African Journal of Primary Health Care & Family Medicine最新文献

{"title":"Continuing professional development training needs for primary care doctors in central Uganda.","authors":"Jane Frances Namatovu, William Buwembo, Janet Nakigudde, Sarah Kiguli, Aloysius G Mubuuke","doi":"10.4102/phcfm.v15i1.3983","DOIUrl":"10.4102/phcfm.v15i1.3983","url":null,"abstract":"<p><strong>Background: </strong>Continuing professional development (CPD) activities relevant to medical doctors and their patients should be informed by current assessed training needs. The CPD provision is expected to improve the quality of professional practice and ethics. However, the Uganda Medical and Dental Practitioners' Council still receives about 40 reports of malpractice every month.</p><p><strong>Aim: </strong>The study aimed to describe the CPD training needs of doctors working in public primary care facilities in central Uganda.</p><p><strong>Setting: </strong>The district health system of central Uganda comprised 10 General Hospitals (GH) and 37 Health Center IVs (HC IVs) with a staffing norm of six and two doctors, respectively.</p><p><strong>Methods: </strong>This was a cross-sectional survey of 100 doctors working in public primary care facilities using the World Health Organization (WHO) Hennessy-Hicks questionnaire. Descriptive statistics of the importance, current performance, and training need of each skilled activity were calculated. Content analysis was applied to data from the open-ended questions.</p><p><strong>Results: </strong>The response rate was 91%, majority were males, 80 (87.9%) from 7 GHs and 24 HC IVs with an average age of 37.9 years. The domain with the highest CPD training need for the doctors was research and audit, with a mean score (standard deviation [s.d.]) of 1.94 (±1.69), followed by administration 1.58 (±1.61) and clinical tasks 1.28 (±1.29). The clinical tasks domain had the most suggested CPD topics.</p><p><strong>Conclusion: </strong>Research and audit and clinical tasks were identified as important domains for CPD training for doctors in this setting.Contribution: The results give insight into CPD training needs of primary care doctors and guide various CPD providers.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e8"},"PeriodicalIF":1.2,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for sexually transmitted infections among men who have sex with men.","authors":"Matshidiso A Malefo,&nbsp;Olalekan Ayo-Yusuf,&nbsp;Mathildah M Mokgatle","doi":"10.4102/phcfm.v15i1.4080","DOIUrl":"10.4102/phcfm.v15i1.4080","url":null,"abstract":"<p><strong>Background: </strong>Sexually transmitted infections (STIs) are a global public health concern and sub-Saharan Africa, has limited data on STIs in the men who have sex with men (MSM) population. Syndromic management has controversies for treating asymptomatic STIs (ASTIs).</p><p><strong>Aim: </strong>The aim of this study was to describe the risk factors for STIs among MSM.</p><p><strong>Setting: </strong>This study was conducted in Tshwane North, Gauteng Province in South Africa.</p><p><strong>Methods: </strong>A cross-sectional quantitative design was employed using structured questionnaires, rapid plasma reagent test, from December 2021 to May 2022. Bivariate and multivariate analyses were used for statistical analysis.</p><p><strong>Results: </strong>A total of 200 MSM with the mean age of 27.6, standard deviations: 6.8 participated, and STIs prevalence was 66%, with 37% concurrent infections. Ureaplasma urealyticum was (24%), Mycoplasma hominis (23%), Chlamydia trachomatis (20%), Treponema pallidum (20%) and Neisseria gonorrhoeae (9%). The risk factors for acquisition of STI include having a new partner in the last month (OR = 1.68; CI: 0.98-3.13).</p><p><strong>Conclusion: </strong>The prevalence of ASTIs is high. Serial and multiple sexual partners are the risk factors.Contribution: This study contributes to the body of knowledge of the burden of STIs among high-risk population.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e7"},"PeriodicalIF":2.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maladaptive behaviours of maternal orphans in high schools of Tshwane North of Gauteng, South Africa.","authors":"Thembi V Khoza,&nbsp;Mathildah M Mokgatle","doi":"10.4102/phcfm.v15i1.3887","DOIUrl":"10.4102/phcfm.v15i1.3887","url":null,"abstract":"<p><strong>Background: </strong>Some orphaned adolescents find it difficult to cope and adjust to the loss of a mother. Studies to explore specific adjustment challenges experienced by this vulnerable group, are necessitated by the growing need to inform support services for orphans.</p><p><strong>Aim: </strong>This study sought to explore maladaptive behaviours among adolescent maternal orphans.</p><p><strong>Setting: </strong>Participants were recruited from the Tshwane North secondary schools of Gauteng province in South Africa.</p><p><strong>Methods: </strong>A qualitative exploratory design was employed; maternal adolescent orphans were purposively selected and included in a one-on-one qualitative enquiry. Twenty-five participants were included in the study. Data were analysed thematically using NVivo12.</p><p><strong>Results: </strong>Emerged themes were: negative thoughts such as suicidal ideation, negative perception of self; silence coded as 'keep life matters private and hide personal feelings'; having psychosocial problems reported as anger, fighting, shouting, crying, short temper; engaging in risky behaviours in the form of smoking and alcohol use and unsafe termination of pregnancy; social withdrawal by self-isolation and being afraid of people.</p><p><strong>Conclusion: </strong>Whole school peer interaction groups could address the functional problems of social ability and silence. Skills development programmes, and other activities that enhance constructive use of free time, instil hope and build self-esteem are recommended.Contribution: The findings of this study serve as a basis to inform interventions that are geared towards supporting adolescent orphans through the school health teams, as one of the domains of the re-engineering of South Africa's primary health care system.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e7"},"PeriodicalIF":2.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workplace-based learning opportunities in a South African family medicine training programme.","authors":"Neetha J Erumeda,&nbsp;Louis S Jenkins,&nbsp;Ann Z George","doi":"10.4102/phcfm.v15i1.4073","DOIUrl":"10.4102/phcfm.v15i1.4073","url":null,"abstract":"<p><strong>Background: </strong>Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised.</p><p><strong>Aim: </strong>This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme.</p><p><strong>Setting: </strong>The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa.</p><p><strong>Methods: </strong>This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach.</p><p><strong>Results: </strong>Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities.</p><p><strong>Conclusion: </strong>Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e13"},"PeriodicalIF":2.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10623584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya.","authors":"Mwaleso Kishindo, Jemima Kamano, Ann Mwangi, Thomas Andale, Grace W Mwaura, Obed Limo, Kenneth Too, Richard Mugo, Ephantus Maree, Wilson Aruasa","doi":"10.4102/phcfm.v15i1.3889","DOIUrl":"10.4102/phcfm.v15i1.3889","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services.</p><p><strong>Aim: </strong>This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities.</p><p><strong>Setting: </strong>The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020.</p><p><strong>Methods: </strong>This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients were computed by disease type and level of healthcare facility visited.</p><p><strong>Results: </strong>Patients with both diabetes and hypertension incurred higher annual costs (KES 13 149) compared to those with either diabetes (KES 8408) or hypertension (KES 7458). Patients attending dispensaries and other public healthcare facilities incurred less direct costs compared to those who visited private clinics. Furthermore, a higher proportionate catastrophic healthcare expenditure of 41.83% was noted among uninsured patients.</p><p><strong>Conclusion: </strong>Despite this study being conducted in facilities that had an ongoing NCDs care project that increased access to subsidised medication, we still reported a substantially high cost of managing diabetes and hypertension among patients attending primary healthcare facilities in Western Kenya, with a greater burden among those with comorbidities.Contribution: Evidenced by the results that there is enormous financial burden borne by patients with chronic diseases such as hypertension and diabetes; we recommend that universal healthcare coverage that offers comprehensive care for NCDs be urgently rolled out alongside strengthening of lower-level public healthcare systems.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e9"},"PeriodicalIF":2.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare workers' perceptions of sexual violence during the COVID-19 pandemic in the Eastern Cape.","authors":"Nolundi Kwinana,&nbsp;Charity Masilela,&nbsp;Oladele V Adeniyi","doi":"10.4102/phcfm.v15i1.4087","DOIUrl":"10.4102/phcfm.v15i1.4087","url":null,"abstract":"<p><strong>Background: </strong>The South African government implemented lockdown restrictions in order to prevent the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).</p><p><strong>Aim: </strong>This study explored the effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual violence in the Eastern Cape province through the lens of healthcare workers' (HCWs) experiences.</p><p><strong>Setting: </strong>A Thuthuzela care centre in the Eastern Cape province, South Africa.</p><p><strong>Methods: </strong>This qualitative study brings together the findings from thematic analysis of semi-structured interviews conducted among 11 purposively selected HCWs in May 2022.</p><p><strong>Results: </strong>Overall, three themes emerged from the study: the effects of COVID-19 on sexual violence, profile of the survivors and recommendations for combating sexual violence in the region. Most respondents believed that the COVID-19 pandemic caused a surge in the incidence of sexual violence, although all acknowledged that movement restrictions affected reporting. The participants treated mostly black women and children's survivors, who experienced physical injuries simultaneously. The respondents' narratives revealed that educational campaigns targeting boys and men could reduce sexual violence in the region. In addition, it was recommended that stricter laws and harsher penalties would serve as deterrents for perpetrators of sexual violence in the country.</p><p><strong>Conclusion: </strong>The COVID-19 lockdown restrictions exposed the vulnerabilities of black women and children to sexual violence in the study setting. Educational programmes aimed at re-orientating boys and men in both rural and urban communities should be implemented.Contributions: This study provides an insight into the perceived effect of the COVID-19 pandemic on sexual violence in the Amathole district and South Africa.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e6"},"PeriodicalIF":2.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the risks of nuclear war - The role of health professionals.","authors":"Abbasi Kamran, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel G M Olde Rikkert, Richard Horton, Robert Mash, Carlos Monteiro, Elena N Naumova, Eric J Rubin, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski, Arun Mitra, Tilman Ruff, Andy Haines, Ira Helfand","doi":"10.4102/phcfm.v15i1.4249","DOIUrl":"10.4102/phcfm.v15i1.4249","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e2"},"PeriodicalIF":2.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the risks of nuclear war - The role of health professionals.","authors":"Abbasi Kamran, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel G M Olde Rikkert, Richard Horton, Robert Mash, Carlos Monteiro, Elena N Naumova, Eric J Rubin, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski, Arun Mitra, Tilman Ruff, Andy Haines, Ira Helfand","doi":"10.4102/phcfm.v15i1.4249","DOIUrl":"https://doi.org/10.4102/phcfm.v15i1.4249","url":null,"abstract":"<p><p>No abstract available.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e2"},"PeriodicalIF":2.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404792","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":"Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa.","authors":"Veronique C Bailey, Atholl V Kleinhans, Mathilda M Mokgatle","doi":"10.4102/phcfm.v15i1.4086","DOIUrl":"10.4102/phcfm.v15i1.4086","url":null,"abstract":"<p><strong>Background: </strong>Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) has shown efficacy and effectiveness in populations who practise high-risk sexual activity. Nurses' knowledge and positive attitudes enhance PrEP implementation.</p><p><strong>Aim: </strong>This study aimed to investigate the knowledge of and attitudes towards PrEP among nurses in primary health care facilities.</p><p><strong>Setting: </strong>The study was conducted in 10 health facilities that offer comprehensive services in Tshwane, South Africa.</p><p><strong>Methods: </strong>A cross-sectional survey assessed the knowledge of and attitudes towards PrEP among 114 nurses. Univariate, bivariate and logistic regressions were performed to estimate odds ratios and to determine whether age, sex and education had an association with the knowledge and attitudes.</p><p><strong>Results: </strong>Majority of the study sample consisted of female nurses (92.1%), and most respondents (68%) had moderate PrEP knowledge. Logistic regression showed that age and education were not associated with high level of knowledge. Pre-exposure prophylaxis was viewed negatively by 84.5% of the respondents. The odds of positive attitudes towards PrEP were 1.92 times higher among males than females (95% CI 0.54-6.83) and 1.24 times higher among nurses who had bachelor's degree than diploma holders (95% CI 0.51-3.01).</p><p><strong>Conclusion: </strong>This study found that there is a need to strengthen the dissemination of information about PrEP, and nurses in South Africa require training to improve their knowledge of and attitudes towards PrEP.Contribution: The findings of the study add to the current knowledge base regarding PrEP access in the public healthcare system and it highlights gaps in the training of healthcare providers.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e6"},"PeriodicalIF":2.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary health care providers' views on managing substance use among people living with HIV.","authors":"Ramprakash Kaswa,&nbsp;Marietjie De Villiers","doi":"10.4102/phcfm.v15i1.3984","DOIUrl":"https://doi.org/10.4102/phcfm.v15i1.3984","url":null,"abstract":"<p><strong>Background: </strong>The growing culture of substance use among people living with human immunodeficiency virus (PLWH) is a serious threat to the human immunodeficiency virus (HIV) pandemic. As the gatekeepers of comprehensive care, primary care providers are responsible for screening, assessing, and managing individuals who use substances.</p><p><strong>Aim: </strong>This study aimed to evaluate primary care providers' views and approaches to substance use management among PLWH who attend primary care services in Mthatha.</p><p><strong>Setting: </strong>This study was conducted at Ngangelizwe and Mbekweni Community Health Centres (CHCs) in the Eastern Cape province's King Sabata Dalindyebo (KSD) sub-district municipality.</p><p><strong>Methods: </strong>This qualitative phenomenological study involved the views of primary care providers. This study included 32 primary health care (PHC) providers. All participants were female except one male with a mean age of 48.6 years (range 27-64 years). Semi-structured interviews were conducted until saturation of the theme was reached. Then, the data from the transcribed interview were analysed with a thematic framework.</p><p><strong>Results: </strong>Substance use among PLWH was reported to be associated with poor clinical outcomes and disruption of antiretroviral therapy (ART) adherence. The significant barriers reported for substance use management in PHC settings were a lack of resources, skilled providers and poor community participation.</p><p><strong>Conclusion: </strong>Substance use management programmes are not commonly offered in PHC because of the lack of human and infrastructural resources, the lack of skilled providers and poor community engagement.Contribution: This study provides a context-specific PHC providers' approach to substance use management.</p>","PeriodicalId":47037,"journal":{"name":"African Journal of Primary Health Care & Family Medicine","volume":"15 1","pages":"e1-e11"},"PeriodicalIF":2.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41147918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}