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Ek, A., Lewis Chamberlain, K., Sorjonen, K., Hammar, U., Etminan Malek, M., Sandvik, P., . . . Nowicka, P. (2019). A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial. Pediatrics, Article ID e20183457.
Open this publication in new window or tab >>A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial
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2019 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, article id e20183457Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND AND OBJECTIVES: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST).

METHODS: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (-0.5) was assessed with risk ratios.

RESULTS: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: -0.45 to -0.15) compared with ST (0.07; 95% CI: -0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (-0.54; 95% CI: -0.77 to -0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST.

CONCLUSION: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.

Keywords
primary care, intervention, family support, children
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-389455 (URN)10.1542/peds.2018-3457 (DOI)31300528 (PubMedID)
Funder
Swedish Research Council, K2015-99X-22713-01-3-
Available from: 2019-07-14 Created: 2019-07-14 Last updated: 2019-08-15Bibliographically approved
Ek, A., Delisle Nyström, C., Chirita-Emandi, A., Tur, J. A., Nordin, K., Bouzas, C., . . . Nowicka, P. (2019). A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study – an intervention within the STOP project. BMC Public Health, 19, Article ID 945.
Open this publication in new window or tab >>A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study – an intervention within the STOP project
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 945Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.

METHODS/DESIGN: A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.

DISCUSSION: This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.

Keywords
Children, Family, Obesity, Overweight, Stop, Treatment, mHealth
National Category
Pediatrics
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-389638 (URN)10.1186/s12889-019-7161-y (DOI)000475744600002 ()31307412 (PubMedID)
Funder
EU, Horizon 2020, 774548
Note

Anna Ek and Christine Delisle Nyström contributed equally to this work.

Available from: 2019-07-19 Created: 2019-07-19 Last updated: 2019-08-15Bibliographically approved
Neuman, N., Eli, K. & Nowicka, P. (2019). Feeding the extended family: Gender, generation, and socioeconomic disadvantage in food provision to children. Food, Culture, and Society: an international journal of multidisciplinary research, 22(1), 45-62
Open this publication in new window or tab >>Feeding the extended family: Gender, generation, and socioeconomic disadvantage in food provision to children
2019 (English)In: Food, Culture, and Society: an international journal of multidisciplinary research, ISSN 1552-8014, E-ISSN 1751-7443, Vol. 22, no 1, p. 45-62Article in journal (Refereed) Published
Abstract [en]

This paper examines how US parents and grandparents describe their provision of food to preschool-age children. Drawing on 49 interviews with 16 families, most of which were socio-economically disadvantaged, we argue that gender and generation intersect in everyday efforts to care for children’s eating. The analysis explores gendered divisions of foodwork, highlights the struggles of single mothers, and examines fathers’ redefinitions of the paternal role to include feeding and caring for children. At the core of the analysis, however, is the participants’ emphasis on grandmothers as sources of knowledge and support, with both fathers and mothers citing grandmothers and other women of earlier generations as culinary influences and as role models for good parenting. We thus discuss “feeding the extended family,” and conclude with a discussion about moving beyond the couple-focused paradigm of parenting in research on food and the gendered division of foodwork.

Place, publisher, year, edition, pages
Routledge, 2019
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) Cultural Studies Gender Studies Other Health Sciences
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-357920 (URN)10.1080/15528014.2018.1547066 (DOI)000471768600005 ()
Available from: 2018-08-22 Created: 2018-08-22 Last updated: 2019-08-05Bibliographically approved
Bergman, K., Eli, K., Persson Osowski, C., Lövestam, E. & Nowicka, P. (2019). Public expressions of trust and distrust in governmental dietary advice in Sweden. Qualitative Health Research, 29(8), 1161-1173
Open this publication in new window or tab >>Public expressions of trust and distrust in governmental dietary advice in Sweden
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2019 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 29, no 8, p. 1161-1173Article in journal (Refereed) Published
Abstract [en]

We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice, or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice, or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and 'alternative' evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency’s advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.

National Category
Sociology Social Sciences Interdisciplinary Other Health Sciences
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-371985 (URN)10.1177/1049732318825153 (DOI)000471163000007 ()30741093 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-08-05Bibliographically approved
Eiffener, E., Eli, K., Ek, A., Sandvik, P., Somaraki, M., Kremers, S., . . . Nowicka, P. (2019). The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial. Pediatric Obesity, 1-12, Article ID e12556.
Open this publication in new window or tab >>The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial
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2019 (English)In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, p. 1-12, article id e12556Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.

Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.

Method: The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.

Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z‐scores.

Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.

Keywords
ADHD, CBCL, CBCL/1.5‐5, Child Behavior Checklist, depression, family, parents
National Category
Nutrition and Dietetics Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-389360 (URN)10.1111/ijpo.12556 (DOI)
Funder
Swedish Research Council, K2015-99X-22717-01-3Vinnova, 2011‐3443
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-08-14Bibliographically approved
Lövestam, E., Neuman, N. & Nowicka, P. (2018). Kritisk dietetik: självreflektion, ödmjukhet och dialog [Letter to the editor]. DietistAktuellt, XXVII(2), 46-48
Open this publication in new window or tab >>Kritisk dietetik: självreflektion, ödmjukhet och dialog
2018 (Swedish)In: DietistAktuellt, Vol. XXVII, no 2, p. 46-48Article in journal, Letter (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Tack vare medel från Vetenskapsrådet och Letterstedtska föreningen anordnade vi den 25 augusti konferensen ”The 1st Scandinavian Critical Dietetics Conference”, som syftade till att introducera ämnet kritisk dietetik i Sverige. I Dietistaktuellt nr 6 2017 skriver redaktören Magnus Forslin en personlig reflektion på åtta sidor där han angriper konferensen och de diskussioner som fördes där. Tonen i texten – kombinerat med associationer till bl a förintelseförnekelse och stalinism samt hånfulla illustrationer – inbjuder tyvärr inte till dialog. Istället för att ge oss in i en debatt på de premisserna tar vi tillfället i akt att kort och koncist lyfta några punkter om kritisk dietetik som vi gärna förtydligar. Då många av de antaganden och insinuationer som görs i artikeln saknar grund vill vi också bjuda in Dietistaktuellts läsare att själva ta del av konferensens presentationer, vilka ligger öppet på Institutionen för kostvetenskap, Uppsala Universitets webbplats.

Place, publisher, year, edition, pages
Bjuv: , 2018
Keywords
dietetik, kostvetenskap, socioekonomi, ojämlikhet
National Category
Health Sciences
Research subject
History of Art
Identifiers
urn:nbn:se:uu:diva-341378 (URN)
Funder
Swedish Research Council, 2016-06849
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2018-02-13Bibliographically approved
Somaraki, M., Eli, K., Sorjonen, K., Flodmark, C.-E., Marcus, C., Faith, M. S., . . . Nowicka, P. (2018). Perceived child eating behaviours and maternal migrant background. Appetite, 125, 302-313
Open this publication in new window or tab >>Perceived child eating behaviours and maternal migrant background
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2018 (English)In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 125, p. 302-313Article in journal (Refereed) Published
Abstract [en]

The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3–8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.

Keywords
appetite, children, culture, family, overweight, obesity
National Category
Nutrition and Dietetics
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-341465 (URN)10.1016/j.appet.2018.02.010 (DOI)000430777900035 ()29438715 (PubMedID)
Funder
Swedish Research Council, 2014-02404Vinnova, 2011-03443Swedish Society of MedicineSven Jerring FoundationMagnus Bergvall FoundationFredrik och Ingrid Thurings StiftelseHelge Ax:son Johnsons stiftelse
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-06-27Bibliographically approved
Sandvik, P., Ek, A., Somaraki, M., Hammar, U., Eli, K. & Nowicka, P. (2018). Picky eating in Swedish preschoolers of different weight status: application of two new screening cut-offs. International Journal of Behavioral Nutrition and Physical Activity, 15, Article ID 74.
Open this publication in new window or tab >>Picky eating in Swedish preschoolers of different weight status: application of two new screening cut-offs
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2018 (English)In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 15, article id 74Article in journal (Refereed) Published
Abstract [en]

Background

Characteristics of picky eaters of different weight status have not been sufficiently investigated. We used two newly developed screening cut-offs for picky eating in the Food fussiness (FF) subscale of the Child Eating Behavior Questionnaire (CEBQ) to investigate the prevalence and characteristics of picky eaters in preschool-aged children with thinness, normal weight, overweight or obesity.

Methods

Data for 1272 preschoolers (mean age 4.9 years) were analyzed. The parent-reported FF subscale ranges from 1 to 5, and two screening cut-offs were applied to classify children as picky eaters (3.0 and 3.33). Structural Equation Modeling was used to study associations with other factors in the CEBQ, the Child Feeding Questionnaire (CFQ) and the Lifestyle Behavior Checklist (LBC). Scores were compared separately for each weight status group.

Results

Nearly half of the children were classified as moderate or severe picky eaters (cut-off 3.0) and 30% as severe (cut-off 3.33). For both cut-offs, prevalence was significantly lower in the obesity group. Still, one-third of children with obesity met the cut-off of 3.0 and 17% met the cut-off of 3.33. While picky eaters displayed similar patterns across weight status groups, some differences emerged. Food responsiveness was lower for picky eaters, but the difference was significant only among children with obesity. Slowness in eating was not as pronounced among picky eaters in the obesity group. In the overweight and obesity groups, parents of picky eaters did not report as high pressure to eat, as compared to the thinness or normal weight groups; in the obesity group, parents of picky eaters also perceived their children’s weight as lower. In all weight status groups, parents of picky eaters were more likely to report their children had too much screen time, complained about physical activity, and expressed negative affect toward food.

Conclusions

Picky eating was less common but still prevalent among children with obesity. Future studies should investigate the potential influence of picky eating on childhood overweight and obesity. Moreover, as children with picky eating display higher emotional sensitivity, further research is needed to understand how to create positive eating environments particularly for children with picky eating and obesity.

Keywords
appetite traits, eating behavior, obesity, parents, parenting practices, preschoolers, screening, sensory hypersensitivity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-357235 (URN)10.1186/s12966-018-0706-0 (DOI)000441206000001 ()
Funder
Swedish Research CouncilVINNOVA, 2011-03443Swedish Society of MedicineThe Karolinska Institutet's Research FoundationSven Jerring FoundationMagnus Bergvall FoundationFredrik och Ingrid Thurings StiftelseHelge Ax:son Johnsons stiftelse
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-11-08Bibliographically approved
Mazur, A., Caroli, M., Radziewicz-Winnicki, I., Nowicka, P., Weghuber, D., Neubauer, D., . . . Hadjipanayis, A. (2018). Reviewing and addressing the link between mass media and the increase in obesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement.. Acta Paediatrica, 107, 568-576
Open this publication in new window or tab >>Reviewing and addressing the link between mass media and the increase in obesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement.
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, p. 568-576Article in journal (Refereed) Published
Abstract [en]

This study reviewed the link between social media and the growing epidemic of childhood obesity in Europe. A task force from the European Academy of Paediatrics and the European Childhood Obesity Group searched published literature and developed a consensus statement. It found that there was evidence of a strong link between obesity levels across European countries and childhood media exposure and that parents and society needed a better understanding of the influence of social media on dietary habits.

CONCLUSION: Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity.

Keywords
Childhood obesity, Consensus statement, Food advertising, Mass media, Obesity prevention
National Category
Nutrition and Dietetics Pediatrics
Identifiers
urn:nbn:se:uu:diva-334537 (URN)10.1111/apa.14136 (DOI)000427002500006 ()29164673 (PubMedID)
Available from: 2017-11-23 Created: 2017-11-23 Last updated: 2018-06-29Bibliographically approved
Bergman, K., Persson Osowski, C., Eli, K., Lövestam, E., Elmståhl, H. & Nowicka, P. (2018). Stakeholder responses to governmental dietary guidelines: Challenging the status quo, or reinforcing it?. British Food Journal, 120(3), 613-624
Open this publication in new window or tab >>Stakeholder responses to governmental dietary guidelines: Challenging the status quo, or reinforcing it?
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2018 (English)In: British Food Journal, ISSN 0007-070X, E-ISSN 1758-4108, Vol. 120, no 3, p. 613-624Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.

Design/methodology/approach

In total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.

Findings

Two main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.

Practical implications

Policymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.

Originality/value

This research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2018
Keywords
Food policy, Concept of advice, Dietary guidelines, Nutritional reductionism, Stakeholder influences
National Category
Social Sciences Interdisciplinary Ethics
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-341383 (URN)10.1108/BFJ-08-2017-0466 (DOI)000427495600008 ()
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2019-06-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9707-8768

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