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      Results of the COVID-19 mental health international for the general population (COMET-G) study

      research-article
      a , a , * , b , c , d , e , f , g , h , i , j , k , l , m , n , o , p , q , r , s , t , u , v , w , x , y , z , aa , ab , ac , ad , ae , af , ag , ah , ai , aj , ak , al , am , ao , l , m , ao , aq , ar , as , at , au , av , e , aw , aw , aw , ax , ay , az , ba , bb , bc , at , r , o , bd , ap , be , bf , bg , ag , aj , bj , bk , bl , bm , bl , bm , bp , v , bo , br , bq , bt , bu , bv , bw , bx , bw , bx , ca , n , cb , cc , cd , ce , al , cf , bq , ay , bg , cf , cg , ch , ci , ap , ap , am , s , cj , s , aq , ck , cl , am , cm , cn , co , n , by , ag , u , ag , co , cp , cq , ar , cr , cs , ct , cu , n , cv , bq , u , bq , bp , cw , cx , t , cx , cy , bs , da , db , dc , dd , de , df , dg , bn , aj , bh , dh , di , an , dj , dk , dl , dm , dn , o , q , do , dp , bn , dq , dr , ds , dt , v , du , dv , dw , dx , bq , dy , cw , ba , dz , ea , ba , eb , ec , ed , ee , ef , eg , eh , ei , dh , di , ej , dj , ek , el , ap , ce , ek , en , ce , em
      European Neuropsychopharmacology
      Elsevier B.V. and ECNP.
      COVID-19, Depression, Suicidality, Mental health, Conspiracy theories, Mental disorders, Psychiatry, Anxiety

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          Abstract

          Introduction

          There are few published empirical data on the effects of COVID‐19 on mental health, and until now, there is no large international study.

          Material and methods

          During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

          Statistical analysis

          Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

          Results

          Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed.

          Conclusions

          The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.

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          Most cited references90

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis

            Background The COVID-19 pandemic has had a significant impact on public mental health. Therefore, monitoring and oversight of the population mental health during crises such as a panedmic is an immediate priority. The aim of this study is to analyze the existing research works and findings in relation to the prevalence of stress, anxiety and depression in the general population during the COVID-19 pandemic. Method In this systematic review and meta-analysis, articles that have focused on stress and anxiety prevalence among the general population during the COVID-19 pandemic were searched in the Science Direct, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases, without a lower time limit and until May 2020. In order to perform a meta-analysis of the collected studies, the random effects model was used, and the heterogeneity of studies was investigated using the I2 index. Moreover. data analysis was conducted using the Comprehensive Meta-Analysis (CMA) software. Results The prevalence of stress in 5 studies with a total sample size of 9074 is obtained as 29.6% (95% confidence limit: 24.3–35.4), the prevalence of anxiety in 17 studies with a sample size of 63,439 as 31.9% (95% confidence interval: 27.5–36.7), and the prevalence of depression in 14 studies with a sample size of 44,531 people as 33.7% (95% confidence interval: 27.5–40.6). Conclusion COVID-19 not only causes physical health concerns but also results in a number of psychological disorders. The spread of the new coronavirus can impact the mental health of people in different communities. Thus, it is essential to preserve the mental health of individuals and to develop psychological interventions that can improve the mental health of vulnerable groups during the COVID-19 pandemic.
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              A Longitudinal Study on the Mental Health of General Population during the COVID-19 Epidemic in China

              Highlights • A significant reduction in psychological impact 4 weeks after COVID outbreak. • The mean scores of respondents in both surveys were above PTSD cut-offs. • Female gender, physical symptoms associated with a higher psychological impact. • Hand hygiene, mask-wearing & confidence in doctors reduced psychological impact. • Online trauma-focused psychotherapy may be helpful to public during COVID-19.
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                Author and article information

                Journal
                Eur Neuropsychopharmacol
                Eur Neuropsychopharmacol
                European Neuropsychopharmacology
                Elsevier B.V. and ECNP.
                0924-977X
                1873-7862
                15 October 2021
                January 2022
                15 October 2021
                : 54
                : 21-40
                Affiliations
                [a ]3 rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
                [b ]Pennine Care NHS Foundation Trust, United Kingdom
                [c ]Manchester Metropolitan University, Manchester, United Kingdom
                [d ]Core Psychiatry training, Health Education England North West, United Kingdom
                [e ]Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
                [f ]Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
                [g ]Section of Psychiatry and Mental Health, Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado, Lima, Peru
                [h ]Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, MN, USA
                [i ]School of Medicine and Health Science, Institute of Health Science Shinshu University, Matsumoto, Japan
                [j ]Department of Psychiatry, Bayero University, Kano, Nigeria
                [k ]Aminu Kano Teaching Hospital, Kano, Nigeria
                [l ]IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
                [m ]Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
                [n ]Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
                [o ]Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain, ISPA, INEUROPA. CIBERSAM
                [p ]Department of Psychiatry, Hospital Universitario Central de Asturias, Oviedo, Spain, ISPA, INEUROPA. CIBERSAM
                [q ]Mental Health Center of La Corredoria, Oviedo, Spain, ISPA, INEUROPA. CIBERSAM
                [r ]Department of Psychology, University of Oviedo, Oviedo, Spain, ISPA, INEUROPA. CIBERSAM
                [s ]Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
                [t ]Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
                [u ]Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
                [v ]Mental Hub, Tbilisi, Georgia
                [w ]NGO Healthcare Research and Quality Agency, Tbilisi, Georgia
                [x ]Hospital San Juan de Dios Hospital, Guadalajara, Mexico
                [y ]Janssen Research and Development, Johnson & Johnson, American Society of Hispanic Psychiatry and WARMI Women Mental Health, Cincinnati, Ohio, USA
                [z ]Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
                [aa ]National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
                [ab ]APM Board Certified in General Psychiatry and Neurology, Addiction Psychiatry, & Addiction Medicine, UPMC, DDAP, Philadelphia, USA
                [ac ]Department of Teaching and Research, Hospital Borda, Buenos Aires, Argentina
                [ad ]University of Buenos Aires, Buenos Aires, Argentina
                [ae ]Universidad Peruana Cayetano Heredia, Clínica AngloAmericana, Lima, Perú
                [af ]Sanitaire and Social Union for Accompaniment and Prevention, Center of Ambulatory Psychiatry of Narbonne and Lezigan, Narbonne, France
                [ag ]Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL Teramo, Teramo, Italy
                [ah ]School of Nursing, University of L'Aquila, Italy
                [ai ]Department of Neuroscience and Imaging, School of Psychiatry, University of Chieti, Chieti, Italy
                [aj ]Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
                [ak ]Departamento de Fisiología e Farmacología, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
                [al ]Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
                [am ]Desousa Foundation, Mumbai, India
                [an ]Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
                [ao ]University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
                [ap ]Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
                [aq ]Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
                [ar ]Psychiatry department, Ankara dışkapı training and research hospital, Ankara, Turkey
                [as ]Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
                [at ]Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
                [au ]Centre of Neuroscience, Queen's University, Kingston, Ontario, Canada
                [av ]Department of Psychiatry and Narcology, Ryazan State Medical University n.a. academician I.P. Pavlov, Ryazan, Russia
                [aw ]State Budgetary Institution of the Rostov Region "Psychoneurological Dispensary", Rostov-on-Don, Russia
                [ax ]Faculty of Medicine, Medical University of Sofia, Bulgaria
                [ay ]Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
                [az ]“Villa dei Pini” Psychiatric Rehabilitation Center, Avellino, Italy
                [ba ]Psychiatric Studies Centre, Provaglio d'Iseo, Italy
                [bb ]Hospital Magalhães Lemos, Porto, Portugal
                [bc ]Department of Psychiatry, Medical Psychology and Drug Abuse, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
                [bd ]Mental Health Center of La Ería, Oviedo, Spain, ISPA, INEUROPA. CIBERSAM
                [be ]Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland
                [bf ]Instituto Nacional de Psiquiatría Ramón De la Fuente Muñiz, Mexico City, Mexico
                [bg ]Department of Psychiatry, University of California San Diego, San Diego, USA
                [bh ]Universidad Diego Portales, Santiago, Chile
                [bj ]Forensic Psychiatry Unit, Abarbanel Mental Health Center, Israel
                [bk ]Faculty of Human Sciences, Education Bureau of the Laboratory Schools, University of Tsukuba, Tokyo, Japan
                [bl ]Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
                [bm ]Public Health Foundation, Dhaka, Bangladesh
                [bn ]Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
                [bo ]Department of Public Health & Informatics, Jahangirnagar University, Dhaka, Bangladesh
                [bp ]Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
                [bq ]Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
                [br ]Department of Psychiatry, Queens University, Kingston, Ontario, Canada
                [bs ]Education center, Mental Health Clinic No 1n.a. N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
                [bt ]Ministry of Health, Millenium Institute for Research in Depression and Personality, Santiago, Chile
                [bu ]Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
                [bv ]National Mental Health Center of the Ministry of Health of the Republic of Azerbaijan, Baku, Azerbaijan
                [bw ]Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
                [bx ]New York Medical College, Valhalla, NY, USA
                [by ]School of Medicine, University of Zagreb, Zagreb, Croatia
                [ca ]Warwick Medical School, University of Warwick, United Kingdom
                [cb ]Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
                [cc ]Child Psychiatry Department, Ankara city hospital, Ankara, Turkey
                [cd ]Faculty of Medicine, Lund University, Malmö, Sweden
                [ce ]International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
                [cf ]Kirov State Medical University, Kirov, Russia
                [cg ]Psychiatry, Drug abuse and Psychology Department, Odessa National Medical University, Odessa, Ukraine
                [ch ]Occupational & Environmental Health Sector, Public Health Policy
                [ci ]Occupational and Environmental Health Sector, Department of Public Health Policy, School of Public Health, University of West Attica, Greece
                [cj ]Department of Psychology, University of Sargodha, Sargodha, Pakistan
                [ck ]Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
                [cl ]Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
                [cm ]Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
                [cn ]Brain Research Foundation onus, Lucca, Italy
                [co ]Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
                [cp ]Private outpatient clinics "JSC InMedica klinika", Vilnius, Lithuania
                [cq ]Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
                [cr ]General Office for the Psychiatric Services of the Ministry of Health, Mexico City, Mexico
                [cs ]Department of Postgraduate Education, Russian National Research Medical University n.a. N.I. Pirogov, Moscow, Russia
                [ct ]Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
                [cu ]Sackler School of Medicine New York State American Program, Tel Aviv University, Tel Aviv-Yafo, Israel
                [cv ]Compartment of Liaison Psychiatry, “Pius Brinzeu” County Emergency Clinical Hospital, Timisoara, Romania
                [cw ]Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyz Republic
                [cx ]School of Social Sciences, Hellenic Open University, Patras, Greece
                [cy ]Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
                [da ]Faculty of Medicine, University of Belgrade, Belgrade, Serbia
                [db ]Clinical Department for Crisis and Affective Disorders, Institute of Mental Health, Belgrade, Serbia
                [dc ]South London and Maudsley NHS Foundation Trust, London, United Kingdom
                [dd ]Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
                [de ]Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
                [df ]Department of the Introduction to Internal Medicine and Family Medicine, International Higher School of Medicine, Bishkek, Kyrgyz Republic
                [dg ]Abarbanel Mental Health Center, Bat-Yam, Israel
                [dh ]Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
                [di ]Riga Centre of Psychiatry and Narcology, Riga, Latvia
                [dj ]Servicio de Emergencia, Acute inpatient Unit, Hospital Moyano, Buenos Aires, Argentina
                [dk ]Argentine Institute of Clinical Psychiatry (IAPC), Buenos Aires, Argentina
                [dl ]General Psychiatry Unit I, Greater Poland Neuropsychiatric Center, Kościan, Poland
                [dm ]Department of Psychiatry, National Autonomous University of Honduras, Tegucigalpa, Honduras
                [dn ]Centro de Investigación en Salud Pública, Facultad de Medicina, Universidad de San Martín de Porres, Instituto Nacional de Salud Mental “Honorio Delgado – Hideyo Noguchi”, Lima, Perú
                [do ]Faculty of Health Sciences, Anahuac University, Mexico City, Mexico
                [dp ]Department of Psychiatry. Escuela Nacional de Medicina, TEC de Monterrey. Servicio de geriatría. Hospital Universitario "José Eleuterio González" UANL. Monterrey, Nuevo León México
                [dq ]Assistant Professor at Cognitive Science and Artificial Intelligence Department Tilburg University
                [dr ]Klinik für Allgemeine Psychiatrie und Psychotherapie Ost, Psychiatrische Institutsambulanz, Klinikum am Weissenhof, Weissenhof, Germany
                [ds ]DY Patil Medical College, Navi Mumbai, India
                [dt ]Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan
                [du ]Psychiatric Unit, Pambalah Batung General Hospital, South Kalimantan, Amuntai, Indonesia
                [dv ]Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
                [dw ]Saint Petersburg Psychoneurological Dispensary No2, Saint Petersburg, Russia
                [dx ]Derbyshire Healthcare NHS Foundation Trust, The Liasion Team, Royal Derby Hospital, Derby, Derbyshire, United Kingdom
                [dy ]Department of Psychoprophylaxis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
                [dz ]European Depression Association and Italian Association on Depression, Brussels, Belgium
                [ea ]Bedforshire Center for Mental Health Research in association with the University of Cambridge, United Kingdom
                [eb ]Health Policy, WHO Regional Office for Europe
                [ec ]Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
                [ed ]″Agios Charalambos" Mental Health Clinic, Heraklion, Crete, Greece
                [ee ]1st Department of Academic Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
                [ef ]Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
                [eg ]Kabir Medical College, Gandhara University, Peshawar, Pakistan
                [eh ]Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
                [ei ]Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
                [ej ]Institute of Public Health, Riga Stradins University, Riga, Latvia
                [ek ]Department for Research and Education, Institute of Mental Health, Belgrade, Serbia
                [el ]Educational and Research Center - Ukrainian Family Medicine Training Center, Bogomolets National Medical University, Kyiv, Ukraine
                [em ]Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
                [en ]Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece
                Author notes
                [* ]Corresponding author.
                Article
                S0924-977X(21)00775-6
                10.1016/j.euroneuro.2021.10.004
                8609892
                34758422
                61ba2704-ebd6-45c4-8a56-9c7e4098a52a
                © 2021 Elsevier B.V. and ECNP. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 16 August 2021
                : 5 October 2021
                : 8 October 2021
                Categories
                Article

                Pharmacology & Pharmaceutical medicine
                covid-19,depression,suicidality,mental health,conspiracy theories,mental disorders,psychiatry,anxiety

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