Potential risk factors for diagnosis of ABPA examined in this analysis included sex; age at enrollment; percent of predicted FVC and FEV1 using the equations of Knudson et al; the presence of wheeze on physical examination at the enrollment visit; a diagnosis of asthma within the preceding 6 months; and positive culture for any Pseudomonas at enrollment or within the preceding year.
For calculation of ABPA prevalence rates and prevalence rates of risk factors, the denominators included all patients > 5 years of age enrolled in ESCF with valid data for sex, age, and medical conditions. Prevalence rates were calculated by dividing the number of patients in whom ABPA was diagnosed by the total number of CF patients at risk. The importance Viagra Australia online of possible risk factors and strength of association was estimated using multiple logistic regression. Age, FVC, and FEV1 were entered into the model as categorical variables rather than continuous variables because exploratory analysis indicated that ABPA risk did not increase linearly in association with these variables.
Between December 1993 and May 1996, 14,210 patients aged > 5 years enrolled in ESCF. The frequency distributions for patients’ demographic and disease characteristics are shown in Table 2. Slightly more male than female patients were in this analysis. The mean (SD) age was 17.1 (9.6) years, with a median of 14.7 years. Pulmonary function test data are summarized, for the patients who had reported test values, in Table 2. Pulmonary function measurements were not reported for 6% of the patients. In those with data, the mean (SD) FVC was 84%(25) of predicted value (median, 86%), and the mean (SD) FEVi was 71%(28) of predicted value (median, 73%). Wheezing on physical examination at enrollment was noted in 11% of subjects; asthma was diagnosed in 19% in the 6 months preceding enrollment; and a positive culture for Pseudomonas spp was reported in 62% in the year preceding enrollment.
ABPA was diagnosed in 281 patients (2%) in the 6 months preceding enrollment. In the children < 5 years of age participating in ESCF (n = 3,796), only one case of ABPA was reported. This age group was therefore not included in the analysis. Table 3 shows the regional differences in prevalence of ABPA. The overall reported prevalence rate of ABPA in North America was 2.0%. Regional rates ranged from the low of 0.9% in the Southwest to the high of 4.0% in the western region of the United States. Canada and the other U.S. regions had intermediate prevalence rates.
The idea that children are sexual beings breaks strong taboos in many cultures and can cause unease among parents and professionals. Teenagers’ sexuality can be presented as inherently problematic, with the focus on unwanted pregnancy and STIs causing a blight upon society as a result of ‘promiscuity’.
The only universally accepted sexual activity is that which is seen to take place for reproductive purposes within marriage: this is explicit in most religions and many societies and implicit in others. Sexual deviance is often measured in terms of how far away an activity is from this norm. If children and young people receive negative reactions about their sexuality from adults, they soon learn not to mention sexual matters. Similarly, the sexuality of children and young people is often disregarded by professionals.
Ignoring or avoiding the sexuality of children and young people means missing a whole dimension of important issues and information. Here I return to the two questions introduced at the beginning of this chapter:
As already indicated, even quite young children may be shy about nakedness and concerned about physical privacy. Children and young people of all ages may fail to disclose symptoms if they fear that disclosure could prompt an unwanted physical examination. Symptoms may be relocated to more ‘public’ parts of the body and some ‘disgusting’ symptoms such as discharges not reported at all. Any discussion of menstruation may be experienced as intensely embarrassing, especially with an adult of the opposite sex. Children may feel the need to keep secret their knowledge about sex and reproduction so discussion about future fertility may need to include reassurance and permission to be knowledgeable, together with sufficient explanation to cover gaps and misinformation. Children and young people are often self-conscious about their physical appearance. They may well be ashamed and confused about sexual feelings and embarrassed about romantic attractions, so these may also be kept secret. Their ideas about their future identity as a man or a woman in a relationship, perhaps being a mother or a father, may be too complex to disclose. One of the greatest drivers to secrecy can be if there is any confusion in the child or young person over their sexual buy levitra online in australia orientation or an awareness that they are gay or lesbian. Another is if they have experienced sexual abuse. Any previous experience of professionals being insensitive or disrespectful, especially if confidentiality has not been respected, is also more likely to lead to reluctance to discuss sexual matters.