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ism. The fact is that the person with heart disease is not really handicapped in the literal sense when he works under the proper conditions. If he is selectively placed in a job that fits within his cardiac reserve, and receives proper medical supervision, continued employment is possible without harmful effect. A large number of cardiac patients can and do work, and many more are employable. Through its cardiac-in-industry committee, the association has provided national guidance and materials to stimulate the establishment of local cardiacin-industry committees and programs by affiliated heart associations and their chapters. In every community where the need is indicated, establishment of a work classification clinic is being encouraged as the facility best able to provide many of the services required to fit the cardiac comfortably in a job. The work classification unit is concerned with finding out the work capacity of patients referred to it, based on medical diagnosis; with evaluation of the patients' economic and family situation and their psychological attitudes; and with matching the patients' capacities to the various types of jobs for which they may be suited. The units are usually established as part of a cardiovascular clinic or they are set up at a rehabilitation center.
The original work classification unit set up by the New York Heart Association at Bellevue Hospital in 1941 is being used as a model by heart associations throughout the country. The experience of this unit was put into a guidebook entitled, "The Work Classification Unit." The American Heart Association is distributing this manual to help interested heart associations and other groups to organize and operate these valuable facilities.
Local cardiac-in-industry committees, established by heart associations to direct the employment and rehabilitation program in their areas, are composed of physicians, employers, representatives of labor and other interested agencies in the community. Besides organizing work-classification units and rehabilitation facilities where needed, they are sponsoring conferences on the problems of the cardiac worker and in many other ways are trying to arouse their communities to effective action.
The educational efforts of these committees in urging the employment of heart patients has received strong support from the national office which published a series of booklets attacking on three levels the misconceptions that keep capable cardiacs out of jobs. The first of these booklets, Facts About Employment and Heart Disease, was planned primarily to correct the false notions and fears of cardiac workers and their families. The booklet cites research studies and industrial experience to show that "many heart patients can work at many kinds of jobs on an equal footing with workers who have no heart disease." The second booklet, These Hands Are Able, was designed to promote the employment of persons with heart disease by appealing to the economic interests of management and presenting favorable employment experiences. This booklet was adapted from a manuscript prepared by the cardiacs-in-industry committee of the Los Angeles Heart Association.
The third in the set, Returning Cardiacs to Work, is believed to be the first practical guide of its kind to aid physicians in their efforts to help the patient realize his full work potential. The manual includes a list of voluntary and private health agencies to which the physician may refer patients for vocational counseling or retraining. The medical staff of the Bellevue work classification unit prepared the guide, based on the unit's experience as a pioneer in the field. Teamwork approach
Following the "teamwork approach” that is a fundamental part of its policy, representatives of the American Heart Association conferred with representatives of Federal agencies on the employment and rehabilitation needs of cardiacs. Local offices of these agencies and heart associations are being encouraged to work together on these problems.
HEART OF THE HOME
The housewife is entitled to no less consideration than the wage earner when she develops heart or circulatory diseases. Housewives with heart ailments outnumber industrial employees with similar conditions, if we accept the statement that these women constitute "the largest segment of the working cardiac population." The housewife with heart disease usually must go right on carrying her burden as mother and homemaker, despite the possible dangers involved.
That is why the Heart of the Home program has been developed by the heart association and its affiliates.
This program aims at simplifying work habits to lighten the load on the housewife's heart and help her guard against further heart damage. Some associations are conducting these activities as a phase of the cardiac-in-industry program. They are rightfully an integral part of the overall problem of rehabilitation.
Kitchen fame spreads
In the 4 years since the New York Heart Association developed a worksimplification plan and a model heart kitchen filled with labor-saving ideas for the cardiac housewife, many heart associations in other parts of the country have adapted the project under the guidance of the national office. Heart associations also have organized homemaker consultation services, classes, and demonstrations of methods for saving time and effort.
The fame of the Heart of the Home program has spread far and wide, with requests for program kits, slide films, and kitchen blueprints, coming to the national office from many foreign lands. The United States Department of Agriculture Extension Service has carried the Heart of the Home idea to housewives in rural communities where there are no heart chapters. Manufacturers of kitchen equipment, impressed by the need for simplification, have produced several of their items according to the specifications of the association. Utility companies have cooperated with heart associations by offering equipment and engineering help to build demonstration kitchens in which courses could be held to show women how to change their work habits for their heart's good. The fact that much remains to be done in applying work-simplification methods to other home areas besides the kitchen is duly recognized. Several heart associations already are expanding their programs to include the home as a whole.
The special problems of women with heart and circulatory diseases also were dealt with by the association in its publications program. Reprints of a Parents magazine article on Varicose Veins, a disease to which women are more susceptible than men, were made available for distribution to women's clubs, nurses' meetings, and to doctors to use with their patients.
RHEUMATIC FEVER AND SCHOOL PROGRAMS
Community programs designed to help heart patients work or otherwise function as closely as possible to the normal pattern often have developed out of the needs of children with rheumatic fever. Program activities to help these youngsters involve such comprehensive planning and so many agencies of the community, that a pattern is set for the creation of a rounded heart program in other areas of cardiovascular disease. Many associations have begun their general program-building efforts through this channel.
In addition to the scientific advances in prevention, described in the first part of this report, increased programs for rheumatic-fever patients have done much to reduce the ravages of the disease and contribute to the optimistic outlook in this field. The association is intensifying its efforts to develop complete programs to meet the needs of the young patients by drawing upon the various community services, agencies, and facilities that are required.
Summing up knowledge
Reporting on the progress being made in these programs, the association's new booklet, Heart Disease in Children, states, "As a result of rheumatic-fever programs, improved health services, and educational programs among parents, school people, social workers, and nurses, more children are brought to physicians in the early stage of the infection when it is most important that they be kept in bed under medical supervision." This new booklet provides an up-to-date summary of present knowledge concerning prevention and treatment of rheumatic fever, treatment of rheumatic heart disease, and the correction of congenital heart defects.
Another educational tool provided for the use of heart associations in their rheumatic-fever programs is Round Trip, a film originally produced for the Missouri Heart Association, which tells how various community agencies were instrumental in a boy's recovery and return to normal life.
With these and many other devices, heart associations are helping their communities make full use of all that has been learned about the prevention, diagnosis, and treatment of rheumatic fever.
Guiding local programs
A committee of the association's council on rheumatic fever and congenital heart disease is engaged in the preparation of a report based on a 2-year survey of rheumatic-fever programs. The purpose of the report will be to set out standards for the development by heart associations of rheumatic-fever programs that will assure proper services and facilities to patients. As another means of assisting heart associations in developing such programs, the association has continued a joint project with the Helen Hay Whitney Foundation, which maintains a clearinghouse and collection center for information on rheumaticfever facilities and programs throughout the country.
Vigil in the schools
Because rheumatic fever ranks high as a cause of heart disease and disability among children of school age, an important part of a rheumati-fever program is the school health program. The school physician, nurse, and teacher may often play an important role in detecting new cases or recurrences, in referring the child to the family physician or clinic for treatment, and in cooperating with the physician afterward in proper management of the child.
Some heart associations are promoting the routine examination of all school children entering the first grade as a measure of mass screening for rheumatic or congenital heart disease.
Several associations have sponsored the establishment of a cardiac case registry, a compilation of data on cardiac children and those suspected of having heart disease. This index provides a method of following the children through the school years, and is used to insure continuing medical observation and treatment where needed and to adjust education to the child's physical status when necessary.
Teaching the teachers
Special educational aids for teachers have been prepared by the national office, including a three-panel exhibit, The teacher and rheumatic fever, designed for use by heart associations at parent-teacher meetings, teachers' conferences, and in colleges. The message indicates the services a heart association offers in the child-health program, and is keyed to the association's booklet, What the Classroom Teacher Should Know and Do About Children With Heart Disease.
The American Heart Association joined with the National Education Association, the American Medical Association, and other voluntary health agencies in a Washington conference in the fall to work out methods of improving school health services.
SCREENING AND CASE FINDING
Direction of cardiac cases in the early stages is an important factor in assuring the most effective treatment. In this regard, heart associations are encouraged to make use of existing community facilities for case finding.
These existing facilities include joint programs that have been developed by health departments and tuberculosis associations for the early detection of TB. As an incidental result of mass X-ray screening conducted by these groups for tuberculosis detection, occasional abnormal heart shadows are found. Heart associations have been urged to take responsibility to plan cooperative procedures so that these suspect cases are appropriately referred for diagnosis and management.
To guide heart associations and other local groups involved, the American Heart Association called together representatives of the National Tuberculosis Association and the United States Public Health Service, and cooperated in preparing a joint statement on use of 70-millimeter photofluorographic films as a method of mass screening for heart disease.
DIET AND HEART DISEASE
Proper diet plays an important role in the prevention and treatment of several kinds of cardiovascular disease and has been found helpful to patients when started early. Low sodium diets, for example, have helped some patients with high blood pressure. It should be understood, however, that diet is by no
means a cure.
To protect persons restricted to a low sodium diet, the association is concerned with seeing to it that foods are accurately labeled as to their sodium content so that the purchaser gets what he is paying for and is not harmed as a result of improper labeling. The association developed recommendations to serve as guidelines for the council on foods and nutrition of the American Medical Association and the Food and Drug Administration of the Federal Security Administration in devising regulations for the labeling of special low sodium dietary food products.
With the endorsement of the AMA's council on foods and nutritions, the Heart Association published Food for Your Heart, the first complete, low-priced diet manual in the heart-disease field. The manual is available to heart patients through a doctor's prescription. It incorporates nine diets, sample menus, the latest information on nutrition and heart disease, on reducing, and a plan for converting regular recipies into low sodium recipes to make eating for the heart patient interesting as well as safe and nourishing. Food for Your Heart was prepared under the supervision of a special committee of the American Heart Association, headed by Dr. Frederick J. Stare, chairman of the department of nutrition, Harvard School of Public Health.
Although it isn't known exactly why overweight is so often associated with heart disease and high blood pressure, many doctors think reducing excess weight is good preventive medicine. In line with this thinking, the association cooperated with the Metropolitan Life Insurance Co. in its weight-reduction program, arranging for local showings of Metropolitan's film, Cheers for Chubby, and in other ways giving impetus to heart associations in tying in local weightreduction programs. The association's film library made available Weight Reduction Through Diet, produced by the National Dairy Council, for showings to school and college classes.
POLICY ON PAYMENT FOR DRUGS AND MEDICAL CARE
From time to time requests are received by the Heart Association for direct financial aid to needy patients for medical care, hospital bills, and drugs. Heart Association policy requires that such requests be referred to the appropriate community agency already established to assist indigent patients. The Heart Association does not provide financial support for individual heart cases. It is the firm conviction that the program of research, community service, and educational activities represents the most profitable way heart associations can spend the limited funds raised through the system of voluntary giving for the greatest benefit to the approximately 10 million persons with heart and bloodvessel disease, as well as to the general public.
PUBLIC INFORMATION AND EDUCATION
So much attention is devoted to heart disease these days in the press, on radio and television, in the magazines, and increased booklet, exhibit, and film material, that it is difficult to realize how little such information was available to the public through these media only a few years ago, before the appearance of the American Heart Association as a voluntary health agency. The reason was a general apathy, fear, misunderstanding, and to a large extent the lack of an enterprising national organization and an active nationwide program in the cardiovascular field.
The changed situation and the altered attitudes of press as well as public have been greatly influenced by the planned public-relations policies laid down by the American Heart Association. This carefully conceived public-relations approach has exerted a strong effect in arousing public interest and winning the cooperation of the various press media in reporting on the increasing progress being made in the fight against heart and blood-vessel diseases.
As a voluntary health agency, the American Heart Association is dependent upon the full understanding and intelligent support of the public. Through its contributions to the heart fund, the public has a direct investment in the heart program, and therefore it has a right as well as a need to be kept informed of the latest scientific advances and community program developments. Because
of this concept of stewardship and obligation to the public the educational program is conducted as a year-round sustained effort.
The educational messages of the Heart Association are designed to stress accurate information without exaggeration or distortion; to correct misconceptions; to substitute encouragement and realistic hope for the fear and fatalism too frequently found in the past; to emphasize the scope of the cardiovascular problem and the belief that heart disease can ultimately be controlled through research; and to urge prompt and proper treatment of heart and circulatory disorders.
The health-education program is a dynamic effort to change people's behavior in relation to the cardiovascular diseases, encouraging them to accept the responsibility of acting upon the knowledge they receive. This action takes the form of self-help through consultation with a physician to obtain needed medical aid, and of community action through participation in Heart Association programs to develop the needed facilities and services for patients with heart diseases.
The core of the Heart Association's educational message is contained in a leaflet issued late in 1952 for general distribution in the heart fund campaign. The leaflet summarized as follows the Five Facts You Should Know About Heart Disease:
1. Some forms of heart disease can be prevented * * * a few can be cured. 2. All heart cases can be cared for best if diagnosed early.
3. Almost every heart condition can be helped by proper treatment.
4. Most heart patients can keep on working-often at the same job. 5. Your symptoms may or may not mean heart disease. Don't guess or worry. See your doctor and be sure.
Realizing the value of an educated public, more and more physicians are supplying their patients with educational aids produced by the Heart Association, in order to develop greater understanding and so assure their cooperation in following directions. Many kinds of materials are produced by the Heart Association to help doctors in the management of their cases. In this way, the doctor serves as a health educator, a service that is valuable in maintaining the basic patient-physician relationship and encouraging the patient to look to his doctor for guidance in medical matters.
See your doctor
See your doctor is an important theme of the Heart Association educational materials which seek to promote good general health habits as disease-preventive measures.
Several of the educational booklets for patient and general education produced by the association during 1952 have already been mentioned in the previous section because they are an integral part of specific kinds of community program development.
In another contribution to the education of heart patients and their families, the Heart Association cooperated with the public affairs committee in the production of the booklet, How to Live With Heart Trouble. This booklet helps cardiacs to avoid the trap of unnecessary chronic invalidism, and to enjoy full and profitable lives within the limits of their strength.
General-health precautions advised by five past presidents of the American Heart Association were contained in a cartoon-illustrated leaflet, Be SmartProtect Your Heart. The illustrations were based on a poster series of Joe Palooka health cartoons contributed to the association by Ham Fisher. The Palooka health cartoons also were converted into TV film strips and newspaper mats.
Information rack services found in many industrial plants were an increasingly important aid in distributing general educational messages about heart disease. Numerous requests have been received for Heart Association educational materials from these services, which are an effective means of directly reaching the working population as well as management.
Booklets were prepared by the association for professionals and others concerned with informing the public, who require more detailed knowledge of the heart diseases. To clarify the tangle of statistical information available to