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Kohler RE, Wagner RB, Careaga K, Btoush R, Greene K, Kantor L. Mothers' perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds. Hum Vaccin Immunother 2023; 19:2270842. [PMID: 37955127 PMCID: PMC10653617 DOI: 10.1080/21645515.2023.2270842] [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: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers' hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.
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Affiliation(s)
- Racquel E. Kohler
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Rachel B. Wagner
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Katherine Careaga
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Rula Btoush
- School of Nursing, Rutgers University, New Brunswick, NJ, USA
| | - Kathryn Greene
- School of Communication & Information, Rutgers University, New Brunswick, NJ, USA
| | - Leslie Kantor
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
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Landon B, Thomas ED, Orlando L, Evans R, Murray T, Mohammed L, Noel J, Isaac R, Waechter R. Spare the rod, spoil the child: measurement and learning from an intervention to shift corporal punishment attitudes and behaviors in Grenada, West Indies. Front Public Health 2023; 11:1127687. [PMID: 37744480 PMCID: PMC10512176 DOI: 10.3389/fpubh.2023.1127687] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
Childrearing practices in the Caribbean and other postcolonial states have long been associated with corporal punishment and are influenced by expectations of children for respectfulness and obedience. Evidence across settings shows that physical punishment of young children is both ineffective and detrimental. Saving Brains Grenada (SBG) implemented a pilot study of an intervention based on the Conscious Discipline curriculum that aimed to build adult caregivers' skills around non-violent child discipline. We hypothesized that attitudes towards corporal punishment would shift to be negative as adults learned more positive discipline methods, and that child neurodevelopment would correspondingly improve. This report reviews the impact of monitoring and evaluation on the design and implementation of the intervention. Study 1 presents findings from the pilot study. Despite positive gains in neurodevelopmental outcomes among children in the intervention compared to controls, attitudes towards corporal punishment and reported use of it did not change. Additionally, several internal conflicts in the measures used to assess corporal punishment behaviors and attitudes were identified. Study 2 is a response to learning from Study 1 and highlights the importance for monitoring and evaluation to be data-informed, adaptive, and culturally appropriate. In Study 2, the SBG research team conducted cognitive interviews and group discussions with stakeholders to assess the content and comprehensibility of the Attitudes Towards Corporal Punishment Scale (ACP). This yielded insights into the measurement of attitudes towards corporal punishment and related parenting behavior, and prompted several revisions to the ACP. To accurately evaluate the intervention's theory of change and its goal to reduce violence against children, reliable and appropriate measures of attitudes towards corporal punishment and punishment behaviors are needed. Together, these two studies emphasize the value of continuous monitoring, evaluation, and learning in the implementation, adaptation, evaluation, and scaling of SBG and similar early childhood development interventions.
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Affiliation(s)
- Barbara Landon
- Windward Islands Research and Education Foundation, St. George’s, Grenada
- Psychological Services Center, St. George's University, St. George’s, Grenada
| | | | - Lauren Orlando
- Department of Public Health, St. George's University, St. George’s, Grenada
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Toni Murray
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Lauren Mohammed
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Jesma Noel
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Rashida Isaac
- Windward Islands Research and Education Foundation, St. George’s, Grenada
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St. George’s, Grenada
- Department of Neuroscience, School of Medicine, St. George's University, St. George’s, Grenada
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Zheng M, Zhong W, Chen X, Wang N, Liu Y, Zhang Q, Cheng Y, Li W, Yu Q, Zhao X, Yuan L, Shen Z, Hao Y, Du Y, Zou K, Zhu C, Long L, Li J. Factors influencing parents' willingness to vaccinate their preschool children against COVID-19: Results from the mixed-method study in China. Hum Vaccin Immunother 2022; 18:2090776. [PMID: 35763311 DOI: 10.1080/21645515.2022.2090776] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
During the COVID-19 pandemic, little is known about parental hesitancy to receive the COVID-19 vaccine for preschool children who are the potential vaccinated population in the future. The purpose of this mixed-method study was to explore the factors influencing Chinese parents' decision to vaccinate their children aged 3-6 years old against COVID-19. In July 2021, we conducted semi-structured interviews (n = 19) and a cross-sectional survey (n = 2605) with parents of kindergarten children in an urban-rural combination pilot area in China. According to the qualitative study, most parents were hesitant to vaccinate their children with the COVID-19 vaccine. In the quantitative study, we found that three-fifths of 2605 participants were unwilling to vaccinate their children against COVID-19. Furthermore, the main predictors of parents' intention to vaccinate their children were fathers, lower level of education, and positive attitudes toward vaccination. Based on our findings, targeted health education techniques may be able to boost childhood COVID-19 immunization rates.
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Affiliation(s)
- Mengmou Zheng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wanzhen Zhong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiyue Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Nan Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yadan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qian Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yaoyilian Cheng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wen Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qiong Yu
- Health Center of Hongguang Street Pidu District Chengdu, Chengdu, China
| | - Xunying Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lu Yuan
- Health Center of Hongguang Street Pidu District Chengdu, Chengdu, China
| | - Ziqiong Shen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yu Hao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yu Du
- Health Center of Hongguang Street Pidu District Chengdu, Chengdu, China
| | - Kun Zou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chenyan Zhu
- Health Center of Hongguang Street Pidu District Chengdu, Chengdu, China
| | - Lu Long
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Choi YY, Jensen ML, Fleming-Milici F, Harris JL. Caregivers' provision of sweetened fruit-flavoured drinks to young children: importance of perceived product attributes and differences by socio-demographic and behavioural characteristics. Public Health Nutr 2022; 25:1-9. [PMID: 35440350 PMCID: PMC9991680 DOI: 10.1017/s1368980022000751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Drinks containing added sugar and/or non-nutritive sweeteners are not recommended for children under 6 years. Yet, most young children consume these products. The current study examined factors associated with caregivers' provision of sweetened drinks to their young child. DESIGN Caregivers reported frequency of providing sweetened fruit-flavoured drinks (fruit drinks and flavoured water) and unsweetened juices (100 % juice and juice/water blends) to their 1- to 5-year-old child in the past month and perceived importance of product attributes (healthfulness, product claims and other characteristics), other drinks provided, reading the nutrition facts panel and socio-demographic characteristics. A partial proportional odds model measured the relationship between these factors and frequency of providing sweetened fruit-flavoured drinks. SETTING Online cross-sectional survey. PARTICIPANTS U.S. caregivers (n 1763) with a young child (ages 1-5). RESULTS The majority (74 %) of caregivers provided sweetened fruit-flavoured drinks to their child in the past month; 26 % provided them daily. Provision frequency was positively associated with some drink attributes, including perceived healthfulness, vitamin C claims and box/pouch packaging; child requests and serving other sweetened drinks and juice/water blends. Provision frequency was negatively associated with perceived importance of 'no/less sugar' and 'all natural' claims. Reading nutrition facts panels, serving water to their child and child's age were not significant. CONCLUSION Misunderstanding of product healthfulness and other marketing attributes contribute to frequent provision of sweetened drinks to young children. Public health efforts to address common misperceptions, including counter marketing, may raise awareness among caregivers about the harms of providing sweetened drinks to young children.
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Affiliation(s)
- Yoon Y Choi
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
- Korea Rural Economic Institute, Naju-Si, Jeollanam-do58321, Republic of Korea
| | - Melissa L Jensen
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
| | - Frances Fleming-Milici
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT06103, USA
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Beck A, Bianchi A, Showalter D. Evidence-Based Practice Model to Increase Human Papillomavirus Vaccine Uptake: A Stepwise Approach. Nurs Womens Health 2021; 25:430-436. [PMID: 34634248 DOI: 10.1016/j.nwh.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/24/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To increase uptake of human papillomavirus (HPV) vaccination by implementing a stepwise evidence-based practice model to offer HPV education along with a strong provider recommendation to parents of youth and adolescents. DESIGN Evidence-based practice change model. SETTING A nurse practitioner-run, primary care walk-in clinic in a rural area of the southeastern United States. PARTICIPANTS Parents of youth and adolescents ages 11 to 17 years. INTERVENTIONS/MEASUREMENTS Education targeting parental hesitancy and strong recommendations for immunization was administered by health care providers to parents of youth and adolescents eligible for vaccination. The Parent Attitudes About Childhood Vaccine instrument was used to identify the presence and degree of parental hesitancy. Vaccination uptake was measured and compared to the same time period from the previous year. RESULTS Data collected from the clinic vaccination log during the same 6-week time period in 2018 identified that four youth/adolescents were vaccinated with the HPV vaccine in 2018. During the same 6-week period in 2019 when the practice change was implemented, 38 parents were approached; 24 met eligibility criteria, and all 24 of their youth/adolescents received HPV vaccination. CONCLUSION Implementation of an evidence-based practice model that includes standing vaccine orders and reminders and recalls may provide an effective way to ensure completion of the HPV vaccine series. Every missed clinical opportunity to vaccinate youth and adolescents against HPV can contribute to lower vaccination rates and increased risk for genital warts and cancers associated with HPV infection.
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Nekrasova E, Stockwell MS, Localio R, Shults J, Wynn C, Shone LP, Berrigan L, Kolff C, Griffith M, Johnson A, Torres A, Opel DJ, Fiks AG. Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study. Hum Vaccin Immunother 2020; 16:1070-1077. [PMID: 32017643 DOI: 10.1080/21645515.2019.1707006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017-2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy - the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) - and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.
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Affiliation(s)
- Ekaterina Nekrasova
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa S Stockwell
- Department of Pediatrics, Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Russell Localio
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Justine Shults
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Chelsea Wynn
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Laura P Shone
- Department of Research, American Academy of Pediatrics, Itasca, IL, USA
| | - Lindsay Berrigan
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chelsea Kolff
- Department of Pediatrics, Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Miranda Griffith
- Department of Research, American Academy of Pediatrics, Itasca, IL, USA
| | - Andrew Johnson
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alessandra Torres
- Department of Research, American Academy of Pediatrics, Itasca, IL, USA
| | - Douglas J Opel
- University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Alexander G Fiks
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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O'Neill A, Swigger K, Kuhlmeier V. 'Make the Connection' parenting skills programme: a controlled trial of associated improvement in maternal attitudes. J Reprod Infant Psychol 2018; 36:536-547. [PMID: 30092657 DOI: 10.1080/02646838.2018.1497779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Assess the effectiveness of Make the Connection (MTC), an attachment-focused parenting programme, in fostering maternal attitudes thought to underlie sensitive responding. BACKGROUND Effective parenting programmes are likely to mitigate negative outcomes associated with insecure attachment in infancy. Negative maternal attitudes and cognitions are thought to underlie insensitive parenting behaviour, and thus constitute a promising target for intervention. METHODS 180 mothers of young infants were assigned to experimental or waitlist control groups based on programme availability. Mothers completed questionnaires assessing parental attitudes at baseline, and again either after participating in MTC or after a 9-week waitlist period. RESULTS Participants who completed MTC showed significant improvement in overall attitude with a medium effect size relative to the waitlist control group, which showed no change. A small but significant interaction with infant age was noted, such that mothers of younger infants showed slightly more attitude improvement. Relative to the control group, participation in Make the Connection was associated with significant improvement in all attitudes except for self-efficacy as a parent, which improved with time regardless of programme participation. CONCLUSION Make the Connection is effective in promoting positive parent-to-infant attachment and is a strong candidate for public health initiatives targeting parenting skills.
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Affiliation(s)
- Amy O'Neill
- a Department of Psychology , Queen's University , Kingston , Canada
| | - Kimberly Swigger
- a Department of Psychology , Queen's University , Kingston , Canada
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Homel J, Edwards B. Factors associated with delayed infant immunization in a nationally representative cohort study. Child Care Health Dev 2018; 44:583-591. [PMID: 29460321 DOI: 10.1111/cch.12560] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio-demographic factors for delayed immunization would inform policy responses. METHODS Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face-to-face interviews in 2003-2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non-immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors. RESULTS Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]). CONCLUSIONS Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy-makers should consider how to make timely immunization easier for busy parents.
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Affiliation(s)
- J Homel
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - B Edwards
- ANU Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia
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