Wellness: Health Promotion and Disease
Question 1
The psychologist Daniel Levinson identified five developmental tasks for young adults. These are 1) pursuing a dream; 2) creating relationships; 3) developing an occupational career; 4) forming a marriage and family; and 5) building responsibility in the larger community. The tasks are all interdependent, meaning that achieving one affects the possibility of accomplishing the other four (StudyMode.com, 2011). For example, developing a career may provide the financial stability necessary to pursue a dream or to form a family. Creating a relationship with another person may lead to marriage and a family, while creating a relationship with a mentor may lead to obtaining a career or to greater responsibility in the larger community. And that greater community responsibility may provide the foundation necessary to pursue a dream or to create other, more personal, relationships, which can lead to marriage and family.
Not every person performs these tasks in the same order or in the same way. Just as every person is an individual, the path he or she takes will be an individual one, too. The important point is that these five tasks are common to the development of all young adults into fully matured members of the community.
Question 2
When we think of fat in our diets, we tend to think in negative terms. First, fats have more calories per gram (9) than protein or carbohydrates (4.5 each), and thereby lead to our gaining weight. Second, our bodies more readily metabolize dietary fats into body fat than they do with either protein or carbohydrates, again leading to gaining weight. And third, excessive amounts of fat can lead to fatty deposits on artery walls, which can, in turn, lead to cardiovascular disease (Sherazi, 2010).
While all of these are true, they do not depict the whole story. There are many different kinds of fats, and some should definitely be included as a regular part of your diet. Saturated fat is the “bad” kind of fat, the kind that leads to coronary artery disease, heart attacks, and strokes. It is found in foods such as beef, pork, lard, poultry, butter, milk, coconut and palm oils, cocoa butter, cheeses and other dairy products. All of these foods also contain dietary cholesterol, which can further lead to clogged arteries (American Heart Association, 2012).
Foods that contain monounsaturated and/or polyunsaturated fats, on the other hand, can support a healthy cardiovascular system and are important in brain development. Monounsaturated fats are beneficial because they lower total cholesterol levels, as well as “bad” (low-density lipoprotein or LDL) cholesterol levels; at the same time, they increase “good” (high-density lipoprotein or HDL) cholesterol levels. There is also some evidence that monounsaturated fats help regulate blood sugar and thereby aid in the control of diabetes, while polyunsaturated fats help fight inflammation (Bradley, 2011). Good sources of monounsaturated and polyunsaturated fats are nuts, avocados, and peanut and corn oils. You should keep your total fat intake between 25 and 35 percent of your daily calories, with most fats coming from polyunsaturated and monounsaturated fatty acids (American Heart Association, 2012).
Unsaturated fatty acids are found in one of two shapes, chemically known as "cis" and "trans," that refer to the physical position of hydrogen atoms around the carbon chain. The cis form is more common than the trans form, but trans-fatty acids, or TFAs, are also created during the process of hydrogenation, the addition of hydrogen atoms to cis fats to make margarine, shortening, and cooking oils. Partially hydrogenated vegetable oils provide about three-fourths of the TFAs in the U.S. diet, and scientists have found that TFAs tend to raise total blood cholesterol levels, increase LDLs and decrease HDLs even more than saturated fats. These changes may increase the risk of heart disease, and the AHA recommends that TFAs should comprise only about one percent of your total daily fat intake (American Heart Association, 2012).
The omega-3 fatty acids are an important component of healthy bodily function. They are needed to ensure that cell membranes in the body function properly, and they can help prevent or relieve symptoms of depression, facilitate the delay of memory loss and dementia, reduce the potential for joint pain and some skin conditions, and contribute to a healthy pregnancy. The best sources for omega-3s are fish, flax seeds, tofu, and walnuts (Bradley, 2011).
According to a study by the Centers for Disease Control and Prevention (Reuters, 16 October 2012), the cholesterol levels of U.S. adults have been dropping since the late 1980s. Overall cholesterol (as well as a decrease in LDL cholesterol), which is closely tied to heart disease risk, may have decreased because of improvements in diet, including the substitution of vegetable oils for less-healthy trans fats.
Question 3
Hahn, Payne, & Lucas (2010, 220-240) identify the risk factors for cardiovascular disease that cannot be changed as:
1) Increasing age. Heart disease tends to develop gradually over the course of one’s life, and despite the fact that some people have a heart attack as early as in their 20s or 30s, almost 84 percent of people who die from heart disease are 65 years and older.
2) Male gender. Before 55 years old, women have lower rates of heart disease than men, which may be due to their production of the hormone estrogen during their child-bearing years. After menopause, and with the increased rate of smoking among younger women, the rates become similar after that age. In an interesting side-note, Petrochko (2012) writes that women are twice as likely to die following a heart attack than men, perhaps because the disease is thought of as a “male” disease, and women tend to take longer to report symptoms than do men.
3) Heredity. The genetic information that is passed from one generation to the next cannot be changed. Some families have genes that predispose them to develop high cholesterol and/or heart disease, and it is therefore all the more important that they learn to reduce the risk factors over which they do have control.
4) Race. African Americans have significantly higher rates of hypertension (high blood pressure) than do their white counterparts, and hypertension increases the risk of both heart disease and stroke. It is therefore extremely important for them to have their blood pressure routinely monitored by a physician to prevent adverse effects.
Hahn, et. al (2010) also describe the “big six” cardiovascular risk factors, the factors that are influenced largely by lifestyle choices and can therefore be controlled. These factors are cigarette smoking and secondhand tobacco smoke; physical inactivity; high blood cholesterol levels, usually from high-fat diets; high blood pressure; diabetes mellitus; and obesity. Diabetes mellitus is a form of diabetes that is not inherited but is often a consequence of obesity and lack of physical activity. The cells in the body become unresponsive to insulin (a hormone needed to break down sugars), leading to dangerously high levels of sugar in the bloodstream. Over 65 percent of people with diabetes die of some type of heart or blood vessel disease.
Additional factors that contribute to cardiovascular disease include an individual’s response to stress, sex hormones, birth control pills, and drinking too much alcohol. Unresolved stress can increase the level of harmful stress hormones in the body, and it can lead to other unhealthy habits, such as smoking, poor dietary practices, and lack of activity; these, in turn, can lead to changes in blood fat profiles, blood pressure, and the heart’s workload. Female sex hormones (estrogen) tend to protect women until they reach menopause, but male hormones (androgens) do the opposite. Birth control pills may increase the risk of blood clots and heart attacks, but the risk is small unless the woman also smokes and is over 35 years. And while moderate drinking – one drink per day for women and two drinks per day for men – may lower the risk of heart disease, too much alcohol can cause high blood pressure, heart failure, and lead to stroke (Hahn, et.al, 2010).
Question 4
Medicare is the United States’ health insurance program for people 65 years or older, as well as those under 65 who have certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. It is financed by a portion of the payroll taxes paid by workers and their employers, as well as by monthly premiums deducted from Social Security and Social Security Disability checks (SSA, 2012). Established in 1965, it is administered by the Health Care Financing Administration, which is a part of the Department of Health and Human Services (Hahn, et. al, 2010, 361-385).
Medicare has four distinct parts: 1) When a person becomes 65 and qualifies to receive Medicare, he automatically receives what is known as Part A, which is a no-cost benefit that covers hospital stays or a period in a skilled nursing facility following a hospital stay. There is a deductible of about $1000 that the beneficiary must meet each time he is admitted to the hospital, but there are no monthly charges; 2) When a person receives Part A, he is eligible to enroll in Part B, which covers doctors’ services and a variety of diagnostic tests and treatments. This part is paid for by withholding a portion of the beneficiary’s monthly Social Security check, and it usually covers 80% of the doctor’s visit or test (or 55% of psychiatric services); 3) When a person has Medicare Parts A and B, he can join a Medicare Advantage plan (Part C). These plans are offered by private companies and approved by Medicare, and they generally cover many of the same benefits that a Medigap policy would cover, such as extra days in the hospital after you have used up the number of days Medicare will allow, so you do not need to purchase another policy; and 4) When a person has Parts A and B, or Part C, he can apply for Part D, which covers the cost of prescription drugs. Joining a Medicare prescription drug plan is voluntary, and there is an additional deductible and/or a monthly premium for the coverage (SSA, 2012).
Medicaid is not the same as Medicare. Medicaid is a joint federal and state program for indigent populations, where each state establishes its own eligibility standards, benefits package, payment rates, and program administration set up under broad federal guidelines (HHS, 2000). It is a public assistance program designed to assist in meeting the health care needs of qualified persons regardless of age.
The Medicaid program was created under the same legislation that created the Medicare program – the Social Security Amendments of 1965 – but it is targeted at a different population. According to HHS (2000), it provides three types of critical health protection: 1) health insurance for low-income families with children and people with disabilities; 2) long-term care for older Americans and individuals with disabilities; and 3) supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare, as well as Medicare premiums and deductibles.
Question 5
Nicotine is a potent substance that affects the body in many ways. Outside the central nervous system, it affects the transmission of nerve signals at neuromuscular junctions (the areas where the nerves connect to the muscles), by mimicking the action of the neurotransmitter acetylcholine. It occupies receptor sites at the junction and thereby prevents the transmission of nerve impulses from the nerve cell to the muscle cell. Nicotine also causes the release of the hormone epinephrine from the adrenal glands, which causes an increase in respiration rate, heart rate, blood pressure, and coronary blood flow (Hahn, et. al, 2010, 189-219).
According to Olpin (2012), your stress level contributes to your risk of developing cardiovascular disease. Constant stress exposes your body to persistently elevated levels of stress hormones such as adrenaline and cortisol. Studies also link stress to changes in the way blood clots, which increases the risk of a heart attack.
Nicotine can influence the body in a manner similar to the way stress does. It is a stimulant that increases the heart rate, increases blood pressure, increases the output of cholesterol in the blood, decreases the size of blood vessels, even in the heart and in the brain, increases blood clotting, and, as a result, increases the overall risk of a heart attack or stroke. This is true both for cigarette smokers and those exposed to secondhand smoke.
Interestingly, though, people who smoke feel that their stress level decreases when they light up. This may be due to what is called the Adrenocorticotropic Hormone (ACTH) Theory (Hahn, et. al, 2010). ACTH releases beta endorphins into the bloodstream, chemical compounds that act as mood enhancers. These “feel good” endorphins are also what gives runners a “runner’s high” after a workout. This effect, however, is fleeting, whereas the effects of chronic stress are not. It is therefore more important to reduce or eliminate nicotine consumption in order to maintain good cardiac and overall health, as well as decrease stress levels.
References
(2000). A Profile of Medicaid: 2000 Chartbook, Section 1. U.S. Department of Health and Human Services, Health Care Financing Administration. Retrieved from http://www.policyalmanac.org/health/archive/hhs_medicaid.shtml
(2012). Cholesterol Levels Declining. Reuters. Retrieved from http://www.reuters.com/article/2012/10/16/health-cholesterol-idUSL3E8LG7C120121016
(2012). Know your Fats. American Heart Association. Retrieved from http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-Fats_UCM_305628_Article.jsp
(2012). Medicare: SSA Publication No. 05-10043. Social Security Administration. Retrieved from http://www.socialsecurity.gov/pubs/10043.html
Bradley, Katherine. (2011). Nutritional Role of Fat. Livestrong.com. Retrieved from http://www.livestrong.com/article/523887-nutritional-role-of-fat/
Hahn, D. B., Payne, W.A. & Lucas, E.B. (2010). Becoming an Informed Healthcare Consumer. In Focus on Health (10th ed.), (361-385). New York, NY: McGraw-Hill.
Hahn, D. B., Payne, W.A. & Lucas, E.B. (2010). Enhancing Your Cardiovascular Health. In Focus on Health (10th ed.), (220-240). New York, NY: McGraw-Hill.
Hahn, D. B., Payne, W.A. & Lucas, E.B. (2010). Managing Stress. In Focus on Health (10th ed.), (51-74). New York, NY: McGraw-Hill.
Hahn, D. B., Payne, W.A. & Lucas, E.B. (2010). Rejecting Tobacco Use. In Focus on Health (10th ed.), (189-219). New York, NY: McGraw-Hill.
Olpin, Michael. (2012). Stress Management for Life. Cengage Learning. Retrieved from http://books.google.com/books?id=snmX7mzDzqQC&pg=PT275&lpg=PT275&dq=nicotine+mimic+stress+response&source=bl&ots=XnYv8PaGS5&sig=FmIytrrjJXEqIa9WcOvfG5V3i7M&hl=en&sa=X&ei=Z06AUN7ZHeO_0QGA8IGoDQ&ved=0CDQQ6AEwAw
Petrochko, Cole. (2012). Heart Attacks Twice as Deadly for Women. MedPage Today. Retrieved from http://www.medpagetoday.com/Cardiology/MyocardialInfarction/35441?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-10-20&eun=g262619d0r&userid=262619&email=&mu_id=5257510
Research Paper Question and Answer. (2011). StudyMode.com. Retrieved from http://www.studymode.com/essays/Research-Paper-Question-And-Aanswer-719271.html
Sherazi, Amina. (2010). Understanding the Role of Fat in Health Nutrition. BodyHealth. Retrieved from http://www.bodyhealth.us/health_general/3104.html
