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1.
The Family Check Up (FCU) is a family-centered intervention for reducing children’s problem behavior through improving parenting skills and family interactions. Although the FCU was designed to prevent conduct problems, we have also found the program to be effective in preventing escalating symptoms of depression in early adolescence. The current analyses examine heterogeneous patterns of response to treatment in an effort to identify factors associated with differential response to family intervention. We examined heterogeneity in trajectories of youth-reported depressive symptoms from grades 6 to 9, using a Latent Growth Mixture Modeling framework to identify patterns of treatment response and non-response. Three symptom trajectories were identified, including the following: (1) a large class exhibiting stable, low symptom levels, (2) a class exhibiting high and stable depressive symptoms, and (3) a class exhibiting low initial symptoms that increased over time. Significant intervention effects were identified only among the third class, as a preventive effect on depression from 7th to 9th grade for youth with low initial symptoms. No effect of intervention was observed in the other two classes. Comparisons of classes 2 and 3 suggested that class 3 members were more likely to be females with high baseline antisocial behavior, but lower initial levels of depression. The findings suggest the importance of exploring heterogeneity within a prevention design, as well as the importance of tailored approaches to the prevention of adolescent depression.  相似文献   

2.
IntroductionWhile depression generally improves after bariatric surgery, less is known regarding heterogeneity in long-term symptom change. Given that depressive symptoms have been associated with weight change following bariatric surgery, identifying and characterizing subgroups with more severe depressive symptoms may have prognostic utility for understanding post-surgical weight loss. This study sought to characterize patterns of change in depressive symptoms and evaluate associations with weight loss in the seven years following bariatric surgery.MethodsParticipants were 2308 patients who underwent bariatric surgery as part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Depressive symptoms (measured by the Beck Depression Inventory) and weight were assessed annually following surgery.ResultsA group-based trajectory model identified six subgroups that evidenced distinct patterns of change in depressive symptoms, with the majority (87.0%) exhibiting stable low to average levels. Generalized linear mixed models indicated trajectory groups differed in percent total weight loss (%TWL), with trajectories characterized by initial decreases in depressive symptoms over the first two years (5.2% of participants) experiencing the highest %TWL (20.7% vs. 14.9–18.4% in the other trajectories at 7 years).ConclusionsFindings demonstrate meaningful heterogeneity in the pattern of changes in depressive symptoms after surgery. While most patients experience relatively low stable levels of depressive symptoms, those who have initial symptom improvement demonstrate the greatest magnitude of weight loss. Further research is necessary to explore the directionality of this association and the time-varying mechanisms by which depression and weight may mutually influence each other.  相似文献   

3.
Perinatal depression is a prevalent and detrimental condition. Determining modifiable factors associated with it would identify opportunities for prevention. This paper: 1) identifies depressive symptom trajectories and heterogeneity in those trajectories during pregnancy through the first-year postpartum, and 2) examines the association between unintended pregnancy and depressive symptoms. Depressive symptoms (BDI-II) were collected from low-income Hispanic immigrants (n=215) five times from early pregnancy to 12-months postpartum. The sample was at high-risk for perinatal depression and recruited from two prenatal care settings. Growth mixture modeling (GMM) was used to identify distinct trajectories of depressive symptoms over the perinatal period. Multinomial logistic regression was then conducted to examine the association between unintended pregnancy (reported at baseline) and the depression trajectory patterns. Three distinct trajectory patterns of depressive symptoms were identified: high during pregnancy, but low postpartum (“Pregnancy High”: 9.8%); borderline during pregnancy, with a postpartum increase (“Postpartum High”: 10.2%); and low throughout pregnancy and postpartum (“Perinatal Low”: 80.0%). Unintended pregnancy was not associated with the “Pregnancy High” pattern, but was associated with a marginally significant nearly four fold increase in risk of the “Postpartum High” pattern in depressive symptoms (RRR=3.95, p<0.10). Family planning is a potential strategy for the prevention of postpartum depression. Women who report unintended pregnancies during prenatal care must be educated of their increased risk, even if they do not exhibit antenatal depressive symptoms. Routine depression screening should occur postpartum, and referral to culturally appropriate treatment should follow positive screening results.  相似文献   

4.
BackgroundAlthough depressive symptoms are common postpartum, few studies have followed women beyond 12 months postpartum to investigate changes in the number and severity of these symptoms over time, especially in overweight and obese women. Using two complementary analytical methods, this study aims to identify trajectories of depressive symptoms over 2 years postpartum among overweight or obese mothers, and assess the demographic, socioeconomic, and health covariates for these trajectories.MethodsUsing longitudinal data from two behavioral intervention studies (Kids and Adults Now!-Defeat Obesity [KAN-DO] and Active Mothers Postpartum (AMP); n = 844), we used latent growth modeling to identify the overall trajectory of depressive symptoms and how it was related to key covariates. Next, we used latent class growth analysis to assess the heterogeneity in the depressive symptom trajectories over time, and thereby, identify subgroups of women with distinct trajectories.FindingsThe overall trajectory of depressive symptoms over 2 years postpartum was relatively stable in our sample. However, the presence of three distinct latent class trajectories (stable-low [82.5%], decreasing symptoms [7.3%], and increasing symptoms [10.2%]), identified based on trajectory shape and mean depressive symptom score, supported heterogeneity in depressive symptom trajectories over time. Lower maternal education was related to a higher symptom score, and poorer subjective health status at baseline predicted inclusion in the increasing symptoms trajectory.ConclusionsIn some overweight or obese mothers, postpartum depressive symptoms do not resolve quickly. Practitioners should be aware of this phenomenon and continue to screen for depression for longer periods of time postpartum.  相似文献   

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7.
Exercise may have both a preventive and a therapeutic impact on mental health problems. The Exercise without Worries intervention aims to reduce stress and depressive symptoms in low-SES women by means of a group-based program combining physical exercise and psycho-education. Between September 2005 and May 2008, 161 Dutch low-SES women with elevated stress or depressive symptom levels were randomly assigned to the combined exercise/psycho-education intervention (EP), exercise only (E) or a waiting list control condition (WLC). The E condition provided low to moderate intensity stretching, strength, flexibility, and body focused training as well as relaxation, while the EP program integrated the exercise with cognitive-behavioral techniques. Depressive symptoms (CES-D) and perceived stress (PSS) were measured before and immediately after the intervention and at 2, 6 and 12 month follow-up. Multilevel linear mixed-effects models revealed no differential patterns in reduction of CES-D or PSS scores between the EP, E and WLC groups on the short (post-test and 2 month follow-up) or long term (6 and 12 months follow-up). Depressive symptom outcomes were moderated by initial depressive symptom scores: women from the EP and E groups with fewer initial symptoms benefited from participation on the short term. Further, women in the EP and E groups with the lowest educational level reported more stress reduction at post-test than women with higher educational levels. In the overall target population of low-SES women, no indications were found that the Exercise without Worries course reduced depressive symptom and stress levels on the short or long term. The findings do suggest, however, that exercise alone or in combination with psycho-education may be a viable prevention option for certain groups of disadvantaged women. Especially those low-SES women with less severe initial problems or those with low educational attainment should be targeted for future depression prevention practice.  相似文献   

8.
Youth depression is a significant and growing international public health problem. Youth who engage in high levels of delinquency are at particularly high risk for developing problems with depression. The present study examined the impact of a behavioral intervention designed to reduce delinquency (Multidimensional Treatment Foster Care; MTFC) compared to a group care intervention (GC; i.e., services as usual) on trajectories of depressive symptoms among adolescent girls in the juvenile justice system. MTFC has documented effects on preventing girls’ recidivism, but its effects on preventing the normative rise in girls’ depressive symptoms across adolescence have not been examined. This indicated prevention sample included 166 girls (13–17 years at T1) who had at least one criminal referral in the past 12 months and who were mandated to out-of-home care; girls were randomized to MTFC or GC. Intent-to-treat analyses examined the main effects of MTFC on depression symptoms and clinical cut-offs, and whether benefits were greatest for girls most at risk. Depressive symptom trajectories were specified in hierarchical linear growth models over a 2 year period using five waves of data at 6 month intervals. Depression clinical cut-off scores were specified as nonlinear probability growth models. Results showed significantly greater rates of deceleration for girls in MTFC versus GC for depressive symptoms and for clinical cut-off scores. The MTFC intervention also showed greater benefits for girls with higher levels of initial depressive symptoms. Possible mechanisms of effect are discussed, given MTFC’s effectiveness on targeted and nontargeted outcomes.  相似文献   

9.
Objectives. We identified courses of depressive symptoms in an epidemiological sample of emerging adults.Methods. We used latent class growth modeling to identify trajectories of depressive symptoms measured by the 12-item Center for Epidemiological Studies Depression Scale (CES-D) during a 14-year follow-up of 2825 Canadian youths aged 10 to 25 years enrolled in the National Longitudinal Survey of Children and Youth between 1994 and 2009.Results. After adjustment for youth, parent, and family factors, the 3 distinct trajectories of depressive symptoms were minimal (55%; CES-D < 6), subclinical (39%; CES-D = 9–13), and clinical (6%; CES-D > 18). All trajectories exhibited a parallel course, with peak symptoms at 15 to 17 years of age. Subclinical and clinical symptoms were more common than minimal symptoms in female youths and in respondents with lower self-concept, lower socioeconomic status, poorer interpersonal relations, and chronic health conditions (P < .01).Conclusions. Among emerging adults, trajectories of depressive symptoms do not trend upward or downward, and variables associated with identified trajectories demonstrated dose–response effects that agreed with vulnerability–stress theories of depression.The 12-month prevalence of depression is higher during emerging adulthood1 than at any other time.2 Understanding the natural course of depressive symptoms during this period and their associated risk and protective factors is important for informing prevention and intervention strategies. Evidence suggests that depressive symptoms are particularly dynamic during emerging adulthood,3–5 peak between 15 and 18 years of age, and exhibit robust associations with the following variables: female gender, poorer physical health, lower self-concept, lower socioeconomic status, and less supportive family environments.3,4,6,7 Previous cross-sectional and longitudinal analyses of our study data have reported that elevated symptoms of depression among youths are associated with maternal depression, lower self-concept, poorer physical health, tenuous peer and parent–child relations, and lower socioeconomic status.5,8,9 Despite consistent findings on the variables associated with youth depression, uncertainty continues about the shape, direction, and magnitude of trajectories. Some studies have shown depressive symptoms to follow an inverted U-shaped trajectory7; others, trajectories of change5,8; and others, multiple trajectories corresponding to subgroups with distinct patterns of change.3,10–12We aimed to identify trajectories of depressive symptoms in an epidemiological sample of youths during emerging adulthood and to evaluate the effect of youth, parent, and family control variables on the number and shape of trajectories. We hypothesized that we would find 3 to 5 trajectory groups, representing chronically low, moderate, and high, as well as increasing and decreasing, levels of depressive symptoms.Our study design addressed the methodological shortcomings of existing research on trajectories of depressive symptoms3–5,7,10,12 by (1) using 8 occasions of measurement that encompassed all of emerging adulthood; (2) including a comprehensive measure of depressive symptoms to represent positive affect, somatic complaints, and interpersonal relations, in addition to depressed affect; (3) introducing a set of time-invariant control variables measured prior to the assessment of depressive symptoms to adjust trajectories of depression throughout emerging adulthood; and (4) including important covariates of youth depression excluded from previous studies (symptoms of childhood anxiety, chronic physical conditions, parental depression, place of residence, and immigrant status) and several indicators of socioeconomic status (parental education and employment and household income).  相似文献   

10.
目的 了解大学生抑郁症状及其家庭影响因素,为大学生抑郁症状防治提供参考依据。方法 选取广州某大学的学生2 519名,采用自编基本人口学和家庭资料问卷、抑郁自评量表(SDS)、家庭关怀指数问卷(APGAR)和简式父母教养方式问卷(s-EMBU-c)进行调查。结果 大学生SDS标准分为(42.23±9.14)分,检出抑郁症状者333例,检出率为13.2%;其中,轻度症状者275人(10.9%),中度53人(2.1%),重度5人(0.2%)。在众多家庭因素中,感知家庭经济一般或较差、家庭功能低、父亲拒绝高、父亲温暖低或中等、父亲过度保护中等或高,是大学生抑郁症状的危险因素(OR>1,P<0.05)。结论 主观家庭经济较差、家庭功能低、父亲教养方式不良是大学生抑郁症状发生的危险因素。〖JP〗  相似文献   

11.

This paper presents the first findings of an integrative data analysis of individual-level data from 19 adolescent depression prevention trials (n = 5210) involving nine distinct interventions across 2 years post-randomization. In separate papers, several interventions have been found to decrease the risk of depressive disorders or elevated depressive/internalizing symptoms among youth. One type of intervention specifically targets youth without a depressive disorder who are at risk due to elevated depressive symptoms and/or having a parent with a depressive disorder. A second type of intervention targets two broad domains: prevention of problem behaviors, which we define as drug use/abuse, sexual risk behaviors, conduct disorder, or other externalizing problems, and general mental health. Most of these latter interventions improve parenting or family factors. We examined the shared and unique effects of these interventions by level of baseline youth depressive symptoms, sociodemographic characteristics of the youth (age, sex, parent education, and family income), type of intervention, and mode of intervention delivery to the youth, parent(s), or both. We harmonized eight different measures of depression utilized across these trials and used growth models to evaluate intervention impact over 2 years. We found a significant overall effect of these interventions on reducing depressive symptoms over 2 years and a stronger impact among those interventions that targeted depression specifically rather than problem behaviors or general mental health, especially when baseline symptoms were high. Implications for improving population-level impact are discussed.

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12.
目的了解中学生抑郁症状变化趋势和父母受教育水平的关系,为制定中学生抑郁症状的干预措施提供依据。方法采取整群抽样方法,于2009年及2010年采用抑郁自评量表(SDS)对南京市5所学校53个班级初一和高一年级2 202名在校中学生进行2次问卷调查。基线调查2 160名中学生,1 a后随访调查2 118名中学生,随访率为98.1%。结果随访共检出抑郁症状学生974名,检出率为46.0%,其中轻、中、重度抑郁的比例分别为29.4%,13.4%和3.3%。父母为初中及以下文化程度的中学生SDS标准总分、抑郁症状检出率均最高,且中度及重度抑郁症状所占比例也较高。多因素Logistic回归分析显示,父母受教育程度均与中学生的抑郁症状呈负关联,仅父亲受教育程度差异有统计学意义。结论父母受教育程度尤其是父亲受教育程度是中学生抑郁症状的重要影响因素。  相似文献   

13.
Adolescent mothers are at high risk of experiencing intimate partner violence (IPV) which may increase their likelihood of depressive symptoms in adulthood, yet little is known about the long-term effects of IPV on adolescent mothers' trajectories of depressive symptoms. The study reported here uses prospective data spanning 14 years from a study of 229 adolescent mothers from Washington State, USA to evaluate the effects of adolescent exposure to IPV on the trajectories of depressive symptoms over time, as well as the likelihood of depressive symptoms at age 28 years. After controlling for levels of economic insecurity, the results indicate that adolescent IPV and an early vulnerability to depression were significantly related to the intercept, but not the slope of the adult depressive symptom trajectories. Both cumulative and concurrent IPV predicted the likelihood of depressive symptoms at age 28 years. Follow-up analyses indicate that adolescent IPV is associated with greater levels of adult IPV, and that women who report both adolescent and adult IPV have the highest mean levels of depressive symptoms. These findings suggest that exposure to IPV in adolescence may alter the life course of young women, increasing their risk for continuing exposure to intimate partner violence in adulthood and its concomitant negative mental health effects. Efforts aimed at prevention and early intervention in IPV among adolescent mothers are important components of the clinical care of young mothers.  相似文献   

14.

Current evidence-based prevention programming targeting child externalizing problems demonstrates modest overall effect sizes and is largely ineffective for a sizable proportion of youth who participate. However, our understanding of the youth and family characteristics associated with response to specific programming is quite limited. The current study used child and family risk profiles as predictors of response trajectories to the Early Risers conduct problem preventive intervention. A sample of 240 kindergarten-aged youth displaying elevated school-based aggression were randomized by school to either the Early Risers intervention or a control condition. Using a number of child and family risk variables, a latent profile analysis produced a solution consisting of five unique risk profiles. Three low and mixed risk profiles were associated with a limited response to the intervention. One high-risk profile characterized by maladaptive parenting and elevated child externalizing demonstrated notably improved trajectories of externalizing behavior over a 3-year period relative to the control condition. Another high-risk profile characterized by inconsistent discipline, high parental distress, and elevated child internalizing and externalizing symptoms seemed to have positive developmental trends disrupted by the intervention relative to the control condition, potentially consistent with an iatrogenic effect relative to the control condition. The study results support continued efforts to use broader risk profiles to examine heterogeneity in response to preventive interventions and, with replication, will have implications for intervention tailoring.

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15.

We examined attendance trajectory profiles among 335 Mexican-American families participating in an 11-week universal intervention to explore if heterogeneity in attendance and thus dosage was associated with intervention response, defined as pre-to-2-year post (T2) reductions in child report of internalizing symptoms. We estimated trajectories accounting for the influence of baseline covariates, selected based on the Health Belief Model (HBM) and Latino family research, to understand covariate associations with trajectories. Results supported six attendance trajectory groups: non-attenders (NA), early dropouts-low internalizing (EDO-LI), early dropouts-high internalizing (EDO-HI), mid-program dropouts (MPDO), sustained attenders-low internalizing (SA-LI), and sustained attenders-high internalizing (SA-HI). All groups except EDO-HI showed significant pre-to-post change on child report of internalizing; however, trajectory groups reflecting more attendance did not have greater pre-to-post change. Nonetheless, child report of internalizing differentiated two subgroups of sustained attenders and two subgroups of early dropouts. These results suggest heterogeneity among families with similar patterns of attendance and highlight the importance of modeling this heterogeneity. Although life stress was a barrier to participation, there was minimal support for the HBM. Cultural influences, acculturation, and familism, played a more prominent role in distinguishing trajectories. As expected, the EDO-HI group was less acculturated than both sustained attender groups and reported weaker familism values than the SA-HI group. However, unexpectedly, the SA-LI group had lower familism than the EDO-LI group. The results suggest that the influence of culture on participation is nuanced and may depend on child symptomatology.

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16.
BackgroundResearch indicates a possible relationship between adolescent depressive symptoms and physical activity, yet few studies have examined whether trajectories of adolescent physical activity differ among adolescents with and without elevated depressive symptoms.PurposeThis study documented change in physical activity from ages 12–17 years among youth with and without elevated depressive symptoms, and examined the influences of key family, physiological, and demographic covariates on activity patterns.MethodsData were from 371 youth. The sample was 50% female; 76% White, 12% African American, 4% Hispanic, 2% Asian, 2% American Indian, and 4% other or mixed races. Mean age was 12.05 years (SD = 1.63) at Time 1. Latent growth curve modeling (LGM), a cohort-sequential design, and a multiple-group design by level of depressive symptoms were employed.ResultsAdolescent physical activity declined significantly from ages 12–17 for those with and without elevated depressive symptoms. Adolescents with elevated symptoms had lower initial levels of physical activity than individuals without. For youth with low depressive symptoms, male sex and parental support of physical activity were related to higher initial levels of physical activity. For youth with elevated depressive symptoms, male sex, being White, and parental support were related to higher initial levels of physical activity. Additionally, for both groups, increases in parent physical activity were related to less of a decline in adolescent physical activity trajectories.ConclusionsFindings highlight the importance of parental support in promoting physical activity among adolescents with and without elevated depressive symptoms.  相似文献   

17.
[目的]调查分析昌宁县地震后一年在校青少年心理抑郁状态,探索在校青少年抑郁症状与心理弹性的关系,为学校心理健康教育尤其是青少年抑郁症状的有效预防和干预提供参考。[方法]采用分层整群抽样法,选取昌宁县5所中学共1174名高中生,使用心理弹性量表(CD-RISC)评价心理弹性水平,症状自评量表(SCL-90)抑郁分量表筛查抑郁症状。[结果]调查样本中有88. 6%的青少年存在抑郁症状,69. 6%有地震暴露。单因素秩和检验分析显示,有、无自然灾害暴露情况与青少年抑郁及CD-RISC评分比较中有12个因素的差异有统计学意义。Iogistic回归分析结果显示,心理弹性高是保护因素,遭遇过旱灾、"觉得自然灾害可能再次发生""因为目前的生活状况而觉得不安全"是青少年产生抑郁症状的危险因素。[结论]自然灾害是青少年抑郁症状的重要影响因素,心理弹性是青少年抑郁症状的保护因素。  相似文献   

18.
《Women's health issues》2022,32(2):147-155
IntroductionResearch on risk factors for prenatal depression is critical to improve the understanding, prevention, and treatment of women's psychopathology. The current study examines the relation between experiences of racial discrimination and trajectories of depression symptoms over the course of pregnancy.MethodParticipants completed standardized measures regarding symptoms of depression at four timepoints during pregnancy and reported on experiences of racial discrimination at one timepoint. Latent growth curve modeling was used to examine the relation between discrimination and initial levels (intercept) and trajectories (slope) of depression symptoms over pregnancy.ResultsParticipants were 129 pregnant individuals recruited from obstetric clinics and oversampled for elevated depression symptoms. Thirty-six percent of the participants were living at or below 200% of the federal poverty line. Fifty-four percent of the sample identified as non-Latinx White, 26% as Latinx, and 13% as non-Latinx Black. An unconditional latent growth curve modeling revealed a negative quadratic trajectory of depression symptoms during pregnancy. When women's report of discrimination was added as a predictor of depression trajectories, discrimination predicted the initial value (intercept) of depression symptoms, but not change over the course of pregnancy (slope). Specifically, higher levels of experiences of discrimination were associated with higher levels of depression symptoms. When sociodemographic and contextual covariates were included in the model, a low family income-to-needs ratio was also related to higher levels of depression symptoms.ConclusionsThese findings provide evidence that women's experiences of racial discrimination and family financial strain are risk factors for prenatal depression, with implications for screening, treatment, and policy.  相似文献   

19.
Study aims were to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Adolescents (N?=?341) with elevated depressive symptoms were randomized to one of four prevention intervention conditions (cognitive-behavioral group, supportive-expressive group, cognitive-behavioral bibliotherapy, educational brochure control). By 2-year follow-up, 14% showed onset of major/minor depressive disorders. Classification tree analysis (CTA) revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Results implicate two key pathways to depression involving negative attributional style and elevated depressive symptoms in this population, and suggest that bibliotherapy may offset the risk conveyed by the most important depression risk factor in this sample.  相似文献   

20.
目的 分析中学生抑郁症状相关影响因素,为进一步预防和干预中学生抑郁症状的发生提供依据。 方法 采用分层整群随机抽样方法通过在线问卷调查形式采集苏州市1 734名中学生相关健康问题信息。利用logistic回归分析探索中学生抑郁症状相关影响因素。 结果 调查的中学生抑郁症状304人,检出率为17.53%。logistic回归分析显示,女性(OR=1.894,95%CI:1.440~2.492)、尝试饮酒(OR=2.902,95%CI:2.188~3.849)、曾被家长打骂(OR=2.674,95%CI:2.026~3.530)和过去一周每天至少60 min及以上中高强度运动0次(OR=3.930,95%CI:2.287~6.753)是中学生抑郁症状的影响因素。 结论 苏州市中学生抑郁症状检出率为17.53%,应将中学生作为重点人群开展防控抑郁症状科普宣传和干预工作,建议根据不同性别、饮酒、运动频次和家庭亲子关系状况采取有针对性的中学生抑郁症状防控措施。  相似文献   

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