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Eryurt MA, Yalçin SS. Zero-dose children in Turkey: regional comparison of pooled data for the period 1990 to 2018. BMC Infect Dis 2022; 22:421. [PMID: 35501702 PMCID: PMC9063378 DOI: 10.1186/s12879-022-07416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization plays a vital role in child health and survival. Zero-dose children are coming increasingly into focus as part of the global Immunization Agenda 2030. Although the percentage of zero-dose children has decreased in Turkey over time, regional/socioeconomic inequalities persist. This study aims to analyze the trend in zero-dose children and the factors associated with this problem in Turkey in light of regional inequalities. METHODS Six data sets (1993, 1998, 2003, 2008, 2013, and 2018) were pooled from the last six Turkey Demographic and Health Surveys (TDHSs). The vaccination module for children aged 12-35 months and variables related to household characteristics, socio-economic, cultural characteristics of parents, bio-demographic/health-related factors were taken from the DHS data. Binary logistic regression analyses were carried out by taking into account the complex sample design of surveys for Turkey in general, the East region, and other regions. RESULTS Significant progress has been made in reducing the number of zero-dose children in Turkey over the last three decades, as it has dropped from 3.2 to 0.9%. The results of multivariate analyses revealed that survey year, household wealth, the mother's level of education, payment of bride price, mother's native language, place of delivery, and the number of antenatal care visits are associated with zero-dose children. Factors associated with zero-dose children also differ between the East region, and other regions. CONCLUSION Public health programs targeting uneducated parents, poor households, lack of social security, Kurdish-speaking mothers, older mothers and those without antenatal care should be implemented to promote childhood immunization.
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Affiliation(s)
- Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Siddika Songül Yalçin
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Mutua MK, Mohamed SF, Porth JM, Faye CM. Inequities in On-Time Childhood Vaccination: Evidence From Sub-Saharan Africa. Am J Prev Med 2021; 60:S11-S23. [PMID: 33191062 DOI: 10.1016/j.amepre.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Vaccination coverage has improved in the past decade, but inequalities persist: the poorest, least educated, and rural communities are left behind. Programming has focused on increasing coverage and reaching the hardest-to-reach children, but vaccination timeliness is equally important because delays leave children vulnerable to infections. This study examines the levels and inequities of on-time vaccination in the Sub-Saharan African region. METHODS The most recent Demographic and Health Surveys or Multiple Indicator Clusters Surveys since 2000 from Sub-Saharan Africa were used to assess on-time vaccination and inequalities by household wealth, maternal education, and place of residence. Inequalities were quantified using slope index of inequality and concentration index. RESULTS The analysis included 153,632 children aged 12-36 months from 40 Sub-Saharan Africa countries. Median on-time vaccination coverage was <50% in all the 4 subregions. Differences in on-time vaccination were observed by place of residence in the Southern (20.8 percentage points, 95% CI=0.8, 40.8), West (17.5 percentage points, 95% CI=5.1, 29.9), and Eastern (20.9 percentage points, 95% CI=6.5, 35.2) regions. Wealth-related inequities were observed in the Southern (22.6 percentage points, 95% CI=4.0, 41.2), Western (30.6 percentage points, 95% CI=19.1, 42.1), and Eastern (26.1 percentage points, 95% CI=8.2, 44.0) regions. Significant education-related differences in on-time vaccination were observed in the Western (20.7 percentage points, 95% CI=10.9, 30.5) and Eastern (21.2 percentage points, 95% CI=7.0, 35.4) regions. CONCLUSIONS On-time vaccination coverage was low in all subregions and nearly all countries. Inequalities in on-time immunization by household wealth, place of residence, and education existed in most countries. Concrete strategies to improve levels of timeliness are needed. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya.
| | | | - Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Cheikh M Faye
- African Population and Health Research Center, Dakar, Senegal
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NAS MA, ATABAY G, ŞAKİROĞLU F, ÇAYIR Y. Vaccine Rejection In A University’s Training Family Health Centers. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.744687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
In Turkey, primary care staffs have observed an increased rate of vaccination refusal in recent years. The aim of the present study was to determine the prevalence of vaccination refusal and hesitancy in Turkey, in addition to the demographic features and underlying reasons. The present descriptive cross-sectional study was conducted in İstanbul and Tekirdağ, two big Turkish cities that are exposed to widespread internal migration. To reflect Turkey’s demographic structure, 1004 participants were selected using cluster sampling based on birthplace, age, and level of education, from all individuals who attended family medicine outpatient clinics at Namık Kemal University and Şişli Hamidiye Etfal Training and Research Hospital. A face-to-face questionnaire method was used. Data show that this decline was mainly the result of the increasing rate of vaccine rejection and hesitation, for which the most important reason was found to be distrust of vaccine companies. It can be concluded that individuals who display vaccine refusal and hesitation are mostly born in the developed geographical regions of Turkey and have high income and educational levels. According to these results, we anticipate that vaccination rates may fall in Turkey in the coming years.
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Affiliation(s)
| | - Dilek Toprak
- Head of Family Medicine Depertmant, Namık Kemal Unıversity Medical School, Tekirdağ, Turkey
| | - Elif Serap Esen
- Şişli Hamidiye Etfal Research and Training Hospital Family Medicine Depertmant, İstanbul, Turkey
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Özer M, Fidrmuc J, Eryurt MA. Maternal education and childhood immunization in Turkey. HEALTH ECONOMICS 2018; 27:1218-1229. [PMID: 29790241 PMCID: PMC6055740 DOI: 10.1002/hec.3770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
We study the causal effect of maternal education on childhood immunization rates. We use the Compulsory Education Law of 1997, and the differentiation in its implementation across regions, as instruments for schooling of young mothers in Turkey. The Compulsory Education Law increased the compulsory years of schooling of those born after 1986 from 5 to 8 years. We find that education of mothers increases the probability of completing the full course of diphtheria, pertussis, and tetanus and Hepatitis B vaccinations for their children. The results are robust to variations in regression specification and including various individual and community variables.
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Affiliation(s)
- Mustafa Özer
- Faculty of Economics and Administrative Science, Kilis Yedi Aralık University, Kilis, Turkey
- Economics and Finance Department, University of Portsmouth, Portsmouth, UK
| | - Jan Fidrmuc
- Department of Economics and Finance and CEDI, Brunel University, Uxbridge, UK
- University of Social and Administrative Affairs, Havířov, Czech Republic
- Institute for Strategy and Analysis (ISA), Government Office of the Slovak Republic
- CESifo Munich, Germany
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
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ERDEM Ö, TOKTAŞ İ, ÇELEPKOLU T, DEMİR V. The Characteristics of Families who rejected Vaccination during the Mop-up Oral Polio Vaccination Campaign and Their Reasons of Rejection: A Family Health Center Experience. KONURALP TIP DERGISI 2017. [DOI: 10.18521/ktd.291931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ozkaya E, Cambaz N, Kolsuz LD, Aycan N, Calis S, Samanci N. Vaccination coverage and risk factors for incomplete vaccination in children with recurrent wheeze. Allergol Immunopathol (Madr) 2011; 39:222-7. [PMID: 21208719 DOI: 10.1016/j.aller.2010.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/02/2010] [Accepted: 07/06/2010] [Indexed: 11/16/2022]
Abstract
AIM To determine the possible impact of recurrent wheeze on immunisation status in the first three years of life. METHOD A cross-sectional case control study of 288 children less than three years of age with a history of recurrent wheezing, hospitalised at a single centre for wheeze; and a control group of 190 children with no prior history of wheezing. Vaccination charts of all children were analysed according to the National Immunisation Schedule. Additionally, some associated data were collected through a questionnaire to the parents. RESULTS Children with recurrent wheezing during the first three years of life were less likely to be vaccinated against BCG (Bacillus-Calmette-Guerin), hepatitis B, Hib (Haemophilus influenza type B), and MMR (Measles, Mumps, Rubella) (p < 0.001). A significant inverse association was also found between the number of wheezy episodes and the number of vaccine doses received. The odds ratio of incomplete vaccination in children with recurrent wheeze was 10.6 (95% CI, 2.96 to 38.1). CONCLUSION Children under three years of age with recurrent wheeze run a high risk of incomplete immunisation. Efforts should be therefore made to insure that such children receive adequate vaccination.
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Affiliation(s)
- E Ozkaya
- Department of Pediatrics, Vakıf Gureba Education and Research Hospital, Istanbul, Turkey.
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Impact of maternal anxiety level on the childhood vaccination coverage. Eur J Pediatr 2010; 169:1397-401. [PMID: 20607284 DOI: 10.1007/s00431-010-1247-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
The mother's mental state as a risk factor for the children's vaccination status in developing countries has received little attention. The aim of this study was to determine the association between childhood vaccination coverage and maternal anxiety. A total of 195 consecutive infants and their mothers attending a tertiary teaching hospital, department of pediatric outpatient center between January 2008 and September 2009 were included in the study. One hundred five infants who have incomplete vaccination schedule (according to the National Immunization Schedule) were matched with 90 controls (fully vaccinated) and their mothers self-report measure of anxiety level using the State-Trait Anxiety Inventory (STAI), a psychiatric screening instrument. The chi-square test and the logistic regression were used in the statistical analysis. High maternal anxiety levels determined by STAI was associated with increased risk of incomplete vaccination status in infants (odds ratio 4.35, 95% confidence interval 1.87-8.79).This association remained significant after controlling for sociodemographic factors. High maternal anxiety scores may result in incomplete vaccination status in children younger than 3 years.
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Usman HR, Kristensen S, Rahbar MH, Vermund SH, Habib F, Chamot E. Determinants of third dose of diphtheria-tetanus-pertussis (DTP) completion among children who received DTP1 at rural immunization centres in Pakistan: a cohort study. Trop Med Int Health 2009; 15:140-7. [PMID: 19930140 DOI: 10.1111/j.1365-3156.2009.02432.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus-pertussis (DTP3) after having received the first dose (DTP1). A cohort study was conducted to identify the factors predicting three doses of diphtheria-tetanus-pertussis (DTP3) completion among children who have received DTP1 at six centres of Expanded Programme on Immunization (EPI) in rural Pakistan. METHOD We analyzed a cohort of mother-child pairs enrolled at DTP1 between November 2005 and May 2006 in the standard care group of a larger randomized controlled trial. Data were collected from mothers on a structured questionnaire at enrollment, and each child was followed up at clinic visits for 90 days to record dates of DTP2 and DTP3. Multivariable log-binomial regression analysis was performed to identify the independent predictors of DTP3 completion. RESULTS Only 39% (149/378) of enrolled children completed DTP3 during the follow-up period. After adjusting for the centre of enrollment in multivariable analysis, DTP3 completion was higher among children who were < or =60 days old at enrolment [adjusted risk ratio (Adj. RR) 1.39, 95% confidence interval (CI): 1.06-1.82], who were living in a household with monthly household income >Rs. 3000 (US$ 50) (Adj. RR 1.76, 95% CI: 1.16-2.65), and who were living < or =10 min away from EPI centre (Adj. RR 1.31, 95% CI: 1.04-1.66). CONCLUSIONS Interventions targeting childhood immunization dropouts should focus on bringing more children to EPI centres on-time for initial immunization. Relocation of existing EPI centres and creation of new EPI centres at appropriate locations may decrease the travel time to the EPI centres and result in fewer immunization dropouts.
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Affiliation(s)
- Hussain R Usman
- Department of Epidemiology, University of Alabama at Birmingham, AL 35294-0022, USA.
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Mitchell AD, Bossert TJ, Yip W, Mollahaliloglu S. Health worker densities and immunization coverage in Turkey: a panel data analysis. HUMAN RESOURCES FOR HEALTH 2008; 6:29. [PMID: 19102741 PMCID: PMC2631449 DOI: 10.1186/1478-4491-6-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 12/22/2008] [Indexed: 05/27/2023]
Abstract
BACKGROUND Increased immunization coverage is an important step towards fulfilling the Millennium Development Goal of reducing childhood mortality. Recent cross-sectional and cross-national research has indicated that physician, nurse and midwife densities may positively influence immunization coverage. However, little is known about relationships between densities of human resources for health (HRH) and vaccination coverage within developing countries and over time. The present study examines HRH densities and coverage of the Expanded Programme on Immunization (EPI) in Turkey during the period 2000 to 2006. METHODS The study is based on provincial-level data on HRH densities, vaccination coverage and provincial socioeconomic and demographic characteristics published by the Turkish government. Panel data regression methodologies (random and fixed effects models) are used to analyse the data. RESULTS Three main findings emerge: (1) combined physician, nurse/midwife and health officer density is significantly associated with vaccination rates--independent of provincial female illiteracy, GDP per capita and land area--although the association was initially positive and turned negative over time; (2) HRH-vaccination rate relationships differ by cadre of health worker, with physician and health officers exhibiting significant relationships that mirror those for aggregate density, while nurse/midwife densities are not consistently significant; (3) HRH densities bear stronger relationships with vaccination coverage among more rural provinces, compared to those with higher population densities. CONCLUSION We find evidence of relationships between HRH densities and vaccination rates even at Turkey's relatively elevated levels of each. At the same time, variations in results between different empirical models suggest that this relationship is complex, affected by other factors that occurred during the study period, and warrants further investigation to verify our findings. We hypothesize that the introduction of certain health-sector policies governing terms of HRH employment affected incentives to provide vaccinations and therefore relationships between HRH densities and vaccination rates. National-level changes experienced during the study period--such as a severe financial crisis--may also have affected and/or been associated with the HRH-vaccination rate link. While our findings therefore suggest that the size of a health workforce may be associated with service provision at a relatively elevated level of development, they also indicate that focusing on per capita levels of HRH may be of limited value in understanding performance in service provision. In both Turkey and elsewhere, further investigation is needed to corroborate our results as well as gain deeper understanding into relationships between health worker densities and service provision.
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Affiliation(s)
| | | | - Winnie Yip
- University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Salih Mollahaliloglu
- Harvard School of Public Health, Boston, Massachusetts, USA
- School of Public Health, Ministry of Health, Ankara, Turkey
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Yahata Y, Imai H, Fukuda Y, Zhang Y, Satoh T, Nakao H, Moji K, Amano K. BCG immunization age in urban and rural areas of Akita Prefecture, Japan. J Physiol Anthropol 2007; 26:547-51. [PMID: 18092511 DOI: 10.2114/jpa2.26.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BCG immunization, utilizing whole-body coordination, is a highly cost-effective means of health intervention for preventing miliary tuberculosis (TB) and TB meningitis. In this study, we investigated the appropriate age by which a child should have completed his or her BCG immunization and discuss the current BCG immunization rate in Akita Prefecture, Japan. BCG immunization rates in urban and rural areas were 90.1% and 80.7%, respectively. Our immunization data were lower than the World Health Organization's (WHO) recommended rate. Immunization coverage rates in urban settings were higher than those in rural areas among infants four months to fifteen months of age, except for those six months old. We recommend: (1) completing BCG immunization by the age of twelve months, (2) preparing and educating parents for BCG immunization by means of a health policy, and (3) changing BCG immunization methods from group to individual inoculation. Immunization coverage rates may be increased or maintained to prevent miliary TB and TB meningitis.
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Affiliation(s)
- Yuichiro Yahata
- Department of Public Health, National Institute of Public Health, Saitama, Japan.
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Akmatov MK, Kretzschmar M, Krämer A, Mikolajczyk RT. Determinants of childhood vaccination coverage in Kazakhstan in a period of societal change: Implications for vaccination policies. Vaccine 2007; 25:1756-63. [PMID: 17229498 DOI: 10.1016/j.vaccine.2006.11.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 11/10/2006] [Accepted: 11/13/2006] [Indexed: 11/24/2022]
Abstract
After the fall of the Soviet Union countries in Central Asia have undergone large changes. In Kazakhstan the vaccination coverage decreased between 1990 and 1995, which resulted in an increased incidence of some vaccine-preventable diseases, e.g. diphtheria and measles. In this study we examined which factors affected the vaccination status of children in Kazakhstan and whether they resemble patterns observed in developing or developed countries. We found a mixed pattern of risk factors, consistent with the status of Kazakhstan as a transitional economy. Especially prominent was the relatively high education of the women and good access to the medical care system.
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Affiliation(s)
- Manas K Akmatov
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany.
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Torun SD, Bakırcı N. Vaccination coverage and reasons for non-vaccination in a district of Istanbul. BMC Public Health 2006; 6:125. [PMID: 16677375 PMCID: PMC1464125 DOI: 10.1186/1471-2458-6-125] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 05/05/2006] [Indexed: 11/20/2022] Open
Abstract
Background In order to control and eliminate the vaccine preventable diseases it is important to know the vaccination coverage and reasons for non-vaccination. The primary objective of this study was to determine the complete vaccination rate; the reasons for non-vaccination and the predictors that influence vaccination of children. The other objective was to determine coverage of measles vaccination of the Measles Immunization Days (MID) 2005 for children aged 9 month to 6 years in a region of Umraniye, Istanbul, Turkey. Methods A '30 × 7' cluster sampling design was used as the sampling method. Thirty streets were selected at random from study area. Survey data were collected by a questionnaire which was applied face to face to parents of 221 children. A Chi-square test and logistic regression was used for the statistical analyses. Content analysis method was used to evaluate the open-ended questions. Results The complete vaccination rate for study population was 84.5% and 3.2% of all children were totally non-vaccinated. The siblings of non-vaccinated children were also non-vaccinated. Reasons for non-vaccination were as follows: being in the village and couldn't reach to health care services; having no knowledge about vaccination; the father of child didn't allow vaccination; intercurrent illness of child during vaccination time; missed opportunities like not to shave off a vial for only one child. In logistic regression analysis, paternal and maternal levels of education and immigration time of both parents to Istanbul were found to influence whether children were completely vaccinated or non-vaccinated. Measles vaccination coverage during MID was 79.3%. Conclusion Efforts to increase vaccination coverage should take reasons for non-vaccination into account.
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Affiliation(s)
- Sebahat D Torun
- Marmara University Medical Faculty Department of Public Health, Istanbul, Turkey
| | - Nadi Bakırcı
- Assistant Professor of Public Health, Marmara University Medical Faculty Department of Public Health, Istanbul, Turkey
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