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Family

Health
Issues
AP DR TIN TIN AYE

1 TTA 2015
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FAMILY HEALTH
WHAT IS FAMILY

a group of people related by blood, by


marriage or by any other legal means.
and sharing the same household, the
same economy, same socio-cultural, and
environment.
Forming the basic unit of society
(Park and ParK)

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A family is regarded as a
Biological unit - The family
members share a pool of genes
Social unit - The family
members share a common physical and
social environment
Cultural unit - It reflects
the culture of a wider society of which it
forms a part and determine the behaviour
and attitudes of its member
Epidemiological unit - Study of
determinants and distribution of diseases

A unit for providing social services as well


as comprehensive health care TTA 2015
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The family consists of


different age groups
Pregnant mothers
Lactating or nursing mothers
Infants
Preschool children
Adolescents
Adults/ working age group
Elderly persons
Handicapped persons
People with chronic illness/ terminal cases
Dying persons
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TYPES OF FAMILY
1. Nuclear family : a family consisting of a
married couples and their children
2Extended Family: nuclear family plus
collateral kinship
3. Joint family: a family consisting of two
or more married couples staying together
with children

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FUNCTIONS OF THE FAMILY 6

Residence- to provide clean and decent


home to its members
Division of labour- work is shared among
the family members
Reproduction and bringing up of children
Socialization- the cultural pattern relating
to eating, cleanliness, dress, speech
language, behaviour and attitudes are all
transmitted through the family
Economic function- earn money for the
family
Social care
Giving status in a society to its members
Protecting its members from insult,
defamation etc.
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Regulating marital activities of its members
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Health of family
Thehealth of each individual is affected
by and effects the health of the
individuals with whom he is in relationship.
There is an intimate relationship with the
members of the family in which one is
born and later with new member of the
family of procreation.

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FAMILY HEALTH
Health of each member
+
how well they relate to other members
+
how
well they relate and cope with the
community outside the family.

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ENDOF SHORT DISCUSSION ON FAMILY


HEALTH

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Population in Malaysia averaged 17.59 Million from


1960 until 2013,
reaching an all time high of 29.95 Million in 2013

Population in Malaysia is reported by the


Department of Statistics Malaysia.

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According to Health facts Malaysia


2014,published in 2014,data are as
follows.

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Health Facts 2014


Land area =330.289 sqkm
Population (000)= (2013 ) 29.7147
Male(000) 15.2780
Female (000) 14.436.7
Population density 89.97 persquare
km
>65 year & above 5.5%
15-64 year 68.5 %
Below15 yr 26%

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Annual growth rate


1.3%
Life expectancy (total) 74.72
yr
Male 72.56yr,
female 77.18 yr
Crude Birth Rate 17.2/00 pop
Crude Death Rate 4.7/00 pop
Annual increase rate 1.3%
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Maternal mortality ratio 25.6 /100,000 LB (2012)


Infant mortality rate 6.6/00LB
Under5 mortality rate 7.7/00LB
Toddle Mortality rate 0.4 /oopopulation aged (1-
4)yr (2012)
Neonatal mortality rate 4/00LB
(2012)
Perinatal mortality rate 7.4/00 Births
(2012)
Still Birth rate 4.6/00 Births

SEE BELOW HEALTH FACTS 2015 DATA TTA 2015


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DOWN LOAD FROM


INTERNET AND SEE
VARIOUS DATA

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Family Health ISSUES


1 Children Health
2 Youth Health (15-24)yr
3 Adolescent health (10-19) yr
(Young people (10-24)yr)
4 Reproductive Health
5 Womens Health
6 Mens Health
7 Health of the Elderly

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1 Childern Health

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Anemia
L.B.W
. INFECTIONS
Maternal infections may cause
Fetal growth retardation
L.B.W
Embryopathy
Abortion and puerperal sepsis

Children
Diarrhoeal disease
Respiratory infections

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Skin infection
Malaria
Tuberculosis
Measles
Poliomyelitis
Diphtheria
Pertussis
Tetanus

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Preventable Child hood


infection
Diptheria
Heamoplillus infection (Hib)
Measel,
Mumps,
poliomyelits,
Rubella,Tetanus
Whooping cough,
HPV

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Causes of ChildHood
morbidity and mortality
Intrinsicfactors
Extrinsic factors
Environmental factors
REFER YEAR2 LECTURES******************

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(1) Causes of Infant mortality


Number of deaths of infants under 1 year
of age among a population of an area,
during a year

IMR = ---------------------------- 1000


Number of live births registered
among the same Population of the same area,
during the year

It is usually expressed as a rated


per 1000 live births.

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Causes of Infant Mortality
-------------------------------
-

Medicalcauses
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1 Neonatal Mortality (0-4 wks ) : 45%


of IMR (1st day 20-40% ,
1st wk 60% )

Immaturity (30.8% prematurity)


Birth injury/ difficult labour (Birth
asphyxia 24.5%)
Congenital abnormalities
Haemolytic diseases of newborn
Conditions of placenta and cord
Diarrhoeal disease
Acute respiratory infections
Sepsis(25.5% )
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2 Post natal mortality(55% of IMR)


Diarrhoea
Acute respiratory infections
Other communicable diseases ( Whooping
cough, influenza, pneumonia etc)
Malnutrition
Congenital abnormalities
Accidents

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2. Biological causes
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1. Birth Weight
2 Age of mother
3. Birth order
4. Interval between births
5. Multiple births
6. Family size
7. High fertility

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3. Socio-economic causes
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Bottle feeding
Religious and (cast) system (socio-cultural
pattern )
illiteracy
Ignorance of child care
Illegitimacy , Broken family
Poverty
Availability and Quality of health care
Lack of trained personnel
Untrained T.B.A.
Sex of child
Brutal habits and customs
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(2 ) Causes of under5 mortality


Acute respiratory disease ( ARI )
Diarrhoeal diseases &
Protein energy malnutrition
Other common childhood disease are:
Malaria
Tuberculosis
Intestinal parasitic
Dengue haemorrhagic fever
Rheumatic fever
Diphtheria, Poliomyelitis, whooping cough
Skin infections, Eye/ Ear infections
Dental disorders (caries )

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Intervention

Child survival project (C.S.P),WCHD


programme
Breast feeding
ORT
ARI control
EPI
Essential new born care

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Malaysia is experiencing a population age structure


characterized by population momentum,
the youthbulge
and the demographic bonus.

According to the WHO,


adolescence is the period from 10 to 19 years
and youth refers to those between 15 to 24 years
old.
The term young people covers those between 10
and 24 years old.

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(2) Youth Health(15-24 yr)


The main sexual and reproductive health
issues facing our youths are:

premarital sex

sexually transmitted diseases (STD),

unwanted and unsafe pregnancies and


abortions,

HIV/AIDS, sexual diversity, cybersex and


NEED sexuality Education
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YOUNG ADULT (10-24 )YEAR


Alcolol use
Tobacco use.
Drug use
Violence, crime. injuries
premarital sex ,Teenage pregnancy
Abortion and complication
STI, RTI,

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There is a growing incidence of premarital sexual


activity among youths, especially adolescents,
owing to the widening gap between age at
menarche and age at marriage.

Thecontinuing prevalence of premarital sexual


activity and the low contraceptive usage, result in a
high rate of adolescent and youth fertility.

The consequences of these pregnancy and


childbearing have significant effects on maternal
and child health.
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Informationon some of the issues which


affect young people including teen
pregnancy, alcohol and drug use and the
laws surrounding them in Malaysia...

1 Alcohol Laws
There is no minimum age for drinking
alcohol in Malaysia. However, it is illegal to
sell alcohol to anyone under the age of 18
years and to Muslims. In areas where the
majority of the population are Muslim,
alcohol sales may be restricted to certain
places.
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2 Drugs

Drug laws are strictly enforced in Malaysia.


Penalties for possession or use of illegal drugs
are harsh and
drug traffickers face the death penalty.

Those caught with more than 15 grams of


heroin or
200 grams of marijuana
are assumed by law to be trafficking drugs

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3 Teenagers and Sexual Health

The age of consent in Malaysia is 16 for both sexes.

4 Contraception

The Federation of Reproductive Health Associations,


Malaysia (FRHAM) is the government organisation
responsible
for promoting and supporting effective family
planning
and sexual and reproductive health services.

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5 Condoms can be purchased in


most pharmacies and
supermarkets.
The pill is available although it can
be difficult to obtain for unmarried
women or girls under the age of 18.

6 The Sabah Family Planning


Association is the only family
planning centre in Malaysia.
Teenagers and young people who
find they are pregnant should
contact this organisation for advice.
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(3 ) Adolescent health
(10-19 year)

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Adolescent health is the optimal state of


pysical, emotional, cognitive, social and
spiritual well beings .
Adolescents are healthy when they
1. engage in healthy behaviors that
contribute to a healthy lifestyle
2. have the capacity to thrive (grow well
and strong) in spite of stressors in life
3. successfully engage in the
developmental tasks of adolescence
4. experience a sense of wholeness and
well being.

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The health of adolescent is


determined by
: ENVIRONMENT
- parents and families
- peers and neighborhoods
- Media ******
- Communities and organizations
-School society,working environment
-Health care delivery services
(Adolescent clinic)
-Government policies and laws TTA 2015

Entertainment,leisure activity
ISSUES of Adolescent 58

violence,crime,,deliquency,injuries
Alcohol, drug and tobacco use.
Mental health problems
Sexual Health-- Teen age pregnancy
,unintended pregnancy, too early
pregnancy and reproductive health
problems
Suicidal problems

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premarital sex , child marriage, teen age


pregnancy, unwanted and unsafe
pregnancies, un safe abortions and
complications,
baby dumping,
sexual violence, unwanted sexual
activity.
RTI ,STI including HIV/AIDS (AIDS
GENERATION)

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Every year, nearly 1.5 million adolescents


die from :::_____
substance abuse, pregnancy-related
complications, suicide, injuries, and
violence
Adolescents account for approximately
50 percent of all new HIV infections.
,
Ministry of Health launched a National
Adolescent Health Policy in 2000.(look at
internet for AH policy)
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ADOLESCENCE HEALTH
CLINIC IN KKS*****
Healthscreening (visual acuity and
Thalassaemia screening)

Health
promotion (Stop smoking, standard
alcohol intake, healthy lifestyles).

Healtheducation on prevention of
sexually transmitted diseases.
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Drugabuse education about the


outcomes of drug abuse towards family,
community and state and the conditions
that affect the individual himself.

Healthy lifestyle education.


Outdoor Youth Program such as aerobic
exercise, gotong royong and
community services.
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4 Reproductive Health
Reproductive Health is a state of
complete physical, mental & social
wellbeing not nearly the absence of
disease & infirmity, all the matters relating
to the reproductive health system, to its
functions & processes.

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Reproductive Health care concerned


with both male & female it should be
accessible, effective, affordable &
acceptable.

There are 3 critical points in


reproductivesystem,
at birth,
adolescence &
reproductive years.
The intervention is needed at these points.
Reproductive health care is life span
approach.
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Essential RH care
Safe motherhood
Prevention of unsafe abortion and
post abortion care
Adolescent Reproductive Health
STIs/HIV and AIDS
Comprehensive RH care
Infertility
Viloence against women
Osteoporosis, Ca Cervix etc...

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Consequences of unsafe
abortion
Infection, hemorrhage,
injury to reproductive organ,
intestinal perforation, toxic reaction to
drug
infertility,
death,
psychological trauma,
negative social reaction
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Family planning
Saves womens lives and improves their health

Spacespregnancies, which saves childrens lives


and improves their health

Benefits couple, family and community

Helps adolescents make responsible choices

Allowmen to share responsibility for reproductive


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health and child rearing


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Reproductive tract infection


(STI)
3 different types of RTIs
1Exogenous -- Through sexual activity
Eg. Syphilis, AIDS
2Endogenous -- Overgrowth of
Normal Flora
Eg. Bacterial Vaginosis, Candidiasis
3Iatrogenic ------ Through Medical
Procedure Eg. IUD Insertion
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Most common STIs


1Curable (mostly bacteria)
Trichomoniasis,
chlamydia,
gonorrhoea,
syphilis

2 Incurable (mostly virus)


HIV/AIDS,
HPV,
herpes,
hepatitis B TTA 2015
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Consequences of STI
Harmful
medical, social and
psychological consequences

PID, infertility, chronic disease, death

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Prevention of STI
Should be part of all RH program
Provide information on STI

Counsel client about safe sexual behavior

Assess risk for STIs

Promote and distribute condom

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(5) Womens Health

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MMR(Maternal mortality ratio)


Causes of maternal mortality (global)
Unsafe abortion (13%)
Hypertensive disorder (12%)
Sepsis (15%)
Obstructed labour (8%)
Haemorrhage (24%)
Indirect causes (20%)
Other direct causes (8%)

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Why do these women die? (Three delay model)

1Delay in reaching care


_ Mountains, islands, rivers _ poor organization
2Delay in receiving care

3Delay in decision to seek care


Lack of understanding of complications
Acceptance of maternal death
Low status of women
Socio- cultural barriers to seeking care
Supplies, personnel
Poorly trained personnel with punitive attitude
Finances
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Safe Mother Hood programme



Ability to have safe and healthy
pregnancy and child birth
Three Strategies for safe mother hood

1) Decreased number of high risk & unwanted pregnancy


through birth spacing

2) Decreased number of obstetric complications through AN,


during & PN care.

3) Decreased case fatality rate in women with complications


through assessing to essential obstetric care.
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Six Pillars of safe mother hood

Safe Motherhood

STI/HIV AIDS Control


Post abortion Care
pPost natal Care
Antenatal Care

Obstetric Care

Birth Spacing
Communication for Behavior Change
Womens Empowerment/Status
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Primary Health Care approach


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MMR in various countries


Malaysia-----
Indonesia-----
Loas ------/100,000
MMR IN DEVELOPED ,DEVELOPING
COUNTRIES SEARCH IN INTERNET

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80%of maternal death related to pregnancy and


child birth ,20% due to prexisting conditions
aggrevating by pregnancy
Related to Pre existing
pregnancy conditions
Hamorrhage CVD
sepsis Infection
CTdisorder
Hypertension
Poor quality care
Unsafe abortion

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6 MENs Health including OH


DISCUSS IN SGD ( OH)

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Atpresent, the number of Malaysians aged


60 years and above is estimated to be 1.4
7 Elderly Health
million
and is projected to increase to 3.3 million in
the year 2020.

The percentage of the population that is 60


years and over has also increased over the
years - 5.2% in 1970,
5.7% in 1990
and 6.3% in the year 2000.
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In the year 2020, this percentage is


expected to be 9.8% of the population.
Between 1990 and 2020, the population
of Malaysia is expected to increase from
18.4 million
to 33.3 million
- an increase of 80%.

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Aged and elderly person

Itwas defined differently in different


society.
In developed countries person 65 and
above are regarded as elderly person..

What is aging?
Aging at individual level is a universal
process in which catabolism exceeds
anabolism so that an individual gradually
lose his or her ability to adapt the
environment and progressive loss of vigor,
eventually leading to death.
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Health problems of the aged

1Physical Problems
2Problems due to aging process
3Problems associated with long term
illness.
4Psychological Problems
5Social problems / Social implication of
aging

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1 Problems due to the Aging Process

Graying of the hair


Senile cataract
Glaucoma
Nerve deafness
Failure of special senses
Oral Health problem
Bony changes affecting mobility
Emphysema
Changes in mental outlook
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LONG TERM ILLNESS 85

1Degenerative diseases
of the heart and blood vessels (arthrosclerosis.
Coronay heart diseases , cerebral thrombosis,
hypertension )
Cancer
Accidents
Diabetes mellitus
2Locomotor system (Rheumatoid, Osteoarthritis,
spondilitis of the spine, fibrositis, Myositis,
neuritis, gout, defect of legs and feet cause
discomfort and disabilities)
3Respiratory illness (Flare up of TB, asthma, chronic
bronchitis)
4Genitourinary system (BPH, UTI , nocturia,
frequency, urgency)
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Nutritional disorders (Anaemia
86
)
Accidents
3Psychological Problems
Mental changes
Loss of recent memory
Forgetfulness
Loss of analytical and critical thinking leading to
indecisive
Misunderstanding
Depression
Dementia
Emotional disorder
Bitterness
Aggressiveness
Sexual adjustment
Menopause
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Decrease sexual activity
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4 Social Problems

_ Dependence: due to physical condition


and socioeconomic condition
_ Conflicts with the family and
environment
_ Difficult to earn for living and poverty
Lack of companionship
Lack of leisure activities
Depression ,
misery
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Comprehensive health care of elderly


person *************************
1 Health Promotion and Specific protection

HE to elderly and their family member


Make opportunity to meet with other elderly
and recreation
Arrangement to maintain their social role
Regular exercise, good nutrition , good
housing
Regular medical check up for elderly person
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Primary Prevention *****

Health habits smoking


alcohol abuse
obesity
nutrition
sleep
risk factors for coronary heart
disease
injury prevention etc

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Secondary Prevention 90

*******

Screening for _ hypertention


_ diabetes
_ dental caries
_ cancer (breast, cervical, prostate )
_ depression
_ stroke etc

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Tertiary Prevention******

Rehabilitation _ physical deficit


_ cognitive deficit
_ functional deficit
_ caretaker support
Social welfare Services for elderly
Special accommodation for elderly
Home for the aged
Priority for elderly at OPD
Elderly Day
Free entranceto park,recreation center.free
travelling.in special occasion days.

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