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    5 Important Tips for Every New Jeep Owner

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    Tips for Designing an Industrial-Style Restaurant

    Tips for Designing an Industrial-Style Restaurant

    Los Angeles implemented a new tax on luxurious real estate to finance affordable housing and combat homelessness

    Los Angeles implemented a new tax on luxurious real estate to finance affordable housing and combat homelessness

    Working shorter hours: 38 companies in the USA are testing the 4-day week

    Working shorter hours: 38 companies in the USA are testing the 4-day week

    World’s largest trial in the UK: 86 percent want to keep 4-day week

    World’s largest trial in the UK: 86 percent want to keep 4-day week

    Rewarding “Good” Companies—How the Economy for the Common Good Wants to Change the World

    Rewarding “Good” Companies—How the Economy for the Common Good Wants to Change the World

    Redistributing 11 billion dollars: Colombia’s left-wing president wants to fight poverty with a wealth tax

    Redistributing 11 billion dollars: Colombia’s left-wing president wants to fight poverty with a wealth tax

    Ban or regulate: The world searches for a way to deal with cryptocurrencies

    Ban or regulate: The world searches for a way to deal with cryptocurrencies

    Bolivia: Less poverty and booming economy through nationalisation of mineral resources

    Bolivia: Less poverty and booming economy through nationalisation of mineral resources

    “Creating Prosperity Together”: How the social economy model saved the English city of Preston

    “Creating Prosperity Together”: How the social economy model saved the English city of Preston

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      Essential Tips for Planning a Great Fashion Show

      Signs That Your Tuxedo Doesn’t Fit Right

      Signs That Your Tuxedo Doesn’t Fit Right

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      Make a Bold Style Statement With These Wide-Leg Pants

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      Power Your Winter Workouts With The Best Zip Hoodies for Men

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      The Ultimate Watch Buying Guide

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      Outdoor Enthusiasts, Take Note: These Watches Are as Tough as You

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      Our 7 Favorite Field Jackets for Tackling Fall Weather

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      The Best Leather Jackets for Guys – No Matter Your Budget

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      Campus-Ready Backpacks for Storing *All* the Books

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        Cheese Tortellini in Creamy Marinara

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        Unusual Products That Come From Animals and Their Uses

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        How the Wine You Choose Can Help You have an Eco-Friendly Home

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          Dental Therapists Help Patients in Need of Care Avoid the Brush-Off

          Dental Therapists Help Patients in Need of Care Avoid the Brush-Off

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          Personal Medical Debt in Los Angeles County Tops $2.6 Billion, Report Finds

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              LIV Golf’s opaque lobbying operations raise questions around foreign influence amid PGA Tour merger

              LIV Golf’s opaque lobbying operations raise questions around foreign influence amid PGA Tour merger

              Companies that publicly condemned legislation targeting the LGBTQ+ community send political contributions to state lawmakers who advanced anti-LGBTQ+ bills

              Companies that publicly condemned legislation targeting the LGBTQ+ community send political contributions to state lawmakers who advanced anti-LGBTQ+ bills

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              Chris Christie launches 2024 campaign following years of lobbying and staying close to donors

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              SEC sues Coinbase, Binance in blow to crypto industry efforts to shape cryptocurrency regulations

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              Independent Sen. Krysten Sinema continues using liberal platforms to fundraise for 2024 reelection campaign

              Watchdog bites Ron DeSantis for alleged “soft money” campaign finance violation

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              Press Release: Over 30,000 White House financial disclosures to be made public in first for transparency and accountability

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                  Tips for Crossing Water in Your Jeep Wrangler

                  Tips for Crossing Water in Your Jeep Wrangler

                  4 Helpful Tips for Giving Your Car a Glossy Finish

                  4 Helpful Tips for Giving Your Car a Glossy Finish

                  4 Common Mistakes To Avoid With Car Restorations

                  4 Common Mistakes To Avoid With Car Restorations

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                  Signs That It Might Be Time To Get a New Car

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                  Ways To Surprise Your Partner Who Loves Cars

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                  5 Important Tips for Every New Jeep Owner

                  The Best Ways To Increase the Value of Your Car

                  The Best Ways To Increase the Value of Your Car

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                  Tips for Designing an Industrial-Style Restaurant

                  Tips for Designing an Industrial-Style Restaurant

                  Los Angeles implemented a new tax on luxurious real estate to finance affordable housing and combat homelessness

                  Los Angeles implemented a new tax on luxurious real estate to finance affordable housing and combat homelessness

                  Working shorter hours: 38 companies in the USA are testing the 4-day week

                  Working shorter hours: 38 companies in the USA are testing the 4-day week

                  World’s largest trial in the UK: 86 percent want to keep 4-day week

                  World’s largest trial in the UK: 86 percent want to keep 4-day week

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                  Rewarding “Good” Companies—How the Economy for the Common Good Wants to Change the World

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                  Redistributing 11 billion dollars: Colombia’s left-wing president wants to fight poverty with a wealth tax

                  Ban or regulate: The world searches for a way to deal with cryptocurrencies

                  Ban or regulate: The world searches for a way to deal with cryptocurrencies

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                  Bolivia: Less poverty and booming economy through nationalisation of mineral resources

                  “Creating Prosperity Together”: How the social economy model saved the English city of Preston

                  “Creating Prosperity Together”: How the social economy model saved the English city of Preston

                  Trending Tags

                  • Fashion
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                    Essential Tips for Planning a Great Fashion Show

                    Signs That Your Tuxedo Doesn’t Fit Right

                    Signs That Your Tuxedo Doesn’t Fit Right

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                    Make a Bold Style Statement With These Wide-Leg Pants

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                    Power Your Winter Workouts With The Best Zip Hoodies for Men

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                    The Ultimate Watch Buying Guide

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                    Outdoor Enthusiasts, Take Note: These Watches Are as Tough as You

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                    Our 7 Favorite Field Jackets for Tackling Fall Weather

                    The Best Leather Jackets for Guys – No Matter Your Budget

                    The Best Leather Jackets for Guys – No Matter Your Budget

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                    Campus-Ready Backpacks for Storing *All* the Books

                    Trending Tags

                    • Food & Drink
                      Cheese Tortellini in Creamy Marinara

                      Cheese Tortellini in Creamy Marinara

                      Unusual Products That Come From Animals and Their Uses

                      Unusual Products That Come From Animals and Their Uses

                      Tips for Creating a Homemade Wine Cellar

                      Tips for Creating a Homemade Wine Cellar

                      How the wine you choose can help you have an eco-friendly home

                      How the Wine You Choose Can Help You have an Eco-Friendly Home

                      Rum and Cola Holiday Ham

                      Special Centerpieces for Holiday Celebrations

                      ChefsGiving 2020

                      This Holiday Season, How about Cooking for a Cause?

                      Iced Cold Moscow Mule cocktail with lime and pomegranate

                      Holiday Spirits: The Cranberry Smash Moscow Mule

                      The Most Beautiful Liquor Bottles in the World

                      The Most Beautiful Liquor Bottles in the World

                      Tao Group Virtual Chef Experience

                      Entertain Your Guests Virtually This Fall ?

                      Trending Tags

                      • Health
                        Dental Therapists Help Patients in Need of Care Avoid the Brush-Off

                        Dental Therapists Help Patients in Need of Care Avoid the Brush-Off

                        Personal Medical Debt in Los Angeles County Tops $2.6 Billion, Report Finds

                        Personal Medical Debt in Los Angeles County Tops $2.6 Billion, Report Finds

                        How the Mixed Messaging of Vaccine Skeptics Sows Seeds of Doubt

                        How the Mixed Messaging of Vaccine Skeptics Sows Seeds of Doubt

                        Burnout Threatens Primary Care Workforce and Doctors’ Mental Health

                        Burnout Threatens Primary Care Workforce and Doctors’ Mental Health

                        Debt Deal Leaves Health Programs (Mostly) Intact

                        Debt Deal Leaves Health Programs (Mostly) Intact

                        A Windfall in Health Insurance Rebates? It’s Not as Crazy as It Sounds

                        A Windfall in Health Insurance Rebates? It’s Not as Crazy as It Sounds

                        Massage Therapists Ease the Pain of Hospice Patients — But Aren’t Easy to Find

                        Massage Therapists Ease the Pain of Hospice Patients — But Aren’t Easy to Find

                        A ‘Payday Loan’ From a Health Care Behemoth

                        A ‘Payday Loan’ From a Health Care Behemoth

                        As Fewer MDs Practice Rural Primary Care, a Different Type of Doctor Helps Take Up the Slack

                        As Fewer MDs Practice Rural Primary Care, a Different Type of Doctor Helps Take Up the Slack

                        Trending Tags

                        • Lifestyle

                          The History and Meaning of Memorial Day

                          Ways To Make Your Partner Feel Loved and Appreciated

                          Ways To Make Your Partner Feel Loved and Appreciated

                          Values and principles, even when faced with temptations, challenges, or potential negative consequences.

                          Acknowledging Racism within Familial and Social Circles: An Examination of Cognitive Dissonance and Socio-Cultural Factors

                          Definition of ethics

                          The Interconnectedness of Racial Opinions and Ethics

                          Sacrifice States: the US Nuclear Sponge

                          woman with gun near thief at night in parking lot

                          Why it’s Important to know Your 2nd Amendment Rights

                          Tips for Growing a Fuller and Healthier Beard

                          Tips for Growing a Fuller and Healthier Beard

                          Fulfilling Side Hustles for Good Money in 2023

                          Fulfilling Side Hustles for Good Money in 2023

                          5 Tips on How To Run Your First Charity Event

                          5 Tips on How To Run Your First Charity Event

                          Trending Tags

                          • Politics
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                            LIV Golf’s opaque lobbying operations raise questions around foreign influence amid PGA Tour merger

                            Companies that publicly condemned legislation targeting the LGBTQ+ community send political contributions to state lawmakers who advanced anti-LGBTQ+ bills

                            Companies that publicly condemned legislation targeting the LGBTQ+ community send political contributions to state lawmakers who advanced anti-LGBTQ+ bills

                            Chris Christie launches 2024 campaign following years of lobbying and staying close to donors

                            Chris Christie launches 2024 campaign following years of lobbying and staying close to donors

                            SEC sues Coinbase, Binance in blow to crypto industry efforts to shape cryptocurrency regulations

                            SEC sues Coinbase, Binance in blow to crypto industry efforts to shape cryptocurrency regulations

                            WEBINAR SERIES:  Federal and State Lobbying Masterclass for Journalists

                            WEBINAR SERIES: Federal and State Lobbying Masterclass for Journalists

                            OpenSecrets releases report on out-of-state donations’ rising role

                            OpenSecrets releases report on out-of-state donations’ rising role

                            Independent Sen. Krysten Sinema continues using liberal platforms to fundraise for 2024 reelection campaign

                            Independent Sen. Krysten Sinema continues using liberal platforms to fundraise for 2024 reelection campaign

                            Watchdog bites Ron DeSantis for alleged “soft money” campaign finance violation

                            Watchdog bites Ron DeSantis for alleged “soft money” campaign finance violation

                            Press Release: Over 30,000 White House financial disclosures to be made public in first for transparency and accountability

                            Press Release: Over 30,000 White House financial disclosures to be made public in first for transparency and accountability

                            Trending Tags

                            • Real Estate
                              Ways To Invest in Real Estate With No Experience

                              Ways To Invest in Real Estate With No Experience

                              How To Make Your Rental Property More Eco-Friendly

                              How To Make Your Rental Property More Eco-Friendly

                              Things To Consider Before Investing in Real Estate Overseas

                              Things To Consider Before Investing in Real Estate Overseas

                              Incredible Areas in Florida To Buy a Vacation Home

                              Incredible Areas in Florida To Buy a Vacation Home

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                              Helpful Home Staging Tips for Virtual Tours

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                              Ways To Decorate and Design a Lake House

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                              Challenges To Managing a Rental Property

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                              The Best Landlord: How To Show Tenants You Care

                              The Best Locations To Invest in a Second Home

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                              Addiction Treatment Proponents Urge Rural Clinicians to Pitch In by Prescribing Medication

                              by Staff Writer
                              December 3, 2022
                              in Health
                              Addiction Treatment Proponents Urge Rural Clinicians to Pitch In by Prescribing Medication
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                              By Tony Leys

                              MARSHALLTOWN, Iowa — Andrea Storjohann is glad to see that she’s becoming less of a rarity in rural America.

                              The nurse practitioner prescribes medication to dozens of patients trying to recover from addiction to heroin or opioid painkillers.

                              The general-practice clinic where she works, housed in a repurposed supermarket building, has no signs designating it as a place for people to seek treatment for drug addiction, which is how Storjohann wants it.

                              “You could be coming here for OB-GYN care. You could be coming here for a sore throat. You could be coming here for any number of reasons,” and no one in the waiting room would know the difference, she said.

                              Privacy is an important part of the treatment. And so is the medication Storjohann prescribes: buprenorphine, which staves off cravings and prevents withdrawal symptoms for people who have stopped misusing opioid drugs. The central Iowa clinic, owned by the nonprofit agency Primary Health Care, has offered buprenorphine since 2016. “We were kind of a unicorn in this part of the state,” Storjohann said, but that’s changing.

                              Unlike methadone, the traditional medication to wean people off heroin or other opioids, buprenorphine can be prescribed at primary care clinics and dispensed at neighborhood pharmacies. Federal and state authorities have encouraged more front-line health care professionals to prescribe Suboxone and other medications containing buprenorphine for patients trying to overcome opioid addiction. Federal regulators have made it easier for doctors, nurse practitioners, and physician assistants to become certified to offer the service.

                              The opioid crisis has deepened in the past decade with the illicit distribution of fentanyl, a powerful, extremely addictive opioid. Its prevalence has complicated the use of medication to treat opioid addiction. Patients who have been misusing fentanyl can suffer severe withdrawal symptoms when they begin taking buprenorphine, so health practitioners must be careful when starting the treatment.

                              In Iowa, officials designated $3.8 million from the state’s initial share of opioid lawsuit settlement money for a University of Iowa program that helps health care providers understand how to use the medications.

                              Federal agencies are spending millions to expand access to medication to treat addictions, including in rural areas. The Health Resources and Services Administration, which aims to improve health care for underserved people, offers many of these grants.

                              Carole Johnson, the agency’s top administrator, said she hopes increased training on treating opioid addiction encourages health care providers to learn the latest ways to treat other kinds of addiction, including methamphetamine dependence and alcoholism, which plague many rural states. “We’re sensitizing people to substance use disorder writ large,” she told KHN.

                              In 2016, just 40% of rural counties nationwide had at least one health care provider certified to prescribe buprenorphine, according to a University of Washington study. That figure climbed to 63% by 2020, the study found.

                              The study credited the rise to changes in federal rules that allow nurse practitioners, physician assistants, and other midlevel health care providers to prescribe buprenorphine. In the past, only physicians could do so, and many rural counties lacked doctors.

                              Buprenorphine is an opioid that pharmacies most often sell as a tablet or a film that both dissolve under the tongue. It does not cause the same kind of high as other opioid drugs do, but it can prevent the debilitating withdrawal effects experienced with those drugs. Without that help, many people relapse into risky drug use.

                              The idea of opioid “maintenance treatment” has been around for more than 50 years, mainly in the form of methadone. That drug is also an opioid that can reduce the chance of relapse into misusing heroin or painkillers. But the use of methadone for addiction treatment is tightly regulated, due to concerns that it can be abused.

                              Only specialized clinics offer methadone maintenance treatment, and most of them are in cities. Many patients starting methadone treatment are required to travel daily to the clinics, where staffers watch them swallow their medicine.

                              Federal regulators approved Suboxone in 2002, opening an avenue for addiction treatment in towns without methadone clinics.

                              Storjohann said buprenorphine offers a practical alternative for Marshalltown, a town of 27,000 people surrounded by rural areas.

                              The nurse practitioner spends about half her time working with patients who are taking medications to prevent relapse into drug abuse. The other half of her practice is mental health care. A recent appointment with patient Bonnie Purk included a bit of both.

                              Purk, 43, sat in a small exam room with the nurse practitioner, who asked about her life. Purk described family struggles and other stressors she faces while trying to abstain from abusing painkillers.

                              Storjohann asked whether Purk felt hopeless. “Or are you just frustrated?”

                              Purk thought for a moment. “I went through a week where I was just crying,” she said, wiping her eyes with a tissue. But she said she hasn’t been seriously tempted to relapse.

                              Storjohann praised her persistence. “You’re riding a roller coaster,” she said. “I think you need to give yourself some grace.”

                              Purk knows Suboxone is not a miracle cure. She has taken the medication for years, and twice relapsed into misusing pain pills. But she has avoided a relapse since spring, and she said the medication helps.

                              In an interview after her monthly appointment with Storjohann, Purk said the medicine dulls cravings and blocks withdrawal symptoms. She recalled terrible night sweats, insomnia, diarrhea, and jitters she suffered when trying to stop abusing pills without taking Suboxone.

                              “You focus on nothing but that next fix. ‘Where am I going to get it? How am I going to take it?’” she said. “You just feel like a train wreck — like you’ll die without it.”

                              Purk said mental health counseling and frequent drug tests have also helped her remain sober.

                              Patients can stay on buprenorphine for months or even years. Some skeptics contend it’s swapping one drug dependence for another, and that it should not be seen as a substitute for abstinence. But proponents say such skepticism is easing as more families see how the treatment can help people regain control over their lives.

                              Dr. Alison Lynch, a University of Iowa addiction medicine specialist, warned about the risks of fentanyl and buprenorphine in a recent lecture to health professionals in training.

                              Lynch explained that fentanyl remains in the body longer than other opioids, such as heroin. When someone with fentanyl in their system takes buprenorphine, it can cause a particularly harsh round of nausea, muscle pain, and other symptoms, she said. “It’s not dangerous. It’s just miserable,” she said, and it can discourage patients from continuing the medication.

                              Lynch noted drug dealers are lacing fentanyl into other drugs, so people don’t always realize they’ve taken it. “I just make the assumption that if people are using any drugs they bought on the street, it’s probably got fentanyl,” she said. Because of that, she said, she has been using smaller initial doses of buprenorphine and increasing the dosage more gradually than she used to.

                              Nationwide, the number of health professionals certified to prescribe buprenorphine has more than doubled in the past four years, to more than 134,000, according to the federal Substance Abuse and Mental Health Services Administration. Efforts to expand access to the treatment come as drug overdose deaths have more than doubled in the U.S. since 2015, led by overdoses of fentanyl and other opioids.

                              Storjohann would like to see more general clinicians seek training and certification to prescribe buprenorphine at least occasionally. For example, she said, emergency room doctors could prescribe a few days’ worth of the medication for a patient who comes to them in crisis, then refer the patient to a specialist like her. Or a patient’s primary doctor could take over the buprenorphine treatment after an addiction treatment specialist stabilizes a patient.

                              Dr. Neeraj Gandotra, chief medical officer of the Substance Abuse and Mental Health Services Administration, said he sees potential in expanding such arrangements, known as a “hub and spoke” model of care. Family practice providers who agree to participate would be assured that they could always send a patient back to an addiction treatment specialist if problems arose, he said.

                              Gandotra said he hopes more primary care providers will seek certification to prescribe buprenorphine.

                              Johnson, the Health Resources and Services Administration administrator, said states can also increase access to medication-assisted treatment by expanding their Medicaid programs, to offer health insurance coverage to more low-income adults. The federal government pays most of the cost of Medicaid expansion, but 11 states have declined to do so. That leaves more people uninsured, which means clinics are less likely to be reimbursed for treating them, she said.

                              Health care providers no longer are required to take special classes to obtain federal certification — called a “waiver” — to treat up to 30 patients with buprenorphine. But Lynch said even veteran health care providers could benefit from training on how to properly manage the treatment. “It’s a little daunting to start prescribing a medication that we didn’t get a lot of training about in medical school or PA school or in nursing school,” she said.

                              Federal officials have set up a public database of health care providers certified to offer buprenorphine treatment for addiction, but the registry lists only providers who agree to include their names. Many do not do so. In Iowa, only about a third of providers with the certification have agreed to be listed on the public registry, according to the Iowa Department of Health and Human Services.

                              Lynch speculated that some health care professionals want to use the medication to help current patients who need addiction treatment, but they aren’t looking to make it a major part of their practice.

                              Storjohann said some health care professionals believe addiction treatment would lead to frustration, because patients can repeatedly relapse. She doesn’t see it that way. “This is a field where people really want to get better,” she said. “It’s really rewarding.”

                              This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

                              KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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