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6 Healthcare Action Items for the LGBTQIA+ Community
Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs. Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health. PrEP and PEP Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months. Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days. PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location. HPV Immunization All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime. The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never! STI Testing Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year. Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you. Prostate Exams Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old. These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened. Pap Tests and Pelvic Exams Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer. Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings. Mammograms and Breast Exams People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual. The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project. Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.
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Prevention Against STIs Matters
According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new sexually transmitted infection (STI) cases in the United States each year, with rates continuing to increase. What you may not know is most STIs are preventable. We talked with Renown Adolescent Medicine Specialist, Caroline Barangan, MD to learn more about STIs. How Can You Get an STI? The CDC (Center for Disease Control) says that STIs are acquired through sexual contact. There are bacteria, viruses or parasites that can cause an STI which may pass from person to person in blood, semen, vaginal and other bodily fluids. How Do You Know if You Have an STI? STIs can have a range of signs and symptoms such as: Warts, bumps or sores on or near the penis, vagina, mouth or anus Swelling, redness or severe itching near the penis or vagina Discharge from the penis Vaginal bleeding that’s not your period Painful or uncomfortable sex Vaginal discharge that has an unpleasant odor, causes irritation or is a different color or amount than usual Weight loss, diarrhea or night sweats Aches, pains, fever and chills Jaundice (yellowing of the skin and whites of the eyes) Painful or frequent urination Sore throat if you engage in oral sex It’s important to know that the majority of people who have an STI commonly have no symptoms at all, which is why it’s important to get regularly tested once you have had any sexual activity. Young people less than 25 years of age should be screened on a yearly basis at minimum.
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Breast Surgical Oncology
Breast Surgery Care at Renown Health Renown Breast Surgery Care, located within the Center for Advanced Medicine B, is a comprehensive, fully integrated breast surgery clinic, addressing a wide spectrum of breast problems ranging from benign to cancerous: Benign breast conditions such as fibroadenoma, phyllodes tumors, and nipple discharge Breast cancer risk assessment and genetics High risk breast lesions such as atypical ductal hyperplasia, atypical lobular hyperplasia, LCIS, papillary lesions, and radial scars Advanced breast cancer surgical techniques including oncoplastic surgery for best aesthetic outcomes possible and nipple sparing mastectomies, working closely with skilled plastic reconstructive surgeons. Our highly experienced breast surgical oncologists are continuing to expand our team to better meet the evolving needs of our community and beyond. We are excited to soon be incorporating an oncology wellness team who can further support our patients with focused nutritional guidance, functional assessments for prehabilitation needs prior to surgery or medical treatments, and guidance for development of physical activity and other exercise programs, for best outcomes in cancer treatment as well as future risk reduction. The National Accreditation Program for Breast Centers (NAPBC) is a rigorous process designed to ensure high quality care for breast centers by meeting thoughtfully created standards that are constantly being reviewed and updated for ongoing improvement of patient care. We are the only NAPBC-accredited program in Northern Nevada.
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Research Shows Genetic Approaches to Breast Cancer Screenings Yield More Accurate Results
Clinical researchers with the Healthy Nevada Project co-author research paper with findings that emphasize the need for a comprehensive approach to breast cancer risk assessment – including a focus on genetic medicine – to help ensure that individuals at high risk are identified and supported proactively rather than reactively. Breast cancer is a leading cause of cancer death among women in the United States. According to the American Cancer Society, about 1 in 8 women will develop breast cancer and about 1 in 39 women will die from breast cancer. Breast cancer is associated with increased age, hereditary factors, obesity, and alcohol use. Since 1990, breast cancer death rates have declined progressively due to advancements in treatment and detection. In Nevada there are an estimated 2,310 new breast cancer cases a year, and genetic mutations such as in the genes BRCA1 or BRCA2 remain a top risk factor for this prevalent disease. Recognizing the urgency for progress in breast cancer research, a collaborative effort between physicians, advanced practice providers and scientists from the Healthy Nevada Project® (HNP) and Helix have unveiled groundbreaking research. This study explores how genetic screenings are a necessary supplement to traditional testing methods, together offering more accurate insights into a patient's likelihood of developing breast cancer in the future. HNP is operated by Renown Genomic Medicine and the Institute for Health Innovation and is one of the largest community-based population health studies in the country. Their team works in collaboration with Helix, a leader in precision health that delivers comprehensive genomic solutions. Together, this dynamic partnership aims to understand breast cancer risk factors and pave the way for more effective preventative measures. The combined research team studied 25,591 female HNP participants to evaluate the performance of different genetic screening approaches to identify women at high risk of breast cancer. The results of this research suggest that a combined monogenic, or single-gene, and polygenic, or multi-gene, approach to breast cancer screenings helped produce more accurate results and more closely identify study participants who have a high genetic risk of developing the disease. "Based on this research, we are advocating a shift in approach which would improve breast cancer risk assessment through a combination of effective family history ascertainment and genetic screening,” said Joseph Grzymski, PhD, principal investigator of the Healthy Nevada Project, research professor at the University of Nevada, Reno School of Medicine and co-author of the breast cancer research paper. “This tailored approach, founded on the assessment of individual genetic risk, not only intends to elevate patient well-being but also will improve efficiency and equity in healthcare." Complementing the team’s research on leveraging genetics to identify women at low genetic risk of breast cancer that could safely defer mammogram screenings by five to 10 years that was released in late 2023 in JAMA Oncology, the study suggests that incorporating genetic information can assist in personalizing breast cancer screenings and optimizing the use of screening resources. "Existing disparities persist across various facets of breast cancer screening and treatment; however, genetic screening is clearly a powerful tool to help facilitate early intervention for those at higher risk,” said Jamie Schnell Blitstein, APRN, a primary care nurse practitioner at Renown Health and co-author of the breast cancer research paper. “By placing a heightened focus on risk, we underscore the pivotal role of preventative breast cancer screening.” Despite the availability of effective methods for early screening, co-authors of this research found that 78 percent of women with a family history of breast cancer had their risk ascertained only after a breast cancer diagnosis. The findings emphasize the need for a comprehensive approach to breast cancer risk assessment – including a focus on genetic medicine – to help ensure that individuals at high risk are identified and supported proactively rather than reactively. “These findings that can profoundly impact how healthcare is delivered were only made possible by all the participants who were willing to consent to research,” said Alex Bolze, PhD from Helix and co-author of the publication. “Broad-scale collaboration projects like these between Renown Health and UNR that engage large populations where participants share both their genetic information as well as electronic health records drive advancements in preventative medicine, as well as fundamental biological research.” The research paper was officially accepted on Jan. 29, 2024, and will be published by Elsevier, Inc. on behalf of the American College of Medical Genetics and Genomics. The contents of the paper will appear in the international journal Genetics in Medicine Open. Read the full article by visiting sciencedirect.com. The Healthy Nevada Project is currently recruiting new study participants. Free to all Nevadans with a saliva sample or blood draw, participants and their referring providers receive access to whole-exome sequencing and clinical grade results that help provide insight into their unique genetic risks tied to heart disease and certain cancers. If you are interested in enrolling in the study, schedule a Virtual Consent Appointment through MyChart or contact the Renown Institute for Health Innovation at RenownIHI@renown.org or (775) 982-6914 to be connected to a Genomic Representative. About Renown Health Renown Health is the region’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the region’s largest, locally owned not-for-profit insurance company, Hometown Health. Renown is currently enrolling participants in the largest community-based genetic population health study, the Healthy Nevada Project®. To join the Renown Health team, visit renown.org/careers. About Helix Helix is the leading population genomics and viral surveillance company operating at the intersection of clinical care, research, and data analytics. Helix enables health systems, life sciences companies, payers, and government partners to accelerate the integration of genomic data into patient care and public health decision-making. Learn more at helix.com.
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Why are Annual Exams & Routine Screenings Important?
March is Colorectal Cancer Awareness Month, and we want you to receive the best preventative care possible. Early detection can help prevent serious illness, yet many people still choose to skip their annual exams and routine screenings. Bonnie Ferrara, MD, MPH, Section Chief for Primary Care at Renown Medical Group, further explains the importance of this simple, easy way to stay healthy. Why are annual exams so important? The benefits of early detection and prevention to save lives and reduce the impacts of disease have been proven. These exams are the perfect opportunity to get your health questions answered. “This is your chance to sit down with your provider and talk about your overall health and your family’s health history as well as your concerns for the future,” says Bonnie Ferrara, M.D., family medicine. “It’s the opportunity for your provider to talk with you about your lifestyle, tobacco use, exercise and alcohol use, all of which make a difference in your future longevity.” The annual wellness exam is also an ideal time for most adult patients to discuss health screenings. In addition, these visits are the perfect time to address issues that may not directly relate to a particular medical problem or immediate illness. A good rule of thumb is to schedule these appointments around your birthday each year to make sure you and your provider are both updated on your care. Why would you need an annual exam if you aren’t feeling sick? According to Dr. Ferrara, seeing your care provider when you aren’t sick is one of the best times. “It is better if you try to arrange this visit when you are not feeling ill,” she says. “It is an opportunity to talk about wellness. Not only how to contribute to your wellness but also the changes that you can make that will make huge dividends in the future for your wellness. In addition, it allows us to do some education about what to expect in the coming years as far as your health and lifestyle changes.” What can you expect at an annual exam? Annual exams usually check your: History – lifestyle behaviors, health concerns, vaccination status, family medical history Vitals – blood pressure, heart rate, respiration rate and temperature General appearance – your care provider can find out a lot about you just by watching and talking to you Dr. Ferrara adds, “If this is a Medicare annual wellness exam, it is an opportunity to talk to your provider about depression and dementia as well as be tested for those.” You can also leverage your annual exam to speak to your provider about managing your chronic health problems. "As a provider, these visits give us the opportunity to hear how the medications and lifestyle changes we have recommended are working and if you are having problems with these, we have the opportunity to make suggestions of how to do things better for the future," Dr. Ferrara.
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Addressing Health Equity for Communities of Color
Area Church Pastors, the City of Reno, the City of Sparks, the Washoe County School District, REMSA and Renown will be available to discuss the impact of COVID-19 on communities of color, and how they have joined together to provide free COVID-19 testing to area residents. WHAT Media is invited to interview community leaders to learn how we are coming together to address health disparities and promote equity in healthcare access and delivery. The first project to support our community and address health equity is to partner with area pastors to provide free COVID-19 nasal swab testing for adults and children of faith-based organizations, churches and school children. The first drive-through/walk-up test site will be hosted on Saturday, September 26 from 1-4 p.m., at Ministerio Palabra de Vida by Pastor Cesar Minera. Testing will be offered for members of Ministerio Palabra de Vida (Word of Life Ministries) and A.M.E.N. (Asociacion de Ministros Evangelicos de Nevada), a network of over 15 churches in the Reno, Sparks and Carson City area, as well as WCSD students and families living in that area. REMSA staff will conduct the nasal swab testing and Renown Health will process the tests. Having symptoms of COVID-19 is not required to get tested. WHEN Thursday, September 24 at 1:45 p.m. WHERE Ministerio Palabra de Vida 2375 S Virginia St, Reno, NV 89502 VISUAL & INTERVIEW OPPORTUNITIES Pastor Cesar Minera A member of the church congregation Representatives from the City of Reno (Vice Mayor Reese), City of Sparks, WCSD, REMSA and Renown Health WHY According to the American Hospital Association, the COVID-19 pandemic is disproportionately affecting our Black, Indigenous and people of color communities. Black and Latino Americans are three times more likely than white people to contract COVID-19. The Centers for Disease Control and Prevention reports the COVID-19 hospitalization rate for Black and Latino persons also face similar grim hospitalization rates, 4.7 and 4.6 times higher, respectively, compared to white persons. Black people are dying at a rate nearly two times higher (24%) than their share of the population (13%), and, in 42 states, including Nevada, Latino people make up a greater share of confirmed cases than their share of the population, according to the COVID Data Tracking Project at The Atlantic. In support of Governor Sisolak’s proclamation of Racism as a Public Health Crisis, a partnership of faithbased organizations, churches and Pastors, along with community leaders recognize that it is critical to change the culture of medicine by addressing racism and implicit biases that contribute to health disparities. The group of northern Nevada community leaders includes; Reno Mayor Hillary Schieve; Sparks City Counselman Kristopher Dahir, Chaplain for the Northern Nevada Veterans Home, and Board President of Excel Christian School; Angela D. Taylor, Ph.D. of Washoe County School District's Board of Trustees, an ordained minister and assistant Pastor at Greater Light Christian Center; Senior Pastor Cesar Minera of Ministerio Palabra de Vida (Word of Life Ministries) and President of A.M.E.N. (Asociacion de Ministros Evangelicos de Nevada), a network of over 15 churches in the Reno, Sparks and Carson City area; Pastor Nathan DuPree of Living Stones Church and executive director of 360 Blueprint, a collaboration of the local law enforcement agencies, the Washoe County School District and local community leaders, and co-chairman of the African American Clergy Council of Northern Nevada (AACCoNN), faith-based organizations, churches and Pastors uniting to support our community focusing on families, health, education, job development, and crime prevention; Norris DuPree, Jr., Ph.D. and President of Transformations Therapy and Behavioral Consultation; Pastor DeSean Horne of Second Baptist Church, Dean Dow, MBA, CMTE, President & CEO of REMSA and Anthony Slonim, MD, DrPH, President & CEO of Renown. The first project to support our community to address health equity is to partner with area pastors to provide free COVID-19 nasal swab testing for adults and children of faith-based organizations, churches and school children of the WCSD. There is no cost to be tested. Those with insurance will be asked to provide an insurance card, all others will be tested free, with thanks to the Renown Community Benefits fund. About Renown Health Renown Health is Reno’s only locally owned, charitable, not-for-profit integrated health network. Being not-for-profit means that all income stays in the community— and is reinvested in programs, people and equipment to improve the health of the community. Renown directly contributes to the community’s overall well-being with a Community Benefit mission to reduce health disparities, promote community wellness and improve access to care for vulnerable populations. This includes offering free and discounted care to those unable to afford healthcare, and partnerships with others to address health and well-being. In partnership with many community-based organizations, area schools, human and social service agencies, and government and business leaders, Renown supports many educational, public health outreach, and community development initiatives throughout Nevada. In FY19, Renown Health, a locally-governed, not-for-profit community health network invested more than $158 Million for health education, community initiatives and non-reimbursed healthcare services. In FY20, CEO, Dr. Tony Slonim provided $150,000 in funding to 60 local agencies to support Diversity & Inclusion efforts and Social Determinants of Health.
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UNR Med and Renown Health Recognize Transgender Day of Remembrance
Medical Students Recognize Transgender Lives Lost to Violence, Address Inequities in Health The month of November includes Transgender Awareness Week, which concludes with Transgender Day of Remembrance (TDOR), on Sunday, November 20, a day for people to come together to recognize the many transgender lives lost to violence over the last year. Transgender people remain one of the most underserved groups of people across several domains, including health care. The Transgender Day of Remembrance and Resilience memorializes people who have passed due to transphobic violence. The Transgender community is an umbrella term used by people who do not identify with the gender associated with the sex they were assigned at birth. Not everyone identifies with the term transgender, and there are many self-identifier terms for people who do not identify with their assigned sex at birth (e.g., woman, man, trans, non-binary, gender nonconforming, gender fluid, gender queer, and more). Transgender Day of Remembrance is held in November to honor Rita Hester, whose murder on Nov. 28, 1998, launched the “Remembering Our Dead” web project and a San Francisco vigil the following year. The event provides a forum for transgender communities and allies to raise awareness of the threat of violence faced by gender variant people and the persistence of prejudice felt by the transgender community. Communities organize events and activities including town hall style "teach-ins," photography and poetry exhibits and candlelit vigils. These activities make anti-transgender violence visible to stakeholders like police, the media, and elected officials. In 2010, TDoR was observed in over 185 cities throughout more than 20 countries. Here in Reno, the University of Nevada, Reno School of Medicine (UNR Med) hosts Diversity Dialogues, a series hosted by the Office of Diversity and Inclusion. This month, the Medical Student Pride Alliance of UNR Med honored transgender people whose lives were lost in acts of anti-transgender violence, that included a medical student-led discussion regarding ways to help raise visibility and awareness for transgender people and the issues faced by the community. Diversity Dialogues is an open discussion of diversity and inclusion issues and the diversity initiatives at UNR Med. The UNR Med Diversity Dialogues included a reading of the names of those who died from October 1st of the former year to September 30th of the current year, and education on transgender and gender non-conforming people. Medical students recommend ways that healthcare providers can help support the community including: Being open to feedback, criticism, and new information Contributing to a LGBTQ+ safe space by using pronoun pins, flags, inclusive language Registering your practice on Nevada Gender Affirming Healthcare Project (NGAHP), GLMA: Health Professionals Advancing LGBTQ Equality, Outcare Health, & other provider lists Reading new research in academic journals and stay up to date with guidelines including World Professional Association for Transgender Health (WPATH) Version 8 and attending CME courses on LGBTQ+ Care. The general public can support the community by: Standing up for trans people in your life, in the media, and amongst your peers, and be an active, proud ally to the community Respecting people’s identities and fluidity and learn to use different pronouns Consuming trans-friendly and LGBTQ+ friendly media (tv shows, movies, music, podcasts) Following trans people on social media, specifically activists/educators, to learn from them This month, the Human Rights Campaign (HRC) Foundation, the educational arm of the Human Rights Campaign, the nation’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ+) civil rights organization, released “An Epidemic of Violence: Fatal Violence Against Transgender and Gender Non-Conforming People in the United States in 2022” a report honoring the lives of at least 32 transgender and gender non-conforming people killed in 2022 and shining a light on data that HRC has continued to collect on the epidemic of violence. HRC has officially recorded at least 300 violent deaths of transgender and gender non-conforming people, including 32 in 2022 alone, since the organization began tracking this violence ten years ago. Overall, transgender and gender non-conforming victims of violence are overwhelmingly Black, under 35, and killed with a firearm. The highest known single-year total of fatal deaths of transgender and gender non-conforming people was in 2021, when at least 57 trans & gender non-conforming people were violently killed. Worse, these disturbing numbers likely underreport the deadly violence targeting transgender and gender non-confirming people, who may not be properly identified as transgender or gender non-conforming by police, media or other sources. In 2022, the Human Rights Campaign Foundation recognized Renown Regional Medical Center in Reno, Nev. as the first and only hospital in Nevada at the highest level of support as “LGBTQ+ Healthcare Equality Leader.” The Healthcare Equality Index (HEI) is the nation’s foremost benchmarking survey of healthcare facilities on policies and practices dedicated to the equitable treatment and inclusion of LGBTQ+ patients, visitors and employees. For more on LBGTQ+ care and providers at Renown, visit renown.org/diversity/lgbtq-at-renown/. The University of Nevada, Reno School of Medicine (UNR Med), Nevada’s first public medical school, is a community-based, research-intensive medical school with a statewide vision for a healthy Nevada. Since 1969, UNR Med has trained more than 3,900 students, residents and fellows. UNR Med continues to improve the health and well-being of all Nevadans and their communities through excellence in student education, postgraduate training and clinical care, research with local, national and global impact and a culture of diversity and inclusion. For more information, visit med.unr.edu. Renown Health is Nevada's largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children's hospital, a rehabilitation hospital, a medical group and urgent care network, and the locally owned not-for-profit insurance company, Hometown Health.
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