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DO NOT CHANGE THE NUMBERS -- CLARIFY THE MESSAGE
The Government Review of the Sensible Drinking Message: A Medical Council on Alcoholism View,
COMMENTARY
This is an edited version of the evidence from The Medical Council on Alcoholism (MCA) on ‘Sensible Drinking’, which is based on the collective views of the Education and Public Health Committee and of The MCA Regional Advisers in medical schools throughout the UK. The contributors are not only university teachers, but also clinicians and health service providers in touch with patients and the public. On one aspect there is total unanimity. On no account should the 21/14 units per week figures for men and women, respectively, be changed: the evidence indicates that this could only lead to increased harm. There seems to be some scope for restatement of the significance of the benchmark such as that ‘below 21/14 units per week is a sensible level, and that, at twice this level, there is an appreciable increase in risk of harm which continues to increase as consumption rises’. Drink-free days are recommended, but the need to suggest an additional curb on intake on any given occasion is also emphasized, since heavy consumption of this sort is that which is particularly associated with behavioural and psychosocial problems, notably in the young. Driving is an obvious example where any drinking could be dangerous. A simple statement such as ‘avoid intoxication and do not exceed 6/4 units in a day, while maintaining the weekly guidelines as at present and bearing in mind the circumstances’ is proposed.
Oxford University Press
1995-09-01 00:00:00.0
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DO CAGE SCORES PREDICT READINESS TO REDUCE ALCOHOL CONSUMPTION IN MEDICAL IN-PATIENTS?
DENT, THOMAS H. S.
SHEPHERD, ROBIN M.
ALEXANDER, GRAEME J. M.
LONDON, MERVYN
RAPID COMMUNICATION
Four-hundred-and-twenty-three medical in-patients received the CAGE, brief Michigan Alcohol Screening Test (MAST) and Readiness to Change (RCQ) questionnaires. Those positive on the CAGE and MAST were more likely to be in contemplation and action phases of the RCQ, suggesting that simple questionnaires identify patients who not only have drinking problems but are ready to make changes to combat them.
Oxford University Press
1995-09-01 00:00:00.0
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ALCOHOL AND OESOPHAGEAL VARICES
SUTTON, R.
SHIELDS, R.
INVITED REVIEW
Oesophageal varices are abnormally dilated veins that develop beneath the mucosa of the lower oesophagus and upper stomach and cause profound gastrointestinal haemorrhage associated with a high mortality. Varices develop in the presence of portal hypertension, which, in Europe and the USA, is most commonly due to alcoholic cirrhosis of the liver. Alcoholic cirrhosis develops in 10–20% of chronic ethanol abusers as a result of prolonged hepatocyte damage, leading to centrilobular inflammation and fibrosis. The net effect on the portal venous system is an elevation of resistance, and/or increase of inflow, producing portal hypertension, and the development of collateral channels in the form of varices. Such parenchymal liver disease also causes ascites, clotting deficiencies, secondary malnutrition and hepatic encephalopathy, all of which contribute to the high mortality associated with vanceat haemorrhage. Variceal bleeding is more likely to occur when the varices are large, long and numerous, with surface red markings, and may be precipitated by respiratory tract infection, non steroidal anti-inflammatory drugs, alcohol, or may occur spontaneously. Once identified by endoscopy, the aims of management are to control the haemorrhage, to prevent recurrent haemorrhage, and to treat the underlying cause of portal hypertension. Attention to nutrition and long-term rehabilitation are particularly important in those alcoholic cirrhotic patients who survive.
Oxford University Press
1995-09-01 00:00:00.0
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PROGNOSIS OF ALCOHOLIC LIVER DISEASE--100 YEARS ON AND THE NEED FOR INTERNATIONAL STANDARDS AND GUIDELINES
HARRIS, DAWN
BRUNT, PETER
REVIEW
Studies of alcoholic liver disease show a wide variation in survival time. This article reviews the relevant literature and draws attention to differences in the measurement of survival. Different starting points, different classifications of drinking behaviour and variations in the terminology used to describe the histological features of different stages of liver disease make it difficult to compare survival figures from various studies. Definitions of excess alcohol intake and of what consistutes ‘abuse’ are also vague. Variations in the way results are expressed may show apparent differences in outcome where none exist in reality. Variations in size of study populations and loss to follow-up are also discussed. It is suggested that resources should be devoted to prevention and early detection of liver disease and that international guidelines are necessary for the adoption of standard terminology, classification of drinking behaviours and alcohol use, methods of analysis and expression of results.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/591
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INFLUENCE OF CGS 8216 ON SOME ACUTE EFFECTS OF ETHANOL
KOTLINSKA, J.
LANGWINSKI, R.
ORIGINAL ARTICLES
The central pharmacological effects of ethanol are well known and resemble those of the benzodiazepines (BZD). In addition BZD may interact with ethanol, resulting in enhanced cerebral depression. Ro 15-4513, BZD inverse agonist, potentially antagonizes a lot of effects of ethanol but not all. In our study, another BZD inverse agonist, CGS 8216, reverses the hypnotic effect of ethanol and hypoactivity in mice and rats. CGS 8216 increased also ethanol's locomotor stimulation in mice. This supports the hypothesis that some effects of ethanol are mediated by the GABA-BZD-chloride channel receptor complex. Our behavioural experiments described in this report suggest that CGS 8216, like Ro 15-4513, may act on the alpha-6 subunit of this receptor complex.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/601
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TIME COURSE AND GENETIC VARIATION IN THE REGULATION OF CALCIUM CHANNEL ANTAGONIST BINDING SITES IN RODENT TISSUES DURING THE INDUCTION OF ETHANOL PHYSICAL DEPENDENCE AND WITHDRAWAL
GUPPY, LEON J.
CRABBE, JOHN C.
LITTLETON, JOHN M.
ORIGINAL ARTICLES
Physical dependence was induced by ethanol inhalation in male Sprague-Dawley rats and, in parallel experiments, in two lines of mice (WSR and WSP) genetically selected for differential severity of ethanol withdrawal. In dependent rats [3H]nitrendipine binding sites were significantly increased in cerebral cortex, cardiac and smooth muscle (vas deferens). Cerebral cortical membranes were the first to show an increase, the <it>B</it><inf>max</inf> for nitrendipine binding rising sharply after 3–4 days of ethanol administration, whereas binding sites in the other tissues increased after 5–6 days. Nitrendipine binding affinity in all tissues was consistently reduced immediately preceding the rise in <it>B</it><inf>max</inf> to a new steady state, but then returned to control values. Between 6 and 10 days of ethanol exposure there was no further increase in the <it>B</it><inf>max</inf> for nitrendipine binding, and on removal of ethanol, the numbers of nitrendipine binding sites fell precipitously to control levels within 24 h of withdrawal. In the genetically selected mice, the up-regulation of nitrendipine binding sites in cardiac membranes was significantly greater in the WSP line. This correlates with severity of physical signs of withdrawal and parallels previous results obtained in brain. The results are consistent with an increase in the synthesis and membrane insertion of dihydropyridine sensitive calcium channel proteins in several tissues during the induction of ethanol dependence and suggest that in the brain this change may play a role in the ethanol withdrawal syndrome.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/607
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ETHANOL DECREASES BASAL CYTOSOLIC-FREE CALCIUM CONCENTRATION IN CULTURED SKELETAL MUSCLE CELLS
COFÁN, MONTSERRAT
FERNANDEZ-SOLÁ, JOAQUIM
NICOLÁS, JOSEP MARIA
POCH, ESTEBAN
URBANO-MÁRQUEZ, ALVARO
ORIGINAL ARTICLES
We analysed the effect of ethanol on basal cytosolic-free calcium concentration ([Ca2+]<inf>1</inf>) in cultured rat myocytes. Ethanol caused a dose-dependent decrease of the resting [Ca2+]<inf>1</inf>). Removal of ethanol was followed by a transitory increase of [Ca2+]<inf>1</inf> above the basal level. In cells chronically exposed to ethanol, [Ca2+]<inf>1</inf> normalized to the previous level.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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ANALYSIS OF ETHANOL AND ACETALDEHYDE RECOVERY FROM PERCHLORIC ACID-TREATED BLOOD
WHITMIRE, DAVID
WHITMIRE, PAULA S.
ORIGINAL ARTICLES
Recovery of acetaldehyde (0–20 μM) or ethanol (0–50 mM) added to blood and subsequently treated with perchloric acid (PCA) was evaluated using head-space gas chromatography and compared with controls. Using blood from five dogs, <100% of acetaldehyde and ethanol was recovered from PCA-treated samples. Mathematical models of putative binding mechanisms indicated acetaldehyde partitioned simply between supernatant and PCA-induced precipitate and occupied <1% of acetaldehyde binding sites on precipitate; ethanol partitioned simply between supernatant and precipitate and occupied >62% of ethanol binding sites. The mathematical model also indicated acetaldehyde binding is 2500-fold stronger than ethanol binding. These results indicate as much as 46.4% of acetaldehyde may be bound to PCA-induced precipitate formed in whole blood. This loss of acetaldehyde is 3- to 4-fold greater than acetaldehyde loss caused by evaporation from PCA-treated blood.
Oxford University Press
1995-09-01 00:00:00.0
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/623
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ACUTE ENCEPHALOPATHY AND POLYNEUROPATHY AFTER DISULFIRAM INTOXICATION
ZORZON, M.
MASE', G.
BIASUTTI, E.
VITRANI, B.
CAZZATO, G.
ORIGINAL ARTICLES
A chronic alcoholic who had ingested a very high dose of disulfiram (29 g over a 1-week period) without simultaneous alcohol intake developed an acute encephalopathy and a severe flaccid tetraparesis that worsened over the course of several days, even after the intake of the drug had stopped. Recovery was both slow and incomplete. One year after intoxication, the patient still had distal weakness in the arms and legs, and hypestesia in the hands and feet.
Oxford University Press
1995-09-01 00:00:00.0
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/629
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ENCOURAGING DRINKING AT SAFE LIMITS ON SINGLE OCCASIONS: THE POTENTIAL CONTRIBUTION OF PROTECTION MOTIVATION THEORY
BEN-AHRON, VERED
WHITE, DAVID
PHILLIPS, KEITH
ORIGINAL ARTICLES
Protection Motivation Theory (PMT) is considered as a possible framework for understanding and moderating higher-risk drinking. To this end questionnaire data were collected from 196 participants about levels of their current drinking and, after they have been alerted to the dangers of excess drinking on single occasions, their cognitions relating to drinking and their intentions for future single occasion drinking. Comparisons of higher and lower risk drinkers among the sample provided support for the applicability of PMT, revealing differences in their cognitions and in their adaptive and maladaptive coping. A supplementary path analysis revealed that health beliefs and coping strategies associated with PMT, together with demographics, account for 42% of the vanance in behavioural intentions. These results suggest that PMT could prove a valuable tool for those working in alcohol research and education. Implications for the design of effective interventions are discussed.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/633
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PHYSICAL MORBIDITY IN PATIENTS ADMITTED TO A PRIVATE HOSPITAL FOR DETOXIFICATION FROM ALCOHOL
WYLIE, A. S.
MILNE, S.
RAMSAY, R. G.
ORIGINAL ARTICLES
A survey of patients admitted to a private hospital for detoxification from alcohol found similar levels of physical morbidity and withdrawal complications to a group admitted to a National Health Service alcohol treatment unit. Although private patients tended to be older than National Health Service patients, the two groups were similar on a number of other variables. The implications for those involved in the management of patients who abuse alcohol are discussed.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/641
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INFLUENCE OF SELENIUM SUPPLEMENTATION IN NON-TOXIC DOSES ON TESTIS LIPID PEROXIDE AND ANTIOXIDANT LEVELS IN CHRONIC ALCOHOL-FED RATS
BEKPINAR, S.
TUG{diaeresis}RUL, Y.
ORIGINAL ARTICLES
Prolonged consumption of alcohol leads to peroxidative damage in testicular tissues and gonadal dysfunction. Selenium (Se) deficiency also gives rise to testicular structural and functional disturbances similar to those caused by alcohol. We examined the possibility that Se supplementation might, at least partially, prevent the testicular disorders induced by alcohol. Rats were fed alcohol and alcohol with 3 p.p.m. Se in drinking water for 5 months. Ethanol administration decreased vitamin C and glutathione levels in testicular tissue, but caused no alterations in vitamin E and polyunsaturated fatty acid levels. However, lipid peroxide levels were increased by alcohol. Selenium supplementation diminished both the depletion of vitamin C and the production of lipid peroxides, but did not affect the depletion of glutathione induced by alcohol in testicular tissue. In addition, Se supplementation amehorated the decrement of serum testosterone levels induced by alcohol.
Oxford University Press
1995-09-01 00:00:00.0
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/645
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THE MEDICAL PROFILE OF UNIDENTIFIED PROBLEM DRINKERS IN GENERAL PRACTICE: TEST OF AN HYPOTHESIS
CORNEL, MICHIEL
KNIBBE, RONALD A.
DROP, MARIA J.
KNOTTNERUS, ANDRÉ
VAN ZUTPHEN, WIM M.
ORIGINAL ARTICLES
In order to facilitate general practitioner (GP) detection of problem drinkers the Dutch College of General Practitioners developed a standard specifying the differences in medical profile between problem drinker and non-problem drinkers. The standard mentions 35 Reasons for Encounter (RFEs) and OP Evaluations (Es) that are thought to be specific for problem drinkers. The studies referred to in the standard base their conclusions about differences in medical profile upon a comparison of problem drinkers already identified by the GP with other patients. This study tests the hypothesis that the medical profile specified by the standard also applies to unidentified problem drinkers. All known problem drinkers in the practices of 16 GPs, as well as a one in 10 random sample of patients considered to be non-drinkers were admitted to the study at their first surgery visit during a 1-year period. Hidden problem drinkers were detected by means of a screening questionnaire, although the results were not conveyed to the GP until the study was completed. Over the 1-year study period the GPs then registered all RFEs and Es of the study population. RFE and E sum scores were then constructed based on the Alcohol Standard. The estimated population prevalence of problem drinking, corrected for the one in 10 sample fraction was 7%. We found 6% problem drinkers (<it>n</it> = 78) in the category regarded by the GPs as non-problem drinkers (<it>n</it> = 1254). Differences in RFEs and Es between hidden problem drinkers and those regarded as non-problem drinkers were significant for irregular heartbeat and psychological problems. Sexual problems were significant at the RFE level, social problems at the E level. When identified problem drinkers are compared with non-problem drinkers more differences in the medical profile are found (four times both RFE and E; twice RFE and once E). We conclude that most of the published differences in the medical profile between problem drinkers and other GP patients are not found for unidentified problem drinkers. The observed differences between unidentified problem drinkers and non-problem drinkers are too small to be helpful to the GP to detect problem drinkers.
Oxford University Press
1995-09-01 00:00:00.0
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/651
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THE THYROTROPIN RELEASING HORMONE STIMULATION TEST IN ALCOHOLISM
PIENAAR, WILLEM P.
ROBERTS, MIMI C.
EMSLEY, ROBIN A.
AALBERS, COR
TALJAARD, FRANS J. J.
ORIGINAL ARTICLES
The mechanism for a blunted thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) in alcoholics is not known. We performed a combined TRH and gonadolibenn stimulation test on three well-defined groups of nondepressed alcoholic men, Group A comprised patients with acute withdrawal symptoms (<it>n</it> = 28), group B patients abstinent for 5–8 weeks (<it>n</it> = 29) and group C patients who had been abstinent for > 2 years (<it>n</it> – 16). Twenty-two healthy male volunteers were used for comparison. A blunted TSH response to TRH (delta TSH < 5 μU/l) occurred only in groups A (39%) and B (17%). In group A delta TSH showed a significant negative correlation with the severity of withdrawal symptoms and a significant positive correlation with serum magnesium levels. In group B, patients with a family history of alcoholism had significantly lower delta TSH levels than those without such a family history. Groups did not differ with respect to basal and delta prolactin, and TSH responses were not significantly associated with vitamin deficiency, cortisol levels or free thyroid hormone levels. We conclude that TRH stimulation test blunting appears to be related to factors operating in the withdrawal state and improves with continued abstinence. A possible role of genetic factors and serum magnesium needs to be further explored.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/661
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OUT-PATIENT ALCOHOL DETOXIFICATION--OUTCOME AFTER 2 MONTHS
KLIJNSMA, MARINUS P.
CAMERON, MARY L.
BURNS, TOM P.
McGUIGAN, SEAN M.
ORIGINAL ARTICLES
We assessed the outcome after 2 months of 28 alcohol-dependent subjects following out-patient detoxification using an uncontrolled follow-up study with data collected at the time of detoxification (T1) and after 2 months (T2). We also determined the cost of out-patient versus in patient detoxification. The setting was a psychiatric emergency clinic at a South West London University Hospital. Self-reported alcohol consumption in the week before T1 and T2, score on the ‘Alcohol Problems Inventory’ measuring alcohol-related relational, occupation, legal and medical problems in the 2 months prior to T1 and T2, mean corpuscular volume and gamma-glutamyl transferase at T1 and T2 were used as outcome measures. Eight subjects had a ‘good’ outcome (seven were abstinent and one only drank four units on one day). Nine subjects were ‘improved’ by either halving their alcohol consumption, or halving their ‘Alcohol Problems Inventory’ score at T2. ‘Good’ and ‘improved’ outcome were confirmed by mean corpuscular volume and gamma-glutamyl transference results. Eleven subjects were ‘not improved’. Engagement following detoxification with voluntary alcohol agencies was associated with a better outcome. In-patient detoxification is calculated to be six times more expensive than out-patient detoxification. Out-patient detoxification is a cost-effective step in the treatment of alcohol-dependent patients.
Oxford University Press
1995-09-01 00:00:00.0
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ETHNIC DIFFERENCES IN THE BIOLOGICAL CONSEQUENCES OF ALCOHOL ABUSE: A COMPARISON BETWEEN SOUTH ASIAN AND EUROPEAN MALES
WICKRAMASINGHE, S. N.
CORRIDAN, B.
IZAGUIRRE, J.
HASAN, R.
MARJOT, D. H.
ORIGINAL ARTICLES
Twenty-two South Asian men and 32 European men who had abused alcohol for at least 1.5 years were studied at the time of admission for detoxification to an Alcohol and Drug Dependency unit. The self-confessed average alcohol consumption during the preceding 3 months was similar in the South Asians (mean 383 g/day) and Europeans (mean 435 g/day) but the total duration of alcohol abuse was significantly shorter in South Asians (geometric mean 7.4 years) than Europeans (geometric mean 13.1 years). The geometric mean values for the concentration of carbohydrate-deficient transferrin in the serum were similar in the two ethnic groups. However, the red cell distribution width, the percentages of HbA<inf>1a+b</inf>, HbA<inf>1c</inf> and total HbA<inf>1</inf> in red cell lysates and the activities of gammaglutamyl transpeptidase, aspartate aminotransferase and alanine aminotransferase in the serum were all significantly higher in the South Asians than Europeans. The data suggest that South Asian men who abuse alcohol may be more susceptible to alcohol-related liver damage and acetaldehyde-mediated haemoglobin modification than European men who abuse alcohol to a similar extent for a considerably longer period.
Oxford University Press
1995-09-01 00:00:00.0
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ALCOHOL CONSUMPTION AND VISUAL CONTRAST SENSITIVITY
ROQUELAURE, Y.
GARGASSON, J. F. LE
KUPPER, S.
GIRRE, C.
HISPARD, E.
DALLY, S.
ORIGINAL ARTICLES
Visual contrast sensitivity (VCS) was measured in 30 alcoholic patients and 52 controls. The results showed a significant reduction in VCS for all the spatial frequencies. The mean reduction for all spatial frequencies was 2.49 dB below the level of the control group. Optimal sensitivity corresponded to a lower spatial frequency in patients than controls, i.e. 1 cycle/degree (c/d) versus 2 c/d. Curves for VCS were normal for five patients. Abnormalities in VCS were suggestive of optic nerve dysfunction for 15 patients (50%), which were probable in seven cases (23%) and possible in eight others (27%). For 10 subjects, the abnormalities were indicative of ametropia. Daily alcohol intake and daily tobacco consumption were not significantly different in the patients who displayed VCS abnormalities, reflecting alcohol-tobacco amblyopia, from those who did not. The presence of higher gamma-glutamyl transpeptidase and mean corpuscular volume levels in patients who had VCS abnormalities indicative of alcohol-tobacco amblyopia suggests that alcohol consumption is involved in the development of these abnormalities.
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/681
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CALENDAR
Calendar
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/686
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THE BRITISH DOCTORS' AND DENTISTS' GROUP
Notices
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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http://alcalc.oxfordjournals.org/cgi/content/short/30/5/687-a
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MEDICAL COUNCIL ON ALCOHOLISM SUBSCRIPTION RATES 1995
Notices
Oxford University Press
1995-09-01 00:00:00.0
TEXT
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