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Oli, N., Vaidya, A., Eiben, G. & Krettek, A. (2019). Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial. Global Health Action, 12, 1-12, Article ID 1670033.
Open this publication in new window or tab >>Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial
2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, p. 1-12, article id 1670033Article in journal (Refereed) Published
Abstract [en]

Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers' knowledge, attitude and practice (KAP) and their children's behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1-9-year-old children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal, during August-November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers' KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had 'good' KAP (>75% of maximum possible scores), and mothers with 'good' knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers' attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children's diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers' KAP scores and children's behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal's Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Diet, health promotion, mothers, physical activity, young children
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17750 (URN)10.1080/16549716.2019.1670033 (DOI)31573416 (PubMedID)2-s2.0-85072763901 (Scopus ID)
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-10-10
Kovalenko, A. A., Brenn, T., Odland, J. Ø., Nieboer, E., Krettek, A. & Anda, E. E. (2019). Risk Factors for hypospadias in Northwest Russia: A Murmansk County Birth Registry Study. PLoS ONE, 14(4), Article ID e0214213.
Open this publication in new window or tab >>Risk Factors for hypospadias in Northwest Russia: A Murmansk County Birth Registry Study
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214213Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hypospadias is the most common congenital anomaly of the penis, but its causes are mainly unknown. Of the risk factors identified, the most plausible are hormonal and genetic. The aim of this study was to identify risk factors for hypospadias in Northwest Russia based on registry data.

METHODS: The study population included male infants registered in the Murmansk County Birth Registry between 1 January 2006 and 31 December 2011 (n = 25 475). These infants were followed-up for 2 years using the Murmansk Regional Congenital Defects Registry to identify cases of hypospadias not diagnosed at birth. We used logistic regression analysis to examine the contributions of hypospadias risk factors.

RESULTS: Out of 25 475 male infants born during the study period, 148 had isolated hypospadias. The overall prevalence rate was 54.2 (95% CI 53.6-54.8) per 10 000 male infants. Those born to mothers with preeclampsia (OR = 1.65; 95% CI 1.03-2.66) or infant birthweight < 2500 g (OR = 2.06; 95% CI 1.18-3.60) exhibited increased risk for hypospadias. Maternal age, smoking during pregnancy, folic acid intake during pregnancy or hepatitis B surface antigen positivity did not associate with increased risk of hypospadias.

CONCLUSIONS: Combining data from a birth registry with those from a congenital defects registry provided optimal information about the prevalence of hypospadias and its association with low infant birthweight and preeclampsia. These factors have in common changes in hormone levels during pregnancy, which in turn may have contributed to hypospadias development.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16752 (URN)10.1371/journal.pone.0214213 (DOI)000463314500020 ()30946760 (PubMedID)2-s2.0-85063936379 (Scopus ID)
Available from: 2019-04-07 Created: 2019-04-07 Last updated: 2019-08-06Bibliographically approved
Povlsen, L., Aryal, U. R., Petzold, M. & Krettek, A. (2018). Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal. International Journal of Adolescent Medicine and Health, 30(1), Article ID 20150124.
Open this publication in new window or tab >>Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal
2018 (English)In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 30, no 1, article id 20150124Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents' smoking behavior and their views, knowledge and experiences are scarce.

OBJECTIVE: To gain a deep understanding of Nepalese adolescents' knowledge and opinions about smoking and reasons for smoking initiation.

SUBJECTS: Adolescents from four secondary schools in the Bhaktapur district, Nepal.

METHODS: Eight focus-group discussions were conducted with 71 adolescents aged 13-16 years and from grades 8-10. Data were analyzed using manifest qualitative content analysis.

RESULTS: The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking.

CONCLUSION: Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.

Place, publisher, year, edition, pages
Walter de Gruyter, 2018
Keywords
adolescents, health behavior, health promotion, Nepal, smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical sciences
Identifiers
urn:nbn:se:his:diva-12128 (URN)10.1515/ijamh-2015-0124 (DOI)27060737 (PubMedID)2-s2.0-85043521607 (Scopus ID)
Available from: 2016-04-12 Created: 2016-04-12 Last updated: 2018-03-20Bibliographically approved
Krettek, A., Magnusson, M., Hallmyr, M. & Ascher, H. (2018). Apropå! »Alla vet att man ska äta frukt och grönt och röra på sig«. Läkartidningen, 115, Article ID E3YZ.
Open this publication in new window or tab >>Apropå! »Alla vet att man ska äta frukt och grönt och röra på sig«
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id E3YZArticle in journal (Other (popular science, discussion, etc.)) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-15013 (URN)29583162 (PubMedID)
Note

Debatt

Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-05Bibliographically approved
Oli, N., Vaidya, A., Eiben, G. & Krettek, A. (2018). Changes in children’s diet and physical activity as perceived by their mothers: Impact of a health promotion intervention for mothers in a sub-urban area of Nepal. Journal of Kathmandu Medical College, 7(4), 140-146
Open this publication in new window or tab >>Changes in children’s diet and physical activity as perceived by their mothers: Impact of a health promotion intervention for mothers in a sub-urban area of Nepal
2018 (English)In: Journal of Kathmandu Medical College, ISSN 2091-1785, Vol. 7, no 4, p. 140-146Article in journal (Refereed) Published
Abstract [en]

Background:

Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are.

Objectives:

To assess changes in children’s diet and physical activity as perceived by their mothers after a health promotion intervention.

Methodology:

The Heart-Health Associated Research, Dissemination and Intervention in the Community is a community trial conducted in the Jhaukhel-Duwakot Health Demographic Surveillance site, in Bhaktapur district of Nepal. We conducted a health promotion intervention on diet and physical activity targeted at mothers with children aged one to nine years old in August-November 2016. Duwakot was randomized as the intervention site and Jhaukhel as the control. We conducted a follow-up study after three months to determine the outcome of the intervention. Nine trained enumerators conducted door-to-door visits to all households with eligible mothers. We calculated mean, frequency and percent changes for children’s behavior.

Results:

As responded by mothers, children in Duwakot consumed more healthy snacks after the intervention compared to Jhaukhel. Children in Duwakot increased consumption of water and milk. Children’s consumption of packet juices and soft drinks was decreased by 30% and 4% respectively. There was 21% increment in the duration of outdoor playing among the children at Duwakot during follow-up.

Conclusion:

The Heart-Health Associated Research, Dissemination and Intervention in the Community that focused on mothers showed indirect positive impact on their young children’s diet and physical activity behavior. In future, the longterm effects of such intervention should be assessed.

Place, publisher, year, edition, pages
Kathmandu: , 2018
Keywords
Behavior, Children, Diet, Health promotion, Physical activity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16750 (URN)10.3126/jkmc.v7i4.23298 (DOI)
Note

Vol. 7, No. 4, Issue 26

Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-06-05Bibliographically approved
Choulagai, B. P., Onta, S., Subedi, N., Bhatta, D. N., Shrestha, B., Petzold, M. & Krettek, A. (2017). A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal. Health Policy and Planning, 32(8), 1092-1101
Open this publication in new window or tab >>A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal
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2017 (English)In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 8, p. 1092-1101Article in journal (Refereed) Published
Abstract [en]

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.

Keywords
Cluster randomized controlled trial, Nepal, epidemiology, evaluation, evidence-based policy, health services research, intervention, maternal health, newborn health, public health, skilled birth attendant
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-13952 (URN)10.1093/heapol/czx045 (DOI)000412288000002 ()28475754 (PubMedID)2-s2.0-85030725299 (Scopus ID)
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2017-11-27Bibliographically approved
Baldursdottir, B., Valdimarsdottir, H. B., Krettek, A., Gylfason, H. F. & Sigfusdottir, I. D. (2017). Age-related differences in physical activity and depressive symptoms among 10-19-year-old adolescents: A population based study. Psychology of Sport And Exercise, 28, 91-99
Open this publication in new window or tab >>Age-related differences in physical activity and depressive symptoms among 10-19-year-old adolescents: A population based study
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2017 (English)In: Psychology of Sport And Exercise, ISSN 1469-0292, E-ISSN 1878-5476, Vol. 28, p. 91-99Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to examine age- and gender-related patterns of PA and depressive symptoms among students through their adolescent years. Design: Data from three population-based surveys were analysed to determine levels of moderate- to vigorous-intensity PA (MVPA), participation in organized sports and depressive symptoms among 10-19-year-old adolescents. Method: Questionnaires assessing PA and depressive symptoms were administered to 32 860 students in compulsory and upper-secondary schools in Iceland. Results: As age increased, depressive symptoms increased and PA decreased with over half of the adolescents in upper-secondary schools not achieving recommended daily PA. There were gender differences in PA and depressive symptoms with girls being less active and reporting higher levels of depressive symptoms than boys. MVPA was associated with lower levels of depressive symptoms among both genders while organized sports had more impact on depressive symptoms among girls. Conclusions: To our knowledge, this study is the first to simultaneously examine patterns of PA and depressive symptoms among students through their adolescent years. Our findings show that the decrease in PA and increase in depressive symptoms is most pronounced around the transition from compulsory to upper-secondary school, or around the age of 15-16. Thus the findings provide important information about when to tailor public health efforts to reduce the burden of depressive symptoms among adolescents, for example by employing PA interventions. (C) 2016 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Organized sports, MVPA, Inactivity, Depression, Youth, Public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:his:diva-13268 (URN)10.1016/j.psychsport.2016.10.007 (DOI)000389168000011 ()2-s2.0-84994704833 (Scopus ID)
Available from: 2016-12-29 Created: 2016-12-29 Last updated: 2017-11-29Bibliographically approved
Kharkova, O. A., Grjibovski, A. M., Krettek, A., Nieboer, E. & Odland, J. Ø. (2017). Effect of Smoking Behavior before and during Pregnancy on Selected Birth Outcomes among Singleton Full-Term Pregnancy: A Murmansk County Birth Registry Study. International Journal of Environmental Research and Public Health, 14(8), 1-11, Article ID E867.
Open this publication in new window or tab >>Effect of Smoking Behavior before and during Pregnancy on Selected Birth Outcomes among Singleton Full-Term Pregnancy: A Murmansk County Birth Registry Study
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2017 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 8, p. 1-11, article id E867Article in journal (Refereed) Published
Abstract [en]

The aim of our study was to assess associations between smoking behavior before and during pregnancy and selected adverse birth outcomes. This study is based on the Murmansk County Birth Registry (MCBR). Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. We adjusted for potential confounders using logistic regression. The highest proportion of infants with low values of birth weight, birth length, head circumference, ponderal index and of the Apgar score at 5 min was observed for women who smoked both before and during pregnancy. We observed a dose-response relationship between the number of cigarettes smoked per day during pregnancy and the odds of the aforementioned adverse birth outcomes; neither were there significant differences in their occurrences among non-smokers and those who smoked before but not during pregnancy. Moreover, smoking reduction during pregnancy relative to its pre-gestation level did not influence the odds of the adverse birth outcomes. Our findings emphasize a continued need for action against tobacco smoking during pregnancy.

Keywords
Murmansk County Birth Registry, Russia, cigarettes, low Apgar score at 5 min, low birth length, low birth weight, low head circumference, low ponderal index, smoking, smoking cessation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-13953 (URN)10.3390/ijerph14080867 (DOI)000408684300037 ()28767086 (PubMedID)2-s2.0-85026797087 (Scopus ID)
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2017-11-29Bibliographically approved
Kharkova, O. A., Grjibovski, A. M., Krettek, A., Nieboer, E. & Odland, J. Ø. (2017). First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study. PLoS ONE, 12(8), Article ID e0179354.
Open this publication in new window or tab >>First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0179354Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/eclampsia; (ii) examine a possible association between the number of cigarettes smoked daily during pregnancy and the development of this affliction; and (iii) determine if first-trimester discontinuation of smoking during pregnancy influences the risk.

METHODS: A registry-based study was conducted using data from the Murmansk County Birth Registry (MCBR). It included women without pre-existing hypertension, who delivered a singleton infant during 2006-2011 and had attended the first antenatal visit before 12 week of gestation. We adjusted for potential confounders using logistic regression.

RESULTS: The prevalence of preeclampsia/eclampsia was 8.3% (95%CI: 8.0-8.6). Preeclampsia/eclampsia associated with maternal age, education, marital status, parity, excessive weight gain and body mass index at the first antenatal visit. There was a dose-response relationship between the number of smoked cigarettes per day during pregnancy and the risk of preeclampsia/eclampsia (adjusted OR1-5 cig/day = 0.69 with 95%CI: 0.56-0.87; OR6-10 cig/day = 0.65 with 95%CI: 0.51-0.82; and OR≥11 cig/day = 0.49 with 95%CI: 0.30-0.81). There was no difference in this risk among women who smoked before and during pregnancy and those who did so before but not during pregnancy (adjusted OR = 1.10 with 95%CI: 0.91-1.32).

CONCLUSIONS: Preeclampsia/eclampsia was associated with maternal age, education, marital status, parity, excessive weight gain, and body mass index at the first antenatal visit. There was a negative dose-response relationship between the number of smoked cigarettes per day during pregnancy and the odds of preeclampsia/eclampsia. However, women who gave up smoking during the first trimester of gestation had the same risk of preeclampsia/eclampsia as those who smoked while pregnant. Consequently, antenatal clinic specialists are advised to take these various observations into account when counselling women on smoking cessation during pregnancy.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-13983 (URN)10.1371/journal.pone.0179354 (DOI)000407396200002 ()28797036 (PubMedID)2-s2.0-85027228259 (Scopus ID)
Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2017-11-29Bibliographically approved
Krettek, A. & Suominen, S. (2017). Folkhälsovetenskaplig utbildning på distans med unik profil för framtiden. Socialmedicinsk Tidskrift, 94(3), 327-339
Open this publication in new window or tab >>Folkhälsovetenskaplig utbildning på distans med unik profil för framtiden
2017 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 327-339Article in journal (Refereed) Published
Abstract [sv]

Vid Högskolan i Skövde har ämnet folkhälsovetenskap utvecklats kraftigt de senaste två åren och förväntas fortsätta expandera som en strategisk satsning från lärosätet. Ämnets ambition är att erbjuda utbildningar med unik  profil  som  ger studenterna god anställningsbarhet och rustar dem för både nuvarande och framtida hälsoutmaningar. I dagsläget erbjuder Högskolan i Skövde ett flertal utbildningsprogram i folkhälsovetenskap; det tvååriga  Hälsocoachprogrammet, det treåriga kandidatprogrammet Folkhälsovetenskapligt program samt magisterprogrammet Folkhälsovetenskap: Smittskydd och vårdhygien. Det senare programmet är unikt i sitt slag, både i Sverige och Norden. Samtliga utbildningsprogram ges på distans med enstaka campusträffar. Artikeln belyser därför även utmaningar och möjligheter med denna undervisningsform och ger praktiska råd hur man kan åstadkomma god genomströmning i distansundervisning.

Abstract [en]

Public Health at University of Skövde is expanding as a strategic effort by the University. The ambition is to provide unique public health education that gives students preparedness to work with current and future public health challenges. To date, University of Skövde offers three educational programmes in public health; the two-year Health Coach, the three-year Public Health Sciences Study Programme and the master’s programme in Public Health Science: Infection Prevention and Control. The latter is unique and one-of-a-kind in both Sweden and the Nordic countries. All educational programmes are given as distance education with a few gatherings on campus. The article therefore also highlights challenges and possibilities with distance education and provides advice on how to make students successfully progress through such educational programmes.

Keywords
folkhälsovetenskap, unik profil, Högskolan i Skövde, magisterprogram, kandidatprogram, campusträffar, distansundervisning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-13954 (URN)
Available from: 2017-08-04 Created: 2017-08-04 Last updated: 2017-11-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4583-9315

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