The Lancet Regional Health: Western Pacific最新文献

{"title":"Effect of restricted retail merchandising of discretionary food and beverages on population diet: post-trial follow-up of a pragmatic randomised controlled trial","authors":"Emma McMahon ,&nbsp;Sarah Dickie ,&nbsp;Khia De Silva ,&nbsp;Megan Ferguson ,&nbsp;Mark D. Chatfield ,&nbsp;Edward Miles ,&nbsp;Anthony Gunther ,&nbsp;Thomas Wycherley ,&nbsp;Leia Minaker ,&nbsp;Anna Peeters ,&nbsp;Catherine L. Mah ,&nbsp;Emma Chappell ,&nbsp;Julie Brimblecombe","doi":"10.1016/j.lanwpc.2025.101673","DOIUrl":"10.1016/j.lanwpc.2025.101673","url":null,"abstract":"<div><h3>Background</h3><div>Healthy Stores 2020 tested a co-designed strategy restricting retailer merchandising of unhealthy foods in a community-level pragmatic, partially randomised, parallel group trial in 20 remote Australian Aboriginal and Torres Strait Islander community stores. We aimed to evaluate the impact of Healthy Stores 2020 on free sugar sales 24-weeks post-trial.</div></div><div><h3>Methods</h3><div>Twenty stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a strategy restricted merchandising of unhealthy food (either six or seven strategy components), or to a control group of usual retail practice. The trial was done in partnership with an Indigenous organisation operating in remote Australia. In the post-trial period (24 weeks), immediately following the 25-week RCT, intervention stores (n = 10) continued the strategy but with no external implementation support, and control stores (n = 10) continued usual practice. The primary outcome was impact on purchases (weekly sales data) of free sugars from all foods and beverages (g/MJ) using mixed models. Secondary outcomes included total food and beverage dollars and gross profit (AUD$) and strategy implementation (number of strategies with full implementation assessed via photographic data collected). Trial registration, ACTRN12618001588280.</div></div><div><h3>Findings</h3><div>We observed a difference in sales of total free sugars to energy between the treatment and control groups post-trial (−4.6%, 95% CI −7.1, −1.9). Between group differences in total food and beverage and gross profit dollars were 7.0% (0.9, 13.5) and 11.4% (4.6, 18.6), respectively. Two intervention stores had full implementation of all strategy components and eight intervention stores had compliance with at least four of the seven strategy components at post-trial end.</div></div><div><h3>Interpretation</h3><div>A health-enabling retail intervention showed an effect on sugar reduction in the post-trial period without adversely impacting profit.</div></div><div><h3>Funding</h3><div><span>Australian National Health and Medical Research Council</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101673"},"PeriodicalIF":8.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights from expert elicitation: prioritising pathogens for genome sequencing for Australian public health response","authors":"Tehzeeb Zulfiqar ,&nbsp;Angeline Ferdinand ,&nbsp;Danielle Cribb ,&nbsp;Patiyan Andersson ,&nbsp;Alireza Zahedi ,&nbsp;Kathryn Glass ,&nbsp;Son Nghiem ,&nbsp;Susan Trevenar ,&nbsp;Nhung Mai ,&nbsp;Benjamin P. Howden ,&nbsp;Martyn D. Kirk ,&nbsp;AusPathoGen Program Partners","doi":"10.1016/j.lanwpc.2025.101670","DOIUrl":"10.1016/j.lanwpc.2025.101670","url":null,"abstract":"<div><h3>Background</h3><div>Pathogen genomics has transformed infectious disease response, yet prioritisation frameworks for genome sequencing remain underdeveloped. This study establishes evidence-based criteria for prioritising pathogens for genome sequencing to maximise public health impact in Australia.</div></div><div><h3>Methods</h3><div>We conducted a modified Delphi study with experts in public health, infection prevention, and pathogen genomics to examine both prioritisation mechanisms, selection criteria and specific pathogen rankings across surveillance contexts. Initially, 38 experts evaluated 89 statements on a 5-point Likert scale with accompanying feedback. In round two, participants reassessed 48 statements, including 28 that were revised based on first-round input. Quantitative data was analysed using STATA-18 and qualitative data using Atlas.ti.</div></div><div><h3>Findings</h3><div>Consensus was achieved on 53 statements across both rounds across three domains: decision-making processes, prioritisation criteria, and high-priority surveillance scenarios to prioritise specific pathogens for genome sequencing. Experts agreed that a national priority pathogen list for genome sequencing should be developed collaboratively with public health laboratories and complemented by state level lists, with biennial reviews and flexibility for situation-based adjustments. Consensus was achieved on prioritising pathogens associated with antimicrobial resistance, novel and emerging potential, virulence, institutional transmission risk, and disproportionate impact on Aboriginal and Torres Strait Islander communities. For routine surveillance, <em>Mycobacterium tuberculosis</em> received highest consensus for sequencing, followed by multidrug-resistant <em>Staphylococcus aureus</em>. Eleven pathogens were prioritised for sequencing in outbreak investigation, including Carbapenemase producing <em>Enterobacterales</em>, pathogenic <em>Escherichia coli</em> subtypes, and <em>Salmonella</em> species. Three pathogens, <em>Shigella</em>, <em>Neisseria gonorrhoeae</em>, and invasive Group A <em>Streptococcus</em>, were prioritised for periodic surveillance sequencing. Our qualitative analysis showed experts emphasised public health significance and actionability while advocating for balanced national-local governance and cross jurisdictional collaboration to maximise resources.</div></div><div><h3>Interpretation</h3><div>This study establishes foundational evidence for developing a comprehensive framework for prioritising pathogens for genomic sequencing in Australian public health surveillance and response.</div></div><div><h3>Funding</h3><div><span>Australian National Health and Medical Research Council, Medical Research Futures Fund</span> (<span><span>FSPGN00049</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101670"},"PeriodicalIF":8.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin resistance and the risk of incident depression: the role of age, glycemic status, and adiposity in a prospective cohort study","authors":"Dae Jong Oh ,&nbsp;Chaiho Jeong ,&nbsp;Junhyung Kim ,&nbsp;Eun Soo Kim ,&nbsp;Kang-Seob Oh ,&nbsp;Young Chul Shin ,&nbsp;Dong-Won Shin ,&nbsp;Sang-Won Jeon ,&nbsp;Sung Joon Cho","doi":"10.1016/j.lanwpc.2025.101672","DOIUrl":"10.1016/j.lanwpc.2025.101672","url":null,"abstract":"<div><h3>Background</h3><div>Despite emerging evidence, the causal relationship between insulin resistance and depression remains controversial. This study aimed to investigate whether insulin resistance is associated with increased risk of incident depression and whether the association is affected by potential moderators.</div></div><div><h3>Methods</h3><div>This multi-centered prospective cohort study analyzed health screening data from 233,452 Korean adults participating in the Kangbuk Samsung Health Study from 2011 to 2022. At baseline, all participants indicated no major psychiatric or neurologic disorders and had not used antidepressant or diabetes medications. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Incident depression was defined as having a Center for Epidemiologic Studies Depression Scale score of ≥16.</div></div><div><h3>Findings</h3><div>Participants (age = 36.1 ± 8.6 years, 54.1% male) were followed up for 4.8 ± 2.9 years. During the 1,124,268 person-years of follow-up duration, 38,801 cases of incident depression were identified. Multivariate Cox proportional hazards analysis revealed a positive dose-dependent association between HOMA-IR level and the risk of incident depression (hazard ratio [HR] for highest vs. lowest quartile = 1.15, 95% confidence interval [CI] = 1.11–1.19). This association was particularly strong in younger adults under 40 years and in individuals with euglycemia, overweight, and low muscle-to-fat ratio.</div></div><div><h3>Interpretation</h3><div>Insulin resistance may be a modifiable risk factor for depression, underscoring the importance of early screening and management of insulin resistance to potentially reduce the burden of depression, especially among at-risk subgroups.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"62 ","pages":"Article 101672"},"PeriodicalIF":8.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who is at risk of a respiratory syncytial virus hospitalisation? A linked, population-based birth cohort analysis in children aged less than 5 years.","authors":"Mohinder Sarna, Christopher C Blyth, Belaynew W Taye, Huong Le, Peter Richmond, Kathryn Glass, Avram Levy, Cara Minney-Smith, Daniel Oakes, Jeffrey Cannon, Melinda France, Hannah C Moore","doi":"10.1016/j.lanwpc.2025.101654","DOIUrl":"10.1016/j.lanwpc.2025.101654","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infections globally in children under five years. With the development of RSV prevention strategies, understanding risk factors and relation to age and population is useful for deciding the type of program implemented.</p><p><strong>Methods: </strong>We used a probabilistically-linked population cohort of children born in Western Australia from 2010 to 2020 and hospitalised before age five years from 2010 to 2021. The primary outcome was the first laboratory-confirmed RSV-hospitalisation. Risk factor exposures included perinatal, socio-demographic, household, environmental, congenital, and comorbid conditions antecedent to RSV-hospitalisation. Adjusted hazard ratios (aHR) and population attributable fractions (PAF) were calculated using survival analysis techniques and Cox regression.</p><p><strong>Findings: </strong>Risk factors for RSV-hospitalisation in 365,582 children included demographic (male sex, Aboriginal ethnicity), perinatal (younger maternal age, maternal asthma, prematurity, maternal prenatal smoking) household/environmental (household size, season of birth), and comorbid and congenital conditions (cardiovascular defects, Trisomy 21 and cerebral palsy). Aboriginal and preterm children had an excess risk of hospitalisation at every age group. Larger households and being born moderate-late preterm had the highest PAFs (36.90% [95% CI: 35.01%, 38.74%] and 7.40% [95% CI: 6.75%, 8.04%]). While the risk of hospitalisation for children with some comorbid and congenital conditions was high (immunological conditions, aHR: 3.94 [95% CI: 2.98, 5.23], respiratory system defects, aHR: 3.13 [95% CI: 1.87, 5.25]), the PAFs were relatively small (1.70% [95% CI: 1.53%, 1.86%] and 0.40% [95% CI: 0.30%, 0.49%]).</p><p><strong>Interpretation: </strong>While children with comorbid conditions were at higher risk of RSV-hospitalisation, the importance of socio-demographic risk factors, particularly modifiable factors such as maternal prenatal smoking and household transmission, should not be undervalued. Our analysis provides information for funders, vaccine policy makers, parents/carers, and immunisation providers.</p><p><strong>Funding: </strong>This work was supported by a Wesfarmers Centre for Vaccines and Infectious Diseases Seed grant and a Stan Perron Charitable Foundation grant (00046ProgPart).</p>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101654"},"PeriodicalIF":8.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the cost-effectiveness of levofloxacin therapy for household contacts of multidrug-resistant tuberculosis in Vietnam.","authors":"Tasnim Hasan, Nguyen Thu Anh, Nguyen Binh Hoa, Nguyen Viet Nhung, H Manisha Yapa, Stephen M Graham, Ben J Marais, Guy B Marks, Tom Lung, Greg J Fox","doi":"10.1016/j.lanwpc.2025.101666","DOIUrl":"10.1016/j.lanwpc.2025.101666","url":null,"abstract":"<p><strong>Background: </strong>Multidrug-resistant tuberculosis (TB) threatens global TB control, on account of poor treatment outcomes, high treatment toxicity and costs. Recent trials demonstrated the effectiveness of six-months of levofloxacin (6Lfx) to prevent TB disease among high-risk contacts. However, the cost-effectiveness of this strategy has not previously been evaluated.</p><p><strong>Methods: </strong>The VQUIN study was a double-blinded randomised control trial in Vietnam assessing the effectiveness of 6Lfx in household contacts of multidrug resistant/rifampicin resistant TB (MDR/RR-TB) to prevent progression to TB disease. Incorporating in-trial costs and effectiveness outcomes from the VQUIN trial, we developed a closed cohort, decision-analytic Markov model to assess the cost effectiveness of 6Lfx versus placebo in a cohort exposed to MDR/RR-TB in Vietnam.</p><p><strong>Findings: </strong>Over a 20-year time horizon, the provision of 6Lfx preventative therapy to household contacts of people infected with MDR/RR-TB was found to gain a total of 40.1 QALYs per 1000 population and save US$23,145 per 1000 population, indicating the strategy was cost saving. MDR/RR-TB cases averted over 20 years was 19.9 per 1000 population treated with 6Lfx, and the number of deaths averted was 3.2 per 1000 people treated.</p><p><strong>Interpretation: </strong>6Lfx therapy is a cost-saving strategy to reduce the incidence of active disease in household contacts of MDR/RR-TB in a resource-limited setting.</p><p><strong>Funding: </strong>National Health and Medical Research Council Project Grant (#1081443). GJF was supported by a NHMRC Leadership Fellowship (Level 1) (#2007920).</p>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101666"},"PeriodicalIF":8.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caution is always needed when interpreting population-level vaping and smoking trends-authors' reply.","authors":"Sam Egger, Michael David, Judith McCool, Lucy Hardie, Marianne F Weber, Qingwei Luo, Becky Freeman","doi":"10.1016/j.lanwpc.2025.101657","DOIUrl":"10.1016/j.lanwpc.2025.101657","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101657"},"PeriodicalIF":8.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bhutan and the Philippines forge new partnership to tackle antimicrobial resistance.","authors":"Charles Coughlan, Sonam Zangmo, Ana Ria Sayo","doi":"10.1016/j.lanwpc.2025.101667","DOIUrl":"10.1016/j.lanwpc.2025.101667","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101667"},"PeriodicalIF":8.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending Healthier SG to Singapore's migrant workforce.","authors":"Bingwen Eugene Fan","doi":"10.1016/j.lanwpc.2025.101658","DOIUrl":"10.1016/j.lanwpc.2025.101658","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101658"},"PeriodicalIF":8.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying localized heatwave impact on mortality: a multi-country modeling study in the Asia-Pacific region.","authors":"Junwen Tao, Zhiwei Xu, Hung Chak Ho, Hao Zheng, Xiuya Xing, Jihong Hu, Shilu Tong, Ho Kim, Mohammad Zahid Hossain, Hong Su, Cunrui Huang, Jian Cheng","doi":"10.1016/j.lanwpc.2025.101653","DOIUrl":"10.1016/j.lanwpc.2025.101653","url":null,"abstract":"<p><strong>Background: </strong>Heatwave is a global health threat. However, existing heatwave definitions often rely on fixed temperature thresholds without incorporating region-specific health outcomes or population acclimatization, limiting their applicability across diverse climatic and demographic contexts. We aimed to assess the impact of localized heatwave on mortality based on a proposed framework of health-based heatwave definition.</p><p><strong>Methods: </strong>Based on daily data on death and weather from 25 cities in Australia, China, South Korea, and Thailand, we proposed a health-based excess heat factor (HEHF) to define the localized heatwave. First, a tiered health risk-based (THR) approach was used to fit the heatwave-mortality association to detect the region-specific temperature threshold for heatwave. Then, the HEHF was derived from a three-day-averaged temperature exceeding the region-specific heatwave threshold multiplied by the acclimatization index, reflecting the difference between recent (past three-day) and preceding (past thirty-day) average temperatures. Finally, the mortality burden attributable to heatwaves was estimated to compare the performance of distinct heatwave definitions including the HEHF, percentile-based definition, and country-specific official definition.</p><p><strong>Findings: </strong>A total of 2,255,634 deaths from four countries were analyzed. Heatwave of all definitions was associated with an increased mortality risk in four countries, with a higher risk estimated by HEHF. The HEHF not only detected a health-based, localized, and time-varying temperature threshold for the heatwave but also captured a continuous pattern of mortality risk associated with changes in heatwave intensity. Compared with percentile-based and country-specific official definitions, using the HEHF also yielded a larger proportion of deaths attributable to heatwaves, accounting for 8.68% (95% CI: 7.19%, 10.50%) in China, 4.50% (95% CI: 3.33%, 5.58%) in Thailand, 2.99% (95% CI: 1.54%, 4.33%) in Australia, and 1.98% (95% CI: 1.24%, 2.71%) in South Korea. The subtropical zone exhibited a higher attributable fraction than temperate and tropical zones.</p><p><strong>Interpretation: </strong>This multi-country study has developed a generalizable and health-based framework for defining the localized heatwave, assisting in assessing and comparing health impact of heatwaves across regions and climates.</p><p><strong>Funding: </strong>National Natural Science Foundation of China.</p>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101653"},"PeriodicalIF":8.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-thinking transitions: why mental health should be a priority for young people with intellectual disability.","authors":"Stefanie Dimov, Marissa Shields, Georgina Sutherland","doi":"10.1016/j.lanwpc.2025.101662","DOIUrl":"10.1016/j.lanwpc.2025.101662","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"61 ","pages":"101662"},"PeriodicalIF":8.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}