Improving health and well-being with the help of cloud computing

ickybiblegroveInternet and Web Development

Nov 3, 2013 (4 years and 1 month ago)

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Improving health and well
-
being with the help of cloud computing


Boris Horvat, UP PINT,

Muzejski trg 2, 6000 Koper,

boris.horvat@upr.si

Primož Lukšič, UP PINT,

Muzejski trg 2, 6000
Koper,

primoz.luksic@upr.si

Lea Jensterle, UP PINT,
Muzejski trg 2, 6000 Koper,
leajen@gmail.com


Abstract

Health 2.0 is a term that describes web applications aimed at solving problems in the area
of health

care

and medicine by helping patients
(
and docto
rs
)

to gain important
information, share data, gain insight of their health state and connect with others with the
same issues.
W
e use
a
similar definition for Environment 2.0

when observing the
environment
.
Even broader
definitions
of

e
-
health and e
-
envir
onment
are used
for
describing processes
in health care and
the
environment that

are electronically / digitally
covered,
instead of
just being available on the Internet.

The article summarizes the present state and challenges in the area of e
-
health and e
-
environment in Slovenia

and worldwide, recognized within project P7 of the competence
centre KC CLASS.
Also presented are s
uggestions for new solutions and implementations
of several pilot e
-
health applications using cloud computing concepts.


Keywords

cloud computing, e
-
health, e
-
environment, health 2.0, mobile applications, sensors


1

Introduction

Project P7


“Cloud services for supporting health and environment” is one of the projects
dealing with cloud computing in Slovenian competence centre KC CLASS.
The goal of
project P7 is to offer objective results and guidelines for developing novel cloud
-
based e
-
health and e
-
environment systems b
y doing experimental research in the fields of cloud
computing, e
-
health and e
-
environment which follow
s
national guidelines and strategies,
combined with study solutions, pilot applications and analyses of these s
olutions.







2
/
14

The definitions of e
-
health and e
-
environment are used for describing processes in health
care and environment, which are electronically / digitally covered. When focusing only on
web applications aimed at solving problems in the area of health
care and medicine we use
the term Health 2.0 and similarly Environment 2.0, when observing the environment.


2

Challenges of e
-
health

In recent y
ears we have witnessed the use

of Internet for various health

care
related
reasons
from the perspective of

end
-
u
sers, especially patients. The users, who
when

being ill

used
to depend only on the doctor and his treatment, now want to actively influence and take
control over their

health and the healing process. The W
eb, with the different services it
provides and no
vel mobile technologies, represents a suitable and reliable communication
and collaboration channel.

Primary health

care demands of
users in the context of (their) health are:
to
get as much
information as one can from different aspects about a specific d
isease;
to
take more active
role in curing the disease;
to
use the applications and electronic services with which one
can simplify the process of healing
, etc
. These e
-
services in collaboration with health

care
institutions, their services and information

systems, combined with active role of all
participants of health

care system, are defined as e
-
health, which is a part of
the
global
strategy
of
Health 2.0.

In recent years in the context of global e
-
health activities, many different applications a
nd
serv
ices have been developed

which serve users i
n improving their health

or getting the
information they need. The services can be roughly divided

into three groups which enable
1) acquiring information,

2) social inclusion and networking, and

3)
informatization and
automation of different user scenarios with health care institutions.


Even though Internet offers a great potential in developing services in the area of e
-
health,
huge amount
s

of data and different fragmented services cause trouble f
or the users. They
have trouble identifying suitable and verified services from the aspect of reliability, safe
use and data confidentiality. Due to fragmentation o
f information, users have to utilize

several different applications and services at the same

time, which takes more time,
especially because of disconnection of some services, which can clearly be associated.






3
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14

B
ecause of the dimension of the Internet, users are not
even
aware
of the existence of
some
services. A potential solution for these troubl
es lies in the development of a larger
collabor
ation system

that

will logically connect different services and applications and
consequently enable access
through one entering point. T
his is at the same time one of the
goals of the project

P7

in the contex
t of e
-
health.

Modern technological solutions have not always been successfully accepted among the

healthcare providers and users

due to unreliability of the system
s

and additional
bureaucracy. One of the key aspects for successful adoption of a new inform
ation system
by health

care professionals is in helping them
to become more effective and obtain
control
over all dependent sub
-
systems, which are crucial for providing good quality services (and
content that is being served). Hence the quality of the clou
d service is necessary for the
involvement of professionals and
for the existence of the user

community.

Because of the sensitivity of the field

it is necessary to pay special attention to data
acquisition, data security, data storage, collection and proce
ssing. It is necessary to ensure
the results will be in accordance with all current regulations in Slovenia which concern
personal data:
Personal Data Protection Act,

Electronic Communications Act
,

Patient

s
Rights Act
,

Decision


Surveillance of the Locat
ion a
nd Health State of the Patients,

Decision


Global Positioning System (GPS) surveillance
,

etc.

With the review of online health service market, we can conclude that a lot of applications
exist to facilitate the planning of a healthy lifestyle and help

diagnose and cure diseases,
though most of these tools are intended for foreign markets. Particularly
,

for the Slovenian
market there is little quality interactive content

dealing

with health is
sues of type Web 2.0.
Based on the

list of applications a plan was made to implement several applications to help
patients with treatment of their health problems.


3

Situation in Slovenia

In the
context of development vision of

Slovenia, e
-
health has an important strategic and
national sig
nificance and is regulated nationally with various plans and strategies that
include health system informatization.

I
n practice
,

however,
we can

talk about different
levels of
informatization
when observing different
institutions

and
recent attempts of

dev
elo
ping

new solutions for
end
users.







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14

In Slovenian health

care the first steps in basic computer technology education were made
relatively recently together with introduction of computer technology equipment
,

implementation of
computerized

exchange of busin
ess data
,

establishment of standards and
data collections and introduction of health

care insurance card system

(KZZ)
.

With the
latter

we achieved a high visibility in Europe,
with our experiences being
used in similar
card projects in other countries.

On
e of the achieved milestones of
the previous period is also the

implementation
of
data

reports

about hospital admissions for the needs of classification in the diagnosis related
groups


DRG
; this method is known is Slovenia as SPP


“skupine podobnih prim
erov”
.
At the same time, other
applications in health

care were developed: electronic discharge
letter
s
; data
monitoring
for risk factors for cardio
-
vascular diseases; test introduction of
digitalization of radiology with

PACS implementation; connection of

providers of health

care services with laboratories; applications for covering emergency health

care help in
dispatcher service
,

etc.

W
hile

develop
ing

and
introducing
the
se applications,
a large
knowledge base

was formed
,
based mainly at

the Health Insurance Institute of Slovenia
(ZZZS) and with providers of information services for health

care practitioners.

Despite

that

basic informatization of health

care organizations in Slovenia
was done early,
we still don't have a
health

care information system

t
hat can be manageably upgraded or

connected to other information
(sub
-
)
systems

. Many
such (sub
-
)
systems were developed
for the needs
of
individual public health

care institutions and are meant especially for
satisfying thei
r own requirements, but are not
inter
-
operable

enough.
For

the
development
of
an
information system
for

Slovenian health

care
,

we still have to tackle
a lot of
inadequacies, which strategic plans try to eliminate.

The vision of informatization of

Slovenian
health

care system is:



e
ffective, adjustable and modern health

care informatics to support achieving
strategic goals of Slovene health

care system for satisfying the needs and interests
of citizens, health

care professionals, leaderships of
health

care organizations and
health

care system managers;



c
onnecting local information systems which will enable citizens and health

care
professionals to cross the administrative and organizational boundaries

when
searching for information,

and to commun
icate directly without temporal or
organizational limitations.







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14

This vision is being realized
using

the following strategic directions:



i
ncreasing the active role and responsibility of citizens in their care for their health
,

ensuring the citizens are bein
g properly informed and ensuring the best possible health
care;



e
nabling health

care professionals secure and reliable access to key information in
electronic health records and other data collections that they need in their everyday
work, with effective e
lectronic communication, better learning and knowledge
management;



e
asier planning and management of
a
health

care organization or
the
health

care system
as a whole on the basis of quality and credible economic, administrative and clinical
data
;



i
mproving
accessibility of health

care services for those patient groups that would be
otherwise excluded on the basis of their lower chances, age or other reasons
;




e
stablishing of basic informatization infrastructure and defining basic collection of
health and
social data for establishing and managing electronic recording of health data
of the patients as well as establishing the foundations f
or electronic recording of this

data on a national level
;



c
onnecting health

care and social information systems into an i
ntegrated system on a
national level with special emphasis on the establishment of standardi
z
ed health care
information portal, which will enable secure and reliable data exchange and
standardi
z
ed and schematic informing and connectivity with comparable EU

systems to
all subjects of health care system
;



e
ffectuation of
e
-
b
usiness a
s a usual way of work in Slovenian

health

care.

In the long run new solutions in the area of
e
-
h
ealth will be needed which will be helpful or
beneficial to all the

participants, i.
e. patients,

users of health

care services
,
health

care
providers,

health care system management
,

health

care ministry
,

and
to the
health

care
system as a whole.

In the context of the project we are monitoring examples of good
practice in Europe as well as

all
over the world. E
-
h
ealth is a popular subject, addressed by
all countries around the world as well as companies, multinational enterprises and web
giants (Google, Microsoft
,

etc.). Despite that in the context of
e
-
h
ealth national projects are
currentl
y effectuated only in some countries Scandinavian countries: Denmark,
Netherlands and Finland
;

with
another p
retty good system being
use
d

in Croatia.







6
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4

Connections

between environment and health

Environment, which we live in,

directly af
fects our health
and well being. T
herefore
,

research
that

investigate
s

the connection between health state of individual and
the
environment that he
or she
lives in

is
of key importance for improving

the

living
environment and health of the population. Environment affects
the individual in different
segments: through
pollution,
air, water, weather changes
,

etc
. As one of the important
factors in health related issues,

the

emphasis is also on finding
a
connection between health
and the state of the environment, particularly
in
the

quality of air.

In the context of e
-
environment (within the project P7) we have focused especially on the effect of air quality
on development of lung and cardiovascular diseases.

The research in this area has until now been done especially in regio
ns, where there is
more

air pollution
because of

various reasons

(factories, transportation
, etc.
)
. In Slovenia
this is especially
the
region of Primorska (Luka Koper, vicinity of the port in Trieste,
logistics, increased traffic due to touristic activitie
s) and Šaleška dolina (industry,
power
plant
, coal

mine
,

etc.). Environment data in Slovenia is being collected by several
organizations and offices

and disseminated over
the
Internet. D
ata can be found on web
-
pages
of Statistical Office of the Republic of

Slovenia and Slovenian Environment Agency

and at

other

data sources with environmental data in Slovenia
managed by

faculties,
research ins
titutes, local communities, etc
. Environmental data
for

Slovenia
is

available
also on
web
-
pages of European
Statistical office of EU (Eurostat) and European
Environment Agency. Slovenian Environment Agency also manages Catalogue Data
Sources, which represents overview of the data, collected on the side of national as well as
other institutions.

But
almost
none o
f those
services

are using cloud
computing concepts
.


5

Including sensor data

Institutionalized health care a lot of times drives people away

from such services
.

A
ccording to research approximately one third of people asked would be prepared to pay a
small
amount of money to have more independency
, offered by

control tools

equipped with
intelligent sensors
. Amon
g possibilities for sensor tool

use
s are
:







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Movement sensors that control if
the elderly

move normally in their home
s
, and also
warn, when there is a
suspicion t
hat a person has fallen or has no
t
got
ten

up from the
bed yet.



Movement sen
sors that people can wear,

e.g.
tools that help with losing weight where
people record the food they have eaten and the system then calculates the difference
between used

and consumed calories.



B
racelets for measuring blood pressure and
glucose meter
s

that send data through
mob
ile devices to patient’s doctor

who can then monitor and detect early signs of a
disease.



Patients with chronic conditions like arthritis, asthma an
d diabetes can themselves take
care of the s
tability of their health state

and in this way can avoid hospitalization. The
solutions for the stability of chronic conditions include monitoring of
vital signs

(
weight, blood pressure, insulin
) and storing

the data in
a

central repository. When the
results drop below or
raise
above the acceptable level, defined
individually
for every
patient, the system automatically informs the competent health

care workers that
an

intervention is needed.



Mobile measurers

of environmental pollution that people can wear. In this way we
measure the exposure to
harmful environmental effects (e
.
g
. passive measurers of
ozone exposure). This data can also be used in detailed
modeling

of pollution
expansion.


We can find several

foreign applications

which
already
includ
e sensor and other patient
data;

for example for measuring insulin and blood pressure: CardioSmart (
American
College of Cardiology),

Diabe
tesPHR,

20/20 LifeStyles, Aetna Personal Health Record,

Acti
vePHR (ActiveHea
lth Management),

Epilepsy Diary (Epilepsy T
herapy Project and
Irody, Inc.),

ApoThera (Drug Regimen Review)
, etc.
.


6

Solutions

Expected results of the project in the context of
e
-
h
ealth and
e
-
e
nvironment are
research
papers, study
solutions
, development and

implementations, intended for different health
aspects of the patient
s

and individual
s
, interested in environmental problems. Study
implementations of

a

multichannel
location
-
based
platform will be developed, which will






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inform the user about
some
meteorological parameters and pollution data, warn about
possible health dangers and
raise alerts on

important information about prevention and
curing of various diseases, especially the ones, connected with pollution.

We are aware that prevention and
edu
cation are of key importance
, t
herefore,

why we will
dedicate special attention to informing the public about risks, connected to pollution. We
will make sure that information will be ad
apted

to different target groups, and will also be
ready to be
used in

school
s
.

In recent years there have been more and more web health care services worldwide that
offer various services for the patients as well as for doctors
,

and also serve as a
communication tool between both sides. Among the most used services are: po
rtals for
general public,

body mass index calculators
,

web tools for healthy diet planning
,

portals
with described diagnoses and responses to users’ questions (from doctors and other
medical staff)
,

pages with advice for healthy lifestyle, recreation and d
iet
, etc
. The most
representative ones are:



Health care portals
:

MerckEngage; MyFamilyHealth; LifeMojo; HealthcareMagic;
Revolution Health;
WebMD
; Healthwise ; RememberItNow!; FreeMD.



Health care communities
:

Daily Strength; Psych Central; TuDiabetes.com
;
SpineConnect.com; Sermo; Patients Like Me; TimedRight; eDrugSearch; Organized
Wisdom; MDJunction; HITSphere; WalkingSpree; CareFlash; Medting; CureTogether;
FacetoFaceHealth.



Health care consultancy
: Healthgrades; Health Dialog; Health2.Info; CiteHealth.



Financial services in the health care area
:

First Horizon Msave; Health Equity;
MedBillManager; MyMedicalControl.



Personal (health

care) records
:

Keyose*; SugarStats.com; MedCommons
;
Tolven
Health; Medic Drive; NoMoreClipboard.



Pages for comparisons in
the health care area
:

Vimo; RateMDS; HealthShoppr;
Intelecare Compliance Solutions; Medziva; InforMed Centers; MyMedLab;
eHealthMe.



Other (undefined)
:

Click4Care; biowizard.com;
Health wikis
; Yahoo Health &
Welness Groups; American Diabetes Association Mes
sage Boards; Microsoft Health
Vault; WhoIsSick; Google Health; Keas; SickKids.







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Slovenian portals with health

care

information
:

Institute for researching the burnout
syndrome and psychotherapy; Viva.si; Med.over.net; Open platform for clinical food
(OPKP); Zdravstvena.info; Zdravjelepota.si; Vizita; SRC infonet; Draagle.

Within the project we will continue to research the trends an
d challenges in the areas
mentioned, and we will deal especially with study implementations of the modules, which
will represent
an
important part of
a
multichannel platform

using location
-
based services
,
described below.

Tools which automatically remind
the user on repeating events and inform the user of
the newest findings in the area that directly affect him
.

We will develop study
implementation
s

of a program
library
, a web application and a mobile application that will
enable registration to the events

and setting
of

events. Examples of such events are: terms
of doctor's appointments or appointme
nts in health care institutions, schedules for taking
medicines,

reminders on approaching vaccinations (for vaccinations that are repeated in
intervals), remind
ers on approaching periodical a
ppointments and optional events

associated with the health interest of the patient
,

etc. With this application a study
implementation of the

reminding

service on the newest findings in the area of
patients’

interest will be d
eveloped. This service will be intended for patients as well as their
personal doctors. Environmenta
l issues will also be addressed

by developing study
implementations of applications, which warn the user of potential pollutants in the air and
propose prev
entive actions.

Tools for making and coordinating appointments with doctors
.

A study
implementation of a cloud service for making appointments with the doctor
will be
performed
. Data
will be stored in a cloud

and integration with the
reminding
system will
also be possible.

Tools for patient
-

docto
r

communication
.
A study implementation of the tool for
communication between
the
doctor and

the

patient, named “MyDoctor”, will be available
as a web portal and will represent a social component in t
he line of
e
-
h
ealth tools. In the
continuation of the project we will
offer
support for mobile clients as well.

Support for computationally intensive analytics in the cloud
-

connection with SaaS
.
We will develop a study implementation of the frame
work
, in
tended for
computationally
intensive
analyses on large amounts of medical data. For acquiring useful information,






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rules and patterns and connections between them we will also make use of data mining
principles

and techniques
.
W
e will try to find connection
s between individual factors

by
analyzing medical data
.

T
he
focus
will be
on the impacts of the environment (in
connection
to
location), especially the impacts on appearance certain signs of a disease in a
selected area.

Tools for data
anonymization
and us
age
.

We will
develop

a study implementation of
module for data
anonymization
. We will examine different possibilities of usage of
anonymi
z
ation algorithms, identify the most suitable and on the basis of these
,

design
our
module for anonymi
z
ation

of medical data
. Phase of prototype implementation will be
followed by evaluation, on which we will implement possible needed improvements of
program module.

Tools for health care
optimization



connection with
logistics
.

A

study implementation
of the clo
ud application will be developed, that will include the
support
for

multichannel
capture, display and optimization of resource
s,

and time management in
the
health care
system. We will select
a
few
optimization
problems, e.g.

optimization of waiting queues,

schedule problems, optimization of usage of healthcare materials, reservations
, time
management
,

and information

support to certain processes of the treatment. The
implemented

study

solutions will be able to
tackle
those problems that users until now
have

n
o
t been able to solve efficiently. Special focus
will be

given to cloud implementation
of clinical pathways, which are an important tool for improving care processes in hospitals.

Educational content and data visualizations


connection to e
-
learning
.

In this section
we will design multimedia
-
rich educational content with interactive quizzes, through
which the public will be able to inform itself about pollution impact on health. The section
will be specifically ad
justed for different age groups, where

s
pecial attention will be paid
on groups of people, for which exposure to pollution is especially dangerous. The
educational content will be prepared in such a way that could be used on out
-
door screens
and in school settings.

Interactive map with pollut
ion levels
.

We will make a study implementation of
an
interactive map of the coast region, on which it will be possible to observe momentary
level of pollution
using

many p
arameters,

check if ther
e is danger for exceeded levels, and

check the real time mea
sures and history of pollution for selected area. Where possible
,

we






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will integrate publicly available data from automatic measuring stations and results from
measures in the field with passive measurers. Our aim is to investigate the relationship
among lo
cation
-
supported mobile services of monitoring
environmental impacts on
people’
s health.

Prototype integration of cloud services and location
-
aware mobile devices in the
context of e
-
health and e
-
environment.

We will make study implementation
s

of
comput
er libraries
and application
s

for
mobile devices running on
iOS and Android
operating systems

that will support
the
use
-
cases stated below.



Calculator of estimated risk for diseases.

The user will enter into his device or
computer his general lifestyle. I
n this way the user will adjust the parameters for
simplified automatic generation of risk estimation and environmental impact on
health. Wherever possible, mobile device will use data gathered from sensors,
especially location
-
based data and publicly avai
lable data from meteorological
stations
.



Impact of weather on health state/condition
. The user will be able to subscribe to
the cloud service, which will send the information on impact of weather on health,
together with real time weather data and
forecasts. Location of the user will be
determined automatically.



Meteorological alarm/alert
. The study implementation
of

a

cloud service that will
send alerts to subscribers when they will be located in the area, where allowed
concentration of harmful su
b
stances in the air is exceeded.
The service will

s
end the
user a notice

with alert about exceeded concentrations, level of risk and
recommendations and directions for preventive measures
.



Carbon print.

The user will be able to follow his movement with his device and
gain a rough approximation of calculation of CO
2

releases, which have been made
in this time. The mobile device will measure the velocity of movement, location,
time and from velocity and lo
cation make a simplified assessment of users »CO
2

print«.



The nearest doctor.

A s
tudy implementation
of
multichannel application
,

which
will be intended especially for tourists that come to Primorska region in the
summer. The users will be able
to
access d
ata about the nearest hospital,






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community health centre and pharmacy according to where they are cu
rrently
located.



Multichannel applications »My Pharmacy« and »My well being«
. A study
implementation of multichannel application »My Pharmacy« will be develo
ped,
including: a catalogue of medicines for certain diseases, a display of side effects,
information about proper medicine storing, reminder for medicine usage and their
dosage, a display of home supply
,

etc. We will also research
the
possibility of
integration of e
-
prescription,

verification of compatibility of various drugs, presents
the composition of medicines, and warns about the potential side effects
.

The
application

“My
well being”
will capture data about the state of the patient
(depression,
disease, well being,
and satisfaction

of the user with health services
).
The users will have an option to check their physical and
mental

state and get
personalized instruction for prevention and
treatment
.



Algorithms for
linking the

history of the state o
f the air
pollution
with the
number of occurrence of certain diagnoses
. Within the project a research on
statistical algorithms will be performed, throug
h which simplified statistical and
epidemiological

occurrence of certain diagnoses in a certain area re
garding the
change in pollution will be modeled. In this way we will try to get important data
about the impact of pollution on health of the people,

and

findings about age
groups, which are influenced the most by environment. The acquired knowledge
will s
erve as a further development of the tool for health workers, Institute for
Health Protection and other health organizations for planning preventive health
care.

7

Conclusion

E
-
health
will be the next step in the development of health
services;

however, the
adoption
will depend on the quality, availability
and the user experience.
In close

relation with

heath

issues

is also the impact

of the e
nvironment

pollution on the health of population.

The
research and resulting services of the project P7 will present a step in the direction

of e
-
health and e
-
environment by providing users more reliable health related information
quickly and easily.








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8

Literatur
e



http://www.ris.org/uploadi/editor/1130935
067OsnutekeZdravje2010
-
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Zdravje
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Zakon o elektronskem poslovanju in elektronskem podpisu (uradno prečiščeno
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Navodilo za uporabo spletne objektne storitve (arso wfs)


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Wikipedia.org Shapefile,
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14
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osebnih
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podatkov/inspekcijski
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nadzor/najbolj
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pogoste
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krsitve/zdravstveni
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podatki