Paediatric and perinatal epidemiology最新文献

{"title":"Weighted Cumulative Exposure Modelling to Assess the Association Between Reproductive Factors and Future Cardiovascular Disease in Women.","authors":"Natalie Dayan, Marie-Eve Beauchamp, Melia Alcantara, Gabriel D Shapiro, Michal Abrahamowicz","doi":"10.1111/ppe.70029","DOIUrl":"https://doi.org/10.1111/ppe.70029","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of reproductive or pregnancy events, such as severe maternal morbidity (SMM), may reveal a predisposition to chronic disease and premature mortality. However, most studies have examined these exposures without considering their timing, severity, or recurrence.</p><p><strong>Objectives: </strong>We propose using a weighted cumulative exposure (WCE) modelling approach to flexibly describe the relationship between reproductive events and longer-term health outcomes in a longitudinal cohort of pregnant women.</p><p><strong>Methods: </strong>Application of the WCE modelling approach is accomplished in three steps. First, relative weights are estimated from a multivariable Cox proportional hazards model corresponding to the association of each reproductive risk factor with a given health outcome. Then, a longitudinal dataset is constructed in which all reproductive predictors are recorded at regular intervals (every 3 months), beginning 42 days after each woman's first birth in the cohort and ending at an outcome or censoring event. A new multivariable Cox model applied to this longitudinal dataset, incorporating time-varying WCE-derived reproductive risk scores along with simple time-varying reproductive and non-reproductive predictors, is estimated. Finally, adjusted WCE-based hazard ratios (HR) associated with different reproductive event exposure histories are calculated.</p><p><strong>Results: </strong>In the cohort of 1,992,972 births in Canada (excluding Quebec), 2008-2021, with mean (SD) follow-up time in the longitudinal dataset of 7.3 ± 3.8 years, we propose to use the WCE approach to predict outcomes such as premature cardiovascular disease (16,846 cardiovascular hospitalisations observed, or 1.19 per 1000 person-years).</p><p><strong>Conclusions: </strong>Use of flexible WCE modelling to quantify risks of pregnancy events such as SMM, adjusted for reproductive and non-reproductive CVD risk factors, will account for variation in timing and severity of these events and will capture their cumulative effects across a woman's reproductive trajectory. This approach can refine estimates of etiologic associations and inform novel clinical prediction models with the potential to predict postpartum long-term health outcomes for a given woman based on her unique reproductive history.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174404","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}

{"title":"Incidence, Risk Factors and Outcomes of SARS-CoV-2 Infection in Pregnant Women: The COROPREG Population-Based Study.","authors":"Caroline Diguisto, Pierre-Yves Ancel, Aurélien Seco, Nathalie Baunot, Cecile Caze, Catherine Crenn-Hébert, Corinne Dupont, Charles Garabedian, Cécile Lebeaux, Camille Le Ray, Mathilde Letouzey, Elsa Lorthe, Emilie Marrer, Valérie Rouger, Christophe Vayssière, Christelle Vauloup Fellous, Marie-Pierre Bonnet, Catherine Deneux-Tharaux","doi":"10.1111/ppe.70028","DOIUrl":"https://doi.org/10.1111/ppe.70028","url":null,"abstract":"<p><strong>Background: </strong>Population-based data are needed to reliably assess the impact of SARS-CoV-2 infection during pregnancy.</p><p><strong>Objectives: </strong>To estimate the population-based incidence of SARS-CoV-2 infection and its severe forms in the obstetric population, identify risk factors of severe SARS-CoV-2 infection (severe COVID-19) and describe delivery, maternal and neonatal outcomes by disease severity, using a definition of severity based on organ dysfunction.</p><p><strong>Methods: </strong>A prospective population-based study conducted over the three first pandemic waves between March 2020 and April 2021 in 281 maternity hospitals in six French regions included all women with SARS-CoV-2 infection during pregnancy or within 7 days post-partum, whether symptomatic or not, hospitalised or not. Severe COVID-19 forms were defined a priori using clinical, biological and management criteria of organ dysfunction. We calculated infection and severe infection rates and studied associations between sociodemographic, medical and pregnancy characteristics and severe COVID-19 by univariate and multivariate modified Poisson regression modelling.</p><p><strong>Results: </strong>From a population of 385,214 deliveries in the participating regions, 6015 women with SARS-CoV-2 infection were identified, including 337 severe cases. The rates of severe COVID-19 were 1.1, 0.9 and 3.6 per 1000 deliveries during the first, second and third pandemic waves, respectively, and the proportions of severe COVID-19 were 8.6%, 3.4% and 9.3%, respectively. On multivariate analysis, the risk of severe COVID-19 was associated with younger and older age, migrant status, living with > 4 people, overweight or obesity, chronic hypertension or diabetes and infection ≥ 22 weeks of gestation rather than earlier in pregnancy. Neonatal morbidity occurred mostly with severe maternal infection.</p><p><strong>Conclusion: </strong>Using an organ-based definition of severity and population-based data, rates of severe COVID-19 appeared lower than in previous studies. A permanent perinatal surveillance system is needed to assess efficiently and rapidly the impact of future pandemics.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111360","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}

{"title":"Paternal Cardiometabolic Conditions and Perinatal Mortality.","authors":"Shwe Sin Win, Gerhard Sulo, Anders Engeland, Kari Klungsøyr","doi":"10.1111/ppe.70032","DOIUrl":"https://doi.org/10.1111/ppe.70032","url":null,"abstract":"<p><strong>Background: </strong>Studies have suggested that men with cardiometabolic conditions may have an increased risk of offspring perinatal mortality. However, this association remains underexplored.</p><p><strong>Objectives: </strong>We aimed to study the association between fathers' cardiometabolic conditions and offspring perinatal mortality utilising linked data from national health registries in Norway.</p><p><strong>Methods: </strong>In this population-based cohort study, males registered in the Medical Birth Registry of Norway (MBRN), born 1967-2005, were linked to their singleton offsprings born 2004-2020. The Norwegian Patient Registry and the Norwegian Prescription Database were used to define study exposures: history of hypertension, diabetes, dyslipidaemia, severe obesity or any of these at any time before/during the year of childbirth while fathers having no such conditions were the reference group. Perinatal mortality was defined as foetal death from 16 weeks' gestation or neonatal deaths within the first month after birth (from the MBRN). We fitted multilevel random-intercept Poisson regression models to account for the clustering of infants born to the same father. We reported incidence rate ratio (IRR) with 95% confidence Intervals (CI).</p><p><strong>Results: </strong>Of 703,746 infants, 3.6% (n = 25,314) were born to fathers with any condition. Overall, 4827 (0.7%) of them died perinatally. In fully adjusted models, infants of fathers with hypertension had a 29% higher risk of dying perinatally (IRR 1.29, 95% CI 1.05, 1.57) relative to those of fathers without cardiometabolic conditions. Effect estimates for paternal diabetes, severe obesity and any condition also indicated a possible increased perinatal mortality associated with these conditions. In the sex-stratified analysis, the associations were stronger in male offspring (IRR 1.29, 95% CI 1.06, 1.58) than female offspring (IRR 1.01, 95% CI 0.78, 1.29).</p><p><strong>Conclusions: </strong>The increased perinatal mortality in offspring to fathers with cardiometabolic conditions emphasises fathers' biological role in foetal and placental programming and development. Whether offspring sex impacts these associations needs further investigation.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102213","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}

{"title":"Attention-Deficit/Hyperactivity Disorder Medication Use in Pregnancy and Risk of Preterm Birth: A Population-Based Cohort Study.","authors":"Chaitra Srinivas, Øystein Karlstad, Hein Stigum, Kari Furu, Carolyn E Cesta, Johan Reutfors, Jennifer A Hutcheon, Jacqueline M Cohen","doi":"10.1111/ppe.70031","DOIUrl":"https://doi.org/10.1111/ppe.70031","url":null,"abstract":"<p><strong>Background: </strong>Medication use during pregnancy for attention-deficit/hyperactivity disorder (ADHD) is increasing, but evidence on its safety in pregnancy for foetal health is limited, with little attention to time-related biases in observational research.</p><p><strong>Objective: </strong>To determine the association between ADHD medication use in early and late pregnancy and the risk of preterm birth.</p><p><strong>Methods: </strong>This population-based cohort study utilised data from national registers, including records on births, prescription medications, specialist healthcare visits, hospitalisations and educational attainment, to account for relevant potential confounders. We included singleton births delivered between 22 and 44 gestational weeks among pregnant individuals with ADHD medication use in the year before conception from Norway (2009-2020) and Sweden (2007-2019). ADHD medications (amphetamine, dexamphetamine, methylphenidate, atomoxetine, lisdexamfetamine and guanfacine) were assessed during early (conception to 21 gestational weeks) and late pregnancy (22-36 gestational weeks). The main outcome was preterm birth, defined as a live birth before 37 completed weeks of pregnancy. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using log-binomial regression and flexible parametric survival modelling to determine the risk of preterm birth in early and late pregnancy, respectively.</p><p><strong>Results: </strong>Among 11,075 pregnancies, early pregnancy ADHD medication use was associated with higher preterm birth risk with ≥ 2 filled prescriptions (aRR 1.29, 95% CI 1.08, 1.53), but not as ≥ 1 prescription (aRR 1.08, 95% CI 0.93, 1.25). Any medication use in late pregnancy increased preterm birth risk (aHR 1.15, 95% CI 0.95, 1.39). For every 30 days of cumulative exposure to ADHD medication, the risk of preterm birth increased in late pregnancy (aHR 1.07, 95% CI 1.02, 1.12), but not in early pregnancy (aHR 1.01, 95% CI 0.97, 1.05).</p><p><strong>Conclusions: </strong>ADHD medication may modestly increase the risk of preterm birth, especially with atomoxetine early and methylphenidate late in pregnancy, and with longer durations of use.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049229","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}

{"title":"Timing of Delivery of Low-Risk Persons and the Risk of Attention-Deficit Hyperactivity Disorder in Offspring: Sweden and British Columbia, Canada.","authors":"Thi Hoang Ha Nguyen, M Zakir Hossin, Stefanie Schmauder, Giulia M Muraca, Sarka Lisonkova, Neda Razaz","doi":"10.1111/ppe.13162","DOIUrl":"10.1111/ppe.13162","url":null,"abstract":"<p><strong>Background: </strong>An evidence gap exists concerning the timing of delivery at 37-42 weeks and the risk of attention-deficit hyperactivity disorder (ADHD) in offspring.</p><p><strong>Objective: </strong>To determine the association between timing of delivery in low-risk pregnancies at term (37-42 weeks) gestations and ADHD in offspring.</p><p><strong>Methods: </strong>This population-based cohort study comprised 1,424,453 singletons in Sweden and 403,765 in British Columbia (BC), Canada, live-born at 37-42 completed weeks to low-risk pregnant women between 2000 and 2018. Children were followed up from age 1 until the date of death, emigration, their first diagnosis, or December 2020 (study's end date). The exposure was time of delivery assessed through gestational age, and the outcome was the diagnosis of ADHD. Cox regression models were used to examine the association between gestational age at delivery and ADHD.</p><p><strong>Results: </strong>During the follow-up period, 59,989 children in Sweden were diagnosed with ADHD (4.5 per 1000 child-years). Correspondingly, in BC, during the same period, there were 27,445 children diagnosed with ADHD (7.4 per 1000 child-years). In Sweden, the adjusted hazard of ADHD was 10%, 6%, and 3% higher at 37, 38, and 39 weeks gestation compared with those born at ≥ 38, ≥ 39, and ≥ 40 weeks, respectively. In BC, the corresponding hazards were 9%, 6%, and 3%, respectively. Both regions showed no elevated ADHD risks for infants born at 40 weeks compared to those born at ≥ 41 weeks, with slightly lower rates at 40 weeks.</p><p><strong>Conclusions: </strong>In low-risk pregnancies, births at 37 and 38 weeks were associated with a higher ADHD risk, while births at 40 weeks showed no increased risk compared with those born at later gestations.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"356-369"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952689","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}

{"title":"The Trade-Off of Delivery Timing Between Reduced Perinatal Complications Versus Adverse Long-Term Outcomes.","authors":"Dieter Wolke, Xuan Zhao, Siobhan Quenby","doi":"10.1111/ppe.70025","DOIUrl":"10.1111/ppe.70025","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"370-372"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998712","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}

{"title":"Perinatal Health and Healthcare Utilisation During the COVID-19 Pandemic: A Nationwide Interrupted Time Series Analysis.","authors":"Deborah Karasek, Daniel F Collin, Rita Hamad, Kaitlyn Jackson, Alison Gemmill","doi":"10.1111/ppe.70000","DOIUrl":"10.1111/ppe.70000","url":null,"abstract":"<p><strong>Background: </strong>Perinatal health was profoundly affected as a result of the socioeconomic hardships and public health measures during the COVID-19 pandemic. Few studies have evaluated changes and disparities in perinatal health using population-based data and rigorous methods.</p><p><strong>Objective: </strong>To examine changes related to the COVID-19 pandemic in perinatal health and healthcare utilisation.</p><p><strong>Methods: </strong>Using population-based data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (N = 116,170), we employed a Bayesian structural time-series approach to examine deviations in perinatal health and healthcare utilisation outcomes from predicted trends following the onset of the COVID-19 pandemic in March 2020, adjusting for covariates.</p><p><strong>Results: </strong>The onset of the COVID-19 pandemic was associated with delayed prenatal care initiation (1.1%, 95% confidence interval [CI] 0.2, 2.0), reduced prenatal care (-2.8%, 95% CI -3.6, -1.7), reduced postpartum visits (-1.0%, 95% CI -1.5, -0.4), and increased gestational hypertension (11.1%, 95% CI 5.4, 16.7), gestational diabetes mellitus (GDM), (17.6%, 95% CI 10.1, 26.2), and prenatal depression (7.3%, 95% CI 1.9, 13.0). Stratified models showed that Black participants experienced earlier prenatal care initiation; Native American participants experienced lower prenatal care visits and greater increases in gestational hypertension and GDM; Asian/Pacific Islander participants experienced delayed prenatal care initiation and heightened prenatal depression and postnatal depressive symptoms; and Hispanic participants experienced higher GWG and reduced postpartum visits.</p><p><strong>Conclusions: </strong>As perinatal health imparts enduring impacts for pregnant people and infants, this study provides insight into the pandemic's potentially long-lasting population health effects. Future work should examine longer-term trends and how pandemic-related policies contributed to disparate impacts.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"373-384"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616627","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}

{"title":"Improving Register Ascertainment of Children With Post-Neonatally Acquired Cerebral Palsy Through Health Service Partnerships.","authors":"Emma Waight, Adrienne Epps, Hayley Smithers-Sheedy, Shona Goldsmith, Sue Woolfenden, Simon Paget, Kerry Hanns, Kylie French, Heather Burnett, Anna Ward, Amy Shaw, Karen Bau, Leanne Diviney, Georgina Henry, Nadia Badawi, Maria Kyriagis, Sarah McIntyre","doi":"10.1111/ppe.70002","DOIUrl":"10.1111/ppe.70002","url":null,"abstract":"<p><strong>Background: </strong>The New South Wales (NSW) and Australian Capital Territory (ACT) Cerebral Palsy (CP) Register is a database of clinical and demographic information from children with CP. A child with CP resulting from an insult to the developing brain sustained between 29 days and 2 years of age is classified as having post-neonatally acquired CP (PNN-CP). In clinical services, children may meet the criteria and timing for PNN-CP but have a singular diagnosis of acquired/traumatic brain injury.</p><p><strong>Objectives: </strong>To implement and evaluate a new CP register ascertainment strategy focused on identifying children with PNN-CP attending acquired brain injury rehabilitation services.</p><p><strong>Methods: </strong>Electronic medical records of children with an acquired brain injury attending the Sydney Children's Hospitals Network and John Hunter Hospital rehabilitation departments 2019-2024 were reviewed by researchers and rehabilitation paediatricians to identify children with PNN-CP. Children who fulfilled the criteria for CP were invited to participate in the CP Register. To evaluate this ascertainment strategy, we (i) ran descriptive statistics to analyse proportional changes of children with PNN-CP on the register and (ii) calculated temporal trends in prevalence per 10,000 live births for birth years 2003-2016, before and after the record ascertainment period.</p><p><strong>Results: </strong>Of 1051 children with an acquired brain injury, 46 had PNN-CP (2003-2019) and had not previously been included on the register. This ascertainment strategy resulted in increased prevalence of PNN-CP in all 2-year time points between 2003 and 2016 and equated to a 31% improvement in ascertainment of children with PNN-CP on the register.</p><p><strong>Conclusions: </strong>Ascertainment of children with PNN-CP for the NSW/ACT CP Register has been improved by systematically reviewing children with an acquired brain injury. This is now part of standard practice, and other registers should consider whether this strategy may improve ascertainment of PNN-CP in their regions.</p>","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"348-353"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449723","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}

{"title":"Towards Comprehensive and Accurate Recording of Cerebral Palsy Diagnoses in Registries: Challenges and Implications.","authors":"Malika Delobel-Ayoub, Catherine Arnaud","doi":"10.1111/ppe.70018","DOIUrl":"10.1111/ppe.70018","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"354-355"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976473","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}

{"title":"Maternal Mortality in the United States: The Need for Accurate Surveillance.","authors":"K S Joseph, Sarka Lisonkova, Amélie Boutin, Giulia M Muraca, Neda Razaz, Sid John, Yasser Sabr, Wee-Shian Chan, Azar Mehrabadi, Justin S Brandt","doi":"10.1111/ppe.13168","DOIUrl":"10.1111/ppe.13168","url":null,"abstract":"","PeriodicalId":19698,"journal":{"name":"Paediatric and perinatal epidemiology","volume":" ","pages":"321-324"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458767","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}