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Evaluation of Premarital Screening tests in Babylon Governorate

MaadJawadKadhim*1; Assist Prof. Buthaina Ateyah Rashid *2; Assist Prof. Amel Mustafa Kamil*3

*1, 2, 3

Middle Technical University, College of health and Medical Technology Baghdad/

Department of Community health, Iraq / Babylon ([email protected])

Abstract:

Background: Premarital screening program is a primarily preventive approach for premarital couples to improve women's wellness and subsequent pregnancy outcomes. Many young men and women need more information about reproductive health and access to services before having their first child. Materials and Methods:A cross-sectional study conducted at ten hospitals in Babylon governorate. These hospitals, selected according to the hospitals that have premarital screening clinic, By using a convenient sample method.

Data were collected using a structured questionnaire approved by the Ministry of Health for the period (16th December 2020 – 31 March 2021). Results: The results of this study indicated that all hospitals had a full evaluation score (100%) regarding the presence of health, administrative, and service staff according to standards, specific records for premarital counseling, the presence of special site for storage records, result confidentiality, the availability of tests, availability of mobile in the clinic for contact with the couple in case abnormal test results, and sending a monthly statistic of those about to get married is submitted to the public health department. While there are two items that had a weak level (<50%) in all hospitals about "the lab is in the same unit" and "the presence of coordinator for the purpose of sending the result to court. Conclusions: We conclude the average percentage for premarital screening programs is 90.0% and this is considered a pass percentage for all the studied hospitals.

Keywords:Evaluation, Premarital Screening, Tests

Introduction:

Premarital screening is one of the most effective methods and plans to prevent inherited disorders and congenital anomalies 1. While premarital tests have importance in places where consanguineous marriages are quite popular, such as in Arab countries 23.

Premarital counseling for a long period of time began in Iraq. It has been carried out in several specialized centers spread across the country. The new Ministry of Health plan is to integrate this service as a regular operation at the primary health care level 4.

Pre-marital genotype screening offers an opportunity for people to become aware of their genetic predisposition to diseases and for couples to be aware of their unborn children's potential genetic characteristics. Therefore, if one assumes that procreation is one of the reasons for marriage, then thinking about genetic compatibility and preventing significant genetic inheritance is something to be strongly considered. Sickle cell disease, cystic

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fibrosis, and Tay-Sach disease, the most common of which is sickle cell disease, are the most common genetic disorders 5.

A lot of young male and female go into marriage with deficient knowledge on reproduction health, sexuality and contraceptive methods even among learned individuals. Today, education and care that given society is very in large of developing countries about growth and development of human genetics and their use in welfare and health. Mass media is best way to give information about genetics to people. When improve the peoples' knowledge about STDs will improve their understanding and cooperation which is capable of reducing marriages between carriers 6.

Aims of the study:

1. To evaluate the pre-marital screening program in the hospitals have premarital screening clinic in Babylon Governorate.

2. Evaluate services provided, which include clinical services, infection reporting and medical advice.

Materials and Methods:

Study design: This is a cross-sectional study conducted at 10 non-randomly selected (By using a convenient sample method) hospitals in Babylon governorate.

Setting of study: This study was conducted in Babylon governorate. which included hospitals that had a premarital screening clinic in Imam Ali Hospital, general Mahawil Hospital, general Alexandria Hospital, Zahraa Maternity Hospital, Hilla Teaching Hospital, Al Noor Children's Hospital, general Al-Qasim Hospital, general Al Hashimiyah Hospital, general Al-Kifl Hospital, and general Al-Shomali Hospital these Hospitals were located within the geographical location of Babylon governorate.

Sampling Technique: The number of the studied hospitals in Babylon governorate are 10 hospitals, selected according to the hospitals that have premarital screening clinic, By using a convenient sample method.

Data collection technique: Data were collected using a structured questionnaire approved by the Ministry of Health 4.

Statistical Analysis: Analysis of data was carried out using the available statistical package of SPSS-27 (Statistical Packages for Social Sciences- version 27).

Results:

Table (1.1) the results of this study indicated that all hospitals had a full evaluation score (100%) regarding the presence of health, administrative, and service staff according to standards, specific records for premarital counseling, the presence of special site for storage records, result confidentiality, the availability of tests, availability of mobile in the clinic for contact with the couple in case abnormal test results, and sending a monthly statistic of those about to get married is submitted to the public health department. While there are two items that had a weak level (<50%) in all hospitals about "the lab is in the same unit" and "the presence of coordinator for the purpose of sending the result to court". As for other items, all clinics were resting on pass level (≥ 50 %).

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Table 1.1: Observed frequencies, percents, and summary statistics of " administrative indicators " items for the studied hospitals

Administrative indicators Resp. No. % MS SD RS

% Evaluation Unit official (A doctor specializing in family medicine

or in community medicine or in internal medicine or in blood diseases)

Yes 6 60.0

0.60 0.52 60.0 Pass (≥ 50 %)

No 4 40.0

NA 0 0.00

Trained physician on premarital counseling

Yes 5 50.0

0.50 0.53 50.0 Pass (≥ 50 %)

No 5 50.0

NA 0 0.00

Health staff (community health technologist or bachelors of science in chemistry or biology and lab health angel

and or lab assistant )

Yes 10 100.0

1.00 0.00 100.

0

Good (All)

No 0 0.00

NA 0 0.00

Trained paramedic on premarital counseling

Yes 8 80.0

0.80 0.42 80.0 Pass (≥ 50 %)

No 2 20.0

NA 0 0.00

Administrative employee

Yes 10 100.0

1.00 0.00 100.

0

Good (All)

No 0 0.00

NA 0 0.00

One Service employee

Yes 10 100.0

1.00 0.00 100.

0 Good (All)

No 0 0.00

NA 0 0.00

Independent Specific place for unit

Yes 5 50.0

0.50 0.53 50.0 Pass (≥ 50

%)

No 5 50.0

NA 0 0.00

Specific records for Premarital counseling

Yes 10 100.0

1.00 0.00 100.

0 Good (All)

No 0 0.00

NA 0 0.00

Private room for examination

Yes 5 50.0

0.50 0.53 50.0 Pass (≥ 50

No 5 50.0 %)

NA 0 0.00

Independent room for take blood sample

Yes 5 50.0

0.50 0.53 50.0 Pass (≥ 50 %)

No 5 50.0

NA 0 0.00

Continue…

Administrative indicators Resp. No. % MS SD RS% Evalua

tion

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There is special site for storage records

Yes 10 100.0

1.00 0.00 100.0 Good (All)

No 0 0.00

NA 0

0.00

Result confidentiality

Yes 10 10.00

1.00 0.00 100.0 Good (All)

No 0 0.00

NA 0 0.00

Index signs for site location

Yes 9 90.0

0.90 0.32 90.0 Pass (≥

50 %)

No 1 10.0

NA 0 0.00

Tests are available always

Yes 10 100.0

1.00 0.00 100.0 Good (All)

No 0 0.00

NA 0 0.00

Availability of mobile in the clinic for contact with couple in case abnormal test results

Yes 10 100.0

1.00 0.00 100.0 Good (All)

No 0 0.00

NA 0 0.00

The lab is in the same unit

Yes 3 30.0

0.30 0.48 30.0 Weak(

<50%)

No 7 70.0

NA 0 0.00

Coordinator for the purpose of sending the result to court

Yes 4 40.0

0.40 0.52 40.0 Weak(

<50%)

No 6 60.0

NA 0 0.00

A monthly statistic of those about to get married is submitted to the public health

department

Yes 10 100.0

1.00 0.00 100.0 Good (All)

No 0 0.00

NA 0 0.00

MS (Mean of score), SD(Standard Deviation(, RS% (Relative Sufficiency)

Table (1.2) represents the duties and tasks of Paramedical towards the couple. The results illustrate that all hospitals have good evaluation score (100%) regarding welcoming the couple, determine the degree of consanguinity between the couple, obtain the family history for both partners, draw a blood sample from both partners for requested lab investigations, the paramedical reviews the results of laboratory investigations of the couple, and take phone numbers of the couple. While there are two items that had a poor score (None) concerning give a dose of tetanus toxoid to the female partner, and giving premarital educational booklet to each partner which includes information on the following: concept and aim, common hemoglobinopathies in Iraq, STI, and healthy life-style. As regards, the remaining indicators all hospitals had a pass level (≥ 50 %).

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Table 1.2: Observed frequencies, percents, and summary statistics of " Duties and tasks of the Paramedical towards couple " items for the studied hospitals

Duties and tasks of Paramedical towards couple Resp. No. % MS SD RS% Evalu ation

Welcome the couple

Yes 10 100.0

1.00 0.00 100.0 Good(

All)

No 0 0.00

NA 0 0.00

Explain the plan of action and agree of couple to investigation

Yes 9 90.0

0.90 0.32 90.0

Pass (≥ 50

%)

No 1 10.0

NA 0 0.00

Determine the degree of consanguinity between the couple

Yes 10 100.0

1.00 0.00 100.0 Good(

All)

No 0 0.00

NA 0 0.00

Obtain the family history for both partners

Yes 10 100.0

1.00 0.00 100.0 Good(

All)

No 0 0.00

NA 0 0.00

Draw blood sample from both partners for requested lab investigations

Yes 10 100.0

1.00 0.00 100.0 Good(

All)

No 0 0.00

NA 0 0.00

Give dose of tetanus toxoid to female partner

Yes 0 0.00

0.00 0.00 0.00 None

No 0 0.00

NA 10 100.0

The paramedic reviews the results of laboratory investigations of couple

Yes 10 100.0

1.00 0.00 100.0 Good(

All)

No 0 0.00

NA 0 0.00

The Paramedic discuss abnormal finding with the physician

Yes 9 90.0

0.90 0.32 90.0

Pass (≥ 50

%)

No 1 10.0

NA 0 0.00

Take phone numbers of couple

Yes 10 100.0

1.00 0.00 100.0 Good(

All)

No 0 0.00

NA 0 0.00

Arrange next appointment for Counseling

Yes 6 60.0

0.60 0.52 60.0

Pass (≥ 50

%)

No 4 40.0

NA 0 0.00

Yes 5 50.0

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Rearrange separate appointment for each partner in case of abnormal findings

No 5 50.0

0.50 0.53 50.0 Pass (≥ 50

%)

NA 0 0.00

Giving premarital educational booklet to each partner which includes information on the following:

concept and aim, common hemoglobinopathies in Iraq, STI, and healthy life-style.

Yes 0 0.00

0.00 0.00 0.00 None

No 0 0.00

NA 10 100.0

Table (1.3) represents the duties and tasks of physicians towards couples. the study demonstrated that all items had a full evaluation score (100%) in all studied hospitals, except one item had a pass degree (50%) regarding review lab reports referring accordingly to:

premarital guidelines for most common hemoglobinopathies in Iraq & premarital guidelines for STIs.

Table 1.3: Observed frequencies, percents, and summary statistics of " Duties and tasks of the physician towards couples " items for the studied hospitals

Duties and tasks of the physician towards

couples Resp. No. % MS SD RS% Evaluation

Welcome the couple

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Explain your plan of action and discuss of results

Yes 10 10.00

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Review lab reports referring accordingly to:

premarital guidelines for most common heamoglobinpathies in Iraq & premarital

guidelines for STIs

Yes 5 50.0

0.50 0.53 50.0 Pass (≥ 50 %)

No 5 50.0

NA 0 0.00

Review the PC risk assessment form

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Take the medical history of each partner

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Perform the physical examination for each partner

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Assess the condition of each partner Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

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NA 0 0.00

Make the required counseling

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Table (1.4) represents the evaluation of premarital tests in studied hospitals. All indicators had a good evaluation score (100%) in all hospitals, except one indicator had a pass degree (90%) regarding tuberculosis screening done.

Table 1.4: Observed frequencies, percents, and summary statistics of " premarital Tests " items for the studied hospitals

Premarital Tests Resp. No. % MS SD RS% Evaluation

Hepatitis C (HCV) screening done

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Hepatitis B (HBV) screening done

Yes 10 10.00

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

AIDs (HIV) test done

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Thalassemia (MCV. Test) performed

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Tuberculosis screening done

Yes 9 90.0

0.90 0.32 90.0 Pass (≥ 50 %)

No 1 10.0

NA 0 0.00

Hemoglobin measured (MCH)

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Syphilis (VDRL test) examination performed

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Blood group and Rh factor tests performed

Yes 10 100.0

1.00 0.00 100.0 Good(All)

No 0 0.00

NA 0 0.00

Table (1-5) demonstrates a summary statistics of studied main domains for premarital screening program questionnaire, such as "Percent Grand Mean of Score-PGMS, and

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Percent Grand Relative Sufficiency-PGRS%", as well as evaluation grades adopting to indicates the levels of implementation of the system in the studied questionnaire for the hospitals, which included four main domains. The results showed that all the main domains are fall within the pass level of evaluation on the degree of "≥ 50%". In addition to that, the global mean of the score for an overall evaluation had the pass level of evaluation on the degree of "≥ 50%".

Table 1.5: Summary statistics of premarital screening program Questionnaire concerning Main Domains Evaluation for the studied hospitals

Main Domains No.

Hospitals Range Min Max PGMS PGRS% Ev.

Administrative indicators 10 0.45 0.55 1.00 0.777 77.7% Pass (≥

50 %)

Duties and tasks of

Paramedic towards couple 10 0.40 0.60 1.00 0.890 89.0% Pass

(≥ 50 %)

Duties and tasks of

physician towards couples 10 0.13 0.87 1.00 0.937 93.7% Pass

(≥ 50 %)

Premarital Tests 10 0.13 0.87 1.00 0.987 98.7% Pass

(≥ 50 %)

Overall Evaluation 10 0.14 0.83 0.97 0.897 89.8% Pass

(≥ 50 %)

Discussion:

The current study showed that 60.0% of the studied hospitals had pass level (>=50%) regarding unit official (A doctor specializing in family medicine or in community medicine or in internal medicine or in blood diseases). This result agreed with the finding of a previous study done in Rajasthan state by Sodani and Sharma, 20147 which found that 60.5% of the health facilities had medical staff according to standard. But, these results disagreed with the finding of the study done in Teaching Baghdad Hospital 8, and the study conducted in Pakistan hospitals by Manzoor et al., 20199, which found that all hospital departments had lacked of medical staff.

The results of this study indicated that (80.0%, and 50.0%) of the studied hospitals had passing scores (>=50%) for the trained paramedical, and physicians on premarital counseling respectively. These results are consistent with the finding of the study done in Teaching Baghdad Hospital 8, which showed that the studied hospital had a fair score regarding the presence of the health staff (trained, and skill).

The present study demonstrated the average percentage of administrative indicators was 77.7%. This percentage inconsistent with the findings of a previous study done in Uganda by Kiran et al., 201810 which found that the average percentage of administrative indicators was 90%.A possible explanation for this result is that the average percentage is within the level of the pass while the result of the comparator study is within the good level.

this refers to the difference between the two studies.

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The results of this study indicated that all the studied hospitals had a good evaluation score (100%) regarding Welcoming the couple. This result is in agreement with the finding of the study done in Teaching Baghdad Hospital 8, which showed that Welcoming the patient was present in all the studied hospital departments.

In this study, a high percentage (90.0%) of the studied hospitals had a pass level regarding explain the action plan of paramedic and the agreement of couple to investigation. This result consistent with the published study findings done in Oman by Al- Kindi et al., 201911, who revealed 87.2% of the participants have agreed an investigation.

But, these results disagreed with a previous study findings done in KuwaitbyAl-Enezi and Mitra, 201712, which found that 56.0% of the health workers did not explain the procedure of the premarital screening program.

A high percentage (90.0%) of the studied hospitals had a pass level concerning the discussion of Paramedic the abnormal finding with the physician. This result consistent with a similar study finding conducted in Egypt by Yousifa et al., 201813, which found that 98.3

% of the participants indicate discuss problems or concerns about health with the provider.

The present study demonstrates that (60.0%, and 50.0%) of the studied hospitals had a pass level (>=50.0%) regarding arrange the next appointment for counseling and rearrange a separate appointment for each partner in case of abnormal findings respectively. These results agree with a previous study's findings done in Bahrain by Shaikha et al., 200914, which found that 82% of the participants faced no problems in taking an appointment and 89% had no problems during the interview.A possible explanation for these results is that some of the hospitals studied have a huge crowd of auditors, which leads to missed appointments.

The current study reveals only 50.0% of the studied hospitals had a pass level regarding review lab reports referring accordingly to premarital guidelines for most common hemoglobinopathies in Iraq and premarital guidelines for STIs. This result is in agreement with another study's findings conducted in Taiwan by See et al., 201015, which found that only 44.3% of Participants indicate an explanation of the lab report was done by a physician in PMS clinic.A possible explanation for this finding is that nearly half of the hospitals studied do not have premarital screening guidelines.

Regarding making the required counseling, the study found that all the studied hospitals had a good evaluation score (100.0%). This result is in agreement with the study findings conducted in Tehran by Abbasi-Moghaddam et al., 201916, which found that 78.3%

of the studied sample was good for Physician’s consultation. But, disagrees with the published study findings done in Taiwan by See et al., 201015, which found that only (36.6%) of the participants had genetic counseling by physician.

In this study, all the studied hospitals had a full evaluation score (100%) concerning explanation the plan of action and discussion of results. This result disagreed with the published study findings done in Taiwan by See et al., 201015, which found that (42.0%) of participants indicate explain examination results by the physician in PMS clinic.

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The present study demonstrates the average percentage of duties and tasks of a physician towards couples was 93.7%. This percentage was consistent with the findings of a previous study done in Iraq by Lafta etal., 201817, which revealed that 53.4% of physicians had poor performance due to working conditions in the health institutions.

Conclusions:

1- The average percentage for the premarital screening program is resting on a pass level for all the studied hospitals.

2- The current study revealed that half of the studied hospitals have no trained physician on premarital counseling, while most hospitals have trained paramedic on premarital counseling.

3- There are only two indicators have weak level (<50%) for the absence of the lab in PMS unit, and lack coordinator who send the test results to court.

Recommendations:

1- Overall, there is a need to strengthen the quality of the premarital screening service in the studied hospitals reach to good level.

2- The cooperation between all branches of the health directorates is important to improve the weak indicators that fall within the level of their duties.

3- Designing appropriate strategies for improving the performance of paramedical and physician by continues training courses and creating appropriate working conditions.

Ethical Clearance: None Source of funding: None Conflict of Interest: None

References:

1. Ali M, Elshabory N, Elzeblawy Hassan H, Zahra N, Alrefai H. Perception about Premarital Screening and Genetic Counseling among Males and Females Nursing Students. J Nurs Heal Sci. 2018;7(1):51–7.

2. Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA.

Consanguinity and reproductive health among Arabs. Reprod Health. 2009;6(1):6–17.

3. Islam MM. The practice of consanguineous marriage in Oman: prevalence, trends and determinants. J Biosoc Sci. 2012;44(5):571–94.

4. Iraqi MOH and USAID. Premarital Counseling Clinical ServicesGuidelines. 2013.

5. Abd Al Azeem ST, Elsayed ET, El Sherbiny NAEK. Promotion of knowledge and attitude towards premarital care: An interventional study among medical student in Fayoum University. J public Heal Epidemiol. 2011;3(3):121–8.

6. Ibrahim NKR, Al-Bar H, Al-Fakeeh A, Al Ahmadi J, Qadi M, Al-Bar A, et al. An educational program about premarital screening for unmarried female students in King Abdul-Aziz University, Jeddah. J Infect Public Health. 2011;4(1):30–40.

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7. Sodani PR, Sharma K. Assessing Indian public health standards for 24× 7 primary health centers: a case study with special reference to newborn care services. J Natl Accredit Board Hosp Healthc Provid. 2014;1(1):12–6.

8. Haider M. K. Assessing the quality of health services applied research 5qs in Baghdad teaching hospital. J Econ Adm Sci. 2016;22(92).

9. Manzoor F, Wei L, Hussain A, Asif M, Shah SIA. Patient Satisfaction with Health Care Services; An Application of Physician’s Behavior as a Moderator. Int J Environ Res Public Health. 2019;16(18):3318.

10. Kiran K, Charlotte M, Janno C, and Deogratious S . Evaluation of the USAID/Uganda Private Health Support (PHS) Program [Internet]. USAID. 2018.

Available from: https://pdf.usaid.gov/pdf_docs/PA00TDFC.pdf

11. Al-Kindi RM, Kannekanti S, Natarajan J, Shakman L, Al-Azri Z, Al-Kalbani NI.

Awareness and attitude towards the premarital screening programme among high school students in Muscat, Oman. Sultan Qaboos Univ Med J. 2019;19(3):217–24.

12. Al-Enezi K, Mitra AK. Knowledge, attitude, and satisfaction of university students regarding premarital screening programs in Kuwait. Eur J Environ Public Heal.

2017;1(2):1–11.

13. Yousifa., Ebtsamshama, Mervetzaghlol, Naglaagheda M. Perception and Satisfaction of Premarital Screening and Genetic Counseling Among Future Couples of Governmental Outpatient Clinics. IOSR J Nurs Heal Sci [Internet]. 2018;7(4):18–26.

Available from: www.iosrjournals.org

14. Shaikha , Al Arrayed MB, Amani, Al Hajeri MD, CABFM I. Clients’ satisfaction of the premarital counseling service in Bahrain. Bahrain Med Bull. 2009;31(3):1–7.

15. See L-C, Teng F-L, Peng P-I, Shen Y-M, Lo Y-J. Implementation of premarital health examination (PHE): an importance-performance analysis from participants who took PHE in Taiwan. Open Fam Stud J. 2010;3(1):1–9.

16. Abbasi-Moghaddam MA, Zarei E, Bagherzadeh R, Dargahi H, Farrokhi P. Evaluation of service quality from patients’ viewpoint. BMC Health Serv Res. 2019;19(1):1–7.

17. Lafta R, Al-Ani W, Dhiaa S, Cherewick M, Hagopian A, Burnham G. Perceptions, experiences and expectations of Iraqi medical students. BMC Med Educ.

2018;18(1):1–8.

18. Zerin, T., Islam, A., Gulnahar, S., Farjana, N. E., Begum, M. A. ., & Sadia, H.-E.

(2021). Identification and Antibiotic Susceptibility of Blood Culture Isolates from Rajshahi, Bangladesh. Journal of Scientific Research in Medical and Biological Sciences, 2(2), 1-10. https://doi.org/10.47631/jsrmbs.v2i2.264

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