Revista Panamericana De Salud Publica-pan American Journal of Public Health最新文献

{"title":"Vacunación contra el VPH en varones: una estrategia incompleta en la lucha por la salud pública.","authors":"Nicole Desiree Vilchez","doi":"10.26633/RPSP.2025.60","DOIUrl":"10.26633/RPSP.2025.60","url":null,"abstract":"","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e60"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of child physical abuse in Guyana: Findings from the 2019 Guyana Multiple Indicator Cluster Survey.","authors":"Gary Joseph, Audrey Benn, Cecil Boston, Debra Lowe, Karishma Jeeboo, La-Toya Arthur-Tucker, Lauristan Choy, Lidon Lashley, Gbenankpon M Houvèssou, Tammy Hopkinson, Thomas B Singh","doi":"10.26633/RPSP.2025.58","DOIUrl":"https://doi.org/10.26633/RPSP.2025.58","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence and factors associated with physical abuse against children in Guyana.</p><p><strong>Methods: </strong>This study utilized nationally representative data from the Multiple Indicator Cluster Survey conducted in Guyana in 2019. The percentage of children who endured physical abuse was the primary outcome studied. Logistic regression was used to assess the association between the exposure variables and the outcome. The slope index of inequality (SII) and the concentration index (CIX) were calculated to assess inequalities in child physical abuse.</p><p><strong>Results: </strong>In Guyana, 53.1% and 4.4% of children endured moderate and severe physical abuse, respectively. Children aged 24 months or older (adjusted odds ratio [AOR] 2.29; 95% CI [1.33, 3.95]), living in the Interior (AOR 2.42; 95% CI [1.20, 4.87]), in households headed by females (AOR 2.32; 95% CI [1.47, 3.65]), whose mothers ever consumed alcohol (AOR 2.41; 95% CI [1.53, 3.79]) or had positive attitudes toward child physical abuse (AOR 4.37; 95% CI [2.07, 9.23]) were at higher risk of experiencing moderate physical abuse. The risk of severe physical abuse increased among children whose mothers had a positive attitude toward child physical punishment and decreased according to the mother's level of education. Important disparities were observed between boys and girls according to maternal education and geographic regions.</p><p><strong>Conclusions: </strong>Children in Guyana who endured moderate physical abuse exceed 50% of the country's child population. Guyana needs to enact legislation that prohibits child physical abuse. Stringent enforcement is necessary to ensure Guyanese children do not continue to experience physical abuse.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e58"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Applicability of World Health Organization guidelines on self-care interventions for reproductive health in selected Latin American and Caribbean countriesAplicabilidade das diretrizes da Organização Mundial da Saúde sobre intervenções de autocuidado em saúde reprodutiva em países selecionados da América Latina e do Caribe].","authors":"Rodolfo Gómez Ponce de León, Gabriela Viviana Perrotta, Sofía Pirsch, Camila Volij, Analía López, Cintia Cejas, Adolfo Luis Rubinstein, Manjulaa Narasimhan, Suzanne Serruya","doi":"10.26633/RPSP.2025.56","DOIUrl":"10.26633/RPSP.2025.56","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the applicability of the World Health Organization's <i>WHO Guideline on self-care interventions for health and well-being</i> in selected Latin American and Caribbean countries.</p><p><strong>Methods: </strong>Countries prioritized by the Pan American Health Organization for technical cooperation in reproductive health were selected: Argentina, Bolivia (Plurinational State of), Chile, Colombia, Ecuador, Guyana, Honduras, Peru, and Uruguay. An exhaustive search was conducted for documents considered to be clinical practice guidelines on family planning, as well as other guidelines on related topics. Two simultaneous strategies were employed: a systematic search of published and indexed literature, and a gray literature search).</p><p><strong>Results: </strong>The applicability of each recommendation on self-care for reproductive health is described for each country in a \"traffic light\" table, where green means \"implemented\", yellow means \"in the implementation process\", and red means \"not implemented\".</p><p><strong>Conclusions: </strong>Favorable frameworks exist for interventions that promote the implementation of self-care strategies for sexual and reproductive health. The least developed thematic areas in the selected countries are: eliminating unsafe abortion and promoting sexual health. Only three countries in the Region of the Americas (Argentina, Colombia, and Uruguay) have laws that guarantee legal abortion and facilitate access to safe abortion. Although most countries in the Region do not guarantee the rights of transgender people, all countries except Guyana and Honduras provide hormones for them.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e56"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of chemical interventions on reducing dengue, Zika, and chikungunya: a systematic review.","authors":"Silvia Tortosa-La Osa, Sandra Roldán-Coronel, Eva Martín-Ruiz, Ángela Galán-Relaño, Antonio Olry de Labry-Lima","doi":"10.26633/RPSP.2025.51","DOIUrl":"10.26633/RPSP.2025.51","url":null,"abstract":"<p><strong>Objective: </strong>Given that vector control represents the primary strategy for preventing these diseases, the objective of this systematic review is to ascertain the efficacy of chemical interventions in reducing their burden.</p><p><strong>Methods: </strong>The PRISMA guidelines were followed to search for experimental studies published between 1987 and 2024 in English, Portuguese, and Spanish. Medline, Embase, WOS-Core Collection, Scopus, Lilacs, Cochrane Library, and Biological Science Database were consulted to identify studies using incidence or prevalence as outcome variables of interest.</p><p><strong>Results: </strong>Of the 2 232 references initially retrieved, 8 articles were included in the review. All studies used entomological indices along with disease burden indices to measure intervention impact. Three studies evaluated the use of insecticide-impregnated curtains alone, one combined those with residual insecticide treatment in dwellings, one evaluated the use of insecticide-impregnated school uniforms, and the remaining three evaluated household insecticide application. Only four of the eight articles showed some level of efficacy of chemical interventions in reducing dengue prevalence or incidence.</p><p><strong>Conclusion: </strong>The chemical interventions under examination did not result in a notable reduction in the burden of these diseases within the population, which would appear contradictory given the prominent role of chemical interventions in vector-borne disease control programs.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e51"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmonization and integration of data from prospective cohort studies across the Region of the Americas.","authors":"Janeil Williams, Olga Tchuvatkina, Marshall K Tulloch-Reid, Joette McKenzie, Novie Younger-Coleman, Ian Hambleton, Kimlin Ashing, Camille Ragin","doi":"10.26633/RPSP.2025.54","DOIUrl":"https://doi.org/10.26633/RPSP.2025.54","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a generalizable extraction, transform, and load (ETL) process and workflow for prospective harmonization of data from active cohort studies being conducted in different geographic locations across the Region of the Americas.</p><p><strong>Methods: </strong>This study harmonized and merged data from two active prospective cohort studies, the Living in Full Health (LIFE) project in Jamaica and the Cancer Prevention Project of Philadelphia (CAP3) in the United States. The RedCAP data collection platform was leveraged in harmonizing and pooling baseline prospective cohort data that was collected from June 2019 to December 2024.</p><p><strong>Results: </strong>The merged data from this harmonization methodology displayed good coverage on the mapped variables. Seventeen of 23 (74%) of the questionnaire forms harmonized greater than 50% of the variables. Statistical tests on the age-adjusted prevalence of health conditions demonstrated regional differences that could be used to investigate disease hypotheses in the Black Diaspora.</p><p><strong>Conclusion: </strong>This study developed a successful data harmonization process that can guide similar projects. Active data harmonization is a useful strategy that can reduce costs and leverage resources required to conduct multi-site cohort studies, while fostering data sharing and collaborative research across the Region of the Americas.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e54"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing population-level cancer data needs in northwestern Mexico: results from a South-South Colombian-Mexican partnership.","authors":"Rebeca Rivera-Gómez, Santiago Bolivar, Oscar E Zazueta, Vivian Piedrahita, Luis Bravo, Gudelia Rangel, William Roberts, Oscar Ramirez, Paula Aristizabal","doi":"10.26633/RPSP.2025.53","DOIUrl":"https://doi.org/10.26633/RPSP.2025.53","url":null,"abstract":"<p><p>\"South-South\" partnerships forged between institutions in resource-constrained settings, usually in low- and middle-income countries, provide innovative frameworks for resource, knowledge, and expertise exchanges to address public health challenges in regions sharing similar contexts. Population-based cancer registries (PBCRs) and surveillance systems in low- and middle-income countries are essential for cancer control, yet they are scarce. In response, the authors formed a South-South Colombian-Mexican partnership to implement the first PBCR in Tijuana, northwestern Mexico, and an integrated pediatric cancer real-time clinical outcomes monitoring system, replicated from Colombia's successful model, VIGICANCER. The newly established team assessed local needs in Mexico, adapted VIGICANCER protocols to the local context, and conducted training. In 2017, BajaREG was inaugurated in Tijuana, and, in 2018, joined the newly launched Mexican National Cancer Registry Network. In 2020, the Pediatric and Adolescent Cancer Registry Surveillance System (PACARSS) was integrated into BajaREG. Between 2018 and 2024, BajaREG registered 8 231 adult and 268 pediatric cases. PACARSS currently collects population-level data on pediatric cancer clinical outcomes in Tijuana. Despite multiple challenges, including the COVID-19 pandemic, stakeholder engagement enabled success. The authors showcase how locally tailored South-South partnerships can capitalize on collaborations and facilitate the implementation of sustainable PBCRs and surveillance systems in regions sharing similar challenges, resources, and health care systems.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e53"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical inequities in cervical cancer screening coverage in Bolivia: a spatial nationwide ecological study.","authors":"Carla Huanca Challgua, Ida Linander, Isabel Goicolea, Daniel Eid Rodriguez, Osvaldo Fonseca-Rodríguez","doi":"10.26633/RPSP.2025.44","DOIUrl":"https://doi.org/10.26633/RPSP.2025.44","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.</p><p><strong>Methods: </strong>Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.</p><p><strong>Results: </strong>Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.</p><p><strong>Conclusions: </strong>Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e44"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic screening of FFPE breast cancer biopsies for the <i>BRCA1</i>-185delAG mutation in Trinidad and Tobago.","authors":"Sheherazade Crystal Abrahim, Dulari Bansraj, Royanne Edwards, Reinand Thompson, Roma Rambaran, Allana Roach, Wayne A Warner, A V Chalapathi Rao, Chandrashekar Unakal, Rajini Rani Haraksingh","doi":"10.26633/RPSP.2025.52","DOIUrl":"10.26633/RPSP.2025.52","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether the quality and quantity of genomic DNA harnessed from existing formalin-fixed paraffin-embedded (FFPE) breast cancer biopsy tissue samples in the public health system of Trinidad and Tobago (T&T) were sufficient for downstream genetic testing and to investigate the occurrence of the common breast cancer susceptibility gene 1 (<i>BRCA1</i>) mutation, <i>BRCA1</i>-185delAG, in these samples.</p><p><strong>Methods: </strong>Genomic DNA was extracted from 67 FFPE samples using a standard protocol (Qiagen). Samples were genotyped using polymerase chain reaction (PCR) and Sanger sequencing.</p><p><strong>Results: </strong>The genomic DNA was highly fragmented in the 250-500 bp range. The quality and quantity only allowed testing of one variant. This study successfully genotyped 34 of 67 FFPE breast cancer tissue biopsy samples for the <i>BRCA1</i>-185delAG mutation. This mutation was not detected in the 34 samples.</p><p><strong>Conclusion: </strong>Existing FFPE cancer tissue biopsies in the public health system in T&T are of limited utility for genetic testing. The absence of the <i>BRCA1</i>-185delAG mutation in the limited number of breast cancer samples tested does not preclude its existence in this population. Further investigations are needed to determine the extent of clinically relevant breast cancer-associated mutations in this population.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e52"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding team-based care for hypertension and cardiovascular risk management with HEARTS in the Americas.","authors":"Vilma Irazola, Carolina Prado, Andres Rosende, David Flood, Ross Tsuyuki, Carolina Neira Ojeda, Matias Villatoro Reyes, Johanna Otero, Irmgardt Alicia Wellmann, Ileana Fajardo, Emily Ridley, Esteban Londoño, Gloria Giraldo, Edwin Bolastig, Bruna Moreno Dias, Nicolas Haeberer, Pedro Ordunez","doi":"10.26633/RPSP.2025.43","DOIUrl":"https://doi.org/10.26633/RPSP.2025.43","url":null,"abstract":"<p><p>Cardiovascular diseases remain the leading cause of premature morbidity and mortality globally, with hypertension as their main modifiable risk factor. In Latin America and the Caribbean, hypertension affects more than 30% of adults, yet control rates remain alarmingly low. The HEARTS in the Americas Initiative, led by the Pan American Health Organization, promotes a model of team-based care to enhance risk management for hypertension and cardiovascular diseases within primary health care. Team-based care leverages the skills of diverse health professionals, including nurses, pharmacists and community health workers, to optimize resource allocation, task-sharing and care delivery. Evidence underscores the effectiveness of team-based care in improving blood pressure control, reducing hospitalizations and enhancing quality of life through strategies such as periodic follow up and medication titration. Despite its benefits, implementing team-based care faces cultural and systemic barriers. This special report outlines a policy framework to scale team-based care across the Region of the Americas, ensuring equitable access to high-quality, cost-effective prevention and care for cardiovascular diseases.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e43"},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Implementation of the ICD-11 in Brazil: an overviewPanorama de la implementación de la CIE-11 en Brasil].","authors":"Ana Carolina Aires Cerqueira Prata, Silvia von Tiesenhausen de Sousa-Carmo, Maria Cristina Horta Vilar, Yluska Myrna Meneses Brandão E Mendes, Heloisa Brunow Ventura Di Nubila, Dácio Lyra Rabello Neto, Letícia de Oliveira Cardoso, Juan José Cortez Escalante","doi":"10.26633/RPSP.2025.55","DOIUrl":"https://doi.org/10.26633/RPSP.2025.55","url":null,"abstract":"<p><p>In 2021, Brazil began implementing the 11th Revision of the International Classification of Diseases (ICD-11), with completion scheduled for 2027. ICD-11 represents a technological and conceptual leap, offering new opportunities for epidemiological analysis and health management. However, it also imposes challenges for interoperability and preservation of historical data series, making its implementation more complex. Given Brazil's vast territory and considering the existing health information systems, the implementation will be phased, focusing on five priority areas: publication, translation, and use of ICD-11 in Brazil; information technology infrastructure; data comparability and quality; capacity building; and promotion and dissemination. The present article aims to provide an overview of the current state of ICD-11 implementation in the country, the steps already taken and future perspectives. The implementation follows the guidelines established by the World Health Organization's Implementation Guide and Technical Note No. 91/2024 issued by Brazil's Ministry of Health. These documents address procedures such as the update of health information systems as well as areas deserving special attention, such as the diversity of regional contexts across the country and the scale of change involved in updating international classifications, with the goal of ensuring safety and effectiveness, preserving time series, and enabling swift adaptation. The process represents another public health milestone in Brazil, while simultaneously promoting the modernization and enhancement of vital statistics information systems, reinforcing Brazil's role in advancing global public health.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e55"},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}