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Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study.

https://arctichealth.org/en/permalink/ahliterature287527
Source
Respir Res. 2016 Nov 15;17(1):152
Publication Type
Article
Date
Nov-15-2016
Author
Stefan Franzén
Christer Janson
Kjell Larsson
Max Petzold
Urban Olsson
Gunnar Magnusson
Gunilla Telg
Gene Colice
Gunnar Johansson
Mats Sundgren
Source
Respir Res. 2016 Nov 15;17(1):152
Date
Nov-15-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - drug therapy - physiopathology
Data Mining
Electronic Health Records
Feasibility Studies
Female
Health Services Research
Hospitals, University
Humans
Logistic Models
Male
Middle Aged
Primary Health Care
Propensity Score
Randomized Controlled Trials as Topic
Registries
Retrospective Studies
Severity of Illness Index
Sweden
Time Factors
Treatment Outcome
Abstract
In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma.
EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates.
We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N?=?151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m2 versus 27.3 kg/m2; and consisted of 40% versus 34% males.
The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.
Notes
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PubMed ID
27842551 View in PubMed
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Redemption of asthma pharmaceuticals among stainless steel and mild steel welders: a nationwide follow-up study.

https://arctichealth.org/en/permalink/ahliterature272123
Source
Int Arch Occup Environ Health. 2015 Aug;88(6):743-50
Publication Type
Article
Date
Aug-2015
Author
Pernille Kristiansen
Kristian Tore Jørgensen
Johnni Hansen
Jens Peter Bonde
Source
Int Arch Occup Environ Health. 2015 Aug;88(6):743-50
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adult
Air Pollutants, Occupational - toxicity
Anti-Asthmatic Agents - therapeutic use
Asthma, Occupational - drug therapy - epidemiology - etiology
Cohort Studies
Denmark - epidemiology
Drug Prescriptions - statistics & numerical data
Follow-Up Studies
Humans
Incidence
Inhalation Exposure - adverse effects
Male
Middle Aged
Particulate Matter - toxicity
Proportional Hazards Models
Registries
Risk factors
Smoking
Steel
Surveys and Questionnaires
Time Factors
Welding
Abstract
The purpose was to examine bronchial asthma according to cumulative exposure to fume particulates conferred by stainless steel and mild steel welding through a proxy of redeemed prescribed asthma pharmaceuticals.
A Danish national company-based historical cohort of 5,303 male ever-welders was followed from 1995 to 2011 in the Danish Medicinal Product Registry to identify the first-time redemption of asthma pharmaceuticals including beta-2-adrenoreceptor agonists, adrenergic drugs for obstructive airway diseases and inhalable glucocorticoids. Lifetime exposure to welding fume particulates was estimated by combining questionnaire data on welding work with a welding exposure matrix. The estimated exposure accounted for calendar time, welding intermittence, type of steel, welding methods, local exhaustion and welding in confined spaces. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox proportional hazards model adjusting for potential confounders and taking modifying effects of smoking into account.
The average incidence of redemption of asthma pharmaceuticals in the cohort was 16 per 1,000 person year (95% CI 10-23 per 1,000 person year). A moderate nonsignificant increased rate of redemption of asthma medicine was observed among high-level exposed stainless steel welders in comparison with low-level exposed welders (HR 1.54, 95% CI 0.76-3.13). This risk increase was driven by an increase risk among non-smoking stainless steel welders (HR 1.46, 95% CI 1.06-2.02). Mild steel welding was not associated with increased risk of use asthma pharmaceuticals.
The present study indicates that long-term exposure to stainless steel welding is related to increased risk of asthma in non-smokers.
PubMed ID
25408460 View in PubMed
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Suboptimal asthma control: prevalence, detection and consequences in general practice.

https://arctichealth.org/en/permalink/ahliterature160627
Source
Eur Respir J. 2008 Feb;31(2):320-5
Publication Type
Article
Date
Feb-2008
Author
K R Chapman
L P Boulet
R M Rea
E. Franssen
Author Affiliation
University of Toronto, Canada. kchapman@ca.inter.net
Source
Eur Respir J. 2008 Feb;31(2):320-5
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - drug therapy - epidemiology
Attitude of Health Personnel
Bronchodilator Agents - therapeutic use
Chi-Square Distribution
Confidence Intervals
Cross-Sectional Studies
Family Practice - standards - trends
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Office visits - statistics & numerical data
Ontario - epidemiology
Patient satisfaction
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Prevalence
Questionnaires
Respiratory Function Tests
Risk assessment
Severity of Illness Index
Treatment Outcome
Abstract
Telephone surveys describing suboptimal asthma control may be biased by low response rates. In order to obtain an unbiased assessment of asthma control and assess its impact in primary care, primary care physicians used a 1-page control questionnaire in 50 consecutive asthma patients. Of the 10,428 patients assessed by 354 physicians, 59% were uncontrolled, 19% well-controlled and 23% totally controlled. Physicians overestimated control, regarding only 42% of patients as uncontrolled. Physicians were more likely to report plans to alter the regimens of uncontrolled patients than controlled patients (1.29 versus 0.20 medication changes per patient) doing so in a fashion consistent with guideline recommendations. Of the uncontrolled patients, 59% required one or more urgent care or specialist visits versus 26 and 15% of well-controlled or totally controlled patients, respectively. Patients were more likely to report short-term symptom control when they had not required urgent or specialist care (odds ratio 5.68; 95% confidence interval 4.91-6.58). The majority of asthma patients treated in general practice are uncontrolled. Lack of control can be recognised by physicians who are likely to consider appropriate changes to therapy. A lack of short-term symptom control of asthma is associated with excess healthcare utilisation.
Notes
Comment In: Eur Respir J. 2008 Feb;31(2):229-3118238943
PubMed ID
17959642 View in PubMed
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[The importance of early detection of asthma in children].

https://arctichealth.org/en/permalink/ahliterature209578
Source
Duodecim. 1997;113(7):613-6
Publication Type
Article
Date
1997

Utilization of anti-asthma medications in two Quebec populations of anti-asthma medication users: a prescription database analysis.

https://arctichealth.org/en/permalink/ahliterature210096
Source
Chronic Dis Can. 1997;18(1):20-6
Publication Type
Article
Date
1997
Author
C. Laurier
W. Kennedy
L. Gariépy
A. Archambault
A P Contandriopoulos
Author Affiliation
Faculté de pharmacie, Université de Montréal, Centre-ville, Québec.
Source
Chronic Dis Can. 1997;18(1):20-6
Date
1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Chi-Square Distribution
Child
Child, Preschool
Databases, Factual
Drug Prescriptions
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Pharmacoepidemiology
Public Assistance
Quebec - epidemiology
Sex Factors
Abstract
This study describes the utilization of anti-asthma medications in two groups of users of such medications in the province of Quebec, Canada, during the year from June 1, 1990, to May 31, 1991. It is based on a secondary analysis of existing data banks recording the medications reimbursed by two government-funded ambulatory drug reimbursement programs that cover individuals aged 65 and over (seniors) and income security (welfare) recipients (ISRs). The study analyzed the use of the anti-asthma medications included in the list of medications eligible for reimbursement for program beneficiaries. Use was studied in two random samples of individuals who had at least one prescription filled for an anti-asthma medication (2566 seniors and 3695 ISRs). The most commonly used medication in both groups was inhaled salbutamol 100 mcg. Various forms of theophylline tablets were also used by a high proportion of the sample studied. Over 75% of the seniors and 68% of the ISR group used at least one form of theophylline during the course of the year. Inhaled corticosteroids were used by 43% of the seniors and by 36% of the ISR group, and sympathomimetics (beta 2-agonists), by 63% of seniors and 68% of ISRs.
PubMed ID
9188516 View in PubMed
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Recognition of asthma in adolescents and young adults: which objective measure is best?

https://arctichealth.org/en/permalink/ahliterature9117
Source
J Asthma. 2005 Sep;42(7):549-54
Publication Type
Article
Date
Sep-2005
Author
Charlotte Suppli Ulrik
Dirkje S Postma
Vibeke Backer
Author Affiliation
Department of Respiratory Diseases, Hvidovre Hospital, Copenhagen, Denmark. csulrik@dadlnet.dk
Source
J Asthma. 2005 Sep;42(7):549-54
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenergic beta-Agonists - therapeutic use
Adult
Albuterol - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Antigens - diagnostic use
Asthma - diagnosis - drug therapy - epidemiology
Bronchial Hyperreactivity - diagnosis - drug therapy - epidemiology
Bronchodilator Agents - therapeutic use
Cross-Sectional Studies
Denmark - epidemiology
Female
Forced expiratory volume
Histamine - diagnostic use
Humans
Intradermal Tests
Lung Volume Measurements
Male
Peak Expiratory Flow Rate
Predictive value of tests
Reference Values
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Smoking - adverse effects - epidemiology
Vital Capacity
Abstract
BACKGROUND: Objective assessment of airway function is important in epidemiologic studies of asthma to facilitate comparison between studies. Airway hyperresponsiveness (AHR), peak expiratory flow (PEF) variability, and bronchodilator reversibility (BR) are widely used as markers of airway lability in such studies. Data from a survey of a population sample of adolescents and young adults (n = 609; 288 males), aged 13-23 years, were analyzed to investigate whether AHR, PEF variability, and BR can be used interchangeably as markers of asthma in an epidemiological setting. METHODS: Case history, including self-reported and doctor-diagnosed asthma, smoking habits, and use of asthma medication, was obtained by interview and questionnaire. Lung function, airway responsiveness (positive test: PC20 FEV1 20%), BR (positive test: deltaFEV1 [(FEV1max - FEV1min)/FEV1max) 100] > 10%), blood eosinophil count, and skin prick test reactivity were measured by using standard techniques. RESULTS: The prevalence of a positive test was AHR 16.4%, PEFpos 13.3%, and BRpos 7.2%, respectively; 73.5% of the sample had three negative tests. Among the 74 participants with current self-reported asthma (12.2%), 34 subjects (46%) had more than one positive test. Using AHR as the only objective marker of asthma identified 93% of the participants with current asthma, whereas PEF and BR identified 45% and 10%, respectively. Confining the analysis to participants with only one positive test revealed that 61% of the subjects with isolated AHR had current asthma, whereas none of the subjects with isolated BRpos had asthma, and only one participant with isolated PEFpos had current asthma. Degree of histamine responsiveness was closer associated with other asthma-related factors, including self-reported asthma, use of asthma medication, and level of lung function, than PEF variability and bronchodilator responsiveness. CONCLUSIONS: Airway responsiveness to histamine, diurnal peak-flow variability, and bronchodilator reversibility cannot be used interchangeably as objective markers of asthma in epidemiologic studies. On the basis of the present findings, airway hyperresponsiveness to a nonspecific bronchoconstrictor is recommended as the objective marker of asthma-related airway lability.
PubMed ID
16169787 View in PubMed
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Asthma control in Canada: no improvement since we last looked in 1999.

https://arctichealth.org/en/permalink/ahliterature161311
Source
Can Fam Physician. 2007 Apr;53(4):672-7
Publication Type
Article
Date
Apr-2007
Author
R Andrew McIvor
Louis-Philippe Boulet
J Mark FitzGerald
Sabrina Zimmerman
Kenneth R Chapman
Author Affiliation
McMaster University and Firestone Institute for Respiratory Health, St Joseph's Healthcare, 50 Charlton Ave E, Hamilton, ON L8N 4A6. amcivor@stjosham.on.ca
Source
Can Fam Physician. 2007 Apr;53(4):672-7
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Administration, Oral
Adolescent
Adult
Age Distribution
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - epidemiology - therapy
Canada
Confidence Intervals
Delivery of Health Care
Family Practice - methods
Female
Health Services Research
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Patient Compliance - statistics & numerical data
Patient Education as Topic
Questionnaires
Risk assessment
Severity of Illness Index
Sex Distribution
Survival Analysis
Treatment Outcome
Abstract
To determine whether asthma control in Canada had improved since the last major survey in 1999 by exploring how well patients' asthma was controlled, how much they knew about asthma control, and how they used health care resources.
National telephone survey of patients between April and August 2004.
Canada.
Eight hundred ninety-three adults 18 to 54 years old diagnosed with asthma more than 6 months before the survey.
Patients' control of their asthma, patients' knowledge about asthma, the frequency and duration of periods of worsening asthma, and patients' use of health care resources to manage those periods.
In total, 26,210 households listed in a consumer database were contacted. Excluding ineligible households and households with a language barrier, a member of 13% of the households completed the 35-minute survey. Based on definitions in Canadian guidelines, 53% of patients had symptomatic uncontrolled asthma. In the previous year, almost all asthma patients had experienced worsening of symptoms that lasted on average 13.6 days for patients with uncontrolled asthma and 8.0 days for patients with controlled asthma (P
Notes
Cites: Int Arch Allergy Immunol. 2000;121 Suppl 1:I-VIII, 1-7710824704
Cites: Can Respir J. 2006 Jul-Aug;13(5):253-916896426
Cites: CMAJ. 1999 Nov 30;161(11 Suppl):S1-6110906907
Cites: Eur Respir J. 2000 Nov;16(5):802-711153575
Cites: Can Respir J. 2001 Mar-Apr;8 Suppl A:35A-40A11360046
Cites: Can Respir J. 2001 Mar-Apr;8 Suppl A:5A-27A11360044
Cites: Chest. 2002 Feb;121(2):329-3311834639
Cites: J Allergy Clin Immunol. 2003 Feb;111(2):263-812589343
Cites: Chest. 2004 Jan;125(1):93-714718426
Cites: Chest. 2004 Mar;125(3):1081-10215006973
Cites: Can Respir J. 2004 May-Jun;11 Suppl A:9A-18A15254605
Cites: Am J Med. 2004 Oct 1;117(7):479-8315464704
Cites: J Allergy Clin Immunol. 1990 Jun;85(6):1098-1112355155
Cites: Can Fam Physician. 1999 Jul;45:1707-1310424270
Cites: Chest. 2004 Nov;126(5):1495-50115539718
Comment In: Can Fam Physician. 2010 Oct;56(10):976-7, e355-620944031
PubMed ID
17872718 View in PubMed
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Attenuation of the September epidemic of asthma exacerbations in children: a randomized, controlled trial of montelukast added to usual therapy.

https://arctichealth.org/en/permalink/ahliterature161582
Source
Pediatrics. 2007 Sep;120(3):e702-12
Publication Type
Article
Date
Sep-2007
Author
Neil W Johnston
Piush J Mandhane
Jennifer Dai
Joanne M Duncan
Justina M Greene
Kim Lambert
Malcolm R Sears
Author Affiliation
Firestone Institute for Respiratory Health, St Joseph's Healthcare, 50 Charlton Ave E, Hamilton, Ontario, Canada L8N 4A6. njohnsto@mcmaster.ca
Source
Pediatrics. 2007 Sep;120(3):e702-12
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Acetates - therapeutic use
Adolescent
Adrenal Cortex Hormones - therapeutic use
Adrenergic beta-Agonists - therapeutic use
Age Factors
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology
Child
Child, Preschool
Common Cold - epidemiology
Disease Outbreaks - prevention & control
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Male
Multivariate Analysis
Office visits - statistics & numerical data
Ontario - epidemiology
Questionnaires
Quinolines - therapeutic use
Schools
Seasons
Severity of Illness Index
Sex Factors
Abstract
A recurring epidemic of asthma exacerbations in children occurs annually in September in North America when school resumes after summer vacation.
Our goal was to determine whether montelukast, added to usual asthma therapy, would reduce days with worse asthma symptoms and unscheduled physician visits of children during the September epidemic.
A total of 194 asthmatic children aged 2 to 14 years, stratified according to age group (2-5, 6-9, and 10-14 years) and gender, participated in a double-blind, randomized, placebo-controlled trial of the addition of montelukast to usual asthma therapy between September 1 and October 15, 2005.
Children randomly assigned to receive montelukast experienced a 53% reduction in days with worse asthma symptoms compared with placebo (3.9% vs 8.3%) and a 78% reduction in unscheduled physician visits for asthma (4 [montelukast] vs 18 [placebo] visits). The benefit of montelukast was seen both in those using and not using regular inhaled corticosteroids and among those reporting and not reporting colds during the trial. There were differences in efficacy according to age and gender. Boys aged 2 to 5 years showed greater benefit from montelukast (0.4% vs 8.8% days with worse asthma symptoms) than did older boys, whereas among girls the treatment effect was most evident in 10- to 14-year-olds (4.6% [montelukast] vs 17.0% [placebo]), with nonsignificant effects in younger girls.
Montelukast added to usual treatment reduced the risk of worsened asthma symptoms and unscheduled physician visits during the predictable annual September asthma epidemic. Treatment-effect differences observed between age and gender groups require additional investigation.
Notes
Comment In: Pediatrics. 2008 Jun;121(6):1289; author reply 1289-9018519503
PubMed ID
17766511 View in PubMed
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Impact on patients' health status following early identification of a COPD exacerbation.

https://arctichealth.org/en/permalink/ahliterature161771
Source
Eur Respir J. 2007 Nov;30(5):907-13
Publication Type
Article
Date
Nov-2007
Author
J. Bourbeau
G. Ford
H. Zackon
N. Pinsky
J. Lee
G. Ruberto
Author Affiliation
Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, 3650 St Urbain, Montréal, QC, Canada. jean.bourbeau@mcgill.ca
Source
Eur Respir J. 2007 Nov;30(5):907-13
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adrenal Cortex Hormones - therapeutic use
Adult
Aged
Aged, 80 and over
Anti-Asthmatic Agents - therapeutic use
Budesonide - therapeutic use
Canada
Drug Combinations
Ethanolamines - therapeutic use
Female
Health status
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive - drug therapy - physiopathology
Questionnaires
Treatment Outcome
Abstract
The current study aimed to assess the impact on patient health status during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A total of 421 COPD patients were enrolled in a multicentre, single-arm study with a 6-month observational follow-up period. Patients received two inhalations of Symbicort 200 Turbuhaler(R) twice a day. Patients were assessed before the run-in period, at baseline and at 1, 3 and 6 months. Patients were instructed to report a change in respiratory symptoms lasting >24 h. This defined an AECOPD. In addition to the initial call, the St George's Respiratory Questionnaire (SGRQ), COPD Control Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and activities of daily living (ADL) were completed at 5-7 and 12-14 days. A group of 176 patients reported at least one AECOPD. Exacerbations were associated with statistically significant mean changes (worsening) in the SGRQ activity and impact domains at onset (mean +/- sd 12.1 +/- 18.1 and 14.0 +/- 15.2), during the first (9.8 +/- 19.0 and 9.4 +/- 16.6) and second weeks (3.1 +/- 15.5 and 3.3 +/- 14.7). Clinically significant deterioration in SGRQ impact scores was shown in 71% of patients following early identification, with 55 and 37% during the first and second weeks of an AECOPD, respectively. Acute exacerbation severely impacts on health status. The current study provides valuable information on the change in health status during an acute exacerbation of chronic obstructive pulmonary disease that can be utilised for future trials that evaluate therapeutic intervention.
PubMed ID
17715163 View in PubMed
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[Prevalence of respiratory symptoms and use of asthma drugs are increasing among young adult Icelanders].

https://arctichealth.org/en/permalink/ahliterature131374
Source
Laeknabladid. 2011 Sep;97(9):463-7
Publication Type
Article
Date
Sep-2011
Author
Stefan Sigurkarlsson
Michael Clausen
Thorarinn Gislason
David Gislason
Source
Laeknabladid. 2011 Sep;97(9):463-7
Date
Sep-2011
Language
Icelandic
Geographic Location
Iceland
Publication Type
Article
Keywords
Adult
Age Factors
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology
Cross-Sectional Studies
Drug Utilization
Female
Humans
Iceland
Male
Physician's Practice Patterns
Prevalence
Questionnaires
Time Factors
Treatment Outcome
Young Adult
Abstract
In the year 1990 the European Community Respiratory Health Survey I (ECRHS I) demonstrated that the prevalence of these diseases was lowest in Iceland (www.ecrhs.org). In order to compare the prevalence of respiratory symptoms in Reykjavik over time, a new identical cross-sectional study was performed seventeen years later.
Both cohorts, were in the age group 20-44 years and randomly selected from the population in Reykjavik and suburbs. Both answered questionnaires about respiratory symptoms, nasal allergy and use of anti-asthmatic drugs. The second cohort was part of the EuroPrevall study (www.europrevall.org) performed in 2007.
Response rate was lower in 2007 (999 or 43.2%) than in 1990 (2.903 or 80.6%).The prevalence of attacks of asthma increased over time from 2.2% to 6.7% (p
PubMed ID
21911911 View in PubMed
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124 records – page 1 of 13.