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Issue 163 - 6 Dec 2010

Articles

1. NIAAA: Advancing Alcohol Research for 40 Years.
By Warren, Kenneth R.& Hewitt, Brenda G. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p5-17
Abstract:
The National Institute on Alcohol Abuse and Alcoholism(NIAAA) has been the lead Federal agency responsible for scientific research on alcohol and its effects for 40 years. During that time, NIAAA has conducted and funded groundbreaking research, distilled and disseminated those research findings to a broad audience, and ultimately improved public health. Among NIAAA's many significant contributions are the National Epidemiologic Survey on Alcohol and Related Conditions, the largest survey ever conducted on alcohol and associated psychiatric and medical conditions; investment in research to identify the genes underlying vulnerability to alcoholism; creation of the Collaborative Studies on Genetics of Alcoholism, a study of the genetics of alcoholism in a human population; leadership in exploring the effects of alcohol on fetal development and on a variety of diseases and organ systems; fostering alcoholism treatment, including supporting a medications development program that has funded more than 30 Phase 2 trials and 15 human laboratory studies; international collaborations and work across the National Institutes of Health; influential research on preventing alcohol problems through community programs as well as policy changes; and the translation of research findings to everyday practice, including the production of award-winning clinician training materials. [ABSTRACT FROM AUTHOR]

2. Preventing Alcohol Related Problems Through Health Policy Research
By Voas, Robert B.& Fell, James C. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p18-28
Abstract:
Alcohol-related health policy research is responsible for guiding the implementation of laws and public health policies that have reduced alcohol-related highway injuries and deaths, as well as other alcohol-related problems over the last 40 years. This research, which tests theories about potential policy changes and responds to specific problems, has examined a vast array of prevention programs. This article briefly identifies 10 program categories and highlights four programs to illustrate the scope and complexity of the individual health policy areas within the categories. [ABSTRACT FROM AUTHOR]

3. Reducing Underage and Young Adult Drinking: How to Address Critical Drinking Problems During This Developmental Period
By Windle, Michael & Zucker, Robert A. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p29-44
Abstract:
Forty years ago, when the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded, alcoholism was considered an adult disease driven principally by physiological determinants. As NIAAA expanded its research portfolio, new data and insights were obtained that led to an increased focus on underage and young adult drinking. Fostered by interdisciplinary research, etiologic models were developed that recognized the multiplicity of relevant genetic and environmental influences. This shift in conceptualizing alcohol use disorders also was based on findings from large-scale, national studies indicating that late adolescence and early young adulthood were peak periods for the development of alcohol dependence and that early initiation of alcohol use (i.e., before age 15) was associated with a fourfold increase in the probability of subsequently developing alcohol dependence. In recent years, developmental studies and models of the initiation, escalation, and adverse consequences of underage and early young adult drinking have helped us to understand how alcohol use may influence, and be influenced by, developmental transitions or turning points. Major risk and protective factors are being identified and integrated into screening, prevention, and treatment programs to optimize interventions designed to reduce drinking problems among adolescents and young adults. In addition, regulatory policies, such as the minimum drinking age and zero-tolerance laws, are being implemented and evaluated for their impact on public health. [ABSTRACT FROM AUTHOR]

4. MAGNITUDE AND PREVENTION OF COLLEGE DRINKING AND RELATED PROBLEMS.
By Hingson, Ralph W. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p45-54
Abstract:
In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) issued a report entitled A Call to Action: Changing the Culture of Drinking at U.S. Colleges. Data on the magnitude of college drinking problems in 1998 to 1999 were reported. From 1999 to 2005, the proportion of college students aged 18-24 who drank five or more drinks on a single occasion in the past month increased from 41.7 percent to 45.2 percent. The proportion who drove under the influence of alcohol increased from 26.1 percent to 29.2 percent. Higher percentages of 21- to 24-year-olds engaged in those behaviors than 18- to 20-year-olds, and between 1999 and 2005 the percentage increased among 21- to 24-year-olds but not among those aged 18-20. From 1998 to 2005, unintentional alcohol-related injury deaths increased 3 percent (from 1,442 to 1,825) per 100,000 college students aged 18-24. Alcohol misuse by college students often harms other people through traffic crashes and sexual/other assaults. Research regarding ways to reduce college drinking problems has shown that individual-oriented interventions, particularly screening and brief motivational counseling interventions, social norms interventions, environmental policy changes such as the minimum legal drinking age of 21 and drinking-and-driving laws, and comprehensive college-community programs, can reduce college drinking and related morbidity and mortality. There is a growing need for colleges and surrounding communities to implement interventions shown through research to reduce alcohol misuse among college-aged people. [ABSTRACT FROM AUTHOR]

5. The Past and Future of Research on Treatment of Alcohol Dependence.
By Willenbring, Mark L. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p55-63
Abstract:
Research on the treatment of alcoholism has gained significant ground over the past 40 years. Studies such as the National Institute on Alcohol Abuse and Alcoholism's Project MATCH, which examined the prospect of tailoring treatments for particular people to better suit their needs, and Project COMBINE, which examined in-depth, cognitive-behavioral therapy and medical management, helped pave the way for a new way of approaching alcoholism treatment. New findings garnered through the National Epidemiologic Survey on Alcohol and Related Conditions further defined the problem. At the heart of this research has been the development of procedures to characterize, measure, and monitor the fidelity to a particular conceptual psychotherapeutic approach so that clear comparisons can be made between conceptually and technically distinct approaches. Advances in scientific methodology and statistics have provided tools to analyze complex datasets. The resulting findings mark an improvement over the first models of treatment developed decades ago, which tended to focus on anecdotal findings and assumptions. This hard-earned progress has enabled scientists today to move ahead and address the next set of challenges. Future research, coupled with a restructured treatment system capable of making new scientific findings rapidly available to the community, hold the key to significantly improving treatment outcomes and reducing suffering from alcohol-related disorders. [ABSTRACT FROM AUTHOR]

6. Genetic Research: Who Is At Risk for Alcoholism?
By Foroud, Tatiana et al. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p64-75
Abstract:
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded 40 years ago to help elucidate the biological underpinnings of alcohol dependence, including the potential contribution of genetic factors. Twin, adoption, and family studies conclusively demonstrated that genetic factors account for 50 to 60 percent of the variance in risk for developing alcoholism. Case-control studies and linkage analyses have helped identify DNA variants that contribute to increased risk, and the NIAAA-sponsored Collaborative Studies on Genetics of Alcoholism (COGA) has the expressed goal of identifying contributing genes using state-of-the-art genetic technologies. These efforts have ascertained several genes that may contribute to an increased risk of alcoholism, including certain variants encoding alcohol-metabolizing enzymes and neurotransmitter receptors. Genome-wide association studies allowing the analysis of millions of genetic markers located throughout the genome will enable discovery of further candidate genes. In addition to these human studies, genetic animal models of alcohol's effects and alcohol use have greatly advanced our understanding of the genetic basis of alcoholism, resulting in the identification of quantitative trait loci and allowing for targeted manipulation of candidate genes. Novel research approaches-for example, into epigenetic mechanisms of gene regulation-also are under way and undoubtedly will further clarify the genetic basis of alcoholism. [ABSTRACT FROM AUTHOR]

7. FOCUS ON: THE CARDIOVASCULAR SYSTEM WHAT DID WE LEARN FROM THE FRENCH (PARADOX)?
By Mochly-Rosen, Daria & Zakhari, Samir. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2, p76-86
Abstract:
Although heavy alcohol consumption has deleterious effects on heart health, moderate drinking is thought to have cardioprotective effects, reducing the risk of coronary artery disease and improving prognosis after a myocardial infarction. It still is unclear, however, if this effect can be achieved with all types of alcoholic beverages and results from the alcohol itself, from other compounds found in alcoholic beverages, or both. For example, the polyphenolic compound resveratrol, which is found particularly in red wine, can reduce the risk of atherosclerosis; however, it is not clear if the resveratrol levels present in wine are sufficient to achieve this result. Alcohol itself contributes to cardioprotection through several mechanisms. For example, it can improve the cholesterol profile, increasing the levels of "good" cholesterol and reducing the levels of "bad" cholesterol. Alcohol also may contribute to blood clot dissolution and may induce a phenomenon called preconditioning, whereby exposure to moderate alcohol levels (like short bouts of blood supply disruption [i.e., ischemia]), and result in reduced damage to the heart tissue after subsequent prolonged ischemia. Finally, the enzyme aldehyde dehydrogenase (ALDH) 2, which is involved in alcohol metabolism, also may contribute to alcohol-related cardioprotection by metabolizing other harmful aldehydes that could damage the heart muscle. [ABSTRACT FROM AUTHOR]

8. FOCUS ON: ALCOHOL AND THE LIVER.
By Szabo, Gyongyi & Mandrekar, Pranoti. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p87-96
Abstract:
Thirty-five years ago Charles Lieber and colleagues (1975) published a seminal article in liver research, showing that alcohol itself is the primary cause for the higher prevalence of liver disease seen in alcoholic patients and not dietary deficiencies and malnutrition that often accompany alcoholism. Their groundbreaking research dispelled previously held theories that alcohol was not a major cause of liver damage and led to several decades of study of the deleterious effects of alcohol and its metabolism on the liver. Since that early study, clinical and experimental studies have continued to show a firm connection between high amounts of alcohol consumption and liver disease. This article tracks advances in alcohol-related liver disease research over the past 40 years and describes how these discoveries are helping scientists to gain insight into therapeutic targets that may help to combat this life-threatening disease. [ABSTRACT FROM AUTHOR]

9. FOCUS ON: ALCOHOL AND THE IMMUNE SYSTEM.
By Molina, Patricia E.et al. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p97-108
Abstract:
Alcohol abuse suppresses multiple arms of the immune response, leading to an increased risk of infections. The course and resolution of both bacterial and viral infections is severely impaired in alcohol-abusing patients, resulting in greater patient morbidity and mortality. Multiple mechanisms have been identified underlying the immunosuppressive effects of alcohol. These mechanisms involve structural host defense mechanisms in the gastrointestinal and respiratory tract as well as all of the principal components of the innate and adaptive immune systems, which are compromised both through alcohol's direct effects and through alcohol-related dysregulation of other components. Analyses of alcohol's diverse effects on various components of the immune system provide insight into the factors that lead to a greater risk of infection in the alcohol-abusing population. Some of these mechanisms are directly related to the pathology found in people with infections such as HIV/AIDS, tuberculosis, hepatitis, and pneumonia who continue to use and abuse alcohol. [ABSTRACT FROM AUTHOR]

10. FOCUS ON: COMORBID MENTAL HEALTH DISORDERS.
By Anthenelli, Robert M. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p109-117
Abstract:
Research advances over the past four decades have demonstrated that a significant proportion of people with alcohol use disorders also suffer from a comorbid mood or anxiety disorder. This article briefly reviews the associations among alcohol dependence, major depressive disorder, and posttraumatic stress disorder. Dysregulation of the brain's and body's stress system (i.e., the limbic-hypothalamic- pituitary-adrenal axis) might serve as a common mechanistic link to explain some of the relationships among these frequently comorbid conditions. Finally, the article examines the role of sex differences in stress circuitry. These differences may explain why men and women differ in their risk for developing comorbid alcoholism and stress-related disorders. [ABSTRACT FROM AUTHOR]

11. Fetal Alcohol Spectrum Disorders
By Thomas, Jennifer D. et al. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p118-126
Abstract:
Forty years ago, alcohol was not commonly recognized as a teratogen, an agent that can disrupt the development of a fetus. Today, we understand that prenatal alcohol exposure induces a variety of adverse effects on physical, neurological, and behavioral development. Research supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has contributed to the identification of the range and prevalence of fetal alcohol spectrum disorders (FASD), as well as methods for prevention and treatment of FASD. The worldwide prevalence and high personal and societal costs of FASD speak to the importance of this research. This article briefly examines some of the ways that NIAAA has contributed to our understanding of FASD, the challenges that we still face, and how this research is translated into changes in public policy. [ABSTRACT FROM AUTHOR]

12. Alcohol's Effects on Brain and Behavior
By Sullivan, Edith V. et al. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p127-143
Abstract:
Over the past 40 years, rigorous examination of brain function, structure, and attending factors through multidisciplinary research has helped identify the substrates of alcohol-related damage in the brain. One main area of this research has focused on the neuropsychological sequelae of alcoholism, which has resulted in the description of a pattern of sparing and impairment that provided an essential understanding of the functional deficits as well as of spared capabilities that could be useful in recovery. These studies have elucidated the component processes of memory, problem solving, and cognitive control, as well as visuospatial, and motor processes and their interactions with cognitive control processes. Another large area of research has focused on observable brain pathology, using increasingly sophisticated imaging technologies-progressing from pneumoencephalography to computed tomography, magnetic resonance imaging (MRI), diffusion tensor imaging, and functional MRI-that have enabled ever more detailed insight into brain structure and function. These advancements also have allowed analysis of the course of brain structural changes through periods of drinking, abstinence, and relapse. [ABSTRACT FROM AUTHOR]

13. HISTORY OF NEUROBIOLOGICAL STUDIES IN ALCOHOL RESEARCH.
By Harris, R. Adron. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p128-129
Abstract:
The article presents an overview of the history of neurobiological studies in alcohol research which have been conducted since 1970. A discussion of predominant themes and breakthroughs which have been seen in the research is presented. The impact that the research has had on the understanding of the mechanisms of alcoholism is discussed

14. THE POTENTIAL OF NEUROSCIENCE TO INFORM TREATMENT.
By Koob, George F. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p144-151
Abstract:
In the 40 years since the founding of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), researchers have gained a better understanding of the brain circuits and brain chemical (i.e., neurotransmitter) systems involved in the development and maintenance of alcoholism and other drug dependence. This understanding has led to the identification of numerous potential targets for pharmacotherapy of addiction. For example, insight into the roles of signaling molecules called endogenous opioids and the neurotransmitter glutamate were fundamental for developing two medications--naltrexone and acamprosate--now used in the treatment of alcoholism. However, the processes of dependence development (e.g., reinforcement, sensitization, and withdrawal) are highly complex and involve a plethora of contributing influences, which also may differ from patient to patient. Therefore, existing pharmacotherapies still are effective only for some but not all alcoholic patients. Accordingly, researchers are continuing to explore the processes involved in addiction development to identify new targets for treatment and develop new medications that can address different aspects of the dependence syndrome, thereby increasing the likelihood of successful treatment. NIAAA continues to play a pivotal role in funding and conducting this research in order to provide effective treatment options to millions of alcohol-dependent patients. [ABSTRACT FROM AUTHOR]

15. Ethnicity and Health Disparities in Alcohol Research.
By Chartier, Karen; Caetano, Raul. Alcohol Research & Health, 2010, Vol. 33 Issue 1/2: p152-160
Abstract:
Recent advances in alcohol research continue to build our understanding of alcohol consumption and related consequences for U.S. ethnic minority groups. National surveys show variations across ethnicities in drinking, alcohol use disorders, alcohol problems, and treatment use. Higher rates of high-risk drinking among ethnic minorities are reported for Native Americans and Hispanics, although within-ethnic group differences (e.g., gender, agegroup, and other subpopulations)also are evident for ethnicities. Whites and Native Americans have a greater risk for alcohol use disorders relative to other ethnic groups. However, once alcohol dependence occurs, Blacks and Hispanics experience higher rates than Whites of recurrent or persistent dependence. Furthermore, the consequences of drinking appear to be more profound for Native Americans, Hispanics, and Blacks. Disparities in alcohol treatment utilization are most apparent for Hispanics. Explanations for these differences are complex, likely affected by risky drinking behaviors, immigration experiences, racial/ethnic discrimination, economic and neighborhood disadvantage, and variations in alcohol-metabolizing genes. Research must maintain a systematic, strong, and growing focus on ethnic minorities. A more complete understanding of these effects for ethnic minority groups is needed to enable researchers to face the challenges of reducing and ultimately eliminating health disparities in the alcohol field. [ABSTRACT FROM AUTHOR]

Journals - Table of Contents

16. From Journal of Primary Health Care, Volume 2, Number 4, December 2010
16A.
From the Editor: Preparation for castastrophe [By Felicity Goodyear-Smith]
Original Scientific Papers - Quantitative Research
16B. Digital monitoring by whole body photography and sequential digital dermoscopy detects thinner melanomas [By Marius Rademaker, Amanda Oakley]
16C. Melanomas detected by screening using whole body photography and sequential digital dermoscopy imaging services  are thinner than those diagnosed by traditional diagnostic methods.
16D. Review of registration requirements for new part-time doctors in New Zealand, Australia, the United Kingdom, Ireland and Canada [By Sharon Leitch, Susan Dovey]
16E. A review of requirements by different countries for medical registration recommends that increased flexibility would help address workforce shortages
16F. Appetite for life:  an evaluation of a primary care lifestyle programme [By Liz Cutler, Bronwen King, Nicky McCarthy, Greg Hamilton & Lynley Cook]
16G. A healthy lifestyle programme offered through primary care that is based on a non-dieting approach may help overweight women develop and sustain positive lifestyle changes
16H. The Flinders Programme of Chronic Condition Self-Management in New Zealand:  survey findings [By Margaret Horsburgh, Janine Bycroft, Felicity Goodyear-Smith, Dianne Roy, Faith Mahony, Erin Donnell, Denise Miller]
16I. Despite the considerable resource being directed into training primary care nurses in the Flinders Programme, there is limited use of the Flinders tools and processes in clinical practice
16J. The feasibility of assessing the Flinders Programme of Patient Self-Management in New Zealand primary care settings [Margaret Horsburgh, Janine Bycroft, Felicity Goodyear-Smith, Dianne Roy, Faith Mahony, Erin Donnell, Denise Miller]
16K. Undertaking a substantive trial to evaluate the effectiveness of the Flinders Model is not feasible until the difficulties of introducing a new and complex intervention in primary care with structured support are resolved
16L. How do newly diagnosed patients with type 2 diabetes in the Waikato get their diabetes education? [By Ross Lawrenson, Grace Joshy, Yoska Eerens, Wayne Johnstone]
16M. Most people access education about their type 2 diabetes through primary care
Qualitative Research
16N.
'Going-to-have-cancerness':  a study of living with increased risk of BRCA1 and BRCA2 mutations for six South Island women [By Raewyn Crump, Ruth Fitzgerald & Michael Legge]
16O. A study involving cancer screening explored experiences of women with high familial risk of breast cancer gene mutations finds that contrary to expectations, genetic testing, screening and prophylaxis may reduce rather than improve the women’s peace of mind
Improving Performance
16P. An audit of two methods of anticoagulation monitoring in a general practice [Kerr Wright]
16Q. Use of a standardised protocol by practice nurses to request International Normalised Ratio (INR) tests and adjust warfarin dosage is to be more efficient than the usual ad hoc GP method, without compromising patient care
16R. Influenza H1N1 2009 in Canterbury:  a case study in pandemic response co-ordination [By Daniel Williams et al]
16S. Description of coordinated response of the Canterbury health sector to the Influenza A H1N1 09 pandemic
Back to Back
16T. All people over 75 years with a five-year CVD risk of > 15% should be treated with statins unless specifically contraindicated [By Yes Sue Wells; No Dee Mangin]
Continuing Professional Development
16U.
String of PEARLS about eczema and asthma
16V. Cocharane Corner:  Spironolactone (when all else fails) in hypertension [Bruce Arroll]
Viewpoint
16W. Primary health care funding for children under six years of age in New Zealand:  why is this so hard? [Nicholas Fancourt, Nikki Turner, M Innes Asher, Tony Dowell]
Ethics
16X. Obesity, autonomy and the harm principle [By Monique Jonas]
16Y. Gems of NZ Primary Health Care Research

News - National

17. Gardeners warned about soil mix
TVNZ - Saturday December 04, 2010
Gardeners who use potting mix are being warned about the risk of catching legionnaires' disease after an elderly woman died from the disease. Canterbury District Health Board said a woman in her 80s died from pneumonia caused by the disease last week and three people with the disease were in intensive care, The Press reported
http://tvnz.co.nz/health-news/gardeners-warned-soil-mix-3942359

18. Rest home closure rocks Taihape
The New Zealand Farmers Weekly - 6 Dec 2010
Taihape residents are concerned the closure of the rest home will have further negative effects on health services in the rural town.
Lou and Joan Campbell managed a large station in the district and lived in Taihape for 60 years. It is their home. Now in their 90s, the couple wanted to spend the rest of their days in the small rural town in the central North Island, so five months ago they moved in to Ruanui House rest home. News the rest home is closing, with families given two weeks' notice to find alternative care for their loved ones, has left them devastated.
http://www.farmersweekly.co.nz/article/8628.html

19. Changes to the Holidays Act and the Employment Relations Act  
Changes to the Holidays Act 2003 and the Employment Relations Act 2000 have been passed by Parliament. The Employment Relations Amendment Act 2010 and Holidays Amendment Act 2010 introduce a wide range of legislative amendments. 
The main changes to the Holidays Act include:
•The ability for employees to cash in a maximum of one week of annual holidays.
•Transferring public holidays to another working day.
The main changes to the Employment Relations Act include:
•Extending trial  periods to all employers
•Changes to the personal grievance provisions
•Requiring consent to be given before a union can access a workplace, and confirming communication with employees can occur during collective bargaining.
•Requiring employers to retain employment agreements
•Extending the role and powers of labour inspectors.
When the changes come into effect
Most changes for both Acts will come into effect on 1 April, 2011.
http://ers.govt.nz/updates/

20. Scientists make chronic pain breakthrough
Reuters - Friday December 03, 2010 
Researchers working on mice have found an enzyme in the brain that appears to make pain last after nerve injury. The finding will now be used in working towards the treatment of chronic pain. In a paper published in Science magazine, the scientists in Canada and South Korea said they managed to alleviate pain after blocking the enzyme.
http://tvnz.co.nz/health-news/scientists-make-chronic-pain-breakthrough-3939689

21. Voice on psychiatrists' body
ODT - 6 Dec 2010
Longtime Dunedin community mental health services campaigner Jim Crowe has become the first consumer representative to be appointed to the Royal Australiasian and New Zealand College of Psychiatrists' general council.
http://www.odt.co.nz/news/dunedin/139337/voice-psychiatrists-body

News - International

22. Labor 'closely watching' clinic rollout
AAP - December 3, 2010 
Health Minister Nicola Roxon says she's keeping "a close watch" on the much-maligned GP super clinics program following fresh accusation of delays and mismanagement. It's been revealed the latest clinic to open, in the Adelaide suburb of Modbury, doesn't actually have any doctors yet. The federal opposition says that proves the program is being "bungled".
http://news.smh.com.au/breaking-news-national/labor-closely-watching-clinic-rollout-20101203-18j58.html

23. Why fine dining may be a health hazard
SMH - 6 Dec, 2010
EATING at gourmet restaurants may be as bad for you as a trip to McDonald's, according to diabetes specialists who are increasingly diagnosing young businessmen with the debilitating condition. Doctors from Melbourne's Baker IDI Heart and Diabetes Institute are now seeing men as young as 40 afflicted by the disease, which is often triggered by obesity and linked to poor diet.
http://www.smh.com.au/entertainment/restaurants-and-bars/why-fine-dining-may-be-a-health-hazard-20101204-18ksv.html

24. The Telegraph - 4 Dec 2010
Patients denied hip surgery and fertility treatment amid NHS cash crisis NHS trusts are delaying major operations and refusing to fund fertility treatment amid a spiralling financial crisis.
http://www.telegraph.co.uk/health/healthnews/8181390/Patients-denied-hip-surgery-and-fertility-treatment-amid-NHS-cash-crisis.html

 

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