Features,  Health Matters,  Red Cross,  Calendar,

West Nile Virus,  Honors & Awards,  Announcements

Health & Fitness News Elsewhere  (fresh daily from the Web)

Features

A life-altering disease: diabetes

Part 3: Discovery to management

[MARCH 11, 2003] 

[Part 1 in this series]

[Part 2: The 1, 2, G's of diabetes]

How is diabetes diagnosed?

Symptoms of type 1 diabetes usually develop over a short period of time, although beta cell destruction can begin months, even years, earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person can lapse into a life-threatening coma.

The symptoms of type 2 diabetes develop gradually and are not as noticeable as in type 1 diabetes. Symptoms include feeling tired or ill, frequent urination (especially at night), unusual thirst, weight loss, blurred vision, frequent infections, and slow-healing wounds and sores.

In 1997 the Expert Committee on the Diagnosis and Classification of Diabetes published new guidelines for the diagnosis of diabetes. The guidelines lowered the blood sugar values for diagnosis and recommended use of the fasting plasma glucose test to diagnose diabetes, a simpler and faster test than the commonly used oral glucose tolerance test. Glucose levels greater than or equal to 126mg/dl with the fasting plasma glucose test or greater than or equal to 200 mg/dl with the oral glucose tolerance test indicate a diagnosis of diabetes. (1)

Diabetes is a self-managed disease because people with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose near normal levels at all times.

Management of type 1 diabetes: People with type 1 diabetes need daily injections of insulin because their bodies no longer produce insulin. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, self-testing of blood glucose and multiple daily insulin injections.

Management of type 2 diabetes: Treatment for people with type 2 diabetes typically includes diet management, exercise, self-testing of blood glucose, and in some cases oral medication or insulin. Approximately 40 percent of people with type 2 diabetes require insulin injections.

The goal of diabetes management is to keep blood glucose levels as close to a normal range as safely possible, while avoiding blood glucose levels that are too high (hyperglycemia) or too low (hypoglycemia).

Two major studies of diabetes among type 1 and type 2 patients provide important direction for managing diabetes.

The Diabetes Control and Complications Trial showed that intensive blood glucose control in people with type 1diabetes delayed the onset and progression of eye disease, kidney disease and nerve disease, reducing the risk by 35 percent to more than 70 percent by lowering hemoglobin Alc from 9 percent to 7 percent. (2)

The United Kingdom Prospective Diabetes Study showed that intensive blood glucose control in people with type 2 diabetes delayed the onset of eye and kidney disease, reducing the risk by 12 percent to 33 percent by lowering hemoglobin Alc from about 8 percent to about 7 percent. (3)

[to top of second column in this article]

These studies further showed that any sustained lowering of blood glucose helps, even if the person has a history of poor control. The degree of risk reduction for the change in hemoglobin A1c in the two trials was about the same.

Both the studies also shed light on the relationship between blood glucose control and cardiovascular disease. In both studies there was a trend toward reduced cardiovascular disease with intensive blood glucose control. The United Kingdom study also showed that lowering blood pressure to normal significantly reduced the risk for all diabetes complications.

In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications.

Major advances include:

--New forms of purified insulin that are less likely to cause allergic reactions and are nearly identical to the insulin naturally produced by the body.

--Development of external and implantable insulin pumps that deliver appropriate amounts of insulin, replacing daily injections.

--New oral medications to improve control of type 2 diabetes.

--Better ways for patients, doctors and other health professionals to monitor blood glucose -- notably, new devices for self-monitoring of blood glucose, which is performed by the patient, and the hemoglobin A1c (also called H-b-A-one-c) laboratory test, which measures blood glucose control during the previous three-month period.

--Effective treatment for diabetic eye disease.

--Better ways to manage diabetic pregnancies, improving chances of successful outcomes.

--Treatment strategies to reduce damage to the kidneys, eyes and nerves.

(Adapted from Diabetes Overview. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, NIH Publication No. 96-3873, October 1995.)

Tomorrow LDN will bring you the final installment in this four-part series, "High blood sugar increases serious health risks."

You can learn more about diabetes:

--Diabetes resources

--http://www.clevelandclinic.org/health/
diabetes_module/dm1/movie1.html

[LDN and press release from
Illinois Department of Public Health]

(1) Report of the Executive Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997 July; 20 (7): 1183-97.

(2) The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. The New England Journal of Medicine. 1993 September 30; 329 (14): 977-86.

(3) United Kingdom Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837-853, 1998.

United Kingdom Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 317:703-713, 1998.

A life-altering disease: diabetes

Part 2: The 1, 2, G's of diabetes

[MARCH 10, 2003]  Diabetes mellitus is one of the most common and serious chronic diseases in the United States. About 16 million Americans have diabetes, 5.4 million of whom do not know they have the disease. Each year, approximately 800,000 people are diagnosed with diabetes. The prevalence of diabetes has increased steadily in the last half of this century and will continue to rise with the aging U.S. population, the growth in minority populations most susceptible to type 2 diabetes and the increasing prevalence of obesity among Americans.

What is diabetes?

Diabetes is a metabolic disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Diabetes is characterized by high levels of blood glucose (sugar).

What are the different types of diabetes?

There are three main types of diabetes:

• Type 1 diabetes 

• Type 2 diabetes

• Gestational diabetes

Type 1 diabetes, formerly called insulin-dependent diabetes mellitus or juvenile-onset diabetes, is an autoimmune disease that results when the body's immune system attacks and destroys its own insulin-producing beta cells in the pancreas. People with type 1 diabetes need daily injections of insulin to live. Type 1 diabetes develops most often in children or young adults and accounts for about 5 to 10 percent of diagnosed diabetes in the United States. Although risk factors are not well defined for type 2 diabetes, autoimmune, genetic and environmental factors are involved in its development.

Type 2 diabetes, formerly called non-insulin-dependent diabetes mellitus or adult-onset diabetes, is a disease that occurs when the body makes enough insulin but cannot use it effectively. This form of diabetes usually develops in adults over the age of 40. About 90 to 95 percent of people with diabetes have type 2; about 80 percent are overweight. Type 2 diabetes is more common among people who are older; obese; have a family history of diabetes; have had gestational diabetes; and are of African-American, Hispanic-American, Asian-American, Pacific Islander and Native American ethnicities. 

[to top of second column in this article]

Gestational diabetes develops or is discovered during pregnancy. This type usually disappears when the pregnancy is over, but women who have had gestational diabetes have a greater risk of developing type 2 diabetes later in their lives. 

What is the scope and impact of diabetes?

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. It was the seventh leading cause of death listed on U.S. death certificates in 1995 and contributed to 187,800 deaths that same year.

Both type 1 and type 2 diabetes are associated with long-term complications that threaten life and the quality of life. Diabetes is the leading cause of adult blindness, end-stage renal disease and non-traumatic lower-extremity amputations (as a result of nerve disease). People with diabetes are two to four times more likely to have coronary heart disease and stroke than people without diabetes. In addition, poorly controlled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

Diabetes costs the United States $98.2 billion each year. Medical costs for diabetes care including hospitalizations, medical care and treatment supplies ­total $44.1 billion. Indirect costs, including disability payments, time lost from work and premature death, total $54.1 billion.

Tomorrow LDN will bring you Part 3 in this four-part series, “Discovery to management.”

You can learn more about diabetes:

--Diabetes resources

--http://www.clevelandclinic.org/health/
diabetes_module/dm1/movie1.html

[LDN and press release from
Illinois Department of Public Health]

[Click here for Part 1 in this series]

Diabetes resources

[MARCH 10, 2003]  These resources will help people with diabetes and their family members find information on diabetes and how to stay healthy. The organizations listed below provide information about healthy foods, recipes, physical activity and other materials for people with diabetes.

American Association of Diabetes Educators

To find a diabetes teacher near you:

1 (800) TEAMUP4; 1 (800) 832-6874

http://www.aadenet.org

American Diabetes Association

1 (800) DIABETES; 1 (800) 342-2383

http://www.diabetes.org

Information on all aspects of controlling diabetes

American Dietetic Association Center

216 W. Jackson Blvd., Suite 800

Chicago, IL 60606-6995

1 (800) 877-1600

Consumer nutrition hot line: 1 (800) 366-1655

http://www.eatright.org

Information on diabetes management for patients and diabetes educators

Food and Nutrition Information Center

National Agricultural Library/USDA

10301 Baltimore Blvd., Room 304

Beltsville, MD 20705-2351

(301) 504-5719

Directory of free or low-cost food and nutrition materials

National Cancer Institute

National Institutes of Health

Building 31, Room IOA24

Bethesda, MD 20892

1 (800) 4-CANCER

Diet, nutrition and cancer prevention booklets

National Diabetes Education Program and

National Diabetes Information Clearinghouse

1 Diabetes Way

Bethesda, MD 20892-3560

1 (800) 438-5383

http://ndep.nih.gov and ndic@info.niddk.nih.gov

Free booklets to help you learn more about controlling diabetes and food choices

[to top of second column in this section]

National Heart, Lung and Blood Institute

Information Center

P.O. Box 30105

Bethesda, MD 20824-0105

(301) 592-8573

(301) 592-8563 fax

www.nhlbi.nih.gov

Information on the prevention and treatment of heart, lung and blood diseases

Office of Minority Health Resource

P.O. Box 37337

Washington, DC 20013

1 (800) 444-6472

www.omhrc.gov

Information on diabetes materials available for minority populations

President's Council on Physical Fitness and Sports

701 Pennsylvania Ave., NW

Suite 250

Washington, DC 20004

http://www.fitness.gov/

Weight-Control Information Network

I Win Way

Bethesda, MD 20892-3665

1 (800) WIN-8098

http://www.niddk.nih.gov/health/nutrit/win.htm

Free brochures on physical fitness and weight management

Health care program implemented:
It's OK to Ask

[MARCH 6, 2003]  Embracing patients as partners with their physicians, nurses and all others responsible for their care, Abraham Lincoln Memorial Hospital and Memorial Health System are celebrating the start of National Patient Safety Awareness Week (March 9-15) by launching "It's OK to Ask" -- a program to increase awareness of the important role patients play in the hospital care they receive.

It's OK to Ask encourages patients, family members and guardians to ask questions about the care being administered or request assistance when it is needed. The new program also addresses the need for safe and effective care in the home following a hospital stay.

"The physicians, nurses and staff at Abraham Lincoln Memorial Hospital are dedicated to providing skilled, compassionate care," said Woody Hester, president and CEO of ALMH. "Patients who see themselves as partners in their care will be comforted and reassured by knowing their questions, comments and requests are encouraged and welcomed by all of us.

"By further embracing patients as partners, It's OK to Ask reduces the risk of accidental injury and improves overall quality of care at ALMH."

It's OK to Ask provides information about five key health care topics to help patients make important contributions as partners with their caregivers.

Infection control -- It's OK for patients to ask nurses and physicians to wash their hands, or that they wear gloves, before examining them or giving a medication. It's also important to ask well-wishers not to visit if they feel ill.

Reducing medication errors -- Patients can help their caregivers prevent medication errors by making sure their doctor knows about all the medications (including prescriptions, over-the-counter drugs and dietary supplements, such as vitamins) they are taking, telling their physician of allergies or adverse reactions they have had to medicines, and asking about the medicines being prescribed.

Preventing falls -- Asking for help is the most important thing patients can do to prevent a fall during their hospital stay. It's okay for patients to let caregivers know they are uncomfortable or in pain.

[to top of second column in this article]

Safe health care at home -- Following a hospital stay, it's important for patients to stay in contact with their physician or pharmacist, asking questions and taking notes. Arranging for others check up on them and having the needed home health equipment and supplies are also important.

Improved communication -- Through It's OK to Ask, patients are encouraged to ask questions, provide information and take an active part in decisions about their treatment and care.

"Quality of care, clinical effectiveness and patient safety are all benefits of It's OK to Ask," said Dolan Dalpoas, ALMH director of quality management. "It's also important that this program is patient-centered."

"We are listening for all the needs of the patient. Can the patient be made more comfortable? How can family members assist while the patient is hospitalized? How can family members help once the patient is discharged? How can outpatient therapy or other treatments be designed to accommodate any special needs that might exist?"

"It's OK to Ask strengthens the voice of the patient," Dalpoas concluded. "We pledge to listen to that voice. That is a pledge we will continue to honor."

Hester said It's OK to Ask reflects Abraham Lincoln Memorial Hospital's century-long commitment to skilled, compassionate patient care.

"At ALMH, skills, expertise, knowledge and experience are combined with compassion, empathy and genuine concern for every patient's well-being," Hester emphasized. "By joining these values with heightened patient awareness of their importance as partners with caregivers, we grow our ability to provide safe, clinically effective care."

[Abraham Lincoln Memorial Hospital
news release]

A life-altering disease: diabetes

[MARCH 6, 2003]  The year is 1995. Local pastor Don Hoover and his wife Deb are on their way to Michigan. Don makes them stop at every rest area and gas station they pass.

Deb, being a nurse, was worried. She took his blood sugar and discovered it was very high. When they returned home Hoover went to see a doctor, who confirmed his wife's suspicions. He had diabetes.

Diabetes, according to the National Diabetes Education Program, is "a metabolic disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life." In other words, the body of a diabetic cannot process sugar and therefore can develop dangerously high blood sugar. This can lead to blindness, kidney failure, lower limb amputations, heart disease and stroke.

There are four types of diabetes: type 1, type 2, mature onset diabetes of the young (MODY) and gestational.

Type 1 diabetes (insulin-dependent diabetes mellitus; juvenile-onset diabetes) occurs when the pancreas does not produce insulin. This means that a person with type 1 diabetes will need daily insulin shots to live. This type of diabetes usually develops in children or young adults.

Type 2 diabetes (non-insulin-dependent diabetes mellitus; adult-onset diabetes) occurs when the body cannot properly use the insulin it produces. This type of diabetes is usually found in adults over the age of 40 and often in people who are overweight or have a family history of diabetes.

[to top of second column in this article]

MODY is an early development of type 2 diabetes. It occurs in children or youth but is not type 1.

Gestational diabetes develops during pregnancy and usually disappears after the pregnancy is over. Women who have gestational diabetes are at a higher risk of developing type 2 diabetes later in life.

Watch this spot in LDN as we bring you more information on this life-altering disease.

There are many levels and several forms of diabetes. Treatment varies according to the type, the discipline and the lifestyle of an individual. To control Hoover's diabetes, the doctor put him on a low dosage of Glucotrol, a medicine that makes the pancreas create more insulin, and a diet consisting of fewer carbohydrates and sweets and more protein and vegetables. He also began to exercise more.

To find out more about his disease, Hoover went to a seminar given by diabetic Amy Olsen, who was the dietician at Abraham Lincoln Memorial Hospital at the time. Through that conference and subsequent talks with Olsen, he learned about living with his diabetes.

With the help of his wife, Hoover has been able to control his diabetes through medication, exercise and healthy eating. He encourages anyone with diabetes to get control and to maintain control of their life.

[LDN and press release from
Illinois Department of Public Health]

Health Matters

A monthly feature from  Logan County Health Department

A preventable cancer

[MARCH 4, 2003] 

Colorectal cancer -- cancer of the colon or rectum -- is the second leading cause of cancer deaths in the United States. In 2002, there will be approximately 148,300 colorectal cancer diagnoses, and 56,600 people are expected to die from the disease.

But you can take steps to protect yourself from the disease: More than 90 percent of colorectal cancer is preventable.

Colorectal cancers can develop in both men and women. More than 90 percent of cases are found in people over the age of 50.

Since people are more likely to get colorectal cancer as they get older, everyone age 50 or over should undergo regular screening for the disease. Some people, however, have a higher risk of colorectal cancer.

If you fall into one of the following groups, you should talk to your health care provider about starting colorectal cancer screening at an earlier age:

--Personal or family history of colorectal cancer, polyps or inflammatory bowel disease.

--Personal or family history of ovarian, endometrial or breast cancer.

African-Americans have higher colorectal cancer incidence and death rates than other ethnic groups, in part because they are less likely to be screened for the disease.

Following colorectal screening recommendations can detect polyps -- grapelike growths on the lining of the colon and rectum that can become cancerous. Removing these polyps can prevent colorectal cancer from ever developing.

There are four common tests used to screen for colorectal cancer. Your health care provider can help you decide which test is best for you.

A fecal occult blood test is a simple chemical test that finds blood present in stool samples. You can perform an FOBT yourself at home with a kit that you can get from your health care provider and send to a laboratory for results. This testing is recommended every year.

While an FOBT tests for warning signs in the stool, the three tests described below look inside the body to find polyps.

Flexible sigmoidoscopy is a visual examination of the rectum and lower portion of the colon, performed in a health care provider's office or in a clinic or hospital. A flexible tube about the thickness of your finger is put into the anus and slowly moved into the rectum and lower part of the colon. Your health care provider can view the area by looking through the eyepiece of the tube. This testing is recommended every five years.

Colonoscopy is like a sigmoidoscopy, but it lets your health care provider examine the lining of your entire colon rather than just its lower portion. Removal of polyps can be performed during colonoscopy to prevent cancer. This testing is recommended every five to 10 years.

A double-contrast barium enema uses an X-ray to look at the colon and is performed in a hospital or clinic. The double-contrast technique involves injecting a liquid called barium sulfate and air into the rectum in order to get a view of the large intestine. This testing is recommended testing every five to 10 years.

Although colorectal cancer can develop without symptoms, there are some warning signs for the disease.

If you have any of these symptoms, contact your health care provider for testing:

• Rectal bleeding
• Blood in or around your stool
• A change in the shape of your stool
• Stomach discomfort, including bloating, fullness or cramps
• Unexplained weight loss or fatigue

[to top of second column in this article]

Since how you live affects your health, you can take steps to help lower your risk for colorectal cancer. Healthy dietary choices, being active and regular screening can help lower your risk.

While regular screening is your best bet for lowering your risk, research suggests that being physically active can help protect against the disease. In addition to exercise and maintaining a healthy weight, eating a low-fat diet full of fruits, vegetables and whole grains may help prevent colorectal cancer.

Staying away from tobacco and alcohol can also lower your risk. In 2002, 170,000 Americans are expected to die from colorectal and other cancers caused by tobacco use. If you don't smoke, don't start, and if you do smoke, quit. And if you drink, do so in moderation; aim for one drink or less per day.

March is National Colorectal Cancer Awareness Month, founded by the Cancer Research and Prevention Foundation in collaboration with many partner organizations. The campaign to designate the special month was launched in March 2000. The goal is to generate widespread awareness about colorectal cancer prevention through screening and healthy lifestyle choices.

Colorectal cancer is preventable. It is easy to treat and often curable when detected early. Talk with your health care professional about colorectal cancer.

To learn more, visit 

http://www.preventcancer.org/colorectal/.

Myth: There is nothing I can do about getting colorectal cancer.

Reality: Colorectal cancer can be prevented. Screening tests can detect polyps (grapelike growths on the lining of the colon or rectum) that can turn into cancer. Removing these polyps can prevent colorectal cancer from ever occurring. Starting at age 50, men and women who are at average risk should be screened regularly for colorectal cancer. Men and women who are at high risk of the disease may need to be tested earlier and should talk to their health care professional about when.

Myth: Colorectal cancer is usually fatal.

Reality: Colorectal cancer is usually curable when detected early. More than 90 percent of patients with localized colorectal cancer confined to the colon or rectum are alive five years after diagnosis.

Myth: Colorectal cancer is a disease of older white men.

Reality: An equal number of women and men get colorectal cancer. An estimated 75,700 women and 72,600 men were diagnosed with colorectal cancer in 2002. African-Americans are more likely to be diagnosed with colorectal cancer at later stages of the disease.

Myth: Screening tests are necessary only for individuals who have symptoms.

Reality: Since symptoms of colorectal cancer are often silent, it is important to get screened regularly. Screenings test for a disease even if the patient has no symptoms. About 75 percent of all new cases of colorectal cancer occur in individuals with no known risk factors for the disease, other than being 50 or older. If you have a personal or family history of colorectal cancer, polyps or inflammatory bowel disease, you may need to be screened before age 50. Talk with your health care professional.

[From the Logan County Health Department]

All information in this article was provided by the Cancer Research Foundation of America, 1600 Duke St., Suite 110, Alexandria, VA 22314;
(703) 836-4412;  www.preventcancer.org.

Red Cross

West Nile Virus

West Nile virus links

LDN articles

• Local authorities watching WNV

Federal websites

• CDC WNV home page

State websites

• State WNV website

• Protect your home against mosquitoes
• State surveillance site
• Logan County surveillance site

Honors & Awards

Announcements

Donate blood on Wednesday

[MARCH 10, 2003]  The mission of the Central Illinois Community Blood Center is to provide a safe, adequate and cost-effective blood supply to the hospitals it serves. CICBC is the sole provider of blood to Abraham Lincoln Memorial Hospital, Hopedale Medical Complex and all of the Springfield hospitals, as well as seven other central Illinois hospitals. No other organization provides blood to any of these hospitals. Patients in these hospitals depend on healthy community members to supply the blood the patients desperately need to stay alive.

In 2002, CICBC provided 668 units of blood to Abraham Lincoln Memorial Hospital and collected 277 units in Logan County. In the first two months of this year, CICBC has provided 138 units to the patients in Abraham Lincoln Memorial Hospital, while collecting 66 units in Logan County. This usage does not include blood used by Logan County patients in Springfield or Hopedale.

When a blood center does not collect enough blood in a community to support its hospital, the blood must come from other communities or it must be imported from another area of the country, depending on availability. This can not only jeopardize local lives, but can be extremely expensive. Consequently, when you support your local blood center, you are supporting your friends, neighbors and family members. It is the policy of Central Illinois Community Blood Center to supply local hospitals first and, secondly, to share any extra with other parts of the country in need.

[to top of second column in this article]

Please support your hospital, your community, your friends, neighbors and family members by donating blood on Wednesday from 2 until 6 p.m. at the First United Methodist Church, 302 Broadway. Please use the rear entrance of the church.

The double red cell technology will be available at this blood drive, as well as phlebotomy for those community members with hereditary hemochromatosis. Anyone needing this service should call ahead for an appointment. Please call Debbie Mast at 753-1530.

For more information on the blood drive, call Terry Bell or Cherie Sexton-Young at 753-1530.

Please watch for the monthly blood drives from noon until 6 p.m. on the first Monday of every month at the new Logan County Paramedic Building, 1300 Postville Drive.

[CICBC press release]

• March 12, 2-6 p.m., First United Methodist Church, 302 Broadway

• April 7, noon-6 p.m., at Logan County Paramedic Association building

• April 11, at Lincoln Community High School

• May 5, noon-6 p.m., at Logan County Paramedic Association building

• May 14, hours and location to be announced

• June 2, noon-6 p.m., at Logan County Paramedic Association building

• July 7, noon-6 p.m., at Logan County Paramedic Association building

• July 15, hours and location to be announced

• Aug. 4, noon-6 p.m., at Logan County Paramedic Association building

[to top of second column in this section]

• Sept. 8, noon-6 p.m., at Logan County Paramedic Association building

• Sept. 24, hours and location to be announced

• Oct. 6, noon-6 p.m., at Logan County Paramedic Association building

• Nov. 3, noon-6 p.m., at Logan County Paramedic Association building

• Nov. 12, hours and location to be announced

• Dec. 1, noon-6 p.m., at Logan County Paramedic Association building

The Rural Health Partnership has announced the schedule for its mobile health unit for 2002.

For more information on the mobile health unit schedule and services, contact Dayle Eldredge at (217) 732-2161, Ext. 409.

Community resource list

This family resource list to save and use is provided by the Healthy Communities Partnership and the Healthy Families Task Force, 732-2161, Ext. 409.         

(updated 2-15-02)

Back to top