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Sudat SEK, Huang Q, Szwerinski N, Romanelli RJ, Azar KMJ. Changes in Healthcare Utilization After Lifestyle Intervention for Weight Loss. Am J Prev Med 2024; 66:619-626. [PMID: 37907133 PMCID: PMC10957326 DOI: 10.1016/j.amepre.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. METHODS Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22. RESULTS Compared to matched nonparticipants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). CONCLUSIONS Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.
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Affiliation(s)
- Sylvia E K Sudat
- Sutter Health, Center for Health Systems Research, Walnut Creek, California.
| | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | - Nina Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | | | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, California; Sutter Health, Institute for Advancing Health Equity, Sacramento, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, Griffin BA, Zambon A, Barter P, Fruchart JC, Eckel RH, Matsuzawa Y, Després JP. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020; 16:177-189. [PMID: 32020062 PMCID: PMC7027970 DOI: 10.1038/s41574-019-0310-7] [Citation(s) in RCA: 695] [Impact Index Per Article: 173.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 02/06/2023]
Abstract
Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.
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Affiliation(s)
- Robert Ross
- School of Kinesiology and Health Studies, School of Medicine, Department of Endocrinology and Metabolism, Queen's University, Kingston, ON, Canada.
| | - Ian J Neeland
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shizuya Yamashita
- Departments of Cardiovascular Medicine and Community Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Iris Shai
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jaap Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands
| | - Paolo Magni
- Department of Pharmacological and Biomolecular Sciences, Universita' degli Studi di Milano, Milan, Italy
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) MultiMedica, Sesto San Giovanni, Italy
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo, Medical School Hospital, São Paulo, Brazil
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Benoit Arsenault
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Ada Cuevas
- Department of Clinical Nutrition and Metabolism, Clínica Las Condes, Santiago, Chile
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bruce A Griffin
- Department of Nutritional Sciences, University of Surrey, Guildford, UK
| | - Alberto Zambon
- Department of Medicine - DIMED, University of Padua, Padova, Italy
| | - Philip Barter
- School of Medical Sciences, University of New South Wales Australia, Sydney, NSW, Australia
| | | | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, and Division of Cardiology, Anschutz University of Colorado School of Medicine, Aurora, CO, USA
| | - Yuji Matsuzawa
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Jean-Pierre Després
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Schousboe JT, Kats AM, Langsetmo L, Taylor BC, Vo TN, Kado DM, Fink HA, Ensrud KE. Associations of recent weight loss with health care costs and utilization among older women. PLoS One 2018; 13:e0191642. [PMID: 29377919 PMCID: PMC5788355 DOI: 10.1371/journal.pone.0191642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC) costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years) enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI), weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars), a 15% increase in outpatient costs ($329 [95% C.I. −1 to 660]), and odds ratios of 1.42 (95% CI, 1.14 to 1.76) for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03) for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.
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Affiliation(s)
- John T. Schousboe
- HealthPartners Institute, HealthPartners, Minneapolis, Minnesota, United States of America
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Allyson M. Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Brent C. Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Tien N. Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Deborah M. Kado
- University of California, San Diego, California, United States of America
| | - Howard A. Fink
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
- Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Kristine E. Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
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Elgart JF, Prestes M, Gonzalez L, Rucci E, Gagliardino JJ. Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America. PLoS One 2017; 12:e0189755. [PMID: 29261739 PMCID: PMC5738071 DOI: 10.1371/journal.pone.0189755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/03/2017] [Indexed: 11/21/2022] Open
Abstract
AIMS Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D. METHODS This observational study utilized data from the QUALIDIAB database on 3,099 T2D patients seen in Diabetes Centers in Argentina, Chile, Colombia, Peru, and Venezuela. Data were grouped according to body mass index (BMI) as Normal (18.5≤BMI<25), Overweight (25≤BMI<30), and Obese (BMI≥30). Thereafter, we assessed clinical and metabolic data and cost of drug treatment in each category. Statistical analyses included group comparisons for continuous variables (parametric or non-parametric tests), Chi-square tests for differences between proportions, and multivariable regression analysis to assess the association between BMI and monthly cost of drug treatment. RESULTS Although all groups showed comparable degree of glycometabolic control (FBG, HbA1c), we found significant differences in other metabolic control indicators. Total cost of drug treatment of hyperglycemia and associated cardiovascular risk factors (CVRF) increased significantly (p<0.001) with increment of BMI. Hyperglycemia treatment cost showed a significant increase concordant with BMI whereas hypertension and dyslipidemia did not. Despite different values and percentages of increase, this growing cost profile was reproduced in every participating country. BMI significantly and independently affected hyperglycemia treatment cost. CONCLUSIONS Our study shows for the first time that BMI significantly increases total expenditure on drugs for T2D and its associated CVRF treatment in Latin America.
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Affiliation(s)
- Jorge Federico Elgart
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Mariana Prestes
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Lorena Gonzalez
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
- School of Health Economics and Management of Healthcare Organizations, Faculty of Economic Sciences, National University of La Plata, La Plata, Argentina
| | - Enzo Rucci
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
- III-LIDI, Faculty of Informatics, National University of La Plata, La Plata, Argentina
| | - Juan Jose Gagliardino
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
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Holzapfel C, Cresswell L, Ahern AL, Fuller NR, Eberhard M, Stoll J, Mander AP, Jebb SA, Caterson ID, Hauner H. The challenge of a 2-year follow-up after intervention for weight loss in primary care. Int J Obes (Lond) 2014; 38:806-11. [PMID: 24030517 PMCID: PMC4052429 DOI: 10.1038/ijo.2013.180] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/25/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many weight loss programmes show short-term success, but long-term data in larger studies are scarce, especially in community settings. Attrition is common and complicates the interpretation of long-term outcomes. OBJECTIVE To investigate 2-year outcomes and explore issues of attrition and missing data. SUBJECTS A total of 772 overweight and obese adults recruited by primary care practices in Australia, Germany and the UK and randomised to a 12-month weight loss intervention delivered in a commercial programme (CP) or in standard care (SC). MEASUREMENT Weight change from 0-24 and 12-24 months including measured weights only and measured and self-reported weights, using last observation carried forward (LOCF), baseline observation carried forward (BOCF), completers-only and missing-at-random (MAR) analyses. RESULTS A total of 203 participants completed the 24-month visit. Using measured weights only, there was a trend for greater 24-month weight loss in CP than in SC, but the difference was only statistically significant in the LOCF and BOCF analyses: LOCF: -4.14 vs -1.99 kg, difference adjusted for centre -2.08 kg, P<0.001; BOCF: -1.33 vs -0.74 kg, adjusted difference -0.60 kg, P=0.032; completers: -4.76 vs -2.99 kg, adjusted difference -1.53 kg, P=0.113; missing at random: -3.00 vs -1.94 kg, adjusted difference -1.04 kg, P=0.150. Both groups gained weight from 12-24 months and weight regain was significantly (P<0.001) greater for CP than for SC in all analysis approaches. Inclusion of self-reported weights from a further 138 participants did not change the interpretation of the findings. CONCLUSION Initial weight loss was poorly maintained during the no-intervention follow-up, but both groups did have lower weight over the 24 months. Attrition was high in both groups, and assumptions about missing data had considerable impact on the magnitude and statistical significance of treatment effects. It is vital that trials on weight loss interventions consider the plausibility of these differences in an analytical approach when interpreting research findings and comparing data between studies.
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Affiliation(s)
- C Holzapfel
- Else Kroener-Fresenius-Centre for Nutritional Medicine, Technische Universität München, University Hospital ‘Klinikum rechts der Isar', Munich, Germany
| | | | - A L Ahern
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - N R Fuller
- Boden Institute, Medical Foundation Building K25, University of Sydney, Sydney, NSW, Australia
| | - M Eberhard
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - J Stoll
- Else Kroener-Fresenius-Centre for Nutritional Medicine, Technische Universität München, University Hospital ‘Klinikum rechts der Isar', Munich, Germany
| | | | - S A Jebb
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - I D Caterson
- Boden Institute, Medical Foundation Building K25, University of Sydney, Sydney, NSW, Australia
| | - H Hauner
- Else Kroener-Fresenius-Centre for Nutritional Medicine, Technische Universität München, University Hospital ‘Klinikum rechts der Isar', Munich, Germany
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Zulman DM, Damschroder LJ, Smith RG, Resnick PJ, Sen A, Krupka EL, Richardson CR. Implementation and evaluation of an incentivized Internet-mediated walking program for obese adults. Transl Behav Med 2013; 3:357-69. [PMID: 24294324 DOI: 10.1007/s13142-013-0211-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In response to rising health care costs associated with obesity rates, some health care insurers are adopting incentivized technology-enhanced wellness programs. The purpose of this study is to evaluate the large-scale implementation of an incentivized Internet-mediated walking program for obese adults and to examine program acceptance, adherence, and impact. A mixed-methods evaluation was conducted to investigate program implementation, acceptance, and adherence rates, and physical activity rates among program participants. Program implementation was shaped by national and state policies, data security concerns, and challenges related to incentivizing participation. Among 15,397 eligible individuals, 6,548 (43 %) elected to participate in the walking program, achieving an average of 6,523 steps/day (SD 2,610 steps). Participants who uploaded step counts for 75 % of days for a full year (n = 2,885) achieved an average of 7,500 steps (SD 3,093). Acceptance and participation rates in this incentivized Internet-mediated walking program suggest that such interventions hold promise for engaging obese adults in physical activity.
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Affiliation(s)
- Donna M Zulman
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA USA ; Division of General Medical Disciplines, Stanford University, Stanford, CA USA
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Berger MB, Patel DA, Miller JM, Delancey JO, Fenner DE. Racial differences in self-reported healthcare seeking and treatment for urinary incontinence in community-dwelling women from the EPI Study. Neurourol Urodyn 2011; 30:1442-7. [PMID: 21717504 PMCID: PMC3184333 DOI: 10.1002/nau.21145] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 03/28/2011] [Indexed: 11/07/2022]
Abstract
AIMS Objectives of this study are: (1) to examine the prevalence of healthcare seeking among black and white women with self-reported urinary incontinence (UI), (2) to investigate barriers to treatment for incontinence, and (3) To investigate commonly used therapeutic modalities for UI. METHODS This is a planned secondary analysis of responses from 2,812 black and white community-dwelling women living in southeastern Michigan, aged 35-64 years, who completed a telephone interview concerning UI, healthcare-seeking behaviors and management strategies. The study population was 571 subjects (278 black, 293 white) who self-identified as having urinary incontinence. RESULTS Of these women with UI, 51% sought healthcare with no statistically significant difference between the two races (53% black, 50.6% white, P = 0.64). In multivariate logistic regression analysis, a higher likelihood of seeking healthcare was associated with increased age, body mass index lower than 30 kg/m(2) , prior surgery for UI, having regular pelvic exams, having a doctor, and worsening severity of UI. There was no significant association between hypothesized barriers to care seeking and race. Almost 95% of the subjects identified lack of knowledge of available treatments as one barrier. Black and white women were similar in percentage use of medications and some self-care strategies, for example, pad wearing and bathroom mapping, but black women were significantly more likely to restrict fluid intake than white women and marginally less likely to perform Kegels. CONCLUSIONS Black and white women seek healthcare for UI at similar, low rates. Improved patient-doctor relationships and public education may foster healthcare seeking behavior.
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Affiliation(s)
- Mitchell B Berger
- Department of Obstetrics and Gynecology, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.
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Abstract
To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. PubMed (1968-2009), EconLit (1969-2009) and Business Source Premier (1995-2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. A total of 33 US studies met review criteria. Among the four highest-quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimates included use of national samples vs. more selected populations, age groups examined, inclusion of all medical costs vs. obesity-related costs only, and body mass index cut-offs for defining overweight and obesity. Depending on the source of total national healthcare expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs and use standard body mass index cut-offs.
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Affiliation(s)
- A G Tsai
- Division of General Internal Medicine and Center for Human Nutrition, University of Colorado Denver, Denver, CO, USA.
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