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Joseph ME, D'Alonzo KT, Btoush R, Fitzgerald N. The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017. J Transcult Nurs 2024; 35:125-133. [PMID: 38111158 DOI: 10.1177/10436596231217662] [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] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). METHODOLOGY This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. RESULTS Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05). DISCUSSION These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.
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Shah MK, Gandrakota N, Gujral UP, Islam N, Narayan KMV, Ali MK. Cardiometabolic Risk in Asian Americans by Social Determinants of Health: Serial Cross-sectional Analyses of the NHIS, 1999-2003 to 2014-2018. J Gen Intern Med 2023; 38:571-581. [PMID: 36418646 PMCID: PMC9971386 DOI: 10.1007/s11606-022-07933-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes and hypertension are common in Asian Americans and vary by subgroup. There may be further variation by social determinants of health (SDOHs), but few studies have examined this previously. OBJECTIVE To examine the associations of SDOHs and diabetes and hypertension within and across Asian subgroups in the USA DESIGN: Series cross-sectional analyses SETTING: National Health Interview Surveys (NHIS) from 1999 to 2018 PARTICIPANTS: Asian-American adults (Chinese, Filipino, Asian Indian, and Other Asian [Korean, Vietnamese, Japanese, and other]) MEASUREMENTS: Self-reported diabetes and hypertension prevalence in pooled 5-year increments over 1999-2018 and multivariable regression models to assess the adjusted prevalence of diabetes or hypertension by poverty, marital status, education, and years in the USA, adjusting for age, sex, BMI, and health insurance status RESULTS: From 1999-2003 to 2014-2018, the age- and sex-adjusted prevalence of diabetes increased for Other Asians (absolute change: 4.6%) but not for other subgroups; age- and sex-adjusted hypertension prevalence significantly increased for Asian Indians and Other Asians (absolute change: 5-7.5%). For Filipinos, high school education or less was associated with an increase in diabetes prevalence over time (difference from 1999-2003 to 2014-2018: +6.0 (95% CI: 2.0-10.0)), while for Asian Indians, college education or higher was associated with an increase in diabetes prevalence for the same period (difference: +2.7 (95% CI: 0.01-5.4). Differences over the 2 time periods (1999-2003 and 2014-2018) show that Filipino and Other Asians, who lived in the USA for ≥10 years, increased in diabetes prevalence. Similar variations in associations of SDOHs by Asian subgroup were seen for hypertension. LIMITATIONS Self-reported primary outcomes and multi-year data were pooled due to small sample sizes. CONCLUSIONS The influence of SDOHs on cardiometabolic risk is not uniform among Asian Americans, implying tailored strategies may be needed for different population subgroups. PRIMARY FUNDING SOURCE NIH.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Dunwoody, GA, USA.
| | - Nikhila Gandrakota
- Department of Family and Preventive Medicine, Emory University School of Medicine, Dunwoody, GA, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nadia Islam
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, Dunwoody, GA, USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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González-Rivas JP, Pavlovska I, Polcrova A, Nieto-Martínez R, Mechanick JI. Transcultural Lifestyle Medicine in Type 2 Diabetes Care: Narrative Review of the Literature. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221095048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disparities in type 2 diabetes (T2D) care is a global problem across diverse cultures. The Dysglycemia-Based Chronic Disease (DBCD) model promotes early and sustainable interventions along the insulin resistance (stage 1), prediabetes (stage 2), T2D (stage 3), and complications (stage 4) spectrum. In this model, lifestyle medicine is the cornerstone of preventive care to reduce DBCD progression and the socioeconomic/biological burden of disease. A comprehensive literature review, spanning 2000 to 2021, was performed and 55 studies were included examining the effects of lifestyle medicine and their cultural adaptions with different prevention modalities. In stage 1, primordial prevention targets modifiable primary drivers (behavior and environment), unhealthy lifestyles, abnormal adiposity, and insulin resistance with educational and motivational health promotion activities at individual, group, community, and population-based scales. Primary, secondary, and tertiary prevention targets individuals with mild hyperglycemia, severe hyperglycemia, and complications, respectively, using programs that incorporate structured lifestyle interventions. Culturally adapted lifestyle change in primary and secondary prevention improved quality of life and biomarkers, but with a limited impact of tertiary prevention on cardiovascular events. In conclusion, lifestyle medicine with cultural adaptations is an integral part of preventive care in patients with T2D. However, considerable research gaps exist, especially for tertiary prevention.
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Affiliation(s)
- Juan P. González-Rivas
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Iuliia Pavlovska
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anna Polcrova
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Ramfis Nieto-Martínez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN, USA
| | - Jeffrey I. Mechanick
- he Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Obichi CC, Dee V. Acculturation, Cultural Beliefs, and Cardiovascular Disease Risk Levels Among Nigerian, Ghanaian and Cameroonian Immigrants in the United States. J Immigr Minor Health 2022; 24:1154-1160. [PMID: 34997444 DOI: 10.1007/s10903-021-01321-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States (U.S.). Immigrant groups from sub-Saharan Africa in the U.S. have higher CVD risk than their African American counterparts. This study examines associations of sociodemographic factors (age, sex, education, & income) to acculturation, cultural beliefs, and CVD risk levels (CVDRL) among Nigerian, Ghanaian, and Cameroonian immigrants (NGCI) in the U.S. A correlational cross-sectional design was used. Data from a convenience sample (n = 178) of NGCI were analyzed using correlations, regressions, and path analysis. Acculturation had a statistically significant influence on cultural beliefs (β = 0.16, P < .05). Age, sex, and education were the strongest predictors of CVDRL among the NGCI sample. High acculturation among NGCI in the U.S. have been associated with more health-promoting cultural beliefs. It is important that NGCI who may have difficulties understanding the culture of the U.S. healthcare system receive quality care.
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Affiliation(s)
| | - Vivien Dee
- School of Nursing, Azusa Pacific University, 901 E. Alosta Ave., Azusa, CA, 91702, USA
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Kalra D, Vijayaraghavan K, Sikand G, Desai NR, Joshi PH, Mehta A, Karmally W, Vani A, Sitafalwalla SJ, Puri R, Duell PB, Brown A. Prevention of atherosclerotic cardiovascular disease in South Asians in the US: A clinical perspective from the National Lipid Association. J Clin Lipidol 2021; 15:402-422. [PMID: 33846108 DOI: 10.1016/j.jacl.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
It is now well recognized that South Asians living in the US (SAUS) have a higher prevalence of atherosclerotic cardiovascular disease (ASCVD) that begins earlier and is more aggressive than age-matched people of other ethnicities. SA ancestry is now recognized as a risk enhancer in the US cholesterol treatment guidelines. The pathophysiology of this is not fully understood but may relate to insulin resistance, genetic and dietary factors, lack of physical exercise, visceral adiposity and other, yet undiscovered biologic mechanisms. In this expert consensus document, we review the epidemiology of ASCVD in this population, enumerate the challenges faced in tackling this problem, provide strategies for early screening and education of the community and their healthcare providers, and offer practical prevention strategies and culturally-tailored dietary advice to lower the rates of ASCVD in this cohort.
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Affiliation(s)
- Dinesh Kalra
- Division of Cardiology, Rush University Medical Center, 1620W. Harrison St, Kellogg Suite 320, Chicago, IL 60612, United States.
| | | | - Geeta Sikand
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Nihar R Desai
- Yale School of Medicine, New Haven, CT, United States
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anurag Mehta
- Emory University School of Medicine, Atlanta, GA, United States
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, NY, United States
| | - Anish Vani
- New York University Langone Health, New York, NY, United States
| | | | - Raman Puri
- Lipid Association of India, New Delhi, India
| | - P Barton Duell
- Oregon Health and Science University, Portland, OR, United States
| | - Alan Brown
- Advocate Lutheran General Hospital, Park Ridge, IL, United States
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Dietary acculturation among African emigrant students in India: determinants and problems. Public Health Nutr 2020; 23:2402-2409. [PMID: 32389158 DOI: 10.1017/s1368980019005226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Emigrants face a high level of food insecurity. There is a wide research gap in the domain of identifying the determinants and problems of dietary acculturation in the context of emigrant students. This article attempts to study the factors affecting the dietary acculturation of African emigrant students in India. DESIGN For conducting a first-of-its-kind study for African emigrant students in India, we used field survey method, and the primary data were collected using a pre-structured questionnaire. SETTING This was a field survey conducted in Punjab (a state of India). PARTICIPANTS One hundred and twenty African emigrant students participated in the survey. RESULTS Results of logistic regression indicated that food awareness (P = 0·027) and food suitability (P = 0·043) were the major determinants of dietary acculturation. Lack of familiarity and lack of proximity to food access points are the major problems faced by the African emigrant students. African emigrant students prepared for dietary acculturation largely only after coming to India. There is a significant positive correlation (P = 0·013) between problems faced by the respondents and tendency to prepare for acculturation after coming to India. CONCLUSIONS Information regarding local food environment plays a significant role in dietary acculturation. There is a pertinent need to educate emigrant students regarding food availability and access by developing suitable educational content.
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Girsen AI, Mayo JA, Datoc IA, Karakash S, Gould JB, Stevenson DK, El-Sayed YY, Shaw GM. Preterm birth outcomes among Asian women by maternal place of birth. J Perinatol 2020; 40:758-766. [PMID: 32094480 DOI: 10.1038/s41372-020-0633-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate overall, spontaneous, and medically indicated preterm birth (PTB) rates between US-born and non-US-born Asian women living in California. STUDY DESIGN Nulliparous women with a singleton livebirth and Asian race in California between 2007 and 2011 were investigated. The prevalence of overall (<37 weeks), spontaneous, and medically indicated PTB was examined by self-reported race and place of birth among ten Asian subgroups. RESULTS There were marked differences in PTB rates between the individual Asian subgroups. After adjustments, non-US-born Chinese, Japanese, Vietnamese, and Indian women had lower odds of overall PTB and Chinese, Vietnamese, Cambodian, and Indian women had lower odds of spontaneous PTB compared with their US-born counterparts. CONCLUSION Further investigation of biological and social factors contributing to these lower odds of spontaneous PTB among the non-US-born Asian population could potentially offer clues for reducing the burden of PTB among the US born.
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Affiliation(s)
- Anna I Girsen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA, USA.
| | - Jonathan A Mayo
- March of Dimes Prematurity Research Center at Stanford University School of Medicine, Stanford, CA, USA
| | - Imee A Datoc
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA, USA
| | - Scarlett Karakash
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA, USA
| | - Jeffrey B Gould
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA
| | - David K Stevenson
- March of Dimes Prematurity Research Center at Stanford University School of Medicine, Stanford, CA, USA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA, USA
| | - Gary M Shaw
- March of Dimes Prematurity Research Center at Stanford University School of Medicine, Stanford, CA, USA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA
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Mathew Joseph N, Misra R, Wang J. Mediating Role of Acculturation and Lifestyle Behaviors on Cardiometabolic Risk Among a National Sample of U.S. Asian Indians. J Immigr Minor Health 2019; 22:727-735. [PMID: 31485817 DOI: 10.1007/s10903-019-00930-5] [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] [Indexed: 10/26/2022]
Abstract
Asian Indians are the third largest and fastest growing Asian subgroup in the U.S. and have high risks for diabetes and cardiovascular disease. This study explored the mediating role of lifestyle behaviors on the relationship between acculturation and cardiometabolic risk factors among Asian Indians using the Diabetes in Indian Americans national study. The cross-sectional study sample comprised 1038 randomly selected adult Asian Indians in seven U.S. sites. Acculturation was assessed using the Acculturation Scale for Southeast Asians. Diet and lifestyle behaviors were measured using the Health-Promoting Lifestyle Profile II subscales. Path analyses with bootstrap methods were conducted. Dietary behavior significantly mediated the relationship between acculturation and HbA1C (β = 0.004, p = 0.047), and physical activity mediated the relationship between acculturation and HDL (β = 0.08, p = 0.011). Other mediation models were not significant (p > 0.05). Mediating factors besides lifestyle behaviors should be explored in future studies.
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Affiliation(s)
- Nitha Mathew Joseph
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave, Houston, TX, 77030, USA.
| | - Ranjita Misra
- Department of Social and Behavioral Sciences, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, Morgantown, WV, 26506-9190, USA
| | - Jing Wang
- School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MC 7950, San Antonio, TX, 78229, USA
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Shah M, Garg A. The relationships between macronutrient and micronutrient intakes and type 2 diabetes mellitus in South Asians: A review. J Diabetes Complications 2019; 33:500-507. [PMID: 31126704 DOI: 10.1016/j.jdiacomp.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND South Asians (SA) have increased prevalence of type 2 diabetes mellitus (T2DM). The role of nutrient intakes in T2DM in SA is not well understood, however. OBJECTIVE The paper reviewed the relationship between macronutrient and micronutrients intakes and T2DM in SA. METHODS The MEDLINE database was searched for relevant papers on this topic in SA. RESULTS There was some evidence that dietary fiber and linoleic acid intake may reduce but carbohydrates may increase the risk of T2DM. Some studies found higher energy from protein and fat in subjects with T2DM versus controls. Other studies, however, found lower carbohydrate intake among those with T2DM or no relationship between diet composition and T2DM. Several vitamins and minerals were also inversely related to T2DM. CONCLUSIONS The data were limited to a few epidemiological studies. Most studies did not distinguish between undiagnosed and known T2DM. Subjects with known T2DM are more likely to have changed their diet. Prospective cohort or randomized controlled studies examining the role of diet composition, using precise image-assisted dietary assessment method and blood biomarkers, in the development of T2DM among migrant and native SA are needed. Lastly, a more complete nutrient database for foods consumed by SA is needed.
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Affiliation(s)
- Meena Shah
- Division of Nutrition and Metabolic Diseases, UT Southwestern Medical Center, Dallas, TX, United States of America; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America; Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, United States of America; Department of Kinesiology, Texas Christian University, Fort Worth, TX, United States of America.
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, UT Southwestern Medical Center, Dallas, TX, United States of America; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America; Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, United States of America.
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Venkatesh S, Weatherspoon LJ. Food Behaviors and Dietary Acculturation of Asian Indians in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:529-535. [PMID: 29246566 DOI: 10.1016/j.jneb.2017.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine food behaviors and dietary acculturation of Asian Indians in the US. DESIGN Qualitative focus group discussions. SETTING Public library and university. PARTICIPANTS Thirty Asian Indian adults in a US Midwestern state. MAIN OUTCOME MEASURES Participant perceptions of food behaviors and 24-hour modified weekday and weekend dietary recalls. ANALYSIS Eight focus group transcripts and participant dietary recalls were independently analyzed by 2 Asian Indian moderators using the constant comparison method. RESULTS The sample (n = 16 males and 14 females) consisted of a variable group of Asian Indians from different generations, religions, and places of origin in India. Key themes associated with modification of traditional behaviors were social independence, social network influences, increased health awareness, cost and quality of Asian Indian foods, and time constraints and convenience. CONCLUSIONS AND IMPLICATIONS This study elucidated dietary behaviors and factors that contribute to dietary acculturation of Asian Indians, which are important considerations for health professionals. These findings inform researchers regarding the development of culturally appropriate dietary assessment measures targeted at Asian Indian individuals.
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