Stress Disorders Linked to Increase Risk of Autoimmune Disease

MedicalResearch.com Interview with:

Huan Song Associated Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Huan Song

Huan Song
Associated
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Earlier findings from our group (e.g. Fang et al., NEJM 2012; Arnberg et al., Lancet Psychiatry 2015; Lu et al., JAMA Oncol 2016; Shen et al., BMJ 2016; Zhu et al., Ann Oncol 2017) have identified pathways through which stressful events contribute to deterioration in human health. With strong animal models and human data supporting a role of stress in immune dysregulation, the hypothesis linking mental distress with autoimmune is indeed plausible. However, the evidence is as yet limited to clinical observations and a few larger observational studies on US veterans, most of them on men only, and some of which have cross-sectional designs and various other methodological shortcomings.

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Adolescent Violent Offenders With Childhood Adversity Have Increased Risk of Suicide

MedicalResearch.com Interview with:
Emma Björkenstam PhD
Department of Public Health Sciences
Karolinska Institutet

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: My research team and I have previously shown that childhood adversity is associated with an elevated suicide risk in young adults, and this increased risk may be explained by maladaptive trajectories during adolescence. We also know that adolescent violent offending is linked with suicide, but up until now, less was known about the role of violent offending in the association between childhood adversity and later suicide.

Our main finding in the current study, based on almost half a million Swedes, is that individuals with a history of childhood adversity who also engage in violent offending in late adolescence, have a substantial increased risk of suicide.

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More Evidence That Higher Education May Lower Risk of Alzheimer’s Disease

MedicalResearch.com Interview with:

Susanna C. Larsson, PhD Associate Professor, Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden

Dr. Larsson

Susanna C. Larsson, PhD
Associate Professor, Karolinska Institutet,
Institute of Environmental Medicine,
Stockholm, Sweden

MedicalResearch.com: What is the background for this study?

Response: The causes of Alzheimer’s disease are largely unknown and there are currently no medical treatments that can halt or reverse its effects. This has led to growing interest in identifying risk factors for Alzheimer’s that are amenable to modification. Several observational studies have found that education and various lifestyle and vascular risk factors are associated with the risk of Alzheimer’s disease, but whether these factors actually cause Alzheimer’s is unclear.

We used a genetic epidemiologic method known as ‘Mendelian randomization’. This method involves the use of genes with an impact on the modifiable risk factor – for example, genes linked to education or intelligence – and assessing whether these genes are also associated with the disease. If a gene with an impact on the modifiable risk factor is also associated with the disease, then this provides strong evidence that the risk factor is a cause of the disease.

MedicalResearch.com:  What are the main findings?

Response: Our results, based on aggregated genetic data from 17 000 Alzheimer’s disease patients and 37 000 healthy controls, revealed that genetic variants that predict higher education were clearly associated with a reduced risk of Alzheimer’s disease. A possible explanation for this link is ‘cognitive reserve’, which refers to the ability to recruit and use alternative brain networks or structures not normally used to compensate for brain ageing. Previous research has shown that high education increases this reserve.

We found suggestive evidence for possible associations of intelligence, circulating vitamin D, coffee consumption, and smoking with risk of Alzheimer’s disease. There was no evidence for a causal link with other modifiable factors, such as vascular risk factors.

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Obsessive-Compulsive Disorder Associated With Educational Underachievment

MedicalResearch.com Interview with:

Ana Pérez-Vigil MD Department of Clinical Neuroscience Child and Adolescent Psychiatry Research Center Karolinska Institutet

Dr. Perez-Vigil

Ana Pérez-Vigil MD
Department of Clinical Neuroscience
Child and Adolescent Psychiatry Research Center
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Everyone who regularly works with persons who have obsessive-compulsive disorder (OCD) has seen that their patients often struggle with school work. It is not uncommon for these individuals to have poor school attendance and severe patients can be out of the education system altogether. This applies to persons of all ages, from school children to young adults who may be at university.

On the other hand there is a group of patients who, against all odds, working 10 times as hard as everybody else, manage to stay in education and eventually get a degree. So we have long suspected that OCD has a detrimental impact on the person’s education, with all the consequences that this entails (worse chances to enter the labour market and have a high paid job). But we did not really know to what extent OCD impacts education. So we wanted to know what is the actual impact of OCD on educational attainment using objectively collected information from the unique Swedish national registers. Previous work had been primarily based on small clinical samples from specialist clinics, using either self or parent report and cross-sectional designs. Previous work also tended not to control for important confounders such as psychiatric comorbidity or familial factors (genetic and environmental factors that could explain both OCD and the outcomes of interest).

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Any Detectable High-Sensitivity Cardiac Troponin T Level Associated With Adverse Outcomes

MedicalResearch.com Interview with:
Martin Holzmann PhD

Department of Medicine
Functional Area of Emergency Medicine,
Karolinska University Hospital, Huddinge
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been a few studies in the general population that indicate that subjects with detectable and elevated high-sensitivity troponin T (hs-cTnT) levels have an increased risk of death and cardiovascular disease. However, in clinical practice troponins are not used for anything else than to rule in or rule out myocardial infarction in the emergency department. In addition, in a previous publication we have shown that patients with persistently elevated troponin levels are rarely investigated or followed-up to exclude heart disease. Therefore, we wanted to investigate how the association between different levels of hs-cTnT are associated with outcomes in patients with chest pain but no MI or other acute reasons for having an acutely elevated troponin level.

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Joint Physical Custody Better For Children’s Psychological Health

MedicalResearch.com Interview with:

Malin Bergström PhD Center for Health Equity Studies  Karolinska Institutet  

Dr. Bergstrom

Malin Bergström PhD
Center for Health Equity Studies
Karolinska Institutet  

MedicalResearch.com: What is the background for this study?

Response: The increase in children who move between their parent’s homes after a divorce is one of the major changes in children’s life circumstances during the last decade. Spending equal amounts of time in both parents’ homes means that these children move fifty times a year. Child experts have claimed this to be stressful and potentially harmful to children’s attachment relations to their mothers. Especially for children this young the practice of joint physical custody has been questioned.

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Alzheimer’s: Antidepressants Increase Risk of Head and Traumatic Brain Injuries

MedicalResearch.com Interview with:

Heidi Taipale, PhD Pharm Senior Researcher School of Pharmacy, University of Eastern Finland; and Department of Clinical Neuroscience Karolinska Institutet 

Dr. Taipale

Heidi Taipale, PhD Pharm
Senior Researcher
School of Pharmacy, University of Eastern Finland; and
Department of Clinical Neuroscience
Karolinska Institutet 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Antidepressant use among older persons has been associated with an increased risk of falling and fall-related events, such as hip fractures, in previous studies. Our previous study identified risk of hip fractures in antidepressant among persons with Alzheimer’s disease. As falling is the main causal factor for head traumas and traumatic brain injuries among older persons, we hypothesized that antidepressant use could also be associated with these injuries.

We utilized a nationwide cohort of 70,718 persons newly diagnosed with Alzheimer’s disease, identified from the Finnish registers. The risk of head injuries and traumatic brain injuries was compared between persons initiating antidepressant use and comparison persons of the same age, gender and time since they received diagnoses of Alzheimer’s disease but not using antidepressants. We found a 40-percent increased risk of head injuries and 30-percent increased risk of traumatic brain injuries associated with antidepressant use. Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use – during the first 30 days – but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors. Continue reading

AEDs Delivered By Drones May Improve Cardiac Arrest Survival

MedicalResearch.com Interview with:
“drones” by Andrew Turner is licensed under CC BY 2.0Andreas Claesson, RN, Paramedic

PhD Centre for resuscitation science
Karolinska institute
Stockholm, Sweden.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Survival from out-of-hospital cardiac arrest is low, the technology is existing. When implementing this kind of system with a drone equipped with an AED, defibrillation may occur at an early stage and before EMS arrival mainly in rural areas.

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Long-acting Injectable Medications Reduce Relapse and Rehospitalizations in Schizophrenia

MedicalResearch.com Interview with:

Jari Tiihonen, MD, PhD Professor, Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden

Prof. Tiihonen

Jari Tiihonen, MD, PhD
Professor, Department of Clinical Neuroscience
Karolinska Institutet
Stockholm, Sweden 

MedicalResearch.com: What are the limitations of existing analyses of the comparative effectiveness of antipsychotics?

Response: It has remained unclear if there are clinically meaningful differences between antipsychotic treatments in relapse prevention of schizophrenia, due to the impossibility of including large unselected patient populations in randomized controlled trials, and due to residual confounding from selection biases in observational studies.

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ADHD Medications Reduce Risk of Motor Vehicle Crashes

MedicalResearch.com Interview with:
Zheng Chang PhD MSc
Department of Medical Epidemiology and Biostatistics (MEB)
Karolinska Institutet
Stockholm Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: About 1.25 million people worldwide die annually because of motor vehicle crashes (MVCs). ADHD is a prevalent neurodevelopmental disorder with symptoms that include poor sustained attention, impaired impulse control and hyperactivity. ADHD affects 5 percent to 7 percent of children and adolescent and for many people it persists into adulthood. Prior studies have suggested people with ADHD are more likely to experience MVCs. Pharmacotherapy is a first-line treatment for the condition and rates of ADHD medication prescribing have increased over the last decade in the United States and in other countries.

Among the more than 2.3 million patients with ADHD (average age 32.5), we found patients with ADHD had a higher risk of an MVC than a control group of people without ADHD. The use of medication in patients with ADHD was associated with reduced risk for motor vehicle crashes in both male and female patients.

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Fetal Reduction in Multifetal Pregnancies Results in Fewer Preterm Births and Deaths

MedicalResearch.com Interview with:

Neda Razaz, PhD, MPH Postdoctoral Fellow Reproductive Epidemiology Unit Karolinska Institutet

Dr. Razaz

Neda Razaz, PhD, MPH
Postdoctoral Fellow
Reproductive Epidemiology Unit
Karolinska Institutet

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Multiple births of twins and triplets – and the associated health risks – have increased in many high-income countries, with a respective two-fold and three-fold increase in recent decades.

In Canada, triplet births or higher have increased from 52.2 per 100 000 live births to 83.5 between 1991 and 2009, mainly because of an increase in fertility treatments for older women of child-bearing age. In this study we found that among twin and triplet pregnancies that were reduced to singleton or twin pregnancies, there was a substantial reduction in complications such as preterm birth and very preterm birth. Although rates of death and serious illness were not lower among all multifetal pregnancies that were reduced, pregnancies that resulted from fertility treatments did show a significant reduction in rates of death or serious illness following fetal reduction.

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Vagotomy May Point To Gut Origin of Parkinson’s Disease

MedicalResearch.com Interview with:

Karin Wirdefeldt, MD, PhD</strong> Associate professor Karolinska Institutet Stockholm, Sweden

Dr. Wirdefeldt

Karin Wirdefeldt, MD, PhD
Associate professor
Karolinska Institutet
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It has been hypothesized that Parkinson’s disease may start in the gut and spread to the brain via the vagal nerve. We found that people who had a truncal vagotomy (ie, the nerve trunk fully resected) at least 5 years earlier were less likely to develop Parkinson’s disease compared to people without vagotomy or people who had a selective vagotomy (ie, only branches of the nerve resected).

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Childhood Adversities Linked To Increased Suicide Risk in Adolescents and Young Adults

MedicalResearch.com Interview with:
Charlotte Björkenstam PhD

Dept of Clinical Neuroscience
Karolinska Institutet
Division of Insurance Medicine
Stockholm

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.

We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.

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Deliberate Self-harm Associated With Violent Criminality

MedicalResearch.com Interview with:

Hanna Sahlin MSc, Lic psychologist, Lic psychotherapist Specialist in clinical psychology PhD-student Departement of Clinical Neuroscience Karolinska Institutet National Self-harm project Centre for Psychiatry Research, CPF Stockholm, Sweden

Hanna Sahlin

Hanna Sahlin
MSc, Lic psychologist, Lic psychotherapist
Specialist in clinical psychology
PhD-student
Departement of Clinical Neuroscience
Karolinska Institutet
National Self-harm project
Centre for Psychiatry Research, CPF
Stockholm, Sweden

What is the background for this study? What are the main findings?

Response: This study is the result of wanting to find a more conclusive answer to whether individuals who engage in non-fatal deliberate self-harm are more prone to aggression towards others. There has long been a debate on whether aggression to oneself and aggression towards others co-occur, but the studies that have been conducted thus far have been on smaller samples or with clinical or forensic cohorts. Also, the studies have had great variability regarding the definition of both “deliberate self-harm” and “violence”. Thus, it has been difficult to establish an ”overall” effect size for this association, or to draw firmer conclusions on how and if this association plays out in the general population.

We had the opportunity to study this association in several large nationwide population-based registries including all Swedish citizens, and with high specificity regarding the ingoing variables of interest – i.e., non-fatal deliberate self-harm (as registered in the National Patient Register) and violent crime convictions (as registered in the National Crime Register).

We found a five times increased crude risk (hazard) of being convicted of a violent crime if one had received self-harm associated clinical care, and vice-versa, that there was an equally increased risk of self-harm if one had been convicted of a violent crime. After controlling for relevant psychiatric comorbidities and socio-economic status, an almost doubled risk of violent crime conviction remained among self-harming men and women compared to individuals not exposed to self-harm. It is important to notice that our study did not find any evidence suggesting that self-harm behaviours cause violent criminality. Therefore, we conclude that the engagement in violence towards oneself and towards others share an underlying vulnerability to impulsive and aggressive behaviours.

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Maternal Obesity Linked To Increased Risk of Epilepsy in Offspring

MedicalResearch.com Interview with:
Neda Razaz-Vandyke, PhD, MPH
Postdoctoral Fellow
Reproductive Epidemiology Unit
Karolinska Institutet  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   There is a growing concern about long-term neurological effects of prenatal exposure to maternal overweight and obesity.

The etiology of epilepsy is poorly understood and in more than 60% of cases no definitive cause can be determined. We found that maternal overweight and obesity increased the risks of childhood epilepsy in a dose-response pattern.

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Parents Live Longer Than Those Without Children

MedicalResearch.com Interview with:

Dr. Karin Modig, PhD Institute of Environmental Medicine,Epidemiology Karolinska Institute

Dr. Modig

Dr. Karin Modig, PhD
Institute of Environmental Medicine,Epidemiology
Karolinska Institute

MedicalResearch.com: What is the background for this study?

Response: The background to the study was that even though it is established that parents live longer than non-parents the underlying mechanisms are not clear. And it was not known how the association changed with the age of the parents. We hypothesize that if social support is one mechanism – the association between having children and the death risk of parents-non-parents would increase with age of the parents, when health starts to deteriorate and the need of support increases.

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Maternal Cancer During Pregnancy Linked To Stillbirths and Infant Mortality

MedicalResearch.com Interview with:

Donghao Lu. PhD student Department of Medical Epidemiology and Biostatistics Karolinska Institute

Dr. Donghao Lu

Donghao Lu PhD student
Department of Medical Epidemiology and Biostatistics
Karolinska Institute

MedicalResearch.com: What is the background for this study?

Response: Cancer during pregnancy is a rare event. Whether prenatal exposure to a maternal malignancy and its treatment during pregnancy impair fetal development and neonatal health is, however, of great clinical concern. The risks of fatal outcomes such as stillbirth and infant mortality, however, have rarely been successfully explored in pregnancies complicated with cancer, in either clinical or population-based studies.

MedicalResearch.com: What are the main findings?

Response: Maternal cancer diagnosed during pregnancy was associated with increased risk of stillbirth (Incidence Rate Ratio, IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as small for gestational age (SGA), and with increased risk of preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Maternal cancer diagnosed during pregnancy or the year after pregnancy were associated with increased risks of both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality.

MedicalResearch.com: What should readers take away from your report?

Response: Maternal cancer diagnosed during pregnancy was associated with increased risks of stillbirths assessed as SGA and preterm SGA live birth, suggesting that cancer and its treatment during pregnancy may impair fetal growth. Maternal cancer diagnosed during or shortly after pregnancy was associated with an increased risk of neonatal mortality, largely attributable to iatrogenic preterm birth. Although stillbirth and neonatal death are rare outcomes, the absolute risks of SGA and preterm birth are not small in pregnancies complicated with cancer. Careful monitoring of fetal growth and cautious decision making on the choices as well as the timing of preterm delivery should therefore be reinforced in these pregnancies.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Sweden is among the high-income countries with the lowest stillbirth and infant mortality rates, and these rates have decreased over time in many populations. Future studies in other populations are warranted to confirm our findings. Our data have also highlighted several cancer types, such as blood cancer, ovarian cancer, and cervical cancer, which entail highly increased risk of SGA or preterm birth and might be worthy of further exploration. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality

Donghao Lu, Jonas F. Ludvigsson, Karin E. Smedby, Katja Fall, Unnur Valdimarsdóttir, Sven Cnattingius, and Fang Fang

Journal of Clinical Oncology
DOI: 10.1200/JCO.2016.69.9439 Journal of Clinical Oncology – published online before print March 6, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Flu Treatment With Neuraminidase Inhibitors During Pregnancy Not Linked To Birth Defects

MedicalResearch.com Interview with:

Dr. Sophie Graner Department of Women's and Childrens Health Karolinska Institute, Stockholm, Sweden

Dr. Graner

Dr. Sophie Graner
Department of Women’s and Childrens Health
Karolinska Institute, Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pregnant women are at increased risks of severe disease and death due to influensa infection, as well as hospitalization. Also influenza and fever increase the risk of adverse pregnancy outcomes for their infants such as intrauterine death and preterm birth. Due to this, the regulatory agencies in Europe and the US recommended post exposure prophylaxis and treatment for pregnant women with neuraminidase inhibitors during the last influenza pandemic 2009-10. Despite the recommendations, the knowledge on the effect of neuraminidase inhibitors on the infant has been limited. Previously published studies have not shown any increased risk, but they have had limited power to assess specific neonatal outcomes such as stillbirth, neonatal mortality, preterm birth, low Agar score, neonatal morbidity and congenital malformations.
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Enrollment in Heart Failure Registry Associated With Improved Survival

MedicalResearch.com Interview with:
Lars H. Lund, MD Phd, Assoc. Prof., FESC
Department of Medicine, Karolinska Institutet, and
Department of Cardiology, Karolinska University Hospital
Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Registries are accepted for quality reporting but it is actually unknown whether in heart failure they directly improve outcomes.

Here, enrollment in SwedeHF was strongly associated with reduced mortality.

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Executive Brain Function Predictive of Success on the Soccer Pitch

MedicalResearch.com Interview with:
soccer; creative commons imageTorbjörn Vestberg

Licensed Psychologist & Researcher
Department of Clinical Neuroscience, Karolinska Institutet
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The aim of our research is to study the importance of executive functions for successful behaviour. In our first study published in 2012 (Executive Functions Predict the Success of Top-Soccer Players) we showed that the level of elite soccer players’ higher executive functions was in general 2 standard deviations above the normal population. It was the same for both men and women.

Moreover, we also found a strong correlation between the capacities of higher executive functions and the number of goals and assists the player made after two and a half year.

In our new study we were interested in how the situation is at a younger age, from twelve to nineteen years of age. Because of the maturation of the brain, higher executive functions do not reach their full capacity before nineteen years of age.

On basis of this, our question was whether there were other parts of the executive functions that correlated with success in soccer. In this new study, we focused on core executive functions like the working memory, as it reaches its full capacity in the early teens. We found that there was a moderate correlation with the accuracy of the working memory and the number of goals the junior elite players made during a period of two years. When we made a composite measurement of both the demanding working memory and the test for the capacity of the higher executive functions, we found a strong correlation between these results and the number of goals that the players made during the two years of time. When we measured IQ and physical features, like length, we found out that those did not influence the results.

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