People’s Pharmacy: Dill pickle juice can soothe aches and pains. 2D
HealthToday
T H U R S D A Y , O C T O B E R 4 , 2007
SECTION D
WWW.TUSCALOOSANEWS.COM
TREATMENTS
Nurses’ cultural competence
ORLANDO, FLA. | As a nurse in Kuwait for five years, Cini Thomas had never cared for a male patient. Now, having worked for 1½ years as a bonemarrow-transplant nurse with Florida Hospital, Thomas says she feels as comfortable caring for an American male patient as the next nurse. As populations become more diverse, nurses and other healthcare professionals have recognized the need for “cultural competence’’ — gaining a better understanding of patients from different backgrounds. Efforts to increase cultural competency for nurses have grown across the country, especially in states such as Florida, a place that people from many different cultures call home. Experts say that 10 years ago cultural competence meant avoiding stereotypes. Today, nurses work to understand patients’ cultures and beliefs to make them as comfortable as possible with the care they receive. “The nurse is sort of what we call the ‘cultural broker,’ ’’ said Willa Fuller, executive director of the Florida Nurses Association. “It’s knowing how to ask the right questions and how to observe.’’ That extends beyond speaking the same language. “You don’t want to say the wrong thing in the wrong way,’’ said Larry James, president and chief executive officer of the Center for Multicultural Competence in Healthcare Organizations, an independent organization based in Ohio. “Keeping distance between people, looking directly or looking away — all of those are cues for respect and dignity and receptiveness that need to be addressed. It’s not one size fits all in health care.’’ Florida Hospital has more than 200 international nurses, said Saji John, international recruitment manager. John said the hospital has had a training program for three years, developed especially for nurses from overseas, to help acclimate them to the United States and its patients. “It takes time to adjust to another country,’’ John said. “It’s a bit difficult in the beginning, but they learn pretty quick.’’ Maureen Johnson, a registered nurse and regulatory consultant for Orlando Regional Healthcare, said she helped create a packet of information to help nurses work with patients who have different backgrounds. She said the emphasis on cultural competence is much bigger than it was in the past. Nationally, the Office of Minority Health announced a free Web-based continuing education program in April to help nurses. Experts say the benefits of such programs are many — not only are patients more likely to relate to a nurse from a similar cultural background, but nurses get the opportunity to learn about others’ cultures and traditions. — McClatchy-Tribune News Service
TIP HEALTHY KNEES
More than 10 million Americans suffer from osteoarthritis of the knee, making it the most common form of arthritis in the United States. When the cushioning layers of cartilage are worn down, the bones begin to rub against each other, leading to swelling and increased stiffness. It can make many routine daily activities painful and difficult. But there are some things you can do to reduce the symptoms. The American Arthritis Society has some self-care tips focused on the knee: ■ Select good shoes, avoid high heels and don’t wear sandals. ■ Walk on flat terrain when possible. ■ For exercise, try a bicycle instead of walking. ■ Use elevators instead of stairs. ■ Avoid standing for too long. ■ Stretch your legs while seated. For more tips, visit www.american arthritis.org.
DON’T LET WORK GO TO YOUR
HEAD Getting depression treated quickly helps workers as well as company By Lindsey Tanner The Associated Press
CHICAGO nvesting in treating depressed employees — quickly getting them help and even offering telephone psychotherapy — can cut absenteeism while improving workers’ health, a study suggests. Many employers view mental health coverage as a financial black hole, but the study shows that spending money on depression is a smar t business move, said researcher Dr. Philip Wang. Wang works
I
93%
employees retained when businesses provided mental health care
88%
employees retained when businesses didn’t provide mental health care
$30 billion
estimated loss of productivity associated with mental depression
for the National Institute of Mental Health, which funded the study. Employees who got the aggressive inter vention worked on average about two weeks more during the yearlong study than those who got the usual care — advice to see their doctor or seek a mental health specialist. Also, more workers in the intervention group were still employed by year’s end — 93 percent versus 88 percent — savings that helped employers avoid hiring and training costs, the researchers said. In addition, intervention employees were almost 40 percent more likely to recover from depression during the yearlong
study, which is reported in the Journal of the American Medical Association. The researchers haven’t finished a formal cost-benefits analysis but early results suggest savings from more hours worked averaged to about $1,800 per employee. That far exceeds the program’s initial $100 to $400 per worker cost. The benefits also likely exceed SEE STRESS | 3D
STAFF ILLUSTRATIONS | ANTHONY BRATINA
FITNESS
About the ‘freshman 15’ Myth or fact? Unlimited access to all-you-can-eat dining halls. Late-night partying and pizzas. Studying fueled by high-fat snacks.
College lore has it that students — especially women — pack at least 15 pounds that first year away from home. But the “freshman 15” may be a myth. Although studies have involved only small groups of students on individual campuses, most suggest the majority of students gain 3-10 pounds during their first two years of college, and that some actually lose weight. One study found that males piled on significantly more pounds than females. Still, doctors are concerned that students who gradually put on pounds are establishing a pattern of weight gain that could spell trouble if it continues. The propensity for the “freshman 5 to 7’’ to be followed by the “sophomore 2 or 3’’ prompted Brown University researchers to dub today’s college students “Generation XL.’’ Small lifestyle
changes can make a difference. A 2006 Rutgers study found that all it took for freshmen to gain 7 pounds over two semesters was about 112 extra calories a day. That’s one soda or half a cookie a day, or 10 minutes less of exercise, the researchers pointed out. Another study found that food eaten between 8 p.m. and 4 a.m. was a leading contributor to weight gain. To avoid gaining weight, students should eat breakfast, keep an exercise routine and limit alcohol (a 12-ounce beer contains 150 calories). Chartwells Dining Services, which provides the food services at 230 college campuses maintains a Web site — www.dineoncampus.com — that lists the calorie and fat content of hundreds of foods. The site helps students calculate their body mass index and the number of calories they naturally burn each day. Students also can create a food journal on the site, which will keep a running total of what’s been consumed for the day, week or month. — McClatchy-Tribune News Service
CHRONIC AILMENTS
Heart patients’ surgery guides
The nation’s two leading heart groups have issued new guidelines about what should be done for patients with heart disease before they have surgery on other parts of the body. The aim is to reduce a heart patient’s risk of complications during and after an operation. The recommendations were based on a critical review of studies, particularly those published since the two groups’ last guidelines in 2002. A panel of experts from the American College of Cardiology and the American Heart Association wrote the guidelines, which affect the quality and cost of care. The guidelines, 82 pages long, cover a number of wide-ranging medical issues. One is whether to stop taking certain prescribed drugs before an operation. Another is whether to implant stents or perform coronary bypass surgery before conducting other types of elective surgery. The decisions depend on the urgency of the operation, its type and risk, a patient’s general ability to function and the hospital where the surgery is performed, the panel said. Although the safety of surgery for heart patients has improved in recent years, problems affecting the heart and blood vessels are the most common and treatable complications of nonheart operations. For example, patients have a 40 percent to 70 percent increased risk of dying if they have a painful heart attack after surgery, the panelists wrote. If heart patients need emergency non-heart surgery, doctors should forgo heart testing and send a patient straight to an operating room, said the panel’s chairman, Dr. Lee A. Fleisher, chairman of anesthesiology and critical care at the University of Pennsylvania School of Medicine. But many people with heart disease can safely undergo non-emergency operations without first undergoing the extensive testing that is common practice. Doctors often do many screening tests and then repair the heart problem to prepare the patient for non-cardiac surgery. For example, doctors often perform an artery-opening procedure and implant a stent or do a coronary bypass operation. The panel said such interventions are rarely necessary to lower the risk of non-heart surgery unless a patient needed the intervention. The guidelines recommend that patients undergo evaluation and treatment before non-cardiac surgery only for active heart problems like severe angina, late-stage heart failure, serious heart-rhythm abnormalities (arrhythmias) and severe heart valve disease. The guidelines also say new studies show that patients should not stop taking the cholesterol-lowering drugs called statins before surgery, an issue not addressed in earlier versions. Another recommendation concerns the use of anti-clotting drugs that patients take after they have received a stent. In the past, such patients were advised to stop taking such drugs before surger y because of the risk of bleeding. Newer information shows that anti-clotting drug treatment is important after stent placement, and the guidelines urge patients to stop taking such drugs for as short a time as possible. The panel said that for many people the need for non-heart surgery is their first chance to receive evaluation for the risk for heart disease. In analyzing the published studies, the panel found that most were too small to provide meaningful statistical results, increasing the difficulty of making recommendations. “A lot of the studies should never have been star ted or published,” Fleisher said in an interview. The panel also urged researchers to conduct sufficiently large clinical trials to clarify areas where data is lacking. Among them are the safety and effectiveness of starting and stopping drugs like aspirin, statins and beta blockers before surgery. The guidelines will be published in the Oct. 23 issue of the heart association’s journal, Circulation. — N.Y. Times News Service