graves consecuencias a nivel social, emocional y biológico tanto para la madre joven como para el bebé. Material y métodos: Estudio de corte transversal con componente analítico dónde se tomó una muestra representativa de 13.313 mujeres entre 13 y 19 años quienes respondieron la Encuesta Nacional de Demografía y Salud (ENDS) 2010. Se realizaron análisis bivariados y análisis de regresión logística multinomial con el fin de identificar factores individuales, del hogar y del comportamiento sexual asociados con el inicio de la vida sexual y con el embarazo en adolescentes colombianas. Resultados: A través del análisis multivariado se encontró que tener mayor edad, convivir en pareja, haber sufrido violencia parental y haber sufrido violencia sexual fueron factores de riesgo tanto para inicio de vida sexual como para embarazo adolescente. Se identificó que el hecho de estar asistiendo al colegio es un factor protector para ambos eventos. La pobreza, el hacinamiento y la falta de educación estuvieron asociados con el embarazo adolescente pero no con el inicio de la vida sexual. Conclusiones: Existen múltiples factores asociados con el inicio temprano de vida sexual y con el embarazo adolescente susceptibles de intervención. Este estudio presenta factores clave para generar programas de prevención para esta problemática.

ABSTRACT Introduction: In Colombia, between 2008 and 2014, 23.4% of births were product of adolescent pregnancies, which have serious social, emotional and biological consequences for both the young mother and the baby. Materials and methods: Cross-sectional study with analytical component, with a sample of 13,313 women between 13 and 19 years of age who answered the National Survey of Demography and Health (ENDS) 2010. Bivariate analyzes and multinomial logistic regression analysis were carried out in order to identify individual, home-related, and sexual behavior factors associated with sexual debut and adolescent pregnancy among Colombian adolescents in 2010. Results: Multivariate analysis shown that being older, living together as a couple, having suffered parental violence, and having suffered sexual violence, were risk factors for initiation of sexual life and teenage pregnancy. School attendance was found to be a protective factor for both events. Poverty, overcrowding and lack of education were associated with teen pregnancy but not with sexual debut. Conclusions: There are multiple factors associated with early sexual debut and adolescent pregnancy which are susceptible to intervention. This study presents key factors to generate prevention programs for these situations.

Constituição e desenvolvimento do self dialógico e da relação triádica / Emergence and development of the self and the triadic relationship / La constitution et développement du self et de la relation triadique / Formación y desarrollo del self dialógico y de la relación tríada

Resumo: Ressaltamos a importância do estudo da gênese do self dialógico. Propomos que esse self emerge e se desenvolve no processo de comunicação em face do Outro. Tendo como foco a história da díade mãe-bebê nos primeiros oito meses de vida do bebê, sugerimos que tanto os padrões de organização do diálogo - atingindo a forma abreviada do diálogo - como a análise das posições que assume a fala da mãe denotam um processo de diferenciação do bebê como parceiro nesse diálogo. Também, o despontar do bebê como agente e sua subjetividade emergem respaldados no desenrolar da historia construída pela díade. Essa historicidade, possível de ser construída através de uma emergente capacidade do bebê de distanciamento e, portanto, capaz de abstrair as ações do contexto imediato no qual ocorrem, se constitui como um terceiro polo do diálogo, formando, então, uma relação triádica.

Abstract: This work highlights the importance of the study of the genesis of the dialogical self. We assume a perspective that this self emerges and develops immersed in the communication process facing the Other. Focusing on the history of mother-infant dyad during the first eight months of the infant's life, we suggest that both the pattern of organization of the dialogue, achieving an abbreviated form, and the analysis of the mother's speech exhibit a process of differentiation of the infant as a dialogical partner. Moreover, simultaneously appear the rise of agentivity and subjectivity of the infant, anchored by the growth of the history constructed by the dyad. This historicity, allowable by the emergent infant's capacity for distancing from the here and now of actions, appears as a third pole of the dialogue, constituent, thus, a triadic dialogical relationship.

Résumé: Cet article souligne l'importance de l'étude de la genèse du self dialogique. Nous proposons que ce self émerge et se développe dans le processus de communication face à l'Autre. En focalisent l'histoire de la dyade mère-bébé dans les huit premiers mois de la vie de celui-ci, nous suggérons que les modèles d'organisation du dialogue - lesquels comprennent la forme abrégée du dialogue -, aussi bien que l'analyse des positions qu'assume le parler de la mère, dénotent un processus de différentiation du bébé comme partenaire dans le dialogue. En outre, l'éveil du bébé comme agent dans ce dialogue et sa subjectivité trouvent appui dans le déroulement de l'histoire construite par la dyade. Cette historicité, dont la construction est rendue possible par la capacité du bébé de commencer à se distancer et, dès lors, d'abstraire les actions du contexte immédiat dans lequel elles se produisent, constitue un troisième pôle du dialogue et forme ainsi une relation triadique.

Resumen: Este ensayo señala la importancia del estudio del self dialógico. Proponemos que ese self surge y tiene su desarrollo en el proceso de comunicación hacia otra persona. Desde la historia de la díada madre hijo en los primeros ocho meses de vida del nene, consideramos que tanto los estándares de organización dialógicos -llegando a la forma abreviada del diálogo- como el análisis de las posiciones que asume el habla de la madre denotan un proceso de diferenciación del nene como compañero en ese diálogo. También, cuando el nene surge como agente y con su subjetividad garantiza el desarrollo de la historia construida por la díada. Esa historicidad, posible de ser construida a través de una emergente capacidad del nene en alejarse y, siendo así, capaz de abstraer las acciones del contexto inmediato en la cual ocurre, forma un tercer polo de diálogo, construyendo, así, una relación tríada.

Del deseo de nada al vóley / From the desire of nothingness to volleyball

Este caso clínico se refiere a una adolescente de 14 años, que presenta un cuadro de anorexia, internada con riesgo de vida.En este trabajo intento mostrar la intervención terapéutica desde su inicio, hasta un fin de análisis posible. Con un modo particular no convencional ni ortodoxo, pero si con una mirada psicoanalítica. Creando demanda donde no había, posibilitando mi intervención, el tratamiento, haciendo un recorrido desde el deseo de “nada” al deseo de “vida”.Este recorrido fue posible a través del trabajo terapéutico de sostén, apuntalamiento, intervenciones subjetivantes, tanto con Laura como con sus padres. Quedando abierta la posibilidad de retomar en un segundo ciclo, un nuevo análisis.

This case refers to a 14-year-old who presents symptoms of anorexia and was hospitalized with risk for her life. In this practical job, I try to show the therapeutic intervention since its inception, until a possible analysis.With a particular unconventional or unorthodox way, but with a psychoanalytic look.Creating demand where there was not, to make possible my intervention, treatment, doing a journey from the desire to “nothing” to the desire to “life”.This tour was made possible through the therapeutic support work, underpinning subjectifying interventions, as much Laura and their parents.Leaving the possibility to resume a second period a new analysis.

Ce cas concerne une jeune de 14 ans qui présentait des symptômes de l’anorexie et a eté hospitalisée car ceci representait un danger pour sa vie.Dans ce travail j’ai l’intention de dèmontrer l’intervention thérapeutique depuis le dèbut jusqu’à la fin de l’analyse possible par une manière particulière non conventionnelle ni orthodoxe mais sous une optique psychanalytique.Ceci en créant une demande là ou il n’y en avait pas ce qui a permis mon intervention, le traitement, en faisant un parcours de la volonté du “rien” á la volonté de “vie”.Cela a été possible gràce au travail thérapeutique de soutien, d’appui, avec des interventions subjectivants, à la fois avec Laura et ses parents laissant ouverte la possibilité de reprendre dans un second cycle, une nouvelle analyse.

Fin de análisis en niños / End of child analysis

Ante un tema tan amplio y en el que confluyen muchos otros, se propone pensar el fin de análisis como un prisma imaginario donde cada cara de éste represente cada uno de esos temas. Se abordan de este modo: los diferentes criterios teóricos sobre el fin de tratamiento según distintos autores; la articulación entre comienzo de un análisis y su final; la relación entre fin y finalidad del análisis; el final y las transferencias en juego, así como la articulación entre final de tratamiento, constitución subjetiva y psicopatología infantil.Se concluye con la presentación de viñetas clínicas de dos análisis que terminaron de maneras diferentes.Se plantea que debido al proceso de constitución subjetivo que los niños se encuentran atravesando y las características particulares de su psicosexualidad en el momento de la consulta, cada final de tratamiento podría ser pensado como “tramos” donde se acompañe al niño en la tarea específica que su problemática requiera.

In a topic that is so broad and that it converges with many others, it issuggested to think as the end of analysis as an imaginary prism in which everyface of it represents each one of these topics. It is addressed in the followingways: the different theoretical criteria about the end of treatment accordingto different authors; the coordination between the beginning of analysis andits end; the relationship between the end and purpose of analysis; the endand the transferences that are at stake; as well as the coordination betweenthe end of treatment, the subjective constitution and infant psychopathology. It ends with the presentation of clinical vignettes of two analyses that endedin different ways.It is considered that due to the process of subjective constitution that the childis going through and the particular characteristics of his psychosexuality inthe moment of the consultation, each end of treatment might be consideredas “sections” in which the child is taken care of in the specific task that hisproblematic requires.

Face à la largeur de ce sujet, dans lequel convergent en plus tant d’autres,on propose de penser la fin de l’analyse comme un prisme imaginairedont chaque face représenterait un de ces thèmes. Ainsi on aborde: lesdifférents critères théoriques sur la fin du traitement selon divers auteurs;l’articulation entre le début et la fin d’une analyse; le rapport entre lafin et la finalité de l’analyse; la fin et les transferts en jeu, de même quel’articulation entre la fin du traitement, la constitution subjective et lapsychopathologie infantile.On conclut avec la présentation de vignettes cliniques de deux analyses quiont fini de manière différente.Dû au processus de constitution subjectif que les enfants sont en train detraverser et aux caractéristiques particulières de leur psychosexualité lors dela consultation, on établit que chaque fin de traitement pourrait être conçuecomme des “tronçons” le long des quels l’enfant serait accompagné dans latâche spécifique que sa problématique réclame.

Riesgo sexual en adolescentes según la edad de debut sexual / Sexual risk in adolescents depending on the age of sexual debut / Risco sexual em adolescentes de acordo com a idade de debute sexual

En España los jóvenes debutan sexualmente antes que en otros países; sin embargo, poco se sabe de la relación entre la edad de debut sexual y el comportamiento sexual en esta población. Se analizan las prácticas sexuales y el uso del preservativo según la edad de debut sexual en adolescentes españoles sexualmente experimentados (N = 351); la edad media fue 15.9 años (DT = .75, rango: 14-18). Se establecieron tres grupos a partir de la edad de debut sexual informada: debut sexual temprano (anterior a los 15 años), promedio (15 años) y tardío (posterior a los 15 años). El grupo con debut sexual temprano practicó en mayor medida masturbación mutua, coito vaginal y sexo oral, con un número de parejas sexuales superior al resto. El uso del preservativo en la primera relación sexual, el porcentaje de uso y el uso consistente del preservativo fue inferior en el grupo debut sexual temprano respecto a los otros dos. El debut sexual anterior a los 15 años se asoció con mayor riesgo de contraer infecciones sexuales por déficit en el uso del preservativo y mayor exposición sexual. Los hallazgos de este estudio sugieren que la edad de debut sexual tiene implicaciones en la salud sexual de los jóvenes.

In Spain young people have their first sexual intercourse at an earlier age than in other countries; however, little is known about the relationship between age of sexual debut and sexual behavior in this population. Sexual practices and methods of protection are analyzed depending on the age of sexual debut among Spanish adolescents who are sexually experienced (N = 351). The mean age was 15.9 years (SD = .75, range: 14-18). Three groups were formed according to the age of sexual debut reported: early sexual debut (earlier than 15 years), average (15 years) and late (later than 15 years). The early sexual debut group reported further mutual masturbation, vaginal intercourse and oral sex with a higher number of sexual partners than the rest. Condom use at first intercourse, percentage of use and consistent condom use was significantly lower in the early sexual debut group compared to the others. Sexual debut before 15 years old was associated with increased risk of sexual infections, deficit in condom use and increased sexual exposure. The findings of this study suggest that the age of sexual debut has implications for the sexual health in young people.

Na Espanha os jovens debutam sexualmente antes que em outros países; porém pouco se sabe com respeito à relação entre idade de debute sexual e o comportamento sexual nesta população. Analisam-se as práticas sexuais e o uso do preservativo segundo a idade de debute sexual em adolescentes espanhóis sexualmente experimentados (N = 351); a idade média foi 15.9 anos (DT = .75, faixa: 14-18). Estabeleceram-se três grupos a partir da idade de debute sexual informada: debute sexual precoce (anterior aos 15 anos), média (15 anos) e tardio (posterior aos 15 anos). O grupo com debute sexual precoce praticou em maior medida masturbação mútua, coito vaginal e sexo oral, com um número de parceiros sexuais superior ao resto. O uso do preservativo na primeira relação sexual, a porcentagem de uso e o uso consistente do preservativo foi inferior no grupo de debute sexual precoce com respeito aos outros dois. O debute sexual anterior aos 15 anos foi associado com maior risco de contrair infecções sexuais por déficit no uso do preservativo e maior exposição sexual. Os descobrimentos deste estudo sugerem que a idade de debute sexual tem implicações na saúde sexual dos jovens.

Community Factors Shaping Early Age at First Sex among Adolescents in Burkina Faso, Ghana, Malawi, and Uganda.

Using data from the National Survey of Adolescents (2004), we examine the community-level factors associated with early age at first sex among adolescents 14-19 years old in four African countries. Regression models are fitted separately by sex for each country for an outcome measuring early age at first sex, with a focus on community-level factors as potential influences of age on sexual debut. The community-level factors associated with adolescents’ sexual debut vary widely by both country and gender. Community influences that emerge as risk or protective factors of early sexual debut include community levels of adolescent marriage, wealth, religious group affiliation, sex education, parental monitoring, reproductive health knowledge, media exposure, membership in adolescent social group, and use of alcohol. Results indicate the importance of context-specific understanding of adolescents’ sexual behaviour and suggest how elements of place should be harnessed in the development of effective HIV and sexual health interventions.

Factors Associated with Sexual Debut among Korean Middle School Students

PURPOSE: The purpose of this study was to investigate factors associated with sexual debut among Korean middle school students. METHODS: From the database of the Eighth Korea Youth Risk Behavior Web-based Survey (KYRBS), the researchers selected 37,297 middle school students aged 12-15 years. Data were analyzed using chi2 test and multiple logistic regression with the SPSS WIN 18.0 program. RESULTS: The proportion of middle school students who had a sexual debut was 2.1% of boys and 1.5% of girls. In multiple regression analysis, economic status, experience of part time work, smoking, drug use and depression were associated with an increased proportion of sexual intercourse for both boys and girls. Living with parents, drinking alcohol and suicidal ideation were associated with sexual debut for boys only. By contrast, formal sexual education was associated with a reduced risk of sexual debut. CONCLUSION: The results of this study show the factors associated with sexual debut among Korean middle school students. Gender-related interventions should be taken into consideration in school sexual education programmes, because of differences in related factors according to gender.

Debut clínico del SIDA y su diagnóstico tardío / AIDS Clinical Onset and its Late Diagnosis

El debut clínico es un fenómeno particular dentro de la epidemia de VIH/SIDA que se viene observando en todo el mundo. Objetivo: describir un caso de debut clínico de SIDA cuyo diagnóstico fue tardío. Presentación del caso: se reporta un caso con Virus de Inmunodeficiencia Humana que su debut clínico estuvo caracterizado por manifestaciones respiratorias y lesiones por herpes virus genitales y peri anales de más de 3 meses de evolución, en el cual su diagnóstico serológico fue tardío, presentándose con estado de inmunodepresión por conteo TCD4. El diagnóstico fue hecho hospitalario, pero pudo haberse realizado antes. Se identificó el elemento epidemiológico como población clave de mayor riesgo. Conclusiones: en el caso estudiado se realizó el diagnóstico tardío de SIDA, en etapa clínica categoría C3. Un buen interrogatorio, que incluya aspectos de antecedentes de tipo epidemiológico y un correcto y completo examen físico, es la base para un certero razonamiento científico en el proceder diagnóstico...

The clinical presentation is a particular phenomenon in the HIV / AIDS that has been observed worldwide. Objective: to describe a case of AIDS clinical onset whose diagnosis was delayed. Objective: to describe a case of clinical debut of been whose diagnosis was late.Case presentation: a case is reported with Human Immunodeficiency Virus (HIV). Its clinical onset was characterized by respiratory symptoms and genital and perianal injuries by herpes virus for more than 3 months. In this case, HIV diagnosis was late. A state of immunosuppression by CD4+ T count was present. A hospital diagnosis was made, but it could have done earlier. The epidemiological element as target population in higher risk was identified. Conclusions: in this case, late diagnosis of AIDS was made in clinical stage category C3. A good interview, including epidemiological background aspects and a correct and complete physical examination are the basis for an accurate scientific reasoning in the diagnostic procedure...

Factores asociados al inicio sexual en adolescentes de ambos sexos de nivel socioeconómico medio-bajo de la Región Metropolitana / Factors associated to the sexual debut in adolescent populations in precarious economic settings of Metropolitan Region

Antecedentes: escasa evidencia está disponible en Chile acerca del inicio de la actividad sexual adolescente. Objetivo: examinar cuales variables identificadas previamente están asociadas al inicio de la actividad sexual en una población adolescente de nivel socioeconómico medio-bajo de la Región Metropolitana. Método: los datos corresponden a adolescentes consultantes en CEMERA. Se compararon con adolescentes que habían iniciado actividad sexual y aquellos que no. La información fue recolectada en la primera consulta a 5.854 adolescentes de ambos sexos entre 12 y 19 años. Se usó regresión logística para identificar los factores asociados al inicio sexual. Resultados: 92,6 por ciento mujeres y 7,4 por ciento hombres. El 84,2 por ciento había iniciado actividad sexual y no el 15,8 por ciento. Las variables asociadas al inicio sexual fueron: ser hombre; mayor edad; mayor escolaridad; aspiraciones académicas básicas; desempeño escolar bajo; repitencia escolar; no afiliación religiosa; no asistencia a servicios religiosos; tener un trabajo; tener pareja mayor; tener una pareja que trabaje; conversar temas de sexualidad solo con la pareja; más parejas románticas; no participación social; historia de abuso sexual; mayor número de hijos; mala relación padre-hijo; mala comunicación familiar; supervisión parental limitada; historia de paternidad y/o maternidad adolescente en los padres; padres con baja educación; menor supervisión parental. Conclusión: se necesitan programas que motiven a retardar el inicio sexual. Los programas de educación sexual deberían animar a la conversación de los temas de sexualidad con los padres y capacitar a los educandos a demorar el inicio sexual y/o obtener anticonceptivos, en forma expedita, amigable y confidencial.

Background: little evidence is available from Chile concerning adolescent people's sexual debut. Objective: to examine which variables previously identified were associated to the sexual activity in adolescent populations in precarious economic settings of Metropolitan Region. Method: data from a population of adolescents attending at CEMERA were used to compare those who had sexual debut and those who had not. Analysis used data collected at the adolescent's first visit of 5,854 adolescents, both sexes, aged 12-19. Logistic regression was used to identify factors associated with sexual debut. Results: 92.6 percent were females and 7.4 percent males. 84.2 percent adolescents had sexual debut and 15.8 percent did not. Variables associated with sexual debut were: gender (male); age (older); education (higher): low academic aspirations (finishing high school only); low academic performance; repeating an academic year; no religious affiliation; no attendance at religious services; having a job; having an older partner; having a partner who works; discussing topics related to sexuality only with partner; more lifetime romantic partners; no social participation; history of sexual abuse; higher number of siblings; poor parent-child relationship; poor family communications; limited parental supervision; history of adolescent parenthood in parents; low parental education; low family involvement in the adolescent's life. Conclusion: programs that encourage the delay of sexual debut are needed. Sexual health education programs should encourage the discussion of sexuality with parents and enable girls and boys to delay sexual debut or to obtain contraceptives easily and privately.

Variables psicosociales que median en el debut sexual de adolescentes en España / Psychosocial variables related to sexual debut in adolescents in Spain

El objetivo de esta investigación es analizar las variables sociodemográficas y psicosociales que median en el debut sexual de los adolescentes en España. Participaron 2.153 adolescentes residentes en España, entre 14 y 19 años de edad, y de distinto origen cultural. De ellos, el 67.7% eran autóctonos españoles y el 32.3% inmigrantes latinoamericanos. El 19.2% de los participantes no había tenido contacto sexual, el 47.3% lo había tenido sin penetración y el 33.5% restante manifestó haber tenido relaciones sexuales con penetración. Se llevó a cabo una regresión logística multinomial para comparar a los adolescentes de los tres grupos, a través de la cual se concluye que las relaciones sexuales sin penetración pueden ser predichas por las actitudes positivas hacia el preservativo y que las relaciones sexuales con penetración pueden serlo por la adaptación personal, la adaptación escolar y las actitudes positivas hacia el preservativo. Posteriormente, a través de un análisis de regresión logística binaria, se obtuvo que los adolescentes latinoamericanos, las mujeres, los que están más adaptados en el ámbito personal y los que presentan menos autoeficacia en el uso del preservativo tienen más probabilidades de tener relaciones sexuales con penetración. En la discusión se resalta la importancia de la edad de inicio en las relaciones sexuales como factor clave para la emisión de conductas sexuales de riesgo.

The aim of this study was to analyze variables that are related to sexual debut in adolescents in Spain. Participants were 2.153 adolescents who lived in Spain. Ages ranged from 14 to 19 years old. Of them, 67.7% were native Spanish and 32.3% were Latin American immigrants. 19.2% of adolescents had never had any sexual contact; 47.3% had had sexual activities without penetration and 33.5% reported sexual intercourse experience. A multinomial logistic regression analysis was performed to compare these three groups of adolescents. According to that analysis, positive attitudes towards condom use predicted sexual activities without penetration. Likewise, personal and scholar adaptation and positive attitudes towards condom use predicted sexual intercourse experience. Subsequently, a binomial logistic regression analysis was performed. This analysis showed that Latin American adolescents, females, those adolescents who were more adapted in the personal area as well as those who had less self-efficacy towards condom use, had a higher likelihood of having had sexual intercourse experience. In the discussion section, relevance of age at first sexual intercourse as a key factor for sexual risk behaviour engagement is highlighted.

Factors Associated with the Timing of First Sexual Intercourse Among College Students in Busan, Korea / 대한남성과학회지

PURPOSE: The purpose of this study was to predict when college students in Korea have their first sexual intercourse and to explore the factors associated with the timing of first sexual intercourse. MATERIALS AND METHODS: Data are collected by using self-report survey toward total 797 of male and female college students who are currently attending the college in Busan, Korea. Students were divided by four groups according to their age of timing of first sexual intercourse, <16 years, between 16 to under 19, over 19 years and non-experienced. To examine the difference of four groups, Chi-square test and ANOVA (analysis of variance) were used. For estimation of the timing of first sexual intercourse we used Kaplan-Meier estimation and for differences of each group we used log-rank test. To identify the factors associated with the timing of first sexual intercourse we used Cox proportional hazards model. RESULTS: 41.4% of college students have experienced sexual intercourse. Of four groups the early sexual intercourse group (<16 years) had high rate of cigarette smoking, alcohol drinking, drug use, open sexual attitude, and a high number of sex partner. The factors associated with the timing of first sexual intercourse among college students was identified male, open parents attitude about sex, pornography experiences, cigarette smoking, alcohol drinking. CONCLUSIONS: This study predicts the timing of first sexual intercourse among college students in Korea. Early sexual debut is an important indicator for continued risk behavior regarding reproductive health.

Percepciones y experiencias del inicio sexual desde una perspectiva de género, en adolescentes consultantes en un centro universitario de salud sexual y reproductiva / Perceptions and experiences of sexual debut from a gender perspective in adolescents consulting in a university centre for sexual and reproductive health care

Antecedentes: El contexto en que se inicia la actividad sexual en adolescentes tiene importantes signifca-dos para las personas e implicancias en salud pública. Objetivo: Conocer con un enfoque exploratorio, los factores que infuyen en el inicio de la actividad sexual en adolescentes y explorar el contexto en el cual ocurre. Método: Muestra de adolescentes, hombres y mujeres, sexualmente activos entre 14 y 19 años, re-clutados en el CEMERA, durante 2007. Se realizaron 117 entrevistas semiestructuradas. Se utilizó el análisis temático de los datos. Los signifcados e interpretaciones fueron constantemente verifcados a través de sucesivos análisis. Resultados: El grado de control personal que tuvieron sobre los factores que condujeron a su primera experiencia sexual, determinó como ellos/as se sintieron con esta experiencia. Aquellos/as que dijeron que había sido una buena experiencia, demoraron el inicio sexual hasta que se sintieron cómodos/as con el momento y con quien debutaron sexualmente. Sin embargo, sentimientos de culpa marcaron el evento, porque ellos/as habían transgredido las normas sociales. En contraste, la coerción de sus parejas y los efectos del alcohol, fueron razones que llevaron a una experiencia sexual prematura y no deseada. Conclusiones: El rol de la interacción con sus pares, el abuso de alcohol y la presión de la pareja, en el caso de las niñas, infuyen en la actividad sexual prematura y no deseada. Las intervenciones educacionales debieran considerar estos aspectos para que tengan relevancia personal y el impacto pueda ser mayor en la postergación del inicio de la actividad sexual o que esta sea protegida.

Background: It is important to understand that the timing and context in which sexual intercourse is initiated, has signifcant personal and public health implications. Objective: To explore the factors that infuence the initiation of frst intercourse among adolescent females and males and the context in which this event occurs. Methods: A sample of sexually active teenagers both female and male, aged between 14 and 19 years, were recruited from a University Centre for Sexual and Reproductive Health Care (CEMERA), during 2007. One hundred and seventeen semi structural interviews were conducted. Thematic analysis was used to analyze the data. Meanings and interpretations that emerged were constantly verifed through subsequent inquiry. Results: The degree of personal control over the factors that led to their frst experience of intercourse determined how adolescents refected upon the experience. Those who were ready and felt well were more likely to have delayed intercourse until they were comfortable with when and with whom the sexual debut occurred. However, feelings of blame because the social norms were transgressed marked the event. In contrast, coercion from sexual partners and being under effect of alcohol were reasons for premature and unwanted frst experience of sexual intercourse. Conclusions: The role of peer interaction and abuse of alcohol, and the pressure from sexual partner to infuence in premature and unwanted sexual activity, may to generate educational interventions of greater personal relevance and impact to prevent risky sexual behaviors.

Iniciação sexual de homens adolescentes / Sexual initiation in male adolescents

Trata-se de pesquisa quantitativa que teve como objetivo investigar a iniciação sexual de adolescentes do sexo masculino em Concórdia, Santa Catarina. Participaram da mesma 340 adolescentes do sexo masculino, com idades entre 14 e 19 anos, que frequentavam o ensino médio em seis instituições de ensino do município de Concórdia, que aceitaram participar e que trouxeram o termo de consentimento livre e esclarecido assinado pelos pais ou responsáveis. Destes, 69,7 por cento afirmaram ter relações sexuais, sendo que a média de idade da primeira relação foi de 14,4 anos, menor que a média nacional de 15 anos. A primeira relação sexual ocorreu com uma ficante para 45,1 por cento e 64,2 por cento afirmaram que o principal motivo para a mesma foi vontade/tesão. A maioria (74,2 por cento) qualificou a experiência como boa ou muito boa. O uso da camisinha foi apontado como método utilizado na primeira relação sexual por 73,8 por cento dos adolescentes e como método usado em todas as relações por 72,5 por cento. Alguns adolescentes relataram não conversar sobre sexualidade, mas a maioðria aponta os amigos como principal fonte de informações sobre sexo. Frente ao exposto, fica claro que, apesar de terem sua primeira relação sexual cada vez mais precocemente, o diálogo sobre prevenção tem surtido efeito, o que é reforçado pelo uso expressivo do preservativo entre os adolescentes.

This quantitative study aimed to investigate the sexual initiation of male adolescents in the city of Concordia, Santa Catarina State. A total of 340 male adolescents aging from 14-19 years, from secondary education in six urban schools, that accepted to answer the questionnaire and whose parents signed the authorization. From the total, 69.7 percent had already had sexual relations, with average age of 14.4 years old, lower than national average of 15 years old. The first sexual relation occurred with a date to 45.1 percent and 64.2 percent affirmed that the main reason to have it was desire/excitation. Most of adolescents (74.2 percent) valued the experience as good or very good. Condoms were the contraceptive method used at first sexual relation by 73.8 percent and in all others relations by 72.5 percent. Some adolescents do not talk about sexuality, but the main source of information about sex was their friends. The data shows the importance of the work on prevention of STD/AIDS and pregnancy developed in the last decades, what is showed by the expressive condom use among the participants.

Prevención y diagnóstico tardío de SIDA en Ciudad de La Habana, 1986-2007 / Late prevention and diagnosis of the AIDS present in Havana City, 1986-2007

OBJETIVO: caracterizar la ocurrencia de los diagnósticos tardíos en personas con VIH y posibles fallas de la prevención en la atención primaria. MÉTODOS: se realizó un estudio descriptivo de corte transversal, de los 422 casos ocurridos en la Ciudad de La Habana, en el período comprendido entre 1986-2007. La información se obtuvo de la base de datos nacional de casos VIH/SIDA del Ministerio de Salud Pública. RESULTADOS: los casos de inicio clínico se incrementaron a partir de 1997, con un máximo en 2007, y los municipios con un mayor porcentaje de afectados son La Lisa, Plaza y Habana Vieja. Hubo un predominio del sexo masculino (91 por ciento) con orientación sexual de hombres que tienen sexo con hombres (85,3 por ciento); el grupo de edad más afectado fue de 40-44 años (20,4 por ciento), y el 53,3 por ciento son diagnosticados por la pesquisa de ingresos. Las entidades más frecuentes son, el desgaste por VIH (34,4 por ciento), adenopatías generalizadas con CD4 bajos (21,7 por ciento), y neumonía por Pneomucystis jiroveci (16,0 por ciento). En los últimos 10 años hubo un incremento de las defunciones y un 38,4 por ciento fallecen el mismo año de su diagnóstico. CONCLUSIONES: existen dificultades en el trabajo de prevención del VIH/SIDA, en la Atención Primaria de Salud.

OBJECTIVE: to characterize the occurrence of late diagnoses in HIV-persons, and the possible failures in primary care. METHODS: a cross-sectional and descriptive study was made of the 422 cases occurred in Havana City from 1986 to 2007. Information is from the national data-base of HIV/AIDS cases of Public Health Ministry. RESULTS: cases of clinical beginning were increased from 1997, with a peak in 2007, and the municipalities with greater percentage of diseased include La Lisa, Plaza, and Habana Vieja. There was a predominance of male sex (91 percent) with sexual intercourse from man to man (85,3 percent); the more affected age group was that aged 40-44 (20,4 percent), and the 53,3 percent was that more diagnosed through admission inquiry. More frequent entities are: weakness by HIV (34,4 percent), systemic adenopathies with low DC4 (21,7 percent), and pneumonia by Pneumucystis jiroveci (16,0 percent). In past 10 years there was an increase of deceases, and the 38,4 percent die during the same year of its diagnosis. CONCLUSIONS: there are difficulties in prevention tasks of HIV/AIDA in Health Primary Care.

Iniciação sexual de homens adolescentes / The onset of sexual activity in male adolescents

Trata-se de pesquisa quantitativa que teve como objetivo investigar a iniciação sexual de adolescentes do sexo masculino em Concórdia, Santa Catarina. Participaram da mesma 340 adolescentes do sexo masculino, com idades entre 14 e 19 anos, que freqüentavam o ensino médio em seis instituições de ensino do município de Concórdia, que aceitaram participar e que trouxeram o Termo de Consentimento Livre e Esclarecido assinado pelos pais ou responsáveis. Destes, 69,7 por cento afirmaram ter relações sexuais, sendo que a média de idade da primeira relação foi de 14,4 anos, menor que a média nacional de 15 anos. A primeira relação sexual ocorreu com uma ficante para 45,1 por cento e 64,2 por cento afirmaram que o principal motivo para a mesma foi vontade/tesão. A maioria (74,2 por cento) qualificou a experiência como boa ou muito boa. O uso da camisinha foi apontado como método utilizado na primeira relação sexual por 73,8 por cento dos adolescentes e como método usado em todas as relações por 72,5 por cento. Alguns adolescentes relataram não conversar sobre sexualidade, mas a maioria aponta os amigos como principal fonte de informações sobre sexo. Frente ao exposto, fica claro que apesar de terem sua primeira relação sexual cada vez mais precocemente, o diálogo sobre prevenção tem surtido efeito, o que é reforçado pelo uso expressivo do preservativo entre os adolescentes.

This quantitative study aimed to investigate the onset of sexual activity in male adolescents from Concordia, Santa Catarina, Brazil. The studied sample consisted of a total of 340 14-19-year-old male adolescents attending secondary school in six local educational institutions, who accepted to answer the questionnaire and whose parents signed the Free and Informed Consent. From these, 69,7 percent affirmed that they already had sexual relations; the mean age at the first relation was 14,4, lower than national average of 15 years. The first sexual relation occurred with a date in the case of 45,1 percent and 64,2 percent affirmed that the main reason was sexual desire/excitation. Most of adolescents (74,2 percent) qualified the experience as good or very good. The condom was used in the first sexual relation by 73,8 percent and in all relations by 72,5 percent. Some adolescents do not talk about sexuality, but most of them indicate friends as the main source of information about sex. These data show the effectiveness of the dialogue about STD/AIDS prevention and contraception developed over the last decades, expressed by the considerable condom use among the adolescents.

Sexual behavior of Korean young women: preliminary study for the introducing of HPV prophylactic vaccine / 부인종양

OBJECTIVE: The decision of optimal age for administration of recently approved prophylactic human papillomavirus (HPV) vaccines in the world depend on the basis of the sexual behavior of each countries. The aim of the study was to survey the age-specific sexual behavior including the sexual debut time and sexual experience in the Korean young women to design the tailored HPV vaccination. METHODS: This study was conducted by the Synovate Healthcare in the 6 city of Korea e.g. Seoul, Pusan, Daegu, Incheon, Kwangju and Daejon. By a stratified sampling methods 2,400 women aged 12-29 years old were included. The measures of sexual behavior presented in this report were collected by a Computer-Assisted Self-Interviewing (ACASI), in which the respondent enters her own answers into a computer without telling them to an interviewer. RESULTS: Among women 12-29 years of age, 39 percent of women (934 persons in 2,400 women) and 33 percent of single women (724 persons in 2,190 women) have had vaginal intercourse; 8 percent of women under 19 years old single women (79 persons in 1,045) and 56 percent of single women with 20-29 years old (645 persons in 1,145). Number of sexual partner was 2.8 person and 54 percent of women had more than 2 partners. Age of the first sexual activity (sexual debut) was 21 years old. The age of partner at the sexual debut was 23.2 years old. Sexual experience before 15 years old was only 2%. About the condom, 41% did not use or rarely use. CONCLUSION: Our data demonstrate that the sexual debut time of young Korean women differ from other countries in which the prophylactic HPV vaccine had already used. We conclude that the optimal age for HPV vaccination in Korea would be determined at 15-17 years old by this situation.