Compare, contrast, correlate, create an essay from the material.
Essays must be a minimum of a page-single spaced, 12 font.
Essay #4-Pregnancy, healthy relationships, exercise
Many doctors and patients have long considered two common pregnancy complications as temporary medical problems that essentially go away once the baby is born.
Now there’s growing recognition that expectant women who have preeclampsia or gestational diabetes are at much greater risk of developing illness well beyond the baby’s birth, including cardiovascular disease and diabetes, compared to women with uncomplicated pregnancies. What’s more, the complications have been linked to health problems in the children as late as early adulthood, researchers say.
The medical findings led the American Heart Association last month to issue updated guidelines that list a problem pregnancy as a risk factor for a woman to develop heart problems, along with such well-established dangers as smoking and high cholesterol. The two chief culprits identified in the guidelines, preeclampsia and gestational diabetes, are potentially serious complications that have long been known for their immediate danger to both the mother and the baby.
Preeclampsia, a rapid rise in blood pressure, more than doubles a mother’s chance of developing cardiovascular disease, stroke or other conditions five to 15 years after the pregnancy. Meanwhile, gestational diabetes, a type of diabetes that occurs only during pregnancy, increases both the mother’s and baby’s risk of developing the full-blown condition later in life.
Both complications can have other long-term consequences for the baby. A study of more than 280,000 Swedish men published in January in the AHA journal Circulation found that those born to mothers with gestational diabetes were more likely to be overweight at age 18 than those whose mothers were free of the complication. A Finnish study published in 2009 in the journal Stroke found a higher risk of stroke in adults born after pregnancies complicated by preeclampsia or high blood pressure.
“How a woman does in her pregnancy gives you a glimpse of what the future will be 10 years down the line,” says Jennifer Mieres, a cardiologist at North Shore-LIJ Health System, Long Island, N.Y., and a national spokeswoman for the AHA.
Most medical experts believe that a difficult pregnancy, by putting unusual strains on the body, provides a warning sign for heart risks that are already there. However, the connection between the pregnancy complications and later health risks isn’t well understood.
“Pregnancy is like a stress test for the heart,” says Heidi Connolly, a cardiologist at Mayo Clinic, Rochester, Minn., with a special interest in pregnancy and heart disease.
Gestational diabetes occurs in as many as 10% of pregnancies, according to the National Institutes of Health. Up to 8% of pregnant women develop preeclampsia.
The conditions are among the leading causes of maternal and fetal death, though such outcomes are uncommon in the U.S. Most cases can be effectively managed with regular OB/GYN checkups during pregnancies, doctors say. (African-American women and women living in poverty are at higher risk for both complications.)
Because in both cases, symptoms typically go away soon after the baby is born, the long-term implications often go unaddressed.
“Preeclampsia has suffered from this concept that it’s just a pregnancy thing,” says Eleni Tsigas, executive director of the Preeclampsia Foundation, a Melbourne, Fla., patient-advocacy group. In the majority of cases where “Mom and baby go home fine,” she says, “it disappears from that woman’s radar screen.”
Laura Dale was 28 years old and in good health when she found she was expecting her first child. The pregnancy was smooth until the sixth month, when her feet began to swell so much she had trouble walking. Her blood pressure began to rise by the 32nd week. But it wasn’t until week 35 when she was rushed to the hospital that she learned she had preeclampsia and was told she had to have the baby that night or she might die. “It came on like lightning,” she says.
Her son was born just under five pounds. Her blood pressure declined, but a few days later she was back in the hospital with readings so high she thought she was having a stroke. She says her doctor told her he just hoped to get her out of the hospital alive.
Ms. Dale, a pharmaceutical company employee in Easton, Pa., who turns 32 next week, and her son (“a big strapping three-year-old,” she says) ultimately survived the ordeal in good shape. Now in May, she plans to run in her fourth half-marathon and is training to run a full marathon next year. She’s also looking ahead to having another baby.
“It made me take a better look at my health and my lifestyle,” she says. “It probably wouldn’t have crossed my mind if I didn’t have preeclampsia.”
Preeclampsia is characterized by a sudden increase in blood pressure and protein in the urine after at least 20 weeks of pregnancy. Severe headaches and blurred vision are also among symptoms. What causes it isn’t clear, but it is associated with damage to the lining of blood vessels, says Elizabeth Ofili, chief of cardiology at Morehouse School of Medicine, Atlanta.
One possible consequence is poor blood flow to the placenta, which in turn deprives the fetus of necessary oxygen and nutrients, undermining development. The only cure is delivery of the baby; if it is necessary to induce labor before the baby reaches full term, that further increases risk of developmental problems.
Gestational diabetes, marked by a rise in blood sugar late in pregnancy, may result from an exaggerated interference by hormones in the placenta on the action of insulin in the tissues. One possible consequence is excessive growth of the baby, increasing risk of premature birth and other complications.
There aren’t any sure fire ways to prevent either problem. A family history increases risk for both conditions, as does obesity.
Sharonne Hayes, a Mayo Clinic cardiologist, suggests women who are overweight or obese and planning a pregnancy take steps to lose weight before conceiving.
“Women quit smoking, and stop drinking alcohol and caffeine for their kids,” she says. “If you lose 40 pounds and wait till next year, your baby will be healthier,” says Dr. Hayes. As will the mother. Still, there’s no assurance that taking such steps, or perhaps getting high blood pressure under control, will prevent the pregnancy complications.
Living together gained momentum during the 1960s, when traditional moral strictures began to unravel and “the pill” made sex outside of marriage more commonplace. Historically, unmarried cohabitation was most common among the lower classes, for whom marriage held few social, legal, or economic benefits (see “Unmarried with Children,” Contexts, Spring 2005). As cohabitation became more widespread, many commentators mistakenly characterized it as a college-student phenomenon. In reality, college-educated Americans are the least likely to cohabit. This same myth also perpetuated a stereotype of cohabitors as never married and childless, when in actuality a slight majority of cohabitors have been married previously, and 40 percent of cohabiting unions involve children. By comparison, 45 percent of married-couple families have minor children living with them.
Cohabitation today shapes the lives of many Americans. The 2000 Census counted close to five million opposite-sex couples living together in America. In 1970, there were just 500,000 cohabiting couples. More than half of young adults in their 20s and 30s have experienced cohabitation. Cohabiting unions are relatively short-lived, lasting on average less than two years. For this reason, the percentage of young adults who have ever experienced cohabitation is considerably greater than those currently cohabiting. About one-quarter of young adults are currently cohabiting. Most cohabitors are under age 35, but cohabitation affects all age groups. More than one million Americans over age 50 currently cohabit, and this number is expected to grow as baby boomers (who led the surge in cohabitation during the 1960s and 1970s) move into older adulthood. At the other end of the age spectrum, five percent of children (roughly 3.5 million) reside with cohabiting parents. About 20 percent of single-mother families actually comprise a single mother and her live-in boyfriend, and one in three single-father families includes a live-in girlfriend. Widespread experience of cohabitation among adults and children alike attests to its growing centrality in family life.
Cohabitation and Marriage
Cohabitation is less likely to be a step toward marriage than it was in the past. In the 1980s, 60 percent of couples who lived together got married; a decade later, such couples were as likely to break up as to marry. Divorced people used to remarry, but now they are more likely to cohabit. And cohabiting arrangements increasingly provide what marriages do: companionship, sexual intimacy, and a place to raise children. The dramatic rise in unwed childbearing over the past four decades is common knowledge, but it is less well known that 40 percent of these births are to two biological parents who are living together. Shotgun marriages to legitimate unplanned, nonmarital pregnancies are a relic of the past; the birth of a child does not automatically prompt couples to marry anymore. Many couples are content to live together while they consider whether or not to marry. Although three quarters of cohabitors report that they intend to marry their partners, cohabitors also maintain that the transition to marriage necessitates substantial economic resources. Financial security and stable employment, home ownership, and money for a wedding are not always attainable and represent an insurmountable barrier to marriage for many Americans. The economic status of cohabitors is more precarious than that of married couples, who enjoy higher average incomes and education levels. For this reason, some scholars characterize cohabitation as an “adaptive family formation strategy.”
Research supports this argument. Economic stability promotes marriage among cohabitors. The likelihood that a heterosexual couple living together will marry increases as the male partner’s education and earnings levels go up. Sociologists Pamela Smock and Wendy Manning interviewed 115 working- and middle-class cohabitors living in the Toledo, Ohio, area. A central theme from these interviews is that cohabitors believe marriage is appropriate after they have achieved financial stability. The male partner must be able to provide economically for the couple, ensuring they have “enough” money to live comfortably and to afford a “real” wedding. One cohabitor described his relationship by saying, “The love is there, uh…trust is there. Everything’s there except money.”
Cohabitors who do marry tend to experience greater marital instability and are more likely to divorce than their counterparts who did not premaritally cohabit. Ironically, the primary reason people cohabit is to test their relationship’s viability for marriage. Sorting out bad relationships through cohabitation is how many people think they can avoid divorce. Yet living together before marriage actually increases a couple’s risk of divorce. There are competing explanations for this counterintuitive finding. On the one hand, cohabitation may change people’s attitudes or behaviors, putting them at greater risk for divorce. On the other hand, people who are willing to cohabit are also willing to divorce in the event of an unhappy marriage. That is, cohabitors may be less committed to marriage and less traditional in their views on family issues. The same segment of society that sees divorce as unacceptable also tends to view cohabitation as unacceptable. Both explanations have received some support from social science research, and both may be valid.
Architects Use Design to Help Fight Obesity
By Haya El Nasser
• Buildings that promote activity get workers to move
The push to reverse the obesity epidemic and promote physical fitness is spilling into design and architecture and beginning to target one of the nation’s most sedentary environments: the office.
“Active design”–the architectural principle of creating spaces that encourage healthy lifestyles–is gaining popularity as more cities and companies join the fight and embrace healthy initiatives and “green” measures.
New York–the city that banned trans fats in restaurants and will soon ban sales of large sugary drinks in cups–adopted Active Design Guidelines in 2006. That has sparked interest among architects and planners, even amid a sluggish economy. With the help of a grant from the Centers for Disease Control and Prevention, the city is mentoring 14 other cities, including Philadelphia, Tucson, Nashville and Seattle, to improve the built environment to reduce obesity.
“How do you get people moving?” asks Rick Bell, executive director of the New York chapter of the American Institute of Architects. “If exercise and everyday activity is the mantra, how do you, through design, get people to exercise? There is a direct relation between the built environment and people’s lifestyles.”
History has proved it. Architecture played a major role in defeating infectious diseases such as cholera and tuberculosis in the 19th and 20th centuries by designing better buildings, streets, clean-water systems and parks.
Today, obesity is the threat. More than a third of American adults, teens and children are obese, or roughly 30 pounds over a healthy weight.
“It’s very new to people,” says Joan Blumenfeld, an architect at Perkins+Will who has worked on active interior design in offices and public buildings. “Now interior designers are getting interested in it and in health in workplaces. … It makes (workers) feel valued, and a lot of this stuff doesn’t really cost anything because it’s where you locate things.”
Aside from obvious incentives such as on-site health clubs, some of the features of “active design”:
Stairs, stairs, stairs. In most buildings, they’re hidden in stairwells behind fire doors because they are designed primarily as emergency exits. Exposed staircases that connect to different parts of a building encourage people to use them, Blumenfeld says.
Studies show that if the average American adult climbed stairs for just two minutes a day (six to eight flights), enough calories would be burned to prevent average annual weight gain, says Dr. Karen Lee, director of built environment and healthy housing for New York City’s health department.
Brightly colored signs showing a figure climbing stairs have gone up near elevators in buildings across the city, she says. The message: “Burn Calories, Not Electricity.”
Some clients are paying to upgrade stairs. New buildings are being designed to make the stairs more prominent than elevators when people enter the lobby–a feature that is more adaptable in low-rise buildings.
The new Queens Elmhurst Library will feature a grand staircase and emphasize stair use throughout the building.
Get up and walk. In offices, the push is on to remove printers from individual desks. That forces workers to get up and walk a few paces. Coffee machines are also being moved to central pantries that may require walking to another section.
“This is not just to annoy people but to also add value,” Bell says. “They can socialize with co-workers.”
Shared space. When workers are in a communal space rather than a cubicle or office, it “makes people get up and encourages people to be more collaborative,” Blumenfeld says.
Outdoor space. Trails or stairs to outside work areas encourage workers to be as mobile as the electronic devices they do their work on.
“Providing an outdoor space of some sort, whether it’s a plaza or a deck, encourages you to walk around on a nice day,” says Barry Hersh, associate professor at NYU Schack Institute of Real Estate.
Office furniture company Haworth rebuilt its global headquarters in Holland, Mich., under the principles of active design. Besides environmentally sound features such as energy efficiency, natural light and clean air, Haworth wanted to open spaces to encourage movement and interaction, says Kurt Vander Schuur, corporate brand director.
Before the redesign, “We had 90% individual space,” he says. “In the new building, we have 55% individual and 45% shared.”
Before, less than a third of workers had access to natural light and now 90% do. “Having daylight encourages more movement in the office,” Vander Schuur says.
The central feature of the 300,000-square-foot building is a three-story atrium, an open stairway and a big public space that is designed like a pit or sunken living room. The Starbucks is there and so is the “tech bar” to help workers with their computer problems.
“We’re trying to attract young workers,” Vander Schuur says. “Everybody cares about the health and wellness of their workers.”
Caring for workers also can help to reduce health care costs for employers.
Bell recounts vivid illustrations of the connection between design and physical activity he saw at a presentation years ago. One slide showed an escalator–not stairs–leading up to a second-story health club in a Southern California strip mall. Another slide showed a man driving alongside his dog, holding the leash out the car window, in a neighborhood without sidewalks.