Book 1 Reading and Speaking (1108795), страница 19
Текст из файла (страница 19)
Too much alcohol raises the risk of alcoholiccardiomyopathy, in which the heart muscle becomes too weak to pump efficiently; high blood pressure (itself a risk44factor for CHD, stroke, heart failure and kidney failure); and hemorrhagic stroke, in which blood vessels rupture inor on the surface of the brain. Alcohol overindulgence is also related to “holiday heart syndrome,” an electricalsignal disturbance that disrupts the heart rhythm. The name refers to its increased frequency around particularholidays during which people engage in binge drinking.Given the potential dangers of alcohol, how can individuals and their physicians make the decision as towhether to include alcoholic beverages in their lives and, if so, in what amounts? The ability to predict accurately anindividual’s risk of a drinking problem would be a great boon; the least disputed possible consequence of moderatedrinking is problem drinking.
Individual risk can be approximated using family and personal histories of alcoholrelated problems or conditions, such as liver disease or, of course, alcoholism. Even when known factors are takeninto account, however, unpredictable events late in life may result in deleterious drinking changes.Exactly because of these dangers, public health concerns about alcohol until recently have beenappropriately focused solely on the reduction of the terrible social and medical consequences of heavy drinking.And the correlation between total alcohol consumption in society and alcohol-related problems has been used tojustify pushes for abstinence. Ultimately, however, a more complex message is necessary.
Merely recommendingabstinence is inappropriate health advice to people such as established light drinkers at high risk of CHD and at lowrisk of alcohol-related problems—which describes a large proportion of the population. Of course, the mostimportant steps for this group are proper diet and exercise; effective treatment of obesity, diabetes, high bloodpressure and high cholesterol; and avoidance of tobacco. But there is a place on that list of beneficial activities forlight drinking. Most light to moderate drinkers are already imbibing the optimal amount of alcohol for cardiovascularbenefit, and they should continue doing what they are doing.Abstainers should never be indiscriminately advised to drink for health; most have excellent reasons for notdrinking.
Yet there are exceptions. One case is the person with CHD who “goes clean”—quits smoking, switches toa spartan diet, starts exercising and, with good intentions, gives up the habit of a nightly bottle of beer or glass ofwine. This self-imposed prohibition should be repealed. In addition, a number of infrequent drinkers might thinkabout increasing their alcohol intake to one standard drink daily, especially men older than 40 and women olderthan 50 at high risk of CHD and low risk of alcohol-related problems.But women also have to consider one possible drawback of alcohol: several studies link heavy drinking—anda few even link light drinking—to an increased risk of breast cancer, a less common condition than heart disease inpostmenopausal women but certainly quite a serious one.
For young women, who are generally at low short-termrisk of CHD and therefore may not benefit greatly from alcohol’s positive cardiovascular effects, this possible breastcancer link looms larger in estimating the overall risks and benefits of alcohol. And for all women, the upper limit onmoderate drinking should be considered one drink a day.The only clear-cut message regarding alcohol and health, then, is that all heavy drinkers should reduce orabstain, as should anyone with a special risk related to alcohol, such as a family or personal history of alcoholismor preexisting liver disease.
Beyond that, however, the potential risks and benefits of alcohol are best evaluated ona case-by-case basis. I believe that it is possible to define a clear, safe limit for alcohol consumption that wouldoffer a probable benefit to a select segment of the population. The ancient Greeks urged “moderation in all things.”Three decades of research shows that this adage is particularly appropriate when it comes to alcohol. (Featurearticle, abridged. From Scientific American, February, 2003)Exercise 6.
Would you recommend moderate amounts of alcohol to the following groups of patients?Why? Why not?● heavy drinkers● pregnant women● diabetics● patients with CHD● people with family history of alcoholism● young people● obese people● women older than 50Exercise 7. You are going to interview your fellow-students. Make up 10 questions about the key factsdiscussed in the article.Exercise 8. Summarize all the information discussed in this unit and speak on the effects of alcohol onhuman organism.45Unit 13.
Sex and GenderA woman is only a woman, but a good cigar is asmoke.Rudyard KiplingExercise 1. What do you know about the sexes?1. What are the physiological differences between individuals of male and female gender? What organs and organsystems differ between males and females?2.
What mechanisms and when determine the sex of the future individual?3. What are the functions of reproductive hormones (sex hormones)?4. What are the secondary sexual characteristics?5. Why do women generally live longer than men?6. Do men and women really have different patterns of mental activity and emotions? Are they genetically orsocially programmed?Exercise 2. Read the text to check some of your answers in Exercise 1.Why is life expectancy2 longer for women than it is for men?Bertrand Desjardins, a researcher in the demography department of the University of Montreal, explains.Men dying sooner than women makes sense biologically: because 105 males are born for every 100females, it would assure that there are about the same number of men and women at reproductive ages.
But eventhough women showed a longer life expectancy in almost every human society in the last decade of the 20thcentury, the size of the advantage varied greatly. For example, in the U.S. life expectancy was 73.4 years for malesand 80.1 years for females, a difference of 6.7 years, whereas in France it was 7.8 years and in the U.K., 5.3 years.The discrepancy was much greater in some countries, with the difference in Russia reaching more than 12 years,but in others, such as India (0.6 year) or Bangladesh (0.1 year), it was much less.The diversity in worldwide longevity alone indicates that the difference in mortality between the sexes is notpurely biological and that there are intervening social factors.
The current range of situations actually reflectsdifferent stages of a three-part historical evolution. Women most probably have a biological advantage that allowsthem to live longer, but in the past--and in several places, still today--the status and life conditions of womennullified this benefit. Today, given the general progress in female life conditions, women have not only regainedtheir biological advantage, but have gone much beyond it, both because they tend to engage in fewer behaviorsthat are bad for health than men do and because they better profit from current advances in health care and livingconditions.The biological advantage that women have is taken as a certainty, because the mortality of males is higherthan that of females from the very outset of life: during the first year of life, in the absence of any outside influencewhich could differentiate mortality between the sexes, male mortality is 25 to 30 percent greater than is femalemortality.
The genetic advantage of females is evident. When a mutation of one of the genes of the X chromosomeoccurs, females have a second X to compensate, whereas all genes of the unique X chromosome of malesexpress themselves, even if they are deleterious. More generally, the genetic difference between the sexes isassociated with a better resistance to biological aging. Furthermore, female hormones and the role of women inreproduction have been linked to greater longevity. Estrogen, for example, facilitates the elimination of badcholesterol and thus may offer some protection against heart disease; testosterone, on the other hand, has beenlinked to violence and risk taking.
Finally, the female body has to make reserves to accommodate the needs ofpregnancy and breast feeding; this ability has been associated with a greater ability to cope with overeating andeliminating excess food.Even though many biological and genetic factors have been identified, their overall effect is impossible tomeasure, especially given the influence of social factors on mortality. The extraordinary economic and socialprogress, that has occurred since the 18th century, has been accompanied by a dramatic reduction of the socialdifferences between men and women and of the burden of motherhood, which had previously negated women'sbiological advantage. But the recent mortality trends have gone much farther than the mere recovery of an originaladvantage, creating instead a new advantage of greater magnitude for women.
Observations indicate that thegrowing excess male mortality in industrial countries could be explained by the rise of so-called "man-madediseases," which are more typically male. These include exposure to the hazards of the workplace in an industrialcontext, alcoholism, smoking and road accidents, which have indeed increased considerably throughout the 20thcentury.2The measure of life expectancy at birth is a statistic that represents the expected duration of life for babies born during a giventime period, usually one calendar year. Calculated from death rates observed at every age, it is based on the critical assumptionthat the age-specific risks of death observed during a given year will prevail for all babies born in that year, for the remainder oftheir lives.
In contrast, life span is the theoretical upper limit to life that would be observed if everyone in the population adoptedideal lifestyles from birth to death and if external threats to life were eliminated. Some researchers believe that there is nobiologically determined life span per se, but rather a series of time-dependent physiological declines that may eventually besubject to modification (Encyclopedia of Bioethics, 2004, p.98)46But if these diseases are the only explanation for longer female life expectancy, why has the gap continuedto grow even though male and female behavior and life conditions have been converging in recent years? Part ofthe paradox can certainly be explained by the fact that this convergence is not absolute: male smokers tend tosmoke more cigarettes than female smokers do, and men drive more recklessly than female drivers do, forinstance.French demographer Jacques Vallin has long been monitoring longevity in general and sex differences inmortality in particular.
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