Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

{"title":"Determinants of antiretroviral therapy adherence among people living with HIV in a poor urban setting in Ghana: a hospital-based cross-sectional study.","authors":"Evelyn Adjei-Mensah, Yakubu Alhassan, Richmond Owusu, Irene A Kretchy","doi":"10.1093/trstmh/trae091","DOIUrl":"https://doi.org/10.1093/trstmh/trae091","url":null,"abstract":"<p><strong>Background: </strong>Without a cure, antiretroviral therapy (ART) continues to be the primary mode of managing HIV, transforming it from a formerly lethal disease to a less severe one. Adherence to ART can be impacted by several factors, including poor quality of care.</p><p><strong>Methods: </strong>A quantitative cross-sectional study design was used to assess the factors that influence adherence to ART among adults receiving care at two health facilities in Accra. A structured interviewer-administered questionnaire was used to collect data on factors associated with medication adherence using a modified four-item Medication Adherence Rating from 255 people living with HIV (PLHIV). Descriptive statistics were used to summarise the data, while multiple binary logistic regression was used to assess the factors influencing adherence to ART.</p><p><strong>Results: </strong>Adherence to HIV medication was 44.7% among PLHIV. Adherence was positively correlated with high client health service satisfaction (adjusted OR [AOR]: 26.59, 95% CI 7.46 to 94.82, p<0.001), increased privacy at the HIV clinics (AOR: 3.40, 95% CI 1.40 to 8.21, p<0.007) and among PLHIV who had been diagnosed with HIV for ≥5 y (AOR: 7.59, 95% CI 2.76 to 20.85, p<0.001).</p><p><strong>Conclusions: </strong>Adherence to ART was significantly low among study participants. The study highlights the importance of maintaining privacy and confidentiality at the facility while ensuring client satisfaction with HIV care to promote adherence to ART.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatosplenic schistosomiasis, treatment outcomes and associated factors among adult patients treated at public hospitals in the Harari Region of Ethiopia: retrospective cross-sectional study.","authors":"Derara Kumela, Aliyi Ahmed, Ame Mehadi, Fenta Wondimneh, Mohammed Ahmed, Ahmednajash Yusuf, Fitsum Weldegebreal","doi":"10.1093/trstmh/trae088","DOIUrl":"https://doi.org/10.1093/trstmh/trae088","url":null,"abstract":"<p><strong>Background: </strong>Schistosomiasis is one of the neglected tropical diseases that pose a significant burden in developing countries, particularly in sub-Saharan Africa. Hepatosplenic schistosomiasis (HSS) is a substantial cause of morbidity and mortality. This study aimed to determine clinical patterns, outcomes and factors associated with HSS in the Harari Region of Ethiopia.</p><p><strong>Methods: </strong>An institutional-based retrospective cross-sectional study was conducted among 93 adult patients diagnosed with HSS at public hospitals in the Harari Region from December 2018 to November 2022. Data were extracted from medical records using a standardized data extraction tool. EpiData version 4.2 and SPSS version 26.0 were used for data entry and analysis. Fisher's exact test was used to identify the association between dependent and independent variables, and statistical significance was declared at p<0.05.</p><p><strong>Results: </strong>In the current study, HSS-related mortality was recorded in 7.5% of patients. Recurrent episodes of upper gastrointestinal (GI) bleeding (p=0.04), hypotension (p=0.02), altered mental status at admission (p=0.009) and antibiotic use for the treatment of spontaneous bacterial peritonitis (p=0.04) were significant factors associated with HSS-related mortality.</p><p><strong>Conclusions: </strong>The study found that treatment outcomes of HSS patients were strongly associated with recurrent upper GI bleeding, hypotension, altered mental status and antibiotic use for spontaneous bacterial peritonitis treatment. The use of antibiotics for spontaneous bacterial peritonitis treatment was strongly associated with the treatment outcome of patients with HSS and was unique to our study. Adequate recording of patient data, improving chart keeping, integration of preventive and curative programs, improvement of the diagnostic tools, comprehensive treatment guidelines, early diagnosis and treatment are strongly recommended. Rigorous prospective studies that can fully reflect cause-and-effect relationships are crucial to fill fundamental evidence gaps.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary melioidosis mimicking lung cancer: a diagnostic challenge.","authors":"Xiaohong Yang, Zhuopeng Ying, Yuefu Zhan, Jianqiang Chen","doi":"10.1093/trstmh/trae089","DOIUrl":"https://doi.org/10.1093/trstmh/trae089","url":null,"abstract":"<p><strong>Background: </strong>The overlapping clinical and radiographic features of pulmonary melioidosis and lung cancer present diagnostic challenges to healthcare providers in endemic settings.</p><p><strong>Methods: </strong>We compared the clinical, laboratory and imaging characteristics of 19 pulmonary melioidosis cases with those of 15 cases of small cell lung cancer (SCLC) and 17 cases of non-small cell lung cancer (NSCLC).</p><p><strong>Results: </strong>Compared with SCLC/NSCLC cases, those with pulmonary melioidosis were more likely to have diabetes, have fever, neutrophilia and leukocytosis on presentation (p<0.05). While certain CT imaging features were shared between pulmonary melioidosis and SCLC ('frozen mediastinum sign', 'vascular encasement sign'), extensive liquefactive necrosis, uneven ring-enhancement, circular lesions and 'air-bubble' signs were more commonly seen in pulmonary melioidosis cases than in those with SCLC/NSCLC (p<0.05).</p><p><strong>Conclusions: </strong>Despite the similarities in presentation of pulmonary melioidosis, SCLC and NSCLC, several clinical, laboratory and imaging factors may help delineate these diagnoses and improve patient care.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trust in institutions affects vaccination campaign outcomes.","authors":"David Leblang, Michael D Smith, Dennis Wesselbaum","doi":"10.1093/trstmh/trae048","DOIUrl":"10.1093/trstmh/trae048","url":null,"abstract":"<p><strong>Background: </strong>Trust is an important driver of various outcomes, but little is known about whether trust in institutions affects actual vaccination campaign outcomes rather than only beliefs and intentions.</p><p><strong>Methods: </strong>We used nationally representative, individual-level data for 114 countries and combined them with data on vaccination policies and rates. We measured the speed of the vaccination campaign for each country using the estimated growth rate of a Gompertz curve. We then performed country-level regressions in the global sample and explored heterogeneity across World Bank development groups.</p><p><strong>Results: </strong>Globally, higher trust in institutions significantly increased vaccination rates (p<0.01) and vaccination speed (p<0.01). The effect was strong in low- and middle-income countries but statistically not significant in high-income countries.</p><p><strong>Conclusions: </strong>Our findings have implications for the design of vaccination campaigns for national governments and international organizations. The findings highlight the importance of trust in institutions when designing communication strategies around vaccination campaigns in low- and middle-income countries.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793563","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":"High mitochondrial gene diversity of Pediculus humanus capitis among children in northern Iran.","authors":"Fayaz Mirzajanzadeh, Mohsen Karami, Tahmineh Gorgani-Firouzjaee, Rahman Babapour, Jalal Jafarzadeh, Mohamad Jalilnavaz-Novin","doi":"10.1093/trstmh/trae040","DOIUrl":"10.1093/trstmh/trae040","url":null,"abstract":"<p><strong>Background: </strong>The head louse, Pediculus humanus capitis, is an obligate ectoparasite and its infestation remains a major public health issue worldwide. Determining the genetic characteristics of the existing clades is essential to identify the population structure and to develop head lice-control programs. Hence, we aimed to investigate the genetic diversity of head lice among infested individuals in northern Iran.</p><p><strong>Methods: </strong>Adult head lice were collected from 100 infested individuals referring to the health centers throughout five geographical regions in Mazandaran Province, Iran. Partial fragments of the mitochondrial cytb gene were amplified by PCR, then consequently sequenced.</p><p><strong>Results: </strong>The results of the phylogenetic tree of collected head lice confirmed the existence of two clades, A and B, in the studied areas. Thirteen haplotypes were detected in the studied populations, of which 11 were novel haplotypes. Clade A was the dominant form and accounted for 75% of samples, while clade B included the rest. Haplotype and nucleotide diversity were 0.999 and 0.0411, respectively.</p><p><strong>Conclusions: </strong>Clade A and B of Pediculus humanus capitis exist among the human populations of northern Iran. We observed high genotypic diversity of this head lice.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insecticide-treated bednets and chemoprophylaxis reduce malaria mortality and parasite prevalence.","authors":"Thomas J Peto","doi":"10.1093/trstmh/trae090","DOIUrl":"https://doi.org/10.1093/trstmh/trae090","url":null,"abstract":"<p><p>This commentary discusses an influential study from 1993 that demonstrated, among West African children, an overall mortality benefit of insecticide-impregnated bednets, and the reduction of malaria prevalence by chemoprophylaxis. Led by Brian Greenwood and colleagues in The Gambia, the trial also showed these tools to be affordable and practicable. In the years since, >2 billion bednets have been provided to high-risk populations and have contributed greatly to reductions in malaria-attributable mortality. Seasonal malaria chemoprevention now protects 50 million African children annually. Few interventions in tropical medicine have achieved such an impact.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival analysis of adult visceral leishmaniasis patients admitted to Metema Hospital, Metema, Ethiopia: a hospital-based cross-sectional study.","authors":"Habitamu Wudu, Chekol Alemu","doi":"10.1093/trstmh/trae034","DOIUrl":"10.1093/trstmh/trae034","url":null,"abstract":"<p><strong>Background: </strong>Visceral leishmaniasis (VL) is a neglected tropical disease that mostly affects the working class and impoverished segments of society, having a significant negative effect on the economic development of the affected nation. While anti-leishmanial medications lower mortality among VL patients, patients may still die or require more time to recover while receiving treatment. In this regard, there are limited studies in Ethiopia. This study aims to determine the time to recovery and its associated predictors among adult VL patients at Metema Hospital, Metema, Ethiopia.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was employed and the data were collected from patient's charts from September 2017 to September 2021. Data were entered and analysed using EpiData version 3.1, Stata version 14.2 and R version 3.4.0 statistical software. Kaplan-Meier survival curves and logrank tests were used to compare the survival time. The Cox proportional hazards model assumption and model fitness were checked and used to identify statistical association predictors in VL patients.</p><p><strong>Results: </strong>The Cox proportional hazards model was fitted. The overall medium recovery time was 7 d (minimum 4, maximum 14). The variables of nasal bleeding (adjusted hazard ratio [aHR] 0.44 [95% confidence interval {CI} 0.19 to 0.89]), no comorbidity (aHR 2.29 [95% CI 1.27 to 4.11]), relapse of VL (aHR 0.33 [95% CI 0.15 to 0.75]), low parasite load (aHR 2.58 [95% CI 1.48 to 4.51]) and ambulatory (aHR 3.26 [95% CI 2.45 to 6.53]) were significantly associated with time to recovery in VL patients.</p><p><strong>Conclusions: </strong>Patients with comorbidities, nasal bleeding, relapse of VL, bedridden and high parasite load should be treated and monitored carefully to recover quickly from their illness.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Alzheimer's disease and Toxocara infection/exposure: a case-control study.","authors":"Ali Alizadeh Khatir, Fariborz Mousavi, Mahdi Sepidarkish, Mahdi Arshadi, Delaram Arjmandi, Maryam Aldaghi, Ali Rostami","doi":"10.1093/trstmh/trae039","DOIUrl":"10.1093/trstmh/trae039","url":null,"abstract":"<p><strong>Background: </strong>Infections may contribute to Alzheimer's disease (AD) risk. Limited evidence suggests Toxocara spp. infection/exposure could influence AD development.</p><p><strong>Methods: </strong>We investigated Toxocara seropositivity and AD in Iranian adults using a matched case-control study. Our sample included 90 AD cases and 91 healthy older adults. Anti-Toxocara immunoglobulin G (IgG) antibodies were assessed via enzyme-linked immunosorbent assay. We computed the odds ratios (ORs) and 95% confidence intervals (CIs) through univariable and multivariable analyses, adjusting for potential confounders.</p><p><strong>Results: </strong>There were 33/90 (36.67% [95% CI 26.75 to 47.48]) anti-Toxocara IgG seropositive individuals identified among the AD cases and 21/91 (23.07% [95% CI 14.89 to 33.09]) among the healthy controls. In univariable analysis, a significant association was identified between anti-Toxocara IgG seropositivity and AD (OR 1.93 [95% CI 1.01 to 3.69], p<0.001). Moreover, the association remained significant (OR 2.18 [95% CI 1.05 to 4.49], p<0.001) in multivariable analysis after adjustment for covariates. There was no association between anti-Toxocara IgG seropositivity and the severity of AD (OR 0.75 [95% CI 0.21 to 2.61], p=0.47).</p><p><strong>Conclusions: </strong>Our findings indicated that Toxocara exposure/infection could be a potential risk factor for development of AD. To better understand a real causality between Toxocara exposure/infection and AD and related dementias, follow-up designed and adequately powered studies are needed.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Household satisfaction with health services and response strategies to malaria in mountain communities of Uganda.","authors":"Siya Aggrey, Anthony Egeru, John Bosco Kalule, Akim Tafadzwa Lukwa, Noah Mutai, Sonja Hartnack","doi":"10.1093/trstmh/trae084","DOIUrl":"https://doi.org/10.1093/trstmh/trae084","url":null,"abstract":"<p><strong>Background: </strong>Measuring satisfaction with health service delivery in fragile communities provides an opportunity to improve the resilience of health systems to threats including climate change. Additionally, understanding factors associated with the choice of response strategies to certain public health threats provides an opportunity to design context-specific interventions.</p><p><strong>Methods: </strong>We used polytomous latent class analyses to group participants' responses and an additive Bayesian modelling network to explore satisfaction with health service delivery as well as factors associated with response strategies of households to malaria. We did this with a focus on the rural parts of Uganda in Mount Elgon.</p><p><strong>Results: </strong>We found that approaches to malaria control and management at household level include the use of traditional (54.5%), private (20.5%) and publicly available services (25%). Regarding satisfaction with health services, 66.6% of respondents were satisfied with health service components of information flow, drug/vaccine access and accessibility. Type of housing, livelihood sources, previous malaria experience and health services were strongly associated with responses to malaria occurrence at household level. The rest of the factors were weakly associated with malaria responses.</p><p><strong>Conclusions: </strong>The indigenous interventions utilised by households to manage and control malaria were largely dependent on their satisfaction with health service delivery components. Interventions thus ought to leverage local existing knowledge to optimise outcomes and ensure sustainable health.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The performance and costs of XTT, resazurin, MTS and luciferin as viability dyes in in vitro susceptibility testing of Madurella mycetomatis.","authors":"Jingyi Ma, Kimberly Eadie, Ahmed Fahal, Annelies Verbon, Wendy W J van de Sande","doi":"10.1093/trstmh/trae030","DOIUrl":"10.1093/trstmh/trae030","url":null,"abstract":"<p><strong>Background: </strong>in vitro susceptibility testing for the non-sporulating fungus Madurella mycetomatis is performed with a hyphal suspension as starting inoculum and a viability dye for endpoint reading. Here we compared the performance of four different viability dyes for their use in in vitro susceptibility testing of M. mycetomatis.</p><p><strong>Methods: </strong>To compare the reproducibility and the agreement between the viability dyes 2,3-bis-(2-methoxy-4-nitro-5-sulfphenyl)-2H-tetrazolium-5-carboxanilide salt (XTT), resazurin, 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium salt (MTS) and luciferin, the in vitro susceptibilities of 14 genetically diverse M. mycetomatis isolates were determined for itraconazole and amphotericin B. The reproducibility, agreement, price and ease of use were compared.</p><p><strong>Results: </strong>Each of the four dyes gave highly reproducible results with >85.7% reproducibility. Percentage agreement ranged between 78.9% and 92.9%. Resazurin was the most economical to use (0.0009 €/minimal inhibitory concentration [MIC]) and could be followed in real time. Luciferin omitted the need to transfer the supernatant to a new 96-well plate, but cost 6.07 €/MIC.</p><p><strong>Conclusion: </strong>All four viability dyes were suitable to determine the in vitro susceptibility of M. mycetomatis against itraconazole and amphotericin B. Based on the high reproducibility, high percentage agreement, price and possibility to monitor in real time, resazurin was the most suited for routine in vitro susceptibility testing in the diagnostic laboratory in mycetoma-endemic countries. Because luminescence could be measured directly without the need to transfer the supernatant to a new 96-well plate, luciferin is suitable for drug-screening campaigns.</p><p><strong>Lay summary: </strong>To determine the in vitro susceptibility testing in the non-sporulating fungus Madurella mycetomatis, a viability dye is needed for endpoint reading. In this study we tested the viability dyes XTT, resazurin, MTS and luciferin for their use in in vitro susceptibility testing. It appeared that they all could be used but there were differences in time to result and costs associated with them.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892542","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}