Sociodemographic, sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group?

Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups. Methods: We recruited a nationally representative sample of 224 adolescents (<16 years, n = 18; 16-17 years, n = 103; 18-19 years, n = 103) who had an abortion. Data were collected from 16 health care services that provide abortion. Results: The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18-19 years age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age. Conclusions: Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy

Trajetórias reprodutivas na origem da gravidez na adolescência: Um estudo representativo da realidade nacional e regional portuguesa

O presente estudo pretendeu caracterizar a história de saúde sexual e reprodutiva de uma amostra de grávidas adolescentes, analisar as trajetórias reprodutivas que conduziram à gravidez e explorar a existência de especificidades regionais neste processo. A amostra foi constituída por um grupo nacional e regionalmente representativo (NUTSII, 2002) de grávidas adolescentes (N = 475) e foi recolhida entre Maio de 2008 e Março de 2013 em 42 serviços de saúde. Os resultados revelaram diferentes sequências de acontecimentos e decisões na origem da gravidez, que se traduziram numa diversidade de trajetórias; estas são detalhadamente descritas. Verificaram-se ainda diferenças regionais ao nível de algumas das variáveis em estudo. Estes resultados são reveladores da diversidade de trajetórias que podem conduzir à gravidez adolescente e da heterogeneidade regional que as caracteriza, podendo contribuir para a especialização da educação sexual e do planeamento familiar no âmbito da sua prevenção

Trajetórias relacionais e reprodutivas conducentes à gravidez na adolescência: A realidade nacional e regional portuguesa.

RESUMO Introdução: Este estudo pretendeu caracterizar as trajetórias relacionais e reprodutivas conducentes à gravidez na adolescência em Portugal, explorando a existência de especificidades regionais. Material e Métodos: O estudo decorreu entre 2008 e 2013 em 42 serviços de saúde públicos. A amostra, nacionalmente representativa, incluiu 459 grávidas com idades entre os 12 e os 19 anos. Os dados foram obtidos por autorrelato, através de uma ficha de caracterização construída para o efeito. Resultados: Independentemente de terem tido um (59,91%) ou múltiplos parceiros sexuais (40,09%), as adolescentes engravidaram de forma mais frequente numa relação de namoro, utilizando contraceção à data da conceção e tendo identificado a falha contracetiva que esteve na origem da gravidez (39,22%). A nível regional, outras trajetórias surgiram com elevada prevalência, refletindo opções como a decisão de engravidar (Alentejo/Açores), a não utilização de contraceção (Centro/Madeira) ou a sua utilização ineficaz sem que a falha contracetiva fosse identificada (Madeira). As relações de namoro revelaram-se maioritariamente duradouras (> 19 meses), com homens mais velhos (> 4 anos) e fora do sistema de ensino (75,16%); estes resultados foram particularmente expressivos quando a gravidez foi planeada. Discussão: O conhecimento gerado por este estudo reflete a necessidade de investir em abordagens preventivas que atendam às necessidades específicas das jovens de cada região e integrem a população masculina de maior risco. Conclusão: Os nossos resultados podem contribuir para o delineamento de políticas de saúde mais eficazes e para uma atuação multidisciplinar mais informada ao nível da educação sexual e do planeamento familiar nas diferentes regiões do país. Palavras-chave: Adolescente; Contraceção; Educação Sexual; Gravidez na Adolescência; Planeamento Familiar. ABSTRACT Introduction: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents’ place of residence. Material and Methods: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). Results: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents’ partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. Discussion: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents’ needs in each region and should include high-risk male groups. Conclusion: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts. Keywords: Adolescent; Contraception; Sex Education; Pregnancy in Adolescence; Portugal

Trajetórias Relacionais e Reprodutivas Conducentes à Gravidez na Adolescência: a Realidade Nacional e Regional Portuguesa

Introdução: Este estudo pretendeu caracterizar as trajetórias relacionais e reprodutivas conducentes à gravidez na adolescência em Portugal, explorando a existência de especificidades regionais. Material e Métodos: O estudo decorreu entre 2008 e 2013 em 42 serviços de saúde públicos. A amostra, nacionalmente representativa, incluiu 459 grávidas com idades entre os 12 e os 19 anos. Os dados foram obtidos por autorrelato, através de uma ficha de caracterização construída para o efeito. Resultados: Independentemente de terem tido um (59,91%) ou múltiplos parceiros sexuais (40,09%), as adolescentes engravidaram de forma mais frequente numa relação de namoro, utilizando contraceção à data da conceção e tendo identificado a falha contracetiva que esteve na origem da gravidez (39,22%). A nível regional, outras trajetórias surgiram com elevada prevalência, refletindo opções como a decisão de engravidar (Alentejo/Açores), a não utilização de contraceção (Centro/Madeira) ou a sua utilização ineficaz sem que a falha contracetiva fosse identificada (Madeira). As relações de namoro revelaram-se maioritariamente duradouras (> 19 meses), com homens mais velhos (> 4 anos) e fora do sistema de ensino (75,16%); estes resultados foram particularmente expressivos quando a gravidez foi planeada. Discussão: O conhecimento gerado por este estudo reflete a necessidade de investir em abordagens preventivas que atendam às necessidades específicas das jovens de cada região e integrem a população masculina de maior risco. Conclusão: Os nossos resultados podem contribuir para o delineamento de políticas de saúde mais eficazes e para uma atuação multidisciplinar mais informada ao nível da educação sexual e do planeamento familiar nas diferentes regiões do país.Introduction: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents’ place of residence. Material and Methods: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). Results: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents’ partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. Discussion: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents’ needs in each region and should include high-risk male groups. Conclusion: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts

Trajetórias reprodutivas na origem da gravidez na adolescência: Um estudo representativo da realidade nacional e regional portuguesa

O presente estudo pretendeu caracterizar a história de saúde sexual e reprodutiva de uma amostra de grávidas adolescentes, analisar as trajetórias reprodutivas que conduziram à gravidez e explorar a existência de especificidades regionais neste processo. A amostra foi constituída por um grupo nacional e regionalmente representativo (NUTSII, 2002) de grávidas adolescentes (N = 475) e foi recolhida entre Maio de 2008 e Março de 2013 em 42 serviços de saúde. Os resultados revelaram diferentes sequências de acontecimentos e decisões na origem da gravidez, que se traduziram numa diversidade de trajetórias; estas são detalhadamente descritas. Verificaram-se ainda diferenças regionais ao nível de algumas das variáveis em estudo. Estes resultados são reveladores da diversidade de trajetórias que podem conduzir à gravidez adolescente e da heterogeneidade regional que as caracteriza, podendo contribuir para a especialização da educação sexual e do planeamento familiar no âmbito da sua prevenção

Relational and Reproductive Trajectories Leading to Adolescent Pregnancy in Portugal: a National and Regional Characterization

Introduction: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents’ place of residence. Material and Methods: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). Results: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents’ partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. Discussion: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents’ needs in each region and should include high-risk male groups. Conclusion: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.Subsídios e bolsas que contribuíram para a realização do trabalho: estudo integrado no projeto de investigação Gravidez na adolescência em Portugal: Etiologia, decisão reprodutiva e adaptação, da responsabilidade da Linha de Investigação Relações, Desenvolvimento & Saúde do Instituto de Psicologia Cognitiva, Desenvolvimento Vocacional e Social da Universidade de Coimbra (Unidade I&D, PEst-OE/PSI/UI0192/2011). Durante a sua execução, os três primeiros autores foram financiados pela Fundação para a Ciência e Tecnologia através de Bolsas Individuais de Doutoramento (SFRH/BD/63949/2009, SFRH/BD/89435/2012 e SFRH/BD/3168/2000, respetivamente)

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms

Contraceção na adolescência - Recomendações para o aconselhamento contracetivo

Adolescente do sexo feminino, 16 anos de idade, naturale residente em Portugal, antecedentes pessoais e familiaresirrelevantes. Contexto sócio-familiar e económicodesfavorável

Sociodemographic, sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group?

Objectives: The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups. Methods: We recruited a nationally representative sample of 224 adolescents (<16 years, n = 18; 16-17 years, n = 103; 18-19 years, n = 103) who had an abortion. Data were collected from 16 health care services that provide abortion. Results: The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18-19 years age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age. Conclusions: Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy

Changes over time in the weight of tablets stored at 25°C/60% RH in comparison with T0.

<p>The vertical bars represent the 95% confidence interval limits for the measured weight variation.</p