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A 10 year asthma programme in Finland: major change for the better.

https://arctichealth.org/en/permalink/ahliterature168103
Source
Thorax. 2006 Aug;61(8):663-70
Publication Type
Article
Date
Aug-2006
Author
T. Haahtela
L E Tuomisto
A. Pietinalho
T. Klaukka
M. Erhola
M. Kaila
M M Nieminen
E. Kontula
L A Laitinen
Author Affiliation
Skin and Allergy Hospital, Helsinki University Central Hospital, P O Box 160, FIN-00029 HUS, Finland. tari.haahtela@hus.fi
Source
Thorax. 2006 Aug;61(8):663-70
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - economics - epidemiology - therapy
Child
Communication
Cost of Illness
Disabled Persons
Emergency Treatment - statistics & numerical data
Finland - epidemiology
Health Promotion - economics - organization & administration - trends
Hospitalization - statistics & numerical data
Humans
Incidence
Insurance, Disability - economics
Interprofessional Relations
National Health Programs - economics - trends
Pharmaceutical Services - standards
Primary Health Care
Program Evaluation
Smoking - epidemiology
Abstract
A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.
The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched.
The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro).
It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.
Notes
Cites: Eur Respir J. 1999 Aug;14(2):288-9410515403
Cites: BMJ. 1996 Mar 23;312(7033):762-68605467
Cites: Allergy. 2005 Mar;60(3):283-9215679712
Cites: N Engl J Med. 2005 Apr 14;352(15):1519-2815829533
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Cites: Thorax. 2001 Oct;56(10):806-1411562522
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Cites: Eur Respir J. 2002 Aug;20(2):397-40212212973
Cites: Thorax. 2003 Feb;58 Suppl 1:i1-9412653493
Cites: Int J Tuberc Lung Dis. 2003 Jun;7(6):592-812797704
Cites: J Allergy Clin Immunol. 2004 Jul;114(1):40-715241342
Cites: Scand J Public Health. 2004;32(4):310-615370772
Cites: Am Rev Respir Dis. 1985 Apr;131(4):599-6063994155
Cites: N Engl J Med. 1991 Aug 8;325(6):388-922062329
Cites: N Engl J Med. 1994 Sep 15;331(11):700-58058076
Cites: Qual Health Care. 1994 Mar;3(1):45-5210136260
Cites: BMJ. 1996 Mar 23;312(7033):748-528605463
Cites: Eur Respir J. 2004 Nov;24(5):734-915516665
PubMed ID
16877690 View in PubMed
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Association study of 15 novel single-nucleotide polymorphisms of the T-bet locus among Finnish asthma families.

https://arctichealth.org/en/permalink/ahliterature179237
Source
Clin Exp Allergy. 2004 Jul;34(7):1049-55
Publication Type
Article
Date
Jul-2004
Author
E. Ylikoski
R. Kinos
N. Sirkkanen
M. Pykäläinen
J. Savolainen
L A Laitinen
J. Kere
T. Laitinen
R. Lahesmaa
Author Affiliation
Centre for Biotechnology, University of Turku and Abo Akademi University, Finland. emmi.ylikoski@btk.utu.fi
Source
Clin Exp Allergy. 2004 Jul;34(7):1049-55
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Asthma - genetics - immunology
Chi-Square Distribution
Female
Finland
Humans
Immunoglobulin E - blood
Linkage Disequilibrium
Male
Polymorphism, Single Nucleotide
T-Box Domain Proteins
Transcription Factors - genetics - immunology
Abstract
T-box expressed in T cells (T-bet) is a transcription factor regulating the commitment of T helper (Th) cells by driving the cells into the Th1 direction. Abnormal Th1/Th2 balance may lead to complex disorders like asthma or autoimmune diseases. Recent studies have suggested that T-bet might be a candidate gene for asthma. This led us to screen 23 Finnish individuals for single-nucleotide polymorphisms (SNPs) in the T-bet locus and study the association between the SNPs and high serum IgE level and asthma.
We screened all six exons, adjacent intronic areas and 2 kb of the 5'-flanking region from 23 individuals utilizing WAVE trade mark technology. To explore whether T-bet is associated in serum IgE regulation or asthma we genotyped the SNPs in a Finnish asthmatic founder population. The association analyses were made using haplotype pattern mining.
Fifteen novel SNPs were found in the T-bet gene. Within the Finnish asthmatic founder population, there was no association between T-bet SNPs and high serum IgE level or asthma.
The genetic variability in the T-bet gene does not play a role in the pathogenesis of human asthma. Our results provide a novel panel of SNPs in T-bet and will help determine whether the SNPs have a functional role in other T cell-mediated diseases.
PubMed ID
15248849 View in PubMed
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Association study of the chromosomal region containing the FCER2 gene suggests it has a regulatory role in atopic disorders.

https://arctichealth.org/en/permalink/ahliterature199219
Source
Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):700-6
Publication Type
Article
Date
Mar-2000
Author
T. Laitinen
V. Ollikainen
C. Lázaro
P. Kauppi
R. de Cid
J M Antó
X. Estivill
H. Lokki
H. Mannila
L A Laitinen
J. Kere
Author Affiliation
Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland. tarja.laitinen@helsinki.fi
Source
Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):700-6
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alleles
Asthma - genetics - immunology
Chromosome Mapping
Chromosomes, Human, Pair 19
Cross-Cultural Comparison
Female
Finland
Genes, Regulator - genetics
Genetic Markers - genetics
Genetics, Population
Haplotypes
Humans
Male
Middle Aged
Phenotype
Polymerase Chain Reaction
Polymorphism, Genetic - genetics
Receptors, IgE - genetics
Respiratory Hypersensitivity - genetics - immunology
Spain
Abstract
On the basis of studies with animal models, the gene for the low-affinity receptor for immunoglobulin E (IgE) (FCER2, CD23) has been implicated as a candidate for IgE-mediated allergic diseases and bronchial hyperreactivity, or related traits. Given evidence for genetic complexity in atopic disorders, we sought to study two European subpopulations, Finnish and Catalonian. We studied three phenotypic markers: (1) total serum IgE level; (2) asthma; and (3) specific IgE level for a mixture of the most common aeroallergens in Finland. Altogether, eight polymorphic markers spanning a region of 10 cM around the FCER2 gene on chromosome 19p13 were analyzed in 124 families. The physical order of the markers and the location of the FCER2 gene were confirmed by using radiation hybrids. The allele and haplotype association study showed a suggestive haplotype association (significance of p
PubMed ID
10712310 View in PubMed
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Asthma programme in Finland: a community problem needs community solutions.

https://arctichealth.org/en/permalink/ahliterature193225
Source
Thorax. 2001 Oct;56(10):806-14
Publication Type
Article
Date
Oct-2001
Author
T. Haahtela
T. Klaukka
K. Koskela
M. Erhola
L A Laitinen
Author Affiliation
Division of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, 00029 HUS, Finland. tari.haahtela@hus.fi
Source
Thorax. 2001 Oct;56(10):806-14
Date
Oct-2001
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Agonists - economics - therapeutic use
Anti-Inflammatory Agents - economics - therapeutic use
Asthma - drug therapy - economics
Drug Costs
Finland
Humans
Morbidity
Patient Education as Topic
Program Evaluation
Public Health Administration
Smoking - adverse effects - trends
Steroids
Notes
Cites: Eur Respir J. 2000 Feb;15(2):235-710706483
Cites: Am J Respir Crit Care Med. 2000 May;161(5):1720-4510806180
Cites: Allergy. 2000 May;55(5):505-910843434
Cites: Respir Med. 2000 Apr;94(4):299-32710845429
Cites: CMAJ. 1999 Nov 30;161(11 Suppl):S1-6110906907
Cites: BMJ. 2000 Dec 16;321(7275):1482-311118160
Cites: J Clin Epidemiol. 2000 Dec;53(12):1217-2111146267
Cites: Eur J Clin Pharmacol. 2000 Nov;56(8):591-611151750
Cites: Eur Respir J. 2000 Nov;16(5):802-711153575
Cites: Eur Respir J. 2000 Nov;16(5):824-3011153578
Cites: Lancet. 2001 Apr 7;357(9262):1076-911297958
Cites: Nat Genet. 2001 May;28(1):87-9111326283
Cites: Duodecim. 2000;116(22):2568-8412053356
Cites: Am Rev Respir Dis. 1985 Apr;131(4):599-6063994155
Cites: BMJ. 1990 Aug 4;301(6746):266-82390620
Cites: N Engl J Med. 1991 Aug 8;325(6):388-922062329
Cites: J Allergy Clin Immunol. 1992 Jul;90(1):32-421629507
Cites: N Engl J Med. 1994 Sep 15;331(11):700-58058076
Cites: Qual Health Care. 1994 Mar;3(1):45-5210136260
Cites: BMJ. 1996 Mar 23;312(7033):748-528605463
Cites: Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):308-178756799
Cites: J Investig Allergol Clin Immunol. 1997 Sep-Oct;7(5):369-709416551
Cites: BMJ. 1998 Apr 11;316(7138):1138-99552954
Cites: Patient Educ Couns. 1999 Jan;36(1):13-2110036556
Comment In: Thorax. 2001 Oct;56(10):744-511562510
PubMed ID
11562522 View in PubMed
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Chronic bronchitis and chronic obstructive pulmonary disease: Finnish National Guidelines for Prevention and Treatment 1998-2007.

https://arctichealth.org/en/permalink/ahliterature201038
Source
Respir Med. 1999 May;93(5):297-332
Publication Type
Article
Date
May-1999
Author
L A Laitinen
K. Koskela
Author Affiliation
Helsinki University Central Hospital, Finland.
Source
Respir Med. 1999 May;93(5):297-332
Date
May-1999
Language
English
Publication Type
Article
Keywords
Bronchitis - diagnosis - prevention & control - therapy
Chronic Disease
Female
Finland
Humans
Lung Diseases, Obstructive - diagnosis - prevention & control - therapy
Male
Abstract
1. A national recommendation for the promotion of prevention, treatment and rehabilitation in relation to chronic bronchitis and COPD from 1998 to 2007 has been prepared on the basis of extensive collaboration by order of the Ministry of Social Affairs and Health. The Programme needs to be revised as necessary, because of rapid developments in medical knowledge, and in drug therapy in particular. 2. COPD is a disease characterized by slowly progressing, irreversible airways obstruction. Over 5% of the population suffer from symptomatic forms of the disease. It is estimated that a further 5% of the population may suffer from latent COPD. Most patients (75%) suffer from mild forms of the disease. The disease is often preceded by chronic bronchitis. A total of 400,000 Finns suffer from chronic bronchitis or COPD. Occurrence of these diseases in future will be particularly affected by decreased smoking by men, increased smoking by the young and by women, and aging of the population. 3. In 1997, the annual treatment costs of chronic bronchitis and COPD were estimated to be FIM 1.5 thousand million, total costs FIM 5 thousand million. Without intensification of measures to prevent and treat the diseases, costs will rise significantly. Costs arising from severe COPD (5% of patients with COPD) account for roughly 65% of costs overall and are primarily related to hospitalizations. 4. The goals of the Programme for the Prevention and Treatment of Chronic Bronchitis and COPD are as follows: (a) to decrease the incidence of chronic bronchitis; (b) to ensure that as many patients as possible with chronic bronchitis recover; (c) to maintain capacity for work and functional capacity of patients with COPD; (d) to reduce the percentage of patients with moderate to severe COPD; (e) to decrease the number of hospitalization days of COPD patients by 25% overall; and (f) to decrease annual costs per patient. 5. The following means are suggested for achieving the goals: (a) reduction in smoking; (b) reduction in work-related and outdoor air pollutants and improvement of quality of indoor air; (c) enhancement of knowledge about risk factors and treatment of the diseases is in key groups; (d) promotion of early diagnosis and active treatment, in smokers in particular; (e) improvement of guided self-care; (f) early commencement of rehabilitation, individual planning and implementation, primarily as an element in treatment; and (g) encouragement of scientific research. 6. COPD and exacerbation of its symptoms can be prevented through choices relating to life habits, such as not smoking, maintaining good general condition, and protection against exposure to dusts. The Programme gives examples of such measures and appeals to various authorities and voluntary organizations to increase their cooperation. Preventive methods should be individualized, and based on due consideration. 7. Chronic bronchitis and COPD should be diagnosed at early stages, and treated appropriately from the outset. Treatment consists of: (a) treatment according to causes, such as stopping smoking and work hygiene; (b) early rehabilitation such as patient education and guided self-care: (c) drug therapy; (d) hospital treatment; and (e) rehabilitation. 8. The hierarchy of referrals in the treatment of COPD should be revised to accord a greater role to the primary health care sector. Good exchanges of information and cooperation between the primary health care and specialized medical care sectors will all be necessary if this hierarchial model is to have the desired effect. 9. Hospital districts and health centres should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. One specialist in each hospital district should be given charge of prevention and assembly of know-how relating to treatment, and of quality of treatment at regional level. (ABSTRACT TRUNCATED)
PubMed ID
10464898 View in PubMed
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Chronic bronchitis and chronic obstructive pulmonary disease. The Finnish Action Programme, interim report.

https://arctichealth.org/en/permalink/ahliterature164715
Source
Respir Med. 2007 Jul;101(7):1419-25
Publication Type
Article
Date
Jul-2007
Author
A. Pietinalho
V L Kinnula
A R A Sovijärvi
S. Vilkman
O. Säynäjäkangas
K. Liippo
E. Kontula
L A Laitinen
Author Affiliation
Filha (Finnish Lung Health Association), Sibeliuksenkatu 11 A 1, FI-00250 Helsinki, Finland. anne.pietinalho@filha.fi
Source
Respir Med. 2007 Jul;101(7):1419-25
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Bronchitis, Chronic - diagnosis - epidemiology - therapy
Delivery of Health Care, Integrated - organization & administration
Early Diagnosis
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Male
Prevalence
Program Evaluation
Pulmonary Disease, Chronic Obstructive - diagnosis - epidemiology - therapy
Smoking - epidemiology - therapy
Spirometry - standards
Tobacco Smoke Pollution - statistics & numerical data
Abstract
The Finnish National Prevention and Treatment Programme for Chronic Bronchitis and COPD, launched in 1998, has, to date, been running for 6 years (2003). The goals of this action programme were to reduce the incidence of COPD and the number of moderate and severe cases of the disease, and to reduce both the number of days of hospitalisation and treatment costs. A prevalent implementation of over 250 information and training events started. Health centres and pharmacies appointed a person in charge of COPD patients. In order to improve the cooperation between primary and specialised care, two thirds of hospital districts created local COPD treatment chains. The early diagnosis of COPD by spirometric examination was activated during the programme. Number of health centres with available spirometric services increased to 95%. Before the start of the programme, approximately 5-9% of the adult population had COPD. During the whole programme, the proportion of male and female smokers decreased from 30% to 26% and from 20% to 19%, respectively. The total number of hospitalisation periods and days due to COPD decreased by 15% and 18%, respectively. Both the number of pensioners and daily sickness days due to COPD also decreased by 18%. Registered COPD induced deaths remained at their previous levels during the monitoring period, i.e. around 1000 deaths out of 5.2 millions annually. The measures recommended by the programme have been widely introduced but they need to be still more effective.
PubMed ID
17353122 View in PubMed
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Comparison of ipratropium bromide and salbutamol in a long-term trial in asthmatic and bronchitic patients in a cold climate.

https://arctichealth.org/en/permalink/ahliterature13092
Source
Scand J Respir Dis Suppl. 1979;103:163-9
Publication Type
Article
Date
1979

A controlled study on the effect of treatment with cromolyn sodium pressurized aerosol on bronchial reactivity in patients with asthma.

https://arctichealth.org/en/permalink/ahliterature16195
Source
Ann Allergy. 1986 Mar;56(3):270-3
Publication Type
Article
Date
Mar-1986
Author
L A Laitinen
K. Venho
H. Poppius
Source
Ann Allergy. 1986 Mar;56(3):270-3
Date
Mar-1986
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aerosols
Asthma - physiopathology
Bronchi - drug effects
Child
Child, Preschool
Climate
Clinical Trials
Cold
Cromolyn Sodium - administration & dosage
Female
Histamine - pharmacology
Humans
Male
Middle Aged
Skin Tests
Abstract
The effect of cromolyn sodium (CS) pressurized aerosol on bronchial hyperreactivity was assessed by comparison with placebo in a double-blind crossover study of 14 adult patients with clinically stable asthma. The trial was performed in a cold climate during the pollen-free winter months and the patient's risk of exposure to clinically relevant allergens was judged to be low. The dose was two puffs, each of 1 mg CS or placebo, four times daily over two successive 4-week periods, the order of treatment being decided by random allocation. No significant difference between treatments was observed in bronchial reactivity to histamine, determined as PC15. There was no difference between treatments with regard to symptoms, which were slight, or daily peak expiratory flow recordings, which showed minimal circadian variation. The results suggest that, although prolonged treatment with CS may decrease bronchial reactivity by reducing airway inflammation secondary to the assault of allergic stimuli, the drug probably has little or no effect on the basal bronchial reactivity in asthma.
PubMed ID
3082257 View in PubMed
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Does non-responder bias have a significant effect on the results in a postal questionnaire study?

https://arctichealth.org/en/permalink/ahliterature189639
Source
Eur J Epidemiol. 2001;17(9):809-17
Publication Type
Article
Date
2001
Author
J T Kotaniemi
J. Hassi
M. Kataja
E. Jönsson
L A Laitinen
A R Sovijärvi
B. Lundbäck
Author Affiliation
Department of Pulmonary Medicine, Päijät-Häme Central Hospital, Lahti, Finland. jyrki.kotaniemi@phks.fi
Source
Eur J Epidemiol. 2001;17(9):809-17
Date
2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bias (epidemiology)
Chi-Square Distribution
Epidemiologic Methods
Female
Finland - epidemiology
Humans
Logistic Models
Male
Middle Aged
Postal Service
Prevalence
Questionnaires
Respiratory Tract Diseases - epidemiology
Risk factors
Abstract
In epidemiological questionnaire studies results can be influenced by non-responder bias. However, in respiratory epidemiology this has been analysed in very few recently published papers. The aim of our paper is to assess if the results found in our previous postal questionnaire study in an adult population in Northern Finland were biased by non-response.
A random sample of 385 persons from the 1,284 non-responders in a previous postal questionnaire study was examined. The same questionnaire as in the original study was again mailed to these persons, and those still not answering were contacted by phone.
Totally 183 complete answers (48%) were collected. Lack of interest (56%) and forgetting to mail the response letter (22%) were the most common reasons to non-response. Typical non-responders were young men and current smokers who less frequently reported respiratory symptoms in exercise and asthma than the responders in the original study. Answers collected by phone gave for some questions higher prevalence rates than postal answers.
Firstly, in this population the response rate (83.6%) in the original study was high enough to provide reliable results for respiratory symptoms and diseases, only the prevalence of current smoking was biased by non-response. Secondly, the methods used for collecting responses in a non-response study may influence the results.
PubMed ID
12081098 View in PubMed
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Genetic control of serum IgE levels and asthma: linkage and linkage disequilibrium studies in an isolated population.

https://arctichealth.org/en/permalink/ahliterature207467
Source
Hum Mol Genet. 1997 Nov;6(12):2069-76
Publication Type
Article
Date
Nov-1997
Author
T. Laitinen
P. Kauppi
J. Ignatius
T. Ruotsalainen
M J Daly
H. Kääriäinen
L. Kruglyak
H. Laitinen
A. de la Chapelle
E S Lander
L A Laitinen
J. Kere
Author Affiliation
Department of Medical Genetics, Haartman Institute, Haartmaninkatu 3, 00014 University of Helsinki, Helsinki, Finland.
Source
Hum Mol Genet. 1997 Nov;6(12):2069-76
Date
Nov-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Asthma - blood - genetics
Chromosome Mapping
Female
Finland
Genetic Linkage
Haplotypes
Humans
Immunoglobulin E - blood - genetics
Interleukin-9 - genetics
Linkage Disequilibrium
Male
Middle Aged
Pedigree
Selection Bias
Abstract
Immunoglobulin E (IgE) concentration in serum is elevated in atopic diseases such as asthma. A large genomic region on chromosome 5 has previously been implicated in the control of IgE levels and bronchial hyperreactivity and may, therefore, harbor genes predisposing to asthma. In an effort to confirm this linkage and to delimit the critical region, we took advantage of an isolated founder subpopulation in Finland to study genetic linkage and haplotype associations. Sixteen polymorphic markers, including the Interleukin-4 and -9 genes (IL4, IL9), were physically ordered and genotyped in 157 nuclear families. Genetic linkage studies involving sib- and cousin-pair analyses found no evidence of genetic linkage between markers in 5q and either serum IgE levels or asthma. Haplotype association studies were also performed. Although initial inspection suggested the possibility of linkage disequilibrium in the region of IL9, we developed a rigorous permutation test for assessing association and determined that the association was no greater than would be expected by chance. Sequence analysis of the IL9 gene in three patients sharing a possibly conserved haplotype revealed a T113M coding polymorphism, but this variant showed no association with either serum IgE levels or asthma. We conclude that allelic variation at chromosome 5q31 is not likely to contribute to inheritance of serum IgE levels or the development of asthma in this Finnish subpopulation.
PubMed ID
9328470 View in PubMed
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30 records – page 1 of 3.