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Chapter 3 reviewed the extent and gravity of gender-based violence doctor for erectile dysfunction philippines purchase cheap malegra fxt online, focused primarily on violence in the home impotence yahoo answers discount malegra fxt 140mg without a prescription. In Kerala erectile dysfunction pump in india purchase 140 mg malegra fxt otc, India erectile dysfunction diagnosis purchase malegra fxt 140mg with amex, a panel survey of ever-married women (that is, married women, widows, or divorcees) found that more than 70 percent of the women who owned land or housing and who had experienced long-term physical violence had left their husband and the matrimonial home, and few had returned. In contrast, almost all of the 20 percent of women who did not own such property went to live with their parents, and, ultimately, half returned to their husbands. Land and housing ownership also demonstrated a more secure exit option than employment: only one-third of women were employed, and the majority were in low-paying and irregular employment. In West Bengal, India, women who did not own land or housing were more likely to report domestic violence than those who did-57 percent of those without property compared to 35 percent of women property owners. In contrast, in Sri Lanka, women who owned property did not report lower rates of intimate partner violence than women who did not own property. The mixed nature of these findings may be due in part to women acquiring property after marriage, when a pattern of violence may already be entrenched in the relationship, but further exploration is needed. However, whether this trend is beneficial for women or ties them to abusive relationships is unclear. It is important to bear in mind that most of the studies do not show causal relationships but instead demonstrate associations. Generally, survey measures of ownership use self-reported ownership, which is obtained simply by asking respondents whether they own the land. This means that land may be reported as "owned" even when this is not strictly the case legally. Questions about asset ownership more generally typically refer to the household and are only sometimes followed by inquiries about individual ownership, which is needed to conduct gender analysis. Questions about access and control may differ depending on the purpose of the survey. The Demographic and Health Surveys, for example, ask men and women individually about ownership of land and housing. It is also important to recognize that joint ownership does not necessarily mean that women and men have equal management rights over the land or housing they own. Reported ownership is where a respondent reports that they own land or housing (usually posed at the household level). However, even when women self-report as joint owners of land parcels with their husband, often only his name is on the documentation. This document may be a formal land title or a customary certificate, certificate of sale, or inheritance documentation. Effective ownership is about decision-making power over how to use and dispose of property. Individuals may have partial ownership rights, such as user rights to cultivate, rent, and even bequeath land, but lack authority to sell the land. For example, 8 percent of women and 15 percent of men are self-reported landowners in Ghana, which falls to 1 percent and 2 percent, respectively, among those with a formal ownership document. Individuals can have control over land under customary law in a number of countries, including Malawi and Rwanda. Under customary law individuals may have rights of use, with differing degrees of freedom to lease out, mortgage, bequeath, or sell. The extent to which an individual perceives herself to be an owner may affect her choices about the land and decision-making more broadly. Increased urbanization means that owning housing in urban areas will become increasingly important for providing a place for women and their families to live as well as a potential source of income. Data on land ownership are scarce and often not comparable across countries but available data suggest that women are disadvantaged. Women who own land are more likely to own it jointly, whereas men are more likely to own land alone. Our analysis of Demographic and Health Survey data suggests that women are less likely to report owning land or housing than are men in most of the 13 countries covered.

Different ethical principles are given greater or lesser consideration in the process of resolving any particular dilemma and a John L erectile dysfunction jet lag order malegra fxt 140mg amex. See also Devereaux best erectile dysfunction pills uk buy malegra fxt 140 mg fast delivery, Definitive Care for the Critically Ill During a Disaster erectile dysfunction doctors in st louis mo order malegra fxt toronto, supra note 8 impotence quoad hoc meaning generic malegra fxt 140 mg overnight delivery, at 61-2S. Duty to Care Duty to Steward Resources Duty to Plan Distributive Justice Transparency Duty to Care First and most importantly, an ethical allocation scheme must respect the fundamental obligation of health care providers to care for patients. Indeed, in an influenza pandemic, health care providers try to care for and save the lives of as many patients as possible. However, the existing medical standard of care necessitates that doctors, nurses, and other health care professionals offer care at the bedside to individual patients, not to populations. Even during a pandemic, medical staff may be unwilling to overlook their responsibilities to their patients. An ethically sound allocation system must sustain rather than erode this relationship between patient and provider. Physicians must not abandon, and patients should not fear abandonment, in a just system of allocation. In the delivery of day-to-day health care in the United States, the preferences of capable patients are generally the deciding factor in whether recommended treatments will or will not be initiated. However, patient preference is not and cannot be the primary factor in devising an allocation system for ventilators in an influenza pandemic; more patients will want ventilators than can be accommodated. A public health emergency such as an influenza pandemic, by virtue of severe resource scarcity, imposes harsh limits on decision-making autonomy for patients and health care providers. Nonetheless, a just scheme must endeavor to support autonomy, when possible, in ways that also honor the duties of care 66 See generally Benjamin Berkman, Incorporating Explicit Ethical Reasoning Into Pandemic Influenza Policies, 26 J. For example, where an eligible patient for ventilator therapy has appropriately articulated the wish to forgo such treatment, that expression of autonomy should be honored. Furthermore, an allocation system should stress the provision of care that may be possible when ventilator therapy is not. An ethically sound allocation system includes alternative forms of medical intervention and/or palliative care for patients not eligible for ventilator therapy. Duty to Steward Resources the second element in the ethical framework for allocating ventilators is the obligation for government and health care providers to responsibly manage resources during a period of true scarcity. The effort to balance this obligation to the community of patients against the primary duty to care for each patient generates the ethical tension in devising an allocation system. Even under ordinary, non-emergency circumstances, health care providers may question whether the estimated benefit of an intervention merits the use of scarce resources. For example, health care providers currently struggle to decide whether a blood transfusion (or antibiotics, or surgical intervention) is appropriate or justified for a particular patient, given that the quantity of a particular resource is limited. Yet an emergency on the scale of a severe influenza pandemic forces health care providers to confront limits far more starkly than they now do. Patients, some of whom might survive under ordinary circumstances, cannot be given the standard level of resources at the expense of numerous other patients who will likely die without any resources at all. Providers need to balance the obligation to save the greatest possible number of lives against that of the obligation to care for each single patient. As the number of affected patients increase, accommodating these two goals require more and more difficult decisions. An allocation system incorporates ethical decision-making processes so that the duty to steward resources and the limitations it may place on individual care is recognized as fair and acceptable under emergency circumstances. Duty to Plan A motivating force in designing an allocation system is the knowledge that planning is an obligation. An absence of a plan leaves allocation decisions to exhausted, over-taxed, front-line health care providers, who already bear a disproportionate burden in an emergency. A failure to produce an acceptable plan for a foreseeable crisis amounts to a failure of responsibility toward both patients and providers. In addition, health care providers are aware that some who served in the aftermath of Hurricane Katrina faced accusations of criminal conduct. Appropriate guidance may help prevent both the actuality and the fear of similar consequences for those who provide care in a future emergency. Although plans are obligatory, the Guidelines represent a starting point for the public and decision-makers to discuss how scarce resources, particularly ventilators, should be allocated. The Task Force acknowledged that current access to health care is unequal; no allocation system for a crisis can resolve inequities in pre-existing health status resulting from unequal access.

The most striking change was a decline in prevalence of asthma in the English speaking counties which formerly had had the highest prevalence erectile dysfunction gene therapy treatment order discount malegra fxt online. A study from Finland indicated a sharp rise in asthma in young adults beginning about 1960 impotence exercises malegra fxt 140 mg amex, while in Scotland the prevalence of wheezing in school children doubled from 10% to 20% between 1965 and 1989 erectile dysfunction pump treatment malegra fxt 140mg on-line. In the United States impotence of organic origin meaning order discount malegra fxt on-line, hospitalizations for asthma began to increase in 1972, deaths attributed to asthma began to rise in 1978, while from 1980 to 1994 the Copyright 2011 World Allergy Organization 36 Pawankar, Canonica, Holgate and Lockey 4. Factors considered to underlie the increase in asthma are poorly understood even though connections with the Western-type lifestyle seem to be a common factor. Possibilities include diet, air pollution, exposure to certain environmental chemicals and drugs, virus infection, maternal tobacco smoking and changes in housing type and indoor environment. Most likely multiple factors will interact and these may differ in different countries. Hospitalizations and Mortality Annual worldwide deaths from asthma have been estimated at 250,000 and mortality does not appear to correlate well with asthma prevalence. Several countries have experienced a decline in asthma deaths that appears to correlate with increasing use of inhaled corticosteroids in those countries. Asthma mortality is most accurately tracked in the 5-34 year old age group, due to absence of confounding diagnoses. Data from the United States, Canada, New Zealand, Australia, Western Europe, Hong Kong and Japan show a rise in the asthma mortality rate from 0. This has coincided with the introduction of national and international asthma management guidelines, although the implementation of these in different countries is highly variable dependent in Figure 3 - 12-month prevalence of self-reported asthma symptoms from written questionnaires. Data were obtained on asthma prevalence in 138,565 subjects 2044 years of age from 22 countries mostly in Europe, but also Oceania and North America. Overall, the prevalence of reported wheezing in the adults varied from part on costs and socio-economic conditions. In the United States nearly a half million hospitalizations occur each year for asthma and, despite declining mortality, hospitalization rates have remained relatively stable over the last decade which must reflect persisting problems with diagnosis and health care provision. Treatment Guidelines Inhaled corticosteroids are currently the most effective antiinflammatory medications for the treatment of persistent asthma. They are effective in reducing asthma symptoms, improving quality of life, improving lung function, decreasing airway hyperresponsiveness, controlling airway inflammation, reducing frequency and severity of exacerbations, and reducing asthma mortality. However, they suppress but do not cure asthma and when discontinued deterioration of clinical control follows within weeks to months in the majority of patients. Due to the shallow dose-response to inhaled corticosteroids, patients not controlled on low dose inhaled corticosteroids will usually do better with the addition of another controller medication rather than an increased dose of inhaled corticosteroids. Somewhat less effective than long-acting beta-agonists, but still having some additive effect with inhaled corticosteroids, are the leukotriene pathway modifying agents and theophylline. It is in these patients that acute exacerbations triggered by environmental factors, including common respiratory virus infections, cause the most difficulty, often leading to unscheduled physician consultation, hospitalization or emergency room treatment. It follows that the economic burden of asthma disproportionately affects those with the most severe asthma. It is critical in patients presenting with severe asthma that the diagnosis of asthma be confirmed, as misdiagnosis is common in this setting. Despite this burden of asthma, use of anti-inflammatory medication was the exception, ranging from 26% in Western Europe to 9% in Japan. A Norwegian survey in 2006 showed that less than half of children admitted to hospital with asthma had been taking a regular inhaled corticosteroid, and in Turkey this fell to only one fifth of children diagnosed with asthma. In all cases, there is overdependence on short acting bronchodilators to manage acute attacks without considering the benefits of long-term antiinflammatory treatment with topical corticosteroids. Studies from Europe and America indicate that one third of school-age children with asthma may be undiagnosed. Undiagnosed asthma has also been reported to be common among adults and to be a particular problem in the elderly. Undiagnosed asthma is usually also untreated, although lack of treatment or under-treatment is common even among those who have been diagnosed with asthma. The reasons for this are complex and are inadequately dealt with by health professionals. Financial Burden the monetary costs of asthma are substantial and include both direct medical costs (hospitalization, emergency room treatment, doctors visits and medication) and indirect, nonmedical costs (time lost from work and premature deaths). Compared to patients with mild asthma, the costs in those with moderate asthma were approximately twice as great and costs for patients with severe asthma were 6-fold higher.

These and other such initiatives were not welcomed by the most powerful Western countries erectile dysfunction treatment garlic order generic malegra fxt from india, but on the whole erectile dysfunction causes pdf order malegra fxt cheap online, through successes and failures erectile dysfunction caused by hemorrhoids discount malegra fxt 140 mg overnight delivery, international cooperation for development through the United Nations and its specialized agencies continued along its established course impotence for males order malegra fxt 140 mg mastercard. It was generally acknowledged that the United Nations system deserved some credit not only for the decolonization process but also for contributing significantly to the betterment of the human condition in a number of developing countries. The "oil crisis" at the beginning of the 1970s and the adoption by the General Assembly of resolutions incorporating the Declaration and the Programme of Action on the Establishment of a New International Economic Order16 and of another resolution that included the Charter of Economic Rights and Duties of States17 collectively marked a turning point in the brief history of the United Nations as a global forum and an agent for development and international justice. The oil crisis served to underline the dependence of many countries and regions, particularly Europe and Japan, on oil-producing developing countries that, Social Justice in an Open World: the Role of the United Nations through the establishment of cartels, had acquired the capacity to control the prices of their products. Ultimately the crisis led to an extended slowdown in economic growth-again, chiefly in Europe and Japan. Perhaps most importantly, there was evidence that developing countries were using this opportunity to try to modify the balance of economic power in the world in their favour and to practice a form of economic nationalism that could seriously hinder the development of global capitalism. The above-mentioned documents on the establishment of a new world economic order emphasize the right of every State to regulate and control foreign investment and the activities of transnational corporations within its borders. Recognition is also given to the right of each State to choose its political, social and economic systems; nationalizations and expropriations are considered permissible within this context. Other controversial provisions of these texts relate to science and technology transfer and research cooperation. Full disarmament is also envisaged, as is cooperation in environmental protection. The Charter of Economic Rights and Duties of States was adopted by the General Assembly in December 1974 by 120 votes to 6, with 10 abstentions. In March 1975, the Second General Conference of the United Nations Industrial Development Organization adopted the Lima Declaration and Plan of Action on Industrial Development and Cooperation. In this Declaration, it was stated that the share of developing countries in total world industrial production "should be increased to the maximum possible extent and as far as possible to at least 25 per cent of total world industrial production by the year 2000, while making every endeavor to ensure that the industrial growth so achieved is distributed among developing countries as evenly as possible. It was both ridiculed as an unattainable objective and denounced as an attempt to place the world economy and its market forces within the straightjacket of world planners and technocrats. From the mid-1970s onward, these countries relied increasingly on the better-controlled Bretton Woods institutions, strengthening their role and influence in global economic development, and pressed for the reform of the United Nations, which was formally initiated at the end of 1986 and is still very much on the international agenda. With the collapse of the Soviet bloc at the end of the 1980s, Social Justice in an Open World: the Role of the United Nations the United States and its allies no longer had any major obstacles to the dissemination of their views on the organization of the world economy and on the meaning of international justice. Developing countries, partly out of conviction and partly because they sense the probable futility of resistance and understand the need to adapt to the new global political configuration, have abandoned their demands for revolutionary changes in the world economic and political order and are now pursuing an incremental approach in defence of their interests. Rather than controlling the activities of transnational corporations in their territories, they are offering fiscal and other incentives to attract private foreign investment. Nationalization and expropriation have disappeared from their political vocabulary. Global trade and participation in the world economy are the order of the day; self-reliance and self-sufficiency are perceived as antiquated concepts. Justice is sought through efforts to ensure the elimination of measures and practices (such as domestic agricultural subsidies) that allow some countries to maintain an unfair advantage over others. The leaders of developing countries contend that if the guiding principle of the world market economy is competition on an open and even playing field, obstacles to fair competition should be removed. The most important text adopted by the United Nations in recent decades is the Millennium Declaration,19 which reflects a consensus on what constitutes just relations between countries with unequal power and affluence. In section I of the Declaration, entitled "Values and principles", mention is made of "the sovereign equality of all States, respect for their territorial integrity and political independence, [and the] resolution of disputes by peaceful means and in conformity with the principles of justice and international law" (para. However, among the six fundamental values considered "essential to international relations in the twenty-first century" (para. Tolerance may also be included in this group, as it implies acceptance of the differences and richness within and between societies and "a culture of peace and dialogue among all civilizations" (para. The last of these values, shared responsibility, necessitates the multilateral management of "worldwide economic and social development" (para. The right to development is mentioned, but its application for "everyone" and to "the entire human race" suggests that it is regarded more as an individual and collective right than a right of nations. Reference is made to the "abject and dehumanizing conditions" endured by billions of "our fellow men, women and children" in extreme poverty. There is no mention of the distribution of income and wealth among countries or of the various gaps that separate developed from developing countries. It is stressed that development will depend first on "good governance within each country" but also on "good governance at the international level and on transparency in the financial, monetary and trading systems".

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In addition erectile dysfunction caused by performance anxiety discount 140mg malegra fxt, while apparent progress has been made in achieving equality of rights erectile dysfunction killing me order 140 mg malegra fxt visa, there have been notable setbacks in connection with the basic rights of individuals erectile dysfunction commercial discount malegra fxt 140mg otc, who in some settings have been subjected to discrimination and even torture impotence drugs for men generic 140 mg malegra fxt mastercard. A composite picture is also apparent for the previous period, identified here as the years between the end of the Second World War and the collapse of the Soviet Union. State intervention and extensive redistribution policies led to improvements in the distribution of income and access to public services. In poor developing countries, the model of the welfare state and society, if not fully implemented, was generally accepted. Even in relatively affluent countries with a strong liberal tradition, the "deals" struck by Governments and societies to resolve the economic and social crisis of the 1930s were pursued with increasing vigour; most notably, public programmes were implemented to fight poverty, and universal social security schemes financed by extensive and progressive tax systems were adopted. However, the spirit of enterprise and entrepreneurship, or economic freedom and economic justice, was suppressed in totalitarian countries and not given the chance to flourish in newly independent developing countries compelled to devote much of their attention and resources to political development and stability. The spirit of free enterprise was also bridled in a few of the countries with socialist or social democratic regimes, but there is certainly no evidence that it suffered in liberal democracies with free markets and solid redistributive policies. This last point is important for the agendas of international organizations today. The justice situation was also ambiguous from an international development perspective prior to the great global economic transformation that began to sweep the world in the 1980s. Financial and other forms of assistance to developing coun Social Justice in an Open World: the Role of the United Nations tries were seen to be in the best interest of both donors and recipients and to constitute a normal expression of solidarity meant to contribute to the building of a more prosperous and more secure world. International economic justice was elusive, however, as the world economy during this period was more a collection of controlled markets than an open field with negotiated common rules, universally accessible opportunities and extensive freedom for all players; a number of developing countries with the requisite capacity, will and dynamism were subjected to serious constraints when they sought to compete in this economy. This recurrence, at least during the limited historical period reviewed, of ambivalent, sometimes contradictory and often ambiguous trends relating to the practical application of the concept of justice should represent a sufficient deterrent to those tempted to make strong, unequivocal statements regarding the status of social justice in the present and recent past. Particularly from the perspective shaped by the founding texts of the United Nations (the aforementioned Charter and Universal Declaration), it would be both imprudent and incorrect to assert that justice, whether defined in terms of its individual components or more broadly, has either improved or deteriorated globally during the past several decades. The multifaceted nature of the concept of justice and the ambiguousness of relevant trends should not be used as an excuse for moral laxity and political indifference, however. The enjoyment of rights by some people does not compensate for violations of the same rights among others. The risk of laxity and indifference is even higher when history is viewed as a succession of cycles. From this perspective, the current emphasis on economic freedom and economic justice would likely be interpreted as a corrective or compensatory trend counterbalancing the excessive past preoccupation with redistributive social justice, and the presumption is that "reverse" corrections would occur when the limits of present views and policies have been reached or surpassed. The validity of such cyclical movement might be confirmed in subsequent analysis, but institutions with public responsibilities cannot operate on the assumption that corrections occur automatically or providentially. Correctives occur as a result of changes in ideas, power structures, political processes and policies, and moral outrage and public protest certainly guide such changes in the direction of greater justice and fairness. The great transformation that has shaken the world was set in motion a couple decades ago and shaped by the rise to preeminence of the United States, a nation embodying the political philosophy of liberalism and its economic and financial component, global capitalism. Global capitalism gives economic and financial forces the power to treat the world as a global market. As these ideas and forces swept the world, communist sys Social Justice in an Open World: the Role of the United Nations tems collapsed and socialism and social democracy retreated, as did the notion that there should be public institutions at both the national and international levels that defined the common good, pursued social justice, and had the power to take effective action. The promotion of social justice through public institutions is a deeply rooted tradition. Throughout history, the advances made by humankind have been conceived by great individuals-including philosophers, scientists, political leaders, prophets, and even ordinary inspired and courageous citizens-and implemented by institutions. Individuals, institutions and forces driven by power and greed can undo what are clearly political and social gains. Social justice and international justice, at least from the distributive or redistributive perspective, do not appear to constitute a high priority in this modern age. From the comprehensive global perspective shaped by the United Nations Charter and the Universal Declaration of Human Rights, neglect of the pursuit of social justice in all its dimensions translates into de facto acceptance of a future marred by violence, repression and chaos. Advancements in social justice, except in extraordinary situations and circumstances such as the gaining of political independence, the aftermath of a long war or the depths of an economic depression, require pressure from organized political forces.