The data demonstrate that parent involvement in diabetes management tasks can be strengthened through a low-intensity intervention integrated into routine follow-up diabetes care. Moreover, despite increased engagement between teen and parent centered around diabetes tasks, the teamwork families showed decreased diabetes-related family conflict. Within the context of a broader cultural recognition of the protective function of parent involvement in the lives of adolescents, the findings of this study reinforce the potential value of a parent-adolescent partnership in managing chronic disease.
Many patients had abnormal puberty and excessive virilization associated with increased adrenal androgens and decreased SHBG. Pubertal patients had low LH and FSH suggesting impaired pituitary-gonadal axis function.
Growth is disturbed by adrenal hypersecretion of androgens or cortisol. Androgen excess in virilizing adrenal tumours causes advanced growth and bone age. In 9 girls with virilizing tumours, mean heights at diagnosis and final heights were 1.23 ± 0.42 and 1.3 ± 0.37 SDS respectively. In poorly controlled CAH, excess androgens cause early epiphyseal fusion and adult short stature. Increased growth occurs only after 18 months of age, even in untreated CAH, i.e. hydrocortisone >10 mg/m2/day is not generally required and may suppress infantile growth, affecting childhood and adult height. Growth was studied in 19 patients, aged 6.4–17.8 years, with Cushing’s disease (CD). At diagnosis, mean height SDS was –1.81 (1.2 to –4.17), 53% < –1.8 SDS, height velocity in 6 was 0.9–3.8 cm/year and mean BMI SDS 2.29 (0.7–5.06). From 1983 to 2001, CD was cured in 18 patients (61%) by transsphenoidal surgery (TSS) alone and 39% by TSS plus pituitary irradiation (RT). In 13 patients, growth hormone (GH) was assessed by ITT/glucagons at 1–108 months after cure. Four had severe GH deficiency (<9 mU/l), 7 subnormal (10–29 mU/l) and 2 normal (>30 mU/l) GH status. Subnormal GH was present in 7 subjects >2 years after TSS or RT cure. In 10 subjects, aged 12.9 ± 3.4 years, growth after cure was studied for 9.1 ± 5.0 years. Nine had no catch-up growth in the interval of 0.3–1.1 years after cure (mean HV 5.3 ± 2.4 cm/year). All these had GH deficiency peak GH 0.5–20.9 mU/l, and received hGH 2.7 mg/m2/week, 3 with GnRHa. All 10 showed long-term catch-up growth with mean delta SDS at diagnosis (Ht SDS–target Ht SDS) –1.72 ± 1.26 improving to –0.83 ± 1.08 (p = 0.0005) at latest of final Ht. At diagnosis, virilization was present in 82% of 17 patients with CD. Mean SDS values of serum androstenedione, DHEA-S and testosterone were normal, i.e. 0.72 (–2.9 to 3.0), –0.8 (6.0 to 2.2), 0.7 (–7.9 to 9.5) respectively, whereas SHBG was reduced at –2.1 (–5.3 to 1.2), increasing free androgen levels. Bone age (BA) was delayed (mean 1.46 years) in 14/16 patients, suggesting cortisol excess contributed more then androgen effect to skeletal maturation. In conclusion, most paediatric patients with CD had subnormal linear growth with delayed BA. After cure by TSS or pituitary irradiation, GH deficiency was frequent and persisted for many years. Treatment with hGH induced significant long-term catch-up growth leading to reasonable final height.
An overview of the state of men's sexual and reproductive health since the 1994 Cairo Conference is presented. Men's involvement in contraception and family planning, paternal involvement, and violence toward women are noted. The five articles in this special issue are introduced. The authors conclude, "Cairo gave us our blueprint for action. The examples here [the five articles] give voice to the slow but important progress of engaging men in achieving this vision of true gender equality." Keywords: International Conference on Population and Development, ICPD, Cairo Conference, men, sexual, reproductive, health, gender revolution, gender equality In 1994, delegates from 180 countries met in Cairo at the International Conference on Population and Development (ICPD, or the Cairo Conference). These delegates included leading advocates in the field of sexual and reproductive health nominated by their governments as well as official representatives from national-level governments. Reflecting and deliberating on the field of sexual and reproductive health, the delegates included in the Plan of Action the following statement:Special efforts should be made to emphasize men's shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning; maternal and child health; prevention of STIs, including HIV; ... shared control and contribution to family income, chilCorrespondence concerning this article should be sent to Gary Barker, Superintendente/Chief Executive, Instituto Promundo, Rua México, 31/1502, Bloco D, Rio de Janeiro, RJ, Brasil. Electronic mail: g.barker@promundo.org.br. Men's Health, Vol. 3, No. 3, Fall 2004, 147-153. © 2004 by the Men's Studies Press, LLC. All rights reserved. 147 dren's education, health and nutrition; and recognition ... of the equal value of children of both sexes. Male responsibilities in family life must be included in the education of children from the earliest ages. Special emphasis should be placed on the prevention of violence against women and children. (United Nations, 1994) While the Cairo Conference was seen as focusing on sexual and reproductive health, and much of it did, the Plan of Action was no less than a manifesto for a gender revolution: namely, men should be fully engaged in achieving gender equality in their family lives and intimate relationships. The Cairo Conference is rightly considered a fundamental moment in the growing international field of promoting men's positive involvement in sexual and reproductive health. It was, and still is, for those of us who are advocates in the field of engaging men in achieving gender equality, our rallying cry. International Journal ofWhen we consider the domain of reproductive and sexual health, women's concerns have always been at the forefront. Maternal mortality and morbidity, family planning and contraception, safe and legal abortion services, and reproductive tract infections are issues that have traditionally been associated with women. Men's...
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