Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.4
, Dece
m
b
er
2
014
,
p
p
.
2
4
6
~
252
I
S
SN
: 225
2-8
8
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46
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Anxiety and Family Support on
Infected TORCH Patients
Eirene Shinta
Vale
vi, Lin
a
Han
d
ayani
Public Health
Faculty
,
Univ
ersitas Ahmad Dahlan
, Yog
y
ak
arta, In
donesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Sept 28, 2014
Rev
i
sed
O
c
t 20
, 20
14
Accepted Nov 22, 2014
TORCH is an acron
y
m of
Tox
oplasmosi
s, Rubella, C
y
tomeg
a
lovirus, and
Herpes sim
p
lex diseases. Th
ese
diseases can cau
s
e a
bnorm
a
liti
es in the brain,
im
paired ps
ych
o
m
o
tor and cognitive fun
c
tion
,
fertil
it
y, m
i
sca
rriage
,
birth
defec
t
s
,
e
t
c. In
f
ect
ed TORCH pati
ent t
e
nd to ex
perien
ce an
xie
t
y and worr
y
after d
i
scover
i
n
g
he/she was
diagnos
ed inf
e
cted TORCH. F
o
r infected
TORCH patient, family
support is exte
rn
al
factors th
at inf
l
uence th
e
treatment TOR
C
H process. Th
e purpose of this stud
y
was to describe
the
anxiety
and
fam
i
ly
support on infected
TORCH
patients
in Klinik Utama
Thursina Husada, Yog
y
akarta,
Indonesia.
Th
e design of this
stud
y
was
descript
ive qua
li
tativ
e with c
a
se
stud
y
appro
ach
. All subjec
ts in this stud
y
had worries on costly
medical
ex
pens
es of TORCH. TORCH sy
mptoms that
as
y
m
ptomatic made informants
and
family
ever
thought that
it
was a non-
m
e
dical d
i
s
eas
e
.
Each
inform
an
t can ov
ercom
e
the anx
i
et
y
tha
t
the
y
f
a
c
e
because of em
o
tional support
,
esteem
support, instrum
e
ntal support, and
informational support from family
. Infe
cted
TORCH caused the patien
t
had
anxiety
and
worries. Family
su
pport wa
s ver
y
helpful in
the process o
f
TORCH trea
tm
ent.
Keyword:
An
xiety
Family Su
p
port
Patien
t
TORCH
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Lina Handayani,
Pub
lic Health
Facu
lty,
Uni
v
ersitas A
h
m
a
d
Da
hlan,
Jl
. Pr
of
.D
r.
S
o
epom
o, Ja
nt
u
r
a
n
,
Y
ogy
a
k
art
a
55
1
6
4
,
In
d
one
si
a.
Em
a
il: l
i
n
a
fk
m
@
g
m
ail.co
m
1.
INTRODUCTION
TOR
C
H
i
s
a com
b
i
n
at
i
on fr
o
m
four t
y
pes o
f
di
sease w
h
i
c
h are;
To
xo
pl
a
s
m
o
si
s, R
ubel
l
a
, C
M
V, and
Her
p
es Si
m
p
l
e
x. T
O
R
C
H
has
sprea
d
al
l
ove
r t
h
e w
o
rl
d
.
Hi
gh
pre
v
al
ence
of T
o
x
o
p
l
a
sm
osi
s
m
o
st
l
y
happe
n
s
i
n
t
h
e
s
o
ci
et
y
wh
o
pet
s
m
a
n
y
cat
s an
d
ha
ppe
ns
i
n
w
h
er
e there
are
m
a
ny rats
or
birds which ca
n
be the
in
term
ed
iary of th
e d
i
sease. R
u
b
e
lla ep
id
em
i
c
s m
o
stly h
a
pp
en i
n
s
p
ri
ng
se
aso
n
a
n
d
m
o
st
cases ha
p
p
e
n
i
n
ki
ds
and y
out
h. C
M
V i
n
fect
i
on ca
n be
seen e
n
de
m
i
cal
ly
and ca
n ap
pea
r
any
t
i
m
e wi
t
hout
bei
ng i
n
fl
uence
d
by
t
h
e
season c
h
ange
s. Infection pre
v
alence
o
f
t
h
e
C
M
V i
s
hi
g
h
i
n
t
h
e
devel
opi
ng
co
u
n
t
r
y
a
n
d
m
o
st
of t
h
e ca
ses ar
e
in the m
i
ddle-down class
of s
o
ciety.
Hi
g
h
i
n
ci
dence
of
He
r
p
es si
m
p
l
e
x co
ul
d al
s
o
be
f
o
u
nd i
n
t
h
e l
o
w i
n
com
e
society who lives in t
h
e crowded a
r
ea
[1
].
TORCH
d
i
sease o
f
ten
cau
s
es
fertility in
b
o
t
h m
a
le
an
d
female, strik
e
all ag
es an
d sex. TORCH can
al
so st
ri
ke t
h
e brai
n whi
c
h o
f
t
e
n cause hea
d
ache sym
p
t
o
m
s
, oft
e
n cause
a sore t
h
r
o
at
, p
r
ol
on
ge
d fl
u,
p
a
i
n
i
n
m
u
scl
e
s, joi
n
t
s
, hi
ps,
l
e
gs
, st
om
ach an
d ey
es, a
n
d
s
o
on
[2]
.
Tox
o
pl
as
ma
g
o
ndi
i
(
T. g
ond
ii
), t
h
e s
o
urce
of
TORCH
disea
s
e can cause
the abortio
n i
n
p
r
eg
na
nt
w
o
m
e
n or t
h
e
babi
es
bo
r
n
wi
t
h
de
fect
s s
u
ch as
hy
d
r
oce
p
hal
u
s
and a
n
ence
p
h
a
l
y
[1]
.
TOR
C
H
i
n
fect
i
on ca
n st
ri
ke t
h
e w
hol
e
bo
dy
sy
st
em
, incl
u
d
i
n
g o
r
ga
n
s
of
the central
nervous system
and pe
ripheral
which c
ont
ro
l the v
i
su
al fun
c
tio
n, card
i
ov
ascu
lar
system
, al
so
bod
y
im
m
une [3]
.
No
t all o
f
TORCH p
a
tien
t
s
can
ad
ap
t to
co
v
e
r th
e
p
r
ess
u
re that they a
r
e facing,
whic
h causes t
h
eir
psy
c
hi
c
pr
o
b
l
e
m
s
t
o
ap
pear
a
n
d
are
ha
rd
t
o
be s
o
l
v
e
d
whi
c
h ca
n al
so
i
m
p
act
t
o
t
h
ei
r
psy
c
hol
ogy
.
T
h
ey
t
e
nd
t
o
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
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6
An
xiety and
Fam
ily Su
ppo
rt
on Infected
TOR
C
H
P
a
tients
(E
irene Shi
nta V
a
levi)
24
7
feel the ne
gative im
pacts from their disease, suc
h
as hi
gh
worry
feeling
wh
en
th
ey
notice that they are being
infected. Conc
erns
and s
u
pports from
the fa
mily and s
p
eci
al people are re
a
lly i
m
p
o
r
tan
t
for th
em
to
ad
ap
t and
face thei
r
disea
s
e [3]. T
h
e
pre
s
ence a
n
d
helps from
people l
i
ke
pare
nts,
pa
rtners, a
n
d
frie
nds
ca
n m
ean
big
for
th
eir
h
ealth
[4
]
and
well-b
e
i
n
g
in ind
i
v
i
du
al
s [3
].
2.
R
E
SEARC
H M
ETHOD
Design
of th
is research
was q
u
a
litativ
e d
e
scri
p
tiv
e wi
th
th
e case st
u
d
y
app
r
o
a
ch
. Case stu
d
y
researc
h
is
a st
udy t
h
at e
xpl
ores a
problem
with a
certa
i
n
l
i
m
i
t
a
t
i
on,
ha
v
e
a deep
dat
a
col
l
ect
i
ng pr
oc
essed,
and em
bedding va
rious information so
urces
. This resea
r
ch is being limit
ed by tim
e
and place and the case
th
at is b
e
i
n
g st
u
d
i
ed
are in term
s o
f
: p
r
og
ram
s
, ev
en
ts, act
iv
ities, o
r
ind
i
vid
u
a
ls
[5
].
Data was co
llected
b
y
in
-d
epth
in
terv
iew tech
n
i
q
u
e
and
in-d
ep
th
in
terv
iew ob
serv
ation
wh
ich
are
th
e p
r
o
cess to
g
a
in
inform
at
i
o
n
b
y
d
i
rect in
terv
iew wit
h
th
e in
fo
rm
an
ts, with
o
r
withou
t u
s
ing
th
e interv
iew
g
u
i
d
a
n
c
e,
w
h
er
e th
e i
n
terv
iew
e
r
s
and
i
n
fo
rman
ts ar
e involv
e
d
i
n
long
ter
m
so
cial in
ter
actio
n
.
Ob
servatio
n
i
s
a
m
e
th
o
d
o
f
collectin
g
d
a
ta pro
cess wh
ich
is g
a
in
ed
b
y
o
b
s
erv
i
n
g
th
e
p
l
ace, actors,
activ
ities, obj
ects, act
io
n
s
,
accidents
or e
v
ents, tim
es, and feelings
[5].
By using th
is qualitative
resea
r
ch,
the re
searc
h
er hope
s
to get
the
in
fo
rm
atio
n
that is n
o
t
on
ly ab
ou
t th
e anx
i
ety an
d
supp
or
ts
fro
m
th
e famili
es of th
e
TOR
C
H infected
p
a
tien
t
s,
but als
o
the
ot
her t
h
ings that
are related
with anxiet
y and
supports
from
the fam
i
lies of the TORC
H infecte
d
p
a
tien
t
s.
W
ith
th
is q
u
a
litativ
e resou
r
ce also, th
e research
er h
o
p
e
to
see the co
nd
itio
n
of
th
e research
sub
j
ect
by them
selves, fam
i
lies, or
even
th
e related do
ctors.
The re
searc
h
er did the
resea
r
ch to indivi
duals in
r
a
ng
e 15
–
30
year
s o
l
d
,
bo
th
th
e mar
r
i
ed
and
unm
arri
ed
one
s, an
d bei
n
g i
n
fect
ed i
n
o
n
e a
nd/
or al
l
ki
nds of
T
O
RCH diseases.
The
r
e
are 3
in
fo
rm
an
ts in
th
is
researc
h
. T
h
e
vari
a
b
l
e
of t
h
i
s
researc
h
wa
s
t
h
e anxi
et
y
o
n
i
n
fect
e
d
T
O
R
C
H
pat
i
e
nt
a
nd
fam
i
l
y
suppo
rt
o
n
infected T
O
R
C
H patient. Da
ta was analysed by usi
ng th
e
semiotic content analysis syste
m
and triangulated.
Conte
n
t analysis syste
m
is
the researc
h
techn
i
qu
e th
at is u
s
ed
to
referen
c
e th
e rep
licab
le an
d
v
a
lid
d
a
ta in
th
e
rel
a
t
e
d c
ont
e
x
t
.
The
resea
r
c
h
er i
s
l
o
oki
ng
fo
r t
h
e i
rre
gul
ar f
o
rm
s and
pat
t
e
rns
o
f
t
h
e
t
e
xt
an
d m
a
ki
ng a
concl
u
si
o
n
ba
s
e
d o
n
t
h
at
i
rre
gul
a
r
fi
n
d
i
n
g [
6
]
.
The st
a
g
e
we use
d
t
o
a
n
a
l
y
s
e our
dat
a
was:
1
)
dat
a
o
r
gani
zi
n
g
base
d on the interviews
, obse
rvations,
and tri
a
ngulate; 2) ca
se descri
ptions
in each subjec
t. This researc
h
wa
s
co
ndu
cted
in
Janu
ar
y 20
14 to
Ju
ly 2
0
14 at th
e K
lin
i
k
Ut
am
a Thurs
i
na Hus
a
da
, Go
dea
n
, Y
o
gy
akart
a
.
Ho
we
ver
,
t
h
e
m
i
nim
u
m
num
ber
o
f
s
u
bject
s
can
be t
h
e
l
i
m
it
at
i
on o
f
t
h
e st
udy
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Res
u
l
t
s
Th
e research
er co
nd
u
c
ted
ob
serv
ation
s
and
in
terv
iews with a n
u
m
b
e
r o
f
in
fo
rm
an
ts, n
a
mely
: P1
o
n
2
1
Mar
c
h
20
14, P2
on
2
4
May 2
014
, and
P3 on
25
May
2
0
1
4
. Tr
iangu
latio
n w
a
s also
d
o
n
e
w
ith
t
h
e
f
a
mil
y
o
f
P1 a
n
d P
2
(o
n
28
M
a
y
2
0
1
4
)
,
an
d t
h
e
fam
i
ly of
P
3
(
o
n
25
M
a
y
20
14
).
Tr
i
a
ng
ul
at
i
on t
h
r
o
u
g
h
i
n
t
e
r
v
i
e
w
s
wa
s
al
so do
ne wi
t
h
a neu
r
ol
ogi
s
t
on 2 Ju
ne 2
0
1
4
an
d a ps
y
c
hi
at
ri
st
on 2
5
Jul
y
20
1
4
,
aft
e
r t
h
e psy
c
hi
at
ri
st
in
terv
iewed all th
e info
rm
an
ts to
m
easu
r
e t
h
eir resp
ectiv
e lev
e
l of anx
i
ety.
3.
1.
1.
An
xiet
y
To m
easure
the a
n
xiety level
of
each inform
ant, the
resea
r
che
r
a
s
ked for assist
ance
from
a
psy
c
hi
at
ri
st
t
o
m
easure i
t
si
nc
e t
h
e use
o
f
t
h
e
HR
S-
A a
nxi
et
y
scal
e can o
n
l
y
be pe
rf
orm
e
d by
a psy
c
hi
at
r
i
st
or
an
exp
e
rt in
this field
.
Accord
ing
to
th
e d
i
ag
no
sis of th
e p
s
ych
i
atrist, the an
x
i
ety lev
e
l o
f
P1
rem
a
in
s in
a
m
e
di
um
l
e
vel
,
but
P
2
an
d P
3
di
dn
’t
ha
d a
nxi
et
y
.
Based
o
n
i
n
terv
iews
with
in
form
an
t
s
an
d
triang
u
l
ated
, P1
expe
ri
ence
d
w
o
r
r
i
e
s
ove
r
w
h
et
her t
h
e
di
sea
s
e t
h
at
P
1
de
v
e
l
ope
d c
o
ul
d
be c
u
re
d
o
r
n
o
t
a
n
d
i
t
s
aca
dem
i
c
activ
ities o
n
cam
p
u
s
. P2 and
P3
, who
already
m
a
rried
an
d
h
a
v
e
ch
ildren
u
n
d
e
r fi
v
e
,
h
a
ve wo
rries if TORCH
in
fects th
ei
r child
ren.
All in
form
an
ts h
a
d
worries abo
u
t
TORCH m
e
d
i
cal co
st.
3.
1.
2.
Family Sup
port
Th
er
e ar
e
f
our typ
e
s of
f
a
m
i
ly su
pp
or
t,
n
a
mely e
m
o
t
io
nal su
ppo
r
t
, estee
m
su
pp
or
t, i
n
stru
m
e
n
t
al
support, and i
n
form
ational s
u
pport.
He
re a
r
e
the types
of
fa
mily support
that each
researc
h
s
u
bject obtained:
Evaluation Warning : The document was created with Spire.PDF for Python.
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SN
:
2
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IJPHS
Vol. 3, No. 4,
Decem
ber 2014
: 246 –
252
24
8
Tabl
e
1. Ty
pe
of
Su
p
p
o
r
t
P
r
o
v
i
d
e
d
by the R
e
search Subjec
ts’ Fam
i
ly
I
n
form
ant
T
y
pe of Suppor
t
T
y
pe of Suppor
t Pr
ovided by
Fam
i
ly
P1
Em
otional
a.
P1 took the
m
e
dicine while eating bananas,
P1’
s
fam
i
ly
often asked if t
h
er
e were
still any bananas or not, if the bana
nas ha
d been up, P1’s fa
m
i
l
y
would bought P1
bananas.
b.
T
h
e fam
ily
put their
tr
ust on the God’
s hands an
d pr
ay
ed for
P1’
s
im
p
r
oved
condition.
c.
P1’
s
m
o
ther
r
e
m
i
nded P1 not to feel too tir
ed.
d.
P1’
s
par
e
nts alway
s
woke P1 up if P1
was sleeping dur
ing the hour
s th
e
m
e
dicine
should be take.
e.
P1’
s
fam
ily pr
ovided full supp
or
t and
encour
agem
ent to
get r
ecover
e
d.
Estee
m
The fa
m
i
l
y
supported P1’s activities
to be ac
tively
invo
lved in religio
us a
c
tivities and
P1’
s
hobby
play
ing with co
m
puter
s.
In
stru
m
e
n
t
al
a.
P1’s f
a
ther paid the
m
e
dicat
ion and
acco
m
p
anied P1 to
see the doctor.
b.
P1’s father and elderly
sibling accom
p
anie
d P1 to have blood checks a
nd x-ray
s
at
the hospital.
I
n
form
a
tiona
l
a.
P1’
s
elder
l
y
sibling br
owsed the inter
n
et
looking f
o
r
inf
o
rm
ation about the disease
b.
P1’
s
father
asked his fr
iends
P2
Em
otional
a.
P2’
s
par
e
nts and p
a
r
e
nts in-
l
aws becam
e ove
r
pr
otectiv
e and told him
not to be to
o
exhausted.
b.
P2’s wife always g
a
ve positive spirit
and a
dvice, for an
exa
m
pl
e if P2 felt
exhauste
d
when he was r
i
din
g
a
m
o
tor
c
y
c
le,
he
should sto
p
to r
e
st.
c.
P2’s wife alwa
y
s
e
n
couraged P2 who
so
m
e
ti
m
e
s felt pe
ssi
m
i
stic.
Estee
m
P2’s wif
e
always reassured hi
m
to be able
to do physi
cal activ
ities because she knew
that P2 had strong phy
sical condition
s
.
In
stru
m
e
n
t
al
a.
P2’s wif
e
acco
m
p
anied hi
m
to have a labor
atory exam
in
ation and to
go to the t
h
e
hospital f
o
r a CT scan as we
ll
as to se
e the doctor.
b.
T
h
e
m
e
dication was paid by
P2 and his wife.
I
n
form
a
tiona
l
a.
P2’
s
wife explained to P2,
her
par
e
nts a
nd her
par
e
nts in-
l
aws that the T
O
RCH was
trans
m
itted by
poultry
because the
y
did not
keep s
u
ch ani
m
als
,
but P2 perhaps
developed this
dis
ease due to his h
a
bbit
befor
e
m
a
r
r
y
i
ng her
that often ate fr
esh
vegetables and satay
that
m
i
ght be u
nder
c
ooked.
b.
P2’
s
elder
l
y
sibling su
ggested
him
to go
to a
neur
olo
g
ist after
hear
ing
about
his
stagnant health im
pr
ovem
e
nt.
c.
Other
fam
i
ly
m
e
m
b
er
s suggested him
to take alter
n
ative
m
e
dication.
P3
Em
otional
a.
P3’
s
par
e
nts pr
ay
ed for
her
im
pr
oved hea
lth conditions
and str
oked P3’
s
head.
b.
For
P3,
her
par
e
nts and
husba
nd ar
e
people
who
had
pr
ovided m
o
st supp
or
t for
her
r
ecover
y
and she was close to her
m
o
ther
who always sup
por
ted her
de
spite livin
g
fa
r
a
w
ay
fr
o
m
her
.
E
s
teem
Her
husband alway
s
gave wh
at
P3 w
a
nted to cure her.
In
stru
m
e
n
t
al
a.
P3’
s
husba
nd acc
o
m
panied her
to the hos
p
ital and handled all the
adm
i
nist
ration,
such as JAMK
ES
MAS
(the Co
mm
u
n
ity Hea
lth
Insura
nce) and acco
m
p
a
n
ied her to
seek treat
m
e
nt to
Klinik Utama Thursina Husad
a
.
b.
P3’
s
husband pai
d
P3’
s
m
e
dication and ot
her
fam
i
ly
m
e
m
b
er
s
pr
ovided financial
suppor
t whenever
they
lacked
m
oney
for
the m
e
dication.
I
n
form
a
tiona
l
a.
P3’
s
husband sear
ched inform
ation about T
O
RCH
b.
Other
fam
i
ly
m
e
m
b
er
s suggested her
to take alter
n
ative
m
e
dication.
3.
2.
An
al
ysi
s
Th
is
research
was
qu
alitativ
e d
e
scrip
tiv
e wi
th
th
e cas
e st
ud
y appro
a
ch
an
d an
alysed
d
a
ta b
y
u
s
ing
the
semio
tic co
n
t
en
t an
alysis syste
m
an
d
trian
g
u
l
ated
.
Th
e r
e
se
a
r
c
h
er
co
ndu
cte
d
in
te
rv
iews
with
each
inform
an
t
and thei
r own fa
m
ily as we
ll as observati
ons
, then a
n
alyzed the case of each re
sea
r
ch s
u
bject wi
th the
fo
llowing
resu
lts:
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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6
An
xiety and
Fam
ily Su
ppo
rt
on Infected
TOR
C
H
P
a
tients
(E
irene Shi
nta V
a
levi)
24
9
Table
2.
Analysis of the
Rese
arch Subjects
N
o
.
Ca
te
gor
y
I
n
form
a
n
t P
1
I
n
form
a
n
t P
2
I
n
form
a
n
t P
3
1
TORCH S
y
m
p
to
ms that
appear
a.
Fr
equently
losing
unconscio
u
sness
b.
Having concentr
ation
pr
oblem
s
c.
Im
pa
ire
d
psy
c
ho
m
o
tor
i
c
abilities
a.
Headache, f
e
ver
b.
Im
paired cognitive
abilities
a.
Headache
b.
Im
paired psy
c
ho
m
o
tor
i
c
abilities
2
Health condition after
being diagn
o
sed as
positive TORCH
Im
pr
oved after
m
e
dication
Im
pr
oved afte
r
m
e
dication
Im
pr
oved
after
m
e
dication
Not allowed to suffer fro
m
fatigue
Not allowed to suffer fro
m
fatigue
3
Knowledge and views
about T
O
RCH
a.
Having no idea about
T
O
RCH befor
e
being
diagnosed as
developin
g
it
a.
Having no idea about
T
O
RCH befor
e
being
diagnosed as
developin
g
it
a.
Having no idea about
T
O
RCH befor
e
being
diagnosed as devel
oping
it
b.
F
a
mi
l
y
me
m
b
e
r
s
a
n
d
the environ
m
ent
thoug
ht that P2 was
possessed
b.
F
a
mi
l
y
me
m
b
e
r
s
thoug
ht that P2 was
followed su
per
n
atur
al
beings
b.
P3 once thought th
at it
was a
m
y
st
ical illn
ess
4
Anxiety when inf
ected
with TORCH
a.
Anxiety
about the
expensive costs of
T
O
RCH m
e
dicatio
n
b.
Anxiety
about
whether the illness
could be cur
e
d or
not
c.
Anxiety
about not
passing the cour
ses
because of
f
r
equently
skipping the class
a.
Anxiety
about
trans
m
itting TOR
C
H
to the child
b.
Anxiety
about the
expensive costs of
T
O
RCH m
e
dicatio
n
a.
Anxiety
about
trans
m
itting TOR
C
H to
the child
b.
Anxiety
about the
expensive costs of
T
O
RCH m
e
dicatio
n
5
Suppor
t fr
o
m
the f
a
m
i
ly
of the T
O
RCH patients
a.
Em
otional Suppor
t
a.
T
h
e fam
i
ly
did not
allow P1 to feel to
o
tired
b.
The f
a
m
i
l
y
pra
y
ed
f
o
r
P1’
s
im
pr
oved health
c.
T
h
e fam
i
ly
bought
P1
bananas to help P1
took the dr
ugs
d.
P1
’s p
a
ren
t
s re
m
i
n
d
ed
P1 not to for
g
et taking
the m
e
dicine
a.
T
h
e fam
i
ly
did not
allow P1 to feel to
o
tired
b.
P2’
s
par
e
nts spoiled P2
c.
P2’
s
par
e
nts and
par
e
nts in-
l
aw becam
e
over protective
a.
The f
a
m
i
l
y
pra
y
ed
f
o
r
P1’
s
im
pr
oved health
b.
P3’
s
par
e
nts visited P3’
s
house to give sup
p
o
r
t
b.
E
s
teem
Suppor
t
T
h
e fam
i
ly
suppor
t P1’
s
hobby
to be actively
involved in r
e
ligio
us
activities
P2’
s
wife knew that he had
strong phy
sical conditions,
and theref
ore his wif
e
encouraged hi
m
to ride a
m
o
torcyc
le
Although she was a
housewife, P3’s hu
sband still
allowed her
to hav
e
a par
t
-
ti
m
e
job in a
village unit
cooper
a
tive
c.
In
stru
m
e
n
t
al
Suppor
t
a.
P1’
s
par
e
nts paid for
P1’s treat
m
e
nt
b.
P1’s f
a
ther and
elder
l
y
sibling
acco
m
p
anied P1 to
see the doctor
a.
Together with his
wife,
they paid the treat
m
e
nt
b.
His wife and elder
l
y
sibling acco
m
p
ani
e
d
P1 to see the doctor
a.
Her
husband
acco
m
p
anied P3 to see
the doctor
b.
Her
husband and o
t
her
f
a
m
i
l
y
me
mb
e
r
s
p
a
i
d
f
o
r
P3’s treat
m
e
nt
d.
I
n
form
a
tiona
l
Suppor
t
a.
P1’
s
elder
l
y
sibling
br
owsed the inter
n
et
lookin
g
for
inform
ation about the
disease
b.
P1’
s
father
asked his
fr
iends
c.
P1’
s
uncle suggest
ed
to take P1 to so
m
e
one
who knows about t
h
e
super
n
atur
al
a.
His wife explained
about T
O
RCH to their
fam
i
ly
b.
O
t
h
e
r
f
a
mi
l
y
me
m
b
e
r
s
suggested P2 to take
the alternative
m
e
dication
a.
P3 and her
husban
d
helped each other
lookin
g
for
inf
o
rm
ation
about T
O
RCH
b.
O
t
h
e
r
f
a
mi
l
y
me
m
b
e
r
s
suggested P2 to take the
alternative m
e
dicat
ion
An
xi
et
y
i
s
an
un
pl
easa
n
t
e
m
oti
onal
st
at
e,
i
n
v
o
l
v
i
ng
su
b
j
ect
i
v
e
fear,
di
scom
fort
i
n
t
h
e b
ody
a
nd
physical sym
p
tom
s
[8], occurring when
ex
per
i
en
cing
fr
ustr
atio
n
an
d
i
n
ter
n
al conflicts [9
], th
e ex
istence of
d
eep and
con
tin
uou
s
worry, no
t h
a
v
i
ng
proble
m
s j
u
d
g
i
n
g
th
e reality, p
e
rso
n
a
lity rem
a
in
s in
tact, an
d b
e
h
a
v
i
or
can
b
e
d
i
sru
p
t
ed
b
u
t
still with
in
th
e norm
a
l l
i
m
its [1
0
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
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06
IJPHS
Vol. 3, No. 4,
Decem
ber 2014
: 246 –
252
25
0
Accord
ing
to
th
e d
i
agno
sis of th
e p
s
ych
i
atrist, th
e an
x
i
ety lev
e
l o
f
P1
rem
a
in
s in
a m
e
d
i
u
m
lev
e
l. P1
still th
o
u
g
h
t
abo
u
t
t
h
e TO
RC
H
treatm
e
n
t
th
at P1
h
a
d
an
d
to
ok
th
e m
e
d
i
c
i
n
e
ev
en
t
h
ough
in a low
e
r do
sag
e
.
Based
o
n
th
e
in
terv
iew
t
h
at
t
h
e research
er had
with
P1
, P1 experie
n
ced worries
ove
r whether
t
h
e disea
s
e
that
P1
de
veloped c
oul
d
be c
u
re
d
or not, t
h
e m
e
di
cal cost, a
n
d its academ
ic acti
v
ities on cam
pus.
“Sure,
I
feel s
o
s
o
rry
for my pare
nts si
nc
e it co
sts
ve
ry m
u
ch to c
u
re
this
disease.
Because m
y
pare
nt
s
do
n’t
h
a
ve a
perm
anent
occ
u
pat
i
o
n
.
So, i
f
I
ha
ve t
o
ask t
h
em
t
o
p
a
y
a consi
d
era
b
l
e
am
ount
o
f
m
oney
for the m
e
d
i
cat
io
n
ev
ery two
weeks,
I t
h
ink
it will b
e
a
g
r
eat bu
rd
en for
th
em
an
d
th
at
mak
e
s m
e
can
’t stop
th
in
k
i
n
g
abou
t
it. Th
at’s ri
g
h
t
, it’s also stressfu
l.”
P2
d
i
d
no
t experien
ce anx
i
et
y sin
ce h
e
could
q
u
i
ck
ly ad
ap
t to
h
i
s illn
ess an
d
h
e
also
o
b
t
ain
e
d
fu
ll
fam
i
ly support
from
his fam
i
ly so th
at he did not feel too
worrie
d
about
his illness fo
r a long
peri
od
of tim
e.
Ho
we
ver
,
acc
or
di
n
g
t
o
t
h
e i
n
f
o
rm
at
i
on p
r
ovi
ded
by
P
2
’
s
wi
fe,
he
o
n
c
e
ex
peri
ence
d
wo
rri
es
w
h
en
fi
rst
l
y
d
i
agn
o
sed
to
dev
e
lop
TORC
H, especially a
b
ou
t th
e exp
e
nsiv
e co
st to
cure th
is illn
ess. P3
th
at h
a
s married
was also
worri
ed
if th
e TOR
C
H m
a
y in
fect h
e
r in
fan
t
ch
ild.
“P3
j
u
st
w
onder if later th
is d
e
sease w
ill also
attack
h
e
r ch
ild
o
r
n
o
t
. A
n
d
in
relatio
n
to
the
m
e
di
cat
i
on, i
f
every
t
w
o wee
k
s I h
a
ve t
o
s
p
en
d R
p
1,
0
0
0
,
00
0;
i
t
m
eans t
h
at
I have t
o
al
l
o
cat
e a bud
ger
of
Rp2,000,000; in a m
onth.
If I
continue taki
ng this m
e
dication, I’m
affraid
if I will just wa
ste
m
oney on i
t
, so I
deci
de t
o
st
op
t
h
e m
e
di
cat
i
on
fo
r a
w
h
i
l
e
.”
Sim
i
l
a
r t
o
P2,
t
h
e psy
c
hi
at
ri
st
al
so di
ag
no
sed P
2
as n
o
t
expe
ri
enci
ng t
h
i
s
so
rt
of a
n
x
i
et
y
.
Thi
s
i
s
because at the tim
e
the psychiatrist
exa
m
ined the anxiety level of P3, s
h
e
had
been alre
ady diagnosed
as not
havi
ng
TOR
C
H.
Ho
we
ver
,
d
u
ri
ng t
h
e
peri
o
d
w
h
e
n
s
h
e
wa
s ha
vi
n
g
her T
O
R
C
H
t
r
eat
m
e
nt
, P
3
a
d
m
i
t
t
e
d t
h
at
she
onc
e fel
t
wo
rri
e
d
, e
s
pec
i
al
l
y
i
f
her s
o
n
m
i
ght
de
vel
o
p t
h
e
sam
e
di
sease si
nce
P3
was
gi
vi
ng e
x
cl
usi
v
e
breast
f
eedi
n
g a
t
that tim
e
and
the ex
pe
nsi
v
e
cost
of TOR
C
H
m
e
di
cat
i
on.
“Of cou
r
se, I
was still b
r
east
f
eed
i
n
g
at th
at
ti
m
e
, wh
at mig
h
t
h
a
p
p
e
n
to
m
y
b
a
b
y
?
Cou
l
d
m
y
so
n
b
e
in
fected
?
Cou
l
d
it b
e
tran
sm
it
ted
to
m
y
h
u
s
ban
d
throug
h sex
u
a
l i
n
terco
u
rse?
”
In
add
itio
n
to
t
h
e anx
i
ety th
at th
e subjects of the resea
r
ch e
xpe
rience
d,
ba
sed
on t
h
e pe
rs
pectives
of
psy
c
hi
at
ry
an
d
neu
r
ol
o
g
y
,
i
t
i
s
al
so ex
pl
ai
ne
d
t
h
at
t
h
e an
xi
et
y
i
s
resul
t
e
d f
r
o
m
t
h
e effect
s of
brai
n dam
a
ge du
e
to
to
xop
lasm
a
attack
s. Based
on
th
e triang
u
l
ation
w
i
t
h
a neu
r
ol
ogi
st
,
whe
n
a pat
i
e
n
t
i
s
di
agn
o
sed
wi
t
h
TORCH, h
i
s/her p
s
ych
o
l
og
ical co
nd
itio
n
will ch
an
g
e
, su
rp
ri
sed
is th
e
first th
ing
th
at t
h
ey will exp
e
rien
ce.
Anx
i
ety grows sin
ce t
h
e
b
r
ai
n exp
e
rien
ces cerebritis.
“There a
r
e certain parts
of t
h
e brai
n that be
com
e
im
paired due t
o
the attacks
by this di
sease, so it
seem
s l
i
k
e t
h
e
pers
o
n
i
s
devel
opi
ng t
h
i
s
di
se
ase, psy
c
hi
at
ry
. Or i
t
m
i
ght
be t
h
at
t
h
e brai
n
i
s
not
di
st
ur
be
d b
u
t
as a res
u
lt of,
what is it, t
h
e
disease that is
not t
r
eat
ed
properly, e
x
cessi
ve anxiety, suc
h
c
o
m
p
laints might
arise, tho
s
e are qu
ite se
imilar, h
a
llu
cinatio
n.
"
To
xo
pl
asm
o
si
s i
s
acqui
re
d d
u
r
i
n
g p
o
st
nat
a
l
(aft
er
bi
rt
h), this form
is charact
erized by the existenc
e
of
t
a
ki
zoi
t
i
n
t
h
e
bl
o
o
d
a
n
d
ot
her
t
i
ssu
es, ca
usi
n
g
a
va
riety of cl
inical sym
p
tom
s
, such as
cervical
l
y
m
phaden
o
p
a
t
hy
, fe
ver
,
hea
d
ache
,
as
wel
l
as psy
c
hi
at
ri
c
and
ne
u
r
ol
ogi
c
a
l
com
p
l
i
cat
i
o
ns t
h
at
can
be
fo
u
n
d
i
n
i
m
m
unoco
m
pet
e
nt
pat
i
e
nt
s [1
2]
. I
n
T. go
nd
ii
cy
st
fo
r
m
at
i
on, a va
ri
e
t
y
of
brain cell
s
, including as
trocytes
and
neu
r
ons
,
can be i
n
fe
ct
ed, so t
h
at
vari
o
u
s c
h
a
nge
s suc
h
as
anat
om
y
,
imm
unol
ogy
,
pa
t
hol
o
g
y
,
neu
r
ot
ran
s
m
i
t
t
ers a
n
d
gene
exp
r
essi
on
m
a
y
occu
r
d
u
ri
n
g
t
h
e
brai
n
i
n
f
ect
i
on
by
T. go
nd
ii
. Som
e
of these
chan
ges
m
a
y
al
so
pl
ay
a r
o
l
e
i
n
cau
si
n
g
vari
ous
n
e
u
r
ol
ogi
c
a
l
di
so
rde
r
s
[
1
3]
.
M
a
ny
fact
ors i
n
fl
uence a
nxi
e
t
y
,
one o
f
w
h
i
c
h i
s
soci
al
su
pp
o
r
t
fr
om
fam
i
ly
[9]
.
Soci
al
sup
p
o
r
t
i
s
defi
ned as the
prese
n
ce of ot
hers
who can
be relied on
to ask for hel
p
, e
n
couragem
ent and acce
ptance
whe
n
one e
xpe
ri
enc
e
di
ffi
cul
t
y
[9]
,
and t
h
e
pres
ence o
f
phy
si
c
a
l
and psy
c
h
o
l
ogi
cal
com
f
ort
gi
ven
by
fri
e
nds
or
fam
i
l
y
[11]
. S
o
ci
al
su
pp
ort
a
l
so co
ver
s
ve
r
b
al
an
d
no
n-
v
e
rbal
i
n
f
o
rm
at
ion
o
r
real
assi
st
ance gi
ven t
h
r
o
ug
h
social fam
i
liarity because thei
r pres
ence
provides em
otiona
l usefulness
or
beha
vioral effe
cts for t
h
e reci
pient
[11
]
. It can
b
e
co
n
c
l
u
d
e
d
t
h
at fam
i
ly su
p
port is a
p
h
y
sically an
d
p
s
ych
o
l
o
g
i
cally co
m
f
ortab
l
e cond
ition
th
at
affects and
is
p
e
rcei
v
e
d
b
y
an
ind
i
v
i
du
al fro
m
h
i
s/ h
e
r famil
y
en
v
i
ron
m
en
t and
th
e ind
i
v
i
du
al will get h
e
lp
and
s
u
p
p
o
rt
w
h
en
s
h
e/
he
i
s
havi
ng
t
r
ou
bl
e.
Ty
pes
of
fam
i
ly
sup
p
o
rt
[
12]
:
1)
Em
o
tiona
l su
ppo
rt
, whic
h is an expres
sion of em
phaty, care and
atten
tio
n
to
an
in
d
i
v
i
du
al so
th
at th
e
i
ndi
vi
dual
feel
s com
f
ort
a
bl
e,
l
ove
d a
n
d
care
d
a
b
o
u
t
.
2)
Est
e
e
m
s
u
p
port
, wh
ich
is an
expression o
f
ag
reem
en
t an
d
a
po
sitive assessm
en
t
o
f
i
d
eas,
feelin
g
s
and
per
f
o
r
m
a
nce, as wel
l
as enc
o
ura
g
em
ent
t
o
m
ove for
w
a
r
d
gi
ve
n t
o
a
n
i
n
d
i
vi
dual
i
n
o
r
d
e
r t
o
est
a
bl
i
s
h
h
i
s/
her
confide
n
ce when
e
xpe
rienci
ng press
u
re.
3)
I
n
st
r
u
me
nt
a
l
supp
ort
,
whi
c
h i
s
di
rect
assi
st
ance pr
o
v
i
d
ed
based
on
what
an i
n
di
vi
dual
nee
d
s
,
su
ch as
providing fina
ncial
assistanc
e
, provi
ding a
place to
say,
or doing ce
rtain t
a
sks.
4)
In
fo
rma
tio
na
l su
ppo
rt
, w
h
i
c
h
i
s
p
r
o
v
i
s
i
on o
f
a
dvi
ce,
g
u
i
d
a
n
ce, su
gge
st
i
ons
o
r
f
eedbac
k
so
t
h
at
an
in
d
i
v
i
d
u
a
l
can
li
mit th
e p
r
ob
le
m
an
d
t
r
y to
fin
d
a way
ou
t to
so
lv
e th
e
p
r
ob
lem
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
An
xiety and
Fam
ily Su
ppo
rt
on Infected
TOR
C
H
P
a
tients
(E
irene Shi
nta V
a
levi)
25
1
All these three
inform
ants gained
s
u
pport from
their own
fam
i
ly wh
en t
h
ey becam
e infected
with
TORCH. T
h
e
fam
i
ly
that liv
ed with
the inform
ants became the first to
prese
n
t whe
n
the inform
ants were
expe
rienci
ng t
h
e sym
p
to
m
s
of TORC
H and
they were al
ways th
ere wh
en
th
e inform
an
ts were tak
i
ng
TORCH
med
i
catio
n
.
In th
e case o
f
P3
, alth
oug
h
th
i
s
in
form
an
t d
i
d
no
t liv
e at h
o
m
e with
i
t
s p
a
ren
t
s, th
is info
rm
an
t
always found t
h
e s
u
pport t
h
at it neede
d
.
The
prese
n
ce a
nd
su
p
p
o
r
t
fr
o
m
parent
s a
n
d
spo
u
ses
ha
ve a
m
a
jor i
m
pact
on t
h
ei
r
heal
t
h
,
t
h
ey
co
ul
d
im
prove and a
ccelerate healing a
n
d im
prove com
p
liance w
ith the
rules
of t
h
e use of
drugs
[14]. T
h
rough al
l
these types of family support that
they received, the
s
e three inform
an
ts could
go through the pe
riods of
TORCH m
e
d
i
catio
n
th
at was
ex
p
e
n
s
i
v
e and
to
ok
a lo
ng
time well. Fa
m
i
l
y
su
pp
ort m
a
k
e
s p
r
o
d
u
c
tiv
ity o
f
the
in
fo
rm
an
ts which
o
n
ce
was disrup
ted
du
e to TORCH in
fe
c
t
i
ons bec
o
m
e
s
no
rm
al
agai
n, i
n
f
o
rm
ant
s
’ an
xi
et
y
ab
ou
t th
ing
s
th
at in
terfere with
th
eir p
s
ycho
log
i
cal
well-bein
g
is red
u
c
ed
, and
th
e inform
an
ts can
m
a
in
tai
n
their physical health
althou
gh infected with TORCH.
4.
CO
NCL
USI
O
N
4.
1.
An
xiet
y
P1 e
xpe
ri
ence
d an
xi
et
y
,
w
h
i
l
e
P2 an
d P
3
di
d
not
.
These
three in
fo
rm
ants we
re w
o
rri
ed since t
h
e
y
had t
o
u
n
d
er
g
o
T
O
R
C
H
t
r
ea
tm
ent
i
n
t
h
e l
o
ng
r
un i
n
w
h
i
c
h t
h
e
pri
ces
of
t
h
e d
r
u
g
s
wer
e
expe
nsi
v
e. T
h
ese
si
t
u
at
i
ons m
a
de i
n
fo
rm
ant
P2 st
oppe
d i
t
s
TOR
C
H
t
r
eat
m
e
nt
i
n
t
h
e secon
d
m
ont
h of t
h
e
t
r
eatm
e
nt
, wh
i
l
e
P1
an
d
P2
still h
a
d
th
eir TORCH treatm
e
n
t
. P
1
wh
o
is a stude
n
t
was wo
rried
abo
u
t
no
t p
a
ssin
g
th
e co
urses as P1
ofte
n ski
ppe
d t
h
e class. P2 and P3 are m
a
rried and eac
h
h
a
s a ch
ild
so
t
h
at th
ey were worried
if t
h
is TORCH
d
i
sease m
i
g
h
t
b
e
tran
sm
itted
to
th
eir own
child
.
4.
2.
Family Sup
port
All th
ese t
h
ree in
fo
rm
an
ts obtain
e
d
em
o
tio
nal sup
p
o
r
t, est
e
e
m
su
ppo
r
t
, in
stru
m
e
n
t
al su
p
por
t, and
in
fo
rm
atio
n
a
l su
ppo
rt fro
m
th
eir o
w
n
fam
i
ly
. Th
ey all liv
e with
th
eir
fam
i
ly, su
ch
as t
h
eir p
a
ren
t
s
o
r
p
a
ren
t
s
in-laws
,
thei
r
husband
or wi
fe
, their child
, their sib
ling
s
, and
th
ei
r
o
t
h
e
r relativ
es.
The researc
h
e
r
offe
rs a
num
b
er of s
u
ggestions
with respect to a
n
xiety and fam
i
ly support
for
p
a
tien
t
s infected
with
TORC
H,
n
a
m
e
ly
:
a.
For T
O
RCH
patients who experie
n
ce a
nxie
t
y, they
are e
xpect
e
d
t
o
fi
n
d
out
m
o
re a
b
out
TOR
C
H
a
n
d
con
s
ul
t
m
e
di
cal
or
pa
ram
e
di
cal
pers
o
nnel
i
n
or
de
r t
h
at
t
h
e
i
r an
xi
et
y
do
es
n
o
t
m
a
ke t
h
ei
r p
s
y
c
h
o
l
o
gi
cal
wel
l
-
bei
ngs
di
s
t
ur
bed
.
b.
For T
O
RCH
patients, they a
r
e ex
pected
to ask for
m
o
re fa
m
i
ly
suppo
rt
for thei
r treat
ment and recovery
.
Sev
e
r
a
l th
ing
s
th
at can
b
e
done in
clud
e:
1)
Inc
r
easi
n
g t
h
e
fre
que
ncy
of
c
o
m
m
uni
cat
i
on
and
t
e
l
l
i
ng a
b
o
u
t
t
h
ei
r
heal
t
h
i
m
provem
e
nt
.
2) Taki
ng fa
mily
m
e
m
b
ers to ta
ke turns
accom
p
an
ying thei
r treatment and
m
eeting the
doctor who
exam
ines them.
3
)
Exp
l
ain
i
ng
an
d d
i
scu
ssing
t
h
e
med
i
cal co
st so
th
at it
will not b
e
a
bu
rd
en
du
ri
n
g
th
e
h
ealin
g pro
cess.
c.
For health
obs
e
rve
r
s (h
ealth
workers, stude
n
ts and
th
e
commu
n
ity), th
is research
is e
x
pected t
o
m
a
ke a
pu
bl
i
c
heal
t
h
p
r
om
ot
i
on p
r
og
ram
t
h
at
can i
n
crease
k
n
o
w
l
e
dge a
b
out
m
e
nt
al
heal
t
h
an
d
TOR
C
H
. Se
v
e
ral
t
h
i
n
g
s
t
h
at
ca
n
be
do
ne a
r
e:
1
)
Edu
catio
n
o
n
th
e ep
id
em
io
lo
g
y
, effects as well as p
r
ev
en
t
i
v
e
an
d
curative
m
easu
r
es and
reh
a
b
ilitatio
n
of
TOR
C
H.
2)
Inc
r
easi
n
g t
h
e
m
a
rket
i
ng
of
heal
t
h
y
and
hal
a
l
m
eat
co
nsum
pt
i
on t
h
r
o
u
g
h
bet
t
e
r r
e
gul
at
i
o
n a
n
d
su
perv
ision
.
3)
Or
ga
ni
zi
ng
he
al
t
h
exam
i
n
at
ion
pr
o
g
ram
s
and m
e
nt
al
heal
t
h
t
e
st
s on a
reg
u
l
a
r
basi
s a
i
m
e
d at
hi
gh
sch
ool
st
ude
nt
s
,
col
l
e
ge
st
u
d
e
n
t
s
, em
pl
oy
ees, o
r
c
o
m
m
uni
t
i
es wi
t
h
a
hi
g
h
ri
sk
f
o
r a
n
xi
et
y
o
r
T
O
R
C
H
.
4)
Public service
announcem
ents on
an
x
i
ety fa
m
i
l
y
su
ppo
r
t
an
d TO
RCH
on
telev
i
sion
o
r
so
cial m
e
d
i
a.
Tel
e
vi
si
on
a
n
d
soci
al
m
e
di
a are
very
po
we
rf
ul
m
e
di
a for
i
n
fo
rm
ati
on
di
ss
em
i
n
at
i
on.
d.
For furt
her res
earch, c
o
m
p
arativ
e studies
with m
o
re s
u
bjects are
expe
cted
to
con
d
u
c
t
,
wh
ich con
s
ist o
f
newl
y
-
di
ag
n
o
s
e
d wi
t
h
T
O
R
C
H pat
i
e
nt
s,
TO
R
C
H
pat
i
e
nt
s
wh
o are
pre
g
n
a
nt
or
ha
ve gi
v
e
n bi
rt
h rece
nt
l
y
,
or subjects
with
othe
r c
h
aract
eristics th
at currently undergo
TORCH t
r
eatment.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS
Vol. 3, No. 4,
Decem
ber 2014
: 246 –
252
25
2
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