Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities.

While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.

Self-Reported Nutritional Status and Breakfast Characterization in Latin American University Students.

OBJECTIVE: To associate breakfast consumption frequency with self-reported nutritional status and dietary patterns of Latin American university students by human development. MATERIAL AND METHODS: This was a cross-sectional, multicenter observational study. University students from 11 Latin American countries (Argentina, Chile, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, Peru, Paraguay, Panama and Uruguay) were invited to participate by answering an online self-administered questionnaire on food consumption and sociodemographic indicators, associations were investigated using logistic regression. RESULTS: The logistic regression analysis showed significant associations between breakfast consumption and the crude model, models 2 and 3 in countries with very high and upper-middle/high human development. However, after adjustment in the most comprehensive model, the association is no longer statistically significant. In the fully adjusted model of the variables, a significant relationship was observed between breakfast consumption and both healthy and unhealthy dietary patterns. Specifically, students who typically consume breakfast exhibit greater consumption of oatmeal and fruits, as well as healthier dinner choices. Conversely, they exhibit lower consumption of fast food, sugary drinks, and juices. In particular, in highly developed countries, along with the mentioned foods, consumption of dairy was linked to breakfast consumption in a positive way, while alcohol consumption was negatively associated. CONCLUSION: University students who eat breakfast on a regular basis maintain a healthier diet in comparison to those who do not, irrespective of their country's level of human development.

Factors associated with the consumption of fruits and vegetables in latin american university students

Objective: Explore the association between compliance with recommended consumption (5-a-day) of fruits and vegetables (F&V) with sociodemographic factors of university students of Latin America. Subjects: We conducted an analytical cross-sectional study in which 4,880 university students from 10 Latin American countries completed a self-administered online survey. Methods: F&V consumption and other sociodemographic variables were measured according to a validated survey. Body mass index was self-reported. Ordinal logistic regression models were applied. Results: Regarding the consumption of F&V, 4.7% of men complied with the recommendation, while in women this value reached 7.7%. In the adjusted model, having a normal weight (OR= 0.59; 95% CI 0.44-0.7; p=<0.001), being female (OR= 0.67; 95% CI 0.49-0.89; p=<0.01), being enrolled in a health-related degree program (OR= 0,60; IC95% 0,45-0,78; p<0.001), having professional parents (OR= 0.75; 95% CI 0.60-0.95; p=<0.05) and practicing physical activity (OR= 0.34; 95% CI 0.27-0.42; p=<0.001) were associated with compliance to F&V consumption recommendations. In the analysis by country, physical activity was the variable most associated with F&V consumption. Conclusion: We observed a low consumption of F&V in university students. The variables associated with compliance to the F&V recommendation were being normal weight, female, being enrolled in a health-related degree program, having professional parents, and practicing physical activity, the latter being the most important variable.

Objetivo: Explorar la asociación de la frecuencia de cumplimiento de las recomendaciones de consumo (5 al día) de frutas y verduras (F&V) con factores sociodemográficos de estudiantes universitarios de América Latina. Metodología: Se realizó un estudio transversal analítico con 4.880 estudiantes universitarios de 10 países de América Latina, quienes completaron una encuesta en línea autoadministrada. Se midió el consumo de F&V y otras variables sociodemográficas según una encuesta previamente validada. El índice de masa corporal fue autoinformado. Se aplicaron modelos de regresión logística ordinal. Resultados: En cuanto al consumo de F&V, en los hombres el 4,7% cumple con la recomendación, mientras que en las mujeres este valor alcanza el 7,7%. En el modelo más ajustado, presentar normopeso (OR= 0,59; IC 95% 0,44-0,7; p=<0,001), ser mujer (OR= 0,67; IC 95% 0,49-0,89; p=<0,01), estar matriculado en carrera relacionada con la salud (OR= 0,60; IC95% 0,45-0,78; p<0,001), tener padres profesionales (OR= 0,75; IC 95% 0,60-0,95; p=<0,05) y realizar actividad física (OR= 0,34; IC 95% 0,27-0,42; p=<0,001) fueron las variables asociadas al cumplimiento del consumo de F&V. En el análisis por país, la actividad física fue la variable más asociada al consumo de F&V. Conclusión: Se observa un bajo consumo de F&V en estudiantes universitarios, y entre las variables asociadas al cumplimiento de la recomendación de F&V se encuentran estar normopeso, sexo femenino, estar cursando una carrera relacionada con la salud, tener los padres y la práctica de actividad física, siendo esta última la variable más importante.

Asociación entre sueño insuficiente, cambio en el tamaño de lasporciones, patrones alimentarios y sobrepeso/obesidad enestudiantes latinoamericanos / Association between insufficient sleep, change in portion size, eating patterns and overweight/obesity in latin american students

Fundamentos: El sueño es una función biológica de vital importancia ya que interviene en múltiples procesosbiológicos como la regulación energética, estando asociada una mala calidad y/o cantidad de sueño con elsobrepeso y la obesidad. El objetivo fue identificar la asociación de sueño insuficiente con cambios en el tamaño delas porciones, patrones alimentarios y sobrepeso/obesidad en estudiantes universitarios de América Latina.Métodos: Estudio transversal y multicéntrico. A los estudiantes, utilizando un cuestionario on-line, se les consultósobre su alimentación, horas de sueño, peso y estatura y otras variables sociodemográficas.Resultados: El estudio incluyó a 4.880 estudiantes, mayoritariamente mujeres (73,8%), la regresión no mostróasociaciones entre sueño insuficiente con estado nutricional y aumento del tamaño de las porciones de alimentos.En el modelo 3 (mayor ajuste) se observó que el sueño insuficiente se asoció con el consumo de infrecuente dedesayuno OR:1,22 (IC 95% 1,07-1,40) y frutas OR:1,16 (IC 95% 1,01-1,33), y no realizar actividad física OR:1,18(IC95% 1,03-1,34). Por otro lado, hubo asociaciones protectoras frente al sueño insuficiente como pertenecer alsexo femenino OR: 0,86 (IC 95% 0,74-0,99) y ser estudiantes de carreras de la salud OR:0,64 (IC 95% 0,56-0,73).Conclusiones: El estudio revela que el sueño insuficiente en estudiantes universitarios se asocia con no desayunartodos los días y consumir insuficiente fruta.(AU)

Background: Sleep is a biological function of vital importance since it intervenes in multiple biological processessuch as energy regulation, with poor quality and/or quantity of sleep being associated with overweight and obesity.The objective was to identify the association of insufficient sleep with changes in portion sizes, eating patterns andoverweight/obesity in university students in Latin America.Methods: Cross-sectional, multicenter study. Students, using an online questionnaire, were asked about their diet,hours of sleep, weight and height, and other sociodemographic variables.Results: The study included 4,880 students, mostly women (73.8%). The regression showed no association betweeninsufficient sleep with nutritional status and increased food portion size. In model 3 (higher adjustment), it wasobserved that insufficient sleep was associated with infrequent consumption of breakfast OR:1.22 (95% CI 1.07-1.40) and fruits OR:1.16 (95% CI 1.01-1.33), and no physical activity OR: 1.18 (95% CI 1.03-1.34), on the other handthere were protective associations against insufficient sleep such as belonging to the female sex OR: 0.86 (95% CI0.74-0.99) and being students of health careers OR:0.64 (95% CI 0.56-0.73).Conclusions: The study reveals that insufficient sleep in university students is associated with not eating breakfastevery day and insufficient fruit consumption.(AU)

Quality of life in Down syndrome in Brazil: a cross-sectional study.

BACKGROUND: Down syndrome is the most commonly genetic cause of developmental delay and intellectual disability, affecting 1:700 live births. It is associated with heart disease and recurrent infections, among other complications that greatly impair the patient's quality of life. OBJECTIVE: To evaluate the major factors associated with quality of life in a cohort of patients with Down syndrome. METHODS: We assessed 1,187 patients with Down syndrome, older than 4 years old, with an adaptation of the Personal Outcomes Scale validated for Portuguese language, interviewing patients, parents, and caregivers. RESULTS: A bad quality of life was reported in 56.4% of the sample. The main factors associated with better quality of life were female sex, first medical visit before 4 months old, higher parental education, a professionally active mother, and prenatal care. The main factors associated with worse quality of life were family history of alcohol abuse and psychiatric disorders and comorbidity with autism and epilepsy. CONCLUSION: Clinical comorbidities such as autism and epilepsy carry a heavy burden among patients with Down syndrome, while factors related to family support, such as employment status and educational background of the parents, enhance quality of life. The factors associated with quality of life among patients with Down syndrome should be adequately evaluated in medical consultation and targeted in public health policies.

ANTECEDENTES: A síndrome de Down é a mais comum causa identificável de atraso de desenvolvimento e deficiência intelectual, afetando 1 a cada 700 nascidos vivos. Está associada a cardiopatias, infecções recorrentes e outras complicações que impactam significativamente a qualidade de vida dos pacientes. OBJETIVO: Avaliar os principais fatores associados a qualidade de vida em uma coorte de pacientes com Síndrome de Down. MéTODOS: Avaliamos 1.187 pacientes com síndrome de Down com mais de 4 anos de idade utilizando uma adaptação da versão validada para o português da Escala Pessoal de Resultados, entrevistando pacientes, pais e cuidadores. RESULTADOS: Uma má qualidade de vida foi encontrada em 56.4% da amostra. Os principais fatores associados à melhor qualidade de vida foram sexo feminino, primeira consulta médica antes dos 4 meses de idade, maior nível educacional dos pais, mãe profissionalmente ativa e atenção pré-natal. Os principais fatores associados à pior qualidade de vida foram o histórico familiar de abuso de álcool e distúrbios psiquiátricos, além de comorbidade com autismo e epilepsia. CONCLUSãO: As comorbidades clínicas como autismo e epilepsia levam a um maior impacto entre os pacientes com síndrome de Down, enquanto fatores relacionados ao apoio familiar, como situação profissional e formação educacional dos pais, estão associados à melhor qualidade de vida. Os fatores associados à qualidade de vida de pacientes com síndrome de Down devem ser adequadamente avaliados em consulta médica e alvo de políticas públicas de saúde.

Quality of life in Down syndrome in Brazil: a cross-sectional study / Qualidade de vida na síndrome de Down no Brasil: um estudo transversal

Abstract Background Down syndrome is the most commonly genetic cause of developmental delay and intellectual disability, affecting 1:700 live births. It is associated with heart disease and recurrent infections, among other complications that greatly impair the patient's quality of life. Objective To evaluate the major factors associated with quality of life in a cohort of patients with Down syndrome. Methods We assessed 1,187 patients with Down syndrome, older than 4 years old, with an adaptation of the Personal Outcomes Scale validated for Portuguese language, interviewing patients, parents, and caregivers. Results A bad quality of life was reported in 56.4% of the sample. The main factors associated with better quality of life were female sex, first medical visit before 4 months old, higher parental education, a professionally active mother, and prenatal care. The main factors associated with worse quality of life were family history of alcohol abuse and psychiatric disorders and comorbidity with autism and epilepsy. Conclusion Clinical comorbidities such as autism and epilepsy carry a heavy burden among patients with Down syndrome, while factors related to family support, such as employment status and educational background of the parents, enhance quality of life. The factors associated with quality of life among patients with Down syndrome should be adequately evaluated in medical consultation and targeted in public health policies.

Resumo Antecedentes A síndrome de Down é a mais comum causa identificável de atraso de desenvolvimento e deficiência intelectual, afetando 1 a cada 700 nascidos vivos. Está associada a cardiopatias, infecções recorrentes e outras complicações que impactam significativamente a qualidade de vida dos pacientes. Objetivo Avaliar os principais fatores associados a qualidade de vida em uma coorte de pacientes com Síndrome de Down. Métodos Avaliamos 1.187 pacientes com síndrome de Down com mais de 4 anos de idade utilizando uma adaptação da versão validada para o português da Escala Pessoal de Resultados, entrevistando pacientes, pais e cuidadores. Resultados Uma má qualidade de vida foi encontrada em 56.4% da amostra. Os principais fatores associados à melhor qualidade de vida foram sexo feminino, primeira consulta médica antes dos 4 meses de idade, maior nível educacional dos pais, mãe profissionalmente ativa e atenção pré-natal. Os principais fatores associados à pior qualidade de vida foram o histórico familiar de abuso de álcool e distúrbios psiquiátricos, além de comorbidade com autismo e epilepsia. Conclusão As comorbidades clínicas como autismo e epilepsia levam a um maior impacto entre os pacientes com síndrome de Down, enquanto fatores relacionados ao apoio familiar, como situação profissional e formação educacional dos pais, estão associados à melhor qualidade de vida. Os fatores associados à qualidade de vida de pacientes com síndrome de Down devem ser adequadamente avaliados em consulta médica e alvo de políticas públicas de saúde.

"Your son needs help and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department.

Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.

Asociación entre consumo de alcohol y exceso de peso entre estudiantes universitarios de América Latina

Introducción: El sobrepeso y la obesidad son problemas de salud pública de nivel mundial. Si bien existe información respecto al consumo de alcohol en estudiantes universitarios durante la pandemia, pocos autores han señalado la asociación entre este hábito y el exceso de peso en esta población. El objetivo fue determinar la asociación entre el consumo de alcohol y el exceso de peso en estudiantes universitarios de 10 países de Latinoamérica durante la pandemia por COVID-19. Metodología: Se realizó un estudio transversal y multicéntrico con 4.539 estudiantes universitarios matriculados en diez países de América Latina. Para la valoración del consumo de alcohol se utilizó la pregunta ¿Consumes bebidas alcohólicas? (1 porción 1 vaso de 200 ml). El índice de masa corporal (IMC) se determinó a partir del peso y la altura auto informado. Para determinar si el exceso de peso (IMC ≥25 kg/m2) estaba asociado con el consumo de alcohol, se utilizó un análisis de regresión logística, ajustado por edad, sexo, año de estudio, nivel socioeconómico, actividad física y tabaquismo. Resultados: Entre los estudiantes con estado nutricional normal, un 59,6% no consumía alcohol, mientras entre los que presentaban un exceso de peso era un 55,1%. Los estudiantes que consumían 2 o más porciones de alcohol al día tenían 2,18 veces más riesgo de tener exceso de peso (OR: 2.18 [95% IC: 1,26 a 3,77]), comparado con aquellos que no consumían alcohol. Conclusión: Se observó que aquellos estudiantes que consumieron más alcohol tuvieron más probabilidades de tener exceso de peso.

Introduction: Overweight and obesity are public health problems worldwide. Alcoholic beverages could increase total energy intake causing an increase in body weight. However, few authors have pointed out the association between this habit and excess weight in this population. The objective of this study was to determine the association between alcohol consumption and excess weight in university students from 10 Latin American countries during the COVID-19 pandemic. Methodology: A cross-sectional and multicenter study was carried out with 4,539 university students enrolled in ten Latin American countries. To assess alcohol consumption, the question Do you consume alcoholic beverages? (1 portion 1 glass of 200 ml). Body mass index (BMI) kg/m2 was determined from self-reported weight and height. To determine if excess weight was associated with alcohol consumption, a logistic regression analysis was used, adjusted for age, sex, year of study, socioeconomic level, physical activity, and smoking. Results: Among students with normal nutritional status, 59.6% did not consume alcohol, while among those with a BMI ≥25 kg/m2 it was 55.1%. Students who consumed 2 or more servings of alcohol per day had a 2.18 times greater risk of being overweight (OR: 2.18 [95% CI: 1.26 to 3.77]), compared with those who did not consume alcohol. Conclusion: It was observed that those students who consumed more alcohol were more likely to be overweight.

Microbiota unbalance in relation to high-risk human papillomavirus cervical infection.

OBJECTIVES: To assess vaginal dysfunction using basic vaginal states and the presence of lactobacillary microbiota in patients with human papillomavirus (HPV) infection with no squamous intra-epithelial lesions (SIL), with low-grade squamous intra-epithelial lesions (L-SIL), and with high-grade squamous intra-epithelial lesions (H-SIL) or squamous cell carcinoma compared with a control group (HPV-negative); to establish the prevalence of bacterial vaginosis, candidiasis, and trichomoniasis in the different age groups; and to characterize the species of lactobacilli according to the type of lesion. METHODS: A cross-sectional study was carried out of patients who underwent clinical examination and collection of vaginal fornixes to study basic vaginal states and culture. Species identification of lactobacilli was performed by mass spectrometry. The results were analyzed using the χ2 and Fisher's tests; p<0.05 was considered significant. High-risk viral types were determined using a multiplex real-time polymerase chain reaction test. RESULTS: A total of 741 patients were analyzed and divided into three age groups: Group 1 aged 18-24 years (n=138), Group 2 aged 25-50 years (n=456), and Group 3 aged >50 years (n=147). All groups were further divided into an HPV-negative (control) group and an HPV-positive group without lesions, with L-SIL, or with H-SIL/squamous cell carcinoma. The prevalence of unbalanced basic vaginal states in patients with H-SIL/squamous cell carcinoma was 72.7% (p=0.03) in Group 1, 53.1% (p=0.05) in Group 2, and no cases of unbalance were detected in Group 3. The prevalence of bacterial vaginosis in women with H-SIL/squamous cell carcinoma in Group 1 was 54.5% and in Group 2 was 43.7%. Patients with H-SIL/squamous cell carcinoma had a prevalence of 21.4% of Lactobacillus crispatus, 42.9% of L. jensenii, and 14.3% of L. iners. CONCLUSIONS: A greater unbalance of vaginal microbiota was observed in patients with SIL, especially in those with H-SIL/squamous cell carcinoma. In this group, an increase in L. jensenii and L. iners compared with control was found. L. crispatus had a similar prevalence to the control group. It is important to characterize the lactobacilli species since the unbalance alters the vaginal microenvironment and acts as a co-factor in the persistence of HPV infection.

The Need for Community-Responsive and Flexible Sex Ed for Historically Marginalized Youth.

Introduction: When it is offered, sexuality education in the USA is far from standardized. While studies have explored differences in delivery and type of sexuality education across the USA, sexual and reproductive health inequities persist among historically marginalized groups (Latino/a/x, Black, African American, LGBTQ +). There is a critical need to better understand the systemic barriers to receiving effective sexuality education in these communities. Methods: Participatory research methods were used in working with a community advisory board (CAB)-consisting of emerging adults and service providers from community-based organizations (CBOs) serving youth-to examine how structural barriers contribute to adolescent sexual and reproductive health (ASRH) inequities in Massachusetts. CAB meetings and semi-structured interviews were conducted in the cities of Springfield (n = 14) and Lynn (n = 9) between December 2020 and May 2021. Results: Inflexible funding guidelines, a related evidence-based curricular mandate, and a lack of community-responsive sexuality education fail to meet the sexual and reproductive health (SRH) needs of these youth. Conclusions: Current evidence-based mandates must be revisited to improve young people's access to quality sexuality information in public schools. To guarantee sexuality education curricula is centered in the context of the community and population in which it is implemented, collaboration between youth-serving CBOs and school districts could improve students' overall experience and social-emotional growth by providing comprehensive, positive, and community-responsive curricula. Policy Implications: Funders and programming should prioritize community responsiveness by financially supporting and developing and/or adapting evidence-based curricula to better match the community's needs, which can be completed through culture-centered training and community-based partnership.

[Complete androgen insensitivity syndrome: diagnosis and multidisciplinary management]. / Síndrome de insensibilidad completa a los andrógenos: diagnóstico y manejo multidisciplinario.

Background: Complete androgen insensitivity syndrome (CAIS) is a sexual differentiation disorder, caused by a defect in the androgen receptor gene (AR; OMIM# 313700). It is characterized by the resistance of target tissues to the action of testosterone, which prevents normal male genital development. The objective is to describe a family case of CAIS and highlight the importance of multidisciplinary medical management and early diagnosis of this syndrome. Clinical case: We present two cases of SICA in a Mexican family. Case 1: 18-year-old female patient with primary amenorrhea and a history of surgery at an early age, without performing gonadectomy. Case 2: 11-year-old female patient who, due to the history of her sister, underwent surgery at that age. In both patients, absence of uterus and ovaries, hypoplastic vagina and male gonads is reported. The 46,XY karyotype was detected with the GTG and CBG band technique and fluorescent in situ hybridization with the presence of the Y chromosome in 100% of the cells analyzed. Although both patients were identified with their assigned sex, they were referred to the institution's psychiatric clinic. Conclusions: The importance of multidisciplinary management for the diagnosis of SICA at an early age is discussed, in order to make decisions regarding the treatment and management of patients, avoiding malignant transformation of the male gonads.

Introducción: el síndrome de insensibilidad completa a los andrógenos (SICA) es un desorden de la diferenciación sexual, causado por un defecto en el gen receptor de andrógenos (AR; OMIM# 313700). Se caracteriza por la resistencia de los tejidos diana a la acción de la testosterona, lo que impide el desarrollo genital masculino de manera normal. El objetivo es describir un caso familiar de SICA y destacar la importancia del manejo médico multidisciplinario y el diagnóstico temprano de este síndrome. Caso clínico: presentamos dos casos de SICA en una familia mexicana. Caso 1: paciente de 18 años con amenorrea primaria y antecedente de intervención quirúrgica a edad temprana, sin realizarle gonadectomía. Caso 2: paciente de 11 años que debido al antecedente de su hermana fue intervenida quirúrgicamente a esa edad. En ambas pacientes, se reporta ausencia de útero y ovarios, vagina hipoplásica y gónadas masculinas. El cariotipo 46,XY fue detectado con técnica de bandas GTG y CBG e hibridación in situ fluorescente con presencia del cromosoma Y en el 100% de las células analizadas. Aunque ambas se identificaban con su sexo de asignación, fueron referidas a consulta de psiquiatría de la institución. Conclusiones: se discute la importancia del manejo multidisciplinario para el diagnóstico de SICA a edades tempranas con la finalidad de tomar decisiones respecto al tratamiento y manejo de las pacientes y evitar la malignización de las gónadas masculinas.

Structural Racism and Its Influence On Sexual and Reproductive Health Inequities Among Immigrant Youth.

This community-based participatory research study explores the influence of structural racism on sexual and reproductive health (SRH) inequities among immigrant, including refugee, youth. We conducted interviews with emerging youth and youth service providers living in two communities in Massachusetts. Our results detail three major themes illustrating how structural racism influences SRH inequities among immigrant youth: (1) lack of culture-centered SRH supports for recently immigrated youth; (2) immigration enforcement and fear impacting access to adolescent SRH (ASRH) education and services; and (3) perceived ineligibility related to tenuous legal status as a barrier to accessing ASRH services. Conclusions: Findings illustrate the importance of rooting sexuality education curricula in a culture centered framework that recognizes local cultural understandings, acknowledges structural constraints faced by young people, and prioritizes youth agency and voice when engaging in this work. Raising awareness of SRH resources available to immigrant youth may expand access for this underserved population.

Índice de massa corporal, nutrição e atividade física em crianças e adolescentes com síndrome de Down / Body-mass index, nutrition and physical activity in children and adolescents with Down syndrome

Objetivo: Descrever e comparar hábito nutricional, prática de atividade física e índice de massa corporal (IMC) de crianças e adolescentes com síndrome de Down acompanhados em ambulatório especializado de um hospital terciário no sul do Brasil. Método: Estudo transversal realizado a partir da análise de prontuário de pacientes com síndrome de Down em idade escolar e adolescentes acompanhados em ambulatório especializado do Complexo Hospital de Clínicas da Universidade Federal do Paraná. A alimentação foi considerada adequada se consistisse em alimentos de todos os grupos nas três refeições principais e um ou dois lanches e água nos intervalos. Sedentarismo foi definido como tempo de atividade física inferior a 300 minutos por semana. O estado nutricional foi avaliado usando as curvas de IMC da Organização Mundial da Saúde, 2007.Resultados: O estudo incluiu 755 pacientes, sendo 236 (31,3%) crianças e 519 (68,7%) adolescentes. Sobrepeso e obesidade foram observados em 10,7% e 14,8% da população, respectivamente, sem diferença significativa entre os gêneros. Alimentação inadequada foi observada em 34,6% e sedentarismo em 23,7% dos pacientes. IMC elevado foi observado em 20,3% das crianças e 27,9% dos adolescentes (p=0,026). Observou-se sedentarismo em 29,5% dos adolescentes e 11% das crianças (p<0,001). Alimentação inadequada também foi mais prevalente em adolescentes, porém sem diferença estatística. Pacientes com IMC elevado, em comparação com eutróficos, tiveram maior prevalência de alimentação inadequada e sedentarismo, com significância estatística. Nesse subgrupo, o sedentarismo foi observado em 25% das crianças e 57,2% dos adolescentes (p<0,001). Conclusão: Adolescentes com síndrome de Down apresentam maiores taxas de IMC elevado e sedentarismo comparados com crianças. Estudos específicos em educação em saúde para essa população são necessários com o objetivo de promover hábitos de vida saudáveis e prevenir a obesidade com efetividade. [au]

Objective: To describe and compare the nutritional habits, physical activity, and body mass index (BMI) of children and adolescents with Down syndrome followed up in the specialized outpatient clinic of a tertiary hospital in southern Brazil. Method: Cross-sectional study conducted from the analysis of medical records of patients with Down syndrome at school age and adolescents followed up at the Complexo Hospital de Clínicas of the Universidade Federal do Paraná. The diet was considered adequate if it consisted of foods from all groups in the three main meals and one or two snacks and water in the intervals. A sedentary lifestyle was defined as physical activity time of fewer than 300 minutes per week. Nutritional status was assessed using BMI curves from the World Health Organization, 2007. Results: The study included 755 patients, of whom 236 (31.3%) were children and 519 (68.7%) were adolescents. Overweight and obesity were observed in 10.7% and 14.8% of the population, respectively, without significant gender differences. Inadequate diet was observed in 34.6% and sedentarism in 23.7% of the patients. High BMI was observed in 20.3% of children and 27.9% of adolescents (p=0.026). Sedentarism was observed in 29.5% of adolescents and 11% of children (p<0.001). Inadequate diet was also more prevalent in adolescents but without statistical difference. Patients with high BMI, compared to eutrophic patients, had a higher prevalence of inadequate diet and sedentarism, with statistical significance. In this subgroup, sedentarism was observed in 25% of children and 57.2% of adolescents (p<0.001). Conclusion: Adolescents with Down syndrome have higher rates of high BMI and sedentarism compared to children. Specific studies in health education for this population are necessary to promote healthy lifestyle habits and effectively prevent obesity. [au]

Calidad de la dieta, estado nutricional y nivel de actividad físicaen estudiantes universitarios de la carrera de enfermería / Diet quality, nutritional status and physical activity level in university students of the nursing career

Fundamentos: Para los estudiantes comenzar los estudios en la universidad es un momento en donde lospatrones nutricionales adquiridos previamente, relacionados con la satisfacción de las necesidades dietéticas,se fijan o se forman nuevos patrones de comportamiento. El objetivo fue evaluar la calidad de la dieta, elestado nutricional y el nivel de actividad física de estudiantes universitarios de enfermería.Métodos: estudio observacional, analítico de corte transversal realizado en 50 universitarios de primer ysegundo año de enfermería. Se recabaron datos sociodemográficos como sexo, estado civil, ocupación yprocedencia, datos antropométricos como peso, talla e IMC; y datos de nivel de actividad física a través delcuestionario internacional versión corta IPAQ. Para evaluar la calidad de la dieta, se aplicó una encuestacerrada de frecuencia de consumo de alimentos basada en las Guías Alimentarias del Paraguay.Resultados: la edad promedio fue de 22,2±4,9 años, 76% fue del sexo femenino, el 86% de los estudiantestenía una calidad poco saludable. 52% de la población se encontraba con estado nutricional adecuado, el 58%de la población universitaria tiene un nivel de actividad física bajo. La calidad de dieta según el sexo, mostróque las mujeres tienen la mayor proporción de dieta poco saludable (64%). Según el estado nutricional, losque se encontraban en normopeso tuvieron la mayor proporción de dieta poco saludable seguidos de losobesos 44% y 28%, respectivamente; y según el nivel de actividad física, los que presentaban un nivel bajo,fueron los que mayormente tuvieron una dieta poco saludable. Se encontraron diferencias significativas entodos los grupos (p<0,05).Conclusiones: la mayor parte de la población universitaria tiene una dieta poco saludable y bajo nivel deactividad física. (AU)

Background: for students, starting their studies at the university is the moment where previously acquirednutritional patterns, related to the satisfaction of dietary needs, are fixed or new patterns of behavior areformed. Objective: to evaluate the quality of the diet, the nutritional status and the level of physical activity ofuniversity nursing students.Methods: observational, analytical cross-sectional study carried out in 50 first- and second-year nursingstudents. Sociodemographic data such as sex, marital status, occupation and origin, anthropometric data suchas weight, height and BMI, physical activity level data were collected through the international short versionIPAQ questionnaire. To evaluate the quality of the diet, a closed survey of food consumption frequency wasapplied, based on the Food Guidelines of Paraguay.Results: the average age was 22.2 ± 4.9 years, 76% were female, 86% of the students had an unhealthyquality. 52% of the population had adequate nutritional status, most of the university population has a lowlevel of physical activity (58%). The quality of diet according to sex, showed that women have the highestproportion of unhealthy diet (64%). According to the nutritional status, the normal weight had the highestproportion of an unhealthy diet followed by the obese 44% and 28% respectively and according to the level ofphysical activity, those who had a low level were the ones who had an unhealthy diet the most. Significantdifferences were found in all groups (p <0.05).Conclusions: most of the university population has an unhealthy diet and low level of physical activity. (AU)

Investigación-acción en las prácticas pedagógicas sobre la enseñanza del cuidado: experiencia docente / Action research in pedagogical practices of teaching caring: teaching experience

Introducción: La enseñanza del cuidado requiere especial atención, así como reconocer su naturaleza representacional, cuál es su dinámica y cuáles son sus relaciones con la propia práctica.Objetivo: Intervenir en la capacitación de profesores para la enseñanza del cuidado, mediante la interpretación y concientización de sus prácticas pedagógicas que trasciendan en el desempeño académico de los estudiantes de la Licenciatura en Enfermería.Metodología: Investigación-acción con enfoque cualitativo-interpretativo. La intervención se llevó a cabo mediante un curso-taller sobre la enseñanza del cuidado, impartido por las investigadoras a 30 docentes de práctica y clínica en el pregrado de Enfermería. El curso se estructuró mediante la metodología del Arco de Charles Maguerez, en sus cinco etapas. Los encuentros de las sesiones fueron observados de forma participante, registrados en un diario de campo y audio-grabados, para posterior transcripción y análisis de contenido. Se conformaron categorías de análisis a partir de las reflexiones y participaciones de los docentes: a) Significado de la enseñanza del cuidado, b) Prácticas pedagógicas a partir del ejemplo (currículum oculto) y c) Identificación de necesidades para mejorar las prácticas pedagógicas.Resultados: Entre los discursos de los profesores se identificó que el significado de la enseñanza del cuidado trasciende en la relación humana; que las prácticas pedagógicas tienen que promover la relación y acompañamiento al estudiante, así como el empoderamiento, la seguridad y confianza en sí mismo y que existen necesidades pedagógicas y didácticas para favorecer el aprendizaje y vincular la teoría y la práctica.Conclusiones: Se requiere fortalecer los equipos de trabajo y la capacitación continua en la enseñanza del cuidado, distinguiendo que existen oportunidades de mejora en el desarrollo de las prácticas pedagógicas (AU)

Introduction: The teaching of care requires special attention, as well as recognizing its representational nature, what is its dynamics and what are its relationships with the practice itself.Objective: To intervene in the training of teachers for the teaching of care, through the interpretation and awareness of their pedagogical practices that transcend the academic performance of the students of the Nursing Degree.Methodology: Action research with a qualitative-interpretive approach. The intervention was carried out through a course workshop on the teaching of care, given by the researchers to 30 practice and clinical teachers in undergraduate Nursing. The course was structured using the Charles Maguerez Arc methodology in its five stages. The meetings of the sessions were observed in a participatory way, recorded in a field diary and audio-recorded, for later transcription and content analysis. Categories of analysis were formed from the reflections and participation of the teachers: a) Meaning of the teaching of care, b) Pedagogical practices based on the example (hidden curriculum) and, c) Identification of needs to improve pedagogical practices.Results: Among the professors' speeches it was identified that the meaning of the teaching of care transcends in the human relationship; those pedagogical practices must promote the relationship and accompaniment of the student, as well as empowerment, security, and self-confidence, and that there are pedagogical and didactic needs to favor learning and link theory and practice.Conclusions: It is necessary to strengthen work teams and continuous training in the teaching of care, distinguishing that there are opportunities for improvement in the development of pedagogical practices (AU)

Vaginal States: Detection of Conversion Processes in Women Using Contraception and Characterization of Vaginal Lactobacillus Species.

BACKGROUND: The vaginal microenvironment, regulated by an immune system, can be protected or altered by many factors, including contraceptive methods. OBJECTIVE: The objective of this study is to evaluate the impact of contraceptive methods on the basic vaginal states (BVSs) and to identify culturable vaginal Lactobacillus species. METHODS: This is a prospective, consecutive, longitudinal, and descriptive study. The vaginal contents of 208 women were sampled prior to initiating contraception and six months later. The BVSs were established using the balance of vaginal content (BAVACO) methodology that evaluates microbiota and vaginal inflammatory reaction (VIR). Lactobacillus species were characterized by biochemical tests and mass spectrometry. The following contraceptive methods were evaluated: combined oral contraceptive pill (COCP), condom (CON) and rhythm method (RHYT). McNemar's test was used. RESULTS: Of the 208 women, 171 attended both examinations. In the COCP group (n=127), 83 vaginal contents maintained a normal microbiota, 1 sample became dysbiotic, and 37/43 dysbiotic microbiota samples reverted to normal (p<0.0001). A conversion to BVS with VIR was detected in the CON group (n=31) (p=0.001). The RHYT group (n=13) maintained its initial BVSs. The predominant Lactobacillus species found were L. crispatus and L. gasseri, with a trend toward a positive association between L. crispatus and COCP (OR=2.82; p=0.058). CONCLUSION: Hormone administration corrected the dysbiosis and preserved a normal BVS. The CON increased the VIR. The protection of the microbiota observed in the rhythm method probably responds to a systemic hormonal influence. The trend toward a positive association between COCP and L. crispatus, with its protective properties, evidenced an effective hormonal relationship.

Biochemical profiling study in umbilical cord blood in mothers with metabolic disorders.

BACKGROUND: During pregnancy metabolic disorders that affect differently the fetus, are known. These could be early or late disorders. OBJECTIVES: To analyze different biochemical parameters in umbilical cord blood (UCB) of healthy and pathological newborns from mothers with metabolic disorders. MATERIALS AND METHODS: Samples from UCB (121) were analyzed of newborn from mothers with metabolic disorders who attended at Obstetrics Division. Patients were consecutive, prospective and transversally studied. Newborn were classified as healthy (n = 65) and pathological (n = 56). The maternal metabolic disorders were gestational or non-gestational diabetes, glucose intolerance, insulin resistance and/or obesity).The disorders of the pathological newborns were intrauterine growth restriction (IUGR) and/or fetal distress. Glucose (Glu), urea, creatinine, uric acid (UA), total bilirubin (TB), total proteins (TP), albumin (Alb), transaminases (ALT/AST), alkaline-phosphatase (ALP), gammaglutamyltranspeptidase (GGT), creatinkinasa (CK), lactatedehydrogenase, amylase (amy), pseudocholinesterase, iron, calcium, phosphorus, magnesium (Mg), sodium, potassium, chlorine, cholesterol (Chol), HDL-Chol, LDL-Chol, triglycerides (TG), high sensitivity C reactive protein (hsCRP) were determined by recommended methods. T-Student's and Mann Withney tests were applied, p < .05. RESULTS: Pathological neonates (n: 56) showed a significant decrease in maternal gestation weeks (GW) and in newborn weight (NW) with respect to healthy newborns (n: 65) from mothers with metabolic disorders (p < .0001). Pathological neonates from mothers with metabolic pathologies (n: 56) showed significant increases in Chol, TG, TB (p < .01), LDL-Chol, UA, Mg, hsCRP, ALP levels (p < .05) and significant decreases in TP, Alb (p < .0001) and Glu, ALT, CK, GGT, amy (p < .05) in UCB with respect to healthy newborns. CONCLUSIONS: In pathological newborn, the decrease in GW and NW would be related to IUGR that accompany these metabolic disorders. The increases observed of the analyzed parameters would be related to cellular destruction associated to maternal pathology and decreases of the parameters to IUGR with hepatic immaturity.

Processed and ultra-processed foods consumption in adults and its relationship with quality of life and quality of sleep / Consumo de alimentos processados e ultraprocessados em adultos e sua relação com qualidade de vida e qualidade do sono

ABSTRACT Objective: To evaluate the consumption of processed and ultra-processed foods in Paraguayan adults and its relationship with quality of life and sleep quality. Methods: A cross-sectional descriptive observational study was carried out on Paraguayan adults in May 2022. An online survey was applied in which sociodemographic data, frequency of food consumption using the NOVA classification and Pan American Health Organization criteria, quality of life evaluated by the European Quality of Life-5 Dimensions and report of hours of sleep were collected. Results: A total of 273 Paraguayan adults were included in the study, of which 71.1% were female, 51.6% lived in the capital, 53.1% were single, 66% had a university educational level and the average age was 36.48±13.2. Regarding the consumption of processed and ultra-processed foods, the critical nutrients most consumed daily were free sugars by 34.0%, and fats by 23.4% of the population. The global quality of life index was low (0,58±0,05) and 69.0% reported insufficient hours of sleep. Statistically significant relationships were found between the consumption of processed and ultra-processed foods with quality of life and quality of sleep (p<0.05 for both). Conclusion: The most consumed critical nutrients in the Paraguayan adult population are free sugars and fats, finding a significant relationship between the consumption of processed and ultra-processed foods with quality of life and quality of sleep.

RESUMO Objetivo: Avaliar o consumo de alimentos processados e ultraprocessados em adultos paraguaios e sua relação com a qualidade de vida e qualidade do sono. Métodos: Foi realizado um estudo observacional descritivo transversal em adultos paraguaios em maio de 2022. Foi aplicado um questionário online onde foram questionados datos sociodemográficos, frequência de consumo alimentar pela classificação NOVA e critérios da Organização Pan-Americana da Saúde, qualidade de vida avaliada pelo Qualidade de Vida Europeia-5 Dimensões - foram coletados e relato de horas de sono. Resultados: Foram incluídas no estudo 273 paraguaios, das quais 71,1% eram do sexo feminino, 51,6% residiam na capital, 53,1% eram solteiras, 66,0% tinham nível universitário e a média de idade foi de 36,48±13,2 anos. Em relação ao consumo de alimentos processados e ultraprocessados, os nutrientes críticos mais consumidos diariamente foram os açúcares livres por 34.0% e as gorduras por 23,4% da população. O índice global de qualidade de vida foi baixo (0,58±0,05) e 69.0% relataram horas insuficientes de sono. Foram encontradas relações estatisticamente significativas entre o consumo de alimentos processados e ultraprocessados com qualidade de vida e qualidade do sono (p<0,05 para ambos). Conclusão: Os nutrientes críticos mais consumidos na população adulta paraguaia são os açúcares e gorduras livres, encontrando uma relação significativa entre o consumo de alimentos processados e ultraprocessados com a qualidade de vida e qualidade do sono.

Hábitos alimentarios y estado nutricional en niños y adolescentes con trastornos del espectro autista que acuden a la Asociación Esperanza / Food habits and nutritional status in children and teenagers with autism spectrum disorders attending the hope association

Los trastornos del espectro autista (TEA) son un grupo de síndromes de desarrollo neurológico, que se manifiestan en la primera infancia. Debido a la selectividad que estos pacientes presentan respecto a los alimentos, es crucial velar por su estado nutricional y calidad de su alimentación. El objetivo fue evaluar los hábitos alimentarios y estado nutricional de niños y adolescentes con TEA que acuden a la fundación Esperanza para el Autismo. El estudio es del tipo observacional, descriptivo de corte transversal realizado en diciembre del 2019 a 30 niños y adolescentes con TEA de 2 a 15 años. Se estudiaron variables sociodemográficas, estado nutricional y hábitos alimentarios. El 80 % de la población fue de sexo masculino. La edad promedio fue de 4,7 años. 83,3 % tenía escolarización. El estado nutricional predominante fue el de obesidad en un 30 %. En relación a los hábitos alimentarios, el consumo de los diferentes alimentos fue de diariamente para los lácteos, frutas y verduras, moderado en cuanto al consumo de carnes, huevo y cereales y azúcares. Los hábitos alimentarios de la población fueron adecuados en cuanto a frecuencia semanal. El estado nutricional predominante fue el de obesidad.

Respiratory and otolaryngological disorders in Down syndrome from one center in Brazil.

Down syndrome (DS) is the most common chromosomal condition. Anatomical and functional variations in the upper and lower airways are component manifestations of the syndrome and increase the risk of various medical problems. The objective of this study was to determine the prevalence of otorhinolaryngological and respiratory diseases in a DS outpatient clinic over a 3-year period. Medical records data from 1207 patients were retrospectively reviewed. Newborn Hearing Screening was positive in 7.1% of patients. Brainstem auditory evoked potential was performed in 1101 children and showed a hearing loss of 19.8% in the first year. It was positive in 21% of 1021 exams. Audiometry was altered in 64 of 994 exams (6.4%), showing a conductive loss in 90%. Adenotonsillectomy was performed in 308 (25.5%) patients, and 169 (14.0%) required serous otitis ventilation tubes. Asthma was observed in 140 (11.6%) patients, and allergic rhinitis in 544 (56.6%). There were hospitalizations for invasive infection in 480 (39.8%) children, and two (0.2%) patients had severe septicemia from pulmonary focus. Five (0.4%) infants had laryngotracheomalacia, and one patient had anomalous right tracheal bronchus. Recognizing the prevalence of respiratory and otorhinolaryngological disorders in patients with DS allows the promotion of optimal follow-up and early treatment, preventing the development of sequelae.