Personal Health Final Exam

where does cardiovascular disease (CVD) rank in terms of risk for death in US adults

it's the leading cause of death for both men and women in the US

what are the preventable risk factors for CVD

- tobacco smoke

- excessive alcohol consumption

- obesity

- sedentary lifestyle

- diet

- psychosocial factors

what specific behaviors help to prevent these risk factors

lifestyle changes

what are the diagnostic numbers for total, HDL and LDL cholesterol that are associated with the greatest risk for CVD

LDL cholesterol

- <100 = optimal

- 100-120 = near or above optimal

- 130-159 = borderline high

- 160-189 = high

- >190 = very high

total cholesterol

- < 200 = desirable

- 200-239 = borderline high

- >240 = high

HDL cholesterol

- <40 = low

- >50 =high

what are the major forms of CVD

- hypertension

- atherosclerosis

- angina

- coronary artery disease (CAD)

- arrhythmias

- myocardial infarction

- cerebrovascular accident (stroke)

how is hypertension different from the other forms of CVD

it's both a risk factor and a type of CVD

what are the two types of hypertension (HTN) or high blood pressure

1. secondary hypertension

- caused by another medical condition

2. primary or essential hypertension (most common)

- develops over time

- caused by genetics and/or lifestyle risk factors

- cannot be cured but can be controlled

are there signs or symptoms associated with HTN

most often no and that's why it's called "the silent killer"

what are the diagnostic levels associated with normal BP? pre-hypertension? hypertension?

normal bp

- systolic below 120 and diastolic below 80

pre-hypertension

- systolic 120-139 or diastolic 80-89

hypertension stage 1

- systolic 140-159 or diastolic 90-99

hypertension stage 2

- systolic 160 & above or diastolic 100 & above

what is the definition of atherosclerosis

it's a form of arteriosclerosis - thickening and hardening of the arteries

what's the physiologic process associated with the development of atherosclerosis

step 1 - plaque build up begins when cells lining arteries are damaged by smoking, high BP, oxidized LDL, and other causes; excess cholesterol particles collect beneath these cells

step 2 - in response to damage, platelets and other cells collect at site; a fibrous cap forms, isolating the plaque within the artery wall (an early-stage plaque is called a fatty streak)

step 3 - chemical released by cells in and around plaque cause inflammation and buildup; advanced plaque contains LDL, white blood cells, connective tissue, smooth muscle cells, platelets, and other compounds

step 4 - the narrowed artery is vulnerable to blockage by clots; the risk of blockage and heart attack rises if the fibrous cap cracks (due to destructive enzymes released by white blood cells within the plaque)

what are the symptoms of a heart attack

- shortness of breath

- chest pain (angina)

- excessive sweating

- numbness in left side of face and arm

- nausea

- vomiting

- indigestion

in women:

- upper back or abdominal pain

- pain at rest

- fatigue

what are arrhythmias

an abnormal heartbeat, resulting from a disruption of the electrical system that regulates the heart's beating

what are the two types of arrhythmias

1. atrial fibrillation - most common types of arrhythmia caused by chaotic electrical impulses in the atria causing weak heart contractions

2. ventricular fibrillation - most serious type; occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body

what is the definition of ischemic stroke

a stroke that is caused by blockages in brain blood vessels; potentially treatable with clot-busting drugs

what are the two types of ischemic strokes

1. embolic stroke

2. thrombotic stroke

what are the signs and symptoms of a stroke

- sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

- sudden confusion, trouble speaking or understanding

- sudden trouble seeing in one or both eyes

- sudden trouble walking, dizziness, loss of balance or coordination

- sudden, severe headache with no known cause

how is overweight and obesity diagnosed in adults based on their BMI

overweight - adult who has a BMI between 25 and 29.9

obesity - adult who has a BMI of 30 or higher

how is overweight and obesity diagnosed in children based on their BMI

overweight - between 85th and 94th percentile

obese - >95th percentile

how does a children diagnosis differ from adult diagnosis when looking at BMI

a BMI for children and teens takes into account normal differences in body fat between boys and girls and differences in body fat at various ages

what is the prevalence of obesity in the US

- about 2/3 of US adults are either overweight or obese

- all adults = 133.6 million (66%)

according to trust for america's health where does oklahoma rank in terms of the prevalence of obesity compared to other states

oklahoma, along with 19 other states, has an adult obesity rate of at least 30%

what is the % increased risk of death from all-cause mortality caused by obesity

50%

how much have the rates of childhood obesity increased since 1980

tripled

what is the office of genetics and disease preventions definition of obesity

"obesity is a chronic lifelong condition that is the result of an environment of caloric abundance and relative physical inactivity modulated by a susceptible genotype"

what factors heavily influence energy intake and lack of physical activity contributing to the obesity epidemic

1. genetics

2. physiological factors

- deregulation of energy homeostasis

- number/size of adipose cells

- body fat distribution

3. sociocultural norms

4. environmental factors

5. psychological factors

how does the number and size of a child's fat cells affect their risk of being an overweight or obese adult

the more fat cells we have at puberty and through out life, the more fat cell hormones will be circulating in the body asking that the cell be "fed"

how does body fat distribution affect the health risks associated with obesity

- abdominal fat is more mobilized and sent to bloodstream

- abdominal fat can induce insulin and leptin resistance

what are the environmental factors that contribute to "an environment of caloric abundance"

1. excessive marketing and advertising of high fat and high sugar foods, especially to children

2. food subsidies make fat/processed foods readily available vs. healthy foods

3. food distribution programs

4. resistance to changes in school lunch program

what are the environmental factors that contribute to "an environment of relative physical inactivity"

1. lack of planned communities that focus on safe pedestrian accessibility

2. safety of urban and suburban communities

3. community infrastructures focused on cars and convenience

4. marketing of products that promote convenience and less physical effort

5. reduction or elimination of PE, health education and recess in schools

what are the psychological factors that contribute to the development of obesity

1. chronic stress

2. obesity related disorders

- body image disparagement

- binge eating disorder

3. weight discrimination can lead to

- low self-esteem and low self-efficacy

- depression, anxiety, stress, shame and guilt

- ineffective, or dangerous, weight loss practices

what medical conditions specific to children are associated with childhood obesity

orthopedic complications

1. maturing bone and cartilage aren't strong enough to withstand excess weight

2. higher incidence of musculoskeletal injury

what are the treatment recommendations for obesity

physical activity

1. cardiorespiratory exercise

- modest weight loss: 45-60 min/day > 5 days/week

- weight loss maintenance: 30-45 min/day > 5 days/week

2. resistance training exercise

- > 2 times a week targeting all major muscle groups

- intensity set to increase strength

3. physical activity

- at least one hour/day of general activity

nutrition

1. practice portion control, not deprivation

2. spread caloric intake out throughout day

3. shift dietary focus to nutrient dense foods

4. eat, don't drink your calories

5. increase knowledge and awareness

behavior and attitude

1. because weight loss and weight loss maintenance is a lifelong task, it's important to success that people:

- focus on the journey, not the outcome

- identify a deeply emotional and personal reason for embarking on this journey

- promote understanding and acceptance of all people, regardless of weight or size

describe the physiology of type 1 diabetes, pre-diabetes, gestational diabetes, and type 2 diabetes

1. type 1 (insulin dependent) - due to autoimmune, genetic, or environmental factors, the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin causing absolute deficiency

2. pre-diabetes (impaired fasting glucose IFG or impaired glucose tolerance IGT) - caused by relative, rather than absolute, insulin deficiency or resistance by the cells to insulin and the sugar it carries

3. gestational - glucose intolerance diagnosed in some women during pregnancy

4. type 2 (non-insulin dependent) - pre-diabetes progresses to type 2 diagnostic level

what are the risk factors associated with the development of type 2 in adults

1. being overweight or obese

2. metabolic syndrome

- hypertension, poor lipid profile, pre-diabetes abdominal obesity

3. specific medical conditions

- polycystic ovarian syndrome, hypothyroidism

4. poor nutrition

- high fat/calorie dense diet, high intake of HFCS, large portions

5. family history

6. sedentary lifestyle

7. ethnic background

8. tobacco use

what are risk factors specific to children that are associated with the development of type 2 diabetes

- not breastfed or breastfed for less than three months

- birth weight is either small or large for gestational age

what are the symptoms of hyperglycemia usually seen in people with type 1 diabetes

- frequent urination

- extreme thirst or hunger

- dehydration

- irritability

- unusual weight loss

- blurred vision

- life-threatening symptoms

what is the definition of acanthosis nigricans (AN)

a brown to black, velvety hyper-pigmentation of the skin, usually present in the posterior or lateral folds of the neck, under the armpits and in the crease of the elbow

what is the cause of AN

obesity and/or insulin resistance

of what is AN a symptom

spillover of insulin into the skin

what are the diagnostic criteria for the following types of diabetes: pre-diabetes, type 1 diabetes and type 2 diabetes

Pre-diabetes:

1. impaired fasting glucose - FPG = 100-125 mg/dl (ADA); 100-110 mg/dl (WHO)

2. impaired glucose tolerance - OGTT = 140-199 mg/dl

Type 1 & 2 require one of the following to be present:

1. symptoms of unequivocal hyperglycemia AND a casual plasma glucose > or equal to 200 mg/dl

2. A1C > or equal to 6.5%

3. FPG: 126 mg/dl or higher

4. OGTT: 2 hour postload glucose = 200 mg/dl

what characteristics help to differentiate between a person with type 1 diabetes and a person with type 2 diabetes

Type 1

- usually at a normal weight

- often presents w/ extremely high blood glucose levels, symptoms of hyperglycemia and/or in diabetic ketoacidosis

- present w/ high insulin antibody levels in blood

Type 2

- usually overweight or obese

- have blood sugars that are within diagnostic range but not as high as type 1's present with

- may show symptoms of insulin resistance

- have few or no insulin antibodies in the blood

what is the definition of macro vascular complications associated with diabetes - be able to recognize examples of this type of diabetic complication

degeneration in the function of the large blood vessels (AA and VV)

- ex: heart disease, stroke, high BP

what is the definition of microvascular complications associated with diabetes - be able to recognize examples of this type of diabetic complication

degeneration in the function of small blood vessels (capillaries)

- ex: nephropathy (kidney disease), retinopathy, neuropathy

what is diabetes-related stress

a common factor in diabetic patients - characteristics include feelings of shock, guilt, anger, anxiety, depression, and helplesness

with what is diabetes-related stress associated

being diagnosed with diabetes

how long does diabetes-related stress last

mean duration of almost 15 years

do clinicians feel able to address diabetes-related stress in treatment

only 10% reported receiving psychological treatment

what are the self-management goals for effectively taking care of type 2 diabetes

1. self-monitoring of blood glucose

2. therapeutic lifestyle change: nutrition and physical activity

3. overweight or obese patients: modest weight loss (5-10% of current weight) > reduces insulin resistance and risk of complications

4. meeting nutrition therapy recommendations

- sat. fat intake less than 7% of total calories

- intake of trans fat eliminated

- carb intake monitored

- dietary fiber = 14g/1000 kcal

- follow the 50/50 plate rule

- practice portion control

5. physical activity

- perform at least 150 min/week of moderate intensity aerobic physical activity (50-70% of max HR) spread over at least 3 days/week with no more than 2 consecutive days without exercise

- perform resistance training 2-3 times/week

6. foot self care

7. other:

- lose 5-10% of your body weight if you're overweight or obese

- do not smoke or, if you do, quit

- stress management

- manage psychosocial comorbidities: depression, axiety

based on the results of the diabetes prevention program (dpp) can type 2 diabetes be prevented

yes

what rank in terms of risk for death does cancer pose to US adults

it's the 2nd leading cause of death in the US

what does the american cancer institute believe could prevent thousands of cases of colon, breast and uterine cancer

lifestyle changes

what is the physiology associated with the development of cancer

the DNA of a cell can become damaged or changed producing mutations that affect normal cell growth and division. when this happens, cells don't die when they should and new cells form when the body doesn't need them. the extra cells may form a mass of tissue called a tumor (no physiological purpose)

- some cancers don't form tumors like leukemia that is a cancer of the bone marrow and blood

how does a cancer spread

metastasis - the spreading of cancer cells, which occurs due to the lack of cellular cohesiveness - they break away and pass through the lining of lymph or blood vessels to invade nearby tissues

what are the 3 main categories related to the causes of cancer

1. cancer initiators

2. cancer promoters

3. cancer risk factors

what are the preventable and non-preventable risk factors associated with the development of cancer

preventable

1. lifestyle diet

2. viruses and bacteria

- HPV, hepatitis B and C viruses

- human t-cell leukemia/lymphoma virus

- HIV

- EBV

- human herpes virus 8

- helicobacter pylori

non-preventable

1. family history of cancer: genetics

2. growing older: the risk increases with age, especially after the age of 50

what are the 4 most common treatment options used to treat cancer

1. surgery

2. radiation

3. chemotherapy

4. medications

what is remission

remission - a period of time when the cancer is responding to treatment or is under control

does being in remission mean a person's cancer is cured

doesn't always mean cancer is cured - means that all the signs and symptoms go away and cancer cells can't be found with any tests used for cancer

what preventive screenings should individuals participate in to reduce their risk of developing colon cancer

sigmoidoscopy/colonoscopy

when should colon screenings begin

begin at the age of 50, earlier if one has a family history of the disease

how often should colon screenings be done

5 year or 10 year intervals

what controllable or preventable risk factors increase a person's risk for colon cancer

diet and cigarette smoking

what preventive screenings should individuals participate in to reduce their risk of developing breast cancer

mammography

when should mammography screenings begin

starting at age 20

how often should mammography screenings be done

every 2 years for women over 40 and every year for women over 50

what preventable or controllable risk factors increase a woman's risk for breast cancer

- body weight

- physical activity level

- alcohol

- long-term use of menopausal hormone therapy

what risk factors increase a person's risk for both non-melanoma and melanoma skin cancers

non-melanoma

- being exposed to natural or artificial sunlight over long periods of time

- having a fair complexion: light eyes, red/blonde hair, fair skin/freckles

- having actinic keratosis

- being exposed to arsenic

- having a weakened immune system

melanoma

- being exposed to natural or artificial sunlight over long periods of time

- having a history of many blistering sunburns, especially as a child or teen

- having a fair complexion: light eyes, red/blonde hair, fair skin/freckles

- moles

- race: being white

what does the acronym CAUTION stand for

C - change in bowel/bladder habits

A - a sore that doesn't heal

U - unusual bleeding or discharge

T - thickening of tissues (schlerotic change)

I - indigestion or difficulty swallowing

O - obvious change in a wart/mole

N - nagging cough

what is environmental health

the study of how the environment affects human health and whether the environment you are part of is helping you stay healthy, or making you sick - it's not just about the health of the environment

how does environmental health differ from environmental science

an environmental scientist might study how water pollution is hurting fish while environmental health scientists would study what happens to the health of people when they catch and eat those fish

what things are the effects of a dose of a hazard on an individual's body dependent upon

1. the dose-response relationship

2. duration of exposure

3. frequency of exposure

4. body size

what population groups are most susceptible to environmental hazards

- pregnant women and their developing babies

- elderly people whose defense mechanisms are less efficient

- sick people who have weakened immune systems

- infants and children who are still developing

what are the 3 environmental elements we need to survive

1. clean air: indoor and outdoor

2. clean food sources

3. clean water

what is the definition of off-gassing

products that contain formaldehyde compounds can release formaldehyde gas into the air

what household products produce off-gassing

plywood, carpet, wallpaper, urea formaldehyde foam insulation, paneling

is the earth's water an unlimited resource

no, the earth's water is a finite source

what is the importance of water to life

- our water is part of a deeply interconnected temperature regulation system made up of wetlands, watersheds, aquifiers, waterways, lakes, oceans, and the atmosphere

- water makes up between 55-78% of a human's body weight

- water regulates body temperature, carries nutrients and oxygen to cells, cushion joints protects organs and tissues, and removes wastes

- only live one week without water (one month without food)

what is the definition of acid rain

occurs when atmospheric pollutants combine with moisture in the air and fall to the earth as highly acidic rain, snow, sleet, or hail

what causes acidic rain

burning coal, motor vehicle exhaust and some industrial activities

how many millions of calories does the average american family leave uneaten every year

1.2 million calories

how much more plastic waste was in the waste stream in 2010 versus in the 1960s

1960: plastics were less than 1% of the waste stream

2010: 31 million tons of plastic waste was generated, representing 12.4% of total municipal solid waste

what are the ways that we can all adopt to promote clean air

1. fossil fuel energy use

- auto use

* purchase a hybrid vehicle or compressed natural gas vehicle

* keep your car tuned up and well maintained

* have your car serviced by a station that uses environment friendly refrigerants

* keep tires inflate to recommended levels

* obey the speed limit on highways (55-65 MPH is most fuel efficient)

- use and maintian energy efficient appliances

- replace incandescent bulbs and compact fluroescent bulbs with led bulbs

- insulate your home with ozone-safe agents

- lower your thermostat in winter and raise it in the summer

- reduce electrical use during peak hours (2pm-7pm)

2. promote tree growth in your yard and neighborhood

3. check with your waste hauler or local government to ensure that ozone-depleting refrigerents are removed from refrigerators, air conditioners, or humidifiers before disposal

4. ventilate your home adequately and buy radon test kits and carbon monoxide detectors

5. buy environmentally safe or "green" home furnishings

6. build or buy a green home

7. keep houseplants: ferns, palm trees, and English ivy work best

8. keep chemicla products in original, tightly sealed containers

9. do not smoke or allow others to smoke in or around your home

10. clean and maintain ductwork, chimneys and furnaces

11. use duct filters and dust often

what are the ways you can insure safe food consumption

1. learn how to store/cook food correctly

- don't over lead your fridge or freezer

- thoroughly cook all animal protein

2. don't leave foods vulnerable to bacterial growth unrefrigerated for long periods of time (meat and dairy)

3. wash ALL fruits and veggies with a produce wash

4. grow your own organic vegetable garden

5. buy food that's organic, grown without antibiotics or pesticides, has been minimally processed and/or has been treated humanely

6. pay attention to expiration dates

7. get USDA recall and food allergy alerts

how can you reduce your production of solid waste

1. buy products in bulk or with minimal packaging

2. buy recycled and recyclable products; avoiding disposables

3. avoid disposable plastic bottles, foam, plastic or paper cups and plastic stirrers or straws

4. pack your lunch and store food in reusable glass or plastic containers rather than plastic bags or tin foil

5. take part in community recycling programs

6. compost organic garbage rather than tossing it or putting it down a garbage disposal

7. cancel junk mail

8. use online or phone bill payment and statement services

9. when hiking or camping, observe the "leave no trace" rule

what is your "just one thing" environmental action that you will now adopt to help protect the environment

use glass reusable containers to pack lunch instead of plastic bags

what are the facts related to water overconsumption and the actions individuals can take to address each fact

fact: more water is used in the bathroom than any other place in the home

action: turn off the water when you brush your teeth, install low-flow toilets or use a displacement device in the toilet tank, use a low-flow shower head and faucet aerator, take 5-10 minute shower instead of bath and you'll save thousands of gallons of water a year

fact: at 1 drip per second, a faucet can leak 3,000 gallons per year

action: check your plumbing and repair any leaks as soon as possible

Describe extraction, production or disposal. Then relate back to either the slides or the video.

Disposal is simply the garbage we throw away. On average, a person throws away 4.5 pounds of garbage per day. This garbage is either dumped in a landfill or incinerated then dumped in the landfill. Both ways pollute the air, but incinerating releases the toxins and new super toxins form. Individuals participate in environmental changes and reach out to the government to fix the issue. In the slides, it agrees that incinerating does reduce the bulk of the garbage, but it is still harmful to the air. Steps of action include calling or writing an elected official to seek higher help or write a petition. Behavior changes include buying recyclable products, avoiding disposable products, use reusable glass for lunches, join a community recycling program, and compost organic garbage rather than putting it down the garbage disposal.