33 research outputs found
Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study
<p>Abstract</p> <p>Background</p> <p>Puberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years).</p> <p>Methods</p> <p>Early menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire from a nationally representative sample of 1072 15 years old girls in school classrooms. Family environment, school experience, physical and psychological factors, risk behaviours (substance use and sexual initiation) were recorded. Logistic regression models were applied (analysing for crude and adjusted relationships between early menarche and risk behaviours controlled for family context).</p> <p>Results</p> <p>Median age at menarche was 13.0 years; 57 girls (5.3%) were early-matured. Controlled for familial environment, early menarche was associated with having had more than two life-drunkenness episodes (adjusted OR = 2.5 [1.3-4.6]), early sexual initiation (adjusted OR = 2.8 [1.3-6.0]) and overweight (adjusted OR = 7.3 [3.6-14.9]).</p> <p>Conclusion</p> <p>Early-maturing girls may affiliate with older adolescents, hence engage in risk behaviours linked to their appearance rather than their maturity level. Factors associated with early menarche highlight the need to focus attention on early-matured girls to prevent further health problems linked to risk behaviours.</p
Prevalence of emergency contraceptive pill use among Spanish adolescent girls and their family and psychological profiles
The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background:Adolescent girlsâ family context and psychological characteristics play important roles in their sexual behavior, including the use of the emergency contraceptive pill (ECP). This study aims to (1) determine the prevalence of ECP use among girls who have had sexual intercourse and (2) comparatively analyze their family and psychological profiles according to whether they have used ECPs. Methods:The sample of 1735 Spanish girls aged 15 to 18 came from a representative sample of the 2014 edition of the Health Behaviour in School-aged Children (HBSC) study. Of this sample, 398 girls had sexual intercourse and reported their ECP use. Data collection for the HBSC study was performed through an online questionnaire to which adolescents responded anonymously in school. Data analyses were descriptive and bivariate and were performed with the statistical program IBM SPSS Statistics 23.Results:The results demonstrated that 30.65% of girls who had sexual intercourse used ECPs. Noticeable differences in paternal knowledge and communication with the father were observed between girls who used the ECP at least once and those who did not use it. In contrast, differences between girls who used the ECP once and those who used it twice or more were pronounced with regard to parental knowledge, communication with parents, maternal affection,life satisfaction, sense of coherence and depression. Conclusions:This work demonstrates a high prevalence of ECP use and a more positive family and psychological profile for girls who used ECP once compared with those who used it twice or more.Peer reviewedFinal Published versio
Use of emergency contraceptive pill by 15-year-old girls: results from the international health behaviour in school-aged children (hbsc) study
Objective
To describe emergency contraceptive pill (ECP) use and variation across countries/regions; and to explore personal and contextual factors associated with ECP use and differences across countries/regions.
Design
Data were obtained from 11 countries/regions in the 2006 Health Behaviour in School-aged Children cross-sectional study.
Setting
Data were collected by self-report questionnaire in school classrooms.
Population
The analysis is based on 2118 sexually active 15-year-old girls.
Methods
Contraceptive behaviours were compared across countries/regions by chi-square tests. Individual factors related to ECP use were investigated with separate logistic regression models. Multilevel random-intercept models allowed the investigation of individual and contextual effects, by partitioning the variance into student, school and country/region levels.
Main outcome measures
ECP use at last sexual intercourse.
Results
ECP use rate varied significantly across countries/regions. Poor communication with at least one adult (odds ratio [OR] 1.62 [1.12-2.36], P = 0.011) and daily smoking (OR 1.46 [1.00-2.11], P = 0.048) were independently associated with ECP use in comparison with condom and/or birth-control pill use. Sexual initiation at 14 years or later (OR 2.02 [1.04-3.93], P = 0.039), good perceived academic achievement (OR 1.69 [1.04-2.75], P = 0.035) and daily smoking (OR 1.63 [1.01-2.64], P = 0.045) were associated with higher levels of ECP use in comparison with unprotected girls. The country-level variance remained significant in both comparisons.
Conclusions
These data document the large heterogeneity in rates of ECP use between countries/regions. These differences could not be explained by individual or contextual factors, and raise further questions in relation to ECP access for adolescents and their education in its appropriate use
Use of emergency contraceptive pill by 15-year-old girls: results from the international health behaviour in school-aged children (hbsc) study
Objective
To describe emergency contraceptive pill (ECP) use and variation across countries/regions; and to explore personal and contextual factors associated with ECP use and differences across countries/regions.
Design
Data were obtained from 11 countries/regions in the 2006 Health Behaviour in School-aged Children cross-sectional study.
Setting
Data were collected by self-report questionnaire in school classrooms.
Population
The analysis is based on 2118 sexually active 15-year-old girls.
Methods
Contraceptive behaviours were compared across countries/regions by chi-square tests. Individual factors related to ECP use were investigated with separate logistic regression models. Multilevel random-intercept models allowed the investigation of individual and contextual effects, by partitioning the variance into student, school and country/region levels.
Main outcome measures
ECP use at last sexual intercourse.
Results
ECP use rate varied significantly across countries/regions. Poor communication with at least one adult (odds ratio [OR] 1.62 [1.12-2.36], P = 0.011) and daily smoking (OR 1.46 [1.00-2.11], P = 0.048) were independently associated with ECP use in comparison with condom and/or birth-control pill use. Sexual initiation at 14 years or later (OR 2.02 [1.04-3.93], P = 0.039), good perceived academic achievement (OR 1.69 [1.04-2.75], P = 0.035) and daily smoking (OR 1.63 [1.01-2.64], P = 0.045) were associated with higher levels of ECP use in comparison with unprotected girls. The country-level variance remained significant in both comparisons.
Conclusions
These data document the large heterogeneity in rates of ECP use between countries/regions. These differences could not be explained by individual or contextual factors, and raise further questions in relation to ECP access for adolescents and their education in its appropriate use
Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians
International audienc
Lâinterruption volontaire de grossesse : recommandations pour la pratique clinique â Texte des recommandations (texte court).
National audienceObjectif Ălaborer des recommandations pour la pratique des IVG. MatĂ©riel et mĂ©thodes Consultation de la base de donnĂ©es Medline, de la Cochrane Library et des recommandations des sociĂ©tĂ©s savantes françaises et Ă©trangĂšres. RĂ©sultats Le nombre dâIVG est stable depuis plusieurs dĂ©cennies. Il existe plusieurs Ă©lĂ©ments expliquant le choix de lâIVG lorsquâil existe une grossesse non prĂ©vue (GNP). Lâinitiation prĂ©coce de la contraception et le choix de la contraception en rapport avec la vie de la femme sont associĂ©s Ă une diminution des GNP. Les contraceptions rĂ©versibles de longue durĂ©e dâaction apparaissent comme une contraception Ă positionner en premiĂšre ligne pour lâadolescente du fait de son efficacitĂ© (grade C). LâĂ©chographie avant une IVG doit ĂȘtre encouragĂ©e mais nâest pas indispensable pour rĂ©aliser une IVG (accord professionnel). DĂšs lâapparition Ă©chographique de lâembryon, lâestimation de la datation de la grossesse se fait par la mesure de la longueur cranio-caudale (LCC) ou par la mesure du diamĂštre bipariĂ©tal (BIP) Ă partir de 11 SA (grade B). Les mesures Ă©tant fiables à ± 5 jours, lâIVG peut ĂȘtre rĂ©alisĂ©e lorsque les mesures de LCC et/ou de BIP sont respectivement infĂ©rieures Ă 90 mm et 30 mm (accord professionnel). LâIVG mĂ©dicamenteuse rĂ©alisĂ©e avec la dose de 200 mg de mifĂ©pristone associĂ© au misoprostol est efficace Ă tout Ăąge gestationnel (NP1). Avant 7 SA, la prise de mifĂ©pristone sera suivie entre 24 et 48 heures de la prise de misoprostol par voie orale, buccale, sublinguale voire vaginale Ă la dose de 400 ÎŒg Ă©ventuellement renouvelĂ© aprĂšs 3 heures (NP1, grade A). Au-delĂ de 7 SA, les modes dâadministration du misoprostol, par voie vaginale, sublinguale ou buccale, sont plus efficaces et mieux tolĂ©rĂ©s que la voie orale (NP1). Il est recommandĂ© dâutiliser systĂ©matiquement une prĂ©paration cervicale lors dâune IVG instrumentale (accord professionnel). Le misoprostol est un agent de premiĂšre intention pour la prĂ©paration cervicale Ă la dose de 400 ÎŒg (grade A). Lâaspiration Ă©vacuatrice est prĂ©fĂ©rable au curetage (grade B). Un utĂ©rus perforĂ© lors dâune aspiration instrumentale ne doit pas ĂȘtre considĂ©rĂ© en routine comme un utĂ©rus cicatriciel (accord professionnel). LâIVG instrumentale nâest pas associĂ©e Ă une augmentation du risque dâinfertilitĂ© ultĂ©rieure ou de GEU (NP2). Les consultations mĂ©dicales prĂ©-IVG nâinfluent pas sur la dĂ©cision dâinterrompre ou non la grossesse et une majoritĂ© de femmes est assez sĂ»re de son choix lors de ces consultations. LâacceptabilitĂ© de la mĂ©thode et la satisfaction des femmes semblent plus grandes lorsque celles-ci sont en mesure de choisir la mĂ©thode dâIVG (grade B). Il nây a pas de relation entre une augmentation des troubles psychiatriques et le recours Ă lâIVG (NP2). Les femmes ayant des antĂ©cĂ©dents psychiatriques sont Ă risque accru de troubles psychiques aprĂšs la survenue dâune grossesse non prĂ©vue (NP2). En cas dâIVG instrumentale, la contraception estro-progestative orale et le patch devraient ĂȘtre dĂ©butĂ©s dĂšs le jour de lâIVG, lâanneau vaginal insĂ©rĂ© dans les 5 jours suivant lâIVG (grade B). En cas dâIVG mĂ©dicamenteuse, lâanneau vaginal devrait ĂȘtre insĂ©rĂ© dans la semaine suivant la prise de mifĂ©pristone, la contraception estro-progestative orale et le patch devraient ĂȘtre dĂ©butĂ©s le jour mĂȘme ou le lendemain de la prise des prostaglandines (grade C). En cas dâIVG instrumentale, lâimplant devrait ĂȘtre insĂ©rĂ© le jour de lâIVG (grade B). En cas dâIVG mĂ©dicamenteuse, lâimplant peut ĂȘtre insĂ©rĂ© Ă partir du jour de la prise de mifĂ©pristone (grade C). Le DIU au cuivre et au lĂ©vonorgestrel doit ĂȘtre insĂ©rĂ© prĂ©fĂ©rentiellement le jour de lâIVG instrumentale (grade A). En cas dâIVG mĂ©dicamenteuse, un DIU peut ĂȘtre insĂ©rĂ© dans les 10 jours suivant la prise de mifĂ©pristone aprĂšs sâĂȘtre assurĂ© par Ă©chographie de lâabsence de grossesse intra-utĂ©rine (grade C). Conclusion Lâapplication de ces recommandations devrait favoriser une prise en charge plus homogĂšne et amĂ©liorĂ©e des femmes dĂ©sirant une IVG. Summary Objective Develop recommendations for the practice of induced abortion. Materials and methods The Pubmed database, the Cochrane Library and the recommendations from the French and foreign Gyn-Obs societies or colleges have been consulted. Results The number of induced abortions (IA) has been stable for several decades. There are a lot of factors explaining the choice of abortion when there is an unplanned pregnancy (UPP). Early initiation and choice of contraception in connection to the woman's life are associated with lower NSP. Reversible contraceptives of long duration of action should be positioned fist in line for the teenager because of its efficiency (grade C). Ultrasound before induced abortion must be encouraged but should not be obligatory before performing IA (Professional consensus). As soon as the sonographic apparition of the embryo, the estimated date of pregnancy is done by measuring the crown-rump length (CRL) or by measuring the biparietal diameter (BIP) from 11 weeks on (grade B). Reliability of these parameters being ± 5 days, IA could be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BIP (Professional consensus). A medical IA performed with a dose of 200 mg mifepristone combined with misoprostol is effective at any gestational age (EL1). Before 7 weeks, mifepristone followed between 24 and 48 hours by taking misoprostol orally, buccally sublingually or eventually vaginally at a dose of 400 ug possibly renewed after 3 hours (EL1, grade A). Beyond 7 weeks, misoprostol given vaginally, sublingually or buccally are better tolerated with fewer side effects than oral route (EL1). It is recommended to always use a cervical preparation during an instrumental abortion (Professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 mcg (grade A). Aspiration evacuation is preferable to curettage (grade B). A perforated uterus during an instrumental suction should not be considered as a scarred uterus (Professional consensus). IA is not associated with increased subsequent risk of infertility or ectopic pregnancy (EL2). The pre-abortion medical consultations does not affect, most of the time, the decision to request an IA. Indeed, a majority of women is quite sure of her choice during these consultations. Acceptability of the method of IA and satisfaction appears to be larger when they are able to choose the abortion method (grade B). There is no relationship between an increase in psychiatric disorders and IA (EL2). Women with psychiatric histories are at increased risk of mental disorders after the occurrence of an UPP (EL2). In case of instrumental abortion, oral estrogen-progestogen contraceptives and the patch should be started from the day of the abortion, the vaginal ring inserted within 5 days of IA (grade B). In case of medical abortion, the vaginal ring should be inserted within a week of taking mifepristone, oral estrogen-progestogen contraceptives and the patch should be initiated on the same day or the day after taking prostaglandins (grade C). In case of instrumental abortion, the contraceptive implant may be inserted on the day of the abortion (grade B). In case of medical abortion, the implant can be inserted on the day of mifepristone (grade C). The copper Intrauterine Device (IUD) and levonorgestrel should be inserted preferably on the day of instrumental abortion (grade A). In case of medical abortion, an IUD can be inserted within 10 days following mifepristone after ensuring by ultrasound of the absence of intrauterine pregnancy (grade C). Conclusion The implementation of these guidelines may promote a better and more homogenous care for women requesting IA in our country
Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study
Contains fulltext :
154413.pdf (publisher's version ) (Open Access)BACKGROUND: The primary aim of this study was to describe the variation in intrapartum referral rates in midwifery practices in the Netherlands. Secondly, we wanted to explore the association between the practice referral rate and a woman's chance of an instrumental birth (caesarean section or vaginal instrumental birth). METHODS: We performed an observational study, using the Dutch national perinatal database. Low risk births in all primary care midwifery practices over the period 2008-2010 were selected. Intrapartum referral rates were calculated. The referral rate among nulliparous women was used to divide the practices in three tertile groups. In a multilevel logistic regression analysis the association between the referral rate and the chance of an instrumental birth was examined. RESULTS: The intrapartum referral rate varied from 9.7 to 63.7 percent (mean 37.8; SD 7.0), and for nulliparous women from 13.8 to 78.1 percent (mean 56.8; SD 8.4). The variation occurred predominantly in non-urgent referrals in the first stage of labour. In the practices in the lowest tertile group more nulliparous women had a spontaneous vaginal birth compared to the middle and highest tertile group (T1: 77.3%, T2:73.5%, T3: 72.0%). For multiparous women the spontaneous vaginal birth rate was 97%. Compared to the lowest tertile group the odds ratios for nulliparous women for an instrumental birth were 1.22 (CI 1.16-1.31) and 1.33 (CI 1.25-1.41) in the middle and high tertile groups. This association was no longer significant after controlling for obstetric interventions (pain relief or augmentation). CONCLUSIONS: The wide variation between referral rates may not be explained by medical factors or client characteristics alone. A high intrapartum referral rate in a midwifery practice is associated with an increased chance of an instrumental birth for nulliparous women, which is mediated by the increased use of obstetric interventions. Midwives should critically evaluate their referral behaviour. A high referral rate may indicate that more interventions are applied than necessary. This may lead to a lower chance of a spontaneous vaginal birth and a higher risk on a PPH. However, a low referral rate should not be achieved at the cost of perinatal safety