The authors analysed the gonadal function and age of menarche of 23 female adolescents and young women with SLE, and correlated these with clinical, SLEDAI and therapeutic parameters. The presence of one or more clinical and laboratory parameters defined normal gonadal function: normal menstrual cycles with or without dysmenorrhea; elevated cervical mucus length; normal levels of plasma FSH, LH, estradiol, progesterone, prolactin and testosterone; normal urinary hormonal cytology; serial pelvic ultrasound compatible with ovulatory pattern; and present or previous pregnancy. The mean age of menarche (13.5 +/- 1.4 years) was greater than that found among 2578 healthy Brazilian adolescents (12.5 +/- 1.3 years; P = 0.0002). The delay in menarche correlated with an increase in the duration of the disease (P = 0.0085) and the cumulative dose of prednisone (P = 0.0013) used until the appearance of the menarche. The mean phase length in SLE was 31.5 +/- 10.3. Sixteen female (70%) patients showed normal and seven (30%) abnormal gonadal function. Gonadal function was not correlated with parameters of SLE. These results suggest that the patients of this study reach adulthood with a high chance of fertility.

Menstrual cycles of 30 patients with juvenile systemic lupus erythematosus (JSLE) were compared with 30 age-matched controls. The mean age of patients with JSLE and controls was similar (17.4 +/- 3.2 vs 17.06 +/- 2.08 years, P = 0.66). The mean menarche age was higher in JSLE than controls (13.13 +/- 1.4 vs 11.56 +/- 1.5 years, P = 0.0008). On the contrary, the mean maternal menarche age was similar in both groups (P = 0.62). Menstrual abnormalities and longer length cycles were more frequently observed in JSLE than controls (63% vs 10%, P = 0.0001; 23% vs 0%, P = 0.0105, respectively). The median of follicle stimulating hormone was significantly higher in patients with JSLE compared with controls (4.6 vs 3.4 IU/L, P = 0.0207), and the median of progesterone was lower (32.5 vs 70 ng/mL, P = 0.0033). The median of luteinizing hormone was lower in patients with JSLE with menstrual abnormalities versus normal cycles (2.9 vs 5.5 IU/L, P = 0.019) and both had a high percentage of decreased progesterone levels (63% vs 73%, P = 0.70). Our findings support the notion that menstrual disturbances are frequent and may be associated with pituitary dysfunction leading to a decreased progesterone production. We also reported that in spite of premature ovarian failure being a rare event in JSLE the follicular reserve seems to be low regardless of intravenous cyclophosphamide treatment.

Introduction: The human papillomavirus (HPV) is a prevalent viral infection in the sexually active population, which can be oncogenic and non-oncogenic. Educational efforts by health professionals, aimed at adolescents and their parents, help decision-making on human papillomavirus vaccination, benefiting the implantation process and vaccine coverage.

To evaluate cervicovaginal cytology in adolescents with juvenile systemic lupus erythematosus (JSLE) and to compare them to controls. Fifty-two female adolescents with JSLE (ACR criteria) were compared to 52 age-matched healthy controls. All Pap smears were evaluated by the same cytopathologist blinded to gynecology examination (Bethesda 2001). The mean age of JSLE patients and controls were similar (16.17 +/- 1.94 versus 16.13 +/- 2.16 years, P = 0.92). The cervicovaginal cytology was found to be similar in both groups, although sexual intercourses in the last month were less frequent in JSLE than controls (23% versus 59.6%, P = 0.0003). Only one patient (2%) with JSLE versus two controls (4%) had cervical dysplasia (LGSIL) and human papilomavirus (P = 1.0). Candida spp vaginitis was observed in seven JSLE (14%) versus none in controls (P = 0.012) and was associated with immunosuppressive drugs (P = 0.01) and high dose of prednisone (P = 0.002). Of interest, inflammatory cervicovaginal cytology was observed in 21 (60%) of patients with SLEDAI > or = 4 and only four (23%) of those with SLEDAI < 4 (P = 0.001). Likewise, a higher frequency of inflammatory changes was also observed in virgin JSLE (57% versus 8%, P = 0.005). Our findings supports the notion that female genital tract may be a potential target organ in SLE since cervical inflammation is associated to disease activity independently of sexual activity.

Background Low national immunization coverage (44.64%) requires strengthening the vaccination campaign to improve knowledge about HPV and its vaccine among adolescents and parents/guardians. Our aim is to evaluate factors related to knowledge about HPV, its vaccine, acceptability and divergences among Brazilian adolescents and parents/guardians. Methods A cross-sectional study was performed at a health unit of Sao Paulo University, Brazil, from 2015 to 2016. The convenience sample comprised 1047 individuals, including 74% (n = 776) adolescents and 26% (n = 271) parents/guardians, who answered a survey (knowledge about HPV, its vaccine, barriers and acceptability). Results The main source of information for adolescents was school (39%, n = 298); for parents/guardians, it was health professionals (55%, n = 153). Parents/guardians were 2.48 times more likely than adolescents to know that HPV caused changes in the Pap smear test [RR 2.48, 95% CI 2.03–3.01 (p < 0.001)], 1.43 times likely to be aware that HPV was a sexually transmitted infection [RR 1.43, 95% CI 1.22–1.68 (p < 0.001)], and 2.77 times likely to be informed that the HPV vaccine decreased the chance of having genital warts [RR 2.77, 95% CI 2.22–2.47 (p < 0.001)]. Girls knew more about the topic than boys (RR 1.67; 95% CI 1.10–2.60); education increased parents’ knowledge [(RR 3.38; 95% CI 1.71–6.69)]. Conclusion Female adolescents and parents/guardians with a higher level of education are factors related to suitable knowledge about HPV and its vaccine among Brazilian respondents. There were differences between parents/guardians and adolescents in HPV awareness, clinical implications, vaccine knowledge and vaccine acceptance.

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OBJECTIVE:The aim of this study was to evaluate the frequency of teenage pregnancy in all Brazilian regions and states in the period of 2000-2019 among two age groups, namely, 10-14 and 15-19 years old, and correlate it with the human development index. METHODS:A cross-sectional study was performed by using the data from the Live Birth Info System from the National Health System's database. RESULTS:The percentage of live births from teenage mothers (age 10-19 years) in Brazil decreased by 37.2% (i.e., 23.4 in 2000 to 14.7% in 2019) in all regions. Amazonas and Maranhão were the only states to show increased fertility rates for teens in the age group of 10-14 years. The fertility index decreased from 80.9-48% in all states among mothers aged 15-19 years. Only the Southeast and South regions showed levels below the Brazilian average (i.e., 38.2 and 39%, respectively). The proportion of live birth showed an inversely proportional trend to the human development index score.CONCLUSIONS: Brazil shows a decline in the percentage of live birth among adolescent mothers and the fertility rate. Live birth is inversely proportional to the human development index score. However, the teenage pregnancy numbers are still high, with great regional inequality in the country.

Background As reported by the World Health Organization, adolescent pregnancy is a major public health concern given its impact on the life of mothers and their family members. In this study we investigated possible cause-effect relations between teenage pregnancy and school dropout, and other attributes that gravitate around them, using the Bayesian network approach. Methods We used a database prepared by the Adolescent House Project and invited experts in the areas of Health, Education and Social Assistance to answer a survey containing questions aimed at detecting possible causal relationships. To perform the statistical analysis and the numerical simulations we employed the language and formalism of Bayesian networks. Results The analysis indicated a strong cause-effect relation between teenage pregnancy and school dropout, bolstered by economic vulnerability. We were able to identify the profile of the female teenager who drops out from school: white girls older than 15 years who got pregnant at least once, are not working to generate an income, and who belong to the group where the family income is less than or equal to US$780 per month. Also we detected the “maternal impact factor", i.e., the effect caused by whether or not the mothers of the teenagers have experienced teenage pregnancy. Conclusion There are many factors that lead teenagers to drop out of school; we confirmed not only the commonsense notion that pregnancy of the teenager is a major factor but found that a history of teenage pregnancy on the part of the mother is a major factor. Moreover, Bayesian networks emerged as an interesting mathematical framework to perform the statistical analysis.