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Xu J, Akezhuoli H, Zhou M, Yao T, Lu J, Wang X, Zhou X. Development and evaluation of a culturally adapted digital-platform integrated multifaceted intervention to promote the utilization of maternal healthcare services: a single-arm pilot study. Int J Equity Health 2023; 22:217. [PMID: 37848902 PMCID: PMC10583400 DOI: 10.1186/s12939-023-02033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The utilization of hospital delivery and antenatal care (ANC) is essential for improving maternal and newborn outcomes. However, social and cultural barriers in underdeveloped rural areas hindered maternal care utilization. This study aims to design and evaluate the effectiveness of a culturally adapted digital-platform intervention to promote maternal care utilization among women in ethnic minority communities in China. METHODS From January 1st, 2020, to December 31st, 2021, all pregnant women in Mianshan town, Liangshan Autonomous Prefecture, were invited to participate in the intervention. The multifaceted intervention included participatory and cultural-tailored health education on a popular social media platform, transportation subsidies, and capacity building and economic incentives for healthcare providers. The effectiveness of the intervention was evaluated by comparing two groups: mothers who gave live birth before the intervention (January 1st to December 31st, 2019) and mothers whose entire pregnancy period was covered by the intervention. The primary outcomes were the rate of hospital delivery and ANC utilization. Data on pregnant women were retrospectively collected through telephone surveys and the maternal and newborn's health monitoring system. RESULTS A total of 237 intervention sample and 138 pre-intervention sample were included. The intervention group demonstrated significantly higher rates of hospital delivery (97.5% vs. 87.7%, p < 0.001), timely initiation of ANC (73.0% vs. 62.3%, p = 0.031), and timely completion of five-time ANC visits (37.1% vs.4.3%, p < 0.001) compared to the pre-intervention group. The intervention group was more likely to utilize hospital delivery (OR = 9.26, 95%CI [2.83-30.24], p < 0.001) and ANC, including timely initiation of ANC (OR = 2.18, 95%CI [1.31-3.62], p = 0.003), completion of five ANC visits (OR = 1.72, 95%CI [1.05-2.83], p = 0.032), and timely completion of five ANC visits (OR = 15.12, 95%CI [6.24-36.64], p < 0.001). CONCLUSIONS The culturally adapted digital-platform integrated multifaceted intervention effectively promoted the utilization of hospital delivery, timely initiation of ANC, and completion of ANC visits in the Yi ethnic community in China. This study provides valuable insights for future interventions targeting maternal healthcare services in underdeveloped ethnic minority communities worldwide. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2300073219. Registered 4 July 2023 - Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=199202 .
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Affiliation(s)
- Jiayao Xu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Hailati Akezhuoli
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Meng Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Tingting Yao
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Lu
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China
| | - Xiaomin Wang
- School of Public Health, Hangzhou Normal University, No. 2318 Yuhangtang Road, Yuhang District, Hangzhou, 311121, China.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, 310058, China.
- The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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Huang Y, Xiao X, Wan Y, Ye Q, Yang Z, Xu L, Chen S, Li H, Wang F, Chen Y, Zhao D, Zhang Q, Zheng J, Guo G, Li Y. Tracking progress towards equitable maternal and child health in Yunnan: a systematic assessment for the Health Programme for Poverty Alleviation in China during 2015-2020. BMJ Open 2023; 13:e070809. [PMID: 37821133 PMCID: PMC10583063 DOI: 10.1136/bmjopen-2022-070809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES To inform the impacts of health programmes which aimed at preventing women and children from being trapped in or returning to poverty because of illness in Yunnan, the main battlefield against poverty in China. DESIGN The longitudinal comparative evaluation design. DATA COLLECTION AND ANALYSIS National and Yunnan policy documents related to maternal and child health programmes for poverty alleviation during 2015-2020 were analysed. The changes in disparities in maternal and child health system inputs, service coverage, and health outcomes between poor and non-poor areas, as well as out-of-pocket payments between poor and non-poor populations were assessed before and after 2017. RESULTS In total 12 policies and 15 programmes related to poverty alleviation for poor women and children in Yunnan were summarised. As a result of health system strengthening in Yunnan, the densities of licensed doctors, nurses, obstetricians, midwives, township health workers and female village doctors had been increased substantially in poor areas, with the annual rates of 14.3%, 22.5%, 21.8%, 23.9%, 14.1% and 7.1% separately. Although disparities existed in some of service coverage between poor and non-poor areas, the health programmes had narrowed the gaps in utilisation of facility birth, caesarean section, prenatal screening and newborn screening across Yunnan (p<0.01). The out-of-pocket payments for inpatient care for serious illnesses among women and children with poverty registration had been considerably decreased to 10.0%. Paralleling the universal coverage, maternal deaths per 100 000 livebirths and child deaths per 1000 livebirths had further declined in both poor and non-poor areas, and the impacts of health programmes on closing the gaps in child survivals across Yunnan were significant (p<0.01). CONCLUSIONS Remarkable progress in equitable maternal and child survival has been achieved in Yunnan. The practices in Yunnan have shown the Chinese model in ending poverty by strengthening health system and implementing universal coverage with firm commitment, determined leadership, detailed blueprint and social participation.
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Affiliation(s)
- Yuan Huang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Xia Xiao
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Ying Wan
- Information Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Qingyun Ye
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Zhongting Yang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Lingling Xu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Shuqi Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Huifang Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Fangfang Wang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yurong Chen
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Dandan Zhao
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Qian Zhang
- Information Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Jiarui Zheng
- Health Care Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Guangping Guo
- Health Care Centre, Yunnan Maternal and Child Health Care Hospital, Kunming, Yunnan, China
| | - Yan Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
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Feng XL, Wang Y, Chen Z, Carine R. Factors affecting the frequency and contents of routine antenatal care in remote rural China in 2009-2016: an observational study. BJOG 2021; 129:1062-1072. [PMID: 34860444 DOI: 10.1111/1471-0528.17037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/27/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We assessed factors associated with frequency and contents of antenatal care (ANC) in remote rural China, including province of residence and individual level factors. DESIGN Survey-based cross-sectional study. SETTING Remote rural China, Five provinces- Jilin, Shaanxi, Hunan, Guizhou, and Ningxia. SAMPLE 3,918 women with a live birth in 2009-2016. METHODS Poisson regression. MAIN OUTCOME MEASURES ANC frequency- 5+ visits starting in the first trimester. ANC contents- co-coverage of six care components, and overuse of ultrasound. MAIN RESULTS Three quarters (72.9%) of women had 5+ visits starting in the first trimester, 68.8% received all six care components, and 94.5% had 3+ ultrasounds. Only 30.9% women sought ANC from township hospitals, paying between $3.8 and 25.8 per-visit. ANC frequency and contents were associated with women's socio-economic characteristics, but provincial effects were much stronger, even after adjusting for individual factors. Women living in Guizhou and Ningxia, the two poorest provinces with high proportions of ethnic minorities, were particularly underserved. Compared to women in Shaanxi, women in Guizhou were 33% (adjusted RR 0.67, 95%CI 0.61-0.74) less likely to receive 5+ ANC starting in the first trimester; women in Ningxia were 17% less likely (adjusted RR 0.83, 95% CI 0.76-0.90) to receive all six care components. CONCLUSION The province of residence was a stronger predictor of ANC frequency and contents than women's individual characteristics in China, suggesting that strengthening the decentralised system of financing and organisation of ANC at province level is crucial to achieving success. Future efforts are warranted to engage sub-regional administrations.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, UK
| | - Ying Wang
- Department of Health Policy and Management, School of Public Health, Peking University, UK
| | - Zhengchao Chen
- Department of Health Policy and Management, School of Public Health, Peking University, UK
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Duan R, Wang X, Shan S, Zhao L, Xiong J, Libuda L, Cheng G. The Chinese Adolescent Cohort Study: Design, Implementation, and Major Findings. Front Nutr 2021; 8:747088. [PMID: 34805242 PMCID: PMC8604082 DOI: 10.3389/fnut.2021.747088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
The importance of diet quality on children's growth is being increasingly recognized. The Chinese Adolescent Cohort (CAC) is a longitudinal cohort study to comprehensively investigate the health impacts of nutritional factors on child growth. From 2013 to 2018, 6,967 children aged 6-8 years have been recruited from 23 primary schools in Sichuan, Guizhou, and Chongqing, which have been planned to be followed up annually until their age of 15 years. Regular assessments included the measurement of height, weight, waist circumference, and skinfold thicknesses; pubertal development was examined by trained investigators according to Tanner stages; dietary intake was obtained by three 24-h recalls and food frequency questionnaire; validated questionnaires were used to estimate socio-demographic characteristics, physical activity, and sedentary behaviors. Findings from the CAC baseline and the first follow-up data suggested that higher protein intake among girls and unhealthy eating habits among children might increase the risk for childhood obesity. Also, higher intakes of grain and meat and lower overall diet quality and intakes of dietary fiber and tuber might be associated with advanced pubertal development. Those results indicated that the CAC study could contribute to the development of strategies for optimizing Chinese children's health.
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Affiliation(s)
- Ruonan Duan
- Laboratory of Molecular Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Department of Pediatrics, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Wang
- Laboratory of Molecular Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Department of Pediatrics, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shufang Shan
- Laboratory of Molecular Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Department of Pediatrics, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Zhao
- Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Jingyuan Xiong
- Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Lars Libuda
- Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, Nutrition Sciences, Paderborn University, Paderborn, Germany
| | - Guo Cheng
- Laboratory of Molecular Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Department of Pediatrics, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Laksono AD, Wulandari RD, Matahari R. The determinant of health insurance ownership among pregnant women in Indonesia. BMC Public Health 2021; 21:1538. [PMID: 34380463 PMCID: PMC8359302 DOI: 10.1186/s12889-021-11577-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health insurance ownership is one indicator of the readiness of pregnant women for the delivery process. The study aimed to analyze the determinants of health insurance ownership among pregnant women in Indonesia. METHODS The study population was pregnant women in Indonesia. The study involved 2542 pregnant women in Indonesia. The variables analyzed included type of place of residence, age group, education level, employment status, marital status, parity, wealth status, and know the danger signs of pregnancy. In the final step, the study employed binary logistic regression to explain the relationship between health insurance ownership and predictor variables. RESULTS The results show that pregnant women with higher education were 3.349 times more likely than no education pregnant women to have health insurance. Pregnant women with wealth status in the middle category were 0.679 times the poorest pregnant women to have health insurance. Meanwhile, the richest pregnant women had 1.358 times more chances than the poorest pregnant women to have health insurance. Grande multiparous pregnant women were 1.544 times more likely than primiparous pregnant women to have health insurance. Pregnant women who know the danger signs of pregnancy were 1.416 times more likely than pregnant women who don't see the danger signs of pregnancy to have health insurance. CONCLUSIONS The study concluded that four variables, including education level, wealth status, parity, and knowledge of the danger signs of pregnancy, were significant determinants of health insurance ownership in Indonesia.
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Affiliation(s)
- Agung Dwi Laksono
- The Ministry of Health of the Republic of Indonesia, National Institute of Health Research and Development, Jakarta, Indonesia.
| | | | - Ratu Matahari
- Faculty of Public Health, Ahmad Dahlan University, Jogjakarta, Indonesia
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Li F, Qin J, Zhang S, Chen L. Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis. Pregnancy Hypertens 2021; 24:13-21. [PMID: 33626437 DOI: 10.1016/j.preghy.2021.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I2 statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35 years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.
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Affiliation(s)
- Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China.
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Xu J, Zhang Y, Yao M, Wu G, Duan Z, Zhao X, Zhang J. Long-term effects of ambient PM2.5 on hypertension in multi-ethnic population from Sichuan province, China: a study based on 2013 and 2018 health service surveys. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 28:5991-6004. [PMID: 32978739 DOI: 10.1007/s11356-020-10893-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
Hypertension, a major risk factor of many severe chronic diseases and leading cause of global disease burden, is reported to be associated with long-term exposure to PM2.5. China's high PM2.5 pollution level has become a major public health issue. However, existing studies from China have got inconsistent results with very limited investigation into the multi-ethnic peoples. This study adds multi-ethnic evidence from Sichuan Province, southwestern China, and assesses ethnic differences of PM2.5 exposure effect on hypertension. We pooled large cross-sectional data from two surveys conducted in 2013 and 2018 to examine the association of long-term exposure to PM2.5 on prevalence of hypertension in adults aged 30 years old and above. Community-specified annual PM2.5 concentration was estimated using satellite data. Thirty-one thousand four hundred sixty-two participants with average exposure concentration of 32.8 μg/m3 were included. The proportions of the Han, the Tibetan, the Yi, and other ethnic people were 89.2%, 7.3%, 3.2%, and 0.3%, respectively. The adjusted odds ratio (OR) was 1.08 (95% CI, 1.04-1.12) for a 10 μg/m3 PM2.5 concentration increment. The adjusted ORs for the Han, the Tibetan, and the Yi were 1.08 (95% CI, 1.04-1.12), 0.03 (95% CI, 0.00-0.27), and 1.75 (95% CI, 1.28-2.38) for a 10 μg/m3 PM2.5 concentration increment, respectively. Stratification analysis found stronger associations in participants with chronic diseases and Yi minority population. The results showed that long-term exposure to PM2.5 may increase the risk of hypertension prevalence in Chinese multi-ethnic adults. The associations were different among ethnicities.
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Affiliation(s)
- Jiayue Xu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuqin Zhang
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Minghong Yao
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Gonghua Wu
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Zhanqi Duan
- Big Data Center of Sichuan Province, Chengdu, 610041, Sichuan, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Juying Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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