By Alyson E Raletz

Editor’s note: A similar profile on Democrat Mark Sheehan will be featured in the News-Press later this week.

Both candidates in a St. Joseph House of Representatives race have described Rob Schaaf as a maverick.

While previously employed as the News-Press’ Opinion editor, Democrat challenger Mark Sheehan dubbed the incumbent so after going up against the governor on controversial health care issues.

Now Dr. Schaaf, R-St. Joseph, is using the adjective with pride in campaign speeches and advertisements to convince voters in the 28th House District that they should elect someone unafraid of fighting the establishment to a fourth term.

“I’m just persistent. I’m as persistent as a pit bull,” Dr. Schaaf said.

His list of goals and achievements certainly has a theme.

He pointed to a guiding statistic from the U.S. Government Accountability Office that put St. Joseph adjusted hospital prices as the fourth-highest in the nation among 232 metropolitan areas in 2001.

Since being elected to office in 2002, he’s advocated for higher Medicaid reimbursements for doctors and multiple ways to lower health care costs. He now serves as the chairman of a House health care transformation committee.

He took flak from both parties this year when his efforts to increase hospital competition and transparency tripped up Gov. Matt Blunt’s Insure Missouri proposal to expand Medicaid eligibility. The Missouri Hospital Association, which represents Heartland Health, had launched an intense lobbying effort against any Insure Missouri bill with those provisions, and the whole proposal ultimately died.

Now the association’s political action committees and Heartland’s chief executive officer, Lowell Kruse, are financially backing Mr. Sheehan.

“This race is of vital importance,” MHA President Marc Smith stated in a letter to hospital CEOs.

Mr. Sheehan criticizes Dr. Schaaf for making enemies in Jefferson City because of a personal vendetta.

“That is how my opponent would like to characterize me, just in order to make me look small — that I have a vendetta against Heartland. What vendetta?” Dr. Schaaf said.

Mr. Sheehan pointed to the Heartland-owned Northwest Health Services buyout of a practice where Dr. Schaaf worked in 1997. Northwest Health, which operates several federally qualified health centers in St. Joseph, didn’t hire Dr. Schaaf.

Former CEO Susan Wilson, now of the Missouri Primary Care Association, said Northwest Health hired physicians who were board- certified. It’s a standard of training not required to practice medicine in the state of Missouri that Dr. Schaaf admittedly didn’t obtain because he didn’t want to undergo the three-year residency requirement.

Dr. Schaaf never applied to work for Northwest, Ms. Wilson said. He has had staff privileges at Heartland since Dec. 3, 1985.

He worked closely with Sen. Charlie Shields, R-St. Joseph, in 2007 to craft MO HealthNet, the state’s updated version of Medicaid.

The Infection Control Act he sponsored that made it into law in 2004 is his crowning achievement as a legislator, he said. The law now requires hospitals to post infection rates online.

“I believe more lives have been saved by that one thing than probably the sum total of my whole medical professional life,” he said.

Beth Wheeler, external relations director for Missouri Western State University, said while Dr. Schaaf hasn’t been the primary sponsor of any major higher education bills, he’s used his vote for the school’s favor.

“He was a big supporter of our university status,” Ms. Wheeler said, noting he had also backed funding proposals for Western.

He said he hopes to be re-elected so he can continue to pursue legislation he refers to as “any willing provider” laws that would protect the doctor-patient relationship during insurance changes. He also aims to draft legislation to help eliminate the “wage trap,” when people on public assistance would be worse off financially if they took higher-paying jobs because they’d lose their benefits.

Alyson E. Raletz can be reached

at [email protected].

(c) 2008 St. Joseph News-Press. Provided by ProQuest LLC. All rights Reserved.

Parents have been given the low down on skin complaints for National Eczema Week.

Sure Start Children’s Centres in Torquay, Paignton and Brixham hosted clinics with health visitor Vashti Wilks and nurse Sarah Burns.

They offered advice and showed parents how to use moisturisers and creams.

Ms Wilks said: “There are a few things parents can do to help like freezing soft toys overnight to kill dustmites, cool creams in the fridge before putting them on the skin and apply creams downwards so that the hair is combed. This will stop the hair from being itchy.”

(c) 2008 Herald Express (Torquay UK). Provided by ProQuest LLC. All rights Reserved.

Jill K. Singer, Buffalo State College professor of earth sciences and director of the Undergraduate Research Office, was honored Thursday with the State University of New York’s Chancellor’s Award for Excellence in Scholarship and Creative Activities for 2008 at the college’s academic convocation in Rockwell Hall auditorium. The award was for her service to Buffalo State and SUNY. Singer, who for more than two decades has researched river restoration and sediment dynamics, has received grants totaling nearly $3.5 million from agencies including the U. S. Environmental Protection Agency.

***

Jane Cole Godin, a leader in Buffalo’s Jewish community for more than 40 years, received the Nathan Benderson Community Service Award at the Jewish Federation of Greater Buffalo’s United Jewish Fund Campaign 2009 Kick-Off Community Dinner on Monday in the Hyatt Regency Buffalo.

Jewish Federation President Arthur A. Glick noted that the award is for extraordinary service and commitment to the Jewish community. Past recipients include: Nathan Benderson, Ann H. Cohn, Harold S. and Fanette) Goldman, Gordon

R. Gross, Irving M. and Marilyn C. Shuman, Ruth Kahn Stovroff, Haskell Stovroff, James Stovroff, Milton and Amy Zeckhauser, Rose

H. and Leonard H. Frank, Donald S. Day, Shirley T. Joseph, Larry and Sharon Levite, Janet Desmon and Richard Zakalik. Godin was chairwoman of the Women’s Division of the United Jewish Fund Campaign in 1981 and over the years has served as a Federation board member, officer and member of the executive committee. She currently is secretary of the Federation’s board. She and her husband, William Godin, headed the 2007 UJF Kick-Off Dinner and were co-chairmen of the 2006 dinner.

She has been one of the chairwomen of the Women’s Philanthropy Lion of Judah Team and is now serving on the Foundation for Jewish Philanthropies board for the second time. Godin has also been director of volunteers at the Rosa Coplon Home.

The UJF Campaign Kick-Off Dinner was headed by Marilyn and Irving Shuman, Julie Kianoff and Ray Fink, and featured political analysts Paul Begala and William Kristol.

***

James Olson, professor of pharmacology and toxicology in the School of Medicine and Biomedical Sciences at the University at Buffalo, is leading research studies on exposure to pesticides, the potential for adverse effects associated with exposures in certain populations and genetic susceptibility to the pesticides. The studies are funded by $1.5 million in new grants from the National Institute of Environmental Health Sciences and the Environmental Protection Agency.

The three-year EPA grant focuses on the activation and detoxification of the most commonly used pesticides in the U. S. and worldwide. These pesticides can stop the action of an enzyme essential to nerve function in humans.

UB will lead studies assessing human exposure to these pesticides in the study population.

Matthew Bonner, of the UB School of Public Health and Health Professions’ department of social and preventive medicine, and James Knaak, of the UB department of pharmacology and toxicology, are co- investigators on the UB portion of both grants.

UB co-investigators on the EPA grant are Aiming Yu, of the School of Pharmacy and Pharmaceutical Sciences; Richard Browne, department of biotechnology and clinical laboratory sciences; and Paul Kostyniak, department of pharmacology and toxicology, both in the UB School of Medicine and Biomedical Sciences.

***

James Dunlop, senior vice president and chief financial officer of the Catholic Health System, has been chosen as a “rising star” by Modern Healthcare magazine.

Dunlop is one of a dozen health-care executives in the nation profiled as a rising health care management star in the publication.

The magazine’s annual recognition program drew a near-record 134 applicants from all sectors of the health care industry, according to magazine officials. An editorial review board composed of the magazine’s senior editors reviewed the nominations and selected Dunlop.

[email protected]

(c) 2008 Buffalo News. Provided by ProQuest LLC. All rights Reserved.

By Ed Blonz

Supplements not the basis for good nutrition

By Ed Blonz, Ph.D.

DEAR DR. BLONZ: I have a long workday and often don’t leave the office until it’s time for dinner. I am not questioning the importance of eating grains, fruits and vegetables, but I have neither the time nor the knowledge to cook. During the week, I usually end up eating out, doing takeout or buying single-serving entrees to make at home. My diet is not what I would consider to be marginal, but it is certainly not where it should be. I haven’t really suffered for it yet. How much will I be helping things out by adding a dietary supplement or a vitamin-fortified drink to my daily regimen? — M.Q., Danville, Calif.

Dear M.Q.: Your question goes to the heart of what nutrition and good eating are all about. The short answer is that it’s unrealistic to think that supplements or a vitamin-fortified drink can capture all the goodness that healthful whole foods have to offer. They can’t transform a marginal diet into a good one. However, it is not unreasonable to take multivitamin/mineral supplements or drinks, but you will still need to make good choices with the foods you do eat.

The healthfulness of eating fresh fruits, vegetables and grains has been verified through epidemiology, the science that investigates the connection between what people are eating or doing and their state of health.

The fact that good eating leads to good health is certainly not news. What’s relatively new is the technical ability to tweak out the identity of the beneficial compounds. I like to think of whole foods as providing a symphony of healthful compounds that work together like the instruments in an orchestra. If you rely on supplements, you will get only those ingredients that have been studied to the point that they have tickled the fancy of supplement makers enough to include them in their mix. Taking the same supplement day after day provides only those components. It is not the same as eating from a variety of healthful whole foods.

There are many excellent single-serving entrees in stores, and you can find restaurants that serve healthful foods on a takeout basis. What I would suggest, however, is that you consider making the time to take a basic cooking class. It is not that difficult, and it will open up a world of possibilities, such as learning how to prepare and store multiple portions of a meal. You state that you haven’t, as yet, suffered because of your dietary habits. Life, however, is a cumulative affair, so why not take this opportunity to make some positive adjustments?

DEAR DR. BLONZ: I have lost almost 30 pounds on a low- carbohydrate diet, but I wanted to try a little veggie pasta made with semolina flour. It is from a small gourmet company, and they don’t have a nutrition index. What is semolina flour, and is it going to be something that is OK on this diet? — W.F., Arlington Heights, Ill.

DEAR W.F.: Congratulations on your weight loss. Semolina is a coarse flour that is used in traditional pasta dough. It is made by milling whole kernels of durum wheat. Semolina flour is relatively high in (gluten) protein, and it absorbs less water, giving pasta dough and pizza dough their chewy texture. The semolina flour from durum wheat is used in Italy to make commercial pasta. It is also used to make couscous. The carbohydrate content will be in the same range as other wheat flours, which is around 100 grams per cup.

Originally published by Ed Blonz, Contra Costa Times Correspondent.

(c) 2008 Oakland Tribune. Provided by ProQuest LLC. All rights Reserved.

WAYNE, Pa., Sept. 29, 2008 (GLOBE NEWSWIRE) — Who would think that a dean, especially one of a medical school, could have an exciting and adventurous life full of rewards and failures? But with Decanus Maximus, the new memoir by Joseph R. DiPalma, M.D., one will have every reason to think so. This deeply moving account tells of DiPalma’s life and times as a medical school dean, covering a period of extraordinary growth in science and technology accompanied by the commercialization of medicine and healthcare delivery.

Decanus Maximus tells the story of a youngster who had a career in aviation in mind but was forced into the field of medicine by his family. Contrary to expectation, he became accomplished in science, medical practice, education, and administration. As dean of the Hahnemann University Medical School in Philadelphia, he encountered the intrigues of medical politics and the misadventures of successive presidents of the university. Among these were the colorful Wharton Shober and the incredible Sherif S. Abdelhak. The final chapter covers the details of the largest failure and bankruptcy of a Philadelphia healthcare plan.

“This book is a must-read for those contemplating a career in the health sciences or those interested in the romance and history of medicine as it developed in the last century,” says DiPalma. Indeed, Decanus Maximus is a beautifully realized work and, at the same time, an astonishing personal account of struggle and achievement in the challenging but ultimately rewarding world of medicine.

Decanus Maximus is now available for your reading pleasure at your local bookstore and online at Xlibris.com, Barnesandnoble.com, Amazon.com and Borders.com

About the Author

Joseph R. DiPalma, M.D., spent ten years in the private practice of internal medicine. He later became a professor, chairman of the Department of Phramacology, dean, and senior vice president of Hahnemann University School of Medicine. DiPalma authored a textbook of pharmacology and over two hundred scientific papers.

                   Decanus Maximus * By Joseph R. DiPalma, M.D.                 The Life and Times of a Medical School Dean                     Publication Date: October 15, 2004            Trade Paperback; $21.24; 485 pages; 978-1-413446-89-0            Cloth Hardback; $31.49; 485 pages; 978-1-413446-90-6 

To request a complimentary paperback review copy, contact the publisher at (888) 795-4274 x. 7479. Tear sheets may be sent by regular or electronic mail to Marketing Services. To purchase copies of the book for resale, please fax Xlibris at (610) 915-0294 or call (888) 795-4274 x.7876.

Xlibris books can be purchased at Xlibris bookstore. For more information, contact Xlibris at (888) 795-4274 or on the web at www.Xlibris.com.

This news release was distributed by GlobeNewswire, www.globenewswire.com

 CONTACT:  Xlibris           Marketing Services           (888) 795-4274 x. 7876           [email protected] 

By Kumar Sambhav

Mumbai: Remember the fat lady from last year’s dandiya group? Don’t be surprised if you find her shimmying on the floor this year at half her size and with twice the energy . Dandiya aerobics is the new get-thin-quick trick, aimed at those who want to be as slim as the sticks they twirl during the nine nights of Navratri.

Mahesh Roy, a finance consultant from Goregaon, weighed a sobering 115 kg a month ago. Now his friends and relatives find it difficult to recognise him. The 35-yearold has shed 13.5 kg in a month. “It really worked,” he says about dandiya aerobics. “I feel much more energetic and plan to dance for a much longer time this year. I can do all the steps as well.”

Those who have signed up say that the loss in flab is paralleled by a rise in confidence. Corroborating this, Vijay Kumar , a dance trainer at the Step and Dance Academy in Andheri, says that the fun lies in the fact that while the steps are like those in aerobics, the hand movements and the music are dandiya-like . “Only, the beats are faster and instead of dancing on the flat floor, we do it on step boards,” he adds. Kumar claims that one can reduce up to two or three kilos in a week because “the calories burnt in normal dandiya in, say, 12 hours can be reduced in just two hours of dandiya aerobics” .

Suchitra Pradhan, an Andheri-based pilates and bodytoning instructor, agrees. “Aerobics is always a good way to tone your muscle and if fused with dance it becomes entertaining too. You can work out longer without feeling exhausted ,” she says.

Age is no bar. Dandiya aerobics has a pan-age appeal. For some, like Madhavi Pandey, a SAP consultant, it’s the modernisation of dandiya that excites. “I like trying new things,” she says. “I’ve been doing dandiya for many years but the fast pace of dandiya aerobics gives me a kick.” For 54-year-old Dipavali Naik it’s a chance to shake a leg with her daughter. “Even today I can outwalk any of the youngsters,” she boasts. “I like this form. Earlier it was played with Tashas, Nagaras and Shahnayee. Now, that has changed. They have increased the tempo of the beats so the dance acts as a good cardio.”

Dance guru Shiamak Davar who has conducted workshops on the fusion of dandiya and jazz says that after disco dandiya and dandiya jazz, dandiya aerobics is the new kid on the block. “This is latest blend,” he says. “People always want change, so it’s always good to fuse forms. In that sense, dandiya blended with aerobics is a great idea, but it should not lose its original essence.”

(c) 2008 The Times of India. Provided by ProQuest LLC. All rights Reserved.

Every year, the TLC Real Estate Group participates as a team in the American Heart Association Heart Walk. This year the team, decided to walk in memory of Taylor Waltman, the Chesapeake Bay Middle School eighth-grader who died of an undetected heart disease Sept. 4, just 10 days shy of her 13th birthday.

“This will help the students and community heal after such a tragic loss,” wrote Linda Thackston in an e-mail. Ms. Thackston is an associate at TLC and one of the team organizers.

This year’s walk takes place at 9 a.m. Oct. 11 in Ellicott City’s Centennial Park. The team hopes to raise at least $1,500.

There are a number of ways people can get involved. There are donation jars set up throughout the county, including at the 7- Eleven stores in Pasadena and on Taylor Avenue in Annapolis; the TLC offices at 7500 Teague Road, across from the Arundel Mills mall in Hanover; and at several stores in Arundel Mills mall. They can also join the team by picking up a registration form at the 7-Eleven on Mountain Road or by calling Ms. Thackston at 410-691-4912.

People can also make a donation to the team by calling Ms. Thackston.

NFL punt, pass, kick

Youth can get a chance to toss or kick a football like the pros when the Buccaneers Athletic Club hosts a local competition of the NFL Pepsi Punt, Pass and Kick Competition from 4 to 8 p.m. tomorrow at the club’s field at 8572 Fort Smallwood Park.

The top finisher in each of the boy’s and girls’ divisions from the four age brackets of local competition will advance to the sectional round of the competition.

Though the competition is free, there are very specific requirements to participate, including parental signatures, birth certificates and the fact that only soft-sole gym shoes are permitted.

For more information, call Gwynn Philhower at 410-360-5953, e- mail [email protected] or visit www.ppk.nflyouthfootball.com.

Downs Park Quilters

The Downs Park Quilters is rested up after the summer hiatus and now working diligently on its raffle quilt, an annual effort by the club which helps fund beautification projects for its host park, Downs Memorial Park.

This year the raffle proceeds will benefit a wildlife meadow to be created in the park with trees and pushes designed for wildlife to feed on and live in, houses for birds and a walkway for enthusiasts to enjoy.

The members will soon be showing up at local grocery stores selling tickets for people to try to win the quilt.

The quilters meet at 9:30 a.m. Fridays in the Chesapeake Room on the lower level of the park information at 8311 John Downs Loop. The first Friday of each month features a brief business meeting, refreshments and “show and tell.”

For details, call Jackie Demerest at 410-437-7573.

Fun at ‘The Beach”

October will be a busy month at “The Beach,” aka the Riviera Beach Volunteer Fire Company, 8506 Fort Smallwood Road. The company recently announced a number of events planned for next month.

There will be a quarter auction featuring prizes for scrapbooking and rubber stamp enthusiast from 7 to 9 p.m. Oct. 8. The doors will open at 6 p.m. Food and drinks will be sold. The cost is $3. Extra paddles can be purchased for $3. Vendors interested in getting in on the auction can call Annette Lotz at 410-437-6119.

The company’s annual private prevention open house and safety day will take place from noon to 4 p.m. Oct. 26. It will include a Halloween costume contest, fun activities and demonstrations. Call Ms. Lotz for details.

For the gift that could keep on giving, the company is selling 2009 lottery calendars for a donation of $25. To purchase a calendar or for details, call Gloria Lewis at 410-693-0020.

Scout fundraiser

The Friends of 441 will host a shrimp, bull and oyster roast from 1 to 6 p.m. Oct. 11 to benefit Boy Scout Troop and Cub Scout Pack 441 of Pasadena.

The fundraiser will be held at the Veterans of Foreign Wars Post 2462, 1720 Bayside Beach Road. Food will be served from 1 to 4 p.m. There will be music provided by Rock’n’ Ron from 2 to 6 p.m.

The menu includes fried and steamed shrimp, oysters on the half shell, pit beet and ham, oyster stew, sausage and sauerkraut, macaroni and cheese, mashed potatoes and gravy, dessert, beer and soda.

Attendees are not allowed to take their own beverages to the event.

Tickets are $30.

For tickets or details, call Vince Rogalski at 410-255-4701 or Dan Bradley at 443-742-9989.

Scouts and spaghetti

Dig into a big plate of spaghetti and meatballs so that Boy Scout Troop 870 can fund its many troop activities.

The troop will host its seventh annual spaghetti dinner at St. Andrew’s Episcopal Church, 7859 Tick Neck Road, from 3 to 7 p.m. Oct. 11.

The menu also will include tossed salad, garlic bread, soda, coffee and dessert.

There will also be raffles, door prizes and home-baked goods for sale.

Tickets are $7 in advance or $8 at the door. Children ages 6 and younger dine for free. All carry-outs must be purchased.

For tickets or details, call Carmen Medina at 410-255-2843 or Julia Streeter at 410-360-6696.

Clubs and organizations in Pasadena can contact the Maryland Gazette at 410-766-3700, Ext. 2402, or send e-mail to [email protected]. {Corrections:} {Status:}

(c) 2008 Maryland Gazette. Provided by ProQuest LLC. All rights Reserved.

To: STATE EDITORS

Contact: Ali Williams of Shady Grove Fertility Reproductive Science Center, +1-301-545-1350, [email protected]

Nation’s leading fertility center announces opening of an onsite holistic care center

ROCKVILLE, Md., Sept. 29 /PRNewswire-USNewswire/ — In a formal acknowledgement of the value of combining Western and Eastern medical techniques to optimize patient care, Shady Grove Fertility Reproductive Science Center, the nation’s largest fertility and in vitro fertilization (IVF) center, announces the opening of a full- service holistic center in its Rockville headquarters offering complementary therapies such as fertility-focused acupuncture and yoga.

As of Oct. 1, Pulling Down the Moon — founded in 2002 in Chicago through a similar alliance with Fertility Centers of Illinois — will offer Shady Grove Fertility patients the option of supplementing their conventional treatment program with Integrative Care for Fertility(TM), its proprietary holistic approach that includes fertility yoga, acupuncture, massage, nutrition counseling, spiritual guidance and more.

“Our physicians have long recognized the importance of the mind- body connection and have provided increasing levels of alternative services in the 17 years since Shady Grove Fertility opened,” said Robert Stillman, MD, Shady Grove Fertility’s Medical Director, who nine years ago spearheaded a formal relationship with several local complementary medicine experts in acupuncture, yoga, mind-body nutrition, massage therapy and smoking cessation. “The logical next step for us is to offer a full array of fertility-specific holistic services under our roof through this alliance. As a premier clinical research facility committed to advancing the science of fertility treatments, Shady Grove Fertility has a responsibility to ensure that complementary fertility treatments are carefully considered as part of the care next to traditional fertility technologies.”

Open Monday through Saturday from 7 a.m. to 7 p.m. in Shady Grove Fertility’s Rockville headquarters at 15001 Shady Grove Road, Pulling Down the Moon staffs five acupuncturists and two yoga instructors, as well as massage therapists and nutritionists. “Our philosophy is that the best infertility treatment involves a truly holistic approach that maximizes potential for a successful conception and pregnancy through a range of therapies — from ancient Chinese healing arts practiced for thousands of years, to the latest techniques developed by today’s Western-trained researchers,” said Tamara Quinn, who along with Elisabeth Heller, co- founded Pulling Down the Moon after both women succeeded at conceiving following a combined East-West treatment program. “When it comes to fertility treatment, the whole truly is greater than the sum of its parts.”

A grand opening celebration is scheduled on Thursday, Oct. 2, from 5 to 7:30 p.m. for Shady Grove Fertility patients, medical staff and the media. The “Wine and Chi” party — “chi” in ancient Chinese culture is life force or energy flow — will feature complimentary acupuncture demonstrations on doctors and patients alike.

For more information, contact Ali Williams, Marketing Coordinator, Shady Grove Fertility, at 301-545-1350 or via email at [email protected].

About Shady Grove Fertility Center

Shady Grove Fertility Center is America’s largest progressive, private practice fertility center performing more than 3,500 in vitro fertilization (IVF) cycles annually, including 400 egg donation cycles and an equal number of ovulation induction and intrauterine insemination cycles annually in 2007. Twenty-one reproductive endocrinologists plus PhD scientists, and geneticists as well as 350 specialized staff care for patients in 11 full- service offices throughout the Washington DC, and Baltimore areas. Shady Grove Fertility offers a comprehensive range of fertility treatment options including IVF, donor egg and pre-implantation genetic diagnosis (PGD), as well as resources to address all patients’ needs–medical, emotional, and financial. Shady Grove Fertility conducts clinical research in collaboration with the National Institutes of Health. Since Shady Grove’s inception in 1992, more than 15,000 IVF babies have born. Shady Grove Fertility physicians have been featured as experts for comment on media outlets such as NBC’s The Today Show, The New York Times, NPR’s Diane Rehm Show (WAMU-FM 88.5, Washington, DC), and Parent Magazine. Washingtonian magazine listed Shady Grove among the area’s Best Places to Work in 2007. For more information, visit http:// www.ShadyGroveFertility.com.

About Pulling Down the Moon

Pulling Down the Moon, (PDtM) a fertility-focused holistic healing center that developed the trademarked Integrative Care for Fertility(TM) service, a set of individualized, holistic therapies designed to treat infertility via yoga, acupuncture, massage, nutrition counseling, spiritual guidance and more. Founded in 2002 in Chicago through an affiliation with the Fertility Centers of Illinois (FCI), PDtM operates three full-service holistic healing centers in Chicago-area FCI clinics. PDtM co-founders Tamara Quinn and Elisabeth Heller, M.S., are registered yoga teachers and co- authors of Fully Fertile: A Holistic 12-Week Plan for Optimal Fertility (Findhorn Press, February 2008). Their work has been featured by media outlets such as ABC, Fox, NBC, Chicago Tribune, Chicago Sun Times, MSNBC.com, Conceive Magazine, Yoga Journal and more. For more information, visit http:// www.PullingDowntheMoon.com.

SOURCE Shady Grove Fertility Centers

(c) 2008 U.S. Newswire. Provided by ProQuest LLC. All rights Reserved.

Zila, Inc. (NASDAQ:ZILAD) today announced that ViziLite(R) Plus with TBlue(R), its flagship oral cancer screening product, will be prominently featured at the British Dental Trade Association (BDTA) Dental Showcase in London on October 2-4, 2008. The BDTA meeting will be held at ExCeL London, the international exhibition and conference centre. The BDTA is attended by more than 10,000 dental professionals and has over 300 companies exhibiting.

Early detection of oral cancer will be a focus at the Showcase with presentations from the Mouth Cancer Foundation and members of the dental profession. A presentation featuring ViziLite Plus as a new screening technology in the UK will be presented on Thursday and repeated again on Friday on the exhibition floor.

Richard Horner, recognized UK mouth cancer awareness and prevention advocate, stated, “recent studies indicate that new cases of oral and oropharyngeal cancer continue to rise across the United Kingdom among all ages and both sexes.” He went on to state, “the timely introduction of products like ViziLite Plus further helps to bring focus on the identification of cancers and suspicious lesions earlier than visual examination alone.”

ViziLite Plus is currently available in the UK and Ireland exclusively through a distribution partnership with Panadent Limited. Orders for ViziLite Plus will be taken at the Panadent booth during Showcase hours.

About Oral Cancer and ViziLite Plus

Oral cancer is the sixth leading cause of cancer worldwide, and in the U.S., one person dies every hour from the disease. According to American Cancer Society data, nearly as many women will be diagnosed with oral cancer as with cervical cancer this year. The key to reducing the impact of this disease is early detection, yet prior to the introduction of ViziLite Plus the only screening tools available were the manual and visual exam, which helps explain why the mortality and morbidity associated with oral cancer have not markedly improved in the past 40 years. Worldwide clinical trials have demonstrated that the conventional visual/tactile examination may fail to identify up to 40% of cancers and precancers.

ViziLite Plus, an oral screening technology that utilizes a chemiluminescent light source (ViziLite) and a patented vital tissue dye (TBlue), helps dentists and dental technicians identify and evaluate abnormalities in the mouth that could potentially harbor pathologic changes. The ViziLite Plus exam takes only minutes and is totally painless and non-invasive.

Oral Cancer Risk factors:

— age – adults, especially those 40 years of age and older

— tobacco use – particularly if combined with heavy alcohol consumption

— heavy alcohol consumption

— excessive sun exposure to the lips

— sexually transmitted human papillomavirus (HPV)

About Zila, Inc.

Zila, Inc., is a fully integrated oral diagnostic company dedicated to the prevention, detection and treatment of oral cancer and periodontal disease. ViziLite(R) Plus with TBlue(R), the company’s flagship product for the early detection of oral abnormalities that could lead to cancer. In addition, Zila designs, manufactures and markets a suite of proprietary products sold exclusively and directly to dental professionals for periodontal disease, including the Rotadent(R) Professional Powered Brush, the Pro-Select Platinum(R) ultrasonic scaler and a portfolio of oral pharmaceutical products for both in-office and home-care use.

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. These forward-looking statements are based largely on Zila’s expectations or forecasts of future events, can be affected by inaccurate assumptions and are subject to various business risks and known and unknown uncertainties, a number of which are beyond the Company’s control. Therefore, actual results could differ materially from the forward-looking statements contained herein. A wide variety of factors could cause or contribute to such differences and could adversely affect revenue, profitability, cash flows and capital needs. There can be no assurance that the forward-looking statements contained in this press release will, in fact, transpire or prove to be accurate. For a more detailed description of these and other cautionary factors that may affect Zila’s future results, please refer to Zila’s Form 10-K for its fiscal year ended July 31, 2007 and Form 10-Q for the quarter ended April 30, 2008.

For more information about the company and its products, please visit www.zila.com.

Shipcom Wireless, a provider of healthcare solutions, has announced that its contract with the Air Force Surgeon General’s office to review the current uses of radio frequency identification technology across the US Air Force medical service has been extended.

According to Shipcom Wireless, the original contract involves a baseline assessment of clinical and business processes at Keesler medical center using Shipcom’s hospital operational and clinical assessment model (HOCAM). This assessment will be followed by recommendations on how the Air Force can utilize RFID and related technologies to improve patient care and make clinical processes efficient.

Finally, Shipcom will model and implement Rfid solutions at Keesler medical center using Shipcom’s x/Care suite of healthcare applications, including the patient care module p/care and the module a/care.

Abeezar Tyebji, CEO of Shipcom, said “Shipcom is pleased to continue our partnership with the Air Force medical services. This validates our approach of focusing on the clinical/business issues and validating technology use for specific areas.”

Valence Health, a leading provider of clinical integration and data management solutions, today announced that St. Luke’s Episcopal Hospital IPA (www.stlukestexas.com) in Houston, TX, has chosen Valence to help it become a clinically integrated provider organization. Valence offers the tools and technology infrastructure that enables entities like St. Luke’s to integrate data, improve physician performance and advance the quality of care to patients without changing the way physicians do business.

Executives at St. Luke’s Episcopal Hospital IPA recognized the importance of aggregating physician and hospital data to improve quality of care, facilitate hospital initiatives and increase overall efficiency. The hospital’s 500 independent physicians were ready to clinically integrate by collaborating and connecting electronically to collect office-based claims data, coupled with hospital data, to provide better care for patients.

“We had all of this data — patient information, physician notes, claims data — that we knew could be used to provide better patient care if we had it all coordinated in one easy-to-use system,” said Susan Kiley, vice president and chief managed care officer, St. Luke’s Episcopal Health System. “Valence Health has an excellent understanding of the physician world and the reasons that we at St. Luke’s were looking to clinically integrate. It has been able to provide us with a method of collecting and combining the data that is efficient and unobtrusive, allowing us to reap the benefits of clinical integration.”

“St. Luke’s has long been committed to providing exceptional quality services to its physicians,” said C. George Kevorkian, MD, president, St. Luke’s Episcopal Hospital IPA. “By teaming up with Valence, St. Luke’s will most certainly become a clinically integrated organization.”

Valence is assisting St. Luke’s with the selection of clinical protocols and guidelines for their clinical integration program that will affect the quality of care delivered to a majority of patients in its hospital population. Using vMine, Valence’s application for mining physician practice data, Valence is able to collect patient level data from disparate physician billing systems, aggregate the data into a single repository, and report variations in care for the organization as a whole and for individual physicians. This information becomes a powerful tool for helping physicians to work collaboratively, and focus on areas where quality improvement is most needed.

“The proper management and coordination of data and patient information can very often be daunting for IPAs and PHOs,” said Phil Kamp, president and CEO, Valence Health. “Helping organizations like St. Luke’s to clinically integrate and streamline its processes benefits the patients, the physicians and the hospital which, in turn, results in better overall quality of care.”

About Valence Health

Chicago-based Valence Health was formed in 1996 with the goal of providing data management and consulting support to provider owned organizations. Over the past several years, our team of experts has grown and so has our suite of products. We’ve built upon our data analytics and medical management expertise, and added third party administration, development of custom web-based applications, and clinical integration support to our list of core competencies. What hasn’t changed is our focus…providing innovative solutions to meet the needs of providers. For more information call (312) 277-6304 or visit www.ValenceHealth.com.

St. Luke’s Episcopal Health System (www.stlukestexas.com) includes St. Luke’s Episcopal Hospital in the Texas Medical Center, founded in 1954 by the Episcopal Diocese of Texas; St. Luke’s The Woodlands Hospital; St. Luke’s Episcopal Health Charities, a charity devoted to assessing and enhancing community health, especially among the underserved; and KS Management Services, LLC, overseeing 18 area clinic locations. St. Luke’s Sugar Land Hospital is under construction, scheduled to open in October 2008, and St. Luke’s Clear Lake Hospital is scheduled to open in 2010. Plans are underway for St. Luke’s Lakeside Hospital in The Woodlands. St. Luke’s Episcopal Hospital is home to the Texas Heart(R) Institute, which was founded in 1962 by Denton A. Cooley, MD, and is consistently ranked nationally among the top 10 cardiology and heart surgery centers in the nation by U.S. News & World Report. Affiliated with several nursing schools and two medical schools, St. Luke’s Episcopal Hospital was the first hospital in Texas named a Magnet hospital for nursing excellence, and twice has been honored with the Distinguished Hospital Award for Clinical Excellence(TM) by HealthGrades, a leading independent company that measures healthcare quality in hospitals. The Health System has been recognized by FORTUNE as among the “100 Best Companies to Work For” and by the Houston Business Journal as a top employer in Houston. St. Luke’s Episcopal Health System also was honored as one of Modern Healthcare magazine’s “100 Best Places to Work.”

By SHIRA SCHOENBERG

Concord Hospital will pay $100,000 in a settlement with six deaf people who say the hospital did not provide them with the services they needed to communicate with hospital staff, the U.S. Attorney’s Office said.

The hospital will also establish a new program to provide more effective communication for people who are deaf or hard of hearing. Although the U.S. attorney determined that the hospital violated the Americans with Disabilities Act, the hospital did not admit to any liability as part of the settlement.

In a written statement, Concord Hospital CEO and President Michael Green acknowledged that the hospital needed to improve its services for the deaf and hard of hearing. “Concord Hospital is very sorry that we failed to meet the needs of the deaf and hard-of- hearing population,” Green said. “We take this settlement agreement very seriously and understand that although those involved received excellent care, sub-optimal communication creates stress and anxiety for patients and their families.”

The complainants in the case are William Case, Joan Case, Christopher Emerson, Glenys Crane-Emerson, Gerald Girouard and Pamela Goguen. The Cases and the Emersons are married couples. Crane- Emerson is listed on the website of Northeast Deaf and Hard of Hearing Services as the organization’s New Hampshire telecommunication equipment distribution program coordinator. All of the complainants are deaf and communicate through American Sign Language. Joan Case and Goguen are also visually impaired.

According to the settlement agreement, each of the complainants claimed that the hospital discriminated against him or her by not providing services that would have allowed them to communicate with hospital personnel when they, or someone they were with, received medical treatment. They say they were not provided with sign language interpreters, and were required to use inadequate or inappropriate auxiliary aids, which hospital personnel did not know how to operate. In some cases, they had to rely on family members to help them communicate their medical concerns.

Assistant U.S. Attorney John Farley said that an initial complaint was submitted to the Department of Justice, and while investigating, Farley found other people who had similar experiences. Farley said the hospital cooperated with the investigation. “They expressed willingness to enter a settlement so we wouldn’t have to enter litigation,” Farley said.

None of the complainants could be reached for this story. But Joan Case’s case may have stemmed from a 2005 incident that was reported by the Associated Press. According to the AP, Joan Case was hospitalized with high fever and body aches. She asked for an interpreter but said no one showed up. Her husband gave an emergency medical technician a card with a toll-free number for an interpreter program, but records showed that no call was ever made.

Joan Case said that as a result, the emergency room doctor misunderstood her symptoms, leading to three days of unnecessary tests. Even after she had been admitted and treated for a leg infection, she said she did not learn of her diagnosis until two days later.

According to the terms of the settlement, the hospital will pay $50,000 to the Cases, $20,000 to the Emersons, $20,000 to Girouard and $10,000 to Goguen.

The settlement also lays out a detailed plan that Concord Hospital has agreed to implement. The hospital will need to create new positions for program administrators. These are people who will be available around the clock to answer questions and provide assistance to those who need it. The hospital will need to determine what assistance is required as soon as the patient comes into contact with the hospital. It will need to keep records of which patients need services, in order to provide the services on each visit.

The hospital will be required to provide qualified sign language, oral or tactile interpreters to patients and companions who need them, for things such as determining a patient’s medical history, receiving permission for treatment, explaining a diagnosis or treatment, explaining medication or test results, understanding billing or insurance issues, or a variety of other circumstances.

Within 30 days, the hospital will need to enter into a contract with an interpreter or an agency that can provide interpreters within the hour for at least 80 percent of the incidents. The hospital will also be required to maintain a list of all known freelance interpreters within 15 miles of the hospital who can be called in an emergency. The hospital will be required to meet certain guidelines ensuring quick response times for interpreters. It must also document every request for an interpreter and the response to that request.

In addition to personnel, access to technical equipment will also be improved. The hospital will be required to have high-quality video interpreting services available. It will also need to provide TTY devices, which allow those who are deaf to talk on the phone, wherever there are public phones. Portable TTYs will need to be available to patients in their rooms.

The hospital is forbidden to require a family member or companion to interpret.

The hospital will also need to do outreach to both staff and the public, posting signs about the availability of services, advertising its services and making information such as hospital polices and procedures available on video in American Sign Language. Physicians and emergency department personnel will receive mandatory training regarding how to assist patients with special needs.

The hospital will report to the U.S. Attorney’s Office regarding compliance with the settlement.

The hospital says it has already appointed a deaf and hard of hearing program coordinator, who will be an advocate for patients and companions. It has expanded the availability of devices and services, established a hospital-wide education program and modified its medical forms to ensure compliance.

Originally published by SHIRA SCHOENBERG Monitor staff.

(c) 2008 Concord Monitor. Provided by ProQuest LLC. All rights Reserved.

Wellstar International, Inc. (OTCBB: WLSI), a developer of thermal imaging, diagnostic software and equipment, announced today that it has made another key appointment to its medical advisory board. Ms. Edna Edwards Atwater, RN, BSN, widely respected as a premier wound care specialist, and current administrator at the Wound Management Institute of Duke University Medical Center, has already been serving as consultant to Wellstar and will now join Dr. Shen, Dr. Makowka and Courtney Lyder, ND to advise the rapidly emerging company on the medical and health care administration aspects of the Company’s business activities.

EDNA EDWARDS ATWATER, RN, BSN

Edna Edwards Atwater has been a registered nurse in the state of North Carolina since 1975. Among her professional appointments, she has served as President of the Dermatology Nurses’ Association, Chairperson of the Surgical Core Curriculum, Dermatology Nurses’ Association, on the Health Policy Committee, National Federation of Specialty Nursing Organization, and Dermatology Nurses’ Association Representative to the National Pressure Ulcer Advisory Panel. Atwater has served as an administrator / director for the Wound Management Institute of Duke University Medical Center, in addition to several other key roles for Duke, since 1998. Wellstar is very pleased that Edna Edwards Atwater has agreed to join the Company’s advisory board, and anticipates that she will play a very big role in the Company’s efforts to roll-out its thermal imaging systems nationwide.

Current shareholders and interested investors seeking additional biographical / background information on Edna Edwards Atwater, or any of the four newly appointed advisors to Wellstar, should visit the Company’s corporate Website at www.wellstar.us. Curriculum vitae for all four can be downloaded in PDF format. In addition, interested investors seeking further information are encouraged to call the Company’s investor relations’ representatives toll-free at (800) 953-3350.

ABOUT WELLSTAR INTERNATIONAL, INC:

Wellstar International, Inc., through its wholly owned operating subsidiary Trillenium Medical Imaging, Inc. (TMI), is poised to become a leading diagnostic company in the health care industry. TMI has developed and is marketing fully calibrated and functional, thermal imaging systems that utilize state-of-the-art infrared technologies and proprietary software to accurately and cost-effectively measure physiological changes in the human body. More information on the Company and its unique diagnostic software and product line is available on Wellstar’s corporate Website, by visiting: www.wellstar.us.

FORWARD-LOOKING STATEMENTS:

This press release contains statements, which may constitute ‘forward- looking statements’ within the meaning of the Securities Act of 1933 and the Securities Exchange Act of 1934, as amended by the Private Securities Litigation Reform Act of 1995. Prospective investors are cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, and that actual results may differ materially from those contemplated by such forward-looking statements. Important factors currently known to management that could cause actual results to differ materially from those in forward-statements include fluctuation of operating results, the ability to compete successfully and the ability to complete before-mentioned transactions. The company undertakes no obligation to update or revise forward-looking statements to reflect changed assumptions, the occurrence of unanticipated events or changes to future operating results.

 CONTACT: Equiti-trend Advisors LLC (800) 953-3350 Toll-Free, U.S. & Canada (858) 436-3350 Local or International  

SOURCE: Wellstar International, Inc.

PARSIPPANY, N.J., Sept. 29 /PRNewswire/ — Ferring Pharmaceuticals today announced a new, expanded cost-saving program for patients who are considering fertility treatment, but find the costs a challenge. Ferring’s HEART (Helping Expand Access to Reproductive Therapy) Rx Initiative gives women greater access to fertility medications by providing significant cost savings on two frequently prescribed fertility treatments. The program now includes both BRAVELLE(R) (urofollitropin for injection, purified) and MENOPUR(R) (menotropins for injection, USP).

“In our ongoing effort to increase access to safe, effective fertility treatments, we have expanded our long-time HEART Program, now called the HEART Rx Initiative, to give qualified couples a greater chance to build families,” said Olivier Delannoy, Vice President, Infertility Business Unit. “Cost should not be a barrier to parenthood.”

With Ferring’s expanded HEART Rx Initiative, cash-paying patients save up to $2,100 on BRAVELLE and MENOPUR. The program helps reduce costs for patients undergoing ovulation induction, donor or in vitro fertilization cycles. Full program details are available at http://www.ferringfertility.com/HEART.

How the Program Works

If you are a cash-paying patient and your doctor prescribes a fertility treatment, ask the doctor if these products are right for you and if you qualify for the HEART Rx Initiative.

   --  To receive the savings, your doctor will give you a HEART Rx brochure       along with the prescription.   --  Take the prescription and brochure to a participating pharmacy.  For a       list of participating pharmacies, visit       http://www.ferringfertility.com/HEART.   --  Pay a $10 enrollment fee for the annual membership.  The pharmacist       will give you a membership number.   --  Fill out the membership card.  You will automatically receive the       cost-savings each time you fill the prescription.    

For more information, speak to your doctor or call 1-888-FERRING (337-7464).

About BRAVELLE and MENOPUR

BRAVELLE and MENOPUR, like all gonadotropins, are potent substances capable of causing mild to severe adverse reactions, including OHSS (incidence of 6.0% and 3.8%, respectively), with or without pulmonary or vascular complications, in women undergoing therapy for infertility. Like other products for ovarian stimulation, treatment with BRAVELLE and/or MENOPUR may result in multiple gestations. Only physicians thoroughly familiar with infertility treatment, including the risk of multiple births and adverse reactions, should prescribe these medications.

About Ferring Pharmaceuticals

Ferring Pharmaceuticals, part of the Ferring Group, a privately owned, international pharmaceutical company, manufactures and markets the largest family of fertility treatments of any manufacturer in the U.S. The Company markets MENOPUR, BRAVELLE, REPRONEX(R) (menotropins for injection, USP), NOVAREL(R) (chorionic gonadotropin for injection, USP) and ENDOMETRIN(R) (progesterone) Vaginal Insert 100 mg in the U.S. to infertility specialists and their patients. Ferring also offers the Q-CAP(TM), the first and only needle-free reconstitution device, for use with its fertility treatments.

Ferring’s line of orthopaedic and urology products includes EUFLEXXA(R) (1% sodium hyaluronate) hyaluronic acid for pain from osteoarthritis in the knee and PROSED(R)/DS for the relief of discomfort of the lower urinary tract. Other products include: ACTHREL(R) (corticorelin ovine triflutate for injection) for the differential diagnosis of Cushing’s syndrome; and DESMOPRESSIN ACETATE in injectable and rhinal tube forms for the treatment of diabetes insipidus and primary nocturnal enuresis.

The Ferring Group specializes in the research, development and commercialization of compounds in general and pediatric endocrinology, urology, gastroenterology, obstetrics/ gynecology and infertility. For more information, call 888-337-7464 or visit http://www.ferringusa.com/ or http://www.ferringfertility.com/.

Please contact Andrea Preston for full prescribing information for BRAVELLE and MENOPUR.

Ferring Pharmaceuticals

CONTACT: Andrea Preston, Kovak-Likly Communications, +1-203-762-8833,[email protected]

Web Site: http://www.ferringfertility.com/http://www.ferringfertility.com/HEARThttp://www.ferringusa.com/

ARLINGTON, Va., Sept. 29 /PRNewswire-USNewswire/ — Health Care Without Harm applauds the Massachusetts Department of Public Health’s new guidelines requiring health-related institutions to use the Green Guide for Health Care (GGHC; http://www.gghc.org/) or its equivalent in the design, construction, and renovation of facilities seeking Determination of Need (DoN) approval. The DoN Environmental Guidelines, approved September 24, are the first of their kind in the country.

The DoN changes require hospitals and extended care applicants to get at least 50% of the possible green building points in the Green Guide for Health Care or the US Green Building Council’s Leadership in Energy and Environmental Design-Health Care (LEED-HC; http://www.usgbc.org/Displaypage.aspx?categoryID=19), a “silver” level of achievement. As a result, new and renovated hospitals and nursing homes will emphasize non-toxic materials, more efficient and renewable energy systems, better air quality and day-lighting.

John Auerbach, Massachusetts Dept. of Public Health Commissioner, stated, “With this action the Department is adding a new layer of protection for the health of our citizens, and establishes the importance of improving patient healing and staff wellness through environmentally sound building, construction and operation of health care facilities.”

“This guideline will contribute to the sustainable operation of hospitals and extended care facilities in Massachusetts, and sets a precedent we hope will be followed by other states,” stated Bill Ravanesi, MA, MPH, Boston Regional Director, Health Care Without Harm.

“This guideline is consistent with our commitment to provide a healthy and sustainable environment for our patients, visitors and staff,” stated Arthur Mombourquette, Vice President for Support Services at Brigham and Women’s Hospital. “It is helpful to have a designated standard to use to ensure that hospitals are utilizing the best resources available to them.”

Effective January 1, 2009 for hospitals, and July 1, 2009 for extended care facilities, applicants will submit a provisional green and healthy strategy credit point assessment in their initial DoN application, then a completed certifiable assessment as part of their plan review. Final approval will be contingent on their getting at least 50 percent of the possible points.

“We are very pleased,” said Gail Vittori, convener/director of the GGHC. “Our standard is being used all over the country by hospitals developing sustainable operations.” The major teaching hospitals in Boston and several community hospitals in Massachusetts have or are currently using the GGHC for their capital projects.

“This new guideline will help assure Massachusetts residents that their health facilities continue to be constructed in a manner that minimizes environmental impact and that contributes to the fundamental mission of hospitals – the safe care of patients and the protection of their staff members,” stated Lynn Nicholas, FACHE, president & CEO of the Massachusetts Hospital Association (MHA).

An MHA conference “Hospitals Going Green” (http://www.mhalink.org/) on October 3, and a Health Care Without Harm Seminar on October 29 will include in-depth presentations and discussion of the new guidelines and other emerging standards.

“The field is starting to build children’s hospitals without asthma triggers and cancer centers without carcinogens. This is harder to achieve than you’d think, but we know from many successes that requiring half the possible points is an aggressive but eminently do-able approval threshold. We encourage other states wishing to implement similar measures to contact us for assistance,” stated Paul Lipke, Senior Advisor, Energy and Buildings for Health Care Without Harm.

Heath Care without Harm, an international coalition of more than 473 organizations in 52 countries, is working to transform the health care sector, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment. For more information on healthy building, go to http://www.noharm.org/us/healthyBuilding/issue . To learn more about HCWH’s work on other issues related to health care, go to http://www.noharm.org/.

Health Care Without Harm

CONTACT: Bill Ravanesi, MA, MPH, +1-413-565-2315, [email protected],or Paul Lipke, +1-413-367-2878, [email protected], both of Health Care WithoutHarm

Web Site: http://www.gghc.org/

San Diego-based Concerro, (formerly BidShift), the leading Software-as-a-Service (SaaS) provider of Excellence in Staffing solutions, has successfully launched its web-based service at Garden City Hospital, (GCH) Garden City, MI, combining technology and services to optimize the operational and financial management of their workforce, empower employees, and promote excellence in staffing. GCH was designated as a Thomson 100 Top Hospital in 2007, ranking in the top 100 in the nation for teaching hospitals.

GCH has implemented several of Concerro’s HealthStaff 2.0 modules, available online as a software-as-a-service (SaaS) model, to help reduce use of external contract labor, optimize use of the current workforce, improve process inefficiencies associated with managing external staffing agencies, and improve staff satisfaction.

“As the industry’s need for experienced healthcare professionals grow, hospitals nation-wide will continually seek innovative ways to fill the rising demand for trained staff,” stated Debby Williams, CNO of Garden City Hospital. “Concerro has helped us implement several solutions to help achieve our unique staffing objectives. Since implementing the modules in April, we’ve been able to fill 54% of our open shift needs without expensive contract labor, and this percentage is continually growing.”

Modules implemented include:

– ShiftSelect: Employees are able to view and request available open shifts that match their skills, experience, and lifestyle interests. ShiftSelect can be accessed online anywhere anytime, offering employees maximum flexibility and choice.

– ShiftRewards: Includes non-monetary, point-based incentive program that rewards staff with points that are earned for requesting and/or being awarded a shift. Points are accumulated and redeemed for rewards, much like airline frequent flyer or credit card point programs. Staff have the option to manage their own reward selection and fulfillment process accessing a tiered online merchandise catalog for hundreds of reward items. ShiftRewards is also being used to reward staff for their participation and completion of other hospital activities such as completing hospital surveys, or for outstanding job performance.

– VMShift: Automates rapid communication of shift requests with approximately 45 of the medical center’s external staffing agencies.

GCH will also be one of the first hospitals to implement Concerro’s new ShiftConnect later this year to provide advanced shift management and core scheduling for all shift types, including core, non-duty, on-call, and open shifts.

“Garden City Hospital’s willingness to innovate using technology to redefine excellence in staffing reflects the significance that hospitals are placing on creating an environment where nurses want to work in order to remain competitive,” stated Graham Barnes, CEO of Concerro. “As a nationally recognized hospital, the addition of Concerro to ensure staffing excellence will enhance their reputation as a leader in the healthcare industry.”

About Garden City Hospital

Located in Garden City, Michigan, Garden City Hospital provides comprehensive health care services, medical education, and health care related programs to the community at large. For more information about Garden City Hospital, please call 734-458-3300 or visit http://www.gchosp.org.

About Concerro

Concerro, formerly known as BidShift, is a SaaS (Software-as-a-Service) company that uses Web 2.0 technology to deliver software and services that achieve excellence in staffing by enabling employees to connect and collaborate, online in anyplace at anytime. Based in San Diego, Calif., Concerro helps healthcare organizations realize cost savings, recruit and retain staff, and improve patient care with data-driven decision making. The company was recently recognized by Inc. Magazine as one of the 500 most rapidly growing privately-held companies in the United States. To learn more, visit www.concerro.com.

CORONA, Calif., Sept. 29 /PRNewswire-FirstCall/ — Watson Pharmaceuticals, Inc. , a leading specialty pharmaceutical company, announced today that investigators presented efficacy and safety data on silodosin, its investigational treatment for benign prostatic hyperplasia (BPH, or prostate enlargement), at two regional meetings of the American Urological Association (AUA). The trade name for silodosin will be RAPAFLO(TM).

These abstracts included results of Phase 3 studies, which showed that treatment with RAPAFLO for up to one year effectively reduces the symptoms of BPH and is well tolerated without causing any significant changes in blood pressure or adverse cardiac effects. Cardiac safety data further demonstrated that RAPAFLO, used alone or in combination with medications for erectile dysfunction (ED), showed only minimal effects on blood pressure or heart rate.

“We are excited by these clinical data as they further support the strong and sustained efficacy, as well as the safety and tolerability of RAPAFLO that have been demonstrated in other trials,” said Edward Heimers, Jr., Executive Vice President and President of Watson’s Brand Division. “As a highly selective alpha-1A blocker, we believe that RAPAFLO will address an important medical need in urology. Earlier this year, the New Drug Application for RAPAFLO was filed, and we look forward to working with the U.S., Food and Drug Administration to make this treatment option available to patients.”

Data at the New England Regional AUA

At this year’s New England Regional meeting of the AUA, investigators presented two abstracts on the efficacy and safety of RAPAFLO.

The first abstract was a pooled analysis of two Phase 3 double-blind, placebo-controlled trials involving 923 generally healthy men ages 50 or older, with signs and symptoms of BPH, including a peak urine flow rate (Qmax) between 4 and 15 mL/sec (mean of 8.7 to 8.9) and International Prostate Symptom Score (IPSS) > or = 13 (mean of 21.3). Patients were randomized to either 8 mg RAPAFLO once daily (n=466) or placebo (n=457) for 12 weeks.

After 12 weeks of treatment, RAPAFLO significantly improved urinary symptoms, including IPSS (the primary endpoint), compared to placebo (mean reduction of -6.4 vs. -3.5, respectively; p

Over the course of 12 weeks, treatment was well tolerated and the effect on blood pressure was similar between the RAPAFLO and placebo groups. Incidences of treatment-related dizziness and headache were low. Adverse events were minimal and were generally mild and related to retrograde ejaculation (reduced semen). There were no treatment-related cardiac events or hypertension.

The second abstract included data from a 9-month, open-label extension trial involving patients who had successfully completed the two previous 12-week, Phase 3 trials. A total of 661 patients were enrolled to receive RAPAFLO 8 mg once daily for an additional 40 weeks; 435 (65.8%) completed the extension study. A safety evaluation was based on adverse events, vital signs and clinical laboratory tests, electrocardiography (ECG), and physical examinations. An efficacy endpoint was change in IPSS at 40 weeks.

All 661 patients were included in the safety evaluation. Over the course of one-year of treatment, RAPAFLO was shown to be safe and well tolerated. Sixty-five percent (65.2%) of all patients reported at least one adverse event; less than one third of these (28.4%) were drug related. There were no serious drug-related adverse events. RAPAFLO was not associated with any clinically meaningful changes in blood pressure, clinical laboratory parameters, ECG results, or physical examination findings. Retrograde ejaculation (reduced semen) was the most common adverse event, though it rarely leads to drug discontinuation.

In the evaluable population of 429 (64.9%) patients, the IPSS decreased by a mean of 3.1 points between weeks 0 and 40. Although the change was larger (mean .4.4 points) in patients previously given placebo, the total score also decreased (mean .1.6 points) in patients previously treated with RAPAFLO. Treatment with RAPAFLO for up to one year also reduced IPSS irritative subscore (-1.7 points in patients previously on placebo and -0.6 in patients continuing RAPAFLO) and obstructive subscore (-2.7 in patients previously on placebo and -1.0 in patients continuing RAPAFLO).

Data at the Mid Atlantic Regional AUA

A placebo-controlled, open-label, crossover trial, presented at the Mid Atlantic Regional meeting, evaluated the concomitant use of RAPAFLO with the maximum doses of sildenafil or tadalafil, two agents commonly used to treat ED.

In the study, 22 healthy men (ages 45 to 78 years) received 8 mg RAPAFLO once daily for 21 days. On days 7, 14, and 21, subjects randomly received a single dose of 100 mg sildenafil, 20 mg tadalafil, or placebo. Resting (baseline) and standing orthostatic measurements were performed 0h (predose) to 12h after single-dose treatment. A positive orthostatic test was defined as a decrease in systolic (or diastolic) blood pressure by >30 (or >20) mm Hg, increased heart rate (>20 bpm), or orthostatic symptoms on change of position, such as dizziness.

Overall, concomitant use of RAPAFLO and maximum doses of sildenafil or tadalafil in healthy men caused no symptomatic changes in blood pressure, heart rate, or orthostatic symptoms. The cumulative number of positive orthostatic tests was similar for all treatments — in 16 subjects or = 65 years (sildenafil, 6; tadalafil, 8; placebo 5).

“These data provide important new evidence about this potential treatment option for BPH. Considering that many men with BPH also have other co-morbid conditions, including erectile dysfunction, heart failure, hypertension and coronary artery disease, it’s important to find complementary treatments that can be used with other medications without deleterious cardiovascular interactions, including the prolongation of the QTc interval and do not complicate patient care,” said Norman Lepor, M.D., a cardiologist and associate clinical professor of medicine, University of California, Los Angeles (UCLA) and attending cardiologist at the Heart Institute at Cedars-Sinai Medical Center.

About RAPAFLO(TM) (silodosin)

RAPAFLO is a highly selective alpha-1 adrenergic receptor antagonist under development in the US for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). RAPAFLO binds with high affinity to the alpha (1A) receptors in the prostate causing the smooth muscles in these tissues to relax, resulting in an improvement in urine flow and a reduction in BPH symptoms. The binding affinity for the alpha (1B) receptors that cause smooth muscle relaxation and blood pressure effects in the cardiovascular system is significantly lower, thereby maximizing target organ activity for treating BPH while minimizing the potential for blood pressure effects. RAPAFLO was originally developed by Kissei Pharmaceutical Co., Ltd. in Japan and licensed to Watson for the US, Canada and Mexico markets.

About Watson Pharmaceuticals, Inc.

Watson Pharmaceuticals, Inc., headquartered in Corona, CA, is a leading specialty pharmaceutical company that develops, manufactures, markets, sells and distributes brand and generic pharmaceutical products. Watson pursues a growth strategy combining internal product development, strategic alliances and collaborations and synergistic acquisitions of products and businesses.

The mission of Watson Urology is to offer products and services that improve the quality of patients’ lives, and satisfy the needs of physicians who specialize in the diagnosis, management, and treatment of urological disorders. By advancing education and support for urological diseases, we are creating the differences that make life more livable.

In the U.S., the Watson portfolio includes: Oxytrol(R); TRELSTAR(R) LA; TRELSTAR(R) Depot; Androderm(R); ProQuin(R) XR, under a co-promotion agreement with Depomed, Inc.; and AndroGel(R), under a co-promotion agreement with Solvay Pharmaceuticals, Inc. The Watson portfolio also includes a number of products under development including: silodosin, a product under development for the treatment of benign prostatic hyperplasia; a six-month formulation of TRELSTAR(R) (triptorelin pamoate for injectable suspension), under development for the treatment of advanced prostate cancer; and OTG, under development for overactive bladder.

For press releases and other company information, visit Watson Pharmaceuticals’ Web site at http://www.watson.com/.

Forward-Looking Statement

Any statements contained in this press release that refer to future events or other non-historical facts are forward-looking statements that reflect Watson’s current perspective of existing trends and information as of the date of this release. Except as expressly required by law, Watson disclaims any intent or obligation to update these forward-looking statements. Actual results may differ materially from Watson’s current expectations depending upon a number of factors affecting Watson’s business. These factors include, among others, the difficulty of predicting the timing or outcome of product development efforts and FDA or other regulatory agency approvals or actions, if any; whether the results of clinical trials for silodosin and other information will be sufficient to support approval by FDA or other regulatory authorities; the impact of competitive products and pricing; market acceptance of and continued demand for Watson’s products, including silodosin; difficulties or delays in manufacturing; and other risks and uncertainties detailed in Watson’s periodic public filings with the Securities and Exchange Commission, including but not limited to Watson’s Annual Report on Form 10-K for the year ended December 31, 2007.

(Logo: http://www.newscom.com/cgi-bin/prnh/20020214/WATSONLOGO)

Photo: NewsCom: http://www.newscom.com/cgi-bin/prnh/20020214/WATSONLOGOAP Archive: http://photoarchive.ap.org/PRN Photo Desk, [email protected]

Watson Pharmaceuticals, Inc.

CONTACT: Patty Eisenhaur of Watson Pharmaceuticals, Inc.,+1-951-493-5611; or Trina Chiara, +1-646-420-3365, or Rashelle Isip,+1-212-880-5354, both of Ogilvy Public Relations, for Watson Pharmaceuticals,Inc.

Web site: http://www.watsonpharm.com/

Hudson, Wis., Sept. 29 /PRNewswire-USNewswire/ — Dr. Barry Karlin, CEO of CRC Health Group, the nation’s largest provider of substance abuse treatment services, today announced the acquisition of Burkwood Substance Abuse Services in Hudson, Wisconsin (615 Old Mill Road). Burkwood is a residential treatment facility with a capacity of 29 beds serving both short and long term needs.

Dr. Karlin stated, “We are especially pleased at acquiring Burkwood, which has a successful history of treating underserved patients through local State contracts. The facility has demonstrated unique abilities to assist ‘dual diagnosis’ clients with both substance abuse problems and mental health issues.”

Dr. Karlin added that “the acquisition will continue the local leadership, retain Burkwood’s outstanding staff, and will achieve the benefits of comprehensive services from the country’s largest provider. It is an excellent strategic fit and value to both Burkwood and CRC and will strengthen support of the community.”

Burkwood is a dual-diagnosis/12-step facility located in Hudson, WI, approximately one hour east of Minneapolis/St. Paul, MN. The facility, founded twenty years ago, is housed in a 120-year-old mansion on 2.5 acres with beautiful, mature trees on property adjacent to a state park. It is licensed through the state of Wisconsin DHS as a Community Based Residential Facility, has a CSAS-Medically monitored treatment license, and is licensed for partial hospitalization outpatient services.

Contact: Bob Weiner/Rebecca Vander Linde 301-283-0821/202-329-1700

Robert Weiner Associates; CRC Health Group

CONTACT: Bob Weiner, +1-301-283-0821; or Rebecca Vander Linde+1-202-329-1700, both of Robert Weiner Associates, for CRC Health Group

Sanguine Corporation (OTCBB: SGUI) is pleased to announce that the Company has expanded the use of PHER-O2 by signing a Memorandum of Understanding (MOU) with a medical device company to test the product as a potential carrying agent for a patented MRI procedure. Testing to verify the effective use of PHER-O2 as a carrying agent will be paid for by the medical device company. Management recognizes the importance of this opportunity and believes the worldwide marketplace for an MRI diagnostic carrying agent is substantial.

Dr. Thomas Drees, Sanguine’s CEO, stated, “We are happy to have signed a Memorandum of Understanding (MOU) with this distinguished group. It is a natural step in the process of seeking the commercialization of our PHER-O2 product. The MOU is intended to provide for PHER-O2 testing, which validates the use of PHER-O2 in conjunction with this group’s proprietary diagnostic procedure. Pending PHER-O2’s successful testing, it is Sanguine and the medical device company’s intention to move rapidly into a worldwide product licensing agreement. The agreement will detail a regulatory approval path for this specific application.”

Drees added, “The need for earlier detection of all cancers is essential to the best possible treatment and survival. This is especially true of the most deadly malignancies; cancers of the brain, lung and pancreas, where the mortality rates are significantly higher than other forms. Experts estimate that in the United States there are approximately 275,000 new cases of these three types diagnosed every year; and while this number has declined, the mortality rates from them have risen substantially over the past decade. In fact, the five-year survival rate for patients with Pancreatic cancer, where no screening system exists, is 5% if spread and 20% if localized. The biggest reason is that they are very difficult to detect in their formative stages. The medical community has been searching for a better way to screen for these cancer types and has not been very successful to date. The reason being that detection is often late in the process when pain or other symptoms occur. Should PHER-O2 play a role as a carrier agent for early screening processes, as we believe it very well could, it could lead to a significant achievement in treatment and longevity.”

The device company’s product is in use for: Oxygen-based diagnostic agents, preparations and substances for medical purposes, including, contrast media for medical imaging for use with MRI diagnostic machines, and diagnostic scanning agents in the nature of contrast media for use in “In-Vivo” imaging. As a carrying agent, PHER-O2, in conjunction with the device company’s proprietary diagnostic procedure, could play a significant role in the following:

 --  Ability to assess tissue viability in cases of neurological and     cardiovascular catastrophes such as (Heart or Stroke attack), or other     tissue injury. --  Ability to determine Oxygen Extraction Fraction [OEF] of Tissue such     as in stroke at a 1 mm resolution, because they can cross the intact blood     brain barrier. [Presently can only be done with PET/CT, using a radio-     active isotope oxygen-15] at its best resolution of 6 mm. --  Current PET studies show, with OEF as an indicator the "Golden hour -     3 Hours after onset of Stroke" can now be extended up to 12 hours or more,     enabling the clinician and thereby saving lives, reducing disabilities and     costs. --  Ability to track tumor angiogenesis. --  Usefulness as "Non Invasive Realtime Tissue Stress Monitor" to     evaluate normal and abnormal Oxygen Consumption rates in a biological     subject, without any limitations on repeating the test due to dosage and/or     other limitations.      

For information related to the Sanguine Corporation, contact Investor Relations: Michael Dancy, 801-746-3570, email: [email protected], or visit: www.sanguine-corp.com.

Forward-looking statements in this release are made pursuant to the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995. Investors are cautioned that such forward-looking statements involve risks and uncertainties, including without limitation, continued acceptance of the Company’s products, increased levels of competition for the Company, new products and technological changes, the Company’s dependence on third-party suppliers, and other risks detailed from time to time in the Company’s periodic reports filed with the Securities and Exchange Commission.

 Contact: For Sanguine Corporation Michael Dancy Investor Relations 801-746-3570 Email Contact

SOURCE: Sanguine Corporation

Research and Markets (http://www.researchandmarkets.com/research/798b8b/taiwan_pharmaceuti) has announced the addition of the “Taiwan Pharmaceuticals and Healthcare Report Q3 2008” report to their offering.

The Taiwanese pharmaceutical market was worth around US$4.32bn in 2007, which is small by global standards, but a considerable value given the small size of the country. Overall, Taiwan remains firmly planted in the middle of BMI’s Business Environment Rankings table for Q308, being placed in a seventh position out of 14 evaluated Asia Pacific markets. It is found just ahead of the emerging markets, such as Malaysia and the Philippines, but below comparable more advanced markets, such as Singapore and South Korea. In the coming months, Taiwan is not expected to improve the placing significantly in the near term as the key fundamentals are forecast to remain relatively static, while its regulatory and pricing environment becomes more challenging in the face of the recently introduced health technology assessment (HTA) system for pricing and reimbursement of new drugs.

On the other hand, Taiwan will continue to draw interest from foreign companies due to a traditional preference for branded medicines and high usage of pharmaceuticals. For example, statistics published in March 2008 indicated that, in 2007, people in Taiwan consumed over TWD3bn (US$97.7mn) worth of non-steroidal anti-inflammatory drugs (NSAIDs) as generalised painkillers, or per capita spending of US$4.25. While this is good news for drug makers in this particular therapeutic area, as heavy use of painkillers in Taiwan has been a problem for many years, the government is likely to take action to rectify the situation and protect public health.

On the more positive note, the population’s health is improving. According to a recently published study, the compulsory National Health Insurance (NHI) scheme has succeeded in reducing the life expectancy gap between the richer and poorer sections of society. However, key industry stakeholders continue to criticise the NHI for failing in its fundamental mandate of helping the vulnerable get access to medical services, with patients on low incomes paid more in relative terms for medical treatment due to fixed co-payment and other fees. The investigation also concluded that the NHI did not significantly accelerate lengthening of life expectancy.

In terms of company developments, in April 2008, Wyeth Taiwan defended itself against charges levelled by the Taiwanese newspaper United Daily News that it is overcharging consumers for one of its leading multivitamins. However, the company denies that the price is too high, and claims that a complicated manufacturing process and government regulations are the reason for the high cost. Centrum is classed as a drug and accordingly is subjected to greater scrutiny by the Bureau of Pharmaceutical Affairs (BPA) than if it were a health supplement. However, as several lawmakers have expressed concern over the pricing issue, the government has promised to investigate the cost of vitamins further.

BMI’s Taiwan Pharmaceuticals and Healthcare Report provides independent forecasts and competitive intelligence on Taiwan’s pharmaceuticals and healthcare industry.

Key Topics Covered:

— Executive Summary

— Recent Regulatory Developments

— Foreign Company Activity

— Key Growth Factors – Industry

— Company Profiles

— BMI Forecast Modelling

Companies Mentioned:

— Pfizer

— Sanofi-Aventis

— GlaxoSmithKline

— Novartis

— Merck & Co

— Bayer Schering Pharma

— Yung Shin Pharmaceutical (YSP)

— ScinoPharm Taiwan

— Synmosa Biopharma

— Life Star Pharmaceutical

— EMO Biomedicine Corporation

— Empax Pharma

— Purzer Pharmaceutical

— Taiwan Biotech Co

For more information visit http://www.researchandmarkets.com/research/798b8b/taiwan_pharmaceuti.

By CHRIS LEONARD

By CHRIS LEONARD

Staff Writer

MILLERSBURG — Out of 99 of the best organizations to work for in Northeast Ohio — such as Kent State University, The Cleveland Clinic and its hospitals or the Federal Reserve Bank of Cleveland — Pomerene Hospital for the fourth year in a row ranked as one of them.

At its Thursday board meeting, Connie Poulton, vice president of human resources and support services, said the hospital accepted the NorthCoast 99 award from the Employers Resource Council on Sept. 17 at LaCentre Conference & Banquet Facility in Westlake.

“I think it just validates the fact that we know we are on the right track,” Poulton said.

ERC is Northeast Ohio’s largest professional organization dedicated to HR practices, programs and services. Since 1999, hundreds of organizations have been nominated and applied for the award. Winners are recognized for their ability to maintain great workplaces that support the attraction, retention and motivation of top performers, according to the organization’s Web site.

As part of the application process, several Pomerene employees had to complete an online survey, Poulton said, and rate various characteristics of the job and what motivates them at work.

The hospital was evaluated in six other categories: compensation and benefits; communications; community service; recruitment and selection; training and development; and workplace health and safety.

Being ranked as one of the top 99 places to work shows the hospital is doing its job in employee satisfaction, Poulton said.

“We know we’re retaining people, which is definitely what we want to do,” she said.

She estimated company turnover at 6 percent, which she said was below state and industry averages.

In other business, vice president of patient services Nicole Gemma said the hospital will hold an eight-hour community-based program for its nurses and physicians aimed at stabilizing infants less than a month old before transfer to other hospitals.

CEO Tony Snyder said most cases at the hospital are taken to Aultman Hospital in Canton.

Reporter Chris Leonard can be reached at 330-674-1811 or e-mail [email protected].

Originally published by By CHRIS LEONARD Staff Writer.

(c) 2008 Daily Record, The Wooster, OH. Provided by ProQuest LLC. All rights Reserved.

By SYDNEY SCHWARTZ

DUXBURY – George Senerchia has the dreams of a 51-year-old Boston woman.

Senerchia, 55, of Northford, Conn., received a heart transplant from the woman on Nov. 6, 2004. He has written letters to the woman’s two children, which he believes they have received. But he hasn’t heard back.

This weekend he’s coming to the South Shore to run in the Duxbury Beach Triathlon. He’s hoping someone here will know more about his donor, the woman he calls his “Boston girl.”

Senerchia is participating on a team with Tom Colligan, 71, and Pete Kenyon, 70 – the latter of whom received a heart transplant from Colligan’s son.

But his reason for participating are a little different. For him, it is hard not to know who his donor was, he said.

“Being involved with Pete and Tom, it’s very very uplifting and rewarding for me. Those two have a definite connection,” he said. “What’s very hard for me is I do not know who that woman was.”

“I’m doing this, my part of the triathlon, in memory of my donor,” he said. “In hopes that some how, some way, someone in her family, someone who knew her, will read what I’m doing with her heart, this 51-year-old heart from my Boston girl.”

Senerchia suffered from a disease called berylliosis, caused by copper beryllium poisoning from high voltage wires he worked with. He waited for a heart for four years, and had a non-FDA-approved heart pump for nine months. Today he volunteers as a heart transplant peer mentor at Yale New Haven Hospital, where he received his transplant. He also raises money for people in need through Northford TimberFramers Transplant Fund, a non-profit he started in 2002.

A participant in the U.S. Transplant Games, Senerchia now swims two miles a week and walks two miles a day.

He wants to be able to tell this to his donor’s children, to express to them how tremendously grateful he is. He wants them to know “that their mother’s heart did not go to waste.”

Senerchia knows his donor died of a brain aneurysm, leaving a son and a daughter. He knows his heart came from Massachusetts General Hospital. He has written three letters to the children, including one about three weeks ago.

He says he feels their mother with him always and believes he has her dreams. He has visions of people he’s never met and places he’s never been.

And, he said, he can’t stop buying shoes. He’s bought at least 30 pairs since his transplant.

“I want them to know how grateful I am and I want them to know that I contribute to the betterment of man kind every day that I breath,” he said.

“I long for and pray for the day when I can hug my donor’s daughter,” he said. “Because it haunts me that I have her mother’s heart.”

Sydney Schwartz may be reached at [email protected].

Originally published by By SYDNEY SCHWARTZ, The Patriot Ledger.

(c) 2008 Patriot Ledger, The; Quincy, Mass.. Provided by ProQuest LLC. All rights Reserved.

By STACY PARKER

By Stacy Parker

Correspondent

OCEANFRONT

Helping others is at the heart of nursing. In keeping with the profession’s compassionate quality, two nurses’ legacies live on through the giving of annual scholarships for nursing education.

The Mary Meyer and Alice Pyle Memorial Scholarship Foundation provides two $2,000 scholarships each year to help students pursue a career in nursing.

Kelly Shields and Lauren Murphy of Virginia Beach received the 2008 scholarship checks at an award presentation Sept. 9. Ameriprise Financial sponsored the reception at Town Center City Club.

“We feel that it’s a wonderful tribute to our mothers and they’d be humbled by this ongoing contribution to our community on their behalf,” said Dr. Pamela Pyle , a Virginia Beach obstetrician and gynecologist.

Her mother, Alice Pyle met Mary Meyer in 1970. The military wives and registered nurses became neighbors. They were also volunteers at the Virginia Beach Health Clinic and helped with many outreach programs.

Meyer, who was a nursing supervisor at Sentara Virginia Beach General Hospital, died in 1994 at age 60 from lung cancer. The original scholarship fund was established in her honor .

Two years later, Alice Pyle also died at age 60 from cancer.

“With the blessing of the Meyer family, her name was added to the nursing scholarship,” said Dr. Pyle.

The initial scholarship was awarded in 1995. To date, 22 recipients have received a total of $39,000.

Kelly Shields of Princess Anne is studying organizational leadership and management at Regent University. She is manager of the recovery room and anesthesia at Sentara Virginia Beach General Hospital.

Receiving the scholarship has been a “blessing,” she said, and a big help in continuing her studies. Shields graduated from Kempsville High School in 1985 and has worked at the Beach hospital since 1991. She is a mother of two.

“I enjoy management,” said Shields, who added that her nursing perspective will influence her approach to administration and her leadership decisions in a positive way.

Lauren Murphy , who is pursuing a nursing degree at James Madison University and is from the Oceanfront area, also received $2,000.

Her mother, Lynn Murphy , a former nurse at Sentara Virginia Beach General Hospital, accepted the scholarship on behalf of her daughter who was away at school.

Lynn Murphy helped care for Mary Meyer when she was treated for cancer at the hospital, and she reunited with Meyer’s family at the reception.

Lauren Murphy graduated from Bishop Sullivan Catholic High in 2006 and said she has always been interested in health sciences.

“My ultimate goal is to be a nurse practitioner,” she said. “I’ve always had in my head that I want to heal people.”

In addition to the two annual recipients, a third person was awarded a scholarship. Lydia Gonzalez received funding toward nursing school in Chiapas, Mexico, where Pyle recently volunteered at a health clinic.

For more information about the scholarship, contact Dr. Pamela Pyle at 425-2612 or [email protected].

Stacy Parker, [email protected]

Originally published by BY STACY PARKER.

(c) 2008 Virginian – Pilot. Provided by ProQuest LLC. All rights Reserved.

DARE COUNTY | A ribbon-cutting and open house will be held at 3 p.m. Thursday in the Dare County Substance Abuse Center at 2808 S. Croatan Hwy. in Nags Head.

New Horizons, the program offered at the facility, is a Dare County initiative that gives individual assessments, group counseling and family education to residents experiencing substance abuse problems.

Walk-ins are accepted, or call (252) 441-2324 to schedule an appointment.

Currituck County

League of voters offers registration

The Currituck County League of Women Voters will hold voter registration from 9 a.m. to 3 p.m. Saturday at the Food Lion stores in Grandy and Moyock.

The deadline date to register to vote in the Nov. 4 election is Oct. 10.

Dare County

chamber looking for volunteers

The Outer Banks Chamber of Commerce is looking for volunteers for its annual Golf Tournament and Auction on Oct. 8 at Duck Woods Country Club.

A volunteer training meeting will be held at 4 p.m. Oct. 6 at the club, in Southern Shores. Volunteers should contact the chamber as soon as possible to allow for shirts to be ordered.

Call (252) 441-8144.

BENEFIT YARD SALE set for saturday

The annual Master Gardener Volunteer Yard Sale will be held from 8 a.m. to noon Saturday at the Thomas A. Baum Senior Center in Kill Devil Hills.

Household items, clothing and more will be available, and proceeds will benefit the Outer Banks Arboretum and Teaching Garden.

COMMUNITY MEETING is Thursday

A community meeting will be held at 7 p.m. Thursday in the Roanoke Community Center (Head Start Building) in Manteo.

The University of North Carolina Cancer Care Initiative for Dare County will be the topic, and all Dare County residents are invited.

Refreshments and a question-and-answer period will be part of the program.

LINE DANCE LESSONS on the agenda

Line dance lessons will be offered from 7 to 8:30 p.m. Monday through Nov. 4 at the Thomas A. Baum Senior Center in Kill Devil Hills.

The classes are free for seniors 55 and older.

Call (252) 475-5638 to sign up.

EMPLOYEE OF THE MONTH named

Lt. Paul Cagiano of the Dare County Emergency Medical Services Department received the county’s Employee of the Month Award for September.

Cagiano is a paramedic and shift supervisor at EMS Sta- tion 1 in Kill Devil Hills and has been with the county for 17 years.

LUNCH AND LEARN WORKSHOP set

Dr. Fran Collichio, a University of North Carolina cancer specialist, will present a free workshop on skin cancer from noon to 1 p.m. Friday at the Cancer Resource Center in the medical building behind The Outer Banks Hospital in Nags Head.

The Lunch and Learn program includes a light lunch; reservations are requested.

Call (252) 475-5900 to reserve a space.

Aquarium to hold NATIVE PLANT SALE

The North Carolina Aquarium on Roanoke Island will have its annual native plant sale from 10 a.m. to 3 p.m. Saturday.

A variety of trees, shrubs, vines, perennials, grasses and ferns will be available, and proceeds will benefit environmental programs and events at the aquarium.

Caseworker to be available at center

The Dare County Department of Social Services will have a caseworker from 9:30 a.m. to 3 p.m. on Thursdays at the Thomas A. Baum Senior Center in Kill Devil Hills.

The purpose is to accept applications for public assistance programs, including Medicaid, Food and Nutrition Services, Work First Family Assistance and Special Assistance.

Pasquotank County

roundtable to be held at museum

The Museum of the Albemarle in Elizabeth City will hold its Albemarle Roundtable at 7 p.m. Thursday in the Gaither Family Auditorium.

The speaker will be Harry Warren, director of the North Carolina Museum of Forestry. He will discuss the development and economic importance of tar, turpentine, rosin and pitch and how North Carolinians got their nickname.

The event is free and open to the public.

YMCA schedules registration

The Albemarle Family YMCA is holding registration for a variety of programs.

Sign-up for Beginning and Advanced Karate for ages 4 to 13 ends Wednesday . Members pay $30; non members, $60. Monday and Wednesday sessions start Oct. 6, with beginning level at 5 p.m., intermediate at 6. Weekend sessions start Oct. 11 at 10 a.m.

Registration for Tumbling Classes ages 18 to 36 months and 3 to 5 and 6 to 12 years ends Wednesday . Members pay $20; non members, $35. Saturday and Monday sessions will be at various times based on age.

Sign-up for Youth Basketball ages 3 to 11 ends Oct. 20. Members, $40, non members $55. Session starts Nov. 4.

Registration for Tiny Tot Ballet Classes ages 3 to 5 ends Wednesday . Members pay $20; non members, $35. Session begins Friday, 4 to 4:45 p.m.

For more information, call (252) 334-9622.

board to hold community forum

The North Carolina Caucus of Black School Board Members will host a community forum at 7 p.m. Thursday, “The Courage to Engage: A Leadership Model for 21st Century Learning.”

The event will be held at Elizabeth City State University’s K.E. White Graduate Center in Elizabeth City. Registration and reception will begin at 6 p.m.

The event is being held to address the need to prevent young people from dropping out of school and to improve their chances for success in the 21st century.

Encouraged to attend are parents, school administrators, faith- based and community-based organizations, social workers, student groups, school board members, child/parent/family advocacy organizations, elected officials, and business owners.

There is no charge, but registration is encouraged. Call (252) 312-8779.

celebration to be held at church

Powerhouse Church of Redemption, 2554 Peartree Road in Elizabeth City, will celebrate the sixth annual Founders Day and the Pastor’s Anniversary at 4:30 p.m. next Sunday.

Pastor Robert and Sheila Lee will be honored. The guest speaker will be Pastor Michael Blanchard of Corner stone Christian Center in Norfolk .

For information, call (252) 562-1819 or visit www.powerhouse churchofredemption.org.

meetings + events

Camden County

Blessing of the animals Church of the Redeemer in Camden, 5 p.m. Saturday. All animals in a cage or on a leash are welcome.

CURRITUCK COUNTY

Luncheon 11:30 a.m. Oct. 8, Currituck County Christian Women’s Club, American Legion Post 288, Coinjock. Cost is $6. For reservations, call (252) 453-3266.

DARE COUNTY

Blood drive 10 a.m. to 3 p.m. Tuesday, Charter Communications (on the bus), Nags Head.

Advisory meeting Manteo Collins Park Advisory Committee, 4 p.m. Thursday, Collins Park Cookhouse.

Commissioners meeting Manteo Board of Commissioners, 7:30 p.m. Wednesday, Manteo Town Hall.

Commissioners meeting Nags Head Board of Commissioners, 9 a.m. Wednesday, Nags Head Municipal Complex Board Room.

Public meeting Dare Coalition Against Substance Abuse, 9 a.m. Friday, Kill Devil Hills Town Hall.

PASQUOTANK COUNTY

Meeting Guild of Museum Friends, Museum of the Albemarle, Elizabeth City, 10:30 a.m. Thursday.

Beverlie Gregory, (252) 441-1620,

[email protected]

Karen Santos, (252) 338-2590,

[email protected]

(c) 2008 Virginian – Pilot. Provided by ProQuest LLC. All rights Reserved.

Road projects are under way throughout the metropolitan area. A few have changes drivers should watch out for this week.

Thornydale Road widening: Paving in the North Thornydale Road widening project from West Orange Grove Road to the Canada del Oro Wash will affect traffic this week.

Drivers should expect increased truck traffic in the southbound lanes near Costco Drive Monday and Tuesday, and should watch for flaggers directing traffic.

The left-turn lane from southbound Thornydale to Costco is scheduled to close Monday and Tuesday from 6 a.m. to 2:30 p.m.

Access from Thornydale to West Horizon Hills Drive is scheduled to close Tuesday night at 9 p.m. It is scheduled to reopen Sept. 30 at 6 a.m.

Oracle Road widening: The right lane of northbound North Oracle Road is scheduled to close Monday from 5 a.m. to 2 p.m. from the Canada del Oro bridge to Catalina State Park. The right lane of northbound Oracle also is scheduled to close from 6 a.m. to 2 p.m. between Catalina State Park and Rancho de Kuda each day Monday through Friday.

The right lane of southbound Oracle is scheduled to close Monday from 9 a.m. to 2 p.m. at Innovation Marketplace Loop. The right lane of southbound Oracle is scheduled to close on the Canada del Oro bridge Tuesday from 9 a.m. to 4 p.m.

Interstate 10 widening: Tangerine to Pinal Air Park: The right lane is scheduled to close on eastbound I-10 between West Marana and West Tangerine roads Tuesday night from 7:30 p.m. to 5 a.m. The left lane in the same area is scheduled to close on eastbound I-10 Wednesday night from 7:30 p.m. to 5 a.m.

The left lanes in both directions are scheduled to close on I-10 from Marana Road to Pinal Air Park Road Thursday night from 7:30 p.m. to 5 a.m.

I-10 widening: Picacho Peak to Pinal Air Park: Intermittent lane restrictions are scheduled each day Monday through Friday on Picacho Peak Road under I-10 from 5 a.m. to 5 p.m. Flaggers will direct traffic during the closure.

Originally published by ARIZONA DAILY STAR.

(c) 2008 Arizona Daily Star. Provided by ProQuest LLC. All rights Reserved.

TEMPLE CITY – The fourth annual Temple City Senior Health Fair will be held from 10 a.m. to 2 p.m. Oct. 4 at the Live Oak Community Center, 10144 Bogue St.

The event will feature free health screenings, including tests for blood pressure levels and bone density, body fat analysis and stroke screening.

There also will be free refreshments, prize drawings and information on Medicare Advantage. Co-sponsors are the city of Temple City, the county Department of Public Health and Monrovia Health Center. For more information, call (888) 715-4922.

(c) 2008 San Gabriel Valley Tribune. Provided by ProQuest LLC. All rights Reserved.

By Resick, Lenore Kolljeski

Purpose: To explore the meaning of health among midlife Russian- speaking women from the former Soviet Onion. Design and Methodology: A hermeneutic phenomenological design was used. Study participants included 12 Russian-speaking women ages 40-61, who also spoke English and had migrated to the United States after 1991.

Findings: These themes were identified: health as being highly valued, though less of a priority during immigration; being a stranger and seeking the familiar; grieving and loss and building a new life; experiencing changes and transitions; trusting self; and the importance of hope.

Conclusions: Although health was less of a priority during the immigration process, the women valued and were knowledgeable about health, participated in self-care practices, trusted their own abilities to make self-care decisions, and sought health-related information. This is a vulnerable population at risk for the onset of chronic medical conditions associated with the process of aging, past exposures, the tendency to avoid health screening, and current stressors related to immigration and family responsibilities. Implications include the need for interventions to build trust, assess self-care practices, and understand values and beliefs concerning health screening. Future research recommendations include replication with other samples within this population and exploring curative beliefs and practices more fully. Ultimately, this study design could be applied to other immigrant populations in Western cultures.

Clinical Relevance: Midlife Russian speaking women from the former Soviet Union are a vulnerable group at risk for the onset of chronic medical conditions associated with aging, past exposures, the tendency to avoid health screening, and current stressors related to immigration and family responsibilities.

[Key words: immigrant or refugee health; meaning of health, Russian-speaking women, midlife women, hermeneutic phenomenology, immigration, emigres]

JOURNAL OF NURSING SCHOLARSHIP, 2008; 40:3, 248-253. (c)2008 SIGMA THETA TAU INTERNATIONAL.

Since the collapse of the former Soviet Union (FSU) in 1991, migration to the West has increased dramatically. Data sources show that since 1992, approximately 2.66 million people have migrated from the Commonwealth of Independent States (CIS) to Western countries with most migrating to Germany, Israel, and the United States (Tishkov, Zayinchkovskaya, & Vitkovskaya, 2005). Unlike other immigrant populations, midlife women make up a significant portion of these recent emigres (U.S. Immigration and Naturalization Service, 2000). As this population of immigrant midlife Russian- speaking women ages, healthcare providers in host countries are challenged to provide this population with culturally appropriate disease prevention and health promotion interventions that mediate the effect of chronic disease conditions associated with aging.

The purpose of this study was to describe the essence of the meaning of health for midlife Russian-speaking women and to provide an interpretive understanding of the ways in which they managed health during immigration. This research was guided by features of descriptive and interpretive phenomenology (Cohen, Kahn, & Steeves, 2000).

The terms immigrant and emigre are used interchangeably to refer to those who have emigrated either with refugee or with immigrant status. Russian-speaking immigrant women are identified as self- defined English-speaking women who claim the Russian language as the dominant language in their country of origin. The Russian language is the dominant language across the FSU and the “main axis of identity” for an otherwise diverse group of immigrants (Remennick, 1999a, p. 458).

Background

Approximately 80% of all immigrants and refugees worldwide are women (Meleis, Lipson, Muecke, & Smith, 1998). Although historically, a large percentage of international migrants have been women, only recently have immigrant women’s health issues emerged as public health issues (Remennick, 1999a; 2003). In a review of literature by Aroian, Chiang, and Chiang (2003) regarding gender and psychological distress, the majority of the study findings indicated that psychological distress was significantly greater for immigrant women. Immigrant women often experience barriers to accessing and receiving health care (Meleis et al., 1998). These barriers are frequently related to lack of understanding by healthcare providers in the country of destination about the health beliefs, values, and practices that the new arrivals bring with them from the country of origin (Meleis et al., 1998). The explanatory models of health, disease, and illness of the immigrant women might not be congruent with the biomedical model prevalent in Western cultures (Meleis et al., 1998).

Previous studies of Russian-speaking emigres have included older immigrants (Aroian, Khatutsky, Tran, & Baksan, 2001; Benisovich & King, 2003), stress related to immigration (Leipzig, 2006; Miller & Chandler, 2002), and onset of disease related to the Chernobyl disaster (Foster & Goldstein, 2007). The literature includes studies about midlife Russian-speaking women who have migrated to Israel (Remennick, 1999b; 2003), help-seeking patterns of Russian-speaking parents in Israel (Shor, 2007); health of Russian-speaking immigrants in Germany (Kirkcaldy et al., 2005), primary healthcare challenges of Russianspeaking emigres in Sweden (Blomstedt, Johansson, & Sundquist, 2007), and well-being in Finland (JasinskajaLahti & Liebkind, 2007). Little has been reported about health within the context of immigration from the perspective of midlife Russian-speaking women who have migrated to Western cultures.

Research Design and Methods

A hermeneutic approach (Cohen et al., 2000) was used to explore the meaning of health among midlife Russian-speaking women within the context of immigration; 12 women from ages 40-61 who migrated from FSU between 1992 and 2001 participated in the study. All of the participants were professionals with university-level degrees from their homeland and self-defined as speaking and understanding the English language. Eleven of the 12 participants were married and reported that they were ethnically but not religiously Jewish before immigration or at the time of this study. One of the participants was single and not of Jewish descent. The majority of the interviews took place in the homes of the participants; three women were interviewed in the workplace; and one interview took place in a private dining area. All the study participants lived in an urban community in the Northeastern region of the United States with the largest foreign-born population from Russia (Migration Information Source, 2004). No research could be found about the group in this particular location. The researcher, although not Jewish, nor Russian speaking, is midlife, second generation American born of Eastern European ancestry and has lived and worked as an advanced practice nurse in this community for over 25 years.

Purposive and “snowball” sampling techniques were used (Polit & Hungler, 1999) for this study. Data were collected until saturation (Denzin & Lincoln, 1994) was reached.

Recruitment took place through written advertisements in English and in Russian. Permission from the university’s internal review board was obtained, and a consent form was provided in English and in Russian. All study participants agreed to be audiotaped. Before beginning the interviews, the researcher bracketed her presuppositions by writing her own answers to the interview questions to ensure that preconceptions of the researcher did not influence participants during the study (Le Vasseur, 2003). All interviews were conducted in English.

The interview began with a demographic questionnaire followed by a semi-structured list of questions by the investigator. The interview was focused on three open-ended questions:

1. What is the meaning of health among midlife Russianspeaking immigrant women in the United States?

2. How has immigration influenced the experiences, values, and practices concerning the health of midlife Russian-speaking women in the United States?

3. What are the health experiences of midlife Russianspeaking immigrant women in the United States?

The researcher used journaling to provide a record of the decision trail during this study. An example of an early journal entry was a reflection on how the researcher conducted the interview so as not to “lead” the interview by supplying “lost” words for study participants when expressing themselves but needing time to find the word to use.

Using the method of phenomenological analysis described by Barritt, Beekman, Bleeker, and Mulderj (1984; 1985), the investigator began data analysis by listening to the audiotapes and reading each transcription verbatim several times line by line, highlighting the whole and parts of the sentences, and assigning tentative themes to these passages, using words as close as possible to those used by the participants themselves. The researcher identified common themes or substantive codes in all the transcripts of the interviews. After each identified theme (or substantive code), the researcher wrote the supporting phrases from the transcription. The identified themes, as well as a critical evaluation of the investigator’s interview process evident in the transcripts, were discussed in the interpretive process with a researcher consultant to ensure accuracy of coding and theme identification, clustering, and analysis. Data were managed both manually and by use of the software NVivo(c) (2002, QRS International). The identified themes served as topics for discussion at the second interview which was scheduled 3-4 weeks after the initial interview with the study participants. The purpose of the second interview was to confirm meaning, to clarify understanding, and to ask additional questions to ensure that the clusters and themes from the first interview appropriately captured the meaning that the participant sought to convey. Participants were asked if they had anything to add or to remove from their descriptions. One informant asked that information about her daughter not be included. Conducting the second interview assisted in ensuring trustworthiness of the findings.

Because of work schedules and travel to care for family out of state, only 9 of the 12 study participants were available for the second interview. These three initial interviews contained no new themes and were consistent with the other nine initial interviews. Because a second interview was not possible, the researcher explored the descriptions with 2 of the 9 study participants who were interviewed twice. No new descriptions were added in the second interviews.

The thematic analysis of transcripts after the second interview was once again discussed with a researcher consultant to ensure accuracy of coding and identification of themes, clustering, and analysis. Based on this process, the themes were organized into a written account that described the essence of the meaning of health among the study participants and an interpretive understanding of the ways in which they managed health during the immigration process.

Findings

The following themes were identified: health as being highly valued, though less of a priority during immigration; being a stranger and seeking the familiar; grieving and loss and building a new life; experiencing changes and transitions; trusting self; and the importance of hope. In order to maintain confidentiality, pseudonyms are used in the quoted passages below.

Health as being highly valued, though less of a priority during immigration. All study participants emphasized the value they placed on health: “[Hjealth is everything, very important.””‘Be healthy.’ It’s the first wish for everybody in your family and for everyone you want to say something good. Not wealth. Not beauty. But healthy” (Raisa).

Health, although valued, was not a priority of focus during the immigration experience. “Looking back … I realize I was really healthy [during migration] because without this health, I wouldn’t be able to survive. I needed a lot of energy” (Nadya).

When a person is healthy [during immigration], person doesn’t think of it. (Fekla)

We think about everything [during immigration]-children and our parents. To stay alive. When we have everything for living … then we will think of health. (Hanna)

I don’t remember the time around immigration-I was so stressed. (Evgenia)

[T]he mother always think about her children and older people … to help first your family … it’s human nature … to keep safe her children, her family, close family. (Raisa)

I am working … my children and my mom 1 have to think about too. I have to clean … wash … do everything. (Caterina)

Being a stranger and seeking the familiar. During the interviews, the women spoke of first impressions of the Western culture as being very different than expected.

[I]t is a different world … life in Russia … I couldn’t believe the amount of paper in the mail [in the United States)… I was thinking it must be a rich country that can waste so much paper… Everything works-lots of food, everything so clean. (Evgenia)

I was shocked to see how dirty the streets-how friendly the dogs were. (Bella)

I couldn’t believe it-there were no drunks in the streets. (Hanna)

I was shocked by the buses … helping elderly to enter the bus … people with wheelchairs can enter a bus … this would never happen in Russia … never. (Tatyana)

[F]irst time I came here … I was real impressed … everybody smiles … and I said, “such good people, they smile at me … they like me … so nice,” then I started hating smiles. I thought, “Its not sincere, why are they smiling, it’s not sincere….” You know, when you are in [a] different position from them and they smile at you, you say, “it’s not honest, not sincere.” My feeling was that Russian people are open people and sincere…. In Russia, if they don’t like you, they don’t smile at you. If they do like you, they smile. (Hanna)

I thought I had family here, someone familiar … but I understand this is not family anymore … because we changed, they had changed. It was not what we thought. (Naydia)

I went a lot to Russian stores just to buy something I recognize from Russia. (Vera)

Grieving and loss and building a new life. The women spoke of grieving and loss involved in the decision to migrate to the West to seek a better life and future:

[I]n Russia … our generation was very lost generation, completely … we did not achieve anything … only to survive … I got such a great education … and I wanted a job … I really wanted a job. …but in Russia no one needs [our] brain at all. (Bella)

I was a person who spent a lot of time preparing for my job [in the FSU] … I study a lot. I did not think I could get the same job in the US … in the US I felt like zero … it was a big difference for me … some just looking down at me [eyes tearing] … but, sometimes you just cannot stay where you are born. (Hanna)

My father is very depressed because the idea to come here was mine … it is very painful … he did this for grandson to have a better life. (Vera)

On the plane … my parents looked so scared … I was thinking, my dear mom, will you ever be able to forgive me for this? That I am pulling you from your roots and trying to put the old tree in the new soil? (Fekla)

It is another life here. It is painful … but I try to see as a new life. (Tatyana)

Experiencing changes and transitions. The women described both external and internal forces influencing the experiences of health. Those family members who migrated to the West before 1991 and whom the new arrivals were meeting in the host country, were not perceived as understanding the changes or supporting the emotional needs and priorities of the newly arrived family members. Dasha’s description summarizes what many of the women expressed: “[I]t is like they [those family members who migrated before 1991] are from different country … Russians don’t understand how it is different … there are more changes every year after 1991.”

The women described many transitions in their roles including helping maturing children and aging parents.

My children now have children. They work all day. I help take care of the baby and do work for money too. It’s very hard being with [grandchild] all day. (Evgenia)

I have mama here and mother-in law here, both are getting older and I am busy… they go to doctors and treatment. I do everything they need … no time for me. (Caterina)

Age, past environmental exposures, and migration were reported as affecting health.

Stresses, stresses, stresses … I got blood sugar [diabetes] from stresses. That’s age. Immigration for our age is not good … It’s so hard. It’s our choice. (Katya)

[D]ifferent women have different problems … because we live from ’86 to ’95 in Kiev, and Chernobyl [is] 60 miles from Kiev. Maybe this is problem. In Russia I did not hear so many breast cancers. Maybe this breast cancer spread and they died … but I met these people more often [in the United States] than Russia that’s cured from breast cancer … in Russia we did not know a good diagnosis. (Galena)

Age and maturity were also identified as strengths during the migration process. Vera described a commonly reported experience:

I was not afraid … because we lived in the kind of life you had in Ukraine, kind of not afraid of anything that it’s very hard…. But I was afraid to be a failure … it was too late for me … I thought people come to America to start a new life … I thought that I was too old to start over.

Trusting self. Trusting oneself to make decisions was important to the study participants in terms of self-management of health. The women reported a lack of trust in healthcare professionals and health-related treatments. One said, “I don’t trust… difference between Russian and American people, that American people trust doctor … follow advice. We did not trust anybody in Russia.”

Lack of trust of pharmaceuticals or “chemicals” was commonplace. It was not unusual for the women to report that they ordered natural herbs, roots, and cosmetics from Russian catalogs. Dasha said, “I always have something [herbs, medication from Russian] at home.” Katya said, “Pills seem like a chemical thing and I [am] afraid of some of them.”

Participants believed that Americans considered doctors “good” if the doctors gave pills to do the healing. In contrast, in the Russian culture, doctors were considered good if they did not use pills to do the healing. Fekla said, “In Russia, if the doctor is good, he will give you less medicine. Here the opposite, here pills … if the doctor gives you pills, he is considered a good doctor.”

Nearly all the women reported that they did not always follow the treatment plan of their physicians. Instead, they relied on their own plan of care. Many of the women reported they often stopped taking prescription medications or adjusted the dose on their own after reading about or experiencing side effects.

I have books. I have lots of books. I know what I am taking. If I see it is not for me, I’m not going to take it … because I read side effects. I said no. I said if I want to live, I can change my life. So I made exercise, no sweets. I feel good again. (Katya) Physicians whose first language was Russian were sought for discussion of questions related to diagnosis and treatment options. Nadya summarized what other participants reported concerning the importance of understanding the language in order to make an informed health-plan decision.

I’m getting older and I’m trying to go deep in what is going on, what they’re telling me. I need to get all information. I try to find Russian doctor. I can get detailed information in Russian, because I am afraid that I can miss something important… even assuming that I am speaking good English … I am afraid I will miss some detail which can be important. I’m trying to get information to be absolutely clear what’s going on.

Seeking information about a diagnosis was reported to be common in the FSU and in the host country. Bella summarized what other women also reported:

People are trying to fight the diseases themselves. That’s why over here Russian women are not coming to doctor’s offices … 80% of them already know how to treat their diseases, disregarding what the doctor will say. This is not because they know everything much better than doctor. No, it’s kind of self-defense issues that they brought from Russia, because if you do not understand how to treat yourself, there is a good chance you will die.

Participants spoke of their distrust for American-born physicians related to communication issues. Another reason for distrust of American healthcare professionals was the perception that medicine is a business and that physicians are focused on making money rather than caring for people. The women reported that although they did not always follow the treatment plan, they did not openly challenge the treatment plan with the physician.

The importance of hope. Hope was mentioned by nearly all the women in the context of a better future and as being an important reason to migrate. They also emphasized the importance of not taking hope away from a person who had been diagnosed with a malignancy: Galena described how hope was related to the decision to migrate, “[I]t can’t be worse than I have in my natural country … I am thinking it will be better. It’s not possible to be worse … I was hoping for something better.”

In the FSU, discovery of a malignancy was reported by all the women to be considered fatal. According to the women, cancer was a diagnosis feared by most of them. The women reported that patients in the FSU are not routinely told by the healthcare provider if they have a confirmed malignancy. Family members are told that a patient has a malignancy but not the patient. One participant said, “[A]s far as you don’t know [about a diagnosis of cancer], there is some hope … if you know that you will die … maybe you won’t fight against something.”

In regard to beliefs related to not seeking routine preventive screening: All the women in the study also reported that routine health screening in the FSU was considered by Russian people to be “just looking for trouble.”

[Y]ou go to the doctor just when you are sick. (Raisa)

[Having routine screening done] is just looking for trouble … if you are going to look for a problem, eventually you will find one. (Dasha)

Discussion

The findings show that within the context of immigration, health was less of a priority for the midlife Russianspeaking women in this study. However, the women described health as highly valued in the Russian culture. The study participants were knowledgeable about health-related issues and treatments, participated in self-care practices, trusted their own abilities to make self-care decisions, and sought health-related information when they were unsure.

The high value placed on health within the context of the Russian culture is consistent with other studies of Russian-speaking participants (Lipson, Weinstein, Gladstone, & Sarnoff, 2002). However, in contrast to the reported findings of older Iranian immigrants in Sweden (Emami, Benner, & Ekman, 2001), a multiethnic group in the Pacific Northwest (Woods et al., I988) and of American midlife women (Maddox, 1999), none of the participants in this study directly mentioned a spiritual component when describing health. Of the 11 participants who reported that they were ethnically Jewish, all reported that they did not actively practice the religion. The secular identification rather than religious identification of being Jewish concurs with other studies of Russian-speaking emigres (Birman & Tyler, 1994).

As noted by Lipson et al. (2002), during this study the participants also did not always focus on the open-ended questions that were asked. Instead, they took the focus of the topic to those areas they wanted or needed to talk about. For example, other themes not directly related to health arose such as those of being a stranger and seeking the familiar. This development is consistent with findings reported by Aroian, Morris, Patsdaughter, and Tran (1998).

Loss and grieving of the former life coincided with building a new life in a new land for self and family. The women in the study were highly educated and had a strong identity with their former professions. All reported that they were currently employed in another field and in a lesser position than they had attained in the FSU. These findings were similar to those reported by Miller and Chandler (2002) who studied acculturation and depression in midlife Russian-speaking women. In fact, feelings of loss and depression were commonly reported in studies of Russian-speaking emigres conducted in other parts of the United States (Aroian et al., 1998; Lipson et al., 2002). The study participants, like those in the study by Lipson et al. (2002), indicated that they relied on self- care and trusted their own self-care first in the health process. This trust in self-care indicates that these women believed that they could control some aspects of their own health in regard to health-restoring behaviors.

The midlife women reported caring for aging parents. This finding correlates with other studies that show that older Russians relied primarily on their children for support, even though the children had less time and support from other family members than they did in the FSU (Aroian et al., 2001; Remennick, 1999b).

The findings in this study concur with those of Russian-speaking women in Israel (Remennick, 2003) in regard to the avoidance of routine screening for a latent or early malignancy. Like the finding reported by Lipson et al. (2002), the women in this study also associated newly diagnosed cancers with past exposures to pollution and living in the FSU during the Chernobyl nuclear disaster in 1986.

The study participants stated that they were not afraid to leave their homeland; although the decision to leave was associated with much stress, loss, and grief, the women had made the choice to migrate because of the hope for a better future not only for themselves, but especially for their children. The migration from the homeland involved moving toward the future by acting in the present and remembering the past.

Limitations

The findings of this study cannot be extrapolated because of constraints imposed by the nature of the group, the immigration cohort they represent, the community in which they live, and the voluntary nature of participation in this research study.

Recommendations

Implications for clinical practice include the finding that although the women did not challenge the treatment plan prescribed by a healthcare provider, they often chose not to follow the prescribed plan of care. These findings indicate that health care providers caring for Russian-speaking immigrant women need to be focused on interventions to build trust, assess self-care and curative practices, and explore values and beliefs concerning health screening. Future research recommendations include: replicating and using longitudinal designs with other samples within this population who have migrated to other Western nations and exploring self care and curative practices.

Conclusions

The findings of this study show that although the Russian- speaking midlife immigrant women in this study value and are knowledgeable about health, participate in self-care practices, trust their own abilities to make self-care decisions, and seek health-related information, health is less of a priority during the immigration process. Findings show that this is a vulnerable population at risk for the onset of chronic disease conditions associated with the process of aging, past exposures, the tendency to avoid health screening, and current Stressors related to migration and family responsibilities.

Clinical Resources

* Information related to cultural beliefs and health care needs of immigrants and refugees: http://www.ethnomed.org

* The Global Commission on International Migration information: http://www.gcim.org

* Minnesota’s refugee health program information on comprehensive health screening and follow-up related to immigrant and refugee health: http://www.health.state.mn.us/divs/idepc/refugee/topics/ immigrant.html

* Essential data and information on migration worldwide: http:// www.migrationinformation.org

* Multilingual health information for refugees and healthcare providers: http://www.rhin.org/default.aspx

* A resource for health-related materials for refugees and immigrants: http://www.sunyit.edu/library/culturemed/

References

Aroian, K.J., Chiang, A.E., & Chiang, L. (2003). Gender differences in psychological distress among immigrants from the former Soviet Union. Journal of Sex Role Research, 48(1-2), 39-51.

Aroian, K.J., Khatutsky, G., Tran, T.V., & Balsam, A.L. (2001). Health and social service utilization among elderly immigrants from the former Soviet Union. Journal of Nursing Scholarship, 33(3), 265- 271.

Aroian, K.J., Norris, A.E., Patsdaughter, C.A., & Tran, T.V. (1998). Predicting psychological distress among former Soviet immigrants. International Journal of Social Psychiatry, 44(4), 284- 294. Barritt, L., Beekman, T., Bleeker, H., & Mulderij, K. (1984). Analyzing phenomenological descriptions. Phenomenology & Pedagogy, 2(1), 1- 17.

Barritt, L., Beekman, T., Bleeker, H., & Mulderij, K. (1985). Researching education practice. Grand Forks, ND: Center for Teaching & Learning.

Benisovich, S.V., & King, A.C. (2003). Meaning and knowledge of health among older adult immigrants from Russia: A phenomenological study. Health and Education Research, 18(2), 135-144.

Birman, D., & Tyler, EB. (1994). Acculturation and alienation of Soviet Jewish refugees in the United States. Genetic, Social, and General Psychology Monographs. Washington, DC: Heldref.

Blomstedt, Y., Johansson, S., & Sundqust, J. (2007). Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross- sectional study. BioMed Central Public Health, 7. Retrieved November 17, 2007, from http://www.biomedcentral.com/1471-2458-7-27

Cohen, M.Z., Kahn, D.L., & Sleeves, R.H. (2000). Hermeneutic phenomenological research: A practical guide for nurse researchers. In P. Brinks (Ed.), Methods in nursing research. Thousand Oaks, CA: Sage

Denzin, N., & Lincoln, Y.S. (Eds.) (1994). Handbook of qualitative research. Thousand Oaks, CA: Sage.

Emami, A., Benner, P., & Ekman, S. (2001) A sociocultural health model for late-in-life immigrants. Journal of Transcultural Nursing, 12(1 ), 15-24.

Foster, R.P., & Goldstein, M.F. (2007). Chernobyl disaster sequelae in recent immigrants to the United States from the former Soviet Union (FSU). Journal of Immigrant Health, 9(2), 115-124.

Jasinskaja-Lahti, I., & Liebkind, K. (2007). A structural model of acculturation and well-being among immigrants from the former USSR in Finland. European Psychologist, 12(2), 80-92.

Kirkcaldy, B., Sienfen, R.G., Wittig, U., Schiiller, A., Brahler, E., & Merbach, M. (2005). Health and emigration: Subjective evaluation of health status and physical symptoms in Russian- speaking immigrants. Stress and Health, 2(5), 295-309.

Leipzig, C. (2006). When Russians come to therapy. The American Journal of Family Therapy, 34(3), 219-262.

Le Vasseur, J.L. (2003). The problem of bracketing in phenomenology. Qualitative Research, 13(3), 408-420.

Lipson, J.G., Weinstein, H.M., Gladstone, E.A., & Sarnoff, R.H. (2002). Bosnian and Soviet refugees’ experience with health care. Western Journal of Nursing Research, 27(0), 1-18.

Maddox, M. (1999). Older women and the meaning of health. Journal of Gerontological Nursing, 25(12), 26-33.

Meleis, A.I., Lipson, J.G., Muecke, M., & Smith, G. (1998). Immigrant women and their health: An olive paper. Indianapolis, IN: Sigma Theta Tau International, Center Nursing Press.

Migration Information Source. (2004). Retrieved July 9, 2004, from http://www.migrationinformation.org/USFocus/whosresults.cfm

Miller, A.M., & Chandler, PJ. (2002). Acculturation, resilience, and depression in midlife women from the former Soviet Union. Nursing Research, 51(1), 26-32.

Polit, D.F., & Hungler, B.P. ( 1999). Nursing Research: Principles and methods (6th ed.). Philadelphia: Lippincott.

Remennick, L.I. (2003). “I have no time for potential troubles:” Russian immigrant women and breast cancer screening in Israel. Journal of Immigrant Health, 3(4), 153-163.

Remennick, L.I. (1999a). “Women with a Russian accent” in Israel: On the gender aspects of immigration. The European Journal of Women’s Studies, 6, 441-461.

Remennick, L.I. (1999b). Women of the “sandwich” generation and multiple roles: The case of Russian immigrants of the 1990s in Israel. Sex Roles, 40(5/6), 347-378.

Shor, R. (2007). Differentiating the culturally-based help- seeking patterns of immigrant parents for the Former Soviet Union by comparison with parents in Russia. American Journal of Orthopsychiatry, 77(2), 216-220.

Tishkov, V., Zayinchkovskaya, Z., & Vitkovskaya, G. (2005). Migration in the countries of the former Soviet Union. Retrieved November 17, 2007, from http://www.gcim.org

U.S. Immigration and Naturalization Service (2000). Statistical Yearbook of the Immigration and Naturalization Service, 1998. Washington, DC: U.S. Government Printing Office. Retrieved March 6, 2003, http://www.ins.gov/graphics/aboutins/statistics/index.htm

Woods, N.F., Laffrey, S., Duffy, M., Lentz, M.J., Mitchell, E.S., Taylor, D., et al. (1988). Being healthy: Women’s choices. Advances in Nursing Science, 11(1), 36-46.

Lenore Kolljeski Resick, PhD, FNP-BC, Epsilon Phi and Eta, Associate Professor, Director Nurse-Managed Wellness Center and Director of Family Nurse Practitioner Clinical Specialty, Master of Science in Nursing Program, Duquesne University School of Nursing, Pittsburgh, PA. The author acknowledges Drs. Joan Such Lockhart, Eileen Zungolo, and Juliene Lipson for their guidance during this research study. Correspondence to Dr. Resick, 525 Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA15282. E-mail: [email protected]

Accepted for publication March 27, 2008.

Copyright Blackwell Publishing Ltd. Third Quarter 2008

(c) 2008 Journal of Nursing Scholarship. Provided by ProQuest LLC. All rights Reserved.

By Akyuz, Aygul Guvenc, Gulten; Ustunsoz, Ayfer; Kaya, Tulay

Purpose: To describe the experiences of Turkish women with gynecologic cancer and their partners. Design and Methods: Qualitative research using a descriptive phenomenological approach.

Setting: Gynecologic oncology outpatient clinic of the Gulhane Military Medical Academy in Ankara, Turkey. Nineteen women with gynecologic cancer aged 43-70 years and 12 partners aged 46-73 years were recruited. Data were obtained through open-ended and in-depth, audio-taped interviews which lasted approximately 35-45 minutes each.

Findings: Seven themes emerged from the participants’ description of their experience: (a) experiences during the diagnosis period; (b) experiences during the treatment period; (c) the effect of cancer on family life; (d) changes in daily life; (e) coping methods and support sources; (f) the meaning of illness; and (g) experiencing the illness as a woman.

Conclusions: Receiving the diagnosis of gynecologic cancer was remembered as a very dramatic experience. The women and partners reported many physical and psychosocial difficulties relating to the treatment period. Healthcare professionals must understand and recognize cancer patients’ and their partners’ experiences to provide appropriate holistic care.

Clinical Relevance: Nurses can only provide effective and comprehensive nursing care to gynecologic cancer patients and their families if they fully understand the physical, emotional, social, and spiritual experiences in their lives.

[Key words: gynecologic cancer, women’s experience, partners’ experience]

JOURNAL OF NURSING SCHOLARSHIP, 2008; 40:3, 241-247. (c)2008 SIGMA THETA TAU INTERNATIONAL.

Every year, 10 million people worldwide are diagnosed with cancer and 6 million die because of it. Cancer is the second leading cause of death in Turkey (Akyuz et al., 2007; Gozum & Aydm, 2004). Ovarian, endometrium, and cervical cancers are the fourth, seventh, and ninth reasons for death respectively among Turkish women (Ministry of Health, 2007). Gynecologic cancers pose special problems because they involve organs related to femininity, fertility, and sexual life, and the diagnosis and treatment of gynecologic cancer is stressful for women and their families (Costanzo, Lutgendorf, Rotrock, & Anderson, 2006; Ekwall, Ternestedt, & Sorbe, 2003).

Patients treated for gynecologic cancer experience physical symptoms such as pain, nausea, vomiting, insomnia, and lethargy and they suffer psychological symptoms, including stress, anxiety, depression, and fear of death. Cancer treatment changes a woman’s daily routine, social relations, employment status, and quality of life (De Groot et al., 2005; Ekwall et.al., 2003; Holzner et al., 2003; Howell, Fitch, & Deane, 2003; Reis, 2003).

Gynecologic cancer can affect the whole family because women play a central role in the management of the family in daily life. During the intensive treatment period, most of the cancer patients’ roles are taken over by their partners, adult children, and relatives. People caring for cancer patients can experience helplessness, uncertainty, stress-related agitation, depression, and fear of loneliness. Children are also affected in various ways by cancer, depending on their age and developmental stage (De Groot et al., 2005; Ferrell, Ervin, Smith, Marek, & Melancon, 2002; Hodgkinson et al., 2007; Lowdermilk & Germino, 2000; Northouse, 2005).

Nurses can only provide effective and comprehensive nursing care to gynecologic cancer patients and their families if they fully understand their experiences in every area of their lives. Nursing studies on the subject of gynecologic cancer experiences have, therefore, increased rapidly, although only a limited number of studies on the effect of diagnosis of gynecologic cancer were present until 10 years ago. Currently, studies that include the experience of families and especially partners, in addition to the women, are still limited. Few studies have been undertaken on the subject in Turkey and no reported studies included partners.

Many women in Turkey do not work in paid employment. They play a more active role at home and have more responsibility for housework and childcare than in some other societies, and this might influence the experience of gynecologic cancer (Turmen, 2003). The purpose of this study is to describe the meaning of the gynecologic cancer experience from the perspective of Turkish women participants and their partners in Turkey, a society where women’s work centers on the home and family. We believe that this study is going to provide important information for nurses globally in that nurses caring for women who work at home can understand how gynecologic cancer might influence a woman who is primarily a homemaker.

Methods

Study Design

Based on the study’s purpose, descriptive phenomenology was selected as the appropriate design to discover the essence of the experience. Phenomenology, a frequently used approach in qualitative nursing research, is focused on the experience of individuals as the major way to understand the broader meaning of people’s life experiences. Phenomenologists assert that reality is not a fixed entity, it changes and develops according to people’s experiences and the social context within which they find themselves (Dowling, 2007; Duffy, 2005; Rapport & Wainwright, 2006; Schultz & Cobb- Stevens, 2004).

Sample and Setting

This research was performed in the gynecologic oncology outpatient clinic of the Gulhane Military Medical Academy (GMMA) in Ankara, Turkey. The clinic is provided every Tuesday and Thursday and three to four patients per week are followed up for gynecologic cancer. The study was approved by the ethics committee of the GMMA. This study was started in January and completed in April 2006. Participants were recruited until the data saturation limit was reached, that is, when no new information was obtained. During the study period, two couples refused to be interviewed. In addition, it was not possible to interview the partners of seven women: four partners did not come for the check-up and three women were widows. In all, 19 women diagnosed with gynecologic cancer and 12 husbands making a total of 31 voluntary participants were interviewed.

Of the women interviewed, seven were being followed for endometrial cancer, five for ovarian cancer, four for cervical cancer, and three for uterine corpus cancer. The time since diagnosis was between 6 months and 10 years. The average age was 55.5 (SD, 6.85; range 43-70 years) for the women and 64.5, (SD, 9.73; range 46-73 years) for their partners. Two couples had no children.

Data Collection

Data were obtained through a semistructured interview schedule. All interviews were done in Turkish. Interviews began with a broad open-ended introductory question specific to the purpose of the study: “What was the experience of gynecological cancer like for you?” This was followed by some more open-ended questions such as: “What were your thoughts and feelings when you first learned you (your wife) had cancer?””What difficulties did you encounter in (your wife) seeking treatment?” and “What effect has the disease had on your family daily life as you cope with your (your wife’s) disease?” The introductory question and the other open-ended questions were formulated in the interview guide, which was generated from issues identified in the investigators’ clinical practice, an extensive review of the literature, and consultation with both methodologie and clinical experts. Also, during the progress of the interviews, some questions were provoked by participants’ statements. Open-ended questions made the dialogue easier and helped us get patients and their partners to describe their experiences of the disease.

Participants included in the study were informed about the study and written permission was obtained to interview and make audio recordings. One woman and one partner were interviewed per day at the most. The same researcher carried out the audiotaped interviews for both women and men. Men and women were interviewed separately one after another in a quiet and private room. Each interview took approximately 35-45 minutes.

Data Analysis

Analysis of interview transcriptions was based on Colaizzi’s phenomenologic methodology. During the analysis, women and men informants’ oral descriptions were read separately by researchers to gain a general understanding. Significant statements and phrases that pertained to the study objectives were identified. Meanings were formulated from these significant statements and phrases. The formulated meanings were then organized into clusters of themes. Results of the data analysis were integrated into a description of the experience.

To maintain the credibility of data analysis, the transcripts were examined repeatedly by each researcher in order to include them into the data. Two researchers worked independently to identify the major categories of the transcripts. The coding was compared. Between the coding of the two researchers, which mainly related to the choice of words, were minor differences. Differences were discussed until a final agreement was reached. To achieve final validation (Colaizzi, 1978; Wong & Chan, 2006), four informants (two men and two women) were selected randomly and contacted again to read the descriptions; they agreed that the analyses had accurately represented their personal experiences. Common themes were created by merging similar statements for every category. Overall, consistent with the question format, seven major themes were formulated from the analysis of the statements and the transcript that reflected the common experiences of gynecologic cancer.

A manuscript about the study was written in Turkish following completion of the study and analysis of the interviews. The patient and partner statements were then translated into English, retaining the original meaning. The English translation was then back- translated into Turkish by a bilingual speaker to make sure that the translation was accurate. Finally, the two translations were matched for the original meaning of the Turkish version.

Results

Theme 1: Experiences During the Diagnosis Period

Signs of disease and emotions prior to diagnosis. This period was described as difficult and stressful by many women and partners. Both the men and women stated that they experienced anxiety once advanced tests were performed and feared the diagnosis would be cancer. Nine patients and five partners used the term “a bad result” instead of “cancer disease.”

* I did not know what to do during this period. My older sister has ovarian cancer. I tried not to think of bad things. But I also thought if I would also go through the same sorrows if I were found to have cancer (Participant 3, cervix carcinoma, 61 years old).

Some of the patients and partners stated that they had not guessed that a diagnosis of cancer would be made:

* I felt anxious when a lot of tests were [requested] for my wife. However, I had never guessed that it would be a bad disease. I did not think that such a disease would affect my family (Participant 9’s partner, 51 years old).

Emotions when the diagnosis was first received. Many participants stated that when they were informed of the gynecologic cancer diagnosis, they experienced a huge shock followed first by denial and then acceptance. The women asked themselves and others: “Why me?””Why has this happened to me?” Some of the women faced their fear of death directly and became anxious about their future and their children and then tried to find a way out. Both men and women noted that when informed of the diagnosis they mostly focused on “death” instead of what they would experience as a result of the cancer treatment. Some partners mentioned that once the diagnosis was made they feared that their wives would die. For the emotions experienced when the diagnosis was first stated, 12 women and 5 partners used the term “a big shock:”

* It was as though I was shot at. I felt a big shock. My whole life passed before my eyes. When they said cancer I thought I would just die (Participant 10, endometrial carcinoma, 58 years old).

* I lived the first shock when the diagnosis was explained. I felt as though they poured boiling water on me. My whole body was burning (Participant 11’s partner, 73 years old).

* Cancer is a bad disease just like its name. We were retired. We had dreams. Our projects were always for the future. Now you have to live in this way if you can (Participant 8’s partner, 60 years old).

Theme 2: Experiences During the Treatment Period

Difficulties during the treatment period. All participants stated that the treatment was stressful and described many physical and psychosocial difficulties. Many of the women described physical difficulties such as pain, nausea, vomiting, insomnia, fatigue, and hair loss plus psychological problems such as stress, fear, and anxiety because of the radiation treatment and chemotherapy. Half of the partners noted that they had experienced some physical and emotional difficulties such as fear, anxiety, stress, fatigue, and insomnia during this period.

* The main difficulty was during chemotherapy. Losing my hair affected me a lot. I did not want to look in the mirror after I lost my hair. It was as if I was looking at someone else (Participant 13, ovarian carcinoma, 58 years old).

* It was really difficult. I lost sleep during treatment. My wife couldn’t eat much. I also had difficulty swallowing my food. Stress made my stomach ache and the physician prescribed medication for it (Participant 2’s partner, 68 years old).

Emotions experienced during the treatment period. Many patients and their partners experienced various phases of showing their sadness, dependency, despair, hopelessness, and hope during treatment. Many patients mentioned that they were afraid of the treatment they would receive. More than half of the women were in tears when sharing their feelings related to the treatment. Many partners classified the treatment period as difficult and a time they did not want to remember and some used the term “our treatment” to describe the process.

* It’s as though there are two lives for me. It’s as though I am on a razor’s blade and the others are living (Participant 8, ovarian carcinoma, 58 years old). The partner of Participant 8 stated his feelings as follows:

* Some of the patients we were treated [with] died. I took over everything during this period. I don’t even want to remember those days. Despite all, I never lost hope (Participant 8’s partner, 60 years old).

Coming for follow-up was described by all participants as stressful but necessary to follow the disease and plan the treatment. The vulnerability for recurrent disease was explained as a continuing, present concern for both women and partners.

* My disease recurred. This was found during the followup. I always feel anxious and I can’t sleep when I am going to go for follow-up [visits]. (Participant 10, endometrial carcinoma, 58 years old).

* I was even more anxious than my wife. I put every test result in the folder. I collect them all. We compare results ourselves after the physician (Participant 9’s partner, 51 years old).

Theme 3: Effect on Family

Changing roles, responsibilities. Almost all patients and their partners reported that the household roles were taken over by their partners, older family members (especially mothers and older sisters), and grown-up daughters during the postoperative phase and while receiving chemotherapy and radiotherapy. Many of the women stated that they felt uncomfortable and anxious as they became dependent on others and were unable to carry out the duties they had easily taken care of previously. The partners noted that they and other family members assumed the responsibility for daily chores and they felt the need to “be strong” for their wives and children.

* My husband and my daughter are doing all they can. My daughter is getting very tired with housework, cooking, etc. I am sad because I am preventing her from studying and I feel as though I am having a negative influence on her future (Participant 14, endometrial carcinoma, 46 years old).

* I supported my wife in every way. Housework, cleaning, cooking. I did not let her tire herself at all. There is nobody closer than your wife. I did not used to do housework before. I started when my wife became ill. I was getting very tired but did not let her know (Participant 10’s partner, 62 years old).

The effects on the partners and the children. The men stated their fear that their wives would die of this disease. Women expressed their fear of death as well as their anxieties about their family members.

* My partner was worse than me, he thought I would die. He even had a nervous breakdown on the night I had the surgery (Participant 1, ovarian carcinoma, 43 years old).

* My wife’s disease was advanced when she was diagnosed. However, during the long treatment, we saw the people we talked with die in front of our eyes. These affected me and my wife a lot. I am very scared that something will happen to her (Participant 19’s partner, 62 years old).

Many of the women and partners stated various anxieties according to the age and gender of the children.

* When I fell ill, my son was five and my daughter seven. One becomes more attached to life after seeing the state they are in. The children also became more attached to me. My children are young. Who will look after them if I die (Participant 1, ovarian carcinoma, 43 years old)?

* I’ve heard that hereditary transmission is seen frequently in this disease. When the doctor suggested that my daughter have a check-up regularly, I was very scared considering the possibility that it might develop in my daughter as well. Our family is already ruined (Participant 9, ovarian carcinoma, 49 years old).

Sexual relations. Many of the participants explained that it was difficult to talk about sexual relations with the physician or nurses and they did not receive adequate information from healthcare staff. Women mentioned that they had avoided sexual relations in the 6 months after treatment believing it would cause pain or harm. On the other hand, the men stated that their sexual life had been affected because they were trying to avoid harming their wives and because their wives expressed little sexual desire. Some women said that to be in good health and alive were more important than were sexual relations.

* I was scared for the first 5-6 months. Just in case. But I felt that my surgical wounds had not healed completely. So I did not want it much. Then we started doing it slowly but I had pain, especially at the back. We did not have sex for awhile and my partner understood. We don’t have any problems now (Participant 17, cervical carcinoma, 57 years old).

One patient stated that no significant changes in their sexual relations occurred while the partner thought their sexual relations were almost over.

* [O]f course our sexual relations changed a lot. Now, we have it now and then. It has been a long time since the treatment ended but we are both scared. I am anxious something will happen to my wife and she is not that keen either, so it doesn’t happen often (Participant 18’s husband, 46 years old). Theme 4: Changes in Daily Life

Friendships and social relations. About half of the patients stated that their friendships and social relations did not change while half reported a decrease. The men mostly made their decisions regarding social life according to their wife’s preference but they were less affected in their friendships than were the women. One husband stated that he had been forced to retire because his wife’s treatment was in another city and their social relations therefore suffered greatly and he was unable to see his good friends anymore.

* I don’t want to join any group. Everyone asks what happened and how it happened. It makes me feel bad. They wish me good health. But I don’t want to respond. Sometimes I want to get rid of these feelings and talk to a friend (Participant 8, ovarian carcinoma, 58 years old).

The same patient’s husband said the following about social relations:

* Previously we used to go to activities with friends, go to the theatre and go for walks. She was very tired. It is also not nice to be exposed to the questions of others (Participant 8’s partner, 60 years old).

Theme 5: Coping Methods and Support Sources

Many of the patients and their partners reported that they prayed, received psychological help, talked to other patients, or accepted the disease and complied fully with the treatment as coping mechanisms. Many women stated that they received the most support from their partner, mother, daughters, and friends during the treatment. Also, several women noted that their husbands reassured them saying: “We’ll go through this together.”

* Of course I did everything for her to get better. We go to follow-ups on time. We are happy when the results are good. I found peace in praying. I felt happy when the results were good. It is God’s will, after all (Participant 5’s partner, 49 years old).

Theme 6: Finding Meaning in Disease and Future Views of the Participants

About half of the participants expressed the view that they had discovered certain positive gains from the disease experience. Many participants made different deductions about the meaning of life, the future, and what they expected from the future. Some of the women and partners stated that they recognized an increase in spiritual presence in their lives. Learning that they might die meant that they had felt drawn to re-evaluate their relationships with God and recognized that they needed something more powerful than themselves to see them through.

* You’ll get nowhere by crying and complaining. We’ll all die some day. I am not afraid of dying. Praying makes me comfortable. I don’t want to feel sick (Participant 4, endometrial carcinoma, 64 years old).

* I feel much better though when my wife has a good day. So I thank God each day for one more day of healthy life (Participant 18’s husband, 46 years old).

Some of the participants explained the women’s disease as “fate”. One husband said: “I told my wife that a lot of women got this disease. This is our fate and we have to face it” (Participant 2’s partner, 68 years old).

Theme 7: Disease Experience as a Female

Statements of patients regarding having gynecologic cancer varied depending on their ages and whether they had children.

* As a woman I was not saddened by having a cancer of women but by having cancer. I did not care at all whether I had a womb or not. I am not going to have any other children anyway. My health is more important (Participant 12, cervical carcinoma, 50 years old).

* I felt very sad because I wouldn’t have children. I wouldn’t be this sad if I had a child. I was most saddened for children. I felt incomplete. I felt as though I had lost my femininity (Participant 18, corpus carcinoma, 45 years old).

Discussion

In this study, the experiences of gynecologic cancer patients and their partners were summarized under seven main themes. Although each story was unique, some concepts were more prominent and it was seen that gynecologic cancer had important effects on family life.

Many participants used the term being afraid of “a had result” instead of “cancer” and avoided using the word “cancer.” Both the women and their partners talked about the fear and marked stress and anxiety caused by cancer, as reported in other articles (Friedrichsen, Strang, & Carlsson, 2001; Saegrov & Halding, 2004).

Cancer is a difficult disease for the whole family. Almost all patients and their partners in our study emphasized that they felt huge shock, uncertainty, hopelessness, fear of death, and a deep sadness when they first learned of the diagnosis and some did not believe the diagnosis but only accepted it later. Other investigators also report marked stress when the patient and family first heard of the cancer diagnosis (Friedrichsen et al., 2001; Iconomou, Vagenakis, & KaIafonos, 2001; Kozachik et al., 2001; Saegrov & Halding, 2004).

Intensive fatigue and pain are common symptoms in gynecologic cancer patients and have a direct effect on daily activities, work life, self-perception, and psychosocial status in these patients (Holzner et al., 2003; Howell et al., 2003; Molassiotis, Chan, Yam, Chan, & Lam, 2002).

Some researchers emphasize frequent psychological problems and physical signs such as insomnia, fatigue, and loss of appetite in those caring for cancer patients (Fang, Manne, & Pape, 2001; Ferrell et al., 2002; Northouse, 2005). In our study, the women reported many physical and psychosocial difficulties during the treatment. The most common physical side effects were pain, nausea, vomiting, fatigue, and hair loss and these side effects affected the role and responsibilities of the women within their families, social lives, and psychological outlooks.

In addition to these known effects of cancer in women, approximately half of the husbands in this study reported symptoms such as fatigue, insomnia, stress, anxiety, and fear-the same findings reached by Demiralp, Hatipoglu, Basbozkurt, Demiralp, and Erler, (2004) in their study about difficulties experienced by family members of patients with orthopedic tumors in Turkey.

In our study, women and partners experienced dependency, hopelessness, fear, anxiety, and stress during treatment. Studies show that many women with gynecologic cancer experience psychosocial difficulties such as anxiety, depression, and fear of recurrence and of dying (De Groot et al., 2005; Ferrell et al., 2005; Steginga & Dunn, 1997). In our study, as in other studies, men also experienced psychosocial problems during the treatment of gynecologic cancer because they need information regarding the disease and are anxious about their wives’ condition (Hodgkinson et al., 2007; Lalos, 1997). A study on the psychosocial effect of gynecologic cancer on the community indicated that both partners had similar problems and no difference was noted between the difficulties experienced by the women and their partners regarding cancer (De Groot et al., 2005). We therefore believe it is important for the nurses providing care to a patient with gynecologic cancer, to take this fact into account and plan care with a view to including the partner.

We found that the women were unable to take care of their everyday responsibilities because of physical problems that surfaced, especially during the intensive treatment period, in addition to the psychological effects of cancer. Every society around the world assigns gender roles that direct activities and govern behavior for women and men. In traditional countries like Turkey, where women work mostly at home, it is the women who usually take care of responsibilities such as housework, cooking, cleaning, ironing, childcare, and child education (Turmen, 2003). From the nursing point of view, these can be seen as the “daily living activities” of a family. Having gynecologic cancer creates problems in the flow of daily life. The other members of the family (partner, oldest daughter, the patient’s mother) therefore assume these responsibilities to preserve the balance of family dynamics in line with the observations by Howell et al. (2003) that the partners take on most of the household roles during the intensive treatment period. However, because of the traditional structure of Turkish society it is not common for men to take over housework even in such extraordinary conditions. Depending on the strength of the family ties, it is more common that the patient’s mother, mother-in-law, or daughter take the responsibility.

We understood that most of the women and partners in the study did not want to talk with their physicians or nurses about sexual relations, and avoided sexual relations, because they feared that sexual relations might negatively influence the quality of life. Many studies indicate that sexual and psychosexual problems are often related to gynecologic cancer treatment (Donovan et al., 2007; Lowdermilk & Germino, 2000; Molassiotis et al., 2002; Reis, 2003), and that sexual life should receive as much attention as other aspects of cancer treatment (Ekwall et al., 2003; Molassiotis et al., 2002). It is important that nurses play a significant role in the sexual rehabilitation of women with gynecologic cancer and their partners.

In society, pregnancy and childbirth are important duties of women. We found that some women with gynecologic cancer also felt anxiety because of losing their ability to become pregnant and have children. This anxiety about sexual relations was felt mostly by young patients in relation to fertility while elderly patients did not see loss of fertility as a threat to their femininity or sexual life. Loss of fertility is especially a significant problem for women who plan to have children in the future (Molassiotis et al., 2002). However, we noticed that gynecologic cancer did not affect the concept of femininity greatly for those of older age, and that concepts of “living” and “being healthy” came first.

We found that the effects of gynecologic cancer on the social life of the women and their partners varied according to stage of the cancer, post-treatment duration, the person’s characteristics, and the social environment. Patients with more advanced cancer and those whose treatment took 6 months to a year had a significant decrease in social life and relationships. Many studies from Turkey and other countries show that social relations are affected for various reasons (Ferrell et al., 2002; Howell et al., 2003; Lowdermilk & Germino, 2000; Sevil, Ertem, Kavlak, & Coban, 2006). We observed that not only the women but also their partners were affected socially and that they arranged their social and even work lives according to the wish of the women to be isolated. This finding is important in that it shows how much their life is affected. Nurses should, therefore, keep in mind that these physical effects may push not only the woman but also her partner towards loneliness.

Patients and their partners were seen to use methods such as praying, obtaining psychological help, abiding by all instructions, asking for support from friends, and continuing social relations in order to cope. Akyuz et al. found that 95% of the gynecologic cancer patients in Turkey used worship and prayer as disease-control methods, for feeling good, increasing quality of life, and constructing psychological support mechanisms (Akyuz et al., 2007).

Turkish society has a more fatalist approach to events than do some societies, in other words, a more subservient approach, because of religious beliefs. This fatalism might affect the use of coping methods of patients and their relatives (Tan, 2007).

Many cancer patients receive a lot of help and support from family and friends (Howell et al., 2003; Isaksen, Thuen, & Hanestad, 2003; Liu, Mok, & Wong, 2005). In this study, some of the participants accepted women’s disease as their fate, and because fate cannot be changed, one has to endure it with courage. This result might be explained as the role of God in disease and death, which is common in Muslim cultures like Turkey (Gozum & Aydin, 2004). Other studies on cancer patients and their careers report that religious beliefs and spiritual applications are important in coping with and fighting the disease and increasing the hope for survival (Boscaglia, Clarke, Jobling, & Quinn, 2005; Ferrell et al., 2002; Northouse, 2005; Weaver & Flannelly, 2004).

Conclusions

Although the sample in this study is nonrandom and therefore cannot be generalized, the goal of this qualitative study was to describe how women and their partners experience gynecologic cancer. Among Turkish women, and their partners, it has been determined that gynecologic cancer has important effects on life. However, in this study more reports of general experiences of the women and their partners regarding almost all aspects of life with cancer were provided. It is recommended for future studies that the effects of gynecologic cancer should be investigated in-depth for each aspect of life.

Integrated holistic care provided by Healthcare professionals upon understanding the physical, emotional, social, and spiritual experiences of both women with gynecologic cancer and their partners is important. We believe that studies which indicate the results of nursing applications directed towards detailed experiences and helping families to cope with these experiences are required so that healthcare staff can assume responsibility properly.

Clinical Resources

* American Cancer Society: www.cancer.org

* Oncology Nursing Society: www.ons.org/

* Association of Cancer Online Resources (ACOR): www.asco.org

* Women’s Cancer Network/Gynecologic Cancers Foundation: www.wcn.org/gc

* The Society of Gynecologic Nurse Oncologists (SGNO): www.sgno.org/

References

Akyuz, A., Dede, M., Cetinturk, A., Yavan, T., Yenen, M.C., Sarici, S.U., et al. (2007). Self-application of comlementary and alternative medicine by patients with gynecological cancer. Gynecological and Obstetric Investigation, 64, 75-81.

Boscaglia, N., Clarice, D.M., Jobling, T.W., & Quinn, M.A. (2005). The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer. International Journal of Gynecological Cancer, 15(5), 755-761.

Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. Valle & M. King (Eds.), Existential phenomenological alternative for psychology (pp. 48-71). New York: Oxford University Press.

Costanzo, E.S., Lutgendorf, S.K., Rotrock, N.E., & Anderson, B. (2006). Coping and quality of life among women extensively treated for gynecological cancer. Psycho-Oncology, 15(2), 132-142.

De Groot, J.M., Mah, K., Fyles, A., Winton, S., Greenwood, S., Depetrillos, A.D., et al. (2005). The psychosocial impact of cervical cancer among affected women and their partners. International Journal of Gynecological Cancer, 15(5), 918-925.

Demiralp, M., Hatipoglu, S., Basbozkurt, M., Demiralp, B., & Erler, K. (2004, April). The problems of the families of patient’s orthopedic malignant tumors. Paper presented at the meeting of Asia Pacific Musculoskeletal Tumor Society Izmir, Turkey.

Donovan, K.A., Taliaferro, L.A., Alvarez, E.M., Jacobsen, P.B., Roetzheim, R.G., & Wenham, R.M. (2007). Sexual health in women treated for cervical cancer: Characteristics and correlates. Gynecologic Oncology, 104(2), 428-434.

Dowling, M. (2007). From Husserl to van Manen. A review of different phenomenological approaches. International Journal of Nursing Studies, 44(1), 131-142.

Duffy, M.E. (2005). Resources for critically appraising qualitative research evidence for nursing practice clinical question. Clinical Nurse Specialist, 9(6), 288-290.

Ekwall, E., Ternestedt, B.M., & Sorbe, B. (2003). Important aspects of health care for women with gynecological cancer. Oncology Nursing Forum, 30(2), 313-319.

Fang, C.Y., Manne, S.L., & Pape, SJ. (2001). Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients’ spouses. Health Psychology, 20(6), 452-457.

Ferrell, B., Ervin, K., Smith, S., Marek, T., & Melancon, C. (2002). Family perspectives of ovarian cancer. Cancer Practice, 10(6), 269-276.

Ferrell, B., Cullinane, C.A., Ervin, K., Melancon, C., Uman, GC., Juarez, G. (2005). Perspectives on the impact of ovarian cancer: Women’s views of quality of life. Oncology Nursing Forum, 32(6), 1143-1149.

Friedrichsen, M.J., Strang, P.M., & Carlsson, M.E. (2001). Receiving bad news: Experiences of family members. Journal of Palliative Care, 17(4), 241-249.

Gozum, S., & Aydm, I. (2004). Validation evidence for Turkish adaptation of Champion’s Health Belief Model Scales. Cancer Nursing, 27(6), 491-498.

Holzner, B., Kemmler, G., Meraner, V., Maislinger, A., Kopp, M., Bodner, T., et al. (2003). Fatigue in ovarian carcinoma patients. A neglected issue? Cancer, 97(6), 1564-1572.

Hodgkinson, K., Butow, P., Hunt, G.E., Wyse, R., Hobbs, KM., & Wain, G. (2007). Life after cancer: Couples’ and partners’ psychological adjustment and supportive care needs. Supportive Care in Cancer, 15(4), 405-415.

Howell, D., Fitch, M.I., & Deane, K.A. (2003). Impact of ovarian cancer perceived by women. Cancer Nursing, 26(1), 1-9.

Iconomou, G., Vagenakis, A.G., & Kalafonos, H.P. (2001). The informational needs, satisfaction with communication, and psychological status of primary caregivers of cancer patients receiving chemotherapy. Supportive Care in Cancer, 9(8), 591-596.

Isaksen, A.S., Thuen, F., &i Hanestad, B. (2003). Patients with cancer and their close relatives. Cancer Nursing, 26(1), 68-74.

Kozachik, S.L., Given, C.W., Given, B.A., Pierce, S.J., Azzouz, E, Rawl, S.M., et al. (2001). Improving depressive symptoms among caregivers of patients with cancer: Results of a randomized clinical trial. Oncology Nursing Forum, 28(7), 1149-1157.

Lalos, A. (1997). The impact of diagnosis on cervical and endometrial cancer patients and their spouses. European Journal of Gynaecological Oncology, 18(6), 513-519.

Liu, J. E., Mok, E., & Wong, T. (2005). Perceptions of Chinese cancer patients of the favorable and unfavorable words conveyed by their social support providers. Cancer Nursing, 28(5), 348-354.

Lowdermilk, D., 8c Germino, B.B. (2000). Helping women and their families cope with the impact of gynecological cancer. Journal of Obstetric, Gynecological, and Neonatal Nursing, 29(6), 653-660.

Ministry of Health. (2007). Republic of Turkey Cancer statistics. Retrieved January 21, 2008, from http://www.saglik.gov.tr/KSDB/ Default.aspx

Molassiotis, A., Chan, C.W.H., Yam, B.M.C., Chan, E.S.J., & Lam, C.S.W. (2002). Life after cancer: Adaptation issues faced by Chinese gynecological cancer survivors in Hong Kong. Psycho-Oncology, 11(2), 114-123.

Northouse, L. (2005). Helping families of patients with cancer. Oncology Nursing Forum, 32(4), 743-750.

Rapport, F., Sf. Wainwright, P. (2006). Phenomenology as a paradigm of movement. Nursing Inquiry, 13(3), 228-236.

Reis, N. (2003). Jinekolojik kanser ve tedavilerinin kadin cinsel sagligina etkileri. [Effects of gynecological cancers and treatment on women’s sexual health]. Journal of Cumhuriyet University School of Nursing, 7(2), 35-40.

Saegrov, S., & Halding, A.G. (2004). What is it like living with the diagnosis of cancer? European Journal of Cancer Care, 13(2), 145- 153.

Schultz, G.S., & Cobb-Stevens, R. (2004). Husserl’s theory of wholes and parts and the methodology of nursing research. Nursing Philosophy, 5(3), 216-223.

Sevil, U., Ertem, G., Kavlak, O., & Coban, A. (2006). The loneliness level of patients with gynecological cancer. International Journal of Gynecological Cancer, 16(Suppl. 1), 472- 477.

Steginga, S.K., & Dunn, J. (1997). Women’s experiences following treatment for gynecological cancer. Oncology Nursing Forum, 24(8), 1403-1410.

Tan, M. (2007). Social support and coping in Turkish patients with cancer. Cancer Nursing, 30(6), 498-504. Turmen, T. (2003). Toplumsal cinsiyet ve kadin saghgi [Gender and women’s health]. In A. Akin (Ed.), Gender, Health and Women (pp. 7-14). Ankara, Turkey: Hacettepe University Press.

Weaver, A.J., & Flannelly, K.J. (2004). The role of religion/ spirituality for cancer patients and their caregivers. Southern Medical Journal, 97( 12), 1210-1214.

Wong, M., & Chan, S. (2006). The qualitative experience of Chinese parents with children diagnosed of cancer. Journal of Clinical Nursing, 15(6), 710-717.

Aygul Akyuz, RN, PhD, Assistant Professor; Gulden Guvenc, RN, PhD; Ayfer Ustunsoz, RN, PhD, at Obstetric Gynecologic Nursing Department; Tulay Kaya, PhD, Assistant Professor, at Public Health Nursing Department; all at School of Nursing Gulhane Military Medical Academy, Ankara, Turkey. Correspondence to Dr. Akyuz, Obstetric Gynecologic Nursing Department, School of Nursing Gulhane Military Medical Academy, Ankara, Turkey. E-mail: [email protected]

Accepted for publication March 13, 2008.

Copyright Blackwell Publishing Ltd. Third Quarter 2008

(c) 2008 Journal of Nursing Scholarship. Provided by ProQuest LLC. All rights Reserved.

By Norris, Kathleen

Struggling with acedia THE DIFFICULT THING about days is that they must be repeated. It may be, as we read in 2 Peter, that with the Lord, one day is like a thousand years, and a thousand years are like a day. What we perceive as slowness is merely the Lord’s patience. But like many children of the middle class, I was schooled in a particular kind of impatience that devalues such chores as cooking, cleaning and taking out the garbage. An unspoken premise of my education was that it would enable me to employ someone else to perform these tasks. If the heady world of ideas tempted me to despise repetition, it also taught me to value the future over the present moment.

The immediate future for which I was meticulously preparing, of course, was college. From the eighth grade on, my classmates and I were urged to endeavor to become “well rounded” so as to be more attractive to college admissions officers. As the dean politely reminded me every year, when I met with her to assess my program of study, I was deficient in that regard, harboring a virulent case of “math anxiety.” But rather than attempt to become less lopsided, I rebelled, enrolling in both art and music courses. The dean disapproved, but my parents backed me up, and I won that battle. In the long run, though, the preparatory nature of my schooling had its effect. I had learned that the present is but a prelude to something more important.

I was a moody adolescent, unathletic, the last to be picked for any team sport. Perversely, I turned my shyness into pride and wore my role of campus oddball like armor. Eventually I found a small group of friends with whom I shared similar interests and who were also socially inept. I could reveal myself in their company, in the safe environs of the art studio, English class or the office of the school literary magazine. Under my senior photo in the yearbook, where my classmates cited Kahlil Gibran or the Beach Boys, I placed a quotation from S0ren Kierkegaard: “When a man dares declare, ? am eternity’s free citizen,’ necessity cannot imprison him, except in voluntary confinement.” In way over my head, I had misread this statement as a manifesto of the airy freedom I aspired to. The significance of “voluntary confinement” escaped me, and I sensed none of the grit of Kierkegaard’s insight, that true freedom develops out of discipline and a healthy respect for necessity. I was a bratty kid who didn’t want to make her bed.

“Why bother?” I would ask my mother in a witheringly superior tone. “I’ll just have to unmake it again at night.” To me, the act was stupid repetition; to my mother, it was a meaningful expression of hospitality to oneself, and a humble acknowledgment of our creaturely need to make and remake our daily environments. “You will feel better,” she said, “if you come home to an orderly room.” She was far wiser than I, but I didn’t comprehend that for many years. Neither of us could see that I was on my way to becoming a cerebral disaster zone. Reading Sylvia Plath’s The Bell Jar, I identified uncomfortably with her protagonist, Esther, and cringed at her rationale for not washing her hair for three weeks: “The reason I hadn’t washed my clothes or my hair was because it seemed so silly. I saw the days of the year stretching ahead like a series of bright, white boxes. … I could see day after day glaring ahead of me like a white, broad, infinitely desolate avenue. It seemed so silly to wash one day when I would only have to wash again the next. It made me tired just to think of it. I wanted to do everything once and for all and be through with it.”

One of the first symptoms of both acedia and depression is the inability to address the body’s basic daily needs. It is also a refusal of repetition. Showering, shampooing, brushing the teeth, taking a multivitamin, going for a daily walk, as unremarkable as they seem, are acts of self-respect. They enhance the ability to take pleasure in oneself and in the world. But the notion of pleasure is alien to acedia, and one becomes weary thinking about doing anything at all. It is too much to ask, one decides, sinking back on the sofa. This indolence exacts a high price. Esther’s desire to “do everything once and for all and be through with it” has all the distorted reasoning of insanity. It is a call to suicide.

Repetition is at the heart of learning to play any musical instrument, and while I knew that practicing scales and fingering exercises on my flute was intended to provide a foundation for more advanced work, I was easily bored, and often skipped to playing what I enjoyed. I mystified my long-suffering teacher by excelling at the Bach flute sonatas when I had done miserably with work she considered much easier. I had an affinity for the Bach and enjoyed it more. As she pointed out to me, with exasperation and on more than one occasion, I liked to play rather than to practice, and that marked me as an amateur.

If I was slow to appreciate the role of repetition in my learning to play the flute, I also resisted acknowledging its value in learning to live my life. My father used to say that if he ever wrote a self-help book, he would call it Overcoming Peace of Mind. His little joke packs a punch for me, because it reminds me that I all too readily spin my gold into straw until my precious equilibrium and sense of well-being give way to restlessness and dissatisfaction. Unfortunately, this process takes hold precisely when I most need rest and relaxation, and I succumb to an anxious acedia.

It begins as a deceptively slight shift in thought, or ratherin a process much commented on by the desert monks-a quick succession of thoughts that distract me from my right mind. I’ve been working too long and need a break; maybe I should read a mystery novel to clear my head. I tell myself that I’m too weary to concentrate. I tell myself that it is a matter of respecting my limitations and of being good to myself. If I manage to read one book and then return to my other obligations, no harm is done. But often one book does not satisfy me. My “rest” has only made me more restless, and as I finish one book, I am tempted to pick up another. If I don’t check myself, I can slip into a state both anxious and lethargic, in which I trudge through four or five paperbacks a day, for three or four days running. I am consuming books rather than reading them.

I may have begun with a well-written novel, but soon I am ingesting whatever I can get my hands on. Morbidly conscious of the time I am wasting, I race feverishly through a book so preposterous and badly written that it nauseates me. If I pick up a more serious book, something that might bring me to my senses, I am likely to plow through it as thoughtlessly as if it were a genre thriller. I have become like the child I once knew who emerged one morning from a noisy, chaotic Sunday school classroom to inform the adults who had heard the commotion and had come to investigate, “We’re being bad, and we don’t know how to stop.” In this new, repulsive world I now inhabit-and indeed have created for myself-I sleep fitfully with the light on, waking at frequent intervals to read the same sentences over and over. My days are not lived so much as wasted in compulsive reading. I stop answering the phone and getting the mail, ignoring everything but the next page, the next book in the pile.

The contemporary maxim “Listen to your body” is useless to me when all I want to do is lie down, turn pages and ignore that ringing phone. I may in fact need bodily refreshment, yet that is exactly what acedia will prevent. My lying for hours on the sofa, book in hand, is a sad parody of leisure. I have reached the state S0ren Kierkegaard described in Either/Or:”I do not care for anything. I do not care to ride, for the exercise is too violent. I do not care to walk, walking is too strenuous. I do not care to lie down, for I should either have to remain lying, and I do not care to do that, or I should have to get up again, and I do not care to do that either. Summa summarum: I do not care at all.”

It amazes me how quickly acedia can deaden what has long been a pleasure for me, and with what facility despair will replace the joy I once found in the act of reading. But my dilemma is less literary than spiritual. If my torpor is left unchecked, I lose the ability to savor not only reading but life itself. I develop a loathing for fresh food, letting salad greens and strawberries languish in the refrigerator while I fill up on popcorn. As Chaucer notes in “The Parson’s Tale,” acedia “wastes, and it allows things to spoil.” Although reading has led me into this dreary state, the books are not to blame. I have been reading for all the wrong reasons, rejecting life as it is in favor of a world of neat conclusions. While I would distinguish this onslaught of acedia from episodes of depression I have experienced, there are also correspondences. William Styron, in Darkness Visible, describes a state in which the mind feels “like one of those outmoded small-town telephone exchanges, being gradually inundated by floodwaters: one by one, the normal circuits began to drown, causing some of the functions of the body and nearly all of those of instinct and intellect to slowly disconnect.” As the telephone rings and my mother begins to leave me a message, I am too heavy with weariness to answer. I do not know why I am unable to respond to that dear voice, and why this should trouble me so little. If I were depressed, I suspect that I would feel more pain. But safe within my carapace of sloth, I sluggishly acknowledge that even though I do love my mother, it is easy to act as if I did not. In Maurice Sendak’s Pierre, a child responds to all parental inquiries by saying “I don’t care.” When he encounters a lion who offers to eat him, and responds with his habitual “I don’t care,” the lion pounces and devours him. The book is a perfect exposition of acedia: happily, when the lion is shaken upside down, Pierre emerges, laughing because he is not dead, and because life is worth living. If only I could so easily free myself from the lion of acedia! Often I can. But if I become too weary, I can care for so little that it becomes hard to care even whether I live or die. I need help to learn to see again, and to reclaim my life through ordinary acts: washing my hair, as well as the dishes in the sink, and walking out of doors to enjoy the breeze on my neck. I may attempt to regain my ability to concentrate by taking on a good book of poetry. And I certainly will answer that ringing phone. Even if it is someone calling over a trivial or annoying matter, our conversation will have the salutary effect of reconnecting me with another. When I stop running from my life, I can return to living it, willing to be present again, in the present moment. But this means embracing those routine and repetitive activities that I tend to scorn.

Repetition is at the heart of monastic life, which is one reason my attraction to it seemed odd at first. Morning, noon and evening, monks return to church to pray the psalms. When they have gone through the entire cycle of 150 psalms, a process that takes three or four weeks, they begin again, day after day, year after year. In a similar way, a community reads through major portions of the Bible. Every Advent one hears Isaiah, ancrxluring Easter the Acts of the Apostles and Revelation. An elderly monk, disparaging the romantic image of monastic life, once said to me, “People don’t realize how much of it is just plain tedium.”

But it is tedium with a purpose. To support themselves, the first Christian monks spent their days weaving palm branches into baskets and ropes they could sell. And as they worked, they prayed. The steady rhythm of the work helped the monks memorize the psalms and the Gospels, which was a necessity in the fourth-century desert, as books were expensive and rare. But the monks also regarded this repetitive work and prayer as their way to God, hoping that over time the “straw” of mundane tasks could become the “gold” of ceaseless prayer. Cassian’s story of Abba Paul reveals this hope as firmly established in the real world of unrelenting and seemingly fruitless toil. Because Paul lived at such a remove from civilization that he could not even distract himself with the notion of selling his baskets, he was forced to admit that he was engaged, day in and day out, in useless activity. As soon as he had filled his cave with baskets, he would have only to burn them and begin again.

The tale is a wry comment on the futility of all human effort, and on mortality itself. There is no denying that we, like Paul’s baskets, will one day be nothing but ashes. Our work is bound to be forgotten. But monks still tell Paul’s story because they take heart from his perseverance and bold humility in the face of acedia. His steadfast labor at both work and prayer reminds us that even if what we do seems worthless, it is worth doing.

The notion that repetition can be life-enhancing was not something I found in the literature that had made its way onto my high school reading lists: Sartre’s No Exit, Camus’s The Stranger, lonesco’s The Bald Soprano. Resigning myself to the notion that straw can be nothing but straw, and that ennui is an inevitable, if not preferable, emotional state, I resolved to live a life superior to that of people still entranced by the false promises of religion or the inanities of popular culture. What I most needed to know as a young woman who, like many of her peers, suffered from occasional bouts of despondency, was effectively hidden from me by the confluence of a determinedly fashionable literary education and a typically deficient religious one, which excluded much mention of spiritual experience. The notion that monastic wisdom might be of use to me was unthinkable. It took me years to discover in the curious history of acedia a key to understanding myself and my work as a writer.

Left unchecked, acedia can deaden what has long been a pleasure.

Kathleen Norris is the author of Dakota and Amazing Grace: A Vocabulary of Faith. This article is excerpted from her new book, Acedia and Me: A Marriage, Monks, and a Writer’s Life, published by Riverhead. (c) 2008 by Kathleen Norris. Used with permission of the publisher.

Copyright Christian Century Foundation Sep 23, 2008

(c) 2008 Christian Century, The. Provided by ProQuest LLC. All rights Reserved.

By Trachtenberg, Alan

“I DON’T KNOW WHY A REPLICANT WOULD COLLECT PHOTOS-MAYBE they were like Rachel-they needed memories.” In the role of the bounty hunter Rick Deckard in Ridley Scott’s 1982 cult classic, Blade Runner, Harrison Ford utters these words with a bitter edge. Assigned to “terminate” the beautiful Rachel, an “android” especially menacing because she’s almost (almost!) indistinguishable from a “real” person, Deckard lusts after her and wants to be sure she’s human, not machinemade, before bedding her. Based on Phillip K. Dick’s brilliant science fiction novel of 1968, Do Androids Dream of Electric Sheep? the film adds the bit of sentiment about collecting photographs to the otherwise unmitigated darkness of Phillip Dick’s vision of a near future. The year is 2021, and by means of mechanical replication-the electric sheep of Dick’s title- warm-blooded animal life has been all but totally replaced by replicants, copies or duplications of almost forgotten originals. Memories of real sheep and toads and living human flesh are struggling against the irresistible tide of a programmed second- order reality unburdened by personal or cultural memory. In the film version memory survives paradoxically only as a faint reminder of itself, a remembered need to a memory and thereby an individual identity. Here’s where the collected photographs come in. They answer to the need for at least an illusion of memory. Deckard vents his angst just after Rachel leaves his apartment in tears, her selfdelusion shattered by the hardboiled bounty-hunter’s refusal to accept the presumptive snapshot of a mother and child fished from her purse as proof of human rather than laboratory birth. “Look,” she had said, “here’s me with my mother.” But Deckard knows better; he has his own tests for androids or “humanoid robots.” True, she’s a special model, long-lasting and seductively beautiful but still a replicant. “Not your memories,” Deckard had said to her, “but some else’s,” a “synthetic memory system” as fraudulent as the faked photo.

Crushed, Rachel leaves him musing at his piano, flipping through another set of faked “old” snapshots he had commandeered from another android. He has also spread his own family snapshots on the piano top, some faded, browned, curling with age and use. These photos are presumably the real thing, true memories of a past that actually happened. Replicants collect photos because they need memories in order to believe they are human, a need itself programmed into their system. The photos in the film are something like the electric sheep in the novel, fake pets in the absence of real ones. In such a world, where the photograph has lost its ground of reference in the past, where the surrogate assumes the look and force of the real, Deckard’s faded personal photos represent pure nostalgia; they are symbols of a life already lived, a dream of the human persisting in the nightmare world of replicants dreaming of electric sheep.

With its cult status as book and film, the story has an aura of foreknowing coming events in real-world genetic engineering and robotics. The pathos of the photograph as faked memory strikes an especially prescient note. As far as we can tell, the photos collected by the androids were made by actual cameras, with lenses and film. The chief point is that their fakery lies in their use, their implied captions or texts and narratives, the fictions that falsely identify them as memories of a past that never was. Yet many of the pictures Deckard holds in his hand seem to have been made by the replicants themselves, of their rooms, of one another-all the more ironic and pathetic examples of futile and abortive yearning for human emotion, attachment to things and persons who can be thought to represent a tangible past. The film accepts the traditional idea of the photograph as reliable proof that something once existed before a lens. What is false about the pictures is not what is pictured but the implied story about what is pictured: “Look, here’s me with my mother.” In fact, Deckard has such faith in the firstorder reliability of photographs that he uses an enhancement on a digital scanner of a tiny section of one of the commandeered snapshots to identify one of the rebellious androids he is assigned to destroy. In the film, digital scanners serve to deconstruct images in order to see more of what is there, rather than to reconstruct an image of something that is nowhere else but in the image. In this sense the film seems to stand firmly within the horizon of conventional photography, even as it envisions the limits of that horizon, the end of the era of the photograph as memory in the old, familiar sense.

As represented in Blade Runner the kind of picture known as “photograph” (written in light, literally) conveys the traditional association of memory and history with photography. Today that simple idea of a light-based transparent nexus between photograph and a determinate past is undergoing radical reappraisal. The digital revolution, as probably everybody on earth now realizes, has eroded the old confidence in that transparency. We and our comfortably reliable old paper photographs now live alongside the all-pervasive digital method of producing replicas, virtual replicants, of the old photographic image without the old apparatus of lenses and film, or indeed of anything we need believe was ever to be photographed.

Calling these new instruments “electronic photography” or “digital camera,” we employ metaphors in hope of easing the passage into a new regime of picturing the putative “real world.” But as William J. Mitchell points out in his recent book, The Reconfigured Eye: Visual Truth in the Post-Photographic Era, this particular metaphor misleads, obscures the digital difference. He writes: “Although a digital image may look just like a photograph when it is published in a newspaper, it actually differs as profoundly from a traditional photograph as does a photograph from a painting” (1992:4). Based on changes in chemical emulsions caused by exposure to light, old-style photographs are analog or continuous tone images; computer-generated images are digital, based on discrete units called pixels, entirely the product of computer programs.

These programs may include actual photographs converted into digital images, which then can be altered, reprocessed, or recombined to produce an image as if made in the old manner of light- generated miages. The hardware for producing such electronic images has swept the mass market: Kodak’s Photo CD Player, for example, converts snapshots into still video, and electronic cameras can digitize the image as it is being recorded by light. The image can be manipulated even as it is being “captured.” As a result, writes Mitchell, we are faced “with a new uncertainty about the status and interpretation of the visual signifier” (Mitchell, 1992: 17). On an ominous note he adds: “The inventory of comfortably trustworthy photographs that has formed our understanding of the world for so long seems destined to be overwhelmed by a flood of digital images ofmuch less certain status” (1992:19).

Such radical technological change in image-making affects the mass experience as well as the theoretical understanding of photography as memory. Imagine memory as a storage area where images or traces of past sensations lie in wait of retrieval on call or involuntarily. In analogue photography memory takes the form of the material negative, an image held in an emulsion on celluloid. When reproduced in a chemical-mechanical process that reverses the making of the negative, the image gives a “positive” picture that is the memory proper. It is an extractive process, from negative to positive, from potency to realitya second or reborn reality of the sensory past as a positive picture. In digital photography memory potency and reality lose their distinctiveness. In place of a store of images (such as negative versions of positive pictures) are electronic “chips” that compress electrical changes that can be called up, shaped and. reshaped by command as images that look like those of a sensory past though are not necessarily so. In the old photography the camera is an instrument of memory; in the new photography the camera itself serves as electronic repository of memory from which a past, a simulacrum of any past, can be called up and programmatically shaped.

If the nineteenth century invented photography, the late- twentieth-century began to disinvent it. We’ve learned how machines can be made to mimic or replicate human ways of seeing, and with robotic modes of mass production cheap versions of replication devices are available to everyone on earth. It has been a quiet cultural revolution of incalculable consequence. Everywhere you look you see people with these slips of metal and plastic instruments not peering at the world through a view finder but looking for the world at or on the back of the new-style “camera” (another sly metaphor) with its screen or monitor. The wonder is that people have adjusted to this new phenomenon so easily, as if without a grunt or ripple, perhaps with minor annoyance at the baffling array of choices among digital settings that soon gives way to happy complacence. But think of what happens. It is as if the world given to the eyesight no longer lies in front of the instrument of seeing but on its backside, already processed into image: a digital version of seeing through a glass, darkly. The new photography elides so well with the old, and digital image-making couples so smoothly with laptops and desktops, that snapshot memory has taken an amazingly radical turn. Most users of these compact boxes rigged with hi-tech switches and chips may barely notice the difference. But difference is real and stunning. It teaches a high-stake lesson about our lingering assumptions regarding photographs and memory. People seem still to believe that if it looks like a photo, it must be one of the old kind, a record of something that truly happened. Post-photography undermines that glib assumption. MitchelTs image of a flood hardly exaggerates. With electronic imagemaking having effectively taken over and computer memory established as the matrix of images-of-the- world, we are already well within the era of post-photography.

A backward look can help us better see what lies ahead. In the nineteenth century and early twentieth century the most commonplace idea of photography was of its role as memory. People spoke in awe of how photographs made the past seem here and now, restored to visual presence hi ghostly vividness. The notion of photography as a form of memory unique among the visual arts became the groundwork conception of the medium. It seemed archetypically true, a proposition held with spontaneous conviction. Didn’t the camera reproduce with automatic mechanical accuracy exactly what appeared before the lens during a measurable slice of time? Recording the world as it looked through a lens within a distinct duration meant that the resultant picture offered to the eyes an image of time that was already a particular determinate “past” when the exposure ended.

BELIEF IN PHOTOGRAPHS AS TRUE PICTURES OF THE PAST COMES FROM apparent correspondence between them and images we hold in the mind and call “our” memory, traces of what our eyes once delivered to our brains. Collecting and preserving snapshots, making family albums, pinning pictures of loved ones on the wall, all are based on the belief that photographs are remnants of past experience, imageremnants of past feelings, associations, stories, the stuff of the pictures we carry in our heads of our pasts, of the private history we have lived and the public history we share with overlapping communities. Indeed, the line between private and public began to blur as more and more photo-images of private life began to circulate in the expanding public sphere to the point where all private lives and intimate experiences now seem grist for the insatiable public eye of the mass media, including the snooping eye of government surveillance.

Between the photograph and history in the sense of everything past, there was assumed to be an absolute continuity assured by nature and by culture working in tandem: light acting on certain chemically treated surfaces within a controlled interior site, the “dark chamber” of the camera by means of a controlling mechanism of lens, shutter, secure slot for the plate to be exposed to light. The cultural part was to assure an image “fixed” or stable on the model of paintings, drawings, or engravings, the older tradition of referential image-making used to represent and confirm a “real” world. Photography made the real seem the function of memory, image- traces of the visible world preserved on its exposed plates. The camera was understood to be a machine for freezing time into recoverable images in this, as Roland Barthes (1981) remarks in Camera Ludda, renouncing “the Monument” on behalf of the passing and the fleeting. Barthes calls it a paradox that “the same century invented History and Photography,” History substituting memory for life, photography giving “a certain but fugitive testimony.” Accordingly, the camera produces not “the Past” but the intractableness of “what has been.” Nothing fugitive can escape its pounce and its paralyzing memorial gaze.

One of the inventors of photography, the Englishman William Henry Fox Talbot, spoke of his pictures as “impressed by Nature’s hand,” as if the making of a photograph were equivalent to the action of a bed of type upon a sheet of paper in a printing press. The printer is “Nature” itself, possessed now, by virtue of the camera, of a “hand” by which it imprints itself in the form of image, of what Talbot dubbed “calotype” (from the Greek word for beauty) or, proprietorially, as “talbotype.” Talbot titled his 1844 book of pictures and commentary The Pencil of Nature, a trope that links the new medium to both drawing and writing, to media of imaginative creativity. Scientist, inventor, gentleman scholar, Talbot was also one of the original artists in photography who explored the new medium’s aesthetic possibilities in picturing.

For Talbot, the power of the sun gave rise to “one of the charms of photography,” that unexpected discoveries can be had through close reading of what the pencil of nature has writ:

in examining photographic pictures of a certain degree of perfection, the use of a large lens is recommended, such as elderly persons frequently employ in reading. This magnifies the objects two or three times, and often discloses a multitude of minute details, which were previously unobserved and unsuspected. It frequently happens, moreover-and this is one of the charms of photography-that the operator himself discovers on examination, perhaps long afterwards, that he has depicted many things he had no notion of at the time. Sometimes inscriptions and dates are found upon the buildings, or printed placards most irrelevant, are discovered upon their walls: sometimes a distant dial-plate is seen, and upon it- unconsciously recorded-the hour of the day at which the view was taken (plate 13).

This extraordinary account of what the eye missed reveals that claims of certainty in the camera-made picture of the world are contingent on perception. The words “unconsciously recorded” suggest simply that the mechanism of the camera records more than the photographer knows at the time, that “time” is in fact one of the unregistered visual elements in the image. The photograph provides a record of what the mind might have known had it been aware of the totality of its visual field at that moment. The unconscious field Talbot calls attention to is a dial-plate, a human mechanism for translating the movement of a shadow across a calibrated surface into a human discourse of time, into a grammar of number, name, and tense. What Talbot discovers at the buried heart of this image is the artifice of language, the arbitrary devices and constructions that underlie all human cultures.

About a hundred years later in 1931 essay, the German critic Walter Benjamin also speaks of an “optical unconscious” in photographs. He refers to old nineteenth-century portraits made at the dawn of the medium:

All the artistic preparations of the photographer and the design of in the positioning of the model to the contrary, the viewer feels an irresistible compulsion to seek the tiny spark of accident, the here and now. In such a picture, that spark has, as it were, burned through the person in the image with reality, finding the indiscernible place in the condition of that long past minute where the future is nesting, even today, so eloquently that we looking back can discover it (1980: 202).

Benjamin’s optical unconscious refers to what appears in the image unintended, not the product of the photographer’s will but a sign of the contingency involved in the making of the photograph: a blur or the glint of light hi an eye quite unlike any handmade inscription m a painting or drawing. It comes from the photographic process, from the duration of time in which exposure occurs. Most important for Benjamin is the notion that such unconscious signs of life as the look we return to a sitter’s eyes construct the palpable sense of a future “nesting” within the past registered by the image. The photograph’s past contains its future, a future realized when the picture is seen by a viewer, received in another’s eyes. As viewers we are the future of the past recorded in the image; we realize the presentness of that past. The relation to time, then, gives the photograph its distinguishing traits for Benjamin; the image contains time, not a picturetime passing but an experience of a past exactly at the instant it crosses into an indeterminate future.

Another early witness, Elizabeth Barren, future wife of the poet Robert Browning, made a similar point when she wrote longingly in 1843 of the photograph as a prosthesis of private memory.

I long to have such a memorial of every being dear to me in the world. It is not merely the likeness which is precious in such cases- but the association and the sense of nearness involved in the thing… the fact of the very shadow of the person lying there fixed forever! It is the very sanctification of portraits I think-and it is not at all monstrous in me to say, what my brothers cry out against so vehemently, that I would rather have such a memorial of one I dearly loved, than the noblest artist’s work every produced (Heron and Williams, 1996: 2).

Barrett speaks of the daguerreotype, whose images appeared on a mirror-like sheet of metal that could, when held at a certain angle, produce what seemed “the very shadow of the person.” The conception of an intimate memorial image that will not fade but retain its brilliance fit nicely into sentimental middle-class culture of the time. By making palpable the absence of the sitter, making that person appear as already having been, the photograph rehearsed the experience of mourning at the heart of sentimentalism.

The notion of the photograph as an uncanny memory continued with the introduction of paper prints. New technologies of reproduction extended the memorializing claims for the medium so that when Baudelaire in 1859 described the “true duty” of photography as that of a “humble handmaid” of art rather than an art in its own right, he evoked precisely those imperial claims: “Let photography quickly enrich the traveler’s album and restore to his eyes the precision his memory may lack. . . . Let it save crumbling ruins from oblivion the prey of time, all those precious things, vowed to dissolution, which claim a place in the archives of our memories” (1980: 88). At the same time Lady Elizabeth Eastlake in England in 1857 also argued against confusing photography with fine art. Photographs are simply too accurate, too precise, too indiscriminate; for this very reason they answer best the modern need for empirical knowledge. A “purveyor” of knowledge, “she [photography] is the sworn witness of everything presented to her view; she gives “unerring records.” Her realm is fact, not art, and the facts she renders are unsurpassed in communicative power-a “new form of communication between man and man- neither letter, message, nor picture.””In this sense,” Eastlake continues in high-toned prophecy, “no photographic picture that ever was taken in heaven, or earth, or in the waters underneath the earth, of any thing, or scene, however defective when measured by an artistic scale, is destitute of a special, and what may be called an historic interest.” City views may be weak in tonality compared to what painting can achieve, “yet the facts of the age and the hour are there, for we count the lines in that keen perspective of telegraphic wire, and read the characters on that playbill or manifesto, destined to be torn down on the morrow.” Here, then, is photography’s “legitimate stand”: “her business is to give evidence of facts, as minutely and as impartially as, to our shame, only an unreasoning machine can give” (1980: 65-67). Unreasoning machine, evidence of facts: the terminology seems dated and naive in our age of artificial intelligence, digital scanners, random access memory- a world more like that of replacants and blade runners than the world of Daguerre and Mathew Brady. Digital photography reinforces recent post-Enlightenment suspicion that “reality” is something made up, a construction, not something secure for a camera to confirm. More likely the camera is part of the game, not to be trusted as a guide to anything but itself. Still, the confidence of nineteenthcentury witnesses remains a tenet of popular belief much exploited by commercial advertising for digital cameras. Our typical curiosity about photographs, like Deckard’s, tells us as much.

In recent years a growing number of historians have begun to explore common ground with the photographer. It has been pointed out that historian and photographer share the business of discerning and describing fact, which is transformed then into narrative or picture. The act of transformation, as Siegfried Kracauer and others have observed, gives presence to what is absent, what has passed away. “The photographic media,” Kracauer wrote in 1969 (192), “makes it easier for us to incorporate the transient phenomena of the outer world, thereby redeeming them from oblivion. Something of this kind will also have to be said of history.” Hence, for Kracauer, history as writing and photography as picturing parallel and complement each other as modes of saving, preserving, fixing, knowing, and finally redeeming physical reality from the fate of mere transience.

But the analogy goes only so far. What historians produce as “history” are mainly written texts. Images may be seen as analogous to words but not identical with them; they are a different kind and order of thing from narrative or written description. Andre Bazin has said that the photograph is an actual portion of the visible world, a physical trace or residue of an actual event within light. In this view the photograph appears to be less cognate with written history than with the raw materials of written history: traces of lived experience such as letters, journals, artifacts, the data historians sort through, arrange, measure, analyze, and interpret. It is not an identity but a symbiosis that links photography and history: the historian needs the visual record as supplementary data or information; the image needs the historian or historically minded viewer to read in its hieroglyphic markings the possibility of meaning.

WHETHER WE SAY PHOTOGRAPHS ARE MERELY SURFACE DESCRIPTIONS or interpretations analogous to written history comes down to how we look at the image. We look in order to recognize what exists in the recorded field of vision. Choices in the act of viewing are rarely as deliberate and reflective as this account makes it seem, but as a general rule we choose to see a photograph either as a mechanical transcription of a field of light with randomly disposed objects, or as an intentional reordering of that field into a deliberate meaning. We can look at the picture as the world, or the maker’s mind or imagination playing upon the world. Photographs typically provoke and pose questions. What is it? When and where was it made? What does it mean? We desire and need more information than the image alone. Uncaptioned, a photograph can seem a mote floating in space, unmoored, unattached. Or a cryptic hieroglyph. Hieroglyphs hide the codes, the secret knowledge they require for decipherment. For all their apparent transparency and ease of identification, photographs often seem hieroglyphic, obscure, ambiguous, elusive, the more so the more transparently window-like they seem. The bafflement photographs inevitably arouse in close, attentive viewers at some stage of their viewing is a good thing. The era of digital post-photography brings a healthy infusion of skepticism to our reading and experience of photographs old-style or new, analogue or digital.

The old regime photograph (analogue) had seemed a certifier of authenticity, an assurance that here at least was a sign that matched a referent. Hence on the centenary of photography in 1939, Paul Valery could put down in words a sentiment that may sound oddly naive in our ears: “The mere notion of photography, when we introduce it into our meditation on the genesis of historical knowledge and its true value, suggests this simple question: Could such and such a fact, as it is narrated, have been photographed?” (1980:195). The Civil War photographs associated with the name of Mathew Brady offer a case hi point: they perpetuate a collective cultural image of what that war must have looked like to those who saw it. Civil War photographs continue to historicize the war, to confirm that certain events took place then and there: this is how places and persons would have looked had you been there, pristine landscapes, ruined cities, battlefields wreckage, the shapeless debris of war, signs of violence, pain, and terrible deaths. “These time-stained photographs,” wrote historian Francis Trevalyan Miller in 1911 in the monumental and monumentalizing 10-volume Photographic History of the Civil War are the only incontrovertible facts to survive the partisan passions of the war (Miller, 1911:16). The pictures “bring past history,” wrote another historian, “into the present tense” (George Haven Putnam in Miller, 1911:60).

This positivist view claims that memory is whatever survives from the past as present experience, not something shaped by will or desire but only what is left over from the great passage of time. This view of memory pretends to pure objectivity, and like classic nineteenth-century historicism (“how it really was”) denies its own ideological complicity in saying what are and were “the facts.” Constructions such as the grand “photographic history” and its more famous companion, the film by D. W. Griffith, The Birth of a Nation (1915), foreclose and forbid ambiguity of interpretation. Once certainties quaver, the whole edifice of “Civil War” as cultural memory risks coming apart. Hence the fervency of the 1912 presentation of the largest selection of Civil War photographs ever published, a fervent race-based nationalism that attaches each image to an urgent idea of the war and the nation. The pictures either support the following assumption or the nation as an idea falls in shambles.

This is the American epic that is told hi these time-stained photographs-an epic which in romance and chivalry is more inspiring than that of the olden knighthood; brother against brother, father against son, men speaking the same language, living under the same flag, offering then- lives for that which they believe to be right. No Grecian phalanx or Roman legion ever knew truer manhood than in those days on the American continent when Anglo-Saxon met AngloSaxon in the decision of a constitutional principle that beset their beloved nation. It was more than Napoleonic, for its warriors battled for principle rather than conquest, for right rather than power. (Miller, 1911:16).

The pictures in the 10-volume history produce what the text names as “the American War of the Roses,” a war of brothers based on a disagreement over a principle-the allusion is to “state’s rights,” the Confederacy’s preferred rationale for its secession. “We must all be of one and the same mind,” we read, “when we look upon the photographic evidence. It is in these photographs that all Americans can meet on the common ground of their beloved traditions. Here we are all united at the shrine where our fathers fought-Northerners or Southerners.””As Americans” looking at these pictures “we can see only the heroicself-sacrifice of these men who battled.” Slavery excised blacks, extirpated and driven from sight, “we” confirm ourselves “as Americans” by seeing “only” what the text sees and says we see, by seeing, as it were, Anglo-Saxonly. (Miller, 1911:18).

The 1912 appropriation of the photographic record of the war gives an extreme instance of ideology trumping vision. The same ideology of race, of “Anglo-Saxon” superiority, dominance, and privilege that by the end of the nineteenth century had purged slavery and blacks from public memory and memorializing events of the war also asserted exclusive rights of interpretation over the photographs. The power of photographs as cultural memory, the memory of events or persons we could not have experienced firsthand except through photographs, derives from ingrained belief that every photograph portrays at least the raw material of memory, shows what memory is. This assumes that, whatever else it shows by way of composition and design, each photograph cannot help but show a residue of something that once existed before a lens. By reflex alone photographs produce memory. But the Civil War photographs teach that without accompanying words, without captions or surrounding text, photographs remain helpless examples of indiscriminate visual experience open to many understandings. They become cultural memory only by deliberate acts of will and purpose. Those moved to contest the larger frame of memory imposed on the photographs, as in the 1912 volumes as well as albums by Alexander Gardner, George P, Barnard, and others that appeared shortly after the war, can begin by freeing images from their putative frame in order to open the eyes to neglected, repressed, or forgotten memories. To imagine alternative captions offers a path toward revised and refreshed collective memories. As much an interpretation of the present as the past, and an anticipation of a future, the framing of visual memory can have major consequences on how people identify shared historical culture. It is not cultural memory of the Civil War as such that is at stake but the role that photographs play in any version of the past we call memory.

Gardner makes explicit this theory of the photograph in his preface to the Photographic Sketchbook of the Civil War, where he speaks of wishing to preserve images of “localities that would scarcely have been known, and probably never remembered” if it were not for “the fearful struggle” of the war, signs of which may or may not be visible in the local scene. Gardner’s task as editor of the volume is to provide a textual means to connect the local with the national, the particularity of the scene with the grand narrative of the constructed cultural memory. Local images become “mementoes of the fearsome struggle,” and “remembered” becomes another form of re- connection or “union” (“reunification”), of “re-membering” broken or dis-membered localities (such as the rebellious states) to resume wholeness or to make one body with the newly confirmed nation. Anticipating 1912, Gardner writes about haunting battlefield scenes such as the famous “Harvest of Death,” that they are “held sacred as memorable fields, where thousands of brave men yielded up their lives a willing sacrifice for the cause they had espoused.” Remembrance of “sacrifice” re-members the dismembered, reunites the dead with the living, a type or model of the nation restored to itself as “union.” As if preparing the way for Trevalyan in a later generation, Gardner directs the reading of the photographs as visual equivalents of victory, of “union,” not simply in the sense of making a record of victory but by demonstrating in the act of interpretation how victory comes about and especially how victory counts on the imaginative labor of viewers who thereby come to themselves “as American.” The reading of the photographs as collective memory becomes a prime nationalizing experience.

We can see more exactly how this is imagined to occur by the design of the title page of the Photographic Sketchbook. Images are sketchily dispersed on the page. With its allusion to hand-drawn impressions made with pen or pencil, sketchbook implies images made on the spot by an eyewitness, someone who was there. Pen and pencil are a far cry from the cumbersome equipment and time-consuming labor of the wet-plate photographer, but subsumes the photographer under the heading of the hand-based arts of visual storytelling or reportage. The organization of the title page divides memory of past scenes-army camp life and battle on the right and left-from the scene of present retelling at the bottom center of the page. The panoramic vista of the entire page promises bird’s eye or “eye of God” unity, a view to which the reader is invited as eyewitness from above, with draped flag framing the vista and affirming its national outlook. Setting sun affirms that war and nation remain embraced by “nature” and its cycles-a healing of pain by sacred memory. Military hierarchy belongs as well to the structure of the national view, officer on right and mounted figure on left obviously, “naturally” social superiors to foot soldiers and diggers of trenches. In the two figures lounging in the foreground, we see a different remembered social order, of male comrades swapping tales around a wilderness campfire, the long rifle at the ready. The design and vignettes of the title page thus prepare a role for the photographs within what is already (and so acknowledged) a nostalgia, a cultural memory of white frontier manliness and class-based military noblesse oblige.

The unstated predicament that the title page confronts and solves is how to make perception into memory, how to pile trace upon trace in a certain order so that cultural memory-shared (hence public) conception of the way things were that must have brought about the way things are-arrives as a visible tangible of social experience. In other words: how to monumentalize. Gardner gets to the heart of the matter when he writes about a rather quotidian picture of “a mud- bespattered forge,” some mules, and knapsacks and blankets “carelessly thrown on the ground” that if we had been at this same spot earlier, before the picture was made, we would have seen “one of the most magnificent spectacles ever seen in the army,” something “truly grand”: the mass encampment of troops. Now that all that has “passed away,” this decidedly unheroic picture becomes “particularly interesting.””Interesting as it is,” writes Gardner, “our picture… gives but a small portion of the gorgeous whole.”

Mud-spattered forge (symbol of the mechanical fire and brimstone of this war) and mules bring the picture to life as a comic variant of the absent “gorgeous whole.” The disjunction between the gorgeous and the mundane echoes Melville’s sardonic insight in “A Utilitarian View of the Monitor’s Fight”-that “Orient pomp” no longer befits a war fought by machines, “by crank,/ Pivot, and screw,/ And calculations of caloric.””The clangor of that blacksmiths’ fray” proclaims that “warriors/ Are now but operatives.” The covert text within the Gardner picture suggests less a missing “whole” than a wholly new picture, not pomp and ceremony but mud, forges, and mules.

Image and text seem more seamless, more transparent to each other in the most famous picture, Timothy O’Sullivan’s “A Harvest of Death, Gettysburg, July, 1863” (plate 36). The allegorical title disguises the political making of sacral memory as natural process (“harvest”), though ironically so; by dislocating the bloated corpses from their history as objects of political violence and subsuming them under natural process or “harvest,” irony powerfully jerks the image from the realm of repertorial disclosure of ugly fact into the “gorgeous whole” of cultural memory. “Such a picture conveys a useful moral: it shows the blank horror and reality of war, in opposition to its pageantry. Here are the dreadful details! Let them aid in preventing such another calamity falling upon the nation.”

The text reads the blankness of the image, writes as if upon the yet unseen scene. Fixed in their final agony, the corpses are self- memorializing. Here Gardner articulates the central motive of the photographic project of the war and acknowledges its ideological moment: to transform what is seen and recorded (the camera’s mode of “remembering”) into sacral monument. Appropriately, Gardner’s album concludes not with an image of Appomattox but of the “Dedication of Monument on Bull Run Battle-field, June, 1865” (plate 100). The monument, a stone carving of a classical motif, serves as another ironically dislocated paradigm of the stiffened human remains of the battlefield, analogue of the memorializing function of the photographs. The picture shows the stone shaft in the rear and those performing the dedication immortalizing themselves in the stillness of having their picture taken.

Writing about an exhibition in New York of battlefield photographs showing piled up corpses similar to “A Harvest of Death,” Oliver Wendell Holmes write in Atlantic Monthly in July 1863:

Let him who wishes to know what war is look at this series of illustrations. These wrecks of manhood thrown together in careless heaps or ranged in ghastly rows for burial were alive but yesterday…. It is so nearly like visiting the battlefield to look over these views, that all the emotions excited by the actual sight of the stained and sordid scene, strewed with rags and wrecks, came back to us, and we buried them in the recesses of our cabinet as we would have buried the mutilated remains of the dead they too vividly represented.

Holmes had just returned from a visit to the Antietam battlefield in search of his son, and the exhibit of photographs revived his revulsion and fear. The pictures stirred memories too fresh to bear, images that must be buried, as when one hides a photograph in a drawer. The passage illustrates vividly the role of the photograph in the process of distancing and transmuting pain into memory

How to deal with the corpse, the most gruesome and reproaching of the nongorgeous objects of war-the human body frozen in its shock of violent death-was one of the two great challenges to the war photographers. The other was the sight of black people, the visible sign that slavery was what the war was insistently about, slavery the cause of secession, and ultimately the cause of battlefields and corpses unbearable to see. How Gardner deals with blacks in the few pictures that allows them to be seen at all is instructive. One solution is minstrel comedy. Plate 27, “What Do I Want, John Henry? Warrenton, Va., November, 1862,” stages a scene of stereotypical servility. A black youth stands beside a seated officer, poised to serve him a demijohn of whiskey and a plate of food. As if oblivious of his presence three other figures, also white officers, appear in poses that make hem seem to believe they are sitting in a photographer’s studio, their eyes gliding off at an angle oblique to the camera. The standing figure may be looking at the transaction between the black servant and his officer, though we cannot tell. The picture makes little effort to hide its stilted triteness, a performance designed to show that even good Union officers know the difference between the white and the black “race” and thus to give comfort to the “whiteness” upon which the nation would seal its reunion under the farce of “reconstruction.” Master and servant might just as well be master and slave. The text speaks of the servant, “John Henry,” as “that affectionate creature” with an “untutored nature.” The caption fills out the portrait of “an unusual capacity for the care of boots and other attentions,” a propensity for his master’s “spirits” and for “the other sex,” and a distaste for “manual labor.” This stereotype would survive the war and provide a new rallying cry for “union” of North and South, as in the 1912 Photographic History. It appears scattered among the Civil War photographs at large. So do clusters of black refugees on the edge of Union army camps, “contraband” (as former slaves freed by Union forces were known) gathered at depots, and many albums of portraits of black Union soldiers. On the whole, just as Northern rhetoric stressed the cause of “Union,” called the enemy “rebels” rather than slaveholders, and made the defeat of secession rather than of slavery the most loudest rallying cry, the photographic record tends to banish blacks to the margin of visibility, their presence unacknowledged even when plainly there.

A memorable case in point is Plate 94, “A Burial Party, Cold Harbor, Va., April, 1865.”

This sad scene represents the soldiers in the act of collecting the remains of their comrades, killed at the battles of Games’ Mill and Cold Harbor. It speaks ill of the residents of that part of Virginia, that they allowed even the remains of those they considered enemies, to decay unnoticed where they fell. The soldiers, to whom commonly falls the task of burying the dead, may possibly have been called away before the task was completed. At such times the native dwellers of the neighborhood would usually come forward and provide sepulture for such as had been left uncovered.

Black “soldiers”-or are they “the native dwellers”?-clean up after those to whom “the task of burying the dead” have “possibly” been called away. This image is Gardner’s only acknowledgement that the Union forces included former slaves, and it presents them in the most menial of roles.

The image resonates beyond text and frame, its grim ironies and bizarre revelations suddenly flashing before us the “remains” Holmes wished to bury from view: decomposing flesh and bleached bones attended by those very humans whose claim to humanity gave cause to the horrors of war. In a gesture so simple it eludes the author of the text, the two grand invisibilities of the war appear together as one image: death as decomposition and dissolution; blacks laboring in once pastoral fields, reaping an even grimmer harvest than that imagined by “Harvest of Death.” The grim image and its equivocal text shows with even grimmer irony how the victors cleansed the war of troubling debris and in the fading replications of the photograph found evidence of a gorgeous whole, the desired sacredness of a bleached cultural memory.

REFERENCES

Barthes, Roland. Camera Lucida: Reflections on Photography. Trans. Richard Howard. New York: Hill and Wang, 1981.

Baudelaire, Charles. “The Modem Public and Photography” (1859). In Trachtenberg (1980:83-89).

Benjamin, Walter. “A Short History of Photography” (1931). In Trachtenberg (1980:199-216).

Dick, Philip K. Do Androids Dream of Electric Sheep? New York: Doubleday and Co., 1968.

Eastlake, Lady Elizabeth. “Photography” (1857). In Trachtenberg (1980: 39-68).

Gardner, Alexander. Photographic Sketch Book of the Civil War. New York: Dover Publications, 1959 (1866).

Heron, Liz, and Val Williams, eds. Illuminations: Women Writing on Photography from the 1850s to the Present. London: I. B. Tauris, 1996.

Holmes, Oliver Wendell. “Doings of the Sunbeam.” Atlantic Monthly (July 1863).

Kracauer, Siegfried. History: The Last Things before the Last. New York: Oxford University Press, 1969.

Miller, Francis Trevalyan. Photographic History of the Civil War. Vol. 1. New York: Review of Reviews Company, 1911.

Mitchell, William J. The Reconfigured Eye: Visual Truth in the Post-Photographic Era. Cambridge: MIT Press, 1992.

Talbot, William Henry Fox. The Pencil of Nature. London: Longman, Brown, Green, and Longmans, 1844.

Trachtenberg, Alan, ed. Classic Essays on Photography. New Haven, Conn.: Leetes Island Books, 1980.

Valery, Paul. “The Centenary of Photography” (1939). In Trachtenberg (1980: 191-198).

ALAN TRACHTENBERG is Neil Grey, Jr. Emeritus Professor of English and Professor Emeritus of American Studies, Yale University. His books include Reading American Photographs: Images as History (1989; winner of the Charles C. Eldredge Prize), Shades of Hiawatha: Staging Indians, Making Americans, 1890-1930 (2004; winner of the Francis Parkman Prize), and Lincoln’s Smile and Other Enigmas (2007).

Copyright New School for Social Research, Graduate Faculty Spring 2008

(c) 2008 Social Research. Provided by ProQuest LLC. All rights Reserved.

By Pam Starr

Finola Hughes has suffered from allergies for much of her life.

As a child growing up in damp London, Hughes had severe allergies, but grew out of them by the age of 10. When she moved to New York as an adult, Hughes developed a cough that was caused by dust mites.

But the Emmy Award-winning actress, best known for her recurring role as Anna Devane on “General Hospital,” now lives practically allergy-free in Southern California. The mother of three even has an indoor Labrador retriever — and doesn’t sniffle.

“I don’t get allergy shots or use medication,” Hughes says. “Relief came when we encased our mattresses and pillows. Aller-Ease approached me to be their spokesperson, and it was a perfect fit. I’ve been using their products for years but didn’t know it.”

Aller-Ease is a brand of bedding that is made by Pittsburgh’s American Textile Company. Hughes, host of Style TV’s “How Do I Look” show, says Aller-Ease is not your typical crinkly, uncomfortable pillow protector.

“They have great new cotton products,” she says. “The fabric has to be woven so tightly so nothing can get in.”

Fall allergies are nothing to sneeze about if you’re one of an estimated 62 million Americans who have them. Right now, in the Pittsburgh area, the ragweed and sagebrush is in full swing, according to Pollen.com. That spells misery for hay fever sufferers, says Monroeville allergist Barry Asman .

“When someone has an allergy, it means that their body has created an antibody against a certain protein in the environment,” says Asman, of the Allergy & Asthma Care Center. “The first step is to find out what you’re allergic to and learn how to avoid it. The second step is medication. The third step, if the first two steps have failed, is allergy shots.”

When dealing with pollens, ragweed runs from about Aug. 15 to the first frost. Pollen counts are highest in the early morning and late afternoon.

“It’s best to keep your windows closed,” he says. “Don’t hang laundry outside, or your sheets will be full of pollen.”

Some people think they’re allergic to grasses when, in fact, it’s the mold in the dirt that is kicked up by the lawnmowers.

“Mold is going to become an issue because of leaves falling on damp ground, so again, keep your windows closed,” Asman advises. “Some people use humidifiers because they think their rooms are too dry. If you let the water sit in the humidifier, or if you over- humidify your room, mold will grow.”

Once a person knows what he or she is allergic to, they should stay away from the allergen. But Asman knows that it’s a lot easier said than done.

“If you’re allergic to cats or dogs, fall may be worse for you because you bring the animals inside,” he says. “The easy thing to do is to get rid of the dog or cat.

“But in all my years as an allergist, no one has ever done that,” he admits with a laugh. “So, we make compromises. Keep the pet out of the bedroom — that’s ideal. Some say no, the cat stays on the bed. So run a HEPA filter in your bedroom to filter out the animal dander.”

Hughes has a lot of company when it comes to her dust mite allergy. Asman says 20 percent to 30 percent of people are allergic to those pesky critters. They live with you in upholstered and carpeted areas.

“Do the easy things first — use protective pillow cases and mattress covers,” he says. “You can’t eliminate dust mites, but you can decrease them.”

Hughes also suggests washing your bedding in hot water weekly; and removing dust magnets such as toys, books and papers from the bedroom.

“I’ve just learned that you should clean your children’s soft toys or throw them in the freezer for a few hours,” she says. “But I’m not super, super chemically clean. I want my children to build their own immune system. If children are over-sanitized, it’s not healthy.”

If encasing your pillows and mattresses does not bring relief, you might need medication, Asman says. But the wrong medication can cause more problems than the relief is worth.

“For a long time, we used antihistamines such as Benadryl to treat allergies,” he explains. “But reflexes are inhibited by Benadryl, and it’s like you are legally drunk while taking it. That’s not a good option. I’ve seen remarkable improvements with (prescription) nose sprays.”

The last resort, allergy shots, help to make the body less allergic and help about 80 percent of allergy sufferers, Asman says.

Controlling allergens

Actress Finola Hughes offers these tips for helping keep allergens under control in your home:

Encase your pillows and mattresses in allergen-barrier protection, such as Aller-Ease allergen filtration products.

Substitute blinds or shades, which can be cleaned regularly, in place of draperies or curtains.

Change filters monthly for heating and air conditioning.

Turn up the air conditioning on warm days, because the units dehumidify the home and filter the air.

Bathe pets weekly to minimize the spread of dander.

Sanitize the bathroom and kitchen to remove contaminants from buildup.

Replace or wash the shower curtain often.

Do not use aerosol sprays in the bedroom.

Wash sheets weekly in hot water.

Use a dehumidifier to reduce humidity to under 50 percent.

For more information on Aller-Ease, go

online.

(c) 2008 Tribune-Review/Pittsburgh Tribune-Review. Provided by ProQuest LLC. All rights Reserved.

D r BETH de Sousa is sitting at the wooden kitchen table at her home next to a farm in the East Devon countryside. She is smiley and slim, wearing a bright pink top and baubly necklace, her hair long and glossy, the picture of health.

The GP, who works part-time at Honiton Surgery, practises what she preaches to her patients. She hardly drinks alcohol, exercises regularly, eats healthily and says she has never felt better.

Dr Beth, 41, really believes anyone can dredge up the motivation to quit smoking, give up alcohol and take up exercise. Now she has written a guide – The Health Compass – advising others how to turn good intentions into action.

“I really do believe making healthy lifestyle changes can make a dramatic difference to all sorts of medical conditions,” she says. “It protects you against diabetes, strokes, high blood pressure, arthritis, back pain and depression.”

Her guide makes the point that lifestyle changes are interlinked; if you do more exercise you will feel less like eating rubbish and drinking too much alcohol. Likewise if you eat healthily and exercise you will find it easier to lose weight than doing just one or the other.

While Beth is hard-pressed to come up with examples of when she has been tempted off her healthy living path, she does have a go, wisely deducing that this is more motivational for readers than appearing too perfect.

She confides that she was once “a glass of wine a day girl”.

“Every night after I’d put the children to bed I’d go to the fridge and I would pour myself a glass of wine,” she says. “That was my regular habit. Then I decided one year that I would see if I could have alcohol-free days, and I was really shocked. I lasted three weeks and was climbing the walls.

“It was a real surprise and education to me to see that such a small amount of alcohol could have such a psychological pull.”

That said, she did then manage to give up wine completely for three months later that year.

“When I came back to it I didn’t like the taste of it and I got a headache,” she says. “I don’t drink wine at all now, I have an occasional beer.”

Practically giving up alcohol has, she says, given her much more energy.

“I used to be exhausted by 9.30pm but now I still feel awake at 11pm,” she says.

But what does she do if she has a really, really bad day? Is she ever tempted to reach for a bottle, or a large bar of chocolate?

“I have a hot bath or take my dog for a walk,” she says, laughing. “It is about using other things.”

Obesity is something that is becoming more of a problem across all age groups and Beth, like other GPs, says she sees her fair share of overweight children in her surgery.

The answer, she admits, is not straightforward and parents, schools and doctors all need to play a part.

She also thinks that curbs are needed on advertising chocolate bars and the placing of snack machines in gyms.

She acknowledges that there is a psychological element to weight problems, which can be hard to extricate yourself from. She describes her own struggles as a teenager with her “yo-yo weight” – but it’s hard to believe looking at her slim figure.

“My mum was really into healthy eating but I had a fantastically sweet tooth as a teenager and used to crave chocolate and swing between putting on lots of weight and going on really strict diets,” she says.

“I went on like that for years and years until I met my husband. He’s from Kenya and the Kenyan women are very curvaceous, and he said ‘this is ridiculous, all these diets. I like a woman with curves’.

“For the first time I ate a diet I was happy with, I actually lost weight and I wasn’t thinking all the time about food. It was about eating regular, sensible meals and I wasn’t snacking.”

She can’t stress the importance of exercise in keeping the spirits up and the body healthy.

Beth runs with her children, 11-year-old daughter Ashe and son Fynn, nine, at the Sidmouth Running Club on Saturday mornings. She confesses to having to push herself to do it, but knows it is worth it for the endorphin high that comes afterwards. Her advice to even the most unfit person is to stick with it, even if you puff and pant at first.

“Sometimes you have to work at liking something because if you are very unfit when you first start it takes a while to build up that endorphin high,” she says.

It was like that for her when she took up cycling again, a sport she once loved. At first she struggled but now she can’t stop.

“It took me a couple of months to build up what I was doing to start to enjoy it,” she says. “I think sometimes you have to take that leap of faith that once you get to a certain level you will start to benefit.”

Succeeding in making changes to your lifestyle, she says, comes down to taking things slowly and gradually, in manageable steps. She cites her husband Nigel, also a GP, as someone who has found a way to put big plans into practice by adopting the one step at a time approach.

It was he who suggested she hide the chocolates in advance of my visit; she points to several boxes stacked on top of a cupboard.

“I said ‘no’,” she says. “That isn’t the message I’m giving at all!”

So, a little of what you fancy does do you good. Sound advice, I think we’d all agree.

The Health Compass will be launched at Waterstone’s at Roman Gate in Exeter on Friday at 6.30pm. Dr Beth de Sousa will be joined by Olympic medallist Mary King. Tickets cost pounds3, which is deductable from the pounds17.99 cost of the book (also available from www.healthcompass.co.uk). Dr Beth will also be sharing advice on healthy living in a new monthly column in the Western Morning News. Read her first article in on Tuesday.

(c) 2008 Western Morning News, The Plymouth (UK). Provided by ProQuest LLC. All rights Reserved.

Fourteen over-50s got up, got out and got active as they took the initiative to dive into Swim Torquay to take part in a fitness first on Wednesday at midday.

Swim Torquay fundraiser Peter Tysoe said: “We had 14 over-50s, mostly new users, most had never been to pool before.”

They had come to take part in the launch of the very first Fit as a Fish initiative in the country.

Peter said: “They had a great time doing water dancing and exercises to music, under the lively instructions of Paul Harrison.

“Representatives from Age Concern, Help the Aged and Brixham Pool were also in attendance to see this launch.

“It was a nice lift for Swim Torquay.

“It was a great success and good to see users and staff enjoying themselves.

“Pool manager, Derek Wyatt, is to be congratulated for the organisation of the scheme.”

Fit as a Fish is part of the National Lottery-funded Fit as a Fiddle initiative encouraging over-50s to ‘get up, get out, get active’ with the emphasis on exercise, healthy living and social inclusion.

Throughout the country coordinators have been busy rolling out various exercise programmes such as yoga, walking and fitness for over-70s.

Here the twice-weekly Fit as a Fish initiative for over-50s at Plainmoor is a partnership with Swim Torquay, Torbay Council, Age Concern Devon and Age Concern Torbay, and has attracted funding from the Devon Community Foundation and Sport Relief.

The project at Swim Torquay is set to continue to deliver a programme of activities with Fit as a Fish sessions, including access to stroke technique, on Wednesdays from noon to 1pm, and lane swimming and stroke technique on Fridays from 3.30pm to 4.30pm.

Sessions are pounds1.50 to include refreshments in the social room afterwards. The only requirement is that you are more than 50 years old.

For further information contact the pool on 01803 323400 or visit the website www.swimtorquay.com

(c) 2008 Herald Express (Torquay UK). Provided by ProQuest LLC. All rights Reserved.

By MARY JO LAYTON and LINDY WASHBURN, STAFF WRITERS

Bergen County doesn’t need another hospital and adding one will seriously harm existing hospitals in the area, according to a report commissioned by The Valley Hospital and Englewood Hospital and Medical Center.

The two hospitals stand to lose patients, doctors and income if Pascack Valley Hospital is reopened. They are fighting Hackensack University Medical Center’s plan to have a 128-bed hospital at the Westwood site.

“It will do us harm,” said Douglas Duchak, Englewood’s president and chief executive officer.

Reopening Pascack “will weaken the other hospitals,” said Audrey Meyers, president and chief executive officer of Valley. “It makes no sense.”

It’s the first time competing hospitals have teamed up to block the expansion of Hackensack, which has grown to dominate the local market. Next month, Duchak and his team will make their case before state Health Commissioner Heather Howard. Valley officials will attend a separate meeting. In the meantime, the hospitals are taking their opposition public with a Web site launched Thursday that invites people to sign an online petition against the reopening.

“We’re going to be aggressive,” said Robin Goldfisher, vice president of legal affairs at Valley.

The report commissioned by the two hospitals found that other hospitals sufficiently absorbed the patients when Pascack Valley went bankrupt and closed in November. The closure “strengthened the existing hospitals without harming access [to care] in any significant way,” said David Bender, vice president of The Lewin Group, the Washington, D.C.-based firm that conducted the study. “This region has been given a bit of a gift.”

It is the second report this year to conclude that North Jersey has too many hospital beds. In January, Governor Corzine’s own blue- ribbon commission said Bergen and Passaic counties could lose one or two hospitals without affecting patient care. Excess capacity drives up health care costs for everyone and helps make the state’s health insurance premiums among the highest in the nation, the report said.

Hackensack bought the Westwood hospital in partnership with Touro University for $45 million at a bankruptcy auction in February. A private equity firm, the Texas-based Legacy Hospital Partners, has committed to invest $80 million in the renovation, and would run the facility. Hackensack would remain a minority owner.

On Wednesday, Hackensack will reopen the emergency room in Westwood, a plan local hospitals haven’t objected to.

But the “certificate of need” application Hackensack filed with the state Health Department to open “Hackensack University Medical Center North at Pascack Valley,” now looms as a major battle in politics, policy and public opinion. Residents in the area are clamoring for the reopening – 7,000 have signed an online petition so far.

Englewood and Valley executives cite the former health commissioner’s own words in opposing Pascack’s reopening: “I believe that the existing area hospitals have sufficient bed capacity to meet the continuing needs of the population,” then-Health Commissioner Fred M. Jacobs wrote last year when Pascack closed.

Two lawmakers, including a member of the state Senate Health Committee, have joined Englewood and Valley in opposing Pascack’s reopening.

“Granting this approval … would represent irrational health policy,” state Sen. Loretta Weinberg, D-Teaneck, and Assemblyman Gordon M. Johnson, D-Englewood, wrote in a letter to Howard.

“These closures have not been easy, but as your administration has rightly argued, the reduction of excess hospital bed capacity is a necessary part of health care reform.”

Hackensack’s executives dismissed opposition to their proposal, while noting that it was “unprecedented” to commission a private report. “Of course the report will come out the way they want it,” Hackensack President John Ferguson said Thursday.

Jacobs did not terminate the hospital’s license, but allowed 24 months for its reactivation, noted Robin Ratliff, Hackensack’s vice president for planning. “If the state had wanted the hospital to close, they would not have held the license open for two years,” Ratliff said.

Ratliff said more hospital beds are needed in the region. The state report — the New Jersey Commission on Rationalizing Health Care Resources — used data on hospital capacity that do not reflect recent closings in Bergen and Passaic counties that took nearly 700 beds out of circulation, Ratliff said.

Hackensack’s plan has been embraced by community leaders in the Pascack Valley and Northern Valley towns, and endorsed by that district’s legislators, including state Sen. Gerald Cardinale, R- Cresskill.

“I find it very unfortunate that Englewood and Valley who are in the business of providing health care services have made this into a business situation,” said Westwood Mayor John Birkner. “This is more than business. This is a matter of providing quality accessible health care for area residents.”

Cardinale said that state officials will likely view the proposal favorably since it involves no state financing. He said that Howard assured him the state “would do everything possible to expedite the granting of the CN [certificate of need].”

A spokeswoman for the commissioner said the department does not comment on pending applications.

But Englewood and Valley officials argue that approving Hackensack’s plan will mean future problems for those served by the area’s other hospitals.

Englewood lost $15 million in the three years before Pascack Valley closed, but went from a negative operating margin of 2.8 percent in 2006 to a positive margin of 2.2 percent in the first six months of this year. It added employees and opened new beds. But of its 540 licensed beds, half still go empty.

“I don’t think it puts us out of business” if Pascack Valley reopens, said Tony Orlando, Englewood’s chief financial officer. “But it makes us inefficient. It’s very hard to cut those costs.”

Valley is experiencing the biggest bump in patients from the Pascack Valley service area — nearly 3,000 more patients a year. Valley stands to lose $8.3 million to $18.5 million annually if an acute-care center reopens in Westwood, the Lewin report concluded.

Hackensack has projected turning a profit within three years in Westwood, which means that it will not only recover patients it once served, it will take away patients that would have gone elsewhere, Orlando said.

The fact that this would be a for-profit facility is causing even more angst, especially when local hospitals are seeing dramatic increases in charity care and less funding from the state.

“They put profit before patients,” Duchak said.

(c) 2008 Record, The; Bergen County, N.J.. Provided by ProQuest LLC. All rights Reserved.

GIRL SCOUT FUN DAY

Botetourt Service Unit Girl Scouts sponsored its third Annual Girl Scout Fun Day Saturday, Sept. 13 at Cloverdale Church of the Brethren. Girls ages kindergarten to seniors in high school were invited to learn more about Girl Scouting and to join or form a troop. The activities included games, crafts, s’mores, popcorn, edible fires, camp scene, face painting, a community project, Girl Scout Hall of Fame, Girl Scout vintage uniform display, age level displays, flag ceremony and videos starring local Girl Scouts.

For more photos, see The Notebook on botetourtview.com.

Submitted by Jane Garnett

Historic Fincastle hosts book signing

Historic Fincastle is hosting a book signing for the re- publication of the beautiful Fincastle book “Around Town” on Sunday, Sept. 28.

Time: 2:30 PM Ceremony honoring 1st & 2nd printings and authors, 3:00 p.m. Book Signing

Location: Fincastle Presbyterian Church

Details: Book signing and celebration in honor of the 2nd printing of “Around Town: A Pictorial Review of Old Fincastle Virginia.”

This is a lovely hard bound book that was developed and published in 1990 through the work of eight HFI Volunteers. All the original volunteers and authors will be present to sign the new books and also the 1st edition, if you have one.

Additionally, the 2nd editions will have an original jacket cover from the first printing. Books cost-$32.00.

Visit www.hisfin.org or call 473-3077 for additional information.

Submitted by Historic Fincastle

Car seat safety check set for Sept. 27

Cadette Girl Scout Troop 59 and Botetourt County Sheriff’s Department are sponsoring a car seat safety check Sept. 27 from 9 to 11 a.m. at Troutville Church of the Brethren, 5133 Lee Highway, Troutville . Various surveys have shown that 90% of car seats are not installed properly, putting you and your child at risk. Ensure safety by having your car seat checked by Botetourt County Sheriff’s Department. For more information please contact Sharon Coleman at (540)-473-8351. Babysitting will be provided.

Submitted by Jane Garnett

James River Class of ’74 plans reunion

Members of the James River High School Class of 1974 interested in planning a class reunion may contact Charlie Alphin @ 254 1418 or email: [email protected]

Waller completes Hollins graduate program

Donna M. Waller, daughter of Dorothy and John Martin of Buchanan, has completed all degree requirements for the Certificate of Advanced Studies Program (CAS) at Hollins University. The sixth- year academic degree consists of an additional 40 credit hours beyond a masters.

Waller graduates with honors with an overall GPA of 3.5. She earned her MBA from Averett University in 2000 and she also holds a Bachelor of Science in Resources Management from Troy State University; a Journeyman in Logistics Management from the Community College of the Air Force and a Certificate in Inventory Management from the USAF Technical Training Center at Lowry Air Force Base.

Waller is a graduate of James River High School and is currently employed by Virginia Forge Company.

GIRL SCOUTS THANK CHURCH FOR HELP

Pastor Glenn McCrickard and Assistant Pastor Karen B. Cassell of Cloverdale Church of Brethren were presented with a Girl Scout Appreciation Plaque for the church’s contribution for supporting Botetourt Girl Scouts. The church has supported Girl Scouting for over 25 years. The ceremony took place during the 3rd Annual Girl Scout Fun Day. The event is Botetourt Service Unit’s recruitment for girls ages kindergarten through Senior high school. This year there were approximately 100 participants, including 25 non-Girl Scouts.

HATCHER COMPLETES NAVY BASIC TRAINING

Navy Reserve Seaman Recruit Derek M. Hatcher, son of Laura J. and James M. Hatcher of Fincastle, recently completed U.S. Navy basic training at Recruit Training Command, Great Lakes, Ill.

During the eight-week program, Hatcher completed a variety of training which included classroom study and practical instruction on naval customs, first aid, firefighting, water safety and survival, and shipboard and aircraft safety. An emphasis was also placed on physical fitness.

The capstone event of boot camp is “Battle Stations.” This exercise gives recruits the skills and confidence they need to succeed in the fleet. “Battle Stations” is designed to galvanize the basic warrior attributes of sacrifice, dedication, teamwork and endurance in each recruit through the practical application of basic Navy skills and the core values of Honor, Courage and Commitment. Its distinctly “Navy” flavor was designed to take into account what it means to be a sailor.

Hatcher is a 2007 graduate of Lord Botetourt High School.

Scouts help with park

Troop 333 located in Fincastle, a combo of Cubs, Bears, Wolves and Webelos are helping the Town of Fincastle with Big Spring Park. Pictured here are Brycen Ford, Mitchell Boone, Ben Rakes, Dalton Simmons, Wyatt Smith, Zach Spickard and Austin Boone. They have spruced up the place by scraping and priming the footbridge. A wedding party painted the bridge before they finished! The boys have begun to wash the mold from the white fences surrounding the park. They have also painted some of the fire hydrants in the town a bright red. The troop is led by Mary Bess Smith.

(c) 2008 Roanoke Times & World News. Provided by ProQuest LLC. All rights Reserved.

Eagles landing

One of rock’s most successful groups, The Eagles, has announced a Memphis stop for their “Long Road Out of Eden” tour. The group will play FedExForum on Nov. 16 at 8 p.m.

Tickets range from $45 to $150 and go on sale Monday at 10 a.m. They’re available at all Ticketmaster outlets, online at ticketmaster.com or by phone at 525-1515.

Indigo Girl

Singer-songwriter and one half of the Indigo Girls, Amy Ray, makes her way to the Hi-Tone Caf for a solo performance on Oct. 20 at 9 p.m.

Tickets cost $15 and are available at hitonememphis.com or by calling (800) 594-TIXX (8499).

(c) 2008 Commercial Appeal, The. Provided by ProQuest LLC. All rights Reserved.

Five years ago today, Kim and Thomas Champion welcomed their healthy daughter, Jessie, into the world. Within days of birth, Jessie developed severe jaundice, a common, but potentially life-threatening, condition when left untreated. Her doctors failed to test and treat her jaundice, which developed into kernicterus, a preventable, lifelong, debilitating, neurological syndrome. Jessie now suffers from numerous disabilities including quadriplegic cerebral palsy, severe motor skills impairment, and hearing and speech dysfunction.

Today, on her fifth birthday, a lawsuit (Action No. RG-08-412032) was filed in Alameda Superior Court alleging that Alta Bates Summit Medical Center (Alta Bates), Kaiser Permanente Oakland Medical Center (Kaiser Oakland) and others were medically negligent for failing to diagnose and treat Jessie’s severe newborn jaundice. The suit seeks compensation for lifelong medical care and special needs.

“This tragedy was an unnecessary and completely avoidable medical complication that only occurs in cases of medical negligence. Jessie was visibly jaundiced within the first two days of her life, and her doctors noted it on her medical records but failed to conduct a simple, inexpensive blood test that would have identified her elevated bilirubin level and allowed for timely treatment to reverse this toxic process entirely,” said Cynthia McGuinn, Jessie’s attorney and a senior trial lawyer at The Veen Firm. “Now, due to her medical providers’ negligence, this once healthy baby girl is celebrating her fifth birthday brain damaged and severely disabled, relegated to a wheelchair and completely dependent upon others for all aspects of her care.”

“Our community, simply can’t stand for another healthy child to become completely disabled from an easily detectable, treatable and totally reversible condition,” McGuinn added.

The medical negligence suit alleges that Jessie’s doctors missed four opportunities to intervene and prevent her worsening brain damage. Her jaundice was visible within the first 48 hours of her life and was brought to the attention of and noted by Alta Bates, which, at the time, was under contract with Kaiser Oakland to handle births. Medical providers failed to consider the unreliability of visual jaundice assessments in dark-skinned newborns and allowed Jessie to be discharged without a blood test – known as a baseline total serum bilirubin test – or any treatment for jaundice and without explaining the potential complications of untreated jaundice or signs that might indicate problems to her parents.

According to court documents, the day after discharge, Jessie’s jaundice became more severe, and her parents rushed her to Kaiser Oakland where medical treatment was further delayed by medical personnel’s failure to adequately obtain and promptly test Jessie’s blood. Kaiser sent Jessie and her parents home to wait for results that were never determined, and the Champions were forced to return to Kaiser for a second blood test, which demonstrated a life-threatening bilirubin level.

After the second blood test was processed and Jessie’s excessive bilirubin level identified, medical providers instructed the Champions to drive their daughter to Alta Bates hospital during rush hour traffic. The suit alleges that, despite the medical providers’ knowledge of Jessie’s dire situation and rapidly worsening brain damage, no ambulance was provided. The failure to transport Jessie to Alta Bates via ambulance and failure to administer immediate medical attention upon discovering that she had a critical bilirubin level were unacceptable treatment delays that increased the severity of her injuries. Once readmitted, the hospital took more than four and half hours to start the blood work required for treatment of Jessie’s condition, yet another delay that allowed the situation to worsen according to the complaint.

About The Veen Firm

The Veen Firm focuses on recovering damages for the catastrophically injured and has since 1975. The firm specializes in catastrophic injury, construction accident, legal malpractice, medical malpractice, negligence, premises liability, product liability, toxic exposure and wrongful death cases. On the Net: www.veenfirm.com

ST HELENA, Calif., Sept. 26 /PRNewswire/ — When Patty Brown goes to the local high school track for exercise she carries 20 almonds in her left pocket. As she completes each lap, she transfers one almond to her right pocket. “When all 20 almonds are in my right pocket, I know I’ve walked and jogged five miles,” she said. “On my way home I eat the almonds as a healthy snack.”

Patty, a stay-at-home mother of two who lives in Hollister, Calif., is a guest speaker this week at the Harvard Medical School-sponsored Healthy Kitchens conference at the Culinary Institute of America in St. Helena. She will tell a group of doctors, nutrition experts and chefs how loosing over 60 pounds with the help of the Transformations program at the St. Helena Center for Health (http://www.sthelenacenterforhealth.org/) changed her life.

“It’s one thing to hear a doctor talk about a successful program, but another to actually have someone whose life was transformed by the program tell their story,” said Heather Pena, MD, a lead presenter at this weekend’s conference and the Harvard-trained medical director of the St. Helena Center for Health. “We’ve now been able to collect data on over 300 people who have participated in our Transformations program since its inception and, to date, the dramatic, life-changing results such as Patty’s are the rule rather than the exception.”

Transformations(TM): The Napa Valley Weight and Lifestyle Management Program is an 11-day residential experience where participants — led by physicians, nutritionists, exercise physiologists and behavioral therapists — learn how to live a healthy life through good nutrition, exercise and other lifestyle changes. The Center for Health was established in 1968 on the campus of St. Helena Hospital in the Napa Valley and applies a multidisciplinary approach to its programs, which also include smoking-cessation and a one-day personal health “super” evaluation.

Four years after graduating from the program, Patty says “I feel so vibrant and healthy” and is not the person she was: a 40-year-old obese woman who at 5-feet, 8-inches tall tipped the scales at 232 pounds; a person scared to death of suffering the kind of massive heart attack that killed her father at age 41. “I was just 14 when my father died and his death left me fearful of my own heart,” said Patty.

After repeated failures to lose weight on all the popular diets, she discovered the Transformations program during an Internet search. “On day five of the program, I finally said to myself: I get it: you have to change your lifestyle, not just learn to cut calories,” she said. “I realized although I could eat Pop Tarts and be within my Weight Watchers point total, that didn’t help my cholesterol, my energy or my long-term prospects for improving my health and keeping the weight off.”

Today a strong, fit 170 pounds, Patty lives mostly on a plant-based diet with some fish and chicken dinners. Her husband, always healthy and a runner — and a good cook — has enthusiastically embraced the lifestyle changes and helps come up with good-tasting, but healthy meals. She has eliminated all processed foods from her diet, helping lower her cholesterol from 300 to 122. She says when she goes to the supermarket, she now buys food that “speaks to my heart. I ask a lot of my body in terms of exercise so I want to give it the right fuel.”

Patty’s 20-year-old daughter Aly, who struggled with her own weight, attended the Transformations program after seeing the positive affect it had on her mom. Despite all the family enthusiasm for their new lifestyle, her 15-year-old son Robbie still pushes mom for occasional visits to McDonalds. “I just say no,” says Patty. “It’s a lot easier than it used to be. And when he protests, I tell him, go ahead and sue me for loving you.”

For more information, contact the St. Helena Center for Health at 1-800-358-9195 or http://www.sthelenacenterforhealth.org/

St. Helena Center for Health

CONTACT: Jeff Davis of St. Helena Center for Health, +1-707-963-6545

Web site: http://www.sthelenacenterforhealth.org/

PROVIDENCE, R.I., Sept. 26 /PRNewswire/ — Rhode Island Hospital is the first site in the world to treat endometrial cancer using the Axxent Electronic Brachytherapy System. The system, first approved for early stage breast cancer, is now approved by the United States Food & Drug Administration (FDA) for treatment of uterine cancer. The first patient received treatment on September 9 at the Providence, RI hospital.

The Axxent Electronic Brachytherapy System by Xoft uses a miniaturized X-ray source to deliver localized and targeted radiation treatment to reduce the risk of recurrence of the disease. It is inserted into the tumor through a catheter to the tumor site and allows medical staff administering the treatment to be in the room with the patient. The new treatment requires fewer sessions than traditional radiation and eliminates the use of radioactive isotopes, resulting in better outcomes for patients, less exposure to radiation and fewer side effects. The system was designed to improve survival and reduce recurrence of cancer

Rhode Island Hospital, the first in the world to use the Axxent System for the treatment of endometrial cancer, was also among the first in the country to use the system in the treatment of early stage breast cancer, and has seen positive results since it was FDA approved in 2007.

Endometrial cancer is a disease in which malignant cells grow in the lining of a woman’s uterus, affecting about 40,000 women each year. It is the most prevalent gynecologic cancer in the United States, and is also the fourth most common invasive cancer. It is estimated that nearly two-thirds of these cases are eligible for treatment with electronic brachytherapy.

The most common treatment is surgery, however, additional types of treatment are often used following surgery to prevent tumor recurrence or if it is considered to be an aggressive form of cancer. These treatments include traditional radiation, chemotherapy or hormone therapy. When radiation therapy is determined to be the most appropriate course of action, women will undergo radiation treatments that can often last up to five weeks and then use vaginal cylinder implant treatment. In some patients we use vaginal cylinder implant treatment alone.

Yakub Puthawala, MD, a radiation oncologist with Rhode Island Hospital, says, “This treatment is revolutionary in the way we provide care to women with endometrial cancers. Vaginal brachytherapy for endometrial cancer is well accepted and we are excited to be the first cancer center to offer this wonderful new electronic treatment option.” He also notes, “We believe our patients will find it comforting that we can be in the room with them, unlike other forms of radiation treatment. It allows us to provide more compassionate care.”

For more information, call the Rhode Island Hospital Radiation Oncology department at 401-444-8311 or visit the web site at http://www.rhodeislandhospital.org/.

Founded in 1863, Rhode Island Hospital (http://www.rhodeislandhospital.org/) is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital ranks among the country’s leading independent hospitals that receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, neurology, orthopedics and minimally invasive surgery and radiation oncology. The hospital’s pediatrics division, Hasbro Children’s Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.

Rhode Island Hospital

CONTACT: Nancy Cawley, +1-401-444-4039, [email protected], for RhodeIsland Hospital

Web site: http://www.rhodeislandhospital.org/

By SHARPE, Marty

THE hidden health effects of graffiti vandalism are the subject of a $36,000 Government-funded study being carried out by Hawke’s Bay District Health Board.

The board’s senior population health adviser, Ana Apatu, and health protection officer Maree Rohleder began the study in May after an approach from Hastings District Council, which is struggling to cope with the high level of graffiti in the district.

The council’s graffiti vandalism strategy is now out for public consultation.

The women agreed to conduct a health impact assessment of the council’s strategy, and received approval and $36,283 funding from the the Public Health Advisory Committee.

Health impact assessments analyse central and local government policies for their potential effects on health and wellbeing. Previous topics include gaming machines, the legal drinking age, urban design and transport.

Graffiti vandals, their victims, police, iwi, councillors and council staff have been consulted in the preparation of the report, which will be published later this year. “People might ask what graffiti vandalism has got to do with health, but if we think of young people being imprisoned . . . what could the potential health impact be on that individual later on in life, what is the pathway for that young person?” Ms Apatu said.

“Another example is the elderly who have had their fence tagged. That might be quite a threat for them. They might be less likely to go walking, they might feel isolated. It’s amazing what has health consequences.”

She believed the council strategy was good, but there were areas on which she and Ms Rohleder would be making recommendations.

Director of Public Health Mark Jacobs said there were many different influences on health and they were much broader than someone suffering a disease or having a heart attack.

“If graffiti is causing community concern in terms of safety, it could affect the broader health and well- being of that community,” he said.

“It’s not just about the rates of cancer in a community or the number of people being injured in car accidents. It can be about how healthy a community feels in itself.”

(c) 2008 Dominion Post. Provided by ProQuest LLC. All rights Reserved.

WASHINGTON — In separate meetings with Middle East leaders yesterday, President Bush applauded Lebanon’s efforts to forge a national reconciliation and told Palestinian President Mahmoud Abbas that the administration has not given up hope on an agreement to create a Palestinian state. “I appreciate your determination and your desire to have a Palestinian state,” Mr. Bush told Abbas in front of reporters before an Oval Office meeting. “I share that desire with you. It’s not easy.” Mr. Bush said the administration will continue to work with Palestinian authorities on security matters and on helping to coordinate international economic assistance. (AP)

Medicare drug costs may jump

WASHINGTON — Federal health officials encouraged Medicare participants yesterday to shop around for their prescription drug coverage next year because it could include significant price increases or changes regarding which drugs the plans will cover. Overall, the landscape for prescription drug coverage won’t look dramatically different. The typical beneficiary will still have dozens upon dozens of plans to choose from, but most people will see an increase in their monthly premiums if they stay with the same insurer. For those enrolled in the 10 most popular drug plans, the cost increases will range from 8 percent to as much as 64 percent, according to an analysis by Avalere Health, a consulting firm. The monthly premium for the most popular Medicare Part D plan, the AARP Medicare Rx Preferred Plan, will increase 15 percent, from $32 to $37. Still, the vast majority of participants will have access to prescription drug coverage for the same amount or for less than they’re paying now. (AP)

Evangelist is arrested

LITTLE ROCK, Ark. — FBI agents arrested evangelist and convicted tax evader Tony Alamo at an Arizona motel yesterday, alleging days after raiding the Arkansas headquarters of his ministry that he took minors across state lines for sexual purposes. Alamo is suspected of violating the Mann Act, which prohibits taking children across state lines for illegal purposes. Federal agents and Arkansas State Police had raided the headquarters of Tony Alamo Christian Ministries in tiny Fouke on Saturday and removed six girls ages 10 to 17. (AP)

(c) 2008 Providence Journal. Provided by ProQuest LLC. All rights Reserved.

US-based pharmacy chain Rite Aid has announced that customers will be able to realize savings on more than 10,000 prescription drugs with the free Rite Aid RX Savings Card available at all Rite Aid drugstores across the US, beginning September 29, 2008.

The card, which requires no membership fee and is free to anyone who enrolls, also provides an immediate 10% discount on more than 3,200 Rite Aid brand products, including 1,500 over-the-counter medications.

Cards can be obtained at any Rite Aid store nationwide. Card benefits are effective as soon as the application is completed and turned into a Rite Aid pharmacy.

Benefits of the free card include access to more than 400 generic medications at $8.99 for a 30-day supply and $15.99 for a 90-day supply for each prescription; a 20% discount on all other generic medications and brand drug prescriptions; and a 30-day supply of select generic oral contraceptives for $19.99.

Rite Aid said that the savings card will especially benefit those who have no or limited prescription insurance. Others who will find particular benefit from the card are those whose prescription plan does not cover certain drugs or who have reached their benefit limits. Persons receiving benefits from publicly funded health care programs are ineligible.

Customers can get a list of the medications covered by the savings card at any Rite Aid pharmacy. The card can be used for prescriptions for any member in a family, including pets, but cannot be used in conjunction with prescription insurance.