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Baratta F, Allais G, Gnavi R, Scarinzi C, Enri LR, Rolando S, Spadea T, Costa G, Benedetto C, Mana M, Giaccone M, Mandelli A, Manzoni GC, Bussone G, Brusa P. Triptans utilization in Italian population: A real-life study in community pharmacies. PLoS One 2023; 18:e0291323. [PMID: 37682959 PMCID: PMC10490971 DOI: 10.1371/journal.pone.0291323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
The term Headache Disorders (HD) refers to a number of nervous system pathologies characterised by recurrent headaches. Despite the serious impact HD have on the health system, society, and the economy, these are an underestimated, underdiagnosed, and, hence, undertreated phenomenon. Triptans are the first-line therapy for the acute treatment of moderate to severe migraine but their utilization is still inadequate, perhaps also because in Italy no triptan can be bought without a medical prescription. In this article, the data from a 2016-2017 study has been further analysed with the aim of evaluating any associations between the use of triptans and the other series of variables identified in the questionnaire. This further analysis has been connected to the role that community pharmacies could play on this issue. The questionnaire was administered to 4,424 pharmacy users by 610 purposely trained pharmacists working in 514 pharmacies. The survey was carried out in 19 of the 20 Italian regions. The data shows that only 25% of patients suffering from HDs are prescribed triptans. Older patients, those with definite migraines, and those with a chronic disorder resort more frequently to this class of pharmaceuticals, as do those patients in care at a specialist headache centre. The multivariable analysis also confirmed these results. Our study, which performed a direct detection, in real life, on patients requesting pharmacological treatment for a migraine headache, therefore confirmed the need to investigate the reasons behind the low use and prescription of triptans in the Italian population. Moreover, any future studies should take advantage of community pharmacies, plan actions that would allow a series of evaluations over time of the requirements of migraineurs, and establish a process to put these patients under the care of the pharmacy to ensure adherence to therapy.
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Affiliation(s)
- Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Gianni Allais
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
- FI.CEF Onlus, Italian Headache Foundation, Milan, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy
| | | | | | - Sara Rolando
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences, Women’s Headache Center, University of Turin, Turin, Italy
| | | | - Mario Giaccone
- Order of Pharmacists of Turin, Turin, Italy
- FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy
| | - Andrea Mandelli
- FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy
| | | | | | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
- Order of Pharmacists of Turin, Turin, Italy
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Baratta F, Enri LR, Brusa P. Community pharmacists as vaccinators in the SARS-CoV-2 immunization campaign: implications beyond the pandemic. Health Policy 2023; 131:104798. [PMID: 36966630 PMCID: PMC10030261 DOI: 10.1016/j.healthpol.2023.104798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
Italy was one of the last European countries to introduce vaccination in pharmacies. The urgent need to extend the vaccination campaign against SARS-CoV-2 led to the approval of Law no. 178/2020. The Law allowed the administration of COVID-19 vaccines in Italian pharmacies by community pharmacists on an experimental basis for the years 2021-2022. Stakeholders took contrasting positions on the idea of enabling pharmacist to vaccinate after proper training. Sometimes, controversy existed even within the same associations representing pharmacists. As observed in other countries, the medical profession in Italy also expressed its opposition to the idea of pharmacists as vaccinators, while the general public and pharmacy customers were generally in favour of the policy. Over two million doses of SARS-CoV-vaccines were administered in Italian pharmacies in less than one year after the introduction of the policy. Criticism and concerns raised during the debate about the introduction of vaccination in pharmacies has subsided. It is yet unclear whether vaccination in pharmacies will be prolonged after the pandemic and whether it will, in fact, be expanded to other vaccines. Potentially, this could contribute towards increasing immunisation rates, not only for COVID-19, but also for other vaccines.
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Affiliation(s)
- Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy.
| | | | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
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Spadea T, Onorati R, Baratta F, Pignata I, Parente M, Pannacci L, Ancona D, Ribecco P, Costa G, Gnavi R, Brusa P. Monitoring adherence to pharmacological therapy and follow-up examinations among patients with type 2 diabetes in community pharmacies. Results from an experience in Italy. PLoS One 2021; 16:e0256478. [PMID: 34492060 PMCID: PMC8423241 DOI: 10.1371/journal.pone.0256478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Type 2 diabetes is an important public health issue, yet adherence to drugs and regular clinical follow-up is still suboptimal. This study aims to evaluate a community pharmacy programme for monitoring and enhancing adherence to prescribed pharmacological therapies and recommended examinations among patients with confirmed diabetes. Methods The intervention was conducted in different Italian areas between April 2017 and January 2018. All adult patients who entered a pharmacy with a personal prescription for any antidiabetic drug and agreed to participate, were interviewed. Those found to be non-adherent received counselling from the pharmacists. All patients were invited for a follow-up interview after 3 months. Results Overall, 930 patients were enrolled and completed the baseline interview. We found low rates of non-adherence, ranging from 8% to 13% for prescribed pharmacological therapies, and 11–29% for the recommended clinical examinations. Non-adherence to oral therapies was higher among younger and recently diagnosed patients; that to clinical examinations was higher in men, those with an intermediate duration of diabetes and less educated patients. Large geographical differences persisted after the adjustment for individual factors. Only 306 patients (32.9%) returned for the follow-up interview, most of whom were already adherent at baseline. Conclusions Poor adherence to drugs or clinical examinations is not easy to identify in the usual operating setting of community pharmacies. Furthermore, the majority of patients did not return for follow-up, making it impossible to evaluate the efficacy of the pharmacists’ counselling. It might be more effective to plan interventions addressed to specific subgroups of patients or areas.
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Affiliation(s)
- Teresa Spadea
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy
| | - Roberta Onorati
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy
| | - Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
- * E-mail:
| | - Irene Pignata
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | | | | | - Domenica Ancona
- Pharmaceutical Department ASL BAT, Puglia Region, Trani, Italy
| | | | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy
| | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
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Keber E, Rocco P, Musazzi UM, Morselli-Labate AM, Floris NP, Pedrazzini A, Minghetti P, Giua C. The management of upper gastrointestinal symptoms: A study on community pharmacies in Italy. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e66065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Upper gastrointestinal (GI) symptoms are usual complaints among patients presenting to Italian community pharmacies. However, information on treatment history of those patients is often lacking. This descriptive, cross-sectional study aims at exploring the medication history of individuals with upper GI tract symptoms visiting one of the 20 enrolled community pharmacies, over a period of 7 months, based on the administration of a questionnaire. Of 1,020 interviewees, 62.1% had asked for a medical consultation. The most frequent symptom was epigastric burning (31.8%), followed by acid regurgitation (14.6%) and post-prandial fullness (12.0%). Of the 1,609 therapies, proton pump inhibitors constituted the most represented therapeutic class (35.6%) followed by antacids (17.5%) and alginate-based products (17.2%). In treating symptoms, 38.1% of the patients do not seek medical advice, while 42.0% rely on non-prescription therapies. As findings suggest, support to patients with GI disorders in community pharmacies can be enhanced for a safer self-medication.
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Fanelli E, Ravetto Enri L, Pappaccogli M, Fasano C, Di Monaco S, Pignata I, Baratta F, Eula E, Masera G, Mana M, Rabbia F, Brusa P, Veglio F. Knowledge on arterial hypertension in general population: Results from a community pharmacy screening program. Nutr Metab Cardiovasc Dis 2021; 31:1081-1086. [PMID: 33618921 DOI: 10.1016/j.numecd.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUNDS AND AIMS Hypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers. METHODS AND RESULTS A questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03). CONCLUSION Knowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.
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Affiliation(s)
- Elvira Fanelli
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | | | - Marco Pappaccogli
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Chiara Fasano
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Silvia Di Monaco
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Irene Pignata
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Elisabetta Eula
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Masera
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Franco Rabbia
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Franco Veglio
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
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Schulz M, Griese-Mammen N, Schumacher PM, Strauch D, Freudewald L, Said A, Tsuyuki RT, Laufs U, Kintscher U, Böhm M, Mahfoud F. Development and implementation of blood pressure screening and referral guidelines for German community pharmacists. J Clin Hypertens (Greenwich) 2020; 22:1807-1816. [PMID: 32864864 PMCID: PMC8029717 DOI: 10.1111/jch.14020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 01/20/2023]
Abstract
Involvement of community pharmacists in the detection and control of hypertension improves patient care. However, current European or North‐American guidelines do not provide specific guidance how to implement collaboration between pharmacists and physicians, especially when and how to refer patients with undetected or uncontrolled hypertension to a physician. The German Society of Cardiology and the ABDA – Federal Union of German Associations of Pharmacists developed and tested referral recommendations for community pharmacists, embedded in two guideline worksheets. The project included a guideline‐directed blood pressure (BP) measurement and recommendations when patients should be referred to their physician. A “red flag” referral within 4 weeks was recommended when SBP was >140 mm Hg or DBP >90 mm Hg (for subjects <80 years), and >160 mm Hg or >90 mm Hg (≥80 years) in undetected individuals, or >130 mm Hg or >80 mm Hg (<65 years) and >140 mm Hg or >80 mm Hg (≥65 years) in treated patients. BP was measured in 187 individuals (86 with known hypertension, mean [±SD] age 62 ± 15 years, 64% female, and 101 without known hypertension, 47 ± 16 years, 75% female) from 17 community pharmacies. In patients with hypertension, poorly controlled BP was detected in 55% (n = 47) and were referred. A total of 16/101 subjects without a history of hypertension were referred to their physician because of uncontrolled BP. Structured BP testing in pharmacies identified a significant number of subjects with undetected/undiagnosed hypertension and patients with poorly controlled BP. Community pharmacists could play a significant role in collaboration with physicians to improve the management of hypertension.
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Affiliation(s)
- Martin Schulz
- Drug Commission of German Pharmacists, Berlin, Germany.,Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Nina Griese-Mammen
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Pia M Schumacher
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Dorothea Strauch
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Leonard Freudewald
- Drug Commission of German Pharmacists, Berlin, Germany.,Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - André Said
- Drug Commission of German Pharmacists, Berlin, Germany.,Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Ross T Tsuyuki
- Division of Cardiology and Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Kintscher
- Institute for Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Michael Böhm
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Felix Mahfoud
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
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Gijón-Conde T, Rodilla E, Molinero A, Alvargonzález M, Ruilope LM. [Awareness, treatment and control of blood pressure according to place of recruitment and sex in the May Measure Month 2018 survey in Spain]. HIPERTENSION Y RIESGO VASCULAR 2020; 38:4-12. [PMID: 32807680 DOI: 10.1016/j.hipert.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/31/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyse the data, according to recruiting place and sex, of the survey May Measure Month in 2018 (MMM18) in Spain, promoted by the International Society of Hypertension. METHODS Subjects more than 18 years old were studied. MMM18 protocol was performed. Volunteers were recruited through the Spanish Society of Community Pharmacy (SEFAC) and the Spanish Society of Hypertension (SEH-LELHA). General linear models of blood pressure (BP) were carried out in subjects with and without treatment, and adjusted by age, sex, tobacco use, obesity and recruitment site. RESULTS 7 511 individuals (mean age 51.7 ± 19.6 years, 36.8% males) were screened. Systolic and diastolic BP was higher in males (129.0-16.7/119.6-18.2 mmHg) (78.3-11.1/74.8-10.7 mmHg) (p < 0.001). There was a linear relationship between systolic BP, age and sex, with higher values in males (11.2 mmHg in untreated and 4.5 mmHg in treated) (p < 0.001). Diastolic BP was inverted U-shaped, with highest level in males and between 50-55 years. The proportion of individuals with hypertension (pharmacies; public and clinical area) was 47.2% (54.2; 34.1 and 34.8%). Seventy-five percent were aware of their diagnosis (77.5; 61.5 and 69.2%), with 22% of them without pharmacological treatment (20.7; 26.0 and 27.9%). Sixty-four point five percent of those under antihypertensive treatment met targets (62.9; 65.6 and 69.1%) (p < 0.001). CONCLUSIONS There is big room for improvement in MMM indicators in Spain. Nearly half of subjects are hypertensive. Of those aware of their condition, 1 in 5 did not follow pharmacological treatment and of those treated, 1 in 3 did not meet targets. BP levels were significantly higher in males. Our study suggests that gender differences described should be considered in the BP thresholds established.
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Affiliation(s)
- T Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Madrid, España.
| | - E Rodilla
- Medicina Interna, Hospital Universitario de Sagunto, Valencia, España
| | - A Molinero
- Sociedad Española de Farmacia Comunitaria (SEFAC), Madrid, España
| | - M Alvargonzález
- Centro de Salud Universitario Cerro del Aire, Madrid, España
| | - L M Ruilope
- Instituto de investigación 12 de octubre, Madrid, España
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Barrett R, Hodgkinson J. Quality evaluation of community pharmacy blood pressure (BP) screening services: an English cross-sectional survey with geospatial analysis. BMJ Open 2019; 9:e032342. [PMID: 31831543 PMCID: PMC6924779 DOI: 10.1136/bmjopen-2019-032342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The primary objective was to assess the accuracy (calibration and validation status) of digital blood pressure (BP) monitors used within community pharmacy in England and the secondary objectives were to assess the overall quality of the BP service by assessing service prevalence, service utilisation and other in-service considerations. DESIGN A cross-sectional survey. SETTING Primary-care retail-pharmacies. PARTICIPANTS 500 pharmacies that contribute to government dispensing-data were invited by post to complete the survey. Private contractors were excluded. INTERVENTIONS We conducted a questionnaire survey with a follow-up (September 2018 to December 2018). RESULTS 109 responses were received. 61% (n=66) of responding pharmacies provided a free BP check to their patients. 40 (61%) pharmacies used recommended validated clinical metres, 6 (9%) had failed validation and 20 (30%) provided too little information to enable us to determine their monitor's status. CONCLUSIONS Responding pharmacies were able to provide useful BP monitoring services to their patients, though quality enhancements need to be implemented. Majority of pharmacies use validated BP monitors, however, there was a lack of range of cuff sizes, variation in replacement and calibration of monitors and apparent absence of such practice in a minority of pharmacies alongside variation in training standards. We noted higher frequency of BP screening in the most deprived postcodes.We recommend in-service redesign and delivery improvements, and suggest professional bodies and researchers work together to create clearer frameworks for front-line practitioners, creating appropriate incentives to facilitate this service redesign.Funders and policy setters should consider the value added to the National Health Service and other healthcare agencies of such screening by pharmacy providers both nationally and internationally. It has the potential to reduce complications of undiagnosed hypertension and the medicines burden that it creates. Future work should examine the impact of pharmacist-led BP screening on patients.
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Affiliation(s)
- Ravina Barrett
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
- Pharmacy Practice, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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