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Eriksson A, Kimmel MC, Furmark T, Wikman A, Grueschow M, Skalkidou A, Frick A, Fransson E. Investigating heart rate variability measures during pregnancy as predictors of postpartum depression and anxiety: an exploratory study. Transl Psychiatry 2024; 14:203. [PMID: 38744808 PMCID: PMC11094065 DOI: 10.1038/s41398-024-02909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk for developing postpartum depression and anxiety. Lower heart rate variability (HRV) has been shown to be associated with affective disorders. The current exploratory study aimed to evaluate the predictive utility of late pregnancy HRV measurements of postpartum affective symptoms. A subset of participants from the BASIC study (Uppsala, Sweden) took part in a sub-study at pregnancy week 38 where HRV was measured before and after a mild stressor (n = 122). Outcome measures were 6-week postpartum depression and anxiety symptoms as quantified by the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Anxiety Inventory (BAI). In total, 112 women were included in a depression outcome analysis and 106 women were included in an anxiety outcome analysis. Group comparisons indicated that lower pregnancy HRV was associated with depressive or anxious symptomatology at 6 weeks postpartum. Elastic net logistic regression analyses indicated that HRV indices alone were not predictive of postpartum depression or anxiety outcomes, but HRV indices were selected as predictors in a combined model with background and pregnancy variables. ROC curves for the combined models gave an area under the curve (AUC) of 0.93 for the depression outcome and an AUC of 0.83 for the anxiety outcome. HRV indices predictive of postpartum depression generally differed from those predictive of postpartum anxiety. HRV indices did not significantly improve prediction models comprised of psychological measures only in women with pregnancy depression or anxiety.
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Affiliation(s)
- Allison Eriksson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Women's Mental Health during the Reproductive Lifespan - WOMHER, Uppsala University, Uppsala, Sweden.
| | - Mary Claire Kimmel
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marcus Grueschow
- Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas Frick
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
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Wenze SJ, Mikula CM, Battle CL. Two babies, two bonds: Frequency and correlates of differential maternal-infant bonding in mothers of twins. Infant Ment Health J 2024; 45:286-300. [PMID: 38403982 DOI: 10.1002/imhj.22108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
We assessed prevalence and correlates of differential maternal-infant bonding (i.e., experiencing a stronger bond with one baby vs. the other) in mothers of twins, focusing on aspects of maternal mental health, well-being, and pregnancy/birth that have been previously linked with maternal-infant bonding. Participants (N = 108 American women, 88.89% White, 82.41% non-Hispanic, aged 18-45, who gave birth to twins in the past 6-24 weeks) were recruited from postpartum support websites. Participants completed a Qualtrics survey assessing pregnancy/birth history, symptoms of depression and anxiety, sleep, stress, romantic relationship satisfaction, and postpartum bonding. Twenty-six participants (24.07%) reported a bonding discrepancy. These participants endorsed higher symptoms of depression and anxiety, lower relationship satisfaction, lower average postpartum bonding, higher general and parenting stress, and longer pregnancy (all ps > .05). Greater degree of bonding discrepancy correlated with more depression, higher parenting stress, longer pregnancy, and lower relationship satisfaction (all ps > .05). Mothers of twins may benefit from postpartum mental health support, stress management strategies, and interventions to improve bonding. Future work should assess the role of breastfeeding difficulties, delivery method, birth-related trauma, infant regulatory capacity, and temperament. Longitudinal studies will help test cause and effect and potential long-term repercussions of maternal-infant bonding discrepancies.
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Affiliation(s)
- Susan J Wenze
- Department of Psychology, Lafayette College, Easton, Pennsylvania, USA
| | - Cynthia M Mikula
- Department of Psychology, Lafayette College, Easton, Pennsylvania, USA
| | - Cynthia L Battle
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Women and Infants' Hospital of Rhode Island, Providence, Rhode Island, USA
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Lorén H, Weineland S, Rembeck G. Facing a new life-The healthy transition to motherhood: What individual and environmental factors are needed? A phenomenological-hermeneutic study. Midwifery 2024; 130:103917. [PMID: 38232668 DOI: 10.1016/j.midw.2024.103917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/03/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE The aim of the study was to highlight first-time mothers' experiences of the transition to motherhood uncovering personal and environmental conditions facilitating or preventing the process of a healthy transition in a Swedish context. DESIGN A qualitative study with interview data analyzed using a phenomenological hermeneutic method. SETTING AND PARTICIPANTS Ten recent first-time mothers were selected from three primary healthcare centers in western Sweden. FINDINGS Four themes emerged, and the transition could be divided into several phases, interpreted as facing a new life, while feeling unprepared for identity and existential issues. The experience of becoming a mother was described as oscillation between a loss of former identity from previous life, and on the other hand, the joy and expectations of forming a new family. The mothers had high demands of themselves, often influenced by social media and needed to value the flow of information and `let go of control` to be able to make adequate decisions. The close family of origin was invaluable in this process being able to provide confirmation in the new role, facilitating the development of their own security and self-confidence. KEY CONCLUSIONS The vulnerability expressed by new mothers shows that support from the family of origin, partners and professionals are indispensable. The desired result after the transition to motherhood is a prosperous, maturity and confident mother. The main promoting factor in this process seems to be having a safe base that can provide required support. IMPLICATIONS FOR PRACTICE The level of wellbeing after the transition is crucial and the possibility of a warm, responsive and secure parenting needs to be strengthened. The challenge to preventive health care will be to identify a lack of support and ensure that these mothers gain sufficient support to meet today´s demands and still feel that they are good enough mothers for their children.
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Affiliation(s)
- Helena Lorén
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden; General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Närhälsan Dalsjöfors vårdcentral, Region Västra Götaland, Dalsjöfors, Sweden.
| | - Sandra Weineland
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden; General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Gun Rembeck
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden; General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Health, Youth Guidance Centre, Region Västra Götaland, Borås, Sweden
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Rusanen E, Lahikainen AR, Vierikko E, Pölkki P, Paavonen EJ. A Longitudinal Study of Maternal Postnatal Bonding and Psychosocial Factors that Contribute to Social-Emotional Development. Child Psychiatry Hum Dev 2024; 55:274-286. [PMID: 35870058 PMCID: PMC10796530 DOI: 10.1007/s10578-022-01398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/23/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
In this longitudinal study, we examined how maternal bonding and psycho-social factors are associated with social-emotional problems in two-year-old children. Our data came from a birth cohort from which data were collected at four timepoints: prenatally during the third trimester, and postnatally at 3, 8 and 24 months. The participants were 1,667 mothers, of which 943 (56.6%) returned the questionnaire at each timepoint of the longitudinal study. The Children's social-emotional problems were examined using the Brief Infant-Toddler Social and Emotional Assessment. According to linear regression analysis, maternal bonding difficulties at three and eight months, maternal expectations of the unborn baby during pregnancy, and maternal relationships within and outside the family were related to social-emotional problems in children of two years of age. The results highlight the importance of screening mothers who already prenatally have bonding problems or mothers who have bonding problems postnatally to provide effective and targeted intervention support.
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Affiliation(s)
- E Rusanen
- Faculty of Educational Sciences, University of Helsinki, P.O. Box 9, 00014, Helsinki, Finland.
- Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
| | - A R Lahikainen
- Faculty of Social Sciences, University of Tampere, FI-33014, Tampere, Finland
| | - E Vierikko
- Faculty of Social Sciences, Tampere University, FI-33014, Tampere, Finland
| | - P Pölkki
- Department of Social Sciences, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - E J Paavonen
- Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 400, 00029, HUS, Finland
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Meza-Rodríguez MDP, Farfan-Labonne B, Avila-García M, Figueroa-Damian R, Plazola-Camacho N, Pellón-Díaz G, Ríos-Flores BA, Olivas-Peña E, Leff-Gelman P, Camacho-Arroyo I. Psychological distress, anxiety, depression, stress level, and coping style in HIV-pregnant women in Mexico. BMC Psychol 2023; 11:366. [PMID: 37915068 PMCID: PMC10621089 DOI: 10.1186/s40359-023-01416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE To evaluate the presence of psychological distress (PD) and its association with the mental health and coping styles of pregnant women living with HIV (PWLWH). METHOD An observational, cross-sectional descriptive study was performed. Seventy-three PWLWH were included. Patients responded to a psychometric battery for PD, depression, anxiety, stress, and coping style evaluation. The scales used in the study were: Goldberg's 30-item General Health Questionnaire (GHQ-30), State-Trait Anxiety Inventory (STAI), Zung Depression Self-Measurement Scale (ZDS), Nowack Stress Profile, Lazarus and Folkman's Coping Styles Questionnaire. RESULTS PD was observed in 31.5% of the participants. PD-positive patients showed a higher probability of presenting traits of depression and anxiety and medium/high stress levels. Besides, they preferentially used emotion-focused coping styles. CONCLUSION PD is associated with a higher probability of presenting anxiety and depression in PWLWH. Emotion-focused coping style could be a factor in decision-making associated with risk behaviors in PWLWH.
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Affiliation(s)
- María Del Pilar Meza-Rodríguez
- Coordinación de Investigación en Psicología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Blanca Farfan-Labonne
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Miroslava Avila-García
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Ricardo Figueroa-Damian
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Noemí Plazola-Camacho
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Gabriela Pellón-Díaz
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Braulio Alfonso Ríos-Flores
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Efraín Olivas-Peña
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Phillipe Leff-Gelman
- Departamento de Investigación en Salud Reproductiva y Perinatal, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Montes Urales 800, Lomas de Chapultepec Miguel Hidalgo, Ciudad de México, C.P. 11000, México.
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Benton M, Davies M, Ismail K, Lenzi J. Gestational diabetes mellitus and its impact on the mother-infant relationship: A cohort study in the postnatal period. Prev Med Rep 2023; 34:102270. [PMID: 37334211 PMCID: PMC10272488 DOI: 10.1016/j.pmedr.2023.102270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Women with gestational diabetes mellitus (GDM) are at increased risk of poor perinatal mental health outcomes. However, the association between GDM and the mother-infant relationship is unclear. This study aimed to examine whether GDM itself impacts the mother-infant relationship and maternal mental health using a cohort study design. We used data from the Cohort of Newborns in Emilia-Romagna (CoNER) study, which included 642 women recruited in Bologna, Italy. Psychological data were collected at 6 and 15 months postnatally using a purpose designed measure to examine the mother-infant relationship. We used linear fixed effects and mixed-effects models to assess the effect of GDM on relationship scores at 6 and 15 months postpartum. Women with GDM had significantly lower relationship scores at 15 months postpartum [β - 1.75 95% CrI (-3.31; -0.21)] but not at 6 months [β - 0.27 95% CrI (-1.37; 0.81)]. Mother-infant relationship scores were significantly lower overall at 15 months compared to 6 months postpartum [β - 0.29 95% CrI (-0.56; -0.02)]. Our findings suggest that there may be a delayed effect on the mother-infant relationship in response to the experience of GDM. Future research using large birth cohorts should investigate this further to confirm these findings, and whether women with GDM would benefit from early interventions to improve relationships taking into account length of time postpartum.
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Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King’s College London, United Kingdom
| | - Megan Davies
- Section of Epidemiology, University Copenhagen, Denmark
| | - Khalida Ismail
- Department of Psychological Medicine, King’s College London, United Kingdom
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Donovan J, Chiatti BD, McKeever A, Bloch JR, Gonzales MS, Birati Y. "Yes, I can bond." Reflections of autistic women's mothering experiences in the early postpartum period. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231175312. [PMID: 37209090 DOI: 10.1177/17455057231175312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Autism is a neurodevelopmental condition affecting communication and social interaction. Much of the research regarding childbirth and motherhood is focused on non-autistic women. Autistic mothers may experience challenges communicating their needs to health care professionals and find aspects of the hospital environment distressing, indicating a need for more informed practice. OBJECTIVE To describe the experiences of autistic women bonding with their newborns after delivery in an acute care setting. DESIGN The study used a qualitative interpretative description design with data analysis using the method described by Knafl and Webster. The study explored the women's childbirth experiences in the early postpartum period. METHOD Interviews were conducted using a semi-structured interview guide. The women were interviewed in a setting of their choosing and included in person meetings, meetings over Skype, over the telephone, or via Facebook messenger. Twenty-four women ages 29-65 years participated in the study. The women were from the United States, the United Kingdom, and Australia. All women gave birth to a healthy term newborn in an acute care setting. RESULTS Three major themes emerged from the data: having difficulty communicating, feeling stressed in an uncertain environment, and being an autistic mother. CONCLUSION The autistic mothers in the study expressed love and concern for their babies. Some women described needing more time to recover physically and emotionally before assuming care of the newborn. The stress of childbirth left them exhausted and the demands of caring for a newborn could be overwhelming for some women. Miscommunication during labor affected some of the women's ability to trust the nurses caring for them and, in two cases, left the women feeling judged as mothers.
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Ahrnberg H, Pajulo M, Scheinin NM, Kajanoja J, Karlsson L, Karlsson H, Karukivi M. Alexithymic traits and parental postpartum bonding: Findings from the FinnBrain Birth Cohort Study. Scand J Psychol 2022; 63:100-108. [PMID: 35066882 DOI: 10.1111/sjop.12797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
In the postpartum period, some parents experience problems in bonding with the infant, which can lead to difficulties in adjusting to the parental caregiving role. Alexithymia, through deficits in emotional processing, could potentially be associated with problems in parental postpartum bonding. In the current study, this association has been explored in a large population-based sample of mothers and fathers, and to our knowledge, this is the first study to investigate this association. The study population (n = 2,671) was part of the FinnBrain Birth Cohort study and included 1,766 mothers and 905 fathers who returned The Postpartum Bonding Questionnaire (PBQ) at three months postpartum and the 20-item Toronto Alexithymia Scale (TAS-20) at six months postpartum. Correlation analyses and hierarchical regression modeling, adjusted for selected background factors, were performed separately for mothers and fathers. The alexithymia dimension "Difficulty Identifying Feelings" (DIF) in mothers and fathers, and additionally dimensions of "Difficulty Describing Feelings" (DDF) and "Externally Oriented Thinking" (EOT) in fathers were associated with weaker postpartum bonding, when related background factors were controlled for. To our knowledge this was the first study to investigate the relationship between parents' alexithymic traits and postpartum bonding within a large birth cohort study population. The main finding was that especially higher levels of maternal DIF and paternal EOT were associated with weaker postpartum bonding. Longitudinal studies are needed to establish the potential causality of this relationship.
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Affiliation(s)
- Hanna Ahrnberg
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland
| | - Marjukka Pajulo
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Jani Kajanoja
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Max Karukivi
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
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