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					                  IOWA DEPARTMENT OF PUBLIC HEALTH

                            Iowa Health



   JUNE 2002
                                            focus                                   WWW.IDPH.STATE.IA.US


Iowans move to combat obesity, inactivity
By Louise Lex, Ph.D., Healthy Iowans 2010 Coordinator




T
        he Public Health     and next to the bottom
        Summit, sched-       in eating five fruits and
        uled just before     vegetables a day. She
the Memorial Day week-       went on to say, “Unless                Public Health Summit
end on May 24, featured      we begin doing some-
a group of diverse and       thing right now, there
motivated Iowans who         will not be enough time
answered Governor Vil-       or money to deal with
sack’s call to do some-      the increasing number
thing about Iowa’s epi-      of Iowans with diabetes,
demic of overweight and      cardiovascular disease,
physical inactivity. They    arthritis, high blood
understood the problem       pressure, and cancer –
threatening our health,      just some of the dis-
resources, and quality       eases related to over-
of life.                     weight and sedentary
                             lifestyles.” She noted
In opening the meeting,      that we need to become
state epidemiologist Dr.     more focused if we are
Patricia Quinlisk ac-        to achieve the nutrition      Overweight: Iowa ranks the 5th worst
knowledged Iowa’s            and physical fitness
                                                           Fruit and Vegetable Consumption: Iowa ranks 49th
ranking among the            goals in Healthy Iowans
states as fifth from the     2010. (Continued on           Together we can make a change.
bottom in overweight         page 2.)
                                                                    Illustration by Larry Malmin, IDPH Graphic Artist

Distributing federal resources – democratically                                         Inside this issue:
By Stephen Gleason, D.O., Director
                                                                                        3R Net Resource         4



                       I t will soon be nine
                         months since that terri-
                         ble day in September
                       when terrorists attacked
                                                         they helped us, at least,
                                                         shed a naïve sense of i n- Rape Victims
                                                         vulnerability. We now re-
                                                         alize that no one – in New Sun block
                                                                                                                5


                                                                                                                6
                       our citizens, our buildings       York, Washington or
                       and our sense of security.        Iowa – is immune from      Have a safe 4th             8
                                                         attack. (Continued on
                       It’s hard to put a positive       page 3.)
                                                                                        New farm bill           9
                       spin on those attacks, but
The Iowa leaders drawn together        pects of the effort. Here is a sam-      Center, Dubuque and Dyers-
for the meeting represented            pling of responses:                      ville)
groups that will make a major dent
in changing the shape of Iowa.         Ø Help organize an ICN confer-        Ø Develop tools and guides from
Before the day was over, the             ence to educate health profes-        which local boards of health
group had crafted a strategy with        sionals on obesity, exercise,         can choose to meet the State
the assistance of Dr. Elizabeth          and healthy food choices.             Board of Health challenge for
Schafer and Dr. Gregory Welk,            (Physician)                           community projects (Calhoun
Iowa State University; Dr. Karin                                               County Department of Health)
Van Meter, Des Moines University;      Ø Increase physically active ex-
and Dr. John Lowe, University of         periences at schools.               Ø Act as an advocate for funding
Iowa. As Susie Roberts from              (University Professor and Ath-        and promotion of the summit
Holmes Murphy & Associates, de-          letic Coach)                          ideas (Iowa Association of
scribed the process, “… It was                                                 Health, Physical Education,
helpful to have all the different      Ø Assist with work site initiatives     Recreation, and Dance)
people gathered in one place and         (Industry Wellness Coordina-
to actually come out with a work         tor)                                Ø Provide information related to
plan, with ideas of things that we                                             trail systems and future trails
can start working on today – not       Ø Make the networking connec-           (Iowa Department of Transpor-
10 years from now!”                      tions needed for insurance            tation)
                                         companies (Insurance Repre-
The strategy was developed               sentative)                          Ø Advocate to the legislature for
around three themes: community                                                 appropriate policies (Iowa En-
coalitions, lifestyles, and media      Ø Work with 107 departments             vironmental Council)
promotion and the following vision:      across the state on programs
Iowans promote and support               and information (Iowa Parks         The summit demonstrated, once
healthy lifestyles through commu-        and Recreation Association)         more, that Iowans can come to-
nity-based systems. More work is                                             gether to solve big problems. The
to be done in refining the summit      Ø Serve as a resource for chil-       meeting certainly epitomized Mar-
strategy. Before leaving the meet-       dren and disability issues          garet Mead’s often-quoted com-
ing, participants committed them-        (Center for Disabilities and De-    ment, “Never doubt that a small
selves to the work ahead.                velopment)                          group of thoughtful, committed citi-
                                                                             zens can change the world: In-
Participants completed “please         Ø Serve as a resource on devel-       deed, it’s the only thing that ever
call on me” forms, indicating their      oping community-based well-         has.”
willingness to help with various as-     ness programs (Mercy Medical


                                 Keep this statewide effort moving!

    Send your ideas and suggestions to Susan Pohl: spohl@idph.state.ia.us or Tim
    Lane: tlane@idph.state.ia.us.
    To follow up on strategies, send your name and e-mail address to Kim Brunette at
    kbrunette@idph.state.ia.us. You can expect a weekly progress report from Susan
    or Tim.
    Public Health Summit materials are available at www.idph.state.ia.us/dir_off.htm



Page 2
Distributing federal resources – democratically
By Dr. Stephen Gleason
Continued from page 1

Our elected officials, along with       the directions of the congress as      tia or regions and management of
most Americans, are keenly aware        long as it meets the CDC guide-        the funds. They, too, will present
of the possibility of other attacks     lines and all other regulations and    their decisions, in the form of mo-
and are trying to overcome the in-      doesn’t jeopardize the funding of      tions, to the plenary session for vot-
ertia resulting from a sense of se-     any other party to the grant.          ing.
curity developed over decades of
life without war.                       Each delegate will have the oppor-     Representatives from the DPHAC,
                                        tunity to be part of a single focus-   the Iowa Public Health Association
If, or when, another attack occurs,     area work group, and part of his or    (IPHA), Iowa Environmental Health
our preparations will undoubtedly       her respective congressional dis-      Association, and Iowa Association
seem inadequate, but we can’t let       trict work group. The focus areas      of Local Public Health Agencies
the perfect be the enemy of the         are Preparedness Planning and          (IALPHA) will all be members of the
good. We have to do everything          Readiness Assessment; Surveil-         CDC’s Iowa Health Advisory Com-
we can to be prepared, knowing          lance and Epidemiology Capacity;       mittee. Those representatives are
we may still not be when the time       Health Alert Network/                  required to hold regular meetings
comes.                                  Communications/Information             with, or provide regular updates to,
                                        Technology; Risk Communication         their constituents to get feedback
To help us with that effort, the        and Health Information Dissemina-      on the process.
Centers for Disease Control and         tion; and Education and Training.
Prevention (CDC) will provide the       The districts are based on Iowa'sAn ad-hoc rules committee is help-
state with an $11.5 million grant,      old congressional districts.     ing the IDPH staff prepare for the
nearly half of which – $5,556,460                                        Congress. The committee includes
                                    The meetings will be conducted
to be precise – is allocated to local                                    Fran Sadden (IALPHA); Cindy Kail
public health. This brings up the   according to a condensed version (DPHAC); Mary Rose Corrigan
question, how should the local      of Roberts Rules of Order, with      (DPHAC); Denise Schrader (District
public health money be distributed  parliamentarians and other techni- 1); Ron Garceau (District 2); Deb-
and managed?                        cal advisers helping but not voting. bie Green (District 3); Lorilyn
                                    IDPH employees will be among         Schultes (District 4); Elaine Boes
We hope some of you will help an- the advisers, but they, too, will not (District 5); and Gary Bargstadt,
swer this question at the Public    vote. Each focus-area work group representing the Des Moines area.
Health Congress, planned for        will discuss ways to assure that
June 18-19 at the STARC Armory the CDC guidelines are met while Though some of you will be dele-
in Johnston. The congress, so       determining how the money will be gates to the Congress, most of you
called because it will use parlia-  allocated, either on a local, re-    will not be, and should make your
mentary procedure, is an attempt    gional, consortia or state basis.    ideas known to whoever is chosen
to answer the above questions in    The groups will then present their to represent your county. Delegates
the best American tradition – de-   ideas to the plenary session in the have been chosen by local boards
mocratically. Boards of health of   form of motions for voting.          of health. Contact them to find out
all 99 counties have been asked to                                       who your delegates are.
send one delegate to the con-       The congressional district work
gress.                              groups will elect two members        Finally, now that we’re over our
                                    each to the CDC Cooperative          pre-September 11 naiveté, we can
Each delegate will have one seat    Agreement Subcommittee. This         all get down to the business of pre-
and one vote, and the votes will be group will determine, by majority    paredness. As we’ve discovered,
binding. The department will follow vote, methods for building consor- it’s a critical part of public health.




Page 3                                                                                                         Page 3
3R Net: A health care resource for rural Iowa
By Patricia Kehoe, Bureau of Health Care Access




s       ome busy urban medi-
        cal professionals are
        curious about practice
opportunities in rural settings.
And some administrators
                                      throughout the nation. In re-
                                      sponse to this shortage, the
                                      Bureau of Health Care Access
                                      at the Iowa Department of Pub-
                                      lic Health recently opened the
                                                                         or have a position to advertise,
                                                                         please visit www.3rnet.org

                                                                         Health-care practice catego-
                                                                         ries on 3R Net include physi-
struggle to attract talented          3R Net web site to public and      cians, physician assistants,
practitioners to their small          non-profit health facilities       nurse practitioners, registered
town hospitals.                       across the state. More than 70     nurses, certified nurse mid-
                                      opportunities in 30 communi-       wives, and dentists. Physician
3R Net (Rural Recruitment             ties appear on the Iowa net-       opportunities include primary
and Retention Network) is a           work pages, with new positions     care specialties in family prac-
job-search web site fo-                                                       tice, geriatrics, internal
cused exclusively on ru-                                                      medicine, obstetrics/
ral medical opportunities                                                     gynecology, orthopedics,
in Iowa and over 40                                                           pediatrics, psychiatry,
other states. The site of-                                                    surgery and women’s
fers a forum for commu-                                                       health. An “other” cate-
nication between job                                                          gory offers opportunities
seekers and hiring offi-                                                      for certified nurse anes-
cials without cost to ei-                                                     thetists, cytotechnolo-
ther party.                                                                   gists, medical laboratory
                                                                              technicians, physical
According to Fred                                                             therapists, radiology tech-
Moskol, executive direc-                                                      nicians, and speech pa-
tor of 3R Net, “Despite                                                       thologists.
predictions of the Graduate           added weekly. Each listing
Medical Education National            provides a brief job description The 3R Net web site was de-
Advisory Committee published          and contact information to       veloped at the Wisconsin Of-
in 1980, which expected a sur-        speed the opportunity for a      fice of Rural Health in 1995,
plus of 3,100 family physicians       successful “match.”              and today the network oper-
by 1990, rural areas have not                                          ates as a not-for-profit corpo-
seen the benefits of this pre-        The bureau is frequently con-    ration providing technical as-
dicted surplus. A further the-        tacted by health-care profes-    sistance to member states.
ory promoted by the Rand              sionals who want to return to    Iowa site membership is sup-
Corporation suggested that            Iowa, or relocate within Iowa,   ported by a federal grant
the surplus of physicians in ur-      and request a list of available  through the Iowa Primary Care
ban areas would result in a mi-       openings in rural or health-care Office, and Iowa web pages
gration to rural and shortage         shortage areas. Prior to joining are administered by bureau
areas.”                               3R Net, we had no resource to staff. For more information,
                                      recommend. Now the bureau        please visit the web site or
More than two decades later,          can direct callers to the Iowa   contact Patricia Kehoe at 515-
the physician shortage contin-        pages of 3R Net. If you would 281-5069 or e-mail
ues in rural communities              like to view available openings, pkehoe@idph.state.ia.us.

Page 4                                                                                              Page 4
Rape victims: How health care professionals can help
By Jaime Tokheim, IDPH Intern




R      ape is a serious health
       issue around the nation,
       including Iowa. During
2000, 675 forcible rapes were
                                 victimization. Health profession-
                                 als should be alert to these
                                 symptoms. Victims who have
                                 experienced abuse over time
                                                                         working with sexual abuse.
                                                                         Contact the statewide ho t-
                                                                         line, 1-800-284-7821, to find
                                                                         out about services in your
reported in Iowa. Most incidents will not usually discuss a history      area.
go unreported because these      of sexual violence unless asked      3) If the patient is a minor and
crimes are highly personal and   or unless they are experiencing         was or is currently being
traumatic and leave many vic-    symptoms directly related to the        sexually abused by a care-
tims feeling responsible for the abuse. Therefore, it is the re-         taker (parent or other adult
assault.                         sponsibility of health-service          responsible for their care),
                                 providers to inquire about a pos-       report the abuse to the De-
Only about 20 percent of sexual sible history of abuse as a mat-         partment of Human Ser-
assault victims seek services.   ter of routine.                         vices (1-800-362-2178) and
Anonymous surveys suggest                                                explain that you legally must
that many victims never seek     Victims of sexual abuse may             report.
assistance.                      also seek health care following a    4) Keep brochures about sex-
                                 sexual assault to receive emer-         ual assault and the state-
According to the 1992 National gency contraception or testing/           wide hotline, especially if
Women’s Study, one in eight      treatment for STD’s. They may           you serve young women in
women will be forcibly raped in or may not inform the practitio-         their teens and early adult-
her lifetime. The following are  ner that a sexual assault is the        hood.
factors that put people at in-   cause of their concerns. Health-
creased risk for sexual assault: care providers should be pre-        Binnie LeHew, IDPH violence
                                 pared to assist in the following     prevention coordinator, is a re-
1) female                        ways:                                source for health-care provid-
2) between 16 and 19 years of                                         ers helping victims of sexual
    age                          1) If the patient discloses a re-    violence. “The department of-
3) unmarried                         cent sexual assault (within      fers training to health-care pro-
4) physically or developmen-         the past 72 hours), encour-      viders and local prevention pro-
    tally disabled                   age her to obtain a sexual       gramming through the federal
5) history of sexual violence in     assault evidentiary examina-     Rape Prevention Education
    the family                       tion by a sexual assault         grant,” says LeHew. “We
6) acquaintance of victim to at-     nurse examiner or at an          would like health-care providers
    tacker                           emergency department.            to recognize their unique role in
                                 2) If the person discloses a his-    identifying victims and support-
Because most sexual assault          tory of sexual abuse (recent     ing them in seeking assis-
victims never seek help, sev-        or past), briefly assess the     tance.” For more information,
eral long-term consequences          impact of the abuse on her       contact LeHew at (515) 281-
are common among adults              current physical and mental      5032 or blehew@idph.state.ia.
abused as children. Many have        health. Refer her to a local     us.
depression and chronic gastro-       sexual assault service pro-
intestinal problems, and are at      gram or other mental health
increased risk for re-               provider who has expertise




Page 5                                                                                           Page 5
Enjoy the sun but break out the sun block
Comprehensive Cancer Control Program




B       eing outdoors in these
        warm, sunny days can
        be fun, but remember
that the sun’s ultraviolet (UV)
                                      the last five years. Also disturb-
                                      ing is that fact that even though
                                      the new cases rate is low, the
                                      death rate for skin melanoma is
                                                                             late spring and early summer in
                                                                             North America. Relatively
                                                                             speaking, the hours between
                                                                             10 a.m. and 4 p.m. (daylight
rays can damage skin in as lit-       relatively high. This means that       savings time) are the most ha z-
tle as 15 minutes.                    skin melanoma is a relatively          ardous for UV exposure.
                                      aggressive form of cancer and
Although some sun exposure            places a significant health bur-       Unprotected skin can be
can yield a few positive bene-        den on the state.                      harmed by UV rays in as little
fits, some doctors consider the                                              as a quarter of an hour, yet it
skin’s tanning a re-                                                                        can take up to 12
sponse to injury as                                                                         hours for skin to
the sun’s UV rays                                                                           show the effects of
kills some cells                                                                            sun exposure.
and damages oth-                                                                            Even if skin only
ers. Excessive                                                                              looks a little pink at
and unprotected                                                                             first, it may actually
sun exposure can                                                                            be burned and the
also lead to pre-                                                                           effects will be felt
mature aging and                                                                            later.
changes in skin
texture. In addi-                                                                           Blistering sun-
tion, UV radiation                                                                          burns, especially
is a risk factor for                                                                        before age 20, is a
lip cancer and has                                                                          significant risk fac-
been associated                                                                             tor for skin cancer.
with forms of eye                                                                           Data from the
                     Make sure you break out the sun block this summer, or you and your
damage, such as loved ones could get burned.                                                1999 Behavioral
cataracts.                                                                                  Risk Factor Survey
                                    Although we tend to focus on             indicate that 45 percent of Io-
Of major concern is the fact        the need for protection from sun wans reported having sunburn
that exposure to the sun’s UV       exposure during the spring and in the previous 12 months.
rays appears to be the most im- summer months, it’s important                Over 71 percent of survey re-
portant environmental risk fac-     all year round. Any time the             spondents between ages 18
tor in the development of skin      sun’s UV rays are able to reach and 24 reported a sunburn.
cancer. That includes mela-         the earth — regardless of the
noma, one of the most serious       season or temperature — peo-             Although anyone can get skin
and deadly forms of the dis-        ple are at risk for skin damage.         cancer, people with the follow-
ease. In Iowa, rates of new         UV rays can penetrate cloud              ing characteristics are particu-
cases of skin melanoma are          and haze and can reflect off of          larly at risk:
relatively low, compared to         any surface, like water, cement,
other types of cancer, but new      sand, or snow.                           • Fair to light complexion
case rates have increased over UV radiation is greatest during               • Chronic exposure to the sun



Page 6
•   History of sunburns early in         can’t avoid midday sun or find             using sunscreen.
    life                                 shade, try to take a break from
•   A large number of moles or           the sun during the day.         •          Grab Your Shades – Sun-
    atypical moles                                                                  glasses that block both UVA
•   Freckles (an indicator of sun    •   Use Your Head – Up to 80                   and UVB rays offer the great-
    sensitivity and sun damage)          percent of skin cancers occur              est protection for the tender
•   Personal history of skin can-        on the head and neck so us-                skin around the eyes. Wrap
    cer                                  ing a hat, preferably with a               around sunglasses work best
•   Family history of skin cancer        four-inch brim, is a great way             because they block UV rays
                                         to shade the face, ears, scalp             from sneaking in from the
Simple steps can be taken to             and neck. If wearing a base-               sides.
protect skin from sun exposure           ball cap use a sunscreen to
and sunburn and reduce the risk          protect the ears and neck.             Despite what many of us were
for skin cancer. Through its                                                    led to believe when were young,
Choose Your Cover program, the •         Shield Your Skin – Loose-              a suntan is not an indicator of
Centers for Disease Control and          fitting, long–sleeved shirts and       good health. So, choose your
Prevention (CDC) suggests the            long pants made from tightly           cover and protect your skin.
following steps to protect skin:         woven fabric offer the best
                                         protection. Keep in mind that          For more information about skin
•   Rub It On – Use a sunscreen          a typical t-shirt has an SPF           cancer or CDC's Choose Your
    with a sun protection factor         rating substantially lower than        Cover skin cancer prevention
    (SPF) of at least 15, gener-         the recommended SPF 15.                campaign, go to http://www.cdc.
    ously apply it 30 minutes be-        Double up on protection by             gov/chooseyourcover.
    fore going outdoors, and re-
    apply it frequently throughout
    the day, especially after                                Iowans Who Have Had A Sunburn in the Past
    swimming or exercise. Also,                                         12 Months By Age,
    be sure to check the expira-                                 1999 Behavioral Risk Factor Survey
    tion date. Sunscreen without
    an expiration date has a shelf                  80
    life of no more than three                      70
    years.                                          60
                                                    50
                                          Percent




•   Seek Shade - Whenever pos-                      40
    sible, avoid the midday sun                     30
    when UV rays are the strong-                    20
    est and cause the most dam-                     10
    age. When outdoors, find                         0
    shade under trees or by us-
                                                         18-24   25-34     35-44     45-54     55-64     65+
    ing a beach umbrella. If you



                       Obtaining Past Issues
      Back issues of Iow a Health FOCUS are available on
      the Iow a Department of Public Health Web site at:
                    w w w . idph.state. ia. u s .

                                                                                                               Page 7
                                                                                                               Page 7
Safe and fun ideas for the 4th of July
By Debbi Cooper, Iowa Safe Kids Coalition & IDPH Environmental Specialist Senior




C
        elebrating our nation’s       making noise and there are lots              and pie pans.
        birth should be fun and       of safe ways for them to do it.         •    Use horns, whistles, bells
        safe. Unfortunately,                                                       and cymbals.
consumer fireworks are not            •   Step or sit on inflated bal-
only dangerous enough to spoil            loons until they pop                Safe Sparklers
the fun, they are dangerous               (because of suffocation ha z-       The other component of fire-
enough to take lives.                                                                works is the glitter.
                                                                                     Here are some safe,
In July of 2000 a 15-                                                                fire-free suggestions.
year-old Des Moines
girl was killed and five                                                                • Use glo -sticks, glo-
others seriously injured                                                                ropes and glo-jewelry.
when a stash of fire-                                                                   • Give your kids flash-
works e xploded in the                                                                  lights, plain or with fil-
sport utility vehicle in                                                                ters made by wrapping
which they were riding.                                                                 the flashlight in colored
Except for caps, spar-                                                                  cellophane.
klers and charcoal                                                                      • Try neon and glow-
snakes, all fireworks are                                                               in-the-dark paint. Kids
illegal in Iowa, other                                                                  enjoy watching their art
than in supervised dis-                                                                 take on a special glow
plays.                                                                                  as the sky darkens.
                                                                                        • A jar of fireflies or
Even though sparklers,
                                                                                        lightening bugs can pro-
snakes and caps are le-
                                                                                        vide lots of fun. Na-
gal, they are still dan-
                                                                                        ture’s little sparklers
gerous. Sparklers,
                                                                                        provide a fun challenge
which can burn at 1,800
                                                                                        to your insect hunters;
degrees Fahrenheit,
                                                                                        just remember to re-
nearly hot enough to
                                                                                        lease the bugs before
melt gold, cause many
                                                                                        bedtime.
problems.
                                                                                        • Buy a novelty flash-
                                          ard, children under age 8
To help keep your celebrations                                                     light You can buy them with
                                          should be closely super-
safe try these suggestions.                                                        mirrors to bounce the light
                                          vised).
                                                                                   and changeable colored fil-
                                      •   Inflate small lunch bags.
Safe Sounds                                                                        ters or optic fibers that look
                                          Popping the bags makes a                 like sparklers but are much
                                          nice loud ‘BANG.’                        safer.
Part of fireworks’ attraction for  •      Buy noisemakers from a
children is the big noise that ac-        party store.
companies them. Kids love          •      Bring out your old pots, pans




Page 8
Farm Bill Promotes Healthy Iowans 2010 Objectives
By Louise Lex, Ph.D., Healthy Iowans 2010 Coordinator




T
      en percent of America’s           For example, this legislation re-      had their funding increased. All
      households, and almost 9          stored food stamp benefits to le-      of these programs are aimed at
      percent of Iowans, face           gal immigrants. A legal immigrant      reducing food insecurity.
hunger. They include the work-          who has lived in the United States
ing poor, single working mothers        for at least five years and has low    Healthy Iowans 2010 also in-
with children, seniors forced to        income may now receive food            cludes a goal to increase the
choose between paying for food          stamps just like other Americans.      proportion of people who con-
and paying for their prescription       In addition, legal immigrant chil-     sume at least five fruits and
medications, and families forced        dren and disabled persons are          vegetables per day and goals to
each winter to choose between           not subject to the five-year waiting   reduce overweight and obesity
heating and eating.                     period.                                among children and adults.

With this in mind, a nutrition          The Food Stamp Pro-
package worth $6.4 billion is in-       gram is an important
cluded in a new farm bill passed        work-support program.
by Congress and signed into law         People who are in the
by the president. The package           process of leaving wel-
aims to strengthen the nutrition        fare will now be able to
and food assistance safety net          receive transitional food-
for rural and urban Americans.          stamp benefits without
Various provisions of the farm          having to reapply. They
bill’s nutrition title are consistent   can now concentrate on
with the aim of both Healthy Io-        work, rather than on
wans and Healthy People 2010,           food-stamp rules and
to promote health and prevent           regulations. Also, bene-
disease.                                fits in the Food Stamp
                                        Program have eroded
The Food Stamp Program is one           over time. The bill will
of the most effective and efficient     adjust them for inflation
programs for low-income fami-           and increase benefits to
lies, the elderly and disabled. It is   adjust for family size. Food           Some provisions in the farm bill
a critical work support program,        Stamp Program rules are simpli-        will promote good nutrition and a
one that boosts low-income fami-        fied and better harmonized with        healthy weight by funding pro-
lies’ wages and helps poor fami-        other public-assistance programs.      grams to increase fruit and vege-
lies make ends meet and put                                                    table consumption.
food on the table each month.           Increased funding is also pro-         Through a new pilot program in
                                        vided for The Emergency Food           four states, including Iowa, chil-
To begin restoring cuts made in         Assistance Program --- the gov-        dren will receive free fresh fruits
welfare reform legislation in           ernment program that distributes       and vegetables throughout the
1996, reduce food insecurity            commodities to facilities that pro-    school day. Hopefully, this pro-
around the country, and meet the        vide food for those who need it.       ject will show that children will
Healthy Iowans 2010 goal of re-         In addition, other food assistance     eat more fruits and vegetables
ducing the incidence of food in-        programs, like the Commodity           when they are easily available
security to 5 percent by the year       Supplemental Food Program, the         and that there is an interest in
2010, significant changes were          Food Distribution Program on In-       reaching more children.
made to the Food Stamp Pro-             dian Reservations, and the Com-
gram.                                   munity Food Projects, have been        The bill also provides additional
                                        reauthorized and, in some cases,       funding for fruits and vegetables

Page 9
for school meals, including a          income women, children and              is essential that legislators, re-
doubling of funds for a joint          seniors buy fresh fruits and            searchers, and program designers
USDA/Department of Defense             vegetables.                             and directors use this guidance as
effort that delivers fruits and                                                a framework for progress. It is re-
vegetables to schools across the       The overarching objective of            warding that in the case of the
nation. This should enable Iowa        Healthy Iowans 2010 — “To Ad-           farm bill’s nutrition title, legislators
to participate in this popular pro-    vance the Boundaries of Healthy         worked with the nutrition and
gram. Finally, the bill provides       Living and the Quality of Life in the   health community to craft policies
funding for the both the Women,        New Decade” — can only be               that will help improve America’s –
Infants, and Children (WIC) and        achieved if the public health com-      and specifically Iowa’s – health
the Seniors Farmers’ Market Nu-        munity comes together to provide        and reduce hunger.
trition Programs, to help low-         guidance and direction. In turn, it


New office to fill several positions
By Jami Haberl, Office of Disease Epidemiology and Disaster Preparedness



I
   n October 2001, the director of     In addition to current staff within     Prevention (CDC) and Health Re-
   the IDPH, in consultation with      CADE, a public health veterinarian      sources and Services Administra-
   the governor, established an Of-    will be hired to train and educate      tion (HRSA) cooperative agree-
fice of Disease Epidemiology and       veterinarians on bio-terrorism. The     ments will fund a number of new
Disaster Preparedness (ODEDP)          veterinarian will also improve com-     positions for the CDOR. A Hospi-
and appointed Mary Jones as ex-        munication between the agricul-         tal Bio-terrorism Medical Director
ecutive director.                      ture industry and animal health         will be hired to provide medical di-
                                       communities and public health,          rection for hospital, emergency
Jones provides the organizational      and coordinate the development          medical services (EMS), and pub-
oversight and operational respon-      and testing of bio-terrorism re-        lic health bio-terrorism prepared-
sibility of the complete scope of      sponse plans with those in the ag-      ness. A strategic planner will be
disaster/terrorism activities within   riculture industry.                     responsible for developing com-
the context of the state’s overall                                             prehensive strategic work plans,
public health system. It is meant to   To meet local needs, regional epi-      monitoring plan progress and re-
ensure statewide preparedness          demiologists will be hired to pro-      porting to CDC on activities.
for, and response to, disaster/        vide training, education and re-
terrorism incidents. An advisory       sources to health-care providers.       A chief of operations will provide
medical group consisting of Dr.        They will provide the same to local     oversight for all state public health
Stephen Gleason, Dr. Patricia          public health personnel, law en-        emergency response operations,
Quinlisk, Dr. Cort Lohff, and Dr.      forcement, and first responders on      activation and deployment. This
Tim Peterson, and the hospital         disease surveillance and disease/       person will also be responsible for
disaster/terrorism preparedness        outbreak investigations. They will      Iowa’s Disaster Medical Assis-
medical director, will provide over-   coordinate bio-terrorism prepared-      tance Team (IA-DMAT) program.
sight for this new position.           ness and response planning at the       A logistics coordinator will assist
                                       local level and lead routine out-       with the state National Pharma-
Two centers are within the OD-         break investigations. The CDC           ceutical Stockpile (NPS), and
EDP, the Center for Acute Dis-         Cooperative Agreement for Public        serve as the logistics and equip-
ease Epidemiology (CADE) and           Health Preparedness and Re-             ment coordinator for all state pub-
Center for Disaster Operations         sponse for Bio-terrorism will fund      lic health response and planning
and Response (CDOR). CADE              these positions.                        activities. The Health Alert Net-
consists of two medical epidemi-                                               work (HAN) coordinator will be the
ologists, one veterinary epidemi-      The CDOR currently consists of a        state public health communication
ologist, three nurse epidemiolo-       program planner and administra-         and health-alert network coordina-
gists, one masters-level epidemi-      tive assistant. Funding from the        tor.
ologist, and a surveillance officer.   Center for Disease Control and

Page 10
To increase the technology and         will be support technician for local    Office.
communication capabilities across      public health and other partner
the state, four new positions will                                     Three staff members will be hired
                                       sites across the state. In addition
be funded within the information                                       to facilitate education and training
                                       this person will provide knowledge
technology department. A pro-                                          across the state. Two education co-
                                       on protecting data and information
grammer will be hired to improve                                       ordinators will be responsible for
                                       systems. An administrative assis-
the surveillance infrastructure that   tant will assist on the helpdeskplanning, coordinating, and deliver-
will allow for timely, complete and                                    ing educational programs to local,
                                       and take on related duties to com-
accurate reporting of diseases .                                       county, state public health agen-
                                       plement work throughout the infor-
This position will be responsible                                      cies, health-care practitioners and
                                       mation technology infrastructure.
for the development and imple-                                         local and county first responder
mentation of the proposed Na-       A public health risk communication agencies/organizations. An educa-
tional Electronic Disease Surveil-  coordinator will also be funded to tion assistant will assist the educa-
lance System (NEDSS).               be a liaison between the IDPH and tion coordinators.
                                    the firm responsible for producing
A business analyst will be hired to risk communication and health in- Together these two centers will
be the technical analyst and pro-   formation materials. Additionally, work on developing plans to re-
ject manager for disaster prepar-   this person will coordinate the    spond to bio-terrorism, other infec-
edness development efforts. This    state training sessions to educate tious disease outbreaks and other
person will also monitor implemen- local public health/emergency       public health threats and emergen-
tation progress and milestone       management professionals and       cies.
achievements. An information        coordinate town hall meetings in
technology connectivity specialist  conjunction with the Governor’s




Epidemiology Notes
From the Center for Acute Disease Epidemiology, Iowa Department of Public Health,
1 800 362-2736 (24-hour number)

Update on Hepatitis C Activi-          for hepatitis C. Developing goals       Hal Chase, Hepatitis C Coordina-
ties: The first meeting of a strate-   and objectives to integrate hepati-     tor with the Iowa Department of
gic planning committee to develop      tis C activities within all levels of   Public Health, at 515-281-5027 or
a response to hepatitis C was held     public health was discussed.            hchase@idph.state.ia.us
on May 1, 2002. The meeting was
well attended with participants        Educating physicians, mid-level         Reptile-associated Salmonel-
from state & local public health,      practitioners, health-care person-      losis: In the last several weeks
private citizens, physicians, edu-     nel, the general public, developing     we have received at least three
cators, and school nurses. A           prevention programs that reduce         reports of salmonellosis in infants.
presentation on hepatitis C and        new infections, and developing          Though the cases do not appear
treatment regimens was given, a        programs to identify and provide        to be related, all of them share the
personal account of experiences        medical evaluation and treatment        same risk factor - contact with
dealing with hepatitis C was           of people with chronic hepatitis        some type of a reptile. According
heard, and a staff person from the     were also discussed. The commit-        to CDC estimates, approximately
University Hygienic Laboratory         tee’s next meeting will be held on      7% of cases of salmonellosis may
gave an overview of the facility       July 2, 2002. If you, or someone        be due to contact with pet reptiles
and the laboratory tests required      you know, may be interested in          or amphibians. Many reptiles are
                                       being part of this process, contact


                                                                                                            Page 11
colonized with Salmonella spp.          anyone who was potentially ex-            mer Sun: Since Memorial Day
and intermittently shed the organ-      posed. Vaccine given within 4             marked the unofficial beginning of
ism in their feces.                     days after exposure can prevent           summer, we'd thought we'd pro-
                                        the disease or lessen symptoms.           vide some interesting and impor-
People become infected by ingest-       The vaccine does not contain              tant information to help everyone
ing Salmonella after handling a         smallpox virus.                           have a safe and healthy summer.
reptile or objects contaminated by
a reptile and then failing to wash      Further information on smallpox           Protecting Yourself from that
their hands properly. More infor-       can be found by accessing the fol-        "Stuff": With county fairs soon un-
mation on this subject, as well as      lowing links: http://www.idph.state.      der way and the state fair quickly
recommendations for preventing          ia.us/pa/ic/epifacts/smallpox.pdf ,       approaching, there are plenty of
transmission of Salmonella from         http://www.astho.org/about/media.         opportunities for kids to be kids--
reptiles to humans can be found at      html> or <http://www.cdc.gov/nip/         run around, get dirty, eat junk
http://www.cdc.gov/mmwr/preview/        smallpox/>                                food, and not necessarily care
mmwrhtml/mm4844a1.htm                                                             whether or not they're practicing
                                        West Nile Virus Identified in a           proper hygiene. Although most
Smallpox on "ER": The May               Dead Crow in Illinois: A dead             animals at fairs pose minimal risk
16th season finale of the NBC TV        crow collected in northwestern            (they have all been examined and
program, "ER," featured a story-        Kane County (Illinois) has been           approved by a veterinarian to par-
line about a possible smallpox out-     confirmed as the first bird in the        ticipate in the shows), there is a
break. It was quite dramatic - with     Midwest to test positive this year        chance that children (and adults
grotesque facial pox on children        for West Nile virus (WNV). In an-         as well) could come in contact
who recently returned from a for-       ticipation of further WNV activity in     with some zoonotic infectious
eign country, people trying to          the midwest (and Iowa) this year,         agents. Since animals do not
break out of quarantine, medical        IDPH and it's state and local part-       shower or bathe on a regular ba-
staff becoming ill, etc. In anticipa-   ners are planning to enhance sur-         sis, they often have dirt and fecal
tion of the show generating alot of     veillance and educational efforts.        material within their immediate
public concern, public health offi-                                               surroundings.
cials stressed the following few        Rabies Vaccines Misspercep-
facts about smallpox:                   tions: Had a caller with concerns         While this is generally not a prob-
                                        about the rabies vaccine. The             lem, it is possible for people to
1) Smallpox does not occur natu-        caller was under the impression           pick up this "stuff" while petting an
rally. Smallpox disease has been        that the shots were given into the        animal or by grabbing the animal
eradicated from the earth. There-       abdomen and were extremely                enclosure itself. Washing your
fore, a person cannot get smallpox      painful. This is a common misper-         hands with soap and clean water
by traveling to a foreign country,      ception (enhanced by old movies           is the best way to prevent con-
nor can they get it from people vis-    about rabies). The fact is that the       taminating yourself or others.
iting this country.                     rabies vaccine is given in a series       Hand-washing stations should be
                                        of five (yes- only five) shots into       provided in the petting zoo/barn
2) Other than through a criminal        the upper arm. These shots are            areas for easy accessibility. So,
act, the risk of exposure to small-     no more painful than a flu shot. In       while one should ALWAYS wash
pox is 0%. While the chance of          addition, rabies immune globulin          their hands after handling animals,
such an act occurring is very low,      (RIG) is given - one shot, with up        remember to do so before sitting
federal, state, and local govern-       to half infiltrated around the bite (if   down to enjoy a corn dog or funnel
ments are seriously working to en-      possible) and the other given in a        cake at your local fair.
sure that if such an act occurs we      large muscle, usually the upper
are prepared to deal with it quickly    thigh in small children. More infor-      Get out the fly swatters, cause
and effectively.                        mation on rabies can be found at          summer's here: With the start of
                                        http://www.idph.state.ia.us/pa/ic/        mosquito season, comes the risk
3) In the unlikely event of a crimi-    epimanual/Chp5.pdf                        of mosquito borne illnesses such
nal act resulting in exposure, vac-                                               as La Crosse Encephalitis and
cine would be made available to         Preparing for Fun in the Sum-             West Nile Virus. To reduce your


Page 12
risk of mosquito exposure, get rid     course a popular summertime ac-       mended minimum), and it's esti-
of standing water around your          tivity, but according to CDC esti-    mated that 1 out of every 3 Iowa
home, use insect repellents that       mates, some 15,000 people be-         children are overweight.
contain DEET (see attached fact        came ill during the past decade
sheet), dress properly to minimize     from swimming. In order to pre-       Overweight and unfit people are
exposed areas of skin, and avoid       vent such illness, the CDC has        more likely to have health prob-
being outside during the times         several resources available.          lems including high blood pres-
mosquitoes are most active (dawn       These can be found at http://www.     sure, diabetes, heart disease,
and dusk).                             cdc.gov/healthyswimming/              stroke, arthritis and some cancers.
                                                                             In Iowa the cost of sedentary life-
Summer Food Safety: With sum-          Another Great Lice Paper:             styles exceeds $1 billion dollars
mer here, people are turning their     The New England Journal of Medi-      per year. If this trend continues,
attention to cookouts and picnics.     cine (NEJM) has published a terri-    this epidemic of overweight and
While these are great summertime       fic paper on head lice in the May     unfitness will soon overtake smok-
activities, they can also invite       23rd issue. The author, Richard       ing as the leading cause of death.
foodborne illness if not careful.      Roberts, from North Wales, U.K.,      At a summit, attended by medical,
The main areas of concern for          reviewed treatment management         industry, health, community and
summer food preparation are the        available to patients in the U.S.     government leaders, the Governor
length of time and the temperature     and rates malathion "good," per-      proclaimed "Move for Health Day.”
foods are allowed to sit at, the       methrin/pyrethrin as intermediate,"
temperature they are cooked at,        and wet combing as "poor." Not to     To those attending the summit, he
and the availability of hand wash-     worry, we have been advocating a      stated, "I am keenly aware of the
ing facilities.                        combination of pyrethrins and wet     emerging epidemic of overweight
                                       combing for the past five years.      and obesity that is consuming our
It's Time to Get "Ticked Off": Ac-                                           state, and the challenge it pre-
cording to Dr. Wayne Rowley,           Of interest, Roberts, expresses       sents to Iowans' health and well-
medical entomology professor at        obvious displeasure with "no-nit"     being. As leaders in your organi-
ISU, "The chance of a person liv-      policies in the U.S. His last para-   zations and communities, you can
ing in central Iowa being bitten by    graph reads, "In 1998, half the       raise awareness and motivate
an infected deer tick (with Lyme       school nurses in the United States    change on a number of fronts.
Disease) is remote." What are the      would not allow a child with nits     Therefore, I am charging this Pub-
best protective measures? Dr.          back in school. Excluding children    lic Health Summit with developing
Rowley offers, "In my opinion, hik-    from school because of head lice      a strategy to address the issue
ers, campers, people who fish,         results in anxiety, fear, social      and change the shape of our fu-
golf or enjoy the outdoors in any      stigma, overtreatment, loss of edu-   ture. Your efforts can result, not
way should not be fearful of con-      cation, and economic loss if par-     only in reducing health-care costs,
tracting Lyme disease. A good          ents miss work - a classic case of    but also in helping Iowans live
idea is to take a hot shower in the    the cure being worse than the dis-    more fulfilling lives."
evening after being out in the         ease. Management should not
woods and check yourself for           harm the patient more than the        Addressing this epidemic will take
ticks. Another preventive measure      pest." This paper is required read-   multiple strategies, many people
is to apply a DEET-based mos-          ing for anyone who deals with this    and resources. Thus, the Iowa De-
quito repellent to shoes, socks and    pediatric problem.                    partment of Public Health is look-
lower legs before going into the                                             ing for ideas, community efforts,
woods. However, Lyme disease           Epidemic of Obese and Unfit           and some good people to help. If
infected ticks are not common in       Iowans: Did you know that 60%         anyone is interested in becoming
this state and there are no scien-     of adults in Iowa are overweight,     involved (or just wants to find out
tific data to substantiate the idea    88% of Iowans do no regular and       more), contact Tim Lane at
that they are a "threat" to most Io-   sustained exercise, 82% of Iowans     tlane@idph.state.ia.us.
wans."                                 consume less than 5 fruits and
                                       vegetables a day (the recom-
Swimming safety: Swimming is of


                                                                                                         Page 13
Worth Noting
Home Care Aide of the Year - Jo Ellen Howard of Boone County Hospital Home
Health in Boone recently received the national 2002 Home Care Aide of the Year
Award on behalf of the National Association for Home Care and the Home Care Aid
Association of America.

Howard has been a home care aide for 20 years. She was nominated for the award
by her peers and customers for her dedication and leadership. Aids from about 30
other states were nominated for the award.
                                                                                         Jo Ellen Howard
IDPH Doctor Named to National Committee - Dr. Tim Peterson, chief and medi-
cal director of the Bureau of Emergency Medical Services at the Iowa Department of Public Health,
has been named a representative to the federal Health Resources and Services Administration’s
new National Trauma Advisory Committee.

               The committee will advise the federal government on policies for trauma-system de-
               velopment throughout the nation. It will also provide a locus for coordination of the
               work of federal agencies and professional organizations with injury-related programs.
               Iowa is among the first in the nation to develop an all-inclusive trauma system and is
               a model for the nation.

                 Dr. Peterson was principal investigator for the Iowa Trauma System Development
                 project from 1991 to 1995, and since then has been chairman of the Trauma System
Dr. Tim Peterson Advisory Council (TSAC) and medical director of the Iowa EMS/trauma system. The
Health Resources and Services Administration is part of the federal Department of Health and Hu-
man Services.

Governor’s Golden Dome Award Winners - IDPH’s Julie McMahon, Division Di-
rector of Family and Community Health, received the Leader of the Year Award for
her 32 years of revolutionizing public health services in both local and state govern-
ment.

              IDPH’s Pat Young, HIV/AIDS program, received the Employee of the
              Year Award for her efforts in helping create a state-wide plan for HIV
              prevention, which is used by the CDC as a model for other states to fol-
              low.                                                                     Julie McMahon




  Pat Young




Page 14
Side Notes
Patient Safety Conference       - This iMAPS event is June 12 from 8 a.m. to 5:30 p.m. at
the Four Points Sheraton in Des Moines. Iowans Mobilizing Action For Patient Safety
(iMAPS) is comprised of the Patient Safety Team at the Iowa Department of Public Health,
the Patient Safety Advisory Committee which is composed of many provider groups and
business leaders, and the University of Iowa-College of Public Health. This conference will
present results and updates on completed and ongoing patient safety research. Also in-
cluded will be an update by the CDC on new issues effecting patient safety in Iowa and the
entire country. For a conference brochure see www.idph.state.ia.us/dir_off/CSHA/
psconference.htm. For questions, contact Joe Kane at 319 363-2531.

I-CASH accepting entries - Iowa's Center for Agricultural Safety and Health (I-CASH) is
accepting nominations for its new Agricultural Safety and Health Hall of Fame Award. The
award recognizes individuals and/or organizations in Iowa who have made substantial and
long-term contributions to the health and safety of the state's agricultural community. Nomi-
nation deadline is July 1. Those nominated should have contributed in a leadership role to ag-
ricultural safety and health prevention through promotion or awareness activities for five or
more years. The recipient will receive a $100 cash award at a ceremony during Farm Safety
Week. Nomination forms are available at www.public-health.uiowa.edu/ICASH/
Hall_of_Fame_Award.html, or contact Eileen Fisher, Ph.D., associate director of I-CASH, at
319 335-4224 or eileen-fisher@uiowa.edu.

U of I College of Public Health Summer Institute - The University of Iowa College of
Public Health is offering the following graduate courses during their fist summer institute.
1) Intro to Public Health Practice—Web-based class with ICN session July 8 to Aug. 16.
   Sites include Spencer, Council Bluffs, Sioux City, Mason City, Cedar Falls, Ames, Des
   Moines, Dubuque, Bettendorf, Ottumwa, Creston, and Iowa City.
2) Environmental Health—ICN class July 8 through August 2. Sites include Iowa City, Cedar
   Falls, and Ames.
3) Intro to Biostatistics—Main campus, July 8 to August 16. M T W Th F, 1:30 to 3 p.m.
4) Epidemiolgy I: Principles - Main campus, July 8 to August 16. M T W Th F, 3:30 to 5 p.m.
5) Seminar in Patient-oriented Research, Lecture & Discussion - Main campus, July 8 to
   16. M T W Th F, 8 to 10 a.m. Open to K30 participants and selected other clinicians train-
   ing for careers in patient-oriented research. Courses are taught in seminar discussions. See
   http://www.medicine.uiowa.edu/gtpci/
6) Seminar in Patient-Oriented Research Data Analysis—Main campus, July 8 to 16. M T
   W Th F, 10:15 to 11:45 a.m. Open to K30 participants and selected other clinicians training
   for careers in patient-oriented research. Courses are taught in seminar discussions. See
   http://www.medicine.uiowa.edu/gtpci/

For more information on the above classes see Http://www.public-health.uiowa.edu/
mphdegree.html or e-mail barbara-brown@uiowa.edu.

2002 JEL Summit - The JEL (Just Eliminate Lies) Summit July 23-25 at Iowa State Univer-
sity will focus on anti-tobacco advocacy and education. For more information or an application
go to www.jeliowa.org and click on JEL Summit 2002.

Page 15
UI College of Public Health Offers New Certificate - Starting fall 2002, a 12-hour Cer-
tificate in Public Health will be offered by the college. Although intended for current members of
the public health workforce, it also is available for qualified individuals considering a career in
public health. Students have up to five years to successfully complete the certificate program.
Courses will be offered via ICN, Internet, or both. For more information, contact Barbara
Brown, Graduate Studies Coordinator, at 319 335-8992 or 1-800-553-4692, ext. 5-8992, or at
barbara-brown@uiowa.edu.

Required Courses (6 hours) 170:101 Introduction to Public Health Practice, 3 s.h.; 170:099 Ev i-
dence-based Public Health Methods, 3 s.h.
Additional Courses (6 hours required from the following) 172:101 Introduction to Health Promo-
tion and Disease Prevention, 3 s.h.; 174:102 Introduction to the Health Care System, 3 s.h.; 175:197
Environmental Health, 3 s.h.

Summer School for Helping Professionals - The 23rd Annual Summer School for Help-
ing Professionals at the University of Iowa Aug. 5 to 8. There are two day workshops, two two-
day workshops, and a four day workshop. For more information on classes and registration
costs call 319-335-4141, 1 800-551-9029, or go to http://www.uiowa.edu/~asshp/. Cost of
registration changes after June 15. Co-sponsors include: The University of Iowa College of Edu-
cation, Counseling, Rehabilitation, and Student Development; Juvenile Justice Advisory Council,
Division of Criminal and Juvenile Justice Planning; Iowa Department of Public Health, Division of
Health Promotion, Prevention, and Addictive Behaviors, Iowa Substance Abuse Program Direc-
tor’s Association.

Iowa HIV Conference 2002 - Successes, Challenges and Renewed Commitment, October
8 and 9 at the Holiday Inn Airport in Des Moines. The conference will include information on
HIV prevention interventions, care and treatment updates, turning theory into practice, reach-
ing at-risk populations, and networking with peers. Substance abuse, social work, and nursing
CEUs available. Sponsored by the Iowa Departments of Public Health and Education, and HIV
Community Planning Group. For more information, call 319-363-2531 or go to www.
trainingresources.org. For hotel information call 1 800-248-4013.

Changes at ISAIC - The Iowa Substance Abuse Informatio n Center will no longer have a
printed quarterly newsletter, instead they are going online. To find the newsletter, go to www.
drugfreeinfo.org, or to have the next issue e-mailed to you send your e-mail address to
isaicmail@mail.crlibrary.org.


Iowa Dept. of Public Health
                                                FOCUS Editor: Kara Berg
Lucas State Office Building
321 E. 12th St.
Des Moines, IA 50319-0075                       What would you like to see in Iowa
Phone: 515 281-5787                             Health FOCUS? Send your suggestions
                                                for future articles, letters to the editor,
                                                and upcoming events or to add names
    Check out our web site                      to the mailing list by e-mailing us at
    at www.idph.state.ia.us                     kberg@idph.state.ia.us.


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