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Wang B, Peng X, Liang B, Fu L, Lu Z, Li X, Tian T, Xiao X, Liu J, Shi T, Ouyang L, Wang Y, Yu M, Wu G, Wu D, Tang W, Tucker JD, Cai Y, Zou H. Sexual activity, sexual satisfaction and their correlates among older adults in China: findings from the sexual well-being (SWELL) study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100825. [PMID: 37927996 PMCID: PMC10624984 DOI: 10.1016/j.lanwpc.2023.100825] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 11/07/2023]
Abstract
Background Sexual activity is important to the holistic health of older adults. However, the sexual lives of older adults are understudied. We aimed to investigate the prevalence and correlates of sexual activity and sexual satisfaction among older adults in China. Methods In this multi-centre cross-sectional study, individuals aged 50 years and older were recruited from four regions in China between June 2020 and December 2022. An investigator-administered questionnaire was completed to collect information on socio-demographics, health status (general health and specific health), and sexual health characteristics. Sexual activity (including vaginal, oral, or anal sex) in the past year was treated as sexually active. Sexual satisfaction was measured using a validated five-point Likert scale. Logistic regression was used to assess correlates of sexual activity and sexual satisfaction. Findings 3001 older adults (1182 women and 1819 men, mean age 60.3 ± 7.8 years) were recruited. Most participants were living in urban areas (1688, 56.2%), in a stable relationship (2531, 84.3%), and satisfied with life (2141, 71.3%). 46.8% of men and 40.7% of women were sexually active. Better self-reported general health status (good: aOR 0.53, 95% CI 0.34-0.82; fair: 0.47, 0.29-0.76; bad or very bad: 0.58, 0.35-0.96; versus very good), no difficulty walking upstairs (0.63, 0.41-0.97), diabetes (0.64, 0.42-0.98), and menopause (0.57, 0.36-0.92), were associated with sexual activity among women. Such an association was not found among men. Among sexually active participants, about three-quarters (men: 73.6%, women: 73.4%) were sexually satisfied. Self-reported general health status (men [good: 0.25, 0.12-0.53; fair: 0.17, 0.08-0.37; bad or very bad: 0.15, 0.06-0.34]; women [good: 0.27, 0.10-0.70; fair: 0.11, 0.04-0.30; bad or very bad: 0.11, 0.04-0.32]), life satisfaction (men: 1.73, 1.22-2.46; women: 2.23, 1.34-3.71) and talking about sexual preferences with a partner (men: 1.77, 1.23-2.56; women: 2.93, 1.69-5.09) were associated with sexual satisfaction. Interpretation Older adults who had better health status and talked easily with their partners about their sex life were more likely to report sexual satisfaction. For women, better self-reported general health status and lack of disability were associated with sexual activity. Further research should address measures that improve sexual satisfaction, especially among sexually active older adults. Funding This study was supported by the Natural Science Foundation of China International/Regional Research Collaboration Project [72061137001] and the Economic and Social Research Council [ES/T014547/1].
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Affiliation(s)
- Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xin Peng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bowen Liang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tian Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xin Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Department of Scientific Research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jiewei Liu
- Baiyun District Center for Disease Control and Prevention, Guangzhou, China
| | - Tongxin Shi
- Hexi District Center for Disease Control and Prevention, Tianjin, China
| | - Lin Ouyang
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maohe Yu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Guohui Wu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Joseph D. Tucker
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- University of North Carolina Project-China, Guangzhou, China
| | - Yong Cai
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
- School of Public Health, Southwest Medical University, Luzhou, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Haugeberg G, Michelsen B, Østensen M, Kavanaugh A. Perceived influence of health status on sexual activity in patients with psoriatic arthritis. Scand J Rheumatol 2020; 49:468-475. [PMID: 32669024 DOI: 10.1080/03009742.2020.1774647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: To examine the prevalence of self-reported problems with sexual activity among psoriatic arthritis (PsA) patients, and to explore potential associations of such problems with various demographic, musculoskeletal, and dermatological disease variables. Method: Consecutive PsA patients were recruited from an outpatient clinic. Data collected included demographics, measures of musculoskeletal and skin disease activity, and treatments. Perceived effect of health status on sexual activity was assessed using question number 15 from the health-related quality of life instrument 15D; this was explored in univariate and multivariate logistic regression analyses. Results: The study assessed 135 patients (mean age 52.1 years, disease duration 8.7 years, 51.1% male). Mean scores included Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) 2.9, Disease Activity index for PSoriatic Arthritis (DAPSA) 18.2, patient global assessment (PGA) 36.0 mm, pain 33.7 mm, fatigue 45.1 mm, modified Health Assessment Questionnaire (mHAQ) 0.42, Psoriasis Area Severity Index (PASI) 2.5, and Dermatology Life Quality Index (DLQI) 3.4. Twenty-four patients (17.8%) reported that their health status had a large negative effect and 111 (82.2%) that it had no or little effect on their sexual activity. In univariate analyses, a statistically significant association with impaired sexual activity was found for longer disease duration and higher MASES, DAPSA, PGA, fatigue, and mHAQ scores, but not for demographic variables or variables reflecting skin psoriasis involvement (PASI, DLQI). In adjusted analyses, only PsA disease duration remained independently associated with impaired sexual activity. Conclusion: One in five PsA patients perceived that their health status had a negative impact on sexual activity. Disease duration and measures reflecting musculoskeletal involvement, but not measures reflecting skin psoriasis involvement, appeared to be associated with impaired sexual activity.
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Affiliation(s)
- G Haugeberg
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital , Kristiansand, Norway.,Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology , Trondheim, Norway
| | - B Michelsen
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital , Kristiansand, Norway
| | - M Østensen
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital , Kristiansand, Norway
| | - A Kavanaugh
- Department of Medicine, School of Medicine, University of California , San Diego, CA, USA
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Faus-Bertomeu A. [Health, sex and sexual behaviour: sexually active life expectancy]. GACETA SANITARIA 2020; 35:28-34. [PMID: 32146001 DOI: 10.1016/j.gaceta.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To measure sexually active life expectancy (SALE) estimating the average age at which sexually active life finishes, paying special attention to the older population. Variations in SALE according to self-rated health are examined. METHOD Descriptive analysis with cross-sectional data. SALE was calculated for the population by age group (30 to 80 years old) and sex using the Sullivan Method, with data from the Human Mortality Database and the National Survey of Sexual Health (Spain). The analysis distinguishes between individuals that have had coital sex in the last year and those who have not. RESULTS Coital activity continues in those aged from 55-59 years old, the SALE is 13.3 years in males and 8 in females. Coital activity is related to health and sexual health, diverging depending on sex and age group. The males showed a more extended sexually active trajectory than the females, but were also more influenced by good general health (adding 2.6 and 1 years respectively) and good sexual health (5.2 and 4.3 years). SALE also varies when poor health (subtracting 2.7 years and adding 2 years) and poor sexual health (subtracting 2.9 and 1.3 years) are considered. CONCLUSIONS the results reveal that sexual health programmes must be extended to the older ages, given that it is confirmed that sexual activity continues in old age.
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Affiliation(s)
- Aina Faus-Bertomeu
- Departamento de Sociologia i Antropologia Social, Facultat de Ciències Socials, Universitat de València, València, España.
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Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, Härkönen P, Jurvelin H, Suija K. Validation of the Zung self-rating depression scale (SDS) in older adults. Scand J Prim Health Care 2019; 37:353-357. [PMID: 31286810 PMCID: PMC6713148 DOI: 10.1080/02813432.2019.1639923] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: The main objective of this study was to investigate the psychometric properties of the Zung Self-Rating Depression Scale (SDS) and evaluate screening parameters capability of the SDS with the Beck Depression Inventory (BDI-21) among the elderly population. Design: A population-based study Setting: Community Subjects: 520 adults, aged 72-73 years, living in the city of Oulu, Finland. Main outcome measures: The screening parameters of the SDS questions and BDI-21 for detecting severity of depression. The Mini Neuropsychiatric Interview for diagnosing major depression. Results: The optimal cut-off point for the SDS was 39. The sensitivity and specificity parameters for this cut-off point were 79.2% (95% CI 57.8-92.9) and 72.2% (95% CI 67.9-76.1), respectively. Positive and negative predictive values were 12.5% (95% CI 7.7-18.8) and 98.6% (95% CI 96.7-99.5), respectively. Moreover, there was no statistically significant difference in diagnostic accuracy indices of the cut-off points 39 and 40. In a receiver operating characteristic analysis, the area under the curve was 0.85 (95%CI 0.77-0.92) for the SDS total score and 0.89 (95% CI 0.83-0.96) for the BDI-21 (p = 0.137). Conclusion: Using the traditional cut-off point, the SDS was convenient for identifying clinically meaningful depressive symptoms in an elderly Finnish population when compared with the BDI-21 which is one of the most commonly used depression screening scales. The sensitivity and specificity of these two screening tools are comparable. Based on our study, the SDS is convenient for identifying clinically meaningful depressive symptoms among older adults at the community level. Key points The widely used Zung Self-Rating Depression Scale (SDS) has not previously been validated among elderly people at the community level. The sensitivity and specificity of SDS (cut-off point 39) were 79.2% and 72.2%. The positive and negative predictive values for SDS were 12.5% and 98.6%. SDS is convenient for identifying major depression in an elderly population and regarding sensitivity and specificity comparable to BDI-21.
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Affiliation(s)
- Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland;
- CONTACT Jari Jokelainen Center for Life Course Health Research, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Unit of General Practice, Oulu University Hospital, P.O. Box 10, FI-90029 Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland;
- Health Center of Oulu, Oulu, Finland;
| | - Pirjo Härkönen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
| | - Heidi Jurvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
| | - Kadri Suija
- Center for Life Course Health Research, University of Oulu, Oulu, Finland;
- Department of Family Medicine, University of Tartu, Tartu, Estonia
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Archangelo SDCV, Sabino M, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clinics (Sao Paulo) 2019; 74:e883. [PMID: 31166474 PMCID: PMC6542498 DOI: 10.6061/clinics/2019/e883] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.
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Affiliation(s)
| | - Miguel Sabino
- Programa de Pos-graduacao em Cirurgia Translacional, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Daniela Francescato Veiga
- Programa de Pos-graduacao em Cirurgia Translacional, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Ciencias Medicas, Universidade do Vale do Sapucai, Pouso Alegre, MG, BR
| | - Elvio Bueno Garcia
- Disciplina de Cirurgia Plastica, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Lydia Masako Ferreira
- Disciplina de Cirurgia Plastica, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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Berg KH, Rohde G, Prøven A, Almås E, Benestad EEP, Østensen M, Haugeberg G. Exploring the relationship between demographic and disease-related variables and perceived effect of health status on sexual activity in patients with axial spondyloarthritis: associations found only with non-disease variables. Scand J Rheumatol 2017; 46:461-467. [DOI: 10.1080/03009742.2017.1279684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- KH Berg
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - G Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sørlandet Hospital, Kristiansand, Norway
| | - A Prøven
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - E Almås
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - EEP Benestad
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - M Østensen
- Department of Clinical Research, Sørlandet Hospital, Kristiansand, Norway
| | - G Haugeberg
- Department of Clinical Research, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
Sexual dysfunction is a common problem in chronic obstructive pulmonary disease (COPD). We aimed to assess the presence of erectile dysfunction (ED) in COPD patients. Ninety-three outpatients who had been diagnosed as COPD and followed in Bolvadin State Hospital, Afyon, Turkey, were included in the study. All patients underwent pulmonary function tests and arterial blood gas analysis. They completed International Physical Activity Questionnaire (IPAQ), Medical Research Council (MRC) Dyspnea Scale, Short Form 36-item Scale (SF-36), and International Index of Erectile Function (IIEF) Questionnaire. The mean age of 10 (10.8%) mild, 46 (49.5%) moderate, 28 (30.1%) severe, and 9 (9.7%) very severe COPD patients was 61.4 ± 9.8 years. Varying degrees of ED were detected in 67.7% of COPD patients. All patients with hypoxemia had ED. IPAQ score and all SF-36 parameters were low in patients with ED, while MRC score was high. Forced expiratory volume in one second, forced vital capacity, partial pressure of oxygen in blood, oxygen (O2) saturation, IPAQ score, and role-physical parameters were statistically low in ED patients (p = 0.04, 0.02, <0.01, <0.01, 0.02, and 0.04, respectively); MRC score was statistically higher in patients with ED (p = 0.02). Patients with moderate and severe ED had statistically lower score of mental health (p < 0.01 and p = 0.02, respectively). There was a positive correlation between IIEF score and IPAQ scores (p < 0.01), MRC scores (p = 0.01), general health (p < 0.01), role-physical (p < 0.01), role-emotional (p < 0.01), physical functioning (p < 0.01), and mental health (p < 0.01) parameters in SF-36. ED is frequently seen in COPD patients. Hypoxemia, smoking, and limitation of physical activity are thought to be associated with ED in COPD as mechanisms. Quality of life and the functional capacity are negatively affected with the presence of ED. It is important for a physician to question the sexual functions in patients with COPD. The presence of ED may be routinely considered in the daily practice of pulmonologists in COPD patients.
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Affiliation(s)
- Onur Turan
- Department of Chest Diseases, Gelibolu State Hospital, Canakkale, Turkey
| | - Iyimser Ure
- Department of Urology, Eskisehir Osmangazi University, Osmangazi, Turkey
| | - Pakize Ayse Turan
- Department of Chest Diseases, Canakkale State Hospital, Canakkale, Turkey
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Lindau ST, Abramsohn EM, Matthews AC. A manifesto on the preservation of sexual function in women and girls with cancer. Am J Obstet Gynecol 2015; 213:166-74. [PMID: 25818667 PMCID: PMC4692159 DOI: 10.1016/j.ajog.2015.03.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/19/2015] [Accepted: 03/19/2015] [Indexed: 12/17/2022]
Abstract
Malignancies that affect females who survive cancer commonly originate in, invade, and/or metastasize to the sexual organs, including the ovaries, uterine corpus, uterine cervix, vagina, vulva, fallopian tubes, anus, rectum, breast(s), and brain. Females comprise most of the population (in number and proportion) with cancers that directly affect the sexual organs. Most females in the age groups most commonly affected by cancer are sexually active in the year before diagnosis, which includes most menopausal women who have a partner. Among female cancer survivors, the vast majority have cancers that are treated with local or systemic therapies that result in removal, compromise, or destruction of the sexual organs. Additionally, female cancer survivors often experience abrupt or premature onset of menopause, either directly with surgery, radiation, or other treatments or indirectly through disruption of female sex hormone or other neuroendocrine physiology. For many female patients, cancer treatment has short-term and long-lasting effects on other aspects of physical, psychological, and social functioning that can interfere with normal sexual function; these effects include pain, depression, and anxiety; fatigue and sleep disruption; changes in weight and body image; scars, loss of normal skin sensation, and other skin changes; changes in bodily odors; ostomies and loss of normal bowel and bladder function; lymphedema, and strained intimate partnerships and other changes in social roles. In spite of these facts, female patients who are treated for cancer receive insufficient counseling, support, or treatment to preserve or regain sexual function after cancer treatment.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL; Department of Medicine-Geriatrics, University of Chicago, Chicago, IL.
| | - Emily M Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Amber C Matthews
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
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