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Workrelatedmusculoskeletaldisordersamonghealthcareprofessionals:Acrosssectionalassessmentofriskfactorsinatertiaryhospital,India

IndianJOccupEnvironMed.2014MayAug18(2):7581.

PMCID:PMC4280781

doi:10.4103/00195278.146896

Workrelatedmusculoskeletaldisordersamonghealthcareprofessionals:A
crosssectionalassessmentofriskfactorsinatertiaryhospital,India
SandulYasobantandParamasivanRajkumar1
DepartmentofResearch,IndianInstituteofPublicHealth,Gandhinagar,Ahmedabad,Gujarat,India
1
DepartmentofEnvironmentalHealthEngineering,SriRamachandraUniversity,Chennai,India
Forcorrespondence:Dr.SandulYasobant,IndianInstituteofPublicHealth,Gandhinagar,SPIESRCampus,DriveinRoad,Ahmedabad,
Gujarat,India.Email:dryasobant@gmail.com
Copyright:IndianJournalofOccupationalandEnvironmentalMedicine
ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommonsAttributionNoncommercialShareAlike3.0Unported,which
permitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.

Abstract
Background:

Workrelatedmusculoskeletaldisorders(WMSDs)areresponsibleformorbidityinmanyworking
populations.Apartfromloweringthequalityofworkerslifeandreducingtheproductivity,WMSDsarethe
mostexpensiveformofworkdisability,attributingtoabout40%ofallcoststowardthetreatmentofwork
relatedinjuries.WMSDsareconsideredtobemultifactorialsthatarecausedduetotheinteractionsbetween
variousriskfactors,whichresultinconditionsthatvaryacrossdifferentoccupations.Althoughhealthcare
professionisknowntobeatahighriskforWMSDs,itisoneoftheleaststudiedoccupations.Mostofthe
previousstudiesonWMSDsamonghealthcareworkerswerelimitedtoanyoneoftheprofessionalgroups
suchasnurses,physicaltherapists,dentists,andothers.Hencethisstudywasaimedatlookingintothe
WMSDsaffectingfivedifferenthealthcareprofessionalsworkinginatertiarycarehospital.Itcomparedthe
prevalenceanddistributionofWMSDsamongthefivegroups,evaluatedthemultipleriskfactorsthat
contributetothedevelopmentofWMSDs,andidentifiedthehighriskgroup.
MaterialsandMethods:

Itwasacrosssectionalstudyconductedamongdentists,laboratorytechnicians,nurses,physicians,and
physiotherapistsofvariousclinicaldepartmentsinatertiarycarehospitalinChennai,India,fromJanuaryto
June2013.Facetofaceinterviewsaswellasobservationalanalysisofvarioustaskswereemployed.
Differentcombinationsofvalidatedandstandardizedquestionnaireswereusedforcollectingdifferenttypes
ofdata.
Results:

AhighproportionofhealthcareprofessionalsreportedWMSDsatoneortheotherbodyregion,lowerback
beingthemostcommonlyaffectedarea.Workinginthesamepositionforlongperiods,workinginawkward
orcrampedpositionsandhandlinganexcessivenumberofpatientsorsamplesinonedaywerefoundtobe
themostcommonlyreportedjobriskfactorthatcontributedtothedevelopmentofWMSDs,inthisstudy.
Conclusion:
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Amongallthehealthcareprofessionalsassessedinthisstudy,nurseswerefoundtobeatthehighestrisk,
whereasphysicianswereatthelowestrisk.Alongitudinalstudyusingquantitativeanalyticaltoolsmaygive
amoreaccurateestimateofWMSDsandjobriskfactors,whichwouldpavewayformakingmoreprecise
recommendationstoeliminatetheriskfactorsandtherebypreventWMSDs.
Keywords:Healthcareprofessionals,riskfactors,WMSDs
INTRODUCTION
Musculoskeletaldisorders(MSDs)intheworkplacehaveahugeimpact,emergingasagrowingproblemin
ourmodernsocieties[1]theyrepresentthesecondlargestcauseofshorttermortemporaryworkdisability
afterthecommoncold.[2]Workrelatedmusculoskeletaldisorders(WMSDs)areresponsibleformorbidityin
manyworkingpopulationsandareknownasanimportantoccupationalproblemwithincreasing
compensationandhealthcosts,reducedproductivity,andlowerqualityoflife.[3]WMSDsarecharacterized
asmultifactorial.[4]
WMSDsarealsoreportedtocauselostworktimeorabsenteeism,increaseworkrestriction,transferto
anotherjob,[5,6]ordisabilitythananyothergroupofdiseases[7,8,9]withaconsiderableeconomictollon
theindividual,theorganizationandthesocietyasawhole.[10]Findingsofscientificresearchhaveidentified
physical,[11]psychosocial/organizational,[12,13,14]andindividual[15]occupationalriskfactorsforthe
developmentofWMSDs.Thesestudieshavemeasuredthelevelsofavarietyoffactorsacrossarangeof
occupationsatdifferentlevelsofrisk,andinvestigatedtheirassociationswiththeincidence(orprevalence)
ofMSDsforthepopulationsconcerned.[16,17]
Moreover,WMSDisthemostexpensiveformofworkdisability.[18,19]Itwasestimatedthatthecostof
WMSDwasapproximately215billiondollarsin1995intheUnitedStates26billionCanadiandollarsin
1998inCanada,and38billionEurosin2002inGermany.[20]Indiahasbeenbattlingwithconventional
publichealthproblemssuchascommunicablediseases,malnutrition,highrateofpopulationgrowth,and
inadequatemedicalcare,apartfromtheoccupationalhealthproblems.[21]MSDisoneofthemajor
occupationalhealthproblemsinIndiaandestimateshaveshownthatMSDcontributestoabout40%ofall
coststowardthetreatmentofworkrelatedinjuries.[22]
HealthcareprofessionisknowntobeathighriskforWMSDs.[23,24,25]Healthcareprofessionalsare
reportedtobevulnerabletosustainingmusculoskeletaldisordersduringthecourseoftheirworkroutine.[26]
ItisestimatedthatalmostonethirdofallcasesofsickleaveamonghealthcareworkersarerelatedtoMSDs.
[27]Evenindevelopedcountries,itappearsthatWMSDsamonghealthcareprovidersareunderreported.
[28]IndevelopingcountriessuchasIndiaitismuchnegligible.StudiesofWMSDsamonghealthcare
providershavemainlyfocusedonphysicians,dentists,physicaltherapists,labtechnicians,andnurses.
[29,30,31]Back,neck,shoulder,andkneeproblemsarethemostcommoncomplaintsamongmedical,
dental,andnursingpersonnel.[32,33,34]MostofthepreviousstudiesonWMSDsamonghealthcare
workerswerelimitedtoanyoneoftheprofessionalgroupssuchasnurses,physicaltherapists,dentists,and
others.ThisstudycomparedtheprevalenceanddistributionofWMSDsamongfivedifferentgroupsof
healthcareprofessionalsworkinginatertiarycarehospitalinChennai,India.Italsoevaluatedmultiplerisk
factorsthatcontributetothedevelopmentofWMSDsandidentifiedthehighriskgroup.
MATERIALSANDMETHODS
Itwasacrosssectionalstudyconductedamongdentists,laboratorytechnicians,nurses,physicians,and
physiotherapistsofvariousclinicaldepartmentsinatertiarycarehospitalinChennai,fromJanuarytoJune
2013.Anonprobabilitysamplingasconvenienttotheinvestigatorswasemployedafterobtainingethical
clearancefromtheInstitutionalEthicalCommittee.
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Inalltheabovementionedcategoriesofprofessionals,cliniciansandcliniciancumacademicianswith
willingnesstotakepartinthestudywereincludedasstudyparticipants.Thehealthcareprofessionalswho
arepurelyacademicians,thosewithcurrentmusculoskeletaltraumaandthosewhorefusedtoparticipate
wereexcludedfromthestudy.
Facetofaceinterviewsaswellasobservationalanalysisofvarioustaskswereemployed.Different
combinationsofvalidatedandstandardizedquestionnaireswereusedforcollectingdifferenttypesofdata.
SectionAisageneralquestionnaireondetailsofdemography,medicalandoccupationalhistory,diet
pattern,lifestyle,andpersonalhabits.Italsoincludesquestionstodetermineifthesymptomswerework
related.SectionBisaquestionnairethatgathersinformationaboutworkstationandnatureofvarioustasks.
SectionCisaratingscaletoidentifyjobriskfactorsbasedonworkerperceptionsaboutvariousconditions
andtasksthatmaycontributetothedevelopmentofworkrelatedmusculoskeletaldisorders,byascoring
methodusinganordinalscaleof010.SectionDistheNordicMusculoskeletalQuestionnaire(NMQ),a
standardizedscreeningandsurveillancetooltofindoutthebodyregionsaffectedbymusculoskeletal
symptoms.Inthisstudy,itwasusedtoidentifythehighriskgroupfordifferentbodyregions.
Datadescriptiveswerederived.Univariateanalysiscomparedthedemographicvariablesoftheparticipants
withworkrelatedfactors.Jobriskfactorsamongthedifferentsubgroupswereanalyzedusingindependent
samplettestforcontinuousvariables,andChisquaretestfornominalorordinalvariablesandoddsratiohas
beenreportedconsideringnullhypothesistobesignificantifPvalueis<0.05,whichisthelevelof
significance.DataanalysiswascarriedoutusingthesoftwareR3.0.1version.
RESULTS
Themeanage,height,weight,andbodymassindexofallrespondentswere32.58.1years,1.60.1m,
66.513.4kg,and24.94.3,respectively.Thetotalyearsofworkexperienceandtotalworkinghoursper
weekwasfoundtobe8.68.1yearsand484h,respectively.Thesummaryofdescriptiveinformationof
allrespondentsispresentedinTable1.
Thisstudypopulationcontains64.3%(41.4%maleand58.6%female)ofexclusiveclinicalpractitionersand
35.7%ofthosewhoarebothcliniciansaswellasacademicians.Amongall,68.5%oftheparticipantswere
married.Only3.6%participantsweresmokersand8.6%werealcholics,whichisanegligibleportion.Ofall,
35%wereinvolvedinothertypesofphysicalactivitiessuchassports,exercises,andyogaroutinely,whereas
only12.2%takepartinrecreationalactivitiesoutofworkingschedule.Inthisstudypopulation,61.4%ofthe
participantsworkinasingleshiftdutyof8hduration,whereas38.6%workinthreeshifts,theshiftduration
being6hinthemorning,6hintheeveningand12hinthenight.Mostoftheparticipants(77.1%)workin
thesamestationasthereisnojobrotation,whereastherestofthem(22.9%)havejobrotationoncein3
monthsorbiannually,whichisshownintheFigure1.
Table2demonstratesdifferencesbetweenthewithMSDsgroupandthewithoutMSDsgroupforage,
gender,shiftwork,yearsofemployment,andworkhourspershift.Ingeneral,participantsinthe
musculoskeletalcomplaintgroupwereyounger,obese,hadlesseryearsofexperiencebutmoreworking
hourspershift,andwereexclusivelyclinicians.Therewerenostatisticallysignificantdifferencesintermsof
smoking,alcoholism,andphysicalorrecreationalactivitiesbetweenthetwogroups.
Workinginthesamepositionforlongperiod(37.10%),workinginawkwardandcrampedpositions
(29.20%),andperformingthesametaskoverandover(29%)werereportedasthehighestjobriskfactors
amongallparticipants[Figure2].Inaddition,physiotherapistsreportedthatperformingmanualorthopedic
techniquesandassistingpatientsingaitactivitiesweremajorriskfactorsintheirprofession.Figure3shows
thehighestjobriskfactorsforthedifferentcategories.Almostalljobriskfactorssignificantlyvaryamong
thedifferentgroups(P<0.05).
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Abouthalf(50.7%)oftheparticipantsreportedsymptomsatleastinonepartoftheirbodies,overthepast12
months.Amongallthesymptoms,lowbackpainwasthehighest(45.7%),followedbyneckpain(28.5%)
andshoulderpain(23.5%),whereaship/thighpain(7.1%)andelbowpain(5%)wastheleastreported,as
showninFigure4.Irrespectiveofregions,bodypainduringlast12monthswascomplainedby56%of
nurses55%ofphysiotherapists,54%ofdentists,39%oflabtechniciansand38%ofphysicians.
Overall,musculoskeletalpaincomplainedbyallparticipantswas50.7%,andamongthat26.4%wasfound
tobeofworkrelatedorigin.WorkrelatedpainwasfoundtobehighinNurses,Dentists,and
Physiotherapists,whereasnonworkrelatedpainwasfoundtobepredominantinPhysiciansandLab
Technicians,asshowninFigure5.
DISCUSSION
Prevalenceofmusculoskeletaldisordersvariesacrossoccupationalgroupsandovernationalboundaries.
Subjectivityofterms,variationsinassessmenttools,organizationaldifferencesinworksettings,andcultural
differencesinperception,andreportingofpainanddisordersareadducedforthevariationinratesof
WMSDsindifferentstudies.ThegenderpatternofWMSDsfoundinthisstudyissimilartotheresultof
moststudies.Manypreviousstudiesreportedafemalepredominanceintheprevalenceofmusculoskeletal
disordersinboththegeneralpopulation[35,36]andworkingpopulation.[33,37]Inthisstudy,itwasfound
thatfemalehealthprofessionalshave1.9timeshigherrisk(OR=1.9)fordevolopingMSDsthanmalehealth
professionals.Itwasalsofoundthatoverweight(OR=2),obese(OR=1.26)professionalshaveagreater
chanceofdevelopingWMSDs.Buttheagegroupdistributionandworkexperiencerevealsthatyoungerage
groupof<30years,with<5yearsofprofessionalexperience)haveagreaterchanceofdevelopingWMSDs,
whichsupportsthestudyfindingsofCromieetal.,[37]butisopposedtothestudybyTinubuetal.[33]It
maybeduetolackoforientationtotheworkstationorvigorousworkingstyleoftheyoungstersas
comparedwiththeolderprofessionals,whoarewelladaptedtotheworkstationandmostlyfollowsafe
workingprinciples.Thoseprofessionalsinvolvedinbothclinicalaswellasacademicwork(32.4%)have1.1
timeshigherchanceofdevelopingWMSDsascomparedwiththosewhoareexclusivelyinvolvedinclinical
work(67.6%).Theparticipantswhoworkin3shiftshavegreaterchanceofdevelopingWMSDs(OR=
1.08)ascomparedtothosewhoworkinsingleshift(61.4%),whichissimilartotheresultofaprevious
studybyShafiezadehetal.[38]Thisstudyshowedthatjobrotation(28.2%)mayprotectfromtheriskof
developingWMSDs.Theparticipantswhoareinvolvedactivelyinotherphysicalactivitieshave1.85times
greaterchanceofdevelopingWMSDsthanthosewhoarenotinvolvedinotherphysicalactivity.Thisisin
consistencewithpreviousfindings.Alltheabovedemographicvariablesinourstudywerefoundtobe
nonsignificantfordevelopingWMSDsasPvaluewasnot<0.05inanyofthevaraibles.
Fromthisstudy,anassociationwasfoundbetweenoccupationandprevalenceofWMSDsamongthehealth
workers.Inthiscurrentstudy,wefoundtheWMSDsprevalencetobe26.4%anditismuchlesserthana
previousstudybyEmmanueletal.amongtertiaryhealthcareworkers,inwhichitwasreportedas68.7%.
[35]Amongall,lowbackpain(45.7%)wasthepredominantcomplaint,followedbyneckpain(28.5%),
shoulderpain(23.5%),andkneeandanklepain(20%).Theleastofcomplaintswerereportedatwrist(12%),
hip/thigh(7.1%),andelbow(5%),whichsupportsthestudyresultsofEmmanueletal.[35]
ThehighestprevalenceofWMSDsfoundamongnurses(55.5%)issimilartoapreviousstudybyKarahaet
al.[39]whoassessedtheprevalenceandriskfactorsforlowbackpainamongavarietyofTurkishhospital
workers,includingnurses,physicians,physicaltherapists,technicians,secretaries,andhospitalaides,in
whichthehighestprevalencewasreportedbynurses(77.1%).Similarly,thestudiesbyEmmanueletal.[35]
andTinubuetal.[33]foundhighestWMSDsprevalenceamongnursesreporting30.4%and78%,
respectively.SeveralauthorshavereportedhighprevalenceofWMSDsamongnursesindeveloped
countries.[40,41]Themajorcomplaintfromnurseswaship/thighpain(60%),followedbyankle/feet(55%),
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andknees(53%).Itmaybebecauseofworkinginthesamepositionsforlongperiods(44.4%),bendingor
twisitngbackinanawkwardway(41.7%),andworkinginawkwardorcrampedposition(63.9%),which
werethemostperceivedjobriskfactorsprecipitatingWMSDsamongthenurses.Butthisfindingis
inconsistentwiththefindingsofthestudybyTinubuetal.[33]
Theresultsobtainedinourstudyindicatenotonlythatthesurveyeddentistsdemonstratedimproperworking
habitsbutalsothattheylackbasicknowledgeofergonomics.Similartotheresultsobtainedfromprevious
studies,themostfrequentMSDswerereportedintheshoulder(39.4%),followedbyupperback(38.1%),
neck(37.5%),andwrist(29.4%).Also,thefindingsaboutworkingpositionanddentistryreportedby
Kierkloetal.[42]areconsistentwithourresults.Theabovereportedregionwisebodypaincorrelateswell
withjobriskfactorssuchasworkinginthesamesittingposition(71%),performingthesametaskoverand
over(48.4%),andcontinuingtoworkwhileinjured(35.5%).
Thecurrentstudyhasrevealedthatassistingpatientsduringgaitactivities(50%),repetitivetasks(50%),and
workinginawkwardorcrampedpositions(35%)arethefactorsperceivedbyphysiotherapistsasmostlikely
tolimittheircapacitytocontinueworkinginaphysicallydemandingrole.[28,43]Itisalsonoteworthythat
someoftheseriskfactorsareinherenttothenatureofclinicalworkofphysiotherapyprofessionals.[44]With
respecttotheaffectedbodyregions,thehighestincidenceisintheelbow(28.6%)andwrist(23.5%),asmost
ofthephysiotherapistsusemanipulativetechniquesforlongerperiodsandrepetitively.Thisisfollowedby
neckpain(22.5%)andbackpain(18.8%).Thisisinconsistentwiththefindingsofapreviousstudy
conductedbySaliketal.,[28]inwhichbackpain(26%)wasthepredominantcomplaintfollowedbywrist
pain(18%).Atthesametime,itisstronglyconsistentwiththefindingsofanotherstudy(Cromieetal.[37]),
whichshowedthatincreasedprevalenceofwrist/thumbsymptomswasassociatedwiththeuseof
mobilizationandmanipulationtechniques.Riskfactorspertainingtoworkloadwereassociatedwithahigher
prevalenceofneckandupperlimbsymptoms,andposturalriskfactorswereassociatedwithahigher
prevalenceofspinalsymptoms.
Inthepresentstudy,thepercentageofsymptomsreportedbylaboratorytechnicianswaslow(21.1%),as
comparedwiththoseobtainedbyotherauthors.However,amongthestudiesfocusingonlaboratory
workers,onlyKilroyandDockrell[45]describedtheglobalprevalenceofMSDsymptoms,butthey
consideredtheperiodofthepreceding3monthsasagainsttheperiodof12monthsinthepresentstudy.
Amongthisgroup,shoulderpain(18.2%)wasthechiefcomplaintfollowedbyneckpain(17.5%),backpain
(15.6%),andwristpain(11.8%).Themajorjobriskfactorswerefoundtobeprocessinganexcessive
numberofsamples(14.3%)andworkinginawkwardposutres(10.7%).Itmaynotbenegligible,andcanbe
minimizedwithpropereducationoflaboratoryergonomics.
ComparedtothestudybyMehrdadetal.[36]aswellastothatofotherhealthcareprofessionalsinthe
presentstudy,theMSDsreportedbyphysicianswasmuchlower(18.3%).Elbowpain(28%),backpain
(19%),andshoulderandwristpain(12%)werethemaincomplaints.Themajorjobriskfactorsofworking
inthesameposture(28%)andtreatinganexcessivenumberofpatients(24%)puttogetherproducesariskof
developingWMSDsamongphysicians.Overall,theprevalenceofMSDsamongthesephysiciansissimilar
tothegeneralpopulation,whichis18%forlowbackpainand7%forneckpain.Thereasonforthisshould
betheabsenceofrepetitiveand/orstrenuoustask.
CONCLUSION
AhighproportionofhealthcareprofessionalsreportedWMSDsatoneortheotherbodyregion,lowback
beingthemostcommonlyaffectedarea.TheoccurrenceofWMSDsishigheramongnursesthanother
healthcareprofessionalsfollowedbyphysiotherapistsanddentists.Thelaboratorytechniciansand
physiciansaretheleastaffected.Workinginthesamepositionsforlongperiods,workinginawkwardor
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crampedpositionsandhandlinganexcessivenumberofpatientsorsamplesinonedaywerefoundtobethe
mostcommonlyreportedjobriskfactorsforthedevelopmentofWMSDs,inthisstudy.Hencethisstudy
concludesthatamongallthehealthcareprofessionalsassessedinthisstudy,nurseswerefoundtobethe
highriskgroup,whereasphysicianswerefoundtobeatthelowestrisk.
Thenonprobabilitysamplingmethodemployedinthisstudypreventsgeneralizationoftheresults.Also,the
questionnaireonjobriskfactorsusedinthisstudyareselfreported,andhencesubjectivebiasmightbethere.
Werecommendthatawareness,education,andtrainingprogramsonpreventionandcopingstrategiesfor
musculoskeletaldisordersbemademandatoryforhealthcareprofessionalsespeciallyforthehighrisk
groupssuchasnurses,dentists,andphysiotherapistsnotonlytoreducetheoccurrenceofWMSDsamong
thembutalsotopromoteefficiencyinpatientcare.Anintegratedhealthpromotionmodelshouldbeplanned
forhealthcareprofessionalsinworkplace.
Abetterplannedlongtermstudyeliminatingthelimitationsofthecurrentstudy,usingmorequantitative
analyticaltoolsmaygiveanaccurateestimateofWMSDsandjobriskfactorswithexposuretorisklevels
amonghealthprofessionalsandthereby,abettermeanstoaccuratelyrecommendandimplementpoliciesand
strategiestocombattheseriskfactorsforWMSDsamonghealthcareprofessionals.Thefutureworkmaybe
expandedtoincludeothercategoriesofhealthcareprofessionalsaswellasotherprofessionalsinvolvedin
healthcareindustrywhoareathighriskforWMSDsincludingwardboys,sanitaryworkers,emergency
personnel,andothers.
ACKNOWLEDGMENTS
WearethankfultoparticipantsofthestudywhogaveusunconditionalsupportandNMQteamtopermitus
forusingthescaleinthisstudy.
Footnotes
SourceofSupport:Nil
ConflictofInterest:Nonedeclared.

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FiguresandTables
Table1

Descriptivestatisticsfordemographicvariablescollectedfromstudyparticipants
Figure1

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Basicinformationabouttheparticipants
Table2

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PredictorsofMSDsamonghealthcareprofessionals
Figure2

SelfreportedJobriskfactorsamongallparticipants
Figure3

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Selfreportedjobriskfactorsamongdifferentparticipants
Figure4

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Bodyregionpainsamongallparticipants
Figure5

Musculoskeletalpainsandworkrelatednessamongdifferentparticipants

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ArticlesfromIndianJournalofOccupationalandEnvironmentalMedicineareprovidedherecourtesyof
MedknowPublications

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