Child Health Disparities

Robert M. Kliegman Physician , in Nelson Textbook of Pediatrics , 2020

Determinants of Wellness and Health Disparities

Fig. 2.1 displays a categorization of the multiple determinants of health and well-being. Applying this categorization to health disparities, conceptualizations of the root causes of health disparities emphasize the nearly modifiable determinants of health: the physical and social surroundings, psychology and wellness behaviors, socioeconomic position and status, and access to and quality of healthcare. Differential access to these resources result in differences in material resource (eastward.g., coin, education, healthcare) orpsychosocial factors (e.g., locus of control, adaptive or risky behaviors, stress, social connectedness) that may contribute to differences in health condition.

Fig. 2.2 illustrates the complex relationships among multileveled factors and health outcomes.Social stratification factors such as socioeconomic status (SES), race, and gender have profound influences on environmental resources bachelor to individuals and groups, including neighborhood factors (eastward.grand., safety, healthy spaces), social connection and back up, piece of work opportunities, and family unit surroundings. Much of the differential access to these resources results from bigotry, on a systematic or interpersonal level.Discrimination is defined as negative beliefs, attitudes, or behaviors resulting from categorizing individuals based on perceived grouping affiliation, such as gender (sexism) or race/ethnicity (racism).

SES, race/ethnicity, gender, and other social stratification factors also have furnishings on psychological performance, including sense of control over 1's life, expectations, resiliency, negative bear on, and perceptions of and response to discrimination. Environmental and psychological context and then have influence over more proximal determinants of health, including health-promoting or gamble-promoting behaviors; access to and quality of healthcare and health education; exposure to pathogens, toxins, and carcinogens; pathophysiologic (biologic) and epigenetic response to stress; and the resource available to support optimal child evolution. Variability in these factors in turn results in differential health outcomes.

Psychosocial Stress and Allostatic Load

An understanding has emerged that helps explain how psychosocial stress influences disease and health outcomes (Fig. ii.3). This theory,allostatic load, provides insight into the processes and mechanisms that may contribute to health disparities.Allostasis refers to the normal physiologic changes that occur when individuals feel a stressful consequence. These internal reactions to an external stressor includes activation of the stress-response systems, such as increases in cortisol and epinephrine, changes in levels of inflammatory and immune mediators, cardiovascular reactivity, and metabolic and hormone activation. These are normal and adaptive responses to stress and event in physiologic stability in the face of an external challenge. After an acute external stress or challenge, these systems revert to normal baseline states. All the same, when the stressor becomes chronic and unbuffered by social supports, dysregulation of these systems may occur, resulting in pathophysiologic alterations to these responses, such as hyperactivation of the allostatic systems, orexhaustion. Over time this dysregulation contributes to increased risk of disease and dysfunction. This pathophysiologic response is chosenallostatic load.

Concepts of Health and Illness

Bhushan Patwardhan PhD, FAMS , ... Girish Tillu Md , in Integrative Approaches for Wellness, 2015

Determinants of Wellness

Determinants of health may be biological, behavioral, sociocultural, economic, and ecological. Broadly, the determinants of health tin be divided into 4, core categories: diet, lifestyle, environment, and genetics, which are like four pillars of the foundation. When any one of the pillars of health determinants becomes weak, a support organization is needed. This is considered the fifth determinant of wellness and involves medical care ( Figure iii.iii). A cursory review of these cadre determinants of health volition provide more insight.

Figure 3.3. Determinants of health: Nutrition, lifestyle, environs, and genetics are considered as cadre determinants and iv pillars of health. When whatsoever one or more of these is compromised, wellness is at take chances and medical care is required every bit a support system.

Interestingly, ii determinants, diet and lifestyle, are totally in our hands, and hence are called modifiable factors. Many diseases are caused by bad practices of nutrition and lifestyle. The degraded ecosystem, and environmental pollution are the causes of several disorders and diseases. With the help of powerful engineering science and screening methods, many disorders of genetic origin can be prevented. If one or more than core determinants become weak, and so just the support of medical care is needed.

Over 75% or more of the resource allocated in health care budgets, especially from rich countries, are used for the treatment of lifestyle-related conditions. There is a growing consensus that lifestyle modifications should be the foundation of any wellness intendance arrangement. According to the American College of Lifestyle Medicine, nearly 80% of all chronic diseases are preventable by readily available means—lifestyle modification equally medicine.

People should be empowered to "take their health into their ain hands" through lifestyle modifications. This will drastically reduce dependence on doctors. Traditional knowledge can be immensely useful to design advisable lifestyle interventions. For instance, Swasthavritta, a branch of Ayurveda is dedicated totally to healthy lifestyle. Swasthavritta dictates do's and don'ts for a healthy daily regimen, and outlines diet and lifestyle modifications advisable to unlike seasons. Swasthavritta, and biobehavioral practices suggested by Yoga are very useful sources for lifestyle medicine.

Nutrition is another of import determinant. Information technology has individual, family unit, and community dimensions. The E/Westward, and rural/urban regions have remarkably dissimilar challenges related to nutrition. More often than not, at one finish of the spectrum, in Western and/or urban spheres, at that place is less physical activeness, calorie overload, but poor nutrition mainly due to junk food consumption. At the other end of the spectrum, in the East and/or rural spheres, at that place is calorie deficiency, protein malnutrition, and undernourishment. The lower socioeconomic communities may accept a greater incidence of premature and depression nascence weight babies, higher hazard of heart disease, stroke, and some cancers. Poor people living in urban areas may have a diet consisting of cheap free energy mainly from sugar-rich foods, with little intake of vegetables, fruits, and whole grains. They have relatively less concrete activity. On the other hand, poor communities from rural areas might take intense physical activities, but not sufficient energy and protein.

In general, urban communities face problems related to environmental degradation, and air and water pollution; rural communities face problems related to sanitation, hygiene, insecticides, pesticides, and agrochemicals. Thus, the poor are well-nigh probable to suffer because of the interplay of the deranged determinants of health.

In the interconnected, borderless world, determinants of wellness cannot be considered in isolation. They will always be interdependent. The substantial health inequity in different parts of the world is today's reality. This inequality of health is due to inequalities in income, education, gender, and availability of resource.

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Public health

Adam Feather MBBS, FRCP, FAcadMEd , in Kumar and Clark'southward Clinical Medicine , 2021

Wider determinants of health

Wider determinants of health (WDHs) are the broader social, economic, political and environmental circumstances that influence health outcomes throughout life. Dahlgren and Whitehead (1991), subsequently modified past Barton and Grant (2006), developed an influential model of the main determinants of health, in which, at the core, are constitutional factors such as sexual activity, historic period and genetics; overlapping layers represent individual lifestyle factors, followed by the wider determinants ( Fig. 14.four ). The cadre attributes are relatively fixed but, as the layers of influence extend outwards, the determinants are amenable to change:

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The first layer represents private lifestyle behaviours , eastward.g. nutrition, physical activity, smoking and booze consumption.

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The second layer represents the communities in which individuals live – social networks that influence wellness and the health behaviours we exhibit.

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Side by side, living and working atmospheric condition take an touch on on health, due east.g. the quality of an individual'south employment, housing and education.

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Finally, the prevailing socioeconomic, cultural and environmental weather bear upon the wellness of the whole population, and these are influenced past local, regional, national and international factors.

These overlapping layers exert an influence over each other and there is a complex interplay betwixt them.

Air pollution

Air pollution is an example of a WDH, representing a huge ecology health risk globally. Poor air quality has a range of brusk- and long-term health impacts, including but not limited to cardiovascular and respiratory affliction, emergency hospital admissions and expiry. I of the starting time demonstrations of these furnishings was during the 'dandy smog of London' in 1952, which contributed towards a large number of deaths. This led to the Clean Air Act of 1956, which express the burning of solid fuel for heating in urban areas.

A range of pollutants are known to be harmful to health, including particulate matter and nitrogen dioxide. Although tackling air pollution requires private efforts, the problem cannot be fairly addressed without local, national and international policy change. Examples of interventions for tackling air pollution include:

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setting objectives and limits for different pollutants

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encouraging use of active transport instead of cars

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encouraging manufacturers to produce cleaner vehicles, and industry to prefer greener technologies

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introducing ultra-low emissions zones in urban areas and 'no-idling zones' around schools.

Understanding Environmental Quality Through Quality of Life (QOL) Studies☆

R.J. Lawrence , in Reference Module in Earth Systems and Environmental Sciences, 2014

Determinants of Health

The term 'determinants of health' was introduced in the 1970s and it refers to those factors that have a significant influence, whether positive or negative, on health. The term should non imply a cause–event relationship between a risk gene and a wellness status. Health is the upshot of multiple factors including those genetic, biological, and lifestyle factors relating to the individual and those factors relating to the structure of society and its policies. Figure 1 presents eight classes of factors that can have a pregnant influence on health and well-being. One class of factors, such as national and local policy definition and implementation, can influence a multitude of wellness issues within and beyond the wellness sector. The improvement of population health status implies that policies and interventions exterior the wellness sector should be addressed at the same time as conventional biomedical and public health approaches.

Figure 1. 8 classes of central factors ('déterminants') that influence health status and quality of life, and the interrelations between them, illustrate the multidimensional and systemic nature of wellness and well-being.

 Copyright R. Lawrence.

Amidst those factors that have a pregnant influence on health are the ecology and social weather condition in which people alive. There is a large amount of empirical evidence that shows that social inequalities, peculiarly poverty, affect inequalities in wellness and well-being. The poor are more probable to endure illness during their life span considering they have more exposure to risk factors. In 1998, the WHO established the Commission on the Social Determinants of Health. The commission recommended policies and interventions co-ordinate to ten of import topics. These topics are addiction, early life, food, stress, social exclusion, social gradient, social support, unemployment, work, and transportation. The commission differentiated between structural determinants (including the labor market, pedagogy system, and welfare state), the private's social status (gender, ethnicity, socioeconomic rank, and social cohesion), and intermediary factors (lifestyle and living and working conditions).

In the field of health promotion, health is not considered every bit an abstract condition, just every bit the ability of an individual to achieve his/her potential and to respond positively to the challenges of daily life. Hence, health is an asset or a resource for everyday life, rather than a standard or goal that ought to be achieved. This redefinition is pertinent for QOL studies considering the ecology and social conditions of man habitats do affect human relations, and they can have positive or negative impacts on the health status of groups and individuals. It besides implies that the capacity of the wellness sector to deal with the health and well-being of populations is express and that close collaboration with other sectors would exist beneficial.

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The health and legal consequences of trouble drinking

Ken Barrie , Angela Scriven , in Public Health Mini-Guides: Alcohol Misuse, 2014

Deprivation is a central determinant of health. The and then-called 'Glasgow effect' refers to the higher levels of mortality and morbidity experienced in the deprived post-industrial region of West Central Scotland, with Glasgow at its middle, which exceeds that which may be explained by deprivation alone (Hanlon et al., 2006; Bromley and Shelton, 2010; McCartney et al., 2011). These measures are then significant that they skew the overall motion-picture show of Scotland'south wellness. The 'Glasgow effect' reflects a slower rate of health improvement in the city compared to the residual of the UK, a miracle which may engagement from the early 1980s. A similar effect has also been reported in parts of both South Wales and North East England (Bromley and Shelton, 2010).

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Nutritional Hormesis in a Modern Environment

O. Stella Ademowo , ... Helen R. Griffiths , in The Science of Hormesis in Health and Longevity, 2019

Abstract

Diet is a powerful determinant of health and well-being. In the modern environment where energy-rich foods are prevalent, challenges exist to improve diets that will provide an appropriate free energy density while maintaining the required nutritional value. A contempo concept in nutrition is that components of food which are not abundant in the diet may exert a regulatory effect on physiological and biological processes. Some of these components appear to deed as hormetins, i.e., they exert a mild stress and in turn arm-twist and adaptive response that offers greater health advantages than the stress itself. Therefore, nutritional hormesis play a vital function in the modernistic aging population by modulating the susceptibility to diseases. Adequate and advisable dietary levels of hormetic phytochemicals; polyphenols, carotenoids, sulforaphane, and other bioactive compounds have been recognized every bit activators of intracellular signaling cascades and modifiers of gene expression with health benefits. Research to date has focused on individual hormetins in isolation, however, the bioavailability, bioaccessibility, and potential for interaction of these compounds in combination through interim on distinct intracellular signaling pathways are of significance in the homo torso. Equally the mod world'southward population ages chronologically, yet biologically at different rates, it is increasingly important to understand how diet and hormetins within the nutrition could reduce adventure for historic period-associated disease. Further work is needed in the field of nutrigenomics to identify the key biochemical targets that are modifiable by hormetins.

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Dietary Guidelines, International

A. Seow , in International Encyclopedia of Public Wellness, 2008

Introduction

Nutrition is a key determinant of wellness of a population, and of growth and development in children. Dietary guidelines are tools that translate the science of nutritional requirements to a applied blueprint of nutrient choices for the general population. On a national level, they provide guidance for health promotion and risk reduction, and often form the basis of national food and nutrition policies and education programs. Over time, these guidelines are constantly revised to include upward-to-engagement evidence from experimental studies and big population databases, to which sophisticated dietary analyses accept been applied.

The history of official guidance for food intake dates back to the commencement one-half of the twentieth century. Dietary guidelines were initially targeted at preventing deficiencies of micro- and macronutrients. In the The states, the start daily nutrient guides aimed at improving the wellness of the population were published in 1916 by the Section of Agriculture. They identified v food groups: milk and meat, cereals, vegetables and fruits, fats and fat foods, and sugars and sugary foods. This afterwards became the 'Basic 7' in 1942, the aforementioned year that Canada'due south Official Food Rules were beginning issued (Health Canada, 2002). At that time in the midst of wartime food rationing, nutritional deficiencies were a prominent concern, and alternate choices were suggested in case of shortages.

With lifestyle-related diseases rising in prominence throughout the world, the focus of dietary guidelines in many parts of the world has shifted to preventing chronic diseases such as diabetes and cardiovascular diseases. In addition, along with the recognition that patterns of food intake are more predictive of health outcomes than individual components of the diet, the emphasis has been toward providing guidelines which are food-based and flexible. At the same time, in that location is a growing agreement of cultural dietary traditions and evolution of ways to incorporate them into national guidelines

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Health literacy and how to communicate effectively with patients to elicit a long-term behavioural alter

Sonal Shah , in A Prescription for Healthy Living, 2021

Decision

Health literacy is a key determinant of health and is influenced by multiple, complex, interacting factors. To ameliorate health literacy requires a collaborative arroyo involving government and policymakers, and front-line professionals responsible for health and pedagogy. For policymakers, an example of a arrangement-based intervention is ensuring that the marketing and labelling of food is clear, transparent and accessible to consumers. This volition support the public in making amend health choices. Similarly, interventions through the education system, particularly in the early on years, can embed the foundations of health literacy which is vital for lifelong health and well-existence. For health practitioners, developing systems to support people with poor literacy through improved communication and preparation for all staff will help empower individuals to have control of their own health.

Summary

Health literacy is a key determinant of health, associated with significant economical implications.

Those with poor wellness literacy have more than adverse wellness outcomes, including increased morbidity and increased adventure of premature death.

For practitioners to back up those with poor health literacy:

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There should be preparation in and sensation of health literacy in healthcare settings.

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Advice, both written and exact, should be patient centred and appropriate to an private's level of understanding.

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Patients should be empowered to take control of their health and well-being.

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Racism and Health

Y.C. Paradies , D.R. Williams , in International Encyclopedia of Public Wellness, 2008

Conceptualizing Racism

In conceptualizing racism equally a determinant of health, it should start be recognized that racism is only 1 of several causes of ethnoracial disparities in health. Genetic, sociocultural, and socioeconomic differences between ethnoracial groups are too responsible for such disparities. While the latter two factors are substantial drivers of ethnoracial health disparities and are themselves strongly influenced by racism, genetic variation accounts for only a tiny fraction of health disparities across ethnoracial groups.

To the extent that racism drives wellness outcomes, information technology does and then in interaction with other oppressions such every bit sexism, ageism, and classism. Oppression is manifested in societies through the diff distribution of power among social groups resulting from attitudes, beliefs, behaviors, norms, and practices relating to these social groups. The miracle of oppression is besides intrinsically linked to that of privilege. In addition to disadvantaging minority racial groups in society, racism also results in groups (such as Whites) being privileged and accruing social power.

Figure 1 is a representation of how privilege/oppression may act as a determinant of wellness. The processes shown in this figure occur across the dimensions of both time (history) and space (geography) as well as across the life class.

Effigy 1. Conceptualizing privilege/oppression as a determinant of health. Reproduced from Paradies Y (2006a) Defining, conceptualizing and characterizing racism in health research. Disquisitional Public Health16(ii): 143–157.

In the structural realm, central features of gild, equally encapsulated by the terms culture, ideology, and worldview, interact with societal institutions and are influenced by and produce systemic privilege/oppression. Systemic privilege/oppression can be divers as the production, control, and access to textile, data, and symbolic resource within a guild that serve to increase power differentials between social groups. Systemic racism, which has also been referred to every bit institutional (or institutionalized), structural, cultural, societal, and civilizational racism, is an example of systemic privilege/oppression. As shown in Figure 1 , systemic oppression acts to differentially construct and constrain the interpersonal realm equally represented by an private's social identities (or locations). As a form of oppression, systemic racism is a strong determinant of an individual'southward place of residence, living weather condition, and socioeconomic position (SEP).

An individual's social locations then become the basis on which interpersonal and internalized oppression is perpetrated. Interpersonal oppression is the interactions betwixt individuals that serve to increase power differentials between social groups. Using the framework presented past Jones (2000), internalized oppression can be defined as the incorporation of attitudes, beliefs, or ideologies within an individual's worldview that issue in the unequal distribution of ability among social groups. In that location are two forms – internalized dominance (i.e., privilege) and internalized oppression (i.e., oppression). Internalized potency is the incorporation of attitudes, beliefs, or ideologies about the inferiority of other social groups and/or the superiority of one's own social group. Conversely, internalized oppression is the incorporation of attitudes, beliefs, or ideologies about the superiority of other social groups and/or the inferiority of one's own social group.

At the level of the individual, a biopsychosocial approach represents the interaction of interpersonal and internalized oppression with psychosocial and behavioral factors besides as biophysical (including genetic) processes. Individuals with diverse social identities who have disparate exposure to interpersonal and internalized oppression feel differential health outcomes past way of the processes shown. These processes also feed back into the interpersonal and structural realms, such that these three levels together enact on each other. The commencement step toward measuring the effects of racism, as represented in Effigy 1 , is to empathize how racism tin can be operationalized as a determinant of health.

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Racism and Health

Yin Paradies , in International Encyclopedia of Public Health (Second Edition), 2017

Conceptualizing Racism

In conceptualizing racism as a determinant of health, it should first exist recognized that racism is just one of several causes of ethnoracial disparities in health. Genetic, sociocultural, and socioeconomic differences betwixt ethnoracial groups also contribute to such disparities. Sociocultural and socioeconomic factors are substantial drivers of ethnoracial health disparities that are both strongly and bi-directionally influenced past racism. On the other mitt, aside from the case of epigenetics touched on briefly below, genetic variation accounts for only a small fraction of ethnoracial health disparities (Diez Roux, 2012).

To the extent that racism drives health and well-being, it does so in interaction with other oppressions such as sexism, ageism, and classism (Bauer, 2014). Oppression is manifested in societies through the unequal distribution of power (resource, opportunities, benefits, capacities, etc.) amidst social groups resulting from attitudes, behavior, behaviors, norms, and practices relating to these social groups (Berman and Paradies, 2010). The miracle of oppression is also intrinsically linked to that of privilege. Specifically, in addition to disadvantaging minority racial groups in society, racism besides fundamentally results in some groups (e.g., Whites) systematically accruing unearned advantage (Monahan, 2014).

Systemic oppression can be defined as the production, control, and access to fabric, information, and symbolic resources within a guild that serve to increase ability differentials between social groups. Systemic racism, which has also been referred to as institutional (or institutionalized), structural, cultural, societal, and civilizational racism, is an example of systemic oppression which profoundly shapes an individual's place of residence, living atmospheric condition, and socioeconomic position (SEP).

An individual's social locations then get the properties upon which interpersonal and internalized oppression are perpetrated. Interpersonal oppression is the interactions between individuals that serve to increase power differentials between social groups. Internalized oppression can exist defined as the incorporation of attitudes, beliefs, or ideologies within an individual's worldview that result in the unequal distribution of ability among social groups. There are ii forms – internalized dominance (i.eastward., privilege) and internalized oppression (i.eastward., oppression). Internalized authority is the incorporation of attitudes, beliefs, or ideologies about the inferiority of other social groups and/or the superiority of one'southward own social group. Conversely, internalized oppression is the incorporation of attitudes, beliefs, or ideologies about the superiority of other social groups and/or the inferiority of i's own social group (Berman and Paradies, 2010).

Above and beyond the complexity of conceptualizing racism, its touch on in society is mediated through expression in individual behaviors and institutional practices. These action-oriented aspects of racism are often encompassed by the term 'racial discrimination' which tin be broadly divers as differential and unfair/negative treatment centered on notions of ethnoracial difference, which tin besides include distinctions relating to civilization, emphasis, linguistic communication, nationality, and religion (on this final, come across alsoTaras, 2013; Meer, 2013). The study of racism equally a determinant of health has, to appointment, predominately focused on understanding how discrimination impacts upon health via several recognized pathways: (1) reduced access to social outcomes such every bit employment, housing, and education, and/or increased exposure to risk factors (due east.m., racial violence); (2) negative cognitive/emotional and related pathopsychological processes (hyper-vigilance (Clark et al., 2006; Hicken et al., 2013), anticipatory/attributional feet (Sawyer et al., 2012; Mendes et al., 2008) and rumination (Borders and Liang, 2011; Borders and Hennebry, 2015)); (iii) allostatic load and concomitant pathophysiological processes; (4) diminished participation in good for you behaviors (east.thou., sleep and practice) and/or increased engagement in unhealthy behaviors (e.thousand., alcohol consumption and smoking) either direct as stress coping or indirectly via reduced cocky-regulation (Smart Richman and Lattanner, 2014); (5) physical injury as a result of racially motivated violence (Paradies, 2006b; Brondolo et al., 2011; Harrell et al., 2011; Pascoe and Richman, 2009; Priest et al., 2013; Gee et al., 2009). Building on conceptual diagrams in existing scholarship (Paradies, 2006a; Harrell et al., 2011; Pascoe and Richman, 2009; Williams, 1997), Figure 1 broadly details these multiple pathways linking bigotry to ill-health.

Figure 1. Conceptual model linking racial discrimination and health outcomes.

 Source: Paradies, Y., Priest, N., Ben, J., Truong, One thousand., Gupta, A., Pieterse, A., Kelaher, M., Gee, G., 2013. Racism as a determinant of wellness: a protocol for conducting a systematic review and meta-assay. Syst. Rev. 2 (85).

Above and across clearly delineated definitions and conceptual models detailing plausible pathways leading from racial discrimination to ill-health, empirical enquiry to mensurate and appraise these impacts require further explication of how racism can be operationalized as a determinant of health.

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