From the Director

I subscribe to the Twitter BioSense feed (@CDC_BioSense), and this time of year, there are tweets almost every day relating to incidents of Carbon Monoxide poisoning.  Often, the incidents involve fatalities.

I think almost all of us have heard about Carbon Monoxide. Carbon monoxide (CO), is an odorless, colorless gas, which can cause sudden illness and death.  It is produced any time a fossil fuel is burned.   Since this often involves a home heating system, we tend to hear about CO poisoning incidents more often in the winter.  Generators located too close to a residence are another common source of CO, and every year we read of tragic accidents involving the use of portable generators during power outages.

The holiday season is upon us with Thanksgiving a memory and Christmas and the New Year ahead. Throughout our community people will celebrate. Public health by its very nature is part of the community whether it is protecting the community through the promotion of immunization against preventable disease or the inspection of food establishments to ensure the highest level of sanitation and safety for food provided to the public.

The holiday season is upon us with Thanksgiving a memory and Christmas and the New Year ahead. Throughout our community people will celebrate. Public health by its very nature is part of the community whether it is protecting the community through the promotion of immunization against preventable disease or the inspection of food establishments to ensure the highest level of sanitation and safety for food provided to the public.

Historically, we expect seasonal flu to infect significant numbers of people from late October through the end of February. Seasonal influenza and its complications annually cause the death of 35,000 to 40,000 people in the United States. Seasonal influenza also is more likely to affect adults and the elderly, with the elderly being at highest risk for complications and death.

It seems like mandatory vaccination for children is a topic that is constantly in the spotlight. Articles that claim that vaccination is not effective or that vaccination is dangerous abound. This is in spite of the fact that time and again, evidence has shown that the vaccination of children and adults against vaccine preventable disease has been highly effective and has prevented millions of illnesses and deaths since vaccines were introduced. I don’t want this to be a long discussion advocating vaccine use. There are countless resources available on the Internet discussing the topic of vaccine effectiveness. Days or months could be spent reading about the history of vaccines, the history of vaccine preventable diseases and the arguments pro and con.

It is something we in health departments across the state can count on. Come late July and August of each year parents and children will swarm to our immunization clinics to get caught up on required shots for schools. We hold “back-to-school walk-in clinics” to help deal with the rush of students needing shots. There are usually long waits in crowded waiting rooms, sometimes HOT crowded waiting rooms, and finally the shots are given and a long morning or afternoon spent at the health department is over. In past years, this was mostly an inconvenience for kids and parents.

In 2008, I wrote about West Nile Virus in humans in the United States. I presented a map and then discussed prevention. You can see by the map below, that based on 2010 data on where of West Nile Virus activity was reported, we are at risk pretty much anywhere in the United States. This is unlikely to change in the foreseeable future. And although the number of human cases diagnosed each year has declined, the infection can be serious and the risk of being infected should be taken seriously.

This month, in recognition of June being National Dairy Month, we have an article on the nutritional value of including dairy products in the diet. Dairy products offer concentrated nutrition in a moderate sized serving and taste good, but, what about the safety of dairy products? For almost nine years, I was privileged to serve as a member of the Missouri State Milk Board. The Milk Board website states the following:

Sometime in the 1980’s, I needed to get a copy of our son’s birth certificate.  At that time, we resided in the City of St. Louis.  But he had been born in St. Louis County, so I had the choice of either going to the St. Louis County Health Department in Clayton or applying by mail to the Missouri Health Department in Jefferson City.  Because I needed it quickly, I trekked out to St. Louis County, completed an application, paid the fee and received a certified copy of his birth certificate.

This time-consuming journey to obtain a birth certificate in person or by mail was repeated many tens of thousands of times a year across the state.  It was the norm until 1995-1996, when local health departments in all 114 counties of the State were given the capability to issue official copies (with embossed seal) of all births registered in the State of Missouri after 1920 and for all deaths registered after 1980.

n 1996, when I relocated to St. Charles County and began working as the Director of the then new Department of Community Health and the Environment, one of the first things I noticed was the dynamic energy of the county and its residents. During confirmation before the County Council after being introduced by the County Executive, I stayed for the rest of the Council meeting and was in awe of the level of public participation in the meeting and the depth of the discussions surrounding various issues during public comment and on the ordinances being considered for adoption that evening. During my first months as the new health director I became involved in a number of groups, all volunteer, that dedicated their time and talents on a number of issues affecting our county. People were involved in a wide array of committees making recommendations for the next revision of the County’s Master Plan. A number of committees were working on community health focus areas as part of a dynamic Healthy Communities St. Charles County organization. Hospitals, physicians, citizens and healthcare organizations were all at the table working on these issues and planning. It was an eye-opener and a satisfying experience which continues today.

The Federal Government released the results from the 2010 Census on February 24. As expected, the population of St. Charles County continues to grow. The growth since the 2000 Census was 27%, with our population now over 360,000. The release of actual numbers after a decade of annual estimates is important to the way we look at numbers in the health department. Although not yet released, the zip code population figures will be especially helpful.

Preparedness is usually not an obvious activity. Yet, planning for and preparing to respond in a public health emergency is an extremely important function of health departments across the country. Public health has always devoted time and resources to preparing for and responding to natural disasters and disease outbreaks. This took on a new urgency in October of 2001 with the appearance of letters containing weaponized anthrax in Florida and then in Washington D.C. and New York City. The attack ultimately killed five and infected an additional 17 who survived. Many of the survivors had the cutaneous form of anthrax, which is less deadly with treatment than inhalational anthrax that has a high mortality rate even with treatment.

In this second discussion of “Invisible Public Health,” I want to take a brief look at one of the foundations of the science of public health — communicable disease control and epidemiology. It is also one of the most invisible to the public.

What does public health do for you? That’s probably a question you’ve never asked yourself. Yet public health, as invisible as it may be, is around you every day and providing benefits that are important to almost everyone. In Part I of “Invisible Public Health”, I’m going to look at food issues that have a daily impact on a number of residents who “eat out” and participate in activities common in the community.

This issue of Health-E-News marks the last issue that will be created and published by Cameron Satterfield, our department’s Public Information Officer (PIO). Cameron has accepted employment in the Pacific Northwest and will, I’m sure, be providing his new employer with the benefits arising from all of the many talents that he has shown during his time with us. His list of accomplishments with our department is long and he is leaving a legacy of innovation and communication with the public that his successor will continue.

One event not specifically discussed in the above articles is the summer family picnic or outdoor family reunion. Picnics and large outdoor reunion get-togethers, almost always involve some food and drink prepared at home. Sometimes larger family events are actually an outdoor family “potluck dinner” with food supplied by a number of different people. Both picnics and reunions are a wonderful way to be outside and enjoy family and friends during the summer.

Our public health caution is to observe food safety rules when preparing food at home and refrigerate food immediately. When it is transported to the picnic or reunion keep it cold and continue to keep it cold or discard the remainder if it isn’t all served. Food cooked at the event should be kept hot and consumed. If bulk ice is used for a drink, make sure the ice is from an approved source. Some businesses sell ice that is intended for cooling purposes only and not certified for human consumption.

Whether you are a beginner or an expert “green thumb,” backyard gardening canon be one of the most enjoyable (and tastiest!) ways to enjoy the summer months. However, you should keep your health and safety in mind as you headed out to your garden. Gardening can be a great way to get physical activity, beautify your neighborhood, and “go green.” But, itt can also expose you to harmful elements like UUV radiation an from the sun, stinging insects, lawn and garden chemicals, and motorized equipment. Here are some health and safety tips's for backyard farmers's to follow while still enjoying the beauty and bounty that gardening can bring.

As May arrives, so do mosquitoes. In fact, our department has already been receiving calls complaining of mosquitoes in some residential areas of the country. It is always hard to predict how severe a mosquito season will be. It not only depends on a compbination of rain and warmer weather but the timing of the rainfall and how hard it rains can make a big difference. "Gully-washers" can flush away developing larvae while gentler rains may just keep everything nice and wet, creating a real mosquito nursery.

In Missouri, we begin with nuisance mosquitoes that are voracious biters and make life miserable if they are presnt in large numbers. In late June r early July to the first hard freeze we see growing populations of mosquito species that are capable of transmitting disease to humans. Below is some information that I provided four years ago that still is good advice. Consider it and consider your options. Most improtantly remember that as July approaches the reason for taking precautions to protect you and your family from mosquito bites changes from avoiding discomfort to avoiding mosquito-borne diseases. More specifically, there are two reasons to protect yourself and your children from mosquito bites:

On two occasions in the past, I have devoted this monthly discussion to the benefits of purchasing locally grown produce at “farmers markets” roadside stands and directly from the farmer. Perhaps because we are becoming a more health-conscious nation or perhaps because of the troubled economy or perhaps for both reasons, we have seen a number of new “farmers markets” appear in St. Charles County in the last year. I personally think a big part of the reason for the popularity of farmers markets is that fresh, locally grown produce tastes better. Whatever the reason for the increase in markets, it has created a need for us to provide more specific information about what can and cannot be sold at the markets, what needs a permit and why we have these rules. In an effort to provide guidance to the public we have created a Frequently Asked Questions document which will be distributed to markets and vendors and posted on our website. I am providing the entire document in this month’s From the Director so that more people become aware of farmers markets and the role of a health department in ensuring the safety of products sold at such a market. 

After devoting substantial department resources to working with health care providers and the public in order to provide 2009 H1N1 (swine flu) vaccination to as many people as possible, we awaited the arrival of the seasonal flu. Historically, we expect seasonal flu to infect significant numbers of people from late October through the end of February. Seasonal influenza and its complications annually cause the death of 35,000 to 40,000 people in the United States. Seasonal influenza also is more likely to affect adults and the elderly, with the elderly being at highest risk for complications and death.

Are you looking for a pet? St. Charles County has a solution for you. Check out the many dogs and cats available for adoption from the St. Charles County Pet Adoption Center operated by the Division of Humane Services.

Since the beginning of October, local health departments across the state of Missouri have had little time to do anything but deal with the demands of responding to the H1N1 influenza outbreak. Activities have included using previously written pandemic preparedness plans to guide preparation for the arrival of H1N1 disease, H1N1 vaccines, and antiviral drugs.

Events of recent months should lead each of us to ask the simple question, “What responsibility do I have to myself and my family to be prepared?” Now is a good time for all of us to ask ourselves that question.

Tornadoes, severe winter storms, and now a pandemic threat all have public officials and representatives of private relief agencies hammering home the need for everyone to plan for a disaster. It would be impossible to count the number of times that we have heard that everyone should have a three-day supply of food and water and a seven-day supply of medication on hand. However, time and time again, we hear people affected by disaster complain that they need food and water in the first 24 hours after the calamity.

There is a lot of information in this month’s issue of Health-E-News discussing the Novel H1N1 flu, also known as swine flu. I want to take this opportunity to assure all of our residents and others who read this publication that we will always do our best to share what we know when there is a rapidly changing health situation such as the current H1N1 Influenza epidemic.

What is the Community Needs Health Assessment Survey and why do we have one? This month, I’ll try to answer those questions.

The traditional swimming and boating season is about to launch. That means that we will be flocking to lakes, rivers, beaches and swimming pools, some of us to relax, some of us to play and many of us to do both. Outdoor recreation is a valuable part of a healthy lifestyle. But there are risks; avoidable, but risks nonetheless.

We spend many days a year developing and updating preparedness plans. Public Health has more than its share of plans. In addition to being part of the overall planning for the county or the city, the health department must plan for those events that are uniquely related to public health. This includes plans for response to bioterrorism, pandemic influenza, and general disasters.

If you are a senior or have an older relative or friend, it is important to plan for emergencies. The unique needs of older Americans are often overlooked when planning for an emergency. This is true whether living at home, in a retirement community, or in a long-term care residential facility.

Over the past decade, we have seen a steady increase in reports from emergency rooms of injuries caused by animal bites. Most of these animals are domestic dogs. These are not stray animals, but animals owned as pets. Unfortunately, not all owners have the same definition of what a pet should be. Some think of their pet in the traditional way, an animal that gives affection and companionship and that functions as a member of the family. On the other hand, a number of pets involved in bite incidents come from families where the definition of “pet” has been expanded to include an intimidating presence on the property of the owner which goes far beyond the usual idea of a “watchdog.” Animals that are encouraged to be intimidating to strangers are more than watchdogs; they are accidents waiting to happen.

East-central Missouri is currently experiencing an increase in pertussis in school-age children. Since the early 1980’s, in the United States we have seen increasing rates of pertussis with periodic peaks every three to four years. Most of those reported with the disease had been vaccinated. However, the rates today are far lower than when there was no vaccine to protect against pertussis and no vaccine is 100% effective. Although most of those with pertussis make a full recovery it can be very dangerous, especially to very young infants. So it is still very important to be vaccinated and most of those who are vaccinated will be protected.

As I watched the tragic events unfold in India last week, the many people shown using cell phones impressed on me the need to be able to communicate with family during a crisis. I’ve talked about the “Ready in 3” program before. (More information is available at www.dhss.mo.gov/Ready_in_3.) One of the recommendations of “Ready in 3,” like all emergency plans, is to have contact numbers readily available. For families, having one or more “central” contact numbers may make the difference between knowing that a family member is okay or being worried to death about them because you can’t contact them.

Although this month’s thoughts may be a bit off of the beaten public health track, they do relate to the way we develop and modify ordinances that authorize and direct programs on a local level. We do this through the legislative process.

As we enter October we look forward to a beautiful time of the year. Autumn leaves, fresh clean air, chilly evenings but perfect days. We have pumpkins, apple cider and Halloween and maybe even a hayride. Who would want to travel elsewhere when the hot summer ends and slowly morphs through a beautiful fall into a cold winter? But when winter does come, thoughts shift to warmer climates and vacations away from snow and ice and freezing.

In August, we were able to resume posting basic restaurant scores on our website, www.scchealth.org. This public service was discontinued several months ago when the old electronic food inspection software ceased to function. Now, until we obtain a newer and more effective system, we will use an alternate method of making this information available on the Internet.

It has been more than a year since emergency preparedness was last mentioned in the “From the Director” messages. I think revisiting the topic is overdue. Even for those families, individuals, businesses, and facilities that have prepared and planned, maintaining a plan and the “things” that are a part of it is an ongoing necessity and an ongoing challenge.

WNV is almost everywhere in the United States, and indicates it is probably here to stay. What do all the cases and deaths have in common? They were all preventable! So were the likely thousands of cases that went undetected because West Nile Virus is often a mild and undiagnosed illness. Those over 50 years of age are most likely to have severe illness and be at greatest risk of death. Serious cases DO OCCUR in younger individuals though, so everyone is at risk.

A St. Charles County municipality's Wellness Commission recently recommended the enactment of a legislated smoking ban in restaurants and bars. An alternative proposal was also offered: a recommendation to put the issue on the ballot for voters to decide. For a number of reasons, these proposals did not gain significant support.

During the morning of April 18, 2008 (4:37 a.m. CDT) a magnitude 5.2 earthquake occurred in the Wabash Valley Seismic Zone. The shock was felt over a multistate area, with the quake’s epicenter in far eastern Illinois. It is believed by many geologists that the Wabash system is related to and/or part of the New Madrid Seismic Zone (NMSZ).

Last year I talked about the fresh bounty of fruits and vegetable grown locally. Recently, the Missouri Department of Health and Senior Services updated their fruit and vegetables website. Not only is there good content on the updated site, there are many links on the site.

One of the great things about late spring to mid-autumn is the arrival of many festivals, craft shows, and outdoor events. Many of these gatherings include food vendors. The availability of food and drink greatly enhances the appeal of the events to those enjoying the activities. Making sure that the food and drink is safe is another responsibility of the Environmental Public Health Section of the Department of Community Health and the Environment Division of Public Health.

National Radon Action Month 2008 ended on January 31, but that doesn't mean the threat has ended. In recent weeks, the Department of Community Health and the Environment received a number of requests for free radon testing kits. While we don't know exactly why the number of requests increased, the fact that they did increase is encouraging. More requests are a good thing!

Have you ever travelled one of the many scenic corridors or highways that our beautiful county has to offer, only to spot a carelessly discarded furniture item, appliance, scrap tire, or even trash bag along the roadside? Not a pleasant nor a welcome sight for sure!

Last month I reviewed the first seven chapters of Municipal and Rural Sanitation by Ehlers and Steel, sixth (and last) edition published in 1965. These chapters give a picture of the diversity of the profession of Environmental Public Health Specialist, historically, sanitation practiced by sanitarians. This month I want to continue to review the chapters.

We who are in the practice of public health often struggle with how to describe what "public health" is to our citizens and those who make decisions about our funding. It is not obvious to most people just what public health means. Public health departments are often vaguely thought of as some kind of extension of Medicaid or other public programs involved with providing healthcare to those with limited income.

The St. Charles County Department of Community Health and the Environment, Division of Public Health, recently sent out a press release to alert residents that shigellosis cases in daycare centers had increased in the last month.

Is it your turn to get immunized too? Trying to keep adults up–to–date with their immunizations is a never–ending task.

Does your drinking water come from a private well? Do you know what's in it? Is it safe for you and your family to drink? When was the last time you had your private well water tested? Five years ago? Ten years ago? Never?

I look forward every year to summer. While I enjoy the many summer−related activities in our area, it is the bounty of fresh, locally−grown produce that I look forward to with the most anticipation.

The St. Charles County Department of Community Health and the Environment is one of thousands of public health agencies across the country that has adopted a new identity for local public health that communicates our dedication to community health and safety.

This month's From The Director is by guest author Cameron Satterfield, Public Information Officer for the Department of Community Health and the Environment. Do you have a smoke detector in your home? How about a spare tire in your car? Is there a box of bandages in your medicine cabinet? If so, then you have experience in preparing for an emergency. These may seem like small things, but small things can save lives.

Recently, I watched a discussion on a cable news morning program regarding a 27-year-old tuberculosis (TB) patient in Phoenix, Arizona. The case was somewhat alarming. The man is infected with Extensively Drug Resistant TB, or XDR-TB. Unlike Multi-Drug Resistant TB (MDR-TB), which is resistant to two of the drugs used for TB treatment, XDR-TB is resistant to all combinations of available drugs and is therefore essentially untreatable. Because this particular patient refused to wear a mask in public, county public health authorities obtained a court order to take the man into custody and place him in an isolation room at the hospital.

In recent months, the Department of Community Health and the Environment has received an unusual number of requests for free radon test kits. The Missouri Department of Health and Senior Services sends these test kits to local health departments throughout the state for distribution to residents. Why the number or requests has increased is much less important than the fact that it is a very good idea to test your home for radon. More requests are a good thing!

Body piercing and tattooing have become increasingly popular forms of personal expression over the last two decades. These practices have ancient roots, but greater public acceptance has created a widespread demand for these procedures. A University of Michigan survey of undergraduates found that 50 percent had some type of body piercing and 23 percent had tattoos.

As we enter 2007, I want to briefly describe the Department of Community Health and the Environment. We are a large department with many different programs. Understanding the structure of the department simplifies the process of knowing where to go for assistance with a problem or to obtain a service.

The department is made up of four divisions. They are:

The Pet Adoption Center has various programs designed to help both animals and people.  We are constantly looking for ways to better serve the community and help more animals.  One very positive change we have made in the last few months is the introduction of the “Differential Licensing” program.   Previously, licenses for all dogs and cats cost the same, regardless of whether the animal was altered or unaltered.  Now the spayed and neutered animals remain at the low licensing fee of $5.00 and those animals that are not spayed or neutered are a $10.00 licensing fee.  The objective of a differential licensing program is to promote spaying and neutering by giving owners a financial incentive to do so.  It also gives local veterinarians a tool to encourage their clients to spay and neuter.  Differential licensing is not a new concept and has been done with impressive results in many other communities throughout the United States. 

There are several good reasons to promote pet licensing programs, some of which are:

Lead poisons children. Those words opened a presentation I gave to a national childhood lead poisoning prevention meeting in New Orleans in June of 1981. As I told the audience, "Just as Dickens Christmas Carol begins with the statement, MARLEY was dead: to begin with. There is no doubt whatever about that, there is also no doubt that lead poisons children." At the time I gave the presentation, old lead-based paint applied to many residences again and again over many decades presented the greatest hazard to young children. In the two and a half decades since I gave that presentation abatement activities have substantially reduced the amount of hazardous lead-based paint found on residential dwellings across the United States.

Every year women in St. Charles County Government have the opportunity to attend a Women's Health Fair. Reliable recommendations and information is available along with some freebies, blood pressure screening and free chair massages. Many women take advantage of the opportunity to learn more about health topics of interest to them and it is a popular event. Also, very predictably, each year a few men ask, "Why isn't there a men's health fair?" While the health education department is very willing to host a men's health fair, unfortunately there has never been a huge interest from the male employees. Health fairs are just one option for finding reliable health information and I would like to offer an alternative.

This month it's time for another common-sense topic; dealing with the hot sun, heat and humidity of a Metro St. Louis summer. As with our discussion of mosquitoes last month, I won't give you long lists of do's and don’ts. Still, it is important to know about the information that we as a public health department collect each summer relating to heat illness.

Heat illness occurs when the body loses its ability to regulate body temperature. Normally, the body can keep our temperatures in the neighborhood of the 98.6 degrees Fahrenheit that we are familiar with. In the summer that is a harder job and requires that we use common sense when out in the heat. You have heard these precautions many times but the most important ones are drink non-alcoholic drinks, rest periodically, stay out of the sun if you can and try to periodically cool off in an air conditioned area or in water (pool, bath, shower or garden hose for the kids). Sunscreen is also a must in order to avoid injury to the skin. Wearing lighter colored clothing also helps.

It's that time of year again. Mosquitoes normally make their first appearance in St. Charles County during the month of May. Exactly when they appear depends on spring temperatures and rainfall, but we can be sure they will be here buzzing and biting.

Since most of us will be inundated with mosquito "tips" in upcoming months, I won't repeat that advice here. Look for it in your local newspaper and on radio and television or follow the link below. The tips REALLY DO WORK and you can help reduce the overall mosquito population in your neighborhood by following the recommendations. But, after removing all the hype, what makes sense in dealing with mosquitoes? It is really as simple as thinking about two basic reasons for personal protection and two approaches to reducing the number of mosquitoes you have to deal with.

I am going to take a departure from strictly public health topics this month to share reflections on my past connections to St. Charles County. I didn't live in St. Charles County growing up but in Kirkwood Missouri, a City in St. Louis County. But I did visit St. Charles County on a regular basis over the years.

I suppose there is some connection to health since everything I'm going to talk about relates to enjoying the recreational resources of St. Charles County. Recreation relieves stress and the exercise associated with it promotes cardiovascular fitness. But mostly, this is just a reminiscence of pleasant times I spent in St. Charles County back then.

more info . . .

In the February Issue of Health E-News, Ina McCaine-Obenland of the St Charles County Division of Emergency Management provided detailed information on NOAA Weather Radios with an excellent link to the NOAA website for additional information. www.crh.noaa.gov/lsx/nwr/nwr.php . Hopefully, everyone who read Ms. McCaine-Obenland's article has by now purchased one of these inexpensive radios. In this issue Ms. McCaine-Obenland focuses on common tornado myths and important safety tips.

Public Health deals with more than disease. The prevention of injury and death from injury has historically been a major part of the CDC mission. Every year tornadoes can be counted on to inflict injury on hundreds or thousands of people in the United States. Many of these injuries, as well as death from the injuries, are preventable. The NOAA All Hazards Weather Radio is an important tool for prevention. They are inexpensive and widely available.

more info . . .

One of the traditional, and critical, responsibilities of Public Health Departments is the inspection of "Food Service Establishments". This term certainly includes restaurants, but it also refers to food carts, festival food booths, mobile food trucks, and retail grocery stores.

This topic of restaurant inspection is always of great public interest. The restaurant inspection score listing ("Know the Score") on our website (www.scchealth.org) is consistently among the most accessed features on our monthly website statistical reports. Of special interest to many is the "Smoke-Free Dining" listing of restaurants. It is always among the top 10. In addition, over half of the comments and enquiries received from the website comment forms and from general email deal with questions or complaints about restaurants.

more info . . .

As I write this month's column, the tragic misunderstanding in West Virginia is still unfolding. Initial joyous reports of 12 surviving miners quickly were replaced by the sad news that only one had actually survived. At the moment, information is indicating that the erroneous information reached the families when individuals, overwhelmed by what they thought was the best possible news, used personal cell phones to communicate prematurely with family members. This picture may change as more information becomes available. Nonetheless, it illustrates the complexity of communications during a crisis situation.

more info . . .

In the fall of 1999, a decision was made to develop a website for the St. Charles County Department of Community Health and the Environment. The primary goal of the site was to create a presence on the web that would provide information and services to residents of St. Charles County and other visitors, 24 hours a day, 7 days a week. A secondary goal was to provide a comprehensive public health resource by using a combination of onsite information and links to reliable external agency and organization websites. These resources were to be designed in such a way that adults, students and medical professionals would find them useful.

more info . . .

Events of recent months should lead each of us to ask the simple question, "What responsibility do I have to myself and my family to be prepared?" Now is a good time for all of us to ask ourselves that question.

more info . . .