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Swahnberg, K., Zbikowski, A., Wijewardene, K., Josephson, A., Khadka, P., Jeyakumaran, D., . . . Infanti, J. J. (2019). Can Forum Play Contribute to Counteracting Abuse in Health Care?: A Pilot Intervention Study in Sri Lanka. International Journal of Environmental Research and Public Health, 16(9), 1-10, Article ID 1616.
Open this publication in new window or tab >>Can Forum Play Contribute to Counteracting Abuse in Health Care?: A Pilot Intervention Study in Sri Lanka
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 9, p. 1-10, article id 1616Article in journal (Refereed) Published
Abstract [en]

Obstetric violence refers to the mistreatment of women in pregnancy and childbirth care by their health providers. It is linked to poor quality of care, lack of trust in health systems, and adverse maternal and neonatal outcomes. Evidence of interventions to reduce and prevent obstetric violence is limited. We developed a training intervention using a participatory theatre technique called Forum Play inspired by the Theatre of the Oppressed for health providers in Sri Lanka. This paper assesses the potential of the training method to increase staff awareness of obstetric violence and promote taking action to reduce or prevent it. We conducted four workshops with 20 physicians and 30 nurses working in three hospitals in Colombo, Sri Lanka. Participants completed a questionnaire before and three-to-four months after the intervention. At follow-up, participants more often reported that they had been involved in situations of obstetric violence, indicating new knowledge of the phenomenon and/or an increase in their ability to conceptualise it. The intervention appears promising for improving the abilities of health care providers to recognise obstetric violence, the first step in counteracting it. The study demonstrates the value of developing further studies to assess the longitudinal impacts of theatre-based training interventions to reduce obstetric violence and, ultimately, improve patient care.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
maternal and reproductive health services, quality of care, dignity and respect, abuse in health care, obstetric violence, intervention science, participatory theatre, Theatre of the Oppressed
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-85280 (URN)10.3390/ijerph16091616 (DOI)000469517300141 ()31072034 (PubMedID)2-s2.0-85065878732 (Scopus ID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-08-29Bibliographically approved
Simmons, J. & Swahnberg, K. (2019). Can nonresponse bias and known methodological differences explain the large discrepancies in the reported prevalence rate of violence found in Swedish studies?. PLoS ONE, 14(5), Article ID e0216451.
Open this publication in new window or tab >>Can nonresponse bias and known methodological differences explain the large discrepancies in the reported prevalence rate of violence found in Swedish studies?
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 5, article id e0216451Article in journal (Refereed) Published
Abstract [en]

Introduction The reported prevalence rate of violence varies considerably between studies, even when conducted in similar populations. The reasons for this are largely unknown. This article considers the effects of nonresponse bias on the reported prevalence rate of interpersonal violence. We also single out violence perpetrated in intimate relationships and compare our results to previous Swedish studies. The aim was to explore the reasons for the large discrepancies in the prevalence rates found between studies. Material and method This is a cross sectional study of a random population sample. The NorVold Abuse Questionnaire (NorAQ), covering emotional, physical, and sexual violence, was answered by 754 men (response rate 35%) and 749 women (response rate 38%). Nonresponse bias was investigated in six ways, e. g., findings were replicated in two samples and we explored nonresponders' reasons for declining participation. Also, the prevalence rate of intimate partner violence was compared to four previous studies conducted in Sweden, considering the methodological differences. Results and discussion The only evidence of nonresponse bias found was for differences between the sample and the background population concerning the sociodemographic characteristics. However, the magnitude of that effect is bleak in comparison with the large discrepancies found in the prevalence rates between studies concerning intimate partner violence, e. g., emotional violence women: 11-41% and men: 4-37%; sexual and/or physical violence women: 12-27% and men: 2-21%. Some of the reasons behind these differences were obvious and pertained to differences in the definition and operationalization of violence. However, a considerable proportion of the difference could not easily be accounted for. Conclusion It is not reasonable that so little is known about the large discrepancies in the prevalence rate for what is supposedly the same concept, i.e., intimate partner violence. This study is a call for more empirical research on methods to investigate violence.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Social Work
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-84523 (URN)10.1371/journal.pone.0216451 (DOI)000467552100050 ()31071131 (PubMedID)2-s2.0-85065643966 (Scopus ID)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-08-29Bibliographically approved
Karim, K. R. & Swahnberg, K. (2019). Does female authority prevent male marital violence?: Evidence from rural Bangladesh. Journal of Interpersonal Violence, Article ID 886260518801023.
Open this publication in new window or tab >>Does female authority prevent male marital violence?: Evidence from rural Bangladesh
2019 (English)In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, article id 886260518801023Article in journal (Refereed) Epub ahead of print
Abstract [en]

While relative resource status between husband and wife is widely discussed in the explanation of male marital violence (MMV) behaviors, the influence of relative family authority between husband and wife on the violence has been generally overlooked in previous studies. An examination can provide a better understanding of the issue. This study examined how various levels of female authority within the family are associated with MMV against women in rural Bangladesh. The study adopted a cross-sectional design and included 342 married men randomly selected from five northwest villages. Negative binomial regression was performed to predict the frequency of self-reported MMV behaviors in a 1-year recall period which estimated the ratios comparing absolute male authority to egalitarian authority within the family. Of the sample, 37.4% were the egalitarian/fair female authority, 41.2% were the higher male authority, and 21.4% were absolute male authority families; 71.1% of the men revealed that they had resorted to at least one incident of MMV (psychological or physical or sexual) against their wives in the year preceding the survey. The mean of yearly MMV occurrences was 6.29 ( SD = 7.58), ranging from 0 to 42. The study revealed that the frequency of MMV against women was 1.96 times higher among absolute male authority families than in egalitarian families. It further revealed that the frequency of psychological abuse was 1.63 times, physical attack 2.89 times, and sexual coercion 1.88 times higher among absolute male authority families than among egalitarian/fair female authority families. Higher male authority did not appear to be different from egalitarian authority in MMV occurrences. The study suggests that increased female authority within the family unit may prevent women from being exposed to MMV in a patriarchal social order.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Female family authority, Male marital violence, Rural Bangladesh
National Category
Gender Studies
Research subject
Social Sciences, Gender Studies
Identifiers
urn:nbn:se:lnu:diva-82965 (URN)10.1177/0886260518801023 (DOI)30261799 (PubMedID)
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-05-23
Pun, K. D., Rishal, P., Darj, E., Infanti, J. J., Shrestha, S., Lukasse, M., . . . Campbell, J. C. (2019). Domestic violence and perinatal outcomes - a prospective cohort study from Nepal. BMC Public Health, 19, Article ID 671.
Open this publication in new window or tab >>Domestic violence and perinatal outcomes - a prospective cohort study from Nepal
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 671Article in journal (Refereed) Published
Abstract [en]

Background: Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. Methods: In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen (modified) was used to assess fear and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 (69%) women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500g was defined as low birthweight and preterm birth as birth before completion of 37weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Results: Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 (95% CI;1.10-4.73)]. Conclusions: Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Domestic violence, Perinatal outcomes, Low birthweight, Preterm birth, Cesarean section
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-85856 (URN)10.1186/s12889-019-6967-y (DOI)000469787300002 ()31151395 (PubMedID)
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Moellerberg, M.-L., Årestedt, K., Swahnberg, K., Benzein, E. & Sandgren, A. (2019). Family sense of coherence and its associations with hope, anxiety and symptoms of depression in persons with cancer in palliative phase and their family members: A cross-sectional study. Palliative Medicine: A Multiprofessional Journal
Open this publication in new window or tab >>Family sense of coherence and its associations with hope, anxiety and symptoms of depression in persons with cancer in palliative phase and their family members: A cross-sectional study
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2019 (English)In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background: There is evidence indicating that family sense of coherence predicts quality of family life and promotes family well-being. In families living with the palliative phase of cancer, low hope, anxiety and symptoms of depression are common in both persons with cancer and their family members. Aim: To determine whether family sense of coherence was associated with hope, anxiety and symptoms of depression, respectively, in persons with cancer in the palliative phase and their family members. Design: An observational, cross-sectional, multicentre study was conducted. Nested linear regression analyses were performed in two blocks to determine whether family sense of coherence was associated with hope, anxiety and symptoms of depression. Setting/participants: Persons with cancer (n = 179) and their family members (n = 165) were recruited from two oncology clinics and two palliative centres in three regions in Sweden. Results: The main findings showed that family sense of coherence was significantly and independently associated with hope, anxiety and symptoms of depression. Stronger family sense of coherence was associated with higher hope and lower anxiety and symptoms of depression levels in both persons with cancer and their family members. Conclusion: Health care providers should strive to identify families with weak family sense of coherence, because of its associations with hope, anxiety and symptoms of depression, in order to offer them professional support and thereby achieve increased well-being during the palliative phase of cancer. Future studies should expand our knowledge of family sense of coherence and how to identify families at risk of lower levels of well-being.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Anxiety, cancer patient, cross-sectional study, depression, family members, hope, multicentre study, palliative care, sense of coherence
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-88834 (URN)10.1177/0269216319866653 (DOI)000480022600001 ()31368844 (PubMedID)
Available from: 2019-08-29 Created: 2019-08-29 Last updated: 2019-08-29
Rask, M., Swahnberg, K. & Oscarsson, M. (2019). Notification of an abnormal Pap smear: an intervention study. European Journal of Cancer Care, 28(2), 1-7, Article ID e12969.
Open this publication in new window or tab >>Notification of an abnormal Pap smear: an intervention study
2019 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 28, no 2, p. 1-7, article id e12969Article in journal (Refereed) Published
Abstract [en]

This study aims to assess whether notification of an abnormal Pap smear result via a phone call, delivered by a trained healthcare provider, has an effect on women's HRQoL, coping and awareness of HPV. For this intervention study, women were consecutively recruited from a women's health clinic in Sweden. Women in the intervention group (n = 113) were notified of their Pap smear result via a phone call by a trained healthcare provider, while those in the comparison group (n = 122) were notified via a standard letter. A questionnaire was used to collect data. The results found no significant differences between the groups for HRQoL. However, 42.5% ofwomen in the intervention group versus 48.3% in the comparison group reported anxiety. Women in the intervention group were more satisfied with the manner in which they were notified of their abnormal result than those in the comparison group (92.0% vs. 67.2%; p < 0.001), more aware of HPV (71% vs. 50%; p = 0.001), and called healthcare services less often (10.6% vs. 18.0%; p = 0.113), no significance. In conclusion, notification of an abnormal Pap smear result via a phone call does not increase women's HRQoL or reduce their anxiety.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Abnormal Pap smears, Experience, Healthcare professionals, Qualitative method, Sweden
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-80224 (URN)10.1111/ecc.12969 (DOI)000461076700009 ()30457186 (PubMedID)2-s2.0-85056755716 (Scopus ID)
Available from: 2019-02-05 Created: 2019-02-05 Last updated: 2019-08-29Bibliographically approved
Jonsdottir, S. S., Steingrimsdottir, T., Thome, M., Oskarsson, G. K., Lydsdottir, L. B., Olafsdottir, H., . . . Swahnberg, K. (2019). Pain management and medical interventions during childbirth among perinatal distressed women and women dissatisfied in their partner relationship: A prospective cohort study. Midwifery, 69, 1-9
Open this publication in new window or tab >>Pain management and medical interventions during childbirth among perinatal distressed women and women dissatisfied in their partner relationship: A prospective cohort study
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this study was to investigate possible associations between distress in pregnant women and their use of pain management and medical interventions. Furthermore, we assessed the effects of reported dissatisfaction in relationship with their partner, or weak social support. Design: This was a prospective cohort study. Setting: Women were invited to participate while attending prenatal care at participating Icelandic health care centres. Birth outcome data were obtained from the hospitals where these women gave birth. Participants: Women in this study participated in a research project where 2523 women were screened three times during pregnancy for anxiety and depression. Women who had positive results at screening were invited to a semi-structured interview during pregnancy as well as every fourth woman who had negative results. Five hundred and sixty-two women participated in the interviews and the final sample was 442 women. Measurements: Distress was defined as symptoms of anxiety, stress and depression. The Edinburgh Post-partum Depression Scale (EPDS) and the Depression, Anxiety and Stress Scales (DASS) were used for screening purposes. During the interview, the women answered the Dyadic Adjustment Scale (DAS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Adverse Experienced Interview (AEI). The main outcome variables that were obtained from the women's childbirth records were: (1) use of pain management, categorized as: epidural analgesia, non-pharmacological pain management, nitrous oxide, pharmacological medication, or no pain management; (2) medical interventions categorized as: induction, stimulation, and episiotomy; and (3) mode of childbirth. A logistic regression analysis, adjusted for significant covariates, was conducted. Findings: A significant association was found between perinatal distress at 16 weeks gestation and use of epidural as single pain management. Overall, distressed women were 2.6 times more likely than non-distressed women to use epidural as a single pain management. They were also less likely to go through childbirth without use of any pain management method. Women who were dissatisfied in their relationship were significantly more likely to undergo induction of childbirth, an episiotomy and/or a vacuum extraction than those who were satisfied in their relationship, regardless if they were distressed or not. No association was found between social support and the outcome variables. Key conclusions: Women with perinatal distress were more likely to use an epidural than non-distressed women. The use of an epidural might help them manage pain and uncertainties related to childbirth. Women who were dissatisfied in their partner relationship may be more likely to undergo induction of childbirth, episiotomy and/or vacuum extraction. Implication for practice: Midwives need to acknowledge the possible association of distress and use of an epidural during childbirth and screen for distress early in pregnancy. It is important to offer counselling and help during pregnancy for expectant parents who are distressed or dissatisfied in their relationship. (C) 2018 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Perinatal distress, Interventions, Childbirth, Pain, Emotions
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-79732 (URN)10.1016/j.midw.2018.10.018 (DOI)000454129800001 ()30390461 (PubMedID)2-s2.0-85055731159 (Scopus ID)
Available from: 2019-01-23 Created: 2019-01-23 Last updated: 2019-08-29Bibliographically approved
Rask, M., Swahnberg, K. & Oscarsson, M. (2019). Swedish women's awareness of human papillomavirus, and health-related quality of life, anxiety and depression after a notification of an abnormal Pap smear result : a cross-sectional study. European Journal of Cancer Prevention, 28(2), 96-101
Open this publication in new window or tab >>Swedish women's awareness of human papillomavirus, and health-related quality of life, anxiety and depression after a notification of an abnormal Pap smear result : a cross-sectional study
2019 (English)In: European Journal of Cancer Prevention, ISSN 0959-8278, E-ISSN 1473-5709, Vol. 28, no 2, p. 96-101Article in journal (Refereed) Published
Abstract [en]

This study aims to assess (a) women's awareness of the human papillomavirus (HPV), (b) women's health-related quality of life (HRQoL) and levels of anxiety and depression symptoms, and (c) to compare the outcomes between women who are aware of the sexually transmitted nature of the HPV infection and women who are not. Swedish women who have been notified of an abnormal Pap smear result completed a questionnaire. This questionnaire consisted of sociodemographic characteristics, items on awareness of HPV, and how to cope with the Pap smear result and the instruments: the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using descriptive statistics, Student's t-test, χ-tests, Fisher's exact test, the Mann-Whitney U-test, and Fisher-Freeman-Halton exact test. In total, 122 women participated. The women reported a median (quartile 1-quartile 3) score of 87.6 on the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (81.8-107.0), compatible with a good HRQoL. The median (quartile 1-quartile 3) scores on HADS-anxiety and HADS-depression were 7.0 (4.0-10.0) and 3.0 (1.0-5.3), respectively; however, 48.4% of the women reported anxiety (compared with 20% in a normal population). There were no statistically significant differences in the median scores in any of the scales, including the prevalence of distress between the subgroups. Women with abnormal Pap smear results have a good HRQoL; they can become anxious, but not depressed. Awareness of HPV as a sexually transmitted infection is low, but being aware does not impact on women's HRQoL or on anxiety and depression.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
Keywords
Abnormal Pap smear result, Anxiety, Cervical abnormalities, Depression, Health-related quality of life, Human papillomavirus
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-71404 (URN)10.1097/CEJ.0000000000000430 (DOI)000480688900006 ()29406336 (PubMedID)2-s2.0-85055659995 (Scopus ID)
Available from: 2018-03-06 Created: 2018-03-06 Last updated: 2019-08-29Bibliographically approved
Smirthwaite, G. & Swahnberg, K. (2018). Comparing critical realism and situated knowledges approaches in research on (in)equity in health care: an exploration of their implications (1ed.). In: Lena Gunnarsson, Angela Martinez Dy & Michiel van Ingen (Ed.), Gender, feminism and critical realism: exchanges, challenges, synergies. Routledge
Open this publication in new window or tab >>Comparing critical realism and situated knowledges approaches in research on (in)equity in health care: an exploration of their implications
2018 (English)In: Gender, feminism and critical realism: exchanges, challenges, synergies / [ed] Lena Gunnarsson, Angela Martinez Dy & Michiel van Ingen, Routledge, 2018, 1Chapter in book (Refereed)
Place, publisher, year, edition, pages
Routledge, 2018 Edition: 1
National Category
Gender Studies
Research subject
Social Sciences, Gender Studies
Identifiers
urn:nbn:se:lnu:diva-73763 (URN)9781138301719 (ISBN)
Available from: 2018-05-02 Created: 2018-05-02 Last updated: 2018-12-05Bibliographically approved
Muzrif, M. M., Perera, D., Wijewardena, K., Schei, B. & Swahnberg, K. (2018). Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka. BMJ Open, 8(2), Article ID e017745.
Open this publication in new window or tab >>Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 2, article id e017745Article in journal (Refereed) Published
Abstract [en]

Objectives The aims of this study were to assess the regional differences in domestic violence among pregnant women in the capital district and in the tea plantation sector of Sri Lanka, to explore potential contributory factors and to assess whether healthcare workers addressed domestic violence and disclosure among survivors. Design A cross-sectional study was carried out using interviewer-administered Abuse Assessment Screen. Setting Fifty-seven antenatal clinic centres in the capital district and 30 in the tea plantation sector. Participants Pregnant women between 6 and 40 weeks of gestational age. In the capital district, 1375 women were recruited from antenatal clinic centres in the urban (n= 25) and in the rural areas (n= 32), and 800 women from 30 centres in the tea plantation sector. The response rate in the capital district was 95.6% and 96.7% in the tea plantation sector. Results Among the total sample of pregnant women (n= 2088), the prevalence of 'ever abused' was 38.6%, and the prevalence of 'currently abused' was 15.9%. 'Ever abused' (31.5% vs 50.8%) and 'currently abused' (10% vs 25.8%) were significantly higher (P< 0.001) among the women living in the tea plantation sector. 'Ever abused' was associated with living in the tea plantation sector, being employed, living far from gender-based violence care centre and of Muslim ethnicity, after adjusting for age, education and family income. Only 38.8% of all participants had been asked by healthcare workers about abuse. Living in the tea plantation sector and lower level of education were associated with not being asked. Among those who reported 'ever abused', only 8.7% had disclosed the experience to a healthcare worker. Conclusion Domestic violence was prevalent and highest among women in the tea plantation sector compared with the capital district. The capacity of healthcare workers in addressing domestic violence should be increased.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Other Health Sciences
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-76931 (URN)10.1136/bmjopen-2017-017745 (DOI)000433129800086 ()29463585 (PubMedID)2-s2.0-85051928138 (Scopus ID)
Available from: 2018-07-17 Created: 2018-07-17 Last updated: 2019-08-29Bibliographically approved
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