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Accumulation of Major Life Events in Childhood and Adult Life and Risk of Type 2 Diabetes Mellitus.

https://arctichealth.org/en/permalink/ahliterature273707
Source
PLoS One. 2015;10(9):e0138654
Publication Type
Article
Date
2015
Author
Jolene Masters Pedersen
Naja Hulvej Rod
Ingelise Andersen
Theis Lange
Gry Poulsen
Eva Prescott
Rikke Lund
Source
PLoS One. 2015;10(9):e0138654
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Denmark - epidemiology
Diabetes Mellitus, Type 2 - epidemiology - etiology
Female
Follow-Up Studies
Humans
Life Change Events
Logistic Models
Male
Middle Aged
Multivariate Analysis
Risk Assessment - methods - statistics & numerical data
Risk factors
Stress, Psychological - complications
Surveys and Questionnaires
Time Factors
Young Adult
Abstract
The aim of the study was to estimate the effect of the accumulation of major life events (MLE) in childhood and adulthood, in both the private and working domains, on risk of type 2 diabetes mellitus (T2DM). Furthermore, we aimed to test the possible interaction between childhood and adult MLE and to investigate modification of these associations by educational attainment.
The study was based on 4,761 participants from the Copenhagen City Heart Study free of diabetes at baseline and followed for 10 years. MLE were categorized as 0, 1, 2, 3 or more events. Multivariate logistic regression models adjusted for age, sex, education and family history of diabetes were used to estimate the association between MLE and T2DM.
In childhood, experiencing 3 or more MLE was associated with a 69% higher risk of developing T2DM (Odds Ratio (OR) 1.69; 95% Confidence Interval (CI) 1.60, 3.27). The accumulation of MLE in adult private (p-trend = 0.016) and work life (p-trend = 0.049) was associated with risk of T2DM in a dose response manner. There was no evidence that experiencing MLE in both childhood and adult life was more strongly associated with T2DM than experiencing events at only one time point. There was some evidence that being simultaneously exposed to childhood MLE and short education (OR 2.28; 95% C.I. 1.45, 3.59) and work MLE and short education (OR 2.86; 95% C.I. 1.62, 5.03) was associated with higher risk of T2DM, as the joint effects were greater than the sum of their individual effects.
Findings from this study suggest that the accumulation of MLE in childhood, private adult life and work life, respectively, are risk factors for developing T2DM.
Notes
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PubMed ID
26394040 View in PubMed
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Burnout as a risk factor for antidepressant treatment - a repeated measures time-to-event analysis of 2936 Danish human service workers.

https://arctichealth.org/en/permalink/ahliterature269559
Source
J Psychiatr Res. 2015 Jun;65:47-52
Publication Type
Article
Date
Jun-2015
Author
Ida E H Madsen
Theis Lange
Marianne Borritz
Reiner Rugulies
Source
J Psychiatr Res. 2015 Jun;65:47-52
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - therapeutic use
Burnout, Professional - drug therapy - epidemiology - psychology
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Motivation
Proportional Hazards Models
Psychiatric Status Rating Scales
Sensitivity and specificity
Sex Characteristics
Workplace - psychology
Abstract
Burnout is a state of emotional exhaustion, feelings of reduced personal accomplishment, and withdrawal from work thought to occur as a consequence of prolonged occupational stress. The condition is not included in the diagnostic classifications, but is considered likely to develop into depressive disorder in some cases. We examined the prospective association between burnout and antidepressant treatment, as an indicator of clinically significant mental disorder. We further investigated potential effect-modifiers of the association, to identify factors that may prevent this progression of burnout. We used questionnaire data from a three-wave study of Danish human service workers conducted during 1999-2005, linked with national register data on purchases of antidepressants (ATC: N06A). We included 4788 observations from 2936 individuals (81% women) and analysed data by Aalens additive hazards modeling, examining the risk of entering antidepressant treatment in relation to the level of work-related burnout measured by the Copenhagen Burnout inventory. As effect-modifiers we examined both sociodemographic factors and a range of psychosocial work environment factors. The level of burnout predicted antidepressant treatment. This association was modified by sex (p 
Notes
Comment In: J Psychiatr Res. 2015 Oct;69:7-826343588
Comment In: J Psychiatr Res. 2015 Oct;69:180-126168885
PubMed ID
25943951 View in PubMed
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Cohort profile: the Social Inequality in Cancer (SIC) cohort study.

https://arctichealth.org/en/permalink/ahliterature266116
Source
Int J Epidemiol. 2014 Dec;43(6):1750-8
Publication Type
Article
Date
Dec-2014
Author
Helene Nordahl
Ulla Arthur Hvidtfeldt
Finn Diderichsen
Naja Hulvej Rod
Merete Osler
Birgitte Lidegaard Frederiksen
Eva Prescott
Anne Tjønneland
Theis Lange
Niels Keiding
Per Kragh Andersen
Ingelise Andersen
Source
Int J Epidemiol. 2014 Dec;43(6):1750-8
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alcohol drinking - epidemiology
Cohort Studies
Denmark - epidemiology
Educational Status
Female
Health Status Disparities
Humans
Male
Middle Aged
Neoplasms - epidemiology
Risk factors
Sedentary lifestyle
Smoking - epidemiology
Social Class
Social Determinants of Health
Socioeconomic Factors
Young Adult
Abstract
The Social Inequality in Cancer (SIC) cohort study was established to determine pathways through which socioeconomic position affects morbidity and mortality, in particular common subtypes of cancer. Data from seven well-established cohort studies from Denmark were pooled. Combining these cohorts provided a unique opportunity to generate a large study population with long follow-up and sufficient statistical power to develop and apply new methods for quantification of the two basic mechanisms underlying social inequalities in cancer-mediation and interaction. The SIC cohort included 83 006 participants aged 20-98 years at baseline. A wide range of behavioural and biological risk factors such as smoking, physical inactivity, alcohol intake, hormone replacement therapy, body mass index, blood pressure and serum cholesterol were assessed by self-administered questionnaires, physical examinations and blood samples. All participants were followed up in nationwide demographic and healthcare registries. For those interested in collaboration, further details can be obtained by contacting the Steering Committee at the Department of Public Health, University of Copenhagen, at inan@sund.ku.dk.
PubMed ID
24550248 View in PubMed
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Education and cause-specific mortality: the mediating role of differential exposure and vulnerability to behavioral risk factors.

https://arctichealth.org/en/permalink/ahliterature258942
Source
Epidemiology. 2014 May;25(3):389-96
Publication Type
Article
Date
May-2014
Author
Helene Nordahl
Theis Lange
Merete Osler
Finn Diderichsen
Ingelise Andersen
Eva Prescott
Anne Tjønneland
Birgitte Lidegaard Frederiksen
Naja Hulvej Rod
Source
Epidemiology. 2014 May;25(3):389-96
Date
May-2014
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Alcohol drinking - epidemiology
Cardiovascular Diseases - diagnosis - mortality
Cause of Death
Cohort Studies
Confidence Intervals
Denmark
Educational Status
Female
Health Behavior
Health Status Disparities
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasms - epidemiology
Prospective Studies
Respiratory Tract Diseases - diagnosis - mortality
Risk assessment
Sex Distribution
Smoking - epidemiology
Survival Rate
Vulnerable Populations
Abstract
Differential exposures to behavioral risk factors have been shown to play an important mediating role on the education-mortality relation. However, little is known about the extent to which educational attainment interacts with health behavior, possibly through differential vulnerability.
In a cohort study of 76,294 participants 30 to 70 years of age, we estimated educational differences in cause-specific mortality from 1980 through 2009 and the mediating role of behavioral risk factors (smoking, alcohol intake, physical activity, and body mass index). With the use of marginal structural models and three-way effect decomposition, we simultaneously regarded the behavioral risk factors as intermediates and clarified the role of their interaction with educational exposure.
Rate differences in mortality comparing participants with low to high education were 1,277 (95% confidence interval = 1,062 to 1,492) per 100,000 person-years for men and 746 (598 to 894) per 100,000 person-years for women. Smoking was the strongest mediator for cardiovascular disease, cancer, and respiratory disease mortality when conditioning on sex, age, and cohort. The proportion mediated through smoking was most pronounced in cancer mortality as a combination of the pure indirect effect, owing to differential exposure (men, 42% [25% to 75%]; women, 36% [17% to 74%]) and the mediated interactive effect, owing to differential vulnerability (men, 18% [2% to 35%], women, 26% [8% to 50%]). The mediating effects through body mass index, alcohol intake, or physical activity were partial and varied for the causes of deaths.
Differential exposure and vulnerability should be addressed simultaneously, as these mechanisms are not mutually exclusive and may operate at the same time.
PubMed ID
24625538 View in PubMed
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Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model.

https://arctichealth.org/en/permalink/ahliterature118684
Source
Eur J Epidemiol. 2013 Feb;28(2):149-57
Publication Type
Article
Date
Feb-2013
Author
Helene Nordahl
Naja Hulvej Rod
Birgitte Lidegaard Frederiksen
Ingelise Andersen
Theis Lange
Finn Diderichsen
Eva Prescott
Kim Overvad
Merete Osler
Author Affiliation
Section of Social Medicine, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark. henor@sund.ku.dk
Source
Eur J Epidemiol. 2013 Feb;28(2):149-57
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Body mass index
Cohort Studies
Coronary Disease - epidemiology - prevention & control
Denmark - epidemiology
Educational Status
Exercise
Health Behavior
Humans
Life Style
Male
Proportional Hazards Models
Questionnaires
Registries
Risk factors
Sex Factors
Smoking - adverse effects - epidemiology
Abstract
Educational-related gradients in coronary heart disease (CHD) and mediation by behavioral risk factors are plausible given previous research; however this has not been comprehensively addressed in absolute measures. Questionnaire data on health behavior of 69,513 participants, 52 % women, from seven Danish cohort studies were linked to registry data on education and incidence of CHD. Mediation by smoking, low physical activity, and body mass index (BMI) on the association between education and CHD were estimated by applying newly proposed methods for mediation based on the additive hazards model, and compared with results from the Cox proportional hazards model. Short (vs. long) education was associated with 277 (95 % CI: 219, 336) additional cases of CHD per 100,000 person-years at risk among women, and 461 (95 % CI: 368, 555) additional cases among men. Of these additional cases 17 (95 % CI: 12, 22) for women and 37 (95 % CI: 28, 46) for men could be ascribed to the pathway through smoking. Further, 39 (95 % CI: 30, 49) cases for women and 94 (95 % CI: 79, 110) cases for men could be ascribed to the pathway through BMI. The effects of low physical activity were negligible. Using contemporary methods, the additive hazards model, for mediation we indicated the absolute numbers of CHD cases prevented when modifying smoking and BMI. This study confirms previous claims based on the Cox proportional hazards model that behavioral risk factors partially mediates the effect of education on CHD, and the results seems not to be particularly model dependent.
Notes
Comment In: Eur J Epidemiol. 2013 Feb;28(2):113-723371044
Erratum In: Eur J Epidemiol. 2014 Apr;29(4):303-6
PubMed ID
23179630 View in PubMed
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Effectiveness of an early versus a conservative invasive treatment strategy in acute coronary syndromes: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature270424
Source
Ann Intern Med. 2015 Nov 17;163(10):737-46
Publication Type
Article
Date
Nov-17-2015
Author
Kim Wadt Hansen
Rikke Sorensen
Mette Madsen
Jan Kyst Madsen
Jan Skov Jensen
Lene Mia von Kappelgaard
Poul Erik Mortensen
Theis Lange
Soren Galatius
Source
Ann Intern Med. 2015 Nov 17;163(10):737-46
Date
Nov-17-2015
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - radiography - therapy
Aged
Aged, 80 and over
Cardiac Catheterization
Cause of Death
Coronary Angiography
Denmark - epidemiology
Female
Hospitalization
Humans
Incidence
Male
Myocardial Infarction - epidemiology
Propensity Score
Retrospective Studies
Risk factors
Time Factors
Abstract
Randomized clinical trials have found that early invasive strategies reduce mortality, myocardial infarction (MI), and rehospitalization compared with a conservative invasive approach in acute coronary syndromes (ACSs), but the effectiveness of such strategies in real-world settings is unknown.
To investigate adverse cardiovascular outcomes of an early versus a conservative invasive strategy in a national cohort of patients with ACSs.
Retrospective cohort study.
Administrative health care data on hospitalizations, procedures, and outcomes abstracted from the Danish national registries and covering all acute invasive procedures in patients presenting with an ACS.
19 704 propensity score-matched patients hospitalized with a first ACS between 1 January 2005 and 31 December 2011.
Risk for cardiac death or rehospitalization for MI within 60 days of hospitalization.
Compared with a conservative approach, early invasive strategies were associated with a lower risk for cardiac death (cumulative incidence, 5.9% vs. 7.6%; adjusted hazard ratio [HR], 0.75 [95% CI, 0.66 to 0.84]; P 
PubMed ID
26502223 View in PubMed
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Immunoglobulin for necrotising soft tissue infections (INSTINCT): protocol for a randomised trial.

https://arctichealth.org/en/permalink/ahliterature280218
Source
Dan Med J. 2016 Jul;63(7)
Publication Type
Article
Date
Jul-2016
Author
Martin Bruun Madsen
Theis Lange
Peter Buhl Hjortrup
Anders Perner
Source
Dan Med J. 2016 Jul;63(7)
Date
Jul-2016
Language
English
Publication Type
Article
Keywords
Adult
Denmark - epidemiology
Dose-Response Relationship, Drug
Double-Blind Method
Female
Follow-Up Studies
Humans
Immunoglobulin G - administration & dosage
Immunoglobulins, Intravenous - administration & dosage
Immunologic Factors - administration & dosage
Incidence
Male
Middle Aged
Necrosis - drug therapy - epidemiology
Retrospective Studies
Soft Tissue Infections
Treatment Outcome
Abstract
Necrotising soft tissue infections (NSTI) are aggressive infections that can result in severe disability or death. Intravenous polyspecific immunoglobulin G (IVIG) is used as supplementary treatment for patients with NSTIs. The level of evidence is very low, but suggests that IVIG may have beneficial effects. However, IVIG may also have adverse effects. With this trial we will estimate the effects of IVIG on a patient-reported outcome and other patient-centred outcomes in patients with NSTI.
INSTINCT is a randomised, double-blinded, parallel-group, placebo-controlled trial with concealed allocation of patients with NSTI 1:1 to IVIG or an equal volume of 0.9% saline. Patients are recruited at Rigshospitalet, Denmark. The primary outcome is the physical component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey as assessed six months after randomisation. Secondary outcomes are: mortality; time to resolution of shock; bleeding; sequential organ failure assessment scores on days 1-7; use of renal-replacement therapy, mechanical ventilation and vasopressors; days alive and out of hospital; amputation; and severe adverse reactions.
This study will be the only completed trial testing IVIG for NSTI, thereby providing important data on a severely sick patient group.
The trial is supported by CSL Behring in the form of trial medication and a € 92,182 grant for trial conduct, research, nurse salary and statistical analyses.
The trial is registered with clinicaltrials.gov (NCT02111161). .
PubMed ID
27399982 View in PubMed
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Impaired sleep and allostatic load: cross-sectional results from the Danish Copenhagen Aging and Midlife Biobank.

https://arctichealth.org/en/permalink/ahliterature268481
Source
Sleep Med. 2014 Dec;15(12):1571-8
Publication Type
Article
Date
Dec-2014
Author
Alice Jessie Clark
Nadya Dich
Theis Lange
Poul Jennum
Ase Marie Hansen
Rikke Lund
Naja Hulvej Rod
Source
Sleep Med. 2014 Dec;15(12):1571-8
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Allostasis - physiology
Biomarkers - blood
Blood pressure
C-Reactive Protein - analysis
Cholesterol - blood
Cholesterol, HDL - blood
Cross-Sectional Studies
Denmark
Female
Health status
Hemoglobin A, Glycosylated - analysis
Humans
Interleukin-6 - blood
Longitudinal Studies
Male
Middle Aged
Risk factors
Sleep Wake Disorders - etiology - physiopathology
Surveys and Questionnaires
Triglycerides - blood
Waist-Hip Ratio
Abstract
Understanding the mechanisms linking sleep impairment to morbidity and mortality is important for future prevention, but these mechanisms are far from elucidated. We aimed to determine the relation between impaired sleep, both in terms of duration and disturbed sleep, and allostatic load (AL), which is a measure of systemic wear and tear of multiple body systems, as well as with individual risk markers within the cardiac, metabolic, anthropometric, and immune system.
A cross-sectional population-based study of 5226 men and women from the Danish Copenhagen Aging and Midlife Biobank with comprehensive information on sleep duration, disturbed sleep, objective measures of an extensive range of biological risk markers, and physical conditions.
Long sleep (mean difference 0.23; 95% confidence interval, 0.13, 0.32) and disturbed sleep (0.14; 0.06, 0.22) were associated with higher AL as well as with high-risk levels of risk markers from the anthropometric, metabolic, and immune system. Sub-analyses suggested that the association between disturbed sleep and AL might be explained by underlying disorders. Whereas there was no association between short sleep and AL, the combination of short and disturbed sleep was associated with higher AL (0.19; 0.08, 0.30) and high-risk levels of immune system markers.
Our study suggests small but significant differences in the distribution of allostatic load, a pre-clinical indicator of disease risk and premature death, for people with impaired relative to normal sleep. Impaired sleep may be a risk factor for developing disease and be a risk marker for underlying illness or sleep disorders.
PubMed ID
25316292 View in PubMed
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Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients: rationale and design of the TRIAGE III cluster randomized interventional trial.

https://arctichealth.org/en/permalink/ahliterature279337
Source
Scand J Trauma Resusc Emerg Med. 2016 Aug 05;24:100
Publication Type
Article
Date
Aug-05-2016
Author
Andreas Sandø
Martin Schultz
Jesper Eugen-Olsen
Lars Simon Rasmussen
Lars Køber
Erik Kjøller
Birgitte Nybo Jensen
Lisbet Ravn
Theis Lange
Kasper Iversen
Source
Scand J Trauma Resusc Emerg Med. 2016 Aug 05;24:100
Date
Aug-05-2016
Language
English
Publication Type
Article
Keywords
Acute Disease - mortality - therapy
Adult
Aged
Biomarkers - blood
Denmark - epidemiology
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Risk assessment
Survival Rate - trends
Triage - organization & administration
Abstract
Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious complications or deaths. Our aim is to determine whether measurement of the blood level of the biomarker soluble urokinase plasminogen activator receptor (suPAR) can enhance early risk stratification leading to reduced mortality, lower rate of complications, and improved patient flow in acutely admitted adult patients at the ED. The main hypothesis is that the availability of suPAR can reduce all-cause mortality, assessed at least 10 months after admission, by drawing attention towards patients with an unrecognized high risk, leading to improved diagnostics and treatment.
The study is designed as a cross-over cluster randomized interventional trial. SuPAR is measured within 2 h after admission and immediately reported to the treating physicians in the ED. All ED physicians are educated in the prognostic capabilities of suPAR prior to the inclusion period. The inclusion period began January 11(th) 2016 and ends June 6(th) 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017.
The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability of prognostic information can improve outcome in acutely admitted patients. This might have an impact on health care organization and decision-making.
The trial is registered at clinicaltrials.gov (ID NCT02643459 , November 13, 2015) and at the Danish Data Protection agency (ID HGH-2015-042 I-Suite no. 04087).
PubMed ID
27491822 View in PubMed
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Is the high-risk strategy to prevent cardiovascular disease equitable? A pharmacoepidemiological cohort study.

https://arctichealth.org/en/permalink/ahliterature121941
Source
BMC Public Health. 2012;12:610
Publication Type
Article
Date
2012
Author
Helle Wallach-Kildemoes
Finn Diderichsen
Allan Krasnik
Theis Lange
Morten Andersen
Author Affiliation
Centre for Healthy Aging, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark. hewk@sund.ku.dk
Source
BMC Public Health. 2012;12:610
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cardiovascular Diseases - drug therapy - epidemiology - prevention & control
Cohort Studies
Denmark - epidemiology
Female
Healthcare Disparities - economics
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Pharmacoepidemiology
Risk assessment
Social Class
Abstract
Statins are increasingly prescribed to prevent cardiovascular disease (CVD) in asymptomatic individuals. Yet, it is unknown whether those at higher CVD risk - i.e. individuals in lower socio-economic position (SEP) - are adequately reached by this high-risk strategy. We aimed to examine whether the Danish implementation of the strategy to prevent cardiovascular disease (CVD) by initiating statin (HMG-CoA reductase inhibitor) therapy in high-risk individuals is equitable across socioeconomic groups.
Cohort study.
Applying individual-level nationwide register information on socio-demographics, dispensed prescription drugs and hospital discharges, all Danish citizens aged 20+ without previous register-markers of CVD, diabetes or statin therapy were followed during 2002-2006 for first occurrence of myocardial infarction (MI) and a dispensed statin prescription (N?=?3.3 mill).
Stratified by gender, 5-year age-groups and socioeconomic position (SEP), incidence of MI was applied as a proxy for statin need. Need-standardized statin incidence rates were calculated, applying MI incidence rate ratios (IRR) as need-weights to adjust for unequal needs across SEP.Horizontal equity in initiating statin therapy was tested by means of Poisson regression analysis. Applying the need-standardized statin parameters and the lowest SEP-group as reference, a need-standardized statin IRR?>?1 translates into horizontal inequity favouring the higher SEP-groups.
MI incidence decreased with increasing SEP without a parallel trend in incidence of statin therapy. According to the regression analyses, the need-standardized statin incidence increased in men aged 40-64 by 17%, IRR 1.17 (95% CI: 1.14-1.19) with each increase in income quintile. In women the proportion was 23%, IRR 1.23 (1.16-1.29). An analogous pattern was seen applying education as SEP indicator and among subjects aged 65-84.
The high-risk strategy to prevent CVD by initiating statin therapy seems to be inequitable, reaching primarily high-risk subjects in lower risk SEP-groups.
Notes
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