Lecture 1 Intro to Health and Trends of Women's Health

Question 1

What are Leading Health Indicators? What are they used for?

Answer 1

1. Provides overview signs of the nation’s health.
2. Provide each country with guidelines to assess their own health status
3. Reflects major health concerns in the U.S
4. Selected on ability to motivate action, access data to measure results and importance as public heath issues.

Question 2

What are the current leading U.S Health indicators? (They are ten)

Answer 2

1. Physical Activity
2. Overweight/Obesity
3. Tobacco Use
4. Substance Use
5. Responsible sexual behavior
6. Mental health
7. Injury and violence
8. Environmental quality
9. Immunizations
10. Access to health care

Question 3

What are some National Indicators of Women’s Health? (there’s a lot but name 5 at a time)

Answer 3

1. Lung cancer death rate
2. Diabetes
3. Heart Disease Death Rate
4. Binge Drinking
5. High school completion
6. Access to health insurance
7. Wage gap
8. Maternal Mortality Rate
9. Rate of chlamydia infection
10. Breast cancer death rate
11. Colorectal screening
12. Smoking
13. Being overweight
14. Lack of aerobic exercise
15. Poverty
16. teenage pregnancies
17. rate of AIDS
18. Mammograms
19. Pap smears
20. Prenatal care

Question 4

What are some factors impacting women’s health? List about 5 at a time

Answer 4

1. Poverty
2. Lack of health care access
3. Lack of insurance
4. Family/Work Life conflicts
5. Lack of information/education
6. Health care costs
7. Aging demographics
8. Violence against women
9. Increase in high risk pregnancies
10. Increase in twin births
11. Focus on woman as the family gatekeeper to medical care

Question 5

What is the Healthy People 2020?

Answer 5

1. Agenda of the US for improving health of all citizens.
2. Collaborative federal and state initiative identifying national disease prevention and health promotion objections to be achieved by the end of the decade

Question 6

How many objectives and specific focused areas are there in Health People 2020?

Answer 6

476 objectives organized into 18 specific focus areas

Question 7

What are 2 goals of Health people 2020?

Answer 7

1. Increase quality and years of health life

2. Eliminate health disparities

Question 8

Write 5 of the maternal and infant health goals, and increase the list when you get it.

Answer 8

1. Reduce fetal & infant deaths
2. Reduce maternal deaths
3. Reduce maternal illness and complications from pregnancy
4. Increase the % of women receiving 1st trimester & adequate prenatal care
5. Increase the % of pregnant women attending prepared childbirth classes
6. Increase the % of VLBW infants born at Level III hospitals or subspecialty perinatal centers
7. Reduce cesarean births among low-risk (full term, vertex, singleton) women
8. Reduce low birth weight (LBW) and very low birth weight (VLBW) infants
9. Reduce preterm births
10. Increase the % of women breastfeeding infants
11. Increase the % of healthy, full term infants who are laid down to sleep on their backs
12. Reduce the occurrence of spina bifida and other neural tube defects
13. Increase the % of pregnancies begun with an optimum folic acid level
14. Increase abstinence from alcohol, cigarettes and illicit drugs among pregnant women
15. Reduce the occurrence of fetal alcohol syndrome
16. Increase the % of mother who breast feed their babies
17. Ensure appropriate newborn screening, follow-up testing and referral to services
18. Reduce the occurrence of developmental disabilities

Question 9

What are the lead causes of death for women? Notice the percentage.

Answer 9

Cardiovascular Disease 24.5%

Cancer				21.7%
Lung Cancer 		34.4%
Breast			19%		
Colorectal			11.6%
Reproductive		11.4%

Question 10

What are some statistics for the number one cause of death for females in the US?

Answer 10

Cardiovascular Disease
1 in 4 women ages 40 -64 has some form of CVD

35% of heart attacks in women go unnoticed

Heart attacks are twice as deadly in women as men

One of two American women dies of CVD; 1 in 5 dies of reproductive CAs

Question 11

What are some CVD risk factors in females?

Answer 11

1. Smoking
2. Use of OCPs (Oral Contraceptive Pills) or HRT (Hormone Replacement Therapy)
3. Sedentary lifestyle and obesity
4. Diet high in sat fats
5. Chronic Stress
6. Hypertension
7. Hyperlipdemia
8. Strong family history
9. Diabetes
10. Postmenopausal/Age

Question 12

What are some modifiable risk reductions for CVD?

Answer 12

1. Low cholesterol, low fat diet
2. Mediterranean or DASH diet
3. ASA (aspirin) Therapy
4. Monitoring and treatment of hypertension
5. 30 minutes of aerobic exercise daily
6. Maintain ideal body weight
7. Stress management for chronic stress reduction
8. Use of statins
9. Sleep:Short sleep duration was associated with angina, while both sleeping too little and sleeping too much were associated with heart attack and stroke

Question 13

What are non modifible risk of CVD? (3)

Answer 13

1. Gender
2. Menopause
3. Age

Question 14

What are risk factors for reproductive cancers? (Write 5 and increase it slowly)

Answer 14

1. Nulliparity
2. Obesity
3. Early menarche (12 years)
4. High fat diet
5. Late menopause (55 years)
6. Hx of STI’s
7. Persistent ovulation over time.
8. Increasing age
9. First degree maternal relative
10. Positive CA- 125 (this is a cancer antigen level, that’s SOMETIMES elevated in ovarian cancer)
11. Hormone replacement therapy greater than 5 years
12. Positive BRACA 1 and BRACA 2 mutation
13. Older than age 30 at first pregnancy
14. Infertility

Question 15

What are some actions that can reduce the risk of reproductive cancers?

Answer 15

1. Eliminate tobacco
2. ETOH within ACA guidelines
3. 30 min of Aerobic activity
4. Diet low in animal fat
5. Stay within 10% of IBW
6. Vaccine for HPV
7. Surveillance and fast treatment of STI

Question 16

What are non modifiable risk factors for breast cancer?

Answer 16

1. Gender
2. Being older than 50 years old
3. BRACA 1 and 2 genes
4. Personal hx of ovarian/colon cancer
5. Increased breast density
6. Positive family hx
7. Race
8. Previous hx of abnormal breast bx (atypical hyperplasia)
9. Hx of breast radiation
10. early menarch (12 years)
11. Late onset of menopause (55 years)

Question 17

Read why Gender Affects Risk for Breast Cancer

Answer 17

Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but this disease is about 100 times more common among women than men. This is likely because men have less of the female hormones estrogen and progesterone, which can promote breast cancer cell growth

Question 18

Read why menstrual periods are non mod risk factors for breast cancers?

Answer 18

Women who have had more menstrual cycles because they started menstruating early (before age 12) and/or went through menopause later (after age 55) have a slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone.

Question 19

Read why BRCA1 and BRCA2 are non mod factors for breast cancer

Answer 19

The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. If you have inherited a mutated copy of either gene from a parent, you have a high risk of developing breast cancer during your lifetime. The risk may be as high as 80% for members of some families with BRCA mutations. These cancers tend to occur in younger women

Question 20

Read why Dense breast tissue

are non mod factors for breast cancer

Answer 20

Women with denser breast tissue (as seen on a mammogram) have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer. Unfortunately, dense breast tissue can also make it harder for radiologists to spot problems on mammograms.

Question 21

Read why family history of breast cancer are non mod factors for cancer

Answer 21

Breast cancer risk is higher among women whose close blood relatives have this disease.
Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk. Having 2 first-degree relatives increases her risk about 3-fold.
The exact risk is not known, but women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, less than 15% of women with breast cancer have a family member with this disease. This means that most (over 85%) women who get breast cancer do not have a family history of this disease.

Question 22

Read non mod factors of Hx Abnormal Breast BX

Answer 22

In these conditions, there is an overgrowth of cells in the ducts or lobules of the breast tissue, with some of the cells no longer appearing normal. They have a stronger effect on breast cancer risk, raising it 3 1/2 to 5 times higher than normal.

Question 23

Read non mod factors of previous chest radiation

Answer 23

Women who, as children or young adults, had radiation therapy to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) have a significantly increased risk for breast cancer. This varies with the patient’s age when they had radiation. If chemotherapy was also given, it may have stopped ovarian hormone production for some time, lowering the risk. The risk of developing breast cancer from chest radiation is highest if the radiation was given during adolescence, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.

Question 24

What are modifiable risk factors for breast cancer?

Answer 24

Nulliparity
Birth Control
Hormone Therapy
Breastfeeding
ETOH
Obesity
Exercise
Tobacco Use
Diet
BSE, mammograms.

Question 25

Read mod risk factors for breast cancer: Not having children

Answer 25

Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk. Having many pregnancies and becoming pregnant at a young age reduce breast cancer risk. Pregnancy reduces a woman’s total number of lifetime menstrual cycles, which may be the reason for this effect.

Question 26

Read mod risk factors for breast cancer: Birth control

Answer 26

Recent oral contraceptive use: Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk. When thinking about using oral contraceptives, women should discuss their other risk factors for breast cancer with their health care team.
Depot-medroxyprogesterone acetate (DMPA; Depo-Provera®) is an injectable form of progesterone that is given once every 3 months as birth control. A few studies have looked at the effect of DMPA on breast cancer risk. Women currently using DMPA seem to have an increase in risk, but the risk doesn’t seem to be increased if this drug was used more than 5 years ago.

Question 27

Read mod risk factors for breast cancer: Hormone therapy

Answer 27

Combined hormone therapy: Using combined hormone therapy after menopause increases the risk of getting breast cancer. It may also increase the chances of dying from breast cancer. This increase in risk can be seen with as little as 2 years of use. Combined HT also increases the likelihood that the cancer may be found at a more advanced stage. 
The increased risk from combined hormone therapy appears to apply only to current and recent users. A woman's breast cancer risk seems to return to that of the general population within 5 years of stopping combined treatment. 
Estrogen therapy (ET): The use of estrogen alone after menopause does not appear to increase the risk of developing breast cancer. In fact, some research has suggested that women who have previously had their uterus removed and who take estrogen actually have a lower risk of breast cancer. Women taking estrogen seem to have more problems with strokes and other blood clots, though. Also, when used long term (for more than 10 years), ET has been found to increase the risk of ovarian cancer in some studies.

Question 28

Read mod risk factors for breast cancer: Breastfeeding

Answer 28

Some studies suggest that breastfeeding may slightly lower breast cancer risk, especially if breastfeeding is continued for 1½ to 2 years. But this has been a difficult area to study, especially in countries such as the United States, where breastfeeding for this long is uncommon.
One explanation for this possible effect may be that breastfeeding reduces a woman’s total number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or going through early menopause)

Question 29

Read mod risk factors for breast cancer: Alcohol

Answer 29

The use of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol. Excessive alcohol use is also known to increase the risk of developing several other types of cancer.

Question 30

Read mod risk factors for breast cancer: Obesity

Answer 30

Before menopause your ovaries produce most of your estrogen, and fat tissue produces a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher blood insulin levels. Higher insulin levels have also been linked to some cancers, including breast cancer.
But the connection between weight and breast cancer risk is complex. For example, the risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.

Question 31

Read mod risk factors for breast cancer: Sedentary lifestyle

Answer 31

Physical activity
Evidence is growing that physical activity in the form of exercise reduces breast cancer risk. The main question is how much exercise is needed. In one study from the Women’s Health Initiative, as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman’s risk by 18%. Walking 10 hours a week reduced the risk a little more.

Question 32

Read mod risk factors for breast cancer: smoking

Answer 32

Tobacco smoke
For a long time, studies found no link between cigarette smoking and breast cancer. In recent years though, some studies have found that smoking might increase the risk of breast cancer. The increased risk seems to affect certain groups, such as women who started smoking when they were young. In 2009, the International Agency for Research on Cancer concluded that there is limited evidence that tobacco smoking causes breast cancer.

Question 33

Read mod risk factors for breast cancer: diet

Answer 33

Diet
Most studies have found that breast cancer is less common in countries where the typical diet is low in total fat, low in polyunsaturated fat, and low in saturated fat. But many studies of women in the United States have not linked breast cancer risk to dietary fat intake. Researchers are still not sure how to explain this apparent disagreement. It may be at least partly due to the effect of diet on body weight (see below). Also, studies comparing diet and breast cancer risk in different countries are complicated by other differences (like activity level, intake of other nutrients, and genetic factors) that might also affect breast cancer risk.

Question 34

These are the FDA pregnancy med categories:
A
B
C
D
X

Describe each

Answer 34

Category A – no risk to fetus;
Category B – no demonstrated fetal risk in animal studies, but no studies or contradictory findings in controlled studies of pregnant women
Category C – Adverse effects in animal studies, but no controlled studies of pregnant women. Should only be given if maternal benefit outweighs to fetus.
Category D – Shown positive fetal risk in humans, but maternal benefits may outweigh fetal risk
Category X – should never be used in pregnancy. Known teratogens.

Question 35

What are some meds that appear in each category?
A
B
C
D
X

Answer 35

Category A - folic acid, Vitamin B6, Synthroid

Category B - Antibiotics, Tylenol, Zofran, Pepcid, Prednisone, Insulin,

Category C meds = Compazine, Diflucan, Cipro, Ibuprofen (prior to 30 weeks gestation)

Category D - ETOH, ChemoRx, Dilantin, Ibuprofen (equal to or greater than 30 weeks gestation)

Category X - Accutane, Coumadin, Streptomycin, Thalidomide, DES, organic mercury