Barriers and facilitators for the sexual and reproductive health and rights of displaced Venezuelan adolescent girls in Brazil.

Background: The crisis in Venezuela has forced almost eight million people to flee to mainly neighbouring countries, including Brazil. Half of the displaced Venezuelans are women and girls, with adolescent girls facing distinctive challenges to their sexual and reproductive health during displacement and settlement. The aim of this study is to understand the barriers and facilitators for the sexual and reproductive health of adolescent Venezuelan girls residing in Brazil. Methods: The study used qualitative methods, including semi-structured interviews with 19 Venezuelan migrant adolescent girls conducted in Boa Vista and Manaus. We analysed transcripts using thematic analysis, and mapped findings to a theoretical framework based on the Bronfenbrenner Socio-ecological Model, which we adapted to explore how intersectional vulnerabilities at the individual level interact with contextual factors creating barriers and facilitators for health and rights of migrant adolescent girls. Results: Venezuelan adolescent migrants in Brazil face practical and structural barriers in realising their sexual and reproductive health and rights in four areas: menstruation; family planning, contraception and sexually transmitted infection; prenatal, childbirth and postnatal care; and preventing gender-based violence. The reported barriers were lack of knowledge around sexual and reproductive health rights, exposure to violence and lack of access to age-appropriate healthcare services. Mitigating factors included education (both in the family setting and at school); prevention activities undertaken by health services; care provision from non-governmental organisations and international agencies; and best practices in local health services. Conclusions: Host states must take action to enhance the right to sexual and reproductive health for adolescent migrants to allow them to make autonomous, independent and informed choices. A socioecological perspective on sexual and reproductive health and rights can help formulate intersectional policies that interconnect different levels of adolescent migrants' experience.

Exploring the potential of meeting adolescent girls' nutrient needs in urban Colombia using food-based recommendations.

During adolescence, many young people gain greater food choice agency but also become increasingly exposed and susceptible to environmental pressures that influence their food choices. This coincides with increased nutritional needs, especially for girls. In urban Colombia, adolescent diets are often high in undesirable foods and low in nutritious foods, contributing to overweight and micronutrient deficiencies. This study aimed to explore the potential of improving diet quality using food-based recommendations (FBRs) within the parameters of local food systems and adolescents' existing dietary patterns to inform context-specific programmatic responses to malnutrition. We applied linear programming analysis to dietary data from 13- to 20-year-old girls in Medellin to identify problem nutrients, local micronutrient sources, and promising FBRs. Iron and, to a lesser extent, calcium targets were difficult to meet using optimized diets based on local foods, especially for 13- to 17-year-olds. High habitual consumption of foods with excessive salt, fat, or sugar provided >5% of micronutrients in optimized diets. Otherwise, significant micronutrient sources included legumes, meat, dairy, bread, potatoes, and fruit. FBRs met targets for 10 micronutrients but only 32%-39% recommended nutrient intake for iron. FBRs, including occasionally consumed foods and supplements, met all intake targets for less cost, indicating a need to increase access to nutrient-dense products.

"They are men, they will be looking even if you put on pants or a sweatshirt": Girl athletes' and coaches' experiences of body image in Mexico City sport settings.

Body image concerns are a barrier for girls' participation in sports. Scarce evidence from Mexico suggests adolescents experience high levels of body dissatisfaction, and national statistics report low levels of physical activity among girls. This study aimed to explore girls' body image concerns and coaches' perceptions of girls' body image experiences in sport. We used reflexive thematic analysis on secondary data from semi-structured focus groups conducted in Mexico City with 12 girls aged 11-17 years and six coaches from two sports organizations. Girls expressed feelings of self-consciousness about their performance, body-related teasing, the male gaze, and harassment within and outside sports contexts. Lack of support from coaches resulted in making excuses for withdrawing or supporting one another. Coaches' accounts demonstrate gender stereotypes about girls in sport. They acknowledge that girls abandon sport because of appearance-related teasing and body image concerns. In addition, colorism and discomfort with speaking directly about bodily functions are fundamental sociocultural influences affecting their communication. This is the first qualitative study exploring girls' body image concerns and coaches' perceptions of such concerns in Mexico City. Further research in lower- and middle-income countries is key in developing effective intervention programs to help girls benefit from sport.

The paradox of choice in the sexual and reproductive health and rights challenges of south-south migrant girls and women in Central America and Mexico: A scoping review of the literature.

The last decade has seen high levels of displacement in Central America and Mexico, with women and girls representing a growing share of this flow. Women and girls face a unique set of sexual and reproductive health risks, both as a direct result of the migration process, and as a consequence of violence, conflict and oppressive gender norms in the region. This scoping review adopts a five-stage process to search for, identify, and review selected literature to answer two questions: (1) what sexual and reproductive health and rights risks, challenges, and needs do women and girls face before and during displacement; and (2) how do issues of sexual and reproductive health and rights influence women and girls' coping mechanisms and decisions in displacement in the region? Extracted data from intersecting literature on migration, gender, and health in the corridors of migration in Central America and Mexico are mapped and analyzed against a framework adapted from the Guttmacher-Lancet Commission on components of sexual and reproductive health and rights. Many Central American and Mexican women and girls flee conditions of gang-related conflict, gender-based violence, poverty, and other situations of extreme disadvantage. Findings from this study demonstrate they face further deprivation and suffering from the denial of health and rights throughout the migratory cycle. This review finds that migrant women and girls encounter considerable barriers to accessing services of sexual and reproductive health, are vulnerable to sexually transmitted infections, and face many violations of sexual and reproductive rights. Young migrants and sex workers, who are often connected with irregular migration in border areas, appear to be particularly vulnerable. Findings also reveal that the literature tends to focus on sexual health and rights, with a relative paucity of evidence on wider reproductive health issues. Of critical importance is how women and girls must constantly balance risk and opportunity in situations of constrained choice, and how their coping strategies and decisions define and influence their migration trajectories and broader wellbeing. This review identifies a gap in the literature around comprehensive studies that define sexual and reproductive health and rights beyond the confines of disease and sexual behavior, as well as a need for greater focus on under-represented migrant groups such as adolescent girls.

The Economic Burden of Intimate Partner Violence in Colombia: Estimated Health Costs Among Females Aged 13-24.

BACKGROUND: Intimate partner violence (IPV) is the most pervasive form of gender-based violence, often first experienced in adolescence. While the prevalence of IPV is known to be exacerbated in humanitarian settings, little is known in regard to the economic burden of IPV between conflict-affected and non-conflicted-affected groups of women and girls. This top-down costing study examines the total health burden of physical IPV in Colombia, and whether these costs differ by conflict exposure. METHODS: We utilized a nationally representative sample of 13-24-year-old females from the Violence Against Children Surveys (VACS) in Colombia conducted in 2018. Using physical IPV prevalence, the analysis was conducted in four steps: 1) estimate the relative risk of seven IPV-associated health outcomes among the sample and subgroups, 2) estimate the population attributable fraction of IPV for each health outcome, 3) quantify the burden of IPV in disability-adjusted life years (DALYs), and 4) assign health costs in US dollars to the estimated DALYs. RESULTS: We found that the single year health burden associated with physical IPV was $90.6 million USD. Moreover, nearly 40% of the economic burden of physical IPV among females aged 13-24 in Colombia was from those who were conflict-affected (24%). CONCLUSION: Our findings demonstrate that at least 16% of the overall health costs among females 13-24 in Colombia is from the preventable epidemic of physical IPV. In order to prevent and mitigate the costs of gender-based violence, multi-lateral and government investment is critically needed to prevent IPV and support women and girls.

The effects of the aerobic endurance running program on the morphological characteristics of adolescent girls with different nutritional status / Efectos del programa de carrera de resistencia aeróbica en las características morfológicas de las adolescentes con diferentes estados nutricionales

SUMMARY: This study aimed to explore the effects of a single moderate-intensity aerobic endurance running program on the morphological characteristics of normal-weighted and overweighted female adolescents and whether effects differ between individuals of different nutritional statuses. A total of 47 adolescent girls participated in this randomized controlled trial. Before and after 12 weeks of intervention, measurements were obtained for body height, body mass, BMI, triceps, subscapular, abdominal, thigh, and calf skinfolds, and chest, abdominal, thigh, and calf circumference. The total duration of the program was 12 weeks, with a frequency of 2 hours/week (24 sessions). The individual session lasted 60 minutes, and the intensity ranged from 60 % HRmax to 80 %. The findings from the present study suggest that the 12-week aerobic endurance running program induced changes in morphological characteristics of female adolescents. The significant reductions in body mass and BMI were small for normal-weight adolescents (-2,64 % and -3,48 %) and moderate for overweight adolescents (-4,14 % and -4,36 %) following the experimental program. The magnitude of reductions in the skinfold thickness was small for both groups (triceps, subscapular, abdominal, and calf) and moderate for thigh skinfold and a sum of skinfolds in the overweight group. The reductions in the magnitude of all circular measures were small for both groups. It ranged from - 1.59 % to -2.59 % for normal-weight and from -2.54 % to -3.92 % for overweight adolescents, respectively. Additionally, the effects of the applied program seem more favorable to overweight than normal-weight adolescents. This study's current findings indicate that the 12-week aerobic endurance running program is effective due to improvements in morphological characteristics, body mass, and BMI of female adolescents. Additionally, this study's findings show that applied aerobic endurance running program proved more effective for overweight adolescents.

RESUMEN: Este estudio tuvo como objetivo explorar los efectos de un programa único de carrera de resistencia aeróbica de intensidad moderada sobre las características morfológicas de mujeres adolescentes con peso normal y con sobrepeso y si los efectos difieren entre individuos con diferentes estados nutricionales. Un total de 47 niñas adolescentes participaron en este ensayo controlado aleatorio. Antes y después de 12 semanas de intervención, se obtuvieron mediciones de altura corporal, masa corporal, IMC, tríceps, pliegues cutáneos subescapular, abdominal, muslo y pantorrilla, y circunferencia torácica, abdominal, muslo y pantorrilla. La duración total del programa fue de12 semanas, con una frecuencia de 2 horas/semana (24 sesiones). La sesión individual tuvo una duración de 60 minutos y la intensidad osciló entre el 60 % y el 80 % de la FCmáx. Los hallazgos del presente estudio sugieren que el programa de carrera de resistencia aeróbica de 12 semanas indujo cambios en las características morfológicas de las adolescentes. Las reducciones significativas en la masa corporal y el IMC fueron menores para los adolescentes con peso normal (-2,64 % y -3,48 %) y moderadas para los adolescentes con sobrepeso (-4,14 % y -4,36 %) después del programa experimental. La magnitud de las reducciones en el grosor del pliegue cutáneo fue pequeña para ambos grupos (tríceps, subescapular, abdominal y pantorrilla) y moderada para el pliegue cutáneo del muslo y la suma de los pliegues cutáneos en el grupo con sobrepeso. Las reducciones en la magnitud de todas las medidas circulares fueron pequeñas para ambos grupos. Osciló entre -1,59 % y -2,59 % para normopeso y entre -2,54 % y -3,92 % para adolescentes con sobrepeso, respectivamente. Además, los efectos del programa aplicado parecen más favorables para los adolescentes con sobrepeso que para aquellos de peso normal. Los hallazgos actuales de este estudio indican que el programa de carreras de resistencia aeróbica de 12 semanas es eficaz, debido a las mejoras en las características morfológicas, la masa corporal y el IMC de las adolescentes. Además, los hallazgos de este estudio muestran que el programa de carrera de resistencia aeróbica aplicada demostró ser más efectivo para los adolescentes con sobrepeso.

Diet quality, school attendance, and body weight status in adolescent girls in rural Guatemala.

A cluster of factors affects nutritional status among adolescent girls in low- and middle-income countries (LMICs). We investigated the association between school attendance and diet quality among 498 rural adolescent girls (352 attending and 146 not attending school) in Tecpán, Guatemala. In a cross-sectional study, we collected sociodemographic and anthropometric data and characterized the dietary intake using a Food Frequency Questionnaire. We then calculated diet quality using the Healthy Eating Score (HES). Multiple linear regression models were conducted to evaluate the effects of school attendance on diet quality. We found that the overall diet quality among the study participants was poor, according to the HES. However, those who attended school had significantly higher intakes of vitamin A-rich fruits and vegetables (P = 0.04), other fruits (P = 0.01), and milk and milk products (P = 0.004), but a higher intake of fast foods, chips, and saturated fatty acids (P < 0.001). Furthermore, the effects of school attendance on diet quality were significant after adjusting for sociodemographic and lifestyle factors (ß coefficient = -1.70, 95% CI: -3.30 to -0.11) but was attenuated when further adjusted for weight status (ß coefficient = -1.58, 95% CI: -3.17 to 0.02). Our findings suggest that diet quality among girls in rural Guatemala is poor, particularly among those who do not attend school. To advance our understanding of adolescent diet in LMICs, future studies should include adolescents who are out of school.

Knowledge about cervical cancer and HPV immunization dropout rate among Brazilian adolescent girls and their guardians.

BACKGROUND: Infections with Human Papillomavirus (HPV) are the main cause of cervical cancer. Since 2014, the HPV vaccine was introduced in the Brazilian National Vaccination Calendar. The purpose of this study was to assess the knowledge of adolescent girls and their mothers/guardians about HPV and HPV vaccine, identify the factors associated with this knowledge, and evaluate immunization dropout rate. METHODS: This was a cross-sectional study involving adolescent girls and their mothers/guardians. Participants underwent an interview that addressed sociodemographic data, sexual and gynecological history, and knowledge about HPV, HPV vaccine and cervical cancer. The third quartile of the total score was established as a cutoff for assessing knowledge. Adolescents who correctly answered more than four questions and mothers/guardians who obtained more than five correct responses were categorized into high knowledge. Poisson regression analysis was performed to identify variables associated with low knowledge. Vaccination records were used to assess immunization dropout rates. Any adolescent who did not complete the two-dose vaccination schedule was considered dropout. RESULTS: A total of 666 adolescent girls and 623 mothers/guardians were interviewed. Low knowledge was observed in 76.7% of adolescents and 79.8% of mothers/guardians. Most were unaware of the causal relationship between HPV and cervical cancer, signs and symptoms of HPV infection, and had limited knowledge about the HPV vaccine. Factors associated with low knowledge of adolescents were aged 12 years [IRR 1.2 (95% CI 1. 1-1.3)] or less [IRR 1.3 (95% CI (1. 2-1.4)]; household income lower than US$750 [IRR 1.7 (95% CI 1. 1-2.6)] and household income between US$751 and US$1500 [IRR 1.6 (95% CI 1.0-2.6)]. Among mothers/guardians, low knowledge was related to having completed elementary school or less [IRR 1.5 (95% CI 1. 2-2.0)]; and household income lower than US$750 [IRR 1.2 (95% CI 1.0-1.4)]. Knowledge of adolescents and mothers/guardians was not associated with vaccine uptake. HPV immunization dropout rate was considered high (32.3%). CONCLUSION: Knowledge about HPV and cervical cancer as well as vaccine uptake was low. Results highlight the need for educational interventions about HPV and cervical cancer. These actions may contribute to improve adherence to HPV vaccination.

Examining marianismo gender role attitudes, ethnic identity, mental health, and substance use in Mexican American early adolescent girls.

Given the increased trend in substance use patterns among Latina adolescents in recent years, the need for research that identifies gender-specific and culturally relevant protective factors is essential in tailoring interventions. The current study examined the links between marianismo gender role attitudes, ethnic identity, and substance use abstinence among 277 low-income Mexican American early adolescent girls. Mental health was also examined as a potential moderator in these links. Results of linear regression analysis revealed that familismo, virtuous/chaste, and spiritual marianismo gender role attitudes were predictive of stronger ethnic identity; conversely, self-silencing marianismo attitudes were predictive of weaker ethnic identity. Second, results of hierarchical logistic regressions revealed that both virtuous/chaste marianismo gender role attitudes and mental health (low rates of psychological distress) were inversely linked with substance use; furthermore, they had a combined link that was related to even lower rates of substance use among participants. However, ethnic identity did not have a direct or moderating effect on substance use. Findings suggest that the promotion of positive components of marianismo and mental health may have a protective effect against early substance use in Mexican American early adolescent girls.

Fibroadenoma gigante juvenil: reporte de un caso / Giant juvenile fibroadenoma: Case report

Resumen ANTECEDENTES: El fibroadenoma gigante es raro; suele aparecer en mujeres entre 10 y 18 años. Se caracteriza por el crecimiento rápido de una tumoración encapsulada. De 0.5 a 4% corresponden a una forma especial descrita como fibroadenoma gigante o juvenil. La ecografía es el método de elección para el diagnóstico primario. Si bien la causa principal de una masa asimétrica mamaria en niñas es benigna, la extirpación quirúrgica temprana es la mejor manera de asegurar un buen resultado estético. CASO CLÍNICO: Paciente femenina de 12 años, llevada a la consulta debido al aumento de tamaño de la mama izquierda en el lapso de los tres meses previos. Sin antecedentes personales de importancia, sin cirugías previas, sin consumo de medicamentos y sin alergias conocidas. En la exploración física se apreció la asimetría de las mamas debido al aumento de tamaño de la izquierda; la forma de la areola y el pezón sin alteraciones. Se palpó una tumoración de bordes delimitados, consistencia homogénea blanda que ocupaba toda la glándula mamaria de aproximadamente 20 cm. CONCLUSIONES: El fibroadenoma juvenil es una lesión de crecimiento rápido y exponencial que distorsiona la asimetría y afecta la calidad de vida de la paciente. Es importante establecer el diagnóstico diferencial con tumoraciones mamarias para poder aclarar las dudas de nuestras pacientes acerca de su pronóstico. En pacientes jóvenes es importante tener en cuenta un solo acceso para la reconstrucción.

Abstract BACKGROUND: Giant fibroadenoma is rare; It usually appears in women between 10 and 18 years old. It is characterized by the rapid growth of an encapsulated tumor. From 0.5 to 4% correspond to a special form described as giant or juvenile fibroadenoma. Ultrasound is the method of choice for primary diagnosis. Although the main cause of an asymmetric mammary mass in girls is benign, early surgical removal is the best way to ensure a good aesthetic result. CLINICAL CASE: Female patient of 12 years, taken to the consultation due to the in-crease in size of the left breast in the span of the three previous months. No significant personal history, no previous surgeries, no medication and no known allergies. On physical examination, the asymmetry of the breasts was seen due to the increase in size of the left; the shape of the areola and nipple without alterations. A tumor of delimited edges was palpated, smooth homogenous consistency that occupied the entire mam-mary gland of approximately 20 cm. CONCLUSIONS: The juvenile fibroadenoma is a rapidly growing and exponential lesion that distorts the asymmetry and affects the quality of life of the patient. It is important to establish the difference diagnosis with mammary tumors in order to clarify the doubts of our patients about their prognosis. In young patients it is important to consider only one access for reconstruction.

Experiences of violence and abuse among internally displaced adolescent girls following a natural disaster.

AIM: To describe the physical, psychological and sexual violence among internally displaced adolescent girls following the 2010 Haiti earthquake and related risk factors, health concerns and cultural norms. BACKGROUND: Thousands of adolescents were displaced following the earthquake, leaving them vulnerable to abuse and violence. Displaced survivors are disproportionately vulnerable to violence after natural and man-made disasters. DESIGN: A descriptive-correlational design was used to: (1) describe the extent of violence, health risks and concerns in the displaced adolescent girls; and (2) identify correlations in the strength and magnitude of relationships between selected variables including demographics, risk factors and cultural tolerance of violence. METHODS: Data were collected from participants using computer-assisted self-interviews between 2011-2013 including demographics, pre- and post-earthquake violence, perpetrators, risk factors and health consequences. Analysis included frequency, logistic regression and multiple regression. RESULTS/FINDINGS: A majority reported physical, psychological, or sexual abuse both pre- (59%) and post- (64.1%) earthquake. Pre-earthquake, abused adolescents reported the perpetrator as a boyfriend (50%) or family member (30%). Post-earthquake, 20.5% of physical abuse perpetrators were family members. Pre- and post-earthquake physical and sexual abuse did not change. The risk of being sexually abused post-earthquake increased after controlling for age and education. CONCLUSION: Displaced adolescent girls reported similar rates of physical and sexual abuse pre- and post-earthquake. These findings show the importance of preventive policies for adolescent girls in disaster situations in countries with low resources. Social and cultural change is critically needed since abuse was at an unacceptably high rate prior to the earthquake.

Prevalence and factors associated with coinfection of human papillomavirus and Chlamydia trachomatis in adolescents and young women.

BACKGROUND: Human papillomavirus and Chlamydia trachomatis share the same route of sexual transmission and possess similar risk factors, indicating that coinfection may act synergistically in the induction of epithelial cell abnormalities. OBJECTIVE: This study aimed to determine the prevalence of human papillomavirus and Chlamydia trachomatis in adolescents and young women and identify factors associated with coinfection. STUDY DESIGN: This cross-sectional study included 276 female participants, aged 15-24 years, who were sexually active. Interviews were conducted and cervical specimens were collected for cervical smears and molecular tests. All cervical specimens were tested for 27 human papillomavirus genotypes by polymerase chain reaction amplification and hybridization to a human papillomavirus linear array. Detection of Chlamydia trachomatis was performed by polymerase chain reaction using primers directed to the region encoding the cryptic plasmid. Bivariate and multivariate analyses were performed to evaluate the factors associated with coinfection with human papillomavirus and Chlamydia trachomatis. The odds ratio, the adjusted odds ratio, and the 95% confidence interval were calculated. RESULTS: The prevalence of infection by Chlamydia trachomatis and human papillomavirus was 9.1% (95% confidence interval, 5.61-12.4) and 47.1% (95% confidence interval, 41.0-53.2), respectively. The prevalence of coinfection with human papillomavirus and Chlamydia trachomatis was 5.8% (95% confidence interval, 3.3-9.2); coinfection with 1 human papillomavirus type was 3.3% (95% confidence interval, 1.5-6.1) and with multiple types was 2.5% (95% confidence interval, 1.0-5.2). The prevalence of cytological abnormalities was 12.3% (95% confidence interval, 8.6-16.79). Human papillomavirus infections of high oncogenic risk were more prevalent (85.4%). Factors independently associated with coinfection of human papillomavirus/Chlamydia trachomatis obtained by multivariate analysis were the initiation of sexual activity under 16 years of age with an an odds ratio of 4.9 (95% confidence interval, 1.0-23.63; P = .05) and cytological abnormalities with an odds ratio of 10.7 (95% confidence interval, 1.9-59.5; P = .01), which indicates there is risk for the detection of cytological abnormalities in adolescents and young women coinfected with human papillomavirus/Chlamydia trachomatis. CONCLUSION: The prevalence of coinfection among our study population was of a magnitude that warrants attention by public health services. Adolescents and young women should be monitored for Chlamydia trachomatis infection and vaccinated against human papillomavirus. The association between cytological abnormalities and coinfection with human papillomavirus and Chlamydia trachomatis indicates the potential synergistic role of these infections in carcinogenesis of the cervix.

Brief Client-Centered Motivational and Behavioral Intervention to Promote HPV Vaccination in a Hard-to-Reach Population: A Pilot Randomized Controlled Trial.

Objective To evaluate the impact of a client-centered behavioral intervention (Brief Negotiated Interviewing) on mothers' human papillomavirus (HPV) vaccine knowledge and vaccination initiation for their adolescent daughters. Methods We randomized mothers to intervention (n = 100) and control (n = 100) groups, and followed them over 12 months. Electronic medical records were reviewed to determine vaccination status. The primary outcome was receipt of the first vaccine. The secondary outcome was HPV vaccine knowledge among mothers. Results Brief Negotiated Interviewing intervention mothers demonstrated increased knowledge about HPV (pre/post mean score of 5 to 10 out of a possible 11; P < .001) and significantly higher mean knowledge scores (10 vs 6, P < .001) than control mothers. However, initiation and completion rates of the vaccine were not significantly different between groups. Conclusions Increasing HPV vaccine knowledge did not translate into increased vaccine uptake or completion of vaccination series. Future intervention must explore vaccine reminders to increase HPV vaccination rates.

Association between the human papillomavirus, bacterial vaginosis and cervicitis and the detection of abnormalities in cervical smears from teenage girls and young women.

BACKGROUND: Human papillomavirus (HPV) infection, bacterial vaginosis (BV), and cervicitis may play a role in the presence of cytological abnormalities in female adolescents and young women. This study aimed to estimate the prevalence of HPV, BV and cervicitis in female adolescents and young women and evaluate whether these conditions are associated with a finding of cytological abnormalities in cervical smears. METHODS: Cervical smears were screened using the conventional method and HPV-DNA detection was performed by PGMY-PCR. BV was defined as ≥20% clue cells in cervical smears. Cervicitis was assessed by counting leukocytes in five non-adjacent microscopic fields at 1000× magnification. Odds ratios and 95% confidence intervals were calculated. RESULTS: The study analyzed 251 samples, with cytological abnormalities being found in 9.5% (24/251). Atypical squamous cells of undetermined significance (50.0%) and low-grade squamous intraepithelial lesions (29.1%) were the most common findings. HPV, BV and cervicitis were found in 44.2% (111/251), 41.0% (103/251) and 83.2% (209/251) of cases, respectively. Of the variables investigated, BV and an abnormal cytological diagnosis were independently associated with HPV positivity. Cytological abnormalities were significantly associated with a finding of HPV and BV in the same woman, and also with a simultaneous finding of HPV, BV and cervicitis; however, the independent association of these combined variables did not remain significant in the multivariate analysis. CONCLUSIONS: BV and cytological abnormalities were independently associated with HPV infection in female adolescents and young women.

Zinc Absorption from Fortified Milk Powder in Adolescent Girls.

Zinc (Zn) is essential for development, growth, and reproduction. The Mexican government subsidizes micronutrient-fortified milk for risk groups, with positive effect on the targeted groups' plasma Zn level, inferring a good absorption is achieved although it has not being measured. The aim of this study was to determine the impact of micronutrient-fortified milk intake during 27 days on Zn absorption in adolescent girls from northwest Mexico. Therefore, Zn absorption was evaluated in 14 healthy adolescent girls (14.1 years old) with adequate plasma Zn levels, before and after 27 days of fortified Zn milk intake. Fractional Zn absorption (FZA) was calculated from urinary ratios of stable isotopic Zn tracers administered orally and intravenously on days 0 and 27, and total absorbed Zn (TZA) was calculated. At the beginning, Zn intake was 6.8 ± 0.85 mg/d (mean ± SE), and 50 % of the adolescent girls did not achieve their requirement (7.3 mg/d). Additionally, FZA was negatively correlated with Zn intake (r =-0.61, p = 0.02), while TZA (1.06 mg/d) was insufficient to cover the physiologic requirements of adolescent girls (3.02 mg/d). At the end of the intervention, all the girls reached the Zn intake recommendation and TZA, 3.09 mg/d, which was enough to meet the physiological requirement for 57 % of the adolescent girls. Therefore, the low Zn intake and the Zn status of adolescent girls were positively impacted by Zn-fortified milk intake and its good absorption rate.

Effect of micronutrient-fortified milk on zinc intake and plasma concentration in adolescent girls.

OBJECTIVE: To assess the effect of dietary fortified milk with zinc and other micronutrients on zinc intake and plasma zinc content of adolescent girls. METHODS: The study included 108 schoolgirls (12-18 years old) from northwest Mexico, randomly assigned to either the control group (CG; n = 55) or the intervention group consuming a regular diet plus fortified milk (MG; n = 53). At the beginning of the study, age, weight, and height were measured. Food intake by the 24-hour recall method and plasma zinc levels assessed by absorption spectrophotometry were determined before and after 27 days of fortified milk intake. RESULTS: At baseline, no significant group-related differences were observed for energy, protein intake, zinc intake, and plasma zinc level (p > 0.05), and 35.2% of participant girls did not achieve their zinc requirement. After 27 days of treatment, there were no significant differences in energy and protein intake between groups (p > 0.05). Zinc intake was higher for MG than CG (16.7 ± 8.3 mg/d vs 10.5 ± 6.4 mg/d; p < 0.01), and there was a lower proportion of low zinc intake in MG than for CG (7 vs 16, respectively; p = 0.04). In addition, plasma zinc improved in the MG (116.6 ± 26.9 µg/dL, p < 0.01) compared with CG (98.5 ± 26.6 µg/dL), and it was mainly attributed to the fortified milk intake, as the main dietary zinc contributor. CONCLUSION: Fortified milk intake is effective in increasing both intake and plasma zinc levels of adolescent Mexican girls; therefore, it could be an adequate strategy for zinc deficiency prevention or correction among adolescent girls.

HIV-related sexual risk behaviours among late-adolescent Jamaican girls with older male partners / Comportamientos de riesgo sexual en relación con el VIH entre las adolescentes tardías jamaicanas con parejas masculinas de mayor edad

OBJECTIVE: To describe HIV-related sexual risk behaviours among late-adolescent Jamaican girls and examine whether having an age-discordant male sexual partner (> 2 years older) was associated with a decrease in condom use at last coitus. METHODS: Utilizing an expanded Theory of Planned Behaviour, a survey was designed to capture HIV-related sexual risk behaviours. Descriptive and inferential statistics were used to analyse the final sample of one hundred and eighty-four late-adolescent girls (18-21 years) in Kingston, Jamaica. RESULTS: At first coitus, 70.3 per cent of the survey participants had done so with an older partner. At the time of the survey, 58.7 per cent of the sample reported being in an age-discordant relationship, with age differences between 2 and 39 years. While only 12 per cent of the sample reported having more than one sexual partner, 40 per cent of the sample reported that their older male partner had multiple sexual partners. Slightly more than half (58%) of late-adolescent girls reported condom use at last coitus. No significant differences were found in condom use between girls who had age-discordant partners and girls who had similar aged-partners. CONCLUSION: Sexual relationships with older male partners are common among late-adolescent Jamaican girls, and may put girls at risk for acquiring HIV through unprotected coitus and coitus with someone who has multiple partners. As Jamaica and the broader Caribbean struggle to curtail the emergent HIV epidemic among adolescent girls, age-discordant relationships are a significant area for research and prevention efforts of clinicians and public health professionals.

OBJETIVO: Describir los comportamientos de riesgo sexual relacionados con el VIH entre las muchachas jamaicanas adolescentes tardías, y examinar si el tener un companero sexual de edad discordante (> 2 años mayor) estaba o no asociado con la disminución del uso del condón en el último coito. MÉTODOS: Utilizando una teoria del comportamiento planificado extendida, se disenó una encuestapara registrar comportamientos de riesgo sexual en relación con el VIH. Se usaron estadísticas descriptivas e inferenciales a fin de analizar la muestra final de ciento ochenta y cuatro muchachas adolescentes tardías (18-21 anos) en Kingston, Jamaica. RESULTADOS: El primer coito, 70.3 por ciento de las participantes en la encuesta lo tuvieron con un companero de mayor edad. Al momento de la encuesta, 58.7 por ciento de la muestra informó hallarse en una relación de edad discordante, con diferencias de edad entre 2 y 39 anos. Mientras sólo 12 por ciento de la muestra informó tener más de un companero sexual, 40por ciento de la muestra informó que su pareja masculina de mayor edad tenia múltiples parejas sexuales. Casi más de la mitad (58%) de las adolescentes tardías reportaron uso del condón en el último coito. No se encontraron diferencias significativas en el uso del condón entre las muchachas con companeros de edad discordante y muchachas con parejas de edad similar. CONCLUSIÓN: Las relaciones sexuales con parejas masculinas de mayor edad, son comunes entre las muchachas jamaicanas adolescentes tardías. Estas relaciones pueden poner a las muchachas en riesgo de adquirir el VIH a través del coito no protegido y el coito con alguien que tiene múltiples parejas. En un momento en que Jamaica y la región del Caribe luchan por cortar el desarrollo de la epidemia de VIH entre las adolescentes, las relaciones de edades discordantes son un área significativa para los esfuerzos de investigación y prevención por parte de los médicos y los profesionales de la salud pública.