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Gustafsson, Per E
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Publications (10 of 80) Show all publications
Wagenius, C. M., San Sebastian, M., Gustafsson, P. E. & Goicolea, I. (2019). Access for all?: Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden. Scandinavian Journal of Public Health, 47
Open this publication in new window or tab >>Access for all?: Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden.

METHODS: The study used data from the Health on Equal Terms survey (age group 16-24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables.

RESULTS: Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services.

CONCLUSIONS: These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.

Keywords
Inequity, Sweden, access to healthcare, youth
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150573 (URN)10.1177/1403494818774965 (DOI)000458888900001 ()29779450 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-04-16Bibliographically approved
San Sebastian, M., Mosquera, P. A. & Gustafsson, P. E. (2019). Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis. BMC Public Health, 19, Article ID 202.
Open this publication in new window or tab >>Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 202Article in journal (Refereed) Published
Abstract [en]

Background: Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987-2013.

Methods: An ecological controlled interrupted time series design, with pre-intervention period defined as 1987-1993 and post-intervention period 1994-2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers.

Results: Impressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences.

Conclusions: Taken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Ischemic heart disease, Morbidity, Mortality, Interrupted time series analysis, Intervention, Northern Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-157210 (URN)10.1186/s12889-019-6514-x (DOI)000459132800003 ()30770750 (PubMedID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
Jonsson, F., San Sebastian, M., Hammarström, A. & Gustafsson, P. E. (2018). Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis. Health and Place, 52, 127-134
Open this publication in new window or tab >>Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis
2018 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 52, p. 127-134Article in journal (Refereed) Published
Abstract [en]

This study explains neighbourhood deprivation inequalities in adult health for a northern Swedish cohort by examining the contribution of socio-economic and psychosocial determinants from adolescence (age 16), young adulthood (age 21) and midlife (age 42) to the disparity. Self-reported information from 873 participants was drawn from questionnaires, with complementary neighbourhood register data. The concentration index was used to estimate the inequality while decomposition analyses were run to attribute the disparity to its underlying determinants. The results suggest that socio-economic and psychosocial factors in midlife explain a substantial part, but also that the inequality can originate from conditions in adolescence and young adulthood.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Decomposition analysis, Life course, Neighbourhood inequality, Northern Sweden, Social determinants
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150249 (URN)10.1016/j.healthplace.2018.05.010 (DOI)000439053800014 ()29886129 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0451Swedish Research Council Formas, 259-2012-37Västerbotten County Council, 355661Västerbotten County Council, 402131
Available from: 2018-07-25 Created: 2018-07-25 Last updated: 2018-11-12Bibliographically approved
Mosquera, P. A., San Sebastian, M., Ivarsson, A. & Gustafsson, P. E. (2018). Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population. International Journal for Equity in Health, 17, Article ID 102.
Open this publication in new window or tab >>Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population
2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 102Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Socioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. However, research on inequalities in antecedent cardiovascular risk factors (CVRFs), and particularly what underpins them, is scarce. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities.

METHODS: Participants (N = 12,481) comprised all 40- and 50-years old women and men who participated in the regional Västerbotten Intervention Programme in Northern Sweden during 2008, 2009 and 2010. All participants completed a questionnaire on behavioural and psychosocial conditions, and underwent measurements with respect to eight CVRFs (body mass index; waist circumference; total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic/diastolic blood pressure; glucose tolerance). Data on cardiovascular risk, psychosocial and health behaviours were linked to national register data on income and other socioeconomic and demographic factors. To estimate income inequalities in each CVRF concentration indexes were calculated, and to examine the contribution of the underlying determinants to the observed inequalities a Wagstaff-type decomposition analysis was performed separately for women and men.

RESULTS: Health inequalities ranged from small to substantial with generally greater magnitude in women. The highest inequalities among women were seen in BMI, triglycerides and HDL-cholesterol (Concentration index = - 0.1850; - 0.1683 and - 0.1479 respectively). Among men the largest inequalities were seen in glucose regulation, BMI and abdominal obesity (Concentration index = - 0.1661; - 0.1259 and - 0.1172). The main explanatory factors were, for both women and men socioeconomic conditions (contributions ranging from 54.8 to 76.7% in women and 34.0-72.6% in men) and health behaviours (contributions ranging from 6.9 to 20.5% in women and 9.2 to 26.9% in men). However, the patterns of specific dominant explanatory factors differed between CVRFs and genders.

CONCLUSION: Taken together, the results suggest that the magnitude of income-related inequalities in CVRFs and their determinants differ importantly between the risk factors and genders, a variation that should be taken into consideration in population interventions aiming to prevent inequalities in manifest cardiovascular disease.

Keywords
Cardiovascular risk factors, Decomposition analysis, Income inequality, Middle age, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150576 (URN)10.1186/s12939-018-0804-2 (DOI)000438822600001 ()30005665 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-2725Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0451Swedish Research Council, 2008-7491
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-01-31Bibliographically approved
Trygg, N., Gustafsson, P. E. & Månsdotter, A. (2018). Does it add up?: intersectional inequalities in mental health in the Swedish adult population. Paper presented at 11th European Public Health Conference Winds of change: towards new ways of improving public health in Europe Ljubljana, Slovenia, 28 November–1 December, 2018.. European Journal of Public Health, 28, 95-95
Open this publication in new window or tab >>Does it add up?: intersectional inequalities in mental health in the Swedish adult population
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 95-95Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Social inequalities in mental health is a growing public health concern, but has so far been approached in a disentangled manner. To better capture the complexity of reality with multiple interlocking axes of inequalities, intersectionality theory instead highlights how health is expressed in the interactions between these axes. This may expose important knowledge about particular risk groups and protective factors. In this study, we explore how mental health is distributed across intersections of gender, income, education, class, country of birth and sexual orientation as well as their interaction effects.

Methods: The study population (N = 52,743) consists of a yearly random sample of the Swedish population 26-84 years between 2010 and 2015, from The Health on Equal Terms survey coordinated by the Public Health Agency of Sweden. Mental health was measured through self-administered General Health Questionnaire (GHQ)-12, and gender, income, education, class, country of birth and sexual orientation through survey and linked register data. Intersectional inequalities in mental health were estimated for all pairwise combination of inequalities by joint disparity, excess intersectional disparity and referent disparities.

Results: The prevalence of symptoms of poor mental health were highest among non-heterosexuals with low income (40%) followed by non-heterosexual women (38%). However, intersectional inequalities showed unpredictable patterns; among non-heterosexuals, those with long education reported more symptoms (36%) than those with short education (31%). The excess intersectional disparity showed synergistic effects for income in combination with education; country of birth and class, but antagonistic effects for the intersections of gender and income as well as education and class.

Conclusions: Multiple inequalities in mental health may add up in various and unexpected manners, which needs to be considered in efforts for equity in mental health.

Key messages:

  • Mental health is distributed in various and unexpected manners across intersections of inequality dimensions.

  • Intersectionality theory may be useful when addressing mental health inequalities.

Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-157988 (URN)10.1093/eurpub/cky213.272 (DOI)000461384200222 ()
Conference
11th European Public Health Conference Winds of change: towards new ways of improving public health in Europe Ljubljana, Slovenia, 28 November–1 December, 2018.
Note

Supplement 4

Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-09Bibliographically approved
Ramadani, R. V., Mosquera, P. A., San Sebastián, M. & Gustafsson, P. E. (2018). The moderating effect of income on the relationship between body mass index and health-related quality of life in Northern Sweden. Scandinavian Journal of Public Health
Open this publication in new window or tab >>The moderating effect of income on the relationship between body mass index and health-related quality of life in Northern Sweden
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: This study aimed to investigate the relationship between body mass index (BMI) and health-related quality of life (HRQoL) and whether this relationship is influenced by the level of income in Northern Sweden. Overweight and obesity are rising major public health problems which also affect HRQoL. While socioeconomic inequalities in health are persisting or increasing in many countries, including Sweden, little attention has been paid to the more complex roles of income in relation to health.

METHODS: Data were drawn from a 2014 cross-sectional survey from Northern Sweden (Health on Equal Terms), comprising individuals aged 20-84 years ( N = 20,082 individuals included for analysis). BMI and HRQoL were self-reported and individual disposable income in 2012 was retrieved from population registers. Multiple linear regressions were performed with HRQoL scores regressed on BMI and income, their interaction and additional covariates.

RESULTS: The underweight, overweight and obesity groups reported significantly lower HRQoL compared to the normal weight group. Moreover, the relationship between BMI and HRQoL varied significantly by level of income, with a stronger association among those with the lowest level of income.

CONCLUSIONS: Income has a role as an effect modifier in the relationship between BMI and HRQoL that can be construed as an indirect income inequality. Efforts to promote HRQoL in populations should consider the different impact of being overweight and obese in different socioeconomic groups.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
obesity, Sweden, health-related quality of life, income, inequality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150608 (URN)10.1177/1403494818761418 (DOI)29516787 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014- 2725Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0451
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2019-04-04
Szilcz, M., Mosquera, P. A., Sebastián, M. S. & Gustafsson, P. E. (2018). Time trends in absolute and relative socioeconomic inequalities in leisure time physical inactivity in northern Sweden. Scandinavian Journal of Public Health, 46(1), 112-123
Open this publication in new window or tab >>Time trends in absolute and relative socioeconomic inequalities in leisure time physical inactivity in northern Sweden
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 1, p. 112-123Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim was to investigate the time trends in educational, occupational, and income-related inequalities in leisure time physical inactivity in 2006, 2010, and 2014 in northern Swedish women and men.

METHODS: This study was based on data obtained from the repeated cross-sectional Health on Equal Terms survey of 2006, 2010, and 2014. The analytical sample consisted of 20,667 (2006), 31,787 (2010), and 21,613 (2014) individuals, aged 16-84. Logistic regressions were used to model the probability of physical inactivity given a set of explanatory variables. Slope index of inequality (SII) and relative index of inequality (RII) were used as summary measures of the social gradient in physical inactivity. The linear trend in inequalities and difference between gender and years were estimated by interaction analyses.

RESULTS: The year 2010 displayed the highest physical inactivity inequalities for all socioeconomic position indicators, but educational and occupational inequalities decreased in 2014. However, significant positive linear trends were found in absolute and relative income inequalities. Moreover, women had significantly higher RII of education in physical inactivity in 2014 and significantly higher SII and RII of income in physical inactivity in 2010, than did men in the same years.

CONCLUSIONS: The recent reduction in educational and occupational inequalities following the high inequalities around the time of the great recession in 2010 suggests that the current policies might be fairly effective. However, to eventually alleviate inequities in physical inactivity, the focus of the researchers and policymakers should be directed toward the widening trends of income inequalities in physical inactivity.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Physical inactivity, relative index of inequality, slope index of inequality, socioeconomic inequality, time trend
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143318 (URN)10.1177/1403494817713123 (DOI)000428758000016 ()28707564 (PubMedID)
Note

Special Issue

Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Waenerlund, A.-K., Mosquera, P., Gustafsson, P. E. & San Sebastian, M. (2018). Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993–2010. Scandinavian Journal of Public Health, Article ID 1403494818790406.
Open this publication in new window or tab >>Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993–2010
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494818790406Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: Research is scarce regarding studies on income and educational inequality trends in cardiovascular disease in Sweden. The aim of this study was to assess trends in educational and income inequalities in first hospitalizations due to cardiovascular disease (CVD) from 1993 to 2010 among middle-aged women and men in Northern Sweden.

METHODS: The study comprised repeated cross-sectional register data from year 1993-2010 of all individuals aged 38-62 years enrolled in the Västerbotten Intervention Programme (VIP). Data included highest educational level, total earned income and first-time hospitalization for CVD from national registers. The relative and slope indices of inequality (RII and SII, respectively) were used to estimate educational and income inequalities in CVD for six subsamples for women and men, and interaction analyses were used to estimate trends across time periods.

RESULTS: Educational RII and SII were stable in women, while they decreased in men. Income inequalities in CVD developed differently compared with educational inequalities, with RII and SII for both men and women increasing during the study period, the most marked for RII in women rising from 1.52 in the 1990s to 2.62 in the late 2000s.

CONCLUSIONS: The trend of widening income inequalities over 18 years in the middle-aged in Northern Sweden, in the face of stable or even decreasing educational inequalities, is worrisome from a public health perspective, especially as Swedish authorities monitor socioeconomical inequalities exclusively by education. The results show that certain social inequalities in CVD rise and persist even within a traditionally egalitarian welfare regime.

Keywords
Inequalities, Sweden, cardiovascular diseases, education, income
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; Social Medicine; Epidemiology
Identifiers
urn:nbn:se:umu:diva-154002 (URN)10.1177/1403494818790406 (DOI)30113264 (PubMedID)
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-04-04
Boldis, B. V., San Sebastian, M. & Gustafsson, P. E. (2018). Unsafe and unequal: a decomposition analysis of income inequalities in fear of crime in northern Sweden. International Journal for Equity in Health, 17, Article ID 110.
Open this publication in new window or tab >>Unsafe and unequal: a decomposition analysis of income inequalities in fear of crime in northern Sweden
2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 110Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Fear of crime is not solely an individual concern, but as a social determinant of health structured by gender it also poses a threat to public health. Social inequalities are thought to represent a breeding ground for fear of crime, which subsequently may contribute to social inequalities in health. However, little research has focused on social inequalities in fear of crime, particularly in Sweden where the level of fear of crime and income and gender inequalities are comparatively low. With a conceptual model as a point of departure, the present study aimed to estimate and decompose income-related inequalities and explore gender differences in fear of crime in northern Sweden.

METHODS: Participants (N = 22,140; 10,220 men and 11,920 women aged 16 to 84 years) came from the Health on Equal Terms cross-sectional survey with linked register data, carried out in the four northernmost counties of Sweden in 2014. Disposable income was used as the socio-economic indicator, fear of crime as the binary outcome variable, and sociodemographic characteristics, residential context, socio-economic and material conditions and psychosocial conditions as explanatory factors. Concentration curve and concentration index were used to estimate the income inequality in fear of crime, and decomposition analysis to identify the key determinants of the inequalities, in collapsed and gender-stratified analyses.

RESULTS: Substantial gender differences were found in the prevalence of fear of crime (20.8% in women and 3.5% and men) and among the contributing factors to fear of crime. Additionally, the analyses revealed considerable income inequalities in fear of crime in the northern Swedish context (C = - 0.219). Gender, socio-economic and material, and psychosocial conditions explained the most in income inequalities of fear of crime in the total population.

CONCLUSIONS: The existing gender and socio-economic inequities need to be approached as a greater structural problem to mitigate inequalities in fear of crime. Further research is needed to reveal more aspects of income inequalities in fear of crime and to develop efforts to create safe environments for all.

Keywords
Concentration index, Decomposition analysis, Fear of crime, Gender, Income inequality, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Work
Identifiers
urn:nbn:se:umu:diva-150575 (URN)10.1186/s12939-018-0823-z (DOI)000440468000001 ()30068322 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014–0451
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-09-04Bibliographically approved
San Sebastian, M., Mosquera, P. & Gustafsson, P. E. (2018). Whose income is more important: mine, yours or ours? Income inequality and mental health in northern Sweden. European Journal of Public Health, 28(6), 1056-1061
Open this publication in new window or tab >>Whose income is more important: mine, yours or ours? Income inequality and mental health in northern Sweden
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1056-1061Article in journal (Refereed) Published
Abstract [en]

Background: Three main explanations of the relationship between income and population health have been identified: the absolute, the contextual and the relative income hypotheses. The evidence about their relevance particularly in egalitarian societies is, however, inconsistent. This study aimed to test the three hypotheses in relation to psychological distress in northern Sweden.

Methods: Data come from the 2014 cross-sectional survey from the four northern-most counties in Sweden, and included people aged 25-84 years (n = 21 004). Psychological distress was measured by the General Health Questionnaire-12 and income information came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzhaki index. Prevalence ratios (PR) were calculated from log-binomial regression analyses.

Results: A gradient in poor mental health was observed across quintiles of individual income, with the poorest substantially more likely to report poor health compared with the highest quintile (PR = 1.56; 95% CI = 1.19, 2.04). Second, municipalities in the quintiles 2-3 of the Gini coefficient had a better mental health compared with those in the most equal municipalities. Third, a gradient in poor mental health across quintiles of relative deprivation was also found, with the most deprived quintile the most likely to report poor health (PR = 1.37; 95% CI = 1.06, 1.76).

Conclusion: This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap may be necessary in order to reduce psychosocial distress differences in northern Sweden.

Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150577 (URN)10.1093/eurpub/cky110 (DOI)000456673500015 ()29982407 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-2725Forte, Swedish Research Council for Health, Working Life and Welfare, 2014- 0451Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00236
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-02-20Bibliographically approved
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