The El Paso Collaborative Health Literacy Curriculum Introduction
2
Lessons
3
Diabetes Breast Health Menopause Lead Poisoning Household Hazards Nutrition Fact Sheets and Other Handouts Diabetes Fact Sheet Breast Health Fact Sheet Menopause Fact Sheet Las Yerbas y la Monopausia Lead Poisoning Fact Sheet Household Hazards Poem Household Hazards Disposal List Household Cleaner Alternatives Other Support Materials Online Resources The Five-Step Model Ideas for Collaborating with Health Organizations
4 6 9 11 13 17 19 20 25 29 32 34 37 38 39 41 42 44 49
Introduction The following health literacy lessons were developed by different staff at the El Paso Community College/Community Education Program (EPCC/CEP). All the lessons were developed using the EPCC/CEP Five-Step Model. They were developed with different funding sources. Funding sources include Laubach/Women in Literacy/USA, Pfizer, and EPCC/CEP. The lessons were developed to meet the educational and health needs of students attending classes in our program at a particular period in time. They were developed in a specific context. (For example, some of the health information we used is in Spanish.) The needs of the students and the information and services available to them may vary from community to community. Therefore, these lessons should serve as a guide. Some may be replicable in their entirety in certain communities, while others may not. For some of the lessons, teachers will need to find an appropriate brochure or handout for the reading activity. Local health clinics or hospitals may have some. There are also suggestions in Online Resources for handouts and additional information. The Health & Literacy Special Collection is another source for health information or brochures. Find it at: www.worlded.org/us/health/lincs Teachers should work collaboratively with the students and local entities to determine health needs and available resources. For more information on forming collaborations with health entities in your community, please see Ideas for Collaborating with Health Organizations. While the lessons may not be entirely replicable, the Five-Step instructional model is. We recommend that teachers become familiar with the Five-Step Model when they look at lessons and when they deliver health literacy instruction.
2
LESSONS
Diabetes
4
Breast Health
6
Menopause
9
Lead Poisoning
11
Household Hazards
13
Nutrition
17
3
DIABETES Introduction: This lesson will enable the students to learn more about Diabetes Mellitus. They will discuss: Who develops diabetes What are the symptoms How to naturally help control diabetes
Critical Discussion: Use the Diabetes Fact Sheet to guide a discussion about diabetes. The fact sheet can be used to follow along as the instructor guides the discussion, or the students can divide into groups to study the fact sheet and present what they learned.
Reading Activity: After the instructor or student groups have presented, have students form small groups and review the entire Diabetes Fact Sheet in case they didn’t grasp some of the information. Then have the students read any additional handouts found from local organizations or the Online Resources.
Writing Activity: In the same small groups have students work on the Diabetes Risk Test. If your class has access to the Internet, you can use the Online Diabetes Risk Test. Both are also available in Spanish.
Group Activity: In the same small groups or individually, students need to review the factors that contribute to their own risk of developing diabetes. Have them write about ways that they can lower their risk of diabetes (for example: maintaining healthy weight, reducing physical and emotional stress and including exercise in their lives.)
4
Action Activity: Have students make an appointment to check their blood glucose level. Make sure they ask about the fasting guidelines they must follow before the test.
Handouts And Brochures Needed:
Diabetes Fact Sheet Other brochures found from local organizations or Online Resources Diabetes Risk Test Online Diabetes Risk Test
5
BREAST HEALTH Introduction: The breast health component will educate the students on the following breast cancer issues:
Probability Risk factors How to do breast self-exams Pros and cons of mammograms Healthy lifestyles that can help reduce the risk of breast cancer An orientation to national and local health advocacy organizations
Critical Discussion: Use the Breast Health Fact Sheet to guide a discussion about breast health. The fact sheet can be used for students to follow along as the instructor guides the discussion, or the students can divide into groups to study the fact sheet and present what they learned.
Reading Activity: Have students form small groups and read through the Breast Health Fact Sheet after the instructor or student groups have presented the information. This will give the students a chance to review any information that they did not grasp. Then have students read through the brochures on how to perform a Breast Self-Exam. If possible, try to find the brochures in English and some other of the students' native languages. You can also use other brochures from local health clinics or national organizations about breast cancer or mammograms.
6
Writing Activity: Have the students write a short essay addressing their fears and concerns about breast cancer or any other serious health condition. Ask them to think of some ways in which they can help prevent these conditions. Encourage them to write about some of the positive habits and/or lifestyle changes they can make to improve their health. Ask them to address the risk factors that they believe are possible to change( i.e. diet, exercise, reducing weight, stress reduction, etc.)
Group Activity: Have the students watch the video “Women Take Care… Take Action.” Then have students form small groups and discuss the video’s impact. OR: Use the story Breast Cancer As I Lived It (available in English and Spanish). Have the students take turns reading parts of the story aloud. Then form small groups and discuss the impact of the story. OR: Divide the class into two groups (although they will do the activity as a whole class). One group will be in favor of getting regular mammograms and/or encouraging the women in their lives to do so. The other group will be skeptical. Have the groups stay in character and discuss the pros and cons, benefits and fears of mammograms.
Action Activity: Identify some local or national organizations that do advocacy for cancer, breast cancer, or women's health. Then have the students, individually or in small groups, write letters to one or more of the organizations to obtain more current information on this subject. The materials they receive can be used in a research paper, and/or further presentation. This is also an excellent opportunity for the students to become aware of advocacy programs. (You may want to use some of your own materials on proper letter format. This is also a good time to review address abbreviations and proper letter labeling when they send their letters to the following organizations.)
7
Handouts And Brochures Needed:
Breast Health Fact Sheet Other brochures from local organizations or Online Resources The video "Women Take care…Take Action" (See below) The story Breast Cancer As I Lived It (See below) A list of local or national advocacy organizations that work with cancer, breast cancer, or women's health.
Women Take Care…Take Action This video was published in 1993 by the Massachusetts Cancer Education and Literacy Initiative. It was designed to educate literacy students about mammography, breast self-exam, and pap smears. The set includes the video, a viewer's guide in the form of a photonovella, and a teacher's guide. It is available at cost from:
World Education 44 Farnsworth St. Boston, MA 02210 (617) 482-9485
You can inquire by phone or e-mail the HEAL:BCC Staff Associate, Caye Caplan at:
[email protected]
Breast Cancer As I Lived It This true story, by an adult learner named Mary Scanlon, is available online at the following addresses: English: http://www.worlded.org/us/health/docs/mscanlon2/
Spanish: http://www.worlded.org/us/health/docs/mscanlon/ 8
MENOPAUSE Introduction: The students will learn about menopause. They will discuss the pros and cons of allopathic and natural remedies to alleviate menopausal conditions and discomforts.
Critical Discussion: Use the Menopause Fact Sheet to guide a discussion about menopause. The fact sheet can be used by students to follow along as the instructor guides the discussion, or the students can divide into groups to study the fact sheet and present what they learned. Following are some guiding questions to use for the discussion: What do you know about menopause? What are some of the myths and stereotypes about menopause?(for example: menopause is a curse, wild woman, depression, anger, not sexual) How can you compare this to the idea that menopause is a time of growing wisdom, confidence, financial security, freedom from raising children and the worries of birth control, mental calm and stability. How is menopause viewed in your home culture or home country?
Reading Activity: After the Critical Discussion presentation, have students read another handout or brochure found from local organizations or the Online Resources. If your students speak Spanish, they can read Las Yerbas y La Monopausia.
Writing Activity Using the Menopause Fact Sheet and the readings from the Reading Activity, have students write letters to the “editor” on their menopause beliefs and what they believe is the right approach to menopause (i.e. HRT, natural remedies, nothing, etc.).
9
Group Activity Act out small skirts demonstrating the positive and negative stereotypes around menopause. How do our beliefs reflect on our culture’s view on women and aging in general?
Action Activity Have students conduct an informal oral history report with an older woman. Have them ask her about the positive and/or negative changes she has felt, changes in family’s attitude, changes in community’s attitude.
Handouts And Brochures Needed: Menopause Fact Sheet Other readings found from local organizations or Online Resources Las Yerbas y La Monopausia.
10
LEAD POISONING Introduction: The students will learn about the dangers of lead poisoning, the common symptoms, where it is found, and what they can do to reduce the risk of lead poisoning in the home.
Critical Discussion: Pass out the Lead Poisoning Fact Sheet (click below). Divide the class into small groups and each group will be responsible for presenting one of the sections A-E. Try to find and distribute the following additional handouts: 1.) a brochure on lead poisoning, 2.) a handout on foods rich in iron and calcium, and 3.) a list of local clinics that provide free or low cost blood tests. (Try local organizations and the Online Resources.) The students should present their sections with writing and drawing samples and skits. Encourage the students to discuss their section before beginning the presentation preparation.
Reading Activity: The students will be reading the Lead Poisoning Fact Sheet and other handouts as part of the “Critical Discussion” presentation activity.
Writing Activity: The students will be writing, drawing and creating skits as part of the “Critical Discussion” presentation activity
Group Activity: The student groups will make their presentations. Make sure each student has the complete Lead Poisoning Fact Sheet and the other handouts. Students should follow along with these materials as the other groups present. At the end of each presentation, the students should have time to clarify any vocabulary or concept before moving on.
11
Action Activity: Have the students call the state and local health department or local clinics to find out where they can access free or low cost lead poisoning blood tests. This is an excellent opportunity for the students to become more involved with their community, more aware of the services available, and make them the active participants in their families’ health.
Handouts And Brochures Needed: Lead Poisoning Fact Sheet Lead poisoning brochures found from local organizations or Online Resources A list of local clinics that provide free or low cost blood tests (this needs to be researched by the instructor)
12
HOUSEHOLD HAZARDS Introduction: The students will learn about hazardous household products with the following questions in mind: How can dangerous products in your home have an impact on your physical health? What do we know about such dangers and what are our consumer rights? What is the environmental impact of these products on a local and global level? Is there a lack of corporate responsibility when it comes to household hazards? The students will also create different “plans of action” and learn about alternatives to the hazardous household products that we are exposed to every day.
Critical Discussion: The instructor should post the following questions to the students. How do dangerous products in your home have an impact on your physical health? What do we know about such dangers and what are our consumer rights? What is the environmental impact of these products in the community and for the earth? Is there a lack of corporate responsibility when it comes to household hazards? Clarify terms like: household hazards, consumer rights, environmental impact, etc.
Then the instructor can continue with the following questions, or small groups of students can be responsible for reading the question to the class and facilitating the answer period on the board. If the second option is chosen, copy each question on notecards and the student groups can have time to read and thoroughly comprehend the question before presenting and facilitating.
13
What household products do you use (including garage and garden)? Are any of these products dangerous to your health (for example: if you ingest it, if it gets on your skin or into your eyes, or from smelling the fumes)? Have you or your family experienced any accidental poisoning in your home (for example: nausea dizziness, vomiting, coughing, blacking out, getting light headed, rashes or sores)? Are you aware of any dangerous product combinations (for example: chlorine bleach and ammonia)? When you are finished with these products, where do you dispose of them? Household hazardous wastes contain dangerous chemicals. Where do the chemicals go when they are thrown into the dump? (If the students are unable to answer this question, the instructor should help them out and draw a simple diagram of chemicals leaching into the ground and explain how it can affect our underground water sources) Who sells us these products? Are they responsible for accidents that happen to consumers? Are these products too toxic for you and your family? For your neighbors, your community, animals, water systems, the whole ecosystem? What products can we eliminate? What products are necessary in our lives?
Reading Activity: Most areas should have a time and place set aside for residents to bring their hazardous household waste. Try to find out if there is a household hazards "Drop-off Day" in your area, and when it happens. You can find out from your local Public Works Department. Before the reading activity begins, explain how this "Drop-off Day works. Have the students read the handout with the Poem and the Household Hazards Disposal List, which lists products that can be safely disposed of at such a “Drop-Off” day (click below).
14
Writing Activity: The students should write a short essay on a dangerous spill, intoxication or ingestion that has happened in their home, garage, garden or workplace. Have them describe what was done to remedy the situation. Then have the students read their stories to the class.
Group Activity: As a class, or in small groups, have the students brainstorm on safer, cheaper and effective household alternatives. They should draw on family, cultural and national alternatives to the products sold at stores in the U.S. What did their parents and grandparents use? Do they use different products here than in their home countries? Then give the students the Household Cleaner Alternatives handout to compare with the list that they have compiled.
Action Activity: Student should go home and assess the harmful products in their home and workplace. They should develop a plan of action to phase out dangerous products and switch to safer, more economic and environmentally friendly alternatives. Have the students post their plans of action the following day to compare ideas. OR: Have the students write a letter to the City Recycling Program or the Department of Solid Waste and ask for a “Household Hazardous WasteDrop-Off” day. (explain to the students that in some areas, such an event comes only once every two years because of lack of funding) In their letters, the students should explain the importance of having a facility for dropping off batteries, cleaning fluids, anti-freeze and much more. They can also write about their concern for the safety of their families, communities, and the environment when they have no other choice than to dump these substances into a city or county dump.
15
Handouts And Brochures Needed:
Information on local household hazard "Drop-off Days" Poem Household Hazards Disposal List Household Cleaner Alternatives
16
NUTRITION Introduction: The students will discuss the benefits of healthy eating habits and brainstorm on economic and realistic dietary changes for themselves and their family.
Critical Discussion: The instructor should facilitate these questions: What are the benefits of healthy eating habits? What are some of the diseases and ailments associated with a high fat, low nutrient diet? (heart disease, diabetes, obesity, cancer, etc.) Is it difficult to change bad eating habits? Why? How do family and cultural traditions make it difficult to change eating habits? Does it cost more money to eat well? Does it take more time?
Reading Activity: Have students read the handout on the Food Pyramid, and a handout about different cooking methods (found from a local organization or Online Resources.) Discuss both handouts to be sure they understand the concepts of portions and categories in the Food Pyramid, and which cooking methods are healthier.
Writing Activity: On notecards, have the students write down the recipe for their favorite food or snack. Encourage them to use descriptive words to explain the taste, smell, texture and smell of the food. Also ask them to put down the origins of the food (plant from the ground, dairy product from a cow or goat, etc.) This is also a good time to review measurements and fractions as part of the recipe.
17
Group Activity: On the board, from top to bottom, instructor should write down soda, beer, coffee, potato chips, candy and chocolate, french fries, sweet bread and any other ideas from the students. Then draw a parallel column and have the student fill in healthier alternatives to foods and beverages contained in the first list. The instructor may want to begin the activities with some of the ideas below, then let the students complete the activity on their own. Coffee Hot chocolate Soda Potato chips Candy and chocolate French fries Sweet bread
Herbal tea (with a little lemon and honey) Herbal tea (with a little lemon and honey) Mineral water, seltzer water, real fruit juice Pretzels, low fat tortilla chips (tostadas), chopped vegetables Dried fruit and nuts in moderation, low fat granola Baked potato Whole wheat toast with peanut butter or low-sugar jam/fruit preserves
Ask students about the alternative cooking methods that were explained in the brochures. With this review and the above activity the students should now be ready to critique the recipe cards they completed in the “writing activity.” Shuffle the recipe cards and have every student read one card to the class and make some healthy variations to the recipe.
Action Activity: Have the students write down every meal and snack for 1-3 days. Then come back and have the students review their peers’ eating habits. What realistic changes have been made or what changes can be made in the future?
Handouts And Brochures Needed: Handout on the Food Pyramid Handout about different cooking methods found from a local organization or Online Resources.
18
FACT SHEETS AND OTHER HANDOUTS
Diabetes Fact Sheet
20
Breast Health Fact Sheet
25
Menopause Fact Sheet
29
Las Yerbas y la Monopausia
32
Lead Poisoning Fact Sheet
34
Household Hazards Poem
37
Household Hazards Disposal List
38
Household Cleaner Alternatives
39
19
Diabetes Fact Sheet Diabetes is a condition when the body cannot use foods correctly. Normally, food is digested and broken down into a sugar called glucose that the body uses for energy. When the glucose in the blood rises after eating, then a gland called the pancreas releases insulin into the bloodstream. Insulin is made by the pancreas and is very important. The insulin helps the glucose go from the blood into the cells of the body for energy to use later. A person with diabetes does not make enough insulin, or has insulin that does not work as well as it should. If a diabetic does not get medical care, the amount of glucose in the blood rises above normal. Then the cells of the body cannot use the important glucose for nourishment.
A.
What is a normal fasting level of blood glucose? It is approximately 60 to 115 milligrams/100 milliliters
B.
What do hyperglycemia and hypoglycemia mean? Hyperglycemia is a higher than normal blood glucose level. Hypoglycemia is a lower than normal blood glucose level.
C.
Who is at risk for diabetes? There are over 14,000,000 people with diabetes in the United States. The high-risk populations are: Native American Hispanic/Latino African American White/European decent
1 in every 5 1 in every 6 1 in every 8-10 1 in every 12-15
20
D.
What causes diabetes? We do not know exactly what causes diabetes. Factors that contribute to the risk of diabetes are:
E.
Heredity (family history) Obesity (being overweight) Pregnancy (gestational diabetes) Physical stress Emotional stress Aging
Are there different kinds of diabetes? There are three types of Diabetes: 1. Type I - Insulin dependent diabetes: This usually happens between birth and age 18. The pancreas produces little or no insulin and daily insulin injections are needed. A good diet and exercise are important to maintain good health. 2. Type II – Non-insulin dependent diabetes: This usually happens after age 40. Normally, the pancreas continues to produce insulin and the person can treat the condition with a nutritious diet and regular exercise. 3. Gestational Diabetes: This sometimes happens in women during pregnancy. There are possible complications for the mother and child during labor and after the birth.
REMEMBER: DIABETES CAN BE CONTROLLED WITH A GOOD DIET AND REGULAR EXERCISE!
F.
What are the symptoms of diabetes?
Sugar, or glucose, usually appears in the urine when the blood glucose level reaches 180 milligrams/100 milliliters. Increased urination (polyuria): because the body tries to get rid of excess sugar. Water is taken from the tissue to make more urine. 21
Excessive thirst (polypidsia): because the body tries to replace the waste that has been eliminated. Fatigue, weakness, and weight loss: because the body cannot use or store glucose for energy. Increase in appetite (polyphagia): because the body wants more energy in the form of food. Other symptoms include: infections, slow healing, itching, numbness, pain or tingling in hands or feet, changes in vision, vaginal infections, sexual dysfunction.
G.
If diabetes is ignored, can it lead to more serious problems? Definitely yes! You must talk with your doctor or health care provider to help you manage this disease. It is also important to eat well and exercise regularly. By doing these things, you can prevent or slow down the following complications:
H.
Blindness Kidney failure Amputations (due to poor circulation) Heart disease Birth defects (gestational diabetes) Difficult labor and birth for mother and child Premature death Disabilities
How can you control diabetes? 1.
Exercise: Exercise can delay or prevent amputations of limbs and other diabetic complications. A person with diabetes often has poor circulation. Exercise can help improve circulation.
2.
Well Balanced Diet: A nutritious diet, low in sugar, helps stabilize the function of the organs. A good diet consists of many fresh vegetables and fruits and does not contain a lot of
22
fat. The diabetic diet should also include foods with these vitamins and minerals: manganese vitamin B12 (Riboflavin) zinc Manganese helps with glucose metabolism. Diabetics have about half the manganese found in people without diabetes. Foods rich in manganese: Avocadoes Barley Beans Blackberries Bran Buckwheat Coffee
Ginger Nuts Oatmeal Peas Seaweed Spinach
Vitamin B12 helps release energy from food. It also preserves the integrity of the nervous system, eyes and skin. It also seems to decrease the craving for sugar. Foods rich in vitamin B12: Almonds Beef Brewer’s Yeast Cheese
Chicken Kidney Liver
Zinc deficiencies have been found in diabetics. Zinc is essential for making insulin. Remember, insulin is the hormone responsible for maintaining normal glucose levels in the body. Foods rich in zinc: Egg yolk Fish Lean beef Milk Oysters Pork
Soybeans Turkey Wheat bran Wheat germ Whole grains
23
I.
How can you prevent serious diabetic complications?
1.
Good hygiene is an important method of prevention. It is very important to take care of the feet. Diabetics can have more infections and poor circulation. This can cause serious infections in the extremities like the hands and feet. It is also very important to take care of the teeth and gums. Diabetics should brush their teeth several times a day with a soft toothbrush.
2.
Regular eye exams are also very important. Diabetics often have problems with retinopathy. The retina of the eye leaks fluid or blood. This can damage the eyesight and result in blindness. 6-80% of diabetics that have suffered from diabetes for 15 or more years have retinopathy. Many times, there are no early symptoms. No pain and no changes in vision until the disease is at a severe level. Other vision conditions like glaucoma and cataracts can occur if the diabetic individual does not get medical attention.
J.
What other health problems are related to diabetes?
Type II diabetics have a higher risk of heart disease than non-diabetics. Men have 2-3 times the rate of heart disease Women have 3-7 times the rate of heart disease
K.
Questions to ask your health care provider:
How can Vitamin A help improve the effects of retinopathy? Why does Vitamin E appear to worsen diabetic eye disease?
L.
Diabetes remedies of Mexico Huereke – a root taken twice a day, grows in the sierra and is sold around Camargo, Chihuahua. People with Type II diabetes say this helps balance their glucose blood levels. Tronadora – unknown source and specific use Talbutamida – unknown source and specific use
24
Breast Health Fact Sheet A. How does breast cancer begin? A small group of abnormal cells, called a tumor, forms in the breast. The abnormal cells grow and invade normal cells. Cells can separate from the tumor and travel through the blood and lymph system to other parts of the body.
B. What are some of the symptoms? Swollen or enlarged blood vessels in one breast A lump or dent in the breast or armpit Abnormal discharge from the nipple (for example: bloody, brown or green liquid) Flaking or red, rough skin around the nipple Swollen breasts or recent changes in the shape, size, color or contours of the breasts If you have any of these symptoms, make an appointment with your health care provider. Remember, these symptoms could also be caused by other health problems and may not be cancer. Often there are no symptoms until a tumor has grown quite big. This is why it is important to get checked regularly, even if you don’t notice any changes. Finding a tumor before it gets big can save your life.
C. Who is at risk?
Previous history of cancer (breast, ovary, colon, endometrium) Mother or sister with breast cancer (family history) 40 years or older No pregnancies, or 1st pregnancy after age 30 Diet high in fat (whole milk, fried foods, lard, fatty meats) Benign breast disease ( a growth or lump that was not cancer) Have had frequent chest or breast x-rays with heavy radiation 25
Started period before 12 Began menopause after 50 Overweight Studies show that breast cancer may be related to a woman’s length of exposure to her own hormones (estrogen and progesterone)
If a woman has had more years with her menstrual cycle (1. She started her period before age 12; and/or 2. She began menopause after age 50) then she will be exposed to more female hormones during her lifetime. Before menopause, a woman’s fat deposits produce 1/3 of her estrogen hormone. If she is overweight, she produces a higher quantity of estrogen.
D. Are breast cancer rates related to ethnic background? Studies show that women in certain ethnic backgrounds have a higher probability of getting breast cancer. However, these are only studies. Everyone is responsible for their personal health, regardless of the high or low probability in their ethnic group. Age adjusted Rates per 100,000 women (in order of probability/American Health July/August 1996) White (European descent) Native Hawaiian Black (African American) Japanese Alaska Native Filipino Hispanic (Latino and Chicano) Chinese Vietnamese American Indian Korean
115.7 105.6 95.4 82.3 78.9 73.1 69.8 55.0 37.5 31.6 28.5
Breast cancer is the most common type of cancer in all these groups except Vietnamese women. Their most common cancer is cervical cancer.
26
E. What can you do? It is important to do a Monthly Breast Self-Exam. Every year you should receive a Well-Woman Exam. Your health care provider checks your blood pressure, lungs, blood, and urine. She also examines your pelvis, performs a Pap smear and does a Clinical Breast Exam. Your health care provider also teaches you how to do your Monthly Breast Self-Exam.
F. At what time of the month should you do the Monthly Breast Self Exam? Do the exam 7-10 days after your menstrual period because many women experience breast tenderness during their period. If you do not have a period anymore, do your exam the 1st of every month.
G. What is a mammogram? Should you get one? A mammogram is a low-dose x-ray of your breast. The x-ray can detect early cancers that a Breast Self-Exam and Clinical Breast Exam cannot find. The American Cancer Society recommends the following schedule for women: Between the ages of 35-39: only one time Ages 40-50: every 1-2 years Over age 50: every year
H. What are the Pros and Cons of a mammogram? (From "American Health": December 1996) Pros Earlier diagnosis of fast growing tumors Makes women feel more secure Establishes a baseline, future mammograms can be compared
27
Cons Accuracy is a problem with dense breast tissue of young women False sense of security from mammograms. Breast Self-Exams are ignored Multiple biopsies can cause tiny scars, they could appear suspicious in future mammograms
28
Menopause Fact Sheet
A.
What are the main symptoms and/or conditions of menopause?
hot flashes mood swings vaginal dryness fatigue
abnormal uterine bleeding depression osteoporosis weight gain
Some women feel no symptoms or conditions, others feel one or two, and others feel many of them.
B.
Hormone Replacement Therapy(HRT)
A common treatment of these symptoms and conditions is called Hormone Replacement Therapy (HRT). This section will look at the benefits and risks of this treatment Proven Benefits of HRT: Relieves hot flashes Reduces bone loss Relieves vaginal dryness and atrophy Possible Benefits of HRT:
Improves cholesterol Reduces risk of colon cancer Reduces mood swings, mental fogginess, and memory lapses Keeps skin and blood vessels more resilient
Proven Risks of HRT: Increases incidence of cancer of the endometrium (if HRT does not have progesterone or progestin) With progestin, menstrual period can return Premenstrual Syndrome (PMS) symptoms 29
Possible Risks of HRT:
Higher rate of breast cancer Abnormal blood clots Weight gain Increased risk of gallstones Headaches Increased growth of benign fibroid cysts in the uterus
10% of women who use HRT also experience:
Breast tenderness Fluid retention Swelling Mood changes Pelvic cramping
Other HRT affects are:
Nausea More yeast infections High blood pressure Liver disorders Blood sugar problems
At nine months, 1/3 of the women who receive HRT stop the treatment because of side effects. At one year, ½ of the women who receive HRT stop the treatment because of side effects.
C.
Hormone Replacement Therapy and Breast Cancer
Studies have shown that women who use HRT have a higher risk of breast cancer. Used HRT for 5-9 years = 59% increased risk for breast cancer Used HRT between ages 65-69 = 70% increased risk for breast cancer
30
D. A good diet can make a difference These foods are good for everyone, especially women in menopause. Eat soy: Soy foods like soybeans and tofu contain phytoestrogens. These can help reduce hot flashes, improve moisture and health of vaginal tissue, increase bone mass and reduce cholesterol. Eat fruits, vegetables and legumes: Many fruits and vegetables contain phytoestrogens and bioflavonoids. Bioflavonoids help the circulatory system, which affects hot flashes, excessive menstruation and varicose veins. Fruits, vegetables and legumes with phytoestrogen: apples, carrots, garbanzo beans, garlic, green beans and peas. Fruits with bioflavonoids: citrus fruit, berries, cherries and grapes. Eat whole grains: These grains contain phytoestrogens: Oats, barley (cebada) and rye`(centeno) Other beneficial supplements: Eat flax seeds for a good source of omega-3 essential fatty acids. They also contain phytoestrogen and are good for your heart. Take Vitamin E orally and also apply to the skin (CAUTION: ask your doctor first if you have high blood pressure or diabetes)
E. Lifestyle Changes Do regular exercise – exercise can reduce hot flashes, stress, insomnia and mood swings Try to relax – hot flashes, insomnia, anxiety, difficulties in concentration and mood swings are stronger if you feel stress or anxiety Positive attitude -If you think menopause is terrible, you will feel terrible. -If you think menopause is normal and natural, you will feel that it is a normal and natural process. 31
LAS YERBAS Y LA MONOPAUSIA Aqui tienen una lista de algunas yerbas que se pueden usar para combatir los efectos molestos de la menopausia. Lengua de baca (yellow dock) – se usa para combatir la anemia, falta de hierro en la sangre Diente de leon o amargon (dandelion)- tambien usado para combatir la anemia Sarasamora (red raspberry) – se usa para ayudar a los musculos que apoyan al utero y los otros organos reproductivos a que esten fuertes y elasticos; demasiado te de sarsamora puede causar insomnio Gobernadora (chaparral) – se usa para purificar la sangre y el higado; la gobernadora es una planta muy fuerte y si se usa inadecuadamente puede ser venenosa Zumo de orozuz (licorice) – el jugo de esta planta contiene estrogeno cual le ayudara a tener efectos menos fuertes y tambien ayuda con la digestion Jengibre (ginger) – Usado para mejorar la circulacion y se dice que puede tomar te de gengibre para que le baje la regla mas rapidamente Pimienta o pimiento guindilla (cayenne pepper) – estos piemientos se usan para cocinar; se dice que ayudan con la circulacion y ayuda si sufre de manos o piernas frias; esta yerba es muy, muy fuerte Perejil (parsley) – esta yerba contiene mucho estrogeno y la puede comer o tomar en te; esta es una yerba muy fuerte Ortiga (nettle) – contiene calico y estrogenol ayuda con todo el sistema reproductivo y puede hasta que ayude a prevenir o retardar el procedimiento de la osteoporosis Manzanilla (chamomile) – en te, esta yerba ayuda a dormir y relajarse; tambien ayuda con reglas y colicos dolorosos
32
Salvia (sage) – despues de dar a luz y si ya la mujer no quiere dar pecho, se puede usar el te para parar la produccion de leche maternal Black cohosh - para bochornos, sequedad vaginal y depresion
AVISO IMPORTANTE: Si uno no sabe usar las yerbas es muy importante que no las use por que algunas formas de las yerbas son venenosas
33
Lead Poisoning Fact Sheet A. Lead poisoning can cause: Damage to the brain, nervous system, kidneys, red blood cells, bones and reproductive organs High blood pressure Mental retardation, learning problems, behavior problems During pregnancy, lead poisoning can affect the fetus. A pregnant woman could have a spontaneous abortion or the baby could be born with birth defects. Children are more vulnerable to lead poisoning than adults because of their size.
B. Lead poisoning symptoms are:
Stomachaches and cramps Vomiting Constipation Fatigue Irritability Poor appetite Insomnia
More serious symptoms and damage are:
Dizziness Paralysis Convulsions Loss of memory of recently learned skills(especially in kids)
34
C. Where do you find lead?
Peeling or chipped paint Window sills and on the floor near windows Batteries Lead pipes(water pipes) Bullets Folk medicines (like greta, azarcon, pay-loo-ah) Food grown in contaminated soil Lead glazed pottery and pewter dishes Old abandoned cars Leaded gasoline and the exhaust from cars using leaded gasoline Lead smelters
D. How do you prevent lead poisoning? Frequently wash your child’s hands. Give your children three nutritious meals and two snacks every day, the foods should be: rich in calcium and iron, this prevents lead absorption. low in fat. Fatty foods attract chemicals, metals and other toxins. Always wash all fruit and vegetables before eating. Always wash countertops and the table before preparing food. Clean up chipping and peeling paint. Clean lead dust from window sills and the floor near windows. Frequently wash children’s toys and pacifiers. Don’t keep food in open cans, pewter dishes or ceramic pots. Leave your shoes outside or near the door, so that lead dust isn’t carried in from the outside. If you work with metals or chemicals, you should bathe, change, and wash clothes before spending time with your family. Run water from the water faucet at least 30 seconds before using it, the metal deposits will go down the drain. Use cold water from the faucet for cooking or making formula. Hot water contains more metal deposits. Don’t use folk medicines that contain lead like Greta, Azarcon and Pay-loo-ah. 35
E.
What else can you do? Inspect your plumbing (lead is a dull gray metal, you can scratch the pipe with a coin). Talk to the water utility company for more information. Ask your doctor or clinic for a lead poisoning blood test.
36
HOUSEHOLD HAZARDS by Andrea Heckert I open my cupboards and drawers, and look into my garage… what do I see? Oven cleaners, batteries, furniture polish and anti-freeze! I shout, “where do I throw them? What should I do? Will they harm my family, community and earth too? I must get rid of the drain cleaners, degreasers and old medication. I will use less! I will find new alternatives! This is the answer to my family and community’s health and education!
How can we ensure that our children will not have a chemical accident? Never keep harmful liquids or other substances in easily recognizable containers like soda cans, juice bottles, etc. Put child safety hinges on cabinets where you keep harmful products (the plastic hinges can be purchased at any hardware store). It is even better to keep these products up high where children cannot reach or climb. Create a labeling system with your children, if something is dangerous mark it with a skull and crossbones or purchase monster stickers and put these on the harmful products (this has actually been adopted as a community campaign in some cities).
37
HOUSEHOLD HAZARDS DISPOSAL LIST Hazardous products you can dispose of at most “drop-off days”: Used oil
brake fluid
oil filters
old medication
all batteries
drain cleaners
tires
degreasers
oven cleaners
dry cleaning fluids
paint solvents
rust removers
anti-freeze
furniture polish
toilet bowl cleaners
pesticides and herbicides
pool chemicals
The following materials are not acceptable at “dropoff days”:
Explosives (ammunition) radioactive wastes business generated waste compressed gases biomedical wastes non-hazardous wastes
For Spanish translations, please see Web version.
38
ALTERNATIVES TO HOUSEHOLD CLEANING PRODUCTS
White vinegar Lemon and other citrus fruits Baking soda Vegetable-based soap and warm water Salt water Essential oils (peppermint, eucalyptus, lemon, rose) to freshen the house. In a spray bottle mix 4 drops of oil with one pint of water, shake and spray Eucalyptus leaves (steam the leaves to freshen the house and keep cockroaches away Potpourri (to freshen the house) Cooking oil and lemon combined (to clean and polish the furniture) Mayonnaise (to polish furniture and remove water stains on wood) Boric acid (put in the corners and near molding to kill cockroaches) Cayenne pepper or paprika (ants will stay away) "Simple Green” non-toxic cleaner (available at many stores)
Other safe and cheap cleaning recipes: All Purpose Cleaner Combine in a spray bottle: 2 tsp. Borax 1 tsp. Soap enough water to fill the spray bottle Bathtub Cleaner Mix baking soda and vinegar to form a thick paste. Spread it onto the bathtub and wait 15 minutes before scrubbing. Wall and Wallpaper Cleaner Dissolve ¼ cup borax in 1 gallon hot water. Then use a sponge or rag to wash. 39
Glass Cleaner Mix ¼ cup white vinegar and enough water to fill a spray bottle. After washing, dry glass with a clean, dry rag. Better than Bleach (for clothes) Use ½ cup white vinegar, or ½ cup baking soda, or ½ cup borax per washload. Safe Drain Cleaner Pour ½ cup baking soda down the drain, then pour ½ cup vinegar down the drain. The mixture will gurgle and bubble. Wait 15 minutes then follow with hot water, a plumbing snake or a plunger. Grease Stain Remover Rub borax into the stain, let it sit for 5 minutes, then rinse with cool water. Mold Remover Saturate a sponge with vinegar and scrub the moldy area. Do you want to make the recipes anti-bacterial? Just add a little hydrogen peroxide. You don’t like the smell of vinegar? Just add a few drops of essential oils.
40
OTHER SUPPORT MATERIALS
Online Resources
42
The Five-Step Model
44
Ideas for Collaborating with Health Organizations
49
41
Online Resources Diabetes:
EZ Read Handouts from NIDDK www.niddk.nih.gov/health/diabetes/diabetes.htm#easy
General Info and to Find Local Organization www.diabetes.org
Breast Health:
Brochure: Facts About Breast Cancer and Mammograms http://cancernet.nci.nih.gov/peb/mammog_facts.html
Breast Cancer Info from the National Cancer institute http://cancernet.nci.nih.gov/cancer_types/breast_cancer.shtml#testing
Breast Cancer As I Lived It http://www.worlded.org/us/health/docs/mscanlon2/index.htm
General Info and to find Local Organizations www.cancer.org
Menopause:
Handout From Familydoctor.org http://familydoctor.org/healthfacts/125/
FDA Handout www.fda.gov/opacom/lowlit/menopause.html
General Info and to find Local Support Activities www.menopause.org
Lead Poisoning:
CDC Lead Poisoning Info and Fact Sheets www.cdc.gov/nceh/lead/lead.htm
EPA Lead Poisoning Info www.epa.gov/lead
Household Hazards: Brochure and more links: 42
www.epa.gov/ebtpages/washazarhouseholdhazardouswaste.html
Nutrition:
General Info and Nutrition Fact Sheets www.eatright.org
Good Food Guide Pyramid Article from Kidshealth.org www.kidshealth.org/kid/stay_healthy/food/pyramid.html
EZ Read Brochure on Lowering Fat & Cholesterol www.nhlbi.nih.gov/health/public/heart/other/chdblack/smart.htm
More Health Literacy Resources
The Health & Literacy Special Collection www.worlded.org/us/health/lincs
43
The Five-Step Model An Instructional Model for Adult Education From the El Paso Community College/Community Education program (EPCC/CEP) The Five Step model is built on using learner-generated topics, informationgathering involving reading and discussion, and a learning process that engages reading, writing, speaking, listening, and critical thinking resulting in practical out-of-the-classroom English language use (action activities). Philosophically, the approach builds on whole language theory while addressing learner needs for practical instruction that works. The Five Step model was developed by EPCC/CEP (formerly the Literacy Center) based on lengthy experience providing literacy instruction in various contexts in a Mexican-immigrant border culture. The model consists of the following steps: Critical Discussion: An oral language activity which encourages group discussion, questioning, and critical thinking. Reading Activity: Provides the participant information about a topic and develops language skills. Writing Activity: Develops writing ability in different contexts and the particular rules for that context. Group Activity: Students use language while interacting with other students. Home Activity: An application activity to apply learning outside of the classroom Beginning twelve years ago with the creation of the Community Education Program, the Five Step model has been applied in a number of contexts, including workplace literacy, family literacy, health literacy, home ownership literacy, and community literacy. Model instructional materials using the Five Step model have been created with funding from the Texas Education Agency, U. S. Department of Education, U. S. Department of Housing and Urban Development, U. S. Department of Labor, U. S Department of Health and Human Services, Fannie Mae Foundation, Pfizer Health Foundation, and business and industry. 44
The Five Step model of language instruction can be used as a catalyst for students to obtain, learn and use information facilitated by entities that exist in a community. Representatives from these entities provide brochures, booklets and pamphlets with information regarding their programs and services, and make presentations and organize tours of facilities. Through this process, students improve their language communication skills while learning how to access community programs, services, and activities. The Five-Step instructional model is an excellent tool to improve the math and language communication skills of the students while they engage topics of personal interest. For example, teachers can develop instructional activities using health-related information and a GED assessment format. After discussing and reviewing an article facilitated by a local health representative, the teacher gives the students an excerpt from the health article with multiple choice questions similar to what they would find in a GED test. After discussing statistics about the incidence of heart disease in the U. S., students may be given a related math activity also similar to one in the GED test. Through this approach, students learn about a topic that has direct impact on their lives while they get ready for the GED. Classes have students of different academic levels. The Five-Step model can be used successfully with students who have different educational levels. For example a teacher assigns a health related reading to the students and divides them into groups of three to five students. A low-level group is asked to read the first sentence in the reading, identify two words that they do not know, and look for their meanings in the dictionary. With this information, the group attempts to infer the meaning of the complete sentence. Another group is asked to read a paragraph from the reading and identify vocabulary that they do not understand. A third group may be asked to paraphrase sentences from the same paragraph. A fourth group may be asked to summarize the entire reading and a fifth group is asked to do a math activity related to the reading. The students become responsible for their own learning and develop metacognitive learning strategies (i.e., how to collaborate on an assignment, how to divide responsibilities, and the advantages of group learning). The instructor meets with each group for a short period and answers relevant questions. This creates a better opportunity for the instructor to engage all students on a more personal basis and reduces the amount of lecture time. Research shows that academically disadvantaged students do not respond well to lecture time, preferring a more personalized approach. This method is also effective when students are working on different topics, as may be the case in certain classes. 45
Description of steps in the Five Step model Critical Discussion: The purpose of the critical discussion is:
for students to engage freely in conversation about a topic for students to think about a topic in more depth to activate the student’s thinking process in relationship to a topic raise the student’s interest and curiosity regarding a topic
Critical discussions are not controlled pronunciation activities. Students should speak freely and if they wish to, in their native languages. If students in a class speak several languages, they should be paired with speakers of the same language whenever possible. Some activities that promote critical discussion include:
Asking questions to the students Writing a list of questions on the board for discussion Showing a movie and asking the students to discuss it Inviting a speaker to present on a topic and having the students discuss the topic once the guess speaker leaves Combination of the above Reading Activity: The purpose of this activity is for the students to: increase their knowledge of a topic expand their vocabulary gain exposure to a variety of print materials After the interest and curiosity of the students about a topic has been activated, students will desire to obtain more knowledge about it. Therefore, a reading activity may be appropriate to satisfy the students. The following are suggested reading activities: Reading comprehension activity about a brochure, sign, form, paragraph, prescription, drug indications, poem, song, article or any other type of text Summarizing information from text Paraphrasing text Using dictionaries to search for definitions of terms 46
Memorizing and reciting poems Reading aloud to practice pronunciation Writing Activity: The purpose of this activity is for students to: Become familiar with different types of writing contexts and situations To develop their writing skills in various contexts Reading and writing activities are intimately related. The more people read, the better they write and writing always involves reading. The following are suggested writing activities: Informal journal writing, spontaneous and unchecked. Students may write in native language, draw, and misspell words. More structured journal writing. Students may be asked to read from their journals or share the journal with their teacher. Writing notes to co-workers, fellow students, relatives, etc. Drawing maps or charts. Writing instructions on how to do something, i.e., doing laundry, replacing a tire, cooking, getting to a specific location Writing grocery lists, recipes, etc Writing resumes or job letters Writing letters to relatives Taking dictation Writing words, sentences, paragraphs, compositions, research papers, or other academic writing Revising and editing During reading and writing activities, students may do some traditional language instruction activities such as spelling or grammar exercises. Traditional grammar exercises are appropriate within whole language instruction methods provided that they emerge from a context and are not given at random. Group activity: The purpose of the group activity is to: Expose students to a variety of communication contexts Some group activities include: 47
Role playing and acting Group research and reports Tours Interaction between students and speakers Discussions Interviews Family activities
Action Activity: The purpose of this activity is for learners to use language outside the class and home. The classroom is an experimental setting while the home is a safe place. In order for students to measure their communicative competence, they need to use language in community contexts. Action activities may include:
Procuring services from community entities Applying for jobs Interviewing for jobs Using public libraries Shopping Asking for directions Writing letters to the newspaper’s opinion page
*Note: The steps are presented sequentially, but the order is not important. The important thing is for students to talk about important topics, read about them, write about them, go into their communities to get a need met, and for them to interact with others. For example, a group of students may be writing collectively. As a result of the collective effort, they will be talking to each other, and may decide that they need to obtain and read more information. They may go to the library, procure information, read it and apply it to their writing. In this case, they engaged all five steps in the Five Step model in an unspecified sequence. Since they are writing collectively, they are doing a writing and a group activity. Since they are talking with each other, they are discussing and still doing a group activity. They do an action activity by going to the library to do some research. Finally, they do a reading activity to get more information.
48
Ideas for Collaborating with Health Organizations This is an excerpt from the article What is Health Literacy? by Andres Muro: Here are some ways that health organizations can collaborate with adult education programs:
Provide health professionals to give presentations in class Provide free health screenings to eligible students Allow students to research or present a health project Provide education materials
Following is a list of health entities that may exist in most Communities and can facilitate health information. Community/City/County/Public Hospital: They usually have an education department that facilitates literature and make presentations about health services and how to access them. Private hospitals: While they may discourage the uninsured from seeking services, they often want to have a good image. They have human relations’ offices and they may provide literature, grants, and donations of cash, equipment, or other resources. Department of Human Services/Welfare Office: They will make presentations and facilitate information about accessing Medicare or Medicaid and other existing health services in communities for the poor. They will help students enroll in Medicaid, Medicare programs. Community/City/County Health Department: They educate communities about household hazards, antiseptic practices, infectious diseases, contamination, and availability of vaccination Community Health Clinics: They will make presentations about their services and how to access them. They will distribute literature about health problems affecting a given community. Health clinics in poor communities sometimes operate as community centers. They may refer students to classes, or facilitate adult education classes in their facilities. 49
Planned Parenthood: They will make presentations and distribute literature about family planning, sexually transmitted diseases, and reproductive health. They will also provide counseling and help people access health services at reduced or no cost. United Blood Services: Can make presentations and facilitate literature about donating blood, and safety of blood donation and transfusions. American Cancer Society, American Heart Association, American Lung Association, American Diabetes Association, Center for Disease Control, Environmental Protection Agency: These are national entities that often have local representatives. They have a lot of literature about diseases, how to prevent them, and how to access services. They may perform basic health tests for students such as blood pressure, cholesterol, and blood sugar. They may refer people at risk to health entities, and they can facilitate information about programs for poor people to access health services. Community Voices: These are organizations founded by the Kellogg Foundation. They exist in some communities and provide minimal cost primary health insurance coverage for the uninsured. People can access information about these entities in their communities in their phonebooks. Local public libraries may also have directories of health and other resources. People may also find information by typing the name of the entity and the name of their community in their web browsers. They can also type the name of the entity and find information available nationwide. The American Cancer Society, American Heart Association, American Lung Association, American Diabetes Association, Center for Disease Control, Environmental Protection Agency have extensive web-sites with a lot of health related information. Often times, immigrants may be afraid to seek health services for fear of deportation. Health entities, however, are not in the immigration business and are willing and able to assist poor immigrants. In fact, some of their funding requires that they do this.
50
