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Pathways of less healthy diets. An investigation of the everyday food practices of men and women in low income households 不健康饮食的途径。对低收入家庭男女日常饮食习惯的调查
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-07-26 DOI: 10.1080/09581596.2022.2101917
Kia Ditlevsen, B. Halkier, L. Holm
ABSTRACT Dietary health is a key theme of health policy and public debates on health and inequality. The social gradient in dietary health is evident, but less is known about the processes in everyday life through which less healthy diets are shaped among people with low socio-economic status. In this mixed methods study we recruited 30 men and women living in low income households in Denmark and combined qualitative interviews about household practices with quantitative estimates of the quality of participants’ diets. The qualitative findings show that in general, the participants’ food practices were conditioned by budget restrictions and bundled with other non-food practices in their everyday life, which in most, but not all, cases conflicted with engagement in healthy eating. Only few participants reported feeling able to provide ‘proper foods’ according to their own preferences. We identified five distinct pathways through which food practices were performed. All were structured by distinct life situations which created different ways in which food practices were bundled with other practices. The quantitative estimates of participants’ diets show that none of the participants’ diets categorized as healthy. The combined analysis showed that estimated dietary quality varied between the five pathways, and that the degree of budget restraint and the practice of handling a disease in the household were notably important for the performance of food practices.
摘要饮食健康是卫生政策和关于健康与不平等的公共辩论的一个重要主题。饮食健康的社会梯度是明显的,但人们对低社会经济地位人群在日常生活中形成不太健康饮食的过程知之甚少。在这项混合方法研究中,我们招募了30名居住在丹麦低收入家庭的男性和女性,并将关于家庭实践的定性访谈与对参与者饮食质量的定量估计相结合。定性研究结果表明,总体而言,参与者的饮食习惯受到预算限制的制约,并与日常生活中的其他非饮食习惯捆绑在一起,在大多数情况下,但并非所有情况下,这与健康饮食相冲突。只有少数参与者表示能够根据自己的喜好提供“合适的食物”。我们确定了五种不同的食物实践途径。所有这些都是由不同的生活环境构成的,这些生活环境创造了食物实践与其他实践捆绑在一起的不同方式。对参与者饮食的定量估计表明,没有一个参与者的饮食被归类为健康。综合分析表明,估计的饮食质量在五种途径之间存在差异,预算限制的程度和家庭中处理疾病的做法对食品做法的表现尤为重要。
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引用次数: 1
Framing health, behavior, and society: a critical content analysis of public health social and behavioral science textbooks 框架健康,行为和社会:公共卫生社会和行为科学教科书的关键内容分析
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-07-08 DOI: 10.1080/09581596.2022.2095255
Marisa Westbrook, M. Harvey
ABSTRACT Despite the increasing focus within public health on the social determinants of health and ‘structural approaches’ over the past three decades, controversy remains regarding the field’s relative emphasis on the behaviors of individuals versus the organization of societies when explaining why some are healthy and others are not. This research seeks to clarify how authoritative sources within public health instruction frame the relationship among behavior, society, and health by identifying common themes within social and behavioral science textbooks assigned within MPH programs located primarily in the US. Textbook analysis was informed by a modified grounded theory approach and is situated broadly within the critical discourse analysis tradition. Common themes include: the primacy of behavior to health outcomes; the purpose of public health theory is explaining behavior and informing behavior change; social and individual factors influence health behaviors; and ecological approaches are necessary for behavior change. Notable divergences from these themes are also discussed. These findings suggest a continuing need to think critically about how health, behavior, and society are framed within public health instruction specifically and within the field of public health more broadly. We close by considering the relevance of social theories of health inequality and structural competency to these discussions.
摘要尽管在过去的三十年里,公共卫生界越来越关注健康的社会决定因素和“结构方法”,但在解释为什么有些人健康,而另一些人不健康时,该领域相对强调个人行为与社会组织,仍存在争议。本研究试图通过确定主要位于美国的公共卫生硕士项目中分配的社会和行为科学教科书中的共同主题,阐明公共卫生指导中的权威来源如何构建行为、社会和健康之间的关系。教科书分析是由一种改良的扎根理论方法提供的,广泛地位于批评话语分析传统中。共同的主题包括:行为对健康结果的首要地位;公共卫生理论的目的是解释行为并告知行为变化;社会和个体因素影响健康行为;生态方法对于行为改变是必要的。还讨论了与这些主题的显著差异。这些发现表明,仍然需要批判性地思考健康、行为和社会是如何在公共卫生指导中,特别是在更广泛的公共卫生领域中构建的。最后,我们考虑了健康不平等和结构能力的社会理论与这些讨论的相关性。
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引用次数: 3
The publics of public health: learning from COVID-19 公共卫生公众:从COVID-19中吸取教训
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-07-08 DOI: 10.1080/09581596.2022.2077701
Judith Green, E. Fischer, Des Fitzgerald, T. S. Harvey, F. Thomas
ABSTRACT This commentary reflects on what has been learnt from government and public health responses to COVID-19, suggesting a tension between ‘business as usual’ forms of public health in the face of crisis, and the possibilities for a step-change towards a ‘healthy publics’ approach. We set out a range of ways that diverse, multiple publics have been implicated or brought into being during the COVID-19 pandemic, and we argue that these have generally been ignored or erased by agents or agencies of public health, keen to preserve certainty in their messaging and public confidence in their authority. We conclude with five principles for re-organising pandemic responses around a richer, more context-dependent and diverse account of ‘the public’.
这篇评论反映了从政府和公共卫生应对COVID-19中学到的东西,表明面对危机时“一切照旧”的公共卫生形式与逐步转变为“健康公众”方法的可能性之间存在紧张关系。我们列出了在2019冠状病毒病大流行期间,多种多样的公众受到牵连或形成的一系列方式,我们认为,这些方式通常被公共卫生机构或机构忽视或抹去,因为他们热衷于保持信息的确定性和公众对其权威的信心。最后,我们提出了围绕“公众”更丰富、更依赖情境和更多样化的描述重新组织大流行应对的五项原则。
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引用次数: 8
Internally displaced people in Lagos: environmental health conditions and access to healthcare in the context of COVID-19 拉各斯境内流离失所者:新冠肺炎背景下的环境卫生条件和获得医疗保健的机会
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-07-07 DOI: 10.1080/09581596.2022.2096427
Samuel Ojima Adejoh, I. Kuznetsova, S. Dhesi
ABSTRACT The paper documents environmental health conditions and healthcare access challenges faced by internally displaced people (IDPs) from Borno State living in informal settlements in Lagos, Nigeria, in 2020, during the early stages of the COVID-19 pandemic. This qualitative study with 32 IDPs suggests a high vulnerability to COVID-19. Their accommodation often lacked basic sanitation including water and toilet facilities; overcrowding and high population density restricted ability to adhere to social distancing; and IDPs experienced serious consequences from lockdown, as the majority depended on daily wages, and did not receive food packages or other support from the State. Finally, there were obstacles to accessing healthcare. We highlight the importance of an integrated approach, consolidating the efforts of communities, non-governmental organisations, environmental and public health, and international organisations to address the health and well-being issues of IDPs in urban informal settlements.
本文记录了2019冠状病毒病大流行初期,2020年尼日利亚拉各斯博尔诺州非正规定居点境内流离失所者面临的环境卫生条件和医疗保健获取挑战。这项针对32名国内流离失所者的定性研究表明,他们对COVID-19的脆弱性很高。他们的住所往往缺乏基本的卫生设施,包括水和厕所设施;过度拥挤和人口密度高限制了保持社交距离的能力;国内流离失所者遭受了封锁的严重后果,因为大多数人依靠每日工资生活,没有得到国家的食品包或其他支持。最后,在获得医疗保健方面存在障碍。我们强调必须采取综合办法,巩固社区、非政府组织、环境和公共卫生以及国际组织的努力,以解决城市非正规住区境内流离失所者的健康和福祉问题。
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引用次数: 2
Frailty goes viral: a critical discourse analysis of COVID-19 national clinical guidelines in the United Kingdom 虚弱像病毒一样传播:对英国COVID-19国家临床指南的批判性话语分析
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-06-22 DOI: 10.1080/09581596.2022.2090316
Louise Tomkow, Paul Pascall-Jones, D. Carter
ABSTRACT This paper explores how the rationing of medical care for older people by frailty score was justified and operationalised in the UK during the COVID-19 pandemic. COVID-19 was expected to overwhelm the National Health Service (NHS) in the UK. In March 2020, the National Institute for Health and Care Excellence (NICE) published the ‘COVID-19 rapid guideline: critical care in adults’, which advised that clinicians use the Clinical Frailty Score (CFS) to inform decisions about which patients over the age of 65 should be offered ventilatory support. We present a Foucauldian Critical Discourse Analysis of this guidance and the supporting online resources. Analysis shows how the guidance merchandises the CFS as a quick and easy-to-use technology that reduces social and physical complexity into a clinical score. This stratifies older people by frailty score and permits the allocation of resources along these lines. We show how this is justified through epidemiological discourses of risk, which are merged with the language of individual mortality prediction. We discuss the proceduralisation of the CFS alongside a growing body of research that problematises its application in resource allocation. We argue that the pandemic has increased the use of the concept of frailty and that this effectively obfuscates the concept’s limitations and ambiguities; the ageism implicit in the response to COVID-19 in the UK; and the relative resource scarcity facing the UK’s NHS.
本文探讨了在2019冠状病毒病大流行期间,英国如何通过虚弱评分为老年人提供医疗服务的合理性和可操作性。预计2019冠状病毒病将使英国国家医疗服务体系不堪重负。2020年3月,英国国家卫生与护理卓越研究所(NICE)发布了《COVID-19快速指南:成人重症监护》,建议临床医生使用临床虚弱评分(CFS)来决定哪些65岁以上的患者应该获得呼吸机支持。我们提出了福柯式的批评话语分析,以此作为指导和支持的在线资源。分析表明,该指南如何将CFS推销为一种快速易用的技术,将社会和物理复杂性降低为临床评分。这种方法将老年人按虚弱程度进行分层,并允许按照这些方式分配资源。我们通过流行病学的风险论述来证明这是合理的,这些论述与个人死亡率预测的语言相结合。我们讨论了CFS的程序化以及越来越多的研究,这些研究对其在资源分配中的应用提出了问题。我们认为,大流行病增加了脆弱性概念的使用,这有效地混淆了这一概念的局限性和模糊性;英国应对COVID-19中隐含的年龄歧视;以及英国国民医疗服务体系面临的相对资源短缺。
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引用次数: 0
‘I didn’t feel safe inside’: navigating public health advice, housing and living with bushfire smoke “我在里面感觉不安全”:在公共卫生建议、住房和森林大火烟雾中生活
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-06-02 DOI: 10.1080/09581596.2022.2082923
R. Williamson, C. Banwell, A. Calear, Christine Labond, L. Leach, Anna Olsen, Christine B Phillips, E. Walsh, T. Zulfiqar
ABSTRACT Bushfires, and resulting bushfire smoke, were major environmental, social and health crises in Australia in the summer of 2019–20. In Australia’s national capital the smoke pollution index topped global charts, and public health communications were rapidly developed that advised people to stay indoors to avoid smoke exposure. Drawing on interviews with a diverse range of housed residents, we explore people’s experiences of navigating public health advice and managing the bushfire smoke in relation to the materiality of their homes. Given the increasing likelihood of living with such crises in the Anthropocene, we highlight the need for future bushfire public health advice to recognise local housing geographies, residents’ embodied vulnerabilities and the relational ways people live with their everyday built environment, and suggest possible policy responses.
摘要2019–20年夏季,丛林大火及其产生的山火烟雾是澳大利亚的主要环境、社会和健康危机。在澳大利亚首都,烟雾污染指数在全球排行榜上名列前茅,公共卫生通讯也迅速发展起来,建议人们呆在室内避免接触烟雾。通过对各种居住居民的采访,我们探讨了人们在遵循公共卫生建议和管理丛林大火烟雾方面的经历,这些经历与他们家的物质性有关。鉴于在人类世生活在此类危机中的可能性越来越大,我们强调了未来山火公共卫生建议的必要性,以认识到当地的住房地理位置、居民的具体脆弱性以及人们与日常建筑环境的关系方式,并提出可能的政策应对措施。
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引用次数: 4
Does ’class count’? The evolution of health inequalities by social class in early 21st century China (2002–2013) “班级算数吗”?21世纪初中国社会阶层健康不平等的演变(2002-2013)
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-05-27 DOI: 10.1080/09581596.2022.2077700
Wei Zhang, Xuan Chen
ABSTRACT Does social class matter in understanding health inequalities in early 21st century China, when the country experienced unprecedented social stratification? Using nationally representative data from the latest waves of China Household Income Project surveys, we examine to what extent an individual’s health is structured by social class and how that structure evolved. We draw on a neo-Marxist measure of social class to tap into the hidden mechanism that engenders and sustains inequalities. Four classes are defined based primarily on their relationships to productive resources: owners/managers, professionals/skilled workers, less-skilled workers, and farmers. Such a measure has not been considered in the health gradient literature in the Chinese context. Our results show that, despite remedial policies that helped mitigate economic inequalities, inequalities in health have mostly widened during the early years of the current century between the ‘haves’, who own productive assets and/or managerial authority, and the ‘have-nots’. In 2002, self-rated health (SRH) was not clearly associated with class rank; in 2007, when China’s economic inequality reached a historical zenith, a gradational pattern between SRH and class emerged, and the largest health gap was found between the class of owners/managers and farmers; in 2013, when China’s income inequality reached a plateau, the health gap between owners/managers and less-skilled workers grew larger. Further, we identify job security as a mediator that links class and health among the lower social strata. In addition to improving the health of the disadvantaged, policies designed to narrow health inequalities should be orientated towards addressing social stratification.
21世纪初,中国经历了前所未有的社会分层,在理解中国的健康不平等时,社会阶层是否重要?利用中国家庭收入项目最新一波全国代表性的调查数据,我们研究了个人健康在多大程度上受到社会阶层的影响,以及这种结构是如何演变的。我们利用一种新马克思主义的社会阶级衡量方法来挖掘产生和维持不平等的隐藏机制。主要根据他们与生产资源的关系定义了四个阶层:所有者/管理者、专业人员/熟练工人、低技能工人和农民。在中国背景下的健康梯度文献中没有考虑到这一措施。我们的研究结果表明,尽管补救政策有助于缓解经济不平等,但在本世纪初,拥有生产性资产和/或管理权的“富人”与“穷人”之间的健康不平等在很大程度上扩大了。2002年,自评健康(SRH)与班级等级关系不明显;2007年,当中国经济不平等达到历史顶峰时,社会健康水平与阶层之间出现了递进格局,最大的健康差距出现在业主/管理者阶层与农民阶层之间;2013年,当中国的收入不平等达到平台期时,业主/经理与低技能工人之间的健康差距变得更大。此外,我们确定工作保障是连接社会下层阶级和健康的中介。除了改善处境不利者的健康之外,旨在缩小保健不平等现象的政策应着眼于解决社会分层问题。
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引用次数: 0
#DiabetesOnAPlate: the everyday deployment and contestation of diabetes stigma in an online setting # diabetesonapplate:糖尿病污名在网上的日常部署和争论
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-05-27 DOI: 10.1080/09581596.2022.2077548
Leda Blackwood, Jeffrey Gavin, Emma Arnott, J. Barnett, C. Dack, Jessica Johansen
ABSTRACT People living with Type 1 and Type 2 diabetes (T1DM &T2DM) report that media – including journalism, health promotion, and popular culture – are a primary source of stigmatic representations of diabetes, and that this compromises their physical and mental health. This view of diabetes as stigmatised is not shared by many health professionals and nor the wider public. We used an existing representation of diabetes on Instagram, #DiabetesOnAPlate, to examine how stigmatic representations of diabetes are (re)produced, discussed, and contested. Our analysis found that, consistent with the notion of diabetes as stigmatised, use of the hashtag #DiabetesOnAPlate on Instagram is associated with public health discourses of indulgent eating and with posts that signal recognition of this as a moral transgression. A subsequent on-line survey found that participants who did not have diabetes did not recognise a prototypical #DiabetesOnAPlate post as stigmatic. Whilst some with T1DM and T2DM did perceive and contest the stigma, T1DM participants did so for their group (but not for T2DM); and there was evidence that some T2DM participants internalised the stigma. These findings support concerns about the everyday, divisive nature of stigmatic representations of diabetes on social network sites, which on the one hand reflect public health discourse and on the other may compromise health policy objectives and exacerbate health inequalities.
1型和2型糖尿病(T1DM和t2dm)患者报告称,媒体——包括新闻、健康宣传和流行文化——是糖尿病污名化表征的主要来源,这损害了他们的身心健康。许多卫生专业人员和广大公众并不认同这种将糖尿病视为耻辱的观点。我们使用Instagram上现有的糖尿病代表,# diabetesonapplate,来研究糖尿病的污名化代表是如何(重新)产生、讨论和争议的。我们的分析发现,与糖尿病被污名化的概念一致,在Instagram上使用# diabetesonapplate标签与放纵饮食的公共卫生话语有关,并与承认这是一种道德违规的帖子有关。随后的一项在线调查发现,没有糖尿病的参与者并没有意识到# diabetesonapplate是一种耻辱。虽然一些T1DM和T2DM患者确实意识到并反对这种耻辱感,但T1DM参与者在他们的群体中是这样做的(而不是T2DM);有证据表明,一些2型糖尿病参与者将这种耻辱内在化。这些发现支持了人们对社交网站上对糖尿病的污名化表述的日常、分裂性质的担忧,这一方面反映了公共卫生话语,另一方面可能损害卫生政策目标并加剧卫生不平等。
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引用次数: 1
What you should know about RACISM-20 in the U.S.: a fact sheet in the time of COVID-19 关于美国RACISM-20,你应该知道什么:新冠肺炎时期的情况介绍
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-05-20 DOI: 10.1080/09581596.2022.2078180
Ryan J. Petteway
ABSTRACT Drawing from social epidemiology literature on structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper uses satire and humor as commentary on mainstream U.S. public health discourse related to the role of “race” (properly understood, racism) in shaping inequities observed via COVID-19. Taking the form of a “RACISM-20” fact sheet, this paper transposes structural racism and COVID-19. In doing so, it accentuates how individualist, ahistoric, and pathologizing “downstream” frames of health risks/solutions curtail productive dialogue and action to advance racial and health equity. In the spirit of “racial emancipatory humor”, this work represents a potential pedagogical tool to discuss and critique dominant frames of racial(ized) risks, “vulnerability”, and responsibility – both in the context of COVID-19 and within broader discourse of racial health inequities, including as related to racialized police violence. In this capacity, this “fact sheet” serves as an example health promotion product of critical resistance and counternarrative.
摘要本文借鉴关于结构性种族主义的社会流行病学文献,以批判种族理论和与叙事力量相关的批判理论为基础,运用讽刺和幽默对美国主流公共卫生话语进行评论,这些话语涉及“种族”(正确理解为种族主义)在塑造新冠肺炎观察到的不平等中的作用。本文以“RACISM-20”概况介绍的形式,将结构性种族主义与新冠肺炎进行了转换。在这样做的过程中,它强调了个人主义、非历史性和病态化的健康风险/解决方案的“下游”框架如何阻碍了促进种族和健康公平的富有成效的对话和行动。本着“种族解放幽默”的精神,这项工作代表了一种潜在的教学工具,可以在新冠肺炎的背景下,以及在更广泛的种族健康不平等的讨论中,包括与种族化警察暴力有关的讨论和批判种族化风险、“脆弱性”和责任的主导框架。以这种身份,这份“情况说明书”是一个具有批判性抵抗和反叙事的健康促进产品的例子。
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引用次数: 0
Emotions of burden, intensive mothering and COVID-19 vaccine hesitancy 负担情绪、密集育儿和COVID-19疫苗犹豫
IF 2.8 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2022-04-11 DOI: 10.1080/09581596.2022.2061917
Lisa Schuster, L. Gurrieri, Paula Dootson
ABSTRACT Addressing mothers’ vaccine hesitancy, which is a state of indecision rather than refusal, may become critical to public health responses to the COVID-19 pandemic. Extant research separately examines how intensive mothering ideology and emotions interact with childhood vaccine hesitancy; however, little is known about the emotions at the intersection of motherhood and vaccine hesitancy. To address this, we seek to understand the emotions experienced by COVID-19 vaccine hesitant mothers who experience the societal pressures arising from the ideology of intensive mothering. Interviews (n = 30) were conducted with women in Australia who identify as mothers and self-report to have concerns about COVID-19 vaccination of their children. The findings suggest ‘emotions of burden’, specifically fear of being a ‘bad mother’ and anticipated guilt about failing to be a ‘good mother’, are experienced by mothers striving to meet societal expectations of intensive mothering though their vaccination decision. These findings provide a more nuanced understanding of mothers’ experiences in making vaccination decisions for their children and lends further empirical support to critiques of intensive mothering ideology as well as public perceptions of vaccine hesitant mothers. Practically, public health campaigns that avoid intimations of ‘bad mothering’ and acknowledge how emotionally burdensome the COVID-19 vaccination decision can be for vaccine hesitant mothers are indicated.
解决母亲的疫苗犹豫(一种优柔寡断而非拒绝的状态)可能对应对COVID-19大流行的公共卫生措施至关重要。现有的研究分别考察了强烈的母亲意识形态和情绪如何与儿童疫苗犹豫相互作用;然而,人们对母亲身份和疫苗犹豫之间的情绪知之甚少。为了解决这个问题,我们试图了解COVID-19疫苗犹豫的母亲所经历的情绪,她们经历了密集育儿意识形态带来的社会压力。对澳大利亚的女性进行了访谈(n = 30),她们认为自己是母亲,并自我报告对子女的COVID-19疫苗接种感到担忧。研究结果表明,“负担情绪”,特别是害怕成为一个“坏母亲”和对未能成为一个“好母亲”的预期内疚,是那些通过接种疫苗决定努力满足社会对强化母亲的期望的母亲所经历的。这些发现提供了对母亲为子女做出疫苗接种决定的经验的更细致的理解,并为对密集的母亲意识形态的批评以及公众对疫苗犹豫不决的母亲的看法提供了进一步的经验支持。实际上,公共卫生运动避免暗示“不良母亲”,并承认COVID-19疫苗接种决定对疫苗犹豫不决的母亲来说是多么沉重的情感负担。
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引用次数: 4
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