Kontracept_geo.indd

gadaudebeli
kontraceptiuli abebi
samedicino momsaxurebis saxelmZRvanelo
meore gamocema _ 2004
gadaudebeli kontracepciis saerTaSoriso konsorciumi
wyaroebze miTiTeba
mocemul saxelmZRvanelos safuZvlad udevs ojaxis dagegmvis saerTaSoriso fede-raciis da internacionaluri kvleviTi dawesebulebis mier SemuSavebuli damxmare wignebi (Pathfinder international, PATH) pirveli gamocema 2000 wlis oqtomberSi daibeWda. gansakuTrebuli wvlili, mocemul gamocemaSi, Semdeg pirebs miuZRviT: elisabed raimondi, iusuf ahmedi, Saron kempi, merilin edmundsi, duglas haberi, karlos xuedo-toledo, valeri konCelniki, suni-ta mitali, xose david ortici, karen ostea, hama rojo, jef spaileri, jeims truseli, paul van luki da elena fon herenceni.
meore gamocemis ganaxlebisaTvis, konsorciumi madlobas uxdis elisabed raimonds, enjel kabrias, david graims, siuzan makinTaiars, ilze melingailiss, klavdia mo-riseis, rafaelasCaiavons, haris solomons, perger teodoras, fatiha terkis, jeims trusels, andre ulmans, elena fon hercens, ana uilsons, da beveli uinkofs.
gadaudebeli kontraceftiuli abebi
samedicino momsaxureobis damxmare saxelmZRvanelo 2004;
gadaudebeli kontracefciis saerTaSoriso konsorciumi-a.S.S. q. vaSingtoni;
gadaudebeli kontracefciis saerTaSoriso konsorciumi.
gadaudebeli kontraceptiuli abebi
samedicino momsaxureobis damxmare saxelmZRvanelo
meore gamocema _ 2004.
gadaudebeli
kontraceptiuli abebi
samedicino momsaxurebis saxelmZRvanelo
meore gamocema _ 2004
Sinaarsi
winasityvaoba . 4
gadaudebeli kontraceptiuli momsaxureobis mokle aRwera . 5
1. Sesavali . 7
1.1 daxasiaTeba . 7
2. gadaudebeli kontracefciis abebi . 7
2.1 g.k.a-s moxmarebis reJimebi . 72.2 zemoqmedeba . 82.3 efeqturoba . 82.4 gverdiTi efeqtebi, prevencia da menejmenti . 92.5 ukuCvenebebi . 92.6 samedicino Semowmeba . 107.7 gansakuTrebuli 7.11 Tu momxmarebeli daorsulda . 127.12 regularuli kontracefciis dawyeba an, ganaxleba.
3. g.k.a-Ti momaragebis sistema . 13
1.2 qalebi, romlebmac sqesobrivi Zaladoba ganicades . 14 cxrili 1. g.k.a-s formulebi .
danarTi: Sida saSvilosno spiralis moxmareba gadaudebeli kontracepciisTvis . 16
SeniSvnebi 3
saerTaSoriso konsorciumi gadaudebeli kontracepciis Sesaxeb . 19
Sesavali
dak mayofilebisaTvis, mniSvne lo vani sa- meTodebs srulyofilad ver iyeneben, Semdeg. ikveTeba gadaudebeli kontracepciis gadaudebeli kontraceptiuli abebi an, moamarageben maT g.k.a-Ti, momxmareb- (g.k.a), mosaxmarad martivi da xelmisawv- domia. g.k.a-s SeZena TiTqmis yvela arasasurveli orsulobisagan daucveli dasaxlebul punqtSia SesaZlebeli. mas saSualebebis Sesaxeb. rekomendirebu-
lia adgilobrivi organizaciebisaT-
vis, rogorc aucilebeli saxelmZR-
vanelo saSualeba.
gadaudebeli kontraceptiuli
momsaxureobis mokle aRwera
zemoqmedeba
im qalebisaTvis, romlebmac hqondaT miRebis SemTxvevaSi, sakvercxeebidan dagvianeba xdeba. g.k.a agreTve aferxebs bulma gamokvlevebma gviCvenes, rom g.k.a daniSnuleba
efeqturoba
orsulobis prevencia daucveli an, ara-sakmarisad daculi sqesobrivi kavSiris sqesobrivi aqtis Semdeg g.k.a-s dauyovne- gverdiTi efeqtebi
sabamisad. sqesobrivi kavSiris Semdeg 5 tkivili, Tavbrusxveva, sarZeve jirkv-dRis (120sT-s) ganmavlobaSi orive reJimi xelmisawvdomia umravles dasaxlebul lisreva, da pirRebineba naklebad aRiniS-
adgilebSi. (ix. cxrili 1 an, www.cecinfo.org).
mxolod-levonorgestrelis reJims Semdeg, aReniSnebaT menstruaciis erTi efeqturia da naklebi gverdiTi efeqte-bi axasiaTebs.
gulisreva da pirRebinebis prevencia
• warsulSi momxdari, erTze meti,
daucveli sqesobrivi aqti: g.k.a mo-
ukuCveneba
• g.k.a-s ganmeorebiTi moxmareba: gk.a-s
bebis regularuli moxmareba orsu-lobisagan ufro efeqtur da xan- gamokvleva
• g.k.a-s moxmareba sqesobriv kavSir-
amde: abebis miRebis Semdeg, wamlis ze-
• daucveli sqesobrivi kavSiri arfer-
tilur periodSi: vinaidan ganayofi-
g.k.a. yoveli daucveli an, arasak-marisad daculi aqtis Semdeg.
gansakuTrebuli SemTxvevebi
• sxva abebis paraleluri moxmareba:
• ZuZuTi kveba: miuxedavad imisa, rom Zu-
Cvili gamoikvebos abebis miRebamde. abis • sxva formulebis moxmareba: Tu ki, aq
• sqesobrivi kavSiri 120 saaTis gasv-
lis Semdeg: g.k.a-s moxmareba SesaZle-
informacia momxmareblisaTvis
• g.k.a ar icavs momxmarebels Sidsis an, momxmareblisTvis aucilebeli
informacia:
k.a-s efeqturobaze, gverdiT efeqtebze, moqmedebis meqanizmze, sxva kontracep- • momxmarebelma abebi unda miiRos dauy- ovnebliv, sqesobrivi kavSiris Semdeg.
• Tu momxmarebeli ganicdis uwesrigo cipiT unda Cautardes.
moqmedebis gegma
nawilSi, igi unda daukavSirdes samedi-cino personals; dasaSvebia saSvilo- momxmarebelma g.k.a-s miRebis Semdeg, mizezi gaaCnia SeSfoTebisaTvis, mas samedicino momsaxureobisaTvis gadaudebeli
kontraceptiuli abebis saxelmZRvanelo
1. Sesavali
• kondomis dazianebis, Camosrialebis an, eSe da mis mier daugegmavad xdeba. daugeg- 1.1 daxasiaTeba
gadaudebeli kontraceptiuli abebi • rodesac 2 kviraze metiT dagvinebu- gorc “Semdgomi dilis” an, “koitusis Semdgom” abebad. umjobesia vixmaroT • kontraceptiulma hormonalurma ka- abebi”, radgan es saxelwodeba momxmareb- cavs: am abebiT mkurnalobas xangrZlivi mimdinareoba ar aqvs.
• diafragmis an, xufis adgilis Secvla, I reJimi - mxolod progestinis (le-
II reJimi - progestinis (levonoges-
1.2 daniSnuleba
• Sida saSvilosno spiralis gamovardna;• 2. gadaudebeli
2.2 zemoqmedeba
kontraceptiuli abebi
bas, g.k.a-sac, zemoqmedebis sxvadasxvana- 2.1 g.k.a-s moxmarebis reJimi
• mxolod-levonorgestrelis miRebis uli cikli; rodis moxda sqesobrivi kav- mis SemTxvevaSi), misi zemoqmedeba gamoix- reJimi: 100mkg eTinil estradioli ateba am ukanasknelis SeferxebiT an, ga-plus 0.50mg levonorgestreli, ro- SeniSvna: levonorgestrels, plus tritis histologiuri da bioqimiuri
lis Sesabamisad. adreuli monacemebi variantia dabrkolebis Seqmna spermis gvauwyeben, rom orive reJimi efeqturia sqesobrivi aqtis Semdeg 72 saaTis ganmav- turebuli klinikuri gamokvlevebiT. g.
Zlebelia efeqturobis im maRali donis miRweva, romelsac viRebT g.k.a-s mox- ma dagvanaxa, rom es saSualeba agrZelebs sqesobrivi aqtis 120 saaTis Semdeg aris, es preparati efeqturia mxolod awvdomia. produqts Tan erTvis g.k.a-s saSu- alebis moxmarebisaTvis saWiro instruqcia. g.k.a-s saSualebebi SeiZleba Sedgebodnen sx- ceptiuli abebisagan (ix. cxrili 1 an, www.
Jims mieniWeba upiratesoba, radgan igi ufro an, raime zians miayenebs ganviTarebad em- efeqturia kombinirebul reJimTan Se-darebiT. orsulobis SefardebiTi ricx- 2.3 efeqturoba
traceptiuli meTodebis efeqturobis binirebulTan SedarebiT. mrval-Sesafaseblad, gviCvenebs xangZlivi pe- mniSvneloba ar aqvs g.k.a-s moxmarebis vavebiT, zogierTi adreuli gamokvleva SemTxvevaSi, radgan es preparati ar gviCvenebs drois faqtoris zemoq-erTjeradi moxmarebisTvis aris gankuT- ba g.k.a-s moxmarebas sqesobrivi kavSiri- li wiladi” (“prevented fraction”), rac war- moadgens mosalodneli orsulobis da vimsjelebT am periodSi preparatis mox-acilebuli orsulobis Tanafardobas. marebis efeqturobaze. adgili SeiZleba hqondes uzustobas, g.
domi saSualebaa daucveli sqesobrivi tiuli saSualebebis statistikas, magram kuTrebiT levonorgestrelis reJimis) moxmarebis SemTxvevaSi, orsulobis levam gvaCvena, rom levongestrelis sxv moxmarebis SemTxvevaSi. garda amisa, moxmarebis dros, orsulobis Tavidan g.k.a-s Zalian xSiri moxmareba gamoiwvevs ulma rva gamokvlevam cxadyo, rom g.k.a-s 2.4 gverdiTi efeqtebi, prevencia
da menejmenti
gulisreva da pirRebineba
lisrevis SegrZneba an, pirRebibeba da an, romel qals uSvelis antiemetikuri sa- Tavs iCens qalebis 18 %-Si, piirRebineba vevaSi ki, gulisrevas adgili aqvs 43 %-sa da pirRebinebas 16 %_Si. SedarebiTma menejmenti
gamokvlevam gviCvena, rom mxolod_levenorgestrelis reJimi nakleb gu- ganmeorebiT unda iqnes miRebuli. Zl-ieri perRebinebis SemTxvevaSi ki, g.k.a prevencia
olod_levonorgestrelis rejimis moxmareba. menstruaciuli ciklis dagvianeba
profilaqtikis mizniT, antiemetikuri wodoT, rom g.k.a-s preparatis miReba ar saSualebebis daniSvnas, Cveulebriv iwvevs dauyovnebliv menstruaciuli safuZveli ar aqvs. maSin rodesac kom- tikuri saSualebebis daniSvna xSirad kviriT igvianebs an, erTi kviriT adre saWiro xdeba. menejmenti
abis miRebamde davlevT meklizinis(50m.
g) erT abs, gulisreva mcirdeba 30%--iT, cia erTi kviris dagvianebiTac ar movida, uwesrigo vaginaluri gamonadeni
Jimis dawyebamde, erTi saaTiT adre miRe-bulma 100mg. metoqsopromidmac SeiZle- vadasxva gamokvlevebSi, am gverdiTi saSualeba, orsulobis prevenciis Sede-efeqtis procentuli Sefardebis ricxvi mniSvnelovnad gansxvavdeba. qalebis 0 %-dan 17 %-mde, ganicdis ara–menstru- 2.5 ukuCvenebebi
Semdgom pirveli kviris ganmavlobaSi.
vnea janmrTelobisaTvis. miuxedavad amisa, preparats yuTSi Tan erTvis uku- menejmenti
odis simciris gamo, es ukuCvenebebi g.k.a- uwesrigo sisxldena ufro seriozul nos gare orsuloba, SeuZliaT gamoiye-mizezTan aris dakavSirebuli, kerZod, sisxldenas daerTo saSvilosnos gare daudasturdaT, es preparati ar daeniS-orsulobisaTvis damaxasiaTebeli sxva nebaT. magram im SemTxvevaSi, Tu orsu-simptomebi, (rogoricaa muclis qveda loba mxolod, eWvis qveS aris, g,k,a-s dan-nawilis tkivili), pacientma Sesabamisi iSvna SesaZlebelia, radgan viciT, rom es preparati arsebul orsulobas zians ar miayenebs. aris SemTxvevebi, rodesac g.k.a-s sxva gverdiTi efeqtebi
qali orsuladaa, magram man es ar icis. am gverdiTi efeqtebia: muclis tkivili, araa. ZuZus mgrZnobeloba, Tavis tkivili, Tav- 2.6 samedicino Semowmeba
brusxveva da gulisreva. es gverdiTi ze-mocmedeba. Tavs iCens mkurnalobis ra- brovi kavSiri da radgan cnobilia, rom g.k.a usafrTxoa momxmareblisaTvis, sa- menejmenti
ara g.k.a-s daniSvna (mag. qali ukve orsu- beli kontraceptiuli saSualebebi ufro mizanSewonilia (mag. saSvilosnos zegavlena orsulobaze
alebebze Catarebulma gamokvlelebma li kvalifikaciis mqone specialistma.
gviCvenes, rom, g.k.a-s adreul orsulo- Svilosnos Semowmeba), saWiro ar aris, ma-gram aucileblobis SemTxvevaSi an, qalis Si, Tu qals menstruaciuli cikli vSiri hqonda, garda im SemTxvevisa, rode-daugvianda. samedicino procedurebis sac orsuloba ukve dadasturebulia. Catarebis gamo, g.k.a-s miReba ar unda Sew- rom g.k.a-s efeqturoba klebulobs sqe-sobriv aqtsa da preparatis moxmarebas 2.7 gansakuTrebuli sakiTxebi
Soris intervalis gazrdasTan erTad. qa-lebi unda davarwmunoT, dauyovnebliv meZuZuri qali
dan gamomdinare ar saWiroeben g.k.a-s. ma- g.k.a-s sistematiuri moxmareba
Semdeg menstruaciuli cikli aRudga, orsulobis riskis winaSe dgas.
saTvis, magram msgavsi reJimebis da oral- gamokvebos da Semdegi eqvsi saaTis ganma- keTebis aucileblobas ar adastureben.
g.k.a-s moxmareba koitusis aqtis 120
g.k.a-s, gansakuTrebiT ki maT, vinc es sa- saaTis gasvlis Semdeg
sqesobrivi kavSiris damyarebis 120 vawodoT informacia sxva kontracepti- saaTis Semdeg, g.k.a-s xmarebis Sesaxeb mo- fro efeqturi iqneba, qalma Caidgas rebiTi moxmareba namdvilad mizanSewo-spilenZis saSvilosnos Sida spirali (ix. g.k.a-s moxmareba sqesobrivi aqtis win
g.k.a_s moxmareba, erTze meti
daucveli sqesobrivi aqtis SemTxvevaSi.
g.k.a misi miRebis Semdeg, ar moipoveba. savaraudod, misi sqesobrivi aqtis win miReba iseve efeqturia, rogorc aqtis saSualebis daniSnulebiT, levonorg-estrelis magivrad SesaZlebelia vixma- g.k.a-s gamoyeneba arafertilur
periodSi
2.8 informacia mxmareblisaTvis
brivi aqtis Sedegad, xorcieldeba ovu-laciis wina da Semdgom periodSi (xuTi - g.k.a-s moxmareba saWiro ar aris. magram, lis miRebis Semdegi ori saaTis ganmav-lobaSi, damatebiTi dozis miReba wamlebis urTierTmoqmedeba
• g.k.a-s miRebis Semdeg, momxmarebels moipoveba. savaraudoa, rom g.k.a iseve mo- • g.k.a ar aris xangrZlivi, sistematiuri • g.ka. ar icavs Sidsisgan an, sxva sqeso- sxva ganmartebebi
nebze da misi moqmedebis meqanizmze, aramed sxva kontraceptiul saSualebebsa da sqe- wodoT, ramdenis aTvisebac mas SeuZlia.
bze, an g.k.a-s moqmedebis meqanizmze), ma- sultaciis Catareba ganmartoebiT Seu-Zlebelia (mag. afTiaqebSi), momxmarebels 2.9 rCeva-darigeba
2.10 Tanamimdevroba
qali, (romelsac esaWiroeba g.k.a,) Sei-Zleba nerviulobdes da SeSfoTebuli uSedego xmarebis gamo dabneuloba, sa, rodesac momxmarebeli raime proble-gaupatiurebis Sedegad miRebuli trav- bruli damokidebuleba konsultaciis • aqvs tkivili muclis qveda areSi an dros, xels uwyobs qalis mier infomaci- • saWiroebs sxva saxis momsaxureobas an struqcia exmareba iseT momxmarebels, romlis ganaTlebis donec dabalia. 2.11 Tu momxmarebeli daorsulda
momxmareblma, g.k.a-s miRebis Semdeg Sei- magaliTad, konsultantma SeiZleba Zleba aRmoaCinos rom orsuladaa. es ikiTxos, Tu ra icis man g.k.a-s Sesaxeb an, mizezebia: g.k.a-m ar imoqmeda; igi orsu- miRebis Semdgomma koitalurma aqtma g.k.a-s moxmarebis Semdeg
gamoiwvia misi daorsuleba. romelime am
kontraceptiuli saSualebebis
moxmarebis ganaxleba, an,
Tavidan dawyeba
• kacis an, qalis kondomi- gamoiyeneba
yvitos romlis gamoyenebaa mis mdgo-mareobaSi yvelaze marTebuli. pativi saSvilosnos yelSi mosaTavsebeli
meqanikuri saSualebebi (diaphragm or
• kontraceptiuli qafi, abebi, Jele,
kremi an safeni - gamoiyeneba sqeso-
• oraluri kontraceptiuli abebi,
hormonaluri kontraceptiuli
2.12 g.k.a-s miRebis Semdeg regu-
safeni an vaginaluri rkali - ori
laruli kontraceptiuli
a. momxmarebels SeuZlia am meTodis
gamoyeneba g.k.a-s miRebis dRidanve. Tu
vas adre dawyebuli kontraceptiuli igi adre xmarobda mocemul saSualebebs, meTodis ganaxlebisa an, axlis dawyebisa. (mag. g.k.a daeniSna, imitom, rom man gamo- tova abis miReba, safenma an rkalma adgi- wyeba), gaarCieT momxmarebelTan es gavaxsenoT, rom safeni, rkali an abebi mizezi da momavlisaTvis dasaxeT amis efeqturobas kargaven vargisianobis va- b. momxmarebelma unda daucados
menstruaciuli ciklis mowesrigebas,
da Semdeg daiwyos meTodi, misi mox-
an, pirebs mWidrod dasaxlebuli marebis standartuli wesis Sesabamis-
ad. am SemTxvevaSi, man menstruaciis
baT konsultacia, Tu rogor daicvan mowesrigebamde meqanikuri kontracep-Tavi ara marto arasasurveli orsulo- ineqciebi
Catarebamde qalma Tavi unda Seikavos sqe- mi Svidi dRis ganmavlobaSi unda daiwyos. manamde, Tavi unda Seikavos sqesobrivi 3. g.k.a-Ti momaragebis
sistemebi
ukve aRiniSna, rom g.k.a im SemTxvevaSia implantantebi
wodoT am preparatis Sesaxeb manam, sanam Si. sanam momxmarebeli implantantebs misi moxmarebis saWiroeba Seeqmneba. amas Caidgams, Tavi unda Seikavos sqesobrivi Sida-saSvilosno spirali
SeniSvna: im SemTxvevaSi Tu momxmareb-
mavlobaSi gamoiyenos S.s.s. da amisaTvis SevitanoT informacia g.k.a-s Sesaxeb.
sainformacio saSualebebiT. gansakuTrebiT mniSvnelovania, in- ojaxis dagegmvis bunebrivi meTodebi
formacia droulad mivawodoT: mozard-ebs, romlebic jer sqesobrivad aqtiure- dagegmva SesaZlebelia daviwyoT g.k.a-s arasworad iyeneben kontraceptiul sa- lyofili iyos g.k.a-Ti, dauyovnebliv, saWiroebis warmoSobis SemTxvevaSi. qalis an, kacis sterilizacia
g.k.a_s moxmarebis wesi martivia, imisaT- bis Semdeg. qalma es gadawyvetileba stre- • winaswar movamaragoT qali g.k.a-Ti an, • Tu es nebadarTulia adgilobrivi kanon- kis muSaobis saaTebi;
• sanam momxmarebeli mimarTavs special- • davarigoT g.k.a arasamedicino dawese- ulebebi, skolebi, socialuri samar-ketinge seqtoris da komerciuli seq- 3.2 qalebi, romlebmac seqsualuri
Zaladoba ganicades
ba ganicades. g.k.a-s mommarageblebma yu- • am qalebma SesaZlebelia ar ician, rom va -darigebebis miwodeba. da kidev, radgan unda uzrunvelyon g.k.a-s maragiT is dawese- 3.1 axalgazrdebi
bulebebi, sadac dazaralebulma qalma Sesa- wrafo daxmarebis ganyofilebebi da sxv.
cxrili 1 g.k.a-s formulebi
dasaxeleba
(TiTo abi)
levonorgestrelis
reJimi
imediat n, levonel- 2 abi erT 2, norlevo, plan-b, miRebaze 12sT. post-dei, kombinirebuli
imediati, neoginoni, nordioli, ogestreli, ovrali, ovrani, preveni, tetraginoni lo/femenali, lo/ovrali, lou-ogestreli, mikroginoni 30, nordette, rigevidoni Semoklebebis ganmarteba:
ee _ eTil estradioli ng _ norgestreli lng _ levonorgestreli
rodesac iyenebT oralur kontracefciul abebs, romlis firfitazec 28 abia, anu, bolo Svidi abi ar unda iyos gamoyenebuli. abebis miReba yvela reJimis SemTxvevaSi sqesobrivi kavSiris Semdeg dauyovnebliv unda daviwyoT. abebis miRebis dawyebis optimaluri vada 120 sT-ia sqesobrivi kavSiris Semdeg. cxrilis Sedgenis dro: 2008 w-s oqtomberi. axali cxrili SeiZleba moviZioT veb gverdze: www.cecinfo.org.
danarTi: Sida saSvilosno spiralis moxmareba
xangrZlivi periodis ganmavlobaSi da sqesobrivi infeqciebis didi riski gaaC-romlebic Sss-s gamoyenebisaTvis aucile- nia. am SemTxvevaSi Sss ar warmoadgens op- bel regularul gamokvlevebs itareben.
moxmarebis Sesaxeb mimarTeT IPPF Medical and Service Delivary Guidelines. yvelaze Ta- melic orsulobis risks 99%-iT amcirebs.
namedrove informacia g.k.a-s Sesaxeb Sei- Zleba movipovoT IPPF,Regant’s Collage, Inner Circle, Regent”s Park, London NWI 4NS, REFERENCES
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gadaudebeli kontracepciis saerTaSoriso
konsorciumis Sesaxeb
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gaavrcelos gadaudebeli kontracepti- uli saSualebebi da mTel msoflioSi kavSirdnen gadaudebeli kontracefciis qveynis lokaluri pirobebis Sesabamis- E-mail: [email protected]
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• afrika: EC Afrique. Website: www.ec-af-
rique.org; E-mail: ec-afrique@pcnnairo-
konsorciumis miznebia:
bi.org; Mail: Ecafrique secretariat, Popula-
tion Council, PO Box 17643, 00500 Nairobi,
orciumi (LACEC). Web site:www.clae.
info; E-mail: [email protected]; Mail:
Instituto Chileno de Medicina Reprodactiva (ICMER), Jose Victorino Lastarria 26, Dep- cific Network on Emergency Contraception (APNEC). Web site: N?A; E-mail: equintil- ris, romlebic muSaoben kontracepti-uli saSualebebis Sesaxeb codnis gaR- mail: Pacific Institute for Women’s Health, 3450 • imisaTvis, rom saxalxo seqtoris orga- Wilshire Boulevard, Suite 1000, Los Angeles, • arabeTis regioni: arabregion@cecinfo.

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