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162 Cards in this Set
- Front
- Back
Alcohol Poisoning
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Alcohol depresses nerves that control involuntary actions such as breathing and the gag reflex (which prevents choking)
- the danger of choking on vomit, which could cause death by asphyxiation -alcohol is an irritant to the stomach |
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Critical Signs and Symptoms of Alcohol Poisoning
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Mental confusion, stupor, coma, or person cannot be roused.
Vomiting. Seizures. Slow breathing (fewer than eight breaths per minute). Irregular breathing (10 seconds or more between breaths). Hypothermia (low body temperature), bluish skin color, paleness. * alcohol overdose can lead to irreversible brain damage. |
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Alcohol Background
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Each year, alcohol use can be linked to:
70,000 reported incidents of sexual assault 400,000 incidents of unprotected sex 500,000 injuries 600,000 assaults 1,400 student deaths |
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Alcohol use & Adolescence
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increase dramatically during adolescence
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Alcohol Use: College Students
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-20% met diagnostic criteria for alcohol use/dependence in the preceding 12 months.
-40% report engaging in “heavy episodic” drinking (binge drinking) in the preceding 2 weeks. |
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The National Minimum Drinking Age Act of 1984
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required all states to raise their minimum purchase and public possession of alcohol age to 21.
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High-risk or “binge” drinking
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consumption of at least 5 or more drinks for men (4 for women) on at least one occasion in the past two weeks.
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Drink = ½ oz. of absolute alcohol
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one 12-oz. beer
one 5-oz glass of wine one 1.5-oz. shot of spirits |
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Binge drinking at UF
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Males 51%
Average male 47% Female 39% Average female 32% |
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binge drinkers
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-Nearly 1/3 meet the criteria for a formal diagnosis of alcohol abuse.
-Nearly 1 in 17 are alcohol dependent. |
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Breath alcohol concentration (BrAC)
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the amount of alcohol in the bloodstream or on one's breath.
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The National Institute on Alcohol Abuse and Alcoholism reports
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25% of college students report academic problems as a result of alcohol use.
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Access to Alcohol
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Parties are key venue for alcohol access through social settings, particularly for older youth.
- Alcohol consumption occurs most frequently at on-premise alcohol establishments; bars, clubs, and restaurants |
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Sex Differences
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Although men drank more and spent more money, there was no significant sex differences in BAC
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Underage Bar Patrons
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*As the evening progresses bars appear to be frequented by younger drinkers.
-On average, underage patrons consumed 4 drinks at the bar they just exited -63% above the legal limit to drive |
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Proximity
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being in the same place at the same time. The more you see a person, the more likely an attraction will occur.
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Reciprocity
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based on similarities (attitudes, values, intellect, interests). The more you express interest, the safer it is for someone else to return the regard, and the cycle spirals onward.
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Physical attraction
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Men – tend to select based on physical attractiveness and youth.
Women – place higher emphasis on partners who are somewhat older, have good financial prospects, and are dependable and industrious. |
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Autoerotic behaviors
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sexual fantasy & masturbation
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Kissing and erotic touching
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nonverbal sexual communication
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Variant Sexual Expression
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Atypical sexual behavior- Not abnormal, just different
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Cunnilingus
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oral stimulation of the female’s genitals
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Fellatio
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oral stimulation of the male’s genitals
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Human Sexual Response
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Excitement/arousal
Plateau phase Orgasmic phase Resolution phase Refractory period |
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Excitement/arousal
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– vasocongestion: is a condition in which the body's tissues swell up because of an increased flood flow in the area (blue balls)
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Plateau phase
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– nipples and penis erect
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Orgasmic phase
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– muscles contract
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Resolution phase
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– profound relaxation
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Refractory period
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– most men unable to become aroused following resolution
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Mons pubis- external
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pad of fatty tissue covering the pubic bone
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Labia minora – external
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folds of mucous membrane
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Labia majora – external
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folds of skin and erectile tissue that enclose openings
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Clitoris – external
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female sexual organ, only known function is pleasure
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Urethral opening – external
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urine leaves the body
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Vaginal opening –external
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opening to the vagina
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Hymen – external
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a thin membrane that may cover the vagina in some women
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Perineum – external
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the area between the vulva and anus
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Sexual Identity & Gender
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Sex – biological condition
Gender – psychosocial condition Gender identity: Transsexual, Transgender, Intersexed |
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Sexual Orientation
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Heterosexual
Homosexual Bisexual Pansexual Polysexual Asexual |
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Intersex conditions
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anatomy that is not considered typically male or female
-pan meaning all, -poly meaning many, though not necessarily all |
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Vagina – internal
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a tubular organ that serves as a passageway from the uterus to the outside of the female body
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Uterus (womb) –internal
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hollow, muscular, pear-shaped
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Endometrium – internal
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inner lining of the uterus, either prepares the uterus for implantation or menstrual flow
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Fallopian tubes – internal
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extending from the uterus, two thin tubes where sperm and egg meet; fertilization occurs in the top 1/3rd section
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Ovaries – internal
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almond-sized structures suspended on either side of the uterus.
-Produces the female sex cell (ovum) Ovum/Egg: Female sex cell containing all genetic information -Contain 400,000 eggs but only 400 mature. -The ovaries also produce estrogen and progesterone. |
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Puberty and the Menstrual Cycle
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Gonadotropin - releasing hormone
Follicle – stimulating hormone |
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Male Anatomy
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Scrotum – protects the testes
Penis – deposits semen Testes – manufacture testosterone Male Gamete (sex cell) = Sperm cells Epididymis – sperm ripen here in a comma shaped structure at the back of the testes Vasa deferentia (Vas Deferens) - Tubules wound in the epididymides that carry sperm from the testes to the urethra |
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Internal Male Anatomy
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Urethra – passes sperm and urine
Seminal vesicles – provides fluids to semen Prostate gland – provides fluids to semen Cowper’s glands – secretes fluid that lubricates the urethra |
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Variant Sexual Expression
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Atypical sexual behavior- Not abnormal, just different
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Elements of a Healthy Relationship
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Predictability – you can predict your partner’s behavior, based on the knowledge that your partner acts in consistently positive ways
Dependability – you can rely on your partner to give support in all situations Faith – you feel absolutely certain about your partner’s intentions and behavior |
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Proximity
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being in the same place at the same time.
*The more you see a person, the more likely an attraction will occur. |
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Reciprocity
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based on similarities (attitudes, values, intellect, interests).
*The more you express interest, the safer it is for someone else to return the regard, and the cycle spirals onward. |
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Environmental Health
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those aspects of human health and disease that are determined by factors in the environment.
biological, chemical, physical, psychological, or sociological |
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Population Growth
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A large and rapidly growing population makes it more difficult to provide the basic components of environmental health.
* accounts for most of the stress humans put on the environment. Factors that contribute to population growth: -high fertility rates -lack of family planning resources -lower death rates |
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Food Security
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Ensuring the Future of Food through the
The Green Revolution – strains of plants developed to resist diseases, pests, drought and flooding. *Reduces hunger but increases life span therefore increasing population |
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Environmental Disease
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any pathologic process having a characteristic set of signs and symptoms which are detrimental to the well-being of the individual and are the consequences of external factors.
Including: - exposure to physical or chemical agents, - poor nutrition -social or cultural behaviors. |
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Environmental Agents
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-Dioxins
-Electric & Magnetic Fields -Endocrine Disruptors -Lead -Mercury -Mold -Ozone -Pesticides |
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Foodborne Illness
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More than 200 known diseases are transmitted through food
6-81 million cases a year & 9,000 deaths Salmonella and E. coli most common Inadequate handling temps, undercooking, improper hygiene, contaminated equipment, getting from unsafe source * Fish, salad, and beef most contaminated |
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Federal Protection
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Centers for Disease Control and Prevention (CDC)
Environmental Protection Agency (EPA) Environmental Protection Agency (EPA) U.S. Department of Agriculture (USDA) Federal Emergency Management Agency (FEMA) |
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Local Environmental Health
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Services that assess and evaluate potential environmental risks to human populations to prevent disease and exposure to hazardous agents
*government and private citizens together |
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Health Care Consumer Survey
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-Americans (73%) are confused about how the U.S. Health Care System works
-Less than 50% act in ways to make themselves healthier -Decisions to forego or delay treatment are prompted by cost concerns -74% support expanding teaching programs in U.S. medical schools to increase the supply of primary care physicians (only 5% oppose) |
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Problems of Healthcare System
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Major problems of system represented in Kissick’s (1994) cost containment, access, & quality triangle
In 2009, 45.7 million Americans were uninsured (Source: Wall Street Journal, 2009) Likelihood of being uninsured greater for those who: are (a) younger, (b) less educated, (c) have lower incomes, (d) not Caucasian, (e) not U.S. citizens, & (f) male More than 8 out 10 uninsured persons are members of working families |
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Paying Health Care Costs
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Cost in 2009 $2.5 trillion
-Health care spending in 2009 accounted for 17.6% of U.S. GDP -US spends more on healthcare than any other nation in the world *Expected to be over 20% in 2018 |
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Primary Sources of Payment
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Out of Pocket: 15.1%
Private health insurance: 36.1% Fed. Gov: 33.9% State & local Gov: 10.5% Other Private Funds: 4.4% |
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Health Insurance Policy
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a written agreement between an insurance company (or the government) & an individual or group of individuals to pay for certain health care costs during a certain period in return for regular, periodic payments (a set amount of $) called premiums
There are expectations for both sides; they are not always met |
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Premiums
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regular periodic payments
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Deductible
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amount of money that the beneficiary must pay before the insurance company begins to pay for covered services
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Co-insurance
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portion of an insurance company’s approved amounts for covered services that the beneficiary is responsible for paying; co-payment: type of co-insurance, a negotiated set fee
*rates differ based on health risk factors, genetic history, preexisting conditions |
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Fee-for-service
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patient (first party), provider (second party), health insurance company or government (third party)
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Origin of Recycle Symbol
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in 1970, a student named Gary Anderson entered a contest to design a symbol for recycling products, he created three curved arrows forming a triangle
* now universally recognized for recyclable or made of recycled content |
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Made of recycled material symbol
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A circle around three arrows
*usually found on paper and cardboard |
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Combination of new and recycled content symbol
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black arrows on a white background
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100% recycled symbol
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white arrows on black background
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Waste
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Unwanted by-products of human activities
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Solid Waste
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Average American = 4.6 lbs of trash/day; ~1.5 lbs of this is recycled
*33 % of the worlds solid waste |
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Components of MSW
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* Paper 32.7% * LARGEST
Yard Trimmings 12.8 % Food Scraps 12.5 % Plastics 12.1 % Metals 8.2 % Rubber, Leather & Textiles 7.6% Glass 5.3 % Wood 5.6 % Other 3.2 % |
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Disposal of Solid Waste
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Landfill 55 %
Recycled 30 % Incinerated 15 % |
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Hazardous Waste
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A solid waste or combination of solid wastes that is dangerous to human health or the environment
*300 million tons annually in the US |
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EPA
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federal agency responsible for setting maintaining and enforcing environmental standards. Environmental Protection Agency
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Air Pollution
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not a human invention or even a new problem, 141 million tons of pollutants are emitted into the atmosphere in the US annually
Industrialization Causes: -Transportation -Electric power plants fueled by oil and coal -Industry |
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Air Quality Index
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Categorizes the air and corresponds to a different level of health concern. The six levels of health concern:
-"Good" AQI is 0 - 50. Air quality is considered satisfactory -"Moderate" AQI is 51 - 100. Air quality is acceptable -"Unhealthy for Sensitive Groups" AQI is 101 - 150. general public not likely to be affected but those more prone to disease are "Unhealthy" AQI is 151 - 200. Everyone may begin to experience some adverse health effects "Very Unhealthy" AQI is 201 - 300. This would trigger a health alert signifying that everyone may experience more serious health effects. "Hazardous" AQI greater than 300. This would trigger a health warnings of emergency conditions. The entire population is more likely to be affected. |
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Acid rain
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wet and dry acidic deposits that occur within areas that produce emissions containing sulfur dioxide and oxides of nitrogen
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Global Warming
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Gradual increase in the earth’s surface temperature
CFCs, carbon dioxide, methane, nitrous oxide *Major contributing factor – greenhouse gasses |
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Sanitation
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the promotion of hygiene and prevention of disease by maintenance of clean conditions through hygienic disposal or recycling of waste material such as human fecal waste
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Point source pollution
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single source of pollution
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Nonpoint source pollution
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runoff, seepage, or pollutants in the water
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Contaminated water diseases
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Typhoid
Cholera Hepatitis A |
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Noise Pollution
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Excessive or unwanted sound, Greater than 80-85 decibels can cause permanent hearing loss.
*overlooked because not detrimental to health |
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Fear of aging
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afraid of getting old or watching loved ones get old. These feelings stem from prejudices, and stereotypes, rather than on knowledge and insight
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Ageism
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is the systematic stereotyping and discrimination against people because they are old.
*old can also be prejudice against young |
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Elderly & the media
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underrepresented, usually shown as feeble, always a supporting character instead of main. cast of older people tv shows cancelled
-elderly men treated more favorable than women -older men paired with younger women more acceptable - more interested in younger audiences, tv shows still dropped even if numbers were better than younger shows |
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Myths & Stereotypes of elderly
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Aging, un productivity,disengagement, inflexibility, conservatism, senility, serenity, nursing homes, no sexual interest, lonley
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Gerontology
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the study of aging from maturity (young adulthood) through old age
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Geriatrics
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the medical care of older adults
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Elderly demographics
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Those over 65 years
*13% of the current population * > 70% of Americans will live to age 65 > 30% will live to age 85 Elderly group will double by 2030 *California & Florida (18.5 %) have the largest senior populations* |
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Baby Boomers
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Those born during 1946-1964
Boomers had childhoods marked by general good nutrition, hygiene, vaccines, and fluoridated water 2/3 desire to live to be 100 Highly educated Financially stable Strong political clout |
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Income sources of seniors
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Social Security 37 %
Assets 25 % Pensions 18 % Earnings 17 % Others 3 % |
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Age Cohorts
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65-74 (young old)
75-84 (middle old) 85+ (oldest old) |
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Chronological age
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birth date, was not counted until Western colonization began
*has little meaning in traditional societies* |
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Biological age
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age relative to the potential maximal lifespan
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Social age
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unwritten expectations of how a person should act
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Psychological age
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ability to adapt to different circumstances; maturity level
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Age-Set Societies
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African cultures, Status and rights are assigned to each age set (novice, warrior, elder)
Male and female are in different groups *Within age sets, there is no stratification |
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Ranked Horticultural Societies
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Permanent residents of an area; larger societies than the egalitarian
“big men” and chiefs acquire a large proportion of goods and power Age is a criteria for distribution of wealth Older members are responsible for holding the extended families together |
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Egalitarian Societies
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Older people are given the highest honor in society
Important tasks are performed by those with the most experience Older people are responsible for teaching and socializing the younger ones *oldest & simplest* |
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Elderly minorities
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double jeopardy
Older adults have low social status Minorities have low social status African Americans—150% increase Native Americans—200% Hispanics—200% Asian Americans—200% |
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Nature
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your genes determine who you are
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Nurture
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Nurture—you are a product of your environment (including your lifestyle).
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Life Expectancy
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determined by year of birth and race/ethnicity
2000 (77 Years) White females 80.0 years White males 74.9 years Black females 75.2 years Black males 68.3 years |
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Levels of prevention
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Primary prevention goals:
-Reduce the risk for disease and illness (check ups) Secondary prevention goals: -Early detection and treatment of disease and illness(increase physical activity) Tertiary prevention goals: Recovery or rehabilitation of a disease or condition after the disease has been developed. (hospitalized) |
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Compression of morbidity
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decreasing the amount of time between the average of onset of disability and the average age of death.
*simple changes in health risk factors can delay the onset of morbidity by 8 years* |
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Accidents
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*7th leading cause of death among elders*
Twice as likely to suffer accidents than young people Rates of illness and death are higher following an accident; falls (10 -15 %), motor vehicle (2nd leading), pedestrian (hit by motor), fires & burns (1/4 killed), choking |
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Functional Assessment
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The assessment of the older person’s functional ability is one important way to determine the health promotion needs and requirements for services.
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Goals for Health Promotion
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Decrease chronic and debilitating conditions
Reduce the need for medical services, medication Improve functional ability Improve quality of life Maintain independence Compression of morbidity |
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Physical Activity
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Older adults are more sedentary
Decrease in muscular strength Decrease in cardiovascular capacity Increase risk for falls Osteoporosis Many benefits for older adults Moderate levels of exercise are beneficial |
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Smoking
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increases risk for lung cancer, emphysema, heart disease, etc.
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Alcohol
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High rate of alcoholism and denial of a drinking problem
High social cost Cirrhosis of the liver Older adults are more affected than younger adults by the same amount Moderate drinking is associated with longer life expectancy than abstinence or heavy alcohol use |
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Sleep
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older adults suffer from insomnia
Illness, medications, alcohol, caffeine, nicotine, and stress can cause problems May need to take naps |
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Medication
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Highest user of prescription and over the counter drugs
Multiple medication and supplements Side effects Direct relationship to the number of drugs and adverse health effects May not take correct dosage and at prescribed times Large % of income |
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Predictors of Physical Function
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Income
Health status High body mass index High blood pressure Leisure and physical activity level |
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Predictors of Cognitive Function
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Education
Strenuous activity in and around the home Peak pulmonary flow rate Self-efficacy (as opposed to vulnerability and fatalism) Resilience to life situations Response to stress |
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Health Insurance Key Terms
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Fixed indemnity: maximum amount an insurer will pay for a certain service
Exclusion: specific health condition that is excluded from coverage Pre-existing condition: that which has been diagnosed or treated 6 months before health policy began *NO LONGER ABLE TO EXCLUDE PATIENTS FROM COVERAGE BASED ON per-exsisiting conditions. |
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Cost of Health Insurance
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Two major factors set the cost: (1) risk of the group, (2) amount of coverage provided
60% of employers provided health insurance in 2009; 69% in 2000 |
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Preferred provider organizations (PPOs)
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closest to fee-for-service; contractual agreement between provider & organization to provide service to members for discounted rate
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Health Maintenance Organizations (HMOs)
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oldest form; combines insurance & medical care; uses primary care physicians & prepaid health care arrangement
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Advantages of Managed Care
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Comprehensive benefits
Evidence-based high-quality care Well-documented services provided through integrated delivery systems Accountability for quality improvement |
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Concerns of Managed Care
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-Not managed care but “managed cost”
-Authorizing only certain practitioners under contract -Reviewing treatment decisions -Closely monitoring high-cost cases -Using lower cost alternative treatments -Reducing inpatient stays -Delays in receiving care Cannot understand bills |
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Consumer-Directed Care
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Gives individuals better access to information and more control over their own health care, allowing them to make informed decisions about treatment and provider options
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Key Building Blocks of Healthcare Consumerism
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-Personal Accounts (e.g., HRAs, HSAs)
-Wellness/Prevention and Early Intervention Programs -Disease Management and Case Management Programs -Information and Decision Support Programs -Incentive and Compliance Reward Programs |
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Health Savings Accounts (HSA)
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How they work: Like 401(k) plans– $ invested grows tax free
-Advantages (bring down monthly premiums) & -Disadvantages (pay more out of pocket & some may skip needed care) |
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Health Care/Insurance Reform
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HR 4872 Health Care and Education Reconciliation Act of 2010; bill passed in the Senate with changes.
-Children permitted to stay on their parents' insurance policies until their 26th birthday. |
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HRAs and HSAs
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HSAs are emerging consumer centric healthcare options with an emphasis on preventive behavior
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Bacterial STDs
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Curable through antibiotics
Antibiotics will not provide lifelong protection against reexposure, and a person can be reinfected with the disease Includes: Chlamydia, Syphilis, and Gonorrhea |
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Viral STDs
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Treatment is available but there are no cures for them
Includes: Herpes, HPV, and Hepatitis |
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Low Risk (or No Risk!):
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Activities that do not involve the exchange of body fluids
Abstinence |
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Moderate Risk:
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sharing of sex toys, hand-to-genital contact, mouth-to-mouth contact, barrier methods with anal, vaginal or oral sex
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High Risk:
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Unprotected anal, vaginal, or oral sex, any contact with fluids from body sores
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Transmission
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You don’t have to have sexual intercourse to contract an STI
Many STIs are spread by direct skin contact Everyone who has “risky contact” is at risk |
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STIs
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20 known types
once called venereal diseases *United States has the highest rate of STIs of any developed nation - more than 12 million new cases yearly |
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Herpes
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Blister-like sores in genital area
Caused by herpes simplex type 2 (HSV-2) virus Sores appear 2-20 days after infection and may last as long as 3 weeks Moisture and friction can help the virus spread -Herpes is most easily spread from genital-to-genital or oral-to-genital contact during an active outbreak or during prodrome -- the few days just before an outbreak. *About 50 to 80 percent of American adults have oral herpes, which is commonly called cold sores or fever blisters |
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Syphilis
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Can damage vital organs
Can cause heart disease, blindness, paralysis, and insanity develops in stages Treatment varies according to stage burrows its way into the bloodstream. can be transmitted from a pregnant female to her fetus. stages can also overlap. |
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Gonorrhea
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Affects the genital mucous membrane, primarily in the lining of the urethra and the vagina
One of the most common STIs in the U.S. CDC estimates over 700,000 cases per year Gonorrhea is highly contagious Pain and increased urination usually within two to five days after the infection. Many men infected exhibit symptoms, while most women are asymptomatic. women symptoms can be mistaken for a bladder infection or other vaginal infection *Whitish discharge, Can be transmitted to baby during delivery, Abnormal menstruation |
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Chlamydia
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*Most common STIs
Symptoms: usually appear one to three weeks after exposure, Often none, Pain and burning during urination Unusual discharge Pain in the pelvic region Secondary damage can lead to sterility Symptoms If left untreated can cause Pelvic Inflammatory Disease (PID) *3 million new cases/year Over 10 % college students |
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The Effects of STIs
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Sterility
Infants can suffer from deformities/other health problems Many STIs don’t have a cure! Individuals with STIs are at greater risk for cancer May affect other organs Death |
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Herpes Treatment
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Stress can cause an outbreak
Outbreaks may reoccur throughout a person’s life Even though blister not present, can still infect others Diagnosed by examination and lab tests Medications can treat only symptoms, no cure *Both viruses remain in the body for life. |
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HIV/AIDS
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Since 1981, over 60 million people in the world have become infected with HIV
-Over 42 million struggle with HIV or AIDS -A cure does NOT exist New drugs slow progression of virus Medication - very expensive and cause many side effects Multidrug treatment exceeds $15,000 per year |
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Viral Hepatitis
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Virus attacks the liver
*HEV is the only one not spread by sexual contact Some are also spread by sharing contaminated needles, food, water, and from mother to fetus -Jaundice is yellowing of the skin and whites of the eyes |
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HPV (Human Papilloma Virus)
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The most common type of viral STD in the U.S.
*3 out 0f 4 Americans between 15- 49 have been infected with genital HPV in their lifetime Also known as Genital Warts Pink or reddish warts with cauliflower like tops that appear on the genitals Warts appear months/years after infection Warts can be removed may reappear, can cause cervical cancer in women Pap smear is conducted to test cells for cancer New vaccine for HPV |
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Trichomoniasis
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Vaginal infection caused by a bacteria
Males rarely infected; can be carriers Can lead to Urethra and bladder infections Nongonococcal urethritis (NGU) Vaginitis - a bacterial infection |
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Testing for STIs
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Chlamydia: cotton swab or pee in a cup
Gonorrhea: cotton swab or pee in a cup Syphilis: skin or sore sample or blood test Herpes: swab a possible sore or blood test HPV: Exam of visible warts Pap smear to check for cervical cancer HIV: blood test or mouth swab |
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Scabies
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Causes red, swollen, itchy bumps
Treatment: hot baths and medicated creams Eggs nest in clothing, furniture and linens |
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Pubic lice
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aka crabs
Attaches in pubic area Causes intense itching Treatment: medicated shampoo Eggs nest in clothing, furniture and linens |
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Chancroid
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Bacterial infection similar to primary syphilis stage
Highly contagious Symptoms: Ulcers or sores Sometimes with swollen, painful lymph glands Treatment with antibiotics Left untreated, may make the transmission of HIV easier |
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Candidiasis (Yeast Infection)
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Yeast-like fungus caused by Candida albicans
Symptoms: Severe itching Burning Swelling Yellowish discharge Strong odor Treatment includes creams and tablets |
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Contraception
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Any technique, method, or device which reduce the risk of the likelihood of a woman becoming pregnant
Prevents conception “Birth control,” “Protection” |
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Typical Use
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% of women who become pregnant during the first year of use
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Perfect Use
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% of women who become pregnant during first year of use when the method is used correctly and consistently
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Birth Control: Behavioral / Natural Methods
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Abstinence 100 % EFFECTIVE
Fertility Awareness Method (abstinence during fertile phase) 25 % Failure rate Withdrawal – “Pull out method” |
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Birth Control: Barrier Methods
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Sponge, Diaphragm, Cervical Cap, and Cervical Shield
Dental Dams Female & Male Condoms |
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Birth Control: Hormonal Methods
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mimicking pregnancy 90 -95 %
Oral Contraceptives Birth Control Pills Seasonale Emergency Contraception- “Morning After Pill” Injectables Depo Provera Lunelle OrthoEvra- “The Patch” NuvaRing- “The Ring” |
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Birth Control: Implantable Devices
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-Hormone rod - Implanon
-IUDs (2 % of women choose this) |
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Birth Control: Permanent Methods
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-Tubal Ligation (Fallopian Tubes are cut)
-Vasectomy (Vas deferens are cut) |