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According to Paragraph 13 buy generic fluticasone 250mcg line asthma symptoms severe, �Health is central to the Millennium Development Goals Criminalization of sexual and reproductive because it is central to poverty reduction and health and rights development fluticasone 100mcg online asthma symptoms back pain. Good health is not just an out the Special Rapporteur presented his report come of poverty reduction and development: it to the General Assembly on 3 August 2011 is a way of achieving them buy fluticasone 500mcg free shipping cardiac asthma definition. International law � and numerous tion between criminal laws and other legal national constitutions � recognize the human restrictions relating to sexual and repro right to the highest attainable standard of phys ductive health and the right to health are ical and mental health cheap 100mcg fluticasone fast delivery asthma unusual symptoms. The Special Rapporteur considers the the right to health and informed consent impact of criminal and other legal restric Reproductive rights are also mentioned tions on abortion, on conduct during preg in the Special Rapporteurs report to nancy, on contraception and family planning, the United Nations General Assembly and on the provision of sexual and repro A/64/272 of 10 August 2009, focusing on ductive education and information. Among other things the criminal and other legal restrictions in each report mentions the right of adolescents to of those areas, which are often discrimina have access to sexual and reproductive ser tory in nature, violate the right to health by vices and information without parental con restricting access to quality goods, services sent, cf. They infringe human dig the law, children often have their rights rele nity by restricting the freedoms to which gated to a legal guardian, compromising their individuals are entitled under the right exercise of autonomy; varying maturity levels to health, particularly in respect of deci makes appropriately assessing legal capac sion-making and bodily integrity. Creation or mainte ization of womens right to health and must nance of criminal laws with respect to abortion be eliminated. These laws infringe womens may amount to violations of the obligations of dignity and autonomy by severely restricting States to respect, protect and fulfl the right to decision-making by women in respect of their health. The choice of whether or not that oppressed women face in asserting their to have children and information on the sexual rights against their male partners, but means of avoiding transmitting the disease also reinforce ideologies of mens control over to an unborn child or a new born infant make womens sexuality (however they may be women the focus of intense scrutiny: preg culturally framed) and thereby contribute to the nancy and childcare are areas around which perpetuation of the root cause of many forms of multiple stigmas of family, community and violence against women. The certainly not only affect womens rights but report insists on the importance of ensur also impose the need to envisage a new form ing not only girls access to school but also of masculinity that is more sensitive, responsi their completion of the education cycle. The ble and proactive towards equality, justice and report identifes obstacles to education for solidarity. He In his report of 23 July 2010 (A/65/162), then addresses the situation of the right to the Special Rapporteur introduces the topic sexuality education, taking State responsi of the right to sexuality education, placing bility into account and analysing regional it in the context of patriarchy and control of and national trends, differing perspectives sexuality. He explains the interdependence and the key role of the family and the com of sexuality, health and education and the munity. The Special Rapporteur concludes relationship of this right to other rights from his report by reiterating the necessity and a gender and diversity perspective. The the relevance of the right to comprehensive Special Rapporteur introduces the right to sexuality education and presenting specifc sexuality education in the context of inter recommendations for States and the inter national human rights law and analyses national community. In addition, teur notes the triple discrimination of which he highlights the discrimination of indige indigenous women are often victims (being nous women within their own communities, indigenous, poor and female) and mentions for example with respect to forced mar some examples of the consequences of this, riages and rape, cf. The instruments, various statements from the African Charter on Human and Peoples African Commission on Human and Peo Rights contains provisions similar to the ples Rights, or declarations, action plans provisions in the United Nations human and similar policy statements by the African rights treaties that have been used to artic governments, are very similar to what can ulate reproductive rights. Article 2 contains be found in the United Nations documents, a general prohibition against discrimina thus refecting concern about the prevalence tion with Article 18 specifcally prohibiting of maternal and child mortality and morbid discrimination against women. Accord access to family planning services, includ ing to Article 16 every individual has the ing contraception. Gender-based analysis right to the best attainable state of physical is applied to harmful practices and violence and mental health. Article demands that the state ensure the physical 7 sets out that both parties have the same and moral health of the family. In Article 2, prohibiting and setting Health and reproductive rights is the subject out specifcs steps to root out discrimina of Article 14. According to this Article, the tion, states are specifcally ordered to take sexual and reproductive health of women steps against �those harmful practices which shall be �respected and promoted�, including endanger the health and general well-being �(a) the right to control their fertility; (b) the of women�; �harmful practices� are defned right to decide whether to have children, the in Article 1 as �all behaviour, attitudes and/ number. Further of superiority or inferiority of either sex or more, states shall provide health services, on stereotypes. Harmful practices is the accessible also in rural areas and including subject of Article 5 which obligates the information and education; shall secure states to take all necessary measures, such pre-natal, delivery and post-natal health and as awareness campaigns, legislative steps nutritional service during pregnancy and and victim support to eradicate all harmful breast-feeding; and shall authorize medi practices against women, including female cal abortion �in cases of sexual assault, rape, genital mutilation. In Article 24 on women in distress, it this Article further obliges states to enact is stated that pregnant and nursing women and enforce laws and take various other shall be provided with an environment steps against all forms of violence against suitable to their condition and treated with women, including unwanted or forced sex, dignity. With respect to marriage, men and women the African Charter on the Rights and shall be treated and considered equal, and Welfare of the Child was adopted in 1990. Article 7 protects the right of mortality may be considered contrary to young persons to privacy from �arbitrary or this provision. According to Article reasonable supervision by parents or legal 8 on the protection of the family, marriage guardians, is protected by Article 10; this is shall only be entered into on the basis relevant when considering an adolescents of free consent and both parties shall be access to confdential reproductive health treated equally. The right to an adequate protection of the family, Article 19 speci standard of living and sustainable liveli fes the rights by children to parental care hoods are also guaranteed in Articles 14 and protection, and Article 20 sets out the and 15. It further specifes the right for youths to be involved in identifying their reproductive and Similar to the Protocol on the Rights of health needs; the obligation to secure health Women in Africa, the Child Charter includes services in poor areas and to vulnerable and a provision on harmful social and cultural disadvantaged youths; the right to access practices, in this case Article 21. Accord youth friendly reproductive health services ing to this, states shall take all appropriate including contraceptives and ante and measures to eliminate such practices, in post-natal care; and the obligation to take particular those affecting the health and life steps to prevent unsafe abortions. Article including the obligation to instigate pro 21 prohibits marriage and betrothal of boys grammes to prevent transmission; to make and girls and mandates a minimum age of testing and counselling available; to provide marriage of 18 years. Among its vation concerning Botswana, adopted in tasks is to consider state reports from the November 2009. Charter and, provided they are parties to the Protocol on the Rights of Women, on the In 2010, the Commission adopted con rights set out in this Protocol. In the guide cluding observations on Cameroon, which lines for reporting on the Protocol, adopted included a recommendation to reinforce by the Commission in May 2010, the follow efforts in relation to reproductive health �in ing issues are mentioned among issues to order to raise the level of access by women and be reported on: protection of women from adolescents to family planning and to accessible violence, harmful practices (including female and good quality health services and to reduce genital mutilation), female stereotypes, mar maternal and infant mortality rates. So far, 195 however, none of these have dealt with fling court cases; and carrying out follow-up issues relating to reproductive rights. The Commission goes on to families caring for the dying, devise health declare that preventable maternal mortality care programmes of education, carry out is a violation of the rights to life, health and awareness-raising campaigns and take dignity of women in Africa, enshrined in necessary medical interventions. The Com both the African Charter and the Protocol mission also called upon the international on the Rights of Women, and calls upon pharmaceutical industry and international the African governments to address this donors to do their share. Among In 2004 the African Commission adopted the recommendations are allocating 15% of the so-called Pretoria Declaration on national budgets to the health sector and Economic, Social and Cultural Rights in to adopt Human Rights Based Approaches Africa. In the Declaration as practicable� free, accessible and available the participants attempted to fesh out the antenatal and obstetric services; ensur economic, social and cultural rights con ing women and civil society participation tained in the African Charter. This General Comment provides more tinental Policy Framework on Sexual and detailed guidance on States obligations in Reproductive Health and Rights, devel this context.

Effect of large oral doses of ascorbic acid on uric acid excretion by normal subjects purchase fluticasone 100 mcg mastercard asthma treatment for athletes. Increase in circulating products of lipid peroxi dation (F2-isoprostanes) in smokers buy 250mcg fluticasone visa asthma symptoms 2. Comparison of the nutritional status of pregnant adolescents with adult pregnant women discount fluticasone 100 mcg visa asthma attack symptoms 2 year old. Use of Vitamin and Mineral Supplements in the United States: Current Users buy 500mcg fluticasone overnight delivery asthma treatment mnemonic, Types of Products, and Nutrients. Advance Data, Vital and Health Statistics of the National Center for Health Statistics. Dietary Reference Intakes: the Essential Guide to Nutrient Requirements. Endothelium-dependent vasodilation in the brachial artery is impaired in smokers: Effect of vitamin C. Compromised concentrations of ascorbate in fluid lining the respiratory tract in human subjects after exposure to ozone. Serum antioxidant potential, and lipoprotein oxidation in female smokers following vitamin C supplementa tion. The effect of vitamin C and E supplementation on lipid and urate oxidation products in plasma. Vita min C deficiency and risk of myocardial infarction: Prospective population study of men from eastern Finland. Effect of supplementation of smoking men with plain or slow release ascorbic acid on lipoprotein oxidation. Repeated measurements of vegetables, fruits, beta-carotene, and vita mins C and E in relation to lung cancer. Measurement of vitamin C in blood components by high-performance liquid chromatography. Secondary hyperoxalemia caused by vitamin C supplementation in regular hemodialysis patients. The influence of smoking on vitamin C status during the third trimester of preg nancy and on vitamin C levels in maternal milk. Dietary Reference Intakes: the Essential Guide to Nutrient Requirements. Purification, cloning and expression of dehydroascorbic acid-reducing activity from human neutrophils: Identification as glutaredoxin. Vitamin C supplemen tation reduces the incidence of postrace symptoms of upper-respiratory-tract infection in ultramarathon runners. Iron, zinc and vitamin C nutritional status is not related to weight gain in pregnant women. Vitamin C intake influences the bleomycin-induced chro mosome damage assay: Implications for detection of cancer susceptibility and chromosome breakage syndromes. Vitamin C at concentrations observed in premature babies inhibits the ferroxidase activity of caeruloplas min. Biological effects of cigarette smoke, wood smoke, and the smoke from plastics: the use of electron spin resonance. Cigarette smoke radicals and the role of free radicals in chemical carcinogenicity. Electron-spin resonance study of main stream and sidestream cigarette smoke: Nature of the free radicals in gas phase smoke and in cigarette tar. Dietary Reference Intakes: the Essential Guide to Nutrient Requirements. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. Dietary supplementation with vitamins C and E inhibits in vitro oxidation of lipoproteins. Rokkas T, Papatheodorou G, Karameris A, Mavrogeorgis A, Kalogeropoulos N, Giannikos N. Vitamin C nutrition during prolonged lactation: Optimal in infants while marginal in some mothers. Smoking cessation increases the resistance of low-density lipoprotein to oxidation. Thiocyanate-indepen dent nitrosation in humans with carcinogenic parasite infection. Dietary Reference Intakes: the Essential Guide to Nutrient Requirements. Ascorbic acid abuse: Effects on long-term inges tion of excessive amounts on blood levels and urinary excretion. Some aspects of current vitamin C usage: Diminished high-altitude resistance following overdosage. Cigarette smoking is pro-oxidant in pregnant women regardless of antioxi dant nutrient intake. Dietary intake, plasma levels of antioxidant vitamins, and oxida tive stress in relation to coronary artery disease in elderly subjects. Quercetin protects cutaneous tissue-associated cell types including sensory neurons from oxida tive stress induced by glutathione depletion: Cooperative effects of ascorbic acid.

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The inde pendent roles of exposure duration and effect modification by age may have been difficult to distinguish buy discount fluticasone 500mcg on line asthma questionnaire for doctors. The studies conducted only weakly suggest that male exposure to lead is associ ated with delayed conception fluticasone 500mcg cheap asthmatic bronchitis without status asthmaticus. There are a number of mechanisms by which exposure to lead may reduce male fertility buy fluticasone 500 mcg amex asthma definition psychology. On the basis of animal studies order 500mcg fluticasone free shipping asthma definition 34, alterations in sperm chromatin stability or epigenetic effects may be the most probable mechanisms involved at low expo sure level. In some studies, paternal exposure to lead has been linked with an There is evidence that heavy exposure to inorganic lead is increased risk of spontaneous abortion or congenital mal detrimental to semen quality [1]. The review is restricted to those epidemiological stud sperm seem to be at least partially reversible [2]. In this ies in which time-to-pregnancy and closely related fertility prospective study, average PbB decreased from 40 to measures, such as subfecundity, fertility rates or infertility, 20 �g/dl during the observation period. Blood lead measure improvements were seen in the proportion of motile cells, ments were applied to exposure assessment in all the stud and in penetration. Throughout the paper, fertility is viewed as the ability and male heavy exposure to inorganic lead with infertility to produce live offspring. However, the current There are four studies of the effects of paternal lead expo epidemiological evidence on male-mediated developmen sure and delayed conception (Table 1A) [6�9]. Data of the the paper presented at the Conference �Metal in Eastern and Central Europe: Health effects, sources of contamination and methods of remediation�, Prague, Czech Republic, 8�10 November 2000. Cohort studies on birth rates and infertility: Pre-employment, Lead battery F: interview (W) 71 69 <25 �g/dl Birth 1. In the Polish study [9], couples are excluded from retrospective time-to-preg the percentage of couples with delayed conception were nancy studies. By contrast, also voluntarily childless couples similar among the exposed and unexposed subjects. The findings of However, no multivariate analyses were performed in that time-to-pregnancy studies may be selective underestim study. In the European multicentre study [6,7], the focus ates whereas the opposite may be true in the studies of was on the time-to-pregnancy for the youngest child of the fertility rates. The findings of this study did not point to an asso There is a number of mechanisms by which lead may affect ciation between exposure to lead and decreased fertility � male reproductive health. This conclusion was further strengthened by the and human studies suggest that the sperm chromatin struc observation that infertility was more common among the ture is altered already at low exposure. A biological ration families of occupationally exposed men (PbB > 10 �g/dl) ale for this finding is that lead and other cations (mercury, than in the less exposed controls [10]. Recently, male suggest an association between lead exposure and infertil mediated effects have been observed in genomic expres ity. PbB levels with positive findings were >25 �g/dl, sion in 2-cell embryos fathered by male rats with PbB 24�74 �g/dl, and >10 �g/dl in the three studies [10,13,15]. Interestingly, fertility was reduced only at Two studies found no effect of lead exposure on fertility a higher PbB level (27�60 �g/dl). However, the design of the French study [12] suggest an effect on the regulation of gene transcription or has been criticized [13]. A ten reproductive toxicant for human males at exposure level of dency towards stronger association at older age was also PbB >40 �g/dl. Also, there seems to be a tendency toward of the studies of fertility rates are consistent in showing an decreased fertility with increasing duration of exposure association between lead exposure and reduced fertility. However, the independent roles of duration of reservation against stronger evidence is related to the lack exposure and effect modification by age may have been of information on a desired family size in studies of fertil difficult to distinguish. In the findings of time-to-pregnancy and fertility rate studies future, childless subjects must be considered in retrospect are contradictory. Fertility of Danish battery workers exposed to probable mechanisms involved at low exposure levels. Fertility of workers exposed to cadmium, lead, or man Occup Environ Med 1998; 55: 364�74. Fertility among workers exposed to solvents or lead [dis ies of paternal occupational exposure and spontaneous abortion. Paternal exposure to lead Received for publication: January 25, 2001 and infertility. Male: Male: Order one semen analysis taken directly to the If abnormal semen analysis prescribe vitamin E examining laboratory. Use luteal phase progesterone only if unsure (>30 nmol/L indicates ovulatory cycles). If ovulating order pelvic ultrasound and tubal imaging to determine structural abnormalities. Ovulatory dysfunction is the most common female cause of infertility and the easiest to treat. Abnormal semen analysis can be treated with antioxidants (vitamin E and zinc) Refer early if endometriosis, abnormal tests or not responding to treatment. The primary care provider is the ideal clinician to provide ongoing emotional support to the couple. Anwar Al-Abadsa, for his enthusiastic support and thoughtful feedback through the inception and completion of this project, as well as his unwavering commitment to mentoring me through my graduate studies. I also thank the members of my thesis committee for lending their wisdom to this project. Osama Balawi, Saleh Al-Deqs, Jihad Okasha, and Hanan Hanona for their time and help. I thank my family, friends, and whose consistent encouragement and enthusiasm provided such support through this process. Finally, I offer my sincere gratitude to the couples who participated in this research, for selflessly sharing their experiences in hopes of helping those who will follow them.

The dishes are then put in an incubator which controls the temperature and the air content generic fluticasone 250mcg asthma resources. The normally fertilized eggs will be kept in the incubator until the day of the embryo transfer purchase fluticasone 250mcg without a prescription asthma in cats. You may choose to have fewer than the recommended number of embryos transferred but not more generic 250mcg fluticasone with amex asthma scientific definition. A syringe at the outer end of the catheter is used to give pressure to empty the catheter fluticasone 100mcg line asthma wheezing definition. Ultrasound is sometimes used to help guide the catheter or verify the placement in the uterus. Oral contraceptive pills: Many treatment protocols include oral contraceptive pills to be taken for 1 to 4 weeks before stimulation injections are started in order to suppress hormone production or to help schedule a cycle. Risks, discomforts: headache, hypertension, nausea, breakthrough bleeding, weight gain, breast tenderness, blood clots. They tend to be used for short periods of time in the late stages of ovarian stimulation or at the end of the prior cycle in the patch protocol. There are two forms of the medication: A short acting medication requiring daily injections and a long-acting preparation lasting for 1-3 months. Risks, discomforts: hot flashes, vaginal dryness, burning on urination, difficulty sleeping bloating, headaches, hair loss, pain or numbness in extremities, local reactions at the injection site and temporary reduction in bone density. Gonadotropins or injectable �fertility drugs� (Follistim, Gonal-F, Bravelle, Menopur, Repronex, Luveris): these naturally occurring hormones stimulate the ovaries in hopes of maturing several oocytes (eggs) over the span of 7-14 days. Risks, discomforts: weight gain, mood changes, stomach pressure, headaches, nausea, vomiting, bloating. These medications are given by subcutaneous (small needle) or intramuscular (big needle) injection. Risks, discomforts: headache, irritability Progesterone (Endometrin, Crinone, Prochieve, Prometrium, or pharmacist compounded suppositories, Progesterone in oil): this medicine is a hormone produced by the ovaries after ovulation to support the uterine lining for implantation (attachment) of the embryo. After egg retrieval, in some women, the ovaries will not produce enough of this hormone for long enough to support the uterine lining and thus the pregnancy. Progesterone is often continued for many weeks after a pregnancy has been confirmed. These medications are given by intramuscular (big needle) injection or vaginal insert. Risks, discomforts: depression, sleepiness, bloating, weight gain, breast tenderness, headache, fatigue, allergic reaction and if given by intra-muscular injection includes the additional risk of infection or pain at the injection site. Estradiol (Vivelle, Estrace): this medicine is a hormone produced by the ovaries to build and maintain a lining in the uterus in preparation for implantation. These medications can be taken by oral, trans-dermal (skin patch), or vaginal administration. Risks, discomforts: nausea, bloating, gallbladder disease, abnormal blood clotting, migraines, darkening of the skin, growth of benign tumors, jaundice, breast tenderness, intolerance to contact lenses, increased vaginal secretions. Other medications: Such as steroids, heparin, low molecular weight heparin or aspirin may also be included in the treatment protocol based on your medical history. These medications are given to mature multiple follicles, and many women experience some bloating and minor discomfort as the follicles grow and the ovaries become temporarily enlarged. Other possible complications include the following: Multiple Pregnancies: the most important complications associated with multiple pregnancies are premature labor and delivery, pre-eclampsia (high blood pressure during pregnancy), and gestational diabetes (see following section on Risks to Woman). Others Page 7 Version 02-2013 include gall bladder problems, skin problems, excess weight gain, anemia, excessive nausea and vomiting, and exacerbation of pregnancy-associated gastrointestinal symptoms including reflux and constipation. Chronic back pain, intermittent heartburn, postpartum relaxation of the abdominal wall, and umbilical hernias also can occur. Triplets and above increase the risk to the mother of more significant complications including severe bleeding after delivery and need for blood transfusion. This results in ovarian enlargement and can lead to lower abdominal discomfort, bloating and distention. The symptoms usually resolve within 1-2 weeks and treatment includes drinking electrolyte fluids such as Gatorade. Pregnancy can worsen the symptoms of ovarian hyperstimulation and make it last longer. Severe ovarian hyperstimulation is characterized by the development of large ovarian cysts and fluid which collects in the abdomen and, sometimes, the lungs. Symptoms of severe ovarian hyperstimulation include abdominal distention and bloating along with weight gain, shortness of breath, nausea, vomiting, and decreased urine output. Approximately 2% of women will develop severe ovarian hyperstimulation and may need to be admitted to the hospital for observation and treatment. To help with the symptoms of severe ovarian hyperstimulation, an ultrasound-guided removal of fluid from the abdominal cavity (paracentesis) can be performed which results in improvement in the symptoms of bloating and distention. Rare, but serious consequences of severe ovarian hyperstimulation, include formation of blood clots that can lead to a stroke, kidney damage, and possibly death. In some cases when there is concern that a woman is at high risk for ovarian hyperstimulation, the cycle may be cancelled or the eggs will be retrieved and any embryos that result may be frozen. This can decrease the blood supply to the ovary and result in significant lower abdominal pain. These studies had significant flaws which limited the strength of their conclusions. A major risk factor for ovarian cancer is infertility itself, suggesting that early studies may have incorrectly attributed the risk associated with infertility to the use of medications to overcome it. The progress of the cycle will be monitored by blood tests and vaginal probe ultrasounds. Testing is used to evaluate the estradiol level and to monitor the number and size of follicles in the ovaries.