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BeSafe Child magazine Anderson County Winter 2009 Edition

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Anderson County Winter 2009

BeSafe Child Since 1994

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Helpful Toll-Free Numbers.................4 We Are THANKFUL to The Addressing After School Dangers.......5 Folowing Sponsors For Making Disease 101: Lead Poisoning...............6 BeSafe Child Possible Flu Season and Your Child..................6 in Anderson County. Childhood Immunizations: Facts & Myths............................7 ACCESS S.T.A.R. Help Children Devolop Reading Habits...........................8 ISLAND TANS Raising Healthier Kids........................9 Hand Washing Tips For Your Child..9 North East Public ACCESS/STAR.............................10-11 Health District Children Online............................10-11 Coping With A Child’s Illness...........12 Vision Is Key to Infant United Way 2.1.1 Development..........................13 Avoiding Constipation In Children.................................13 WHATABURGER What’s New At WIC?........................14 CHIP/Children’s Medicaid...............15

Child Safety Is No Accident! BeSafe Publications ~ 566 C.R. 4103, Jacksonville, TX 75766 903-586-3767 1-800-233-8568 Fax 903-586-0333 www.besafechild.com email: info@besafechild.com Publisher/Editor: Royce Ewing Graphic Design/Layout: Claudette Wooddell Office: Patricia Goar ©Copyright 2009 BeSafe Publications We make every effort to ensure the accuracy of the information within these pages. We cannot, however, assume any liability of any kind for its validity or completeness or for additional or changed information subsequent to the date the information contained herein was submitted for publication. BeSafe Publications welcomes your suggestions and inquiries. Articles from professionals in child safety and health are also encouraged. While we retain our copyright position, we do grant permission to responsible parties to duplicate our articles in the interest of child safety, health and good character.

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www.unitedwaytyler.org No matter where you live, you can call and get referrals to local health and community services. ■ 24-hours-a-day, 7-days-a-week ■ All Languages ■ Dial 2-1-1 or 903-534-9977 2-1-1 East Texas is a collaborative partnership of the United Way of Tyler/Smith County and the Texas Health and Human Services Commission.

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Helpful Toll-Free Numbers • Texas Poison Control 1-800-222-1222

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• Texas Department of Family & Protective Services (DFPS) Abuse Hotline: 1-800-252-5400

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• Texas Department of State Health Services (DSHS) Vision & Hearing Screening 1-800-252-8023 Ext. 6687

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• Office of Attorney General Child Support: 1-800-252-8014

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• Centers for Disease Control & Protection (1-800-CDC-INFO) 1-800-232-4636 • Texas Youth Hotline 1-800-210-2278 • Runaway Hotline 1-800-580-4357 4

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Addressing After-School Dangers

egardless of age, whether a child is 6 R or 16, it is crucial for parents to discuss safety issues with their children. According to

online. • Pay attention to the adults your child interacts with-tutors, coaches, day care providers. new data released by the National Notice when Center for Missing & Exploited someone Children (NCMEC), it was found shows one that almost half of nonfamily or all of your abduction attempts happen when a children a child is walking to or from school great deal of or a related activity. It was also attention or found that the majority of children begins giving affected by abduction attempts are them gifts. young girls (74 percent) between • Check out the ages of 10 and 14 years old. the latest Free Safety Handbook technology. To help parents, NCMEC and DuChild racell have locator deexpanded their child safety resources with the vices with GPS are a popular tool addition of a free “Child Safety Handbook.” being used in an effort to help keep children Because of the different stages of a child’s safer. These devices range from simple audio development, the handbook outlines age-apunits that will emit a high-volume beep until propriate safety tips and scenarios that parents the child is found, to cell phones, watches, need to be aware of. shoes, coats and backpacks installed with Here are a few tips from the Power of Parents GPS technology. “Child Safety Handbook”: The Power of Parents Program offers a vari• Talk to your child. Teach young children ety of important child safety tools at www. their address and telephone number and how powerofparentsonline.com. to use a telephone. Make sure they know how These include a free downloadable child photo handle situations such as adults offering to ID guide, seasonal safety tips, a sixmonth them a ride home. photo ID reminder service, a free children’s • Monitor Internet usage and set guidelines book designed to help 4- to 6-year-olds for the people they may communicate with. understand safety concepts and Teachable Only with your knowledge and supervision Moments Guides. should kids use web cams or post photos

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Disease 101: Lead Poisoning

Source: Rhonda Jones, LVN, Cherokee County Health Department

n the United States, over 300,000 children Ilevels between the ages of 1 and 5 have blood lead greater than the level recommended by the Centers for Disease Control and Prevention, or CDC. Because lead poisoning often has no obvious symptoms, it frequently goes unrecognized. Unfortunately, lead poisoning can result in learning disabilities and behavioral problems. And at very high levels, it can cause seizures, coma, and even death. Even though lead based paints were banned for use in houses in 1978, they are still the major source of lead exposure for our children. Millions of housing units inhabited by children have deteriorated leaded paints and elevated levels of lead-contaminated house dust. Other sources of lead include: • Making stained glass windows • Recycling or making automobile batteries • Some traditional home remedies using azarcon or greta (for upset stomach or indigestion) and payloo-ah (for rash or fever) • Tap water - most lead in tap water usually comes from the plumbing in your house, not the local water supply. Children from all social and economic levels can be affected by lead poisoning. However, children living at poverty level or in older homes have a greater risk. Also, children under the age of six are at an increased risk because they tend to put their hands or other things in their mouths. Lead poisoning can be prevented by removing sources of lead from a child’s environment. Some other methods of preventing or reduc-

ing blood lead levels are: • Make sure children do not have access to peeling paint or chewable surfaces painted with lead based paint • Pregnant women and children should not be present in a home built before 1978 that is being renovated. • Create barriers between living/playing areas and lead sources until they can be removed and cleaned up. • Regularly wash children’s hands, toys and pacifiers . Household dust and exterior soil can both be sources of lead. • Wet-mop floors and wet-wipe windowsills every couple of weeks. • Prevent children from playing in the bare soil. If possible, cover soil with grass, wood chips, or put in a sand box. • Use only cold water from the tap for drinking, cooking, or making baby bottles. Hot water is more likely to contain higher levels of lead. • After exposure to lead based products during hobbies or working take a shower and change your clothes. • Avoid eating candies imported from Mexico • Make sure cookware, tableware, and containers are lead free. If you are concerned about your child being exposed to lead, talk to your doctor. A simple blood test can rule out or diagnose an elevated blood lead level.

FluSource: Season and Your Child Memorial Health System of East Texas

t is estimated between one and five million Imore people will get the flu this winter. Even startling is more than 226,000 people

through eighteen years of age should get the vaccine. Women who will be pregnant during influenza season should consider the vaccine, will be hospitalized with nearly 36,000 people as well as caregivers for children from birth dying from flu complications. up to five years of age. Influenza is spread by coughing, sneezing or Allergic reactions to influenza are rare. nasal secretions. Other illnesses can have the However, since the influenza vaccine virus is same symptoms and are often mistaken for grown in eggs, children with severe egg alinfluenza. Anyone can get influenza, but rates lergy should not get the vaccine. If your child of infection are highest among children. The has had a severe reaction after a previous good news is that the infection only lasts a dose of influenza vaccine, tell your doctor. few days. If you are unlucky and contract the Priority groups receiving the H1N1 shots are virus you may experience fever, sore throat, pregnant women, infant care givers, medical chills, fatigue, cough, headache and muscle workers, children six months of age to twenty aches. four year old adults. Should I get the influenza vaccine for my For more information talk to your local health child? The Centers for Disease Control department. recommends all children from six months 6

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Childhood Immunizations: Facts and Myths Contributed by: Nacogdoches Medical Center

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uch! Yes, those immunization shots can hurt for a moment, but children should be vaccinated to protect them from suffering through a potentially deadly bout of measles, diphtheria, polio, tetanus, meningitis, or whooping cough (pertussis). Some parents may wonder if vaccines are even necessary any more, but if immunization rates drop, vaccine-preventable diseases could make a comeback resulting in dire consequences. The side-effects of vaccines may be uncomfortable, but they are not dangerous. Vaccines can cause a low-grade fever, soreness or redness at the injection site, headache, dizziness, fatigue or loss of appetite. In rare cases, children may have an allergic reaction to a vaccine. Some vaccines could cause a mild form of the disease, such as chickenpox, but the illness would be much less severe than if the child contracted the virus itself. Overall, vaccines are considerably safer than the diseases they prevent. There is no clear evidence linking the measles, mumps, rubella vaccine to autism. A report from the Institute of Medicine found that thimerosal, an organic mercury compound used as a preservative in vaccines, does not cause autism. In addition, other studies have failed to show a link between some vaccines and sudden infant death syndrome, multiple sclerosis, or other problems. All children should be vaccinated to prevent the spread of diseases. Because many people travel to and from other countries, there is no way of knowing if everyone a child comes in contact with has been immunized. Children who are not vaccinated run the risk of not only contracting a disease, but also passing it along to others. This occurred in the United

States between 1989 and 1991 when a lapse in immunizations resulted in an epidemic of measles that caused an increase in the number of measles cases. This outbreak resulted in some cases of children with permanent brain damage and caused some deaths. Immunizations should be given to children when they are healthy and young to reduce the risk of contracting a disease and suffering complications. Because immunizations work by preventing an illness, a vaccine will not work if the child is already sick. Postponing vaccinations until a child is older may be too late. “Make sure your children get all their immunizations and also get them on time, as it protects against dangerous diseases,� said Modupe Sokunbi. M.D., Pediatrician. Children need to get additional shots to continue their immunity against certain diseases. Periodic, or booster, shots are required for several vaccines, including tetanus and pertussis. It is important to keep an accurate record of childhood vaccinations so the doctor can give boosters when needed. Skipping vaccines is not a good idea, as this can leave a child vulnerable to certain diseases. If children fall behind on their immunization schedule, catch-up shots may be given without repeating a dose of an earlier vaccine. Children should be immunized even if the disease rarely occurs in the United States. Diseases such as measles or polio still exist in other parts of the world, and it may be easy to come into contact with the illnesses through travel. For more information about childhood immunizations, talk with your doctor or visit the Centers for Disease Control and Prevention website at www.cdc.gov/vaccines.

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Help Children Develop Reading Habits

etting a child to read can be challenging, but a recent survey found G that 96 percent of U.S. and Canadian

most importantly, magazines, newspapers and books your children will enjoy. 2) Start a parent-child book club-Parparents recognize the importance of having strong reading skills for school ents can learn more about their child’s interests and children will get more and as an adult. “As U.S. literacy rates worsen, parents comfortable reading and sharing in front of peers. need to make daily reading a prior3) Read the book, watch ity for themselves and the movie and discuss-It their children. Our socigives children and adults ety cannot afford a genan opportunity to discuss eration that doesn’t enjoy the content, dilemmas and reading,” says Dr. Mary moral implications of the Mokris, education spestory. This combination cialist for Kumon Math sharpens both comprehenand Reading Centers. sion and decoding abiliActivities such as playing ties, two of the most imoutside, watching a movie portant skills for learning. and eating together are more important to today’s families than 4) Physical reading-Make reading a part of your outdoor playtime. Read to reading together. “Spending as little your child and ask him to act out what as 15 minutes a day reading together he has just heard. Older children can helps children of any age improve read a play and then perform it. literacy, analytical and lifelong learning skills while fostering a love for the 5) Read and explore-Have each family member choose an area attraction English language,” said Mokris, who that he or she would like to visit. Have offers the following tips to promote older children read about the area and literacy at home: play tour guide for the day. 1) Bring reading home-Create a readVisit www.kumon.com ing area in your house that has comfortable furniture, good lighting and,

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Raising Healthier Kids

ccording to the experts at the Centers for Disease Control and Prevention (CDC), here are a few tips for keeping kids healthy: Keep your child’s checkups and immunizations up to date. Routine exams and screenings help you and your kids prevent, identify and treat health problems when they arise. Vaccines help prevent infectious diseases and save lives. Provide healthy meals. Eating right will help provide the nutrients needed to have energy, build strong bones, and fight diseases and other conditions. Pay attention to what and how much your kids eat. Keep kids active. Regular physical activity in childhood and adolescence improves strength

and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels. Teach kids healthy habits, such as hand washing. Provide your kids with a good foundation to help them make healthy choices every day. Seat belts, helmets, sunscreen, toothbrushing and hand washing are just a few of the things that help to keep us all safe and healthy. The CDC says hand washing is one of the most important things children can do to help stay healthy. Visit www.squidsoap.com for more information.

Hand Washing Tips for your Child

each your kids to pay attention to what T they touch and to wash their hands immediately when in the following situations: • Before and after you eat • Before you touch your eyes, nose or mouth • After you pet an animal • After you touch plants or soil • After you visit a hospital or nursing home • After you come in contact with any body fluids or touch items that may have come in contact with body fluids.

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• After you use a restroom Tell them to sing the “Happy Birthday” song while washing their hands with soap. Once they are finish singing the song then they can rinse their hands. Encourage them to always try to sneeze or cough into a tissue or their shirt sleeve if possible. Kids tend to spread infections more readily. Teaching your kids these tips will help and set an example by following them yourself.

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YOUTH SERVICES A DSHS funded Mental Health Program at ACCESS The ACCESS youth mental health program team includes psychiatrists, counselors, service coordinators, and trainers, all working together to help youth who have emotional, behavioral, or mental problems. Services Eligibility Intake and screening Youth, ages 0-17 Crisis intervention Severe emotional, behavioral, or Psychiatric and medication services mental disorders Counseling Serious difficulty in everyday Skills training functioning Parenting skills Risk of removal from home Service coordination Fees Substance abuse counseling Charges for priority population are based on ability to pay Insurance and Medicaic accepted

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(903) 589-9000 5656 N. Jackson, Jacksonville MHMR Crisis Line 24-hour: 1-800-621-1693

Children Online

Brought to you by Universal Child Abuse Prevention Program a Unit of ACCESS STAR Program. Funded by DFPS

illions of youths are online, whether at home, at school, at a friend’s M house, or if they have internet access on

lead to further unsolicited e-mail. 2. Web Sites: They are collections of electronic pages created and maintained by organizations, educational institutions, a handheld device or cell phone—almost businesses, and individuals. Millions of anywhere. If you are a parent, you are sites are available, providing youth with faced with a sobering reality: Your chilendless opportunities to shop, do research, dren are probably more comfortable in connect with this new cyber world than you are, and friends, and they may even know how to keep you in play or downthe dark about their online activities. load games What Parents should know: 1. E-Mails: Written messages that are sent and music. The Web has been electronically. Is a fast and inexpensive exploited by way to correspond with friends and family. Unsolicited e-mail, often called spam, unscrupulous can be more than just an annoyance. Often individuals. Many Web they contain suggestive or blatantly obsites feature exscene content. plicit sex, and Links inside messages may prompt the these are easy user to volunteer personal information, which can lead to identity theft. Replying for the unwary to stumble to such e-mail will confirm that the user upon. has an active e-mail address, which may 10

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3. Chat Rooms: Are electronic spaces for live text conversation, usually centered around a specific topic or interest. Your child can communicate with a number of individuals whom he or she many never have met but who share a common interest. Predators commonly frequent chat rooms hoping to lure a child into an online or even a face-to-face sexual encounter. 4. Instant Messages: Is live text conversations between two or more individuals. With instant messaging, a user can choose which of his friends he will converse with, selecting from a contact list he has created. Instant message conversations can be distracting if your child is supposed to be studying or engaging in another activity that requires concentration such as driving. In addition, how can you be sure with whom your son or daughter is communicating? After all, you can not hear the conversation. 5. Blogs: They are online diaries. Blogging gives youths the opportunity to write about their thoughts, passions, and activities. A blog is open to the public. Some youths carelessly reveal information

that can be used to identify their family, school, or home address. Blogs can harm reputations, including the blogger’s own. 6. Online Social Networks: Sites that allow youths to create a Web page and enhance it with pictures, videos, and blogs. Examples of these are MySpace and Facebook. Creating and enhancing a Web page enables a young person to express his or her identity. Online social networks allow young ones to meet many new “friends”. A social networking site is like an online party. Some very scary people can show up. Unscrupulous youths and adults can exploit the personal information posted on social networks. These sites do not verify a person’s age and many kids and adults use false names and ages. Internet friendships tend to be superficial. Experts believe that up to 750,000 predators may be online on a daily basis, trolling Internet chat rooms and dating services. In the United States, 93 percent of youths between the ages of 12 and 17 use the Internet.

TEXAS Department of Family and Protective Services The STAR/UCAP programs at ACCESS, FUNDED BY Department of Family and Protective Services, works to reduce family conflict, prevent truancy, prevent runaway, reduce delinquent behavior, and prevent child abuse. The program helps families resolve problems within the home. Services are provided at no charge. Services Eligibility Intake and screening Youth, ages 0-17 Crisis intervention, 24 hours Runaway Family counseling Homeless • Parenting and Youth Skills Training Truant Skills training At risk of abuse or neglect Linking with resources In conflict with family Emergency Respite Involved in delinquent offenses, Bilingual services (Spanish, ASL, & English) misdemeanors, or felonies Prevention programs Services To At Risk Children/Universal Child Abuse Prevention at ACCESS (903) 586-3175 or (903) 541-2584 804 Main Street; Jacksonville or 3320 S. Loop 256; Palestine Serving Cherokee, Anderson and Freestone Counties

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STAR Crisis Line 24-hour: 1-877-811-1289

Services for Universal Prevention of Child Abuse are open to all ages, are free, and have no eligibility requirements.

CALL 1-800-252-5400 to report child abuse. BeSafe Child™ magazine

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Coping With A Child’s Illness Source: The National Children’s Cancer Society

aving a child with cancer is perhaps the most stressful ordeal that H any parent could experience. Good

coping skills are essential for improving your ability to handle the stress and keeping the cancer experience from ruling your life. Fortunately, there is an organization dedicated to improving the quality of life for children with cancer and their families-not only the financial hardships but also the emotional stress. The National Children’s Cancer Society (N.C.C.S.) provides both emotional support and direct financial assistance to families of children with cancer. N.C.C.S. offers these suggestions for dealing with your emotions: • Give yourself permission to deal with positive and negative feelings. Recognize that these feelings are normal and healthy. • Become a part of your child’s treatment team. You know your child best

and the team will need your input. • Recognize which areas of your child’s life can be controlled and which cannot. • Know that some questions may not have answers. • Learn to accept help and support from others. • Connect with other parents through the Message Board on the N.C.C.S. Web site. “When a child is diagnosed with cancer, families are faced with a host of stresses, from the stress of the diagnosis itself and its treatment to employment and financial stresses to emotional stress, all of which compound the situation,” says Jessica Cook, MSW, program coordinator for the Pediatric Oncology Program at The National Children’s Cancer Society. “Frequently, caregivers put aside their needs to ensure their child’s well-being. In working with families, I have found that being the best caregiver to their child often means taking care of themselves first.”

For more tips for parents on how to deal with their emotional stress during this challenging time, visit the Web site at www.nationalchildrenscancersociety.org.

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Vision Is Key To Infant Development

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Source: InfantSee, Dr. Peter Kehoe

arents need to be knowledgeable about how to evaluate their infant’s visual development. That’s because it’s estimated that one in 10 children is at risk from an undiagnosed eye or vision problem that, if left untreated, can lead to difficulties later in school or even permanent vision loss. Knowing whether a baby’s vision is maturing on schedule can be confusing, so parents should be aware of some basic signs of normal development: • For the first six to eight weeks, babies’ eyes don’t always track together-and that’s normal. The American Optometric Association (AOA) advises that parents should only be concerned if the eyes never track together. • During the first four months, an infant should begin to follow moving objects with his or her eyes and start reaching for things. • Between months eight and 12, babies are using both eyes together to judge distance

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and to grasp and throw objects with greater precision. Crawling is important for developing the eye-hand-foot-body coordination he’ll need for normal movement for the rest of his life. To check visual development or address problems that parents have observed, a baby’s eyes should be examined before his first birthday. Although vision and eye health problems aren’t common, it’s important to identify children who have specific risk factors early so that any issues can be addressed before they negatively affect a child’s overall development and quality of life. Visit the Web site at www.infantsee.org.

Avoiding Constipation In Children

hildren become constipated for many reasons, and though rarely serious, constipation can cause discomfort and frustration for parents. What You Should Know Children often get constipation from a low-fiber diet or from withholding stool because they don’t want to stop playing, don’t want to use a public bathroom or are afraid of having a painful bowel movement. Some signs of constipation are: • fewer bowel movements than usual • hard, dry or large stools • painful or difficult bowel movements • abdominal pain and cramping • stool in the underwear What to Do Constipation is often helped by: • eating high-fiber foods • having healthy bowel habits • taking laxatives-but only with a doctor’s approval If constipation lasts longer than two weeks or is accompanied by symptoms such as bloody stools, vomiting, fever, a swollen abdomen or Constipation, though rarely seriweight loss, ous, can be a problematic condisee a doctor. tion for children and parents. Constipation

is usually harmless, but it can be a sign of a more serious health problem. For More Information www.digestive.niddk.nih.gov/ddiseases/pubs/ constipationchild. Graphics from Edu-Dula

Share These Thoughts With Your Child: All mothers are physically handicapped. They only have two hands. ~Anonymous Don’t aim to be an earthly saint, with eyes fixed on a star, just try to be the fellow that your mother thinks you are. ~Will S. Adkin My mother gave me a bumble-bee pin when I started work. She said:”Aerodynamically, bees shouldn’t be able to fly. But they do. Remember that.” ~Jill E. Barad You don’t have to be great to start, but you have to start to be great. ~Joe Saban BeSafe Child™ magazine 13


What’s New at WIC? Source: Northeast Texas Public Health District

IC has provided nutritious foods for W households across America since the early 1970’s. Eligible individuals and fami-

lies receive foods which provide protein, iron, calcium, vitamins C&D and dietary fiber. Food choices have remained mostly unchanged since the program’s beginning, until now that is. Beginning this year, WIC is proud to offer new choices that reflect the recommendations of the Dietary Guidelines for Americans and the American Academy of Pediatrics. Healthy nutrition for infants and children begins in pregnancy. During this critical time of fetal development women’s dietary needs are supported by WIC foods high in folate such as fortified breakfast cereals and beans. Now women also receive fruits, vegetables, and whole grain foods. Women who breastfeed their infants exclusively are eligible to receive tuna or salmon in addition

to the other items, and a greater amount of foods each month after the baby is born. Additionally, WIC now offers baby foods for infants. After reaching six months of age, infant food packages include jars of baby fruits or vegetables. As older infants begin spoon-feeding and making the transition to eating more solids, baby cereals are offered to support their growing nutritional needs. Parents can help their children develop healthy food preferences by offering the fresh or frozen fruits and vegetables WIC includes once they reach their first birthday. As their dietary needs change they can better meet those needs for dietary fiber, vitamins A and C, and a variety of antioxidant compounds which fruits and vegetables provide. The whole grain foods available to program participants include whole wheat bread, corn or whole wheat tortillas, quick oats, and brown rice. A variety of whole grain options are available to increase the nutritional value of sandwiches, entrees, breakfast foods, and other tasty combination meal items. So what’s new at WIC? Even more healthy, tasty choices at a store near you!

Barley was probably the first cereal harvested by people. Grains have been found in Egypt that are believed to be 5,000 years old.

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Do your children need low-cost health care coverage?

Find Out about CHIP/ Children’s Medicaid for your children. The most you will pay for all of your children is $50 for one year of coverage, but most families that qualify pay little or nothing. If your family income is below the following limits, there is a good chance your children may be eligible for CHIP or Children’s Medicaid. updated Income guidelines for ChIP/Children’s Medicaid April 2009 – April 2010 Family Members May qualify for Children’s Medicaid May qualify for CHIP (Adults plus children) Annual Family Income Annual Family Income 1 $10,830 $21,660 2 $14,570 $29,140 3 $18,310 $36,620 4 $22,050 $44,100 We also offer assistance with Food Stamps, Temporary Assistance for Needy Families, ChIP Perinatal, and Long Term Care. Contact Us to see how we might be able to assist you!

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We Know Kids

ETMC First Physicians for Kids When it comes to knowing kids, the pediatricians at ETMC First Physicians clinic on Fifth Street in Tyler are experts. They’re specially trained in the care of newborns, infants, toddlers and adolescents, with emphasis on physical, mental and social development. See the ETMC First Physicians for Kids on Fifth Street in Tyler for: • Immunizations • Physicals and developmental assessments • Treatment of childhood viruses and illnesses For an appointment, call 903-596-ETMC. 1000 E. Fifth St. Tyler, TX 75701 ETMC First Physicians are in-network providers for most insurance plans.

A not-for-profit organization committed to improving the quality of life in East Texas communities.

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BeSafe Child magazine Anderson County Winter 2009 Edition by Claudette Wooddell - Issuu