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Omaña-Guzmán I, Ortiz-Hernández L, Ancira-Moreno M, Godines-Enriquez M, O'Neill M, Vadillo-Ortega F. Association between maternal cardiometabolic markers and fetal growth in non-complicated pregnancies: a secondary analysis of the PRINCESA cohort. Sci Rep 2024; 14:9096. [PMID: 38643289 PMCID: PMC11032337 DOI: 10.1038/s41598-024-59940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
The objective of this study was to evaluate the association of maternal cardiometabolic markers trajectories (glucose, triglycerides (TG), total cholesterol, systolic blood pressure (SBP) and diastolic blood pressure (DBP)) with estimated fetal weight trajectories and birth weight in Mexican pregnant women without medical complications. Cardiometabolic marker trajectories were characterized using group-based trajectory models. Mixed-effect and linear regression models were estimated to assess the association of maternal trajectories with estimated fetal weight and birth weight. The final sample comprised 606 mother-child dyads. Two trajectory groups of maternal cardiometabolic risk indicators during pregnancy were identified (high and low). Fetuses from women with higher values of TG had higher weight gain during pregnancy ( β ^ = 24.00 g; 95%CI: 12.9, 35.3), were heavier at the sixth month ( β ^ =48.24 g; 95%CI: 7.2, 89.7) and had higher birth weight ( β ^ = 89.08 g; 95%CI: 20.8, 157.4) than fetuses in the low values trajectory. Fetuses from mothers with high SBP and DBP had less weight in the sixth month of pregnancy ( β ^ = - 42.4 g; 95%CI: - 82.7, - 2.1 and β ^ = - 50.35 g; 95%CI: - 94.2, - 6.4), and a higher DBP trajectory was associated with lower birth weight ( β ^ = - 101.48 g; 95%CI: - 176.5, - 26.4). In conclusion, a longitudinal exposition to high values of TG and BP was associated with potentially adverse effects on fetal growth. These findings support the potential modulation of children's phenotype by maternal cardiometabolic conditions in pregnancies without medical complications.
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Affiliation(s)
- Isabel Omaña-Guzmán
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
- Unidad de Vinculación Científica de la Facultad de Medicina, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Periférico Sur 4809, Arenal Tepepan, 14610, Mexico City, CDMX, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Luis Ortiz-Hernández
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | | | - Marie O'Neill
- Epidemiology and Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Felipe Vadillo-Ortega
- Unidad de Vinculación Científica de la Facultad de Medicina, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Periférico Sur 4809, Arenal Tepepan, 14610, Mexico City, CDMX, Mexico.
- Epidemiology and Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Ruiz OA, Ancira-Moreno M, Omaña-Guzmán I, Cordero SH, Morales ACB, Navarro CP, Méndez SB, Flores EM, Trejo A, Kaufer-Horwitz M, Cajero A, Sánchez B, Bernat C, Salgado-Amador E, Hoyos-Loya E, Mazariegos M, Manrique CM, Cruz RP, Mendoza E, Brero M, Sachse M, Armijo FC. Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders. Int J Equity Health 2024; 23:35. [PMID: 38388936 PMCID: PMC10885649 DOI: 10.1186/s12939-024-02129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. METHODS We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. RESULTS Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. CONCLUSIONS These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.
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Grants
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
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Affiliation(s)
- Omar Acosta Ruiz
- Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Monica Ancira-Moreno
- Health Department, Universidad Iberoamericana, Mexico City, Mexico.
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico.
| | - Isabel Omaña-Guzmán
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México, "Dr. Eduardo Liceaga,", Mexico City, Mexico
| | - Sonia Hernández Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | | | | | - Soraya Burrola Méndez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Eric Monterrubio Flores
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Trejo
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Martha Kaufer-Horwitz
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ariana Cajero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Belén Sánchez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Constanza Bernat
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Elder Salgado-Amador
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Cinthya Muñoz Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Royer Pacheco Cruz
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Instituto de Nutrición, Universidad de la Sierra Sur, Oaxaca, México
| | - Elvia Mendoza
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Matthias Sachse
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Fernanda Cobo Armijo
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
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Ancira-Moreno M, Omaña-Guzmán I, Bautista-Morales AC, Acosta-Ruiz O, Hernández Cordero S, Burrola-Méndez S, Vilar-Compte M, Monterrubio Flores E, Kaufer-Horwitz M, Pérez Navarro C, Muñoz-Manrique C, Mazariegos M, Trejo-Domínguez A, Sánchez Muzquiz B, Cajero A, Brero M, Sachse M, Cobo Armijo F. Development and validation of a new set of indicators to assess the quality of maternal and child nutritional care at the primary care. Front Med (Lausanne) 2022; 9:1011940. [PMID: 36569141 PMCID: PMC9769120 DOI: 10.3389/fmed.2022.1011940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC. Methods We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted. Results Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.
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Affiliation(s)
| | | | | | - Omar Acosta-Ruiz
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Sonia Hernández Cordero
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | | | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Eric Monterrubio Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Cinthya Muñoz-Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Ariana Cajero
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Matthias Sachse
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Fernanda Cobo Armijo
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
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Avendaño-Alvarez F, Monterrubio-Flores E, Omaña-Guzmán I, Teros ML, Cordero SH, Muciño-Sandoval K, Cantoral A, Ancira-Moreno M. Incidence of macrosomia in Mexico: National and subnational estimations. PLoS One 2022; 17:e0276518. [PMID: 36459523 PMCID: PMC9718394 DOI: 10.1371/journal.pone.0276518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022] Open
Abstract
Fetal macrosomia (FM) is a condition with adverse consequences for both mother and offspring. The occurrence of this condition has increased worldwide. The objectives of this study were: (1) to estimate the incidence of FM at the national and state levels in Mexico in 2020; (2) to estimate the incidence of FM stratified by maternal and newborn characteristics; (3) to identify the states with the highest risk of FM; (4) to georeference the incidence of FM. Open data from the Birth Information Subsystem were used. Relative risks were estimated by adjusted Poisson regression models. The national incidence of FM was 2.75%. The entity with the lowest incidence was Mexico City (1.28%) and the most affected states were Sonora (6.20%), Baja California Sur (5.44%), and Sinaloa (5.36%), located in the north of the country. The incidence of FM at the national level is below that reported in the international literature. The results of this study can be used for the design and implementation of programs, public policies, and interventions.
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Affiliation(s)
- Fermín Avendaño-Alvarez
- Maestría en Nutriología Aplicada, Universidad Iberoamericana, Ciudad de México, México
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
| | - Eric Monterrubio-Flores
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Isabel Omaña-Guzmán
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
| | - Miriam López Teros
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
| | - Sonia Hernández Cordero
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Instituto de Investigaciones para el Desarrollo con Equidad, EQUIDE, Universidad Iberoamericana, Ciudad de México, México
| | | | - Alejandra Cantoral
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
| | - Monica Ancira-Moreno
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Ciudad de México, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, México
- * E-mail:
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5
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Ancira-Moreno M, Vadillo-Ortega F, Rivera-Dommarco JÁ, Sánchez BN, Pasteris J, Batis C, Castillo-Castrejón M, O'Neill MS. Gestational weight gain trajectories over pregnancy and their association with maternal diet quality: Results from the PRINCESA cohort. Nutrition 2019; 65:158-166. [PMID: 31132630 PMCID: PMC7276248 DOI: 10.1016/j.nut.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/08/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aims of this study were to characterize, among pregnant Mexican women, gestational weight gain (GWG) trajectories; assess associations of maternal dietary quality score (MDQS) with GWG during early-mid pregnancy, middle pregnancy, late pregnancy, and prolonged pregnancy; and evaluate the association between MDQS and adequacy of GWG, throughout pregnancy. We hypothesized that higher MDQS adherence is protective against insufficient or excessive GWG across pregnancy and that the association between MDQS adherence and GWG would vary by prepregnancy body mass index (BMI) category. METHODS We analyzed data from 660 pregnant women participating in the PRINCESA (Pregnancy Research on Inflammation, Nutrition and City Environments: Systematic Analyses) cohort in Mexico City, 2009 to 2014. Repeated measures of dietary intake and mother's weight were obtained during pregnancy. Individual GWG trajectories were modeled in a multilevel regression framework. Associations between MDQS (low, medium, and high adherence) and GWG were investigated using mixed-effect regression models with linear splines. RESULTS Women with prepregnancy BMI of ≥30 kg/m2 had a slower rate of GWG (RGWG) compared with other categories. A higher adherence to MDQS was protective against an insufficient (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.95; P = 0.03) and an excessive RGWG (OR, 0.62; 95% CI, 0.41-0.94; P = 0.03) throughout pregnancy, adjusting for prepregnancy BMI, energy intake, maternal age, educational level, parity, fetal sex, marital status, and physical activity. Associations between diet and RGWG differed by gestational period. CONCLUSION A better quality diet, as measured by MDQS, was associated with appropriate GWG during pregnancy in the PRINCESA cohort.
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Affiliation(s)
- Monica Ancira-Moreno
- Health Department, Universidad Iberoamericana, Mexico City, Mexico; UNAM, School of Medicine Branch at Instituto Nacional de Medicina Genómica, México City, México; National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Felipe Vadillo-Ortega
- UNAM, School of Medicine Branch at Instituto Nacional de Medicina Genómica, México City, México
| | | | - Brisa N Sánchez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremy Pasteris
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolina Batis
- CONACYT - Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Marie S O'Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
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Palacios-González B, Vadillo-Ortega F, Polo-Oteyza E, Sánchez T, Ancira-Moreno M, Romero-Hidalgo S, Meráz N, Antuna-Puente B. Irisin levels before and after physical activity among school-age children with different BMI: a direct relation with leptin. Obesity (Silver Spring) 2015; 23:729-32. [PMID: 25820255 DOI: 10.1002/oby.21029] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Irisin is a novel myokine that seems to mediate the beneficial effects of exercise. Levels of circulating irisin before and after an 8-month physical activity program (PAP) in school-age children were evaluated. METHODS Irisin and leptin were measured at baseline and at follow-up among 85 children with different BMI. RESULTS Of the 85 children (mean age 8.9; 47% female), 25 children had normal weight, 23 were overweight, and 37 had obesity. We observed no significant difference in irisin serum levels between boys and girls. Irisin was positively associated with BMI before and after the PAP (r(before) = 0.42; r(after) = 0.37, P < 0.001), with the highest levels in children with obesity. There was a slight decrease of circulating irisin after PAP, but this decrease was not of statistical significance. We observed a high and positive association between irisin and leptin levels before and after the PAP (r(before) = 0.78; r(after) = 0.82, P < 0.001). Moreover, changes in leptin correlated with changes in irisin (r = 0.72, P < 0.001). CONCLUSIONS Circulating irisin is positively linked to BMI and leptin in school-age children, supporting the notion that that irisin is produced by adipose tissue. As in previous reports, this study failed to observe changes in irisin levels after exercise, likely because higher irisin levels are produced only during exercise.
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Affiliation(s)
- Berenice Palacios-González
- Unidad de Vinculación de la Facultad de Medicina, U.N.A.M. en el Instituto Nacional de Medicina Genómica, Mexico
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