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Rao V, Lanni S, Yule AM, DiSalvo M, Stone M, Berger AF, Wilens TE. Diagnosing major depressive disorder and substance use disorder using the electronic health record: A preliminary validation study. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 2:100007. [PMID: 37693103 PMCID: PMC10486184 DOI: 10.1016/j.xjmad.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background One mechanism to examine if major depressive disorder (MDD) is related to the development of substance use disorder (SUD) is by leveraging naturalistic data available in the electronic health record (EHR). Rules for data extraction and variable construction linked to psychometrics validating their use are needed to extract data accurately. Objective We propose and validate a methodologic framework for using EHR variables to identify patients with MDD and non-nicotine SUD. Methods Proxy diagnoses and index dates of MDD and/or SUD were established using billing codes, problem lists, patient-reported outcome measures, and prescriptions. Manual chart reviews were conducted for the 1-year period surrounding each index date to determine (1) if proxy diagnoses were supported by chart notes and (2) if the index dates accurately captured disorder onset. Results The results demonstrated 100% positive predictive value for proxy diagnoses of MDD. The proxy diagnoses for SUD exhibited strong agreement (Cohen's kappa of 0.84) compared to manual chart review and 92% sensitivity, specificity, positive predictive value, and negative predictive value. Sixteen percent of patients showed inaccurate SUD index dates generated by EHR extraction with discrepancies of over 6 months compared to SUD onset identified through chart review. Conclusions Our methodology was very effective in identifying patients with MDD with or without SUD and moderately effective in identifying SUD onset date. These findings support the use of EHR data to make proxy diagnoses of MDD with or without SUD.
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Affiliation(s)
- Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sylvia Lanni
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Maura DiSalvo
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Mira Stone
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy F. Berger
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Luo C, Chen K, Doshi R, Rickles N, Chen Y, Schwartz H, Aseltine RH. The association of prescription opioid use with suicide attempts: An analysis of statewide medical claims data. PLoS One 2022; 17:e0269809. [PMID: 35771866 PMCID: PMC9246186 DOI: 10.1371/journal.pone.0269809] [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: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Suicides and opioid overdose deaths are among the most pressing public health concerns in the US. However direct evidence for the association between opioid use and suicidal behavior is limited. The objective of this article is to examine the association between frequency and dose of prescription opioid use and subsequent suicide attempts. METHODS AND FINDINGS This retrospective cohort study analyzed 4 years of statewide medical claims data from the Connecticut All-Payer Claims Database. Commercially insured adult patients in Connecticut (n = 842,773) who had any medical claims beginning in January 2012 were followed through December 2015. The primary outcome was suicide attempt identified using International Classification of Diseases (ICD 9) diagnosis codes. Primary predictor variables included frequency of opioid use, which was defined as the number of months with claims for prescription opioids per year, and strength of opioid dose, which was standardized using morphine milligram equivalent (MME) units. We also controlled for psychiatric and medical comorbidities using ICD 9 codes. We used Cox proportional hazards regression to examine the association between frequency, dose, and suicide attempts, adjusting for medical and psychiatric comorbid conditions. Interactions among measures of opioid use and comorbid conditions were analyzed. In this cohort study with follow-up time up to 4 years (range = 2-48 months, median = 46 months), the hazard ratios (HR) from the time-to-event analysis indicated that patients prescribed opioid medications for at least 6 months during the past year and at 20-50 MME levels or higher had 4.44 (95% CI: [3.71, 5.32]) to 7.23 (95% CI: [6.22, 8.41]) times the risk of attempted suicide compared to those not prescribed opioids. Risk of suicide attempt was sharply elevated among patients with psychiatric conditions other than anxiety who were prescribed more frequent and higher opioid doses. In contrast, more frequent and higher doses of prescription opioids were associated with lower risk of suicide attempts among patients with medical conditions necessitating pain management. This study is limited by its exclusive focus on commercially insured patients and does not include patients covered by public insurance. It is also limited to patients' receipt of prescription opioids and does not take into account opioids obtained through other means, nor does it include measures of actual patient opioid use. CONCLUSIONS This analysis provides evidence of a complex relationship among prescription opioids, mental health, pain and other medical comorbidities, and suicide risk. Findings indicate the need for proactive suicide surveillance among individuals diagnosed with affective or psychotic disorders who are receiving frequent and high doses of opioids. However, appropriate opioid treatment may have significant value in reducing suicide risk for those without psychiatric comorbidities.
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Affiliation(s)
- Chongliang Luo
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St Louis, MO, United States of America
| | - Kun Chen
- Department of Statistics, University of Connecticut, Storrs, CT, United States of America
- Center for Population Health, Uconn Health, Farmington, CT, United States of America
| | - Riddhi Doshi
- Center for Population Health, Uconn Health, Farmington, CT, United States of America
- Beacon Health Options, Rocky Hill, CT, United States of America
| | - Nathaniel Rickles
- Center for Population Health, Uconn Health, Farmington, CT, United States of America
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, United States of America
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Harold Schwartz
- Institute of Living, Hartford Healthcare, Hartford, CT, United States of America
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, United States of America
| | - Robert H. Aseltine
- Center for Population Health, Uconn Health, Farmington, CT, United States of America
- Division of Behavioral Sciences and Community Health, Uconn Health, Farmington, CT, United States of America
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Wilens TE, Woodward DW, Ko JD, Berger AF, Burke C, Yule AM. The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders. J Child Adolesc Psychopharmacol 2022; 32:200-214. [PMID: 35587209 PMCID: PMC9145257 DOI: 10.1089/cap.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background and Objective: Child- and adolescent-onset psychopathology is known to increase the risk for developing substance use and substance use disorders (SUDs). While pharmacotherapy is effective in treating pediatric psychiatric disorders, the impact of medication on the ultimate risk to develop SUDs in these youth remains unclear. Methods: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review of peer-reviewed literature published on PubMed through November 2021, examining pharmacological treatments of psychiatric disorders in adolescents and young adults and their effect on substance use, misuse, and use disorder development. Results: Our search terms yielded 21 studies examining the impact of pharmacotherapy and later SUD in attention-deficit/hyperactivity disorder (ADHD), two studies on Major Depressive Disorder, and three studies on psychotic disorders. The majority of these studies reported reductions in SUD (N = 14 sides) followed by no effects (N = 10) and enhanced rates of SUD (N = 2). Studies in ADHD also reported that earlier-onset and longer-duration treatment was associated with the largest risk reduction for later SUD. Conclusions: Overall, pharmacological treatments for psychiatric disorders appear to mitigate the development of SUD, especially when treatment is initiated early and for longer durations. More studies on the development of SUD linked to the effects of psychotherapy alone and in combination with medication, medication initiation and duration, adequacy of treatment, non-ADHD disorders, and psychiatric comorbidity are necessary.
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Affiliation(s)
- Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Timothy Wilens, MD, Department of Psychiatry, YAW6A, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Diana W. Woodward
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Je Deuk Ko
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy F. Berger
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colin Burke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
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Moro MF, Calamandrei G, Poli R, Di Mattei V, Perra A, Kurotschka PK, Restrepo A, Romano F, La Torre G, Preti E, Mascayano F, Picardi A, Chiarotti F, Rapisarda V, Urban A, Alvarado R, Susser E, Carta MG. The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers in Italy: Analyzing the Role of Individual and Workplace-Level Factors in the Reopening Phase After Lockdown. Front Psychiatry 2022; 13:867080. [PMID: 35722544 PMCID: PMC9200968 DOI: 10.3389/fpsyt.2022.867080] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Italy is one of the high-income countries hit hardest by Covid-19. During the first months of the pandemic, Italian healthcare workers were praised by media and the public for their efforts to face the emergency, although with limited knowledge and resources. However, healthcare workers soon had to face new challenges at a time when the national health system was working hard to recover. This study focuses on this difficult period to assess the impact of the COVID-19 pandemic on the mental health of Italian healthcare workers. MATERIALS AND METHODS Healthcare workers from all Italian regions [n = 5,502] completed an online questionnaire during the reopening phase after the first wave lockdown. We assessed a set of individual-level factors (e.g., stigma and violence against HCWs) and a set of workplace-level factors (e.g., trust in the workplace capacity to handle COVID-19) that were especially relevant in this context. The primary outcomes assessed were score ≥15 on the Patient Health Questionnaire-9 and score ≥4 on the General Health Questionnaire-12, indicators of clinically significant depressive symptoms and psychological distress, respectively. Logistic regression analyses were performed on depressive symptoms and psychological distress for each individual- and workplace-level factor adjusting for gender, age, and profession. RESULTS Clinically significant depressive symptoms were observed in 7.5% and psychological distress in 37.9% of HCWs. 30.5% of healthcare workers reported having felt stigmatized or discriminated, while 5.7% reported having experienced violence. Feeling stigmatized or discriminated and experiencing violence due to being a healthcare worker were strongly associated with clinically significant depressive symptoms [OR 2.98, 95%CI 2.36-3.77 and OR 4.72 95%CI 3.41-6.54] and psychological distress [OR 2.30, 95%CI 2.01-2.64 and OR 2.85 95%CI 2.16-3.75]. Numerous workplace-level factors, e.g., trust in the workplace capacity to handle COVID-19 [OR 2.43, 95%CI 1.92-3.07] and close contact with a co-worker who died of COVID-19 [OR 2.05, 95%CI 1.56-2.70] were also associated with clinically significant depressive symptoms. Similar results were found for psychological distress. CONCLUSIONS Our study emphasizes the need to address discrimination and violence against healthcare professionals and improve healthcare work environments to strengthen the national health system's capacity to manage future emergencies.
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Affiliation(s)
- Maria Francesca Moro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,University of Cagliari, Cagliari, Italy
| | | | - Ranieri Poli
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | | | | | - Alexandra Restrepo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,Universidad de Antioquia, Medellín, Colombia
| | - Ferdinando Romano
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università La Sapienza, Rome, Italy
| | - Giuseppe La Torre
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università La Sapienza, Rome, Italy
| | | | - Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,New York State Psychiatric Institute, NewYork, NY, United States
| | | | | | | | - Antonio Urban
- Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Ruben Alvarado
- Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaíso, Chile
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,New York State Psychiatric Institute, NewYork, NY, United States
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Sanger N, Bhatt M, Singhal N, Panesar B, D’Elia A, Trottier M, Shahid H, Hillmer A, Baptist-Mohseni N, Roczyki V, Soni D, Brush M, Lovell E, Sanger S, Samaan MC, de Souza RJ, Thabane L, Samaan Z. Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:812. [PMID: 33005151 PMCID: PMC7485127 DOI: 10.3389/fpsyt.2020.00812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/28/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Prescription opioid misuse has led to a new cohort of opioid use disorder (OUD) patients who were introduced to opioids through a legitimate prescription. This change has caused a shift in the demographic profile of OUD patients from predominantly young men to middle age and older people. The management of OUD includes medication-assisted treatment (MAT), which produces varying rates of treatment response. In this study, we will examine whether the source of first opioid use has an effect on treatment outcomes in OUD. Using a systematic review of the literature, we will investigate the association between source of first opioid introduction and treatment outcomes defined as continuing illicit opioid use and poly-substance use while in MAT. METHODS Medline, EMBASE, CINHAL, and PsycInfo were searched from inception to December 31st, 2019 inclusive using a comprehensive search strategy. Five pairs of reviewers conducted screening and data extraction independently in duplicate. The review is conducted and reported according to the PRISMA guidelines. A random-effects model was used for meta analyses assuming heterogeneity among the included studies. RESULTS The initial search results in 27,345 articles that were screened, and five observational studies were included in the qualitative and quantitative analyses. Our results found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while on MAT. They were also less likely to use cannabis (0.54, 95% CI 0.32, 0.89), alcohol (0.75, 95% CI 0.59, 0.95), cocaine (0.50, 95% CI 0.29, 0.85), and injection drug use (0.25, 95% CI 0.14, 0.43) than those introduced to opioids through recreational means. CONCLUSION This study shows that the first exposure to opioids, whether through a prescription or recreationally, influences prognosis and treatment outcomes of opioid use disorder. Although the increased pattern of prescribing opioids may have led to increased OUD in a new cohort of patients, these patients are less likely to continue to use illicit drugs and have a different prognostic and clinical profile that requires a tailored approach to treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058143.
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Affiliation(s)
- Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Nikhita Singhal
- Undergraduate MD Program, McMaster University, Hamilton, ON, Canada
| | - Balpreet Panesar
- Life Sciences Undergraduate Program, McMaster University, Hamilton, ON, Canada
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Alessia D’Elia
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- McMaster Integrative Neuroscience Discovery & Study Program, McMaster University, Hamilton, ON, Canada
| | - Maegan Trottier
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Hamnah Shahid
- Arts & Sciences, McMaster University, Hamilton, ON, Canada
| | - Alannah Hillmer
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Natasha Baptist-Mohseni
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Victoria Roczyki
- Department of Biology, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Divya Soni
- Health Sciences Undergraduate Program, McMaster University, Hamilton, ON, Canada
| | - Maurana Brush
- Undergraduate MD Program, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Lovell
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Postgraduate Psychiatry Program, McMaster University, Hamilton, ON, Canada
| | - Stephanie Sanger
- Health Science Library, McMaster University, Hamilton, ON, Canada
| | - M. Constantine Samaan
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph’s Healthcare—Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Busto Miramontes A, Moure-Rodriguez L, Diaz-Geada A, Carbia C, Cadaveira F, Caamaño-Isorna F. The Use of Non-Prescribed Prescription Drugs and Substance Use Among College Students: A 9-Year Follow-Up Cohort Study. Front Psychiatry 2020; 11:880. [PMID: 33192636 PMCID: PMC7481469 DOI: 10.3389/fpsyt.2020.00880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022] Open
Abstract
The use of non-prescribed prescription drugs (NPPD) is common in post-modern societies and a significant proportion of youth consume NPPD concomitantly to other drugs. We studied the prevalence of this consumption among university students in Spain, and its relationship to different patterns of alcohol, tobacco, and cannabis use. A cohort study among university students (n=1,380) (2005-2015) was carried out. Students completed self-administered questionnaires at initial (n=1,363, 98.7%), at 2 years (n=875, 75%) and 9 years of follow-up (n=415, 30.5%). Consumption of medicines (last 15 days), risky alcohol consumption (RC), heavy episodic drinking (HED), and tobacco and cannabis use were measured. Multilevel logistic regressions for repeated measures were generated using consumption of medicines with or without medical prescription as dependent variables. Prevalence of RC, HED, tobacco and cannabis had significant reductions during the follow-up. The use of NPPD increased over time, from 35.5% and 33.3% at 18 and 22 years old, respectively, to 49.6% at 27 years old. The highest rates were found among cannabis, tobacco, RC and HED users. For females, cannabis and RC constitute signitifant risk factors for use of NPPD. Conversely, for males, tobacco and cannabis were risk factors for such use of medicines. Later onset of alcohol consumption constitutes a protective factor for females. Our results reveal high prevalence of NPDD among university students. Those who consume NPPD are -at the same time- more likely to be alcohol, tobacco, and cannabis users than those who take medication under prescription. Preventive strategies should be reinforced and focused on this target population to decrease these high levels of poly-consumption.
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Affiliation(s)
- Alicia Busto Miramontes
- CIBER de Epidemiología y Salud Pública (CIBERESP), Department of Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Lucía Moure-Rodriguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Department of Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ainara Diaz-Geada
- CIBER de Epidemiología y Salud Pública (CIBERESP), Department of Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carina Carbia
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Fernando Cadaveira
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Caamaño-Isorna
- CIBER de Epidemiología y Salud Pública (CIBERESP), Department of Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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