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Mobile Patient-Provider Communication and Lifestyle Improvement: Examining the Role of Mobile Technology Identity and Health Empowerment. 患者与医疗服务提供者之间的移动通信与生活方式的改善:研究移动技术身份和健康赋权的作用。
IF 3.9 3区 医学
Health Communication Pub Date : 2024-09-11 DOI: 10.1080/10410236.2024.2402160
Piper Liping Liu,Jizhou Francis Ye
{"title":"Mobile Patient-Provider Communication and Lifestyle Improvement: Examining the Role of Mobile Technology Identity and Health Empowerment.","authors":"Piper Liping Liu,Jizhou Francis Ye","doi":"10.1080/10410236.2024.2402160","DOIUrl":"https://doi.org/10.1080/10410236.2024.2402160","url":null,"abstract":"In the span of a decade, smartphones have gained popularity and acceptance among both patients and physicians thanks to their advantages in health care delivery. However, research investigating mobile patient-provider communication (MPPC) and its impact on patients' lifestyles is only just beginning. Drawing on the pathway model of health communication and mobile technology (MTI) theory, we developed a research model to explore the effect of MPPC on lifestyle improvement, using health empowerment as a mediator and MTI as a moderator. The findings from 432 participants (Mage = 32.5 years old, female = 212) suggested that after controlling for respondents' age, gender, education, income, and general health status, having greater communication with healthcare providers through mobile devices was positively related to lifestyle improvement and that health empowerment mediated this relationship. Moreover, MTI-emotional energy (MTIE) moderated the direct relationship between MPPC and lifestyle improvement, while MTI-dependency (MTID) moderated the indirect impact of MPPC. Individuals who hold a greater MTIE/MTID were more likely to benefit from MPPC such that they are more likely to be empowered for self-care and maintain healthy lifestyles. This study not only contributes to the growing literature on mobile health communication but also plays a reference role for interventions in patient empowerment and health promotion. Theoretical and practical implications were discussed.","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health-Related Communication of Social Media Influencers: A Scoping Review. 社交媒体影响者与健康有关的传播:范围审查》。
IF 3.9 3区 医学
Health Communication Pub Date : 2024-09-11 DOI: 10.1080/10410236.2024.2397268
Jaroslava Kaňková,Alice Binder,Jörg Matthes
{"title":"Health-Related Communication of Social Media Influencers: A Scoping Review.","authors":"Jaroslava Kaňková,Alice Binder,Jörg Matthes","doi":"10.1080/10410236.2024.2397268","DOIUrl":"https://doi.org/10.1080/10410236.2024.2397268","url":null,"abstract":"Social media influencers (SMIs) are an essential part of today's digital media landscape and have the ability to significantly impact the health-related attitudes and behavior of their audiences. Despite an increasing number of studies, research has produced mixed results, and a comprehensive overview of the main findings is lacking. Therefore, the goal of this scoping review was to comprehensively map the literature focusing on SMIs and their health-related communication. Specifically, we analyzed the most frequently studied health topics and social media platforms, the methodological characteristics of the studies, as well as the communication techniques employed by SMIs, and the potential positive and negative effects of their communication on their audience. Additionally, we examined the major research gaps in this area. Altogether, we analyzed n = 116 empirical papers. The results reveal a wide range of different outcomes influenced by SMIs, including both positive and negative changes in health-related attitudes and behavioral intentions among their followers. Furthermore, our findings highlight the need for future research to prioritize experimental and longitudinal studies, investigate actual behavioral outcomes resulting from influencer content exposure, and closely examine the potential negative effects of SMIs' health-related communication. More attention needs to be paid to health-related misinformation disseminated by SMIs. Lastly, this study identified several highly relevant health topics and social media platforms that should be the focus of future research.","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Fears Come True: An Experimental Approximation of Patient Comprehension During Initial Cancer Diagnoses. 当恐惧成真:癌症初步诊断过程中患者理解力的实验近似。
IF 3.9 3区 医学
Health Communication Pub Date : 2024-09-11 DOI: 10.1080/10410236.2024.2400819
Samuel Bashian,Rachel Barry Wade,Blue Lerner,Hillary C Shulman
{"title":"When Fears Come True: An Experimental Approximation of Patient Comprehension During Initial Cancer Diagnoses.","authors":"Samuel Bashian,Rachel Barry Wade,Blue Lerner,Hillary C Shulman","doi":"10.1080/10410236.2024.2400819","DOIUrl":"https://doi.org/10.1080/10410236.2024.2400819","url":null,"abstract":"An experiment (N = 624 U.S. adults) was designed to approximate how well patients attend to information during a cancer-related doctor visit. To make this assessment, we manipulated mortality salience (present, absent) and language complexity (simple words, complex words) to understand whether these factors impact newly diagnosed patients' ability to attend to relevant treatment information. Message attention was measured through a comprehension quiz and a signal detection task. We found that a state of heightened mortality salience slightly improved message comprehension. We also found that language simplicity in an article about skin cancer treatment improved comprehension and attention, particularly under conditions of high mortality salience. These findings suggest that practitioners should use simple language when discussing health care options with their patients.","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effect of Social Media Influencer Warranting Cues on Intentions to Use Non-Hormonal Contraception. 社交媒体影响者的担保线索对使用非荷尔蒙避孕药意向的影响。
IF 3.9 3区 医学
Health Communication Pub Date : 2024-09-11 DOI: 10.1080/10410236.2024.2402161
Emily J Pfender,Scott E Caplan
{"title":"The Effect of Social Media Influencer Warranting Cues on Intentions to Use Non-Hormonal Contraception.","authors":"Emily J Pfender,Scott E Caplan","doi":"10.1080/10410236.2024.2402161","DOIUrl":"https://doi.org/10.1080/10410236.2024.2402161","url":null,"abstract":"Young women increasingly get sexual health information from social media influencers, who use persuasive communication and can alter attitudes, intentions, and behaviors. Contraception is a commonly discussed health topic among influencers on social media. Previous research suggests that influencers negatively frame and encourage the discontinuation of hormonal contraception. At the same time, influencers also encourage the uptake of less effective non-hormonal options, such as fertility awareness-based methods. Though descriptive content analysis work details these patterns in influencer contraceptive messaging, there is no experimental research that explains message effects. The purpose of this study was to experimentally test the effect of influencer contraceptive-related messaging on behavioral health intentions. This study introduces warranting theory as a potentially valuable model for explaining online health communication message effects. Specifically, this study tested the effect of influencer messages containing sponsorship and medical disclaimers on intentions to use non-hormonal contraception. U.S. females (n = 296) ranging in age from 18-29 years old participated in a survey. Findings suggest that the interaction led to decreased intentions to use non-hormonal contraception. However, findings did not support a relationship between influencer messaging and impressions, which highlights potential boundary conditions for warranting theory and high-risk health behaviors. Additionally, there was a positive relationship between perceived trustworthiness and expertise of the influencer and intention to use non-hormonal contraception. Future research should test influencer messaging using real social media content and consider the effect of parasocial relationships. Practical implications highlight the need for comprehensive contraceptive counseling.","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Discourse Analysis in End-of-Life Communication: A Systematic Review. 临终交流中的话语分析:系统回顾。
IF 3 3区 医学
Health Communication Pub Date : 2024-09-08 DOI: 10.1080/10410236.2024.2400815
Nan Jia, Yijin Wu
{"title":"Discourse Analysis in End-of-Life Communication: A Systematic Review.","authors":"Nan Jia, Yijin Wu","doi":"10.1080/10410236.2024.2400815","DOIUrl":"https://doi.org/10.1080/10410236.2024.2400815","url":null,"abstract":"<p><p>Discourse analysis (DA) has emerged as a valuable method for examining communication between participants in end-of-life (EOL) care. However, there remains a gap in synthesizing the findings of discourse analytic studies focused on communication within EOL care settings. The aim of this study was to synthesize DA studies in EOL care. A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (Prisma) guidelines. An electronic database of Web of Science (WOS), MEDLINE, PubMed, and Embase was performed. 14 peer-reviewed studies published in English before January 10 2024, were included. Thematic analysis identified three overarching themes: (1) caregivers' discursive stances on EOL care, (2) discursive practices of participants in shared decision-making conversations, and (3) discursive resources in talking illness trajectories. Findings suggest that DA has the potential to provide insights into understanding communication practices in EOL care and examining an individual's stance on issues about EOL care, thus informing clinical practice and improving patient-centered care.</p>","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social Determinants of Message Exposure and Health Anxiety Among Young Sexual Minority Men in the United States During the 2022 Mpox Outbreak. 2022 年麻疹疫情爆发期间美国少数性取向年轻男性信息接触和健康焦虑的社会决定因素》(Social Determinants of Message Exposure and Health Anxiety Among Young Sexual Minority Men in the United States during the 2022 Mpox Outbreak)。
IF 3 3区 医学
Health Communication Pub Date : 2024-09-03 DOI: 10.1080/10410236.2024.2397272
Christopher D Otmar, Andy J Merolla
{"title":"Social Determinants of Message Exposure and Health Anxiety Among Young Sexual Minority Men in the United States During the 2022 Mpox Outbreak.","authors":"Christopher D Otmar, Andy J Merolla","doi":"10.1080/10410236.2024.2397272","DOIUrl":"https://doi.org/10.1080/10410236.2024.2397272","url":null,"abstract":"<p><p>This study tested the structural influence model of communication in the context of the 2022 global outbreak of the Mpox virus among young sexual minority men. The primary objective was to understand how distinct social determinants, including education, race/ethnicity, and interpersonal discrimination, influenced exposure to Mpox messages in daily life and affected health anxiety concerning the Mpox virus in the United States. We also explored the significance of LGBTQ+ community connectedness as a crucial form of social capital during the outbreak. We collected a three-wave longitudinal dataset and examined within-person and between-person associations using a random-intercept cross-lagged panel model. Participants (<i>N</i> = 254) reported that internet sources and social media were their primary information sources for Mpox messages during the outbreak. Educational attainment, racial minority status, and LGBTQ+ community connectedness were significantly associated with message exposure. Young sexual minority men who faced greater interpersonal discrimination in their daily lives also reported higher rates of Mpox-related health anxiety. Longitudinal analysis indicated that (at the within-person level) Mpox anxiety was significantly associated with greater Mpox message exposure in the month following the outbreak, but that relationship waned in the subsequent month. The theoretical implications highlight the relevance of minority stress variables in the structural influence model of communication framework and suggest the importance of community connectedness as a distinct form of social capital shaping message exposure and health anxiety during the Mpox outbreak in the United States.</p>","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Haptic Resources in Pain Communication: New Amputees Redirecting Doctors' Professional Touch at the Prosthetic Clinic. 疼痛交流中的触觉资源:新截肢者在假肢诊所重新引导医生的专业触摸。
IF 3 3区 医学
Health Communication Pub Date : 2024-09-01 DOI: 10.1080/10410236.2024.2397614
Monica Simone, Renata Galatolo, Alessandra Fasulo
{"title":"Haptic Resources in Pain Communication: New Amputees Redirecting Doctors' Professional Touch at the Prosthetic Clinic.","authors":"Monica Simone, Renata Galatolo, Alessandra Fasulo","doi":"10.1080/10410236.2024.2397614","DOIUrl":"https://doi.org/10.1080/10410236.2024.2397614","url":null,"abstract":"<p><p>Pain assessment is key in deciding whether amputee patients are fit to receive a prosthesis, but its interactional accomplishment is still underexplored. This study adopts multimodal conversation analysis to investigate how pain assessment is carried out during medical visits at an Italian prosthetic clinic involving 77 patients and 24 health professionals. In the analyzed data, doctors carry out pain assessment by asking patients whether they feel pain during palpation of the stump, and patients respond by elaborating on their sensations and using touch in turn. The analysis focuses on a collection of 10 cases in which patients use response expansions and self-touch to reorient doctors' ongoing inquiry by specifying the type of sensation they experience and its location or to correct doctors' previous inquiry. The analysis illuminates how the patient's body becomes a resource for tactile practices that are shared between doctors and patients in the service of a common understanding of patients' pain. This analysis provides new knowledge of a practice patients use to redirect doctors' attention and understandings.</p>","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Celebrity Identification and Reasoned Action: An Integrative Model of the Relationship Between Media Use and Breast Cancer Screening Intention. 名人识别和合理行动:媒体使用和癌症筛查意向之间关系的综合模型。
IF 3 3区 医学
Health Communication Pub Date : 2024-09-01 Epub Date: 2023-09-21 DOI: 10.1080/10410236.2023.2258308
Suahn Jang Cho, Yan Tian
{"title":"Celebrity Identification and Reasoned Action: An Integrative Model of the Relationship Between Media Use and Breast Cancer Screening Intention.","authors":"Suahn Jang Cho, Yan Tian","doi":"10.1080/10410236.2023.2258308","DOIUrl":"10.1080/10410236.2023.2258308","url":null,"abstract":"<p><p>This study investigates the relationship between media use and breast cancer screening intentions by integrating the celebrity identification model and the theory of reasoned action. It tests an integrative model with survey data from 315 U.S. adult women. The study found that media use for breast cancer information was positively associated with parasocial interaction (PSI) and identification with celebrities who have or have had breast cancer; PSI was positively associated with attitudes, descriptive and injunctive norms in breast cancer screening, while identification with celebrities was positively associated with descriptive norms; attitudes, injunctive norms and descriptive norms were positively associated with breast cancer screening intentions. The study supports the mediating effect of PSI, identification, attitudes, and descriptive and injunctive norms on the association between media use and breast cancer prevention intentions.</p>","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41110424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of a Narrative Medicine Life Story Pilot Program on Press Ganey™ Scores in an Outpatient Cancer Center. 叙事医学生命故事试点项目对癌症门诊中心 Press Ganey™ 评分的影响。
IF 3 3区 医学
Health Communication Pub Date : 2024-09-01 Epub Date: 2023-09-10 DOI: 10.1080/10410236.2023.2255761
Joshua P Raff, Jonathan Sege, Roseanne Braiotta, Farrukh N Jafri, Brennan Cook, Penny Steiner-Grossman, Fredda Cohen
{"title":"The Impact of a Narrative Medicine Life Story Pilot Program on Press Ganey™ Scores in an Outpatient Cancer Center.","authors":"Joshua P Raff, Jonathan Sege, Roseanne Braiotta, Farrukh N Jafri, Brennan Cook, Penny Steiner-Grossman, Fredda Cohen","doi":"10.1080/10410236.2023.2255761","DOIUrl":"10.1080/10410236.2023.2255761","url":null,"abstract":"<p><p>Oncology patients face challenges beyond those directly affecting their cancer management. Guided personal narrative programs have been shown to help patients with chronic conditions and life-framing events. Few such narrative programs have been reported for cancer patients or analyzed for their impact on patient experience. We established our Life Story Narrative Program, modeled on the United States Veterans Affairs' \"My Life, My Story\" for outpatient oncology patients in our hospital's cancer center. Press Ganey™ patient experience scores from program participants were compared retrospectively with scores from patients who were not participants. Over an eight-month period, we invited 30 cancer center outpatients to participate. Twenty-seven individuals accepted, and 18 had their stories edited, approved, and scanned into their electronic health record. Cohort matching yielded a control arm consisting of 255 responses from 48 surveys, while the intervention arm consisted of 68 responses from 12 surveys. 78.4% of responses from the control arm were rated 5 compared with 100% in the intervention arm. The mean Press Ganey™ score response in the control arm was 4.71 compared with 5.00 from the intervention arm. Wilcoxon U value was 10,540 with <i>p</i> < .001. An outpatient narrative medicine program for cancer patients to tell their life stories can easily be organized. Patients were willing to participate, enrollment was brisk, and the use of resources was limited. Although our sample size was small, participation in our Life Story Narrative Pilot Program resulted in a statistically significant improvement in Press Ganey™ scores.</p>","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Intersectional Approach to Understanding Beliefs and Attitudes Toward Mental Health Issues Among Muslim Immigrant Women in Canada. 以交叉方法了解加拿大穆斯林移民妇女对心理健康问题的信念和态度。
IF 3 3区 医学
Health Communication Pub Date : 2024-09-01 Epub Date: 2023-09-05 DOI: 10.1080/10410236.2023.2252644
Rukhsana Ahmed, Yuping Mao
{"title":"An Intersectional Approach to Understanding Beliefs and Attitudes Toward Mental Health Issues Among Muslim Immigrant Women in Canada.","authors":"Rukhsana Ahmed, Yuping Mao","doi":"10.1080/10410236.2023.2252644","DOIUrl":"10.1080/10410236.2023.2252644","url":null,"abstract":"<p><p>Although addressing cultural and religious practices is important in providing mental health care, little research exists on understanding mental health issues of minority groups such as Muslim immigrant women. We employed an intersectional approach to examine beliefs and attitudes toward mental health issues among Muslim immigrant women in Canada. Four focus groups (21 participants) were conducted, and 101 surveys were collected in Ottawa, Canada. Three core themes emerged from thematic content analysis of focus group data that relate to participants' communication about: 1) stressors, 2) mental health care seeking, and 3) utilizing coping strategies. The survey data were analyzed using independent samples t-test and One-Way ANOVA, the results of which supported the qualitative findings that social stigma was an important obstacle preventing those women from seeking professional mental health services. Muslim women with South and Southeast Asian cultural/ethnic backgrounds were more likely to get help from professionals than those with African cultural/ethnic backgrounds. No group differences were found in age, family income, and employment status. Broadly, the findings underscore the importance of developing knowledge about the intersections among gender, religion, cultural identity, immigration status, and social stigma that influence beliefs and attitudes toward mental health issues. Specifically, the findings point to the need for an intersectional approach that offers a more nuanced understanding for tailoring mental health care to Muslim immigrant women's needs.</p>","PeriodicalId":12889,"journal":{"name":"Health Communication","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10218330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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