Cooking skills improve widowers’ nutrition
Cooking skills improve widowers’ nutrition
Teach simple skills that bring familiarity
When physicians at the New Mexico Veterans Affairs Health Care System in Albuquerque noted that some of their recently widowed male patients were not eating nutritious meals, Janet Chambers, RN, patient health education coordinator, set up a series of cooking classes in an effort to improve their health.
"We had some patients who had never been in the kitchen," she says.
A male registered dietitian was brought on board to teach the two-hour class that ran for three weeks. The first week, the menu was breakfast. The second week participants fixed lunch. And the third week, they made dinner, even though the class began at 1 p.m.
The first part of the class was instruction, and the second hour was hands-on cooking. During the cooking series, the patients learned about food safety and the importance of washing hands before working in a kitchen; about grocery shopping; how to read food labels; and about protein, fats, and carbohydrates.
An occupational therapist worked with the group in the beginning on safety issues in the kitchen. He assembled a notebook with photos of various unsafe cooking situations, such as a pot on the stove with the handle out over the edge where it easily could be knocked off the burner.
Making sure the class left with a list of community resources they could investigate at a later date was an important element as well. Several of the men had been identified as being depressed and could use opportunities for socialization.
"We gave them the names of the senior centers and the prices they charged for meals. Also, we provided information on other community resources. Several of the class participants talked about getting together and going out to eat once in a while," says Chambers.
Cost was an issue; therefore the class was held in the kitchen of the independent living apartment for spinal cord patients. It was stocked with staples such as salt and pepper, so these
items did not have to be purchased.
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Money for the groceries was donated by volunteer services, and Chambers also purchased a few items. The total for the ingredients came to about $100 for all three menus. "We picked items that weren’t very expensive," she reports.
For example, students in the class learned several ways to serve eggs for breakfast, along with tortillas and toast. Lunch was pork chops, baked potatoes, and fruit salad. The dinner menu featured meatloaf.
Because class size was limited, many people who wanted to enroll were turned away. The 12 students admitted were all referrals from one physician.
"We are going to have another class, and this time it will be open to anyone who wants to come. However, we do have to limit the size because of the facility," says Chambers.
She says a kitchen in the occupational therapy department would be a good choice, as well as independent living quarters.
Are you offering enough information on IUD use?
If you think you are providing adequate information on intrauterine contraception during your reviews of birth control options, think again. Women are not getting the full message about this effective form of birth control. Results from one national survey show only 15% of women surveyed correctly identified the intrauterine device (IUD) as the most effective contraceptive method in typical use,1 while in another survey, 70% of women were unaware of a reversible contraceptive option that is as effective as sterilization.2
"The whole category of intrauterine contraception is underutilized in the United States," says Laura MacIsaac, MD, MPH, assistant professor of obstetrics and gynecology and director of family planning research at Albert Einstein College of Medicine in New York City. "As we know, only about 1% of contracepting women choose IUDs here in the United States in contrast to the rest of the world, where it is the most common form of reversible contraception."3
U.S. women now have two options in intrauterine contraception: the Mirena levonorgestrel intrauterine system marketed by Berlex of Montville, NJ, and the ParaGard Copper T 380A IUD, marketed by FEI Women’s Health of North Tonawanda, NY. Clinicians need to understand the benefits and disadvantages of both types of intrauterine contraception in discussing them with patients, says MacIsaac, who has recently been named chief medical officer for FEI.
"The ideal candidate for intrauterine contraception is a woman who wants at least two years of very effective contraception and doesn’t want the inconvenience or side effects of other methods," says
Raquel Arias, MD, associate professor in the department of obstetrics and gynecology at the Keck School of Medicine at the University of Southern California in Los Angeles. "The side
effect profiles of the two available intrauterine methods varies considerably, so women should discuss what potential changes, including improvements, they might expect using these methods."
Method is reversible
Berlex commissioned a survey of 400 reproductive-age women by International Communications Research of Media, PA, to check women’s awareness of long-term birth control methods. Among those surveyed who were sterilized, about 60% said their doctors did not offer them any long-term contraceptive alternatives to the procedure.
Such findings are of concern, since sterilization should be regarded as a permanent form of birth control. In contrast, intrauterine contraception is as effective as permanent sterilization, and yet is completely reversible by anyone who can do a Pap smear, says Arias.
Transcervical sterilization (Essure, Conceptus, San Carlos, CA) is not reversible by any means, she states. Tubal ligation can be reversed only at great expense and only yields a 50% rate of success, even in the most skilled and capable of hands, says Arias. The operation to reverse a tubal ligation requires a larger incision, longer recovery, and is less likely to be covered by insurance, she states.
The risk for regret following sterilization is real: Data from the United States Collaborative Review of Sterilization (CREST) study show that while most women express no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization have an increased probability of expressing regret.4 In another analysis of CREST data, women who were sterilized at a young age had a high chance of later requesting information about reversal, regardless of their number of living children.5
"Because no one can predict the future, effective long-term contraception should be carefully considered by anyone planning a separate operation for sterilization," states Arias.
FEI commissioned a survey of sexually active women ages 20-45 through Research International of Chicago and found that birth control pill and condom users greatly overestimate the typical use effectiveness rate of their chosen birth control method. Eight out of 10 pill users said that their method is 99% effective, while more than half of condom users said their method was 99% effective. In reality, in typical use, condoms have a 15% failure rate, while pills have an 8% failure rate.6
Pills and condoms are "high-maintenance" methods, with much work and effort involved in achieving perfect use, MacIsaac notes. In contrast, intrauterine contraception offers 99% effectiveness in typical and perfect use settings, because there is no daily or weekly routine required by the woman to maintain the method, she states. Mirena can be used up to five years, with ParaGard providing effectiveness up to 10 years.
For women who cannot risk the chance of pregnancy due to medical contraindications or other reasons, intrauterine contraception offers a safe, effective, reversible alternative, MacIsaac points out. The effectiveness rate of ParaGard over 10 years and the effectiveness rate of a laparoscopic tubal are exactly the same,7 she notes.
How do you present intrauterine contraception to patients? Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville says he keeps a wall chart in each patient exam room that displays all of the common contraceptives, including illustrations of the levonorgestrel and copper-releasing IUDs. He also keeps a "show-and-tell" box of contraceptives on hand, which includes both IUDs as well as the contraceptive ring and the patch.
"All of this can help provide a point of reference when discussing contraceptive methods our patients may not be familiar with — and this particularly includes IUDs," he notes.
Providers need to look at matching the right IUD to the right woman, says MacIsaac. Bleeding patterns with the two devices vary; the Copper T 380A may increase average monthly blood loss, while the levonorgestrel device may have an initial three- to six-month period of menstrual irregularities.8
"Just like pills, where you have to match the right pill to the right patient, you have to match the right IUD to the right patient," says MacIsaac.
References
1. FEI Women’s Health. Survey Shows Women Overestimate Effectiveness for Most Widely Used Forms of Contraception. Press release. March 30, 2005.
2. Berlex USA. Survey Reveals Widespread Misconceptions About One of the Most Common Methods of Birth Control in the U.S. Press release. March 23, 2005.
3. Hubacher D. The checkered history and bright future of intrauterine contraception in the United States. Perspect Sex Reprod Health 2002; 34:98-103.
4. Hillis SD, Marchbanks PA, Tylor LR, et al. Poststerilization regret: Findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 1999; 93:889-895.
5. Schmidt JE, Hillis SD, Marchbanks PA, et al. Requesting information about and obtaining reversal after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization. Fertil Steril 2000; 74:892-898.
6. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th ed. New York City: Ardent Media; 2004.
7. Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996; 174:1,161-1,168.
8. Hatcher RA, Zieman M, Cwiak C, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2004.
Teach simple skills that bring familiarity When physicians at the New Mexico Veterans Affairs Health Care System in Albuquerque noted that some of their recently widowed male patients were not eating nutritious meals, Janet Chambers, RN, patient health education coordinator, set up a series of cooking classes in an effort to improve their health.Subscribe Now for Access
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