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Cenforce

Marcia Irene Canto, M.D.

  • Director of Clinical Research, Division of Gastroenterology
  • Professor of Medicine

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0005397/marcia-canto

Better governance could also be a spinoff of greater political involvement of women man health news disqus , as some studies suggest participation of women in parliament or senior government positions correlates stronger with lower corruption androgen hormone x organic . Their chances of becoming richer will be substantially greater in cities prostate cancer calculator , but the increasing migration to urban areas will mean at least an initial expansion in the slums and the specter of poverty mens health idris . If new middle-class entrants find it difficult to cling to their new status and are pulled back toward impoverishment prostate cancer vaccine , they will pressure governments for change prostate cancer therapy . Rising expectations that are frustrated have historically been a powerful driver of political turmoil. The increase in the overall numbers of the middle class worldwide disguises growing pressures on the middle class in Western economies. No country has completely closed the economic participation or the political empowerment gap, but the Nordic countries have come closest to gender equality. Most Nordic countries enfranchised women relatively "early" (in the early 20th century), and many political parties introduced voluntary gender quotas in the 1970s. The quotas have led to a high number of women parliamentarians and political leaders in those societies. The Nordic countries also have promoted high female employment participation rates through generous childcare and maternity policies, which has contributed to higher birth rates. Looking ahead to 2030 using the International Futures model suggests that pace of change will continue to be slow in all regions. The Middle East, South Asia, and Sub-Saharan, which start from a relatively low base of economic and political gender parity, will continue to lag other regions. The fastest pace in closing the gender gap is likely to be in East Asia and Latin America. The gap almost certainly will remain significantly narrower in high-income countries in North America and Europe in 2030, where the gap is already smaller than elsewhere. Although some data points to a connection between online participation and radicalization of Muslim women, indications of female empowerment and solidarity are far more plentiful. Participation in online and social media platforms hinges on income, literacy, and access. As these expand by 2030, a growing number of Muslim women are likely to participate in online forums, potentially affecting their societies and governance. The second wave of wireless communications engenders a reduced need for developing countries to invest in and build expansive, costly communications infrastructures. Such technologies will reduce the urban-rural split that characterized first-wave technologies, especially in developing countries. Now millions of Africans are connected to the Internet and the outside world, and they are using such technologies to mitigate deep-seated problems such as waterborne illness, which have slowed development. For example, an innovative program in western Kenya to distribute water filters and stop the use of contaminated water involved using smartphones to monitor changes in behavior. ImprovInG healTh By 2030 we expect to see continued progress on health-including extending the quality of life for those aging (see discussion on pages 98-102). Great strides are being made toward wiping out malaria, but past periods of progress have sometimes given way in the face of donor fatigue and growing disease resistance to treatment. Nevertheless, in Sub-Saharan Africa, where the provision of health-care services has traditionally been weak, we believe the declining total deaths from communicable diseases and the increasing number from noncommunicable causes (such as from heart disease) will cross over in about 2030. Managing the intensifying interaction of traditional political, religious, and cultural norms with the ideologies of the globalizing West will be a core challenge for many rapidly developing societies, affecting prospects for global and domestic governance and economic performance through 2030. The persistence, if not growth and deepening, of religious identity, growing environmental concerns, and resource constraints, and the empowerment of individuals through new communications technologies are already providing alternative narratives for global politics. As non-Western societies continue their economic transformation, the prospect of a retrenchment along religious, ethnic, cultural, and nationalistic lines could fuel dysfunction and fragmentation within societies. Alternatively, the intersection of Western ideas with emerging states could generate-particularly over time-new hybrid ideologies that facilitate collaboration in an expanding number of areas, leading to increased economic output and greater consensus on global governance issues. The role assigned to religion by the state and society probably will be at the center of these ideological debates within and across societies. With the dramatic reduction of infant and child mortality, due to the continued success against communicable diseases and maternal and perinatal diseases, life expectancy in the developing world almost certainly will improve. However, a significant gap in life expectancy will most likely remain between rich and poor countries. Unlike other disruptive global events, such an outbreak would result in a global pandemic that directly causes suffering and death in every corner of the world, probably in less than six months. Advances in genetic engineering by 2030 may enable tens of thousands of individuals to synthesize and release novel pathogens, compounding the already formidable naturally occurring threat. The ability of religious organizations to define norms for governance in religious terms and to mobilize followers on economic and social justice issues during a period of global economic upheaval is likely to raise the prominence of religious ideas and beliefs in global politics. In this new era, religious ideas, actors, and institutions are likely to be increasingly influential among elites and publics globally. Moreover, many developing and fragile states-such as in Sub-Saharan Africa-face increasing strains from resource constraints and climate change, pitting different tribal and ethnic groups against one another and accentuating the separation of various identities. Ideology is likely to be particularly powerful and socially destructive when the need for basic resources exacerbates already existing tensions between tribal, ethnic, religious, and national groups. Urbanization- once expected to encourage secularization-is contributing instead, in some settings, to increased expressions of religious identity. Immigrants to cities- mostly Muslims in Europe and Russia, for example- are coalescing along religious lines. Urbanization is driving demands for social services provided by religious organizations-an opening that Islamic and Christian activists have been effective in using to bolster religious cohesion and leverage. Just as important, the economies of other non-Western states such as Colombia, Egypt, Indonesia, Iran, South Africa, Mexico, Turkey, and others that are middle tier today could rise by 2030. Individually most of these countries will remain second-order players because China and India are so large. However, as a collective group, they will begin to surpass Europe, Japan, and Russia in terms of global power by 2030. When this second tier is combined with the non-Western giants of China and India, the shift of power from the West to the emerging or non-Western world is even more pronounced. The enormity of this shift in national power is reflected in the number of regional power transitions that will be ongoing by 2030-some of the more dynamic will occur outside of Asia, where China and India are already consolidating their regional positions. In 2030 India could be the rising economic powerhouse that China is seen to be today. The total size of the Chinese working-age population will peak in 2016 and decline from 994 million to about 961 million in 2030. Also of significance, India will most likely continue to consolidate its power advantage relative to Pakistan. In Africa, Egypt, Ethiopia, and Nigeria have the potential to approach or surpass South Africa in overall national power, but the key will be better governance to further economic growth and social and human development. By 2030 Russia faces a steep population drop-about 10 million people-a greater decline than any other country during that time frame. However, depending on its economic growth rates and immigration, Russia could retain its current global power share. The share of global power held by the eu, Japan, and less so russia decreases under both indices. These countries will most likely continue to have weak governance, security, and economic performance while facing demographic and environmental challenges. A number of countries will pass through inflection points in the period out to 2030: their global power will either level off or the rate of increase of their global power will slow. Not only China and the United States, but also Europe, Japan, and Russia may be passing through inflection points, which will translate into added stress on the international system. Historically, the rate of change has been far slower for transitions in the power structure. Enabled by communications technologies, power almost certainly will shift more toward multifaceted and amorphous networks composed of state and nonstate actors that will form to influence global policies on various issues. Leadership of such networks will be a function of position, enmeshment, diplomatic skill, and constructive demeanor. Soft power relates to political, diplomatic, social, and cultural attainments and values that also garner influence and the capability to persuade. The table above lists countries that are projected to have a high risk of instability, conflict, or some other type of state failure in 2030 because of their poor human ecology and resilience. Those countries to the northwest of the line (see graphic on page 18) are punching above their weight in hard power. In the next 20 years, we expect many of the middle powers to rise above the line as both their hard and soft powers increase. As these mountains of data are used to improve knowledge of human motivations, non state actors such as private companies will be able to influence behavior on as large a scale as state actors. One could anticipate a dual-pronged movement of more state regulation on bad actors-such as hackers-while more political space opens up for individuals with positive motives. Enabled by communications technologies, power almost certainly will shift more toward multifaceted and amorphous networks composed of state and nonstate actors. These trends are: aging both for the West and increasingly most developing states; a still significant but shrinking number of youthful societies and countries; migration, which will increasingly be a cross-border issue; and growing urbanization, which will spur economic growth but place new strains on food and water resources. These post-mature states will be challenged to undertake cost-effective reforms of their retirement and health-care programs- and muster funding to adequately support needy retirees-while maintaining the living standards of those families and taxpayers who support them. Governments of post-mature countries could be pressured to vastly restrain discretionary state spending and impose a higher tax burden. The median age of almost all societies around the world is rising rapidly, except in Sub-Saharan Africa. Aging countries face an uphill battle in maintaining their living standards while more youthful ones have the potential, owing to the "demographic dividend," to gain an economic boost if they can put the extra numbers of youth to work. Whereas in 2012 only the populations of Japan and Germany have matured beyond the median age of 45 years, by 2030, in a tectonic shift, a much larger group of countries is projected to have entered this post-mature category in Europe and East Asia (see map on page 22). The populations of these countries will feature a large proportion of people over 65 years of age-an unprecedented "pensioner bulge. For some low-fertility Western European countries that have poorly integrated Asian and African immigrants, the rapid growth of these minorities could erode social cohesion and promote reactionary politics. Advances in health care-which we examine on pages 98-102- are likely to improve the quality of life for some seniors, enabling them to work longer. For countries in the mature category, such as China, the advantages and opportunities of the demographic bonus will have largely faded, though those that invested heavily in human capital may prolong that bonus. Despite the fading of their demographic advantages, these countries will not yet have large proportions of seniors. They will, however, need to pay closer attention to creating sustainable pension and health-care programs in order to avoid long-term risks to their development. In the United States and Russia, the advance of the median age and an increase in the proportion of seniors will proceed slowly. In Russia, the high rate of deaths among young men-because of tobacco use, alcohol abuse, and related accidents-means that instead of aging, males especially are dying at a relatively young age-in their 50s instead of living into their 60s and 70s as in other countries. The largest persistent cluster of youthful states is projected to be located along the equatorial belt of Sub-Saharan Africa. In the Americas, only Bolivia, Guatemala, and Haiti are likely to retain their youthful populations. Along the Pacific Rim, this challenging condition is expected to persist in East Timor, Papua New Guinea, and the Solomon Islands. However, the aging that will occur among the large and growing populations in nearby Pakistan and India probably will mask youthful ethnic and regional populations that could remain a security concern. In Pakistan and Afghanistan, the rates of childbearing are probably greater than five children per woman among the Pushtun. In India, where the southern states and large cities have attained low fertility, youthfulness-which can contribute to instability in the absence of employment outlets-is likely to erode more slowly in the central northern states of Uttar Pradesh and Bihar. Kurdish fertility in southeastern Turkey appears to be stalled at about four children per woman. In Israel, the fertility of the diverse Ultra-Orthodox Jewish minority remains above six children per woman. The persistence of high rates of fertility and population growth among dissonant minorities is bound to perturb the political order, particularly as these populations become much larger-although demography alone gives no clues as to how countries will adjust to these population shifts. As a group, these countries have an over-sized impact on world affairs- since the 1970s, roughly 80 percent of all armed civil and ethnic conflicts (with 25 or more battle-related deaths per year) have originated in countries with youthful populations. The "demographic arc of instability" outlined by these youthful populations ranges from clusters in the mid-section of Central America and the Central Andes, covers all of Sub-Saharan Africa, and stretches across the Middle East into South and Central Asia. Due to fertility declines that are well under way today, the tally of countries with youthful populations is projected to fall to about 50 by 2030. We will not see the same high proportion of migrants as in the first industrial revolution, but international migration is set to grow even faster than it did in the past quarter-century. The factors promoting cross-border migration are likely to remain strong or intensify. These factors are globalization, disparate age structures across richer and poorer countries, income inequalities across regions and countries, and the presence of migrant networks linking sending and receiving countries. Internal migration-which will be at even higher levels than international migration-will be driven by rapid urbanization in the developing world and, in some countries toward the end of our time frame, by environmental factors and the impact of climate change. Climate-change-driven migration is likely to affect Africa and Asia far more than other continents because of dependence on agriculture in Africa and parts of Asia and because of greater susceptibility in Asia to extreme weather events. Our interlocutors in Africa pointed to the growing numbers of migrants already spilling over from the Sahel region as it experiences increasingly drier conditions. Flood-driven migration will wipe out homes and infrastructures and significantly increase the perception of the risk of staying. As with international migration, the specter of greater economic opportunities outside of local communities will be the biggest driver of internal migration. In China alone, nearly 250 million people are estimated to be internal migrants today; that number will continue to rise as more rural residents seek to raise their standard of living by moving to cities.

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How Age Influences Physical Activity in Children and Adolescents Children and adolescents should meet the Guidelines by doing activity that is appropriate for their age prostate urologist . For example mens health shoulder workout , children are naturally active in an intermittent way prostate oncology unit , particularly when they do unstructured active play prostate oncology 24 . During recess and in their free play and games prostate lab test , children use basic aerobic and bone-strengthening activities man health guide , such as running, hopping, skipping, and jumping, to develop movement patterns and skills. They alternate brief periods of moderate- and vigorous-intensity activity with brief periods of rest. Any episode of moderate- or vigorousintensity physical activity, however brief, counts toward the Guidelines. Children also commonly increase muscle strength through unstructured activities that involve lifting or moving their body weight or working against resistance. Active Children and Adolescents 16 Regular physical activity in children and adolescents promotes a healthy body weight and body composition. The intensity of aerobic physical activity can be defined on either an absolute or a relative scale. They are able to play organized games and sports and are able to sustain longer periods of activity. But they still commonly do intermittent activity, and no period of moderate- or vigorous-intensity activity is too short to count toward the Guidelines. Adolescents may meet the Guidelines by doing free play, structured programs, or both. Structured exercise programs can include aerobic activities, such as playing a sport, and muscle-strengthening activities, such as lifting weights, working with resistance bands, or using body weight for resistance (such as push-ups, pull-ups, and sit-ups). Muscle-strengthening activities count if they involve a moderate to high level of effort and work the major muscle groups of the body: legs, hips, back, abdomen, chest, shoulders, and arms. As a rule of thumb, on a scale of 0 to 10, where sitting is 0 and the highest level of effort possible is 10, moderate-intensity activity is a 5 or 6. Young people doing moderate-intensity activity will notice that their hearts are beating faster than normal and they are breathing harder than normal. Youth doing vigorous-intensity activity will feel their heart beating much faster than normal and they will breathe much harder than normal. But they can observe whether a child is doing an activity which, based on absolute energy expenditure, is considered to be either moderate or vigorous. For example, a child walking briskly to school is doing moderate-intensity activity. The table on page 18 includes examples of activities classified by absolute intensity. It shows that the same activity can be moderate or vigorous intensity, depending on factors such as speed (for example bicycling slowly or fast). Levels of Intensity for Aerobic Activity Children and adolescents can meet the Guidelines by doing a combination of moderate- and vigorousintensity aerobic physical activities or by doing only vigorous-intensity aerobic physical activities. Physical Activity and Healthy Weight Regular physical activity in children and adolescents promotes a healthy body weight and body composition. Research studies report that fatness can be reduced by regular physical activity of moderate to vigorous intensity 3 to 5 times a week, for 30 to 60 minutes. Meeting the Guidelines American youth vary in their physical activity participation. Active Children and Adolescents 18 Children and adolescents can meet the Physical Activity Guidelines and become regularly physically active in many ways. One practical strategy to promote activity in youth is to replace inactivity with activity whenever possible. For example, where appropriate and safe, young people should walk or bicycle to school instead of riding in a car. Rather than just watching sporting events on television, young people should participate in ageappropriate sports or games. A gradual increase in the number of days and the time spent being active will help reduce the risk of injury. Evidence suggests that even more than 60 minutes of activity every day may provide additional health benefits. Children and adolescents with disabilities are more likely to be inactive than those without disabilities. Youth with disabilities should work with their healthcare provider to understand the types and amounts of physical activity appropriate for them. When possible, children and adolescents with disabilities should meet the Guidelines. When young people are not able to participate in appropriate physical activities to meet the Guidelines, they should be as active as possible and avoid being inactive. These examples illustrate that even though the activity patterns are different, each young person is meeting the Guidelines by getting the equivalent of at least 60 minutes or more of aerobic activity each day that is at least moderate intensity. Both are also doing vigorous-intensity, muscle-strengthening, and bonestrengthening activities on at least 3 days a week. Harold: A 7-Year-Old Child Harold participates in many types of physical activities in many places. For example, during physical education class, he jumps rope and does gymnastics and sit-ups. During recess, he plays on the playground-often by doing activities that require running and climbing. When Harold gets home from school, he likes to engage in active play (playing tag) and ride his bicycle with his friends and family. Harold gets 60 minutes of physical activity each day that is at least moderate intensity. He participates in the following activities each day: Monday: Walks to and from school (20 minutes), plays actively with family (20 minutes), jumps rope (10 minutes), does gymnastics (10 minutes). Tuesday: Walks to and from school (20 minutes), plays on playground (25 minutes), climbs on playground equipment (15 minutes). Wednesday: Walks to and from school (20 minutes), plays actively with friends (25 minutes), jumps rope (10 minutes), runs (5 minutes), does sit-ups (2 minutes). Getting and Staying Active: Real-Life Examples Children and adolescents can meet the Physical Activity Guidelines and become regularly physically active in many ways. Here are just two examples showing how a child and an adolescent can be 19 2008 Physical Activity Guidelines for Americans Friday: Walks to and from school (20 minutes), plays actively with friends (25 minutes), bicycles (15 minutes). Saturday: Plays on playground (30 minutes), climbs on playground equipment (15 minutes), bicycles (15 minutes). Sunday: Plays on playground (10 minutes), plays soccer (40 minutes), plays tag with family (10 minutes). Thursday: Walks dog (10 minutes), plays tennis (30 minutes), does sit-ups and push-ups (5 minutes), plays with children at the park while babysitting (15 minutes). Maria: A 16-Year-Old Adolescent Maria participates in many types of physical activities in many places. For example, during physical education class, she plays tennis and does sit-ups and push-ups. Maria gets 60 or more minutes of daily physical activity that is at least moderate intensity. Tuesday: Walks dog (10 minutes), plays tennis (30 minutes), does sit-ups and push-ups (5 minutes), walks briskly with friends (15 minutes). Active Children and Adolescents 20 Active Adults A dults who are physically active are healthier and less likely to develop many chronic diseases than adults who are inactive. These benefits are gained by men and women and people of all races and ethnicities who have been studied. Adults gain most of these health benefits when they do the equivalent of at least 150 minutes of moderateintensity aerobic physical activity (2 hours and 30 minutes) each week. Adults gain additional and more extensive health and fitness benefits with even more physical activity. This chapter provides guidance for most men and women aged 18 to 64 years, and focuses on physical activity beyond baseline activity (the usual light or sedentary activities of daily living). Physical activity guidelines for women during pregnancy and the postpartum period and for adults with disabilities and select chronic conditions are discussed in Chapter 7-Additional Considerations for Some Adults. Explaining the Guidelines the Guidelines for adults focus on two types of activity: aerobic and muscle-strengthening. Each type provides important health benefits, as explained in Chapter 2-Physical Activity Has Many Health Benefits. Aerobic Activity Aerobic activities, also called endurance activities, are physical activities in which people move their large muscles in a rhythmic manner for a sustained period. Running, brisk walking, bicycling, playing basketball, dancing, and swimming are all examples of aerobic activities. The purpose of the aerobic activity does not affect whether it counts toward meeting the Guidelines. For example, physically active occupations can count toward meeting the Guidelines, as can active transportation choices (walking or bicycling). Additional health benefits are gained by engaging in physical activity beyond this amount. Time spent in musclestrengthening activities does not count toward the aerobic activity guidelines. When adults do the equivalent of 150 minutes of moderate-intensity aerobic activity each week, the benefits are substantial. These benefits include lower risk of premature death, coronary heart disease, stroke, hypertension, type 2 diabetes, and depression. As a person moves from 150 minutes a week toward 300 minutes (5 hours) a week, he or she gains additional health benefits. Additional benefits include lower risk of colon and breast cancer and prevention of unhealthy weight gain. Also, as a person moves from 150 minutes a week toward 300 minutes a week, the benefits that occur at 150 minutes a week become more extensive. For example, a person who does 300 minutes a week has an even lower risk of heart disease or diabetes than a person who does 150 minutes a week. The benefits continue to increase when a person does more than the equivalent of 300 minutes a week of moderate-intensity aerobic activity. For example, a person who does 420 minutes (7 hours) a week has an even lower risk of premature death than a person who does 150 to 300 minutes a week. Current science does not allow identifying an upper limit of total activity above which there are no additional health benefits. Both moderate- and vigorous-intensity aerobic activity should be performed in episodes of at least 10 minutes. Episodes of this duration are known to improve cardiovascular fitness and some risk factors for heart disease and type 2 diabetes. The Guidelines for adults focus on two levels of intensity: moderate-intensity activity and vigorousintensity activity. To meet the Guidelines, adults can do either moderate-intensity or vigorous-intensity aerobic activities, or a combination of both. Active Adults 22 get the same benefit from vigorous-intensity activities as from moderate-intensity activities. A general rule of thumb is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity. For example, 30 minutes of moderate-intensity activity a week is roughly the same as 15 minutes of vigorous-intensity activity. There are two ways to track the intensity of aerobic activity: absolute intensity and relative intensity. Less fit people generally require a higher level of effort than fitter people to do the same activity. Relative intensity can be estimated using a scale of 0 to 10, where sitting is 0 and the highest level of effort possible is 10. The Guidelines for adults For More Information refer to absolute intensity See Appendix 1 for more because most studies information on using demonstrating lower absolute or relative intensity. That is, the Guidelines are based on the absolute amount of energy expended in physical activity that is associated with health benefits. The table lists some examples of activities classified as moderate-intensity or vigorousintensity based on absolute intensity. Either absolute or relative intensity can be used to monitor progress in meeting the Guidelines. As a rule of thumb, a person doing moderate-intensity aerobic activity can talk, but not sing, during the activity. A person doing vigorousintensity activity cannot say more than a few words without pausing for a breath. Muscle-Strengthening Activity Muscle-strengthening activities provide additional benefits not found with aerobic activity. The benefits of muscle-strengthening activity include increased bone strength and muscular fitness. Muscle-strengthening activities can also help maintain muscle mass during a program of weight loss. Muscle-strengthening activities make muscles do more work than they are accustomed to doing. Resistance training, including weight training, is a familiar example of muscle-strengthening activity. Other examples include working with resistance bands, doing calisthenics 23 2008 Physical Activity Guidelines for Americans that use body weight for resistance (such as push-ups, pull-ups, and sit-ups), carrying heavy loads, and heavy gardening (such as digging or hoeing).

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