Discussion

For the discussions please respond to the following questions based on the material covered in each section. *You do not have to do a  discussion for each chapter, just the section as a whole.  (100-150 words total)

1. The most important thing I learned in this class was…

2. The most confusing thing in this class was…

3. One thing I will do as a result of the information in this class…

3. Any other thoughts or suggestions you may have for the course.

16: Injury and Violence

Your Health Today, 6th edition

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All rights reserved. Authorized only for instructor use in the classroom.  No reproduction or further distribution permitted without the prior written consent of McGraw-Hill Education.

Injury: Creating Safe Environments

Unintentional injuries: those that are not purposefully inflicted

Leading causes of unintentional injury death for Americans of all ages:

Motor vehicle crashes

Poisoning

Falls

Choking

Drowning

Males more likely to die from unintentional injury, from birth to age 80

©McGraw-Hill Education.
Motor Vehicle Safety
Defensive driving: anticipating potential hazards by keeping your eyes on other drivers and monitoring conditions
Improper driving: speeding, failing to yield the right of way, disregarding signals and stop signs, making improper turns, following too closely
Other factors that contribute to crashes:
Driver inattention
Aggressive driving; alcohol-impaired driving
Environmental hazards such as weather conditions

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Driver Inattention
Three main types of distraction:
Visual (taking eyes off the road)
Manual (hands off wheel)
Cognitive (mind off what person is doing)
Electronic devices visually and cognitively, and sometimes manually, distract drivers
Drowsiness reduces awareness of surroundings, impairs judgment, and slows reaction time

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Approaches to Motor Vehicle Safety
NHTSA standards
Effective restraint systems
Seat belts reduce the risk of fatal injuries by 47%
Airbags are a passive restraint that protects passengers from impact with the interior of the vehicle in a crash
Child seats and booster seats
Pet restraints

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Approaches to Motor Vehicle Safety (2)
Automated enforcement cameras for red-light running and speed law violations are used in many states
Black boxes in vehicles began in 1994
Crash information is recorded
Motorcycle safety
Motorcyclists are about 5 times more likely to die in a crash than passenger car occupants
Factors include lack of proper training, distraction, alcohol, and environmental conditions
Use of a helmet is important

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Bicycle and Pedestrian Safety
Bicycle safety
Cyclists should make sure their bike fits properly, that they wear a helmet, and that they employ safe cycling practices
Making cyclists visible to other vehicle operators is the biggest safety problem
Bicycles are vehicles; cyclists must follow traffic laws
Pedestrian safety
About 45% of deaths occur when pedestrians enter or cross streets
At night, take steps to be visible

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Recreational Safety
Injuries occur in a variety of recreational activities
Alcohol is a factor in many injuries and deaths
About 10 people drown every day in the U.S.
About half of drownings occur in natural water settings
Life jackets or personal flotation devices (PFDs) are essential protection
Rock-climbing is relatively safe; attention to equipment and instruction can lower the risks
Drones, or unmanned aerial vehicles (UAVs), can cause serious injury if used unsafely

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Home Safety
Nearly 40% of all disabling injuries occur in the home
Falls
Fires
Poisons, gas, and carbon monoxide
Choking
Heimlich maneuver: used to help when choking occurs
Temperature-related injuries
Excessive noise
Noise-induced hearing loss (NIHL) occurs over a period of years
Concussions

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Providing Emergency Aid
You can help others who have been injured or are in life-threatening situations with training in first aid and emergency rescue techniques
Cardiopulmonary resuscitation (CPR) is used when someone is not breathing and a pulse cannot be found
Many organizations offer classes
American Heart Association
American Red Cross
Community or campus resource centers
Automatic external defibrillators (AEDs) are increasingly available

©McGraw-Hill Education.
Work Safety
Improved over the past decades as a result of occupational laws and advances in safety technology
Back injuries account for 24% of total injuries
Common injuries result from:
Improper lifting
Heavy backpacks
Extensive computer use
Strain on neck, back, arms, eyes
Repetitive strain injuries
Carpel tunnel syndrome (CTS)

©McGraw-Hill Education.
Figure 16.2 Proper workstation setup.
Your hips should be slightly higher than your knees, and your feet should be flat on the floor or on a footrest slightly in front of your knees. Your monitor should be an arm’s length away from you, and your eyes should be level with the top of the screen. When you type, your wrists should be in a neutral position, tilted neither up nor down.

©McGraw-Hill Education.
Figure 16.3
Carpal tunnel syndrome (CTS).
Certain repetitive uses of the hands can cause the compression of the median nerve, located inside a “tunnel” created by the carpals (wrist bones) and tendons in the hand. When the tendons become inflamed through overuse or incorrect use, they compress the median nerve, leading to tingling, pain, and weakness in the hand, especially in the thumb and first three fingers.
Source: Core Concepts in Health, 10th ed., by P. Insel and W. Roth. Copyright © 2006 by The McGraw-Hill Companies. Reprinted by permission of the McGraw-Hill Companies, Inc.

©McGraw-Hill Education.
Natural Disasters
Natural disasters are sudden events, caused by natural forces, that result in loss of life, severe injury, or property damage
Tornadoes, hurricanes, floods, wildfires, earthquakes
Individuals can help themselves by preparing as much as they can for the types of disasters likely to occur where they live

©McGraw-Hill Education.
Violence: Working Toward Prevention
Violence: use of force or threat of force to inflict intentional injury, physical or psychological, on oneself or to another person
Murder, robbery, assault
Assault: attack by one person on another using force or threat of force to intentionally inflict injury
Aggravated assault: attack that causes bodily injury, usually with a weapon or otherwise capable of producing bodily harm or death
Simple assault: attack without a weapon that causes less serious physical harm
Also occurs in association with child abuse, sexual harassment, suicide, and other kinds of conduct

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What Accounts for Violence?
Risk factors:
Age and sex: young and male
Being a member of a minority group
At the societal and cultural levels: factors such as poverty, poor schools, disorganized neighborhoods, alcohol, drugs, guns, and lack of opportunity
At the family level, factors such as child abuse, substance abuse, criminal activity, lack of positive role models, and chaotic family organization
At the individual level, factors such as genetics, brain chemistry, low intelligence, aggressiveness and poor impulse control, and antisocial behavior

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Violence on the College Campus
Campuses confront the same violence issues that occur in almost any city
Since the Virginia Tech shooting, campuses have expanded emergency communication measures
Clery Act: institutions must disclose information about crimes on or near campus

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Hazing and Hate Speech
Hazing: actions taken to cause mental or physical discomfort, embarrassment, or ridicule in individuals seeking to join an organization
Deaths have occurred as a result of hazing, most often fraternity hazing; it is illegal in many states
Hate speech: acts that convey a grossly negative view of persons or groups based on gender, ethnicity, religion, sexual orientation, or disability
So as not to infringe on freedom of speech, hate speech must be proven to inflict real, not trivial, harm before it can be regulated

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Sexual Violence
Sexual assault is any sexual behavior that is forced on someone without his or her consent
Forced sexual intercourse (rape)
Forced sodomy (oral or anal sexual acts)
Child molestation
Incest
Fondling
Sexual coercion is the imposition of sexual activity on someone through the threat of nonphysical punishment, promise of reward, or verbal pressure

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Rape
Statutory rape: sexual intercourse with someone under the age of consent, whether consent was given or not
Stranger rape: committed by someone unknown to the victim
Acquaintance rape: committed by someone known to the victim
Date rape: committed by someone with whom the victim has a dating relationship
Use of date rate drugs

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Rape (2)
Red zone: period of time when female students are
at greatest risk for sexual assault
First year: first few days or weeks of initial fall semester
Second year: entire first semester
College students sometimes refer to assaults as “unwanted sex,” likely due to victims being acquainted with their assailants

©McGraw-Hill Education.
Rape (3)
These safety tips are especially important for the red zone times:
If you feel unsafe, trust your instincts
Avoid being isolated with someone you don’t know
Know your surroundings
Don’t post your location online or on voicemail
Use a buddy system when you go out
If you suspect a friend has been drugged, call 911
Always lock your door, and don’t let a stranger in
Practice safe drinking
Don’t go out alone at night

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Rape (4)
In about 1–2% of completed and attempted rapes in the U.S., the victim is male
Male rape victims require the same level of medical treatment, counseling, and support as female victims
For many victims, the effects of rape can be profoundly traumatic and long lasting
Fear, anxiety, phobias, guilt, nightmares, depression, substance abuse, sleep disorders, sexual dysfunctions, social withdrawal
Between 4% and 30% contract an STD

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What to Do If You Are Raped
Do whatever you need to do and can do to survive
Remember rape is not your fault; your attacker is violating your rights and committing a crime
Seek help as soon as possible by contacting law enforcement
Contact your local Rape Victim Advocacy Program (RVAP) or the Rape, Abuse, and Incest National Network (RAIIN)
Rape counseling is critical to recovery

©McGraw-Hill Education.
Campus Responses to
Sexual Assault Complaints
Investigative reports suggest many colleges and universities are underreporting sexual assaults
Campus Sexual Assault Victims’ Bill of Rights: requires college administrators to provide justice, medical treatment, and psychological counseling for crime victims and survivors
Campus Sexual Violence Elimination Act: protection for victims and whistleblowers against retaliation
In response, many colleges have enacted more favorable grievance procedures

©McGraw-Hill Education.
Affirmative Consent
More than 1,400 colleges have implemented an affirmative consent standard: “yes means yes”
Victims must no longer prove they physically or verbally resisted

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Preventing Sexual Violence
Rape prevention involves creating a culture and a community in which sexual violence is not tolerated
Green Dot Violence Prevention Strategy focuses on engaging bystanders to act against sexual violence
Overcoming shyness and lack of assertiveness, peer pressure, the “bystander effect,” and cultural norms

©McGraw-Hill Education.
Child Sexual Abuse
Child sexual abuse: any interaction between a child and an adult or an older child for the sexual gratification of the perpetrator
Incest: sexual activity between family members, a particularly traumatic form of child sexual abuse
Many cases go unreported
Victims suffer long-term effects
Child sexual abusers may or may not be pedophiles
Civil rights groups have objected that sex-offender registration laws are overbroad, unconstitutional, and counterproductive

©McGraw-Hill Education.
Sexual Harassment
Sexual harassment includes two broad types of behavior or situations:
A person of authority who offers benefits for sexual favors or threatens retaliation for withholding sex
Suggestive language or intimidating conduct that creates a hostile atmosphere that interferes with a person’s work or academic performance
Is it harassment or flirting?
One person’s power over the other
Behavior that puts pressure on a person
Desire to end the interaction

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Stalking, Cyberstalking, and Cyberharassment
Stalking: malicious following, harassing, or threatening of one person by another
Cyberstalking: use of electronic media to pursue harass, or contact another person who has not solicited the contact
Threatening, harassing, sexually provocative e-mails; and online attacks or impersonation
Cyberharassment: tormenting e-mails, instant messages, blog entries, and website entries
Cyberbullying: among children and among college students

©McGraw-Hill Education.
Intimate Partner Violence
Violence in families can be directed at any family member, but women, children, and older adults are the most vulnerable
Intimate partner violence or domestic violence is abuse against one’s partner in an intimate relationship
Physical
Sexual
Threats
Emotional abuse

©McGraw-Hill Education.
Intimate Partner Violence (2)
Domestic violence is usually characterized by a cycle of abuse
Tension builds up
Violent outburst occurs
“Honeymoon” period follows, where often the abuser promises change
Violence does recur, and the cycle repeats
Sometimes referred to as battered woman syndrome,
but can occur in any relationship

©McGraw-Hill Education.
Intimate Partner Violence (3)
Dating violence is widespread: 43% of college women experience violent or abusive dating behaviors; 22% report actual physical abuse, sexual abuse, or threats of violence
If concerned that someone you know may be in an abusive relationship, encourage her or him to get support to leave the relationship and begin a new life
Help is available from social services, educational programs, hotlines, shelters, advocacy organizations, and more

©McGraw-Hill Education.
Hate Crimes and Terrorism
Hate crimes: crimes motivated by bias against the victim’s ethnicity, race, religion, sexual orientation,
or disability
Terrorism: violence directed against persons or property, including civilian populations, for the purpose of instilling fear and engendering a sense
of helplessness

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The Role of Guns: Facilitating Violence
Guns contribute to the lethality of any violence
“Keep and bear arms” may not be as important today as in colonial times
Proponents of gun control support bans on the sale of assault guns, waiting periods for gun purchases, licensing of guns, restrictions on access by young people, and safer guns
Advocates for the right to bear arms include Students for Concealed Carry on Campus (SCCC)
Argue students need handguns for self-defense

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The Role of Media and Entertainment: Glorifying Violence
Violent acts occur more frequently in movies and TV than in real life
Repeated exposure may lead to habituation and desensitization
Prominent medical groups have concluded there is a connection between violence in mass media and aggressive behavior in children
The entertainment industry maintains these studies demonstrate only possible associations, and attempts at regulation would border on censorship

©McGraw-Hill Education.
Self-Defense Devices
Products that are wearable, lightweight, and concealable include pepper spray lipstick/perfume cases, defense keychains, rings that can activate a siren, and bracelets that detect a head injury
Smartphones and data connections can serve as a “guardian angel” with certain apps such as Life Button 24
Self-defense technology is not a replacement for being actively aware of your surroundings

©McGraw-Hill Education.
The Role of Communities and Campuses: Promoting Safety
Communities can help provide safe physical environments that are less conducive to criminal activity
Neighborhoods where people look out for each other
are less inviting
College campuses need to continue and adapt prevention efforts and to promote gender equality, healthy relationships, healthy sexuality, and civility

©McGraw-Hill Education.
In Review
How does injury affect personal health?
What are the leading causes of injury-related death?
How does violence affect personal health?
What forms does violence take in our society?
What are strategies to prevent violence?

©McGraw-Hill Education. All rights reserved. Authorized only for instructor use in the classroom.  No reproduction or further distribution permitted without the prior written consent of McGraw-Hill Education.

15: Cancer

Your Health Today, 6th edition

©McGraw-Hill Education.

All rights reserved. Authorized only for instructor use in the classroom.  No reproduction or further distribution permitted without the prior written consent of McGraw-Hill Education.

What Is Cancer?

Cancer is a condition characterized by the uncontrolled growth of cells

Develops from a single cell that goes awry; but a combination of events must occur before the cell turns into a tumor

The process is called clonal growth: replication of a single cell that produces thousands of copies of itself in an uncontrolled manner

©McGraw-Hill Education.
Figure 15.1 10 most common types of cancer, new diagnoses and estimated deaths, 2015.

Jump to long image description
Source: National Cancer Institute, National Institutes of Health, “Number of New Cases and Deaths,”
SEER Stat Fact Sheets, http://seer.cancer. gov/statfacts/html/all.html.

©McGraw-Hill Education.
Healthy Cell Growth
Healthy cells have a complicated system of checks and balances that control cell growth and division
Healthy cells divide when needed to replace cells that have died or been sloughed off
Each time a cell divides, there is a possibility of mutation or an error in DNA replication

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Healthy Cell Growth (2)
Stem cells: undifferentiated cells that can give rise to specialized cells
Because they do not have predetermined number of cell divisions they pose a risk for cancer
Stem cells are located deep within tissues and are protected from factors that increase the risk of genetic mutations (exposure to the sun, chemicals, and irritation)

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Cancer Cell Growth
Cancer starts from a single cell that undergoes a critical mutation
Initiating event in the cell’s DNA allows a cell to evade normal cell restraints
Error in duplication
Exposure to a carcinogen (cancer-causing substance)
Radiation
Escaping all the control mechanisms to become a cancer may take many years

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Cancer Cell Growth (2)
Oncogene: gene that drives a cell to grow and divide regardless of signals from surrounding cells
Tumor: a mass of extra tissues that may form into either a benign or malignant tumor
Benign tumor: slow growth, unlikely to spread
Malignant tumor: capable of spread to surrounding tissues
Metastasis: cancer that has spread from one part of the body to another

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Classifying Cancers
Cancers are classified according to the tissue in which they originate, called the primary site
Most commonly the brain, liver, and bone marrow
Cancer still at its primary site is localized
When metastasized, it is invasive
Extent determines prognosis, or likely outcome

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Classifying Cancers (2)
Stage of the disease is a description of how far the cancer has spread
One common staging system:
Stage 0: cancer in situ (present only in the layer of cells where it began)
Stage I: small and localized
Stages II and III: locally advanced; may involve lymph nodes
Stage IV: metastasized to distant sites

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Types of Cancer
Carcinomas: arise from epithelial tissue (skin, lining of the intestines and body cavities, surface of body organs, outer portions of glands)
Sarcomas: arise in connective tissue (bone, tendon, cartilage, muscle, fat tissues)
Leukemias: cancers of the blood that originate in the bone marrow or the lymphatic system
Lymphomas: cancers that originate in lymph nodes or glands

©McGraw-Hill Education.
Risk Factors for Cancer
Family history
Family history of cancer alters some cancer screening recommendations
Genes interact with environmental exposures and lifestyle behaviors to alter risk
Lifestyle factors
Tobacco use
Nutrition and physical activity
Overweight and obesity
Alcohol consumption

©McGraw-Hill Education.
Risk Factors for Cancer (2)
Social and economic factors
Social determinants of health influence risk behaviors, access to health care, and quality of health care
Environmental factors
Sunlight and other sources of ultraviolet radiation
Other forms of radiation
Chemical and physical carcinogens
Infectious agents

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Cancer Screening
Treatment is more successful the earlier the cancer is identified
Screening tests: given to a large group of people to identify a smaller group who are at higher risk for a specific disease or condition
Key to early detection of cancer
With some cancers, no test has been shown to be effective without increasing harm
Genetic screening can assess cancer risk

©McGraw-Hill Education.
Cancer Treatments
Surgery
Remove the cancer, remove the affected organ; used to treat cancer that has spread
Chemotherapy
Drug treatment administered to the entire body to kill cancer cells
Radiation
Directed to a specific area; used with surgery or chemotherapy, or to control pain

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Cancer Treatments (2)
Biological therapies
Aim to enhance the immune system’s ability to fight cancer (immunotherapy) or reduce side effects of chemotherapy
Bone marrow transplantation
Initially for cancer of the white blood cells (leukemia, lymphoma); now sometimes used when bone marrow cells have been killed in chemotherapy
Gene therapy and genetic testing
Gene therapy is still in the clinical trials stage
Genetic testing may become important in “precision medicine”

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Cancer Treatments (3)
Clinical trials
Research studies to test new drugs and treatment regimens
Complementary and integrative medicine
Currently a hot topic for research
Used at higher rates by cancer patients and survivors, but none have been shown to cure cancers
Some supplements may interact with cancer treatments and should be used with caution and under supervision

©McGraw-Hill Education.
Breast Cancer
Second leading cause of cancer death in women
Risk factors:
Early first menstruation
Late onset of menopause
Family history
Older age
Higher socioeconomic class
Having no children or having children after 30
Obesity
Hormone replacement after menopause
More than two alcoholic beverages a day

©McGraw-Hill Education.
Breast Cancer (2)
Signs and symptoms:
Persistent lump; skin swelling, redness, or bumpiness; change in nipple appearance or discharge
Screening and detection:
Breast self-exam; mammogram screening; biopsy
Treatment:
Lumpectomy: removal of the tumor and some breast tissue around
Mastectomy: removal of the entire breast
Five-year survival rate for all stages is 89%

©McGraw-Hill Education.
Lung Cancer
Leading cause of cancer death in the United States
Second most commonly diagnosed cancer
Risk factors:
Use of tobacco products in any form
Exposure to carcinogenic chemicals, arsenic, radon, asbestos, radiation, air pollution, and environmental tobacco smoke
Signs and symptoms:
Coughing; blood-streaked sputum; chest pain; difficulty breathing; recurrent lung infections

©McGraw-Hill Education.
Lung Cancer (2)
Screening and detection:
No recommended screening for the general population
Low-dose CT screening for high-risk individuals
Bronchoscopy: fiber-optic device inserted into the lungs to examine lung tissue for signs of cancer
Treatment: surgery, radiation, or a combination of radiation and chemotherapy
One-year survival rate is 44%
Five-year survival rate is 17%

©McGraw-Hill Education.
Prostate Cancer
Second most common cause of cancer death in men
Most commonly diagnosed cancer in men
Risk factors:
Age, family history; being Black
Possibly a high-fat diet
Signs and symptoms:
In early stages, usually none
In advanced prostate cancer, difficulty urinating; pain in the pelvic region; pain with urination; or blood in the urine

©McGraw-Hill Education.
Prostate Cancer (2)
Screening and detection
Digital rectal exam; prostate-specific antigen (PSA) test
Treatment
In early stages and younger men: surgery and radiation, sometimes in combination with chemotherapy; and hormonal medication
In later stages: chemotherapy, radiation, and hormonal medication
Vaccine approved in 2010 appears to prolong life
Five-year survival rate for all stages: nearly 100%

©McGraw-Hill Education.
Colon and Rectal Cancer
Third leading cause of cancer death
Third most commonly diagnosed cancer
Risk factors:
Age
Personal or family history of colon polyps, inflammatory bowel disease, or colorectal cancer
Colon polyps: growths that may progress to colon cancer
Smoking, alcohol use, obesity, physical inactivity, a diet high in fat or red or processed meat and inadequate fruits and vegetables

©McGraw-Hill Education.
Colon and Rectal Cancer (2)
Signs and symptoms:
Change in bowel movements; change in stool size or shape; pain in the abdomen; blood in the stool
Screening and detection:
Flexible sigmoidoscopy
Colonoscopy
Double-contrast barium enema
CT colonoscopy
Treatment: surgery; radiation and/or chemotherapy
Five-year survival rate is 65%

©McGraw-Hill Education.
Figure 15.2 Colon.
A colonoscopy allows the entire colon to be examined and facilitates the removal of growths, such as polyps, that may become cancerous.
Source: Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, 11th ed., by T. Fahey.
Copyright © 2014 The McGraw- Hill Companies. Reprinted by permission of The McGraw-Hill Companies, Inc.

©McGraw-Hill Education.
Skin Cancer
Basal cell carcinoma, squamous cell carcinoma,
and melanoma
Basal cell and squamous cell carcinomas are often curable
Melanoma is more likely to be fatal
All forms are linked directly to ultraviolet light exposure—both UVA and UVB
Stay out of the sun during midday
Wear protective clothing
Use a broad-spectrum sunscreen with a sun-protective factor (SPF) of 15 or higher
Wear sunglasses with UV protection

©McGraw-Hill Education.
Skin Cancer: Melanoma
Risk factors:
Personal history
Large number of moles
Fair skin and sun sensitivity increases risk
Signs and symptoms: changes in a mole
Screening and detection: self-exam and evaluation by a health care provider
Treatment: surgery; chemotherapy and immunotherapy in advanced stages
Overall five-year survival rate is 92%

©McGraw-Hill Education.
Figure 15.3 The ABCDE evaluation of moles for melanoma.
A—Asymmetry: Is one half unlike
the other?
B—Border irregularity: Does it
have an uneven, scalloped edge
rather than a clearly defined border?
C—Color variation: Is the color
uniform, or does it vary from one
area to another, from tan to brown
to black, or from white to red to blue?
D—Diameter larger than ¼ inch: At
its widest point, is the growth as
large as, or larger than, a pencil eraser?
E—Evolving: Is it evolving or changing?
Source: “What to Look For: The ABCDEs of Melanoma,” 2014, American Academy of Dermatology, www.aad.org/spot-skin-cancer/ understanding-skin-cancer/how-do-i-check-my-skin/what-to-look-for.

©McGraw-Hill Education.
Skin Cancer:
Basil Cell and Squamous Cell Carcinomas
Risk factors:
Fair skin; blonde, red, or light brown hair; blue, green, or hazel eyes; and freckles and moles
Cumulative sun exposure and age
Signs and symptoms:
Basal cell: a new skin growth; a raised, domelike lesion; or a sore that never heals
Squamous cell: red, scaly area that does not go away; a sore that does not heal; or a raised, crusty sore
Screening and detection: monitoring and evaluation
Treatment: local removal and destruction

©McGraw-Hill Education.
Lymphoma
Cancers that originate in the lymph system, part of the body’s immune system
Hodgkin’s lymphoma; non-Hodgkin’s lymphoma
Risk factors:
Infections, medications, or genetic changes that weaken the immune system, along with exposure to radiation, herbicides, insecticides, and some other chemicals
Bacterium H. pylori for stomach lymphoma
Signs and symptoms:
Swollen lymph nodes, weight loss, fever, other symptoms depending on where it originates

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Lymphoma (2)
Screening and detection:
No screening for those without symptoms
Biopsy and imaging studies
Treatment:
Often includes a combination of surgery, chemotherapy, and radiation; can sometimes involve immunotherapy or bone marrow transplant
Five-year survival rate for Hodgkin’s lymphoma: 86%
Five-year survival rate for non-Hodgkin’s: 70%

©McGraw-Hill Education.
Figure 15.4
The lymph system.
Structures include the lymph nodes and lymph vessels, the adenoids/ tonsils, the thymus gland, the spleen, and the bone marrow. Clusters of lymph nodes can occur anywhere along the lymphatic vessels. Prominent areas include the neck (cervical lymph nodes), armpits (axillary lymph nodes), and groin (inguinal lymph nodes).

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Common Cancers in the Young
At higher frequency in young people:
Cancers of the reproductive system
Leukemia
Associated behaviors are especially common among young people:
Oral cancers

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Cervical Cancer
Risk factors:
HPV infection, tobacco use, immunosuppression, multiple births, early sexual activity, multiple sex partners, socioeconomic status, and nutritional status
Three vaccines are currently available
Screening and detection: early detection through the Pap test has reduced incidence and mortality rates
Treatment: removal or destruction of precursor cells
Five-year survival rate overall is 68%; the rate is 92% if the disease is localized

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Uterine Cancer
Also called endometrial cancer
Risk factors: increased estrogen, obesity, diabetes, early menarche, late-onset menopause, irregular ovulation, infrequent periods
Signs and symptoms: abnormal uterine bleeding, pelvic pain, low back pain
Screening and detection: endometrial biopsy
Treatment: hysterectomy; other treatments depending on the stage
Overall, five-year survival rate is 82%

©McGraw-Hill Education.
Ovarian Cancer
Leading gynecological cause of cancer death and the fifth overall cause of cancer death in women
If diagnosed early, however, survival rate is as high as 92%
Risk factors: family history; personal history; tobacco use and being overweight
Signs and symptoms: in later stages, swelling of the abdomen, bloating, or vague pain
Screening tests are being evaluated
Treatment: surgery, chemotherapy, drug therapy

©McGraw-Hill Education.
Testicular Cancer
Most common cancer for men aged 20–35
Risk factors:
History of an undescended testicle; family/personal history of testicular cancer; abnormal development of the testes; infertility or abnormal sperm
Signs and symptoms: painless lump; swelling or discomfort
Screening and detection: self-exam; ultrasound
Treatment: surgery, chemotherapy, and radiation
Cure rate at all stages is 95%

©McGraw-Hill Education.
Leukemia
Group of cancers originating in the bone marrow or other parts of the body where white blood cells form
Involves overproduction of one type of white blood cell
Risk factors: smoking and chemical exposure (benzene); ionizing radiation; infection with HTLV-1
Signs and symptoms: fatigue, infection, weight loss, fevers, easy bleeding and bruising
Screening and detection: blood test or biopsy
Treatment: chemotherapy, blood transfusion
Five-year survival rates range from 26% to 82%

©McGraw-Hill Education.
Oral Cancers
Cancers that develop in the mouth or the pharynx
Risk factors: tobacco, high alcohol consumption, HPV
Signs and symptoms:
Persistent sore in the mouth; lump or bump; patch of white or red along the gums or cheeks
Late signs include pain or difficulty swallowing or chewing
Screening and detection: doctor or dentist as part of routine care
Treatment: surgery, chemotherapy, radiation
Five-year survival rate for all stages is 63%

©McGraw-Hill Education.
Living with Cancer
If you or a family member is diagnosed with cancer:
Participate in decisions about treatment
Be an informed consumer
Consider how you will interact with others
Consider school or work obligations
Enlist support
Know what physical changes are likely to occur
Consider sperm or egg donation and freezing
Spiritual beliefs and practices can be important
Don’t think about cancer all the time

©McGraw-Hill Education.
In Review
What is cancer?
What causes cancer?
How is cancer detected and treated?
What are the most common cancers?

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Appendix A
Long image descriptions

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Figure 15.1 10 Most Common Cancers Appendix
Overall, new cases diagnosed in 2015, from most to least, were breast cancer (female); lung and bronchus cancers; prostate cancer; colon and rectum cancers; bladder cancer; melanoma (skin); non-Hodgkin’s lymphoma; thyroid cancer; kidney and renal cancers; and endometrial (uterine) cancer.
In the same year, deaths most to least resulted from lung and bronchus cancers; colon and rectum cancers; breast cancer (female); prostate cancer; non-Hodgkin lymphoma; bladder cancer; kidney and renal cancers; melanoma (skin); endometrial (uterine) cancer; and thyroid cancer.
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14:

Cardiovascular Disease

, Diabetes, and Chronic Lung Diseases

Your Health Today, 6th edition

©McGraw-Hill Education.

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Cardiovascular Disease

Cardiovascular disease (CVD): any disease involving the heart and/or blood vessels

Currently the leading cause of death in the United States, accounting for one in three deaths

CVD is a general term for diseases that include heart attack, stroke, peripheral artery disease, congestive failure, and others

Disease process underlying many forms of CVD is atherosclerosis, or hardening of the arteries

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Figure 14.1 Cardiovascular disease mortality trends for males and females, United States, 1979–2009.
Sources: Centers for Disease Control and Prevention/National Center for Health Statistics, www.cdc.gov/nchs; “Heart Disease and Stroke Statistics—2015 Update,” Chart 13-17, American Heart Association, 2015, Dallas: AHA.

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Figure 14.2 Percentage of deaths from types of CVD, United States, 2013.
Nearly half the deaths from CVD (47.7%) are caused by coronary heart disease.
Source: “Heart Disease and Stroke Statistics—2015 Update,” Chart 13-5, American Heart Association, 2015, Dallas: AHA.

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The Cardiovascular System
Cardiovascular system: the heart and blood vessels that circulate blood throughout the body
Pulmonary (lung) circulation: the pumping of oxygen-poor blood to the lungs and oxygen-rich blood back to the heart by the right side of the heart
Systemic (body) circulation: the pumping of oxygen-rich blood to the body and oxygen-poor blood back to the heart by the left side of the heart

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The Cardiovascular System (2)
Aorta: largest artery in the body
Leaves the heart and branches into smaller arteries, arterioles, and capillaries carrying oxygen-rich blood to body tissues
Inferior and superior vena cava: largest veins
Carry oxygen-poor blood from the body back to the heart
Coronary arteries: medium-sized arteries that supply oxygen- and nutrient-rich blood to the heart muscle
Sinus node or sinoatrial (SA) node: group of cells in the right atrium where the electrical signal is generated that establishes the heartbeat

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Figure 4.3 The heart, showing interior changes, valves, and major arteries and veins.

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Atherosclerosis
Atherosclerosis is a common form of arteriosclerosis that involves a thickening or hardening of the arteries due to buildup of fats and other substances
Damage to the inner lining leads to formation of a fatty streak—an accumulation of lipoproteins: a combination of proteins, phospholipids, and cholesterol
Together with white blood cells, collagen and other proteins form a plaque (accumulation of debris)
Reduces the amount of blood that can reach the tissue
Plaque can break off and completely block artery
Stretching of the weakened artery wall can also cause an aneurysm that can tear or rupture, causing sudden death

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Figure 14.4 The process of atherosclerosis.
The process begins with damage to the lining of an artery and progresses to narrowing or blockage of the artery by fatty deposits and plaques.

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Coronary Heart Disease and
Heart Attack
Coronary heart disease (CHD): atherosclerosis of the coronary arteries, which can result in a heart attack
CHD is the leading form of all cardiovascular diseases
An estimated 15.5 million Americans are living with CHD
Those who survive a heart attack are often left with damaged hearts and significantly altered lives

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Coronary Heart Disease and
Heart Attack (2)
Ischemia: insufficient supply of oxygen and nutrients to tissue, caused by narrowed or blocked arteries
Myocardial infarction: lack of blood flow to the heart muscle with resulting death of heart tissue, often called a heart attack
Coronary thrombosis: blockage of a coronary artery by a blood clot that may cause sudden death
Angina: pain, pressure, heaviness, or tightness in the center of the chest caused by a narrowed coronary artery

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Arrhythmias and
Sudden Cardiac Death
Arrhythmia: irregular or disorganized heartbeat
Normal adult heart rate is 60–100 beats per minute
Sudden cardiac death: abrupt loss of heart function caused by an irregular or ineffective heartbeat
Ventricular fibrillation: type of arrhythmia in which the ventricles contract rapidly and erratically, causing the heart to quiver or “tremor” rather than beat

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Stroke
Stroke or cerebrovascular accident (CVA): when blood flow to the brain or part of the brain is blocked
Fourth leading cause of death in the United States and a leading cause of severe, long-term disability
Ischemic stroke: caused by blockage in a blood vessel in the brain; accounts for 87% of all strokes
Thrombus: blood clot in a narrowed artery
Embolism: blood clot elsewhere that travels to the brain
Hemorrhagic stroke: caused by rupture of a blood vessel in the brain, with bleeding into brain tissue
Transient ischemic attacks (TIAs), or “ministrokes”: periods of restricted blood supply that produce stroke symptoms

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Figure 14.5 Types of stroke.
Hemorrhagic stroke: caused by ruptured blood vessels followed by blood leaking into tissue
Ischemic stroke: caused by blockage in brain blood vessels; potentially treatable with clot-busting drugs; less serious than hemorrhagic stroke
Subarachnoid hemorrhage: a bleed into the space between the brain and the skull
Intracerebral hemorrhage: a bleed from a blood vessel into the brain
Embolic stroke: caused by emboli, blood clots that travel from elsewhere in the body to the brain blood vessels
Thrombotic stroke: caused by thrombi, blood clots that form where an artery has been narrowed by atherosclerosis
Source: Harvard Health Letter, April 2000.

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Congestive Heart Failure
Congestive heart failure: heart is not pumping the blood as well as it should, allowing blood and fluids to back up in the lungs
Can develop after a heart attack or as a result of hypertension, heart valve abnormality, or disease of the heart muscle
Person with this condition experiences difficulty breathing, shortness of breath, coughing, fatigue, and confusion

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Other Cardiovascular Diseases
Heart valve disorders: one of the four heart valves does not open well or does not close tightly
Congenital heart disease: structural defect at birth
Peripheral vascular disease (PVD): result of atherosclerosis in the arms and legs
Cardiomyopathy: disease of the heart muscle
Dilated cardiomyopathy: enlargement of the heart in response to weakening of the muscle
Hypertrophic cardiomyopathy: abnormal thickening of one part of the heart, frequently the left ventricle

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Major Factors Contributing to Cardiovascular Health
Four health behaviors contribute to ideal cardiovascular health:
Avoid tobacco
Eat a healthy diet
Be physically active
Maintain a healthy BMI
Three measurable health factors also contribute:
Blood pressure levels
Blood glucose levels
Cholesterol levels

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Maintain Healthy Blood Pressure Levels
Blood pressure: exerted by blood against artery walls
Systolic pressure: produced by the heart contracting and pushing blood out into the arteries; the top number
Diastolic pressure: in the arteries when the heart muscle is relaxed and the ventricles are filling
Hypertension: high blood pressure, forceful enough to damage artery walls
Untreated hypertension can weaken and scar the arteries and make the heart work harder; and increases risk for heart attack, stroke, congestive heart failure, and kidney disease

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Maintain Healthy Blood Glucose Levels
Elevated levels of glucose in the body cause damage to artery walls, changes in some blood components, and damage to peripheral nerves and organs
People with diabetes are 2–4 times more likely to develop cardiovascular disease

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Table 14.1 Blood Pressure Guidelines
Normal: systolic pressure of less than 120 mmHg and diastolic pressure of less than 80 mmHg
Prehypertension: systolic pressure of 120–139 mmHg, or diastolic pressure of 80–89 mmHg
Hypertension stage 1: systolic pressure of 140–159 mmHg, or diastolic pressure of 90–99 mmHg
Hypertension stage 2: systolic pressure of 160 mmHg and above, or diastolic pressure of 100 mmHg and above
Source: “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure” (NIH Publication No. 03-5233), 2003, Bethesda, MD: National Heart, Lung, and Blood Institute, National Institutes of Health.

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Maintain Healthy Cholesterol Levels
Low-density lipoproteins (LDLs): “bad cholesterol” associated with atherosclerosis
The higher the LDL level, the higher the risk
Cholesterol-lowering statin therapy can reduce risk
For those with a history of cardiovascular disease
For those with LDL cholesterol over 190 mg/dl
For those over 40 with diabetes and LDL cholesterol over 70 mg/dl
For those with a 10-year risk of heart attack greater than 7.5%
High-density lipoproteins (HDLs): “good” cholesterol
Help clear cholesterol from cells and atherosclerotic deposits

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Contributing Factors in
Cardiovascular Health
Triglyceride levels
Triglycerides: blood fats similar to cholesterol
High levels are a risk factor for CVD
Alcohol intake
Heavy drinking can damage the heart
Light drinking can increase HDL levels, and therefore may help protect against heart disease and stroke risk
Mental wellbeing
Sleep

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Contributing Factors in
Cardiovascular Health (2)
Age
Probably the most important noncontrollable risk factor
Deaths due to heart disease and stroke rise significantly after age 65, due to the accumulation of risk factors
Gender and postmenopausal status
Death rates for CVD are higher in women
Genetics and family history
Socioeconomic status; and ethnicity and race
Minorities and low-income populations carry a disproportionate burden of CVD

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Areas of Interest for Future CVD Research
Researchers are looking at how the following are associated with CVD:
Low levels of vitamin D
High blood levels of homocysteine, an amino acid
Metabolic syndrome
Inflammation and high levels of C-reactive protein
Lower birth weight

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Testing and Treatment
Diagnostic testing for heart disease:
Electrocardiogram (ECG or EKG) to detect abnormal rhythms, inadequate blood flow, and heart enlargement
Echocardiogram (like an ultrasound) to visualize the heart structure and motion
Exercise stress test to evaluate heart functioning
Diagnostic testing for stroke:
CT scan or MRI to detect stroke and help determine cause
Further testing to find the source of any blockage

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Testing and Treatment (2)
Management of heart disease:
Medications, especially anti-arrhythmics, anti-anginals, and anti-coagulants
Surgeries, such as angioplasty (balloon catheter), a coronary stent, or coronary artery bypass grafting
Management of stroke:
If thrombotic, thrombolytic medications
If hemorrhagic, depends on the underlying cause of the bleed; sometimes surgery is necessary
Rehabilitation, usually including physical therapy, is an important component

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Diabetes
Diabetes: metabolic disorder in which production or use of insulin is disrupted
Most common disorder of the endocrine or metabolic system and the seventh leading cause of death in the U.S.
Rates of diabetes doubled every 15 years between 1950 and 2008 but now appear to have leveled off

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Figure 14.7 Normal insulin and glucose uptake,
and with Type-1 and Type-2 diabetes.
Normal
A healthy person’s body releases a normal amount of insulin from the pancreas after meals. Insulin binds to receptors on the surface of a cell and signals special transporters in the cell to transport glucose inside.
Type-1 diabetes
The pancreas produces little or no insulin. Thus, no signal is sent instructing the cell to transport glucose, and glucose builds up in the bloodstream.
Type-2 diabetes
The pancreas produces too little insulin and/or the body’s cells are resistant to it. Some insulin binds to receptors on the cell’s surface, but the signal to transport glucose is blocked. Glucose builds up in the bloodstream.

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Type-1 Diabetes
Caused by the destruction of insulin-producing cells in the pancreas by the immune system
Insulin must be provided from an external source to keep blood glucose levels under control
Onset usually occurs before age 20
Probably a result of a combination of genetic, autoimmune, and environmental factors
Physical activity is an important component of control and reduction in long-term complications

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Type-2 Diabetes
Caused by insulin resistance in insulin receptors
Pancreas responds by increasing production of insulin, but eventually cannot keep up
Accounts for 90–95% of all diabetes cases
Incidence rising in parallel with obesity levels
Visceral fat and lack of physical activity are strong indicators of risk
Prediabetes: fasting blood glucose levels between 100 and 126 mg/dl
Dietary changes, exercise, and weight loss can prevent or delay onset

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Risk Factors
Type-2 diabetes is a multifactorial disease with an increased risk if there is a family history of diabetes and other risk factors
Higher abdominal fat
Lack of physical activity
Being over 40 years of age
Racial and ethnic minorities and people with low socioeconomic status are disproportionately affected

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Risk Factors (2)
Metabolic syndrome is a set of conditions that significantly increases the risk for developing diabetes and other health complications
Fasting glucose level at or above 100
HDL cholesterol under 40 in men, or under 50 in women
Triglycerides at or above 150
Waist circumference at or above 40″ for men; or at or above 35″ for women
Systolic blood pressure at or above 130 and diastolic blood pressure at or above 85

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Prevention and Treatment
Screening involves tests for blood glucose levels
Dietary changes, exercise, and weight loss can prevent diabetes, delay its onset, and treat it
Treatment includes lifestyle modification, oral medications, and eventually insulin replacement
Exercise is especially important
Long-term control is monitored by a blood test called the hemoglobin A1c test
Closer blood glucose is to the normal range, the lower the risk of complications

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Gestational Diabetes
Develops in 2–10% of pregnancies
Hormonal changes affect the body’s response to insulin
Higher risk for pregnancies after age 35
In 5–10% of cases, diabetes becomes an ongoing condition
Women with a history of gestational diabetes are at a higher risk of developing diabetes in the next 10–20 years

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Chronic Lung Diseases
Also known as chronic lower respiratory diseases, chronic lung diseases are the third leading cause of death in the U.S.
Two most common forms:
Asthma
Larger genetic component
Chronic obstructive pulmonary disease (COPD)
More typical in older adults
Both are triggered by smoking, infection, and pollution

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Figure 14.8 The respiratory system.
Air, breathed in, travels down the trachea and enters the lungs through the bronchi (bronchial tubes)
Bronchi carry air through bronchioles (a series of branching airways) into alveoli (tiny air sacs), which are surrounded by capillaries (tiny blood vessels) where gas exchange takes place
Oxygen is passed from the alveoli into the blood in capillaries, and carbon dioxide moves from the capillaries into the alveoli
Carbon dioxide is then pushed back through the bronchioles and exhaled, while oxygen travels through the bloodstream to body cells

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Asthma
Chronic inflammation, obstruction, and constriction of the airways, causing wheezing, coughing, chest tightness, and shortness of breath
Attack occurs in response to a trigger: an allergen or an irritant in the air
Diagnostic categories:
Intermittent: no symptoms between episodes
Mild persistent: symptoms a few times a week
Moderate: daily symptoms limit some normal activity
Severe: daily symptoms place extreme limits on normal activity

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Asthma (2)
Bronchodilators: quick-relief medications used during an attack to reduce symptoms
Delivered through an inhaler
For long-term control:
Inhaled steroid that works within the bronchioles to reduce inflammation
Avoidance of common triggers such as tobacco smoke, allergens, and air pollution
Flu shots are recommended if viruses and infections are triggers

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Chronic Obstructive Pulmonary Disease
COPD tends to develop from cumulative damage to airways and alveoli; the primary cause is smoking
Chronic bronchitis: persistent inflammation of the bronchioles; excess mucus
Bronchial congestion and a chronic cough
Emphysema: alveoli become less elastic, and walls between alveoli are damaged or destroyed
Person is breathless and gasps for air
Strains the heart
Cannot be reversed; supplemental oxygen may be necessary at later stages

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Preventing Chronic Diseases
Eat a heart-healthy diet
Maintain a healthy weight
Don’t smoke, and avoid secondhand smoke
Be physically active
Limit alcohol consumption
Maintain healthy blood pressure levels
Maintain healthy lipid levels
Maintain healthy blood glucose levels
Manage stress, and take care of your mental, emotional, and social health

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In Review
What is cardiovascular disease?
What is diabetes?
What is asthma?
What is chronic obstructive pulmonary disease?
What are the best ways to protect against the diseases discussed in this chapter?

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Appendix A
Long image descriptions

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Figure 14.3 The Heart Appendix
Significant features of the heart:
Interior and superior vena cava, by which blood returns from the body
Right and left pulmonary veins, by which blood returns from the lungs
Pulmonary trunk
Right atrium and left atrium
Tricuspid valve on the right; and mitral valve on the left
Right ventricle and left ventricle
Interventricular septum
Myocardium (muscular tissue of the heart)
Aorta, by which blood is supplied to the body (systemic circulation)
Aortic valve
Right and left pulmonary arteries, by which blood is supplied to the lungs (pulmonary circulation)

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