ABSTRACT
The study determined the dietary pattern that contributes to healthy ageing among diabetic patients in Abia State. To carry out this research work, four research questions were raised and four hypotheses were tested at 0.05 level of significance. Specifically, the objective of the study includes; identifying the types of meals that are mostly consumed by diabetic patients in Abia State, determining the reasons for choice of meal among ageing diabetic patients, determining the major problem of diabetic patients in Abia State and ways of improving the dietary pattern of diabetic patients in Abia State. It was a descriptive survey design, in which copies of questionnaire were administered. The respondents were consented adult of diabetic patients from the two tertiary health facilities in Abia State since most of the patients were likely to be referred to these tertiary facilities. Proportionate random sampling techniques were used on a population of 2412 diabetic patients that visited the two major hospitals for routine check-up. A sample size of 343 were considered, after which the 343 patients were stratified among the two major hospitals in Abia State (Federal Medical Centre Umuahia and Abia State Teaching Hospital Aba). The data obtained from the following research questions; types of meal the diabetic patients consumed, the reasons for the choice of meal the diabetic patients take, the problems of diabetic patients, how to improve the dietary pattern of a diabetic patients, were computed using Statistical Package for Social Sciences (SPSS version 20) and results are expressed as percentage, frequencies, and mean score ratings. The formulated hypotheses were tested at 5% level of significance using T-test. The total number of respondents were 343 of which is 161 (46.9%) and 182 (53.1%) were males and females respectively. The findings of the study revealed among others that the respondents consumed mainly, vegetable, fish, fruits, garri and soup, meat beans and plantain due to medical advice. Forty nine (14.29%) out of the 343 patients did not report any complications. Most commonly reported complications/problems among the patients were hypertension, retinopathy, neuropathy and ulcer. The study showed that meat was significantly highly consumed among patients aged <55 years, while consumption of rice and plantain were significantly higher among patients aged 55 years and above. Consumption of garri/soup and plantain were significantly higher among patients without complications than among patients with complications. Since the study showed that plantain was consumed significantly more in patients 55years and above and higher in patients without complications. The study therefore recommends that awareness should be created by the Hospital on the types of meals that should be consumed by diabetic patients. The Federal and State governments should equip the laboratories for the proper testing of diabetic patients.
TABLE
OF CONTENTS
Title Page i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
Table of Contents vi
List of Tables ix
Abstract x
CHAPTER 1: INTRODUCTION 1
1.1 Background to the
Study 1
1.2 Statement of the
Problem 7
1.3 Purpose/Objectives of
the Study 10
1.4 Research Questions 10
1.5 Hypotheses 10
1.6 Scope of the Study 11
1.7 Significance of the
Study 11
1.8 Definition of Terms 13
CHAPTER 2: REVIEW OF RELATED LITERATURE 15
2.1 Conceptual Framework 15
2.1.1 Healthy dieting for
diabetic patients 17
2.1.2 Concept of self -
management of diabetes 23
2.1.3 Unhealthy dieting and
diabetes 24
2.1.4 Dietary habits for healthy
ageing 25
2.1.5 Diabetes – types, causes
and factors associated with diabetic patients 25
2.2 Theoretical Framework 32
2.2.1 Atkins diet theory 33
2.2.2 Continuity theory 33
2.2.3 Activity theory 33
2.2.4 Disengagement theory 33
2.2.5 Mitochondrial theory 34
2.2.6 Misrepair accumulation
theory 35
2.3 Review of Empirical
Studies 36
2.4 Summary and Gaps in Literature Review 40
CHAPTER 3: METHODOLOGY 40
3.1 Research Design 43
3.2 Area of the Study 43
3.3 Population for the Study 44
3.4 Sample and Sampling Technique 45
3.5 Instrument for Data Collection 46
3.6 Validation of the Instrument 47
3.7 Reliability of the Instrument 47
3.8 Methods of Data Collection 48
3.9 Method of Data Analysis 48
CHAPTER 4: RESULT AND DISCUSSION 49
4.1 Results 49
4.1.1 Research question 1 51
4.1.2 Research question 2 52
4.1.3 Research question 3 52
4.1.4 Research question 4 54
4.1.5 Hypothesis 1 55
4.1.6 Hypothesis 2 57
4.1.7 Hypothesis 3 58
4.1.8 Findings of the study 59
4.2 Discussion 61
CHAPTER 5: SUMMARY, CONCLUSION AND RECOMMENDATIONS 67
5.1 Summary of the Study 67
5.2 Conclusion 68
5.3 Implication of the
Findings 69
5.4 Recommendations 70
5.5 Suggestions for
Further Studies 70
References 71
Appendices 82
LIST OF TABLES
3.1: Stratified random sampling of diabetic
patients that visited FMC
Umuahia and Abia State University Teaching Hospital as
at 2015 46
4.1: Socio
demographic characteristics 49
4.2: Mean
ratings of respondents and types of meals consumed by diabetic
patients 51
4.3: Mean ratings of respondents on reasons for
choice of meal taken by
patients 52
4.4A: Meaning ratings of respondents on the
biological problems of diabetic patients 52
4.4B: Meaning
ratings of respondents on the physical problems of diabetic
patients 53
4.5: Mean
ratings of the respondents on the ways of improving the dietary 54
4.6: T-test
result of the mean ratings of young and old diabetic patients on the
types of meals
consumed. 55
4.7: T-test result of the
mean ratings of presence of problems among diabetic
patients on the
types of meals consumed. 56
4.8: T-
test result on reasons for choice of food and educational status 57
4.9: T- test result of the problems associated
with diabetes mellitus and
gender 58
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Ageing could be defined as transitional process of becoming older
with time. This represents the accumulation of total changes in a person over
time. Ageing brings about changes in physical, psychological and social
processes, so it is a multi-dimensional process. Due to the reflecting effect it
has on the biological changes, this makes it an important part of all human
societies, though it also reflects cultural and social conventions. Ageing can
also be defined as the process of making optimal use of opportunities for
health participation and security. In developed countries, the life expectancy
of individual increases and birth rates decline, so as the middle age increases
simultaneously; this process is occurring in every country in the world
(Leonard, 2004). By some estimates, a person’s basal metabolism drops by 2 per
decade, starting at the age of 20. Some researchers believe that this decline
is due almost solely to the loss of muscle mass that comes with age, (Clarke et al; 2004).
As the years, the body system continuously becomes less adaptive at
taking up and using glucose from the blood stream, a situation known as
“glucose intolerance”, this trigger the development for diabetes, and one
factor that is contributing to glucose intolerance is a condition known as
“insulin resistance”, in which people’s body tissues become less and less
sensitive to insulin. However, ageing may not necessarily be a burden and as
such does not necessarily reduce the ability of individual contributing to
society and enjoy a high quality of life, (Dullin, et al; 2014).
Health, diet and exercise habits contribute to healthy ageing.
Certain types of diet can prevent and may decrease the risk of disease, (Hemann
and Greide, 2000). According to Gensler, et
al; (2008) to ensure adherence, it is important to increase slowly the
frequency, duration and intensity of exercise, and to find physical exercise
that is proper for the person. A modified exercise and proper diet is a better way
of promoting good health while becoming old. In order to prevent disease and malfunction
of the body system, as well as increase longevity and promotes one’s quality of
life as one age. It is better to engage in appropriate physical exercise,
having healthy diet, avoid smoking, not using alcohol and using medication
wisely, (Bartka, 2011).
Healthy ageing is a function of variety of influences that surround
group of peoples and their environment at large. They include material
conditions as well as social, cultural, economic and environmental factors. All
of these factors and the interaction between them, has an important role to
play in determining how well people age, therefore healthy ageing includes the
life style influence, like a healthy diet and regular physical activity as well
as access to and use of health information and services, (Timiras and Paola,
2003).
Healthy ageing is a term which is often interchangeable with
descriptions such as active ageing, successful ageing, positive ageing and
productive ageing. Although there is a general acceptance that healthy ageing of
individuals involves beyond physically and mentally health issues, (Dedeepiya, et al; 2012).
Guarente (2005) defined
healthy ageing as the act of using
optimal opportunities properly for health participation and security so
as to improve the quality and standard of life of individual as they become
older, allowing people to understand their potential for physical, social and well-being
throughout the life – course. Healthy ageing has a strong relationship with genetic,
environmental and behavioral factors, also with environmental and
socio-economic factors. Most of these factors may be regulated by the
individual and are known as life style factors and other factors which are
outside the individual’s control. However, to improve the life expectancy, a
decline in physical function becomes more prevalent. Half of people that are 65
years old and above, have one or more health condition including cognitive,
impairment, falls, incontinence, low mass index, dizziness and vision
impairment. In any case, failure to detect early signs of malnutrition at early
stage will jeopardize healthy ageing, while unnecessary supplementation can
mask deficiencies and lead to irreversible damage (Agarwal, 2011).
Healthy ageing means finding new things, acquiring and able to adapt
to changes, being physically and socially active and feeling the influenced of your
community and loved ones, although healthy ageing is much more than staying
physically healthy, it’s about maintaining of purpose and your interest for
life (Godson and Kemnitz, 2001). According to Wilner, et al; (2010) healthy ageing is that activities and behaviours individual
undertake assist to decrease the chances of illness and disease, at the time
increase physical, emotional and mental health. Roughly, ten thousand people
worldwide die each day of age related cause (Vincent, 2005).
It is a known fact that a disease is particularly abnormal
condition, a malfunction of structure or function that affects part or the
entire organism. Disease is constructed as a medical condition known to appear
with particular symptoms and signs (Johnson, 2002). The term disease broadly
refers to situation that can impair the normal function of the body, thus
diseases are associated with dysfunction of the body’s normal homeostatic
process, (Alexander, 2011). Diseases are usually accompanied with any situation
that associates with pain, dysfunction, distress and a social problem, which
includes; injures, disabilities, disorders, syndrome and infection. Diseases do
not only cause physical disturbance on people but emotionally because having a
life with a disease can affect one’s perspective of life, as well one’s
personality may also be affected, (Kelley, et
al; 2003). Tagging healthy to a
person with disease can be indication of over treatment, things like taking
drugs that assists individuals with severe disease or engaging in adequate
management pattern, like encouraging the person to partake in physical exercise (Lenzer, 2012). Since ageing
is a cause or major risk factor of the age related disease and many other
causes of mortality, there are growing efforts in ageing to slow ageing and
extend healthy life span. (Shmookler, et
al; 2009).One of these efforts is good dietary habits.
Dietary habits could be described as the habitual decision an
individual or culture makes when making choice of what food to eat. The word
dietary often refers to specific intake of nutrition for healthy or weight
management reasons. Proper nutrition requires ingestions and absorption of
vitamins, minerals and food energy in the form of carbohydrates, proteins and
fats. Dietary habits and choices play an important role in the quality of life,
health and longevity (Gluffrae and Gieronimo, 2000). Many individuals prefer to
select animal source food, just because of their different reasons associated
with their health, (Bogen, 2012). In developed countries, affluence helps to
control the intake of calorie, that is not constrained and possibly not to make
inappropriate food choices. Many authorities have recommended the consumption
of less energy-dense foods and drink that does not contain too much sugar, eat
plant based food, limited and processed meat by people so as to control and maintain
their weight. However, there is no absolute understanding of what a healthy
diet is made up of, (Burke, 2007).
Diabetes may be termed as a chronic disease which occurs when there
is malfunction of the pancreas, that is when insulin produced by the pancreas
may not be sufficient, or the body system is unable to use effectively the
insulin it produces. Health implication of diabetes that is not controlled is
indicated by rise in blood sugar, and if not controlled over times may escalate
and bring about the destruction of the body system, it damages the nerves and
blood vessels mostly, (Inzitari, 2011, and Anderson, 2000). Diabetes can cause
health complication including heart disease, blindness, and kidney failure. In
addition to the growing health burden of diabetes, the diabetic community has
three choices, to make, prevent diabetes, take better care of people with
diabetes and prevent devastating complications (Simsi, 2006). Type 1 diabetes
usually is first diagnosed in teenagers and adolescents, although it may
surface at any stage in life. In respect to this, it could be said that
diabetes is an autoimmune disease that could be traced through genetics,
environmental or other factors; this accounts for about 5% of diabetes cases.
There is no known way to prevent it. An effective treatment requires the use of
insulin (Kravitz, 2005). Statistics shown that Type 2 diabetes accounts for 90%
- 95% of diabetes case and is usually associated with older age, obesity and
physical inactivity, family history of diabetes or personal history of diabetes
(Hussern, 2009).
This condition has brought about negative impact on health and well
– being, if undetected at the early stage and not treated in a timely manner.
Therefore older people with serious situations and their families play a major
role in the management of this disease in their daily life. This is commonly
referred to as self-management whereby the person with the disease takes a more
dimension to their health outcomes, (Lam, et
al; 2011).
Aging can brings about difficulties in managing diabetes. One reason
for this is that insulin resistance increases and glucose tolerance decreases
with age, but there are other indirect reasons as well (Milne, et al; 2005). As people’s attention
declines with age, they may be less concerned with the tasks associated with
diabetes management, such as carbohydrate counting, meal planning, and blood glucose
monitoring and determining correct insulin doses. To have the quality of life
improved as we get older, it is better to improve on the quality of live at an
early stage. Unfortunately, good health is not a guarantee that comes with
aging; it has to be worked on. If we live longer, we will age, that is a fact
of life but we can age and be healthy. Whether we are healthy or not, depends
largely on our life style and many other factors, therefore it is important
that we start to develop a healthy lifestyle early in our lives to ensure
healthy aging in our later years (Sullivan, et
al 2007).
Good health does not always happen naturally. It is mostly the
result of a disciplined way of life involving good eating habits on a continued
basis through our normal daily living. Notably the good things that are longed
for in life, takes time to achieve. Sticking to a good diet regimen, exercise
and proper medical care healthy ageing and longevity is possible. Dietary
factors may contribute too many diseases people are suffering today, some of
which have been since infancy. These factors are then compounded by changes
that naturally occur with the ageing process (Bartali, et al; 2003).
In most developing countries, the prevalence of non-communicable
disease of which diabetes is one of them has almost exceeded the prevalence of
communicable diseases (Nwokediuko and Oli, 2008). Studies indicate that an
ageing population, coupled with rapid urbanization is expected to lead to an
increasing prevalence of diabetes in Africa (Oghera, et al; 2005). In Nigeria, it accounts for between 3.5% and 15% of
medical admission in most health facilities of which Abia State is not an
exception. In Abia State, there is scarcity of health resources and un-accessibility
of health care services. Routine examination for diabetes, using urine/blood
glucose is of paramount interest and should be done in most healthcare facilities
in the State (Unachukwu, et al;
2008). Most health care facilities do not have basic and appropriate technology
for screening, diagnosis and monitoring of diabetes. More often, majority of
diabetic peoples present late and often with age related complications.
Majority of
Abians lives in remote villages with limited resources, being mainly farmers,
hunters, and petty traders among other activities. Abject poverty is prevalent
where diets that are balanced are unavailable. The major type of food consumed
is mainly carbohydrate with little or no protein, milk, vegetable and fruits. Due
to lack of knowledge, poverty and poor health services, diabetes and other
types of diseases are rampant in Abia communities. In Abia State of Nigeria,
large numbers of people leave Rural community in search of improved quality of
life in Urban areas like Umuahia, Ohafia among others. As a result of these
sweeping changes have occurred in people diet and lifestyle modes of physical
activity have dropped sharply with increased consumption of calorie-dense fast
foods and sugary sweetened drinks. This
work is therefore, aimed at identifying dietary factors that contribute to
healthy ageing among diabetic patients with the view of evolving strategies
that will bring about improvement in their patterns of dietary practices for
the diabetic patients in Abia State.
1.2 STATEMENT OF THE PROBLEM
Global demographic report of the World Health organization on health
of ageing diabetic patients shows a high morbidity rate. The high morbidity
rate of diabetic patients in the developing countries like Nigeria in general and
Abia state in particular is a cause for concern (Blas, 2012).
Apparently, there seem to be some common factors that contribute to
the condition affecting the health of the diabetic patients. The adverse
effects of smoking, alcohol, carbohydrate, poor nutrition, poverty and poor
physical condition (the latter due to lack of exercise or the damaging effects
of excessively arduous physical labour) have been repeatedly identified as
causes of the major health problems in Abia State in general and specific localities
and communities. There is an urgent need
to provide more information to diabetic patients about abnormal ageing and
about primary health care and self care approaches to problems that do arise
(Adorno, 2003).
The demographic transition which refers to the transition from high
birth and death rates to low birth and death rates leads to increase in the
aging population. Most developed countries have completed the demographic
transition and have low birth rates while most of developing countries like
Nigeria are in the process of transition leading to increased number of old
people with ageing problems like increase in diabetes and hypertension. These
aging problems are very big in low resource country like Nigeria.
The epidemiological transition accounts for the replacement of
infectious diseases by chronic diseases like diabetes due to expanded public
health and sanitation (Mauck, et al;
2013). There is now a shift from communicable diseases to non- communicable
diseases like diabetes and hypertension. Nigeria is still in-between the
transition, in which there is both communicable and increase in
non-communicable. This is a very big problem in such a resource limited
country, trying to combat both diseases. Therefore, this study intends to find
out the dietary practices that contribute to healthy ageing among diabetic
patients.
The American Dietetic Association advocates that the public should
consume adequate amounts of dietary fiber from a variety of plant foods
(Marlet, 2012). The recommended in take of 20-25 grams per day for healthy
adults is not usually met because of low intake of fruits, vegetables, whole
and high fiber reduces blood glucose and insulin level. A diet adequate in
fiber containing foods usually has fewer calories, fat and refined sugar and is
also usually rich in micro nutrients and non-nutritive ingredients that have
additional health benefits.
Fiber rich meal is processed more slowly in the gastro intestinal
tract, thus promoting satiety. These salubrious features of a high fiber diet
promote the treatment and prevention of diabetes, (Templeton, 2001). Diabetes
requires complex management in a variety of ways and food insecurity in the
state of being without reliable access to a sufficient quantity of affordable
nutritious food. A specific and very complex diet is needed to manage diabetes,
although with it is increasing prevalence and high cost of treatment, diabetes
places an enormous demand on economic resources of the country. The high cost
associated with diabetes suggests that reducing incidence through prevention
might lower life time medical spending and alleviate some of the future
economic burden of treating diabetes. In many cases chronic disease prevention
has been found to be cost effective but not cost saving. While prevention
averts cost from treating the disease, it may also extend life expectancy and
thus could result in more years of health care spending and possibly in greater
life time medical spending. Considering the shortened life expectancy seen with
diabetes, it is unknown whether life time medical cost for people with diabetes
exceeds those of other wise similar people with diabetes.
Difficulty affording food, cost-related medication under use, poor
diabetes control, however difficulties in maintaining the more costly lifestyle
required to combat diabetes affects patients globally regardless of health care
and social services, people with diabetes are at risk for long- term problems
which can affect the eyes, kidney, heart, brain, feet and nerves. The best way
to prevent or delay these problems is to control your blood sugar and to take
good care of yourself.
In the National health and nutrition examination survey, the socio
economic status, as measured by education and income was not associated with
whether or not individuals are likely to have undiagnosed diabetes. This
finding suggests that screening for
diabetes should focus on those adults who are at risk of diabetes based on
ethnic groups and other clinical risks factors (Wilder, 2005).
There is paucity of literature on healthy ageing among diabetic
patients especially in Abia State. Therefore, it is also of utmost importance
to find out dietary factors that contribute to healthy ageing among diabetic
patients in Abia State.
1.3 PURPOSE/OBJECTIVES OF THE STUDY
The major purpose of the study is to determine the dietary practices
that contribute to healthy ageing among diabetic patients in Abia State.
Specifically, the objectives of the study are stated as followings;
- To identify the types of meals
that is mostly consumed by diabetic patients in Abia State.
- To determine the reasons for choice of meal among diabetic patients
- To determine the major problem of
diabetic patients in Abia State.
- To determine ways of improving the
dietary pattern of diabetic patients in Abia State.
1.4 RESEARCH QUESTIONS
The
study sought answers to the following research questions.
- What types of meals do the
diabetic patients consume?
- What are the reasons for the
choice of meal the diabetic patients take?
- What are the problems of diabetic patients?
- What are the measures that can
improve the dietary pattern of the diabetic patients in Abia state?
1.5 HYPOTHESES
The following null hypotheses were tested at 5% level of
significance.
H01:
There is no significant difference in the mean responses of young and
old diabetic patients on the types of meals consumed. .
H02: There is no significant difference in
the mean responses of educated and uneducated diabetic patients on reasons for
the choice of meal.
H03: There is no significant difference in
the mean responses of male and female diabetic patients on the problems encountered.
1.6 SCOPE OF THE STUDY
This study was limited to the investigation of the dietary practices
that contribute to healthy ageing among diabetic patients in Abia State. The
diabetic patients were the respondents to the instruments. The geographical
location of the study is Abia State, Nigeria. The focus hospitals are Federal
Medical Centre, Umuahia and Abia State University Teaching Hospital, Aba. The
aspects of research include dietary behaviour that enhances longevity among
diabetic patients in Abia State. The content scope will be limited on finding out
what negate healthy ageing among diabetic patients and remedies.
1.7 SIGNIFICANCE OF THE STUDY
This study will be of benefit to everybody including the diabetic
patients, dietician, researchers, health workers, young and old people. For
diabetic patients, the findings of the study will be able to provide
information on diet for those with type 2 diabetes which usually affect the
productivity age range from 45 to 65 years in developing countries like Nigeria
and Abia State in particular.
The study will provide information that will reduce the disadvantage
individual of sufficient access to the resources to manage the condition such
as adequate housing, nutritious food and health care services, (Candib 2007).
The result of this study will enable diabetic patients to choose or
select right dietary practices as to be healthy at old age and avoid unhealthy
practices and stay out of hospital. The diabetic patients involved in the study
will be able to gain a lot of knowledge from it. Following a healthy diet is a
fundamental aspect of diabetic management, also food can help you control your
blood sugar level, but it also can cause them to surge out of control.
People with every type of diabetes which are the type1diabetes and
type 2 diabetes, the diet plays large
role in each of them which includes that type 1 diabetes which cannot produce
insulin and must take medication, a
healthy diet can limit the amount of medication needed and reduce the risk for
episodes of excessively high blood sugar. The type 2- diabetes may be managed
through diet and exercise without using drugs, choosing the right food and
following a meal plan is essential.
The government institutions will be informed through the health
education given to them by the health workers, by making the information
available to the health workers.
The findings of this study will also go a long way in adding
knowledge to health workers dealing with aged patients with diabetes, the
patients may be newly diagnosed or have diabetes of long duration and long term
complication, however the appropriate changes in the setting of diabetes are a
critical task in the pursuit of healthy ageing. Diabetes in aging increases the
risk of suboptimal nutrition, hospitalizations, nursing home admission that
substantially impairs quality of lifestyle. The issues include deceased
cognition deficiencies in activities of daily living, functional impairment,
decreased health literacy, depression, financial problems and strategies to
address these issues should be part of health workers practice.
For researchers, the findings of this study will go a long way in
adding to or increasing the body of knowledge or literature on the dietary
practices that contribute to healthy ageing among diabetic patients in Abia
State in particular and Nigeria in general. It will encourage further
investigations by researchers in the area of handling the healthy living of
ageing diabetic patients. The findings of this study will be published in open
access journals so that researchers will reference it and use it.
The findings of this study will also help to clear the doubts in the
minds of some people who have superstitious belief about diabetes, concerning
its causes, curability, social stigma and hope for survival. It could also help
the Home Economics teachers to benefit from the media and publications about
diabetes during Health Education. Above all, the data derived from this work
could also be used in teaching young ones the essence of healthy ageing.
1.8 DEFINITION OF TERMS
The following terms were used in this
study as defined to facilitate the effective communication of the study;
Rethinopathy:
Is any damage to the retina of the eye, which may cause vision impairment.
Neuropathy:
Disease or dysfunction of one or more peripheral nerves, typically causing
numbness or weakness.
Nephropathy:
Is a disease of the kidneys caused by damage to the small blood vessels or to
the units in the kidneys that clean the blood.
Ulcer:
Occur when stomach acid damages the lining of the digestive tract.
Hypertension:
(Also known as High Blood pressure), is a long term medical condition in which
the blood pressure in the arteries is persistently elevated.
Glucagon:
Is a hormone that is involved in controlling blood sugar (glucose) levels.
Hyperglycemia:
Refers to high levels of sugar, glucose, in the blood.
Macrovascular
disease: Is a disease of any large (macro) blood
vessel in the body.
Microvascular
disease: Is heart disease that affects the walls
and inner lining of tiny coronary artery blood vessels that branch off from the
larger coronary arteries.
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