Immune System Review PDF

Immune system is the body's collective set of defenses\ that includes surface barriers as well as the specialized\ cells, tissues, and organs that carry out the immune\ response.\ Protects us not just from pathogens (disease-causing organisms)\ but also from cancer\ Physical and chemical barriers:\...

Immune system is the body's collective set of defenses\ that includes surface barriers as well as the specialized\ cells, tissues, and organs that carry out the immune\ response.\ Protects us not just from pathogens (disease-causing organisms)\ but also from cancer\ Physical and chemical barriers:\ Skin\ Mucous membranes\ Respiratory tract, lined with both mucous membranes and\ cilia\ 2 © McGraw Hill LLC\ The Immune System:\ Cells, Tissues, and Organs 1\ Beyond surface barriers, the immune system operates\ through a network of billions of white blood cells:\ Actually, two interacting systems: the innate immune system\ (first to respond) and the adaptive immune system\ Cells of the innate immune system:\ Neutrophils\ Eosinophils\ Macrophages\ Natural killer cells\ Dendritic cells\ 3 © McGraw Hill LLC\ The Immune System:\ Cells, Tissues, and Organs 2\ Cells of the adaptive immune system:\ Lymphocytes: two main types are T cells and B cells:\ Have receptors that allow it to recognize one specific antigen.\ B cells become plasma cells that secrete antibodies.\ T cells differentiate into helper T cells, killer T cells, or suppressor T cells.\ B and T cells can mount a rapid and powerful response should\ they encounter the same invader months or even years in the\ future.\ Antigens and antibodies: Substances that trigger the\ immune response are called antigens and specialized\ proteins that can recognize and neutralize specific invaders\ are called antibodies.\ 4 © McGraw Hill LLC\ The Immune System:\ Cells, Tissues, and Organs 3\ Inflammatory response:\ Macrophages engulf the invading microbe and convey\ danger to other immune system cells:\ Resulting response causes blood vessels to dilate and fluid to\ flow out of capillaries into the injured tissue.\ Pus---dead white blood cells and debris---may collect at the\ site of infection.\ 5 © McGraw Hill LLC\ The Immune System:\ Cells, Tissues, and Organs 4\ Immune response:\ Phase 1, recognition: Dendritic cells are drawn to the\ site.\ Phase 2, proliferation: Helper T cells multiply.\ Production of killer T and B cells\ Cytokines: chemical messengers\ Phase 3, elimination: Killer T cells strike:\ Cell-mediated immune response\ Antibody-mediated immune response\ Phase 4, slowdown: Some memory T and B cells remain.\ 6 © McGraw Hill LLC\ Figure 14.1 The immune response.\ Once invaded by a pathogen, the body mounts a complex series of reactions to destroy the invader.\ Pictured here are the phases of the immune response as the body works to destroy a virus.\ Access the text alternative for slide images.\ 7 © McGraw Hill LLC\ The Immune System:\ Cells, Tissues, and Organs 5\ Immunity:\ Usually, after an infection, a person has immunity to the\ same pathogen.\ Memory T and B cells continue to circulate in the blood and\ lymphatic system.\ Adaptive immunity: immunity to infection acquired by the\ activation of antigen-specific lymphocytes in response to\ infection or immunization.\ 8 © McGraw Hill LLC\ The Immune System:\ Cells, Tissues, and Organs 6\ Lymphatic system:\ Vessels that carry lymph; and certain organs and structures:\ Spleen and lymph nodes\ Vessels pick up excess fluid from body tissues. This fluid may\ contain microbes and dead or damaged body cells.\ As the immune response progresses, a lymph node actively\ involved in fighting infection may fill with cells and swell.\ Physicians use the location of swollen lymph nodes as a clue to\ an infection's location.\ 9 © McGraw Hill LLC\ Immunization 1\ Immunization, such as by administering a vaccine,\ primes the body to remember an encounter with a\ specific antigen.\ Some people question whether vaccines do more harm\ than good, but decreases in vaccination rates can result\ in outbreaks of dangerous infectious diseases:\ International travel contributes\ Types of vaccines:\ Attenuated organisms\ Killed viruses\ A recent advancement in vaccine technology is the messenger RNA (mRNA)\ vaccine.\ 10 © McGraw Hill LLC\ Immunization 2\ Vaccine efficacy:\ In the past century, vaccines have helped increase the average American\ life span by 30 years.\ For a small proportion of people, the vaccine does not provoke a strong\ enough immune response to avoid disease.\ Keeping vaccination rates consistently high over time is necessary to\ maintain protection.\ Vaccines are approved by advisory committees with expert knowledge in\ virology, microbiology, statistics, epidemiology, and pathogenesis.\ Strict testing is done before vaccines are licensed. Side effects are rare\ and usually mild.\ Any risk must be balanced against the risks of the disease that is\ prevented.\ 11 © McGraw Hill LLC\ Allergy: A Case of Mistaken Identity 1\ Allergies are due to an immune system.\ The immune system reacts to a harmless substance as if it were\ a harmful pathogen.\ Allergens elicit an exaggerated immune response:\ Pollen\ Animal dander\ Dust mites and cockroaches\ Molds and mildew\ Foods\ Insect stings\ 12 © McGraw Hill LLC\ Allergy: A Case of Mistaken Identity 2\ Allergic response:\ Part of the body's response is to release large amounts of histamine, a\ chemical associated with inflammation.\ In some people, an allergen can trigger an asthma attack.\ Causes wheezing, tightness in the chest, shortness of breath, and coughing\ Most serious kind of allergic reaction is anaphylaxis, characterized by swelling\ of the throat, extremely low blood pressure, fainting, heart arrhythmia,\ seizures, and sometimes death:\ Treatment requires immediate injection of epinephrine.\ 13 © McGraw Hill LLC\ Allergy: A Case of Mistaken Identity 3\ Climate change and allergies:\ Likely to exacerbate allergies\ Dealing with allergies:\ Avoidance\ Medication\ Immunotherapy---desensitizing to a particular allergen\ 14 © McGraw Hill LLC\ The Spread of Disease:\ Symptoms and Contagion\ First phase of infection: the incubation period:\ May not have symptoms; may be contagious\ Second and third phases: may "feel a cold coming on":\ Symptoms first appear during the prodromal period\ Many symptoms are due to the immune response.\ You may be contagious before you have symptoms.\ Some people can be infected with the flu virus and yet\ perceive no symptoms.\ 15 © McGraw Hill LLC\ The Spread of Disease:\ Symptoms and Contagion\ First phase of infection: the incubation period:\ May not have symptoms; may be contagious\ Second and third phases: may "feel a cold coming on":\ Symptoms first appear during the prodromal period\ Many symptoms are due to the immune response.\ You may be contagious before you have symptoms.\ Some people can be infected with the flu virus and yet\ perceive no symptoms.\ 15 © McGraw Hill LLC\ The Chain of Infection\ Links in the chain:\ (1) Pathogen: Infectious disease cycle begins with a pathogen that enters the body.\ (2) Reservoir: natural environment of the pathogen.\ (3) Portal of exit: discharge.\ (4) Means of transmission: direct and indirect:\ Vector: carrier of the pathogen from one host to another\ (5) Portal of entry: skin penetration, inhalation, and ingestion:\ Pathogens that enter the bloodstream or lymphatic system cause a systemic\ infection.\ (6) The new host.\ Interrupting the chain of infection at any point can prevent disease.\ Transmission can be disrupted through strategies like hand washing and the use of face\ masks.\ Immunization and the treatment of infected hosts can stop the pathogen from\ multiplying, producing a serious disease, and being passed on to a new host.\ 16 © McGraw Hill LLC\ Epidemics and Pandemics 1\ Epidemic: a rapidly spreading disease or health-related\ condition; occurrence is greater than what is normally\ expected.\ Pandemic: infectious disease has spread widely\ Examples: bubonic plague, smallpox, influenza, and\ Covid-19\ Endemic disease:\ Habitually occurs in a certain region\ 17 © McGraw Hill LLC\ Epidemics and Pandemics 2\ COVID-19:\ Outbreak beginning in 2019\ Respiratory illness caused by the coronavirus SARS-CoV-2\ H1N1 influenza:\ Outbreak in 2009\ Respiratory illness, initially called the swine flu\ Vaccination recommended for persons aged 6 months to\ 24 years and those aged 25--64 who are at high risk.\ 18 © McGraw Hill LLC\ Pathogens, Diseases, and Treatment:\ Bacteria 1\ Bacteria: microscopic single-celled organisms\ Pneumonia: an inflammation of the lungs\ Meningitis: inflammation of the meninges, the protective\ membranes of the brain, and spinal cord\ Streptococcus: strep throat and other streptococcal infections\ Staphylococcus: toxic shock syndrome and other\ staphylococcal infections:\ Tuberculosis (TB), which usually affects the lungs\ Tick-borne infections\ Other bacterial infections, including ulcers, tetanus, C. diff,\ pertussis, urinary tract infections (UTIs), and travelers'\ diarrhea (TD)\ 19 © McGraw Hill LLC\ Figure 14.2 Pathogens and associated infectious diseases.\ Access the text alternative for slide images.\ 20 © McGraw Hill LLC\ Figure 14.2 Pathogens and associated infectious diseases.\ Access the text alternative for slide images.\ 20 © McGraw Hill LLC\ Pathogens, Diseases, and Treatment:\ Bacteria 2\ Antibiotic treatments:\ Antibiotics: drugs that either inhibit the growth of bacteria or kill them\ The action of antibiotics:\ Inhibit the synthesis of the bacterial cell wall\ Interferes with the production of bacterial proteins\ Inhibit the replication of bacterial DNA\ Antibiotic resistant bacteria has resulted from overuse and misuse.\ Proper usage:\ Don't take an antibiotic every time you are sick.\ Use antibiotics as directed.\ Never take an antibiotic without a prescription.\ Antibacterial soaps are no more effective than regular\ soaps and may also be harmful.\ 21 © McGraw Hill LLC\ Pathogens, Diseases, and Treatment:\ Viruses\ Virus: a microscopic organism that replicates inside the\ cells of another organism; cause of most contagious\ diseases:\ The common cold; influenza, measles, mumps, and rubella.\ Chickenpox, cold sores, other herpesvirus infections, including\ the varicella-zoster virus, herpes simplex virus (HSV) types 1\ and 2, and Epstein-Barr virus (EBV)\ Viral hepatitis: HAV, HBV, and HCV\ Human papillomavirus (HPV)\ Antiviral drugs are available for some viruses.\ 22 © McGraw Hill LLC\ Pathogens, Diseases, and Treatment:\ Other Pathogens\ Fungus: an organism that is reproduced by spores:\ Yeast infections, athlete's foot, jock itch, and ringworm\ Protozoa: microscopic single-celled organisms:\ Malaria\ Giardiasis\ Parasitic worms: largest organism that can enter the\ body to cause infection:\ Tapeworm, hookworm, and pinworm\ 23 © McGraw Hill LLC\ Emerging Infectious Diseases 1\ Selected infections of concern:\ Zika disease\ Ebola\ West Nile virus\ Pathogenic Escherichia coli\ 24 © McGraw Hill LLC\ Emerging Infectious Diseases 2\ Factors contributing to emerging infections:\ Drug resistance\ Poverty\ Population growth, urbanization, overcrowding,\ and migration\ Breakdown of public health measures\ Travel and commerce\ Mass food production and distribution\ Human behaviors\ Climate change\ 25 © McGraw Hill LLC\ Immune Disorders\ Autoimmune diseases:\ Immune system targets or destroys specific tissues.\ Immune system and cancer:\ Some types of cancer suppress immune responses.\ 26 © McGraw Hill LLC\ Supporting Your Immune System\ General guidelines:\ Get more sleep.\ Maintain regular eating patterns.\ Wash hands frequently.\ Avoid contact with contagious people.\ Drink plenty of clean water.\ Avoid contact with disease carriers such as rodents,\ mosquitoes, and ticks.\ Keep vaccinations up to date.\ 27 © McGraw Hill LLC\ The Major STIs\ Sexually transmitted infections (STIs) are spread from\ person to person mainly through sexual activity.\ Seven STIs that pose major health threats:\ HIV/AIDS\ Chlamydia\ Gonorrhea\ Human papillomavirus (HPV)\ Herpes\ Hepatitis\ Syphilis\ 28 © McGraw Hill LLC\ HIV and AIDS 1\ Human immunodeficiency virus (HIV) causes acquired\ immunodeficiency syndrome (AIDS).\ Global HIV epidemic peaked in the late 1990s, at about\ 3.5 million new infections per year, compared with an\ estimated 1.5 million new infections in 2020.\ Youth aged 15--24 represent 16 percent of the global\ population and one-third of incident HIV infections.\ In the United States in 2019, 1.2 million people were\ living with HIV.\ 29 © McGraw Hill LLC\ HIV and AIDS 2\ HIV infection is a chronic viral infection that\ progressively damages the body's immune system.\ HIV attacks and invades CD4 T-cells, macrophages, and\ other essential elements of the immune system.\ It enters a human cell and converts its own genetic\ material, RNA, into DNA.\ Viral DNA produces new copies of HIV and reduces\ immune function:\ Signaled by the loss of CD4 T cells\ 30 © McGraw Hill LLC\ HIV and AIDS 3\ AIDS is diagnosed when the number of CD4 cells drops\ below a certain level:\ Opportunistic (secondary) infections take hold.\ Primary infection phase: flu-like symptoms; highly\ infectious\ Chronic asymptomatic stage (latency phase):\ Can last 2--20 years in untreated adults.\ Virus progressively infects and destroys cells of the immune\ system.\ Even if people are symptom-free, people infected with HIV can\ transmit the disease to others if untreated.\ 31 © McGraw Hill LLC\ HIV: Transmitting the Virus\ HIV lives only within cells and blood and blood\ products, semen, vaginal and cervical secretions, and\ breast milk:\ Cannot live in air, water, or on objects or surfaces.\ Three primary means of transmission:\ Specific kinds of sexual contact\ Direct exposure to infected blood\ Contact between a woman with HIV and her child during\ pregnancy, childbirth, breastfeeding, or premastication\ 32 © McGraw Hill LLC\ HIV: Key Populations Affected by HIV\ In 2020, 20 percent of all new HIV diagnoses in the United States\ were among young people.\ Young African American and Latino gay and other men who have\ sex with men were especially affected.\ Most common means of exposure is sexual activity between men.\ In the United States, high rates of HIV infection occur in males,\ certain racial and ethnic groups, and people affected by poverty,\ discrimination, and substance use disorder.\ Complex social, economic, and behavioral factors\ 33 © McGraw Hill LLC\ Figure 14.3 Routes of HIV transmission among\ Americans newly diagnosed with HIV infection in\ 2020.\ Access the text alternative for slide images.\ SOURCE: Centers for Disease Control and Prevention. 2021. HIV Surveillance Report, vol. 33 (https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-33/index.html.) 34 © McGraw Hill LLC\ Figure 14.4 What's risky and\ what's not: the approximate\ relative risk of HIV transmission in\ various sexual activities.\ Access the text alternative for slide images.\ 35 © McGraw Hill LLC\ HIV: Symptoms\ Primary HIV infection: flu-like symptoms within a few\ days or weeks:\ After these initial symptoms, asymptomatic for the first\ months or years\ New symptoms develop as the immune system\ weakens.\ Opportunistic infections occur:\ Pneumocystis pneumonia, a fungal infection.\ Kaposi's sarcoma.\ Frequent and difficult-to-treat vaginal yeast infections in\ women.\ Tuberculosis (TB) is increasingly reported.\ 36 © McGraw Hill LLC\ HIV: Diagnosis\ Three general types of diagnostic tests:\ HIV antibody tests\ Combination HIV antigen/antibody tests\ Nucleic acid tests (NATs)\ If HIV-positive, the next step is to determine the\ disease's severity and the viral load is monitored.\ Certain infections or a severely damaged immune system leads\ to an AIDS diagnosis.\ All diagnosed cases of HIV or AIDS must be reported to\ public health authorities.\ 37 © McGraw Hill LLC\ HIV: Treatment\ Medications can significantly alter the course of the disease and extend life.\ Antiviral drugs either block HIV from replicating itself or prevent it from\ infecting other cells:\ Reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors,\ and entry inhibitors\ Drug combinations\ Antibiotics help prevent opportunistic infections.\ Postexposure prophylaxis (PEP).\ Taking the combination drugs is complicated, and side effects may cause\ people to stop taking them.\ A person who takes medications as prescribed and achieves HIV suppression\ to undetectable blood levels has effectively no risk of transmitting HIV to an\ uninfected partner.\ 38 © McGraw Hill LLC\ HIV: Prevention\ Research into the development of a safe, effective, and\ inexpensive vaccine is ongoing.\ How can you protect yourself?\ Make careful choices about sexual activity.\ Do not share drug needles.\ If you have ongoing risk for HIV exposure, consider\ preexposure prophylaxis (PrEP).\ Participate in an HIV/STI risk reduction education\ program.\ 39 © McGraw Hill LLC\ Chlamydia\ Chlamydia is the most prevalent bacterial STI in the\ United States:\ Chlamydia trachomatis\ Infants of women with chlamydia can acquire the\ infection in the birth canal during delivery:\ Untreated, can lead to PID and increases the risk of infertility and ectopic\ (tubal) pregnancy\ Chlamydia is diagnosed through laboratory tests:\ Antibiotics are the usual treatment.\ Testing and treatment for both partners, often using expedited\ partner therapy.\ 40 © McGraw Hill LLC\ Gonorrhea\ Gonorrhea flourishes in mucous membranes:\ Neisseria gonorrhoeae\ Transmitted by sexual contact with the penis, vagina, mouth, or anus of a\ partner with gonorrhea\ Often has no symptoms, especially in women\ Women: pain with urination, increased vaginal discharge, pain or bleeding\ with intercourse, and lower abdominal pain, and can cause urethritis,\ cervicitis, and pelvic inflammatory disease (PID)\ Men: urinary discomfort and discharge from the penis.\ Infants: gonococcal conjunctivitis\ Treatment: The current recommended treatment for\ gonorrhea is ceftriaxone.\ 41 © McGraw Hill LLC\ Pelvic Inflammatory Disease\ Pelvic inflammatory disease (PID) is a major\ complication of untreated chlamydia or gonorrhea.\ Initial infection travels beyond the cervix into the uterus,\ oviducts, ovaries, and pelvic cavity.\ Leading cause of infertility in young women\ Symptoms vary:\ Some are asymptomatic; others have abdominal pain, fever, chills, nausea,\ vomiting, and abnormal vaginal bleeding.\ Treatment with antibiotics must be started immediately:\ Laparoscopy may be used to confirm the diagnosis.\ Partners must also be treated.\ 42 © McGraw Hill LLC\ Pelvic Inflammatory Disease\ Pelvic inflammatory disease (PID) is a major\ complication of untreated chlamydia or gonorrhea.\ Initial infection travels beyond the cervix into the uterus,\ oviducts, ovaries, and pelvic cavity.\ Leading cause of infertility in young women\ Symptoms vary:\ Some are asymptomatic; others have abdominal pain, fever, chills, nausea,\ vomiting, and abnormal vaginal bleeding.\ Treatment with antibiotics must be started immediately:\ Laparoscopy may be used to confirm the diagnosis.\ Partners must also be treated.\ 42 © McGraw Hill LLC\ Human Papillomavirus\ Human papillomavirus (HPV) can cause several\ disease, including common warts, genital warts, and\ genital cancers (virtually all cervical cancers).\ Most common STI in the United States.\ More than 80 percent of sexually active people will\ have been infected by age of 50.\ Vaccines recommended for girls and boys.\ Most people have no symptoms and are not aware they are\ contagious.\ Treatment: reduction of warts:\ Regular Pap tests for all women recommended\ 43 © McGraw Hill LLC\ Genital Herpes\ Up to one in eight adults aged 14--49 in the United States\ has genital herpes.\ HSV 1 and HSV 2\ Symptoms: up to 90 percent have none:\ Primary outbreak 2--20 days after sex with a partner with HSV:\ flu-like symptoms, genital lesions.\ Outbreaks can be triggered by a number of events, including\ stress, illness, fatigue, sun exposure, sexual intercourse, and\ menstruation.\ Antiviral drugs can shorten duration and severity of\ symptoms.\ 44 © McGraw Hill LLC\ Genital Herpes\ Up to one in eight adults aged 14--49 in the United States\ has genital herpes.\ HSV 1 and HSV 2\ Symptoms: up to 90 percent have none:\ Primary outbreak 2--20 days after sex with a partner with HSV:\ flu-like symptoms, genital lesions.\ Outbreaks can be triggered by a number of events, including\ stress, illness, fatigue, sun exposure, sexual intercourse, and\ menstruation.\ Antiviral drugs can shorten duration and severity of\ symptoms.\ 44 © McGraw Hill LLC\ Hepatitis A, B, and C 1\ Hepatitis is an inflammation of the liver.\ One type is caused by hepatitis B virus (HBV):\ Transmission: blood, semen, saliva, urine, and vaginal\ secretions.\ Sexual exposure, injection drug use, and nonsexual close\ contact; and much more contagious than HIV infection.\ Vaccine is available.\ Hepatitis A (HAV) is of particular concern for people who engage\ in anal sex:\ Vaccine is available.\ Hepatitis C (HCV) is associated with high-risk sexual encounters.\ 45 © McGraw Hill LLC\ Hepatitis A, B, and C 2\ Symptoms: Mild cases of hepatitis cause flu-like symptoms such as fever, body\ aches, chills, and loss of appetite.\ As the illness progresses, there may be nausea, vomiting, dark-colored urine,\ abdominal pain, and jaundice.\ Acute HBV can sometimes be severe, resulting in prolonged illness or death:\ About 5 percent of adults become chronic carriers, and chronic hepatitis\ can cause cirrhosis, liver failure, and liver cancer.\ Diagnosis and treatment: Hepatitis is diagnosed by blood tests used to\ analyze liver function, detect the infecting organism, and detect antibodies to\ the virus.\ There is no cure for HBV and no specific treatment for acute infections.\ 46 © McGraw Hill LLC\ Syphilis\ Syphilis, caused by Treponema pallidum, can now be\ treated effectively with antibiotics.\ Usually acquired through sexual contact:\ Pathogen breaks through openings in the skin or mucous membranes, and\ syphilis can also pass through the placenta to a developing fetus during\ pregnancy.\ Symptoms:\ Primary syphilis: chancres, 10--90 days post exposure.\ Secondary syphilis: 3--6 weeks after chancre, body rash.\ Late or tertiary syphilis: damage to organs, dementia, cardiovascular\ damage, blindness, and death\ Treatment:\ All stages can be treated by antibiotics, but damage from late syphilis can\ be permanent.\ 47 © McGraw Hill LLC\ Other Sexually Transmitted Infections 1\ Trichomoniasis, often called trich, is the most prevalent nonviral\ STI in the United States:\ Highly transmissible during penile--vaginal sex, while\ nonsexual transmission is rare.\ Prompt treatment is important because it may increase the\ risk of HIV transmission and, in pregnant people, premature\ delivery.\ 48 © McGraw Hill LLC\ Other Sexually Transmitted Infections 2\ Bacterial vaginosis (BV):\ Abnormal vaginal discharge caused by unhealthy\ vaginal bacteria\ Pubic lice (crabs) and scabies:\ Contagious parasitic infections Environmental health is concerned with the collective\ interactions of humans with their environment and the\ health consequences of these interactions:\ Environment: Everything that surrounds us.\ Environmental pollutants contribute to infectious diseases,\ immediate symptoms, and chronic diseases as well.\ Technological advances have increased our ability to affect and\ damage the environment.\ Rapid population growth means more competition for and\ consumption of resources.\ 2 © McGraw Hill LLC\ Population Growth and Control 1\ World population: currently around 7.8 billion\ Increasing at a rate of 80 million per year\ How many people can the world hold?\ We use as many ecological resources as if we lived on 1.6 earths.\ Factors that may eventually cap population:\ Food\ Available land and water\ Energy\ Minimum acceptable standard of living\ 3 © McGraw Hill LLC\ Population Growth and Control 2\ Factors that contribute to population growth:\ High birth rates and lack of family planning resources\ Lower death rates\ Successful population management must provide for:\ Less poverty, to remove the pressures to have large families\ Improved health\ Better education\ Increased literacy and employment opportunities for women\ Family planning\ 4 © McGraw Hill LLC\ Figure 15.1 World population growth.\ The United Nations estimates that the world population will reach\ 8.5 billion in 2030, 9.7 billion in 2050, and 10.9 billion in 2100.\ Access the text alternative for slide images.\ SOURCE: United Nations. 2019. World Population Prospects: The 2019 Revision (https://population.un.org/wpp/). 5 © McGraw Hill LLC\ Environmental Impacts of\ Energy Use and Production\ Energy consumption is at root of many environmental\ problems.\ Automobile exhaust and the burning of oil and coal by\ industry and by electric power plants\ Mining of coal and the extraction and transportation\ of oil and natural gas cause pollution on land and in\ the water.\ 6 © McGraw Hill LLC\ Figure 15.2 Energy consumption of selected countries.\ Access the text alternative for slide images.\ SOURCE: U.S. Energy Information Administration. 2021. International Energy Statistics: Total Primary Energy Consumption (Quadrillion BTU): All Countries, 2019\ (http://www.eia.gov/international/rankings/world?).\ 7 © McGraw Hill LLC\ Environmental Threats of\ Extreme Energy Sources\ Worldwide energy demand is expected to continue to\ increase over time, even while supplies of easily\ accessible oil will decline.\ "Extreme energy sources" are fossil fuels that are\ relatively difficult to access and extract:\ Deepwater oil rigs\ Tar sands oil extraction\ Drilling and hydraulic fracturing ("fracking") for natural gas\ extraction\ All of these pose significant new environmental risks.\ 8 © McGraw Hill LLC\ Renewable Energy\ Renewable energy sources are naturally replenished\ and essentially inexhaustible.\ Sustainable development: the development that meets\ society's present needs without compromising the ability of\ future generations\ Some of our best sources of renewable energy:\ Wind power\ Solar power\ Geothermal power\ Biomass\ Biofuels\ 9 © McGraw Hill LLC\ Alternative Fuels\ Ethanol:\ An alcohol made from plant sugars.\ Critics claim it requires more energy to produce than it yields\ and diverts crops from the food supply.\ Although ethanol production dropped in 2020 due to the\ Covid-19 pandemic, it will likely remain an important\ alternative fuel as the economy recovers.\ Biodiesel:\ Biodiesel fuel can likewise be problematic depending on its\ material source.\ 10 © McGraw Hill LLC\ Hybrid and Electric Vehicles\ Hybrid electric vehicles (HEVs) use two or more distinct\ power sources to propel the vehicle:\ Such as batteries, a traditional internal combustion engine,\ and an electric motors\ Greater fuel economy and fewer polluting emissions\ Second generation of all-electric vehicles (EVs) has\ recently been introduced.\ 11 © McGraw Hill LLC\ Air Quality and Pollution\ WHO estimates that air pollution accounts for an estimated 4.2 million\ deaths per year.\ Air quality and smog:\ Air quality index (AQI) indicates whether air pollution poses a health\ concern.\ Used for five major air pollutants:\ Carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2),\ particulate matter (PM), and ground-level ozone\ AQI values run from 0 to 500:\ When it exceeds 100, air quality is unhealthful\ Smog is a mixture of other pollutants from car exhaust, power plants, and\ factory emissions.\ Heavy motor vehicle traffic, high temperatures, and sunny weather can\ increase the production of ozone.\ 12 © McGraw Hill LLC\ The Greenhouse Effect and\ Global Warming 1\ Earth's temperature depends on a balance between energy\ absorption and the amount of energy radiated.\ Greenhouse effect: reradiation causes a buildup of heat that\ raises the temperature of the lower atmosphere\ Global warming, or climate change, is caused by the\ concentration of greenhouse gases:\ Increased rainfall and flooding\ Increased mortality from heat stress, urban pollution, tropical\ disease, and extreme weather\ A poleward shift in the location of vegetation zones\ Alterations of ecosystems\ Increasingly rapid and drastic melting of the polar ice caps\ 13 © McGraw Hill LLC\ Figure 15.3 The greenhouse effect.\ Access the text alternative for slide images.\ titoOnz/Alamy Stock Photo 14 © McGraw Hill LLC\ Table 15.1 Sources of Greenhouse Gases\ GREENHOUSE GAS SOURCES\ Carbon dioxide Fossil fuel and wood burning, factory emissions,\ car exhaust, deforestation\ Chlorofluorocarbons (CFCs) Refrigeration and air conditioning, aerosols, foam\ products, solvents\ Methane Cattle, wetlands, rice paddies, landfills, gas leaks,\ coal and gas industries\ Nitrous oxide Fertilizers, soil cultivation, deforestation, animal\ feedlots and wastes\ Ozone and other trace gases Photochemical reactions, car exhaust, power plant\ emissions, solvents\ 15 © McGraw Hill LLC\ Figure 15.4 Impact of climate change on human health.\ Climate change can influence health and disease in many ways; the effects may vary based on\ location, age, socioeconomic status, and other factors.\ Access the text alternative for slide images.\ SOURCE: Centers for Disease Control and Prevention. 2020. Climate Effects on Health (http://www.cdc.gov/climateandhealth/effects). 16 © McGraw Hill LLC\ Thinning of Ozone Layer\ Another air pollution problem is the thinning of the\ ozone layer.\ A fragile, invisible layer about 10--30 miles above the earth's\ surface shields the planet from the sun's hazardous UV rays.\ Being destroyed primarily by chlorofluorocarbons (CFCs):\ Coolants in refrigerators\ Foaming agents\ Propellants\ Solvents\ Life on earth would be impossible without the ozone layer.\ 17 © McGraw Hill LLC\ Indoor Air Quality (IAQ)\ Indoor pollutants are linked to a range of problems.\ Common indoor air pollutants:\ Environmental tobacco smoke (ETS)\ Carbon monoxide and other combustion by-products\ Volatile organic compounds (VOCs)\ Biological pollutants\ Indoor mold\ 18 © McGraw Hill LLC\ Preventing Air Pollution\ Cut back on driving and keep\ your car well maintained.\ Buy energy-efficient appliances\ and use them only when\ necessary.\ Use energy-efficient lighting.\ Insulate your home with ozone-\ safe agents.\ Plant and care for trees.\ Identify a local waste hauler\ who removes ozone-depleting\ refrigerants from disposed\ refrigerators.\ Ventilate your home.\ Tightly seal paint and other\ chemical containers.\ Don't smoke or allow smoking in\ your home.\ Clean and inspect chimneys,\ furnaces, other appliances.\ Always use an outside venting\ hood when cooking.\ Use paints with low or no VOCs.\ Keep areas mold-free.\ Use a HEPA air filter.\ 19 © McGraw Hill LLC\ Water Quality and Pollution 1\ Water contamination and treatment:\ Ensuring safe, clean drinking water\ Purifying water in water-treatment plants:\ Screening\ Filtration\ Disinfection (chlorine)\ Fluoridation:\ Reduces tooth decay by 15--40 percent\ Some controversy over its safety for human health\ 20 © McGraw Hill LLC\ Water Quality and Pollution 2\ Water shortages:\ Rapid population growth taxes the water system.\ World Health Organization:\ Two billion people do not have safe drinking water.\ Around 4.5 billion do not have access to safely managed\ sanitation.\ Sewage:\ Residual sludge from sewage treatment is often contaminated\ with heavy metals and chemicals such as lead, cadmium,\ copper, and tin.\ 21 © McGraw Hill LLC\ Water Quality and Pollution 2\ Water shortages:\ Rapid population growth taxes the water system.\ World Health Organization:\ Two billion people do not have safe drinking water.\ Around 4.5 billion do not have access to safely managed\ sanitation.\ Sewage:\ Residual sludge from sewage treatment is often contaminated\ with heavy metals and chemicals such as lead, cadmium,\ copper, and tin.\ 21 © McGraw Hill LLC\ Protecting the Water Supply\ Take showers, not baths.\ Install faucet aerators and water-efficient showerheads.\ Replace old toilets.\ Fix any leaky faucets.\ Do not pour toxic materials down the drain.\ Do not flush old medications.\ 22 © McGraw Hill LLC\ Solid Waste Pollution 1\ Biggest single component of household trash by weight\ is paper products.\ Food, yard waste, and plastic are other components.\ About 1 percent of solid waste is toxic.\ Computer components.\ Manufacturing, mining, and other industries all produce\ large amounts of potentially dangerous materials that\ cannot simply be dumped.\ Disposing of solid waste:\ Sanitary landfill disposal sites have several disadvantages.\ 23 © McGraw Hill LLC\ Solid Waste Pollution 2\ Biodegradable: certain products that can break down\ naturally, safely, and quickly into raw materials:\ Products that are compostable may break down through biotic\ and abiotic processes.\ Recycling uses waste materials as raw materials in the\ production of new products.\ Discarded technology: e-waste:\ Americans produce about 7 million tons of e-waste per year\ (42 pounds per person).\ 24 © McGraw Hill LLC\ Figure 15.5 Components of municipal solid waste,\ by weight, before recycling.\ Access the text alternative for slide images.\ SOURCE: U.S. Environmental Protection Agency. 2022. Advancing Sustainable Materials Management: 2018 Fact Sheet (Pub. No. 530-F-20-009). Washington, DC: EPA. 25 © McGraw Hill LLC\ Table 15.2 How Long Items Take to Biodegrade\ ITEM TIME REQUIRED TO BIODEGRADE\ Banana peel 2--10 days\ Paper 2--5 months\ Rope 3--14 months\ Orange peel 6 months\ Wool sock 1--5 years\ Cigarette butt 1--12 years\ Plastic-coated milk carton 5 years\ Aluminum can 80--100 years\ Plastic bottle 450 years\ Plastic six-pack holder ring 450 years\ Disposable diapers 500 years\ Plastic bag 1000 years\ Glass bottle 1 million years\ Styrofoam Does not biodegrade\ 26 © McGraw Hill LLC\ Reducing Solid Waste\ Limit your purchase and use of plastic products.\ Buy products with the least amount of packaging.\ Buy recycled or recyclable products.\ Use your own reusable containers and utensils at work.\ Use reusable containers to store food.\ Take foam pellets to a commercial mailing center that\ accepts them for recycling.\ Do not throw away electronic items---recycle them.\ Start a compost pile.\ 27 © McGraw Hill LLC\ Chemical Pollution and\ Hazardous Waste 1\ Asbestos:\ Widely used for fire protection and insulation in buildings\ until the late 1960s.\ Causes asbestosis, lung cancer, and other serious lung\ diseases.\ Lead:\ In pipes and paints (until banned in 1978).\ Presence of lead pipes contributed to the drinking water crisis\ in Flint, Michigan.\ 28 © McGraw Hill LLC\ Chemical Pollution and\ Hazardous Waste 2\ Pesticides:\ Pesticides are chemicals that kill unwanted pests. Herbicides\ (plant killers) and insecticides (insect killers) are used\ extensively in agriculture.\ Often have toxic effects on unwanted targets.\ Buildup in the food change through biomagnification.\ Mercury:\ From coal-fired power plants, mining and smelting operations,\ and consumer products\ Damages nervous and other body systems\ Bioaccumulates---large, long-lived fish carry high levels of\ mercury\ 29 © McGraw Hill LLC\ Chemical Pollution and\ Hazardous Waste 3\ Other chemical pollutants:\ Dispose of hazardous wastes in the home properly.\ Preventing chemical pollution.\ Read labels and try to buy the least toxic products.\ Eat and live organically.\ Dispose of your household hazardous waste properly.\ Buy organic and local produce.\ Store pesticides or toxic household products in a\ locked place.\ Hire a licensed exterminator.\ 30 © McGraw Hill LLC\ Radiation Pollution\ Radiation differs in wavelength and energy; shorter\ waves have the highest energy level.\ Ultraviolet rays, microwaves, X-rays, from the sun, electronics,\ uranium, and nuclear weapons.\ Gamma rays at high doses can cause radiation sickness and\ death.\ Nuclear weapons and nuclear energy.\ Nuclear power was first developed as alternative power.\ Accidents in nuclear plants have been disastrous.\ Problem of waste disposal.\ Medical uses of radiation: X-rays 31 © McGraw Hill LLC\ Radiation in the Home and Workplace\ Electromagnetic radiation:\ Microwave ovens and computer monitors\ Cell phones\ Radon gas is radioactive.\ Avoiding radiation:\ Only get X-rays when necessary.\ Follow recommendations for radon testing.\ Use sunscreen and clothing.\ 32 © McGraw Hill LLC\ Noise Pollution\ Prolonged exposure to sounds above 80--85 decibels\ can cause permanent hearing loss.\ Some ways to avoid exposing yourself to excessive\ noise:\ Wear ear protectors when working around noisy machinery.\ When listening to music on a headset, set the volume below\ 60 percent of the maximum.\ For children, avoid toys that make loud noise.\ Avoid exposure to painfully loud sounds and repeated\ exposure to any sounds above 80 decibels. Injuries caused almost 201,000 deaths in 2020:\ More than \$4 trillion is spent each year for medical care and\ rehabilitation of injured people.\ Unintentional injury: an injury that occurs when no\ harm is intended:\ Motor vehicle crashes, falls, and fires\ Accounts for more years of potential life lost than any other\ cause of death\ Intentional injury: one that is purposely inflicted\ 2 © McGraw Hill LLC\ Table 17.1 Leading Causes of Deaths from Unintentional Injury, 2020\ RANK ALL AGE GROUPS TOTAL 15--24 YEARS OLD 25--34 YEARS OLD 35--44 YEARS OLD\ 1 Poisoning\* (97,034) Poisoning (7387) Poisoning (22,636) Poisoning (23,723)\ 2 Fall (43,292) Motor vehicle traffic\ (6741)\ Drowning (702) Motor vehicle traffic\ (6031)\ 3 Motor vehicle traffic\ (40,698)\ Drowning (652) Motor vehicle traffic\ (7929)\ Fall (834)\ 4 Suffocation (19,810) Fall (336) Fall (596) Drowning (635)\ \*Mostly overdosing; also includes drug suicide, homicide, and other drug-induced causes.\ SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics. 2022. "Underlying Cause of Death 1999--2020." CDC WONDER Online Database\ (http://wonder.cdc.gov/ucd-icd10.html).\ 3 © McGraw Hill LLC\ Unintentional Injuries\ What causes an injury?\ Human factors:\ Risk-taking behavior and use of alcohol or drugs\ Psychological and emotional factors, including\ inadequate or inaccurate beliefs about what is safe\ or unsafe\ Environmental factors:\ Natural\ Social\ Work-related\ Home-related 4 © McGraw Hill LLC\ Home Injuries 1\ Home injuries are the result of poisonings, falls, fires,\ choking, drownings, and unintentional shootings.\ Poisoning comes in many forms.\ Opioid overdose is a major and increasing cause of\ poisoning deaths.\ Carbon monoxide poisoning:\ Never run a car in an enclosed space.\ Have your furnace inspected yearly.\ Use caution with anything that produces potentially toxic\ fumes.\ National poison hotline: 800-222-1222 5 © McGraw Hill LLC\ Home Injuries 2\ Falls:\ Leading cause of death among people aged 65 and over,\ and a significant cause of unintentional death and injury\ for people ages 44--64.\ Most occur on stairs, and alcohol is often a factor.\ Strategies for preventing falls:\ Install handrails and nonslip mats.\ Keep floors, stairs, and outside areas clear.\ Install proper lighting.\ Use a ladder safely.\ Don't use chairs to reach things.\ Use gates on stairs if small children are in the home.\ 6 © McGraw Hill LLC\ Home Injuries 3\ Fires:\ Cooking is the leading cause of home fire injury.\ Careless smoking is the leading cause of fire death.\ Fire prevention:\ Properly dispose of all cigarettes.\ Maintain fireplaces, furnaces, heaters, chimneys, electrical outlets,\ cords, and appliances.\ Keep portable heaters at least 3 feet from anything that might catch fire.\ Preparation:\ Plan escape routes.\ Install and maintain smoke detectors.\ 7 © McGraw Hill LLC\ Home Injuries 4\ The strategies that can help prevent injuries in a fire:\ Get out as quickly as possible.\ If you're trapped in a room, if smoke is coming in, don't open the door.\ Use the alternative escape route. If you can't, shout for help through the\ window.\ To avoid inhaling smoke, crawl along the floor away from the heat and\ smoke.\ Remember: stop--drop--roll.\ Suffocation and choking:\ Particular danger to children\ Small items in the mouth\ Getting tangled in crib bedding\ Becoming trapped in airtight appliances\ Adults can also become choking victims:\ Know the Heimlich maneuver, which is used to help force an obstruction\ from the airway.\ 8 © McGraw Hill LLC\ Home Injuries 5\ Firearms:\ People who use firearms should remember the following:\ Always treat a gun as though it is loaded.\ Never point a gun at anything you don't intend to shoot.\ Always unload a gun before storing it and store it under lock\ and key.\ Inspect firearms carefully before handling.\ Take a firearms safety course before handling a gun.\ Buy and use a gun lock designed specifically for your weapon.\ 9 © McGraw Hill LLC\ Table 17.2 Lifetime Odds of Death Due to Selected Types of Injury\ INJURY TYPE LIFETIME ODDS\ Suicide 1 in 88\ Opioid overdose 1 in 92\ Motor vehicle crash 1 in 107\ Fall 1 in 106\ Homicide (assault by firearm) 1 in 289\ Pedestrian incident 1 in 543\ Motorcycle rider incident 1 in 899\ Drowning 1 in 1128\ Exposure to fire, flames, or smoke 1 in 1547\ Choking on food 1 in 2535\ Exposure to excessive natural heat 1 in 8248\ Accidental gun discharge 1 in 8571\ Electrocution, radiation, extreme temperatures, and pressure 1 in 13,394\ Contact with sharp objects 1 in 29,334\ Hornet/bee/wasp sting 1 in 59,507\ Cataclysmic storm 1 in 58,669\ Being bitten or attacked by a dog 1 in 86,781\ Lightning strike 1 in 138,849\ Airplane incident Too few deaths in\ 2019 to calculate odds\ SOURCE: National Safety Council. 2022. Lifetime Odds of Deaths for Selected Causes, U.S. Itasca, IL: National Safety Council.\ 10 © McGraw Hill LLC\ Motor Vehicle Injuries\ Around 4.5 million Americans were injured and\ 38,680 were killed in motor vehicle crashes in 2020.\ Factors:\ Distracted driving\ Speeding\ Aggressive driving\ Fatigue and sleepiness\ Alcohol and other drugs\ Lack of seat belts, airbags, and child safety seats\ 11 © McGraw Hill LLC\ Preventing Motor Vehicle Injuries\ Strategies:\ Check rearview and side mirrors frequently.\ Be aware of the driving behaviors of other drivers.\ Don't follow others too closely.\ Never assume other drivers see you or can anticipate your\ actions; use your turn signals, make eye contact, and allow\ space and time.\ Take special care at intersections.\ Always allow enough following distance.\ Slow down if weather or road conditions are poor.\ 12 © McGraw Hill LLC\ Motorcycles and Motor Scooters\ Motorcycles are involved in one in seven traffic\ fatalities:\ Injuries tend to be more severe.\ Motor scooters have less power for maneuverability,\ especially in an emergency.\ Safety strategies:\ Wear light-colored clothing and drive with headlights on.\ Develop the necessary skills.\ Wear a helmet with the symbol DOT.\ Wear eye protection.\ Drive defensively, and never assume that other drivers\ can see you.\ 13 © McGraw Hill LLC\ Bicycles 1\ Bicycle injuries are most often the result of:\ Bicycle injuries are most often the result of:\ Not understanding the rules of the road\ Failing to follow traffic laws\ Not having sufficient skill or experience\ Being intoxicated\ Wearing a helmet reduces risk of head injury by 66--88 percent.\ 14 © McGraw Hill LLC\ Bicycles 1\ Bicycle injuries are most often the result of:\ Bicycle injuries are most often the result of:\ Not understanding the rules of the road\ Failing to follow traffic laws\ Not having sufficient skill or experience\ Being intoxicated\ Wearing a helmet reduces risk of head injury by 66--88 percent.\ 14 © McGraw Hill LLC\ Bicycles 2\ Safety strategies:\ Wear safety equipment, including a helmet, eye protection,\ gloves, and proper footwear.\ Wear light-colored, reflective clothing.\ Ride with the flow of traffic.\ Ride defensively.\ Stop at all traffic lights and stop signs. Know and use hand\ signals.\ 15 © McGraw Hill LLC\ Pedestrians\ Since a low in 2009, motor vehicles deaths involving a\ pedestrian have increased 51 percent and now make\ up 17 percent of traffic fatalities.\ About one in seven motor vehicle deaths involves\ pedestrians.\ Pedestrian deaths make up a larger proportion of traffic\ fatalities than they have in the past 33 years:\ Pedestrian intoxication plays a significant role.\ Walkers and runners should face traffic and cross only\ at marked crosswalks and intersections.\ 16 © McGraw Hill LLC\ Leisure Injuries\ Leisure injuries are a significant health-related problem.\ Safety strategies:\ Don't swim alone; use caution in unfamiliar or cold water;\ check depths before diving.\ In water activities, use personal flotation devices.\ Make sure facilities are safe, follow the rules, and practice\ good sportsmanship.\ Use safety equipment and avoid excessive speeds.\ Use proper precaution when exercising in hot and humid\ weather.\ Do no use alcohol or drugs during recreational activities.\ 17 © McGraw Hill LLC\ Weather-Related Injuries\ Heat: Extreme heat is the leading weather-related killer:\ Heat stroke and heat exhaustion can be fatal.\ Cold: Cold can also be deadly:\ Hypothermia and frostbite.\ Wind: Windy conditions can make it difficult to walk or stand:\ In extreme wind, move to the lowest point or an interior room.\ Lightning: Lightning can strike even when it's not raining, and it\ often strikes with no warning:\ Take precautions when you hear thunder.\ Flooding: Stay away from rapidly rising or moving water:\ Don't attempt to drive or walk through flooded streets.\ 18 © McGraw Hill LLC\ Work Injuries\ A significant factor in the decline in work injuries has been the\ Occupational Safety and Health Act of 1970.\ To avoid back injuries, use proper lifting techniques:\ Bend at the knees and hips, not at the waist.\ Place feet securely about shoulder-width apart; grip the object firmly.\ Lift gradually, with straight arms.\ If you have to turn, change the position of your feet.\ Repetitive strain injuries (RSIs) involve repeated strain on a\ body part:\ Carpal tunnel syndrome is one type that has increased in recent years.\ 19 © McGraw Hill LLC\ Violence and Intentional Injuries 1\ Factors contributing to violence:\ Social factors:\ Rates of violence vary by geographic region, neighborhood,\ and socioeconomic level.\ College campuses can contribute because they are transitory\ communities.\ Violence in the media:\ Mass media plays a major role.\ Because of exposure, people come to see violence as an\ effective means of solving problems.\ Gender:\ Violence is most often committed by men.\ 20 © McGraw Hill LLC\ Violence and Intentional Injuries 2\ Interpersonal factors:\ Majority of victims are acquainted with their attacker.\ Alcohol and other drugs:\ These are consistently associated with violence and suicide.\ On college campuses, alcohol is involved in about 95 percent\ of all violent crimes.\ Firearms:\ Most victims of assaults with other weapons don't die.\ Use of a handgun can change a suicide attempt to a\ completed suicide and a violent assault to a murder.\ 21 © McGraw Hill LLC\ Violence and Intentional Injuries 3\ Assault:\ Use of physical force to inflict injury or death on another.\ Homicide:\ Firearm homicide rates are highest among teens and young\ adults 15--34 years of age, and among Americans of African,\ Indigenous, and Hispanic ancestry.\ Most homicides are committed with a firearm, during an\ argument, among people who know each other.\ Although not technically classified as homicides, about 1000\ people per year lose their lives in law enforcement--related\ incidents.\ 22 © McGraw Hill LLC\ Violence and Intentional Injuries 4\ Gang-related violence:\ Most common in areas where residents experience the most\ violent crime, have low income, and have high unemployment\ rates, population density, and crime rates.\ Hate crimes:\ When a bias against another person's race or ethnicity, national\ origin, religion, sexual orientation, or disability motivates a\ criminal act\ Hateful talk in the media, by politicians, or by others in our daily\ lives can escalate to racist sentiments and scapegoating in times\ of economic and social upheaval.\ 23 © McGraw Hill LLC\ Violence and Intentional Injuries 5\ School violence:\ Approximately 423 homicide incidents between 1994 and 2016 occurred in\ relation to schools.\ Workplace violence:\ Has decreased by 35 percent over the past decade, but still, nearly 2 million\ Americans workers are victims of workplace violence.\ Workers at greater risk include those who exchange money with the public or\ work alone in small groups.\ Also, health care professionals, public service workers, customer service\ agents, and law enforcement personnel have the most dangerous jobs.\ Terrorism:\ The unlawful use of force or violence against people or property to intimidate\ or coerce a government, the civilian population, or any segment thereof in\ furtherance of political or social objectives.\ 24 © McGraw Hill LLC\ Family and Intimate-Partner Violence 1\ Family violence: generally, refers to a broad range of abusive acts committed\ by one family member toward another.\ Intimate-partner violence (IPV):\ Physical, sexual, or psychological harm imposed by a current or former spouse,\ or boyfriend, girlfriend, or other romantic or sexual partners\ Physical violence:\ The need to control another person is at the root of much abusive behavior.\ Stalking and cyberstalking\ Stalking: repeatedly harassing or threatening a person through behaviors such\ as following a person, appearing at a person's residence or workplace, leaving\ written messages or objects, making harassing phone calls, or vandalizing\ property; frequently directed at a former intimate partner\ Cyberstalking: the use of the internet, email, chat rooms, Facebook, Instagram,\ and other electronic means to stalk another person\ 25 © McGraw Hill LLC\ Family and Intimate-Partner Violence 2\ Guidelines for staying safe online:\ Use an age- and gender-neutral identity.\ Avoid using information that could be used to identify you.\ Don't share personal information in public spaces.\ Learn how to filter unwanted email messages.\ Always use unique passwords with many characters.\ In social networking, set your profile to "private."\ If you experience harassment, don't respond to the harasser;\ save all communications for evidence, and contact your ISP\ and your local police department.\ 26 © McGraw Hill LLC\ Family and Intimate-Partner Violence 3\ Violence against children:\ In 2018, one in seven children was abused or neglected in the\ United States.\ External stressors are most closely associated with neglect.\ Interpersonal stressors are more closely associated with\ physical abuse.\ Elder abuse:\ Most abusers are family members serving as caregivers.\ Abuse may become an outlet for frustration.\ The solution to elder abuse is greater social and financial\ assistance.\ 27 © McGraw Hill LLC\ Sexual Violence 1\ Sexual assault: rape\ Sexual assault is any unwanted sexual contact.\ Rape is one type of sexual assault:\ Statutory rape: victim is younger than the age of consent\ Date rape or acquaintance rape: coerced sexual activity in which the victim knows\ or is dating the rapist\ People, in most cases men, who commit rape may be of any age from any\ socioeconomic group.\ About 19 percent of rapes are committed by strangers, but acquaintances,\ current or former intimate partners, and non-spouse relatives make up the\ majority of perpetrators.\ Factors contributing to date rape:\ Men and women also differ in their perception of romantic encounters and signals.\ Men who rape their dates tend to share certain attributes, including hostility\ toward women, a belief that dominance alone is a valid motive for sex, and an\ acceptance of sexual violence. 28 © McGraw Hill LLC\ Sexual Violence 1\ Sexual assault: rape\ Sexual assault is any unwanted sexual contact.\ Rape is one type of sexual assault:\ Statutory rape: victim is younger than the age of consent\ Date rape or acquaintance rape: coerced sexual activity in which the victim knows\ or is dating the rapist\ People, in most cases men, who commit rape may be of any age from any\ socioeconomic group.\ About 19 percent of rapes are committed by strangers, but acquaintances,\ current or former intimate partners, and non-spouse relatives make up the\ majority of perpetrators.\ Factors contributing to date rape:\ Men and women also differ in their perception of romantic encounters and signals.\ Men who rape their dates tend to share certain attributes, including hostility\ toward women, a belief that dominance alone is a valid motive for sex, and an\ acceptance of sexual violence. 28 © McGraw Hill LLC\ Sexual Violence 2\ Date rape drugs:\ Drugs are a factor in more than 60 percent of sexual assaults.\ Rohypnol, GHB, and "Special K."\ Strategies that can help ensure your drink is not tampered with\ at a bar or party:\ Find out if drug-facilitated assault has occurred in your area.\ Drink moderately and responsibly, avoiding group drinking and drinking\ games.\ Be wary of opened beverages, alcoholic or nonalcoholic, and watch the\ bartender pour your drink.\ Let your date be the first to drink.\ If something is strange about your drink or you left it unattended, get a\ fresh drink---the same goes for food.\ When you go, go with friends and leave with friends.\ 29 © McGraw Hill LLC\ Sexual Violence 3\ Dealing with a sexual assault:\ There is disagreement over whether women should fight back or not.\ Tell the first friendly person you meet what happened.\ Recommendations for dealing with sexual assault from Women Organized\ Against Rape (WOAR):\ If you feel you are in danger, trust your gut; don't hesitate to run and scream.\ Yell---and keep yelling.\ If attacked from behind, use your elbows.\ Try kicking; aim low to avoid losing your balance.\ An attacker's most vulnerable spot is his knee. Don't try to kick a rapist in the\ crotch; men will have better protective reflexes there.\ Once you start fighting, keep it up and get away.\ Remember ordinary rules of behavior don't apply.\ Effects of rape:\ Physical and psychological injury\ 30 © McGraw Hill LLC\ Child Sexual Abuse\ Any sexual contact between an adult and child who is\ below the legal age of consent:\ Incest---sexual activity between people too closely related to\ legally marry---is highly traumatic.\ Child sexual abuse is often unreported.\ Joining a support group of people who have had similar\ experiences, confiding in a partner or friend, or seeking\ professional help might help the victim.\ 31 © McGraw Hill LLC\ Child Sexual Abuse\ Any sexual contact between an adult and child who is\ below the legal age of consent:\ Incest---sexual activity between people too closely related to\ legally marry---is highly traumatic.\ Child sexual abuse is often unreported.\ Joining a support group of people who have had similar\ experiences, confiding in a partner or friend, or seeking\ professional help might help the victim.\ 31 © McGraw Hill LLC\ Sexual Harassment\ Sexual harassment is unwelcome sexual advances,\ request for sexual favors, and other conduct of a sexual\ nature, if such conduct explicitly or implicitly:\ Affects academic or employment decisions or evaluations\ Interferes with an individual's academic or work performance\ Creates an intimidating, hostile, or offensive academic, work,\ or student living environment\ 32 © McGraw Hill LLC\ What You Can Do about Violence\ Training for conflict resolution\ Identifying and targeting at-risk groups for intervention\ Reducing gun-related injuries:\ Adoption of consumer safety standards for guns.\ 33 © McGraw Hill LLC\ Providing Emergency Care\ Knowing first aid can help you respond appropriately.\ Learning what not to do in certain situations\ Heimlich maneuver\ Pulmonary resuscitation\ Cardiopulmonary resuscitation (CPR)\ Use of automated external defibrillators (AEDs)\ You are the first link to the emergency medical services\ (EMS) system, which is designed to network community\ resources for providing emergency care. Aging: a normal process of getting older, which includes physical,\ mental, and social changes:\ Biological aging is associated with a reduction in the body's potential to\ repair and regenerate tissue.\ Gerontology: scientific study of the physical changes that occur with aging.\ Programmed aging hypothesizes that our bodies age because of a\ hardwired pattern of shifts in gene expression that have been programmed\ through evolution.\ Psychological aging refers to the cognitive, emotional, and behavioral\ changes that occur over time.\ Social aging refers to the shifts in relationships and societal roles as a\ person ages.\ Even with the healthiest behavior and environment, biological\ aging inevitably occurs:\ Gradual aging and impairment from disease cause physiological changes\ throughout the body.\ 2 © McGraw Hill LLC\ Life-Enhancing Measures 1\ Don't smoke.\ Challenge your mind:\ Reading, writing, doing puzzles, learning a language, and\ studying music stimulate the brain.\ More complex the activity, the more protective it may be.\ Some effects of mental exercise may help delay the onset of\ symptoms caused by dementia.\ 3 © McGraw Hill LLC\ Life-Enhancing Measures 2\ Develop physical fitness.\ Exercise significantly enhances both psychological and physical\ health.\ Studies cited in the 2018 Physical Activity Guidelines for\ Americans Committee Report found:\ Physically active people have a significantly lower risk of dying\ prematurely.\ About 150 minutes of physical activity a week are often sufficient.\ The stimulus that exercise provides also protects against the\ loss of fluid intelligence: the ability to find solutions to new\ problems.\ 4 © McGraw Hill LLC\ Life-Enhancing Measures 3\ Eat wisely:\ Eat a varied diet full of nutrient-rich foods.\ Maintain a healthy weight.\ Control drinking and overdependence on medications.\ Schedule preventive care.\ Recognize and reduce stress.\ Nurture social connections.\ 5 © McGraw Hill LLC\ Dealing with the Changes of Aging 1\ Changing roles and relationships\ Increased leisure time\ Economics of retirement:\ Financial planning should begin early in life.\ Especially critical for women.\ Adapting to physical changes\ Hearing loss:\ Loss of hearing occurs in virtually everyone as they age\ (presbycusis).\ Hearing loss is the result of gradual deterioration of the tiny\ hair cells in the cochlea.\ 6 © McGraw Hill LLC\ Dealing with the Changes of Aging 2\ Vision changes:\ Trouble distinguishing certain colors.\ Glaucoma: increase in pressure in the eye.\ Age-related macular degeneration (AMD): deterioration of\ the central area of the retina\ Cataracts: clouding of the lenses\ Diabetic retinopathy\ Arthritis: inflammation and swelling of a joint or joints:\ Osteoarthritis (OA) is the most common form\ 7 © McGraw Hill LLC\ Dealing with the Changes of Aging 3\ Osteoporosis: loss of bone density:\ Makes the body more prone to fractures, especially at the hip,\ spine, or wrist.\ Weight-bearing exercises beginning early in life are important.\ Increased risk for falls\ Changes in sexual functioning:\ It is still important to practice safe sex.\ 8 © McGraw Hill LLC\ Dealing with the Changes of Aging 4\ Psychological and cognitive changes\ Cognitive impairment:\ Many ultimately develop dementia: a general term for a loss\ of function that interferes with daily life and independence.\ Alzheimer's disease (AD): a progressive brain disorder that\ damages and eventually destroys brain cells.\ Most common disease leading to dementia.\ Vascular dementia, or vascular cognitive impairment:\ changes that occur due to cerebrovascular disease, when\ brain cells die due to inadequate blood flow.\ Lewy-body dementia (LBD): a form of dementia that partly\ resembles AD but may also cause unpredictable levels of\ cognitive ability, attention, or alertness.\ 9 © McGraw Hill LLC\ Dealing with the Changes of Aging 5\ Depression:\ Distinguishing between depression and dementia can be\ difficult in older adults because the two conditions share\ many of the same symptoms.\ Common triggers for depression in older adults include\ unresolved grief, chronic health conditions, unrelieved pain,\ and changes in the social and financial situation.\ Suicide is relatively common.\ Grief:\ Grief is an emotional response to loss.\ People find help through in-person or online support groups\ with others who have experienced similar losses.\ 10 © McGraw Hill LLC\ Life in an Aging Society\ Life expectancy is the average length of time a person is\ expected to live.\ Aging minority:\ People of age 65 and over are a large minority in the United\ States.\ Social Security---a government program that provides financial\ assistance to retirees, disabled persons, and families of retired,\ disabled, or deceased workers.\ Health care remains the largest expense.\ 11 © McGraw Hill LLC\ Family and Community\ Resources for Older Adults\ People in their later years can often remain active and\ independent with help:\ Most often the bulk of the caregiving is provided by the\ elderly person's spouse, grown daughter, or daughter-in-law.\ Caregiving can be exhausting.\ 12 © McGraw Hill LLC\ Government Aid and Policies\ Several programs are in place to help older Americans:\ Food assistance\ Housing subsides\ Social Security:\ Funds comes primarily from American workers who pay into the system, and\ it depends on a sufficient number of current workers to support the number\ of retired people who are receiving benefits.\ Medicare:\ It is a major health insurance program for older adults and disabled persons.\ Medicaid:\ When financial resources are exhausted, people may apply for Medicaid,\ which provides insurance to low-income people of any age.\ 13 © McGraw Hill LLC\ What Is Death?\ The way we choose to confront death can greatly\ influence how we live.\ Questions about the meaning of death and what\ happens when we die are central to the great religions\ and philosophies of the world.\ Senescence, the biological process of aging, is rooted in\ genetics.\ 14 © McGraw Hill LLC\ Defining Death\ Traditionally, the heart stops beating and breathing\ ceases, referred to as clinical death:\ Life-support systems have affected clinical definitions.\ Brain death is the complete and irreversible loss of\ function of the entire brain, including the brain stem.:\ Timing is critical for organ transplantation.\ Cellular death is a gradual process that occurs when\ heartbeat, respiration, and brain activity have stopped,\ and includes breakdown of metabolic processes.\ 15 © McGraw Hill LLC\ Learning about Death\ Child's understanding of death evolves greatly from\ about age 6 to age 9.\ Mature understanding of death: a conscious\ recognition of the facts that death is final, universal,\ and inevitable.\ Non-empirical ideas about death include noncorporeal\ continuity: that we survive in some form after death.\ 16 © McGraw Hill LLC\ Denying versus Acknowledging Death\ Where the reality of death is concerned, "out of sight,\ out of mind" is often the rule of the day.\ In the United States, we tend to "death denying."\ Not the same in all cultures:\ For example, Día de los Muertos (Day of the Dead) in Mexico\ 17 © McGraw Hill LLC\ Planning for Death 1\ Making a will:\ Will: a legal instrument expressing a person's intentions and\ wishes for the disposition of their property after death.\ Estate: money, property, and other possessions.\ Testator: the person who makes a will.\ When a person dies intestate---without having left a valid\ will---property is distributed according to rules of the state.\ It is useful to prepare a document that includes information\ about your personal affairs (bank statements, credit cards,\ documents, etc.).\ 18 © McGraw Hill LLC\ Planning for Death 2\ Completing an advance directive:\ Advance directive: a legal document that states your\ preferences about medical treatment\ Living will: allows individuals to provide instructions about the\ kind of medical care they wish to receive or not receive if they\ become unable to participate in decisions\ Health care proxy, or durable power of attorney for health\ care: allows an individual to appoint another person as an\ agent in making health care decisions\ 19 © McGraw Hill LLC\ Giving the Gift of Life\ Each day 17 people on the waiting list die because not\ enough organs are available.\ If you decide to become an organ donor, you can complete a\ Uniform Donor Card either physically or online (go to\ organdonor.gov).\ Alternatively, in many states you can indicate your wish on your\ driver's license.\ You can also register online through the nonprofit website\ Donate Life America (donatelife.net), which manages a national\ registry for organ donors.\ 20 © McGraw Hill LLC\ Considering Options for\ End-of-Life Care\ Home care is an expressed preference for the majority\ of people.\ Palliative care: a collaborative, team-based approach\ to treatment that aims to prevent and relieve suffering\ in those with serious or life-threatening illness\ Hospice programs offer a special kind of compassionate\ care for those in the final phase of terminal illness:\ Likely to die in six months or less\ 21 © McGraw Hill LLC\ Difficult Decisions at the End of Life 1\ Decision to stop doing tests and treatments is often a\ difficult one for patients and families.\ Persistent vegetative state: a condition of extensive and irreversible\ brain damage with absence of higher brain function for an extended period.\ The person may have sleep-wake cycles, and occasional eyelid opening and\ movement, but lacks awareness or any cognitive function.\ Withholding or withdrawing treatment:\ Right of a competent patient to refuse unwanted treatment is\ now generally established.\ Having a clear advance directive is extremely helpful.\ 22 © McGraw Hill LLC\ Difficult Decisions at the End of Life 2\ Physician-assisted death and voluntary active euthanasia:\ Physician-assisted death (PAD): physician provides a prescription\ for a lethal dose of medication:\ As of 2020, legal in California, Colorado, the District of Columbia, Hawaii,\ Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington\ Concept of double effect: a harmful effect of treatment, even if it\ results in death, is permissible if not intended and occurs as a side\ effect of a beneficial action.\ Active euthanasia: intentional act of killing someone who would\ otherwise suffer:\ Illegal in all US states\ Palliative sedation is used as a last resort.\ 23 © McGraw Hill LLC\ Planning a Funeral or\ Memorial Service\ Disposition of the body:\ Burial\ Embalming for a viewing or wake\ Cremation\ Arranging a service:\ Memorial service\ Funeral ceremony\ 24 © McGraw Hill LLC\ Coping with Imminent Death 1\ There is no one right way to live with or die of a\ life-threatening illness.\ Tasks of coping:\ Kübler-Ross, five psychological stages: denial, anger,\ bargaining, depression, and acceptance\ Notion of stages is now deemphasized.\ Four primary dimensions in coping with dying (Corr):\ Physical\ Psychological\ Social\ Spiritual\ 25 © McGraw Hill LLC\ Coping with Imminent Death 2\ Supporting a person in the last phase of life:\ Most important is to be present.\ If the person wishes to talk, attentive listening is an act of\ great kindness.\ As death draws near, simple steps to give comfort can provide\ relief and reassurance.\ 26 © McGraw Hill LLC\ Coping with Loss 1\ Experiencing grief: the reaction to loss:\ Bereavement: the objective event of loss\ Mourning: the process of adjustment\ The course of grief is highly individual:\ Social support is critical.\ There is no hard and fast "normal" amount of time that grief\ should last.\ When the duration and intensity far exceed what is usually\ expected, it is often referred to as complicated grief.\ 27 © McGraw Hill LLC\ Coping with Loss 2\ Supporting a grieving person:\ Key to supporting a grieving person is being a good\ listener and refraining from making judgments:\ If someone talks about suicide or seems in danger of harm,\ seek professional help right away.\ When a young adult loses a friend, the leading causes\ of death tend to be sudden and unexpected.\ In helping children cope with loss, honesty and\ inclusion are the key aspects.\ 28 © McGraw Hill LLC\ Coming to Terms with Death\ Encounters with dying and death help us appreciate\ the infinite preciousness of life and love.\ Our exposure to death can offer opportunities for\ extraordinary growth in the midst of loss.\ 29 © McGraw Hill LLC\ Coming to Terms with Death\ Encounters with dying and death help us appreciate\ the infinite preciousness of life and love.\ Our exposure to death can offer opport