Hh leaders guide

Kentucky River Foothills Development Council, Inc.
1623 Foxhaven Drive/ P.O. Box 743 Richmond, KY 40476-0743 Nutrition for a Healthy Heart This handbook was produced by Kentucky River Foothills Development Council, Inc. Special thanks to Karen Bailey, April Stone, and Veronica Taylor who wrote the text and designed the layout. It is intended as a source for health and nutrition information. It is not medical advice. If you have a medical problem, please consult your doctor or local health department.
This handbook was made possible through funding from the U.S.
Department for Health and Human Services through the Kentucky Cabinet for Families and Children, Department for Community Based Services.
Kentucky River Foothills Development Council, Inc.
1623 Foxhaven Drive, P.O. Box 743 Richmond, KY 40476-0743 (859) 624-2046/Fax: (859) 624-2049 Thank you for joining Nutrition for a Healthy Heart. Your job is important because you will be teaching your friends about heart disease.
You will also be helping them to understand how to prevent or lessen the effects of heart disease through good nutrition and exercise.
The more people learn about heart disease, the better they will feel about making food choices and changing their lifestyle. You will make a dif erence! The ideas in this manual are not rigid guidelines for you to fol ow, but rather a resource to help you plan each session. We want you to be creative and flexible when leading sessions. The more you show of your personality, the easier it will be for participants to relate to you. You may also need to adjust the program to fit your agency’s budget and available supplies.
We do not expect you to be an expert on nutrition. We realize it is a complex topic and, in response, have provided you with basic, straightforward materials. This Leader’s Guide and the Participant’s Manual will provide you with the information needed to conduct a successful Nutrition for a Healthy Heart group. Be sure to allow your class time to review the various sections in their books as they fol ow your lead. Encourage them to ask questions at any time.
TABLE OFCONTENTS General Instructions Recruiting Participants Keeping Attendance Up Being a Group Leader Handling Difficult People Introduction to Heart Disease Dif erent Types of Heart Disease Risk Factors for Heart Disease Eating for a Healthy Heart The Food Guide Pyramid Reading Food Labels Grocery Store Tour Heart Disease and Exercise Heart Disease Medications Common Heart Disease Tests and Treatment Options General Instructions: ® Each Nutrition for a Healthy Heart class requires dif erent materials.
Be sure to look ahead to each “Materials Needed” list at the begin- ning of each chapter. Keep in mind that there is a snack at the end of each session and that the ingredients and utensils needed to prepare the recipes must be bought ahead of time. Also remember that the proper eating utensils (knives, forks and spoons), cups and ice, napkins, etc. will also be needed at each session.
® A TV/VCR is also needed at all sessions that include a video. The agency should provide this to the leader.
® Prizes are a part of each Nutrition for a Healthy Heart class. Sugges- tions for prizes include: cooking utensils (spatulas, mixing bowls, turkey basters), pot holders, dish towels, recipe books, food storage containers, aprons, etc. The agency should supply the prizes for the leaders. Make sure that you have enough prizes for each class.
® A snack is prepared at the end of each class. Leaders should involve all participants in the preparation and clean-up of the snacks. Preparing the recipes is a group effort. Be sure to read ahead to each chapter to see what ingredients and supplies are needed for each snack.
® The agency will provide the Nutrition for a Healthy Heart leader with a “supply box” for each class. The supply box will contain all the needed materials for that class period including recipe ingredients and supplies, handouts, activities and materials, sign-in sheets, etc. There should be a com- plete list of materials on the outside of the box. The leader should double- check the list with the actual supplies in the box before the class.
General Instructions: ® The agency should provide the Nutrition for a Healthy Heart leader with all necessary materials. The agency should include all materials necessary for each class in a set of containers that include a list of what materials are needed. With the “supply boxes”, the leader should have everything they need to lead a successful class.
® The agency should also provide the leader with a TV/VCR or make sure that the location of the class has one available. The agency should also provide the leader with appropriate videos.
® The agency should provide all Nutrition for a Healthy Heart program leaders with the necessary orientation and training needed. The agency should also offer support to the leaders throughout their period of service to the agency.
® The agency should also provide prizes for each class. Suggestions for prizes include: cooking utensils, potholders, cookbooks, dishtowels, refrigerator magnets, etc. Make sure that there are enough prizes for each class.
Game materials - bal of yarn or string, scissors Ingredients and materials for snack Ingredients and materials for snack Ingredients and materials for snack Video “Eating Healthy for Heart Health” Ingredients and materials for snack Poster of Food Guide Pyramid Food Guide Pyramid handouts or brochures for participants Video “Food Guide Pyramid” Food Guide Pyramid Bingo and bingo pieces Ingredients and materials for snack Video “New Food Label” Ingredients and materials for snack Transportation to grocery store Video “A Supermarket Tour for Elders” Ingredients and materials for snack Ingredients and materials for snack Ingredients and materials for snack Final Assessment Sheet Recruiting Participants Each class should have approximately 10 participants.
Suggested Ways to Recruit Participants Distribute flyers around town.
Release information about the workshop to the local newspaper.
Be sure to include the time, date, location, contact person and phone number in the release. Newspapers will often print this information in the “Upcoming Events” or “Community Calendar” section at no cost.
Make phone calls to local community action agencies, or county coordinators and explain to them what Nutrition for a Healthy Heart is and when the next one will be held. They can get the word out to people they work with who may be interested in Tell your friends. Word of mouth is a very powerful recruiting Of er incentives to participants who bring a friend to class.
Keeping Attendance Up Keeping participation up in any program can be a challenge. Here are some tips on how to keep participation up.
Hold the Nutrition for a Healthy Heart classes at a time when people Keep the atmosphere relaxed and comfortable. Make the class a fun time for the participants. Never embarrass participants for having wrong answers, or promote unfriendly competition.
Give participants as much personal attention as possible. Make every- one feel special and let them know that they are an important part of Of er incentives for perfect attendance. Provide a special prize to the participants with perfect attendance at the end of the workshops.
Stay on schedule. Be sure to begin and end on time. This will help people who are faced with time constraints.
Be enthusiastic! These workshops were developed to be informa- tive and fun. If you are excited about them, the participants will be excited also.
Being a Group Leader A group leader organizes an agenda, presents information and encourages discussion. It is not the role of the leader to change participants ideas or habits, but instead offer alternatives. As a group leader, there are some important principles to remember.
Make sure that everyone in the group gets a chance to be heard.
Keep the group on track.
Don’t be afraid to bring up touchy issues. If left unresolved, they BE POSITIVE! Compliment people on their accomplishments.
Thank people for their contributions.
Set up the meeting place with an eye to participation.
Arrange chairs in a circle where everyone can see each other.
Use a blackboard or flipchart on an easel to keep track of participants ideas and comments.
Participants will feel they have been heard when they see their ideas written out for all to see.
Give a little background for new people who may have missed the last meeting. This will help those who may have forgotten.
It will bring everyone up to the current meeting.
Be sure to keep track of time. Try to stay on a schedule.
Handling Difficult People Sometimes we have participants in our groups who can test our skills as leaders.
They may continuously dominate discus- sions, offend other participants, or be disruptive to the class. Here are some tips on dealing with difficult participants.
Try to maintain or regain focus.
For example, say, “Okay, we’ve strayed a little from our subject. ” Move the class onto a dif erent subject.
Try not to be defensive, or take things personally.
Use body language.
Use humor, be careful not to make fun of the person.
Protect others from personal attack.
If the person insists on dominating every conversation, suggest that the class would like to hear from someone who hasn’t Stay in control of the class. One dif icult person can ruin the experience for everyone.
If the person is a persistent problem, you may want to speak to him or her after the class has left. The person may not have realized how disruptive they have been.
Introduction to Heart Disease GOAL: To introduce heart disease and explain why it is important to take care of your heart.
Materials Needed: Game materials - ball of yarn or Paper and pens for the pre-test Ingredients and materials for snack Welcome everyone and have them introduce themselves.
Everyone will not know what to expect. You need to make them feel at ease, and the best way to do this is be yourself. Have fun and be open with them.
Encourage everyone to talk.
® Everyone is going to have fun.
® Learning about nutrition and how our diets are related to having a healthy heart will help us to keep ourselves and our families strong and healthy.
® We al have a lot to learn. Wrong answers are part of learning. Don’t be embarrassed if you do not know some of the answers. That is why we are ® Keep a list of any questions you need help on. As a group, we can work on answering them together.
Explain what the purpose of the workshop is: ® To make people aware of heart disease and of how deadly heart ® Talk about what topics will be covered in the next 10 classes: types of heart disease, risk factors for heart disease, healthy eating for a healthy heart, Food Guide Pyramid, how to read food labels, they will be taking a trip to the grocery store, physical activity and heart disease, heart medications, and treatment options for heart disease.
® Emphasize that the classes are to be informative and fun.
Encourage people to ask questions.
Get to Know Each Other Game Pass around a ball of yarn or string and tell each person to take however much they want. After everyone has a piece of yarn, start with yourself and each time you wrap the string around your finger, you have to tell something interesting about yourself. This will facilitate a bond between everyone and Pre-test: Tests knowledge of participants, may also point you in the direction you want to go for other topics.
What is the number one killer in the U.S.? What is the area of the U.S. that leads in heart disease called? What are some risk factors for heart disease? T/F A heart healthy diet includes as much fat as you want.
T/F Kentucky is ranked the lowest in cases of heart disease.
Cardiovascular disease Smoking, obesity, high-fat diets and high blood pressure Important Information 1. Cardiovascular disease, including heart disease, is the leading cause of death in the United States. Heart disease is a major killer in Kentucky. in 1995, 73% of all deaths in Kentucky were related to chronic and cardiovascular diseases.
Typically it has been men who were dying from heart disease. However, in the past few years, women have caught up to the number of men dying from heart disease and passed them. Researchers are not sure why this trend is occurring, but some think it may be because many more women are smoking and working in high stress jobs. Whatever the case may be, it is alarming. As an effort to curb this epidemic, we are trying to make individuals, such as yourselves, aware of this ever growing problem.
2. Heart Disease Statistics Gives people the idea of the magnitude of the problem.
ð Cardiovascular disease (CVD) is the nation’s leading killer for both men and women among all racial groups. More than 960,000 Americans die of CVD each year, accounting for 42% of all deaths.
ð One in four Americans have CVD. Alone, heart disease and stroke are the major reason for 6 million hospitalizations each year and cause disability for almost 10 million Americans aged 65 years or older.
ð CVD costs the U.S. in 1999 were estimated to be $286.5 billion.
ð Kentucky has the fifth highest heart disease death rate, 116.7 deaths for every 100,000 people.
ð Death rates resulting from CVD are 36% higher in African-American men than white men and 48% higher among African-American women than white women.
ð CVD is the leading cause of death among middle aged Americans. Heart disease kills more than 160,000 people between the ages of 35 and 64 each year.
ð Almost 11 million Americans aged 65 and older report disabilities caused by heart disease and stroke, such as the loss of speech or mobility.
ð 30-40% of coronary heart disease deaths are linked to obesity and high choles- ð Poor dietary and physical activity patterns are associated with 300,000 deaths each year, second only to tobacco use.
ð One third of adult Americans are overweight, and one half have cholesterol levels above the desired 200 mg/dl level.
ð 35% of all cancer deaths are linked to dietary risk factors.
Explain to people why it is so important in Kentucky to be aware of the problem and what they can do to modify their risks.
Coronary Val ey is an area of the United States that has a higher rate of heart disease than other parts of the United States. This area includes the states that border the Ohio and Mississippi Rivers. These states are Ken- tucky, Missouri, Arkansas, West Virginia, Indiana, Tennessee, Louisiana, Ohio, and Illinois. Dr. Glenn Caldwell, Kentucky’s epidemiologist, stated that Coronary Val ey can be explained by a combination of lifestyle, genetics, and environmental influences. However, there are some other reasons for these states to earn this title. One is the fact that these states tend to have a higher rate of obesity and diabetes, two risk factors for heart disease.
Another may be that most of the states mentioned are more rural, and many people in rural states tend to be uninsured. The fact is, in Kentucky, white males who live in Appalachia are 19% more likely to die of heart disease than males in other states. White Appalachian females for the same age group is 21%. The reason for this is that this area is economically poor and is full of all the things that make heart disease a risk: smoking, obesity, high-fat diets and high blood pressure. Another reason is that people in these areas can’t get to proper health facilities.
Nutrition Awareness Questionnaire Tell the group that there are NO wrong answers and ask them to be honest. This will help give everyone an idea of how their current eating habits are. We will refer back to this questionnaire as we talk more about the Food Guide Pyramid and healthy eating.
Discussion Questions ® Do you think healthy foods can taste good? ® Where have you learned about nutrition? ® Do you think you need to learn more? ® Do you think having an unhealthy diet is related to heart disease? ® Do you have heart disease or a family history of heart disease? Participant Goals What they want to accomplish by the end of the program. Have participants write their goals down (to compare at the end of the sessions.) Empha- size their goals are things that are important to them.
Snacks should be ones that are heart healthy and easy to prepare so everyone can make them at home.
Festive Health Winds Salsa ¼ cup onion, chopped 8 plum tomatoes, coarsely chopped½ red onion, diced 2 jalapeno peppers, diced 1 clove garlic, chopped¼ cup fresh coriander½ tsp. ground roasted cumin¼ cup lime juice salt & pepper to taste Combine ingredients in non-aluminum bowl. Cover and let stand several hours at room temperature, or overnight in refrigerator. Makes 16 servings.
Serve with Baked Tortilla Chips.
Serving Information: Fat: trace Different Types of Heart Disease GOAL: To make the class aware of different types of cardiovascular diseases, such as coronary heart disease, atherosclerosis, congestive heart failure, stroke, and the cost of treating the disease.
Materials Needed: Ingredients and materials for snack Welcome everyone back to the class.
Have any new people introduce Explain how the heart works.
Use a heart model and refer to the Participant’s Manual as a guide.
Explain the different types of heart disease and conditions.
Refer to the Participant’s Manual for details.
Discussion Questions ® Have you or a family member ever had a stroke or heart attack? Explain your experience.
® Do you have high blood pressure, high cholesterol, or high triglycerides? If so, do you realize this puts you at risk for having a heart attack, stroke, or developing coronary artery disease? Healthy Heart Word Scramble Give a set amount of time for the 5 words; the person who gets the most correct wins a prize.
ghih loodb ssperure high blood pressure Bring a copy of your last cholesterol lab test report. If you had this done at the health department or doctor’s office, they should be able to provide you a copy of this. We will talk about it next week.
1/3 cup confectioner’s sugar 1 18 ounce package of brownie mix Pinch of cinnamon (optional) Preheat oven to 375 degrees. Mix brownie mix with water. Form into one inch balls. Dip into confectioner’s sugar, with a pinch of cinnamon, if desired.
Place on a non-stick cookie sheet. Bake for 8-10 minutes. Makes 32 Risk Factors for Heart Disease GOAL: To explain risk factors and have the class identify risk factors for themselves and ways to change them.
Materials Needed: Ingredients and materials for snack This is a very detailed lesson that discusses each risk factor.
The Participant’s Manual discusses the risk factors in detail.
There are controllable and uncontrollable risk factors. Use the Participant’s Manual as a guide to explore each type of risk factor. Explain to the class that a risk factor is some- thing that puts you at risk of developing an illness or a dis- ease. For example, if you smoke, you are at risk of developing high blood pressure.
High blood pressure can increase your risk of having a heart attack and/or developing heart disease. There are many factors that are like a domino effect that can lead to another risk factor then later to heart disease. Another example of this is if you con- sume a diet that is high in fat and low in complex carbohydrates, this can increase your cholesterol levels. If your cholesterol levels remain high and are not controlled with diet and/or medication, this can lead to heart disease and increase your risk of having a heart attack.
Have each participant bring in a copy of their last cholesterol test lab report. They can get a copy from their doctor or the local health department. Or, have a nurse from the health department to come in and check everyone’s cholesterol. You will probably have to schedule this class in the morning, because they have to be fasting before they take this test. There is a sample blood lipid profile in the Participant’s Manual. Most people who have this test done do not understand how to read the results and what each lab data is measuring. If everyone brings a copy of their report, you can go over it together and discuss each lab value. The Participant’s Manual ex- plains each lab value and gives normal and abnormal levels.
Review the Controllable and Uncontrollable Risk Factors It is good for class members to identify which risk factors are present in their lives.
ð A risk factor is any number of things that puts you at risk of developing a ð Risk factors can be controllable or uncontrollable.
ð Risk factors that you can control are not to smoke, eating foods from the Food Guide Pyramid, exercise, and do not be overweight. Those that you cannot control are age, genetics, race, and gender.
ð Cigarette use is a major cause of heart disease among both men and women.
Smokers have twice the risk for heart attack than non-smokers do. Almost 180,000 deaths from heart disease are linked to smoking.
ð Physical activity, or exercising, reduces the risk for heart disease and helps reduce blood pressure. People who are couch potatoes or who don’t move around a lot have twice the risk for heart disease.
ð Overweight and obesity in Americans has increased dramatically in the past ten years. People who are overweight or obese have a higher risk for heart disease, high blood pressure, high cholesterol, and other chronic diseases and 2. Introduce Cholesterol Review the Blood Lipid Profile (cholesterol test) If everyone brought a copy of their last choles- terol lab report, have them look at it and see if they can identify which areas are normal or abnormal. Most lab reports will give a range of what their levels should be. These ranges can vary from one hospital’s lab department to the next. If everyone does not have a copy of their lab report, refer to the sample in the Participant’s What is cholesterol? ð Cholesterol is a waxy substance produced by the liver.
ð Also supplied through the diet from animal products like meats, poultry, fish and dairy products.
ð Cholesterol is needed in some amounts to insulate nerves, make cell mem- branes, and to produce certain hormones.
ð But, since our bodies make cholesterol, the cholesterol that is taken in from our diets may be too much.
What does cholesterol tell you? ð Cholesterol is a measure of how much of the waxy substance is in your blood.
ð Large amounts of cholesterol lead to the fat building up on your veins and arteries, causing damage.
ð Normal total cholesterol levels are < 200 mg/dl of blood ð Borderline high is 200-239 mg/dl ð High blood cholesterol levels are >240 mg/dl What are ‘good’ and ‘bad’ cholesterol? ð There are two different kinds of cholesterol, HDL and LDL.
ð HDL is referred to as ‘good cholesterol’. HDL acts by catching some of the fats and taking them to the liver to be used for other purposes besides collecting on your arteries and veins.
ð You want your HDL level to be above 35 mg/dl to receive the benefits of it.
ð LDL is considered to be the ‘bad cholesterol’. LDL works by increasing the rate at which fat builds up on your arteries and veins.
ð You want to have more HDL than LDL cholesterol in your blood. One of the main ways to raise HDL levels is to exercise.
ð Desirable LDL levels are less than 130 mg/dl.
ð Borderline or high risk levels are 130 to 159 mg/dl.
ð High risk levels are greater than 160 mg/dl.
To help the class remember which is the good cholesterol (HDL) and bad cholesterol (LDL), tell them to think of the “H” in HDL as “Healthy” and the “L” in LDL as “Lousy”. Remember, you want your lab values to be high for HDL and low for LDL. People often get LDL and HDL cholesterol confused.
Introduce Triglycerides What are triglycerides? ð Triglycerides are a part of your total cholesterol. The triglyceride is the part of the cholesterol that is thought to cause the most damage and plaque build up in the veins and arteries.
Why are triglycerides good indicators for risk factors? ð Triglycerides are good indicators for risk factors because they are the part of the cholesterol that lead to a build up of plaque on your arteries.
What are healthy and unhealthy levels for triglycerides? ð Normal triglyceride levels are < 200 mg/dl ð Borderline high levels are 200 to 400 mg/dl ð High levels are 400 to 1000 mg/dl ð Very high levels are > 1000 mg/dl 3. Do Heart Health Risk Assessment andemphasize reducing their risks.
Have the participants to fill out a heart disease assessment survey. This can help them to see how much of a risk they are for developing heart disease.
Fruit Cocktail Salad 1 17 oz. can fruit cocktail, with light syrup 1 3 oz. package of strawberry Jello 1 3 oz. package of fat free cream cheese, softened 1 8 oz. Light Cool Whip Heat fruit cocktail with juice and Jello to boiling point. Remove from heat.
Add cream cheese and stir until it melts. Fold in Cool Whip. Place in a serving container and refrigerate.
Eating For A Healthy Heart GOAL: To teach each participant the connection between heart disease and the amount of fat we eat, and learn how to make better food choices to have a healthy heart.
Materials Needed: Video: “Eating Healthy for Heart Health” Ingredients and materials for snack Introduce topic of eating for a healthy heart Why is eating healthy important? ® Eating a diet low in fat, saturated fat, cholesterol and sodium is important because it will help prevent diseases such as heart disease, atherosclerosis, and certain forms of cancers.
Show Video “Eating Healthy for a Healthy Heart” Discussion Questions ® What percentage of fat should come from our total calories in a day? ® Give some examples of the types of diseases that can be caused by eating a high fat diet.
® Does “cholesterol free” mean “fat free”? Bottom Line on Fat and Cholesterol Discuss the relationship between fat and heart disease. Pass around a fat model and let everyone look at it and feel it. Fat models can come in 3 sizes, 1lb., 5 lbs., and 10 lbs. Your local health department may have one that you can borrow. This is a good motivation tool. Usually, when people see the fat model and are over- weight, this can help motivate them to lose weight. Another visual aid that is much cheaper that can be used is microwave buttered popcorn. Bring a package of this to class. Do not cook it. Open the bag and let the participants view what it looks like before it is cooked. Explain to them that this is what it can look like in your body after you eat it.
In last week’s lesson, the class learned about risk factors for heart disease. One of the risk factors was consuming a diet high in fat. Research indicates that a diet high in saturated fat and low in complex carbohydrates can increase cholesterol and triglyceride levels. Consuming too many calories and too much fat over time can lead to weight gain and increase your risk for developing heart disease and certain forms of cancer.
Saturated fat is mostly found in red meats, (ribs, ground beef, pork chops, steak) eggs, pastries (donuts, muf ins, cakes, cookies) and dairy products (ice cream and cheese). If someone has high cholesterol, a doctor or dietitian will recommend a diet that is low in fat, especially saturated fat. There are certain types of fat, such as monounsaturated fats, that seems to reduce the risk of heart disease. Fish is a good source of monounsaturated fat. Sometimes people get confused when they have high cholesterol. They think if they cut down on the amount of cholesterol they eat, their cholesterol levels will go down. However, this is not true. In order to lower your cholesterol, you must lower your saturated fat intake. It is recommended that 30% of our total calories should come from fat.
Therefore, if someone is consuming 2000 calories a day, they should eat a total of 67 grams a fat a day.
The American Heart Association has a Step I and 2 Cholesterol-lowering diet. This is a plan that provides information on how to lower the fat in your diet. The Participant’s Manual provides good information on how to lower the fat intake in your diet. It provides information on recipe substitutions, seasoning suggestions, lunch ideas, and shopping tips.
Review Information in Participant’s Manual How to eat healthy Healthy substitutes ð To substitute for salt, try using herbs. Most do not contain salt, fat, or choles- terol. Try the food recipe at the end of the lesson for a salt substitute.
ð Use tuna that is packed in water instead of oil.
ð Use low fat cottage cheese and low moisture part skim mozzarella cheese.
ð Eat egg whites and use the egg substitutes like Egg Beaters in recipes.
ð Eat ice milk instead of ice cream.
Have everyone find the amount of calories and fat that they need each day.
Use the formulas provided in the Participant’s Manual.
Have the participants to keep a log of everything and how much they eat this week. Tell them to bring their food log to class next week and we will review it. This can help participants see what areas of their diet they need to work Make salt and butter free popcorn and use the herb salt substitute to flavor.
½ teaspoon cayenne pepper 1 tablespoon garlic powder 1 teaspoon ground basil 1 teaspoon ground marjoram 1 teaspoon ground thyme 1 teaspoon ground parsley 1 teaspoon ground savory 1 teaspoon ground mace 1 teaspoon onion powder 1 teaspoon black pepper 1 teaspoon ground sage Mix all ingredients together and use instead of salt.
The Food Guide Pyramid GOAL: To explain how to use the Food Guide Pyramid as a tool for making better choices for their families.
Materials Needed: Poster of Food Guide Pyramid Food Guide Pyramid handouts or brochures for participants Video “Food Guide Pyramid” Food Guide Pyramid Bingo and bingo pieces Ingredients and materials for snack Show the “Food Guide Pyramid” video.
The Food Guide Pyramid is different from the 4 food groups because the pyramid shows us how much of each of the 6 sections of the pyramid we should eat each day.
We should eat the most from the bigger parts of the pyramid, just as we should eat fewer foods from the smaller parts of the pyramid. For example, it is suggested by the U.S. Department of Health and Human Services that we eat 6-11 servings of bread, pasta, and rice, while we should only eat 2 or 3 servings from the meat group. The Food Guide Pyramid helps us understand how to balance our diets by limiting our fats and sugars (the top and smallest part of the pyramid) and eating more grains, fruits, and Discuss the video.
Discussion Questions ® How is the pyramid different from the four food groups? ® Did any of the serving sizes surprise you? ® From what section of the pyramid do you eat the most? ® From what section of the pyramid do you eat the least? How to Use the Food Guide Pyramid ð Review the Food Guide Pyramid poster (pass out Food Guide Pyramid bro- chures to participants).
ð Review each section of the pyramid.
ð Go over serving sizes for each section.
ð Show an example.
ð Explain how the Food Guide Pyramid helps us in everyday life.
The typical American Food Guide Pyramid is flip-flopped with actually the biggest por- tion of the food that we eat coming from the fats, oils, and sugars group and less from the grains group.
Bread, Cereal, Rice and Pasta Group Base of pyramid.
Largest group because we are supposed to eat more of these foods than any other group.
Foods in this group contain fiber, B vitamins, iron and ð This group is lower in fat, and provides our bodies with ð The pyramid tel s us to eat 6-11 servings of this group each day. One serving is equal to 1 slice of bread, ½ cup of cooked cereal, rice or pasta, ½ to 1 cup of dry cereal, and ½ of a bun, bagel, or English muf in.
ðThey are an important part of the diet.
ðGood source of fiber, vitamin A, vitamin C, and many minerals.
ðWe need 3-5 servings each day of the vegetables.
ð1 serving equals 1 cup of leafy vegetables, ½ cup of cooked or cut vegetables, or ¾ cup of vegetable juice.
ð Third largest group on the pyramid. Not expensive when bought in season.
ð Takes little time to prepare.
ð Low fat snacks.
ð Good source of fiber, vitamin A, vitamin C, and many ð We need 2-4 servings per day of fruit.
ð 1 serving is 1 medium piece of fruit, ½ cup of cooked or cut fruit, or ¾ cup of fruit juice.
REMEMBER, fruit juice counts as a serving of fruit only if it is 100% fruit Milk, Yogurt and Cheese Group ðThis group provides us with calcium that we need for strong bones.
ðSome products in this group are high in fat, and those products should be used sparingly.
ðTo lower fat intake in this group eat ice milk instead of ice cream, use 1% milk instead of 2% or whole milk, and low fat cottage cheese and yogurt instead of the higher fat options.
ð We need 2-3 servings from this group. 1 serving is equal to 1 ½ -2 ounces of cheese or 1 cup of milk or yogurt.
ð However, children under the age of two should drink whole milk.
Meat, Poultry, Fish, Eggs, Dried Beans, and Nuts Group ð This group provides our bodies with protein and iron.
ð Foods from this group must be chosen with care, many are high in fat, some examples are hot dogs, bacon, and some lunch ð Lower fat choices are chicken, turkey, fish, and lean beef or pork.
ð Nuts and peanut butter are good sources of protein, but contain a lot of fat, and need to be used ð 2-3 servings a day are needed from this group.
ð 1 serving is equal to 2-3 ounces of meat (or about the size of a deck of cards).
The following foods equal one ounce of meat: 1 egg (no more than three per week), ½ cup of cooked beans, or 2 tablespoons of peanut butter.
NOTE: most people get much more than this amount in one day.
Fats, Oils and Sweets Group ð This group is the smal est on the pyramid. This is because this is not a group you should eat from often.
ð Some foods in this group are candy, cake, butter, doughnuts, lard, cookies, and mayonnaise. They have little to no nutritional value.
ð This group is full of calories and fat and can lead to weight gain and health problems.
ð If you must use oils, use the ones that are unsaturated (those that don’t raise your cholesterol level). These oils are canola, safflower, sunflower, corn and olive. Use a diet margarine or one made of the above five oils.
ð Oils that raise your cholesterol are palm, palm kernel, and coconut and should not be used.
The Food Guide Pyramid can be used to help us select foods that we should be eating everyday. Use it to base each of your meals around.
For example, if you wanted to plan your lunch using the Food Guide Pyramid, you could start with a sandwich. Turkey on wheat with cheese, lettuce, tomato, and mayon- naise would take care of two servings of bread, one serving of cheese, one serving of meat, and one serving of fat. You wouldn’t be able to count the lettuce and tomato because there isn’t one full serving of these. However, you could have some carrot sticks, celery sticks, and an apple, which would be two servings of vegetables and one serving of fruit. Drink 100% grape juice and you have taken care of another serving of fruit. Just make sure you are following the recommended serving size for each or you won’t be getting what you need for the day.
Food Guide Pyramid Bingo This game will help participants identify which foods fall into the appropriate food sections on the Food Guide Pyramid. Play the game as many times as time allows. The person who wins the most games wins a prize.
Using the Food Guide Pyramid as a base, get foods from each category and serve as the snack.
Use crackers for the bread group Cheese (mozerella or swiss) for dairy Carrots and celery for vegetable group Whatever fresh fruit is available for fruit group Peanut butter for the meat and fat group The next lesson is on “Reading Food Labels”. Ask each participant to bring at least one food label to next week’s session. Show the participants a picture of a food label.
Reading Food Labels GOAL: Explain how to read food labels and how they can help us make better food choices for ourselves and our families.
Materials Needed: “New Food Label” video Ingredients and materials Comparison of Food Labels.
Before this class, you should find a pair of food labels that are either both the same type of food but dif erent brands or an original and a low-fat version of a product (such as salad dressing). Use the labels to compare and contrast the two similar products. Bring more than one pair, if possible.
Discussion Questions ® On what foods did you find the labels? ® What makes the products dif erent? ® After looking at the labels and considering the prices, which product would ® What are some reasons why people do not read food labels? ® If you read food labels often, why? If not, why not? ® How can reading food labels help you eat better? 3. Show the “Food Label” video.
Explain that food labels are tricky to understand. Even the most skilled shopper may not understand what the food labels tell us.
·Explain what the percent daily value means: ð On each food label, there will be something that says “percent daily value”. The percent is the percent of your daily requirement that the food provides.
ð The values are based on government research showing the amount of fat, choles- terol, and sodium that the average person on a 2,000 calorie diet needs.
ð You should try to pick foods that are low in daily percentage values of fat, satu- rated fat, cholesterol, and sodium.
ð For example: If the daily value for fat is 30%, this means that the foodhas 30% of the fat you should eat for the day. The percent that is given shows how the food fits into your diet.
·Explain the serving size and how many servings you should get from the ð Another item on the food label is the serving size. A serving size is how much you can eat of that food for the percentage values that are listed on the food ð For example, if the cholesterol is 10%, which means that it is 10% of your total value for the day, and the serving size is ten potato chips, then if you eat twenty potato chips the cholesterol will be 20% of you total value for the day.
Starting with the calories, talk the class through the rest of the nutrients.
ð Most of the calories on the food label are made for a person on a 2,000 calorie diet. You may need more or less than this value, but you can use these numbers as a general guide.
ð Also keep in mind that you may need to get less fat, less cholesterol, and less sodium due to a medical condition you might have, so you will need to make al owances for this.
ð Food labels include a list of ingredients that are in each food. They generally tend to be listed in the amount that is in the food from most to least. You will want to focus on foods that have the most healthy ingredients listed first.
Labels may claim to be ‘light’, ‘fat-free’, etc. In the past, manufacturers could put ‘light’ on the label if it was light in color. Due to new government regulations, manufacturers have to meet certain standards. The new regulations are: less than 5 calories per serving 40 calories or less 1/3 fewer calories or 50% less fat ð Light in Sodium less than ½ gram of fat 3 grams or less of fat ð Cholesterol Free Less than 2 milligrams cholesterol and 2 grams or less of saturated fat Less than 5 milligrams of sodium ð Very Low Sodium 35 milligrams or less of sodium 5 grams or more of fiber Distribute several sample food labels to the participants. Ask them to find the total calories, total fat, serving size, sodium, and fiber in each product.
1 package low-fat crescent rolls 1 cup cherry pie filling 1large package reduced fat cream cheese ½ teaspoon vanilla Various fresh fruit, cut up Spread crescent rolls into 13X9 inch pan and bake according to directions.
Combine cream cheese with sugar and vanilla. Spread mixture on rolls after they have cooled. Top with cherry pie filling. Add cut-up fresh fruit on top.
Cut and serve in slices.
REMINDER: Before closing remind the class that next week they will be going to the grocery store. Make appropriate arrangements.
Let’s Go To the Grocery Store GOAL: To help the participants to understand the layout of a grocery store that will enable them to make better heart healthy food choices.
Transportation to grocery store Video “A Supermarket Tour This class can be done several dif erent ways. Here are 2 options.
® Have everyone come to class. Watch and discuss the video, then go to a local grocery store together for the tour. Allow more time to do this (class time for video and tour is 1 hour 30 minutes).
® Do the grocery store tour on a dif erent day. Set a time outside of class that is convenient for everyone to do the tour. Schedule transportation if Watch “A Supermarket Tour for Elders” video Discussion Questions ® What are some of the grocery shopping tips identified in the video? ® How many servings of fruits and vegetables are we supposed to ® Which has more fiber: brown rice or white rice? ® How much calcium should the average adult consume? Most grocery stores are laid out the same way. You have your produce (fresh fruits and vegetables) with the breads, meats, and dairy products on the outside edges. Basically, if everyone only shopped the outside edges of the stores and only used a few middle sections to get pasta, rice, and cereal products, this would be a lot more healthy. Most of the foods found on the outside edges are whole foods that contain good sources of fiber, vitamins, minerals, and antioxidants that help reduce the risk of heart disease.
The middle sections of the store are where you will mostly find processed foods such as frozen dinners and other pre-packaged foods. These foods are high in fat, sodium, and calories and can lead to heart disease.
Grocery Store Tour Make arrangements with public transportation for participants. It would be a good idea to reserve your trip 2 weeks in advance. Call a few days before the trip to confirm times, pick up location, and destination.
Also, it would be a good idea to call the grocery store that you will be tour- ing and let the store manager know what you will be doing. He or she might suggest appropriate times to come to the store for the tour to avoid rush hours. This will help control the flow of traffic in the aisles of the store.
Once at the store, encourage the participants to ask questions. Go down each aisle pointing out the different types of foods on the market, which ones are low in fat, high in fat, etc.
Grocery shopping tips ð Avoid the cookie aisle and spend more time in the fruit and vegetable ð Instead of buying soda, buy more fruit juices.
ð Buy non-fat products.
ð Buy and use low fat products like baked tortilla chips and low fat salad ð Buy lean meats such as fresh fish, lean ham, low fat hot dogs,and select of choice cuts of meat.
ð Buy skim, nonfat, or fat free milk products. (Children under the age of 2 need whole milk).
Heart Disease and Exercise GOAL: To explain the relationship between inactivity and heart disease and the benefits of adopting an exercise program.
Ingredients and materials for snack Most Americans get little to no strenuous exercise. Strenuous exercise is needed to work the heart and get rid of excess fat and calories.
There is evidence to suggest that even low to moderate exercise provides short and long term benefits. If you do these daily, they can help reduce the risk for heart disease.
Some activities that are low to moderate exercise are walking, stair climbing, gardening, yard work, moderate to heavy housework, dancing, and home exercise.
More strenuous exercise will improve the fitness of your heart and lungs. But, you don’t have to train like you are going to the Olympics. Any activity that gets you moving around will improve your health status, even if it is only done for a few minutes every day.
The hardest thing to do is to just get started. One way is to schedule exercise into your day, and stick to your plan. Another is to have a buddy to do things with you.
Both of you will be more likely to start and keep with it.
Explain why physical activity is important.
® Physical activity is important to make your heart and lungs work better. Exercis- ing will help to prevent or stop the progression of disease and in general make you feel better.
® Regular physical activity makes you feel better. It will give you more energy, help you cope with stress, improve how you feel about yourself, you won’t feel as tired all the time, helps decrease anxiety and depression, helps you relax and feel less tense, helps you fall asleep more easily and sleep well, and provides an easy way to share an activity with a friend or family member.
® Without regular physical exercise and a healthy diet, heart disease will develop. Although most people do not need to see their doctor before starting an exercise program, if you already have heart disease, you should consult your doctor before starting an exercise program.
Tips to get moving Refer to Participant’s Manual Refer to Participant’s Manual Lead the class in some simple exercises. Use “Exercise: A Guide from the National Institute on Aging” as a guide.
Target Heart Rate Activity Find your target heart rate. Your maximum heart rate is about 220 minus your age. The figures below are averages, so use them as general guidelines.
Target Heart Rate 100-150 beats per minute 200 beats per minute 98-146 beats per minute 195 beats per minute 95-142 beats per minute 190 beats per minute 93-138 beats per minute 185 beats per minute 90-135 beats per minute 180 beats per minute 88-131 beats per minute 175 beats per minute 85-127 beats per minute 170 beats per minute Warming up and cooling down is an important part of your exercise routine.
2. Which of the following can exercise help do? improves circulation lowers blood pressure helps reduce stress 3. How long should you exercise? 1 time a week for 5 minutes 3 times a week for 20-50 minutes 2 times a week for 10 minutes 4. What can happen if you do not cool down properly? get dizzy and lightheaded get more intense muscle soreness the next day puts more strain your heart It is always a good idea to check with your doctor before you begin any type of exercise Gelatin Poke Cake 1 box white cake mix ½ cup egg substitute or 1 egg and 2 egg whites 1/3 cup light or nonfat sour cream 1 4-serving package any flavor Sugar Free gelatin (sweetened gelatin can also be used) 1 cup boiling water ½ cup cold water 2 ½ cups Cool Whip® Lite or Fat Free Following package directions, make a 13X9 cake, except use the sour cream in place of the oil and the egg substitute in place of the 3 eggs. Add the same amount of water called for on the package. Bake as directed. After the cake has cooled for 15 minutes, poke the entire cake with a fork at ½ inch intervals. Dissolve the gelatin in boiling water. Add the cold water, and carefully pour over cake.
Chill a couple of hours. Before serving, spread Cool Whip Lite or Fat Free over the entire cake. Garnish with fresh fruit if desired.
Common Heart Disease Medications GOAL: To define some of the most common heart disease medications and identify their materials for snack Prize (idea - weekly medicine container) This may the most complicated of al the lessons. Anytime someone is taking prescrip- tion medications there will be questions. Questions such as the proper amount to take, when to take or how to take the medication is always the main concern. Your local pharmacy can be a big help. Most pharmacies will provide an information brochure about the medication that you are taking.
This lesson discusses the most common heart disease medications. Refer to the Participant’s Manual for detailed information. One suggestion is contacting your local health department to see if one of the Registered Nurses can come and talk to the class and discuss some of these medications. Another suggestion is have everyone bring a list of their prescription drugs or their prescription drug bottles with them and the class can learn about the type of medication they are taking as a group. A courtesy cal a day before class to remind them would be helpful.
Drug Interactions Ask the class what is a drug interaction. Give everyone a chance to respond. Refer to the Participant’s Manual for a clear definition.
Ask the class if they have experienced a drug interaction.
Any side effects? Give them a chance to explain their experience.
Keeping Track of Your Medications Ask the class how they keep track of their medications. What type of method do they use. You can bring a weekly medicine container to class and show the class. These can be purchased at a local department store or pharmacy. They are very inexpensive and can help people keep track of their medications.
Refer to the Participant’s Manual for more details on how to keep track of medications and what type of questions one should ask their doctor.
Heart Disease Drug Classes This section of the lesson has been broken down into the seven different drug classes. They are as followed: ® Anti-clotting drugs ® Cholesterol-lowering drugs ® Calcium channel blockers ® ACE Inhibitors Use the Participant’s Manual as a guide to explain each of these classes. Give the class time to ask questions and refer to their list of medications or prescription drug bottles to help them learn more about the type of drug they are taking.
Have the class to list their medications listed in the activity section of their Participant’s Manual. They are to find which class of drugs they fit in. They can refer to the Appendix for a listing of all the drugs that are listed in that given drug class. They can get started in class and finish it at home. If there is a certain medication that they are taking and it does not fall into any of the 7 classes of drugs, write down the medication and maybe call the pharmacy or check with the health department to find out more information. At next week’s class, tell them what you found out.
Make up a question from the lesson and ask the class. Whoever gets it right, wins a prize. An ideal prize would be a prescription drug weekly container.
6 cups apples, peeled and cut up into cubes ½ cup quick-cooking oats ¾ cup brown sugar 1 teaspoon cinnamon ¼ cup butter or margarine, cut into small pieces Combine flour, oats, sugar and cinnamon in bowl. Add cut-up butter into mix- ture and mash with fork until the mixture looks like crumbs.
Butter or oil the bottom and sides of a baking dish and spread apples evenly over bottom. Sprinkle the crumb mixture over the apples.
Place in an oven at 350 degrees and cook until the apples are soft and topping is light brown, about 30 to 40 minutes.
Common Heart Disease Tests and Treatment Options GOAL: To increase the participant’s awareness and knowledge of the most common heart disease medical tests and treatment options.
Materials Needed: Final Assessment Sheet Ingredients and materials for snack This lesson focuses on the most common heart disease medical tests and treatment options other than medication. Some of the medical tests can be done in the doctor’s office, while others can be done in the hospital on an out-patient basis. Years ago, heart surgery required several days of recovery in the hospital. However, with better technology, a week’s stay in the hospital is almost unheard of these days. Many people can have a heart catheterization and angioplasty on the same day and come home 24- 48 hours after the procedure.
Maybe have a local doctor or registered nurse come and speak to the class about the different medical tests and treatment options. Also, if time allows maybe do a hospital tour of the cardiac unit. You will have to check with the hospital to make sure this is allowable. They may be able to provide staff to show the participants where to regis- ter, what area of the hospital the specific test or surgery is done, recovery area, and look at the dif erent equipment used to perform the medical procedures. If this is not an option, maybe contact the Cardiac Rehabilitation unit and see if a tour of this area would be feasible.
A trip to the hospital can be a very scary experience especially if you do not know where to go and what exactly the doctors and nurses will be doing to you. If a tour to the hospital is not feasible, have the participants discuss there own experience with a certain type of medical test or heart surgery. Individuals can learn and support one Common Heart Disease Medical Tests and Treatment Options Refer to the Participant’s Manual to review each medical test and treatment option. Give the class time to comment and ask questions.
However, make sure the class does not get of track.
1. A HEART TRANSPLANT is usual y is a type of heart surgery that is the last chance of survival.
2. A STRESS TEST is a test that is done while a person is walking on a treadmill or stationary bicycle.
3. ANGIOPLASTY is a procedure that uses a balloon-like tube that is inflated to widen an artery.
4. An EKG is a test that measures the heart’s electrical activity. The results can be seen being printed out on graph-like paper.
5. PACEMAKERS are commonly used to treat an abnormally slow Sunshine Raisin Fruit Salad ¼ cup orange juice 1 tablespoon honey 1 cup strawberry halves 1 cup red or green seedless grapes 1 cup orange segments Into a large bowl measure orange juice and honey; mix. Add strawberries, grapes, oranges, bananas and raisins; toss gently. Spoon fruit mixture into 4 bowls, dividing equally. Top each bowl with ¼ cup granola and ¼ cup yogurt.
Garnish with whole strawberries of desired.
Participant Goals Have the participants refer back to Lesson 1 and review their goals. Did they meet them? Did anyone change their goals? Al ow time for group Have each participant to fill out a program evaluation (found in the back of the Participant’s Manual). Tell them that their comments and suggestions are very important. The results will be used to help better modify future work- Congratulations on a job well done! We want to sincerely thank you for donating your time and energy to the Nutrition for a Healthy Heart pro- gram. As a peer educator, you have made a great difference in the lives of others. You have passed on valuable nutrition and wellness information to people who may not have received it otherwise. Your job has been very important and we really appreciate all the hard work you have done. We hope that you have enjoyed your experience and that you have also ben- efited from the program.
Common Heart Disease Medications Listing To see what type of heart disease medication you are using, simply match up the name of your prescription drug listed on your medicine bottle to the one found in one of the classes of heart disease medications.
See which drug class it falls into and refer to Lesson 9: “Common Heart Disease Medi- cations” to learn more about that particular class of drugs.
Benazepril (Lotensin) Acebutolol (Sectral) Captopril (Capoten) Atenolol (Tenormin) Enalopril (Vasotec) Bisoprolol (Zebeta) Fosinopril (Monopril) Carvedilol (Coreg) Lisinopril (Prinivil, Zestril) Metaprolol (Lopresso, Moexipril (Univasc) Lopressor LA, Toprol XL) Perindopril (Aceon) Nadolol (Corgard) Quinapril (Accupril) Sotalol (Betapace & Ramipril (Altace) Trandolapril (Mavik) Timolol (Blocadren) Calcium Channel Blockers: Amlodipine (Norvasc) Diltiazem (Cardizem) Felodipine (Plendil) Isradipine (DynaCirc) Nicardipine (Cardene) Nifedipine (Adalat, Procardia) Nimodipine (Sular) Verapamil (Calan, Verelan, & Isoptin) Anti-Clotting Drugs: Warfarin (Coumadin) There are four different classes of cholesterol-lowering drugs. They are as Bile Acid Resins: Colestipol (Colestid) Colesevalam (Welchol) Fenofibrate (Tricor) Gemofibrozil (Lopid) Nicotinic Acid (Vitamin B3 “Niacin”) Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Mevacor) Pravastatin (Pravachol) Simvastatin (Zocor) These drugs are mostly used to treat angina. They are as followed: Erythrityl tetranitrate Erythritol tetranitrate Glyceryl tetranitrate Isosorbide dinitrate (Isordil & Sorbitrate) Isosorbide mononitrate (ISMO & Imdur) Mannitol hexanitrate There are four different types of diuretic drugs. They are as followed: All of them help to lower blood pressure.
Bumetanide (Bumex) Ethacrynate sodium Ethacrynic acid (Edecrin) Furosemide (Lasix) Torsemide (Demadex) Osmotic Diuretics: Amiloride hydrocholoride Triamterene (Dyazide) Thiazide Diuretics: Cholorothiazide (Diuril) Hydrocholorothiazide (HCTZ, Hydrodiuril, & Microzide) Indopamide (Lozol) Adams, Pat & Marc Jacobs. Yo! Let’s Eat! Tulsa, OK: National Resource Center for Youth Services, 1994.
American Heart Association. Available at http://www.americanheart.org. 2002.
—. An Eating Plan for Healthy Americans. 1998.
—. Coronary Artery Bypass Graft Surgery. 1998.
—. High Blood Pressure Fact Sheet. 1998.
Cleveland Clinic Heart Advisor. Stratford, CT: Torstar Publications, Inc. December —, January 2000.
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CNN. Eating Healthy for Heart Health. 1990.
Essentials of Warming Up and Cooling Down. Healthy Heart Newsletter, available at General Information and Safety Issues for You to Be Aware of During Exercise. Healthy Heart Newsletter, available at http://www.healthyheart.org, 1997.
Gershoff, Stanley, Ph.D. The Tufts University Guide to Total Nutrition. New York: Heart Center Online. Available at http://www.heartcenteronline.com. 2000.
Helpful Hints to Keep Exercise a Life-Long Commitment. Healthy Heart Newsletter, available at http://www.healthyheart.org, 1999.
Kentucky River Foothills Development Council, Inc. Food for Thought. 1999.
Kentucky River Foothills Development Council, Inc. Nutrition Basics for Working Fami- Kentucky River Foothills Development Council, Inc. Women’s Circle. 1997.
Kostas, G., M.P.H., R.D. The Balancing Act Nutrition and Weight Loss Guide. Dallas: Kostas, 1993.
Kris-Etherton, Penny, Ph.D., R.D., and Julie H. Burns, M.S., R.D., eds. Cardiovascular Nutrition. The American Dietetic Association, 1998.
Lombardo, Michelle. Take Charge of Your Health: The Active Older Adult Speaker’s Kit.
GA: Wellness Incorporated, 1999.
Massachusetts Gerontological Nutrition Group. A Supermarket Tour For Elders. 1999.
Moquette-Magee, Elaine, M.P.H., R.D. Fight Fat & Win Cookbook. Minneapolis: Chronimed Publishing, 1994.
National Livestock and Meat Board. Painless Lowfat Options. 1994.
Parlay International Kopy Kit. Stress, Heart Health, & Weight Management. Emeryville, CA: Parlay, 1998.
Project Lean. Savvy Supermarket Shopping Skills. 1999.
University of Massachusetts Cooperative Extension System. The Good Eating for Less Cookbook. 1992.
Whitney, Cataldo, Rolfes. Understanding Normal and Clinical Nutrition. 4JD Edition.
If you would like additional copies of the Leader’s Guide and/or Participant’s Manual, please clip and return to: Kentucky River Foothills Development Council, Inc.
Community Food and Nutrition Program 1623 Foxhaven Drive Richmond, KY 40475 _copies of the Leader’s Guide at $5.00 per copy _copies of the Participant’s Manual at $5.00 per copy $ _ Save by ordering in bulk! Package A includes: ® 1 copy of the Leader’s Guide and 10 copies of the Participant’s Manual Package B includes: ® 10 copies of the Participant’s Guide for $40 I would like _ package(s) of Package A _ package(s) of Package B Your feedback is important to us. We use your opinions and insight to improve on our materials and programs. We would like for you to take a minute to tell us what you liked and didn’t like about this handbook.
How would you rate the Nutrition for a Healthy Heart handbook? Excellent Good Fair Poor What did you like most about it? What did you like least about it? What information was most helpful to you? What information was least helpful to you? Was the book easy for you to read and understand? Very easy to read Somewhat easy to read Not easy to read Thank you for taking the time to complete this evaluation form.
We appreciate your comments. Please return this form to: Kentucky River Foothills Development Council, Inc.
Community Food and Nutrition Program 1623 Foxhaven Drive Richmond, KY 40475

Source: http://www.foothillscap.org/Services/CFN%20Documents/Heathly_Heart_Leaders_Guide.pdf

Effectiveness of intralesional triamcinolone in the treatment of keloids in children

Pediatric Dermatology Vol. 33 No. 1 75–79, 2016 Effectiveness of Intralesional Triamcinolone in the Treatment of Keloids in Children Silvana Acosta, M.D.,* Ester Ureta, M.D.,† Ricardo Ya nez, M.D.,* Natalia Oliva, M.D.,‡ Susana Searle, M.D.,* and Claudio Guerra, M.D.* *Plastic Surgery Section, Surgery Division, Medical School, Pontificia Universidad Cat olica de Chile, Santiago,

Microsoft word - 1. content_transalate.doc

Contents Definition, epidemiology, burden and etiology of osteoporosis………………………. 1 I-1 Definition and concept . 1 I-2 Epidemiology of osteoporosis and osteoporotic fractures…………………………… 1 2.1 Worldwide epidemiology . 1 2.2 Epidemiology in Asia and Thailand. 2 I-3 Burden and impact of osteoporosis and osteoporotic fractures . 2 3.1 3 Osteoporosis related mortality and morbidity). 3 3.2 Health economic aspect of osteoporotic fractures)………………………………. 3 I-4 Pathogenesis and etiology . 4 4.1 Pathogenesis . … 4 References . 5