health | winter 2015

SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION

STAY HEALTHY

4 COLD AND FLU OampA Winter is coming protect yourself by S11sa11 Peck RN

PAST LESSONS

6 IN GOOD HANDS The history of hand washing by William Clayto11 Petty MD

FLU HISTORY

8 THE FLU PANDEMIC OF 1918 A Utah retrospective

by Twila Va11 Leer

VACCINATE

1 o GIVE IT A SHOT A journalists perspective by M Sue Bergi11

VIRUS

12 EBOLA The sto1y behind the hype by Li11da Rider RN BSN CIC

GOA L S

14 WINNING THROUGH CONSISTENCY Advice on setting your workout goals by Eric Houle

F A MILY E X ER C I S E

16 WINTER WONDERLANDS Staying active during cold weather by David Heaton

SA FE E A TIN G

18 DONT FEEL GRINCHY Holiday Food Safety Tips by Robert Beers

E A TIN G RI G HT

20 TIS THE SEASON FOR ADDED SUGAR Balancing your intake of sweets by Sara Fausett RD CD

HE A LTH LITER ACY

22 HIDDEN BIAS Health screening mis-conceptions

by David Blodgett MD MPH

FOLLOW SWUHEALTH

BED BUGS

24 GET THE BUGS OUT Tips from a health inspector by Slwlle11 Sterner

DROWSY DRIVING

26 THE A THROUGH ill71S Confessions of a sleepy driver by Jorda11 Merrill

PREPARE

28 WINTER ON THE ROAD How to pack your car for winter

emergencies by Paulette Vale11ti11e

QUESTIONS OR COMMENTS Email dheatonswuhealth org

---- ON THE COVER ----

WINTER WONDERLANDS Special thanks to Erin Mark and baby Lincoln Taylor for snowshoeing duough a winter sunrise Sto1y on page 16

Stereogram on page 22 sse1grno11 cmutesy of easystereogrambuilde1com

PUBLISHER

Jeff Shumway

MANAGING EDITOR

David Heaton

DESIGNER

Kindal Erickson

Jeff David Chrigt Dr Blodgett Todd amp Kinda

FOUNDATION BOARD

David Blodgett MD

Chris White

Jeff Shumway

Todd Stirling

sectOlJTHWEsectT UTAH PUBLIC HEALTH IFOlJNDATliON

lm pleased to introduce the ninth issue of Health to the residents of the five counties served by the Southwest Utah Public Health Department (SWUPHD) Those of us involved in public health realize that the better we do our job the less youll probably hear about it Insuring the safety of air water and food along with the prevention of contagious or chronic diseases is often a behind-the-scenes business

This publication is part of our ongoing effort to get health-promoting information into the hands of our community members to assist you in making the best health decisions for you

and your family We can do our best to present meaningful evidence-based information but its up to you to take action Its our goal to help you do that

Sincerely

David W Blodgett MD MPH SWUPHD Health Officer amp Director

The entire contents of this publication are Copyrightcopy 2014-2015 Health (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner either in whole or

in part without prior written permission of the publisher Health magazine hereby disclaims all liability and is not responshysible for any damage suffered as the result of advertizements claims and or representations made in this publication

NEED A RU SHOT Locations amp Hours (see page 30 for addresses)

SUSAN PECK RN

SWUPHD SURVEILLANCE NURSE

WHT YH NHD TO KNOW

Every year we see our share of colds and flu in southwest Utah Its difficult to predict how seshyvere cold and flu season will be or which illnessshy

es will circulate but here is some basic information that should help keep you and your family healthshyier this year

Visit your nearest health department office and get immunized against the flu

$18 or NO CHARGE with the following insurances Altus Arches CHIP DMBA Medicaid Medicare PEHP SelectHealth Tall Tree or United Healthcare

ST GEORGE Walk-In Monday Wednesday amp Thursday (730 AM - 500 PM) Tuesday (100 PM - 500 PM) Friday (800 AM - 430 PM)

CEDAR CITY Walk-In Monday Wednesday amp Thursday (730 AM - 500 PM) Tuesday (100 PM - 500 PM) Friday (800 AM - 430 PM)

KANABcall 435-644-2537 for nurse availability I BEAVERcall 435-438-2482 for nurse availability I PANGUITCHcall 435-676-8800 for nurse availability

4 HEALTH I WINTER 2015

When exactly is cold and nu season We start seeing an increase in cases after the weathshyer gets cooler in the fall People usually start spendshying more time indoors in closer proximity to others making it easier to spread germs Flu season typically starts in the fall peaks in February then drops off in the spring

How are these illnesses spread Usually through dropshylets from coughing and sneezing and germs left on hard surfaces like toys countertops and door hanshydles You can get sick if you get caught in the line of fire of a sneeze or touch your eyes nose or mouth after touching an infected surface

Whats the difference between a cold and the nu Both are viruses but typishycally the flu (or influenza) is worse with rapid onset of symptoms that include fever body aches headshyache sore throat fatigue and dry cough The flu can keep you bedridden for several days to a coushyple of weeks The common cold is usually milder with congestion runny nose and wet cough and its unshylikely to cause more serishyous complications like the flu can

What is EV-068 EV-D68 is one of over 100 enteroviruses (which inshyclude the common cold pinkeye and meningitis) It got a lot of attention this past summer and fall because although it had been rare in the past EVshyD68 caused a nationwide outbreak of respiratory illshyness which affected mostly children especially those

with asthma Prevention and treatment of EV-D68 is the same as those for colds and flu

What is the stomach nu There really is no stomach flu These are gastrointesshytinal illnesses that can be caused by viruses bacteria or parasites Often its a case of food poisoning and its not uncommon to see an increase in cases during the holidays when people gather to eat

How can colds and nu be prevented Get the annual flu vacshycine Practice frequent and thorough hand washing Keep your hands away from your face and avoid contact with sick people If you do get sick stay home from work or school and cover your coughs and sneezes with your arm

Can I still get a nu shot Yes The health departshyment still has a supply of flu vaccine including the High-Dose vaccine for people 65 and older which offers them better immushynity Many health care providers and pharmacies also offer the vaccine

What can I do if I get a cold or the nu Its the tried and true method of getting plenty of rest fluids and proper nutrition that help you get better sooner You can also treat symptoms with over-the-counter remedies You dont need to go to the doctor unless symptoms are severe Influenza can be treated with anti-viral medication at a doctors discretion but most people recover at home Antibishyotics are useless against a cold or the flu -

PREVENT WHY YH NHD TO DO

DRINK plenty of fluids

COYER when coughing amp sneezing

WASH your hands

STAY at home and recover

for the flu

JO PR(Y(NT COlD amp fl~ SWUHEALTHORG 5

WILLIAM CLAYTON PpoundTTY MD

APPOINTED BOARD MEMBER SWUPHD

TH( HISTORY Of HAND WASHIN~

Ignaz Semmel weis (1818-1865)

Men women and children have always washed their hands when covered with

mud dirt or other undesirshyable solids But it was not unshytil 1847 that the link between hand washing and disease was documented

In 1199 the renowned Arabic physician Moses ben Maimon wrote that one should never forget to wash your hands after touching a sick person There was no scientific evidence for his recommendation but this did not deter him from teachshying that cleanliness was the physicians best friend In his own practice he even went one step further I dismount from my animal wash my hands go forth to my patients

The link proving that hand washing could deter disease begins with the story of childshybed or puerperal fever a bacterial infection contracted by women during childbirth The first known documentshyed evidence of childbed fever was reported in Paris in 1646 Hospitals throughout Europe

and America in those days were reporting between 20 to 25 death rates among women giving birth in hospitals Ocshycasionally there were fatality reports of up to 100

Dr Alexander Gordon of Scotshyland said in 1785 I myself was the means of carrying the infection to a great number of women Fevers were thought to be the result of an infecshytious process even though bacteria had not yet been disshycovered Some physicians of the era felt that childbed fever might be associated with conshytagion and poor hygiene

In 1822 a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the odors of human corpses He postushylated that physicians attending patients with contagious disshyeases would benefit by using a liquid chlorinated solution on their hands

In London Dr Thomas Watshyson recommended that practishytioners who attended birthings


should wash their hands with a chlorine solution and reshyquire obstetrical attendants to change clothes One year later in 1843 Dr Oliver Wendell Holmes of Boston concluded that childbed fever was carshyried from patient to patient by physicians and nurses He suggested that doctors should avoid performing autopsies beshyfore attending births and that all medical staff should wear clean clothing

Author Richard Gordon (Great Medical Disasters) describes conshyventional physician hygiene at the time Cleanliness was next to prudishness there was no object in being clean indeed cleanliness was out of place It was considered to be finicking and affected An exshyecutioner might as well manishycure his nails before chopping off a head Surgeons opershyated in blood-stiffened frock coats - the stiffer the coat the prouder the busy surgeon

Dr Holmes was a crusader for his beliefs and asserted that if a physician had two cases of

childbed fever in his practice within a short time he should remove himself from obstetshyrical duty for a month Such outrageous recommendations were not accepted by his peers Without scientific studies to back up his views he suffered vicious criticism and mockery by other doctors Dr Charles Meigs a leading obstetrician in Philadelphia chided him in a letter Doctors are gentleshymen and gentlemens hands are clean

The link between hand washshying (now referred to as hand hygiene) and disease was finalshyly provided by the work of Dr Ignaz Philipp Semmelweis In 1847 while Dr Semmelweis was working as the Assistant Chairman of Obstetrics at the Vienna General Hospital his good friend Professor Jakob Kolleschka cut himself while doing an autopsy After he died his autopsy showed the same changes as victims of childbed fever Dr Semmelshyweis linked this observation to the difference he noted in the death rates of mothers in the

two obstetrical wards of the hospital

In one ward the mothers were delivered and attended to by student midwives while in the other ward the mothers were delivered and attended to by medical students The death rate in the midwife ward was 285 but on the medical student ward it was a dismal 1125 The medical students were performing aushytopsies in the early morning and then going to the obstetshyrical ward delivering babies and doing vaginal examinashytions on post-delivery mothers No hand washing was done at any time by the midwives the medical students or the attending physicians Dr Semshymelweis postulated that cashydaverous particles were being transmitted on the hands of the medical students from the autopsied corpses to the mothshyers After experimenting with various solutions to cleanse the hands he required medishycal students wash their hands with chlorine waterchlorinatshyed lime solution before start-

ing ward work and before each vaginal examination

The first month after hand washing was instigated the mortality rate in the medical student ward dropped to less than 3 and remained there for the next seven months Yet Dr Semmelweis received only criticism from his colleagues for his efforts The contenshytion became so intense that he left for Pest Hungary in 1850 where he accepted the Chair of Obstetrics at the St Roch us Hospital The death rate in the obstetrical wards he oversaw dropped to 082 In 1861 he wrote a classic paper entitled The Etiology the Concept and the Prophylaxis of Childbed Fever

Dr Semmelweis adamant and outspoken defense of proper hand washing in preventing childbed fever may have played a role in his death He became outraged at the indifference of his fellow physicians and beshygan writing letters to promishynent European obstetricians denouncing some as irresponshysible murderers In 1865 his

wife and contemporaries felt he was losing his mind and admitted him to an insane asyshylum where he died 14 days latshyer from either being severely beaten by hospital personnel or from a wound to his hand Dr Semmelweis has since beshycome known as the Savior of Mothers

Although bacteria originalshyly called animalcules were discovered in 1683 these mishycroorganisms had not yet been linked to disease In 1880 Louis Pasteur a French mishycrobiologist and chemist reshyported his observations on a series of mothers who had died from childbed fever He took blood and pus samples from the deceased and cultured them He then observed the cultures under a microscope and noted that parasites in long chains appear as little tangled packets like tangled strings of pearls These long chains were bacteria later called streptococcus

The link between bacteria and disease had been established

Pasteur and his German conshytemporary Dr Robert Koch are regarded as the fathers of germ theory and bacteriology Evidence was now available to convince doctors and nursshyes that they were responsible for transmitting streptococcus from patient to patient in the hospital The solution Simple hand washing

Medical science and hygiene have come a long way since then but the basic practice of routine hand washing remains Dr Oliver Wendell Holmes could well have replied to his snobbish acquaintance Docshytors may be gentlemen but their hands harbor bacteria-

Dr Petty pmcticed a11esthesiology for 15 years a11d ta11ght at fo11r US 1111iversities for 12 years He served over 20 years i11 the US Navy a11d was promoted to the m11k of captia11 Dr Petty fins a11thored three books 1111111ero11s articles mid has lect11red extensively i11 40 co1111tries His wife Zoe joi11ed hi111 for seveml years of vo1111teer h1111w11itaria11 work developi11g 11eo11atal resuscitatio11 programs i11 the Middle East a11d Africa i11 additio11 to a Visiti11g Professorship at the Ki11g H11ssei11 Ca11cer Center i11 A111111a11 Jorda11 Dr Petty is wrrently retired a11d resides i11 Cedar City Utah

SWUHEALTH ORG 7

This article was originally published in the Deseret News (Tuesday March 28 1995) under the title Flu Epidemic Hit Utah Hard in 1918 1919


TWILA VAN LEER

DESERET NEWS COLUMNIST

I

A UT AH HTRISP(~TIY( Many towns are closed by order of

health board Theaters churches and all public gatherings under ban for present

Spanish influenza rapidly spreading -Deseret News Oct 10 1918

World War I was ending but anshyother scourge influenza stood in the wings as if waiting specifshy

ically to stymie the worlds search for long-awaited peace Spanish influenshyza so called because 8 million people in that countly suffered its ravages was spreading its tentacles into most of the nations of the globe

In September 1918 with the Allies nearing vict01y over the Central Powers the virus spread to China Africa Brazil and the South Pacific infecting millions

Soldiers returning from the front brought it to the US Midwest Then from Boston Philadelphia and New York the disease spread until all of the countly including Utali was in the grip of the worst pandemic since the Black Death (bubonic plague) of the 1400s Over the next year a fifth of the worlds population suffered More than 21 million died includshying 675000 Americans - 10 times as many as died in the world war

More than half of the US soldiers who died in Europe succumbed to the virus and not to enemy action Tens of thousands of milita1y deaths resulted from a virus so small that 30 million could fit on the head of a pin

In Salt Lake City LDS faithful were gathered for regular semiannual conference meetings when the first signs of the outbreak were rep01ted on Oct 3 Within four weeks more than 1500 cases had been documentshyed with 117 deaths and the numbers continued to grow spreading from the urban centers to vi1tually eve1y community in the state

Health officials marshaled their forces for the battle In Ogden with both local hospitals full the LDS 3rd Ward amusement hall became a temshypora1y care center My1tle Swainshyston a recent graduate of LDS Hosshypital School of Nursing in Salt Lake City took charge Her sala1y and the costs of the emergency hospital were shared by the American Red Cross Ogden City and Weber County

Miss Swainston had her work cut out for her The day after her arrival Ogden had 40 new cases With a few hospital beds from Fmt Douglas and donated sheets blankets and other items she coped Over the course of the outbreak several hospitals exshypanded or set up se1vices in public buildings including churches TI1e Judge Memorial Hospital in Salt Lake City which had been closed a short time earlier reopened to make room for the ill

Not all health officials were agreed as to how the epidemic should be handled The state health deshypattment order to close all public places was abshysolutely ridiculous and absurd Such an action can be merely due to hysteria for a disease no more threatening than the measles said Salt Lake Health Director Samuel G Paul

But by the time the flu had run its course thoushysands of Utahns were dead - about 4 percent of all those who contracted the disease Utah was third behind Colorado and Pennsylvania in the rate of deaths

Twila Peck now 89 reshycalls the outbreak in the Tintic Mining District Her father was stricken and her mother nursed him back to health Other family members escaped but she rememshybers looking through a neighbors window to see a young mother with her infant both laid out in the living room awaiting burial

We had to play by ourshyselves and if we went anyshywhere we wore inasks Peck said As it became apparent the epidemic was going to leave no Utal1 community untouched local officials set down stringent rules Stricken homes had to display large quarantine signs

Gauze masks provided by the health depattment were to be worn in the sick room and when in pubshylic Streetcar conductors were instructed to limit the number of riders Stores couldnt hold sales and funeral services were limited to a half hour later reduced to 15 minutes and no more than three veshyhicles could accompany the hearse to a burial place

LDS Church President Joseph Fielding Smith died in November 1918 and his funeral also was restrictshyed to a handful of family members

As conditions worsened the rules were more vigshyorously enforced A barber who refused to wear a mask was fined $10 Police arrested the proprietor of a Salt Lake City soft drink establishment along with seven card-playing customers A farewell patty for one Salt Laker was raided and all 16 present would have been nabbed if five had not bolted out a back door TI1e city put on 100 extra officers to enforce the flu rules

A local newspaper repmter commented on the eerie sense of desettion on downtown Salt Lake streets Along eight blocks of Main Street he spotted one human wearing a mask - a guard checking business doors - and two black cats

But the ban on public assemblies was hard to enshyforce when news of the Nov 11 armistice ending the war was announced People went mad in the streets of Utahs communities restrictions or no Health officials tried to cancel parades but city ofshyficials insisted Influenza cases were on the decline anyway they argued

After the happy chaos of Armistice Day flu took hold again and the dispensations that had been allowed as the disease declined were replaced with even tougher guidelines

The nursing shmtage was so acute that the Red Cross asked local businesses to alshylow employees to have a day off if they would volunteer at hospitals during the night

Whiskey considered one of the more effective remshyedies was hard to come by The states were then in the process of ratifying the 18th Amendment to the US Conshystitution outlawing alcohol Liquor was contraband But some officials released whisshykey to medical personnel for use as medicine

One Ogden man who went to comt inebriated tried to conshyvince the judge he was only trying to fend off the influshyenzy But the judge decided the dosage was overlarge and sentenced the man to a $50 fine or 30 days in jail

Liquor aside the usual treatshyment was bed rest in a cool room plenty of liquids and hot packs to break up chest congestion Vicks VapoRub was in such demand across the country that it became

hard to find Dr Kilmers Swamp Root was offered as a curative for the kidneys after an attack of the grip and Eatonic could help millions suffering the aftereffects of flu by removing acidity and poisons its makers advettised

Panguitch the last Utah town to be struck out until a returning soldier brought

held

PREVENT The epidemic played hob with the 1918 fall elecshytions as would-be officials were stymied by their inability to meet with voters Many simply quit campaigning

Patticularly hard hit were Indian reservations An estimated 2000 Navajo Indians in southern Utah and nmthern Arizona died and 62 deaths were reshycorded on the Uintah Resetvation including Ute Chief Atchee In the four-corner states Utah Coloshyrado Arizona and New Mexico 3293 American Inshydians died Their natural outdoor lives that exposed them to the elements along with failure to undershystand health precautions contributed to the rate

A solar eclipse earlier that summer was blamed by many Indians who saw it as an omen of a challengshying time to come Some white people on the other hand tended to blame the epidemic on the smoke and fumes generated by the war

Christmas 1918 gave the epidemic a fresh statt as groups gathered to celebrate the holiday In Salt Lake City 106 new cases were repmted with 46 in Ogden

In January the return of the 145th Light Field Arshytillery Regiment composed primarily of Utah boys was another temptation for people to gather The regiment had seen no action although it had been in France Its only casualties were 14 flu-related deaths

But Utahns were caught up in the post-war fever and despite discouragement from health officials they again lined streets in Ogden Logan and Salt Lake City to greet the returning warriors A new outbreak of the flu followed within a few days

In the spring of 1919 the epidemic began to wind down although there was another less lethal surge of the disease that winter From September 1918 to June 1919 Utal1 registered 2343 deaths from flu In 1919 the state had the second highest death rate from the disease in the country with 1802 deaths per 100000 population TI1e only state that _ exceeded that rate was South Carolina with 1893 I-

the virus home with him and shared it with others at a homecoming patty Even the small community of Escalanshyte repmted 200 cases at one point

Ml~~ Y lAMB~ON W(NT TO TH( DOtTOR In Blanding the local store ownshyer was stricken and his family made the key available to needy shoppers who promised to take only what they needed and pay for it when he was up and about again Everywhere church members and community groups all rallied to help one another through the height of the epidemic

Ogden and Park City tried to confine the disease by requiring that anyone entering their towns have a cettificate signed by a doctor assuring that they showed no sign of flu Railroads were warned not to accept passengers who had no such cettificate and masks were to be worn by those who were allowed in

State health director TB Beatty huffed off to Ogden to plead for a more rational approach but after a meeting with government and health officials he returned to Salt Lake with nothing accomplished

I want to know if influenza can be transmitted by kissing

Beyond a doubt Miss Lambson

Well a boy with a pronounced case of flu kissed me 11

So How long ago was this

Well lets see I think it was about two months ago

Why Miss Lambson no hann can come fran the exposhysure It is quite too late

I knew it she sighed But I just love to talk about it

-Published 1920 in Agricula (Branch Agricultural College now Southem Utah University)

SWUHEALTH ORG 9

This article was originally featured in BYU Magazine (Fall 2014 pp 24-25) under the title Immunization Misconceptions A wealth of well-researched information on vaccines can be found at morebyueduvaccines

M SUE BERGIN

Writer and hospice chaplain Sue lives in Orem Utah and has written for BYU Magazine the Enshysign the San Francisco Chronicle The Wall Street Journal and Psychology Today

the truth about vaccines is a matter of life and death

1 Q HEALTH I WINTER 2015

Beth Luthys first child was born with a rare bile duct disorder that destroyed his liver by the time he was a year

old He was able to get a liver transplant but the battle was just beginning Because little Michael had to take immune-supshypressing medications to prevent his body from rejecting his new liver he could not be immunized and he could not fight off infections

Luthy had hoped that her vulnerable infant would be protected by the herd effect-if a high enough percentage of

people around Michael were vaccinated contagious diseases would be unlikely to spread to him Instead he caught eve1yshything He got chicken pox and it landed him in the ICU she says He caught whooping cough and he was sick for six months-in the hospital for about half of that It went on and on

As Michael Luthy now a healthy 26-yearshyold grew up his mother became a school nurse Now a nurse-practitioner and asshysociate professor in the BYU College of Nursing she works to spread the word that

childhood vaccines are safe She understands the concerns many parents have but wants them to know that the science behind immunizations is solid and the truth about vaccines is a matter of life and death

Myth 1 Vaccines Cause Autism Only one study linking one immunization (the MMR vaccine-measles mumps rubella) to autism has even been published in a respected scientific journal The Lancet and that article was retracted in 2010 after editors discovered the study was not simply flawed but fraudulent In contrast multiple studies involving several hunshydred thousand children conclude that the rate of autism in immunized children is the same as it is in unimmunized children

So why does the belief that vaccines cause aushytism persist Luthy believes it is partly because correlation-observing that one event follows another-is powe1ful You get your first MMR vaccine at about 12 months and thats also right around the same time that the first signs of aushytism show up So it would be natural to connect the two she says Correlation however is not the same as causation

Personal experience too can sometimes trump science Ben Moulton didnt question vaccines with his first child but as time went on and both his first and second child began showing developmental problems and behaviors on the autism spectrum he began to wonder about vacshycines Not knowing where to point the blame I started looking toward all the immunizations the children got at once as a potential culprit

There is no connection Luthy says but parents want so much to protect their children If they can find the cause for illness in one child they reason perhaps they can prevent it in their next child I understand the fear I was a mother with a child with an illness and nobody knew why she says So I looked for reasons on my own

Another factor in the endurance of this myth is distrust of the pharmaceutical industry Some people call it Big Pharma-the idea that drug companies fund the vaccine studies and skew them because they want to make money off of our children But thats just not true Pharmashyceutical companies make much less from vacshycines because the research is so costly and the profits are sparse

Myth 2 Young Immune Systems Cant Handle So Many Vaccines Giving an hours-old infant its first vaccine (against hepatitis B) and a 2-month-old baby six vaccines seems like a lot to ask of a brand new immune system (see web link at end) But Lushythy says that babies entering into a germ-laden

world are immediately bombarded by far more antigens in their environment than they are through vaccinations

Their immune systems can handle it she says Though babies catch lots of colds and other minor bugs they neednt catch more seriousshyand sometimes deadly-illnesses like whooping cough (pertussis) diphtheria tetanus mumps measles rubella and rotavirus if they are imshymunized she says

Children need protection the most during the first year of life says Luthy because they are so much more vulnerable when they are small If an adult gets whooping cough they will have an annoying cough for a few months A baby who gets whooping cough though has an airshyway the size of a straw and their tiny bodies can much more easily be overwhelmed Infants are often hospitalized for whooping cough and sometimes we cant save them

To address parents worries about overloading their childrens immune systems researchers have studied what it would take to overload an immune system and learned it would take about 100000 vaccines all given at the same time When we talk about four or six vaccines at once were nowhere near the threshold An ear infection challenges a childs immune sysshytem more than a vaccine says Luthy

Hesitators or parents who believe the overshyload myth seek to control how much immune material their child gets and how frequently They come up with their own vaccination schedshyule believing theyre protecting their child In Luthys work in a Utah County clinic parents often bring in a book by a pediatrician who recshyommends an alternative schedule with fewer vaccinations spread out over more time This apshyproach says Luthy has no peer-reviewed science behind it and puts children at risk

While its true that vaccines can cause side efshyfects such as rash fever swelling and soreness the illnesses they protect against have far greatshyer consequences including blindness deafness heart defects paralysis and death

Luthy is grateful that hesitators do usually comshyplete their childrens vaccinations by kindergarshyten age but its better to protect them earlier By the time youre 4 years old if you catch something youre probably not going to die she says When youre an infant is when youre more likely to die

Myth 3 Vaccines Contain Toxic Mercury In Luthys clinical work she regularly encounshyters parents who decline the MMR vaccine-and sometimes all vaccines-because theyre conshycerned about mercu1y MMR however does not and never has contained any form of mercu1y says Luthy

PREVENT In the past many vaccines contained a presershyvative called thimerosal which breaks down in the body into ethylmercury This chemical comshypound clears from the body quickly as opposed to methylmercmy the more familiar form of mercu1y that is not easily cleared and can build up in the body and become toxic Still because of public concern thimerosal has been elimishynated or reduced to trace amounts in vaccines Today no vaccine for children age 6 and under contains thimerosal except the flu vaccine

Luthy wants to be clear that it is possible to have a reaction to a vaccine Each vaccine has difshyferent possible side effects which are outlined on the US Centers for Disease Control and Prevention (CDC) website Reactions are overshywhelmingly mild (sh01t-lived soreness swelling or fever) Severe reactions (seizures death) are extremely rare Luthy believes the benefits of vaccines far outweigh the risks Every medicashytion on the planet has a potential side effect-evshye1y single one even a Tylenol

Choosing Facts over Fear Cory Aitchison the father of three daughters including one with autism says when his first daughter was born 14 years ago he knew that the benefits of vaccines outweighed the slight possibility of complications but when it is your own daughter a l-in-100000 chance seems much more daunting

He remembers his thoughts as this first daughshyter was born I was overwhelmed with joy tershyror love and uncertainty After we had a couple of minutes with her the nurses took our perfect daughter and sta1ted to poke stick and smear her with all kinds of stuff At that moment I wondered if this was all really necessary

But Hannah got her first vaccine in those first hours and Aitchison and his wife Colleen went forward with immunizing all three of their children on schedule They do not connect their middle daughters autism to vaccines and recshyommend that other parents follow where the science leads

I truly understand that the decision to vaccishynate can be difficult Aitchison says But my advice is to trust your doctor Give her all the relevant facts regarding family hist01y and make an informed decision

Luthy too empathizes with parents who agoshynize over immunizations Its their sacred reshysponsibility to protect their children and they feel torn Luthy believes that if parents follow the science they need not agonize The science continues to build that vaccines dont cause aushytism and that infant immune systems can safely handle many vaccines at once We just need to keep working to get the word out

SWUHEALTH ORG 11


LINDA RIDER RN BSN CIC

APPOINTED BOARD MEMBER SWUPHD CERTIFIED INFECTION PREVENTIONIST AT DIXIE REGIONAL MEDICAL CENTER

(PID(MIC IS TH( lARG(ST IN HISTORY Although West Africa has seen over

14400 cases and over 5170 deaths it remains highly unlikely that Ebola

will spread significantly in the developed world (as of 111414)

Ebola previously known as Ebola hemorrhagic feshyver is a rare and deadly disease caused by infecshytion with one of the identified Ebola virus strains

There are five Ebola virus strains four of which are associated with disease in humans A fifth strain (Reston) has only caused disease in non-human prishymates

Ebola viruses are found in several African countries The disease was first identified in 1976 near the Ebshyola River in Zaire (now known as the Democratic Republic of the Congo) Since then outbreaks have occurred sporadically in Africa

The natural reservoir host for Ebola virus remains a mystery However based on evidence and the nashyture of similar viruses researchers believe the virus is animal-borne and that bats are the most likely resshyervoir Four of the five virus strains occur in animal hosts native to Africa

The outbreak in West Africa started in March of 2014 Widespread transmission has occurred in three countries - Liberia Sierra Leone and Guinea Localized transmission has occurred in Nigeria Senshyegal Mali Spain and the United States

PREVENT Linda Rider returned to the United States on November 14th after volunteering as an Infection Control Practitioner for an Ebola

Treatment Unit in West Africa She then voluntarily quarantined herself at home for 21 days while checking in with the health department She recounts

My team was trained in Monrovia Liberia then stationed in the city of Buchanan We got accustomed to wearing the PPE (Personal Protective Equipment) which can be worn up to two hours before becoming unbearable There are only about 60 doctors in the entire country and many people live without electricity and running water We were able to talk to Ebola survivors who were healthcare workers before much was known about the outbreak Liberians seem to have a healthy respect for the disease now but are not fearful or panicked Efforts to educate the public about Ebola and its prevention are evident everywhere in the form of billboards posters and popular music There is evidence that the outbreak may be winding down at least in Liberia

Ebola is spread through direct contact (via broken skin or mucous membrane linings of body openings) with

bull Blood or body fluids (inshycluding vomit feces urine breast milk semen saliva and sweat) of a person who is sick with Ebola disease

bull Objects and surfaces that have been contaminated with the vishyrus

bull Infected animals

Ebola is not spread through air water or in general by food However in Africa Ebola may be spread as a result of hanshydling bush meat (wild animals hunted for food) and contact with infected bats There is no evidence that mosquitoes or other insects transmit Ebola virus Only mammals (humans monkeys apes and bats) have shown the ability to become infected with and transmit Ebola virus

Healthcare workers family and friends who are in close contact with Ebola pashytients are at the greatest risk of getting sick because they come into contact with infected blood or body fluids of sick pashytients During outbreaks the disease can spread quickly within healthcare settings (such as a hospital or medical clinic) Exshyposure can occur in healthcare settings where staff are not wearing appropriate protective equipment such as masks eye protection gowns and gloves Exposure can also occur when the protective equipshyment is not removed safely

Currently the mortality rate of Ebola vishyrus disease is about 50 Aside from supshyportive care in the hospital (giving fluids and nutritional support) there is no speshycific treatment for Ebola No vaccine is currently available Several experimental treatments are being investigated Vacshycine manufacturers are also evaluating potential vaccine strategies

The risk of an Ebola outbreak m the

United States is very low Sporadic casshyes can be expected in travelers coming to the United States from the affected West African countries Humanitarian aid workers returning from affected counshytries may also develop disease Most of these individuals will have instructions regarding monitoring their health status In general the risk among travelers of Ebola disease is very low unless they are spending time inside a hospital having direct contact with infected individuals

The CDC has been working closely with US Customs and Border Protection airshylines and cargo ships to help ensure that the chance of Ebola virus introduction in the United States remains very low Acshycording to the CDC the current outbreak does not pose a major risk to the United States

For the latest updates on Ebola check with the CDC Ebola site at wwwcdc gov or the World Health Organization at wwwwhoorg 6

SWUHEALTH ORG 13

Cam Levins took first in the 5k and 10k during the 2012 NCAA Nationals


ERIC HOULE

HEAD CROSS COUNTRY AND TRACK amp FIELD COACH SOUTHERN UTAH UNIVERSITY

INNING BY TAYING CONSIST(Nl

Want to im~rove your ~~ysical fitness in io151 Heres some ~a lance~ realistic a~vice from a tract coac~ t~at

~el~e~ a runner ~ecome an Olym~ic at~lete

Asustainable long-term training program is a great way to improve your physical and mental health while at the same time achieving realistic goals No matshy

ter what your age or experience the primary focus of any well-thought-out training program should be on your overall physical maintenance and ongoing consistency A long-lasting training program which increases the load and intensity over time helps to control interruptions such as injuries that ultimately affect your enthusiasm and training regularity Consistency lies in getting into the habit of doing something

The phrase use it or lose it couldnt be more true when it comes to a persons physical health A few of the obvishyous benefits of starting a training program are an increase of energy levels throughout the day (which increases moshytivation to accomplish your daily goals) muscle tone and improved appearance (which increases confidence) and strengthening your immune system (which helps to prevent sickness) to name a few The reasons for getting started are plentiful but sticking to it is not so easy Howshyever it is the consistency in all that we do that allows us to reap the benefits If you can stay consistent in most

things you will experience sucshycess throughout life So too it is with our physical well-being

Take the first step by starting whether you choose walking hiking running biking swimshyming or a combination then stay consistent Follow up by incorporating realistic goals with periodic challenges and the rewards will help you stick with your training regimen This will keep you from falling off the proverbial wagon The biggest detriments to sticking with a training program are doing too much too fast not purchasing or replacing approshypriate equipment and setting unrealistic goals that dont alshylow for systematic development

Increasing mileage and intenshysity too quickly will almost alshyways lead to injuries setbacks and loss of motivation When designing a training program take time to do some research and seek advice from someone with experience Remember all of us are unique with strengths and weaknesses that need to be considered when designing a program

When I hear the phrase Ive fallen off the wagon I know the training program was too difficult from the very beginshyning or that the set goals were out of reach When setting goals the foundation should always be to become active and take control of physical health After a while more advanced goals should follow Even exshyperienced runners who have taken time off run for just five minutes a day before increasing the load and intensity when reshystarting their training When it comes to your conditioning and confidence in sticking with a training program remember that everyones starting line is different and consistency is the key

On your mark get set Happy Running

November 14 2014 the SUU cross country team coached by Eric Houle

qualifies for the NCAA Nationals

SWUHEALTH ORG 15


DAVID HEATON

MANAGING EDITOR SWUPHD PUBLIC INFORMATION OFFICER

Dont let the cold weather bother you anyway)

The warmer regions in our corner of the state allow for outdoor exercise year-round walking running hiking biking climbing golf tennis

and pickleball to name a few When temperatures drop there are still lots of indoor options from home exercise equipment to gyms and community centers that offer weight lifting racquetball aeroshybics swimming yoga or Zumba You can even join a team and participate in a league sport

When the snow flies many southern Utahns stay active with winter sports Here are some of our local offerings

Downhill Skiing Snowboarding amp Tubing Brian Head Resort Ski snowboard and tube at Utahs highest base elevation (9600 ft) where the annual snowfall is 300 inches Enjoy 71 runs served by 8 lifts The 2014-1015 season is scheduled from November 21 through April 12 Visshyit brianheadcom

Eagle Point Utahs newest ski resort loshycated on Tushar Mountain 18 miles east of Beaver Eagle Point boasts 450 inches of snow annually and some steep slopes among 40 runs Back country and snowshyshoe trails are also offered season expectshyed to start December 20 Visit skieagleshypointcom

Snowshoeing Each Saturday in January and February rangers at Cedar Breaks National Monushyment provide free guided snowshoe hikes to the public The route is two miles round trip with a break in a cozy yurt Snowshoes are provided Call 435-586-9451 (ext 4425) to make a reservation

Or strike out on your own after renting snowshoes and poles at SUUs Outdoor Center Call 435-865-8704 for more inshyformation

Cross-Country (Nordic) Skiing Southwest Utah offers some of the best terrain in the west for those who enjoy the challenge and solitude of cross-counshytry skiing There are rentals and groomed trails at Brian Head Rubys Inn Bryce Canyon Duck Creek and Cedar Breaks If you want to get serious about this activshyity and find out where the best trails are visit the website for the Cedar Mountain Nordic Ski Club cmnscorg

Ice Skating There are two ice skating rinks operationshyal during the winter months in southwest Utah both with affordable rentals

Cedar City The Glacier next to the aquatic center Facebookcomyetiskatesorg

Bryce Canyon City Rubys Inn 435-834-5341

PROMOTE

Indoor Swimming Miss the water and want to get out of the cold Take a plunge at one of these aquatic centers offering one-time and extended passes

Sand Hollow Aquatic Center (St George) 1144 N Lava Flow Drive 435-627-4585 or visit stgcityorgdepartshyments recreation swimming

Washington City Aquatic Center 350 N Community Center Drive 435-656-6360 or visit washingtoncityorg communitycenter

Cedar City Aquatic Center 2090 W Royal Hunte Drive 435-865-9223 or visit cedarcityorg 445

Dont let the winter keep you down Try to balance time spent in front of the fire (or screen) with the exercise your body needs Its even more enjoyable when you invite family and friends to join you k

SWUHEALTH ORG 17


POULTRY gt 165 deg

FISH PORK RED MEAT gt 155 deg

HOT FOOD gt 135 deg STORAGE

COLD FOOD lt40 deg STORAGE

ROBERT BEERS

SWUPHD ENVIRONMENTAL HEALTH DIVISION DIRECTOR

The holiday season is a special time of the year As families loved-ones

friends and neighbors gathshyer to celebrate special events and express best wishes for the coming year food will likely play a major role A bout of food-borne illness could easshyily ruin festivities and travel plans The following suggesshytions will help keep the upshycoming holidays memorable for all the right reasons

PROMOTE Their mouths will hana open a moment or two Many diseases can be spread through the foods we eat Do not prepare foods if you are experiencing symptoms such as fever nausea vomiting or diarrhea Disease-causing bacteria can also be spread from contaminated foods to safe foods Wash fresh fruits and vegetables thoroughly before preparation Always wash your hands before preparing foods and after handling raw meats fish or poultry

the Last thing he took was the Log for their fire The bacteria that cause food-borne illness are all around us Occasionalshyly they get into the foods we eat and can cause disease Generally these bacteria can be killed by adequate cooking Fish ground meats and pork should be cooked to at least 155deg Fahrenheit Poultry (chicken and turshykey) should be cooked to at least 165degF Using an accurate thermometer is the only way to verify temperatures

He slunk to the icebox Bacteria can reproduce rapidly when foods are left at room temperature Foods should be kept either hot or cold Hot foods should be kept at or above 135degF on a stove or in an oven Cold foods should be stored at or below 40degF in a refrigerator or freezer Bulk foods such as turshykeys roasts hams or pots of stew chili and soup can take several hours to cool - even in a refrigerator Break these items into small secshytions slices or containers to allow for faster cooling Store foods in the refrigerator in a way that keeps liquid from raw products from dripshyping onto other foods Avoid keeping leftover foods at room temperature on tables or countshyers for grazing throughout the afternoon or evening

and he HE HIMSELF the Grinch carved the roast beast Bacteria can spread to foods from contaminated utensils or work suifaces Keep food preparation and storage areas clean Wash dishes and utensils thoroughly after use and keep storage areas clean While sanitizing wipes have gained popularity suifaces should be cleaned first with soap and water since wipes are designed for sanitization only Wash cutting boards and counters using soap and hot water immediately after spills or cutting meats or poultry Use these tips to help protect yourself and others from illness at your next gathering involving food Happy holiday eating

images and text in quotes TM amp copy Dr Seuss Enterprises used with permission

SWUHEALTH ORG 19

2 0 HEALTH I WINTER 2015

SARA FAUSETT RD CD

CLINICAL AND OUTPATIENT DIETITIAN FOR INTERMOUNTAIN HEALTHCARE AT VALLEY VIEW MEDICAL CENTER

BAlANC( YO~R INTAK( Of SW((lS

There is increasing concern that Americans eat too much addshyed sugar which increases the

risk for certain health problems Studies and awareness efforts such as Fed Up a documentary produced by Katie Courie link sugar to our nations obesity epshyidemic As the debate continues among producers government and health groups recommenshydations are emerging for the use and intake of sweeteners Food labels in the United States will soon show added sugars Sugar has become the next big deal in

the food industry and can also be another health topic to feel conshyfused about Here are some basics on sugar which may be especially timely during the holidays when extra food consumption often inshycludes sweet treats

The Scoop On Sugar As a side-effect of the diet era of low-fat foods industry leaders started adding more sugar to prodshyucts to preserve taste and customer loyalty to food products that were deemed healthier Now even

the United States Department of Agriculture has referred to sugar as the number one food additive because of its sweet taste texture and preserving properties Some of the names by which sugar can be found on the ingredients list are sugar molasses syrup corn sweetener fruit juice concentrate and any word ending in -ose (frucshytose sucrose etc) These added sugars are demonized as having absolutely no nutritive value and are often labeled as empty caloshyries

Some may argue that sugars from natural sources are more nutrishytious However natural sugar is still considered added sugar Natural sugar comes from sourcshyes like honey brown sugar and molasses Adding some honey to your tea a spoonful of sugar to your coffee and molasses in your oatmeal are all considered addshyed sugars The difference lies in the nutritive value Natural sugar generally comes with some small amount of vitamins and minerals However these vitamin and minshyeral sources are minimal comshypared to the obvious ones we all know

With the rising obesity epidemic sugar has claimed a top spot for the blame The intake of added sugars has increased to 500 exshytra calories per day or 52 pounds per year on average The Centers for Disease Control (CDC) have found that sugar consumption is highest among the younger genershyation including teens and adults in their twenties although all age groups have seen a rise in sugar intake

We Know the Culprits While the blame for sources of added sugar are often placed on fast food restaurants junk food and beverage industries about half of our sugary foods and bevshyerages are consumed inside the home and include the usual susshypects candy cookies cakes fruit drinks ice cream and especially soda Most of us know what sugshyary foods we could limit in our diet Dont waste time focusing on ketchup barbeque sauce and peanut butter while still drinking

your favorite soda In a year the average American will consume 53 gallons of soda and sugary drinks

How Much Is Recommended The World Health Organization recommends consuming fewer than 100 calories (six teaspoons) of added sugar per day One twelve ounce can of your favorite soda contains about 160 calories (ten teaspoons) Check out food labels to get a better idea of how much added sugar you are consuming in one day Four grams of sugar is equal to about one teaspoon

Easy Ways To Watch Sugar During the Holishydays Most Americans consume more than double the recommended amount of added sugars on an average day During the holiday season added sugar intake climbs even higher Try these tips to reduce your sugar consumption during the holidays (or any day)

1 Watch what you drink Sugary beverages are usually readily availshyable at holiday and social events Drink water instead and you may find you are more alert satisfied and full When at a party if you must have a sugary drink altershynate it with water

2 Use spices or extracts instead of sugar to add flavor such as ginshyger cinnamon nutmeg almond lemon vanilla or orange

3 When baking try an equal amount of unsweetened appleshysauce as a sugar replacement

4 Focus on the produce Try to make your fruits and vegetables beautiful and tasty during the holshyiday season so that you can fuel up and feel full

5 Be picky with your sweets Choose your favorite holiday sweets to make and serve Dont gorge on all that come your way but focus on the ones you really like Plan for them and consume in moderation k

PROMOTE Want some festive color and

a touch of flavor Replace fizzy drinks with

fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21

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DAVID BLODGETT MD MPH

SWUPHD DIRECTOR AND HEALTH OFFICER

1 I J

How results from health screenings are often not what they seem

Health screening tests including elective ones have grown in popshyularity and availability leading to

some misunderstandings about how effective and advisable they actually are In reality screenings that seem like a good idea may not be as benefishycial as we might imagine

Misconception 1 I will always fare better if the disease is detected earlier It makes sense on the sutface that a disease found as early as possible will be much easier to treat and you will then be healthier and happier as a result For some diseases including some cancers this can be the case For example it is clearly better to find high blood pressure as quickly as posshysible in order to prevent fmther comshyplications associated with this disease

Do you remember these Find the hidden image

It is easy to allow things that seem self-evident to cloud our perception It may make sense to say that a patient who is found to have very early-stage cancer is likely to have a longer life span after diagnosis than one presentshying in the very late stages of the disshyease Or that patients whose disease is found as a result of screening are also likely to do better than patients presenting with symptoms However both of these observations can result from what is called a sampling bias A bias is something that seems to sugshygest an outcome but actually is not true In the medical field we talk about this phenomenon in terms of

See page 2 for a hint


lead-time bias and length-time bias These biases in how we perceive the occurrence of disease can prevent us from getting an accurate understanding regarding the value of catching an illness and intershyvening at an early stage

Lead-time bias Lead-time bias is based on the fact that there is a delay in how long it takes a person who is screened for a disease to develop symptoms when compared with someone who is diagnosed when symptoms are noticed Screening leads to an earlier diagnosis so the patient lives longer with the diagnosis but may not live longer overall It is easy to see that the person who was screened lived longer than the one who wasnt but the actual time that the two people had the disease is the same TI1is is pa1ticularly true for diseases that take a very long time to develop like prostate cancer

Heres an example you have two neighbors both of them develop prostate cancer at the same time Your first neighbor (A) visits the doctor gets screened for prostate cancer and is found to have cancer two years after the cancer developed Your second neighbor (B) is not screened so while neighbor A now knows he has cancer neighbor B continues his life as though everything is fine

So who is better off between the two The answer largely depends on the nature of the disease and the effectiveness of interventions which treat the disease Neighbor A now goes to multiple doctors has multiple surgeries and deals with the side efshyfects of treatment along with the emotional and financial burdens associated with knowing he has cancer Neighbor B remains blissfully unaware of his condition until he begins having symptoms ten years later (twelve years from when the cancer actually sta1ted) He goes to the doctor who finds the cancer and he gets the diagnosis Neighbor A meanwhile has been struggling with cancer treatshyments for twelve years but still has cancer and its symptoms Two years later unf01tunately both neighbors A and B die from complications due to prostate cancer

I hope you can see the problem Neighbor A seems like he was able to live longer with his cancer beshycause it was discovered earlier After all he had it for twelve years before he died from it Poor neighbor B died only two years after his diagnoshysis if only he had been screened In this case we have been fooled by lead-time bias We think the screening worked when it did not In reality they both had cancer for 14 years Screening and years of knowing he had cancer didnt help neighbor A In fact it could be argued that it made life much worse for him

Length-time bias Many diseases do not present the same way in difshyferent people Some people have a version of a givshyen disease that progresses ve1y slowly without sympshytoms Their disease can be discovered by screening tests for a ve1y long period of time Others many have the same disease but it might progress rapidshyly and be detectable by screening only for a sh01t

period of time Hence screening is more likely to detect slowly progressing cases making it seem like those who have been screened are more likely to be cured or do better than those that dont In order to understand whats really happening you have to be able to consider larger numbers of people than just the one person you know This population-based approach to disease activity is what we call epideshymiology

To illustrate this concept take a neighborhood with 200 women 0 ne side of the street (100 women side A) decides to get screened for ovarian cancer while the other side (100 women side B) decides not to Over the next ten years you watch these women to see how many of them get ovarian cancer Side A faithfully gets screened once a year Side B never gets screened During the ten years 20 of the women on side A screened positive for ovarian cancer and 18 of them are still alive Two other women from side A also died from ovarian cancer which was not detected by the screening bringing the total deaths to four During the same time peshyriod four women from side B were diagnosed with ovarian cancer after having symptoms and all four of them died of the disease

In this example it is easy to see that the same number of women on both sides died of ovarian cancer However without considering the whole population it would be tempting to believe that screenings had a great benefit to the women of side A because 18 of the 20 women found to have cancer survived What actually happened here is that most of them had a non-fatal form of cancer that was too slow-growing to impact their life TI1ere are probshyably still 18 side B women who would have tested positive as well if they had been screened The real issue to consider here is the impact of all of the testing and treatment endured by 18 non-fatal cancer patients from side A

Misconception 2 If get screened Ill live longer Lead-time and length-time biases have a big imshypact on how we perceive screening tests but there are other influences as well People who readily adopt new supposedly healthy behaviors tend to be healthier than those who do not Observational studies which allow people to volunteer to pa1ticshyipate generally show that people who have opted for screening have better outcomes than those who did not For instance women who have Pap smears are less likely to die from ce1vical cancer Howevshyer they tend to be better-educated and wealthier which also lowers the baseline risk of ce1vical canshycer death It becomes difficult to determine how much the favorable outcome in women who have Pap smears is due to the test and treatment and how much is due to their other favorable health behaviors

Misconception 3 I wouldnt be here today if my disease had not been found early One of the most compelling pro-screening argushyments points to the personal testimonies of patients who having been screened were diagnosed and

PROMOTE treated These patients often attribute their continshyued smvival to the fact that they were screened and sometimes become advocates for it However for an individual case it is impossible to tell if screening has made a difference As an example 97 of those found to have an Abdominal A01tic Aneu1ysm (AAA) from a screening will not die from that conshydition which likely would have been discovered by a good physical exam if it became more threatening anyway On the opposite side of this argument 5 of those who get surge1y for AAA will die from the procedure itself

Misconception 4 If I get a negative screening result there is no chance I have the disease 0 ne danger is the belief that screening is 100 efshyfective People who are undergoing health screenshyings tend to believe that theirs is the life that will be saved Often the decision about whether a screening is effective or not is based on population statistics For example screening and treatment for colorectal cancer reduces m01tality by about 15 but people whose cancers were detected by screenshying can still die from them Studies show that at best breast cancer screening (mammogram) reducshyes m01tality by 30 not 100 Many other screenshying tests are much less effective

The benefits of screening are often communicated in terms of population risks For example breast cancer screening can lower the populations death rate from breast cancer by 30 which may lead to the assumption that an individuals risk must also be reduced by 30 from screening as well But this is a measure of risk as obse1ved in a population of people called relative risk The risk for you as an individual is called absolute risk and is a different st01y A SO-year-old woman who gets screened eve1y two years for the next twenty years only lowers her risk of dying from breast cancer from around 4 to around 3 Although the benefit for the population as a whole is considerable (30) the benefit for the individual can be fairly small (1)

Conclusion As you can see there is often a sto1y behind the st01y when it comes to screening for diseases Beshycoming aware of these subtle realities is imp01tshyant in helping you make fully informed decisions about your health and quality of life Todays health market offers an increasing array of screenshyings and products some of which over-promise or over-simplify on what they deliver Seek out relishyable resources such as the United States Prevenshytive Se1vices Task Force (USPSTF) and consult with a trusted prima1y care physician who knows your medical histo1y and can help determine which screenings are right for you-

The US Preventive Tnsk Force rnrrently reco111111e111ls bishye1111inl brenst cn11cer scree11i11gs (typicnlly 111n11111wgrn111s) for wo111e11 stnrti11g nt nge 50 1111ess other riskfnctors nre present

Click the Reco111111e111lntio11s tnb nt USPreventiveSershyvicesTnskForceorg

SWUHEALTH ORG 23


SHALLEN STERNER

SWUPHD ENVIRONMENTAL HEALTH SCIENTIST

ADYlt( AIO~T 1(0 l~GS f ROM A ff(AlTHINSP(tTOR

Bed bugs Do I need to say anything more to make your skin crawl I know every time I deal with these creatures my skin starts to itch My mind

starts telling me that I am being bitten the very minshyute I know I am in a room with bed bugs While theyre not dangerous and dont transmit disease dealing with bed bugs can be very frustrating so heres some guidance to help with current or future infestations

Bed bugs have been living and thriving with hushymans for thousands of years Bed bugs were nearly eradicated in the United States through the use of DDT but in recent years they have made a strong resurgence The reason for this has been debated with the most common theories being an increase in international travel and resistance to available pesshyticides

The Utah Department of Healths website describes these creatures as follows Bed bugs are small inshysects (adults are about 14 inch long) that feed on the blood of humans and animals Adults are redshydish-brown in color and larvae are a clear-yellowish color They are about the size of an apple seed or smaller depending on what stage of life they are in The eggs are hard to see and are about the size of the head of a pin

Bed bugs usually feed at night which is partly why they are so hard to find and remove After feedshying they will nest in close proximity to their host They can be found nesting in and on mattresses box springs headboards night stands chairs baseshyboards and cracks in the walls and ceiling In fact they will nest in almost any small crevice that keeps them close to their food source

Bed bugs will feed on their host about once each week

Bed bugs know a host is present because they are attracted to the carbon dioxide exhaled when you breathe Their bites leave small itchy spots that are very similar to a mosquito bite An individual who has been living with bed bugs can have dozens of bites This is part of the frustration with bed bugs you can receive many bites and not even know where they are coming from

Fortunately bed bugs will usushyally leave clues of their presence You will start to see blood smears on your sheets and blankets You may also notice small black fecal spots or molted skins near where they are nesting The fecal spots will often turn red when water is added to them If you are getshyting mysterious bites on a regular basis then I would recommend you look closely for these signs If youve got bites but cant find any of these signs then you might want to obtain a monitoring deshyvice The one I prefer is a trap available online that you put unshyder the leg of the bed after adding some dry ice The carbon dioxide from the dry ice will attract the bed bugs and they get caught in the trap

The best way to protect against bedbugs is to never get them in the first place Since bed bugs can be transferred from one location to another very easily people who travel frequently should inspect their hotel or motel rooms at each stop This inspection needs to take place before you make yourshyself at home You dont want to find them in the middle of the night after they have had a chance to get into your belongings First always carry a flashlight which will help spot them or any of their signs Second I would inspect the mattress because this is where you are most likely to find them Gently remove the sheets and look at the seams of the mattress and box spring Use the flashlight to check out the luggage rack and any small crevices near the bed

Be very careful when purchasing used mattresses or furniture You should inspect them carefully beshyfore taking them home Avoid

taking furniture or mattresses from dumpsters because they could be infested with bed bugs

If you do get bed bugs it can be difficult to get rid of them but its not impossible Find a proshyfessional pest control specialist to take care of the problem as soon as possible They have most likeshyly dealt with bed bugs before and know how to do so appropriately The specialist may need to conshyduct more than one treatment beshyfore the bed bugs are eradicated

Unfortunately you cant just leave your home to kill them off Bed bugs can live several weeks or even months without feeding Sleeping on the couch another room or at a friends house could spread the bed bugs and make matters worse

For those who want to try to solve the problem on their own start by getting rid of posters clutter and any other unnecessary items where bed bugs can hide Throwshying the mattress away is usually not recommended because it may be just one of the many hiding places used by the bugs Your money would be better spent on hiring a professional or buying a mattress encasement Onemiddot_- method to physically remove be bugs from a mattress is to wrap tape around your hand sticky side out and run it along the mattress seams and any other potentia hiding place

There are several bed bug contr products available at your lo hardware store Please re ber to follow the manufa recommendations when mg any type of chemical Otherwise you could be inviting another hazard into your home

Having bed bugs in your home or hotel room is not a sign of dirtshyiness These little parasites have become widespread in the past twenty years and can be found in immaculate rooms as well as filthy ones If you are diligent during your travels you will most likely keep them out of your home If you do get bed bugs you will need to be diligent in your efforts to get rid of them -

SWUHEALTH ORG 25

This article is third in a series spotlighting Zero Fatalities a united effort to save lives by preventing the five deadliest behaviors that occur on Utahs roads Not buckling up and distracted driving were covered in the last two issues of Health magazine Aggressive and impaired driving will follow

JORDAN MERRILL

SWUPHD HEALTH EDUCATOR

I

I


Of DROWSY DRIYIN~ Fatigued drivers going without sleep for

24 hours or more are equivalent to a drunk driver with a 10 blood alcohol level

Todays society often has a 247 mentality where people feel they have to get there fast and

get there now Getting sufficient sleep before hitting the road can take a backseat to travel plans that include cutting into normal sleep time or driving through the night The notion of saving time and got to keep on going are unwise justishyfications for driving drowsy

Over 30 million Americans strugshygle to get an adequate amount of sleep each night With over 200 million licensed drivers in the country and 30 million of them lacking sleep on a daily basis the safety of our roads could be quesshytionable How many times have you driven while fatigued and drowsy

A recent study conducted by the AAA Foundation for Traffic Safe-

ty showed that drowsy drivers are responsible for over one in five (20) of fatal car accidents that occur on our roads and highways Drivers age 24 and under are twice as likely to get in a drowsy driving-related accident as drivers ages 40-59

There are multiple studies reportshyed by the Centers for Disease Conshytrol (CDC) which show that fashytigued drivers going without sleep for 24 hours or more are equivashylent to a drunk driver with a 10 blood alcohol level which is above the legal limit in any state

It may not be illegal to drive drowsy but just like drugs or alshycohol drowsiness slows reaction time decreases awareness and drastically impairs judgment Drowsy driving is impaired drivshying

PROTECT 0 ne evening about ten years

ago I was living in St George and drove to Cedar

City after work to hang out with friends After dinner a movie and hours of catching up I realized it was 530 in the morning and I needed to be to work by 7 am I jumped in my car threw my seatbelt on and started for home in the dark with absolutely no sleep for the past 24 hours

I had driven drowsy plenty of times before and always manshyaged to stay awake so I wasnt worried when the tiredness beshygan to set in I found myself doing everything imaginable

to keep alert I rolled down the windows sang to myself and turned up the radio

The moment that I felt I had my drowsiness under control is when I relaxed thinking to myself Ive got this Secshyonds later I opened my eyes and realized I had dozed off I had set my cruise control to 80 mph and was apparently traveling much faster than the red car which was now about three feet in front of me With only a split second to react I grabbed the wheel and hit the brakes which sent me immeshydiately sliding sideways down the freeway at an extreme-

ly high rate of speed At that point I no longer had control of my car which began rolling down the road before flipping end over end until it slid to a stop upside down only feet from oncoming traffic Had I not been buckled up I would have undoubtedly died Even more frightening was the reshyalization that I had almost hit the car in front of me which could have taken the lives of those passengers and weighed on my conscience forever had I survived

Being on time for work was no longer a concern My transshyportation back to town was via ambulance with IVs and straps everywhere followed by many hours of tests and scans All of this because I told myshyself that drowsy driving was something I could handle for a short forty-minute drive I no longer think Ive got this

Never again will I drive when drowsy not even slightly I know the signs to look for as well as the consequences of poor decision-making and hopefully others will reconshysider their driving habits after hearing about my mistake

The remains of Jordans car

The National Highway Safety Adminisshytration has estimated that each year in the United States there are 1550 deaths 71000 injuries and more than 100000 accidents caused by drowsy driving Utahs efforts to curb drowsy driving are now more noticeable on most highways prone to drowsy drivers The Utah Deshypartment of Transportation has placed roads signs warning against drowsy drivshying as well as providing information dishyrecting drivers where they can pull off and rest A poll by the Utah Department of Public Safety found that 71 of drivshyers who admitted to drowsy driving had less than eight hours of sleep and 41 of those drivers had been driving for less than an hour when they started having signs of drowsiness

The Southwest offers many beautiful drives that deserve to be enjoyed with both eyes open Here are some suggesshytions for recognizing fatigue as well as combating those heavy eyelids

My vehicle was completely totaled having been smashed flat and folded almost in half

Recognize the symptoms of fatigue bull Eyes closing or going out of focus bull Persistent yawning bull Irritability restlessness and

impatience bull Wandering or disconnected thoughts bull Inability to remember driving the last

few miles bull Drifting lanes swerving tailgating or

hitting rumble strips bull Head bobbing bull Abnormal speed or failure to obey

traffic signs bull Back tension burning eyes shallow

breathing or inattentiveness

Safety Tips bull Maintain a regular sleep schedule that

allows adequate rest bull When the signs of fatigue begin to

show pull over to a safe location Take a short nap in a well-lit area or

jog around bull Avoid driving between 12am and 6am

(Death rates increase 32 times by driv ing at night)

bull Share driving responsibilities with a companion (Reduces accident risk by 50)

bull Begin long trips early in the day bull Keep the temperature cool in the car bull Stop every 100 miles or two hours to

get out of the car and walk around exercise helps to combat fatigue

bull Stop for light meals and snacks bull Drive with your head up shoulders

back and legs flexed at about a 45 degree angle

The best remedy to avoid drowsy driving is to get adequate sleep at night with 7-8 hours as the recommended amount No destination is ever more important than a life Stay awake stay alert and stay alive-

SWUHEALTH ORG 27

PAULETTE VALENTINE

SWUPHD EMERGENCY PREPAREDNESS DIVISON DIRECTOR

Planning a~ea~ can mate t~e ~iff erence ~etween an inconvenience or a true emergency

2 8 HEALTH I W I NTER 20 15

Southwest Utahs weather is as diverse as its scenery Winter storms come on quickly Travshy

ellers heading north on Intershystate 15 from Washington County under sunny skies can soon find themselves encountering slick treacherous roads as they ascend the Black Ridge and enter Iron County With cold weather comes the hazards of winter driving inshycluding icy roads and reduced visshyibility from fog wind rain and

snow Preparing and planning can make the difference between an inconvenience and a true emer-gency

Know your vehicle Not everyone is a car person but you can take the time to learn about any special features your vehicle may have to help while driving in a snowstorm or on slick roads Some car owners manuals suggest not having your car on

cruise control during any storm event since reaction time is quicker when you have manual control of your vehicle While tapping the brake pedal may work for controlling skids in some cars pumpshying anti-lock (ABS) brakes can be danshygerous Of course ABS brakes and highshytech features like traction control are no substitute for safe stopping distances and reasonable speeds

Watch the weather One way to reduce risk in winter is to plan trips in relatively good weather Be alert and stay up- to-date on changshying weather and traffic reports in order to anticipate and avoid hazardous conshyditions Smartphones make monitoring the weather even easier with real-time updates (just be sure not to check while driving)

Slowdown A little caution can make a lot of difshyference when roads are slick Slowing

down by at least five miles per hour beshylow the normal speed and keeping more car lengths between vehicles will give evshyeryone more time for any sudden stops Theres no obligation to keep up with high speed limits on freeways when road conditions are bad Be patient with other drivers even take time out when frustratshyed Getting anywhere safer is better than faster

Get your vehicles ready for winter Its a good idea to keep your tires at propshyer inflation During winter months in Utah some roads will have rules postshyed which require additional traction including four-wheel drive snow tires or chains Make sure your vehicle has been properly serviced and fluid levels are full especially antifreeze and windshyshield washer fluid Its a good idea to secure an extra jug of washer fluid in your trunk since youll likely use more while driving on wet dirty roads Be-

PROTECT fore driving remove any troublesome ice from the windshield and windows along with piled snow from the hood and cabin top in order to prevent problems with visibility Always keep your gas tank at least half full

Have a winter emergency kit in your car In the event you have to pull over or find yourself broken down during winter weather be prepared with a winter emershygency kit Recommended items include an ice scraper flashlight and batteries (stored separately) hand-warmers blanshykets drinking water high-calorie food bars shovel jumper cables whistle first aid kit and stand-alone emergency lights or flares You can add sanitary supplies and extra clothes (including cold-weather outdoor wear) and makes sure to conshysider extra supplies for others travelling with you-

On the night of December 7 2013 a record-breaking snowstorm hit the Washington County region Traffic ground to a halt along 1-15 in the Virgin River Gorge after numerous cars slid out of control and semi-trailer trucks jack-knifed blocking the freeway Hundreds of vehicles were stranded overnight for up to twelve hours with no cell phone service While many kept their engines

running for heat others shivered through the night in freezing temperatures Travellers with blankets coats food water and plenty of fuel could remain fairly comfortable during the ordeal and some even shared what they had with other motorists While emergency response personnel made efforts to help where they could many were on their own Fortunately everyone survived the incident but a few extra provisions or some basic supplies in the trunk made the difference between an inconvenient wait and a miserable nightmare

SWUHEALTH ORG 29

30

SOUTHWEST UTAH DEPARTMENT

PUBLIC HEALTH PROGRAMS

OUR MISSION IS TO PROTECT the communitys health through the PROMOTION of wellness and the PREVENTION of disease

BE AV ER 75 West 1175 North Beaver UT 84713

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STAY HEALTHY

4 COLD AND FLU OampA Winter is coming protect yourself by S11sa11 Peck RN

PAST LESSONS

6 IN GOOD HANDS The history of hand washing by William Clayto11 Petty MD

FLU HISTORY

8 THE FLU PANDEMIC OF 1918 A Utah retrospective

by Twila Va11 Leer

VACCINATE

1 o GIVE IT A SHOT A journalists perspective by M Sue Bergi11

VIRUS

12 EBOLA The sto1y behind the hype by Li11da Rider RN BSN CIC

GOA L S

14 WINNING THROUGH CONSISTENCY Advice on setting your workout goals by Eric Houle

F A MILY E X ER C I S E

16 WINTER WONDERLANDS Staying active during cold weather by David Heaton

SA FE E A TIN G

18 DONT FEEL GRINCHY Holiday Food Safety Tips by Robert Beers

E A TIN G RI G HT

20 TIS THE SEASON FOR ADDED SUGAR Balancing your intake of sweets by Sara Fausett RD CD

HE A LTH LITER ACY

22 HIDDEN BIAS Health screening mis-conceptions

by David Blodgett MD MPH

FOLLOW SWUHEALTH

BED BUGS

24 GET THE BUGS OUT Tips from a health inspector by Slwlle11 Sterner

DROWSY DRIVING

26 THE A THROUGH ill71S Confessions of a sleepy driver by Jorda11 Merrill

PREPARE

28 WINTER ON THE ROAD How to pack your car for winter

emergencies by Paulette Vale11ti11e

QUESTIONS OR COMMENTS Email dheatonswuhealth org

---- ON THE COVER ----

WINTER WONDERLANDS Special thanks to Erin Mark and baby Lincoln Taylor for snowshoeing duough a winter sunrise Sto1y on page 16

Stereogram on page 22 sse1grno11 cmutesy of easystereogrambuilde1com

PUBLISHER

Jeff Shumway

MANAGING EDITOR

David Heaton

DESIGNER

Kindal Erickson


FOUNDATION BOARD

David Blodgett MD

Chris White

Jeff Shumway

Todd Stirling





Sincerely





SUSAN PECK RN


WHT YH NHD TO KNOW





















WASH your hands


for the flu































SWUHEALTH ORG 7



TWILA VAN LEER


I




























held




















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( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


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Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


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WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

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VITAL RECORDS

Birth Certificates

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841 PERMIT 6563

PUBLISHER

Jeff Shumway

MANAGING EDITOR

David Heaton

DESIGNER

Kindal Erickson


FOUNDATION BOARD

David Blodgett MD

Chris White

Jeff Shumway

Todd Stirling





Sincerely





SUSAN PECK RN


WHT YH NHD TO KNOW





















WASH your hands


for the flu































SWUHEALTH ORG 7



TWILA VAN LEER


I




























held




















SWUHEALTH ORG 9


M SUE BERGIN































SWUHEALTH ORG 11


























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fruit water

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( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

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Counseling




TEST $


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841 PERMIT 6563


SUSAN PECK RN


WHT YH NHD TO KNOW





















WASH your hands


for the flu































SWUHEALTH ORG 7



TWILA VAN LEER


I




























held




















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( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




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fruit water

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rmelon time

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( 435)438-2482

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Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



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WC



St George UT 84 770 ( 435)673-3528



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( 435)438-2482

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Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

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WC



St George UT 84 770 ( 435)673-3528



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VITAL RECORDS

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St George UT 84 770 ( 435)673-3528



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( 435)438-2482

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Case Management


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ManagementEducation


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St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





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KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




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(SNS) Coordination


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( 435)438-2482

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HEALTH PROMOTION



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St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





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POULTRY gt 165 deg




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fruit water

er lemon n~ ~ime

rmelon time

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SWUHEALTH ORG 25


JORDAN MERRILL


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SWUHEALTH ORG 27

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SWUHEALTH ORG 29

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( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




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Panguitch UT 84759 (435)676-8800

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( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563



ERIC HOULE















SWUHEALTH ORG 15


DAVID HEATON














PROMOTE






SWUHEALTH ORG 17


POULTRY gt 165 deg




ROBERT BEERS









SWUHEALTH ORG 19


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563








SWUHEALTH ORG 15


DAVID HEATON














PROMOTE






SWUHEALTH ORG 17


POULTRY gt 165 deg




ROBERT BEERS









SWUHEALTH ORG 19


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563


DAVID HEATON














PROMOTE






SWUHEALTH ORG 17


POULTRY gt 165 deg




ROBERT BEERS









SWUHEALTH ORG 19


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563









PROMOTE






SWUHEALTH ORG 17


POULTRY gt 165 deg




ROBERT BEERS









SWUHEALTH ORG 19


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563


POULTRY gt 165 deg




ROBERT BEERS









SWUHEALTH ORG 19


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563






SWUHEALTH ORG 19


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563


SARA FAUSETT RD CD





















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563















fruit water

er lemon n~ ~ime

rmelon time

SWUHEALTH ORG 21




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563




1 I J


























SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563


















SWUHEALTH ORG 23


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563


SHALLEN STERNER



















SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563











SWUHEALTH ORG 25


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563


JORDAN MERRILL


I

I









































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563































SWUHEALTH ORG 27

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563

PAULETTE VALENTINE

















SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563










SWUHEALTH ORG 29

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563

30





( 435)438-2482

NURSING SERVICES

Baby Your Baby


Case Management


Early Intervention


Home Visitation

Immunizations




Cedar City UT 84 721 ( 435)586-2437

HEALTH PROMOTION



Points

Chronic Disease

ManagementEducation


Outreach










WC



St George UT 84 770 ( 435)673-3528



Body Art Regulation






School Inspections





Permits



Water Lab

KANE 445 North Main

Kanab UT 84741 ( 435)644-2537




Outreach






Preparedness Buddy


(SNS) Coordination


Panguitch UT 84759 (435)676-8800

VITAL RECORDS

Birth Certificates

Death Certificates






Epidemiology



Counseling




TEST $


Al C diabetes $25













841 PERMIT 6563



TEST $


Al C diabetes $25













841 PERMIT 6563


841 PERMIT 6563

health | winter 2015

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