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La santé publique : des fonctions, des compétences, des valeurs ? 公共卫生:职能、技能、价值观?
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-04-05 DOI: 10.3917/spub.241.0005
Olivier Grimaud
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引用次数: 0
Cadre d’action de promotion de la santé reproductive : analyse critique lexicométrique et trans des politiques publiques françaises contemporaines 促进生殖健康的行动框架:对法国当代公共政策的关键词汇和反式分析
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-04-05 DOI: 10.3917/spub.241.0073
Anna Baleige
INTRODUCTIONIn France, since 2017 the law has allowed people to change the gender marker on their civil status documents without having undergone medical treatment and sterilization surgery. However, no legislative framework has been provided to ensure their right to family, leaving those who wish to become parents in a space of social, political, and legal uncertainty that is inconsistent with international and human rights. In parallel, France has developed an arsenal of health strategies that constrain actors working in the field.PURPOSE OF THE RESEARCHThis study examines the possibilities available to public health actors for promoting reproductive health in the absence of legislation and in the context of political and legislative adversity. To this end, it relies on a participatory, critical, and lexicometric analysis of national strategies for sexual and reproductive health and parenthood support.RESULTSGovernance strategies make no mention of parentality among transgender people. Sexual and reproductive health policies focus on tackling sexually transmitted infections, on health pathways, and on violence and discrimination. The analysis also highlights a lack of awareness on this topic.CONCLUSIONSShortcomings in the legislative framework and public health strategies raise ethical questions about the promotion of reproductive health and the potentially non-inclusive approach of actors in the field. These issues force communities to carry out actions outside the scope of ordinary regulations, and they highlight the political positioning of the public-health field in France.
导言在法国,自 2017 年起,法律允许人们在未接受医疗和绝育手术的情况下更改公民身份证件上的性别标记。然而,没有任何法律框架来确保他们的家庭权,使那些希望成为父母的人处于社会、政治和法律的不确定空间,这不符合国际人权。与此同时,法国还制定了一系列卫生策略,限制了在这一领域开展工作的人员。本研究的目的是探讨在没有立法的情况下,在政治和立法不利的背景下,公共卫生人员促进生殖健康的可能性。为此,本研究采用参与式、批判性和词汇计量学的方法,对性健康和生殖健康以及支持为人父母的国家战略进行了分析。性健康和生殖健康政策的重点是应对性传播感染、健康途径以及暴力和歧视。结论立法框架和公共卫生战略中的缺陷引发了有关促进生殖健康的伦理问题,以及该领域行动者可能采取的非包容性方法。这些问题迫使各社区采取普通法规范围之外的行动,突出了法国公共卫生领域的政治定位。
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引用次数: 0
L’identifiant unique comme un des instruments indispensables au pilotage de la couverture sanitaire universelle, le cas du Maroc 唯一标识符是管理全民医保的重要工具之一,摩洛哥的案例
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-04-05 DOI: 10.3917/spub.241.0121
Abdellatif Moustatraf, Fatima Touhami
INTRODUCTIONMorocco is carrying out several actions to generalize basic compulsory health insurance (CHI). Managing this project requires coordination, information sharing, and the commitment of all actors to the goal of covering an additional 22 million people. One of the key factors for achieving this objective is the implementation of a unified registration system.PURPOSE OF THE RESEARCHThe aim is to analyze the existing situation and the feasibility of implementing a unified registration system, and to describe the potential positive impact of the latter on the extension of CHI.RESULTSThis work is based on a diagnosis of the current situation. It draws on the legal framework, all available documents and figures, and on an analytical reading supported by existing literature. It reveals that due to the inadequacy or even the absence of an appropriate legal basis, each managing body has its own registration system. The lack of a unified system has given rise to a number of constraints. These concern, among other things: (i) mobility between or within schemes, which does not operate smoothly because it leads to re-registration (ii) inadequate monitoring of double benefit claims, which is the case for more than one scheme, due to insufficient and hesitant anti-fraud action (iii) the sharing and use of reliable data, which hinders decision making, evaluation, and monitoring.CONCLUSIONSIt is essential to adopt legal texts that will provide the basis for a unified system with regulations enabling the participation of all stakeholders, with the aim of steering the roll-out of CHI effectively and efficiently.
导言摩洛哥正在开展多项行动,以普及基本强制性医疗保险(CHI)。管理这一项目需要协调、信息共享以及所有参与者对额外覆盖 2200 万人这一目标的承诺。研究目的研究目的是分析现有情况和实施统一登记系统的可行性,并描述统一登记系统对扩大 CHI 潜在的积极影响。它借鉴了法律框架、所有可获得的文件和数字,并在现有文献的支持下进行了分析解读。结果表明,由于缺乏适当的法律依据,各管理机构都有自己的登记制度。缺乏统一的制度造成了一些制约因素。这些制约因素包括:(i) 计划之间或计划内部的流动性,这种流动性会导致重新登 记,因而无法顺利开展工作;(ii) 由于反欺诈行动不够充分和犹豫不决,对双重福利申请的监 督不足,不止一个计划存在这种情况;(iii) 可靠数据的共享和使用,这妨碍了决策、评估和监 督工作。结论:必须通过法律文本,为建立一个统一的系统奠定基础,并制定条例,使所有 利益相关者都能参与进来,从而有效和高效地指导共同健康保险的推广工作。
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引用次数: 0
Excess mortality during the COVID-19 pandemic in Algeria: The case of Oran Province 阿尔及利亚 COVID-19 大流行期间的高死亡率:奥兰省的案例
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0141
Mourad Raiah, Aicha Henien Djelloul Saiah, Karima Youcef, Mohammed El-Amine Bahmed, Lydia Benrabah, Khadidja Terki

Objective: This study aimed to estimate excess mortality during the COVID-19 pandemic in Oran between March 2020 and December 2022.

Method: Monthly all-cause data used to estimate excess mortality were modeled against the pre-pandemic period (January 2011-February 2020). Excess mortality between March 2020 and December 2022 was estimated using a quasi-Poisson regression. Analyses were stratified by age group.

Results: From March 2020 to December 2022, there was a 30% excess mortality rate, corresponding to an average of 112 monthly excess deaths. Observed numbers of deaths were higher than expected for the age groups 20–39, 40–59, 60–79, and 80 and above. The age group 0–19 did not show excess mortality.

Conclusion: The COVID-19 pandemic has been associated with a significant increase in all-cause mortality in Oran. Our results highlight the importance of monitoring all-cause excess mortality as an indicator of the disease burden in situations such as the current pandemic.

研究目的本研究旨在估算 2020 年 3 月至 2022 年 12 月 COVID-19 大流行期间奥兰的超额死亡率:用于估算超额死亡率的每月全因数据与大流行前(2011 年 1 月至 2020 年 2 月)的数据进行了对比。2020 年 3 月至 2022 年 12 月期间的超额死亡率采用准泊松回归法进行估算。分析按年龄组进行分层:结果:2020 年 3 月至 2022 年 12 月期间,超额死亡率为 30%,相当于平均每月 112 例超额死亡。在 20-39 岁、40-59 岁、60-79 岁和 80 岁及以上年龄组中,观察到的死亡人数高于预期。0-19 岁年龄组没有出现超额死亡率:COVID-19大流行导致奥兰地区全因死亡率显著上升。我们的研究结果突出表明,在当前大流行病等情况下,监测全因超额死亡率作为疾病负担指标的重要性。
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引用次数: 0
Bibliographic records 书目记录
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0161
Anne Sizaret
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引用次数: 0
The factors associated with contraceptive use among young female students in rural Guinea 几内亚农村地区年轻女学生使用避孕药具的相关因素
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0129
Lancinè Dramé, Delphin Kolié, Sidikiba Sidibé, Jean Faya Yombouno, Alexandre Delamou

Introduction: The low use of modern contraceptive methods by young girls is a real public health problem in sub-Saharan Africa, especially among young female students living in rural areas. The purpose of this study was to analyze the factors associated with contraceptive use among young female students in rural Guinea.

Method: This was an analytical cross-sectional study including 607 students from 10 secondary schools in the rural district of Kankan, Guinea.

Results: A total of 607 female students were interviewed and included in this study. They had an average age of 17.3 ± 1.7 years, 50.9% were in junior high school, and 49.1% were in high school. During our survey period, 67.7% of the girls reported being sexually active, while only 24.4% were on modern contraception. In the bivariate analysis, factors such as age, religion, school level, having heard of contraception, and having had sexual intercourse were statistically associated with contraceptive use. In the multivariate analysis, factors such as age (OR = 2.1; CI = 1.1–3.8), religion (OR = 5.1; CI = 2.8–9.5), and having had sexual intercourse (OR = 2.2; CI = 1.4–3.5) remained statistically associated with the use of contraceptive methods among young female students.

Conclusion: Our study highlights the need to increase awareness of, and access to, contraceptive methods in schools in order to improve contraceptive practice and, in turn, to reduce the frequency of unwanted and early pregnancies among young female students in rural areas of Guinea.

导言:在撒哈拉以南非洲地区,年轻女孩很少使用现代避孕方法是一个真正的公共卫生问题,尤其是在生活在农村地区的年轻女学生中。本研究旨在分析与几内亚农村地区年轻女学生使用避孕药具相关的因素:这是一项横断面分析研究,包括几内亚坎坎农村地区 10 所中学的 607 名学生:本研究共访问了 607 名女学生。她们的平均年龄为(17.3 ± 1.7)岁,50.9%为初中生,49.1%为高中生。在我们的调查期间,67.7%的女生表示性生活活跃,只有 24.4%的女生采取了现代避孕措施。在双变量分析中,年龄、宗教信仰、学校级别、是否听说过避孕措施以及是否有过性生活等因素与避孕药具的使用有统计学关联。在多变量分析中,年龄(OR = 2.1;CI = 1.1-3.8)、宗教信仰(OR = 5.1;CI = 2.8-9.5)和有过性交经历(OR = 2.2;CI = 1.4-3.5)等因素在统计学上仍与年轻女学生使用避孕方法有关:我们的研究突出表明,有必要在学校提高对避孕方法的认识并增加获得避孕方法的机会,以改善避孕实践,进而降低几内亚农村地区年轻女学生意外怀孕和早孕的频率。
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引用次数: 0
Adverse events following immunization reported with COVID-19 vaccines in Burkina Faso: Analysis of spontaneous reports 布基纳法索报告的 COVID-19 疫苗免疫接种后不良事件:自发报告分析
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0149
Ruth Sawadogo, Joël Ouoba, Dieudonné Ilboudo, Edmond Tchoumbi, Sougrimani Lankoandé-Haro, Souleymane Fofana, Issiaka Sombié, Sekou Samadoulougou, Fati Kirakoya-Samadoulougou

The rapid deployment of COVID-19 vaccines to a large proportion of the population requires a focus on safety. However, few studies have assessed the safety of COVID-19 vaccines in Africa. In Burkina Faso, this issue has not yet been addressed. The objective of this study was to contribute to the description of the characteristics of adverse events following immunization (AEFIs) related to COVID-19 vaccines in Burkina Faso. This was a cross-sectional descriptive retrospective study of spontaneous reports of COVID-19 vaccine-related AEFIs recorded in VigiBase® between June 2021 and November 2022 in Burkina Faso. Individual case safety reports (ICSRs) were extracted from VigiBase® using the Anatomical Therapeutic Chemical level 2 (ATC2) code. The proportion of ICSRs according to the reporter’s qualification, the reporting rate, the time taken to submit and record ICSRs, and the completeness score were calculated. A total of 973 ICSRs concerned COVID-19 vaccines and represented 32.6% of all 2,988 reports in VigiBase®. Overall, 82.0% of the reporters were nurses/midwives, 7.8% were physicians, 6.7% were pharmacists, and 3.4% were patients. The median time between the onset of AEFIs and the submission of the report to the Pharmacovigilance Center was 180 days (IQR: 136; 281). The median registration time was 188 days (IQR: 149; 286). The mean ICSR completeness score was 0.8 (standard deviation = 0.1). The overall AEFI reporting rate was 27.8 per 100,000 vaccine doses. The AEFI reporting rates for the ChAdOx1-nCoV-19, JNJ 78436735, Elasomeran, Tozinameran, and HB02 vaccines were 454.2, 17.4, 11.0, 10.2, and 0.4 per 100,000 vaccine doses, respectively. The majority of AEFIs were systemic in nature (90.1%). Headache (21.2%), fever (19.4%), and myalgia (11.0%) were the most frequently reported AEFIs. Eighteen cases (1.8%) of serious AEFIs (9 hospitalizations, 4 life threatening, 3 temporary disabilities, and 2 others unspecified) were reported. The majority of AEFIs reported were systemic in nature and mild. However, there have been reports of serious AEFIs. The overall AEFI reporting rate was low. There is a need to strengthen the monitoring of these vaccines to better organize strategies to optimize the adherence of the population of Burkina Faso.

要将 COVID-19 疫苗迅速部署到大部分人口中,就必须关注其安全性。然而,很少有研究对 COVID-19 疫苗在非洲的安全性进行评估。在布基纳法索,这一问题尚未得到解决。本研究的目的是描述布基纳法索与 COVID-19 疫苗相关的免疫接种后不良事件 (AEFI) 的特征。这是一项横断面描述性回顾研究,研究对象是 2021 年 6 月至 2022 年 11 月期间布基纳法索 VigiBase® 中记录的 COVID-19 疫苗相关 AEFI 的自发报告。使用解剖学治疗化学二级 (ATC2) 代码从 VigiBase® 中提取了单个病例安全报告 (ICSR)。根据报告人的资质、报告率、提交和记录 ICSR 所需的时间以及完整性评分,计算了 ICSR 的比例。共有 973 份 ICSR 涉及 COVID-19 疫苗,占 VigiBase® 中所有 2,988 份报告的 32.6%。总体而言,82.0%的报告人为护士/助产士,7.8%为医生,6.7%为药剂师,3.4%为患者。从发生 AEFI 到向药物警戒中心提交报告的中位时间为 180 天(IQR:136;281)。登记时间的中位数为 188 天(IQR:149;286)。ICSR 完整性平均得分为 0.8(标准差 = 0.1)。总体 AEFI 报告率为每 10 万剂疫苗 27.8 例。ChAdOx1-nCoV-19、JNJ 78436735、Elasomeran、Tozinameran和HB02疫苗的AEFI报告率分别为每10万剂疫苗454.2、17.4、11.0、10.2和0.4例。大多数 AEFI 是全身性的(90.1%)。头痛(21.2%)、发烧(19.4%)和肌痛(11.0%)是最常见的 AEFI。报告了 18 例(1.8%)严重的 AEFI(9 例住院,4 例危及生命,3 例暂时残疾,2 例其他未说明)。所报告的 AEFI 大多是全身性的,病情较轻。但也有严重 AEFI 的报告。AEFI 的总体报告率较低。有必要加强对这些疫苗的监测,以便更好地制定战略,优化布基纳法索居民的接种情况。
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引用次数: 0
Emergence of the “e-patient” and “e-caregiver” around a serious game in ETP 围绕 ETP 中的一个严肃游戏,"电子病人 "和 "电子护理人员 "的出现
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0027
Jean-Denis Aubry, Emmanuel Rusch

Introduction: The advent of e-health has an impact on many areas of health care practice, including TPE. The impact of the introduction of information and communication technologies (ICTs) in health care, such as serious games, remains largely unexplored in the field of e-TPE.

Purpose of the research: To ask patients and health care professionals about the use of a serious game, in order to clarify the impact of these technologies on health care practices and on the relationship between caregiver and patient, as well as their advantages and limitations.

Method: A qualitative study based on the grounded theory approach, using semi-structured interviews with six health care professionals and six patients using the DRAGO© serious game, a smartphone application designed to improve compliance with allergy treatment. A lexicometric analysis was carried out, with classification by theme and sub-theme, followed by a statistical breakdown of verbatims according to whether they expressed a favorable or unfavorable opinion.

Results: 64% of professionals surveyed are in favor of digital innovations in health care, and 67% of patients. Health care professionals have reservations about their patients’ eligibility for these new technologies. In both categories, the ethical issues surrounding the emergence of e-health are positively echoed, with 69% of health care professionals and up to 83% of patients in favor. Both categories are more reserved about the impact of ICTs on the health care relationship.

Conclusion: Health care professionals and patients alike consider the presence of ICTs in TPE to be “acceptable,” although they remain vigilant about the impact they can have on the health care relationship. These developments imply a necessary change in the practices of health care professionals, leading them to think about and encourage the emergence of the profile of tomorrow’s e-caregiver working with e-patients.

介绍:电子保健的出现对包括 TPE 在内的许多保健实践领域产生了影响。在医疗保健领域引入信息和通信技术(ICTs)(如严肃游戏)所产生的影响在很大程度上仍未在电子疗法领域得到探讨:研究目的:向患者和医疗保健专业人员了解严肃游戏的使用情况,以明确这些技术对医疗保健实践和护理人员与患者之间关系的影响,以及它们的优势和局限性:一项基于基础理论方法的定性研究,采用半结构式访谈的方式,采访了六名医疗保健专业人员和六名使用 DRAGO© 严肃游戏的患者,该游戏是一款智能手机应用程序,旨在提高患者对过敏治疗的依从性。根据主题和次主题进行了词性分析,然后根据表达的赞成或反对意见对逐字记录进行了统计分析:结果:64%的受访专业人员和 67%的患者赞成医疗保健领域的数字化创新。医护人员对患者是否有资格使用这些新技术持保留意见。在这两类人群中,69% 的医护专业人员和高达 83% 的患者对围绕电子医疗出现的伦理问题持积极态度。对于信息和通信技术对医疗保健关系的影响,两类人都持保留态度:医疗保健专业人员和患者都认为信息与传播技术在 TPE 中的存在是 "可以接受的",尽管他们仍然对信息与传播技术可能对医疗保健关系产生的影响保持警惕。这些发展意味着医护专业人员的工作方式必须做出改变,引导他们思考并鼓励未来的电子护理人员与电子病人一起工作。
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引用次数: 0
A rural interprofessional primary care team develops a school-based sex education program 农村跨专业初级保健团队开发校本性教育计划
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0087
Manoël Letessier, David Mignot, Ilyess Mejri, Hikombo Hitoto

Introduction: In French rural areas, getting information about sexual health and identifying health actors on the topic is difficult for teenagers. Despite national and international guidelines, school-based sex education programs remain insufficient in France. The aim of this project was to develop a school-based psycho-affective and sexual health program (PASHP) for teenagers, led by an interprofessional primary care team (IPCT) in Montval-sur-Loir (Sarthe) and to coordinate local stakeholders.

Method: The IPCT developed the PASHP using a community-based participatory research method. The first step identified the target population and its needs for sex education. The second step was to create a steering group to tailor PASHP interventions in a participatory way and to define the PASHP’s aims and execution arrangements. The third step aimed at carrying out the PASHP and getting stakeholders’ and the target population’s feedback.

Results: The PASHP, carried out in the 2020–2021 and 2021–2022 school years, included an intervention about contraception and sexually transmitted infections, artistic workshops on consent or gender stereotypes, group discussions, and an intervention about pornography to assist parents.

Conclusion: The PASHP developed and coordinated by the Montval-sur-Loir IPCT is innovative because of its organization. It coordinates local stakeholders, teenagers, and their parents in a disadvantaged rural area, respecting national guidelines on sex education.

简介在法国农村地区,青少年很难获得有关性健康的信息,也很难找到这方面的医疗人员。尽管制定了国家和国际准则,但法国的校本性教育计划仍然不足。该项目的目的是在萨特省蒙瓦尔市(Montval-sur-Loir)的跨专业初级保健小组(IPCT)的领导下,为青少年制定一项以学校为基础的心理情感和性健康计划(PASHP),并协调当地的利益相关者:方法:跨专业初级保健小组(IPCT)采用社区参与式研究方法制定了 "青少年保健计划"。第一步是确定目标人群及其对性教育的需求。第二步是成立一个指导小组,以参与的方式制定 PASHP 的干预措施,并确定 PASHP 的目标和执行安排。第三步是开展 PASHP,并获得利益相关者和目标人群的反馈:结果:2020-2021 学年和 2021-2022 学年开展的 "PASHP "活动包括关于避孕和性传播感染的 干预活动、关于同意或性别陈规定型观念的艺术工作坊、小组讨论,以及为协助家长而开展 的关于色情制品的干预活动:由 Montval-sur-Loir IPCT 制定和协调的 PASHP 计划因其组织形式而具有创新性。它在尊重国家性教育指导方针的前提下,协调了贫困农村地区的当地利益相关者、青少年及其家长。
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引用次数: 0
Evaluation of the “Build your bike!” pilot project by and for disadvantaged youth: A school-based intervention to promote active mobility 由弱势青少年发起并为其开展的 "打造你的自行车!"试点项目评估:促进积极交通的校本干预措施
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2024-02-23 DOI: 10.3917/spub.236.0007
Célia Kingsbury, François Bissonnette, Paquito Bernard

The densification of urban centers has driven individuals with low income toward more affordable suburban neighborhoods, thereby constraining transportation options due to car-centric planning and the difficulty for public transit systems to meet mobility needs. Recognizing that active cycling promotes travel autonomy, social participation, and physical and mental well-being, the promotion of such behavior through localized interventions stands as a critical objective to foster transport equity. In this context, in collaboration with the organization “Cyclo Nord-Sud,” this study aims to explore the outcomes and favorable components of the “Build Your Bike!” pilot project offered as an extracurricular activity to high school students in a disadvantaged neighborhood. A qualitative, comprehensive approach with an inductive and phenomenological perspective was employed. We conducted a focus group at the end of the program and used conceptual categories to complete the analysis. The results revealed positive outcomes from the program related to: 1) well-being, 2) learning, 3) access to a bicycle, and 4) mobility. Favorable mechanisms encompassed: 1) the approach of adult mentors, 2) extracurricular involvement, 3) teamwork, 4) manual labor, and 5) bicycle ownership upon program completion. The mechanisms identified by the participants hold potential for improvement in future program iterations and can guide the development of similar interventions.

城市中心的密集化驱使低收入人群前往价格更低的郊区,从而限制了以汽车为中心的规划所带来的交通选择,公共交通系统也难以满足人们的出行需求。认识到积极骑自行车可以促进出行自主、社会参与和身心健康,通过本地化干预措施促进这种行为成为促进交通公平的关键目标。在此背景下,本研究与 "Cyclo Nord-Sud "组织合作,旨在探索 "打造你的自行车!"试点项目的成果和有利因素,该项目作为课外活动提供给贫困地区的高中生。我们采用了归纳和现象学视角的综合定性方法。我们在项目结束时进行了一次焦点小组讨论,并使用概念分类完成分析。结果显示,该计划在以下方面取得了积极成果:1)幸福感;2)学习;3)获得自行车;4)流动性。有利的机制包括1)成人导师的方法;2)课外参与;3)团队合作;4)体力劳动;5)计划完成后拥有自行车。参与者确定的机制有可能在未来的计划迭代中得到改进,并能指导类似干预措施的开发。
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