Trends in Psychiatry and Psychotherapy最新文献

{"title":"Is digital psychiatry really for all? A cross-sectional analysis from two randomized clinical trials.","authors":"Carolina Gallois, Mairon Machado, Cauê Oliveira, Alice Castro Menezes Xavier, Carolina Dreher, Gisele G Manfro","doi":"10.47626/2237-6089-2024-0826","DOIUrl":"10.47626/2237-6089-2024-0826","url":null,"abstract":"<p><strong>Introduction: </strong>Digital psychiatry holds promise for expanding accessibility to mental health treatment, but concerns exist regarding its inclusivity and the potential for exacerbation of digital exclusion among vulnerable populations. This study aims to evaluate the inclusivity of digital psychiatry research and interventions, and to explore their potential to worsen digital exclusion.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of sociodemographic data from two clinical trials that utilize psychiatric online treatment modalities in Brazil. Participants were recruited nationwide through digital media platforms.</p><p><strong>Results: </strong>The sample comprised 224 individuals, predominantly female (95.1%) and Caucasian (71.87%) participants, with an average of 15.12 years of schooling. It was observed that White individuals were overrepresented compared to national averages (42.8%). Additionally, participants had a higher average number of years of schooling compared to the national average (10.1 years). Our analysis revealed a clear profile among psychiatric patients with access to and interest in digital interventions, predominantly younger, White, educated, and female individuals.</p><p><strong>Discussion: </strong>As digital therapeutic solutions advance, ensuring their inclusivity and accessibility for vulnerable individuals is crucial. Initiatives to promote digital inclusion and reassess participant recruitment strategies are needed to effectively address digital exclusion. By adopting multifaceted approaches, digital mental health care can be made more effective and accessible to all.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Behavioural Therapy for insomnia decreases the discrepancy between objective and subjective measures of sleep.","authors":"Lauren E Cudney, Sheryl M Green, Randi E McCabe, Benicio N Frey","doi":"10.47626/2237-6089-2024-0819","DOIUrl":"https://doi.org/10.47626/2237-6089-2024-0819","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with insomnia disorder often exhibit differences between reported experiences of sleep and objectively measured sleep parameters; however, the implications of this subjective-objective sleep discrepancy during treatment remains unclear.</p><p><strong>Objective: </strong>The aim of this study was to investigate the impact of cognitive behavioural therapy for insomnia (CBT-I) on the discrepancy between objective and subjective measures of sleep, and to assess whether changes in clinical variables such as depression, anxiety, fatigue, and beliefs about sleep, were related to changes in discrepancy.</p><p><strong>Methods: </strong>Twenty-five participants with insomnia disorder were enrolled in group CBT-I. Sleep measures were continually sampled from baseline until 2 weeks post-treatment with both objective (i.e., actigraphy) and subjective (i.e., sleep diary) methods.</p><p><strong>Results: </strong>The subjective-objective discrepancy significantly decreased from baseline early on in treatment (following the second session) and were maintained at post-treatment for sleep onset latency, wake after sleep onset (WASO) and sleep efficiency (SE). Total sleep time (TST) discrepancy and misperception decreased from baseline to post-treatment. Improvement in depression symptoms, fatigue symptoms, and negative beliefs about sleep were significantly correlated with the decrease in the discrepancy for WASO and SE.</p><p><strong>Conclusion: </strong>These findings suggest that CBT-I resolves the mismatch between objective and subjective sleep parameters early in treatment for adults with insomnia. Sleep misperception improved from underestimating to accurately estimating TST. Improvement of psychological symptoms were related to decrease in sleep discrepancies across treatment. Future research is needed to explore how feedback on objective and subjective sleep discrepancy may impact sleep perception across treatment with CBT-I.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blended Psychological Interventions for Emotional Disorders in Youth: Acceptability and Intention to Use in a Sample of Portuguese Psychologists.","authors":"Bárbara Gomes-Pereira, Ana Góis, Ana Maria Pereira, Brígida Caiado, Helena Moreira, Ana Isabel Pereira","doi":"10.47626/2237-6089-2023-0770","DOIUrl":"https://doi.org/10.47626/2237-6089-2023-0770","url":null,"abstract":"<p><strong>Introduction: </strong>The rise of mental health problems in youth highlights the need for accessible and cost-effective psychological interventions. Blended interventions, which combine face-to-face and online sessions, can be an adequate response to the increase in demands for youth mental health services. Although this can be a promising approach, effective dissemination depends on the professionals´ acceptance.</p><p><strong>Objectives: </strong>This study aimed to explore the acceptability of and intention to use blended interventions by psychologists working with children with emotional disorders and to examine their predictors, including previous knowledge, expectancies (i.e., performance expectancy, effort expectancy, social influence, and facilitating conditions), and attitudes toward evidence-based practices.</p><p><strong>Methods: </strong>The sample consisted of 76 Portuguese psychologists (Mage = 37.26 years, SD = 10.47; 92.1% female) working in youth mental health services. The participants completed an online protocol to evaluate the different dimensions included in the study.</p><p><strong>Results: </strong>The results showed that most participants demonstrated moderate to high acceptability of blended psychological interventions for emotional disorders in youth and intend to use them in the future. Regression analysis showed that performance expectancy and positive attitudes toward evidence-based practices were significant predictors of acceptance of blended interventions and that social influence was a significant predictor of both acceptance of and intention to use blended interventions.</p><p><strong>Conclusion: </strong>These results emphasize the importance of sharing the findings of blended interventions, changing professionals' attitudes toward evidencebased practices, and collaborating more closely with organizations and institutions to advance standards that encourage the adoption of this intervention format.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting cholinergic and endocannabinoid system as a therapeutic intervention for core asd associated phenotypes in autism model: a systematic review.","authors":"Princewill Sopuluchukwu Udodi, Godson Emeka Anyanwu, Ebube Roseline Udodi, Damian Nnabuihe Ezejindu","doi":"10.47626/2237-6089-2024-0791","DOIUrl":"https://doi.org/10.47626/2237-6089-2024-0791","url":null,"abstract":"<p><strong>Introduction: </strong>Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been linked to the dysregulation in the cholinergic and endocannabinoid (EC) system. This study systematically reviews the present literature on treatment strategies aimed at enhancing the activity of both systems in ASD models.</p><p><strong>Method: </strong>We performed a systematic evaluation of literatures that investigated the effects of different therapeutic interventions on the components of the cholinergic and EC systems in ASD models, following the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Four databases were searched: Google Scholar, Web of science, EMBASE and MEDLINE/PubMed, between August 2012 and February 2023. The selected research papers' references were also examined. Twelve papers (five for cholinergic system, six for EC system and one for the two systems) were reviewed in this study of prior relevant treatment strategies that impact both systems. There were 77 studies cited in total.</p><p><strong>Results: </strong>The majority of research revealed that different therapeutic interventions down-regulated cannabinoid 1 (CB1) receptors, and the systems hydrolyzing enzymes and up-regulated EC, Alpha7 nicotinic acetylcholine receptor (α7 nAChR), and acetylcholine signaling molecules. The regulation of the components of the cholinergic and EC systems by the therapeutics generally enhanced behaviors in ASD models.</p><p><strong>Conclusion: </strong>It is possible that there are therapeutic interventions assessed in one of the systems that may be effective in treating the core ASD-associated phenotype. The benefits of the reviewed therapeutic interventions in this study need to be further investigated in randomized, blind, placebo-controlled clinical trials.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of burnout among health sciences students in Spain - a systematic review.","authors":"Zoila María Olmos-Bravo, Joan Vicent Sánchez-Ortí, Eugenio H Grevet, Vicent Balanzá-Martínez","doi":"10.47626/2237-6089-2024-0805","DOIUrl":"10.47626/2237-6089-2024-0805","url":null,"abstract":"<p><strong>Background: </strong>There is growing concern about the occurrence burnout syndrome in university students worldwide. This systematic review aimed to estimate the prevalence of burnout syndrome and its associated factors among health sciences students (HSS) from Spain.</p><p><strong>Methods: </strong>Five databases (MEDLINE/PubMed, PsycINFO, EMBASE, Dialnet and MEDES) were searched up to January 5, 2023, adhering to PRISMA guidelines. Quantitative studies reporting the prevalence of burnout syndrome among HSS from Spanish universities were considered. The reference lists of the selected studies were hand searched. Data were extracted from peer-reviewed articles.</p><p><strong>Results: </strong>Twenty-six studies with a total of 14,437 HSS were included (11 nursing, 8 Medicine, five Psychology, two Dentistry, one Physiotherapy, one Pharmacy students). Overall, study quality was fair. The most widely used instrument was the Maslach Burnout Inventory. The mean prevalence of burnout was 35.3% (k=11 studies). However, rates varied widely across the studies, which may result from methodological differences. Inconsistent associations were found with gender and year of study. The relationship of burnout with academic-and mental-health related variables was consistent across studies. Personal attributes such as higher resilience, are likely protective from burnout.</p><p><strong>Conclusions: </strong>Burnout seems to be prevalent among HSS in Spain, and can be affected by academic, mental health-related and personality factors. The identification of risk and protective factors of burnout could help develop preventive and management strategies, to ultimately reduce its negative consequences in this population.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atomoxetine: toxicological aspects of a new treatment for Attention Deficit Hyperactivity Disorder in Brazil.","authors":"Gabriel Christian de Farias Morais, Shopnil Akash, Edilson Dantas da Silva, Claudio Bruno Silva de Oliveira, João Firmino Rodrigues-Neto, Umberto Laino Fulco, Shahina Akter, Jonas Ivan Nobre Oliveira","doi":"10.47626/2237-6089-2024-0798","DOIUrl":"https://doi.org/10.47626/2237-6089-2024-0798","url":null,"abstract":"<p><p>Atomoxetine is a drug widely used for the treatment of the attention deficit hyperactivity disorder (ADHD) with reduced risk of adverse motor reactions and chemical dependence. However, the pharmacokinetics characteristics as well as the toxicological risk of atomoxetine deserves further investigation to comprehensively analyze the therapeutic and safety aspects of this drug. This study aimed to predict the physicochemical profile and medicinal chemistry characteristics of atomoxetine, alongside its pharmacokinetic properties-namely absorption, distribution, metabolism, and excretion-as well as its toxicology (ADMET) potential through the utilization of web-based in silico tools. This research emphasizes predicted physicochemical, medicinal chemistry, and absorption parameters of atomoxetine that could influence the efficacy and safety of this drug for ADHD treatment. Additionally, atomoxetine also presents noteworthy predicted risks of hepatotoxicity, cardiotoxicity, neurotoxicity, nephrotoxicity, respiratory system toxicity, skin toxicity, and carcinogenicity. These findings underscore the necessity for further assessments of atomoxetine's safety profile, particularly considering different patient populations and durations of drug treatment. The data reported here from in silico predictions suggest that closer monitoring is warranted when atomoxetine is administered to patients with ADHD. Moreover, controlled studies detailing reliable protocols for personalized dosing, considering the multifactorial variability in metabolism efficiency and toxicological potential, would enable a more comprehensive assessment of atomoxetine's safety profile.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PID-5-SRF online administration: psychometric indicators and measurement invariance between different formats of data collection.","authors":"Ana Maria Barchi-Ferreira, Flavia Osório","doi":"10.47626/2237-6089-2023-0711","DOIUrl":"https://doi.org/10.47626/2237-6089-2023-0711","url":null,"abstract":"<p><strong>Introduction: </strong>The PID-5 is a tool used to assess maladaptive personality traits according to the DSM-5 Alternative Model. Objective: The objective is to seek evidence of the validity and reliability of the Personality Inventory for DMS-5 (PID-5-SRF) admin-istered online and assess its measurement invariance compared to the paper-and-pencil administration.</p><p><strong>Methods: </strong>A sample of 274 individuals from the general population (73.4% of women; 34.76 years old ±11.6) completed the instrument online after the study was dissemi-nated on social media and among the authors' contacts.</p><p><strong>Results: </strong>Internal consistency (facets α≥0.70; domains α≥0.89) and test-retest reliability (15 to 30 days: facets ICC≥0.63; domains ICC≥0.82) were satisfactory, but a floor effect was found in almost all the items. A large number of facets (N=9) showed better fit to a bifactorial structure, and the Exploratory Factor Analysis suggested that a six-factor model better fits the data. Measurement invariance between the online and paper-and-pencil administrations was not attested at a configural level.</p><p><strong>Conclusion: </strong>The results revealed satisfactory psychometric indicators when the instrument was applied online, confirming its feasibility in collecting data. However, the in-strument's structure is not invariant, and caution must be adopted when compar-ing and interpreting data collected through different formats.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep quality of adult recreational cannabis users: a systematic review of literature.","authors":"Nathália Lima Costa, Wennyo Camilo da Silva E Silva, Marianne Lucena da Silva, Katiane da Costa Cunha","doi":"10.47626/2237-6089-2024-0802","DOIUrl":"https://doi.org/10.47626/2237-6089-2024-0802","url":null,"abstract":"<p><strong>Introduction: </strong>Human sleep is fundamental for the proper occurrence of organic functions. Hence, the lack of sleep can impair cognitive function, resulting in emotional problems, memory changes and disease onset. However, it is worth noting that sleep is influenced by outside factors, such as drug use. In this sense, the aim of this work is to analyze studies that had as their research object the influence of recreational marijuana on the sleep quality of adults.</p><p><strong>Methods: </strong>A high-sensitivity research was conducted in databases (Biblioteca Virtual em Saúde, Medline via Pubmed, Cochrane, Embase, Web of Science and Scopus) using descriptors linked to marijuana and sleep habits.</p><p><strong>Results: </strong>Eighteen studies from four countries were included with a total sample size of 29,858 participants. It was identified that marijuana affects sleep characteristics-such as latency and duration-with these changes being more evident in users who make greater use of marijuana and in those who started premature use.</p><p><strong>Conclusions: </strong>It was observed that most articles demonstrated a detrimental effect of recreational cannabis use on the quality of sleep in adults.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hierarchical analysis of associated factors to lifetime suicide attempts in alcohol use disorder.","authors":"Milton Moçambique, Daniela Benzano, Lisia von Diemen, Felix H P Kessler, Jaqueline B Schuch, Flavio Pechansky","doi":"10.47626/2237-6089-2024-0788","DOIUrl":"https://doi.org/10.47626/2237-6089-2024-0788","url":null,"abstract":"<p><strong>Background: </strong>Substance use is strongly associated with suicide attempts throughout life. We aimed to investigate the prevalence of suicide attempts (SA) and associated factors in life in patients with Alcohol Use Disorder (AUD).</p><p><strong>Methods: </strong>The sample consisted of 424 men with AUD who underwent treatment at the Addiction Psychiatry Unit of the Hospital de Clínicas de Porto Alegre. The clinical evaluation included the Addiction Severity Index, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Variables that showed p-value < 0.05 in the bivariate analyses were included in a hierarchical regression model with robust variance to investigate associations with SA in life via estimation of adjusted Prevalence Ratios (PR).</p><p><strong>Results: </strong>The lifetime prevalence of SA among alcohol users was 36.6%. Patients with childhood maltreatment, borderline personality disorder, and higher impulsivity scores had a higher lifetime prevalence of SA.</p><p><strong>Conclusion: </strong>Our findings indicate that male inpatient alcoholics present an important prevalence of SA. The study also corroborates the relationship between maltreatment, impulsivity, and borderline personality disorder with SA among inpatients in treatment for AUD.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil.","authors":"Flavia Ismael, Artur Ramos, Rafael Erik de Menezes, Regina Maura Zetone Grespam, Cibele Cristine Remondes Sequeira, Jair de Jesus Mari, João Mauricio Castaldelli-Maia","doi":"10.47626/2237-6089-2023-0674","DOIUrl":"https://doi.org/10.47626/2237-6089-2023-0674","url":null,"abstract":"<p><p>São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.</p>","PeriodicalId":46305,"journal":{"name":"Trends in Psychiatry and Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}