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Inequalities in Mortality and Access to Hospital Care for Cervical Cancer-An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010966. [PMID: 34682711 PMCID: PMC8535933 DOI: 10.3390/ijerph182010966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
Cervical cancer is the second most common form of cancer in the world among women, and it is estimated to be the third most frequent cancer in Brazil, as well as the fourth leading cause of death from cancer. There is a difference in cervical cancer mortality rates among different administrative regions in Brazil along with an inadequate distribution of cancer centers in certain Brazilian regions. Herein, we analyze the trends in hospital admission and mortality rates for CC between 2000 and 2012. This population-based ecological study evaluated the temporal trend in cervical cancer between the years 2000 and 2012, stratifying by Brazilian administrative regions. The North and Northeast regions had no reduction in mortality in all age groups studied (25 to 64 years); when analyzing hospitalization rates, only the age group of 50 to 64 years from the North Region did not present a reduction. During the years studied, in the South Region, the age group ranging from 50 to 54 years had the greatest reduction in mortality rates (β = −0.59, p = 0.001, r2 = 0.63), and the group ranging from 45 to 49 years had the greatest reduction in hospital admission rates (β = −8.87, p = 0.025, r2 = 0.37). Between the years 2000 and 2012, the greatest reduction in the incidence of UCC was in the South Region (β = −1.43, p = 0.236, r2 = 0.12) followed by the Central-West (β = −1, p < 0.001, r2 = 0.84), the Southeast (β = −0.95, p < 0.001, r2 = 0.88), the Northeast (β = −0.67, p = 0.080, r2 = 0.25), and, finally, by the North (β = −0.42, p = 0.157, r2 = 0.17). There was a greater reduction in mortality rates and global hospitalization rates for CC in Brazil than in the United States during the same period with exceptions only in Brazil’s North and Northeast regions.
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Nunes MRA, Sousa LVDA, Nascimento VBD. Infant mortality in the Metropolitan Region of São Paulo: an ecological study. EINSTEIN-SAO PAULO 2021; 19:eAO5663. [PMID: 34406314 PMCID: PMC8328149 DOI: 10.31744/einstein_journal/2021ao5663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the impact of risk factors on infant mortality in the Metropolitan Region of São Paulo according to maternal and neonate characteristics, as well as mode of delivery. Methods An ecological, quantitative study based on secondary data retrieved from infant mortality and live birth data systems. Data from 39 municipalities located in the Metropolitan Region of São Paulo were analyzed. Newborn and maternal variables were extracted from the Information Technology Department of the Unified Health System. Absolute and relative frequencies were presented, as well as linear regression and Pearson´s correlation coefficient. Results The following maternal profile prevailed from 2006 to 2016: 8 to 11 years of education (β=73.58; p=0.023), age between 30 and 34 years (β=19.04; p=0.015) and delivery by cesarean section (β=39.59; p=0.009) after full-term pregnancy (β=-14.20; p=0.324). Mortality rates decreased in neonates compared to other age groups (β=-25.30; p<0.001). Infant mortality rates tended to be higher among women experiencing pre-term (r=0.86; p<0.001) or post-term (r=0.95; p<0.001) gestation. Conclusion Maternal age and level of education increased among women giving birth in the Metropolitan Region of São Paulo from 2006 to 2016. These were relevant factors for infant mortality rate reduction.
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de Souza BC, Dos Santos Figueiredo FW, de Alcantara Sousa LV, da Silva Maciel E, Adami F. Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014. BMC Womens Health 2020; 20:137. [PMID: 32605615 PMCID: PMC7325567 DOI: 10.1186/s12905-020-00995-7] [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: 10/17/2019] [Accepted: 06/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil. Method Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0. Results In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods. Conclusion Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.
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Affiliation(s)
- Beatriz Castro de Souza
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil.
| | | | - Luiz Vinicius de Alcantara Sousa
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil
| | - Erika da Silva Maciel
- Universidade Federal do Tocantins, Campus Miracema. Avenida Lourdes Solino s/n°, Setor Universitário, Miracema, Tocantins, Brazil
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil
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Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years. Sci Rep 2019; 9:2962. [PMID: 30814591 PMCID: PMC6393459 DOI: 10.1038/s41598-019-39566-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/22/2019] [Indexed: 11/16/2022] Open
Abstract
This study aimed to analyse the time trends of stroke mortality between 1997 and 2012 according to sex in Brazilians aged 15 to 49 years. This ecological study used data obtained from the Mortality Information System, which is available from the National Health System Department of Informatics - DATASUS and maintained by the Brazilian Ministry of Health. Stroke definition included International Classification of Disease version 10 (ICD-10) codes I60, I61, I63, and I64. Crude and age-standardized mortality rates and respective 95% confidence intervals were estimated per 100,000 inhabitants and stratified by age, region, year, and sex. Linear regression models were used to analyse the time trends with a confidence level of 95%. The statistical program used was Stata 11.0. Between 1997 and 2012, there were 124,866 deaths due to stroke in Brazilians aged 15 to 49 years. There was a decreasing linear trend in stroke mortality among men (β = −0.46, p < 0.001, R2 = 0.95) and women (β = −0.40, p < 0.001, R2 = 0.98) during this period. Overall there was no significant difference in stroke mortality trends by sex, except with respect to the age group of 40 to 49 years where there was a difference in the decrease of stroke mortality between men and women (interaction sex * year: β = 0.238, p = 0.012, R² = 0.96). Mortality rates decrease significantly over time in men and women in the age group 15 to 49 years old, but there is only significant difference in the decrease of rates by sex only in the age group from 40 to 49 years old.
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Hou X, Chen W, Xu H, Zhu Z, Xu Y, Chen H. The rate of early neurological deterioration occurring after thrombolytic therapy: A meta-analysis. Brain Behav 2019; 9:e01210. [PMID: 30632308 PMCID: PMC6379592 DOI: 10.1002/brb3.1210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/06/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The rate of early neurological deterioration (END) occurring after thrombolytic therapy is controversial. To explore a more precise estimation of the rate, a meta-analysis was conducted in the present study. METHODS The relevant studies were identified by searching PubMed, EMBASE, and Cochrane Collaboration Database up to June 2018. The definition of END was prespecified according to the most commonly used definition: ≥4-point increase in National Institutes of Health Stroke Scale between admission and 24 hr. The meta-analysis was performed by using the STATA 12. RESULTS Eleven studies with a total of 3,539 subjects, including 373 patients with END and 3,166 patients without END, were collected. The pooled analysis showed that the rate of END occurring after thrombolytic therapy was about 11.0% (95% CI: 7.8%-14.3%). Subgroup analysis by continent showed that the rate of END occurring after thrombolytic therapy of patients in Asia (15.9%, 95% CI: 7.4%-24.5%) was higher than in Europe (7.6%, 95% CI: 4.9%-10.3%) and in North America (11.8%, 95% CI: 8.5%-15.0%). Subgroup analysis by onset to treatment time (OTT) displayed that the rate of END occurring after thrombolytic therapy was 5.4% (95% CI: 1.2%-9.5%), 15.6% (95% CI: 9.6%-21.5%), and 18.5% (95% CI: 11.2%-25.8%) for the patients whose OTT ≤120.0 min, from 120.1 to 179.9 min, from 180.0 to 270.0 min, respectively. CONCLUSION The rate of END occurring after thrombolytic therapy is about 11.0%. This finding may provide a scientific reference for researchers to evaluate the efficacy and safety of thrombolytic therapy.
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Affiliation(s)
- Xiaowen Hou
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China.,Group of Chronic Disease and Environmental Genomics, China Medical University, Shenyang, China
| | - Wanli Chen
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China
| | - Haibin Xu
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China
| | - Zhi Zhu
- School of Materials Science and Engineering, Shenyang Aerospace University, Shenyang, China
| | - Yuanyuan Xu
- Group of Chronic Disease and Environmental Genomics, China Medical University, Shenyang, China
| | - Huisheng Chen
- The Department of Neurology, General Hospital of Shen-Yang Military Region, Shenyang, China
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Hu Y, Guo TC, Zhang XY, Tian J, Lu YS. Paired associative stimulation improves synaptic plasticity and functional outcomes after cerebral ischemia. Neural Regen Res 2019; 14:1968-1976. [PMID: 31290455 PMCID: PMC6676880 DOI: 10.4103/1673-5374.259618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Paired associative stimulation is a relatively new non-invasive brain stimulation technique that combines transcranial magnetic stimulation and peripheral nerve stimulation. The effects of paired associative stimulation on the excitability of the cerebral cortex can vary according to the time interval between the transcranial magnetic stimulation and peripheral nerve stimulation. We established a model of cerebral ischemia in rats via transient middle cerebral artery occlusion. We administered paired associative stimulation with a frequency of 0.05 Hz 90 times over 4 weeks. We then evaluated spatial learning and memory using the Morris water maze. Changes in the cerebral ultra-structure and synaptic plasticity were assessed via transmission electron microscopy and a 64-channel multi-electrode array. We measured mRNA and protein expression levels of brain-derived neurotrophic factor and N-methyl-D-aspartate receptor 1 in the hippocampus using a real-time polymerase chain reaction and western blot assay. Paired associative stimulation treatment significantly improved learning and memory in rats subjected to cerebral ischemia. The ultra-structures of synapses in the CA1 area of the hippocampus in rats subjected to cerebral ischemia were restored by paired associative stimulation. Long-term potentiation at synapses in the CA3 and CA1 regions of the hippocampus was enhanced as well. The protein and mRNA expression of brain-derived neurotrophic factor and N-methyl-D-aspartate receptor 1 increased after paired associative stimulation treatment. These data indicate that paired associative stimulation can protect cognition after cerebral ischemia. The observed effect may be mediated by increases in the mRNA and protein expression of brain-derived neurotrophic factor and N-methyl-D-aspartate receptor 1, and by enhanced synaptic plasticity in the CA1 area of the hippocampus. The animal experiments were approved by the Animal Ethics Committee of Tongji Medical College, Huazhong University of Science & Technology, China (approval No. TJ-A20151102) on July 11, 2015.
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Affiliation(s)
- Yan Hu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology; Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Tie-Cheng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Xiang-Yu Zhang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province; Department of Rehabilitation Medicine, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jun Tian
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yin-Shan Lu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei Province, China
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de Santana NM, Dos Santos Figueiredo FW, de Melo Lucena DM, Soares FM, Adami F, de Carvalho Pádua Cardoso L, Correa JA. The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings. BMC Res Notes 2018; 11:735. [PMID: 30326942 PMCID: PMC6192154 DOI: 10.1186/s13104-018-3842-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database. Results The highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9–60.5%) followed by that in men (52.9%; 95% CI 52.6–53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5–62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.
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Affiliation(s)
| | | | | | - Fernando Mayo Soares
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | | | - João Antonio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Kollia N, Tragaki A, Syngelakis AI, Panagiotakos D. Trends of Cardiovascular Disease Mortality in Relation to Population Aging in Greece (1956 - 2015). Open Cardiovasc Med J 2018; 12:71-79. [PMID: 30159093 PMCID: PMC6080059 DOI: 10.2174/1874192401812010071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/31/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Demographic dynamics and decreasing trends in mortality from chronic diseases are major contributors to the phenomenon of population aging. The purpose of the present study was to examine the association between cardiovascular disease (CVD) mortality and demographic indicators, in Greece the past 60 years. METHODS Life Expectancy at birth (LE), population age structure, fertility rates (TFR) and all-cause, CVD mortality rates were retrieved (data provided by the Hellenic Statistical Authority, 1956-2015). In order to test the research hypothesis time-series analysis was conducted. RESULTS Increasing trends in LE and in the older age (>65 or >80 years) groups' share and declining trends in TFR were recorded. CVD mortality, after an upward course, showed decreasing trends during 1988-2009, accounting for the 96% and 97% increment in LE in men and women respectively. However, newer records (2010-2015) show a new upward trend. The declining trends in TFR were highly associated with the shifts towards the upper part of the population age pyramid. CONCLUSION Population aging is a historically unprecedented event that cannot be avoided, deterred or alleviated. Its negative effects act cumulatively with the recent increases in cardiovascular mortality, especially in the light of the ongoing economic crisis which is expected to further exacerbate the existing contrasts. A possible way to successfully cope with the new demographic realities is to unlock an, up till now largely overlooked, opportunity named "healthy aging".
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Affiliation(s)
- Natasa Kollia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Alexandra Tragaki
- Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
| | | | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Bruce, Australia
- School of Allied Health, College of Science, Health and Engineering, LA TROBE University, Melbourne, Australia
- Department of Kinesiology & Health RUTGERS, School of Arts & Life Sciences, The State University of New Jersey, New Brunswick, NJ, USA
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da Silva Paiva L, Schoueri JHM, de Alcantara Sousa LV, Raimundo RD, da Silva Maciel E, Correa JA, Adami F. Regional differences in the temporal evolution of stroke: a population-based study of Brazil according to sex in individuals aged 15-49 years between 1997 and 2012. BMC Res Notes 2018; 11:326. [PMID: 29784031 PMCID: PMC5963170 DOI: 10.1186/s13104-018-3439-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Abstract
Objective The present study analyzed the temporal trend of stroke mortality according to sex in individuals aged 15–49 years in the different regions of Brazil between 1997 and 2012. Results There was progressive reduction in mortality rate due to stroke in Brazil. The reduction trend was the same for both sexes, although mortality remained slightly higher among men. There was a difference in mortality rates according to the administrative region of the country. Electronic supplementary material The online version of this article (10.1186/s13104-018-3439-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laércio da Silva Paiva
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil.
| | - Jean Henri Maselli Schoueri
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Luiz Vinicius de Alcantara Sousa
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Rodrigo Daminello Raimundo
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Erika da Silva Maciel
- Universidade Federal do Tocantis, Avenida Lourdes Solino s/n°-Setor Universitário, Miracema, TO, Brazil
| | - João Antonio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Fernando Adami
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
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