Sadly, the Luck O’ the Irish Doesn’t Protect Against Drunk Drivers, STDs, Early Death (Or Anything Else for That Matter)
By spatel | March 17, 2010
By Luke Manley
Since it is indeed St. Patrick’s Day and this is a forum for discussing Men’s health you could probably have guessed that the message today would be about the dangers of alcohol consumption. However, hopefully I can avoid being too stale and provide you with some new information and just enough caution to cause you to not make a complete fool out of yourself and/or die. As Socrates so succinctly put it and a quote that applies to so many situations in life: “Everything in moderation”.
First, some little known history about this most sophisticated of American holidays. Today actually marks the 273rd St. Patrick’s Day celebration in the United States, which began in Boston, Massachusetts in 1737. It was originally intended to be a religious holiday (as it still is in Ireland) with a feast celebrating the former bishop and patron saint of Ireland, St. Patrick. The tradition of imbibing alcohol on this day emerged from an old Irish legend that involves St. Patrick and a stingy innkeeper who less than adequately filled the bishop’s glass. In order to teach the innkeeper a lesson, St. Patrick informed him that a devil in his basement was continually feeding on the man’s dishonesty and that he must turn over a new leaf to rid his establishment of the creature. Lo and behold, upon his return St. Patrick found the innkeeper filling each glass to the brim. After swiftly banishing the now-starving devil, the bishop declared that on this day, each person should have a glass of whiskey.
While not on par with the behavioral lessons of Aesop’s Fables or Mother Goose, the story undoubtedly seeks to encourage saintly generosity. Unfortunately, in the United States you would be hard pressed to find any message attached to St. Patrick’s Day other than “let’s all get hammered” and unlike most other holidays, the celebration’s entire focus revolves around not just drinking, but drinking to excess. It has been documented in nearly every state that St. Patrick’s Day results in the highest number of traffic-related deaths, as well as the highest levels of arrests for DWI/DUI. In fact, individuals face a 23% increase in the likelihood of injury or death from drunk drivers on St. Patrick’s Day.
This of course raises the larger issue of alcohol abuse being the third leading cause of preventable death in the U.S. According to the CDC it results in 75,000 deaths each year and typically steals an average of 30 years of life from those individuals. Additionally, CDC estimates that nearly an additional 41,000 people die each year from alcohol-induced car accidents and other injuries. This is particularly important for men because we account for 72% of these excessive drinkers. Figures from a study in the UK found that the male alcohol-related death rate in men was 18 in 100,000, which was more than twice that of females. Another sobering finding (no pun intended) is that a further 35,000 deaths occur each year from alcohol-related diseases such as liver cirrhosis and cancer. Yes, even cancer. Less commonly known than it’s direct contribution to the death of the liver is the fact that excessive alcohol consumption greatly increases the risk of mouth, throat, esophageal, liver, and colon cancer in men. If appealing to the preservation of the rest of your body wasn’t enough to give you pause I will risk beating a dead leprechaun by appealing to your own lucky charms. High levels of alcohol consumption have been shown to result in impotence, infertility, and face and body alopecia by interfering not only with testicular function, but also hormone production. And we all know the ladies love that.
However, what might prove to be even more dangerous than excessive drinking is the increasing epidemic of binge drinking. Binge drinking is defined as “drinking heavily over a short period of time with the primary intention of becoming intoxicated” and accounts for a staggering 75% of all alcohol consumed by U.S. adults. Binge drinking is particularly troublesome because since it is often infrequent, it is not considered to be a problem, yet it carries all the same consequences of regular over-consumption. In fact, 78% of men who are considered to be frequent binge-drinkers consider themselves to be light or moderate drinkers. Yet with most other health issues, this is an issue that disproportionately affects men. Research conducted by the CDC has discovered that men are twice as likely to binge drink and average four times the number of binge drinking sessions per year than women.
This isn’t meant to be an impassioned harangue against alcohol or celebration, especially considering I enjoy the occasional “Irish Car Bomb” myself. I only preach self-awareness and caution, especially on this most alcoholically indulgent of holidays. Perhaps try floating a shamrock leaf in your whiskey before drinking, another old custom. At least then you’ll get some vegetables to counteract whatever mystery brew really does make that beer green. Happy St. Paddy’s Day!
Links for more information:
http://www.cdc.gov/alcohol/quickstats/mens_health.htm
http://www.sdnn.com/sandiego/2010-03-16/lifestyle/beware-binge-drinking-this-st-patricks-day
http://www.msnbc.msn.com/id/6089353/
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Topics: Education, Lifestyle Issues | No Comments »
Do yourself some good…and others, too
By spatel | March 8, 2010
By Brandon Leonard
Remember the last time you did something nice for someone, just because? It probably felt pretty good. Imagine multiplying that good feeling over many times, and it’s bound to have some positive effects on your own health. For those who have a little or a lot of time to give, volunteering for a cause that means something to you has many benefits. It can help you make connections with people, foster new friendships, and give you the chance to learn about the lives of others. Research has also shown that volunteering can bring health benefits such as lower incidence of heart disease and lower levels of depression. These are some of the findings published in a 2007 report from the Corporation for National and Community Service titled The Health Benefits of Volunteering: A Review of Recent Research. You can find the press release and the report itself here (http://www.nationalservice.gov/about/newsroom/releases_detail.asp?tbl_pr_id=687).
It’s not surprising that volunteering can make us healthier. When we give our time to something we care about, we are happy with ourselves and the fact that we are doing something good. In many cases, it is very easy to see that the work we are doing is having a direct and positive impact on others. Staying active through volunteering also keeps our minds and bodies engaged, providing physical and/or mental exercise that is essential for us to thrive. If you find that something is missing from your life, or if you have too much time on your hands, give some thought to an organization or cause that could use your support. Even if it’s just a few hours a month, the time you spend could end up benefiting a lot of people – including yourself.
If you like to volunteer to help the Men’s Health Network, please email Ramon at ramonl@menshealthnetwork.net
Topics: Well-being | No Comments »
Men’s Health Caucus in the American Public Health Association
By rllamas | March 3, 2010
Men’s Health Caucus in the American Public Health Association
Ramon P. Llamas, MPH
On February 24, 2010, Dr. Georges Benjamin, executive director of the American Public Health Association (APHA), announced the Association’s support for the Men’s Health Caucus, which will draw awareness to an emerging and cross-cutting public health concern. Scott Williams, Chair of the newly formed Caucus and Vice President of Men’s Health Network (MHN), explained that “The Men’s Health Caucus is necessary to bring together academic institutions, health departments, non-profit organizations and others with a common interest in improving the health and well-being of men and their families. This field is in desperate need of a diverse, multi-disciplinary, and coordinated approach to better tackle this public health issue within our communities.”
This caucus will allow APHA members and other individuals interested in the field to coalesce around the impact of poor health outcomes and premature death in men as it pertains to public health. Men of all races, on average, live about 5 years less than their female counterparts because they are less proactive and less engaged with the healthcare system, illustrated by CDC reports that women are 100% more likely than men to seek preventive care. Additionally, poor health outcomes in men cause significant financial burdens on the health care system; higher prevalence rates of chronic disease result in premature death and disability which ultimately affect utilization and rates of health care services. Moreover, the ramifications of chronic disease transcend beyond the individual, often affecting immediate family members as well as members of the individual’s social network. As a result, MHN agrees with the following statement from Dr. Benjamin that “protecting and improving the health of men and their families is essential to improving the health of our nation.” It is MHN’s strong belief that strategic and gender-specific outreach can, in fact, improve health outcomes in men. The formation of an official caucus to facilitate dialogue between health professionals, public health practitioners and researchers will create opportunities for progress in the field.
If you are interested in becoming involved with the Men’s Health Caucus, please do not hesitate to contact me at ramonl@menshealthnetwork.net.
Topics: Public Policy, Well-being | No Comments »
Asking the Tough Questions
By spatel | February 22, 2010
By Adam Dougherty, MPH
This week’s deadly plane crash in Austin, Texas raises important questions regarding national security, anti-government violence, and aviation licensing. One could also make the argument that at the core of the tragedy are questions regarding failure in mental health management. As is frequently mentioned at TAMH, the ability for men to come to terms with personal health issues proves extremely difficult. Mental health is no exception, and in some ways is an even tougher condition to discuss, let alone seek treatment for.
No doubt the above incident is an extreme case, but it nevertheless can act as a learning experience of how best to deal with the demons that we all face. No one piece of the puzzle is to blame, as everything from self-assessment to family support to organizational therapy could have played a larger role. Though the attacker had a history of anti-government sentiments, he reveals in his suicide note that he would write about his disdains ‘as a form of therapy.’ Writing is a common tool for psychotherapy and should be encouraged, though in this case Mr. Stack’s anger management reached a breaking point stating that violence ‘is the only answer.’ With decades of simmering hatred, it is hard to fathom how those close to him could not have seen warning signs at some point. Numerous run-ins with tax officials and auditors could have also raised concerns.
This examination is not meant to highlight the failures that led to the tragedy, but rather raise awareness of the very real sensations that we face every day. No matter the antagonists in our life, it is important to be able to cope with our reactions through personal processes, healthy support from our loved ones, and if needed professional expertise. This is especially relevant during tough economic times. How can I better manage my own trepidations? Would I be able to ask for help if I needed it? How can I act a source of support for a troubled loved one? What other ‘checkpoints’ can be utilized to give people opportunities to work out their thoughts in healthy ways; occupational health systems, government points of contact, or other social services? How does the equilibrium of incarceration versus rehabilitation come into play? To break the social norm of men’s emotional internalization, we must be able to have more thoughtful discussions regarding questions such as these.
Topics: Well-being | No Comments »
Latest Men’s Health in the News
By spatel | February 16, 2010
By Brandon Leonard
Men’s Health issues are featured in an article by Teddi Dineley Johnson in the current issue of The Nation’s Health, a print and online publication of the American Public Health Association. You can access the article here: http://TheNationsHealth.AphaPublications.org/content/40/1/28.full. This piece, which quotes both MHN Vice President Scott Williams and Advisory Board member Dr. Perry Karfunkel, is a call to action for men to consider and improve their health. It’s also a reminder that men’s health issues do not always show up on the radar in discussions about national health in general.
One of the key points in the article is the gap of 2-3 decades in which a large percentage of men have very little contact with health professionals. Having passed through high school and possibly college, men in their 20s, 30s and even 40s become alienated from the healthcare system. This can be attributed to a combination of factors, including fear and the classic tough-guy belief that you don’t need to see a doctor unless you’re in extreme pain. Also, unlike women, men have much less frequent contact with doctors during their adolescence for routine care and never get into a healthy habit of regular check-ups to detect potential problems. When men finally do present themselves in a medical facility, perhaps years after developing mild pain or a nagging health condition, many have missed the chance to catch a serious ailment early.
If this sounds like you, don’t wait any longer to see a professional about any health issues that are bothering you. And if you know someone who is struggling with an ailment, let them know you care enough about them to ensure they get the help they need. Finally, be sure to share information like this article with those you know, and to advocate for more coverage of men’s health issues in both publications and public policy debates. MHN is excited to see this article published in The Nation’s Health and looks forward to engaging in more educational activities about men’s health around the country.
Topics: Education | No Comments »
Happy Pills Or Dummy Pills? Just Don’t Let Them Be Ignorance Pills
By spatel | February 9, 2010
By Luke Manley
I wanted to draw your attention to an article published in the February 8th issue of Newsweek magazine that highlights recently released research that solidly confirms the nearly imperceptible difference between the effectiveness of medications and placebos for the treatment of mild, moderate, and even severe depression. Drawing primarily from a met-analysis published in the January issue of the Journal of the American Medical Association (JAMA), the article explains how it was discovered that after analyzing just published research it was shown that patients taking a placebo improved 75% as often as those taking the actual medication. However, only sixty-percent of clinical trials performed on the main drugs for the treatment of depression have ever been published. After using the Freedom of Information Act to gain access to the remaining 40% of unpublished studies, this number rose to 82%. In addition, when combining both the published and unpublished trials, researchers found that over half showed “the drug alleviated depression no better than a placebo”. Further, in the trials that did show an improvement with those taking the actual medication, it successfully reduced severity of depression by only 1.8 points on the 54-point scale. The final conclusion of the meta-analysis was that the true effect of antidepressants was “nonexistent to negligible” in 87% of people. The only statistically significant drug benefit was in individuals with very severe, chronic symptoms. Just in case there was any doubt remaining, researchers exposed that even the very basis of the effectiveness of antidepressants is based only on a single study from the 1950s. This study showed that a drug called Iproniazid increased serotonin and norepinephrine levels in the brain and seemed to help a number of people with depressive symptoms. Therefore it was decided that it was an imbalance in these two chemicals that must be the cause of depression. Yet a new drug sold in Europe has been shown to be as effective as most current antidepressants and actually lowers levels of serotonin. One of the authors of the ineffectiveness studies puts it plainly, “If depression can be equally affected by drugs that increase serotonin and by drugs that decrease it, it’s hard to imagine how the benefits can be due to their chemical activity.”
Strangely enough, the arguments against this study revolves not around the accuracy of the science, which is admitted even by physicians as well as drug proponents, but whether or not it is morally right to overturn the belief of hundreds of millions of people about the effectiveness of their treatment. It is argued that, even if the improvement truly is fantasy, this belief is necessary for the benefit to continue. Further many fear that exposing the truth might even cause those receiving treatment to abruptly stop taking their medication, which can cause severe withdrawal symptoms such as nausea, vision problems, tremors, and even depression and anxiety. That is certainly an understandable and noble stance if it is indeed patient well-being and not a financial bottom-line influencing such a stance. However, this could easily be the most slippery of slopes. Is it really the moral option to continue to allow millions of people to spend thousands of dollars on drugs that serve no actual benefit? Who is it that is qualified to determine what is best for each of us? Physicians? Pharmaceutical companies? Do the lobbyists for Prozac have depressed people’s best interests at heart?
Both the news and journal articles focus primarily on the lack of a difference between the effectiveness of pharmaceuticals and placebos and the potential consequences. However, it does mention documented methods for successful alternatives, such as psychotherapy, which has been shown to be highly effective for all levels of depression, including very severe. It also makes the case for how the combination of medication and psychotherapy can be even more effective for some people, but warns that this may also be due to the expectation for success.
All this research has important implications for men’s health since men are equally as likely to suffer from depression as women, but are much more likely to successfully commit suicide because of it. The National Institute of Mental Health estimates that depression affects approximately six million men in the United States and between three and five-percent of men worldwide. Additionally, a number of sources confirm that worldwide sales of antidepressants are currently over $20 billion. Therefore any decisions about the distribution and use of these drugs will have profound effects not only on people suffering from depression and the economics that support their treatment, but also the functioning of mental health care systems throughout the world.
References
Begley, S. The Depressing News About Antidepressants. 29 January 2010. Newsweek.
Fournier JC, DeRubeis J., Hollon SD; et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303():47-53.
Topics: Medical Research | No Comments »
Time to reassess
By rllamas | January 28, 2010
Time to reassess
By Ramon P. Llamas, MPH
“Health is the soul that animates all the enjoyments of life, which fade and are tasteless without it.” – William Temple
I recently read “Wake-up Call” by Erika Lovley in Politico this week and my suspicions have been confirmed through anecdotal evidence: people working in Washington, especially those working on Capitol Hill, are extremely stressed out. Having moved to DC last June from California, I first noticed it back in 2008 when I spent a summer here as an intern. It’s the culture to work non-stop. And it’s hard not to. Just take a look around – people almost jogging to the metro because they walk so fast; reading reports on the metro and constant communication through their trusty smartphone, among others. The death of Paula Nowakowski, Chief of staff for John Boehner, serves as a wake up call for everyone in Washington. Slow down and relax, people. Paula passed at the age of 46 from a heart attack. Lovley describes that her lifestyle probably contributed to her passing because “she smoked, she didn’t always eat well, and she often worked seven days a week.” Other Hill staffers have developed health problems as well. From Type 1 diabetes to high blood pressure, the consequences of constant, unrelenting stress can take its toll. Despite one’s passion for the job and work, is it worth the health consequences you develop in return? Is there anything you can do?
A publication from the National Institute for Occupational Health and Safety (NIOSH) recommends the following: maintain a balance between your professional and personal life; have access to a supportive social network of friends and family and maintain a relaxed, positive outlook on life. Early warning signs of job-induced stress include headaches, sleep disturbance, difficulty in concentrating, short temper, upset stomach, job dissatisfaction and low morale. If left untreated, the following health problems have been correlated to job-induced stress: musculoskeletal disorders, psychological disorders, workplace injury, ulcers, impaired immune function, cancer , heart disease and suicide. The first step to solving a problem is to acknowledge that it is there. From that point you can plan accordingly. Mayoclinic.com offers some ideas to relieve stress:
*Keep a log. Track everything you do for one week. Include work-related and non-work-related activities. Decide what’s necessary and what satisfies you the most. Cut or delegate activities you don’t enjoy and don’t have time for. If you don’t have the authority to make certain decisions, talk to your supervisor.
*Learn to say no. Whether it’s a co-worker asking you to spearhead an extra project or your child’s teacher asking you to manage the class play, remember that it’s OK to respectfully say no. When you quit doing the things you only do out of guilt or a false sense of obligation, you’ll make more room in your life for the activities that are meaningful to you and bring you joy.
*Leave work at work. With today’s global business mentality and the technology to connect to anyone at any time from virtually anywhere, there’s no boundary between work and home — unless you create it. Make a conscious decision to separate work time from personal time. When with your family, for instance, turn off your cell phone and put away your laptop computer.
*Communicate clearly. Limit time-consuming misunderstandings by communicating clearly and listening carefully. Take notes if necessary.
*Fight the guilt. Remember, having a family and a job is OK — for both men and women.
*Nurture yourself. Set aside time each day for an activity that you enjoy, such as walking, working out or listening to music. Unwind after a hectic workday by reading, practicing yoga, or taking a bath or shower.
*Set aside one night each week for recreation. Take the phone off the hook, power down the computer and turn off the TV. Discover activities you can do with your partner, family or friends, such as playing golf, fishing or canoeing. Making time for activities you enjoy will rejuvenate you.
*Protect your day off. Try to schedule some of your routine chores on workdays so that your days off are more relaxing.
*Get enough sleep. There’s nothing as stressful and potentially dangerous as working when you’re sleep-deprived. Not only is your productivity affected, but also you can make costly mistakes. You may then have to work even more hours to make up for these mistakes.
If you’ve been able to find a great balance between work and personal life, share your story with me at ramonl@menshealthnetwork.net!
Topics: Lifestyle Issues, Well-being, Workplace Issues | 2 Comments »
Beyond Health Care
By spatel | January 25, 2010
By Ramon P. Llamas, MPH
Health reform has been a topic of great importance here in Washington for the past few months since discussions and debates have intensified in June, 2009. Health reform, however, has primarily focused on one aspect of health – health care. In the broader sense, though, health encompasses a wider reach. For example, health professionals are more likely to acknowledge that culture, race, gender, socioeconomic status (SES) and education, among others, all contribute to an individual’s health status in one way or another. These factors, known collectively as the social determinants of health, continue to gain interest. The Office of Minority Health (OMH), under the Department of Health and Human Services, has issued the National Plan for Action, which sets out a framework to reduce health disparities that result from the various social determinants.
During my brief time here at MHN, I have been fortunate enough to attend two large conferences – the Virginia Health Equality Conference in September and the American Public Health Association’s Annual Conference in November. As a result of attending these events, I met and had discussions with researchers in the field. I highlight a few of them below:
“Sex in Medicine Week: A student-organized educational intervention and its assessment” by Francesca I. Decker and Michael A. Joseph, PhD, MPH from SUNY Downstate.
Background – There is a lack of provider initiative regarding patient sexual health which decreases quality of patient care. Many studies describe this problem but few programs exist to address its causes, and few tools exist to assess existing programs’ effectiveness.
Methods – Student-organized series of lectures and workshops on patient sexual health to educate medical students in order to increase their quality of care post-graduation.
Results – Over 100 students attended and found workshops interesting (100%) as well as useful (98.3%).
“Health Literacy Education and Communication in the Philadelphia Immigrant Community” by Anna M. Quinn, Maura A. Murphy and Katie E. Thomas of Thomas Jefferson University.
Background – Immigrants are less likely to speak to their healthcare providers about diet and exercise than those born in the U.S.
Methods – MPH students worked with two to three ESL students for a specified time and conducted health education and promotion. The sessions discussed local resources for medical care and culturally sensitive health behaviors for each ESL student. Additionally, the MPH students provided ESL students with reviewed health materials.
Results – ESL students reported higher comprehension as well as improved language skills. Additionally, ESL students became more familiar with local resources such as clinics, food banks, farmers’ markets and government services.
Health is an immensely important part of our lives – it is essential to live, work, play and pray, therefore, we should each treat it as a higher priority. We can no longer depend on health care to determine our health status. We must each take a more proactive role in becoming and staying healthy.
If you have any questions or have any ideas on how to empower individuals to take charge of their health, please do not hesitate to contact me at ramonl@menshealthnetwork.net.
Topics: Uncategorized | No Comments »
The Business Case for an Office of Men’s Health
By spatel | January 19, 2010
By Adam Dougherty, MPH
Below is an excerpt from a forthcoming study that I authored, which investigates the federal costs associated with excess disease burden in men in an attempt to substantiate the need for a federal Office of Men’s Health.
Despite the increased risk of disease and injury, the health of men is oft an overlooked subject. Men have significantly higher death rates in nine of the ten top leading causes of death, higher rates of smoking and overweight/obesity, are more often uninsured, and are far less likely to receive routine preventive care. While the moral imperative is evident in reducing health disparities, merely stating the effort is “the right thing to do” often may not provide sufficient motivation to act. Linking the issue to financial incentives, though, gets many more people talking, especially when it’s your tax dollars at work.
The resulting costs of premature morbidity and mortality in men are substantial, particularly so to the federal government in the form of direct medical costs and survivor benefits. Men are at worse health as they enter Medicare, causing substantially higher costs to the program. Excess Medicaid hospital payments for uncompensated care to uninsured men and lost federal revenue as a result of disease burden, disability, and death contribute to excess federal costs. Public benefits for low-income widows and families are substantial as a result of premature death in men including Social Security survivor benefits, Medicaid and Medicare low-income subsidies, and the Food Stamp program.
Across the nation we should dedicate our efforts to improve the health and wellbeing of men, though no organized federal entity is present to provide sustained leadership and national directives. A commitment to prevention and health promotion in men will help curb this expenditure growth and create effective social norms by breaking through the stigma associated with men who avoid seeking care. The time has come for the creation of a federal Office of Men’s Health. A recognized federal focus can act as the apex of promoting healthy lifestyle, workforce safety, and male-specific research advocacy. For more information on the creation of a federal Office of Men’s Health, see H.R. 2115 “The Men and Families Health Care Act of 2009”, Hill [D-ID] and Murphy [R-PA].
Topics: Public Policy | No Comments »
More Money, More Problems
By spatel | January 1, 2010
By Ramon P. Llamas, MPH
First of all, Happy New Year!
USA Today featured a comprehensive story on college football coaches and their total salaries (breakdowns of base salaries and bonuses, etc.) in early November. The highest paid coaches in 2009 lead the most prestigious football programs in the country, including Pete Carroll of Southern California, Bob Stoops of Oklahoma and Urban Meyers of Florida, among others. The aforementioned coaches made at least $4 million dollars in total salary in 2009 (access the full list here). $4 million. A salary of $4 million is higher than most professions, but unfortunately the pressures of receiving such a salary can take their toll. Urban Meyer, for example, recently resigned from his coaching job at the University of Florida due to recent health problems, in which Meyer lost consciousness and was admitted to the hospital. Fortunately for Meyer, there was no heart damage. But he had been experiencing chest pains for the past two years. He reportedly lost 20 pounds during a 10-day period around the SEC title game against arch-rival Alabama. A competitive drive and relentlessness such as Meyer’s are shared, to some degree, by many. It is this same drive that leads to burn out and potential health problems. It is important to be aware of warning signs and symptoms and to discuss any concerns with a physician. Take note of changes and the duration of those changes. For example, weight loss in the past 10 days resulting from a loss of appetite. It is important that each of us takes a more proactive role in maintain our health and well-being, both physically and mentally. Physicians cannot be relied upon to solve all of our health care problems; their job is done more accurately and efficiently when we are fully engaged and assist them in the process.
For this new year, I encourage each of you to reflect on what your health means to you. Remember that health is a resource for living. It is our vehicle to enjoy all that life has to offer, whether it’s traveling, sports, cooking, music or the arts. I wish each of you a healthy and prosperous 2010!
If you have any questions or comments, please drop me a line at ramonl@menshealthnetwork.net.
Topics: Family Issues, Lifestyle Issues, Medical Issues, Sports Issues, Well-being, Workplace Issues | No Comments »
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