Dá el primer paso y los caminos aparecerán: Percepciones de los/as adolescentes sobre el taller de Orientación Vocacional Ocupacional / Take the first step and the paths will appear: Perceptions of adolescents about the vocational orientation workshop

El Equipo de Psicopedagogía del Área Programática del Hospital Vélez Sarsfield, implementa desde el año 1998 procesos de Orientación Vocacional Ocupacional (OVO) en el marco de la Atención Primaria de la Salud (APS), la cual tiene como objetivo generar la participación, autogestión y responsabilidad en el cuidado de la salud de la población en general. El proceso de OVO busca que los/as estudiantes sean protagonistas de su elección, pudiendo llegar a tomar decisiones autónomas y significativas respecto a su futuro y, de esta manera, optimizar así su calidad de vida. Particularmente en este contexto de pandemia por Covid19, se decidió re-pensar de qué modo continuar con la oferta de esta actividad a pesar del impedimento de llevarlos a cabo de forma presencial; se consideró necesario mantener estos espacios donde se pudiera acompañar a los/as adolescentes ante la incertidumbre de la elección de una carrera o trabajo. Por tal motivo, se pensó en la idea de diseñar y llevar a cabo un Taller de OVO de forma virtual y acotado en cantidad de encuentros. La presente investigación tiene como objetivo analizar las percepciones de los/as adolescentes que iniciaron y culminaron el Taller de Orientación Vocacional Ocupacional, realizado de manera virtual en el periodo de octubre a diciembre de 2020, en relación al dispositivo de Orientación Vocacional Ocupacional. (AU)

Preferências dos adolescentes sobre os cuidados de saúde / Adolescents' preferences regarding health care

Resumo Os adolescentes subutilizam os serviços de saúde sobretudo para efeitos de vigilância, o que constitui uma preocupação para os profissionais. Porque a adolescência é uma fase crucial à aquisição de comportamentos saudáveis e de atitudes facilitadoras do acesso a estes serviços, por isso encontrar formas de responder às necessidades específicas dos adolescentes, através da sua participação, constitui um importante investimento no bem-estar das gerações futuras. Este estudo exploratório e descritivo, de natureza qualitativa, com duas fases, teve como objetivos identificar e analisar as ideias e preferências dos adolescentes sobre os cuidados de saúde. Realizaram-se oito entrevistas de grupo com 64 adolescentes dos 13 aos 18 anos: quatro grupos focais (fase 1) e quatro grupos nominais (fase 2). Os dados foram tratados através da análise de conteúdo. Emergiram opiniões favoráveis e desfavoráveis. Nas suas preferências destacaram-se, nas condições dos serviços, haver menos tempo de espera e ambientes mais confortáveis e menos lotados; nas atitudes dos profissionais privilegiaram as competências técnicas, como o saber e a experiência, embora associadas às competências relacionais. Os resultados suportam a necessidade de mudanças nas práticas organizacionais e sobretudo nas atitudes dos profissionais.

Abstract Adolescents underutilize health services, especially for monitoring purposes, which represents a concern for professionals. Since adolescence is a crucial phase in acquiring healthy behaviors and attitudes that facilitate access to these services, finding ways to respond to the specific needs of adolescents through their participation is an important investment in the well-being of future generations. This is an exploratory, descriptive and qualitative study with two phases, seeking to identify and analyze adolescents' ideas and preferences about healthcare. Eight group interviews were conducted with 64 adolescents aged 13 to 18 years: four focus groups (phase 1) and four nominal groups (phase 2). The data was submitted to content analysis. The adolescents revealed both favorable and unfavorable opinions, highlighting a set of preferences regarding service conditions, such as short waiting periods, more comfortable and less crowded settings. Concerning the professionals' attitudes, they emphasized their technical competencies, such as knowledge and experience, although combined with interpersonal skills. These findings support the need for changes in organizational practices, and particularly in the attitudes of the professionals.

Child and Adolescent Psychosocial Care Center service use profile in Brazil: 2008 to 2012

Objective: To describe the service use profile of Child and Adolescent Psychosocial Care Centers (Centro de Atenção Psicossocial Infanto-Juvenil [CAPSi]) in Brazil regarding diagnostic categories, sociodemographic aspects, and care modalities between 2008 and 2012. Methods: A descriptive, ecological study was performed using data from the Unified Health System regarding high-complexity procedure authorizations (Autorização de Procedimentos de Alta Complexidade [APAC]) for the period from 2008-2012. The variables sex, age, diagnosis (F00-F99 of ICD-10), and type of care provided were examined. The data were processed using TabWin and STATA version 12. Results: A total of 837,068 records were examined, each representing one visit to CAPSi. Most visits were by male users (68.8%). The most common diagnoses were hyperkinetic disorders (13%), pervasive developmental disorders (12.4%), and conduct disorders (8.4%). Conclusions: Behavioral and emotional disorders that usually appear during childhood or adolescence and psychological development disorders were frequent, with more than 50% of the latter comprising autism spectrum disorders. Regional differences were observed, with a higher presence of this diagnosis in the Southeast, while the North and Northeast had a high percentage of visits due to mental retardation.

Vigilancia de la tuberculosis y análisis de la situación en menores de 20 años / Tuberculosis surveillance and analysis of the situation under 20 years of age

La tuberculosis es una de las 10 principales causas de mortalidad en el mundo. En 2016, 10,4 millones de personas enfermaron de tuberculosis y 1,7 millones murieron por esta enfermedad. Más del 95% de las muertes por tuberculosis se producen en países de ingresos bajos y medianos. La incidencia mundial de la TB está disminuyendo en aproximadamente un 2% al año, ritmo que habría que acelerar al 4­5% anual si se quieren alcanzar las metas fijadas para 2020 en la Estrategia Fin a la Tuberculosis. La Estrategia Fin a la Tuberculosis de la OMS y los Objetivos de Desarrollo Sostenible (ODS) de las Naciones Unidas, comparten el objetivo común de poner fin a la epidemia mundial de TB para el periodo 2016-2035. Las metas de dicha estrategia consisten en reducir su mortalidad en un 90%, y su incidencia en un 80% de aquí a 2030. En este informe, junto con la presentación y actualización mensual y sistemática de los datos, se realiza un breve análisis de la situación de los menores de 20 años. Dada la importancia del evento en este grupo de edad, se considera significativo que, dentro de la prioridad que tiene el abordaje de la TBC en general, se le dé mayor visibilidad a la situación de los niños y adolescentes. (AU)

Saúde mental de adolescentes internados no sistema socioeducativo: relação entre as equipes das unidades e a rede de saúde mental / Mental health of adolescents in the juvenile detention system: the relationship between the system's staff and external mental health services / Salud mental de adolescentes internados en el sistema de reinserción socioeducativo: relación entre los equipos de las unidades y la red de salud mental

Este artigo tem como objetivo analisar como os profissionais das equipes de saúde mental do sistema socioeducativo do Rio de Janeiro, Brasil, percebem as relações estabelecidas com a Rede de Atenção Psicossocial para atenção às questões de saúde mental dos adolescentes que cumprem medida de internação. Realizaram-se nove entrevistas com profissionais de saúde mental do sistema e os resultados foram apresentados tendo como referência a análise de discurso crítica de Fairclough. Os resultados foram organizados em três partes: relação entre as equipes de saúde mental e a rede, dificuldades das equipes das unidades e dos serviços da rede, e perspectivas e propostas. Pela lógica de construção dos argumentos identificados percebeu-se que a fragilidade dos pactos entre os gestores do Sistema Único de Saúde e do sistema socioeducativo impacta o cotidiano das ações de saúde mental desenvolvidas pelas equipes das unidades. Esse cenário associa-se a outros problemas estruturais, como a falta de transporte e a indisponibilidade de agentes para acompanharem os adolescentes nos atendimentos externos, e às resistências dos profissionais tanto dentro quanto fora das unidades. Evidencia-se haver um isolamento tanto dos adolescentes quanto dos profissionais em relação às ações e políticas de saúde mental do território.

The aim of this article is to analyze how professionals in the mental health teams of the juvenile detention system in Rio de Janeiro, Brazil, perceive the relations with the external Network of Psychosocial Care in dealing with mental health issues in adolescents serving time in juvenile detention centers. Nine interviews were held with mental health professionals in the system, and the results were presented with Fairclough's critical discourse analysis as the reference. The results were organized in three parts: the relationship between the juvenile detention system's mental health teams and the external services, difficulties experienced by the teams from the detention centers and the external network's services, and prospects and proposals. The logic of the arguments' development showed that the weakness in the agreements between administrators of the Brazilian Unified National Health System and the juvenile detention system has a daily impact on mental health activities conducted by the centers' teams. This scenario is aggravated by other structural problems such as lack of transportation and personnel to accompany adolescents on extramural appointments, and resistance on the part of professionals both inside and outside the detention centers. The study showed that both the adolescents and professionals were isolated in relation to mental health activities and policies.

Este artículo tiene como objetivo analizar de qué forma los profesionales de los equipos de salud mental del sistema de reinserción socioeducativo de Río de Janeiro, Brasil, perciben las relaciones establecidas con la Red de Atención Psicosocial, para la atención a cuestiones de salud mental de adolescentes que cuentan con medidas de internamiento. Se realizaron nueve entrevistas con profesionales de salud mental del sistema y los resultados se presentaron teniendo como referencia el análisis de discurso crítico de Fairclough. Los resultados se organizaron en tres partes: relación entre los equipos de salud mental y la red, dificultades de los equipos de las unidades y de los servicios de la red, además de perspectivas y propuestas. Por la lógica de construcción de los argumentos identificados se percibió que la fragilidad de los pactos entre los gestores del Sistema Único de Salud y del sistema socioeducativo impacta en el día a día de las acciones en salud mental, desarrolladas por los equipos de las unidades. Este escenario se asocia a otros problemas estructurales, como la falta de transporte y la indisponibilidad de agentes para acompañar a los adolescentes a las consultas externas, así como las resistencias de los profesionales, tanto dentro como fuera de las unidades. Se evidencia que existe un aislamiento, tanto por parte de los adolescentes, como de los profesionales, respecto a las acciones y políticas de salud mental en el territorio.

Determinantes en la elección de anticonceptivos en adolescentes consultantes en un centro de atención de salud sexual y reproductiva / Determinants in the choice of contraceptives in adolescents consulting in a sexual and reproductive health care center

ANTECEDENTES: Preferencias personales y prioridades son factores importantes a considerar cuando se elige un método anticonceptivo, y son aspectos claves en la toma de decisiones de la población adolescente. OBJETIVO: Identificar los factores más relevantes al seleccionar un método anticonceptivo y sus razones para elegir o rechazar cada uno de los métodos anticonceptivos disponibles en adolescentes. MATERIAL Y MÉTODOS: Estudio transversal analítico. Un cuestionario anónimo y auto-administrado se aplicó a 116 adolescentes que consultaron durante un año a un centro de salud sexual y reproductiva. RESULTADOS: El inyectable fue el método que más conocen y que más usan, seguido de la píldora. La eficacia, protección contra ITS y regular los períodos menstruales son las tres más importantes razones para elegir un MAC. Mientras que las razones más importantes para no elegir la píldora fue tener que recordar su uso cada día. En el caso del implante, el miedo y dolor al colocarlo y removerlo fue la razón más importante. CONCLUSIÓN: A pesar que la confiabilidad y uso de larga duración pueden ser muy importantes ventajas para posponer embarazo en adolescentes, el miedo al dolor e inserción hacen que los métodos de larga duración como el implante y dispositivos intrauterinos sean menos atractivos para adolescentes.

BACKGROUND: Personal preferences and priorities are important factors to consider when choosing a contraceptive method, key aspects in the decision making of the adolescent population. OBJECTIVE: To identify the most relevant factors when selecting a contraceptive method and its reasons for choosing or rejecting each of the contraceptive methods available in adolescents. MATERIAL AND METHODS: Analytical cross-sectional study. An anonymous and self-administered questionnaire was administered to 116 adolescents who consulted for a year in a sexual and reproductive health center. RESULTS: The injectable method was the most known and most used followed by the pill. Efficacy, protection against STIs and regulation of menstrual bleeding are the three most important reasons for choosing a MAC. While the most important reasons for not choosing the pill was to have to remember its use every day, in the case of the implant, it was the fear and pain to place it and removed it. CONCLUSIONS: Although reliability and long-term use may be very important advantages in postponing pregnancy in adolescents, fear of pain and insertion make long-lasting methods such as implant and intrauterine devices less attractive for adolescents.

Centros de Atenção Psicossocial Infantojuvenil no Brasil: distribuição geográfica e perfil dos usuários / Psychosocial Care Centers for Children and Adolescents in Brazil: geographic distribution and user profile / Centros de Atención Psicosocial Infanto-Juvenil en Brasil: distribución geográfica y perfil de sus usuarios

Resumo Poucos estudos brasileiros abordam a utilização de serviços de saúde mental para população infanto-juvenil. Neste trabalho, objetivou-se caracterizar a distribuição nacional dos Centros de Atenção Psicossocial Infantojuvenis (CAPSi) e descrever o perfil nosológico dos atendimentos infantojuvenis entre 2008 e 2012. Realizou-se estudo ecológico, utilizando registros do sistema de Autorizações de Pagamento de Serviços de Alta Complexidade (APAC) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Aspectos sociodemográficos e perfil nosológico foram analisados. Em 2014, 208 CAPSi estavam registrados no CNES, distribuíam-se em 23 das 27 unidades da federação brasileira. Nos atendimentos, predominaram transtornos de comportamento (29,7%), transtornos de desenvolvimento (23,6%) e retardo mental (12,5%). Os CAPSi são insuficientes e desigualmente distribuídos. O perfil nosológico sugere necessidade de articulação entre serviços especializados de saúde mental e atenção básica, além de inclusão do trabalho intersetorial.

Abstract Few Brazilian studies have addressed the use of mental health services for children and adolescents. This study aimed to characterize the national distribution of Psychosocial Care Centers for Children and Adolescents (CAPSi) and describe the patient profile in this age group between 2008 and 2012. An ecological study was carried out, using records from the Authorizations for High-Complexity Procedures (APAC) system and the Brazilian National Registry of Healthcare Organizations (CNES). Socio-demographics and disease profile were analyzed. In 2014, 208 CAPSi were recorded in the CNES, distributed across 23 of Brazil’s 27 states. Treatments included predominantly behavioral disorders (29.7%), developmental disorders (23.6%), and mental retardation (12.5%). CAPSi are insufficient and unequally distributed. The disease profile suggests the need for linkage between specialized mental health services and primary care, in addition to the inclusion of inter-sector work.

Resumen Pocos estudios brasileños abordan la utilización de servicios de salud mental para la población infanto- juvenil. En este trabajo se tuvo por objetivo caracterizar la distribución nacional de los Centros de Atención Psicosocial Infanto-Juvenil (CAPSi), y describir el perfil nosológico de las consultas infanto-juveniles entre 2008 y 2012. Fue realizado un estudio ecológico, utilizando registros del sistema de Autorizaciones de Procedimientos de Alta Complejidad (APAC) y del Catastro Nacional de Establecimientos de Salud (CNES). Se analizaron aspectos sociodemográficos y perfil nosológico. En 2014, 208 CAPSi estaban registrados en el CNES, se distribuían en 23 de los 27 estados brasileños. En las consultas, predominaron trastornos de comportamiento (29,7%), trastornos de desarrollo (23,6%) y retraso mental (12,5%). Los CAPSi son insuficientes y están desigualmente distribuidos. El perfil nosológico sugiere una necesidad de articulación entre servicios especializados de salud mental y atención básica, además de la inclusión del trabajo intersectorial.

Fatores associados à procura de serviços de saúde entre escolares brasileiros: uma análise da Pesquisa Nacional de Saúde do Escolar (PeNSE), 2012 / Factors associated with the demand for health services by Brazilian adolescents: the National School Health Survey (PeNSE), 2012 / Factores asociados con el uso de los servicios de salud por los escolares brasileños: un análisis de la Encuesta Nacional de Salud Escolar (PeNSE), 2012

Os objetivos foram descrever a procura por serviços/profissionais de saúde por escolares brasileiros e identificar fatores associados. Foram analisados dados da Pesquisa Nacional de Saúde do Escolar 2012; estimadas as prevalências e seus respectivos intervalos de 95% de confiança (IC95%) do uso de serviços de saúde entre os escolares. Foi feita regressão logística ajustada por idade. Metade dos estudantes buscaram serviços de saúde; a procura foi maior no sexo feminino; os fatores associados foram: cor branca, escola privada; escolaridade da mãe 12 anos ou mais; ter tido relações sexuais; sofrido ferimento, dor de dentes, tentativa de manter, perder ou ganhar peso, chiado no peito nos últimos 12 meses, ter hábitos de higiene adequados e conhecimento dos pais sobre o que os filhos fazem no tempo livre. A busca por serviços de saúde foi maior no sexo feminino e esteve associada com melhores condições socioeconômicas, presença de sintomas e de comportamentos de risco/proteção.

The objectives of this study were to describe the demand for health services by adolescents and to identify associated factors. The study analyzed data from the National School Health Survey 2012 and calculated prevalence rates and 95% confidence intervals (95%CI). Data analysis used age-adjusted logistic regression. Half of all students required health services and the proportion was higher in girls. Factors associated with demand for health services were white skin color, enrollment in private school, maternal schooling ≥ 12 years, sexual activity, injuries, toothache, attempts to maintain, lose, or gain weight, wheezing, appropriate hygiene, and parents knowing what their children did in their free time. The highest demand for health services was mainly by girls, and demand was associated with socio-demographic characteristics, symptoms, and health risk/protective behaviors.

El objetivo fue describir la demanda de servicios/profesionales de salud por parte de los estudiantes brasileños e identificar posibles conductas de riesgo, condiciones de salud y factores familiares asociados. Se realizó un análisis de datos de la Encuesta Nacional de Salud Escolar 2012; estimadas las tasas de prevalencia y sus intervalos de confianza (IC95%) para el uso de servicios de salud. Asimismo, se efectuó una regresión logística ajustada por edad. La mitad de los estudiantes buscó servicios de salud; la demanda fue mayor en mujeres y factores asociados: color blanco, escuela privada; educación de la madre (12 años o más); haber tenido relaciones sexuales; sufrido daño, dolor de muelas, intentando mantener, perder o ganar peso, sibilancias los últimos 12 meses, higiene adecuada y el conocimiento de los padres sobre lo que sus hijos hacen en su tiempo libre. La búsqueda de servicios de salud fue mayor en mujeres y se asoció con mejores condiciones socioeconómicas, la presencia de síntomas y conductas de riesgo/protección.

Características y consecuencias de las agresiones sexuales en adolescentes consultantes en un centro de salud sexual y reproductiva / Characteristics of sexual assault and its consequences in adolescents at a sexual and reproductive health center

Antecedentes: La agresión sexual es un evento traumático y doloroso que afecta de manera transversal, a las víctimas de ambos sexos, de todos los niveles socioeconómicos con graves consecuencias para la salud física, psicológica y social para quienes la sufren. Objetivo: Determinar las características de las agresiones sexuales y sus consecuencias en adolescentes consultantes en un centro de atención en Salud Sexual y Reproductiva. Método: Estudio analítico de corte transversal de 573 adolescentes atendidas en un centro de medicina reproductiva (CEMERA) en el período 2003-2010 y que reportaron antecedente de abuso sexual. Se estudiaron tanto las características como las consecuencias del abuso, datos que se obtuvieron desde las fichas clínicas. Resultados: En el 86,5 por ciento de los casos se reportó abuso sexual y en un 13,5 por ciento violación. El 48,5 por ciento de los agresores son familiares. La edad más vulnerable fue entre 5-9 años con un 41,2 porciento. En el 39,2 por ciento el abuso sexual fue reiterado. En un 43,4 por ciento el lugar fue el propio hogar de la víctima. Un 70 por ciento reveló y de estos el 45,9 por ciento lo hizo en forma tardía. Sólo en un 19 por ciento se hizo la denuncia legal. De las adolescentes que iniciaron actividad sexual voluntaria (83,3 por ciento), un 35,4 por ciento tenía menos de 15 años. Un 11,8 por ciento reportó 3 y más parejas sexuales. Conclusión: El antecedente de abuso sexual debe ser considerado en la atención de adolescentes que consultan por salud sexual y reproductiva. El equipo de salud debe estar preparado para atender sus múltiples necesidades.

Background: Sexual assault is a traumatic and painful event, which affects victims of both genders, across all socioeconomic levels, with serious consequences for physical, psychological, and social health. Objective: Determine the characteristics of sexual assault and its consequences in adolescents at a sexual and reproductive health center. Method: Analytic and cross-sectional study of 573 adolescents seen at a reproductive medicine center (CEMERA) in the period 2003-2010 and who reported history of sexual abuse. Patient's clinical records were reviewed to study the characteristics as well as the consequences of sexual abuse. Results: The abuse was reported as sexual abuse in 86.5 percent of the cases and as rape in 13.5 percent. In 48.5 percent of the cases, the aggressors were relatives of the victims. The most vulnerable group is between 5-9 of age, representing 41.2 percent of the cases. For 39.2 percent of the cases, the sexual abuse was reiterative, and in 43.4 percent, the abuse took place on the victim's home. 70 percent of the victims told someone about the abuse; 45.9 percent of those revealed their abuse in a delay manner. Only 19 percent of victims filed a legal complaint. Of the adolescents who started voluntary sexual activity (83.3 percent) a 35.4 percent was under de age of 15, and 11,8 percent reported having 3 or more sexual partners. Conclusion: A history of sexual abuse must be considered in the attention of adolescents who consult for reproductive and sexual health. The health team must be prepared to address their multiple needs.

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.

Need of expansion of special adolescent clinic.

A cross sectional study has been done over a period of one year to find out the total number of young people, adolescents and youth attending at general gynaecological OPD and special adolescent clinic and to analyse them in terms of their sex, ethnicity, address, marital status, education, occupation and their health problems in a teaching hospital at Kathmandu. Of the total 2480 patients 31.29% were young people, 18.34% of them were adolescents and 30.52% of them were youth. Male attendance was insignificant. Majority (91%) of the young people were Brahmins, Newars and Chhetriyas. Most (91%) of them were from Kathmandu valley, 73% were already married and 60% had experienced pregnancy. Approximately 12% of these people were illiterate, 24.85% of them had not completed the primary level education. Only 19%of them had completed the SLC examination Lack of education, trend of early marriage has been reflected on to their occupation. 64% of them are engaged in routine household work as housewives. Few (4.3%) of these young people were not doing anything at all. Majority (59%) of them presented with pregnancy related problems and rest of them came for problems like Pelvic infection, urinary tract infection, sub fertility, breast problems and others. This study conclude that good number of young people from different parts of the country attend special adolescent clinic with different needs. Therefore adolescent friendly services in the hospital need to be strengthened to provide special care for them.

Health care seeking behavior of adolescents: comparative study of two service delivery models.

OBJECTIVES: To assess the perceived health problems and help seeking behaviour and utilization pattern of adolescent health clinics. METHODS: A pre-tested, semi-structured questionnaire was administered to 360 school going adolescents who were selected by stratified random sampling from two sectors of Chandigarh where services were being provided by a school-based and dispensary-based adolescent health clinic. RESULTS: Majority (81%) of the adolescents reported having some health problem during last three months prior to the survey; predominant (60%) problems were psychological and behavioural in nature. To resolve these problems boys consulted mainly friends/peers (48%) while girls consulted their mothers (63%). Compared to the dispensary-based adolescent health clinic, utilisation was significantly higher in a school-based clinic where proportion of psychological or behavioural problems reported was also significantly higher (P<0.01). CONCLUSION: Adolescents have greater counselling needs for psychosocial problems than for medical problems. School-based adolescent health clinic was utilized more often than the dispensary-based clinic particularly for psychosocial problems.

Atendimento otorrinolaringológico do Sistema Único de Saúde de crianças e adolescentes em três municípios brasileiros / ENT care of children and adolescents in the Brazilian public healthy system in three different municipalities

A criação de um banco de dados sobre as demandas otorrinolaringológicas no SUS poderá fornecer informações para organizar estratégias de saúde e criar ou otimizar recursos do governo ou privados. OBJETIVOS: Determinar em pacientes até 17 anos de idade: 1) As principais doenças otorrinolaringológicas diagnosticadas; 2) Exames complementares mais solicitados; 3) Medicamentos mais prescritos; 4) Procedimentos ambulatoriais realizados e as indicações cirúrgicas; 5) Estado empregatício dos pais e o número de irmãos dependentes; 6) Comparar e analisar estatisticamente os dados nos locais estudados. MATERIAL E MÉTODO: Estudo prospectivo e análise estatística das variáveis obtidas nas primeiras-consultas na Policlínica de Mariana, na sede Consórcio Intermunicipal de Saúde da Microrregião de Sete Lagoas e na Triagem da Otorrinolaringologia da UNIFESP-EPM. RESULTADOS: Há diferenças estatisticamente significativas quanto às variáveis idade, média salarial dos pais empregados, número de irmãos até 17 anos, rinite, doenças otológicas, exames solicitados, prescrições e indicações de cirurgias micro-otológicas. CONCLUSÕES: O diagnóstico mais encontrado foi respiração oral. O exame complementar e a cirurgia mais indicados foram a radiografia de cavum e a adenoamigdalectomia. O nível de desemprego, a baixa média salarial e o número de dependentes na família dificultam tratamentos que não estejam disponíveis na rede pública de saúde.

The data base of ENT care in the Brazilian public health system (Sistema Unico de Saude - SUS) will help organize public health programs. AIM: The following items were investigated in patients aged up to 17 years attended in public health system outpatient units in the city of Mariana, in the ENT screening unit, UNIFESP-EPM, and in CISMISEL: 1) The main otorhinolaryngological diagnoses; 2) The most frequently required exams, drugs, and surgical procedures and their indications; 3) The jobs of parents; the number of siblings; and 4) A statistical analysis and comparison of data in each location. MATERIAL AND METHODS: We undertook a prospective study and a statistical analysis of variables that were gathered during the first visit. RESULTS: The age, the parents' salary, the number of siblings aged below 18 years, the presence of rhinitis, ears diseases, the exams, drugs and otological surgeries that were indicated were all statistically significant. CONCLUSION: The most common diagnosis was mouth breathing. The most common surgery was adenotonsillectomy. The most frequently requested exam was a lateral cranial radiograph. The number of unemployed parents, their poor salaries, and the number of siblings make if difficult for these patients to be treated in any facility other than the public heath system.

Labeling disorder: the relationship between conduct problems and drug use in adolescents

OBJECTIVE: To verify how conduct disorder and conduct problems are associated with gender, age at onset of drug use and categories of drugs used. METHOD: A test of association was conducted between the presence of comorbidity and gender. Mean age of first use of each drug was compared to mean age of first arrest, of first robbery/theft, and of first drug dealing. RESULTS: In this sample, approximately 59 percent of adolescents had already robbed and/or stolen, 38.6 percent had already been arrested, 32.3 percent had prior history of drug dealing, 24.1 percent had depression, and 9.6 percent had conduct disorder. Prevalence of conduct problems was 65.2 percent. Tobacco, alcohol, marijuana and cocaine were used before the first robbery and/or theft, first drug dealing, and first arrest. DISCUSSION: The fact that drug use onset preceded illegal acts suggests that the latter are the consequence of the consumption of the former, or perhaps, the consequence of "social invisibility" (feeling of not belonging to anything or to anybody) by which these youths undergo. CONCLUSIONS: Labeling these youths as conduct-disordered adolescents may cloud a rather different reality, and it may submit them to more social isolation and stigmatization as well.

OBJETIVO: Verificar como o transtorno de conduta e os problemas de conduta se associam ao gênero, a idade de início do uso de drogas e aos tipos de drogas consumidas. MÉTODO: Realizou-se teste de associação entre presença de comorbidade e sexo. As médias de idade do primeiro uso de cada droga foram comparadas com as médias de idade da primeira prisão e das práticas do primeiro roubo e do primeiro tráfico. RESULTADOS: Aproximadamente 59 por cento dos adolescentes já haviam praticado algum tipo de roubo, 38,6 por cento já haviam sido presos, 32,3 por cento possuíam história pregressa de tráfico de drogas, 24,1 por cento tinham depressão e 9,6 por cento transtorno de conduta. A prevalência de problemas de conduta foi de 65,2 por cento. Tabaco, álcool, maconha e cocaína foram usados antes do primeiro roubo, do primeiro tráfico e da primeira prisão. DISCUSSÃO: Os atos ilegais ocorreram posteriormente ao início do uso de drogas, denotando ser conseqüência deste consumo ou, talvez, conseqüência da "invisibilidade social" (sensação de não-pertencimento a nada ou a ninguém) pela qual passam estes jovens. CONCLUSÕES: A rotulação destes jovens como portadores de transtorno de conduta pode ofuscar uma realidade bem diferente, além de submetê-los a uma maior marginalização e estigmatização.

Comportamientos sexuales y diferencias de género en adolescentes usuarios de un sistema público de salud universitario / Sexual behavior and gender differencesamong adolescents consultingat a university public health system

Background: The predetermined gender roles and the emphasis on reproductive responsibility on women, excluding men, have negative consequences on their sexual reproductive health and satisfactory sexual practices. Aim: To describe and analyze changes in sexual practices and gender differences in adolescents of the lower-middle socioeconomic level, users of public health system who started their sexual activity. Material and methods: We studied 4,971 adolescents of both sexes aged between 12 and 19 years, who consulted in a clinic for adolescents between the years 1990 and 2005. Several variables related to adolescent sexuality were considered. Uni and bivariate analysis were carried out and a model of stratified lineal regression per sex was fixed to explain the following variables: age at which sexual activity is initiated, number of sexual partners, time period between start of dating and the start of sexual activity along time. Results: The average age when men and women start their sexual activity was 15.7 and 15.5years, respectively. Along years and among women but not men, there was a reduction in the age of start of sexual activity and an increase in the number of sexual partners. The mean íapse between start of dating and the start of sexual activity in men and women was 6.2 and 7.5 months, respectively. This figure had an 11.696 and 13.9 percent reduction per year of study in females and males, respectively. Conclusions: There is an increasing expansion of sexual roles in adolescents, but certain patterns of contradictory conservative reasoning are maintained.

Morbidity and treatment seeking behavior among adolescent girls in a rural area of North 24 Parganas district, West Bengal.

A community based, cross-sectional study, conducted in 1999 in a rural area of West Bengal, among 143 adolescent girls (10-19 years), selected through multistage sampling procedure revealed prevalence of acute and chronic morbidity as 30.8% and 7.7% respectively. 84.1% adolescent girls sought for treatment during acute morbidity from various sources; only 22.7% from Government health facilities. Non- availability of medicine (34%), long distance (24%) and poor quality of treatment (10%) were the main reasons for non-utilization of Government health facilities.

Factores familiares asociados al uso de anticonceptivos en mujeres adolescentes solteras sexualmente activas / Associated familiar factors to use of contraceptives in sexually active unmarried adolescent women

La información de investigaciones previas sugiere que varios factores familiares están fuertemente asociados al uso continuo de anticonceptivos en mujeres adolescentes, solteras, sexualmente activas. Entre los factores familiares más importantes están: filiación, figura de crianza, calidad de la relación familiar, comunicación familiar en temas sexuales, escolaridad de los padres, control parental. El objetivo del presente estudio fue examinar factores familiares que se asocian al uso consistente de anticonceptivos en adolescentes, solteras sexualmente activas. Se estudió 2021 adolescentes, solteras, sexualmente activas que solicitaron en forma confidencial anticonceptivos en CEMERA, entre los años 1990 a 2001. A todas ellas se les aplicó un cuestionario previamente diseñado, en la primera consulta y que fue completado con entrevistas posteriores. Se revisaron las fichas clínicas de cada una de ellas para conocer el tipo de método anticonceptivo indicado y el tiempo de uso. Se compararon dos grupos: adolescentes que usaron el método indicado por mas de 6 meses, llamadas usuarias continuadoras, y adolescentes que usaron por menos de 6 meses el método, usuarias discontinuadoras. Se seleccionaron 18 variables familiares para comparar ambos grupos. La información recolectada fue ingresada a una base de datos para su análisis. Se realizaron análisis uni y bivariado. El software EPI INFO 6.0 fue utilizado. Los resultados muestran que la filiación, figura de crianza, calidad de la relación familiar, escolaridad de los padres, control parental, tipo de castigo y comunicación familiar no muestran diferencias entre los grupos.

Study of young people attending an adolescent friendly centre.

Adolescents are the individuals between the ages of 10 and 19 years and the youth are those between the ages of 15 to 24 years. World Health Organisation has therefore defined young people as individuals between the age group of 10 to 24 years. In our country Adolescents comprise more than one fifth (22%) of the total population. Therefore Family Health Division, Ministry of Health, established an adolescent friendly centre at Bir Hospital on 5th January 2002. This paper has tried to study and analyse the young population attending this centre at a fixed period of time. This study was carried out to a. Find out the total number of adolescents. b. Estimate their male: female ratio. c. Find out their ethnicity, address, marital status, education, and occupation d. Learn what Health and Development problems these young people have. This is a cross sectional study done at Bir Hospital adolescent friendly centre for a period of one year. All young people (adolescents and youths) coming to this centre within the specified period are included in this study. OPD register was used to collect the data, which was obtained and analysed manually. Total of 956 young people were provided healthcare and counselling services from this centre. Out of them, only 9.21 % were males. 887 (92.78%) of this population are adolescents, 69 (7.22%) are from 19 to 24 years age group and 880 (92.05%) of them are youth. Majority (28.56%) were Brahmins. 313 (32.74%) of these people were from outside the valley. 9 (10.23%) out of 88 boys and 384 (79.34%) out of 484 girls were married. 1.14% of boys and 14.63% of girls were illiterate. 4.55% of boys and 14.17% of girls had not completed the studies of standard five. 17.05% of boys and 47% of girls had not completed their school. 81.82% of boys and 38.36% of girls had joined the college. It also showed that 521 (54.50%) of these young people are students but 35.94% of girls are housewives. 278 (32.03%) girls presented with menstrual problems and 22.12% (192) came with pregnancy related problems and 15.27 % of these young people presented with the symptoms of various infections Twenty six (3%) girls came with features of anaemia and 22 (2.53%) girls had dropped in for family planning services. 20 (2.09%) of these young people had some psychological problem (mainly anxiety) and 9.62% of them had various types of skin problems. Adolescent friendly centre can play a vital role to support and help a good number of adolescents of the society. Key words: Adolescents, youths, and young people.

Validación de una escala para adolescentes (EBHAD): un estudio piloto en Puerto Rico / Validation of a scale for adolescents (EBHAD): a pilot study in Puerto Rico

This investigation presents the development and validation process of a scale whose principal purpose is to identify those areas in which one is required to achieve improved functioning and adequate emotional health resulting in improved sports performance with adolescent athletes. The "Hechavarria Wellness Scale for Adolescent Athletes" (HWSAA) was developed. The concept of wellness was measured utilizing the following 4 sub-scales measuring; depressive symptomatology, trait anxiety, self-esteem and social relations. A pilot study was undertaken with a universe of 149 adolescent athletes from both sexes with an average of 15.6 years old and residing within the different municipalities of Puerto Rico. The alpha coefficient reliability of the HWSAA and its' subscales fluctuated between 0.71 and 0.82. The results suggest that the HWSAA and its' subscales possess a psychometrically adequate internal consistency. This means that the instrument is valid and reliable for the sample utilized. We suggest further research with the HWSAA

La transición epidemiológica de las y los adolescentes en México / The epidemiologic transition among adolescents in Mexico

OBJETIVO: Identificar los niveles de salud de la adolescencia en México en su demografía, contexto social y económico. MATERIAL Y MÉTODOS: Se efectuó una revisión de la literatura y de estadísticas vitales, así como de encuestas de opinión, con la finalidad de evaluar el impacto de la transición epidemiológica frente a la disponibilidad y prioridades de los servicios de salud para adolescentes. El modelo epidemiológico de Omran se utilizó para clasificar las características demográficas, sociales y económicas de adolescentes mexicanos como un esfuerzo para definir su impacto en la transición epidemiológica de este grupo de edad. RESULTADOS: Los datos demográficos se presentan en una perspectiva de la transición epidemiológica, la cual nos permite realizar inferencias de las condiciones sociales, patrones de desarrollo y de necesidades en salud de este grupo poblacional en México. Los datos se presentan atendiendo a la demanda y disponibilidad de servicios de salud, el impacto de la educación, las oportunidades de empleo, el rol en la familia y el bienestar. Otros aspectos importantes presentados incluyen la educación sexual y la salud reproductiva, y los relacionados con el SIDA/VIH como pandemia en este grupo de edad. CONCLUSIONES: Los hallazgos presentados revelan que la secuencia tradicional de variables, en la explicación de la transición epidemiológica, no puede seguir manejándose como hasta ahora y nos sugieren de manera imperativa la necesidad de perfilar las necesidades de salud de la adolescencia desde un enfoque holístico, con énfasis en la promoción de estilos de vida sana, que favorezcan un desarrollo justo y equitativo y que además ayuden a enfocar la respuesta social organizada