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Méndez-Rivero, F., Matilla-Santander, N., Gunn, V., Wegman, D. H., Hernando-Rodriguez, J. C., Kvart, S., . . . Almroth, M. (2024). Can psychosocial risk factors mediate the association between precarious employment and mental health problems in Sweden? Results from a register-based study. Scandinavian Journal of Work, Environment and Health
Open this publication in new window or tab >>Can psychosocial risk factors mediate the association between precarious employment and mental health problems in Sweden? Results from a register-based study
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2024 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives 

The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts.

Methods

This longitudinal register-study was based on the working population of Sweden, aged 25-60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006-2017.

Results

The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women.

Conclusion

The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers' mental health. Future studies in different social contexts and labour markets are needed.

Keywords
mental health, mediation analysis, precarious work, psychological work environment
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-228272 (URN)10.5271/sjweh.4151 (DOI)001189918700001 ()38522097 (PubMedID)
Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2024-04-11
Almroth, M., Falkstedt, D., Hemmingsson, T., Albin, M., Badarin, K., Selander, J., . . . Kjellberg, K. (2024). Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden. Ageing & Society
Open this publication in new window or tab >>Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden
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2024 (English)In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779Article in journal (Refereed) Epub ahead of print
Abstract [en]

Few previous studies have investigated how socioeconomic differences in labour market exit have changed after restrictions in social insurance policies. The aim of this register-based study is to investigate how early labour market exit pathways among older men and women with different levels of education changed after major restrictive social insurance and retirement policy reforms in Sweden. Cohort 1 (pre-reform) consisted of individuals who were 60 or 61 years old in 2005 (N = 186,145) and Cohort 2 (post-reform) consisted of individuals who were 60 or 61 years old in 2012 (N = 176,216). Educational differences in four labour market exit pathways were investigated using Cox proportional hazards regression; the exit pathways were disability pension, early old-age pension with and without income respectively, and no income for two consecutive years. As expected, exits through disability pension were rarer in Cohort 2. Lower education was also more strongly associated with disability pension in Cohort 2. Parallel to this, lower education showed a stronger association with both early old-age pension types in Cohort 2. Additionally, a tendency towards a relatively higher likelihood of earning no income was seen among the less educated. Increases in inequalities tended to be greater for women. Our results indicate that educational inequalities in labour market exit have grown significantly after restrictions in social insurance and changes in retirement policies, which can have negative financial repercussions for those already in a vulnerable position. These results indicate that careful analyses of effects on disparities are needed before making major changes in welfare systems.

Keywords
early retirement, inequality, longitudinal data analysis, public policy, pension
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-231274 (URN)10.1017/S0144686X24000047 (DOI)001235981600001 ()
Available from: 2024-06-19 Created: 2024-06-19 Last updated: 2024-06-19
Berglund, K., Almroth, M., Falkstedt, D., Hemmingsson, T. & Kjellberg, K. (2024). The impact of cardiorespiratory fitness and physical workload on disability pension–a cohort study of Swedish men. International Archives of Occupational and Environmental Health, 97(1), 45-55
Open this publication in new window or tab >>The impact of cardiorespiratory fitness and physical workload on disability pension–a cohort study of Swedish men
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2024 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 97, no 1, p. 45-55Article in journal (Refereed) Published
Abstract [en]

Objective Understanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD).

Methods A total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45–64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP.

Results Low cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32–1.46) and for those with high physical workload 1.48 (1.39–1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures.

Conclusion Both low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP).

Keywords
Ergonomics, Job-exposure matrix, Physical capacity, Musculoskeletal disorders, Cardiovascular disease, Epidemiology
National Category
Occupational Health and Environmental Health Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-224207 (URN)10.1007/s00420-023-02023-1 (DOI)001102460800001 ()37971680 (PubMedID)2-s2.0-85176793441 (Scopus ID)
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2024-03-11Bibliographically approved
Almroth, M., Hemmingsson, T., Falkstedt, D., Kjellberg, K., Carlsson, E., Pan, K.-Y., . . . Thern, E. (2024). The role of working conditions in educational differences in all-cause and ischemic heart disease mortality among Swedish men. Scandinavian Journal of Work, Environment and Health, 50(4), 300-309
Open this publication in new window or tab >>The role of working conditions in educational differences in all-cause and ischemic heart disease mortality among Swedish men
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2024 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 50, no 4, p. 300-309Article in journal (Refereed) Published
Abstract [en]

Objectives This study aims to investigate the extent to which low job control and heavy physical workload in middle age explain educational differences in all-cause and ischemic heart disease (IHD) mortality while accounting for important confounding factors.

Methods The study is based on a register-linked cohort of men who were conscripted into the Swedish military at around the age of 18 in 1969/1970 and were alive and registered in Sweden in 2005 (N=46 565). Cox proportional hazards regression models were built to estimate educational differences in all-cause and IHD mortality and the extent to which this was explained by physical workload and job control around age 55 by calculating the reduction in hazard ratio (HR) after adjustments. Indicators of health, health behavior, and other factors measured during conscription were accounted for.

Results We found a clear educational gradient for all-cause and IHD mortality (HR 2.07 and 2.47, respectively, for the lowest compared to the highest education level). A substantial part was explained by the differential distribution of the confounding factors. However, work-related factors, especially high physical workload, also played important explanatory roles.

Conclusion Even after accounting for earlier life factors, low job control and especially high physical workload seem to be important mechanistic factors in explaining educational inequalities in all-cause and IHD mortality. It is therefore important to find ways to reduce physical workload and increase job control in order to decrease inequalities in mortality.

Keywords
cardiovascular disease, heavy physical workload, job control, social inequality
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-228870 (URN)10.5271/sjweh.4158 (DOI)001195721900001 ()38536000 (PubMedID)
Available from: 2024-05-06 Created: 2024-05-06 Last updated: 2024-05-06Bibliographically approved
Badarin, K., Hemmingsson, T., Almroth, M., Falkstedt, D., Hillert, L. & Kjellberg, K. (2023). Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden. International Archives of Occupational and Environmental Health, 96(7), 973-984
Open this publication in new window or tab >>Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden
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2023 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 96, no 7, p. 973-984Article in journal (Refereed) Published
Abstract [en]

Objective To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP.

Methods This study uses a sample of 1,804,242 Swedish workers aged 44–63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects.

Results Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18–1.55, women: SI 1.19 95%CI 1.05–1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08–1.69, women: 1.13 95%CI 0.85–1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant.

Conclusion Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

Keywords
Ageing employee, Disability benefit, Heavy manual job, Heavy work, Decision authority, Musculoskeletal, Early exit, Physical health, Work ability, Work conditions
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-220446 (URN)10.1007/s00420-023-01983-8 (DOI)000995899000001 ()37246195 (PubMedID)2-s2.0-85160435263 (Scopus ID)
Available from: 2023-08-30 Created: 2023-08-30 Last updated: 2023-08-30Bibliographically approved
Carlsson, E., Hemmingsson, T., Landberg, J., Burström, B. & Thern, E. (2023). Do early life factors explain the educational differences in early labour market exit? A register-based cohort study. BMC Public Health, 23(1), Article ID 1680.
Open this publication in new window or tab >>Do early life factors explain the educational differences in early labour market exit? A register-based cohort study
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 1680Article in journal (Refereed) Published
Abstract [en]

Background: Socioeconomic inequalities in labour market participation are well established. However, we do not fully know what causes these inequalities. The present study aims to examine to what extent factors in childhood and late adolescence can explain educational differences in early labour market exit among older workers.

Methods: All men born in 1951–1953 who underwent conscription examination for the Swedish military in 1969–1973 (n = 145 551) were followed from 50 to 64 years of age regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment and early old-age retirement with and without income). Early life factors, such as cognitive ability, stress resilience, and parental socioeconomic position, were included. Cox proportional-hazards regressions were used to estimate the association between the level of education and each early labour market exit pathway, including adjustment for early life factors.

Results: The lowest educated men had a higher risk of exit through disability pension (HR: 2.72), long-term sickness absence (HR: 2.29), long-term unemployment (HR: 1.45), and early old-age retirement with (HR: 1.29) and without income (HR: 1.55) compared to the highest educated men. Factors from early life explained a large part of the educational differences in disability pension, long-term sickness absence and long-term unemployment but not for early old-age retirement. Important explanatory factors were cognitive ability and stress resilience, whilst cardiorespiratory fitness had negligible impact.

Conclusions: The association between education and early exit due to disability pension, long-term sickness absence and long-term unemployment was to a large part explained by factors from early life. However, this was not seen for early old-age retirement. These results indicate the importance of taking a life-course perspective when examining labour market participation in later working life.

Keywords
Socioeconomic inequalities, Early retirement, Disability pension, Sickness absence, Unemployment, Older workers
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public Health Sciences
Identifiers
urn:nbn:se:su:diva-225601 (URN)10.1186/s12889-023-16626-3 (DOI)001151590100001 ()37653490 (PubMedID)2-s2.0-85169680279 (Scopus ID)
Funder
Swedish Research Council, 2018-01917Swedish Research Council, 2018-01917Swedish Research Council, 2018-01917Stockholm University
Available from: 2024-01-18 Created: 2024-01-18 Last updated: 2024-02-27Bibliographically approved
Falkstedt, D., Almroth, M., Hemmingsson, T., d'Errico, A., Albin, M., Bodin, T., . . . Kjellberg, K. (2023). Job demands and job control and their associations with disability pension—a register-based cohort study of middle-aged and older Swedish workers. International Archives of Occupational and Environmental Health, 96(8), 1137-1147
Open this publication in new window or tab >>Job demands and job control and their associations with disability pension—a register-based cohort study of middle-aged and older Swedish workers
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2023 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 96, no 8, p. 1137-1147Article in journal (Refereed) Published
Abstract [en]

Objectives Job demands and control at work and their combination, job strain, have been studied in relation to risk of disability pension (DP) previously. In the present study, based on registry data, we aimed to deepen the knowledge by analyzing major disease groups among the DPs, dose–response shape of the associations, and potential confounding effects of physical workload.

Methods Approximately 1.8 million workers aged 44 or older and living in Sweden in 2005 were followed up for 16 years, up to a maximum of 65 years of age. We linked mean values of job demands and job control, estimated in a job-exposure matrice (JEM) by gender, to individuals through their occupational titles in 2005. These values were categorized by rank order, and, for the construction of job-strain quadrants, we used a median cut-off. Associations with DP were estimated in Cox proportional-hazards models.

Results In models accounting for covariates including physical workload, low levels of job control were associated with higher risk of DP among both men and women. This association was most clear for DP with a psychiatric diagnosis, although a dose–response shape was found only among the men. High levels of job demands were associated with decreased risk of DP across diagnoses among men, but the same association varied from weak to non-existing among women. The high- and passive job-strain quadrants both showed increased risk of DP with a psychiatric diagnosis.

Conclusion The results suggest that, at the occupational level, low job control, but not high job demands, contributes to an increased incidence of DP, particularly regarding DP with a psychiatric diagnosis.

Keywords
Occupational exposure, Psychosocial factors, Retirement benefits, Mental disorders, Musculoskeletal diseases, Cardiovascular diseases
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-221204 (URN)10.1007/s00420-023-01995-4 (DOI)001028440200001 ()37450035 (PubMedID)2-s2.0-85164839900 (Scopus ID)
Available from: 2023-09-20 Created: 2023-09-20 Last updated: 2024-03-26Bibliographically approved
Thern, E., Matilla-Santander, N., Bodin, T. & Hemmingsson, T. (2023). Precarious employment at a young age and labor-market marginalization during middle-adulthood: A register-linked cohort study. Scandinavian Journal of Work, Environment and Health, 49(3), 201-210
Open this publication in new window or tab >>Precarious employment at a young age and labor-market marginalization during middle-adulthood: A register-linked cohort study
2023 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 49, no 3, p. 201-210Article in journal (Refereed) Published
Abstract [en]

Objective The present study aims to investigate the association between exposure to precarious employment three years after graduation and the risk of labor market marginalization (LMM) ten years later.

Methods A registered-linked cohort study based on the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was conducted among all individuals born between 1973 and 1976, who were registered in Sweden the year they turned 27 years old (N=365 702). Information on the exposure of labor market establishment three years after graduating from school and outcome of LMM ten years after graduating was collected from nationwide registers. Relative risk ratios (RRR) with 95% confidence intervals (CI) were obtained by multinominal logistic regression.

Results After considering important covariates, young adults in precarious employment three years after graduation were at an increased risk of future long-term unemployment (RRR 2.31), later precarious employment (RRR 2.85), and long-term sickness absence/disability pension (RRR 1.43) compared to individuals who had obtained standard employment arrangements within three years of graduating. Young precariously employed men had a slightly strong association compared to females with regards to all outcomes.

Conclusion The result of this study suggests that both young men and women in precarious employment three years after graduation are more likely to have a weaker attachment to the labor force later in life compared to individuals of the same age in standard employment. This is important as the prevalence of precarious employment is increasing globally, and young adults appear to be especially vulnerable.

Keywords
disability pension, register data, sick leave, sickness absence, unemployment, young adult, young employee, young worker
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-230958 (URN)10.5271/sjweh.4079 (DOI)001015303600001 ()37000458 (PubMedID)2-s2.0-85151574719 (Scopus ID)
Available from: 2024-06-13 Created: 2024-06-13 Last updated: 2024-06-13Bibliographically approved
Pan, K.-Y., Almroth, M., Nevriana, A., Hemmingsson, T., Kjellberg, K. & Falkstedt, D. (2023). Trajectories of psychosocial working conditions and all-cause and cause-specific mortality: a Swedish register-based cohort study. Scandinavian Journal of Work, Environment and Health, 49(7), 496-505
Open this publication in new window or tab >>Trajectories of psychosocial working conditions and all-cause and cause-specific mortality: a Swedish register-based cohort study
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2023 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 49, no 7, p. 496-505Article in journal (Refereed) Published
Abstract [en]

Objectives While psychosocial working conditions have been associated with morbidity, their associations with mortality, especially cause-specific mortality, have been less studied. Additionally, few studies considered the time-varying aspect of exposures. We aimed to examine trajectories of job demand–control status in relation to all-cause and cause-specific mortality, including cardiovascular diseases (CVD), suicide, and alcohol-related mortality.

Methods The study population consisted of around 4.5 million individuals aged 16-60 years in Sweden in 2005. Job control and demands were respectively measured using job exposure matrices (JEM). Trajectories of job control and demands throughout 2005–2009 were identified using group-based trajectory modelling, and job demand–control categories were subsequently classified. Deaths in 2010–2019 were recorded in the national cause of death register. Cox regression models were used.

Results A total of 116 242 individuals died in 2010–2019. For both job control and demands, we identified four trajectories, which were parallel to each other and represented four levels of exposures. Low control and passive jobs were associated with higher all-cause, CVD, and suicide mortality among both men and women. High strain jobs were associated with higher all-cause and CVD mortality among men, while low control, passive jobs, and high strain jobs were associated with higher alcohol-related mortality among women.

Conclusions The trajectories identified may suggest stable levels of job control and demands over time. Poor psychosocial working conditions are related to all-cause and cause-specific mortality, and these patterns vary to some extent between men and women.

Keywords
alcohol-related, all-cause mortality, cardiovascular disease, cause-specific mortality, death, group-based trajectory modelling, job control, job demand, job demand-control, psychosocial, psychosocial working condition, register-based cohort study, suicide, Sweden, trajectory
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-221203 (URN)10.5271/sjweh.4111 (DOI)001049984400001 ()37522817 (PubMedID)2-s2.0-85172940686 (Scopus ID)
Available from: 2023-09-20 Created: 2023-09-20 Last updated: 2024-01-16Bibliographically approved
Kreshpaj, B., Bottai, M., Matilla-Santander, N., Axén, M., Orellana, C., Burström, B., . . . Bodin, T. (2022). Business performance and occupational injuries trajectories in the construction sector in Sweden. Safety Science, 152, Article ID 105772.
Open this publication in new window or tab >>Business performance and occupational injuries trajectories in the construction sector in Sweden
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2022 (English)In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 152, article id 105772Article in journal (Refereed) Published
Abstract [en]

Objective: To identify patterns in business performance and occupational injuries (OIs) in the Swedish construction sector between 2003 and 2015 and investigate associations between these trajectories.

Methods: Company-level data were gathered from national registers. An open cohort of 13,089 private construction companies were classified by size. Yearly business performance indicators were return on equity, operating margin, and labor-to-revenue ratio. OIs rate was defined as number of injuries divided by number of employees. Group-based trajectory models were performed to identify companies with similar patterns in business performance and OIs rate over time. Associations were investigated with binomial regression models.

Results: The model identified two main patterns (high/low) of injuries and business indicators for all company sizes. Trends in low labor-to-revenue ratio were associated with a high injury rate with a pooled estimate of 1.43 (95% CI 1.22–1.64) with some variation by company size: super small OR 1.3 (95% CI 1.01–1.62), small, OR 1.74 (95% CI 1.39–2.18), medium OR 1.3 (95% CI 0.9–1.8) and large OR 2.1 (95% CI 0.77–5.7). Similarly, low patterns of returns on equity were associated with high injury rate patterns across all company sizes, excluding small enterprises. No associations were found for operating margin patterns.

Conclusions: Low returns on equity and labor-to-revenue ratio were associated with higher OIs rate trajectories in the Swedish construction sector, which has implications for injury prevention as well as targeted surveillance and inspection. Further studies could investigate other economic sectors and possible mechanisms for this association.

Keywords
Business performance, Occupational injuries, Occupational epidemiology, Public health
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:su:diva-206176 (URN)10.1016/j.ssci.2022.105772 (DOI)000821675400006 ()2-s2.0-85128232646 (Scopus ID)
Available from: 2022-06-23 Created: 2022-06-23 Last updated: 2022-08-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6156-3964

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