Access to Health

Chapter 4: Violence and Abuse

Cycle of violence theory (94-95)- psychologist Lenore Walker on domestic violence

• Phase One: Tension Building - minor battering occurs; woman may become more pleasing and intent on anticipating spouse's needs to forestall another violent scene; woman assumes guilt for provoking spouse
• Phase Two: Acute Battering - woman can no longer control or predict abuse; spouse often claims he is "teaching her a lesson" and will stop when he has inflicted sufficient pain; after attack, he may respond with shock and denial; both parties dispel seriousness of attack
• Phase Three: Remorse/Reconciliation - batterer may be kind, loving, and apologetic, may "behave" for several weeks, causing woman to believe she overreacted about past abuse; tension resurfaces and man again attacks wife; this cycle will repeat forever until intervention or death occurs

Child sexual abuse (97-98)- sexual abuse of children by adults or older children, including sexually suggestive conversation; inappropriate kissing; touching; petting; oral, anal, or vaginal intercourse; and other kinds of sexual interaction; most frequent abusers - parents or companions, then grandfathers and siblings; 20-30% of women report having had unwanted childhood sexual encounter with adult male;

risky situations: 1. Child lives without one of his or her biological parents

2. Mother is unavailable to child due to work or illness

3. Parents' marriage is unhappy or conflict is common

4. Child has poor relationship with parents or is subjected to excessively punitive discipline

5. Child lives with stepfather

incest and childhood sexual abuse are considered most "toxic" forms of violence because of violations of trust - effects show later in life; psychological abuse also occurs

Sexual victimization (99-101)

sexual assault - any act in which one person is sexually intimate with another person without that other person's consent

sexual harassment - any form of unwanted sexual attention

rape - penetration without the victim's consent; most victims 11-17 years old

2/3of men in recent study said they have engaged in sexual activity unwanted by partner because of peer pressure

date rape is an act of violence - every male should be able to distinguish between seductive/persuasuve resistance and genuine fear, i.e. crying or screaming

social assumptions which lead to misunderstanding of true nature of sexual assault:

• minimization - rape is most underreported of all serious crimes; statistics are inaccurate
• trivialization - people joke about rape
• blaming the victim - woman may have provoked attack - dressing too revealingly or flirting
• boys will be boys - men can't control themselves once they become aroused

Chapter 9: Nutrition: Eating for Optimum Health

Health benefits of a fiber-rich diet (228-229)

• protection against colon and rectal cancer
• protection against breast cancer
• protection against constipation
• protection against diverticulosis
• protection against heart disease
• protection against diabetes
• protection against obesity

insoluble fibers - found in bran, whole-grain breads and cereals, and most fruits and veggies

soluble fibers - found in oat bran, dried beans, and some fruits and veggies

To increase dietary consumption of fibers(229)

• eat a variety of foods
• eat at least five servings of fruits and veggies and three to six servings of breads/cereals
• eat less processed food
• eat the skins of fruits and veggies
• get your vitamins from foods rather than pills or powders
• spread out your fiber intake
• drink plenty of liquids - at least 64 oz. of water daily

To reduce fat in your diet

• read food labels; know what you're eating
• choose fat-free or low-fat versions of cakes, cookies, crackers, chips, etc.; calories must still be considered; don't eat more of a food because it's low-fat
• use olive oil for baking and sauteing
• use liquid, diet, or whipped margarine
• choose lean meats, fish, or poultry; remove skin; broil or bake
• choose fewer cold cuts, bacon, sausage, hot dogs, and organ meat
• select nonfat dairy products
• when cooking, use substitutes for butter, margarine, oils, sour cream, mayonnaise, and salad dressings
• think of food intake as an average over a day or a couple of days; if you have a high-fat breakfast or lunch, have a low-fat dinner to balance it

Specifics under "How to Cut the Fat from Your Diet" (232)

this doesn't seem important to me, but the study guide says specifically to know it; you might want to see the book on this one

• use fruit-only jams on toast rather than butter or sugar-based jams (90 calories and 12g fat saved)
• saute meat and veggies in chicken broth or wine rather than in oil (240 calories and 27g fat saved)
• remove skin from chicken before cooking (51 calories and 5g fat saved)
• use low-cal, low-fat salad dressing in place of mayonnaise (93 calories and 11g fat saved)
• choose nonfat frozen yogurt over ice cream (280 calories and 25g fat saved)
• mix 3 parts blenderized low-fat cottage cheese with one part nonfat yogurt in place of cream cheese (79 calories and 10g fat saved)
• have broth-based soups in place of cream-based soups (116 calories and 13g fat saved)
• substitute fish for meat at least once a week (92 calories and 4.5g fat saved)
• substitute two egg whites for one whole egg in recipes (47 calories and 6g fat saved)
• for protein with less fat than meat, try lentil soup or veggie chili (92 calories and 5g fat saved)
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Chapter 10: Managing Your Weight

anorexia nervosa - eating disorder characterized by excessive preoccupation with food, self-starvation, and/or extreme exercising to achieve weight losses

symptoms of anorexia:

• refusal to maintain minimum body weight for height and age
• intense fear of gaining weight though underweight
• disturbed perception of one's body weight or size
• absence of at least three consecutive menstrual cycles in post-pubescent women

bulimia nervosa - eating disorder characterized by binge eating followed by inappropriate compensating measures taken to prevent weight gain

symptoms of bulimia

• recurrent episodes of consuming much more food than normal during any time period; loss of control over eating during such an episode
• accompanying attempts to compensate for eating binges by vomiting, abusing laxatives or other drugs, fasting, or exercising excessively
• both the binge eating and purging occur at least twice a week for three months
• negative perception of one's shape and weight

women are more susceptible to development of eating disorders - physical attractiveness is more important for women than for men; girls are brought up thinking that beauty is their most important attribute; "self-worth [in women] is closely tied to the establishment of close relationships" (279); some men exhibit signs of eating disorders - athletes in training, but only during training season and for the purpose of enhanced performance; women also may suffer more serious effects of dieting than men do

setpoint theory - Bennett and Gurin - a person's body has a setpoint of weight at which it is programmed to be comfortable; it is easy to lose or gain weight around this setpoint weight; after some weight loss, body may decrease metabolism to prevent further loss

negative health effects of dieting

• dieting to lose weight may be more harmful than helpful in promoting health and psychological well-being
• dieting rarely produces successful weight loss; causes unnecessary physical and psychological stress, damage to self-esteem, and other emotional disturbances
• dieting causes repeated cycles of weight loss and regain, changes in metabolic rates, increased risk for cardiovascular problems, and other hazardous conditions
• dieting contributes to development of eating disorders

rather than dieting, "a person should adopt nutritional dietary changes and a program of increased activity aimed at changing metabolic rates and increasing muscle strength

a person concerned about losing weight may keep a log of when and where he has the urge to eat, how much time he spends eating, what he does while eating (read, etc.), whether he eats alone or with others, and how he felt before taking his first bite - these are triggers

a person can remove his eating triggers by substituting them with other activities: while eating, remove distractions, eat slowly, only eat when hungry (not necessarily by the clock), etc.

Chapter 17: Cardiovascular Disease

CVD - cardiovascular disease - diseases of the heart and blood vessels

Heart function (421-2):

arteries - vessels that carry blood away from the heart to other regions of the body

veins - vessels that carry blood back to the heart from other regions of the body

pulmonary arteries - carry de-oxygenated blood to the lungs where it picks up oxygen and gives off carbon dioxide

arterioles - small branches of arteries

capillaries - minute blood vessels that branch out from the arterioles; their thin walls allow for exchange of oxygen, carbon dioxide, nutrients, and waste products with cells

atria - two upper chambers of the heart which receive blood

ventricles - two lower chambers of the heart which pump blood through blood vessels

atherosclerosis - a general term for thickening and hardening of the arteries

arteriosclerosis - characterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery; resulting buildup called plaque

where plaque occurs: bleeding (hemorrhage) into the plaque or formation of a blood clot (thrombus) on the plaque's surface may occur; increased risk of heart attack / stroke

three causes of damage to inner wall of artery: dramatic fluctuations in blood pressure, elevated levels of cholesterol and triglycerides in blood, cigarette smoking

heart attack (myocardial infarction) - a blockage of normal blood supply to an area in the heart; usually caused by coronary thrombosis - blood clot in the coronary artery - or an atherosclerotic narrowing that becomes closed

ischemia - reduced oxygen supply to the heart

angina pectoris - severe chest pain occurring as a result of reduced oxygen flow to the heart

treatments for angina: rest, in mild cases; in sever cases, drugs that affect supply of blood to heart muscle or the heart's demand for oxygen

nitroglycerin - dilates veins, reducing amount of blood returning to heart and lessening its workload

stroke - a condition occurring when the brain is damaged by disrupted blood supply; kills brain cells and may result in speech impairment, memory loss, and loss of motor control

symptoms of stroke:

• sudden weakness or numbness of the face, arm, or leg on one side of the body
• sudden dimness or loss of vision, particularly in only one eye
• loss of speech or trouble talking or understanding speech
• sudden, severe headaches with no known cause
• unexplained dizziness, unsteadiness, or sudden falls, especially along with any of the previous symptoms

Risks you can control (426-32):

• stop smoking - risk for cardiovascular disease is 70% greater for smokers than nonsmokers; risk declines very rapidly after quitting; two theories on why smoking promotes heart disease:

• nicotine increases heart rate, heart output, blood pressure, and oxygen use by heart muscles; CO displaces oxygen in heart tissue, heart is forces to work harder to obtain sufficient oxygen
• chemicals in smoke damage the lining of coronary arteries, allowing cholesterol and plaque to accumulate more easily
• cut down on fats and cholesterol - fatty foods trigger production of factor VII, a blood-clotting substance; current acceptable cholesterol levels - between 180 and 200 mg/dl; two types of cholesterol: low-density lipoproteins (LDLs) "bad" cholesterol - compounds that facilitate transport of cholesterol in the blood to the body's cells, high-density lipoproteins (HDLs) "good" cholesterol - compounds that facilitate transport of cholesterol in the blood to the liver for metabolism and elimination from the body
• cut back on overall triglycerides - most common form of fat in body; excess calories are converted into triglyderides and stored as body fat
• monitor cholesterol levels - formula for lipoprotein analysis: LDL = total cholesterol - HDL - (triglycerides/5); best evaluation of risk is ratio of HDL to total cholesterol
• control blood pressure:

hypertension - sustained elevated blood pressure

essential hypertension - hypertension that cannot be attributed to any cause (most cases)

secondary hypertension - hypertension caused by specific factors, such as kidney disease, obesity, or tumors of the adrenal glands

systolic pressure - the upper number in the fraction that measures blood pressure, indicating pressure on the walls of the arteries when the heart contracts

diastolic pressure - the lower number in the fraction that measures blood pressure, indicating pressure on the walls of the arteries during the relaxation phase of heart activity

until age 55, men face higher risk of high blood pressure than women; age 55-75 risk is equal; after age 75 women face greater risk

110/80 is normal for average person; table 17.1 (431):

• exercise
• lose weight
• control diabetes risks - diabetics run increased risk for CVD; prescribed drug regimen for diabetes should be followed
• manage stress - Robert S. Eliot demonstrated that one out of five people has an extreme cardiovascular reaction to stressful stimulation; when under stress, their bodies produce large amounts of stress chemicals which cause high blood pressure; these people are hot reactors; cold reactors can experience stress without harmful cardiovascular responses

Women and cardiovascular disease (432-4): estrogen appears to reduce risk of heart disease; estrogen production decreases with menopause, so risk of CVD increases

hormone replacement therapies (HRTs) - therapies that replace estrogen in postmenopausal women

Postmenopausal Estrogen/Progestin Interventions (PEPIs) - a study of how HRTs affect cardiovascular risk; HRT may reduce CVD by 12-25%; HRTs raise HDL levels and lower LDL levels

Techniques of diagnosing heart disease (435-6):

electrocardiogram - a record of the electrical activity of the heart measured during a stress test

angiography - a technique for examining blockages in heart arteries; catheter is inserted into arteries, dye is injected, and X-ray is taken to find blocked areas

positron emission tomography (PET) - produces 3-D images of heart as blood flows through it; patient receives IV radioactive tracer; as tracer decays, it emits positrons which are read by computer and converted into image

magnetic resonance imaging (MRI aka NMR) - computer uses powerful magnets to generate pictures for evaluation

due to aspirin's blood-thinning properties it is advised as a preventive strategy for individuals with no current heart disease symptoms; some people may experience blood clotting problems or gastrointestinal intolerance when using aspirin

Chapter 18: Cancer

tobacco use and excessive alcohol use contribute to 1/3 of today's cancer deaths

cancer - a large group of diseases characterized by the uncontrolled growth and spread of abnormal cells

neoplasm - a new growth of tissue that serves no physiological function resulting from uncontrolled, abnormal cellular development; a mass of neoplastic tissue which grows faster than surrounding tissue is a tumor; tumors can be malignant (cancerous, harmful) or benign (noncancerous, harmless)

benign tumors are not biologically harmful, but can cause damage if the mass physically obstructs normal tissue or organs

biopsy - microscopic examination of tissue to determine if cancer is present

metastasis - process by which cancer spreads from one area to different areas of the body; benign tumors are enclosed in fibrous shell which prevents spreading

three theories on cause of cancer (444)

• spontaneous error that occurs during cell reproduction; overworked or aged cells break down, causing genetic errors and cell mutations
• external agent enters normal cell and initiates cancerous process; carcinogens - cancer-causing agents; exposure to environmental hazards increases risk of cancer; cigarette tar is most common carcinogen
• oncogenes - suspected cancer-causing genes present on chromosomes; dormant oncogenes may be activated by age, stress, exposure to carcinogens, viruses, radiation, etc.; protooncogenes - genes that can become oncogenes under certain conditions

ionizing radiation (radiation from X-rays, radon, cosmic rays, and UV rays) is proven to cause cancer in humans

nonionizing radiation (produced by radio waves, cell phones, microwaves, etc.) - risk has not been proven, but is still being researched

many researchers claim that by reducing stress one may reduce his risk for cancer; sleep and diet disturbances caused by severe stress and depression may weaken the body's immune system

exposure to tobacco and alcohol in social environment are important factors in assessing cancer risk; even secondhand smoke causes 4000 deaths annually from lung cancer

herpes-related viruses may be involved in development of some forms of leukemia, Hodgkin's disease, cervical cancer, and Burkitt's lymphoma; Epstein-Barr virus (mono) may also contribute to cancer development; human papillomavirus (HPV - genital warts) has been linked to cervical cancer

classifications of cancer (452-3):

• carcinomas - cancer of epithelial tissues (tissues covering body surfaces and lining most body cavities; metastasize through circulatory or lymphatic systems; breast, lung, intestinal, skin, and mouth cancers are carcinomas
• sarcomas - occur in mesodermal tissues - bones, muscles, and general connective tissue; metastasize via blood in early stages of disease; less common but more virulent than carcinomas
• lymphomas - develop in and metastasize through lymphatic system; Hodgkin's disease
• leukemia - cancer in blood-forming parts of body - bone marrow and spleen

risk factors for breast cancer

• being over age 40
• having grandmother, mother, or sister with breast cancer
• never having had children or having breast-fed
• having first child after age 30
• having had early menarche
• having had late age of menopause
• lengthy exposure to cyclic estrogen
• having a higher education and socioeconomic status

early recognition of symptoms/early diagnosis is most important factor in survival rate; detection before spread throughout body

exercise may reduce risk by altering hormone production during menstrual cycles

*study figure 18.3 on page 457*

prognosis for colorectal cancer is excellent if detected in early stages - radiation, surgery, and chemotherapy

after skin cancer, prostate cancer is most common type in males; symptoms for prostate cancer:

• weak or interrupted urine flow or difficulty starting or stopping urine flow
• need to urinate frequently
• pain or difficulty in urinating
• blood in urine
• pain in lower back, pelvis, or upper thighs

these symptoms are often mistaken for other nonspecific conditions such as infections

the sun causes nearly one million cases of skin cancer in the US annually

malignant melanoma - a virulent cancer of the melanin of the skin

ABCD rule for detecting melanoma - visit a physician for any symptom:

• A - asymmetry - one half of mole does not match other half
• B - border irregularity - edges are ragged, notched, or blurred
• C - color - pigmentation is not uniform
• D - diameter - greater than 6mm

men between ages of 17 and 34 are at greatest risk for testicular cancer; first noticed as painless enlargement of testis or thickening of testicular tissue; *study figure 18.5 on page 461*

uterine cancer - develops in body of uterus, usually in lining, or in cervix; risk factors: early age of first intercourse, multiple sex partners, cigarette smoking, and certain STDs

Cancer's Seven Warning Signals (463):

• changes in bowel or bladder habits
• sore that does not heal
• unusual bleeding or discharge
• thickening or lump in breast or elsewhere
• indigestion or difficulty in swallowing
• obvious change in a wart or mole
• nagging cough or hoarseness
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Chapter 19:Infectious Diseases and Sexually Transmitted Infections

Acquired Immune Deficiency Syndrome (AIDS) (495-504):

women are among fastest growing segment of the HIV population in the US today

HIV enters one person's body when another person's infected body fluids gain entry through a breach in body defenses; mucous membranes of the genital organs and anus provide easiest route of entry; break in mucous membrane allows virus to enter body; condoms are second line of defense behind celibacy

ELISA test - detects presence of HIV antibodies as a reaction to presence of virus

Western blot - another test for HIV antibodies; more precise than ELISA

seroconversion - when a person who previously tested negative ELISA has a subsequent test that is positive

Zidovudine (AZT) - delays progress of the immunodeficiency that leads to AIDS; some people may develop resistance to AZT, rendering it ineffective; *I find no mention of cost except that these drugs are "difficult to manufacture"*

Reducing Your Risks for HIV Disease (502)

• avoid casual sexual partners
• avoid unprotected intimate sexual activity involving the exchange of blood, semen, or vaginal secretions with people whose present or past behaviors put them at risk for infection
• all sexually active adults who are not in a lifelong monogamous relationship should practice safer sex by using latex condoms
• never share any devices through which the exchange of blood could occur
• avoid injury to body tissue during sexual activity
• avoid unprotected oral sex or any sexual activity in which semen, blood, or vaginal secretions could penetrate mucous membranes through breaks in the membrane
• avoid using drugs that may dull your senses and affect you ability to make decisions about responsible precautions with potential sex partners
• wash your hands before and after sexual encounters; urinate after sexual relations and wash your genitals
• consider abstinence
• when receiving care from medical professionals, make sure they take appropriate precautions to prevent potential transmission
• if you are worried about your HIV status, have yourself tested
• if you are a woman and HIV positive, do not become pregnant
• if you suspect you may be infected or you have been tested positive, do not donate blood, semen, or body organs
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College Students on the Go: Introduction to Healthy Living

1 gram of carbohydrate = 4 kcal

1 gram of protein = 4 kcal

1 gram of fat = 9 kcal

Food Guide Pyramid (12)

• fats, oils, and sweets - use sparingly
• milk, yogurt, and cheese group - 2-3 servings per day
• meat, poultry, fish, dry beans, eggs, and nuts group - 2-3 servings per day
• vegetable group - 3-5 servings per day
• fruit group - 2-4 servings per day
• bread, cereal, rice, and pasta group - 6-11 servings per day

carbohydrates provide glucose to the body

the American Heart Association recommends that fat calories be no more than 30% of your total caloric intake

fat is an essential nutrient - cushions organs, provides insulation, stores energy, provides fatty acids; fat is only bad in large quantities

*I don't see anything about broiling, poaching, roasting, and frying foods*

most Americans get twice the amount of protein they need

non-meat, incomplete protein sources: legumes(dried beans), peas, nuts, seeds, grains, and cereals

two kinds of incomplete proteins must be combined to make complete proteins: grains and legumes, nuts/seeds and legumes, grains and nuts/seeds

dietary cholesterol is only found in animal products - meat, eggs, dairy products, etc.

serum cholesterol - some comes from dietary cholesterol; most is manufactured in liver

vitamin E sources: seeds, nuts, vegetable oils, whole grains, and cereals

fiber-rich foods: fruits, veggies, whole grain and multigrain breads, high-fiber cereals and crackers, beans

1 gram of alcohol = 7 cals

6-8 glasses of water per day is recommended; drink water throughout the day, not just when thirsty

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