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Johansson, K., Bokander Matilainen, L., Wiaderny, M., Berlin, H., Klingberg, G., Ghiasi, H., . . . Paulsson, L. (2024). Self-reported pain during different phases of orthodontic treatment with fixed appliance: A multi-centre randomized controlled trial in adolescents with crowding. Orthodontics & craniofacial research
Open this publication in new window or tab >>Self-reported pain during different phases of orthodontic treatment with fixed appliance: A multi-centre randomized controlled trial in adolescents with crowding
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2024 (English)In: Orthodontics & craniofacial research, ISSN 1601-6335, E-ISSN 1601-6343Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems.

MATERIALS AND METHODS: Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale.

RESULTS: Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively).

CONCLUSIONS: Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
RCT, adolescent, fixed, orthodontic appliances, pain
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66281 (URN)10.1111/ocr.12771 (DOI)001169625100001 ()38389292 (PubMedID)2-s2.0-85186398132 (Scopus ID)
Available from: 2024-03-08 Created: 2024-03-08 Last updated: 2024-03-28Bibliographically approved
Roxner, R., Hallberg, U., Berlin, H. & Klingberg, G. (2024). Undergraduate dental students' perceptions of dental pain in children - A grounded theory study.. European journal of dental education
Open this publication in new window or tab >>Undergraduate dental students' perceptions of dental pain in children - A grounded theory study.
2024 (English)In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: There is an underuse of pain management strategies in dental care for children, possibly owing to perceived stress and discomfort when treating children, which has also been reported by dental students. The aim of this study was to explore how undergraduate dental students experience and understand pain related to dental treatment in children.

MATERIALS AND METHODS: Interviews were held with 21 Swedish dental students, from 3 dental schools, all in their final 2 years of education. The interviews were transcribed verbatim and analysed according to Grounded Theory.

RESULTS: A core category, seeking guidance to avoid pain, was identified and related to 6 conceptual categories. The students used different strategies to manage pain prevention in child dentistry and to become skilled dentists. They described high levels of stress, as well as having high expectations on themselves when treating children. The stress led to a surface learning approach, something the students were not fully aware of.

CONCLUSION: All children should have the right to be ensured optimal pain prevention in dental care. The basis for this is laid during undergraduate education. Thus, pain management in child dentistry is an area in need of special attention in this respect. The academic staff has an important role in supporting their students in their process to gain an identity as professional dentists. To ensure that students incorporate an understanding of the importance of pain prevention when treating children there is a need to create more integration between theory and clinical training in undergraduate education.

Keywords
child, dental education, dental student, paediatric dentistry, pain, procedural pain
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66653 (URN)10.1111/eje.13008 (DOI)001197309800001 ()38581212 (PubMedID)
Available from: 2024-04-09 Created: 2024-04-09 Last updated: 2024-04-11Bibliographically approved
Berlin, H., Hallberg, U., Ridell, K., Toft, D. & Klingberg, G. (2023). A grounded theory study on Swedish 10 to 16-year-olds’ perceptions of pain in conjunction with orthodontically indicated tooth extraction. Acta Odontologica Scandinavica, 81(3), 235-240
Open this publication in new window or tab >>A grounded theory study on Swedish 10 to 16-year-olds’ perceptions of pain in conjunction with orthodontically indicated tooth extraction
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2023 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 81, no 3, p. 235-240Article in journal (Refereed) Published
Abstract [en]

Objective: Children frequently experience pain and/or discomfort during dental treatment. Still, pain research in dentistry has mainly been performed on adults using quantitative methods while research on the child's perspective is scarce. This study aims to explore and describe children's experiences and/or thoughts regarding pain in conjunction with tooth extraction.

Material and methods: Interviews were carried out with twelve Swedish 10-16-year-olds who had recently undergone tooth extractions due to orthodontic reasons. Interviews were transcribed verbatim and analysed according to grounded theory.

Results: A core category was identified and named 'handling the unavoidable unknown'. The informants recalled experiences of pain and discomfort during extractions. However, instead of focussing on pain, they described an urge for more information about the procedure and what to expect in terms of pain and/or discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing feelings of unease.

Conclusions: To improve patients' ability to deal with pain in conjunction with dental extraction, the dental team should ensure better and individually tailored information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Child; adolescent; dental care; grounded theory; pain
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-54805 (URN)10.1080/00016357.2022.2119163 (DOI)000850970700001 ()36070618 (PubMedID)2-s2.0-85137767477 (Scopus ID)
Funder
Region Skåne
Available from: 2022-09-08 Created: 2022-09-08 Last updated: 2023-04-20Bibliographically approved
Klingberg, G., Benchimol, D., Berlin, H., Bring, J., Gornitzki, C., Odeberg, J., . . . Domeij, H. (2023). How old are you?: a systematic review investigating the relationship between age and mandibular third molar maturity. PLOS ONE, 18(5), 1-14, Article ID e0285252.
Open this publication in new window or tab >>How old are you?: a systematic review investigating the relationship between age and mandibular third molar maturity
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5, p. 1-14, article id e0285252Article, review/survey (Refereed) Published
Abstract [en]

Introduction and objective: Radiographic evaluation of the maturity of mandibular third molars is a common method used for age estimation of adolescents and young adults. The aim of this systematic review was to examine the scientific base for the relationship between a fully matured mandibular third molar based on Demirjian's method and chronological age, in order to assess whether an individual is above or below the age of 18 years.

Methods: The literature search was conducted in six databases until February 2022 for studies reporting data evaluating the tooth maturity using Demirjian´s method (specifically stage H) within populations ranging from 8 to 30 years (chronological age). Two reviewers screened the titles and abstracts identified through the search strategy independently. All studies of potential relevance according to the inclusion criteria were obtained in full text, after which they were assessed for inclusion by two independent reviewers. Any disagreement was resolved by a discussion. Two reviewers independently evaluated the risk of bias using the assessment tool QUADAS-2 and extracted the data from the studies with low or moderate risk of bias. Logistic regression was used to estimate the relationship between chronological age and proportion of subjects with a fully matured mandibular third molar (Demirjian´s tooth stage H).

Results: A total of 15 studies with low or moderate risk of bias were included in the review. The studies were conducted in 13 countries and the chronological age of the investigated participants ranged from 3 to 27 years and the number of participants ranged between 208 and 5,769. Ten of the studies presented the results as mean age per Demirjian´s tooth stage H, but only five studies showed the distribution of developmental stages according to validated age. The proportion of subjects with a mandibular tooth in Demirjian´s tooth stage H at 18 years ranged from 0% to 22% among males and 0 to 16% in females. Since the studies were too heterogenous to perform a meta-analysis or a meaningful narrative review, we decided to refrain from a GRADE assessment.

Conclusion: The identified literature does not provide scientific evidence for the relationship between Demirjian´s stage H of a mandibular third molar and chronologic age in order to assess if an individual is under or above the age of 18 years.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-59643 (URN)10.1371/journal.pone.0285252 (DOI)000993222400034 ()37200251 (PubMedID)2-s2.0-85159764106 (Scopus ID)
Available from: 2023-05-23 Created: 2023-05-23 Last updated: 2023-09-05Bibliographically approved
Naimi-Akbar, A., Berlin, H., Klingberg, G. & Roxner, R. (2023). Vetenskapligt stöd saknas för påstående om anestesimedel [Letter to the editor]. Tandläkartidningen, 115(9), 86-87
Open this publication in new window or tab >>Vetenskapligt stöd saknas för påstående om anestesimedel
2023 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, Vol. 115, no 9, p. 86-87Article in journal, Letter (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Sveriges tandläkarförbund, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66655 (URN)
Available from: 2024-04-09 Created: 2024-04-09 Last updated: 2024-04-11Bibliographically approved
Berlin, H. (2020). Procedural and postoperative pain in paediatric dentistry. (Doctoral dissertation). malmö: Malmö universitet
Open this publication in new window or tab >>Procedural and postoperative pain in paediatric dentistry
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tooth extraction is one of the most commonly performed dental treatments and there is always a risk of pain during and after this procedure. Pain is a major contributor to the development of dental fear and anxiety(DFA) and dental behaviour management problems (DBMP) in children and adolescents. These, in turn, are two of the most common reasons for referrals to specialist in paediatric dentistry. DFA and DBMP lead to reduced oral health and possibly suffering for the individual, as well as huge costs for society as a whole. It is therefore of uttermost importance that all dental treatments be performed with the aim of avoiding or minimising pain. The aims of this thesis were to (i) investigate how and to what extent Swedish dentists (both general dental practitioners and specialists inpaediatric dentistry) use different pain management strategies when treating children and adolescents, (ii) explain the natural course of pain after uncomplicated bilateral extractions of maxillary premolars in children between the ages of 10 and 15, (iii) systematically evaluate the effect of postoperatively administered over-the-counter oral analgesics as a means to minimise postoperative pain after oral surgery in children between the ages of 0 and 18, and finally (iv) gain greater insight into how children between the ages of 10 and 16 perceive the whole process of tooth extraction (during the procedure and after extraction) as part of orthodontic treatment. In the first study, a postal survey was sent to all active general dental practitioners (GDPs) in Skåne County, and to all specialists in paediatric dentistry (SPDs) in Sweden. The main findings were that pain management strategies differ between the two groups; in addition, GDPs used different strategies depending on whether primary or permanent teeth were being treated. In general, the survey found an underuse of local anaesthesia by general dentists. This calls for guidelines on pain management strategies in paediatric dental care. In the second study, pain intensity was measured at 14 different time points after tooth extraction performed prior to orthodontic treatment, in a sample of 31 children 10 to15 years of age. Pain intensity after extraction of an upper tooth was generally mild to moderate. The natural course of pain intensity followed the same pattern regardless of how the data were analysed. Pain peaked at 2 hours after treatment, then decreasing rapidly until the next measurement that took place 4 hours after treatment. There was no difference between the first and second extraction, indicating that this model is an excellent one for further research on pain management strategies, with no carryover effect. The third study was a systematic review(SR) and health technology assessment (HTA). A systematic review regarding preoperatively administered oral analgesics has been previously published, but it does not present any scientific evidence showing their administration as providing additional pain relief in children after dental treatment. An SR/HTA looked at postoperatively administered oral analgesics with the goal of minimising postoperative pain after oral surgical therapies in children. This SR/HTA yielded an empty review. As of today, there is no scientific evidence for the effectiveness of the administration of oral analgesics postoperatively in order to minimise postoperative pain after oral surgical therapies in children aged 0–18 years. Neither is there any evidence to reject this strategy. This highlights the need for well-designed primary studies on this topic. In the fourth and final study of this thesis, children’s perception of tooth extraction and the postoperative period was investigated in order to better understand the child’s perspective regarding this treatment. A qualitative research approach, using grounded theory, was used. Although the subjects were a bit anxious before the procedure, they all managed to handle the treatment using different types of coping strategies. One central theme that emerged from analysing the interviews was the importance of getting proper information from dental staff, at the right time. Children who received adequate information were able to withstand some pain and discomfort. Having some form of control over the situation also emerged as a coping strategy.

Conclusions

Among Swedish dentists (both GDPs and SPDs), there seems to be uncertainty regarding pain management strategies in children and adolescents in terms of the use of local anaesthetics and oral analgesics. There are differences in pain management strategies between GDPs and SPDs. The majority of the participants perceived pain intensity after tooth extraction due to orthodontic indication to be mild to moderate. These types of extractions can serve as a good model for future pain research. The amount of pain research on paediatric populations in dentistry is scarce. We need more well-designed primary studies before guidelines on pain management strategies for paediatric dental care can be formulated. When given proper and honest information at the right time, children are able to cope with dental treatments, even if they are a bit anxious beforehand and even if they perceive pain or discomfort during and after treatment.

Place, publisher, year, edition, pages
malmö: Malmö universitet, 2020. p. 124
Series
Doctoral Dissertation in Odontology
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-36856 (URN)10.24834/isbn.9789178771349 (DOI)978-91-7877-133-2 (ISBN)978-91-7877-134-9 (ISBN)
Public defence
2020-12-04, Orkanen, hörsal D138 samt digitalt, Nordenskiöldsgatan 10, Malmö, 09:15
Opponent
Note

Paper IV: Children’s perceptions and coping of pain in conjunction with orthodontically indicated tooth extractions: a grounded theory study (manuscript)

Available from: 2020-11-17 Created: 2020-11-17 Last updated: 2022-06-27Bibliographically approved
Berlin, H., Vall, M., Bergenäs, E., Ridell, K., Brogårdh-Roth, S., Lager, E., . . . Klingberg, G. (2019). Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review. PLOS ONE, 14(12), Article ID e0227027.
Open this publication in new window or tab >>Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review
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2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0227027Article, review/survey (Refereed) Published
Abstract [en]

Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-17235 (URN)10.1371/journal.pone.0227027 (DOI)000515096600052 ()31891621 (PubMedID)2-s2.0-85077390425 (Scopus ID)
Available from: 2020-05-13 Created: 2020-05-13 Last updated: 2024-02-05Bibliographically approved
Berlin, H., List, T., Ridell, K., Davidson, T., Toft, D. & Klingberg, G. (2019). Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars (ed.). European Archives of Paediatric Dentistry, 20(6), 545-555
Open this publication in new window or tab >>Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars
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2019 (English)In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 20, no 6, p. 545-555Article in journal (Refereed)
Abstract [en]

PURPOSE: To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS: 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS: The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI >/= 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS: The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Pain, Child, Adolescent, Visual analogue scale, Self-assessment, Tooth extraction, Postoperative
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6824 (URN)10.1007/s40368-019-00425-9 (DOI)000501308000006 ()30963511 (PubMedID)2-s2.0-85064526234 (Scopus ID)30169 (Local ID)30169 (Archive number)30169 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
Berlin, H., List, T., Ridell, K. & Klingberg, G. (2018). Dentists' attitudes towards acute pharmacological pain management in children and adolescents (ed.). International Journal of Paediatric Dentistry, 28(2), 152-160
Open this publication in new window or tab >>Dentists' attitudes towards acute pharmacological pain management in children and adolescents
2018 (English)In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 28, no 2, p. 152-160Article in journal (Refereed)
Abstract [en]

AIM: This study aimed to investigate Swedish dentists' attitudes regarding pain management strategies for treating children and adolescents. It assessed recommendations for pre- and postoperative analgesics, and use of local anaesthesia, and whether application of these strategies differs between general dental practitioners (GDPs) and specialists in paediatric dentistry (SPDs). DESIGN: We invited all GDPs (n = 807) in southern Sweden (Region Skåne), and all registered SPDs (n = 122) working in Sweden (929 actively practising dentists under age 65 years) to participate in a postal survey on pain management in paediatric dental care. RESULTS: The SPDs reported using all types of pain-reducing strategies more frequently than GDPs except local anaesthesia when extracting a permanent premolar, which SPDs and GDPs used equally often. Preoperative analgesic use was greater among SPDs than GDPs. GDPs used local anaesthesia less frequently for filling therapy in primary teeth than in permanent teeth. CONCLUSIONS: SPDs recommend preoperative analgesics more often than GDPs do. GDPs seem to underuse local anaesthetics when treating children and adolescents. SPDs also use pain management strategies more frequently than GDPs. Among GDPs, pain management is less frequent when treating primary teeth than permanent teeth.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
dentistry, child, adolescent, pain, dental pain, pain management
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15364 (URN)10.1111/ipd.12316 (DOI)000424920200005 ()28691744 (PubMedID)2-s2.0-85023186249 (Scopus ID)23327 (Local ID)23327 (Archive number)23327 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
Klingberg, G., Ridell, K., Brogårdh-Roth, S., Vall, M. & Berlin, H. (2017). Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents (ed.). European Archives of Paediatric Dentistry, 18(5)
Open this publication in new window or tab >>Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents
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2017 (English)In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 18, no 5Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years. METHODS: A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality. RESULTS: 725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents. CONCLUSIONS: At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Adolescent, Child, Dental, Local anaesthesia, Local analgesia, Systematic review
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15857 (URN)10.1007/s40368-017-0302-z (DOI)000413470300002 ()28913645 (PubMedID)2-s2.0-85032180077 (Scopus ID)23676 (Local ID)23676 (Archive number)23676 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3362-3362

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