Be clear that a safe and comfortable sexual relationship requires a certain maturity and power to negotiate for oneself; emphasize especially the importance of mutuality and respect erectile dysfunction caused by supplements purchase viagra 100 mg free shipping. Many young people feel ambivalent about what they want or confused about their partners wishes erectile dysfunction doctor edmonton purchase 75mg viagra with mastercard. You may wish to look for resources or support to help you refect on your areas of discomfort or confict regarding sexuality relative impotence judiciary purchase viagra without prescription. Help your students understand and feel comfortable with the correct terms for body parts impotence because of diabetes order viagra 50mg free shipping. If you are teaching in a language that lacks scientifc terms for certain body parts erectile dysfunction treatment old age buy viagra 100mg, using the most appropriate term with ease is helpful erectile dysfunction drugs causing generic viagra 25 mg visa. Use respectful terms and avoid hurtful language erectile dysfunction protocol free buy viagra 25 mg amex, particularly in regard to same-sex attraction erectile dysfunction treatment center buy 100 mg viagra amex, sexually active girls, and young people who do not conform to conventional gender norms. Students should not feel pressured to disclose information about their own sexual experiences. They must also be aware, however, of legal reporting requirements related to disclosure of abuse of a minor. To foster a safe environment for open discussion, consider separating girls and boys for some activities and then bringing them back together for shared discussion. A number of the fact sheets at the end of this book provide additional details on these topics. Defne the concepts of respect, mutuality, and enjoyment as they apply to sexual relationships. Defne and discuss at least three sexual rights, including the right to refuse unwanted sex in any circumstance. Explain at least two ways that social norms and laws afect peoples attitudes about, and experience of, sexuality. Discuss social norms regarding diverse forms of sexual expression and how such standards have changed or are changing. Afective Objectives Refect upon ways to promote and protect a positive and responsible sense of their sexuality. Refect upon their own feelings, motivations, and experiences about sexual decisionmaking. Defne and express attitudes toward the diferent standards for sexual behavior and pleasure for males and females. At some periods in their lives, however, most people experience little or no sexual desire. Such comfort is also infuenced by individual, family, and social factors and experiences. See the glossary at the end of this unit for a brief introduction to these concepts. However, many girls also face sexual harassment especially with regard to their (and even coercion) at school or on their way to and from school. What impressions do we receive from the media about how to act in 5 All people should be able to participate in political, professional and civic life relationships Sexual norms should not present obstacles to such How do movies portray people participation. Young people should feel proud of themselves and know that they matter in society. Often, however, they feel signifcant pressures to prove their manhood through early, repeated, and sometimes even aggressive, heterosexual experience. Boys and men whose behavior is perceived as feminine are often treated disrespectfully or cruelly. Activity 18 frst impressions Students examine their response to a character in a story based on their assumptions about whether the character is male or female. For example, such attitudes may be aimed at the the experience of being male or female is not the same everywhere elderly, those who live in poverty, those from certain ethnic or racial groups, those or for every group. For example: with a disability, or those who are attracted to others of the same sex. Are males in certain ethnic 5 Each of us can decide how fully we agree with local norms related to sexuality. If groups labeled as highly sexual or we disagree with certain norms and expectations, we can think about whether we asexual Think of a person you know and admire who lives according to his or her own beliefs and values, even though these values difer from those of the larger society. People may feel desire for another person (of the same sex, of the other sex, or both). Or they may feel generalized desire that is not necessarily attached to another person. They may experience sexual desire until the end of their lives, although their physical response may change with age. Personal preferences, life experiences, and cultural norms all infuence these responses. In contrast, females, young people, people with disabilities, and those attracted to the same sex may be taught that expressing their sexual desire is somehow wrong. For example, a person may feel sexual desire for someone whom he or she barely knows. All of us have similarities and diferences to the same or the other sex may be called sexual orientation, sexual compared with others in our families, school, workplace, and communities. This example, there is wide variation in how we look and what we think, in our talents, document uses the terms sexual identity and sexual diversity to and in our sexuality. People who are 2 Variation in peoples sexual desires, behaviors, and identities is referred to as sexual attracted to others of the same sex also use diferent terms to describe diversity. The term homosexual is used uses same-sex attraction and to describe people who desire people of the same sex. In some settings these terms are preferred, in other settings homosexual interchangeably. Some people do not want to be labeled or categorized in terms of their sexuality or sexual identity, regardless of their desires. A persons desires, behavior, or identity may shift over time and from situation to situation. Such norms vary across a continuum that includes: stigma and discrimination (for example, refusing someone housing or employment); rejection (for example, teasing); tolerance; acceptance; respect; and, fnally, valuing and embracing diversity. Such stigma and Do individuals perceived as homosexual face discrimination discrimination harm people and violate their human rights. Why might a person who is attracted to someone of the same sex identify in public as heterosexual and even marry someone of the other sex What are some reasons that a boy might harass or intimidate another boy about not being masculine enough These declarations support peoples right to choose their sex partners and to form relationships based on mutual consent. It responds to the brain mediates many input from hormones and processes emotions. For example, a person may Something that feels sexual or erotic in one situation may feel feel sexual pleasure from a touch to the face, stomach, nipples, ears, legs, or unstimulating or even unpleasant anywhere else. Each person has diferent responses, and each persons response in another situation. Most females reach orgasm (sexual climax) as a result of stimulation of the clitoris (rather than from penile penetration of the vagina). In males, the penis may release a few drops of pre-ejaculate (not the same fuid as that of ejaculation). Public health and rights organizations have issued declarations regarding the rights of all persons to sexual expression. These rights include the right to seek pleasure in the context of safety and of mutual and meaningful consent. Along with a feeling of euphoria, orgasm involves involuntary contraction and release of muscles and secretion of fuid (ejaculate, with semen, in males; genital lubrication in females. As part of knowing her own body, a girl should have the opportunity to learn about the function of the clitoris. These are chemical substances produced in our brains that reduce pain and make us feel good. However, both men and women virginity compare with attitudes may have been taught that men (particularly heterosexual men) have a greater about male virginity How do people treat girls who have 6 As long as sexual activity is undertaken with mutual and meaningful consent and is had more than one sex partner What messages do abstinence only education, child marriage, and female genital mutilation send 7 Most people want their sex partner to experience pleasure. As a result, many parents are unsure about what to tell their children concerning the practice. Other forms of penetrative sex may Activity 22 involve using the fngers or an object. Students play a game in which they Nonpenetrative practices (without exchange of bodily fuids) do not carry the same decide whether statements about sexual behavior are true or false. Often, however, people (especially young people) may feel confused about these issues. Even if having sex is consensual and safe, a person might decide to do so primarily to try to fulfll some other need or social obligation. They may worry about maintaining an erection Students choose whether they or about ejaculating too soon. Such abuse is commonly referred to as rape, sexual violence, sexual coercion, or sexual assault. However, girls and women are forced to have unwanted sex more often than are boys and men. All people have the responsibility to respect their partners right to give or withhold such consent. Activity 25 the matter of consent 3 Regardless of the circumstances under which it occurs, sexual coercion may have Students learn about the concept serious consequences. Because girls are often taught to defer to boys and men, they may feel that they must agree to have sex regardless of their own desires. Such instances are not examples of meaningful, informed, and freely given consent. How easy is it for young people to express their sexual desires and to 5 Many factors afect a persons ability to consent to sex in a way that is meaningful ensure that their partners can do and real. Others sell sex because they are unable to make a living by other means, or How can drugs or alcohol impair they may be forced into sex work through deception or other pressures. In many countries, educators can provide an existing list of hotlines and support services for young people who have experienced sexual coercion. For example, people may worry about their body parts, attractiveness, or ability to perform sexually. They may have learned negative attitudes about sex or have had disturbing sexual experiences. They may not know about normal variation in sexual response or may not be willing or able to talk about sexual needs. It may become a concern for a couple if both partners do not have a similar desire for sex. If a concern continues or interferes with a persons sexual enjoyment, speaking with a trusted counselor may be helpful. Bisexuality: having both same-sex and other-sex attraction or desire, behavior, or identity. In some settings, attraction to the same or the other sex is called sexual orientation, or some other term; this document uses the terms sexual identity and sexual diversity to refer to the broad range of sexual expression, including attraction to the same or the other sex. Intersex: having sex chromosomes, genitalia, and/or secondary sex characteristics that are neither exclusively male nor female. Sexual and reproductive rights: human rights that apply to sexual and reproductive life and health. For example, they include: whether, with whom, and under what circumstances a person has sex; whether to carry a pregnancy to term; and the right to protect ones body from sexual violence or coercion. Sexual diversity: the wide variation in peoples sexual desires, identities, and behaviors. Sexual identity: how people identify themselves in terms of various aspects of their sexuality, which may include their sexual preferences and attractions. A persons sexual identity may or may not be the same as their sexual desire or behavior. Sexual norms: social standards that shape our understanding, attitudes, and experiences related to sexuality. Sexual well-being: a sense of well-being related to ones sexuality and sexual life. Many factors contribute to peoples sexual behaviors, relationships, feelings, identity, desires, and attitudes. Yet another factor is culture, which infuences peoples attitudes, expectations, and experiences related to sexuality. For example, power differences between people, media portrayals of relationships, and other factors strongly infuence our ideas about personal relationships. During adolescence, young people may experience different, often intense, feelings as aspects of their relationships undergo dramatic change. This unit explores diferent kinds of relationships that people have, including romantic or sexual relationships. It encourages young people to think about the qualities they seek in intimate personal relationships in their own lives. The connection between teachers and students is also one kind of interpersonal relationship. Validate your students knowledge: Every person has experience of human relationships. These relationships can be at school, in the community, in the extended family, or elsewhere. This unit touches on topics about which young people typically have many questions and feelings. Describe two personal and two societal or cultural factors that may contribute to , or block, satisfying and mutually respectful relationships.
Utilization of natural antioxidants: green tea extract and Thymbra spicata oil in Turkish dry-fermented sausage importance of being earnest purchase viagra 25 mg on line. Comparison of the effects of sesame and Thymbra spicata oil during the manu facturing of Turkish dry-fermented sausage erectile dysfunction statistics trusted 100 mg viagra. Isolation and identifcation of low molecular weight antioxidant compounds from fermented chorizo sausages erectile dysfunction new treatments 75mg viagra free shipping. Effect of starter culture on proteolytic changes during processing of fermented beef sausages erectile dysfunction juice recipe buy discount viagra on-line. Effect of fat and salt reduction on the sen sory quality of slow fermented sausages inoculated with Debaryomyces hansenii yeast erectile dysfunction wellbutrin xl order discount viagra on line. Salt reduction in slow fermented sausages affects the generation of aroma active compounds erectile dysfunction after zoloft order viagra 25 mg with amex. A large prospective study of meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association tramadol causes erectile dysfunction cheap viagra 75mg on-line. The world cancer research fund report 2007: a chal lenge for the meat processing industry erectile dysfunction age at onset buy cheap viagra 50mg on line. Control of biofavour and safety in fermented sausages: frst results of a European project. Proteoly sis in dry fermented sausages: the effect of selected exogenous proteases. Impact of sodium chloride replacement by salt substitutes on the prote olysis and rheological properties of dry fermented sausages. Scientifc Opinion on Dietary Reference Values for Fats, Including Saturated Fatty Acids, Polyunsaturated Fatty Acids, Monounsaturated Fatty Acids, Trans Fatty Acids, and Cho lesterol Parma, Italy. Effects of addition of carrot dietary fbre on the ripening process of a dry fermented sausage (sobrassada). Optimisation of the addition of car rot dietary fbre to a dry fermented sausage (sobrassada) using artifcial neural networks. Physi cochemical and microbiological profles of salchichon (Spanish dry-fermented sausage) enriched with orange fber. Effect of calcium chloride on the volatile pattern and sensory acceptance of dry-fermented sausages. Occurrence of antilisterial structural bacteriocins genes in meat borne lactic acid bacteria. Impact of lipid content and composition on lipid oxidation and protein carbonylation in experimental fermented sausages. Effects of ionising irradiation on quality and sensory attributes of ready-to-eat dry fermented sausages enriched with folic acid. Reduction of sodium and increment of calcium and omega-3 polyunsaturated fatty acids in dry fermented sausages: effects on the mineral content, lipid profle and sensory quality. Effect of sodium chloride replacement on some characteristics of fermented sausages. A mixture of potassium, magnesium, and calcium chlo rides as a partial replacement of sodium chloride in dry fermented sausages. Calcium ascorbate as a potential partial substitute for NaCl in dry fermented sausages: effect on colour, texture and hygienic quality at different con centrations. The effects of some natural antioxidants on the color, chemical and microbiological properties of sucuk (Turkish dry-fermented sausage) dur ing ripening and storage periods. Potassium chloride, potassium lactate and gly cine as sodium chloride substitutes in fermented sausages and in dry-cured pork loin. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. Partial replacemente of sodium chloride with potassium chloride in dry fermented sausages: infuence on carbohydrate fermetnation and the nitrosation process. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Protein and Amino Acids (Macronutrients). Dietary Reference Intakes for Thiamin, Ribofavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Infuence of probiotic sausage (Lactobacillus paracasei) on blood lipids and immunological parameters of healthy volunteers. Quality characteristics of Dutch-style fermented sausages manufactured with partial replacement of pork back-fat with pure, preemulsifed or encapsulated fsh oil. Effects of Urtica dioica and Hibiscus sabdariffa on the quality and safety of sucuk (Turkish dry-fermented sausage). Effect of replacing beef fat with olive oil on quality characteristics of Turkish soudjouk (sucuk). Identifcation of poten tial probiotic starter cultures for Scandinavian-type fermented sausages. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Effect of carrageenan level and pack aging during ripening on processing and quality characteristics of low-fat fermented sausages produced with olive oil. Antioxidant and antimicrobial activity of Kitaibelia vitifolia extract as alter native to the added nitrite in fermented dry sausage. The antioxidant properties of baechu-kimchi and freeze-dried kimchi powder in fermented sausages. Effect of tocopherol extract, Staphylococcus carnosus culture, and celery concentrate addition on quality parameters of organic and conventional dry-cured sausages. Dry-fermented chicken sausage produced with inulin and corn oil: physicochemical, microbiological, and textural characteris tics and acceptability during storage. Evaluation of antioxidative properties of Geranium macrorrhizum and Potentilla fruticosa extracts in Dutch style fermented sausages. Effect of reducing and replacing pork fat on the physicochemical, instrumental and sensory characteristics throughout storage time of small caliber nonacid fermented sausages with reduced sodium content. Effect of the type of fat on the physicochemical, instrumental and sensory characteristics of reduced fat nonacid fermented sausages. Improvement of nutritional properties of Chorizo de Pamplona by replacement of pork backfat with soy oil. Functional dry fermented sausages manufactured with high levels of n-3 fatty acids: nutritional benefts and evaluation of oxidation. Microbiological and sensory quality of dry fermented sausages containing alginate-microencapsulated Lactobacillus reuteri. Phys icochemical, microbiological and sensory assessments of Italian salami sausages with probiotic potential. Development and assessment of healthy properties of meat and meat products designed as functional foods. Potential probiotic Lactobacillus strains from fermented sausages: further investigations on their probiotic properties. Effect of commercial prote ases on shelf-life extension of Iberian dry-cured sausage. Screening selected strains of probiotic lactic acid bac teria for their ability to produce biogenic amines (histamine and tyramine). Evaluation of func tional aspects in Lactobacillus strains isolated from dry fermented sausages. Variability in the contents of pork meat nutrients and how it may affect food composition databases. The effect of natural antioxidants on the colour and lipid stability of paprika salami. Probiotic fermented sausage: viability of probiotic microorganisms and sensory characteristics. Nutritionally enhanced fer mented sausages as a vehicle for potential probiotic lactobacilli delivery. Konjac gel as pork backfat replacer in dry fermented sausages: processing and quality charac teristics. Short-chain fructooligosaccharides as potential func tional ingredient in dry fermented sausages with different fat levels. Effect of intes tinal Lactobacillus starter cultures on the behaviour of Staphylococcus aureus in fermented sausage. Effect of tiger nut fbre addition on the quality and safety of a dry-cured pork sausage Chorizo during the dry curing process. Cured meat products without direct addition of nitrate or nitrite: what are the issues Usefulness of calcium lactate, citrate and gluconate for calcium enrichment of dry fermented sausages. Partial substitution of pork backfat with extra-virgin olive oil in salami products: effects on chemical, physical and sensorial quality. Meta-analysis of prospective cohort stud ies evaluating the association of saturated fat with cardiovascular disease. Effect of partial replacement of pork meat with an olive oil organogel on the physicochemical and sensory quality of dry-ripened venison sau sages. Antioxidant and angiotensin-I converting enzyme inhibitory activity in the water-soluble protein extract from petrovac sau sage (petrovska kolbasa). Effect of replacing beef fat and tail fat with interesterifed plant oil on quality char acteristics of Turkish semi-dry fermented sausages. Calcium supplementation: is protecting against osteoporosis counter to pro tecting against cardiovascular disease Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the Diet. The effect of the Lactobacillus casei lock 0900 probiotic strain on the quality of dry-fermented sausage during chilling storage. The effects of different levels of orange fber and fat on microbiological, physical, chemical and sensorial properties of sucuk. Response surface methodology study on the possibility of nitrite reduction by glucono-delta-lactone and ascorbic acid in Turkish-type fermented sausage (sucuk). Lipolysis and lipid oxidation in fer mented sausages depending on different processing conditions and different antioxidants. Mineral composition of Italian salami and effect of NaCl partial replacement on compositional, physicochemical and sensory parameters. Oxidative stability of lipids and cho lesterol in salame Milano, coppa and Parma ham: dietary supplementation with vitamin E and oleic acid. The high fat and protein content in cheese makes it an energy-rich and nutritious food for all ages, and today a wide variety of cheese types are avail able. France, Iceland, Luxembourg, Germany, and Finland were the biggest consumers, with more than 23. Cheese is a rich source of essential nutrients, in particular, proteins, fat, vita mins, and minerals. In addition to their nutritional role, cheese components have also shown to exert important health benefits (Walther et al. Calcium, present in large amounts in cheese, has been shown to have a positive effect on various disorders such as osteoporosis (Heaney, 2000) or dental caries (Kato et al. They are produced during cheese ripening, where casein is broken down by proteases and peptidases from milk, rennet, starter culture, and secondary microbial flora. Some of the generated peptides can survive gastrointestinal digestion or serve as precursors from the final peptide form, which is responsible for a wide array of biological activities (Lopez-Exposito et al. This chapter presents an update on the health effects of cheese components focusing on the most commonly studied bioactive peptides activities. Recent studies indicate that there are no demonstrated evidences to recommend the consumption of low-fat dairy foods in healthy people because of the biological activities demonstrated for several compounds present in milk fat (Fontecha et al. For example, the C18:2 trans 10, cis 12, has been reported to promote weight loss, decreasing glucose levels and insulin resis tance in obese men with metabolic syndrome (Riserus et al. If these beneficial effects are confirmed by further studies, this will likely have important repercussions for both human nutrition and the food industry. Furthermore, synergisms between butyric acid and other dietary compounds and common drugs in reducing cancer cell growth have also been shown (Par odi, 2006). However, no human studies have been conducted to confirm these effects after consumption of cheese. For example, the method of coagulation used and the acidity of the curd will have an effect on the salt concentration. Calcium, phosphorus, sodium, and chloride are found in high amounts, while elements such as zinc and potas sium are found at much lower concentration (Table 11. Note the significantly higher daily value of calcium and phosphorus with regard to the rest of the min erals shown. Research has shown that an insufficient intake of calcium, in par ticular, raises the risk of obesity (Parikh and Yanovski, 2003), hyperlipidemia, and insulin-resistance syndrome (Teegarden, 2003; Zemel, 2004). In contrast, a diet rich in dairy calcium intake has shown on enhance weight reduction in type 2 diabetic patients (Shahar et al. A considerable body of research has been published on the cariostatic effect of cheese (Kashket and DePaola, 2002). Assays on human subjects have suggested a caries-protective effect in childhood populations (Ohlund et al. Although more research is needed to elucidate the precise mechanisms for the cariostatic effects of cheese, there is enough evidence to support the con sumption of cheese as an anticaries measure (European Food Safety Agency, 2008). The most plausible mechanism is related to the mineralization poten tial of the casein-calcium phosphate of cheese, to the stimulation of saliva flow induced by its texture, the buffering effects of cheese proteins on acid formation in dental plaque, and the inhibition of cariogenic bacteria (OBrien and OConnor, 2004). In ripened cheeses, calcium availability is determined by fat content, which is lower in full-fat cheeses (13. On the other hand, recent studies suggest that the use of probiotic cultures in the production of cheese increases the availability of calcium, magnesium, and phosphorus. The stimulating effect of probiotic cul tures on the availability of mineral compounds can be attributed to intensified enzymatic conversion, mainly proteolysis and lipolysis (Aljewicz et al. Absorption of vitamin A and other fat-soluble vita mins such as vitamins D, E, and K are increased in the body by the pres ence of fats in the diet, making cheese a good vehicle to deliver them. It has been reported that cheese can provide one-third of the recommended intake of vitamin A, a vitamin with an important role in the normal functioning of the immune system, in gene-expression regulation, and in sustaining low-light vision (Russell, 2000). With regard to the water-soluble vitamins, such as riboflavin, vitamin B12 (niacin), and folate, their content in cheese is lower than in milk. However, the loss of some B vitamins is compensated by the microbial synthesis during ripening. Semihard cheese can provide the average male and female adult with 80% of the recommended intake of vitamin B12. Note that ovine milk is richer than cows milk in most vitamins, and therefore 90g of sheep milk cheese could completely cover the daily requirements for riboflavin (Recio et al. Proteins are one of the major nutrients responsible for the nutritional, physicochemical, functional, and sen sory aspects of cheese. In addition, cheese protein is almost 100% digestible, as the ripening phase of cheese manufacture involves a progressive breakdown of casein by enzymes present in milk and those derived from rennet or micro organisms, releasing both amino acids and peptides. Interestingly, lysine is one of the major amino acids found in cheese with high bioavailability because of the absence of Maillard reactions (de la Fuente and Juarez, 2001). The type Health Effects of Cheese Components Chapter 11| 247 and quantity of milk protein-derived peptides is affected by factors influencing proteolysis, such as pH, type of enzymes, salt-to-moisture ratio, humidity, and storage time and temperature (Park and Jin, 1998). In this sense, different variet ies of cheeses are likely to exhibit peptides with variable bioactivities, such as antihypertensive, antioxidant, opioid, antimicrobial, antiproliferative, and min eral absorption modulatory effects, among others (Lopez-Exposito et al. One of the many physiological pathways that control blood pressure in the human body is the renin-angio tensin-aldosterone system. These two reactions cause a contraction of blood vessels and the release of aldosterone, increasing sodium concentration and blood pressure. The influence of the addition of certain probiotic strains (Ong and Shah, 2008; Wang et al. As an example, this strategy has been applied to isolated peptides from Manchego cheese (Gomez-Ruiz et al. Natural anti oxidants provide additional benefits to the endogenous defense strategies in the battle against oxidative stress (Erdmann et al. First studies reporting antioxidant activity of cheese-derived peptides were carried out with raw and sterilized ovine and caprine cheese-like systems coagu lated with enzymes from the plant Cynara cardunculus (Silva et al. In all cheese samples, changes in the antioxidant activity correlated to the rate of formation of soluble peptides (proteolysis). These preliminary results suggest the potential of cheese as source of antioxidant peptides, although animal models and human trials confirming these effects are needed. Opioid receptors are located in the nervous, endo crine, and immune systems as well as in the gastrointestinal tract of mammals (Teschemacher, 2003). They are char acterized by the presence of a tyrosine residue at the N-terminal and another aromatic amino acid at third or fourth position, which is an important structural motif that fits into the binding site of opioid receptors (Nagpal et al. Furthermore, they have also been observed to prolong gastrointestinal transit time and to exert antidiarrheal action in both animals and humans (Daniel et al. All the extracts, except that from Gouda, were found to affect the intestinal mobility in isolated rabbit ileum similar to morphine, with this effect being reversed by naloxone. Relatively little is known about the actual bioavailability of this kind of pep tides.
Also note that gender identity and sexual orientation are not the same; transgender people may be bisexual erectile dysfunction treatment covered by medicare buy genuine viagra online, gay erectile dysfunction korea viagra 50 mg generic, heterosexual impotence your 20s order cheap viagra online, or lesbian erectile dysfunction ulcerative colitis order genuine viagra on-line. They may identify their gender as combining aspects of women and men or as being neither women nor men erectile dysfunction treatment fruits generic viagra 50mg on line. Transgender people may or may not choose to alter their bodies hormonally and/or surgically impotence pills effective viagra 50 mg. The term may include but is not limited to transsexuals erectile dysfunction johns hopkins discount viagra, third gender/genderqueer people erectile dysfunction causes depression discount viagra american express, cross-dressers, and other gender-variant people. The cultural, legal, and medical adjustments made as part of transitioning may include telling ones family, friends, and/or co-workers; using different pronouns to describe oneself; changing ones name and/or sex on legal documents; beginning hormone therapy; and/or possibly (though not always) undergoing some form of surgical alteration. See also biphobia, homophobia Transsexual An older term which originated in the medical and psychological communities. However, unlike transgender, transsexual is not an umbrella term, and many transgender people do not identify as transsexual. Historically, these individuals crossed gender boundaries and were accepted (sometimes revered) by Native/First Nation cultures. This term is used, particularly in research, to describe sexual behavior as distinct from sexual orientation. This Guidance is the frst of a set of tools that aim at promoting practices and systems in supply chains that empower women. This Guidance was written by Maria Pontes and Magali Barraja with input from David Wofford and Carolyn Rodehau from Meridian Group International, Inc. Contents Executive Summary 4 Guidance Summary 6 Mainstreaming Gender Equality in Supply Chains 12 the Guidance 14 Why the Focus on Women While recognizing the limited role that codes can play in eliminating deeply rooted aspects of gender inequality in the workplace, it is important to recognize that they remain the most widespread approach used by companies to frame the directing principles that drive sustainability and human rights expectations throughout the supply chain. Companies use codes of conduct to communicate internally and externally about both their specifc company values and the minimum requirements they expect suppliers to uphold. When codes are weak and dont effectively address issues that affect a companys workforce, the risk of women being prevented from performing to their full potential is increased, and this can signifcantly disrupt supplier performance and ultimately a companys bottom line. This Guidance recognizes that, although both men and women in the workplace face complex and different challenges, women are disproportionately affected by: exposure to the most vulnerable situations in a workforce. The Guidance, which is not advocating for the establishment of a new code, is structured around two main sections: Traditional issues found in codes related to conditions of employment and employment-related benefts and rights (what we identify as being the most widespread clauses in codes of conducts); Relevant gender issues that are not generally included in codes of conduct but are linked with many core issues addressed by codes. These may not ultimately go into new language, but they are in the Guidance because they are issues that leading companies need to understand and address. This Guidance is intended as a tool to help companies and stakeholders more clearly identify the intersection between the core principles of a code of conduct and specifc womens needs and vulnerabilities. The objective is to provide business with a clear and common set of requirements that can be integrated into their existing codes of conduct. Recommended Clause Wording 1 Discrimination Women and men workers shall be protected against discrimination on the basis of marital status. Any commissions and other fees in connection with employment of migrant workers must be covered by the employer. The employer must not require the employee to submit his/her identifcation documents. To prevent unsafe exposure to hazardous chemicals and hazardous substances, appropriate accommodations shall be made for pregnant women. The number of toilets shall also take into consideration the number of workers, privacy for each individual and gender, accessibility, and hygiene. Designing a strategy that incorporates a focus on women, establishing gender-sensitive sourcing practices, and securing buy-in and building the capacity of suppliers on the topic are examples of elements that a company needs to have in place to drive positive change for women workers in its supply chain. Levi Strauss is often recognized supply-chains-112405 as the frst company to do so. Since then, codes have been viewed as central to reducing companies risks of negative exposure to poor employment practices within their supply chains by providing a clear and strong framework for the implementation 2 Even when integrating international conventions relating to discrimination and inequality, their coverage and gender sensitivity is 3 This is even more relevant today because women represent 60 percent to 90 percent of jobs in the labor-intensive stages of the clothing and fresh-produce global supply chains in many countries. In fact, a recent estimate1 of women employed in global supply chains in 40 countries was, as a group, 2. This does not imply, however, that sectors2 in which women are underrepresented should be exempted from integrating gender Women represent considerations within their codes. As a result, part of their3 labor-intensive workforce wont be protected or empowered, which, in turn, can affect a businesss productivity, performance, and reputation. While not all-comprehensive, the Guidance aims to provide business with good practice examples of how to set workplace standards that are gender sensitive, with a specifc focus on developing and emerging markets-based supply chains. Instead of creating a separate code of conduct or adding a new women-specifc single clause to existing codes, this resource offers an analysis of gender-related issues within traditional code of conduct principles and provides some good practice examples on how to best infuse gender-sensitive content. It suggests how specifc wording can be added to or amended within existing clauses. Given that women are usually in a disadvantaged position in the workplace compared to men, promotion of gender equality implies explicit attention to womens needs and perspectives. Women represent additional gender considerations that have not been considered workplace issues but in fact are, either directly or indirectly. But they are operationalized through a system of implementation resources, auditing of jobs in the tools, and performance metrics that clarify the intention of the code and delineate the means by which the code should be met. While the primary purpose of this Guidance labor-intensive is for the revision of codes, its analysis and leadership suggestions may also be useful stages of the clothing in informing a companys overall approach to gender equality. It will help businesses meet their responsibility to respect international human rights, including fundamental principles and rights at work and those expressed in international labor standards, with the understanding that gender differences manifest themselves differently within different geographies and that there are variations within legal frameworks. This Guidance document should be used in relation to national and all other applicable laws, including applicable international labor standards (such as those included in Annex 1), prevailing industry standards, and other requirements to which the organizations subscribe, and should not in any way prevent these standards from being exceeded. Examples of international gender equality conventions are: 2 Woetzel, Jonathan, et al. Research confrms that companies that are committed to gender equality outperform peers. On the3 other hand, the resilience of global supply chains is intricately linked with the status of women on farms and in factories that manufacture and develop products. In many industries, including agriculture, healthcare, apparel, and toys, women make up a majority of the workers. Yet when womens health, well-being,4 and access to opportunities are compromised, companies lose out on their contributions to productivity and effciency. At the same time, ignoring gender gaps and inequalities can leave companies exposed to production and delivery disruptions, bottlenecks, and ineffciencies. This is important because even when gender is explicitly included, codes tend to treat women the same as men, therefore making 2 ilo. Women are more often represented in low-wage jobs in the lower tiers of the supply chain and are too often subject to discrimination, sexual harassment, and other forms of workplace violence. In addition, they lack access to social protection measures in general, and to maternity protection in particular, and their career opportunities are limited. Therefore,3 both the analysis and recommendations put forward in this Guidance focus primarily on women. Companies that address gender inequality for women workers will fnd they are better prepared to address these issues as they relate to all workers. Inequitable gender norms and ideas of what it means to be a man leads to boys and men being both perpetrators and victims of violence and unhealthy behaviors. In the workplace, such norms of manhood may be expressed, for instance, through harassment of women workers or the failure to use needed health services because of stigma and discomfort with asking for help. In order to address gender comprehensively, men should be engaged in and part of any strategy or commitment to achieve gender equality and advance the rights, health, and well-being of women. The effective translation of these provisions into assessment systems, supplier management systems, and capacity-building activities is essential to drive real impact. Women are affected not only by their own specifc needs but also by virtue of being highly represented in certain industries or by being in the most vulnerable positions in a workforce. Although the workplace offers the opportunity to promote and advance gender equality, true gender equality will require more holistic changes in regulatory frameworks as well as in community norms and values. For example, lower-skilled work in garment factories has offered vaw-prevention/asurvey-on-gbv a route out of poverty for many women, but many women face new challenges, at-the-workplace-in-bangladesh such as increased risks of violence and harassment from superiors or male family garment-factories 1 members who feel threatened by their independence. Similarly, a womans ability to enter the job market, maintain basic employment, or 2 United Nations Population Fund. The lack of access to womens reproductive healthcare and Progress and Challenges. In addition, women still do a disproportionate2 amount of unpaid work (household responsibilities, childcare, etc. This complexity and interlinkage is refected in the analysis provided below for each principle, with numerous issues cross-cutting several principles. Women workers are impacted by codes of conduct shortcomings and violations in two ways: by exposure to the most vulnerable situations in a workforce. In several instances, the core of the issues addressed becomes relevant to men as well, and some of the recommendations set forth in this Guidance are therefore applicable to both genders. With this in mind, we highlight below a few considerations that are important frst steps in changing perception about gender in standards and workplace practices, and which apply to codes of conduct as a whole. An example of how language can be used to protect womens specic needs, from Nike Inc. The contractor shall provide appropriate and reasonable accommodations for women employees in connection with pregnancy, childbirth, and nursing. The contractor must comply with any working hour limits or other work restrictions for pregnant employees required by country law and take other reasonable measures to protect pregnant women from hazardous work, including restricted work hours as recommended by a licensed physician. Pregnancy tests will not be a condition of employment, nor shall they be demanded of employees. Voluntary pregnancy tests may be provided, but only at the request of the employee, and each such request must be documented. Women employees are entitled to maternity leave in accordance with the requirements of country law or Nikes Compensation and Benets Code Leadership Standard, whichever is higher. The generic term workers is typically Code Leadership Standards as a separate translated by management as men workers. Although could be replaced with men and women workers as a way to remind companies we do not recommend including this language as a separate section, the that workers are not necessarily men. This is especially important because men language itself is an example of the best and women have different needs, such as when it comes to healthcare, but also practice addressing the unique needs of suffer from different challenges, such as a higher prevalence of sexual harassment. Management should ensure that all workplace data is collected and disaggregated by sex and that this disaggregation is incorporated into documentation and record-keeping. Without disaggregating data, it is very hard to identify the differential impacts on male and female workers in the workplace. The company aims to ensure that at least 100,000 women are empowered to reach their full potential, while at the same time strengthening their families and communities. Grievance mechanisms should be formalized and have a gender-balance structure that processes complaints. The codes of conduct can be a good channel for companies to communicate their values to stakeholders. A clear statement in the preamble on where the company stands regarding gender and promoting gender equality at work will both show leadership and corporate commitment and will raise awareness among suppliers. By addressing the impacts of their own purchasing practices, companies have a direct impact on the way suppliers treat their workers. Poor buyer/supplier communication, frequent changes in product specication, short lead times, and aggressive price-setting lead to pressure on time and cost for the supplier, who in turn transfers these pressures onto workers. It is therefore essential that companies put in place or review existing sourcing practices that support rather than undermine womens rights, and that companies clearly state what suppliers can expect from them with regards to these practices in codes of conducts. Effective dissemination of the code of conduct and other related policies and procedures to suppliers, as well as to all women and men workers, can be a powerful tool to raise awareness and foster change. Women workers in particular are often less aware of their rights and in vulnerable positions because, for example, they are illiterate, immigrants not uent in the local language, or submissive due to local cultural norms. Companies can encourage communication and awareness-raising by including it as an expectation in their code of conduct. Note | Communicating with Suppliers It is fundamental to ensure that suppliers understand the specic changes to codes of conduct and how the integration of these gender-sensitive provisions impact their own management systems. Effective communication of requirements is essential to developing and maintaining support for your responsible sourcing program. Since these changes will require additional supplier engagement and effort, it is important to clearly articulate the business case to suppliers (in particular productivity gains and reduced turnover), but also to jointly agree on a realistic implementation plan to factor in timing for any necessary adjustments. Building your suppliers awareness and capacity to adjust to these new requirements is key. Collaborating with other brands on capacity-building efforts can be a cost-effective way to do this and reaffirm that these requirements are becoming mainstream for international buyers. Suppliers who demonstrate a strong commitment to gender equality should be encouraged to take part in local as well as global initiatives such as the Womens Empowerment Principles. Some of these sections also propose Leadership Areas that are important for addressing gender equality holistically, which most labor standards fail to consider. These critical issues represent opportunities for business to apply a gender lens to their sourcing decisions, supplier training, and capacity-building, and more widely to their approach to multi stakeholder collaboration. It is also a cross-cutting challenge affecting many of the other principles in codes of conduct, and one that is diffcult to assess in audits. Discrimination is often addressed in codes of conduct through either the principle of nondiscrimination or of equal opportunities pertaining to all aspects of the employment relationship, where gender is one among other potential factors for discrimination. Some of these gender-related practices may be very subtle and diffcult to identify without an in-depth analysis and understanding of the context. Others are quite obvious and linked to women-specifc matters, such as maternity or motherhood. In production job categories, there are fewer women supervisors and they tend to take jobs that require less technical skill and are also lower paid. This may suggest biases in recruitment, access to training, as well as access to career progression. For example, women represent around 80 percent of Vietnams 700,000 light manufacturing workers, but they tend to be in lower-paid positions as seamstresses and helpers, while men are in higher-paid occupations such as cutters and mechanics. Horizontal segregation happens as well, with women1 often concentrating or primarily being employed in certain sectors that are traditionally low paying. There is evidence of women not being hired at all if they are married or have children. They a Gender Perspective: A Preliminary are sometimes required to pre-sign termination letters during recruitment to avoid Exploration of Worker Surveys with a Focus on Vietnam. Their duties as caregivers Finance Corporation and International of children and sick family members may also increase their absenteeism and Labor Organization. There are also cases where policies determining bonuses discriminate against women due to the way they are calculated or attributed (see Wages and Benefts). Tasks that are more technical and require more skills are often dominated by male workers. For example, trainings might be scheduled at times or places that are inaccessible to them. Women who are promoted are also more likely to suffer abuse in the workplace or at home, or other types of retaliation. Although the female supervisor does a better job than her male colleagues, as can be seen from the number of pieces she produces, she relates the diffculties she faces in her work to the fact that she is a woman. In many factories in Bangladesh, there is no proper system for performance review. Supervisors and workers are evaluated according to the impressions their bosses have of them. Female supervisors often fnd it more diffcult because they do not want to use sexually explicit profanity, but they dont always see how they have a choice. Recommended Revisions General nondiscrimination and equal opportunities clauses can be strengthened. We recommend that language be included to specify that the principle of nondiscrimination applies to both women and men and that roles and needs specifc to women, such as those related to pregnancy, may not be used to undermine, cut, or in any way diminish their equal rights to men when it comes to any aspect of the employment relationship. Examples of gender-sensitive 1 provisions regarding Discrimination: Women and men workers should be protected against discrimination on the basis of marital status. In Cambodia, for example, participating women were promoted three times faster than those not participating. Figure 1 | Global improvements and key indicators, percentage improvement over period 35 Self-esteem 49% 52 26 Self-efficacy 65150% 27 Work efficacy 119 % 59 32 Workplace inuence 100% 64
If significant horizontal nystagmus occurs without the sub jective experience of vertigo impotence vacuum treatment purchase viagra cheap online, a central cause of positional nystagmus should be suspected erectile dysfunction treatment new york order 50mg viagra. The direction of nystagmus will either be geotropic (fast phases toward the ground) or ageotropic (beating toward the upper ear) erectile dysfunction from steroids generic viagra 100 mg free shipping, regardless of the position the patient is in [19] erectile dysfunction fruit purchase viagra 75mg amex. The nystagmus often changes direction after a brief nystagmus-free interval erectile dysfunction pumps cost buy viagra 25 mg lowest price, if the head is maintained in the testing position impotence quotes purchase cheap viagra line. If this occurs erectile dysfunction drugs and glaucoma 100 mg viagra amex, the direction of the initial nystagmus should be used to determine the mechanism and affected ear erectile dysfunction protocol by jason 75mg viagra with amex. Thus the nystagmus beats to the left with the left ear down, but less strongly, because excitation can drive the vestibular ocular reflex better than inhibition (Ewalds second law). In this case, rotating the head toward the affected side will cause gravity to deflect the cupula toward the canal, which is inhibitory, thereby resulting in nystagmus beating away from the dependent ear (ageotropic). When the affected ear is upward, the cupula is deflected in the excitatory direction, and therefore a stronger (still ageotropic) nystagmus is observed. Diagnosis and treatment of this condition may both be performed at bedside during an initial visit, without the use of blood or radiographic studies [16]. This would entail sleeping in a recliner chair, and avoiding any bending over or looking upward. Some providers have patients wear a soft cervical collar after treatment to help patients comply with these instructions. The patients are then encouraged to sleep with the affected ear upward for several nights before returning to their normal routine. There is a theoretical rationale for these recommendations, namely to keep the offending particles from re-entering the canal from which they were removed. However, in one study designed to test the necessity of post-treatment instruc tions, there was no significant difference in success (no nystagmus on Dix-Hallpike one week after treatment) following either the Semont or Epley maneuver, with or without instructions. Surgery Semicircular canal occlusion and singular neurectomy these procedures are rarely required, and are reserved for treatment-resistant cases. Hearing loss is a risk with any surgical approach to the labyrinth, and has transiently occurred after canal occlusion. One study [23] concluded that mastoid oscillation was critical for success, however, only a single maneuver was performed prior to determining the outcome. Brandt-Daroff exercises begin by sitting the patient upright on the edge of the bed, with the head turned 45 degrees to one side. The patient is instructed to move rapidly down into the side-lying position, keeping the head turned in the same direction. This position is maintained until the precipitated ver tigo subsides, or at least for 30 seconds. The patient then returns to the upright, and holds this position for an additional 30 seconds. The head is then turned in the opposite direction, and the same procedure is repeated on the other side. Patients repeat the whole sequence until vertigo is no longer experienced with changes in position. These exercises may be performed several times each day, and should continue until at least one full day after no symptoms of vertigo are experienced. Rotator devices Various mechanical devices to perform particle repositioning, including a chair capable of rotating patients upside down have been successfully used [8,26]. These exercises are also useful in habituating the phobic responses, which commonly develop in patients with a predisposition for, or concurrent anxiety disorder. The horizontal canal, which is stim ulated by caloric testing, is supplied by the superior division. A concise, critical review of several studies establishing the effectiveness of particle repositioning procedures. The direction of the nystagmus is variable, and often associated with the canal affected. Having otoconia in the semicircular canals causes endolymph (fluid) to flow abnormally and sends false signals of movement to the brain and initiates nystagmus (Dynamed 2017). It is uncommon in people under 35 and rare in children2 (Dynamed 2017) There is an estimated lifetime prevalence of 2. Patients may describe vertigo as a rotational, spinning, swaying, rocking, or moving sensation. The sensation may occur with any movements of the head, and is commonly reported after such activities as getting out of or rolling over in bed, bending forward, or looking up. Also note that patients may complain of light-headedness, dizziness, nausea, or the feeling of being off balance rather than true room spinning vertigo. A description of feeling faint, lightheaded, off balance or concomitant hearing loss suggests additional diagnoses that may need to be ruled out. One approach is to focus more on the duration (acute vs chronic) and episode triggers rather than on the patients exact description of the symptoms. Associated Symptoms/Signs Possible differential diagnosis to consider Dysequilibrium (feeling off balance), positive Peripheral neuropathy or Parkinsons disease, a Romberg test, altered gait. Cervicogenic vertigo is thought to originate from structures in the neck and is a controversial diagnosis. The exact pathogenesis is unknown, although there are several hypotheses, including altered proprioceptive input from uneven mechanical pressure on cervical muscles and joints. Have the patient sit on a chair that swivels such as a treatment stool and have them close their eyes. If symptoms of vertigo return, the vestibular system or cervical spine may be responsible. Cervicogenic vertigo may be treated effectively with chiropractic manipulation in many circumstances (Lystad 2011; Reid 2005). In the following tests the patients report of vertigo and observed nystagmus is monitored. Clinical warning: A down beating vertical nystagmus with slight torsion towards the down side ear may imply anterior canal involvement, but may also be due to brainstem or cerebellar lesions. Procedure: Instruct the patient to remove glasses and to keep their eyes open during the maneuver. They should sit positioned so that when they lie down their head will be clear of the table and cervical extension will be allowed during the test. Sometimes the patients report of their symptom triggers can help to identify the affected side, and sometimes both sides will need to be tested. The practitioner should be positioned to support the head as it hangs off the end of the table. Observe 4 the patients eyes for nystagmus and ask about reproduction of vertigo symptoms. There is usually a latency period of 2-20 seconds before signs and symptoms appear, and so it is important to maintain this position if they are not immediately present. The patient should then slowly be repositioned and wait until any additional symptoms pass. Sometimes vertigo will be present without nystagmus, and this is an indication to test the lateral canal. If both sides appear to be positive, presume that the affected ear is on the side that produces the most intense nystagmus. Contra-indications and precautions: Caution must be exercised with patients who may have cervical spinal instability or other physical limitations including cervical stenosis, severe kyphoscoliosis, limited cervical range of motion, Downs syndrome, Ehlers Danlos syndrome, severe rheumatoid arthritis, cervical radiculopathies, Pagets disease, ankylosing spondylitis, low back pain, spinal cord injuries, known cerebrovascular disease, and the morbidly obese. Quickly turn the head 90 degrees to one side and observe the patients eyes for nystagmus, again maintaining the position to allow for a latency period before signs and symptoms appear. In most cases, the eyes will beat towards the floor when the patient is turned either direction, but the beating will be more intense towards the involved side. Occasionally, the nystagmus will beat away from the floor towards the upside ear (Bhattacharyya 2017). Clinicians in the past have recommended sleeping with the head elevated or with the treated ear in a dependent position, or to avoid vertical head movements, or wearing a soft cervical collars to limit certain head movements. Spontaneous resolution has been reported in 15% to 85% of cases without intervention at one month. Patients should be warned that there is a significant recurrence rate (see prognosis). Finally, patients, especially older frail patients, should be cautioned regarding the risks and hazards of falling. Counseling should include assessment of home safety, activity restrictions, the need for balance aid such as a cane or a walker and in some cases the need for home supervision until symptom resolution. Procedure: Prior to performing the test, the patient should be warned that this might bring on an episode of vertigo, and they may feel nauseous. Begin with the patient seated upright with legs extended and head in 45 degrees of rotation. The patient is then quickly lowered to the supine position and their head is held in 30 degrees of extension and 45 degrees of rotation. Hold this position for about one minute, or for 30 seconds after their symptoms and nystagmus have subsided. Step 2: Turn the patients head 90 degrees so that it is in 45 degrees of rotation in the opposite direction of step one, and maintain the extension. Step 4: Have the patient bring their knees up toward their chest and then hang their legs over the edge of the table, and bring them to a seated position. Return the patients head to a neutral position and support the patient until they are stable. Common errors: Patients will naturally close their eyes as they are lowered to the supine position. When going from Step 2 to Step 3, it is important to maintain the neck in 45 degrees of rotation relative to the patients chest. Keep the patients chin pointing towards their shoulder as they turn onto their side. Effectiveness: A 2014 Cochrane review (N=745, 11 trials) reported that this treatment was statistically and clinically more effective than sham maneuvers or other controls. Obesity and cervical spine problems such as severe arthritis, carotid artery stenosis, or vertebral basilar insufficiency may make this procedure difficult or impossible to perform. This procedure should not be performed in those with conditions such as Downs syndrome, severe rheumatoid arthritis, Pagets disease, or spinal cord injuries. Procedure: There are a number of variations to performing this maneuver, they all depend on rotating the head and body slowly through 360 degrees in an attempt to guide a free otolith out of the lateral canal where it is stimulating the vertigo. This time is necessary to be sure that the otolith has re-positioned itself by drifting down the lateral canal. Next keep rolling the patient (head and body) in the same direction until they are completely prone. Hold this position for about 30-60 seconds so that the crystal settles into a new position further down the canal. Next continue to rotate head and body on to their side facing the opposite direction. Finally complete the roll, hold for 30-60 seconds and return to a sitting position. If the procedure is done too slowly, there wont be enough momentum to get the otolith moving and the treatment may fail. Effectiveness: Response rates range from 50% to 100% based on several cohort studies and case series. They recommend against radiographic imaging and vestibular suppressant medications. However, this treatment may not be practical in many cases and may more likely be a treatment of last resort. It is recommended especially in geriatric populations that a patients risk for falls be assessed (Lawson 2005). While these may be effective in some cases, one in-office canalith repositioning procedure has been found to be more than 10 times as effective as a week of these home exercises (Amor-Dorado 2012). Having a patient do canalith repositioning procedures by themselves at home has been shown to be more effective than Brandt-Daroff exercises, but still not as effective as in office treatment by a trained provider (Radtke 1999). There is no consensus in the literature about the number of times that a canalith repositioning maneuver such as Epleys or the barbeque roll should be performed, although it usually does not require more than 2 treatments. Clinicians may offer observation with 1 month follow-up as an Recommendation (option) initial treatment approach instead of the head positon Grade B evidence based on control maneuvers. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society and] European Academy of Otology and Neurotology. Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Classification, diagnostic criteria and management of benign paroxysmal positional vertigo. Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit. Original contribution: Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Epidemiology of Balance Symptoms and Disorders in the Community: A Systematic Review. It is recommended that if you are dizzy or unsteady when standing or walking that you use a cane or a walker for support. If you are unsteady on your feet, consider using a plastic chair with a back and non-skid legs in the shower or tub and use a hand-held shower head to bathe. Get up slowly from sitting or lying since a drop in blood pressure may cause dizziness at these times. Also consider purchasing a portable telephone to take from room to room so you can call for help immediately if you fall. For example, use a long-handled grasping device to pick up items without bending or reaching. Use a pushcart to transfer heavy or hot items from the stove or counter top to the table. You may find these in the lobby of a hotel or bank, a hospital, or the grocery store. Do not hesitate to ask for assistance or use a cane or a walker on unfamiliar or uneven ground. Preventing Trauma While in Transit Remain alert and brace yourself when riding a bus that is slowing down or turning. His results have more recently been supported by further research by Masters and Johnson, as well as by several other researchers. The most revealing point from these studies is that there is a broad spectrum of sexual orientation, not just two lifestyles: heterosexual and homosexual. Instead of picturing sexual orientation as an either/or issue, Kinsey developed a seven-point continuum based on the degree of sexual responsiveness people have for members of the same and opposite sex. The continuum is as follows: 0 Exclusively heterosexual 1 Predominately heterosexual, incidentally homosexual 2 Predominately heterosexual, but more than incidentally homosexual 3 Equally heterosexual and homosexual 4 Predominately homosexual, but more than incidentally heterosexual 5 Predominately homosexual, incidentally heterosexual 6 Exclusively homosexual Dr. Alfred Kinsey suggested that it is necessary to consider a variety of activities in assessing an individuals ranking on the continuum: Fantasies Thoughts Emotional Feelings Dreams Frequency of Sexual Activity Therefore, many heterosexuals, in fact, would fall somewhere between numbers 0-3 because they occasionally think/dream/fantasize about sexual activities with members of the same sex and/or occasionally act on these feelings. Vivienne Cass published her six-stage model of homosexuality identity formation in 1979. The stages are not necessarily mutually exclusive and offer for fluid movement between stages. Coming out is a process that happens again and again; it is not just a one-time deal and it does not follow a linear course. It occurs initially when one acknowledges to oneself (most important and difficult aspect of coming out) and to others that one is lesbian, gay, bisexual, or transgender. One claims that orientation as his/her own and begins to be more or less public with it. Coming out to themselves is one of the hardest steps in developing a positive lesbian, gay, bisexual or transgender identity. It involves much soul searching and introspection and a good healthy sense of self-appreciation and acceptance. Coming out to others involves other risks and difficulties depending on who that person is coming out to , how engaged they are with them, how much power they have in the relationship, and how accepting they are. Rejection and loss of relationship, especially family and friends who do not understand or approve, are real fears. There is a real possibility of harassment and abuse from others, ranging from verbal insults to physical violence against them or their possessions. Examples include losing a job, not being hired for a career, being denied housing and other equal opportunity rights. This term generally applies to queer people who struggle to accept themselves or aspects of themselves. There are multiple theories regarding coming out and they follow similar patterns; the initial stage involves some awareness that another way of being (besides being heterosexual) exists and that it somehow fits the individual.
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