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1.
Acad Pediatr ; 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34547518

RESUMO

OBJECTIVE: To examine sources of information used by parents to facilitate parent-adolescent communication about sexual and reproductive health (SRH), parents' preferences for receiving SRH information through primary care, and factors associated with parents' interest in primary-care-based SRH information (i.e., resources recommended or offered in the primary care setting). METHODS: In this cross-sectional study, a nationally representative sample of 11-17-year-old adolescents and their parents (n=1,005 dyads) was surveyed online; 993 were retained for these analyses. Parents were asked about their use of 11 resources to help them talk with their adolescents about SRH and rated the likelihood of using specific primary-care-based resources. We used multivariable logistic regression to examine characteristics associated with parent interest in primary-care-based SRH resources. RESULTS: Only 25.8% of parents reported receiving at least a moderate amount of SRH information from primary care; half (53.3%) reported receiving no SRH information from their adolescent's provider. Parents received the most information from personal connections (e.g. spouse/partner, friends). Most parents (59.1%) reported being likely to utilize a primary-care-based resource for SRH information. Parents who previously received SRH information from primary care sources had greater odds of reporting they would be likely to utilize a primary-care-based resources (AOR = 4.06, 95% CI: 2.55-6.46). CONCLUSIONS: This study provides insights into parents' sources of information for communicating with their adolescents about SRH and ways primary care practices might increase support for parents in having SRH conversations with their adolescents. Future studies are needed to establish clinical best practices for promoting parent-adolescent communication about SRH.

2.
FP Essent ; 507: 11-18, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410092

RESUMO

Communication is an essential component in providing health care for adolescent patients. A critical part of adolescence is identity development. Affirmation of identity and emphasis on individual strengths are important for this age group. The concept of resilience is at the center of adolescent care and shapes how care is defined and delivered. A primary goal is to protect patients from harm through a combination of promotion of protective factors, including resilience, and risk factor reduction. In adolescents, use of motivational interviewing has been shown to decrease risky sexual behaviors, help prevent unplanned pregnancy, increase physical activity levels, and decrease substance use. Confidentiality is another essential component of care. The American Academy of Pediatrics (AAP) recommends use of the Strengths, School, Home, Activities, Drugs/substance use, Emotions/eating/depression, Sexuality, Safety (SSHADESS) screen for psychosocial assessment. Several other standardized, validated screening tools also may be valuable in guiding discussions and identifying risky behaviors. Sexual orientation, gender identity, religious, racial, and ethnic components of identity development should be addressed. The empowerment of adolescent patients to achieve personal independence in the health care setting is part of the transition from an adolescent approach to health care to an adult approach.


Assuntos
Saúde do Adolescente , Identidade de Gênero , Adolescente , Adulto , Criança , Comunicação , Feminino , Humanos , Masculino , Gravidez , Assunção de Riscos , Comportamento Sexual , Estados Unidos
3.
FP Essent ; 507: 19-25, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410093

RESUMO

Unintentional injuries, suicide, and homicide were the leading causes of deaths among US individuals ages 10 to 24 years in 2017. Motor vehicle crashes are the leading cause of death by unintentional injury among US adolescents. Family physicians can encourage adolescent patients who drive to use safe driving practices (eg, seat belt use, cell phone-free driving, sober driving). Poisoning and drowning are the second and third most common causes of death by unintentional injury among adolescents, respectively. Suicide is the second overall leading cause of death among adolescents and is a growing problem. Depression is a risk factor. The Ask Suicide-Screening Questions (ASQ) suicide risk screening tool has been validated for use in patients ages 10 to 21 years in all medical settings. Screening, diagnosis, treatment, and follow-up of adolescent patients for depression and development of safety plans are key to suicide prevention. Homicides are the third leading cause of death among adolescents, and firearms are a clear contributor. Family physicians should assess adolescent patients for risk factors for violence, provide trauma-informed care, promote resilience and strong relationships with adults, and empower adolescents to use their strengths and skills to reduce their risk of involvement in violence.


Assuntos
Saúde do Adolescente , Suicídio , Adolescente , Adulto , Causas de Morte , Criança , Homicídio , Humanos , Suicídio/prevenção & controle , Violência , Adulto Jovem
4.
FP Essent ; 507: 26-32, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410094

RESUMO

Substance use in adolescents affects brain development and can influence health in adulthood. The substances most commonly used by adolescents are alcohol, cannabis, and tobacco. Adolescent alcohol use has been shown to inhibit and alter normal brain development, and has been associated with alcohol use disorder and other mental disorders in adulthood. Cannabis use during adolescence has been associated with adverse mental health outcomes. Adolescents may incorrectly assume that the negative health effects of smoking will not affect them. Electronic nicotine delivery systems, such as e-cigarettes, for vaping may be used to inhale nicotine, cannabis, or both. Strong family relationships and parental monitoring are protective factors against substance use. Screening at every preventive services visit is an essential element of adolescent care. The evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategy has been shown to decrease substance use and its adverse effects in adolescents. On societal and community levels, family physicians have numerous opportunities to advocate for adolescent well-being and prevention of substance use. The American Academy of Family Physicians (AAFP) recommends that family physicians advocate for legislation and governmental policies that facilitate the prevention, diagnosis, and treatment of substance use.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Transtornos Relacionados ao Uso de Substâncias , Vaping , Adolescente , Saúde do Adolescente , Adulto , Humanos , Fumar , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
5.
FP Essent ; 507: 33-38, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34410095

RESUMO

Digital media use has increased rapidly during the past two decades, and media use is now a major issue in adolescent development. Online connections and communities can help foster healthy identity development and provide needed peer support, particularly for adolescents from historically marginalized communities. Online harassment, or cyberbullying, is a common phenomenon. Media use can interfere with sleep hygiene and quality, and screen-based sedentary behaviors have been associated with decreased physical activity, decreased aerobic fitness, and increased adiposity among adolescents. The literature on media use and adolescent mental health still is evolving. Some research suggests a U-shaped association between these two factors, with high and low levels of internet use associated with depression. Social media use may amplify peer pressure to engage in sexual behavior, provide exposure to a greater network of individuals with sexual experience, and increase the risk of sexual behaviors. Counseling adolescent patients about safe and healthy media use is essential. Conversations with patients and their families about media use should begin before adolescence and continue through adolescence in the context of routine preventive care. The American Academy of Pediatrics (AAP) recommends creation and implementation of a Family Media Use Plan.


Assuntos
Saúde do Adolescente , Mídias Sociais , Adolescente , Criança , Comunicação , Humanos , Internet
6.
Pediatrics ; 148(2)2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34253569

RESUMO

OBJECTIVES: To quantify adolescent- and parent-perceived importance of provider-adolescent discussions about sexual and reproductive health (SRH), describe prevalence of provider confidentiality practices and provider-adolescent discussions about SRH topics during preventive visits, and identify missed opportunities for such conversations. METHODS: We used data from a national Internet survey of 11- to 17-year-old adolescents and their parents. Data were weighted to represent the noninstitutionalized US adolescent population. Adolescents who had a preventive visit in the past 2 years and their parents reported on perceived importance of provider-adolescent discussions about SRH topics: puberty, safe dating, gender identity, sexual orientation, sexual decision-making, sexually transmitted infections and HIV, methods of birth control, and where to get SRH services. Adolescents and parents reported whether they had ever discussed confidentiality with the adolescent's provider. Adolescents reported experiences at their most recent preventive visit, including whether a provider spoke about specific SRH topics and whether they had time alone with a provider. RESULTS: A majority of adolescents and parents deemed provider-adolescent discussions about puberty, sexually transmitted infections and HIV, and birth control as important. However, fewer than one-third of adolescents reported discussions about SRH topics other than puberty at their most recent preventive visit. These discussions were particularly uncommon among younger adolescents. Within age groups, discussions about several topics varied by sex. CONCLUSIONS: Although most parents and adolescents value provider-adolescent discussions of selected SRH topics, these discussions do not occur routinely during preventive visits. Preventive visits represent a missed opportunity for adolescents to receive screening, education, and guidance related to SRH.

7.
J Prim Care Community Health ; 12: 21501327211014749, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33980061

RESUMO

INTRODUCTION/OBJECTIVES: Childhood obesity develops as the result of the interplay between individual and environmental factors. Community based participatory research (CBPR) is an effective tool for improving health of communities. There is limited research on CBPR for facilitating healthy lifestyle in community schools with an alternative learning environment. The objective of the study was to explore student and staff perspectives via focus groups on barriers and facilitators for healthy eating and physical activity in a community school with alternative learning environment and to prioritize, design, and implement suggested interventions to improve healthy lifestyle. METHODS: We conducted qualitative research through 8 focus groups of middle and high school students (n = 40) and 2 focus groups of school staff (n = 8). The school community and research team subsequently identified and implemented interventions for facilitating healthy lifestyle in students within the school environment. RESULTS: Barriers identified for healthy lifestyle included lack of motivation, lack of healthy food options at school, inadequate knowledge about healthy lifestyle and insufficient opportunities for physical activity. Facilitators for healthy lifestyle were support and motivation from mentors and knowledge about healthy nutrition. Key strategies implemented were addition of healthier food options, educational materials for healthy eating, creation of a walk path, standing desks in classrooms and additional equipment in the school gymnasium. CONCLUSIONS: Formative feedback from students and staff was helpful in the implementation of strategies for facilitating healthy lifestyle among students within a community school with an alternative learning environment.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Instituições Acadêmicas , Criança , Promoção da Saúde , Estilo de Vida Saudável , Humanos , Estudantes
8.
J Eat Disord ; 9(1): 55, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892810

RESUMO

BACKGROUND: Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices. METHODS: This retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders. RESULTS: In both groups, effect sizes for increased BMI percentile exceeded Cohen's convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment. CONCLUSIONS: Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.

10.
J Pediatr Health Care ; 35(3): 320-326, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33516619

RESUMO

Eating disorders typically have a protracted course, marked by significant morbidity. Male adolescents and adolescents of color are at risk of delayed care. Primary care providers are well-positioned to identify eating disorders early and initiate treatment. This case report describes an adaptation of Family-Based Treatment delivered by a primary care provider to an Asian-American male adolescent from an immigrant family with restrictive anorexia nervosa. The adolescent achieved full-weight restoration and remission of his anorexia through treatment in primary care. Embedding eating disorder treatment within primary care could improve detection, engagement, and retention in treatment among young people from diverse backgrounds.

11.
J Adolesc Health ; 69(1): 134-139, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33342720

RESUMO

PURPOSE: Youth face similar rates of homelessness across rural and urban areas, yet little is known about how the health of unstably housed youth varies by location. We assessed differences in health by location (city, suburb, town, and rural) and housing status among youth facing a range of unstable housing experiences. METHODS: This secondary data analysis from 8th, 9th, and 11th graders completing the 2019 Minnesota Student Survey examined youth who had experienced housing instability in the prior year (n = 10,757), including running away (48%) or experiencing homelessness (staying in shelter, couch-surfing, or rough sleeping) with (42%) or without (10%) an adult family member. We conducted multifactor analysis of variance to assess differences by location (urban, suburban, town, and rural) and housing experience for each of five health indicators: suboptimal health, depressive symptoms, suicide attempts, ≥2 sexual partners, and e-cigarette use. RESULTS: In main effects models, all health indicators varied based on housing status; suboptimal health, ≥2 sexual partners, and e-cigarette use also varied by location. Interaction models showed that unaccompanied homeless youth in suburbs reported poorer health compared with those in cities. Compared with suburbs, youth in towns were more likely to report ≥2 sexual partners (19.9%, 24.1%) and e-cigarette use (39.5%, 43.3%). CONCLUSIONS: Our findings suggest that unstably housed youth face a similar burden of poor health across locations, with only subtle differences in health indicators, yet most research focuses on urban youth. Future research is needed to identify how to best meet the health needs of unstably housed youth across locations.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Pessoas em Situação de Rua , Jovens em Situação de Rua , Adolescente , Adulto , Cidades , Habitação , Humanos , Minnesota/epidemiologia
13.
J Adolesc Health ; 67(4): 569-575, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32389456

RESUMO

PURPOSE: Substantial gaps exist between professional guidelines and practice around confidential adolescent services, including private time between health-care providers and adolescents. Efforts to provide quality sexual and reproductive health services (SRHS) require an understanding of barriers and facilitators to care from the perspectives of primary care providers working with adolescents and their parents. METHODS: We conducted structured qualitative interviews with a purposive sample of pediatricians, family physicians, and nurse practitioners (n = 25) from urban and rural Minnesota communities with higher and lower rates of adolescent pregnancy. Provider interviews included confidentiality beliefs and practices; SRHS screening and counseling; and referral practices. RESULTS: The analysis identified two key themes: (1) individual and structural factors were related to variations in SRH screening and counseling and (2) a wide range of factors influenced provider decision-making in initiating private time. A nuanced set of factors informed SRHS provided, including provider comfort with specific topics; provider engagement and relationship with parents; use of adolescent screening tools; practices, policies, and resources within the clinic setting; and community norms including openness with communication about sex and religious considerations regarding adolescent sexuality. Factors that shaped providers' decisions in initiating private time included adolescent age, developmental stage, health behaviors and other characteristics; observed adolescent-parent interactions; parent support for private time; reason for clinic visit; laws and professional guidelines; and cultural considerations. CONCLUSIONS: Findings suggest opportunities for interventions related to provider and clinic staff training, routine communication with adolescents and their parents, and clinic policies and protocols that can improve the quality of adolescent SRHS.


Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde Reprodutiva , Adolescente , Feminino , Humanos , Minnesota , Percepção , Gravidez , Atenção Primária à Saúde , Saúde Reprodutiva
14.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32152134

RESUMO

BACKGROUND AND OBJECTIVES: Runaway youth and homeless youth are at risk for adverse mental health outcomes. These 2 populations are frequently pooled together in both research and interventions yet may have unique health needs. We sought to assess differences in mental health outcomes among these populations. METHODS: We conducted a secondary data analysis of ninth- and 11th-graders in the 2016 minnesota Student Survey (n = 68 785). We categorized youth into 4 subgroups based on housing status in the previous year: (1) unaccompanied homeless youth (0.5%), (2) runaway youth (4%), (3) youth who had both run away and been homeless (0.6%), and (4) stably housed youth (95%). We performed multivariable logistic regression to compare 4 mental health outcomes (self-injury, suicidal ideation, suicide attempts, and depressive symptoms) across groups, controlling for demographics and abuse history. RESULTS: Unstably housed youth had poorer mental health outcomes when compared with their stably housed peers (P < .05). For example, 11% of homeless youth, 20% of runaways, and 33% of youth who had experienced both had attempted suicide in the previous year compared with 2% of stably housed youth (adjusted odds ratios 2.4, 4.9, and 7.1, respectively). Other outcomes showed a similar pattern. CONCLUSIONS: Our findings suggest that runaway and homeless youth represent unique populations with high levels of mental health needs who would benefit from targeted clinical and community interventions. Pediatric clinicians represent one potential point of screening and intervention.


Assuntos
Depressão , Jovens em Situação de Rua/psicologia , Comportamento Autodestrutivo , Ideação Suicida , Tentativa de Suicídio , Adolescente , Depressão/epidemiologia , Depressão/psicologia , Feminino , Jovens em Situação de Rua/estatística & dados numéricos , Habitação/classificação , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Minnesota/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
15.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31964756

RESUMO

The largest segment of missing children in the United States includes runaways, children who run away from home, and thrownaways, children who are told to leave or stay away from home by a household adult. Although estimates vary, as many as 1 in 20 youth run away from home annually. These unaccompanied youth have unique health needs, including high rates of trauma, mental illness, substance use, pregnancy, and sexually transmitted infections. While away, youth who run away are at high risk for additional trauma, victimization, and violence. Runaway and thrownaway youth have high unmet health care needs and limited access to care. Several populations are at particular high risk for runaway episodes, including victims of abuse and neglect; lesbian, gay, bisexual, transgender, and questioning youth; and youth in protective custody. Pediatricians and other health care professionals have a critical role to play in supporting runaway youth, addressing their unique health needs, fostering positive relationships within their families and with other supportive adults, and connecting them with available community resources. This report provides clinical guidance for pediatricians and other health care professionals regarding (1) the identification of adolescents who are at risk for running away or being thrown away and (2) the management of the unique medical, mental health, and social needs of these youth. In partnership with national, state, and local resources, pediatricians can significantly reduce risk and improve long-term outcomes for runaway youth.


Assuntos
Criança Abandonada , Jovens em Situação de Rua , Determinação de Necessidades de Cuidados de Saúde , Adolescente , Criança , Maus-Tratos Infantis , Criança Abandonada/psicologia , Criança Abandonada/estatística & dados numéricos , Previsões , Cuidados no Lar de Adoção/estatística & dados numéricos , Acesso aos Serviços de Saúde , Jovens em Situação de Rua/psicologia , Jovens em Situação de Rua/estatística & dados numéricos , Linhas Diretas/estatística & dados numéricos , Humanos , Pesquisa , Medição de Risco , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Mídias Sociais , Estados Unidos
16.
Child Abuse Negl ; 100: 104141, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31653444

RESUMO

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Minnesota Runaway Intervention Program (RIP), a Minneapolis-St. Paul based program dedicated to supporting youth aged 12-17 who have run away and experienced sexual violence, including sexual assault and exploitation. It is a comprehensive, health care focused intervention, embedded within a hospital-based Child Advocacy Center. RIP is developed and led by nurse practitioners who provide services tailored to participants' diverse needs, including health care, case management services, and a therapeutic empowerment group.


Assuntos
Abuso Sexual na Infância/psicologia , Jovens em Situação de Rua , Tráfico de Pessoas/psicologia , Trauma Sexual/psicologia , Adolescente , Conscientização , Criança , Abuso Sexual na Infância/legislação & jurisprudência , Abuso Sexual na Infância/terapia , Defesa da Criança e do Adolescente , Terapia Cognitivo-Comportamental/métodos , Aconselhamento/métodos , Feminino , Tráfico de Pessoas/legislação & jurisprudência , Tráfico de Pessoas/prevenção & controle , Humanos , Masculino , Minnesota , Desenvolvimento de Programas , Trauma Sexual/terapia , Resultado do Tratamento
17.
J Adolesc Health ; 65(3): 378-383, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31277994

RESUMO

PURPOSE: Runaway adolescents often have strained relationships with their parents. Given parental support is an important protective resource for traumatized young people, understanding differences in support within parent-adolescent relationships could aid in designing more effective interventions. We hypothesized (1) runaway adolescents seen at a Child Advocacy Center (CAC) would have poorer parental relationships than adolescents without a history of running away and (2) severity of diagnosed sexual violence would be associated with lower parental connectedness. METHODS: Data were from 2,042 adolescents aged 10-19 years and their parents evaluated for any reason at our hospital-based CAC from 2008 to 2017. Parent-adolescent relationship scales were completed by adolescents and at least one parent/guardian (usually mothers). Sexual abuse was stratified at four levels, higher levels indicating increasingly severe forms of abuse. T-tests and analyses of variance to tested relationships between supportive and controlling parental behaviors by runaway status, and, among runaways, by the severity of sexual abuse. RESULTS: Runaway adolescents comprised 58.3% of adolescents seen at the CAC; runaways reported lower parental support and higher parental controlling than patients without a history of running away. Those with the most severe forms of sexual abuse (including sexual exploitation and gang rape) reported the least supportive and most controlling relationships with parents, as did their parents. CONCLUSIONS: Findings support our clinical observations that polyvictimization of adolescents who have spent significant time as runaways may further strain parent-adolescent relationships. Future clinical research should focus on developing interventions to promote parental connectedness after a runaway episode.


Assuntos
Abuso Sexual na Infância/psicologia , Jovens em Situação de Rua/psicologia , Relações Pais-Filho , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Abuso Sexual na Infância/classificação , Defesa da Criança e do Adolescente/psicologia , Estudos Transversais , Feminino , Jovens em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Adulto Jovem
18.
Nurs Clin North Am ; 54(2): 207-225, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027662

RESUMO

This article describes prevalence and recent trends in the most common sexually transmitted diseases (STD) among young people in the United States. Common clinical presentations and best practices related to screening and treatment of these conditions are summarized. Clinical considerations for working with adolescents and young adults in the area of sexual and reproductive health are highlighted. Key approaches for sexually transmitted disease prevention with adolescents and young adults are presented.


Assuntos
Guias de Prática Clínica como Assunto , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Feminino , Humanos , Masculino , Prevalência , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
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