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Möllsten, Anna
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Publications (10 of 36) Show all publications
Waernbaum, I., Lind, T., Möllsten, A. & Dahlquist, G. (2023). The incidence of childhood-onset type 1 diabetes, time trends and association with the population composition in sweden: a 40 year follow-up. Diabetologia, 66(2), 346-353
Open this publication in new window or tab >>The incidence of childhood-onset type 1 diabetes, time trends and association with the population composition in sweden: a 40 year follow-up
2023 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 66, no 2, p. 346-353Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: During the 1980s and 1990s, the incidence of childhood-onset type 1 diabetes more than doubled in Sweden, followed by a plateau. In the present 40 year follow-up, we investigated if the incidence remained stable and whether this could be explained by increased migration from countries reporting lower incidences.

Methods: We used 23,143 incident cases of childhood-onset type 1 diabetes reported between 1978 and 2019 to the nationwide, population-based Swedish Childhood Diabetes Registry and population data from Statistics Sweden. Generalised additive models and ANOVA were applied to analyse the effects of onset age, sex, time trends and parental country of birth and interaction effects between these factors.

Results: The flattening of the incidence increase seems to remain over the period 2005–2019. When comparing the incidence of type 1 diabetes for all children in Sweden with that for children with both parents born in Sweden, the trends were parallel but at a higher level for the latter. A comparison of the incidence trends between individuals with Swedish backgrounds (high diabetes trait) and Asian backgrounds (low diabetes trait) showed that the Asian subpopulation had a stable increase in incidence over time.

Conclusions/interpretation: In Sweden, the increase in incidence of childhood-onset type 1 diabetes in the late 20th century has been approaching a more stable albeit high level over the last two decades. Increased immigration from countries with lower incidences of childhood-onset type 1 diabetes does not provide a complete explanation for the observed levelling off. Graphical abstract: [Figure not available: see fulltext.]

Place, publisher, year, edition, pages
Springer-Verlag New York, 2023
Keywords
Children, Immigration, Incidence, Time trend, Type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-200671 (URN)10.1007/s00125-022-05816-0 (DOI)000870664000001 ()36264296 (PubMedID)2-s2.0-85140249104 (Scopus ID)
Funder
Swedish Research Council, 2018-02565Swedish Research Council, 2016-00703
Available from: 2022-11-07 Created: 2022-11-07 Last updated: 2023-01-11Bibliographically approved
Fredriksson, M., Persson, E., Dahlquist, G., Möllsten, A. & Lind, T. (2022). Risk of cancer in young and middle-aged adults with childhood-onset type 1 diabetes in Sweden - A prospective cohort study. Diabetic Medicine, Article ID e14771.
Open this publication in new window or tab >>Risk of cancer in young and middle-aged adults with childhood-onset type 1 diabetes in Sweden - A prospective cohort study
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2022 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, article id e14771Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: In persons with type 1 diabetes, the risk of cancer remains controversial. We wanted to examine the excess risk of cancer in a large population-based cohort diagnosed with type 1 diabetes before 15 years of age.

Study population and methods: From 1 July 1977 to 31 December 2013, we prospectively and on a national scale included 18,724 persons (53% men) with childhood-onset type 1 diabetes. For each person with type 1 diabetes, we selected four referents, matched for the date at birth and municipality of living at the time when the case developed diabetes. Cases and referents were linked to national registers of cancer and of the cause of death.

Results: A total of 125 persons (61% women) with diabetes had 135 different cancers, all diagnosed after the diabetes diagnosis. The median duration from diabetes diagnosis to first cancer diagnosis was 19 years (interquartile range 10-26). The median age at cancer diagnosis in the diabetes group was 28 years (interquartile range 20-35). The overall standardized incidence ratio (95%), using the Swedish general population as referents for women with diabetes was 1.28 (1.02, 1.58) and when comparing women with diabetes with matched referents, we found a hazard ratio of 1.42 (1.10, 1.85). No elevated risk was seen for men. Cancers of the breast and testis were the most common types in women and men respectively.

Conclusions: Women with childhood-onset type 1 diabetes had a small but significantly elevated risk of cancer. No such tendency was seen for men. The reason behind this is unclear.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-190979 (URN)10.1111/dme.14771 (DOI)000734276400001 ()34923678 (PubMedID)2-s2.0-85121793257 (Scopus ID)
Funder
Region VästerbottenSwedish Research Council, 2018‐02565
Available from: 2022-01-04 Created: 2022-01-04 Last updated: 2022-07-19Bibliographically approved
Toppe, C., Möllsten, A., Waernbaum, I., Schön, S., Gudbjörnsdottir, S., Landin-Olsson, M. & Dahlquist, G. (2019). Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: a 38-Year Prospective Nationwide Study. Diabetes Care, 42(1), 27-31
Open this publication in new window or tab >>Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: a 38-Year Prospective Nationwide Study
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2019 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 1, p. 27-31Article in journal (Refereed) Published
Abstract [en]

Objective: Diabetic nephropathy is a serious complication of type 1 diabetes. Recent studies indicate that end-stage renal disease (ESRD) incidence has decreased or that the onset of ESRD has been postponed; therefore, we wanted to analyze the incidence and time trends of ESRD in Sweden.

Research design and methods: In this study, patients with duration of type 1 diabetes >14 years and age at onset of diabetes 0–34 years were included. Three national diabetes registers were used: the Swedish Childhood Diabetes Register, the Diabetes Incidence Study in Sweden, and the National Diabetes Register. The Swedish Renal Registry, a national register on renal replacement therapy, was used to identify patients who developed ESRD.

Results: We found that the cumulative incidence of ESRD in Sweden was low after up to 38 years of diabetes duration (5.6%). The incidence of ESRD was lower in patients with type 1 diabetes onset in 1991–2001 compared to onset in 1977–1984 and 1985–1990, independently of diabetes duration.

Conclusion: The risk of developing ESRD in Sweden in this population is still low and also seems to decrease with time.

Place, publisher, year, edition, pages
American Diabetes Association, 2019
National Category
Pediatrics Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-153168 (URN)10.2337/dc18-1276 (DOI)000453904900014 ()30352897 (PubMedID)2-s2.0-85059071263 (Scopus ID)
Funder
Swedish Research Council, 0753Västerbotten County Council
Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2023-03-24Bibliographically approved
Salem, R. M., Todd, J. N., Sandholm, N., Cole, J. B., Chen, W.-M., Andrews, D., . . . Florez, J. C. (2019). Genome-Wide Association Study of Diabetic Kidney Disease Highlights Biology Involved in Glomerular Basement Membrane Collagen. Journal of the American Society of Nephrology, 30(10), 2000-2016
Open this publication in new window or tab >>Genome-Wide Association Study of Diabetic Kidney Disease Highlights Biology Involved in Glomerular Basement Membrane Collagen
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2019 (English)In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 30, no 10, p. 2000-2016Article in journal (Refereed) Published
Abstract [en]

Background: Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown.

Methods: To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function.

Results: Our GWAS meta-analysis included association results for up to 19,406 individuals of European descent with type 1 diabetes. We identified 16 genome-wide significant risk loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain (COL4A3) gene, which encodes a major structural component of the glomerular basement membrane (GBM). Mutations in COL4A3 are implicated in heritable nephropathies, including the progressive inherited nephropathy Alport syndrome. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of diabetic kidney disease, including albuminuria and ESKD, and demonstrated a significant association with GBM width; protective allele carriers had thinner GBM before any signs of kidney disease, and its effect was dependent on glycemia. Three other loci are in or near genes with known or suggestive involvement in this condition (BMP7) or renal biology (COLEC11 and DDR1).

Conclusions: The 16 diabetic kidney disease–associated loci may provide novel insights into the pathogenesis of this condition and help identify potential biologic targets for prevention and treatment.

Place, publisher, year, edition, pages
American Society of Nephrology, 2019
National Category
Urology and Nephrology Medical Genetics
Identifiers
urn:nbn:se:umu:diva-165367 (URN)10.1681/ASN.2019030218 (DOI)000493453400022 ()31537649 (PubMedID)2-s2.0-85072790774 (Scopus ID)
Funder
NIH (National Institute of Health)Novo Nordisk, NNF OC0013659Wellcome trust, 098381Wellcome trust, 090532Wellcome trust, 106310Wellcome trustWellcome trust, 084726/Z/08/ZWellcome trust, 084727/Z/08/ZWellcome trust, 085475/Z/08/ZWellcome trust, 085475/B/08/ZSwedish Research Council
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2023-03-23Bibliographically approved
Möllsten, A., Toppe, C., Eeg-Olofsson, K. & Lind, T. (2019). Sex Differences in Treatment With ACE Inhibitors and Angiotensin Receptor Blockers in Patients With Type 1 Diabetes [Letter to the editor]. Diabetes Care, 42(5), E73-E74
Open this publication in new window or tab >>Sex Differences in Treatment With ACE Inhibitors and Angiotensin Receptor Blockers in Patients With Type 1 Diabetes
2019 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 5, p. E73-E74Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
AMER DIABETES ASSOC, 2019
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:umu:diva-158939 (URN)10.2337/dc18-2542 (DOI)000465238900002 ()30885953 (PubMedID)2-s2.0-85065107791 (Scopus ID)
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2023-03-24Bibliographically approved
Pazzagli, L., Möllsten, A. & Waernbaum, I. (2017). Marginal structural model to evaluate the joint effect of socioeconomic exposures on the risk of developing end-stage renal disease in patients with type 1 diabetes: a longitudinal study based on data from the Swedish Childhood Diabetes Study Group. Annals of Epidemiology, 27(8), 479-484
Open this publication in new window or tab >>Marginal structural model to evaluate the joint effect of socioeconomic exposures on the risk of developing end-stage renal disease in patients with type 1 diabetes: a longitudinal study based on data from the Swedish Childhood Diabetes Study Group
2017 (English)In: Annals of Epidemiology, ISSN 1047-2797, E-ISSN 1873-2585, Vol. 27, no 8, p. 479-484Article in journal (Refereed) Published
Abstract [en]

Purpose: Diabetic nephropathy is a severe complication of type 1 diabetes (T1D) that may lead to renal failure and end-stage renal disease (ESRD) demanding dialysis and transplantation. The aetiology of diabetic nephropathy is multifactorial and both genes and environmental and life style related factors are involved. In this study we investigate the effect of the socioeconomic exposures unemployment and receiving income support on the development of ESRD in T1D patients, using a marginal structural model in comparison with standard logistic regression models.

Methods: The study is based on the Swedish Childhood Diabetes Register which in 1977 started to register patients developing T1D before 15 years of age. In the analyses we include patients born between 1965 and 1979, developing diabetes between 1977 and 1994, followed until 2013 (n=4034). A marginal structural model (MSM) was fitted to adjust for both baseline and time-varying confounders.

Results: The main results of the analysis indicate that being unemployed for more than one year and receiving income support are risk factors for the development of ESRD. Multiple exposure over time to these risk factors increases the risk associated with the disease.

Conclusions: Using a MSM is an advanced method well suited to investigate the effect of exposures on the risk of complications of a chronic disease with longitudinal data. The results show that socioeconomic disadvantage increases the risk of developing ESRD in patients with type 1 diabetes.

Place, publisher, year, edition, pages
New York: Elsevier, 2017
Keywords
Socioeconomic disparities, Type 1 diabetes, end stage renal disease, marginal structural model
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-138138 (URN)10.1016/j.annepidem.2017.07.003 (DOI)000411770700004 ()28935026 (PubMedID)2-s2.0-85043353288 (Scopus ID)
Funder
The Royal Swedish Academy of SciencesSwedish Research Council, project number 0753
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2023-03-24Bibliographically approved
Toppe, C., Möllsten, A., Schon, S. & Dahlquist, G. (2017). Socio-economic factors influencing the development of end-stage renal disease in people with Type 1 diabetes: a longitudinal population study. Diabetic Medicine, 34(5), 676-682
Open this publication in new window or tab >>Socio-economic factors influencing the development of end-stage renal disease in people with Type 1 diabetes: a longitudinal population study
2017 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 5, p. 676-682Article in journal (Refereed) Published
Abstract [en]

Aims: The development of end-stage renal disease (ESRD) in Type 1 diabetes is multifactorial. Familial socio-economic factors may influence adherence to and understanding of diabetes treatment, and also general health behaviour. We investigate how parental and personal education level and exposure to low economic status, indicated by the need for income support, influence the development of ERSD caused by Type 1 diabetes.

Methods: Participants were retrieved from the nationwide Swedish Childhood Diabetes Registry, which was linked to the Swedish Renal Registry, to find people with ESRD caused by Type 1 diabetes, and to Statistic Sweden to retrieve longitudinal socio-economic data on participants and their parents. Data were analysed using Cox regression modelling.

Results: Of 9287 people with diabetes of duration longer than 14 years, 154 had developed ESRD due to diabetes. Median diabetes duration (range) for all participants was 24.2 years (14.0-36.7 years). Low maternal education ( 12 years) more than doubled the risk of developing ESRD, hazard ration (HR) = 2.9 [95% confidence interval (95% CI): 1.7-4.8]. For people with a low personal level of education HR was 5.7 (3.4-9.5). In an adjusted model, the person's own education level had the highest impact on the risk of ESRD. If at least one of the parents had ever received income support the HR was 2.6 (1.9-3.6).

Conclusions: Socio-economic factors, both for the parents and the person with diabetes, have a strong influence on the development of ESRD in Type 1 diabetes. It is important for caregivers to give enough support to more vulnerable people and their families.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-134699 (URN)10.1111/dme.13289 (DOI)000399672200012 ()27862276 (PubMedID)2-s2.0-85010289869 (Scopus ID)
Available from: 2017-06-30 Created: 2017-06-30 Last updated: 2023-03-24Bibliographically approved
Berhan, Y., Eliasson, M., Möllsten, A., Waernbaum, I. & Dahlquist, G. (2015). Impact of Parental Socioeconomic Status on Excess Mortality in a Population-Based Cohort of Subjects With Childhood-Onset Type 1 Diabetes. Diabetes Care, 38(5), 827-832
Open this publication in new window or tab >>Impact of Parental Socioeconomic Status on Excess Mortality in a Population-Based Cohort of Subjects With Childhood-Onset Type 1 Diabetes
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2015 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 38, no 5, p. 827-832Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to analyze the possible impact of parental and individual socioeconomic status (SES) on all-cause mortality in a population-based cohort of patients with childhood-onset type 1 diabetes.

RESEARCH DESIGN AND METHODS: Subjects recorded in the Swedish Childhood Diabetes Registry (SCDR) from 1 January 1978 to 31 December 2008 were included (n =14,647). The SCDR was linked to the Swedish Cause of Death Registry (CDR) and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA).

RESULTS: At a mean follow-up of 23.9 years (maximum 46.5 years), 238 deaths occurred in a total of 349,762 person-years at risk. In crude analyses, low maternal education predicted mortality for male patients only (P = 0.046), whereas parental income support predicted mortality in both sexes (P < 0.001 for both). In Cox models stratified by age-at-death group and adjusted for age at onset and sex, parental income support predicted mortality among young adults (≥18 years of age) but not for children. Including the adult patient’s own SES in a Cox model showed that individual income support to the patient predicted mortality occurring at ≥24 years of age when adjusting for age at onset, sex, and parental SES.

CONCLUSIONS: Exposure to low SES, mirrored by the need for income support, increases mortality risk in patients with childhood-onset type 1 diabetes who died after the age of 18 years.

National Category
Clinical Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-101362 (URN)10.2337/dc14-1522 (DOI)000353505600023 ()2-s2.0-84958591961 (Scopus ID)
Funder
Swedish Research Council, 07531
Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2023-03-24Bibliographically approved
Toppe, C., Möllsten, A., Schön, S. & Dahlquist, G. (2015). Low cumulative incidence of end-stage renal disease in young patients with type 1 diabetes in Sweden: a population based study. Paper presented at 51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Stockholm, SWEDEN, SEP 14-18, 2015. Diabetologia, 58(Suppl. 1 Abstr. 402), S201-S202
Open this publication in new window or tab >>Low cumulative incidence of end-stage renal disease in young patients with type 1 diabetes in Sweden: a population based study
2015 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no Suppl. 1 Abstr. 402, p. S201-S202Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and aims: A previous study from our group showed a low cumulative incidence of end-stage renal disease (ESRD) in a Swedish cohort of type 1 diabetes (T1D) patients with median duration of 20 years. We speculated that a good diabetes health care system might have postponed the peak incidence of ESRD and that young age at onset of T1D can postpone the development of diabetic nephropathy (DN) and ESRD. Moreover, diabetes onset during puberty may promote the development of diabetic complications. Our previous study also indicated differences by sex in ESRD development and a possible interaction with age at onset. Female patients who developed T1D after puberty had similar risk of ESRD as those with onset before 10 years of age. Male patients had the same high risk with onset during puberty and after puberty, those with onset before 10 years had the lowest risk. The aims of the present study are to assess the cumulative incidence of ESRD due to DN in a large prospective population-based cohort of T1D patients at maximum 36 years of diabetes duration and to study the effects of sex and age at onset of T1D.

Materials andmethods: Since 1977 all incident cases of T1D in the ages 0-14 years are recorded in the Swedish Childhood Diabetes Register (SCDR). The Swedish Renal Registry (SRR) started in 1991 and collects data on all patients with active uraemia treatment, ESRD. We decided to include patients with diabetes duration ≥14 years. In total 9381 patients from the SCDR were included. We have recently received permission to include data from the Swedish National Diabetes Register, a national quality register, and are awaiting data to include patients with age at onset 15-34 years.

Results: For the childhood onset cases the median diabetes duration was 23.8 years, maximum 36.7 years, and 154 patients had developed ESRD due to diabetes. The cumulative incidence was 4.5%. There was no statistical difference between male and female patients with age at diabetes onset before 15 years of age, males 5.0%, females 3.8%.We confirm that onset of diabetes before 10 years of age postpones the development of ESRD when compared to onset during 10-14 years, HR 2.3 (95% CI= 1.7-3.3). Further analyses will be available for presentation in September.

Conclusion: The cumulative risk of ESRD due to diabetic nephropathy in Swedish T1D patients at maximum36 years of diabetes duration is still exceptionally low. There is no difference in the development of ESRD between male and female patients with onset of diabetes before 15 years of age.

Place, publisher, year, edition, pages
Springer, 2015
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-109374 (URN)000359820901092 ()
Conference
51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Stockholm, SWEDEN, SEP 14-18, 2015
Available from: 2015-09-30 Created: 2015-09-25 Last updated: 2018-11-08Bibliographically approved
Berhan, Y., Möllsten, A., Carlsson, A., Högberg, L., Ivarsson, A. & Dahlquist, G. (2014). Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds. Acta Paediatrica, 103(10), 1078-1082
Open this publication in new window or tab >>Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds
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2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, p. 1078-1082Article in journal (Refereed) Published
Abstract [en]

AIM: Childhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13 years of age.

METHODS: Body mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13 years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m(2) at 18 years of age (ISO-BMI ≥25, n = 1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI ≥25. Children with a Diabetes Control and Complications Trial aligned HbA1c ≥6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis.

RESULTS: Of 1126 children with ISO-BMI ≥25, 24 (2.1%) had at least one HbA1c value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions, and all of them had a normal OGTT.

CONCLUSION: In this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.

Keywords
childhood obesity, diabetes mellitus type 2, epidemiology
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-94194 (URN)10.1111/apa.12729 (DOI)000342753400022 ()24976437 (PubMedID)2-s2.0-84907855678 (Scopus ID)
Available from: 2014-10-06 Created: 2014-10-06 Last updated: 2023-03-24Bibliographically approved
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